Recreating the Spiral in the Crown

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

I am a 45 year old male who is thinning in the front and who is developing a moderate bald spot on the crown. Both issues can be successfully masked by products such as Toppik, but eventually this solution will fail. My question for you is twofold:

1) Is Propecia (finasteride) efficacious in slowing or stopping hair loss in someone of my age.
2) Is it possible to recreate the natural “spiral” pattern at the crown, as it occurs with one’s original hair pattern, with a transplant.

Thanks for your time.

  1. Assuming that your hair is healthy and that there is no significant miniaturization in the donor area, yes, Propecia can positively impact the crown area with some regrowth in about 30% – 40% of men of your age.
  2. Assuming the supply/demand ratio of your donor hair / recipient area is favorable, you can easily replace the spiral pattern in the crown. It requires a skillful, experienced surgeon.
Tags: hair transplant, hairloss, hair loss

Stretching Wounds and Scars

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

How will these new wound closures you discussed in this blog impact people who have scars that stretch? I have scars that stretch every place I have had a surgery, including my hair transplant scar.

A trichophytic closure will not work if the wound widens more than 2-3 mm, because the hair growth from the trichotomy will only grow up to 2-3 mm from the edge of the wound where the trichotomy was done. The stretching may be helped by a sub-fascial closure below the occipitals muscle fascia. The tension reduction of such closures has value in reducing the wound size, but not necessarily in obliterating it. You might have some form of Erlos Danlos Syndrome (see here, here, and here), which comes about from defective collagen by its very nature. The story of EDS is not black and white, for I believe that some people have small amounts of this defective collagen and these people are the ones that may get stretching of the scars. In such situations, even the sub-fascial closures will not work, because eventually the body must heal the wound and as the sutures dissolve, the value of the sutures that hold the wound together will decrease over time.

Scars are at times a price one pays with surgery. For strip harvesting, this could be a price you will pay. If you have FUE harvesting (Follicular Unit Extraction), then this stretched scar problem should not become an issue with regard to your healing, as there is no large line scar to stretch.

Now with that said, putting the scar issue in perspective, the scar only exceeds 3 mm in about 5% of cases. If that happens and it bothers the patient, then I make this my problem as well and we work to solve the problem with whatever it takes.

Tags: fue, scar, hair transplant, hairloss, hair loss

Weight Loss/Gain and Hair Density

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

Hello Dr. Rassman… I am now 4 weeks post op and I seem to be on track, thanks to you and your team. My question is about losing or gaining weight in relation to density/fullness of one’s hair on their head. When a person loses a significant amount of weight this weight lost is evident through out the whole body even the person’s head. With significant weight lost would hair on the head appear more dense or full? And vice-a-versa, would significant weight gain cause hair on the head to appear less dense or full? This question may sound rather odd and funny but I got the idea from a ballon with prints on it. When the ballon with prints was semi-blowned-up it appeared all covered up with prints but when it was blown-up to a nice size ballon it appeared less covered and gaps between the prints were very evident. The reason why I’m asking this question is of course I need to lose a significant amount of weight for health reasons and to get your professional opinion to satisfy my master plan of hair restoration.

I believe that your blog is of great service to many people. Keep up the good work and God bless!!!

I am glad your surgery at NHI went well and that you are pleased.

With respect to weight loss and hair density and your analogy to a balloon, it is an interesting question. However, your head is not a balloon and I suspect when you lose weight your head won’t shrink and it would not have any significant impact on the density of your hair.

I hope to see you on your 8th month follow-up a few pounds lighter and thousands of hairs fuller. Thank you for writing.

