Rapid Growth in Frontal Area, Slow Growth in Crown After Transplant

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

I had a 1565 follicular unit transplant 3.5 months ago and I seem to be experiancing a more rapid pace of growth on my frontal hairline compared to that of the growth on my crown. I am curious to know weather of not this is common and if the number of hairs within each follicular unit impacts the rate of growth? The doctor who operated on me put 3 and 4 hair follicular units on the crown and 1 and 2 hair units in the frontal region.

Almost every patient will experience varied rates of growth by where in the scalp you are looking. I have seen the crown exceed the frontal growth rates and visa versa. You must have patience. Generally you can expect newly transplanted hair to grow within 8 months. You seem to have a relatively early growth and I suspect the transplanted crown area to catchup.

Tags: hair transplant, hair growth

I’ve Experienced Severe Diffuse Thinning in Just 4 Months

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

I am a 22 year old who has experience fairly severe diffuse thinning over a period of just four months. I first noticed the problem in March eventually going to see my doctor in April. He said he could see nothing wrong with my hair but noted that I have two patches of Alopecia Areata and some form of dermatitis on my scalp. My hair continued to thin and in June visited a dermatologist who was similarly distracted by the patches of alopecia and inflamed scalp and also said he could see no sign of MPB. However I feel my hair has continued to thin rapidly since then so I have booked another dermatologists appointment for two weeks on Wednesday but fear I will have little hair left by then.

Is four months considered rapid progression?
I have had an extremely stressful year so far but feel I can rule out T.E because I read you can not have A.A in conjunction with it.
My diet is admittedly poor but a blood test in April turned out to be fine.

Do you have any thoughts?

Thanks

I am assuming that you are a male. Men with genetic hair loss do, at times, develop alopecia areata. There is no connection between the two. With that said, if your hair thinning is diffuse and reflective of some other form of hair loss like diffuse telogen effluvium or diffuse unpatterned alopecia, you should have your scalp mapped out for miniaturization to find out if you have an early subtle patterned genetic hair loss. A hair pull test would also have value for you. Has your doctor done both of these things? Have you had blood tests for endocrine abnormalities such a thyroid disease? The stress you are having can accelerate genetic hair loss or diffuse unpatterned alopecia. If you get the idea, you need a doctor to make the differential diagnosis here.

Tags: hairloss, hair loss, telogen, effluvium, alopecia

Using Straight Razor to Shave Head Stimulates Growth?

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

My hair has been thinning since I was about 18. But it seems to have accelerated in the last year or so since i grew my hair long. (I am now 23) I decided to shave my head, and boy did that reaffirm my receding hairline. When it grew back it looked a little bit odd to me. My left side had no border; it has basically a 2 1/2 by 2 1/2 inch patch of thin hairs (with more density towards the top) with hugh gaps between them from my “peak” in front to the side areas. On my right side it is thinning but there is a border and it is a lot thicker and less receding. There is a major difference. How many years could have stress and growing it long accelereated my hair loss, if what I described is normal. Secondly, I used a straight razor to shave my head thinking that would stimulate hair growth, eventhough i was told about it scarring and or killing the follicles.

I do not believe using a straight razor will stimulate hair growth. If that is true, I would be in the hair shaving business!

You make an interesting observation of being able to see the pattern of hair loss with the short shaved head. What you are seeing is the miniaturized hair, which has less bulk than normal hair. This is fairly difficult to see in patients with average men’s hair lengths. That is why I often write about mapping your scalp for miniaturization with the densitometer that we routinely use at New Hair Institute. Alternatively, if you can not find a doctor able or willing to map your head for miniaturization, you can get a very short hair cut and see with the eye where the miniaturization is.

Tags: hairloss, hair loss, miniaturization

Saw Palmetto for Women?

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

What course of action do you recommend for women with thinning hair? I have low thyroid and take medication for this condition (.75 mg levoxyl)

Should women take Saw Palmetto, or any other product that reduces production of DHT? I am nearing menopause and my estrogen levels are reading very low: >.32. Would HRT help?

Does a completely bald father and mother with thinning hair compound a child proclivity toward hair loss in middle age in women?

My hair loss started 10 years ago mainly in the forhead area and temples. It has now progressed into a triangular pattern stretching toward the back of the head. Luckily I had a thick head of hair to begin with or I’d be wearing a wig by now.

Any advice would be greatly appreciated.

You should discuss these issues with your regular doctor — especially with respect to HRT. HRT may help with your low estrogen levels and overall well being. However, there are breast and cervical cancer issues that your doctor needs to discuss with you before starting HRT.

