Laser Hair Removal on Scalp

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

Dr Rassman-
I am seeking your advice regarding laser hair removal on scalp hair. How safe is the procedure and what is the success? I know that this sounds counter productive for a hair transplant BLOG but here is my dilema…
I have had procedures done and the transplants were put about 1/2-3/4 inch behind my widows peak. The problem I have currently is that my widows peak does not now line up with the hairs behind it making my widows peak not lined up with my new hairline. Should I have transplants put farther down to round out my hairline (still having a very pronounced widows peak) or can I have the small cluster of hairs that make up my widows peak lasered off and use the transplants that would be necessary to round my hairline for other areas? It seems to lower my already low hairline 1/2-3/4″ would be a waste of transplants. Thank you for your response.

For your type of problem, lasers are not the best approach as they have a generally poor response (30% after one treatment) and unknown long term results.

Please send me photos of your situation from front, sides, and top view with hair dry and then another set of photos with your hair wet. Include one or two frontal views that have you lifting your eyebrows as high as you can to show the wrinkles in the brow. I will get back to you with a recommendation.

Daughter Has Psoriasis and Hair Loss

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

Dear Dr. Rassman,

My daughter is 26 and has scalp psoraisis since the age of 15. The worrying thing is that the hair-line parting her hair in the centre is wide about 1/2 inch and clearly bald. The rest of her hair area seems normal. I gather from your feedback that psoraisis does’nt cause balding. What can she do to reverse her bald hair-line? Svensson was consulted and they have their usual hair commercial treatment. Will they be able to do something to adress her problem, albeit costly. I am 53 and bald, and the wife also 53 is losing hair along female hair loss pattern. Is there a connection of our problem with my daughter’s hair problem? Really appreciate your feedback.

Although psoriasis does not cause balding directly, balding from genetic causes can be occuring. With both your wife and daughter having hair loss, you might assume that hair loss is in the female family line. I suspect that other women also have similar problems. First, take a look at the Female Hair Loss category of this blog.

Please send me pictures to the email address on the Contact page and I would be happy to give you my opinion. It is very difficult to diagnose women over the internet, but the pattern of hair loss you are defining for your daughter is a pattern I have seen from time to time in genetic hair loss. Your daughter may be following your wife’s pattern of genetic balding. Check with your wife about her earliest symptoms of hair loss.

Advice for Balding Actor

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

Dear Dr Rassman,
I’ve got to a point now where i need to address my Hair loss!! I started losing my hair in my early 20’s but it was never that noticeable -this was probably due to the fact that it was a gradual thing and that my hair was densly thick! I’m now 29 and my hair seems to be falling out rapidly and it’s becoming harder and harder to cover it up. I’ve started using Propecia with the hope that it will stop the Hair loss. I’m an actor and am worried that my eventual lack of hair will effect my work! Any advice?
Yours Faithfully

I understand the need to maintain your appearance as an actor. Some character actors can establish a balding persona, so you can accept a balding fate and still make it in the movies or theater. As actors reflect the male population, half of all men will be balding by the time they are 45 years old.

Now that does not mean that I am advocating balding. If your desire is to maintain your hairy appearance and Propecia does not hold it, then hair transplantation is a reasonable option that can produce wonderful, normal, and undetectable results. First, get your hair loss pattern established with a map of your miniaturization. Then, work out your supply versus demand possibilities for hair over time based upon the mapping I just outlined. With that in hand, you can establish a Master Plan, from which you can then make plans. Hair restoration surgery does not mean that you must go bald to get hair back. It means that you plan out everything that is happening to you, short and long term, with the best tools and doctors available today. We are there, just look for us.

Hair Transplant Without Surgery?

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

Are any of the topical ointments being sold on TV effective? I have heard (in Jacksonville, FL) of a new transplanting system without surgery – any such thing??

Effective? That depends on what you want them to do. I’m not even sure what hair regrowth products are being marketed on TV these days.

There is nothing new on the face of this earth that can give you a hair transplant without surgery. Someone is dishonest or plainly a crook. Maybe you misunderstood, so giving the benefit of the doubt, please send me a phone number, website, or at least the name of this procedure the next time you hear about it, and I will check it out for you.

