Alopecia Totalis and Laser Results (with Photos)

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

These photos were sent to me by Dr. Richard Burgmeier in Arizona who had a patient with Alopecia Totalis that failed to respond to treatment for many years. Dr. Burgmeier said:

    “The patient is sixteen years of age and had the problem since the age of twelve. She has seen different doctors and has tried multiple treatments with no improvement. She started the Laser (LLLT) in November 2005 and at the same time started Joe Soaza’s protocol which included L-Tyrosine 3 pills in morning 2 at night and minoxidil 5% twice a day after showering. Since November 2005 she has been getting treatments with the Laser for 20 minutes twice a week. The patient is very excited with this treatment. This is the best treatment she has tried. It is the only treatment that has stimulated hair growth over her entire scalp. The patient stated “This is the most hair I have had in 2 years.” She has had problems with eczema over her scalp that has completely resolved since her treatments started.

    We currently have 10 other patients that have been using the Laser Hair Care System 20 minutes twice a week for the past 6-8 weeks. So far every one of these patients have been very happy with results. These other patients have only been treated with the laser.”

It is clear to me that the results in a very short time frame were beyond what Dr. Burgmeier had expected. Like our last blog entry for the laser therapy, Laser Treatment (LLLT) for Hair Loss (with Photos), there were multiple therapies used, but clearly the results were spectacular for the early treatment of this combined therapy. Dr. Burgmeier feels that the laser treatment has great value based upon his experience with it. If this patient continues with this type of gain, we all hope that much more of her hair will return. A bald female at 16 needs all the help and luck she can get. The relationship with the laser and the cause of its benefit is not clear from a scientific basis. I would have liked to see the treatments added with one therapy and then a second therapy separated over time so that their incremental value would be more directly evident. Then we might know which treatment actually produced the benefit you see here. Is there hope for this young girl? Frankly, I am a perpetual optimist, so I hope for her sake that she will continue with the growth, covering a wider and wider area. I will get follow-up pictures on her in the next few months and post them here. What I would hopefully see is that these small islands of hair will grow larger and then merge together to appear like a full head of hair (ideal result, of course). Click the photos below to enlarge.





Temple Hair Transplant

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

Between the ages of 20-23 I went to an Norwood 2. Since the shedding of the hair at my temples, my hair has thickend elsewhere. Can a hair transplant be done just at the temples? Who could I contact for such a procedure?

What I am about to say relates to your age of 20-23. I would recommend first that you get your hair mapped out for miniaturization to determine the degree of the genetic hair loss that you have now and to get a good baseline for future reference. Then, based upon that examination (under the direction of a doctor), you may start on Propecia for your hair loss and take it for at least 8 months to 1 year and see if the temples return to the levels you want. Propecia may help regrow hair in the temple area. At the very least, it is worth an attempt. Beware of any person who would recommend surgery for you because he/she may not have your best interest in mind. I feel strongly that a trusting, supportive doctor-patient relationship is necessary in the hair restoration process. If you have any questions about the above information, I would be happy to answer them by email, telephone, or in person. If you live too far from California, I am more than happy to try to recommend a dermatologist in your area. I can be reached by phone at 800-NEW-HAIR.

Hair Transplants in Women vs Men

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

I’m a 45 yr old woman who has been slowly losing my hair over the past 20 years. Currently, I have the typical female baldness (not completely bald, but lots of scalp showing through) just past the hairline. Blood tests revealed no thyroid issues, but I’m well on my way to menopause as far as hormone levels. I’m healthy as far as diet and exercise, have normal stressors in life, take no meds. There is no history of female baldness in the family, but my mother has always had thin, fine hair. I’m about ready to go the transplant route, but keep reading that it could be hormonal or vitamin based. My ob/gyn and dermatologist are both at a loss to explain it as other than bad luck. How do I know for sure if I’ve exhausted every avenue before resorting to transplants?

You must have the complete work-up of tests (see Female Hair Loss for info) and then get a good, caring, competent, and ethical doctor who understands when a transplant can help and what it will do for you. Setting realistic expectations is critical. Woman’s hair loss is very different than men’s hair loss with regard to the judgments and artistic distribution for transplantation. I use the metaphor that it is easier to make grass grow on an empty lot, than it is to make a green lawn even greener. Bald men scalps are like the ’empty lot’ , so any hair artfully placed and distributed is easily appreciated. Women are more like the green lawn and making it greener is difficult as expectations may not relate to the reality of what the transplant will bring. That is why a choice in the correct hair transplant surgeon is so critical. You must be confident that the surgeon is going to give you transplants because it will help you, not just to put money in his/her pocket. Like all industries, the axion: ‘Let the Buyer Beware’, prevails.

