Transplanting Into a Neurosurgical Scar (with Photos)

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

This patient had an extensive neurosurgical procedure with a corresponding scar. Even when his hair was longer, the scar showed because he had frontal recession from genetic balding. We performed a hair transplant (one session of 1433 follicular units) and successfully treated both the scar and the frontal genetic recession. The “after” photos were taken just over 4 months after his procedure.

I have done this type of corrective surgery on many people. It is a life changing experience for these people, not having to face their deformities every day. Unfortunately, few neurosurgeons understand what modern hair transplants can do, not only for their patients, but for their own balding sons.

Click the photos to enlarge.

Before:

 

After (only 4.5 months):

Tags: hairtransplant, hair transplant, photos, results, hairloss, hair loss, neurosurgical

Antiandrogens

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

Dear Sir,
I am 32 years old male suffering from male pattern baldness. I ask you can I take antiandrogens for treatment of baldness? Looking forward to receive your answer.

Antiandrogen is a group of medications that block different forms of male hormones. What we generally recommend for treatment of male pattern baldness is finasteride, which is also classified as an anti-androgen in some sources. Finasteride blocks production of DHT (dihydroxytestosterone), which is one of the forms of testosterone that can affect hair growth in prone patients.

The typical antiandrogens can block testosterone. Although these medications are used for treatment of prostate cancer, they are not recommended for treatment of hair loss because of their numerous side effects. If you are a man using these antiandrogens for other medical conditions, they may positively affect your hair but may kill your sex life so you should not use them merely for treatment of male pattern baldness.

Tags: antiandrogen, anti-androgen, hairloss, hair loss, testosterone, dht, hormone

I Have Medical Problems, But Don’t Tell Me to See a Doctor

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

Dear Sir,

I am 25. I have very very big problems and it disturbs me, and i cannot concentrate on any thing.

1. I have facial hair on my arms,shoulder,back,chest which can be clearly seen on the day, and thick hair on legs,thighs,bottoms. I will be very glad to get rid of those hairs, PERMANENTLY. The blades,razor,threatning,laser,ointments, will never work, after few weeks, hair grow more and more thickly. So what is the (latest modern equipment or ancient thing or whatever the best one) to take out all the hair from body ? (my father,brother,uncle, all the roots of my family (males ones) don’t have hair, only few have hair on chest and legs only. But why me? Because of it, i cannot wear shorts, vest or go out outside on daylight, or swim or do anything i want. i am good-looking guy, and if someone who knows my secret privacy problem , will be known by everyone, then , i would have to think about ‘suicide’.

2. I have my lower back pain a lot (been 2 years) and my hip bones (feel like my spinal cord), and knees and feel like i might lose my legs (because when my back and hip bones hear, i feel it connected to my brain). what should I really do? (please, don’t just tell me go to doctor) (give me details/pictures of excercises/healthy food to lower the back pain)

please help me about this. One thing is that I cannot go to doctor as I don’t have money, and more importantly, I cannot tell my family or anyone, because when they find out, it would get worse, more pain.

hope to get your reply soon. thank u

This site is intended to educate the public on hair loss topics. Information provided on BaldingBlog.com should not be used for the purpose of medical diagnosis or treatment.

While I empathize with your medical problems and your financial situation, this is not a place to get medical advice. You want me to help you, but I cannot be your doctor. This is the Internet. I cannot examine you and despite what you describe I cannot interview you to know what is really going on.

You write to me asking not to tell you “just to go see a doctor”… but you need to! If you cannot afford one, there are social aid programs that can help you.

If you have unwanted body hair, laser hair removal is an expensive solution, but it works. You might see if it is available in your country.

Tags: doctor, physician, medical, hairloss, hair loss, pain, hair removal, laser

Curious About The Hairline My Transplant Doctor Gave Me

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

I recently had a hair transplant done and I was curious about the way my doctor had done it. I naturally have had a widow’s peak but it has receded some. The way the doctor put the graphs in was sort of also in a M shaped form just out to the sides. Will this restore my natural hairline?

I cannot answer your question without seeing a current photo and comparing it to what you looked like before you lost your hair. More importantly, you should have addressed this before the surgery to make sure that your doctor understood your goals and expectations.