Saw Palmetto has been implicated with DHT reduction (correlations not based upon good clinical science) however if your hair loss is not DHT related it would not work. Women rarely have such a connection. You should be evaluated by a good specialist who can correctly diagnose the cause of your hair loss. Please note that just because there is a diagnosis, it does not mean there may be a solution, as is the case in many women with genetic hair loss.

Tags: hairloss, hair loss, women, female, woman, dht, saw palmetto

I Don’t Have The Kind of Money to Spend on Treatments

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

Hello!
I recently had a free consolt at the Hair Club for Women to discuss options for my thinning hair. I was disappointed with the options I was left with, which were: use the hair care products their company sells for $2400, or do nothing and continue losing hair. Since I have nowhere near that kind of money to spend, I was unable to purchase their product. Now I am left trying to find another option. They talked to me about taking vitamins, but I was never told what kind would be helpful. I am only 25 years old and it makes to sick to think that I may be close to blad by the time I’m 40. I have been losing hair for the past 10 years, and I have probably only half the hair I had as a child. Is there anything you can suggest for me to take or do that will help regrow my hair, or at least stop from further hair loss, that will not drain my bank account?

I would suggest that you should be evaluated by a medical doctor to find any medical causes of your hair loss. Once you have been evaluated for any treatable medical causes of hair loss, you may want to be evaluated by a hair transplant surgeon or dermatologist that can map your scalp hair for hair loss patterns that may shed more light into the cause and the prospect of future hair loss. I agree that $2400 is a significant amount of money to spend on hair loss, but consumers spend billions of dollars on hair loss products each year. Vitamins, special shampoos, and hair loss supplements all promise hair growth, but it is a buyer beware market. Good luck.

Tags: hairloss, hair loss, treatment

Stinging Pain from Hair Transplant 3 Years Ago

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

Hello Dr. Rassman,

I am a 50 year old male and had a hair transplant 3 1/2 years ago. In retrospect any ethical surgeon would have sent me home. I don’t even know the number system that represent how much hair loss I had experienced but I’d give about anything to have not done this.

I thought I was getting 400 grafts using the latest follicular unit technology. What the doctor actually did is anybody’s guess. By two weeks after the surgery, to my complete surprise I had lost about half my hair. When the grafts began to grow a few months later I spent the next 18 months going to another dermatologist whom I understood to be a hair transplant surgeon (I later learned he had possibly never done a single procedure). Every week I would experience around 5 inflammed ingrown hairs, in which I would receive a cortisone injection. The surgeon who performed the procedure even put grafts all over the back of my scalp where I had absolutely no hair loss.

I developed a severe, debilitating pain problem in my scalp which started almost immediately after the procedure and has progessively gotten worse. The pain is a burning, stinging, scratchy sensation in the entire recipient area. A few months ago I started to experience a new wave of transplanted hairs all over my scalp and I have no idea why. The transplanted hairs have always been, and are, extremely stiff and course. They feel like thorns and are very painful.

I have been able to function by taking narcotics for the past few years but the resulting debilitating constipation recently got the best of me and I decided I needed to start making attempts to have the problem diagnosed correctly (and treated if possible)instead of treating the symptoms with no clear understanding of the problem. I had the pain before this last wave of grafts began to grow and I can’t really tell if the grafts are actally growing properly or not. I also don’t understand whether these “thorns” are causing this pain, or whether I have some kind of painful neuralgia. Sometimes I can feel every single graft just stinging.

I need help very badly. I have been to at least 25 doctors including hair transplant surgeons, dermatologists, neurologists, infectious disease, general practioners, pain management, psychological, etc. It seems that nobody has ever heard of this or just admittedly doesn’t know the first thing about hair transplantation, much less its possible complications like mine.

Any helpful advice you can provide would be greatly appreciated.

If you have been to 25 other doctors, I do not know how much I can help. Hair transplants should not hurt after a few days. Moreover it should never require dependancy on narcotics and “debilitating constipation”. It is my opinion your pain may be from other causes.

Tags: hair transplant, hairloss, hair loss

I Stopped Propecia for a Month, Then Restarted — It’s Not Working the Same!

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

I am only 18 but I have been noticing hair falling out since I was little, and it only became more pronounced a couple of years ago. Last year, I began taking Propecia and I was on it for about four months. It was so expensive that I stopped for one month but decided that I really needed to continue with it. I have now been back on it again for just over a month, but I’m still noticing a large number of hairs falling out daily. After stopping treatment for a month, will I never experience the previous effects of Propecia, or do I just need to be patient for it to start working again?

Other men, older and wiser than you, have come to me almost in tears about the same experience they had when they stopped using Propecia and experienced an accerated hair loss. Usually, they stopped for longer than a month. In theory, the drug should remain in the hair follicles to some level up to a month or so, but the blood levels disappear in a day. It is unfortunate, but if you are losing hair from stopping the drug, your hair loss may be permanant, though it is possible that much of it may reverse because of maintained tissue levels. It is probable that some hair may come back if you go back on the Propecia immediately to replenish the tissue levels of the drug in the hair follicles. On the brighter side, Propecia may prevent further hair loss.

