Limit Sun Exposure For Months After Hair Transplant?

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

I recently had a hair transplant completed (approximately 1,500 follicular units). My doctor advised me to limit exposure of the transplant area to the sun to 10 to 15 minutes per day for the first two months following the transplant (this is the same advice given to every patient). Is this precaution necessary?

Yes, it is necessary. There are two reasons to keep sun exposure down after a hair transplant:

  1. UV light damages new collagen
  2. Sun exposure will burn the skin from the recipient area. Skin that is in the donor area (back of the head) has always been covered by hair so that it has never seen sun since the day you were born unless you shaved your head through various periods in your life. People who get sun exposure after a hair transplant may see dots of sunburned skin, like measles.

I tell all of my patients to use a hat or use sunblock when going out into the sun for a period of 3 months. By that time the new tissues will be relatively healed so that damage from UV will not be particularly more harmful than in other skin areas.

Tags: uv, sun, hair transplant, sunburn, scalp

A Recent Visit to an Arizona Transplant Surgeon

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

Dear Dr. Rassman.

Sorry if I’m bombarding you with a lot of questions recently.

I recently met with a hair restoration surgeon here in my city. Let me tell you quickly about how my meeting went, and my impressions:

  1. Uses FUT.
  2. Doesn’t use the Norwood scale. (uh-oh)
  3. Just ran hands on back of my head and said I had good healthy hair. (First red flag. Even I can do that.)
  4. Recommended 2500 grafts. (Second red flag.)
  5. Scalp mapping= Useless.
  6. Got me to speak with a consultant.
  7. Not much regard for developing a master plan. (Third and final red flag.)

In regards to recession, I’m a class 2. If all my thinning hair were to fall off, I’d be a class 3 or 3A. My grandfather on mother’s side was a 5/6. One uncle is a mild 3, other is a 5. My dad barely had a mature hairline. He died with lots of hair. No loss on any of my uncles on his side.

Taking all of this into consideration, I have decided to make a trip to California and meet you or one of your specialists. I don’t want to blow my money and my donor hair lowering my hairline to what it was four years ago, if 10 years down the road I’m going to have the top and crown all bare.

I’ll be calling you soon to see if I can send you some pics of my current condition. 2500 grafts seems excessive to me, after seeing what you do with only 1500-1800 on types 4 or 5. (Or your type 3 patient who only had 860 grafts and looks like a 17-year old now)

Please post this on your blog, Doctor, so others may be aware of the danger of making a bad decision based on impulse. Bad hair transplants, just as the good ones, will stay with you forever.

Thanks for your time, and hope to visit your office soon.

Norwood 2
Norwood 6

Mapping out your scalp for miniaturization is critical for someone like you. Based on what you’ve described, you may be a Class 2 on the Norwood pattern scale on your way to a thinning, more advanced pattern that will reflect long term hair loss (thinning in the Class 6 pattern, possibly leading to balding in that same pattern). The thinning pattern can often be treated with Propecia, preventing further balding and avoiding any hair transplants.

Please send me photographs and then we will talk prior to planning a trip to California to see me. Once I view the photos and talk to you, possibly coming to Los Angeles will get us to the bottom of your diagnosis and Master Plan.

Tags: hair transplant, los angeles, hairloss, hair loss, miniaturization, norwood, warning

Is My Son Too Young For Transplant at 19?

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

Dr. Rassman,

My son is 19 and has always had a lot of forehead. He seems to have been experiencing a receeding hair line, and I would like to know if he is to young to consider hair transplants? If not is there a concern about having a procedure, and then the hair line receeding even potentially leaving a bare spot between the hair that was transplanted and the natural hair line now receeded?

The problem with a 19 year old is that if genetic balding is the correct diagnosis, the pattern is not predictable. In a 26 year old it will probably be predictable based upon the miniaturization patterns that develop by 26. That addresses your question directly, because if he is transplanted, the new hair will be in front of what is lost in the near term future so that a bare spot will develop and could progress. Worse, the balding pattern could develop to be very advanced so that a very bald person may emerge with a transplanted frontal hairline. These is our worst case problem, better to avoid until all of the information is at hand. A good doctor should map out his hair from miniaturization and then with knowing what is actually happening (assuming he has genetic balding), prescribe the use of Propecia with yearly monitoring of the miniaturization process. This will let you know how well it is being managed. The same applies to the maturing hairline, which must be differentiated from genetic balding.