The standard practice at NHI is for the physician to draw a hairline with an erasable marker prior to surgery and have the patient look at the general shape and position so that he/she can approve or modify what the doctor planned. Generally this take a few minutes as the patient has specific concerns and requests (such as adding a widow’s peak). In the end, both patient and doctor are on the same page in agreement before the surgery starts and we take good pictures to document what we had agreed to. After the hairs grow in, we can then go back to the drawing on the head and see if the hairline we had tried to produce, was actually produced.

Tags: hairtransplant, hair transplant, hair loss, hair loss, hairline

My Hair Disappears At Night!

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

I have minor hair loss, but it happened and is still happening during a long period of time. Last winter, i realized there was hair loss on my hair line. I have this skin condition, but my skin doctor told me that it wouldn’t make my hair disappear. I’m 15, and I don’t know what this is. Most of my family (that know about it) say that my hair isn’t disappearing but this is MY body and i know what changes are happening. Now, i have once inch of hair missing from my hair line, more hair above my ears, and the back of my neck. When my hair disappears, it does at night and sometimes after i take a shower. My hair grew very rapidly over a short period of time, and i don’t know what this is. Please, help me.

If what you are saying is that you lose hair at night because you see it on the pillow, you should do a hair count on those hairs you find. The average person loses about 100 hairs per day and regrows that number from below the skin. If you calculate this out, you will see that in three years, the 100,000 hairs on the head (losing them 100/day) will recycle. Get a good doctor who understands hair and teenagers and go about the analysis properly.

Tags: hairloss, hair loss, teen, cycle

Will I Go Bald?

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

Dear doctor, I understand that you’re a busy person, but I’d really appreciate if you took the time to anwser a few questions. I’m a 19 year old male; full head of hair without any signs of balding. My father and my paternal grandfather both have thick hair with no signs of balding. However, I once read an article about baldness being inherited from one’s mother and my maternal grandfather has no hair at all. Does this mean that I should be worried about going bald? I guess all men lose at least some hair due to old age; around what age would you say that natural balding starts to occur?

The leaning to one’s mother’s genetics is 51/49%. You probably won’t inherit any balding based upon what you told me, but if I am wrong, you will see in in your mid-20s or later.

Tags: hairloss, hair loss, genetic, genetics, mother, maternal

I’m 20 and My Forehead is Growing

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

Dear Dr. Rassman,
hair loss started when i was 15, now that am 20 it got worse, and my forhead got bigger due to hair loss,what are the possible causes and treatments for that?

This is most likely genetic male pattern balding. You need to getyour hair mapped out for miniaturization to make the diagnosis and then possibly consider medications like Propecia.

Tags: hairloss, hair loss, propecia, finasteride

Since You Suggested Minoxidil and Propecia Are Better Together…

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

I received 2 emails from 2 different readers about my recent post discussing using minoxidil and Propecia together —

EMAIL 1:

I was interested in your recent suggestion that minoxidil and propecia used together may be better than only one at a time. My question is concerning minoxidil. I tried it a while ago but got very bad itching of the scalp. Is there a form of minoxidil that won’t give me this side effect? (e.g. rogaine foam or some other variation). I would really love to use it in the hope that it will slow down the hair loss process. I know others have previously stated that they couldn’t use it due to the itching, so it would be great if there was something out there to fix that problem.

Thanks doc. I read your site almost every day and love it.

EMAIL 2:

In response to your new theory on the combination of Rogaine and Propecia. Would you then advise immediate combination of the two, or would you still prescribe a one year period of just Propecia? Could it depend on the results that one are looking for? i.e. regrowth vs. maintaining/slight regrowth. Thanks. Very helpful website.

I combined the answer of these two questions.

Although the combination of minoxidil and finasteride is reported to have a superior effect on hair growth over taking them separately, I generally do not start my patients on both of these medications at the same time. I may add minoxidil to the treatment regimen of a patient who has been on finasteride for a while and now feels that finasteride is not holding anymore. This usually happens after the first year of taking propecia when patients are done with the initial hair growth and stabilized in a new and better status. At this point patients’ rapid hair loss either stops or significantly slows down and the patient does not see hair grow as they initially saw within the first year, so they get disappointed and seek further help.

I like to leave at least 6 months to a year before starting a patient on the second medication and I also perform a miniaturization study before starting the second medication. This may give me some idea of the rate of growth with each of them. By starting one medication at a time, I know what medication is responsible for the good or bad changes. Also, if patient develops an allergy to one of these medications, it would be easier to find the culprit when you start them one at a time.