Tags: propecia, finasteride, hairloss, hair loss

Rogaine After Hair Transplant in Woman

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

Thank you for your forum…. it is so helpful. My question is I had a HT of 1480 units about 2 weeks ago. How long should I wait to start using Rogaine again? As a female can I use any oral medication to help maintain the hair I have?

You can start using topical Rogaine after about 1 to 2 weeks after a hair transplant, and it may be a good idea to use it at least for the first 4-5 months after surgery. To date there have been no FDA-approved oral medications available for female hair loss. Propecia is not recommended for women.

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

Propecia and Working Out

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

Hi.

I’m 35 and loosing hair. It’s likely that Propecia could be one good solution. However, from what I understand Propecia blocks DHT by limiting the creation of testosterone which is why it can stop balding process.

Now, I am working out seriously 4 times a week and trying to add on muscle. Muscle growth is due to testoterone. My question: how can my work out be still beneficial in terms of muscle growth if the testosterone is lowered because of use of Proprecia.

Thanks for your time.

Propecia does not decrease testosterone. It decreases the byproduct of testosterone known as dihydrotestosterone (DHT). DHT is what is implicated in male pattern hair loss. Taking Propecia increases testosterone by about 15% and benefit (although not proven) muscle building. Propecia can also apparently be used to mask muscle enhancers. You may recall from the recent Olympic games the controversy surrounding Propecia — Olympic Athlete Banned from Competition for Propecia Use.

Tags: finasteride, propecia, olympics, athlete, hairloss, hair loss

Dutasteride and Drug Interactions

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

i have been taking dutasteride for over 6 months. i am due to have a back op shortly. is it known if there is any interaction with dutasteride and the drugs used to put you out for operations? i would hate to wait 6-8 months for an operation only to find they are unable to proceed.

also after 6 months on 0.5 of dutasteride would it be possible to get away with once every two days without effecting present gains and future hair loss?

You should always check with your surgeon or anesthesiologist for any medical questions before your surgery. It is my opinion that dutasteride will not have interactions with other drugs used for anesthesia.

There are reports that dutasteride has up to a 240 hour half life (half life is the time it takes half of the drug to be cleared from your body) and there are some reports of a longer half life. But to sustain a baseline concentration in your body, you would still need to take a constant dosage. The correct dosage for this drug is not known, considering the high half life for it. When bound by the tissues in your body, the drug may be around for months after you stop taking it. I do not believe there have been adequate studies on the exact dosages and frequencies of dutasteride for androgenic hair loss and the known world of dosing this drug is for Prostate problem in men over 50. Thus it is impossible for me to tell you the efficacy of taking dutasteride every other day or even less frequantly, although in theory that should work as well as alternate daily use.

Tags: dutasteride, hairloss, hair loss, drug

Why Would a Doctor Limit to 1000 Grafts Per Session?

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

hi Dr,
i am considering getiing FUT done in the near future. i am from Ireland and there are limited surgeons here. one surgeon, has an excellent reputation, and an impressive bio, but limits his sessions to 1000. I would need about 2500 to 3000. what would be the reason for the limitation, and do you know of Doctors that also limit their sessions?

The limitation on the number of follicular units transplanted may be due to the limitations of the doctor’s staff and time. For example at New Hair Institute, we are capable of transplanting 3000-5000+ grafts in a day. This is possible because of our experienced staff, mastery of the tools we use, and techniques we have refined over many, many years. We were the first medical group in the world performing sessions of 1000, 2000, 3000 and even 4000 grafts (in 1994). The key to doing these larger sessions must address reasonable limits based upon each patient’s dynamics, skin laxity and supply/demand considerations. Then, the doctor’s team should become a focus and one should never push a doctor or his team to do more than they can competently handle. The level of competence with these large sessions varies between doctors.

If you are referring to Follicular Unit Extraction (some doctors may use different terms) where individual hair follicles are harvested one at a time, 1000 may be a reasonable number because it is a very laborious process, but here too, as the originator of the FUE process, we have performed as many as 2200 grafts in a single session in appropriate candidates. It is all a matter of experienced teams of doctors and staff working together after years of training. If your doctor is unwilling to perform a larger session, either stick with him/her and do more surgeries with smaller numbers of grafts or find another surgical team able to perform larger sessions with lots of experience doing them.

