HairStemcell Transplantation (HST)

/by William Rassman, M.D./5 /,

I would like to know your opinion on this procedure: Hair Science Institute

The procedure is called “HairStemcell Transplantation” and promises near complete regrowth of the donor site. It seems way too good to be true but I want to have an expert opinion on it before I jump to any conclusions.

It seems what they are doing is Follicular Unit Extraction (FUE), but they try to differentiate from FUE with what they call a Hair Stem Cell Transplantation. It is especially confusing when they show both side by side, yet they look the same. From the photograph they provide, they are using a standard dental drill head piece.

In short, stem cells are not readily identifiable even under a microscope. So to claim stem cell transplantation is likely a misnomer or sensationalism at its best to exploit the buzz word of “stem cell”.

Finally there are no doctors mentioned on this website that is associated with “research”. I find that highly suspect.

Tags: hairstemcell, hair stem cell, stemcell, hairtransplant, hair transplant, fue, hairloss, hair loss

From Japanese TV — How to Build a Comb-Over

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

Taken from a Japanese talent show, this video is for those of you who want to know how to build a classy comb-over (if one could ever consider a comb-over to be classy). Actually, the result is quite impressive —

Tags: comb over, combover, hairloss, hair loss, japan, japanese, tv, talent, video

Hair Growth Side Effect from Drugs

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

There is some literature about the association between minoxidil and upregulation of keratinocyte growth factor and vascular endothelial growth factor in dermal tissues. Do you know if there are any groups looking at perhaps topical treatment with either of these growth factors? If not, what do you think about and therapeutic potential?

Also, there is some literature that suggests that topical cyclosporin induces hair growth. What about other topical immunomodulators like Protopic?

There are drugs that have been reported to grow hair as a side effect. In fact, that is how Propecia was discovered. The generic form of Propecia is known as finasteride. Finasteride was used for many years for the treatment of benign prostate enlargement. As a side effect, it grew hair on men. As such, the drugs and growth factors you cite may have had some press in growing hair, but there are trade-offs with risks and benefits and side effects associated with any drug use. Fortunately, Propecia was approved by the FDA and deemed safe with minimal side effects. The other drugs need rigorous testing and clinical trials before they can become clinically reliable. Besides dutasteride, I do not know of any drugs that are in development or undergoing FDA approval process for the treatment of hair loss.

Tags: minoxidil, keratinocyte, hairloss, hair loss, fda, dutasteride, finasteride, growth, side effect

Dermabrasion to Diminish Scars and Encourage Hair Growth?

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

Hi Dr. Rassman,

Thank you for taking the time to write in this informative blog- I read what you write religiously. I’m a female with some large scarring and hair loss due to an accident. I’ve heard a lot of anecdotal evidence of some pretty dramatic effects of ‘skin needling’ or ‘dermabrasion’ on both diminishing scars and encouraging hair growth in the same skin. Do you have any opinions or advice on this technique. Any opinion on the various ‘skin rollers’? Would it help with my husband’s male pattern baldness?

I receive mailings from “skin rollers” with samples sent to my office. There are papers written about these devices which are actually advertisements supporting them, but as you state, these are mostly anecdotal evidence. Some have a hint of scientific research behind them, but I have not seen the research published in creditable medical journals. It is my general opinion (as you also state) that these are just anecdotal observations and if it works for you… great! Buyer beware.

Tags: dermabrasion, rollers, hairloss, hair loss, scarring

Endoscopic Thoracic Sympathectomy and Hair Loss

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

(female)
I am experiencing an irritated and sensitive scalp. I am also suffering excessive hair loss. I have a tiny bit of dandruff but I dont think the dandruff is a contributing factor to hair loss. I
have undergone an Endoscopic thoracic sympathectomy to correct facial blushing, hand and facial sweating. wondering if this operation would restrict the circulation to the scalp, as on
occasions when I exercise I feel my scalp tense up and starts to tingle

Dandruff does not contribute to hair loss. I doubt that a sympathectomy will cut off circulation to the scalp or cause hair loss. You may have hair loss due to a predisposed genetic cause or the physical stress of the surgery may be causing the hair loss. It is impossible to diagnose the cause of your hair loss via the web. You may benefit from a physical exam including a miniaturization study.

