Why Does Accutane Cause Hair Loss?

/by William Rassman, M.D./5 /

Hello Dr. Rassman. I’m a 25 yr old female and I recently took accutane for 6 months(have been off it now for 7 months). I knew hairloss was one of the side effects but I took my chances. My hair was fine during the whole treatment…didn’t have any thinning whatsoever. About 5 months ago, however, my hair started thinning and has gotten progressively worse since then. It’s especially thin on the sides above my ears, and my hairline is much thinner. The top of my head is much thinner also. I don’t know what to do. I don’t know what accutane does to actually cause the hairloss, it would probably help to start there. I’ve been reading online about what others in my situation are doing and I started on the Nioxin hair system, started taking milk thistle for my liver, and a B-Complex vitamin to help with the hairloss. My doctor said to wait it out and that it should be temporary. I don’t really like that idea. It keeps getting worse and I want to put a stop to it. Please help me! I’d appreciate any information you could spare…thank you so much

I am not certain of the specific mechanism causing hair loss by Accutane. The package insert of Accutane stated that this drug may lead to alopecia, but it was rare. Accutane causes dry skin, skin fragility, erythematous rash, vasculitis, and decreased red blood cell formation which may contribute to hair loss. In general, Accutane may contribute to hair loss by creating a not so optimal environment for hair growth and it clearly does impact the glandular elements of the hair, which will make the hair dry and fragile as the amounts of sebum production drops. Rogaine may help improve hair loss, but it also drys the scalp further. I recommended that you see a dermatologist to evaluate your hair loss in person. However, there are many causes of hair loss which also must be evaluated, such as thyroid problem, eczema, infection, autoimmune problems, weight loss, stress, etc.

Natural Looking Hairlines

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

Dr. William Rassman,
is it possible to restore the original hairline through hair transplant since my hairline had receded so much but not completely bald & its really affecting my self confidence. is it too early for me to undergo this procedure or should i go ahead? whats the best hair transplant method that gives a more natural looking hairline? thanks

You did not state your age and without a photo it is impossible to go into detail about whether a procedure is right for you or not. Hair transplantation today can be and should be undetectable and able to produce a completely natural hairline. The appropriateness of the surgery depends on the individual assessment of each person. There are hundreds of patient hairlines on our website, and you are invited to come to one of our open house events in Los Angeles and San Jose to meet patients directly, so you can see for yourself what can be achieved.

For a great example of what is possible in hair transplantation, please see the Steve Hartman feature on the NHI site. There are larger photos available on the previous blog entry, Where Are the Celebrity Transplant Photos?.

Seborrheic Dermatitis in Women

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

I had curly very thick hair all my 56 years. now out of the blue i got seborrheic and it is in my scalp. my hair is falling out. I’m going to the dr. but not much you could do but creams and hard shampoo. it’s not getting better. what can I do? it has been over five weeks. The dr. said this is something I have to live with. I’m not upset. I’m very blessed then other people. thank you if you can give me some feedback. God Bless

Please read the many entries on this blog for female hair loss. First and foremost, you need to have yourself and your health checked out. There are many diseases that can cause hair loss in women and you have to make sure that you do not have one of them. Women, like many men, can get genetic hair loss. In women, it usually is diffuse and not in one of the typical patterns that men show. Women generally thin out, but do not get bald. Some develop a pattern of thinning that can be treated more successfully with Minoxidil and possibly even hair transplants under certain conditions. First, get your self checked out medically and then find a good dermatologist or hair expert physician.

How to Get Propecia

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

Hi,
im 24 and ive been slightly receeding for several years now, however it has sped up in the last 6 months, ive also notice the front of my hair beginning to thin. I have read many things about propecia on your site but have no idea how to go about getting it or how much it costs. ive also read a bit about DHT, which sounds like the cause of my loss. Do you have any suggestions, and any suggestions on someone to see, obtain propecia from the vancouver area
thanks

You may obtain Propecia by asking your physician to write you a prescription and then purchasing it at a pharmacy. Prices in the United States run between $53-120/month for 30 pills, depending on where you buy it from. Being from Canada, you may be able to obtain Propecia at a better price than in the US. You may also obtain Propecia from my company if you become a patient. Our pricing is presently at $160 for a 3 month supply. If you are one of our patients we can ship it to you, but if you are not in California (Los Angeles or San Jose) to be evaluated, just see your family doctor and ask him/her.