Coeliac Disease and Hair Loss

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

hi, i am 17 years old and have been experiencing hair loss for the last 2 years. it is general thinning all over, especially on the sides, and have been told its due to Male pattern baldness (even though parents and grandparents still have full head of hair). i am willing to accept it as i understand these things happen, but i have also lately noticed, that my pubic hair has been thinning reasonably at same rate as hair loss on head. is there possibly any connection? and if there is, any cures? i would also like to add that i have Coeliac Disease, and have constantly recorded low iron levels, though over the last year i have take iron supplements. i would be really delighted to hear that it could be something else other than male pattern baldness

Coeliac disease is an autoimmune disease. All forms of coeliac disease involve IgA antibodies and intolerance to the gliadin fraction of gluten found in wheat. Thus, your hair loss could be due to coeliac disease as your antibodies can attack the hair follicle, leading to generalized hair loss on your scalp and body. Taking a multivitamin may help with hair loss, because people with coeliac disease tend to lack certain minerals and vitamins due to intestinal mal-absorption (which can cause hair loss by missing dietary elements critical to hair growth). However, ultimately, you may need an immune suppression medication to control the antibody produced in your body from attacking your hair. More in depth evaluation of your hair may be a good place to start before considering any treatment. Clearly, the doctor who is in charge of your coeliac problem should be ‘in-charge’ of your medications for any such suppressive immunological treatment.

Lateral Slit Method

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

What exactly is the “lateral slit method”? Do you use it? How does it improve results?

The lateral slit method for placing grafts in a hair transplant recipient area constitutes the use of slits which are oriented from ear to ear, rather than slits that are oriented front to back. Proper slit making is best done with very small slits, measuring between 0.8-1.1 mm in length. Clearly for people with coarse hair the wider hair shaft may require the longer slits, while those people with fine hair will require smaller slits.

The skills in placing lateral slits is different than the more conventional slits oriented front to back. It is slightly more difficult for those not accustomed to the technical issues involved in the process. The claimed advantage of lateral slits are many, including:

  1. As the grafts heal, there is a fence like orientation of the hairs within the grafts which may increase a sense of fullness from a frontal view.
  2. There is a possibility that the hairs may angle forward from the point where they exit the skin. This may accentuate the layering effect from the transplant and some people believe that this will create more fullness.

The problem with these ideas is that there is no proof. But despite the absence of proof, I perform lateral slits in almost all of our transplants because there is no down side to doing it this way. I wrote about the lateral slit method earlier this month: Lateral Slits and Transplanted Hair Direction.

18 Year Old With Hair Falling Out in Clumps

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

I’m only 18 years of age and have started to lose a lot of hair within the last 6 months. I’ve never really had a high hairline or anything. I’ve always had thick bushy hair at the front. I don’t think it can be androgenetic because everybody in my whole entire family, whether it be my parents parents or just my parents, all of them have a full head of hair. My brothers all have a full head of hair too and no sign of receding.

I was reading on the internet about hair loss and how it can be linked with cancer. I have found a lump and I was wondering if this could be anything to do with it. I have seen the doctor and he’s also bald (doesnt give me much hope) and had a blood test. It’s really depressing to find clumps of hair faling out each day and not growing back. If there are any solutions for regrowth please could you let me know. Thankyou!

If you are concerned that you have some disease, then first address this as your highest priority with a good doctor. Assuming that you have no medical problem, then you need to be managed by a doctor who can make the proper diagnosis (assuming that you have genetic hair loss) and then mapping out your head for miniaturization.

9 Months After Hair Transplant (with Photos)

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

This patient is a Norwood Class 6 and had one hair transplant procedure of 3,206 grafts just 9 months ago at the New Hair Institute.

This is what he had to say…

No one ever knew that I had a hair transplant or that it was even me until I told them! I had to let the secret out of the bag, because people couldn’t recognize me.



Even after only one procedure, the change in his appearance is so remarkable, that I wanted to show off his results (with permission, of course). The photo on the left was taken just before hair transplantation, and the photo on the right was taken 9 months after. Click each image to see the full size photo. Forgive the quality of the “After” photo — there was a problem with the camera that wasn’t noticed right away.

Doctor Recommendation in Texas?

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

Received 2 questions asking about Texas doctor recommendations…

Dr. Rassman,
My son who is 20yrs. old is experiencing significant hair loss. Is there a doctor in the Houston area that you could recommend for him to see to receive the correct treatment for his hair loss.
Thanks

im looking for a good hair restoration facility in austin texas , can you direct me to a good one?

Take a look at the ISHRS.org website’s physician search to find a doctor in your area. I believe there are more details on the ISHRS site. I have seen some wonderful work by Alfonso Barrera, MD in Houston at (713) 468-5200 who is a Houston based plastic surgeon. You can have him travel to Los Angeles and his air fare would largely be covered through our reimbursement program. If you consider this last option, I would certainly have him send me pictures and set-up a telephone consultation with me ‘personally’ by calling my office at 800-639-4247.

