Is Hair Cloning Nearing Reality?

/by William Rassman, M.D./1 /

Hi Dr. Rassman,
I was searching the web on the current state of hair cloning and came across an article from WebMD. From the article, Dr. Washenik talks about how hair cloning will be ready in 3 or 4 years. What’s your take on that? Thanks

Dr. Washenik is a reliable source. Like me, he is overly optimistic on some things, but I believe that his timeline have not panned out in the past, so I would expect the same for the future. I do believe that hair cloning will come, but because of legislative challenges, I would doubt that we would be allowed to offer it without FDA and government policy changes, which will take years. The priority of organ cloning must go to the people who are at risk to life (liver, heart, and brain problems) well before the government will allow it for its cosmetic value (in my opinion, of course).

Sideburn Transplants

/by William Rassman, M.D./1 /

How many sideburn transplants have you performed and what is the success rate? How much do you charge per follicular unit? Where are you located?

Although I couldn’t guess the exact number, we have done many sideburn transplants, more in women who had plastic surgery problems following a face lift, rather than men. However, they work wonderfully for both sexes (see Other Hair Restoration Photos).

The fee is $6/graft, or for those with more flexible schedules we have a Standby fee at $5/graft. We have a minimum surgical fee of $3000 (this includes everything except a basic blood test. Our fee includes anesthesia fees, medications after surgery, etc). My personal charge is higher per graft; the minimum fee is $3,500 with me at $10/graft, whichever is greater. We have locations in Los Angeles and San Jose, California.

For more info on pricing and locations, please see:

Balding Fast, Even on Propecia

/by William Rassman, M.D./0 /,

I am 22 years old and have been taking Propecia for 2 years. Although the hair loss slowed a bit, I now see the rim of hair that my dad has around the back and sides of his head. What can I do? Are hair transplants the only option left for me?

You situation reflects that there will be progression of hair loss over a period of months/years, probably taking you to your father’s pattern sooner or later (sounds like sooner, rather than later). The variable response to finasteride speaks to the complexity of the factors at play. Included in these factors are variables like the sensitivity of your androgen receptors, as expressed by androgen receptor gene polymorphism. Simply stated, we can not come up with one treatment for all people, as each of us are different and have different sensitivities to the hormone environment in our body. We make androgens in our adrenal glands as well, and these androgens impact the hair end organ as well as DHT.

It is possible that you might respond better to Avodart, but even that medication may not do what you want. Avodart is not approved by the FDA for hair loss, so if you find a doctor willing to prescribe it, you should weigh the disadvantages of taking it (see previous blog entries) and the safety factors that may relate to having children when you are on the pill.

If you can already see the Class 7 pattern in the mirror that your father is showing, much of what you have lost may not be reversible. You should be checked out for other diseases, but in the probable event that your hair loss in only genetic, then hair transplantation is an option that you might consider. If your densities are good, if you have blonde hair or become blonde, if your hair thickness is reasonable, if you are willing to style your hair to take advantage of hair redistribution, you might have an amazingly good response to hair transplantation. As a general rule of thumb, most good hair transplant doctors do not take on young men prior to 25 years old, but with good support from your family, adequate financial planning, and a maturity that can allow you (best with the help of a parent) to make an informed decision, then you should explore the hair transplant option with an ethical and experienced hair transplant surgeon if you do not try the Avodart option or if the Avodart option fails to solve your problem.

Propecia for Stopping Hair Loss

/by William Rassman, M.D./0 /

I am 26 and my hair has been thinning for a couple of years now. I have some loss on the vertex and some at the corners of the front of my hairline. I have been on propecia for about a month now. I know propecia will not regrow the hair on my hairline, but what is the likelihood it will stop further loss?

It is highly likely that Propecia will slow or stop the hair loss and possibly reverse the crown thinning. Frontal reversal is less likely. Still, I think that you should plot the miniaturization of your impacted area at least once a year, so that you know what is actually happening. The plot will paint your future much better and will help you plan accordingly.

Severe Hair Loss from Ortho Evra?

/by William Rassman, M.D./3 /,

Use Ortho Evra for approximately one year and I am experiencing severe scalp hair loss. Will my hair ever stop falling out? I can barely touch my hair without losing a very large amount. I am very worried.