Tags: teen, hair transplant, hairloss, hair loss

Transplanting Grafts Into 1 Square Centimeter

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

can you fit 100 grafts in a 1sq2 cm without damaging existing hair ?

Yes, the density or 100 grafts per square cm can be achieved in some people. Generally it would take fine hair and supple skin with good elasticity to do it. The issue of a successful transplant is a more important issue. By crowding the grafts at 100 per square cm, the blood supply may be compromised. Some very crude studies of this have been done and presented at the past few ISHRS meetings (the largest society in the industry), which have shown that as more than 40 grafts are put into a square cm, the successful growth of these grafts starts to fall off significantly. If there is hair already present in the transplanted recipient area, there is great likelihood that it would damage the existing hair as well as obtaining poor growth.

I have seen this issue become one where doctor’s ego is pushed at the expense of patient welfare. Just because a doctor says he can do this, does not mean that this type of density has value and will grow out. I did the first dense-packing ever reported at about 100 grafts per square cm in 1993, but the growth was less than that number, so I toned down these numbers and developed judgments that allowed me to know just how far I could push densities at the time of transplants. Everything is strategy and judgments in the field of surgey. So I smile when I hear doctors talk about the high densities that they can achieve, realizing that they may be less patient outcome focused, and more in love with their own image in the morning mirror.

Tags: density, hair transplant, hairloss, hair loss

I Want To Use Leg Hair To Fill in A Small Scalp Scar

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

(female) Hi, I just wanted to say that I really appreciate the feedback you gave me about filling in the small scar on my head. I do however have another question. Since the scar on my head is so small, and I really don’t want to damage any further follicles on my head, is it possible to extract a few hairs from my leg or the back of my leg, and use it to fill in the scar? Because the hair on my legs doesn’t really differ from the hair on my head. And if transplanted, would the hair grow the same length as the rest of the surrounding hair?

Leg LampLeg hair has longer sleep cycles (as does most body hair) than scalp hair and that means that most of the hair is in its sleep cycle and not showing its presence. If you transplant 10 leg hairs and watch them grow, only about 2-3 of them will be evident at any one time (the others are there, but in telogen phase). Body hair also grows at different rates and it may not grow to regular scalp hair length. Furthermore, leg hair does not have the same quality and caliber as your scalp hair. More importantly, even if leg hair transplantation works, are you willing to live with a surgical scar on your leg?

The traditional FUE procedure (on the scalp) is a better solution and the hair is exactly the same quality that exists around it. In addition, it has only a 10-20% sleep phase at any one time. Although your idea sounds interesting, it is not a worthwhile endeavor.

Please see Transplanting Chest, Leg, and Thigh Hair for more.

Tags: leg, hairloss, hair loss, scar, scalp, female, woman, women, bht

No Growth 5 Months After My 2nd Transplant

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

I am mid-way through my 5’th month after having had my 2’nd transplant. What is the longest time one has to wait to notice any growth as nothing has come through yet & I’m becoming concerned ?

I am worried that the 2’nd procedure hasn’t worked for some reason because after my 1’st transplant new sprouts of hair was apparent at the start of the 4’th month.

I had my 2’nd procedure literally 9-10 months after my 1’st.

I would appreciate any advice,

Thank-you

Many times, I have this complaint. I tell people that they must wait for a full 8 months to see 80-90% of the results from the transplant. Be patient and then write me again, sending pictures at the 8th month if you did not get the results in my then.

Tags: hair transplant, hairloss, hair loss, aftercare

Minoxidil and Prostate Cancer?

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

Is there any link to minoxodil and prostate cancer?

There are no prostate cancer and minoxidil linkages that I know which contribute to prostate cancer. You may be thinking of finasteride (Proscar). The issue at hand it that on the 5mg dose of finasteride, there is a reduction in cancer of the prostate in people taking the drug after 7 years.

Tags: finasteride, minoxidil, proscar, propecia, prostate, cancer

I Want Hair Like Tom Hanks in the Da Vinci Code

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

Hello Dr. Rassman!

Thank you for answering my last two questions.
This is a quick one and I’m interested to see what pictures you post along with your answer.

