Regrowing Hair Lost from Stress

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

I recently went through a difficult divorce and have been under a tremendous amount of stress. Within weeks of this starting I noticed my hair falling out rapidly. When I run my hands through my hair in the shower 50 – 100 hairs will fall out. I am 28, male, and had a thick head of hair in October. By Dec I noticed extreme amounts coming out. By feb and now march it is looking thin and I dont know how this could happen so quick. I was thinking Telogen Effluvium due to the stress. Do you think this is likely. If so will it regrow? I do see some small hairs starting. It appears to be thinnig across the whole front of my head. I was thinking this happened to rapidly and spontanously to be MPB is that a fair assumption?
Thanks in advance.

If you have male patterned genetic hairloss, severe distress may accelerate the process. First you need a diagnosis and mapping out your head for miniaturization is critical in determining what is going on. Environmental factors like stress from a divorce are one of the leading causes of acceleration of the hair loss. If it is genetic, then it would be unlikely that it would return. Considering your age, reversal with Propecia or slowing down the loss is something that I would expect. To conclude: Get a diagnosis and start treatment with Propecia if you have genetic hair loss.

Dandruff and Hair Loss in 16 Year Old

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

My son is 16yrs old. I noticed when cutting his hair he had a thick piece of what seemed like caked dandruff it was there for the longest time. Then one day when cutting his hair the thick piece of dandruff was gone and ther was a bald spot. As I looked at his head I noticed there was a thin straight line of baldness then off to the right was another little spot. I took him to the dr. who did a blood test for his throid and that came back good. His spot is getting bigger and it doesn’t look like any hair is growing back from where I orig. saw the spot. There is not balding in either of the families. I checked his head tonight it looks like there is flakey dandruff all over his scalp and even some broken skin like he had been scratching. I have made an appointment with a dermotoligst but what should I expect. Do you have any idea what this is?

What you are describing may be a localized area of psoriasis or seborrheic dermatitis which crusted and then with the crust ‘ripped’ off, the hair came out with it. The loss of local hair from an acute traction episode, could be responsible for what you are observing, and if this is the case, the hair will return if your son leaves it alone. What appears like dandruff may turn out to be seborrheic dermatitis, eczema, psoriasis, alopecia areata, or some other dermatological inflammatory disease of the skin. Your planned visit to a dermatologist for further evaluation is a good next step.

On a separate, interesting note, doctors have recently pinpointed the Psoriasis gene: Forbes.com

I Have No Hair On My Legs

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

i have never had hair on my legs or arms well at least much not enough to see unless your looking right at it up close why have i never grown hair on my legs? I fell shamed to wear shorts cause i have no hair on my leg can you tell me why is this?

PantsYou were born with a ‘bald leg’ and it is just the way you are. It’s in your genes. If you are asking for a surgical or medical solution to your bald leg, there are no medications for bald limbs, but there are always hair transplants, though there are lots of drawbacks to them. If you get hair transplants to cover your arms and legs, the hair will grow out to pony tail length (or longer) and it will take a great deal of surgery. You will have to cut the hair and keep it trimmed to normal body hair length. When it grows, it will look like scalp hair, not leg hair.

As you can probably tell, I am am not enthusiastic to the hair transplant option for leg and arm hair, but I am sure there are doctors out there who would want to take your money and perform this type of procedure. I can however, recommend pants.

Follicular Unit Extraction Tool For Sale?

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

i have run out of donor area and as a result of this i have developed a thick scare at the rear of my head, my doctor would like to try and use a folicular extractor and use my body hair as the donor. Could someone please advice us on where this FUE can be purhased from, as australian doctors have not used this before.

Tool?Even if you could buy an FUE tool, do you really trust a doctor who has never done this procedure before? This is without a doubt the most difficult surgery that is in the hair transplant arena. It took me many years to master it. Few doctors worldwide can do it well. If you and he decide to go forward with this, there is one word to describe you –rather than call you “foolish”, I shall call you “brave”.