ProCede with Medical Conditions?

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

I am a 47 y/o bm with mild hypertension and graves survivor. i have about a 2in spot near the rear crown of my head and thinning, curly, wavy hair on top. Can ProCede help me without aggravating my medical conditions?

See my previous comments about ProCede. I do not know what it does nor what you can reasonably expect of the product. On their website, they make a statement about their line of products being unsuitable for those that have had hair transplantation, but then they go on to add that it is non-toxic. If it is not for use by those that have had transplants, then it suggests to me that there is some kind of potential toxicity to it. I’m sorry, but I can’t reliably answer your question about using the product with a medical condition, but I do suggest you look into the ingredients and ask your doctor if these will cause you health concerns.

My Husband’s Hair is Thinning

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

This question is about my husband. He is 25yrs. old, slightly balding on the front top of his head. I think it is because his father had the same balding, but what hair he has left on top of his head stopped growing. I don’t think it has grown in a long time cause I havent had to trim it, but I have had to cut the hair on the sides and on the back of his head. Why is that? and is there a way to get it growing again so he stops balding? an does the rogaine work and worth the money? thanks so much

Your husband sounds like he has male patterned hair loss, which is present in almost 50% of the male population by the time they each 45. Your husband needs to have his scalp mapped out for miniaturization to determine if he has genetic balding. A good starting point can be found in my book, The Patient’s Guide to Hair Restoration, available free of charge by download (in PDF format) or sent by mail.

Using FUE for Scar Repair

/by William Rassman, M.D./2 /,

Trying to do scar repair on strip scar from 800 graft surgery. I was told the 500 FUE’s into scar would conceal it enough to shave my head or am I better off doing a Trichophytic Donor Closure. Scar is about 5 1/2 inches long and a 1/4 inch to slighlty smaller wide. Tryin to do this just once. Doctor told me he has about 80% growth with FUE (can that be true?). I would like to shave my head completely bald with a razor. please advise. Thank You

There is no guarantee that 500 grafts would cover the donor scar in a single surgery. Based upon that measurement, I would think that 250-300 grafts in two sessions might do the job. The problem is density per hair/graft and that they can not be placed too close in a single session, as that may be unrealistic in a scar (which is often not compliant as it does not stretch well). Packing the grafts too closely in the scar may produce a failure of some of the grafts to grow.

Growth in a scar varies between people. Most people will get 80-90+% growth if the spacing is properly placed. The FUE procedure itself is a reflection of the particular doctor’s skills in doing them (harvesting, graft preparation, placement). I cannot comment on the skill of a doctor I do not know and have not personally observed.

I Had Plugs Transplanted in the 80s

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

Back in 1988 I had some of the old plug transplants done.I realized I made a mistake and stopped any further transplants.( 35 in all)
I had all the transplants (Plugs) removed with some scarring.I also had the doner area removed recently by a plastic surgeon.My problem is I would like to shave my head now but have no idea how bad the scarring is and the only way to find out is to shave my head.Are there any pictures that I may view to see how the area may look like shaved.Is there any makeup I may use after I shave my head until I have the scars corrected.
The were some of the transplants still growing will they look natural when shaved, will they grow faster ( on a daily basis ) then the hair that was originally there. I am exhausted with all the effort I have had to go threw to get me back to where I was in 1988. I await your response.

This is not an uncommon question, but unfortunately the answer is not what you want to hear. The scar from excision of your open donor area will show very well, like any scar on the body, even if it healed perfectly. People who have had any excision (even today’s modern hair transplant) will have a large ‘smile like’ line on the back of their head if they shave their head. The shaved head will bring attention to every defect on your scalp from where each of the grafts were removed and it will be made worse in bright light. Normally, a shaved scalp is smooth, but I suspect that yours is puck-marked and shaving it will only draw attention to the defects.

Female Thinning Hair, Propecia for Women?

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

I am a 57 year old female and lost almost all my hair on the top. I have some hair on the lower back part. Right now I am using Toppik and Couvre to hide my bald spot, but it is very hard. Can I use Propecia? Can women take it? My 25 old daughter, a 4th year medical student, has the same problem. She has seen many doctors (including Cleveland Clinic) but nothing helped. She applies 5% Minoxidil, and takes some Bl. Pr. medicine everyday but still she is losing hair fast. One doctor at IU Med School told her that she is not a good candidate for transplant therapy.

Can you help us?

If you want I can send our pictures to you.