If I get a hair transplant that resembles Tom Hanks in The Da Vinci Code (due to a below average donor density, for instance) could I potentially move my hair line to Tom Hanks in Big if and when hair multipication becomes possible?
More broadly, what is your advice for someone considering a less than juvenille hair line look?
If that is what someone desires can it be created in advance of total hair loss?

Tom HanksI have had many people pick out a celebrity and say that they want to look like this one or that one. Sometimes I make an effort to do just that if:

  1. The hair transplant option is part of a Master Plan that makes sense and looks appropriate.
  2. The patient understands the process.
  3. The goals are realistic with regard to hair supply and demand, and the characteristics of the hair itself.

The isolation of the frontal hairline in the treatment of the balding or thinning process may be appropriate in some people. There is a bonding between doctor and patient here that must be taken into account. If I met with you and bonded and believed that your goals were realistic, I am sure that we could develop a plan that makes sense to both of us. I have had patients get a mature hairline (playing conservative initially) and then move it down to their more youthful childhood hairline in another hair transplant procedure. I would rather do it that way then create a hairline that was too low which (because of its permanent nature) is there for life. If Tom Hanks wanted the hairline he had when he was young in the movie ‘Big’, he could get it moved down with little difficulty. For people who are not balding, I have replaced the youthful hairline to prevent the maturing hairline from appearing, but I have done this mostly for actors or male models whose career depends upon this youthful look.

Please just look at the NHI patient photo gallery and focus upon the variations of the hairlines. I could produce a Count Dracula type of hair line with a very wild widow’s peak, but I wouldn’t do that unless the Count himself asked for it.

Tags: hairloss, hair loss, hair transplant, tom hanks, davinci code, dracula, hairline

Concerned About Taking Propecia For 10-20 More Years

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

Dear Dr. Rassman:
I’ve inherited my father’s genes–my hair began to thin across the top of my head since the beginning of high school. I saw a dermatologist at that time and have been on Propecia ever since. At 27, while the balding process has been slowed significantly, I’m beginning to question the safety of taking Propecia for another 10 or even 20 years. I’ve heard a great deal of positive press about the Hair Max Laser Comb, and because it isn’t a treatment that is taken internally, I decided to order one. What I’d like to know is how much of a gamble it would be to start phasing out my Propecia dosage if I begin using the laser comb? Thanks in advance

I would strongly suggest that you continue to use Propecia for the long term. If you stop it, there will almost certainly be fairly extensive hair loss based upon the fact that you had good slowing of the hair loss from using it. The protection that Propecia gives you will disappear once you stop it and what I call “catch up hair loss” will occur, which means big time hair loss happens in just a few months.

The HairMax comb has little down side, unless you fool yourself into believing that it will replace Propecia. Long term Propecia use has a good up-side — the prevention of prostate cancer. There are no long term reports of problems with the drug if taken for many years.

Tags: propecia, finasteride, cancer, prostate, hairmax, laser, hairloss, hair loss

Eyebrows Fell Out After Moving to a New House

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

Hi I moved into this new house and about a week in i began to experience dryness around my eyebrows and my eyebrows began to fall out because these little white and clear things which may have been exposed hair follicle would form at the base of the hair and the hairs would subsequentely fall out. I have patches of missing hair and saw a dermatologist who said it was seborrhiec dermatitis which i dont think it is – would you have any clue what this condition may be?

Without seeing you, any ideas I’d have about your situation would be a complete guess. If your dermatologist diagnosed it, he/she must have given you some treatment for it. Follow the advice and see where you are in a few months. I always believe that if you are fortunate enough to find a good doctor, stick to that doctor so that you can last long enough to see the benefits of the advice/treatments you are given. If you are not satisfied, then find a new doctor, but do not use the Internet as a doctor substitute (even if I enjoy helping people like you).

Tags: eyebrows, hairloss, hair loss, seborrheic dermatitis

Touch-Up Hair Transplants?

