Donor Scar is Thick on Sides and Thin in Center

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

Hello,
I had a FUSS transplant a year ago. The transplant was successful, but i was left with a scarr which is thin on the center but thick on one side. Please can you tell me what options I have to get rid of the scar. Can you explain what the options consist of and how they are carried out. I like to keep my side hair really short, hence it would be a real great advantage.

Thankyou.

Scarring is a natural part of any surgical procedure. That said, the degree of your scarring may be more than what is considered acceptable. You may also have a condition that predisposes your scars to forming either hypertrophic scars or keloids. Hypertrophic scars are thick and elevate, while Keloid scars are defined as an abnormal scar that grows beyond the boundary of the original site of a scar. The treatment of scars is a science to itself. Some people with really bad scars from burns of the scalp to accident deformities or really bad complications of scalp surgery may require a very experienced, skilled surgeon.

There are many options to fix a large scar through a scar revision or an FUE procedure. This can entail transplanting into a flat, widened scar to the most extreme repairs requiring a balloon to stretch normal scalp and then radically remove the bad scars. Bad burns may require a readjustment of the anatomy of the scalp. See our 2005 NHI Newsletter (in PDF format) article on scar repair. You should return to your doctor who performed your surgery to explore options. In most cases for a hair transplant scar revision, depending on the degree of scarring, there should be a minimal charge (sometimes no charge) to you from the doctor who originally treated you.

Eyebrow and Pubic Hair Loss

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

Can I grow eyebrow hair by applying Rogaine (minoxidil) to the minimal eyebrow hair that now exists?

Also, would I bring my concerns about eyebrow hair loss (I also have completely lost my pubic hair which doesn’t bother me) to a dermatologist rather than internist? What related lifestyle, medical, physical, emotional information should I note to give the physician the information needed to make a proper diagnosis? Do you recommend any physicians in the Boston area who are experts in the area of eyebrow hair loss in women and corrective transplant?

I really appreciate being able to ask questions based on the information you provide on your website. Thank you again. I look forward to your guidance with this matter.

Rogaine should not grow eyebrow hair where there is none. A dermatologist would help you with the correlation between pubic and eyebrow hair, if any. The physician will know what to ask you to help make a diagnosis.

Hair Raiser

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

I was just wondering if you had any information on Billy Jealousy’s new product, Hair Raiser. It claims to regrow lost hair and recently won an FHM grooming award.

It is said to contain Methyl nicotinate and 2 DHT blockers (Swertia and Licorice Extract). Their website says “Hair Raiser takes about 4 months of every day use to experience the beginning growth of terminal hair. Regrowth will not be experienced if hair follicle has been dead for more than 10 years. Hair Raiser was created by world renowned bio-chemist C. Sanders.“

I am not familiar C. Sanders, the bio-chemist — but I am familiar with Colonel Sanders, the purveyor of original recipe and extra crispy fried chicken. Kidding aside, if you have been following this blog, it has always been stressed that it is a “buyer beware” market. Anyone can claim effects of a cream/lotion/potion. What strikes me is that there is a 1989 U.S. Supreme Court decision preventing these products being advertised or sold in the U.S., yet these types of claims are made and products are sold every day. There are only 2 FDA approved medications to treat male pattern baldness: (1) topical minoxidil (such as Rogaine) and (2) oral finasteride (Propecia). Since Propecia is still protected under patent, I suspect this Hair Raiser product contains Minoxidil as one of the ingredients, if it actually does do anything for your lost hair.

More information on this product can probably be found at the official site, BillyJealousy.com.

Wearing a Hair System While New Transplants Are Growing

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

I have been wearing a hair system for almost 10 years and want to transition to a transplant, my concern is really with the transition..how to do this without letting the world know that I am infact wearing a system..or was wearing a system and am gettiong transplants.

Is there a way where I can keep wearing teh system, get transplants and as they start growing just crop the hair as short as aesthetically okay,a nd then just toss the system?

Please let me know I am a level 6 or so, have fairly realstic expectations about what hair transplant can do for me, but am simply confused about the transition period and thus have nto taken any steps.

Yes, many people in your situation continue to use the hair system. The systems must be switched to clips and great care needs to be taken not to allow the piece to irritate and rub the new hair. I generally recommend using a hat when you are not needing the hair system and taking off the system at night (easy to do with clips). Keeping your hair and scalp clean is important. I ask that you hold off using the hair system for the first week after the transplant, and recommend that if you really want to keep it covered, use a hat during this time.