Tags: weight loss, diet, hairloss, hair loss, density

Using Hair Oils And Protein Creams

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

i am 19. my hair is straight and fine…

my hair was usually very full and thick when i was younger. however, i have been using hair oils like amla, almond, amla and black seed.

i shampoo my hair daily with himalaya anti-dandruff shampoo because if i dont, my scalp becomes very itchy. and then i apply the oils after shampooig and keep it for day. is it alright to use hair oils daily? and is light liquid paraffin bad for the hair (i know that mineral oil and petroleum damage the hair)? sometimes i apply a generous amount of himalaya protein hair cream on my hair and scalp… i dont know how much to apply, maybe i am apply alot. basically, my hair is a little thin on the front and middle of my scalp. however, on the back and sides they are full…

i wanna know how to get my hair back. and if using hair oils and protein creams daily and in generous quantities have good/bad effects on my hair.

note: i have seen some improvement after using hair oils…

I am not sure what you are asking. The use of oils and creams on your hair will probably not hurt but the directions on the products will tell you how to use them — hopefully they are safe. The question should be: Will it help deal with male pattern hair loss? From genetic balding, your hair will likely not come back once it is lost and treatments like those that you are using may only slow down the correct way to stop the loss. There are drugs such as finasteride (Propecia) that may prevent further hair loss or may bring some hair back. However, you need to see a medical doctor for the correct diagnosis, get your hair mapped out for miniaturization to establish the diagnosis, and have a prescription to start Propecia if the diagnosis of genetic hair loss is confirmed. It is my medical opinion that the quantity of hair oil or creams that you are using is NOT likely the cause of your hair loss.

Tags: hairloss, hair loss, shampoo, hair oil, hair cream, propecia, finasteride

Itchy Scalp from September to April, Every Year

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

Dear Dr. Rassman,

Thank you for having a site where a consumer can ask questions about there concerns and worries about hair disorders and hair systems. I am a professional cosmetologist of over 23 years. I specialize in non-surgical hair replacement and a retailer of fine wigs and hair pieces. https://www.afoxintl.com/ Over the years I have witness several women loose their hair, it appears to be widespread. Does not matter the ethic background, I have seen in all races. Although Dr. Rassman, I have noticed women of color experiece itchy scalp on the crown area. Not the typical cases of braid, ponytail, high lift colors and weaves. These ladies hairloss starts on the lower crown,but above the occipatal bone.
No medications, never braids-weaves or such. Starts itching in September and goes through winter months to about April, win hair starts to grow back. I have witness this with new clients who have come to me based on recommendation of being able to have the Growing Hand. During this winter dry period I use essential oils, olive oil, moisture conditioners with and without heat, tends to help stop iching somewhat. All have seen dermatologist…they prescribe Biotin and Nizoral, even as sugest to one fugal infection…strange she get fungal same time every year Sept to April. Afterward hair grows great in summer, no itching….What are your thoughts?

Without examing a person, it is difficult to blindly produce a diagnosis. Sound like the right treatments with oils and the like. The dermatologist joke is: “If it is dry, wet it! If it is wet, dry it!”

Fungal infections can cause itching and flaking but it requires the skilled eye of an experienced doctor.

Tags: ringworm, fungus, hairloss, hair loss

Pimples in Donor Area After Transplant

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

Doc,

I have a similar question to the person who asked “about scarring in the donor area”. I had a hair transplant on 5/16/2006, and had my sutures removed on 5/30/2006. I went to my Dr’s office on 5/25, and showed him my scar which I felt was becoming infected due to me being too agressive in cleaning the area. I felt what seemed like pimples in the area.

At that time my Dr., said it looked fine but on when I went to have my sutures removed on 5/30, the outer level (he stated he stitched below the skin as well) of sutures had become loose in some areas. He again said he had seen this before and it was nothing to worry about and would not cause the scar to be wide or hypertrophic. He popped some of these pimples in the donor area and prescribed me an antibiotic for 10 days as “a precaution”.

It has been approximately a week since I had the sutures removed and the scar is very pink and at times I feel sudden, slight, yet sharp pain the area. I think part of the problem is that this doctor excised a previous scar from a previous HT.

My question is do my symptoms sound normal to you, and have you heard of using an antibiotic as “a precaution”

PS If I ever decide to have a third HT, I think I will fly to California to meet with you in person. I regret not finding your site and this blog sooner.