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

Hi, Dr. Rasman I am a 22 year old Korean male that is confused whether I am suffering from a maturing hairline or male pattern baldness receding hairline. Everytime I take a shower and put my hands through my hair there is usually 2-5 strands of hair in my hands. This is especially the case towards the front of my hairline and occasionally the back. This depresses me a lot in the fact that I used to value my nice long soft hair as a teen and now feel unattractive that I can’t pull it off anymore. Many wouldn’t realize that I’m losing hair and just think I look older or have a big forehead. I was wondering if there is such thing as a touch up hair transplantation and if I could be a candidate. Although I know I shouldn’t let it bother me too much, it does do quite a damage to my self-esteem. Thank you and appreciate your help!

Can you email me pictures of your hairline and forehead with your eyebrows lifted high? Generally the youthful hairline touches the highest crease of the wrinkled brow. The mature hairline usually goes up by about 1/2 – 2/3rd of an inch in Caucasian males. Asians have slightly different maturing patterns, particularly with regard to the shape of the hairline, which is flat rather than receeded. You should be evaluated by an expert and as you are a Los Angeles resident, I welcome a visit to my office to help you with this problem. I will also map out your hair for miniaturization and see if any balding is evident today.

At the age of 22, I would not rush to get a transplant. Touch up transplants are like being partly pregnant (metaphorically speaking) — it is not a good idea. Starting a hair transplant process at your age may ‘hook’ you too early and make little sense to reasonable Master Plan for your future hair loss.

Tags: hairloss, hair loss, asian, hair transplant, hairline

Recurrent Scalp Pimples

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

(female) Every now and then I get bumps on my scalp that are tender, itchy. Awhile after I lightly scratch my head,some of the bumps have oozed and dried. I also notice my scalp is oilier than normal and I lose hair. Sometimes one of these bumps appear at my hairline and have a white head on it. What is this and what causes it?
Thank you.

Sounds like you get outbreaks of folliculitis for which you should see a good dermatologist to learn prevention techniques. Folliculitis reflects infections around the hair follicles, most often involving the sebaceous gland. The bacteria that cause these infections reside on the skin. Folliculitis can be caused by scratching of the skin, breaking the skin surface making it vulnerable to infection, or glands that are very oily with the openings of the hair follicle blocked with sebum. Good washing and hygene techniques usually work well to prevent the process.

Tags: folliculitis, pimples, scalp, infection

Swelled Lips from Propecia

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

Dr. Rassman,

I’m 22 years old and my hair line has been receding since i was 20. I know that male pattern baldness can skip a generation, but no one on my mother or father’s side of the family has any hair loss.

I started taking propecia. My sexual drive was waning and my lips were swelling up. How long do these side effects stay around for? And if these side effects don’t go away, what should I do to fight the hair loss.

Thanks.

I would worry about an allergic response to Propecia. Swelling of the lips could point to such a problem. I would assume that some doctor has prescribed the medication for you, so see that doctor and ask for more information from him/her. At 20, you need your hair mapped out for miniaturization to determine what you are treating with the drug, if you have genetic hair loss, and what benefits you may or may not be having with the drug.

Tags: propecia, finasteride, allergic, allergy, swelled, lips, hairloss, hair loss

Phosphorylase Kinase Inhibitor for Psoriasis

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

Hello Dr. Rassman,

How about the aid of a phosphorylase kinase inhibitor for the treatment of psoriasis? Could this work? A friend of mine, Dr. Madalene Heng has conducted significant research in this area. (https://psoriainfo.org/)

I do not know much about phosphorylase kinase inhibitors for the treatment of Psoriasis other than what I have read about it at both the site you recommended and at PubMed.gov

As a psoriasis victim myself, I might look into it further.

Tags: psioriasis, phosphorylase kinase inhibitor

My 9 Year Old Daughter Has Many Bald Spots

/by William Rassman, M.D./17 /,

Dr. Rassman

My daughter has many bald spots on her head, we noticed this back in August of last year and it dosen’t seem to be getting better. I am at a loss as to what to do. I have had her saliva tested and put her on a vitamin and mineral regiment. She has also started to eat more vegetables at our urging to help with her problem. She is nine years old and has always been concerned with her appearance, I am very concerned that this will progress and affect her forever. Please send me any information that you think may help us.

Take her to a good dermatologist. Spots of hair loss are signs of something wrong like a fungal disease of the scalp or alopecia areata or a variety of other conditions. This is not the place for the amateurs (or even online opinions) and your daughter deserves a good professional opinion from an expert in person.

Tags: child, hairloss, hair loss, fungus, bald spot