Hormones and birth control pills are one of the causes of hair loss in women for those who have the genetic predisposition for hair loss. It may reverse by stopping the hormone/birth control pills or it may just stop the progressive loss you are experiencing and hold it at its present status. Ortho Evra has had recent publicity (it has 60% more estrogen) which points to causes of the problems you are having. For details about the new safety information, please read New Important Labeling Information at the official Ortho Evra website.

Hair Loss in 14 Year Old Girl

/by William Rassman, M.D./8 /,

hi, im 14 and i noticed that my hair is getting real thin.it used to be very thick and i was wondering if i have a disease or something..i told my mom but she doesnt know what it is and i just want to know if its just getting thin for no reason or if its something more serious.

There are many causes of female hair loss. You need to see a doctor, because many of the causes of hair loss in a girl of your age may reflect a medical condition that needs to be treated. You and your mom should read through the Female Hair Loss category of this site to see my other commentary about hair loss in women.

FUE After Strip Surgery

/by William Rassman, M.D./0 /, ,

I had a few strip surgeries, decent results but still a bit thin for my liking. I have realistic expectations and don’t think I need that many more grafts to achieve satisfaction (about 500 3-hair grafts perhaps?), but I’m done with strip (my doc said I shouldn’t have any more and I wouldn’t want to anyway). My donor hair on sides and back is decent, not real thin or see-through. Given my thumbnail profile does it sound like FUE can get me to the promised land of being satisfied? Have you seen cases of other guys who could only get down to the 10 yard line with strip and FUE got them into the end zone? I know you’d have to examine me for a full and accurate assessment, but I would appreciate your best answer based on the info I have provided.

When the scalp is too tight, the only option to extract hair is by using the FUE technique. I have done some patients with FUE as the last option with good results, but it is very difficult to evaluate you without at least some photos (personal consultation is always best). Since you’ve indicated that you are in New York, I highly recommend that you contact my colleague Dr. Robert Bernstein in Manhattan at 1-866-576-2400.

Using Toppik to Conceal Transplants After Surgery

/by William Rassman, M.D./0 /,

Hi Dr Rassman… I am thinking of getting a transplant from you as I have met you before. just wondering if you have to shave my reciepient area?? and is it possible to use toppik to conceal the transplanted area?? would using toppik damage new grafts survival rate?? thanks alot!!

I know that some doctors require you to shave your transplanted area, but I have learned to work around the hair that is still present. Some of my patients who use Toppik can continue to use it, but I’d suggest that you hold off for a week or so after the transplant. I like all of the scabs (eschars) to be off prior to the use of Toppik to stop what is a potential irritant and foreign body reaction if it gets under the eschar. After a week, that should not be a problem. With our small wounds and good washing, everything should be pretty clean at a week post surgery with no scabs and small hairs coming from the grafts that look like a beard, which will just make the recipient area fuller. Adding Toppik, can only help fill it in more for create the illusion that you are trying to achieve.

Teenage Female with Thinning Hair

/by William Rassman, M.D./1 /,

Hi I am 17 years old. I’m going to be 18 in 2 months. I used to have very thick, long, black and beautiful hair. Over time it started thinning. I dont know why. Is it that Im not eating enough vitamins? Or that I dyed my hair? I’ve dyed it about 5 times my whole life. I also blow dry and straighten my hair. Is that bad for my hair? I really want my long thick hair back. Will it grow back? What can I do? Is there anything I can take to make it grow faster?

You need a proper examination of the scalp looking for miniaturization. First you must rule out that you are not early in the female genetic hair loss course. Then, if positive, you need to have your overall health checked out, looking for a variety of hormonal issues and diseases that can cause hair loss. If you do not have miniaturization or other causes of hair loss and hair thinning, then you may be having changes into a new adult hair type. Some people as they mature from teens to adults, will change their hair character. Sounds like you need a good doctor to point you in the correct direction.

Fixing Plugs with Electrolysis

/by William Rassman, M.D./0 /

On your site, you write that removing grafts via electrolysis does only work on bigger grafts – what does this mean? How big are bigger grafts? I think my grafts have maximum 5 very thin hairs in it, many have 3 hairs or less. Would it be possible for you to treat 5-hair- grafts via electrolysis?