What you are telling me sounds ok. Recent wounds feel different with different people. You can not really wash too vigorously on the donor wound (reasonable washing is probably what you did). Don’t blame yourself here as everything sounds OK. If there are real pimples in the donor wound, possibly suture abscesses may be occurring. A culture taken by your doctor with follow-up antibiotics are the regular approach to this type of problem. With the sutures now out, most of the pimples should be gone by the time you read this response.

Good luck.

Tags: hair transplant, pimples, donor, hairloss, hair loss

My Hair Is Thinner After Transplant

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

I had a hair transplant in August 2005. The doctor used the slit technique and placed 900 grafts in the frontal 2.5 inches of my scalp. He told me that the “see throughness” would be corrected. I am a 33 year old female who did not notice thinning until after the birth of my son. I waited until he was 22 months old to have the surgery to rule out any acceleration in my hair loss and make sure I was done with the post-partum shed. I had previously seen one other transplant doctor before electing to have the surgery, and he had suggested two procedures in the frontal area, covering about the first 1.5 inches of my scalp. I chose the second surgeon because he said he did two female transplants a week (thus he had experience with women) and could do the whole thing in one procedure.

Immediately after my surgery I was thinner and the doctor said it was normal to lose hair during the procedure; but that it would grow back. Three months after the procedure I had lost so much surrounding hair that it totally negated any gain from the 900 grafts, 25% of which kept growing from day one on, the rest of which had begun to grow at 3-4 months. Today, 10 months later, I am about 25% THINNER than I was before the surgery. The doctor said I suffered some permanent hair loss, probably hairs that were predestined to fall out anyway. Shouldn’t he have known this when he examined me, prior to the procedure????

Now I am very upset because two transplant doctors have told me I was not a candidate in the first place; that I hadn’t lost enough hair to have the surgery. If I choose at some point in the future to have another transplant, to try to put me back where I was beforehand, what is the likelihood that the grafted hairs, and/or additional surrounding permanent hairs will be shocked out? Are there any new techniques in the works that would minimize or eliminate the irritation to existing follicles? Is a smaller procedure (100-200 grafts) in the very frontal region less likely to put my surrounding hairs at risk? Lastly, is the individual follicle removal technique okay for me, as opposed to another strip technique? To give you some idea of the condition of my donor area, the doctor noted that my density was 3.5 out of 5.0.

Thank you in advance for any insight you can offer. I am sorry I don’t live in your area, as I would definitely come in for an in-person consult. I live in the Boston area and would appreciate any sound, competent and surgically conservative referrals you could give me.

I have said many times on this blog that if any doctor tells you that he/she does many hair transplants on women, that you should run for the hills. Women generally make poor hair transplant cases, because the hair from the side and back where the hair is taken from is not normal — so why would one put not normal hair into areas of thinning, where the hair is not normal as well? You need to see a good, honest doctor with a lot of experience in this field — seriously, someone who is impeccably honest. May I suggest that you make a trip to New York and see my colleague Dr. Robert Bernstein?

Tags: hairloss, female hair loss, hair transplant, women

Can I Crush Finasteride To Take With Water?

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

Is it ok to use a pill crusher to turn Proscar (finasteride 5mgs) into a powder to take with a glass of water?

I would imagine that as long as you keep it dry and store it in a air proof container, you can crush it and take it with water. I would not put a few days supply in water, for it may lose its potency. I have no first hand knowledge on the answer to this question and came up with it on a logical basis only (I have no direct experience crushing the pill nor has any patient told me about it).

Tags: hairloss, hair loss, finasteride, propecia, pill

Doctor Using Laser to Transplant Hair?

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

hi dr, i live in tampa and there is a dr markou over here that i really trust & appreciate, he uses a laser to do transplants, not the old laser version but some new technology, is this safe, could you please comment on it,

can a miniatuization tell you what the hair was like before?

Laser hair transplants as I know them, produce damage and are second class transplants. If there is a new technology, I would love to learn about it. Generally, I advise people looking at laser hair transplants to run hard and fast away from those suggesting it.

With regard to miniaturization, please read the many entries on this blog about the subject. A good starting point was my recent post, Miniaturization or Gimmick?