Transplanting Hair Into Scars

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

Hi again Doc! First off, I want to say that I really appreciate your site and plethora of knowledge of this very “thin” topic. My question today concerns whether or not it is possible to transplant hair successfully onto a site where a scar exists? I have had several sebaceous cysts removed over the years, and two of them left very noticeable scars. That coupled with my thinning hair, has made me very self conscious. Your thoughts are greatly appreciated.

By the way, I have begun using that “horse” conditioner, Eqyss Megatek as well as applying some emu oil on my scalp at night. After about 3 weeks or so I do find that my hair appears to be responding well to this combo. I notice less fallout and I have to say am surprised to find quite a few little sprouts along my entire frontal hair line. I am not saying I stumbled upon the cure, however as far as I’m concerned, I’ll keep trying this regimine.

Keep up the great work

Transplanting hair into the scarred area can be done with good success. Generally it may take more than one session to get the thickness you want/need. Thanks for the feedback on Eqyss Megatek and emu oil.

Lost Hair at Hairline After Damaging Hair With Bleach

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

I am female and recently bleached my hair and then dyed it. The problem is that I lost track of time while bleaching and left it on way too long. Not realizing the extent of the damage, I then put a color on it. A couple of days later, when I pulled my hair back I realized that my hair line had receded noticeably in certain areas leading me to believe that I melted my hair to the scalp in those places. My questions are: will my hair grow back in those spots and will I continue to lose my hair? I am seeing a stylist in a couple of days to have it cut very short to try to minimize more damage through breakage but would like to know what kind of fallout I can expect — unfortunately, I have no one to blame but myself in this situation and realize that your forum is for those experiencing some very devastating conditions and although my situation seems vain in comparison any answers you can give me would be greatly appreciated.

Thank you

The good news is that your hair will likely grow back. The bad news is that you will have to be patient and wait until the hair grows back. In the mean time, I suspect you will come up with a new creative hair style — you have little choice.

How Are Grafts Removed From Strip?

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

My brother had a hair transplant with you last summer and I’m seriously considering it myself. I’m still on the fence, but I know that my hair isn’t just going to magically regrow in the front and my brother’s hair is coming in quite nicely. That’s a very positive thing. Anyways I’ve been reading a TON of stuff online (thank you so much for this blog) but I have not read anything about how you cut the hairs out of the donor strip. So I’m just curious to know what is involved with removing the hairs from the strip once the strip is cut from the donor area? Thanks

It is natural to be curious and even nervous if you are considering a hair transplant procedure. The best thing is to come to one of our monthly Open House events to see a live surgery take place (on closed circuit TV with the patient’s blessing) and meet NHI patients in person to see the quality of our work.

If the saying goes, “A picture is worth a thousand words”, then I wonder what a video is worth?

Another great option is to watch this quick, informal video filmed during a hair transplant procedure, shot earlier this week at the New Hair Institute’s Los Angeles office. The video, found below, shows a quick scan of the surgical room, followed by a technician dissecting the grafts from the strip under a microscope. The video is narrated by Dr. Rassman — you can try to count the words, but hopefully, this video speaks more than just a “thousand words”.

Note: This video is of surgical nature and may be too graphic for some viewers.

There’s also more videos available on the NHI Videos page.

Depressed Over Hair Loss

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

I had major hair shedding at age 19-20 all of a sudden. My father said he experienced the same (!) when he was young and he’s now 51 and still has a full head of hair, he just loses a lot (but he has a lot of hairs just like me). But his father went bald in his mid 20’s and because the hairloss was so agressive (you could compare it to the shedding of hair from animals at a certain period in the year) i thought for sure i was going the same way. So I visited 3 doctors/dermatologists and they all concluded it was genetic hairloss, although they didn’t seem to know much about how hairloss/hormones exactly work and were easily agitated when you asked a lot of questions.
Anyhow, i got prescribed proscar together with minoxidil (and nizoral shampoo) and took it for 1-1.5 years, after that I just stopped taking it, followed by rather intensive hairloss (which is normal, and it wasnt the same as when i was 19) i never saw a bald spot. Now at age 25 I still have all my hairs left, although I do lose a lot of them, there’s never a bald spot. I should have listened to my father who said he experienced exactly the same thing(!) when he was younger, he’s now 51 and he still has a full head, and yes he also loses a lot of hairs on a daily basis.(we both have a lot of hairs aswell).

Since i know for a fact that my father and brother both grew (2-3 inches, 5’9 and 5’11 respectively) after the age of 18 and i didn’t (i was 5’7.5 at age 15-16 and still am at age 24) i am very certain that massive hairloss was a testorone surge, and as such probably the start of a second growth spurt.
And i’m quite certain that because of taking proscar I caused premature closure of the growth plates (more production of estrogen due to DHT blocking?). Is this hypothesis correct Dr.Rassman? It’s really depressing to know that one small pill can mess your future up in such a grave way, as my height truly bothers me now. I thank you in advance for your effort.