Propecia and Sperm Banks

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

Good day Doctor

I am a 28 year old male and have axperienced steady hair loss over the last 4 years. I have been to a GP who has advised that I go on a 12 month course of propecia. I am very concerned about eventually conceiving children whilst on the drug even to the point that I am considering visiting a sperm bank before I start the course.

Please advise me as to what is the safest course of action should I want kids whilst on the course.

Thanks for your help.

Propecia is out of your system in a few days after stopping the medication. Therefore, banking your sperm is probably not needed if you are worried about retaining the medication in your sperm. If you want to conceive children while on the drug, there is no official contraindication for that, but some doctors are suggesting that you go off of the medications for 1 week/month while your lady is in her fertile stage. Some doctors take the extreme medical legal position that you should stop the medication, get her pregnant, and then use a condom for the time until the baby is born. That absolutely guarantees that there is no medication possibly transferred. This last approach seems radical to me as there is nothing backing it up in the drug disclosures.

Ortho Evra and Hair Loss

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

I have been using ortho evra for now about 3 months, and I realized that I have been losing a enormous amount of hair…This has been happening since I started using the patch…If I stop using the patch, how long does it take to leave my system, and will I regain my hair???I have lost so much hair that it is depressing at times for me to see that I have lost so much….
I would appreciate a response from you asap…
Thank You!!!

I’ve answered a similar question before: Severe Hair Loss from Ortho Evra

The use of hormones and birth control medications will produce hair loss in genetically prone females. I do not have an answer to your question on the timeline for any reversal, though. There is no assurance that it will be reversed if the hormones precipitated the expression of the hair loss gene, but I would stop using it and consult with your doctor as early as you can.

Marijuana and Hair Loss

/by William Rassman, M.D./4 /

Does smoking marijuana cause hair loss?

It has been suggested that there is a connection between marijuana smoking and hair loss. However, since many young men are genetically predetermined to lose their hair, a man who both smokes and has genetic hair loss may produce further connections, real, circumstantial or otherwise.

Why Can Hairs Come Out After a Transplant?

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

Hi-
I’m in my early 20s and experiencing some pretty serious thinning across the top of my head. I’m curious what doctor(s) you’d recommend I see in the Chicago area. I heard about a place called the Chicago Hair Institute but I don’t know if it’s credible.

Also – I’ve been wondering why grafts don’t fall out after surgery. Would you expect to see a few of them fall out as the scabs come off?
Thanks!

The best way to find a doctor in your area is to check out the physician search on ISHRS.org. That may not tell you the best doctor, but it is a list that you can shop from. Remember to do your research before chosing a doctor.

After a hair transplant, some of the hair will grow and grow and grow to full length. If you are not careful, pulling off the scabs before they are ready could cause you to lose the grafts or the hair. Usually, the hair falls out only to regrow in about 2-5 months. Transplanted hair does not have the gene for hair loss so it grows for the entire lifetime in most people.

My Hair Loss Pattern is Not on the Norwood Chart

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

Dear Sir,
My hair loss does not resemble any of the stages in NORWOOD SCALE! I mean i am using hair on the entire SCALP (Not back and sides), but im using it uniformly on the scalp. Theres no such condition in norwood scale. this makes me wonder if i have MPB….though my dematologist says i do have MPB. Also, can there be any tests, which can be done so that i can figure out if Propecia will have side effects on me or not?

You need to have your hair mapped out for miniaturization, which will show patterns that the eye does not see. Early balding may be diffuse in a pattern or non-patterned. The mapping will show just what it is.

Hair Loss Worse After Rogaine, Part 2

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

I didn’t understand your point about whether the probability of the rogaine working for me outweighed the risk of continued hair loss. If the shedding from rogaine is temporary, and will grow back, what is the risk of continued hair loss? Will the hair still come back if I discontinue the rogaine (which I have)? Especially since I only used it a handful of times? When should I start seeing some signs of regrowth, if there will be any?

Sincerely,
“Sorry I ever used rogaine”

The original question / answer can be found at: Hair Loss Worse After Rogaine

Minoxidil can cause irritation of the skin and some people get hair loss by the drying effect that they see with minoxidil. I had suggested that you stop using it because the topical effects of the medication will go away within days of stopping it. The question that you are asking, which essentially is how long you have to wait for the process to reverse, is difficult for me to answer. I have no information on the cause of your hair loss, if the process was an acceleration of the genetic process and if this process is continuing. I need to know your diagnosis and get an examination which are two essential elements to getting you where you want to be. With a short run of minoxidil, I would expect that there should be no long term response to this medication, but that is just a guess.