Tags: laser hair transplants, hairloss, hair loss, miniaturization

The Look of Hair Fullness

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

I would like to achieve even density on head, like I originally had before I lost it there. I dont mind my hair being short, but i would like to fill in the runways that run down the sides behind what is now an OK frontal area. How many grafts will it take and how much will it cost?

I am not sure if you really understand your own question. The average person has 1250 hairs per square inch so if that is your target, the number of grafts (usually about half of the number of hairs or 625 grafts per square inch in your case) is easy to calculate by measuring the # of square inches you want to cover. But that number has no significance if you really just want to look full in those runways. The answer to looking full depends upon the color/contrast in your hair and skin color, the thickness of each hair shaft (coarse is better than fine and wavy is better than straight). If you are a blonde with white skin, you may only have to return 15% of the hair density, with coarse hair, you might get away with 25% of your original density in the runways, and if your hair is wavy with good body, who knows that value. Our charge per graft is lower during our Summer Special: $5.50 if you schedule an exact date and $4.50 if you take our standby rate. My personal rates are slightly higher.

Tags: hair loss, hairloss, density, hair transplant

Eucapil – Comments from the Inventors

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

I received this comment to my post from last month about Eucapil from M. Sovak, M.D., University of California Medical School —


Response from the inventors of Eucapil:

We understand that a comment by Dr. Rassman was published on the site consecrated to the surgical hair loss restitution. We therefore understand that plastic surgery will remain the priority of its practitioners.

We nevertheless have to correct a number of statements which are erroneous:

1. Eucapil is not a cosmetic available only in “the Czech and Slovak countries”. Eucapil was approved as a cosmetic in the Czech and Slovak Republics and thus under the EU Law of Cosmetics can be made available in all EU countries.

2. The definition of a cosmetic in Europe is not the same as in the US and the producer of Eucapil, Interpharma Praha, is not making any medical claims whatsoever. In the EU, a cosmetic is a product which acts on the skin and its appendages without having any systemic effects.

3. It is not clear what “good things for the appearance of hair” means. To state that there is no suggestion or proof that Eucapil can reverse hair loss is simply untrue. We refer the reviewer to the appropriate scientific presentations and articles in peer-reviewed journals on the website, www.eucapil.com (Sovak M, Seligson AL, Kucerova R, Bienova M, Hajduch M, Bucek M. 2002. Fluridil, a rationally designed topical agent for androgenetic alopecia: first clinical experience. Dermatol Surg 28:678-685, with an erratum on p.971; Bienova M, Kucerova R, Hajduch M, Fiuraskova M, Sovak M. Efficacy and Safety of Eucapil Gel in hirsutism (Pilot Study). Proceedings of 14th Congress of European Academy of Dermatology and Venereology, London, October 12-16, 2005; Kucerova R, Bienova M, Novotny R, Hajduch M, Fiuraskova M, Seligson AL, Sovak M. Eucapil in Female Androgenetic Alopecia: Efficacy and Safety after 9-month use. Proceedings of 14th Congress of European Academy of Dermatology and Venereology, London, October 12-16, 2005).

4. Everybody in hair dermatology knows that the reversal of hair loss can occur only if the follicles are still viable and this applies to systemic therapy such as one with finasteride (Propecia) or the topical material such as minoxidil (Rogaine). We agree, however, with Dr. Rassman that the ultimate and best way of dealing with hair loss which can no longer be reversed is to use implants and other plastic surgery approach which today has been developed to excellence.

5. Eucapil IND has recently been filed with the US FDA with all relevant preclinical and clinical information. We should perhaps state that the primary endpoint of the studies is arrestation of hair loss of those who suffer from continuous effluvium (hair fall out) and that as a secondary point and based on clinical observation there is a statistically significant increase in the hair diameter which may be responsible for the overall improved appearance of the hair. We wish to be sure that the readers of this response understand that Interpharma is not a “producer of natural supplements” which pushes “claims that may not be valid”. Interpharma works strictly under good manufacturing practices (GMP) and publishes its findings in recognized journals. More information for anyone who would wish to read scientific abstracts is contained at the Eucapil website, www.eucapil.com.

