Shower’s Water Pressure Causing Hair Loss?

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

Could water pressure in the shower be causing hair loss? I just moved to a new state about a month ago and the past two weeks I have been noticing hair everywhere. When i wash my hair, it is stringing between my fingers, all over my pillows, i’m having to clean hair out of my brushes constantly. Could it be the water(what’s in the water), shampoo, or conditioner too?

Hair loss is not from shower pressure, and I really doubt it could be the water itself (impact in a month) or in any change in shampoo or conditioner. It would be more likely to ask yourself if you are stressed from the move and living in a new place. Stress can cause hair loss. If it is only going on for a few weeks, calm down and wait it out.

Interviewing Dr. Rassman, Part 1 (Video)

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

We put together a short video series for this site that showcases a little of the history of the innovations made at the New Hair Institute in the field of hair transplantation. This video does have some potentially graphic images of an FUE procedure (grafts being removed, there is a little bit of blood) — so please be warned if you’ve got a weak stomach.

I hope you enjoy part 1 of 3 below:

Cough, Cough — The Cure for Baldness?

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

A reader sent the link to this article from The Independent regarding Intercytex:

It should be interesting reading — though I must warn you that the UK-based website charges you to read the full text (it costs £1, which is around $1.85 US).

The article talks about the nonsense that is being propagated over the internet to drive the price of someone’s stock higher and higher. Although this company’s effort in hair cell research is credible, the P/R that they are doing does not do much for what I think of them. The Euro/Dollar indicates that this hype has driven the stock to almost $100 million in value. Maybe I should try that too, not a bad return for selling hype!

Wrinkles, Shock Loss

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

Did you say that scalp excercises and massages actually CAUSE wrinkles in your forehead?

Also, Im not sure if you answered my question regarding hair follicles, but if you have a hair transplant and hairs fall out due to shock loss and dont grow back….does that mean that the follicle is actually destroyed or is it still intact, but just not producing hair anymore.

Thanks for your help

Sleeping BeautyMassages do not cause wrinkles in the forehead, nor will exercising the forehead muscles make that happen. You may be thinking about what I said when a person is trying to find out where their hairline was when they were youths. Wrinkling the forehead will produce a line at the top of the forehead muscles (frontalis muscle) and that line marks where a child’s hairline or a woman’s hairline starts.

‘Shock loss’ from a hair transplant may grow back if the hair is permanent hair (most women) or hair that is not at the end of its life cycle (such as an accident with a scalp wound in a non-balding man). When the balding process is at the end of the cycle for those hairs that fall out from shock loss, these hairs may not grow back. Miniaturized hairs which result from genetic balding are ‘weak’ hairs that will not live through a major stressful event.

When it does grow back in balding men, it is because the hairs that were lost are usually not at the end of their natural life cycle. If they grow back, then clearly there is life still left in them. Hair that does not return after shock loss in the male is for all practical purposes hair at the end of its ‘life’. With that said, I do not really believe that the hair is ‘dead’, but rather impacted by whatever the defect that causes male patterned genetic hair loss. Some day, hopefully in my lifetime, a medication will be produced that will take up all of the ‘seeds of hair’ that I believe are still in the scalp, closing the defect so that the hair will start to grow… in a way much like the classic tale of Sleeping Beauty, I suppose.

Sometimes ‘shock loss’ can be minimized by being on Propecia prior to having the hair transplant. Shock loss does not happen to all patients who undergo hair transplants, just some of them. Most people are quick to forget the robust nature of permanent hair which comes with the hair transplant process. Shock loss should be something that is explained to you before you get hair transplants. It is a part of the informed consent process and you need to know all of the risks involved when you undergo a hair transplant (or any surgical procedure).

Avoiding Hair Salesmen

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

SalesmanI just saw a 23 year old man come back to see me after he had a hair transplant with another medical group known for ‘overselling’ hair transplants using pressure tactics with an aggressive sales force. He had seen me just a few months earlier and I told him that I felt that he was not a good candidate for a hair transplant at this time, because he was too early in the hair loss process. I further told him that if he had a surgery without a course of Propecia, he might accelerate the hair loss. I thought we had agreed that he would go on Propecia in an attempt to slow down the hair loss he was experiencing and then return in 8 months for further evaluation.