Hair specialists who will often write Propecia prescriptions can be found at ISHRS.org.

Body Hair Transplants, Revisited

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

I am interested in transplants using body hair. Does it work and do you do it? Thanks

Chest hairs and pubic hairs can be harvested for hair transplantation. However, you must realize that body hairs are not ideal for transplants because they tend to be shorter than hairs from your scalp, there are not many of them despite the sense that a very hairy chest is hairy by density, and these hairs do not grow in large groupings like scalp hair does. Body hair transplants must be considered experimental at this time, until some well published sciences stand behind them. Most people who ask me questions about body hair transplantation have depleted donor supplies from the scalp. Is this what you are facing? If it is not, body hair transplants would be completely inappropriate. Since you are in Los Angeles, I want to mention that we have a local office to you, if you would like to setup a free consultation. To schedule an appointment, please call 800-NEW-HAIR or visit the Request Additional Info page at the New Hair Institute website.

Post-Operative Redness and Sebum

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

Dr. Rassman, thanks for starting the ‘Post-Operative’ section. It has been 5 weeks now since my FUE megasession. In the past 2 weeks, I have shed abt 30-40% of my transplanted hair…a condition I had been told is normal, does occur but am happy it has now stabilised. The only hair that I still lose now are those that come off with these thick crusts that form on my scalp every morning after I have applied Minoxidil the previous night. I have been using the 5% strength Minoxidil for abt 4 weeks. I now see redness on the scalp and the area around the red spots is sticky. I won’t call them pimples as another person writes in his message (pimples in transplanted area). But your inference in that post that ‘The more likely cause is the remnants of the sebaceous glands which survive and grow while the hair has not yet started to grow’ seems true to me.

I don’t know why there is this extra sebum production on those reddish areas and why it dries up to form a thick crust? By hit and trial, I found that instead of pealing of this crust if I just wash my head with a pH neutral or baby shampoo, there is much relief. What about your recommendation in that post about frequent soaks…do you mean something like applying a damp towel to the scalp? And could there be any relation between Minoxidil generated redness and sebum production? I don’t use Finasteride, so stopping Minoxidil is difficult for me though I am thinking of going in for reduced strength if this redness aggravates. Pls advise Dr. Rassman.

If you have lost the recently transplanted hair from the FUE, this is normal. The hair that remains may continue to grow. At 5 weeks, I would have expected that all of the crusts would be off. In my practice I get the crusts off in a week or less (often in the first few days with good washing daily). You should take them off in the shower with baby shampoo by gently rubbing them with your fingers.

Redness around a graft may be a sign of infection (folliculitis), so be sure to see your doctor relatively quickly as these may cause permanent loss of the transplanted follicle. Sometimes when crusts stay behind, bacteria will invade through the crusts into the skin and cause local inflamation. Soaks with a damp wash cloth placed on your head prior to shampoo will work for removing the crusts. Minoxidil is an irritant and it may cause increased sebum as your body responds to irritation. I can not advise you on Minoxidil and how to take it. Focus upon the red spots and the scabs that need to come off. That might solve all of the problems. If I were you, I would speak directly to your doctor about these problems and pay him a visit if it is possible, sooner rather than later.

Polycystic Ovary Syndrome and Hair Loss

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

My daughter is 21 and has had thinning hair for the past 3-4 years. She was diagnosed 18 months ago with Polycystic Ovary Syndrome and was placed on a daily dose of Actos to help control her insulin levels. Her hair loss seems to have accelerated since being on the medication. This is very alarming for her. Is her POS causing this or her Actos? Is there anything she can do to reverse it, slow it down or stop it?