Tags: hairloss, hair loss, eucapil

Does Propecia Work In The Front?

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

hello doctor! i have question about propecia. i have a class 2 or 3 hairline but it is thin. i first heard that propecia only works in the back of the head? now i hear it can work where thin hair is growing as well? even in front, so can propecia work in the front as well? thank you

I am sure that Propecia will slow down loss in the front. If you are losing your childhood hairline, this drug may not stop the maturing hair loss evolution. If you are balding in the classic sense, then get your hair mapped out for miniaturization so that you can get a real diagnosis to know where you are going from here. Also, see here for more about mapping.

Tags: frontal, hair loss, hairloss, propecia, finasteride

Accutane Warning from a Woman Who Took It

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

Hi,
I took Accutane 2 times for the past 3.5 years and have lost about 70% of my hair. I has improved a tiny bit, but it’s not the same every since. It is very thin and dry, and UGLY looking. I also developed lots of other problems after this crapy drug: vision problems, dry eyes, dry skin, joint pain, high billirubin and thyroid problems. And it didn’t even cure my acne! My hair stopped falling out about 7-8 months ago, and I still don’t have any regrowth, I have very-very little… There is no family history of hairloss, my 78y.o. grandmother has better hair than I do. Accutane has be taking off of the market, it’s very nasty drug, I wish more people would know about it!

This is one of the worst hair related comments I have received about Accutane. The list of potential side effects is long (see below). The doctors who prescribe it know more about the frequency of such side effects than I do as I only see the worst examples of the hair related problems from it, so I can not advise people who are reading this blog on what to do if they are prescribed Accutane. Speak with your doctor, ask all of the right questions, read the material that comes with the drug and look up more information, starting here:

Tags: hairloss, hair loss, accutane, warning

Tingling Scalp When I’m Stressed

/by William Rassman, M.D./9 /

Hi Dr. Rassman. I am male, 34 years old. I have suffered a lot from stress from work for about five years now. I’ve felt a tingling sensation on the top front part of my head when I’m stressed or anxious, and this is the same area where I’ve noticed some balding (I think this is called Telogen Effluvium). Lately I don’t feel that much stress because I’ve been relaxing more and exercising. If I start using minoxidil, will this affect my hair in a negative way when I stop using it, or should I just try to relax more and let my hair re-grow on it’s own?
Thank you very much.

Stress does strange things. Tingling, hmmm? Maybe. Relaxation is good and learning to manage stress is critical for your health. People who do not manage stress well may get hair loss in those that are genetically prone to it, but more importantly stress produces heart disease and other problems basic to your overall body health. Learning to manage the stress is critical.

With regard to your hair loss, I doubt that anyone can answer your question without knowing your situation is from an examination of your scalp. I would map your scalp for miniaturization and get a diagnosis before using any medication.

Tags: stress, hair loss, hairloss

Pressure Burn Causing Female Hair Loss

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

(female) I had spinal surgery april 7th of this year, and got what I was told was a pressure burn from the face pad in the front of my hairline. It was very painful and red, and it blistered then peeled, then the hair started falling out. New hair started to grow back in as stubble, but that is now falling out too. The spot is about 2 inches wide, and about 3/4 inch deep into my hairline,what new hair I have is extremely sparse (about 1/4, maybe, of what was there before) right in the middle/front. I was treated with silvadine burn cream while in the hospital. The skin there looks normal, not like a scar from a burn. Is there anything I can do to treat this and grow the hair back? I’m hoping to not have to do a transplant type of procedure. And I wouldn’t worry so much if it wasn’t smack-dab in the front of my head, I can’t hide it , even cut bangs. I’m also afraid it will get worse, as the burn was larger than the area of hair loss.

I always tell people to wait at least 8 months, even a year to get the growth to return. Hair goes through cycles and you must wait out the cycling of the hair to see the new growth. Since your surgery was in April of this year, that suggests that new growth should start between October – December and maximize at one year.

Tags: burn, hairloss, hair loss