He went to another doctor for another opinion and then, under pressure by their salesman, he had a hair transplant. On his visit with me yesterday, it is now 5 months after his surgery and he looked fairly bald now, with a reactive hair loss. Prior to his surgery he was a Class 3 pattern balding and now he showed a full Norwood Class 6 pattern. The 1000 grafts he received at the surgery were insignificant in view of the hair loss he had. The patient never took the Propecia (which might have protected him from the loss he experienced).

Some clinics still exist today who ‘sell’ hair transplants like a used car. This young man is now hooked on the hair transplant process, like it or not. Will he ever be normal? Will his supply of donor hair meet the demands of his progressive balding? Will he have enough money to follow the course he is now on? Did he ever really have Informed Consent offered to him? What are his options?

I am not going to answer these questions, because by posing them I have in a way brought the purpose of this blog entry to your attention. For those shopping for a hair transplant today, it is still appropriate to warn: Let the buyer beware!

Itchy Scalp After Transplants

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

I am a 53 year old male who was blessed, until November 2004, with a mostly full, but fine head of hair. At Halloween, I put hair coloring in my hair for a costume, did not wash it out until the following Monday morning (the color came out when I slept and I did think about the chemicals still being there – when I read the can later, it said not to use on fine hair – I was extremely mad at myself). Anyway, I had six weeks of an itchy scalp and some hair loss with it.

This past summer, I had another 8 week bout with itchiness and even more hair loss- I started using tea tree oil shampoo and creme rinse, and Jason’s thin-to-thick shampoo and rinse, as well as putting jojoba oil with tea tree oil into my scalp at night. I visited two Chicago area doctors who told me itchiness was part of the active balding time and nothing was wrong with my scalp. I visited them after this bout ended, with loss that I now wanted to do something about. I decided to go to female doctor at the end of October 2005. Everything went fine until a couple of months ago, four months after the transplants. I started to notice hair coming in, but then the itchiness/sensitivity started. I thought that was just irritation from the new hairs, but then I started to worry that maybe this was not the case. Anyway, the hairs placed deeper in the middle front and the majority of the right side transplants came in, but the front middle (new V) and the front left side mostly did not. I am very unhappy about this, and I just hate this feeling of itchiness /sensitivity that is only on the left side this time. (two months and running-getting better) I was / am taking propecia three times a week, as I had a lowered libido with daily use. (Dr. told me to go to 3x a week) I was not using Rogaine until a week ago, where I started to use Scalpmed, another minoxidal product.

Do I possibly have some stress loss of new hairs? Should I go back to using Propecia more often? I can accept the more frequent use until the hairs come in, if they still can. I was told by an assistant than it will take 18 months for the complete result.

I am in great need of some guidance. Thank you

If you have a good doctor, you should be discussing these things with that doctor. You asked about itchiness and was told that it is caused by male pattern balding. That is not the case as there is no evidence that the two are connected directly unless it is the result of sunburns or other things that dry your scalp skin. You had transplants about 7 months ago. I generally tell patients that 80% of the results will be in by the 8th month and 95% should be in within a year. If one side grows slower than the other, that is ok, but if one side does not grow and the other side grows out well, then the technical people placing (different technicians placing the grafts into the different sides of the transplanted area) may have caused a problem that killed off hair. Less skilled technicians may damage the grafts when moving them around or take longer to place them and in the process of placing the grafts, they just dry them out (just 10-15 seconds exposure of these grafts to the air can kill them). Wait out the full 8 months first before thinking of the worst.

Taking Propecia three times a week makes no sense to me, because it is completely out of your body in a day. Taking 1/2 tablet of Propecia each day has about 80% of the benefits of taking a full tablet if you have a libido problem. Rogaine (which is minoxidil, also contained in ScalpMed) can dry the skin and make it itch and that is not commenting on the other additives in each of the commercial products containing minoxidil. Propecia will have no effect on the new hairs, nor will the minoxidil impact the hairs from the donor area. I think that you need to sit down with your doctor and get answers from your doctor, real answers and not be talking to his technicians. This is what a doctor/patient relationship is about.

Patchy Hair Loss — Is It Fungus?