Please note that the above photo is not used in the FUE procedure, in case you were curious.

Who Do I Take After in My Family?

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

Hello,
I guess like most other guys, I’m a bit paranoid about hair loss. I (age 25) got a haircut recently and my dresser said it was ‘thin’ in the front and that thickening shampoo will make it look better. After CAREFUL examination, I’m quite sure it’s NOT thin, it just looks that way because it’s right where I part the hair and after spiking it with gel, the distribution of hair is completely even. Not that I should even put stock in a hairdresser.

Anyway, I have a question about the ‘genetics’ of hair loss. I realize that it’s not a cut’n’dry thing where you get it from your grandfather. However, in your judgment, whom am I taking after – I have my dad’s color (light brown dirty blonde although he was balding by 20) but my maternal granddad’s hairline and texture (his was black but wispy/baby fine) and he kept it until he died at 84. PS: My mom was graying at 21 and and that is exactly when my graying started. Although my dad’s hair has thinned out majorly he has no gray. So I THINK I’m fairly safe.

Also, this isn’t a question but more of an observation – many people think that treating hair loss is failure to accept the aging process, just like skin creams and facelifts for wrinkles. HOWEVER, I’m pretty sure that anyone with baldness would take a few wrinkles and a full head of white/gray hair ANY DAY!!! So in essence it seems more like not a fear of getting older but the lack of power over an incessant degradation process. Thanks for your input. :)

It is normal to be worried about hair loss. We live in a ‘hair society’ and the history of every civilization has focused upon linking hair and health and virility. We are a product of those prejudices and each culture has its own twist on the balding process. Male pattern baldness (MPB) has a major genetic component, but it does not follow one to one from generation to generation. It can skip generations and what is inherited may not ‘express’ itself the same way as it moves down to the next generation. That is what makes the process so confusing to those that try to sort out some clear, predictive model like the Mendelian genetic predictable pattern.

If you are concerned about hair loss and want a scientific or medical approach, you need to map your scalp for miniaturization to see if the hair loss follows a pattern for MPB. You can setup a free consultation in my Los Angeles office by calling 800-NEW-HAIR or visiting the Request Additional Info page. Your options do not necessarily include a hair transplant. It may be just that you are noticing a mature hair line.

Removing a Sebaceous Cyst from the Eyebrow

/by William Rassman, M.D./6 /

Hi. My 9-year-old daughter has what the plastic surgeon called a ‘sebaceous cyst’ on her left eyebrow (actually sort of in her eyebrow). It started out very small about six months ago and has become so large it distorts her eyebrow hair. He is supposed to remove it on April 5. My question is that she is terribly afraid of scarring: the doc said it won’t happen bc he’ll excise it directly in the eyebrow line. Do all of these cysts HAVE to be removed surgically? Is there any other way to remove them?
Thanks!

When I was in residency training I saw a middle aged bus driver who had a sebaceous cyst on her buttock. It bothered her while she worked, sitting on her bus driver seat. I apologize if this is too graphic, but she finally came to see me when it was the size of a big orange with a foul smelling infection on top of it. When I asked her why she waited so long, she said she didn’t want surgery so she prayed for it to go away.

My point is, sebaceous cysts have the tendency to become infected and when they do, it does create a minor surgical problem, so the issue is: should they be removed? It might be in your daugther’s interest because the alternative will be, as you put it, a “distorted eyebrow” which could become a focus issues for her in her teenage years. All surgical procedures have risks. All surgical procedures will leave a scar and the eyebrow in particular may lose eyebrow hair that will not grow back. But as you have been informed by the plastic surgeon, he/she should take great care to leave a minimal scar in the most inconscpicuous place (along the eyebrow line to hide the scar).

2 Year Old Daughter Has Bald Spot on Crown

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

My 2 year old daughter started with a bald spot on the crown of her head and now it is really thin on top. She pulls out her hair when she gets mad but not often enough to cause this. She wont eat well and vitamins dont seem to healp the situation. Can you please tell me what is wrong?