PCOS (Polycystic Ovary Syndrome) is a well known cause of hair loss. It reflects some extra male hormone production (all women make testosterone and androgens) which tends to grow hair on the face and take it off of the head in those with the gene that produces genetic hair loss, like male patterned balding. Your daughter needs to be evaluated by a good doctor in the hair loss field (like me or a good dermatologist) who can evaluate the type of hair loss she is experiencing. First, her scalp needs to be diagnosed with the form of hair loss (for miniaturization) and then her endocrinologist should get involved. There may be a role for 5 alpha reductase blockers, but I would want her doctor to work with the hair expert on this management process. I’ve posted previously about PCOS on this blog; see Polycystic Ovary Syndrome.

Female Hair Loss After Braids

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

HI, Dr. Rassman, I am an 18 years old female and I used to wear braids on and off for long periods during my life. This past June I decided to take them out to grow out my own hair. I started going to a hair dresser faithfully every 2 or 3 weeks and saw much improvement. Also during that time I started taking OTC diet pills and after a couple of visits to the hair dresser i noticed in August that i was losing hair below my crown. My hair dresser told me it might have been the stress of the braids that made the hair in that area stop growing and it was now regaining its strength. Since then, the area has grown and spread to the left side of my head. I am not sure if i should call these areas bald spots because there is still hair there, they are just very short compared to all the other areas. The temples, the back portion of my head, the top crown, and right side of my head still have all of its hair and i have not noticed any thinning. I am not sure why this is happening and need some advice on what steps I can take to grow back the hair in these areas.

Let the hair grow out for another 6 months and then make a proper assessment with a good doctor who understands hair. A good baseline also is a good idea just to have a measurement for the progress that you would expect to see and to rule out other problems. The differential diagnosis includes traction alopecia, female hair loss, and the huge variety of medical and scalp conditions that are discussed in previous blog posts (see Female Hair Loss category). A baseline assessment would include a full mapping of your head for miniaturization, which would then be remapped at about 6-8 months from now.

My Connection to Merck

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

Can you please make disclosures of your connections with manufacturers of Propecia?

I have no connection to Merck. I do not own any Merck stock and am not reimbursed in any way from them with regard to my medical activities. I do sell Propecia in my office, but it is sold at cost plus a handling and stocking fee of $4.32. I only sell Propecia as a service to our patients.

Any Hair Cloning Update Yet???

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

I am a 42 year old woman. I have androgenetic alopecia. Its diffuse but now its getting see-through right in the front. What I need is hair cloning because I probably don’t have reliable donor hair from the back. Do you have any suggestions of how I could add more hair to my hairline especially. Is hair cloning getting any closer for all of us. I would appreciate any advice you could give me.
Thank You.

I recently had a conversation with my associate Dr. Robert Bernstein, who in turn spoke to the most prominent hair cloning expert in the world today, Dr. Angela Christiano. The gist of their conversation was that there is nothing new on the horizon at this time that has changed the prospects for hair cloning anytime soon.

Please see our fairly extensive coverage from the past few months in the Hair Cloning category.

Female Hair Loss

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

Hiya, I am a 35 year old female and heartbroken. January of this year my hair changed from healthy, quite greasy really, to dry as a bone and unmanageable. Getting worse at every wash, dryer and dryer. Had all the tests done by my gp. Hormone, thyroid, everything was ok. Now my hair pulls out with the gentlest of brushing, snaps in my hands, and my scalp is showing on my part. My fringe has shriveled to nothing and my hair looks like it has been burnt mainly at the front. I have developed a receding hair line in a classic M shape, and have thick black hairs that seem to just grow everywere all over my head. The texture is that of pubic hair. My hair no longer feels like hair, it is so dry when i touch my scalp it crunches. I have conditioner on it, but nothing seems to help. I have started taking vitamins and my hair feels like it is coated with a sticky dry residue now. Seems to be able to help. I am not a vain person, I am nothing special, but to see myself like this is breaking my heart. Please can you offer some idea as to what the problem is? I am spending hours just sitting in front of the mirror in tears. I no longer recognise the person looking back any more. My marriage is suffering and i am finding it difficult to go out. I feel like everyone is looking at me. My self image is on the floor. Please please can you give any ideas as to what the problem is? My hair seems to be shrinking, not growing, apart from the back which seems to be unaffected. So far you are my last hope. Please please can you help?