I am not sure what you are asking. I assume that you lost hair after you stopped taking Propecia and minoxidil and that you noticed that more hair is falling out, yet you still have a full head of hair. Stopping these medications should not cause you to lose more hair than you would have ordinarily lost. I use the term ‘catch-up hair loss’ which means that your hair and scalp will behave the way it wound have gone without the retardation impact of these mediations on your hair. Now you are saying that you have a reasonable head of hair, but that there still may be thinning present and want to know if short term bursts of testosterone could cause hair loss. The answer to this question is yes, but generally when this happens, the lost hair is permanently lost. I have discussed many times on this blog, the need to have your scalp mapped out for miniaturization to establish a working diagnosis. If you have miniaturization in any pattern, you may still lose hair, so one would want this process to be an intelligent process with some metrics to understand what is changing on your head over time.

Gentle Hair Brushing After Transplant

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

I am looking for a “gentle” brush (not so much for my hair, but for my scalp so that I don’t harm my transplants while the scalp is tender. I am also concerned about brushing taking out some of the hair I still have. Do you have a recommendation for me?

A soft brush or one with wide teeth will be gentler on your scalp/hair than the standard comb. Many people want to treat these new hairs from a transplant as special. As the scalp does not have normal sensation, a soft brush may also help. I tell those people who are actively losing their hair not to brush too hard, for the hairs that are fragile may be helped out of the head of the balding person with vigorous brushing. For softer more gentler combs, take a look at: Tenderheaded.com

Propecia for Diffuse Thinning?

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

Is Propecia effective for one such as myself who has “diffuse” thinning all over the top scalp? I’m 19 and I been on the drug for a little over 3 months and I still shed is this normal? Should I give it more time to work?

Some people thing that in a limited number of individuals, the cycling of the hair growth moves in and out of its anogen phase. Prior to the anogen phase, there is often hair loss. This means that the loss may be an indication that you will have a good response when anogen comes into play. Without seeing the miniaturization of your hair under a densitometer (microscope) and your particular hair loss pattern, there is no way to answer this question. I generally like to count hairs, those that are miniaturized and those that are full normal hairs. That tells me where you are starting from when you go on Propecia. Good measurements of hair counts and miniaturization tells me a great deal about your response and puts good science and diagnosis in my hands. You need a good hair transplant doctor or Dermatologist to evaluate your hair loss pattern to see if Propecia is the right medication for your condition.

Why Does Propecia Lose Effectiveness?

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

Hello Doctor,

I have been using propecia for about 16 months with good results, but I’m concerned with the idea of it becoming less effective in time. Is it that the body develops some sort of immunity to the propecia, or is it that other factors contribute to the continuation of hair loss while the propecia continues to lower DHT levels.

I’m considering switching to Avodart, which suppresses a higher amount of DHT in the scalp and serum, and stays in the body longer than Propecia. But I’m wondering how that makes it “more effective” than Propecia if non-DHT factors will still continue to progress hair loss.

I’d really appreciate your advice, since I’m looking to make a move before I notice any more hair loss.

There are generally four causes for hair loss. Genetics (they stay with you for life), hormones (DHT which is central to the hair loss equation can not be fully inactivated in the cells), stress, and time. Medications are not always as powerful as we would hope for. What you are asking really reflects a different and more directed question, which should be:

  • Can Propecia retard or reverse the progressive nature of hair loss?

The answer to this question is simply that Propecia alters the rate of the hair loss in its pattern, but it will not change its deteriorating long term course. It is interesting to note that in the early days when I first started to do hair transplants, the patients kept the steady down hill slide to progressive balding. In the recent days, I rarely see the advanced balding arise on those patients who are on Propecia. I have assumed that the Propecia slows down the hair loss. In you question, you ask if you should be concerned with the idea of Propecia becoming less effective in time and that the body develops some sort of immunity to it. I clearly do not believe that any immunityor resistance to Propecia is developed, but without scientific evidence to the contrary, I can not say for certain beyond my personal belief and experience.

Using Arm or Armpit Hair As Donor?

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

I have an unusual hair replacement question. I suffered from alopecia and my entire hairline fell out along with some of the fron of my browline. I have been using organic products with great success and finally after a year, My hair line is returning, but the space between my brows has not filled in and now my features are greatly imbalalnced. i was wondering if it is possible to have a browline restoration procedure on a very small area, about 5/8inch on front of right brow and 1/4 or 2/8inch on left brow? As technology has advanced so much with the advent of hair restoration, I think this would be great for me, but would it be very expensive as it is such a small area of hair to be replaced/enhanced? ANd would armhair or armpit hair be eligible as donor hair as it more closely resembles the bushy brow area hair. I am AA by the way.