First of all, your pediatrician should be central to your daughter’s management of her ‘hair loss’. Young children go through varying quality of hairs at different ages. Have you noticed that many children are almost bald under the age of 1? This is not really balding, but rather a migration from a baby’s fine hair to a child’s thicker hair that occurs in the first few years of life. Could you daughter be in such a transitional phase, assuming that the bald spot is not really a spot but rather an area that appears bald? Although there are many causes of hair loss in children (infections, genetic and autoimmune diseases, etc.) you have to be sure not to overreact. See your pediatrician.

Non-Transplant Scar On Head — Will Hair Regrow There?

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

I have a dime sized scar on the back of my head where I busted it and didn’t get staples. Will hair ever grow there? If I were to consider surgery, how many hair follicles would be needed to cover that area, and what would the cost of the transplant be? Are there any hair growth alternative to surgery that work on scars? thank you for your time.

If it is a recent injury and it was not a separated gash on your head, your hair may grow back. But if it has been many months to a year (or even more) and you still do not see hair growth or if it was an open wound that was not sutured or stapled, chances are that hair will not grow there. At that point, your choices are:

  1. Leave it alone. It builds character. (I hate it when others say that to me)
  2. Scar reduction surgery. (You’ll have a smaller scar and the surgery may just take a few minutes)
  3. Hair transplant surgery. (Transplanted hair will grow on a scar but this may be overkill for a dime size scar)

DHT Blocking Supplements

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

I currently taking Propecia for the past three months. I would like to do more to help stop my hair loss. I have done reserach and found the following supplements that claim to block DHT. Any insight would be appreciated and I think your sight is extremely helpful. Thanks for your time.

Supplement #1
Saw Palmetto extract, Beta Sitosterol, Pumpkin Seed Extract, He Shou Wu

Supplement #2
beta-sitosterol: 250mg
saw palmetto extract: 200mg
pygenum africanum: 50mg

Saw Palmetto has been covered on this blog quite a bit in the past. It may be a natural DHT blocker, but if so, it has about 1/100th the strength of Propecia even in high doses. There are some investigations that mention all of the other ingredients in these supplements, but I have to tell you that none of this evidence is conclusive or compelling. If it were, I’d have put ALL my patients on supplements, since we have so few agents for stopping hair loss that actually WORK! As it is, you are doing the #1 best thing for keeping your hair, which is to take Propecia. Minoxidil can be helpul as well, and of course, hair restoration is an option for putting hair permanently back where you have lost it. However, for the most part supplements just (in the words of a PhD nutritionist medical school professor I know) “give you expensive urine,” so I recommend you save your money.

Hair Loss After Using a Hair Relaxer

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

Hi. I have read a lot of your articles but still confused. I am asian american female age 18, and about 2 years ago I used a relaxer kit I bought from Walgreens for my hair becuase I had thick Frizzy hair. I asked the lady at the store to see if I can use it beucase I thought it was only for African Americans. She said yes so I bought it. After I used it my hair, it has been falling out really bad after showers especially. I let it fall all it wants knowing that I had thick hair for about a year and a half. About 4 months ago I noticed that my hair are growing thin. I have hair that is at least 16 inches long but my hairs that are newly grown comes out very easily. And the my short hairs come out very easily. When i get out of the shower, about 1/4 of hair that falls out are thin and decreased in size. And they look very thin and you can barely see them. the diameter of my hair has decreased to half the size it used to be but I don’t have any bald spots. Some of my friends I talked to say that it cant be the relaxers becuase chemicals can’t have an effect that last 2 years. And 2 years ago was the first and last time i have ever done that to my hair. I havent dyed my hair since… and my hair should be fairly healthy beucase there arent any chemicals i have put in these for 2 years.. All the relaxed hair has been cut off already… but the hair is growing thin. they said it could have been becuase i switched off and on Birth control. But i dont believe that is the problem. I have gone on and off birth controls before and never encountered this problem. And i only realized it right after that relaxer i used. My father is going bald at the crown but none of my aunts or uncles or grandmothers or father has this issue… even if I am a girl, could I have inherited it from my father… and if so why would it hit me so young. But I did notice that after I used the relaxer, i started getting dandruff and i have never had dandruff in my life before that.. Not the dandruff is still around… But it seems to run in the family from my mother. But the thing I dont understand is that why would i start getting dandruff right after I used that too.. Ugh it is ruining my life and I feel like I have nothing to live for..