I do not have the point of reference, but what I may have been referring to is that electrolysis of the hair has a 50% failure rate per hair. So when a larger graft is treated with electrolysis, the hairs are still present after one or two treatments. For large grafts, when the hair count in the graft is reduced, any skin cobblestonning (characteristic of the older grafts) may become more obvious. The modern approach could be to excise the entire frontal hairline since grafts in that location are most noticeable and bothersome. With fine hair and grafts that only have 4-5 hairs each (rather than the large plugs which may contain over 10 hairs), maybe less can be removed or treated with electrolysis. You can remove the hairs within the grafts with the FUE technique as well, with more certainty than electrolysis. I would need to see pictures to determine what is best. You can send pictures to the email address listed on the Contact page.

Sudden Hair Loss Years After Transplant

/by William Rassman, M.D./0 /, ,

I have had 6 procedures. four smaller (elsewhere) and my last two (more substantial) with NHI. You performed my last procedure about 6 years ago. I started the restoration process early, so I never went through a noticeable hairloss phase. I have been on proscar for about 5 years and it halted my hairloss. Obviously, I still have a significant amount of hair. I normally kept my hair cut short, but recently I let it grow a bit longer and got a trendy razor cut hairstyle. I towel dry my hair and put a manipulator cream (bed head brand) to keep the style. I have never looked so good! Then one week before my next haircut I started to notice hairloss. From Oct. 13-Nov 12 I have lost all the hair behind and between my frontal-most grafts(about a half inch deep, from the front hairline and extending all the way across the front and into the corners. Is this normal? I’m beside myself. I have done everything through the years to combat my hairloss with unbelievable results and now this. It’s as if somebody just flipped a switch and Pow! Can proscar just stop working? I would appreciate any information(based on my brief description). I diligently keep track of my hair–the hairloss happened that quick. Also, I am now 41(a very young looking 41!!) I am on 3 medications. One is allegra D, the other is an acid reflux medication (both prescribed for allergies/cough) and finally, a cortiosteroid nose spray (nasonex). Can any of these be compromising the effects of the proscar? Thanks again.

I am also alarmed. I will try to call you as I know you are not local to California. The corticosteroid nasal spray could cause this, if you are using it regularly and heavily. Loss of transplanted grafts after they have grown is very, very unusual. It could be caused by other medical conditions which you will have to get checked out. The Proscar should not be the problem.

As I think back about hair loss in transplanted grafts, they are rare. I have seen them in some men who have developed a type of senile alopecia where the donor area is thinning. If this was happening to you, your donor area should show signs of miniaturization and that would point to this diagnosis.

We need to talk and get you to a good doctor locally who can map out our scalp for miniaturization and attempt to clarify the cause for the hair loss.

Tidbits: Evolution of Hair Loss

/by William Rassman, M.D./0 /,

A few times each month, I will post some random hair-related information, which I’m calling “tidbits”. I spend hours each day writing responses to questions I receive on this blog, so it is a nice change of pace. For example…

Evolution

In an doctors email group that I subscribe to, some comments were made which I would like to share, as they will have value in understanding the hair loss process from an evolutionary point of view. I want you to know that the comments made by this group of doctors are not intended to start a debate on evolution – we will not relive the famous Scopes/Monkey trial on this blog. It was stimulated by the question: “How long have humans experienced hair loss?”

One doctor suggested that genetic hair loss must go back millions of years. Neanderthal men had hair loss with varying degrees of balding. Humans (in the evolutionary tree) developed in a different line from chimpanzees about 5-6 million years ago. Chimps have crown loss, which progresses over time as the male chimps get older. The hair loss in macaques, also with a similar mechanism, suggests the process was present in our cousins at least 15 million years ago.

We know that monkeys have been around for millions of years longer than homo sapiens. Was the stump-tail macaque always bald? My memory does not work that far back, but one of the doctors believed that the bald characteristic of the stump-tail macaque may have been more recent (I guess he has a better memory than I do). No one today knows what Neanderthal man looked like, although on the time scale discussed above, he was alive just 30,000 years ago. He left a lot of cave paintings of animals but no detailed self-portraits of his manly appearance, certainly not one of a balding cave man.

The group of doctors who share this information do so to disseminate more knowledge to each other. We try to become not only better doctors by helping each other, but also more knowledgeable ones, trying to help our patients who suffer from the pain of hair loss.