This is not something that I can manage over the phone or through an email. You need to be managed by a competent doctor and possibly a good/great hair stylist for the topical management of the fragile hair. Please, find the appropriate people to look after you. Do not become your own doctor or hair specialist. I would suggest using the ISHRS site as a good place to search for a local doctor.

Deformed Hair Plugs — I Just Want to Be Bald

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

I have been mutilated by your hair transplant community and I am angry as hell about it. It has forced me to modify my life to address the deformities of my hair, so I do not and can not have a normal life. I have lived in hats and closets for years, and now I just want to go bald and look bald. How do I do that? I have scars on the back of my head that is wide and long (5 of them), holes in the back of my head from the first surgeon who drilled them out before the second surgeon cut them out, I have pits in my head in the front and top and my hair line looks like a Frankenstein movie part that am auditioning for.

I was told about FUE-extraction but I know that it will lead to more scars. Another doctor told me to do a second step would be to do a scar revision as well, but with than number of scars, I really can not imagine that this can be done. I want to shave my head every day and want my head to be smooth. I have very little money and that makes the problem worse.

There are many things you could do to come out of the ‘closet’ that you are forced to live in. Technology and your decisions processes of ‘old’ (many years ago I suspect) meant that you made decisions at the time that were not wise in hindsight. You can and should get out of your situation and with today’s technology, you probably can.

I am sorry to say, but your plan may just get you in a worse situation than you have now. Scar revisions can be done but you will need to camouflage the new scars (which you will have) with longer hair. There are lots of tricks to make the scars better, like a trychophytic incision which allows hair to grow up from the scar from the edges, but no single solution short of FUE (at the proper time) can address the tendency for scars to widen. Dr. Nordstrom in Helsinki has developed a special suture to address these scars and he is a reputable surgeon, but you have many scars, so that this approach is not a good one unless you get it down to a single scar. Balloon expansion of your scalp, where you will look very bizarre for up to 3 months as your head is expanded to the size of a soccer ball, can deal with the multiple scars, reducing them into a single scar with reasonably assurance of success hopefully achieving only a single small scar is a reasonable approach for multiple scars in the donor area. With the pitting you describe, the scars and the progressive hair loss, adding dermabrasion will be a disaster producing still another set of problems, more than you need.

The key here is to establish reasonable goals with a good surgeon who has lots of experience dealing with people in your situation. I think that your goal should not be to shave your head or to restore you to a hairy man, but to restore you to a normal looking balding male without a freaky, man-made look. With a frame built to your face that is normal looking, and the plugs removed, camouflaged, and properly dealt with, you can achieve this goal. Trying to go bald with what you tell me you look like, will make the scars obvious. A hair system (wig) could be considered as well, though I generally recommend to stay away from those for a variety of reasons.

Be careful not to step off another cliff. You have a bad problem, but if you look at our war stories (see Dean’s Story link below), you might realize that others have been there and fixed that under my care. Get a good doctor first, bond with him/her and then develop a plan that you can afford and live with. Then stick to it.

For more repair information:

Will Flat Irons and Blow Dryers Damage Hair?

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

Hello, I am 20 years old, and I now notice that my frontal area is starting to thin a little bit. But by everyone else who looks at me, they wouldnt even be able to tell that I am losing hair. So I have been taking Propecia in the mean while to halt or slow down the hair loss, until I am old enough to get a transplant. And my father had a hair transplant.

I just want to know, since I work as a actor for commercials and a model, the people who style my hair, they tend to use flat irons(hair straightener) and blow dryers at high heat in where I have the donor area. Because after 6 months of them using the blow dryer and flat iron on me constantly, I decided to have them stop using it and it has been 3 months eversince I stopped. Will this damage and reduce the number of hairs or grafts or FU’s that are transferable or are they safe to use?

Sounds like you really need a good doctor to take charge of your situation. This site is riddled with stories, questions, and inquiries about potions/lotions for hair loss. You need to be smart about decisions going forward. Don’t be foolish with your hair; take command by bringing in a good doctor as a partner for your hair loss problem.