If you develop a contact allergy to minoxidil, it might be the result of the other chemicals in the solution and not the medication itself. You can switch between different versions of the same medication (i.e. minoxidil lotion vs. foam) to see whether you experience the same reaction or not with that particular product.

Tags: finasteride, propecia, minoxidil, rogaine, hairloss, hair loss

Scalp Exercises to Regrow Hair?

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

Dr.,

I came across this web site: https://www.hairloss-reversible.com/my_approach.htm

I’m curious as to your opinion on the possibility that these “scalp exercises” might possibly regrow hair in some individuals after 8 or so months of doing the exercises as a result of increased blood flow to the scalp. It seems like a bunch of unscientific, hocus pocus to me, but if you read the other info on his site, it appears to be very accurate and makes the author
sound very credible.

Thanks.

I visited the above referenced link. It is based on the authors’ personal assumptions on the mechanism of hair loss. He tries to come up with a novel method for treating baldness based on his observation of his bald family members. Although it is interesting to follow his thought process, it is not scientific. Today’s medicine has changed drastically in comparison to 200 years ago. Back then, doctors had their own individual methods of treating different diseases, which at times where completely different and even conflicting with the others.

We use evidence-based medicine to support most of our treatment plans. Although lack of blood and oxygen of the scalp was once thought to be the main cause of baldness, today we know that the scalp oxygen level and blood supply is the same in balding and non-balding people. Massage therapy to increase the blood circulation can not stop the balding process.

Tags: scalp exercise, exercise, blood supply, oxygen level, hairloss, hair loss

False Statements About FUE Published on Doctor’s Website

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

Found this info on Sword site in reference to regenix regarding the FUE…any truth to this, especially in my case?

“The Follicular Unit Extraction Technique: The concept makes sense, and it sounds great! Instead of making an incision in the back of the head, simply remove each individual follicular unit with a punch blade then relocate it to the areas of thinning and loss… all in one step. The problem is, it isn’t quite that simple.

Hair follicles don’t grow straight up and down beneath the skin. They grow at angles, and each follicle can be at a dramatically different angle than the follicle next to it. It’s virtually impossible to know for sure. Clinical studies have shown that 25% to 40% of all follicular units being extracted during follicular unit extraction are destroyed. They are simply cut in half. And since we have a limited supply of donor hairs, we can’t afford to destroy even one unnecessarily. Additionally, the punch blade will leave multiple scars throughout the donor area. When follicular units are simply extracted from areas of the skin, the result is an overall thinning to the remaining hair. Follicular unit extraction procedures last, on average, 30% longer, cost more, result in less density and compromise the donor area.

Every surgeon has this procedure option at their disposal; the vast majority sees that it just isn’t in the patient’s best interest to utilize it.”

Partial truths can be dangerous. In the right hands, under the right conditions, he is wrong about FUE. He is right that 50% or more of the follicular units can be destroyed if the doctor doing it does not know when to do the procedure and how to get out yields in the 90% range. I suspect that either the doctor who wrote this does not want to learn how to do it right, has not been trained in the procedure properly, is ignorant, or he is just incapable of doing it and does not want to admit it. I do not fault a doctor who does not want to perform FUE, but I would expect that doctor to learn what he is talking about and admit he does not know enough.

Tags: fue, follicular unit extraction, physician, doctor, hairloss, hair loss, hairtransplant, hair transplant

Do Propecia and a Hair Transplant Compliment Each Other?

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

I really never believed in hair growth products. But after you mentioned Propecia I tried it. It took a while but I eventually saw a great difference in the thickness of my hair! Then, when I stopped using it, the hair went back as it was before using Propecia. I knew this would happen but I wanted to know if I was just imagining the change.

Hence, my question: You advised using Propecia prior to having the HT procedure. Its seems I must use it before the HT and also before the full effects kick in or how will we know how much density is normal and how much is density is due to Propecia?

If I had a choice I guess I would rather have the great results of a HT without the added cost of meds. But if they compliment each other, well, it may be worth the prescription price. Thanks

I believe that every young man should be on Propecia/finasteride if they have genetic balding. This drug will also offer some protection against shock loss that would be common with a hair transplant, and you should be on the drug at least a couple of weeks prior to having a hair transplant. If your thinning is early, then Propecia may be enough (just as you described), but if you lost hair in the front, it would be unlikely that the drug will return it. So these two modalities (transplant and drug) work nicely together and yet they do compliment each other.