Pimples in Transplanted Area

/by William Rassman, M.D./0 /

Dear Dr. Rassman

After going through your informative blog, i decided to publish my question seeking your good answer so others can benefit too. Am currently 8.5 weeks post HT surgery. Till now things seems to be fine except for one thing, infections from time to time that is, i get those deep pus filled pimples that develop right below the grafted area every now and then, which in part made me consider an oral anti-biotic called DURICEF. My question as follows, will my transplanted follicles survive in the presence of those so-called folliculitis? Is it advisable to leave the pimples un-touched when ever they form? Your Help is greatly appreciated

Pimples in the recipient area are not uncommon in some people. When the transplant is done and the hair sheds, there are two things that could be left behind as the body works through the healing process. The first is that remnants of the actual hair shafts might stay buried under the skin. These would form a foreign body reaction and could manifest themselves with pimples. The more likely cause is the remnants of the sebaceous glands which survive and grow while the hair has not yet started to grow. These glands secrete sebum, which accumulate under the skin and cause pimples of varying sizes. They can be very annoying and become infected, on occasion. The best way to treat them is to have frequent soaks so that the skin softens and your pimples will work their way out with the sebum (or hair shafts). To stop infection (if they occur) a good bacteriostatic antibiotic usually works. I have my preferences, and your doctor will have his/hers.

Steroid Creams and Hair Loss in Women

/by William Rassman, M.D./0 /,

Hello Dr. Rassman

I have a major problem. I am 39 y.o. black female. I see a dermatologist for severe psoriasis in the palm of my hands and my feet. I have had this problem now for more than five years. I was not diagnosed with psoriasis until jan of this year. I saw podiatrists, dermatologists, allergist and no one diagnosed me with this condition. These doctors could not tell me what was wrong with me, they gave different diagnosis and treated me for latex allergy fungus, no sweat gland, vitamin b12 injection, prednisone, lamasil, and none of these treatments worked. I finally gave up and changed doctors and my primary sent me to a dermatologist in the Tampa Bay area. He took his time and treated me with different medications like clobetasol, propionate cream, different ointment combinations, and different creams such as salex, naftin, etc, etc. He did a biopsy on my foot, because at this time the psoriasis was creeping up my legs. That’s when I was finally diagnosed with this problem. I was placed on soriatane with the lowest dosage and then he increased it. I could see a difference in a few months. My labs were monitored monthly and I knew of some of the side effects and the problems that goes along with taking this med, but I was happy. I was in the process of taking soriatane qod until all the pills were finished. While I was in JA on vacation, the hair dresser noticed a bald spot on my scalp the size of a 1/4. It was not there when I left the USA. I have been getting relaxers, weaves, braids and wearing wigs for many years and I also have a hair dresser. She has been taking care of my hair very well and I had no problems. My scalp was itching me very badly and my scalp was tough and leathery and very dark. My hair was breaking and falling out pretty badly. When I washed my hair the shower floor was covered with hair. I got very scared and when into a depression which sent my self esteem in a tail spin. I saw my dermatologist and he gave me a topical abt for scalp due to the itching. The problem still persist and I had a biopsy done on the spots that were bald. The results were neg for any disease process. He told me I was losing my hair due to braids and relaxers and tension on my scalp and I should look into having hair replacement done. That still did not tell me how I came to have bald spots that seem to pop up over night and losing almost half the amount of hair in the front and middle. The back is still thick and less hair loss is seen there and no bald spots but I continue to have an unbearable itch to my scalp. I have not started any kind of treatment as yet. Its about 2 1/2 months now. I have to wear wigs everyday now. I don’t go to the hairdresser any more. I don’t want anyone to see me without hair. I don’t know what to do anymore. I would like to know if the soriatane and other steroid creams could cause my hair to fall out and if it would ever grow back. Will this itching ever stop and will my scalp feel like scalp again? Please give me some hope. I am desperate. Thank you.

I went to the internet to look up Soriatane, which is related to Accutane (known to cause hair loss). This drug does cause depression, amongst other things. One lawyer has a website where he warns people about this drug: Soriatane Overview at YourLawyer.com

Braids do cause hair loss, as does genetic propensities, and an entire class of most drugs have hair loss as a stated side effect. It sounds like your case is too complicated for me to just make a stab at your problem via the internet. Steroids are a cayuse of hair loss also and you must be careful with their use. Even creams with steroids in them will absorbe through the skin and they can impact your body’s cortisone balance if they are used regularly. This is too important of an issue to not have a good doctor meet with you in person to take charge of your problems, as evident by your desperate email.