Your problem does seem a bit serious and if the hair that is falling out is really much thinner that the hair that remains, this complaint is very characteristic of a genetic female hair loss problem. This is best determined by visiting a good hair doctor and having your scalp mapped out for miniaturization. If what you are experiencing is female genetic balding, it will show up in the mapping.

Since it has been over two years since you used the hair relaxer, it is very unlikely that it may have an affect on your hair now. Birth control pills can affect hair loss and hair composition, however, this is generally on an individual basis, so it is not absolutely clear whether it is the birth control that is affecting your hair. The dandruff problem you mentioned does not affect hair loss unless you are scratching your scalp vigorously, but you might want to check into some products such as Selsun Blue or Head and Shoulders. Dandruff seems more detrimental to your self esteem moreso than thinning hair. Getting back to the thinning hair and hair loss, it is normal to lose about 100 hairs a day, but these hairs should not be much thinner than those that remain.

Options for Regrowing Pubic Hair?

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

After I had liposuction several years ago I had pubic hair loss (one of the places the canula was inserted was through the pubic hair area). The hair never grew back. The hair on the sides was not affected, just everything in the middle. Even tho no one sees it except my husband and myself, it’s still so embarrassing to me, and I really HATE HOW IT LOOKS!!!

I tried Rogaine For Women but it didn’t seem to do a thing.

What can be done about this? Of course the less expensive the treatment the better for me. We live in a very modest area, and have a modest income. We only have Kaiser health insurance, which is useless for things like this of course.

Would transplantation be my only option? Please help because I don’t want to look like this for the rest of my life. I just lost 40 pounds & am planning to lose more, have come out of a long depression, love my job and my life, feel healthy, do yoga, etc etc, but feel bad about how I look “down there”.

I’m happy to read that your life is going so well and you’ve gotten back on track towards success. I have done quite a few hair transplants into the pubic area with good success. As you’ve discovered on your own, Rogaine does not address your situation. Hair transplantation is probably the only method that would work. My office in Los Angeles is not too far from you if you’d like to come in for a consultation.

Angry and Depressed Strip Surgery Patient

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

Dear Dr William!!!
I have to say that I’m very sorry doing FUSS on my 6-7 scale bald head. It does not give me chance to cut my hair short and the stripe is from one ear to another, very ugly. Doing a stripe more than 10cm should be forbidden. When I came for surgery i thought “if something went wrong i’m gonna shave”. Dont you think that is better to have a procedure with less FUE and be able to cut hair short, to make a nice hair line. if the vertex is bald it doesnt look bad when the hair is short. I’m sorry I realized that after my surgery. Cant you people see how many people suffer from this frankenstein scar? it is a sin to cut somebody like that. Besides that all the pictures lie about fullness of hair and also nobody ever mentions that the hair above and under the scar can have a big difference in fullness which looks very ugly.

I’m a very depressed and mentally destroyed 33 year old man. I had one chance for HT and I lost it with one of the greatest doctors that could not evaluate me and give me right advice . I signed all these scary papers just because I was trusting him, after all this I see it was all about the money. I would give now everything I have just to go back to normal. Please start up with some medical law to stop doing FUSS. The papers I signed are too scary to be offered to humans.