To answer your question — yes, flat irons may damage hair and blow dryers which are too hot can also damage the hair that is there.

FUE / FIT — Minimally Invasive Hair Transplants

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

Hello Dr Rassman,
Firstly I would like to congratulate you on this website. Its very helpful. I am due to have a FUE transplant (1000 follicles) next month at DHI in Athens. I have read your comments relating to DHI and the importance of a good surgeon.

I know that you normally refrain from doing this but I would really appreciate it if you could please recommend a paticular doctor (whose work you know of) at DHI. I am really freaking out now about getting an incompetent surgeon working on me. I realy dont want to make a wrong decision. I will not dislose your recommendation in any way at all to anybody. Thank you.

I do not know any of the doctors at DHI, so unfortunately I can not help you with that. I am told that they have switched completely to FUE and away from strip harvesting. Frankly, that makes me nervous, because of the complete absence of biopsies to qualify patients. DHI was taught by Dr. Cole, who calls his procedure Follicular Isolation Technique (FIT), which is a sub-set of what I call FUE. Dr. Cole, along with DHI, tell me that 100% of patients qualify. The FUE techniques are a series of processes that are fine tuned in each patient, as each process works uniquely in different patients. Dr. Robert Bernstein and I just wrote a chapter in a new text book on this very subject (due to be published shortly). FUE is an intricate process that requires a series of approaches, each matched to the patient’s tissue characteristics. Last week, for example, I performed an FUE procedure and prior to that procedure on an earlier visit, I used four different methods to optimize the process. One tool worked consistently at 100%, while others methods had failure rates in the same patient ranging from 90-20%. At the time of the surgery, the actual success rate was 88% based upon hair counts. For this very reason, I am absolutely convinced that biopsies are needed to qualify patients and match the techniques that work on that patient prior to the actual FUE surgery. On a few patients, FUE surgery is either not possible or so inefficient (taking a few hours per hundred grafts harvested) to make the process not a reasonable alternative to strip harvesting. Depending upon the technique used, patient eligibility ranges from as high as 95% of all patients in some doctor’s hands (very few doctors fit into this category and this group includes those patients who may not be efficiently harvested) to less than 30% in others.

What bothers me is that some doctors have a loose definition of FUE success. Some doctors may classify 100% success as his/her ability to extract at least one hair in an FUE graft. That does not cut it for me, because I classify success by hair count. That means that if a 3 hair graft was excised with FUE, some doctors would call a single hair extracted and two hairs killed off as 100% success while I would call it 33% success (actually this does not quantify the loss of hair, the negative value of hair that is lost forever). Probe the doctor’s definitions here and get an accurate count of what he did when he does the procedure, as you are entitled to that as part of your medical record. If the doctor does not give it to you or tells you that it does not matter, run for the hills. It may sound like technical talk, but the realities of what you get and what you pay for and what is destroyed by the process all come into the value equation. Again, as I always say, let the buyer beware!

I’m 21 and Balding — What To Do?

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

Dear Sir:
I’m 21 years old , i’m suffering from hair loss , its not that much till now but i have a feeling that if i just ignored it , it will be very bad later , & i realy care sooooooooooo much about my Look. So please tell me what can i do , Do you prefer surgery for me , or Drugs ( if yes mention one ) i used to use REGAIN EXTRA STRAINGTH . but i stopped. because i wanted a faster solution . please reply as soon as possible . thanks so much

It is very difficult to evaluate hair loss without at least pictures, and an in personal consultation is better. I don’t recommend hair transplantation as the first option to solve your balding problem. First, you would have to be evaluated to map out your hair loss as it progresses by determining the degree of miniaturization that is in every part of your scalp. Then, providing you are a male, I would likely have you on Propecia for a year or so, then reassess the miniaturization and your observable pattern of hair loss (if any) or reversal of hair loss. From there, transplantation might be right for you, but only an in-person evaluation will be able to determine this. If you’d like to email photos to me, please use the email address on the contact page.