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

I have had patchy hair loss for about 9 months or so, I went to a derm, he said it did not appear to be normal male loss, he gave me some shampoo and wanted me to come back in 2 month, I did, he did not see any improvememts, the bald spots still become very red, and burn. I just went to a new derm, he also said the hair loss doesn;t appear to me male pattern, he gave me some foam called olux and said it may be a fungal thing, he said if no new hair growth are seen in the bald patches in 4 week, he wants to do a scalp biopsy, what will this show? I really don’t understand, what things can it biopsy turn up, what conditions could make my hair fall out in patches, also the patches are on the top part of my scalp. thanks you and any info would be helpfull.. thanks again

To answer your question I would be giving you a course in dermatology. To answer your question about the scalp biopsy, I believe he is looking for fungal infections (it would show the actual fungus interacting with the skin), autoimmune diseases (it would show certain primative defensive cells attacking the hair follicles with reactive tissues around it), and the like. It sounds like he knows what he is doing, so stick with him.

My 3 Year Old Is Losing Hair

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

My little girl is three and her hair is falling out. When it does it looks and feels like a fur ball from a cat. When she was one she had milk indused anemia. She has been on iron drops since. Her iron levels are now normal, but she is still taking iron drops. Can this have any bearing with the hair loss? Could it be too much iron in her body? She was tested for thyroid, diabetes, and other tests that could cause hair loss – all normal. The way the hair started to fall out was on one side only and now has started to fall from the top of her head. One day at her day care, another girl pulled her hair and a clump of it was sent home to me in an envelope. She is very petite for her age. She is a very nervous little girl. I am a single mother, although she sees her father several times a week and he spends time with her on the weekends. Help me with some answers. Hair loss is not an issue in the family. My hair is red and very thick. With this info please help me?

You need to see a pediatric dermatologist, a specialty in itself. I wouldn’t know how to treat hair loss conditions in a 3 year old over the internet. Sorry.

Asymmetrical Hairline

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

Dear Doc, is it normal to develope a very asymmetric hairline at the age of 18-19 ?
I have the right part of my hairline very regular, but the left side is extremely high… it seems that I losed hair only on the lef temple region. In the other areas of my head I have a full density of hair. Is it a normal thing? Could my stress have caused this recession, or was this something impossibile to avoid anyway?
Thanks for your help Sir

Hair loss from genetic causes, can start on one side and then eventually the other side will catch up. Get a diagnosis by mapping out your scalp for miniaturization to determine if you have genetic hair loss. Then tackle it with a good doctor and the appropriate medications that work really well in young men.

My Father Had Awful Transplants from a Dermatologist

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

I have been on finasteride for 7 years. I have pretty much maintained my same density over this period. A little more thinning in the front. I am now 36. My father had many transplants from a doctor who is a dermatologist. Not from a doctor that specializes in transplants. His transplants are awful. What should my expectations be if I wanted to get off the drug and try transplants? I am fair-skinned with wavy auburn hair, and my individual follicles are thick, but not dense.

First, the old plugs can easily be fixed today. Look at the following links for articles and examples of good repair work which can and should be offered to your father:

The second part is that taking the drug Propecia is a different decision to having transplants. They can be complementary (see: Hair Transplant and Propecia Combination Results). As for expectations about transplants for yourself, meet with your doctor and have him/her develop a Master Plan with you, so that you have your needs addressed before the procedure.

How Long Must Hair Be To Hide Donor Scar for 2500 Grafts?

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

hi dr Rassman, am considering having a megasession but am worried about the linear scar if I want to keep my hair short at the back. how long do you need to keep the hair at the back to hide the scar if I have 2500 grafts. is there anywhere on your website with pictures of the scar etc…

I always tell people that there is always a scar present, the key is to keep the scar as small as possible. 95% of people will have a scar smaller than 1/8th of an inch wide. Assuming that there is a 1/8th of an inch scar, any reasonable length hair will cover it (even hair 1/4 inch in length). With the newer trichophytic incisions (shown here), hair can be forced to grow out of the scar so that in 95% of people, unless you shave the head, the scar will barely be visible. Using special scar reducing techniques, scars are now far smaller than they ever have been and if you are the unlucky 5%, there are ways to solve almost any scarring problem you might develop.