Unfortunately I will have to wear a hat in public for the rest of my life, probably at home too because I dont want my poor mother looking at me like this. People have done the HT for last 40 to 50 years and still do not realize that strip is wrong technique. To sign so many scary papers, like for FUSS, means that doctor still doesnt know what he is doing. I’m sure it is about the time when FUSS will be forbidden. God bless

First, it must be pointed out that this man is not one of my patients.

I sympathize with your predicament and I’m sorry for your situation. The truth is, though, that there are many patients for whom a scar is much less of an issue than the alternative of having a Norwood Class 6 or 7 bald head. For those readers who are unfamiliar, there are some doctors that refer to the Follicular Unit Transplantation (strip procedure) as “FUSS” (Follicular Unit Strip Surgery). I don’t know what your scar looks like, and the fact that it bothers you so much means that it is unacceptable to you, yet these are issues that one needs to deal with before the surgery.

A few points that I want to highlight:

  1. The hair transplant procedure happens on your head, so you must think about every option and its possible consequences carefully.
  2. Never, ever sign anything that you do not understand. If you thought “these scary papers” were too much for you, you should’ve taken a step back and perhaps re-evaluated what you were doing before you agreed to it! This goes for anything you sign your name to. No matter how “trusting” you are, there is no excuse for signing any contract or papers without knowing what you are signing. What you most likely signed was an Informed Consent. According to the American Medical Association:

    Informed consent is more than simply getting a patient to sign a written consent form to protect the doctor when something goes wrong. It is a contract between a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical or surgical intervention. In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with you:

    • The diagnosis, if known;
    • The nature and purpose of a proposed treatment or procedure;
    • The risks and benefits of a proposed treatment or procedure;
    • Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
    • The risks and benefits of the alternative treatment or procedure; and
    • The risks and benefits of not receiving or undergoing a treatment or procedure.

  3. How could you call the doctor who did your surgery “one of the greatest doctors” if he never gave you the “right advice” and you are so dissatisfied with the surgery? You should go back to your doctor to discuss your concerns.
  4. All surgical procedures will leave a scar. Most hair transplant scars can be easily covered by your hair, even with a short haircut. Note that if you shave your head, it will show. I had two hair transplants, and rarely can anyone find my scar unless they work my hair with a comb and use a very bright light, but if I shaved my head (something I do not ever plan to do) one would see a ‘smile’ on the back of my head reflecting this scar, though again, it would be very hard to find when I have hair grown to any length. Finally, if your scar is more than 5mm thick, you may have a keloid formation or may be a candidate for a scar revision (a type of fix that good doctors can do). All of this should have been covered in your Informed Consent.
  5. You state that you are “very depressed and mentally destroyed” and just want to go back before the transplant was done. You condemn your doctor who you have suggested just showed you pictures that lied about the fullness you were going to get. We have open house events in my practice to allow prospective patients to meet actual patients. I do agree that pictures are often not adequate, because they show you what the photographer wants you to see, but by meeting patients, it gives you a good chance to see the quality that you are going to get. As the expression goes, hindsight is 20/20, and hopefully knowing what you know now, you would’ve asked to meet patients in person. This should also be an important lesson for the readers considering a hair transplant (or any cosmetic procedure, really).
  6. Depression is a serious matter and you should think that about getting help directed to what is inside your head, not just addressing the subject of hair loss or scarring. Every human being would love to undo some decisions in their lives, but that is just not reality. As I’ve mentioned on this blog before, I always tell people that the good news and the bad news about hair transplants is that they are permanent. Going back in time is therefore not an option.

I have compassion for you, but you must take charge of your own situation by doing something positive about it. If you can make it to the Los Angeles area and would like me to judge what you have going on, come visit me or send me a good set of photos. At least that would be a small ‘baby step’ in the right direction by starting to take charge of your problem the correct way.