There are many causes for women’s hair loss, such as hypothyroidism, eczema, alopecia, dieting, malnutrition, autoimmune, drugs, infection, genetics, etc. Since your daughter has seen many physicians, I assume that both of you have had numerous blood tests to rule out the many causes. Biopsies may be a next step, but your scalp and the scalp of your daughter should be mapped out for miniaturization. It would be interesting to see if the ‘map’ is similar for miniaturization by distribution, which would suggest genetic causes. Propecia is a very bad idea and not recommended for women. A biopsy of the scalp can evaluate if there is any inflammation process going on. If you would like, you may email your pictures to the address on the Contact page or come in person for a free consult to one of our offices in Los Angeles or San Jose, California.

Darker Hair Growing In After Transplants (with Photos)

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

Dr. Rassman:
I noticed that my hair transplants are not blonde like much of my head hair. You transplanted my head 1 year ago (1500 grafts) in the front and the hair has grown darker where the transplants are. Much of the other hair is blonde, that is, except my beard which has red hair. Now I have a three toned hair color. I can come to your office if that will help!

(This patient subsequently visited my Los Angeles office; see photos below).

The transplanted hair came out of the back and sides where you hair is brown (today). This is the dense area that does not get sunlight and you clearly need sunlight to have the sun bleach out the brown color and turn it blonde. I call this phenomenon the ‘Summer Blonde’. My three sons are all Summer Blondes who have brown hair in the winter. When we met in the office today, you did tell me that the brown color was evident this fall, after the surfing season was over for you and you had to spend more time indoors. You then deprived your hair of the sun that it needs to turn to blonde. That is why the problem was not evident this summer when you ‘lived’ on the beach and in the surf.

The red beard is kind-of funny looking coloring, as long as you keep your goatee. If you like the three tones, then keep at what you are doing. The fact that you grew the goatee means to me that you like the red color. If you want that blonde color to show up all year around, you must either spend more time in the sun, or hit the bleaching bottle.

The photo on the left shows the brown roots of the transplanted hair in the center of his hairline; the photo on the right shows the blonde non-transplanted hair from the corner of his frontal hairline. In the summer, the area that is now light brown will become blonde like the hair on the sides. Please click the photos to enlarge.

 

What is Considered the Hairline?

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

So propecia helps the hair on top and vertex of your head but most of the time not the hairline. My question is how do you determine where the hairline ends and the top begins? Is there a certain measurement that is considered the hairline? Thank for your time Dr. I have asked alot of questions and everyone has been answered. I appreciate it very much! I’ll be in to your office sometime after I manage to get my butt out of Iraq.

I would say the frontal area is roughly the first 3 inches above the highest crease in the wrinkled brow. The hairline should start about 1/2 inch from this crease. Propecia may slow hair loss down everywhere, but the drug is less effective in reversing it in the frontal area. There are exceptions to this rule: see Propecia Patient Results (with Photos).

On a side note, you have my support for what you are doing in Iraq. As you may know, I was in Vietnam and saw the dark side of war and the good side when I helped the people I treated in hospitals. In many ways Iraq and Vietnam were driven by similar ideals. Good luck.

NutriSol-RM from ScalpMed

/by William Rassman, M.D./10 /

I am using the hair growth product called NutriSol-RM. The Company that markets this product (Scalpmed) claims this to be a FDA approved product. I was told that this solution Vitadil-5a is all made of herbs.

However some of the ingrediants seem to be chemical in nature.

Is this product safe to use? Is this FDA approved product?

Appreciate your advise!

I have commented before on this line of products, but I could not tell you if they are safe or effective. I took a look at the FDA registry and found no approval of any reference to this product or company. You may wish to contact the company to find out why they claim FDA approvals when none can be found and if I have failed to find the link for FDA approval, I would be happy to publish a reversal of my opinion from the research I have been able to do. If there is no FDA clearance for safety and effectiveness and that is claimed by the company, then the FDA could shut the business down. Many times I wonder why the government does not do this when so many claims are made by various companies that are clearly false and misleading. The answer probably is that the government prioritizes the degree of ‘evil’ that any one violation is and then the government factors in their costs and available manpower for enforcement.

Iron Levels and Hair Loss

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

Dr Rassman,

I am a 27-year-old female who has experienced a gradual overall thinning for the past 10 years. It is now fairly severe. I have always had low iron levels and saw a hematologist for over a year. My ferritin levels have hovered between 14-35, despite taking a 325mg ferrous gluconate supplement daily.