Tags: propecia, finasteride, hairtransplant, hair transplant, shock loss, shockloss, hairloss, hair loss, balding

What Shampoo Should I Use?

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

Dear Doctor,

I am a little confused on what shampoo I should be using.I was using johnsons & johnsons baby shampoo but a doctor suggested that I make the switch to Head & Shoulders containing 1% zinc pyrithione as this product has been known to thicken hair & even slow down hairloss. However,other arm chair experts on various hairloss forums have compared head & shoulders to sulfuric acid & claim it will thin out my hair even more.

Can shampoo have such an adverse effect on hairloss ? What are your thoughts on this product & can you recomend a shampoo ?
Thank you

Any reasonable commercial shampoo will work just fine and have no impact on thinning. What you could do is try different brands and then settle on the one you like. There are shampoos for dry and for oily hair, shampoos that give your hair more character and make it wave more. It is a trial and error process.

Tags: shampoo, thicken, hairloss, hair loss

Are ALL Steroids Bad? What About Prescribed Topical Corticosteroids?

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

In your July 21st blog entry, you clearly mention that all steroids are bad – both for your body and toward precipitating hair loss. However, specifically what about topical corticosteroids, such as Luxiq? Last year, my dermatologist diagnosed me with seborrheic dermatitis on my scalp and proscribed me Luxiq to take pretty much indefinitely. Could this drug worsen my hair loss? I’m very concerned that I may be doing something that is speeding up my rate of hair loss! Please respond.

Steroids cause hair loss. I personally do not recommend daily or twice daily use of steroids for seborrheic dermatitis. Occasional use one or two treatments a week may not impact hair loss but it should be used sparingly.

Tags: steroids, steroid, seborrheic, dermatitis, luxiq, corticosteroid, hairloss, hair loss

Bald Spots Behind the Ears

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

I am a 37 year old black male. I have recently been getting bald spots on the back of my head, right behind my ears only. My hair is very coarse and for this reson I have been relaxing my hair for over 15 years but never received any bald spots. Right before the balding occurred there was intense itching

Could you have scratched too hard as to cause traction alopecia (hair loss from pulling or scratching)? Send me pictures to the address on the Contact page (please reference this post).

Tags: bald spot, hairloss, hair loss, alopecia

Understanding When a Hair Transplant is Appropriate

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

Hello,

I am a 21 year old male and for the last year or so I have began to notice that my hairline is receding. In an attempt to control my hair loss I have purchased Procerin and minoxidil 5% and I am considering going to my doctor to ask for his opinion on using Propecia. I have also been reading up on the subject of hair transplants but have came to understand that I am too young to consider this sort of option. However, this brings me to my questions:

  1. If I add Propecia to my current regime (Minox, Procerin) will my doctor or dermatologist still be able to map my hair loss and estimate when it would be wise to consider a hair transplant?
  2. Or will I have to stop my regime, for a period of time, to allow the regrown (if there is any) hair to fall out, thus allowing my doctor to see the natural recession of my hair line?
  3. Or would I have to stay on a course of Propecia forever, so to stop any hair loss behind the hair transplant?

I am answering your questions in the order you asked:

  1. The available FDA approved medications for hair loss can help slowing down or in some occasions stopping the process of hair loss. Early 20s is the period that most physicians don’t want to rush into performing a hair transplant, because it is hard to predict the progress of the hair loss and final hair loss pattern at this age. Considering the family history of baldness, hair loss medication use and degree of miniaturization can help establish a Master Plan for a young patient like you. So, you need to find a good doctor for a thorough evaluation and only after considering all above factors should atime table be tailored for your hair transplants.
  2. The effect of these medications on your hair growth is gradual and I don’t recommend stopping them to find out your natural degree of hair loss. You will end up losing more hair unnecessarily by doing that. I have no information about Porcerin, but Propecia is the most appropriate medication to control progression of genetic hair loss in young men.
  3. I recommend that you develop a Master Plan for the treatment and stick to it, being monitored with yearly miniaturization studies to follow the progression of the hair loss. Most of the patients need to continue their treatment for the rest of their lives, so it is wise to do your research before starting such treatments.
Tags: propecia, finasteride, hairloss, hair loss, fda