Transplant Risks, Stopping Propecia After Hair Transplantation

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

  1. What are the risks of hair transplantation?
  2. Will I keep balding after a hair transplant?
  3. Can I stop my hair loss with Propecia?
  4. I am 35 years old and a Class NW 3V, will I get very bald (like a Class 7)?
  5. A Doctor told me that I needed 3500 grafts, Is this a reasonable goal for a NW 3V?

  1. Hair transplantation is a surgical procedure and entails all of the risks of an outpatient procedure. The risks of death and severe complications (in good hands) should approach zero. The usual risks such as infection, drug side effect/overdoses, and the like are rare. Scarring risks for strip surgery are about 5% for a scar measuring greater than 3mm. Folliculitis (local infection/cycts of hair follicles) is not an uncommon problem in the post operative course over the first few months as the sebum builds under the skin and can not get out (this is easy to treat). Most people do not have much of a problem with things that go wrong from the surgery. The biggest problem is for the patient to match his/her expectations with what the surgeon can deliver. Miscommunication here is the biggest problem of all because either patient or doctor often oversell the results.
  2. Male patterned genetic hair loss is a life long process, but most people stabilize or slow down the progression by the time they are 35. From that time forward, hair loss is usually slower. This is what a good doctor will cover as he develops a Master Plan for your hair loss with you.
  3. If you take Propecia (for men only), then hopefully if your goals are achieved with the drug alone, surgery may not be necessary. If Propecia alone does not solve your problem (typical for the NW 3V or more advanced balding patterns), then transplants may be necessary to achieve your goals. Again, that is where the Master Plan is customized to your needs.
  4. A Class 3V varies in size and degree. The ability to supply enough hair from the front and crown depends upon your densities, scalp laxity, hair characteristics, shaft thickness ,and color/contrast of hair to skin. Each person is different so the actual answer to your question is that each person is different and what is good for one person may not be food for another.
  5. It is not unusual for me to perform a session of 3500 grafts, but that depends upon what is safe and what is in the best interest of the patient according to his Master Plan. If you are 25, I would probably not consider the crown transplant. If you were 45 with good density and scalp laxity, then this may be a reasonable option depending on other factors that would be defined in an extensive consultation.

Hair Loss with Bald Spot Above Ear

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

This is a follow-up to Hair Loss from Propecia:

Well i also moved a couple of months before this happened. Also about two months before i moved, i dyed my hair. So im wondering if this could be telogen effluvium? Ive dyed my hair alot in my lifetime and it has seemed to make it thinner but never any hairloss of the front. And if it did it grew back and I just didnt pay my hairline much atttention back then. My Mom’s dad was bald. But thats about it. My dad has a receding hairline but he is 57, and he still has plenty of hair and i dont think he will ever go complety bald. No one else in my family is bald. I also have an almost bald spot on the side of the right ear and my hair is thinner on the sides and the top than the back. I have no good hair doctor in my area so please help.

Please send me photographs. With a bald spot now above your ear, it is possible that you have other causes for your hair loss, rather than pure genetic causes with MPB. Singular bald spots may indicate a series of other etiologies, including infectious or autoimmune causes. Any good dermatologist can address this and even with pictures, there is no substitute for a direct examination by a doctor. Dermatologist are all over the US. See the American Academy of Dermatology to find a dermatologist in your area.

High Protein Diet Can Accelerate Hair Loss?

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

Is it true that weight lifting and a diet high in protein can cause or accelerate hairloss?

Many weight lifters take exogenous steroids and testosterone, which increases the circulating DHT, which then produces more hair loss. The element that runs through my mind is with all of the muscle mass, does the testosterone rise? If so, the hair will fall out more rapidly in those with a predisposition to genetic balding. If the weight lifters have more stress than the typical man, then more hair loss may be present, again in those with genetic predispositions for genetic balding. There are many weight lifters that have a full head of hair, but that may be good genes.

With regard to your questions on diet, any good diet (even high in proteins) provided that it contains the daily requirement of nutrients, will not accelerate hair loss.