My ferritin is currently 14 and my hematologist says that since the laboratory test range is 10-150, my levels aren’t so bad; that it would take anemia to cause hair loss. My B12 is also in the low range – 325 on the 200-1200 normal zone. I feel that I must not be absorbing iron if the levels haven’t changed despite taking a supplement and I am frustrated by wasting more time without being able to rule this out as a source of the thinning. My two younger brothers have male pattern baldness but I am loathe to accept genetics are to blame for me too…

My question is: how low do iron levels have to be to be considered a legitimate cause for hair loss? And how soon would regrowth occur after normal levels are restored?

Thanks so much for your time.

Anemia is a very broad topic to tackle. There are many causes of anemia, like microcytic anemia and macrocytic anemia. Microcytic anemia is caused by iron deficiency, thalassemia, and various chronic disease. Macrocytic anemia is caused by folate and B12 deficiency. There is no cut off level of iron that one can define as the starting point for hair loss. Ferritin & Vitamin B12 deficiencies may produce hair loss and anemia and they may accompany other vitamin deficiencies including the entire B group [Vitamin B1 (thiamin),Vitamin B2 (riboflavin), Vitamin B3 (niacin), Pantothenic acid, Biotin, Vitamin B6 (pyridoxine), Folic acid (folate), Vitamin B12 (cyanocobalamin)].

Have you tried to take iron with vitamin-C? Sometimes that may help to increase absorption of iron. Liver and red meat have high iron levels. Your doctor may have evaluated your GI tract for mal-absorption problems leading to some malnutrition or other vitamins and nutrient deficiencies, each which may contribute to hair loss. If the normal level of iron is restored, it may take a few months before you can see noticeable regrowth of hairs.

Propecia, Paxil, and Erection Problems

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

I am 27 years old and have been on Propecia for about 3 weeks (I am thinning at the top and crown, and just a bit of scalp is showing, but the balding process has started). I have also been taking Paxil for almost 3 years. Recently, I found that my erections have become harder to my maintain and are not nearly as hard or big as they used to be. This concerns me greatly.

  1. If the side-effects are from Propecia, will they ever go away of I stay on Propecia?
  2. Would a switch to Proscar make a difference?
  3. I am weaning myself off Paxil, could this help?
  4. How can I have both hair and erections?
  5. Am I best to get off of Propecia and start to think about transplant procedures?

Thank you!

The effect of Propecia on sexual dysfunction may be temporary, but if they continue for more than a couple of months, then it may prevail. This would only be assuming that the Propecia is the cause of your sexual problem. You can stop Propecia for a month and see if it makes a difference, or you may want to cut the dosage of Propecia down to half a pill per day as an alternative to stopping it. Proscar (packaged in 5mg) and Propecia (packaged in 1mg) are the same medication, finasteride.

Paxil can cause sexual dysfunction which will probably subside, assuming that you can wean Paxil with the endorsement of your doctor. Your hair issue and your sexual dysfunction issue may need separate doctors. These issues are too important to try to solve by yourself.

Ava Renewale, Tribulus Terrestri, and Hair Loss

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

22/male. I’ve currently (last six months) been prescribed to Ava Renewale tablets, and been following normal dosage. Is this a good choice? I am currently taking Tribulus terrestri, 12500m. I’m sure you heard of this natural herb. Can it induce baldness due to the higher levels of testosterone experienced while taking it? Can it reverse the affect of the Renewale medication?

Thank you.

Ava Renewale is a Chinese medication that seems to do everything and anything and is proposed as a cure for many conditions. I can not certify the FDA’s position on such herbal medications, but many professionals like me tend to believe that there are some dangerous herbal medications out there. I have no first hand knowledge of this one, however. With regard to Tribulus Terrestri, I also do not have personal experience with this, but based upon what I read, this has anabolic effects on muscle mass (sounds suspiciously steroid like). Anything that increases testosterone has the ability to increase genetic hair loss in those predisposed to balding. From your question, you are trying to titer two substances that may counter-act each other. I would not recommend this.

Lower the Hairline Without Surgery?

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

I’m a fifteen year old guy that has a high forehead. I would like to know if theres any way to lower it without surgery.

At 15, surgery is not really an option, unless there would be extenuating circumstances. The appearance of a lower hairline can be accomplished by shaving the front of your hair and putting glue to hold a wig in place. However, wigs produce traction alopecia (hair loss from pulling the hair), so using a wig will guarantee long term hair loss. I do not recommend doing this, but it is an option nonetheless. You might just have to learn to live with it. When you get to 30, if there is no male pattern balding that shows up, the lowering the hairline may be a good surgical option. You have a few years to wait on this.