Tags: hair transplant, experience, doctor, hairloss, hair loss

Bioidenticals and Female Hair Loss

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

Two years ago I had my ovaries removed due to solid cysts. I have had problems with HRTs. Some of the physical problems I had with synthetic hormones went away when I started bioidentical hormones. As soon as I started bioidenticals, I could literally watch the hair fall out of my head. The loss has alternately slowed or stopped,however, on a lower dose of estrogen my scalp is very sore to the touch & itchy. (The soreness is not because I have been scratching my head. I haven’t). What causes this?

Also, I had hormone levels tested before going on bioidenticals(18months after surgery & 16 months after HRT) and it showed I had very high androgen levels, but doctors & pharmacists can’t seem to tell me why, or what I can do about it. Any suggestions?

See Bioidentical Hormone Replacement – HRT Without the Side Effects.

Taking out the ovaries will produce an imbalance in your female to male hormone ratios. Many doctors treat women with HRT (Hormone Replacement Therapy) to adjust to the changes associated with surgically induced menopause, which follows the loss of your ovaries. I have no doubt that naturally occurring herbs will supply hormones that have the capacities that you outlined, but the amounts of hormones that you are mimicking with these herbs are clearly producing hair loss. This suggests that the testosterone and androgenic effects are inducing the genetic hair loss that you have programmed in your genes. I would generally tell you to stop taking the bioidentical hormone replacement and see the effects on your hair loss. Seek out the advice of a competent doctor to try to manage what you are treating.

Tags: hairloss, hair loss, hormones, hormone replacement therapy, women, female

Are the Propecia Site Photos Altered?

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

dr. Rassman,

I read one of your articles about laser light therapy and the results of the pictures from the LLT could be altered or they could have been touched up to make it look as if more hair growth occurred. Saying that, how do we know that the people on the propecia.com website didn’t alter their images or the images you see from propecia or avodart results are altered?

Yeah, propecia could work, but to what degree and I personally thing propecia just maintains what you have unless you use minoxidil. What do you think?

The studies that show the benefits of Propecia used in Merck’s material are the results of well controlled and audited scientific studies, some of them done under FDA guidance. I would trust official Propecia photographs from Merck, but I would not trust many of the commercial photographs that are produced just to ‘prove’ that the changes are real. If you look carefully on many photographs used for the various potions, lotions, and herbal solutions for hair loss, the lighting, the hair length, the view — they are all different. On some photographs I have even seen scalp coloring agents used in advertisements, particularly for the crown shots on many commercial products.

So, always check the authority of photograph sourcing. For hair transplantation, I offer open house events at both of my offices just because even from the photographs on our website, the average person may have difficulty in determining just what the change really is. When you meet a patient face to face, what you see is reality and not the best view or an illusion created by the person taking the pictures. Of interest, at each of our open house events, we often have a person present who had created all of the benefits on Propecia alone (no transplants) and they have their before shots to prove where they came from. I still believe and preach: Let the Buyer Beware.

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

0.6mm Tool for FUE

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

Hello or “Hej” – as we say in Sweden.

I did read a post from you talking about FUE instruments, you use 0.9mm and smaller tools will cause greater follicular holocaust, you said.

Recently I did read a blog entry from you where you talked about FUE and the development of smaller tools.

I’m confused. Here in Sweden we have an intresting option, 0.6mm. Is this pure nonsense or could this surgeon be that good? Method is called “FUE plus” and is said to transplant 120-180 hairs / cm2.

I did notice that you said that 200 hairs / cm2 is the original density provided by the “man above”.

Why increased follicular holocaust when using smaller instruments?

GodI am hopeful that some breakthrough will come about that will allow smaller instruments to be used, but alas I have not seen them yet. Without knowing the doctor who proclaims such miraculous instruments, as a betting man, I would wager that some lack of proper representation is the case here. Add to such a wonderful instrument, the ability to achieve within 90% of God density and you have FUE God Plus. That means that some doctors can improve on what God might do if he (or she, depending on your beliefs) was a transplant surgeon here on earth.

Tags: fue, hairloss, hair loss, hair transplant, fue plus, tool

I Want My Donor Area Repaired So I Can Shave My Head

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

Dear Dr. Rassman,

I am looking to have the donor area from an earlier procedure eliminated so that I could wear my hair extremely short or shaved.

Please let me know what you recommend.

Thanks in advance.

All cuts on the skin will produce a scar and most cannot be completely eliminated. Scars can certainly be minimized depending on the individual healing characteristics so that short hair is a reasonable option. At New Hair Institute (NHI), we continually strive to incorporate scar minimizing techniques in all our procedures and will tackle repairs of scars if they are there. Please refer to Techniques to Minimize Donor Scarring. Your original hair transplant surgeon should be able to address your scar. If not, I would be happy to meet with you in person or by phone to discuss your options.

Tags: hairloss, hair loss, scarring, scar, repair