Today we use a deep fascia closure to reduce skin tension (the number one cause of stretching of a scar). Megasessions in the hands of experienced surgeons who practice with these techniques to control scarring is an important consideration when selecting a doctor. I have always assumed that any scarring problem in my patient is my problem and I will often fix the scar at no cost to the patient, if there is such an issue.

A Transplant Doctor Told Me I Need Multiple Procedures

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

I am not bald and have a thick head of hair. My only problem is my naturally deep temples which I want to fill in so that my hair line looks straight.

I was recently told by a hair doctor that only a certain number of grafts can be performed on the temples of my head in 1 session since the number of hair follicles in my hair which is very dense. He states it is impossible to graft too many or the follicles will compete for blood supply and the instrument’s pressure will cause adjacent grafts to pop out. The area I want to fix is rather small. However, he says I will probably need two transplants.

Is this true or is it just a way for him to make more money?

Without knowing the size of the area, the number of grafts, or the thickness of your hair it is hard for me to answer this question. Generally you can safely put 40-50 follicular units into a square cm (normal densities are 100 follicular units per square cm), but that depends upon various mechanical factors. The average person does not need to achieve normal densities to get adequate fullness. With a small balding area I would assume that your blood supply should be very good. Dense packing of the grafts was pioneered by me in 1993. I believe that there are situations where one doctor can put too many grafts too close so that growth might be impacted. Some doctors have extensive experience in dense packing and can do it safely, others have not built the skills and would prefer not to dense pack the grafts. Whatever the doctor is comfortable with is what is probably best in that particular situation. Never push the doctor to do more than his comfort level is. Plus, you always have the option to visit with a different doctor.

Concerned About Possible Gynecomastia from Propecia

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

Dear Dr. Rassman:
I have some questions regarding the possible side effects of taking propecia, and I am wondering if you can help to answer them?

  1. After a patient starts his medication on propecia, how long will it take for the possible side effects, such as gynocomastia to occur?
  2. If gynocomastia does occur, would it be completely reversible after the patience stop using propecia?
  3. If a patient stopped using propecia, will the severity of hair loss process accelerate? Or would the patient simply lose the hair gained from using propecia? If that assumption is valid, would a patience who stopped taking propecia only 1 or 2 weeks into the medication also experience acceleration of hair loss?

Thank you so much for you patience and time.

  1. Breast enlargement or nodules is a rare side effect of Propecia (I suspect one in 500 people might see it at the 1mg dose) and it will usually occur in the first month.
  2. If breast problems do occur, they will disappear within a month or so upon stopping the medication.
  3. Stopping Propecia for 1-2 weeks probably will produce some withdrawal hair loss, but I suspect it will be hard to see and relatively small. The longer you stop the medication, the worse the withdrawal loss will be and the more irreversible it will become.

Skip Taking Propecia a Couple Days a Week To Make Supply Last Longer?

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

Hi Doctor. So if I skip taking my morning Propecia a couple times a week, I shouldn’t be at risk of making the Propecia ineffective right? I just want to see if I can make this 30 day supply last maybe 38-40 days. I know the Propecia is working for me since I stopped seeing hair falling out and landing on my shoulders, but I want to make this stuff last as long as possible. Thanks!!!

Propecia has a half life of 4-6 hours, which means that it will be effectively out of your body in a day. Prolonging the time between doses will just guarantee that the drug will be less effective for you.

Hair Coloring and Scar Visibility After Transplantation?

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

Hi-
Over the past 3+ years, I’ve had 3 transplant surgeries and I’m tremendously happy with the results. Some years ago, I used to occasionally double process my hair blond (it’s dark brown naturally) and I liked the results. Is this still a possibiliy or is it to risky for my hair. Will it make the scars more visible? Needless to say, I wouldn’t want to damage my transplants in any way. Many thanks

Colored HairYour hair is your hair and a hair transplant, once done correctly, means you can dye it, cut it, perm it, spike it, etc. The beauty of a good hair transplant is that it is just like you never had lost your hair. As for the scars, I couldn’t tell you for sure, as there are a number of factors such as width/length of your scars (I am assuming you had strip procedures) and the length of your hair. However, I do not think the scar visibility will be an issue with processing your hair blonde, but the only way to know for sure is to try it once. Generally, the only time the scar has a chance of being seen is when the hair is cut way too short (like crew-cut length).