The technology is available to transplant hair from one part of the body to another. However, the catch is that the hair transplanted from one part of the body, such as your armpit, will retain the same characteristics from the donor site (in this case being the armpit area). So hair moved to your eyebrows will still look like armpit hair. I generally like to use scalp hair as the donor because it most often reflects normal eyebrows. Bushy eyebrows are easy to create if needed, the art is in making it fine and less bushy from any donor site.

Hair Grows to Half Inch, Then Falls Out

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

Well I have a question. I’m trying to grow my hair, this is my third time trying, but when ever I get to a certain length it just stops’ growing and it starts falling out. I’m a 23year old African-American male. I don’t have a receding hair-line and its just weird that when my hair gets to be about half an inch it just start falling out. I have used and still use all of the “DO GROWN” products, and still I can not figure out why my hair falls off. I wash my hair once a week, I always put SULFER8 twice a day, once in the morning and once in the afternoon. I don’t know what to do. Can you help me??

Generally, hair has a cycle that lasts from 2-6 years in my experience. I have always believed that if you let your hair grow out to its full length, take that length and divide it by 1/2 (in inches) and you will get the hair cycle. In your case, if your maximal growth is 1/2 inch, then that would tell me that your hair growth cycle is 1-2 months. If you hair grew slower, then the cycle could be longer.

I have questions for you:

  1. Does it grow to 1/2 inch everywhere, or just in one area?
  2. What about the hair around the sides and back?
  3. With African hair, the length must reflect the straight hair for the calculations above. If you hair is wiry, then you may not be measuring length, but perhaps height. How are you measuring that it is 1/2 inch length?

Practing medicine over the internet is not an easy eask when I can not examine you directly. Miniaturization metrics through mapping your scalp would be a helpful thing for me to do, to help you understand what is happening on your head.

Homeopathic Medicine, Birth Control, and Hair Loss

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

Dr. Rassman – I am a female and have just turned 40yrs. Last year, some time in May of 2005, I stopped taking the birth control pill, Yasmin. I initially started the pill about 5 years ago with Orthotricyclin, then changed to Levlin (due to insurance no longer covering Ortho) and then Yasmin (as I was told was not as potent and wouldn’t cause the nausea) Anyhow, I am Mexican/American and always had a thick set of hair. In the past, my hair would always fall out but still always remained thick; however, after I stopped taking the pill (for which I never consulted my doctor before stopping) I realized my hair was still falling out but after seven months later, realized that the thickness and volume were gone. I’ve always had thicker hair than my older sisters (now 41 and 43) but now theirs still has thickenss & weight whereas mine is literally thinner & has a featherlike feel to it. I’ve been a Kaiser dermatologist who says it’s just part of aging and that my hormones are normal (blood testing was done) however, after seeing a homopathic doctor (without me mentioning my symtoms) she advised that my hormones are not balanced. I have not yet been treated for this imbalance thus far.

My question to you is if I go back on the pill — Yasmin — will my hair slowly come back? As you can see, I’m still off the pill but very tempted to start up again. Had I known the side affects, I would never have discontinued use.

Please reply at your earliest opportunity.

P.S. In the meantime, I am using Nioxin Cleanser and Scalp treatment for thinning hair. Also, I do have lots of fine baby regrowth around my temple area & some wiring hair coming down the center of my head. Does this mean my hair is coming back and will it ever be as thick again?

First off, I am not a homeopathic doctor. We here are allopathic medical doctors. So, if your homeopathic doctor says your hormones are not in balance, I cannot comment on the homeopathic doctor’s opinion or diagnosis. I can only comment on the fact that if your medical doctor has done all the appropriate blood work and states that your hormone levels are “normal”, the cause of your hair loss may be coming from other sources such as age. Having said that, you may be going through early menopause and other hormonal changes which are “normal” parts of the aging process. I cannot tell you that starting Yasmin will help your hair grow back. More importantly, starting and stopping any hormone treatment (such as birth control pills) should be discussed with a medical doctor that has been following your health.

As far as your question on Nioxin, it is a popular shampoo and the company sells other products that are talked up by my readers. We still put forth a buyer beware position, and if you are asking if such products do what they claim to do, I do not have the answer (as you have read many times in this blog). Minoxidil (Rogaine) is the only FDA approved topical treatment for hair loss.

Finally if your homeopathic doctor has a solution to grow hair then he/she will be a rich man/woman if the treatment actually works. Please let us know the results if you take the olive branch and try to get into the balance that your homeopathic doctor recommends (particularly if it succeeds).