Tags: sympathectomy, hairloss, hair loss, endoscopic, dandruff

Using Tar-Based Shampoo After Hair Transplant

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

Dr., After the hair transplant follicular graphs surgery… is it safe to use TAR based shampoo on the transplant area like 2 weeks later…and if so how often? What affect can the tar have on the new follicles? thanks

I do not know what the benefit of using a tar based shampoo would be, but I doubt it will have a negative impact on the transplanted hairs after two weeks. Nevertheless, you should consult with your hair transplant surgeon.

Tags: tar, shampoo, hairloss, hair loss, hairtransplant, hair transplant

I Have a Shunt in My Head — Can I Have a Hair Transplant?

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

I have a VP shunt that drains spinal fluid from my head to my stomach due to a blockage in my spinal column. Could I still get a hair transplant ?

Yes. In fact, we recently had a patient who had a VP shunt and had a hair transplant. Your doctor should be highly qualified and must have experience in such a matter. You would likely require a CT scan or an X-ray to confirm where the shunt traverses so that it is not damaged during the surgery.

Tags: hairtransplant, hair transplant, shunt

Hair Transplants, Shock Loss, and Propecia for Women?

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

(female) I heard of the possibility of shock and its harm to cause loss of existing hair from hair transplantaion. How frequentlly does this happen and does is the risk lower with follicular unit extracton?

Many women can not get real benefits from a hair transplant, so that is why I want to see pictures. There is no substitute for a direct examination of your hair with miniaturization studies to determine just where your hair loss is and how good your donor area is. Most women with genetic hair loss have a poor donor supply because of the thinning and the high degree of miniaturization in the donor area so they do not qualify for a hair transplant. Too many doctors will still perform surgery on these women when there will be no benefit just for the money. You need to find a good, honest doctor who keeps your interests central to your evaluation (not your purse). I am not convinced that Propecia would work for woman’s hair loss and in fact, it is not FDA approved for treating female hair loss because there is no proven benefit of it for women.

When a transplant is done, shock loss may occur in the recipient area so the method of extracting the donor hair is what is important. The best way to reduce the risks for shock loss is the use of Propecia (for men only) to be taken orally prior to the surgery and for the subsequent 6-8 months. For women, hair loss from shock loss usually reverses if it occurs (less than 10% risk in women) and it is possible the Minoxidil may help prevent it.

Tags: propecia, finasteride, shock loss, hairloss, hair loss, hairtransplant, hair transplant, female, women, woman

Wondering If I Should’ve Had an FUE Procedure Instead of Strip

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

I am 26, type V norwood, 5 months ago I had 3500 grafts HT. Just found out about FUE and am very interested as I have a large scar – hair has grown thru as is tryco closure – but still visible on my No 3 cut due to pinkness and 2-3m width (will this improve?). I am happy with results overall but now wonder if I should have had a FUE? Im told I have 3000 left to harvest which I will need for future loss.. should I open up my original scar when needed or opt for FUE? Can i extract more than than the 3000 if I use FUE? Thanks for help!

The Follicular Unit Extraction (FUE) procedure is ideal for patients who cut their hair very short, those who have a relatively small requirement for transplants (less than 1500 grafts), and for patients who absolutely do not want any visible scar on the back of their scalp. Patients who have already had a strip procedure will always have a linear scar, so an FUE procedure would not be of much benefit unless they want to have hair transplanted into the existing scar. While this is possible and routinely done, you must also consider that you will still have a visible scar if you shave your head or cut it too short (with a #1 or 2 cut setting for example).

Tags: fue, follicular unit extraction, hairtransplant, hair transplant, hairloss, hair loss, scar, strip

Immunization Against DHT?

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

Dear Doctor:

Thank you for answering my question regarding the liver’s function in the conversion of testosterone to DHT. Might this prove a new avenue of therapy? In your opinion, if there are
cholesterol-lowering drugs that reduce the amount of cholesterol that the liver produces, could the same not be done for DHT? Also, do you think there could be an immunization against DHT, perhaps triggering an immune response against DHT in the body. I know I am hypothesizing a new approach to immunotherapy, but I figure…what the hey? Thanks, as allways.

I suppose anything is possible, but finasteride (Propecia/Proscar) is a very effective medication that blocks DHT production for the treatment of androgenic hair loss. You can conceive many creative ways to block DHT, but why would you want to when you already have a proven and safe medication such a Propecia. What we really need is more research into finding other non-DHT related drugs that can stop / prevent / or even reverse androgenic hair loss (AGA) or male pattern balding (MPB). In other words, blocking DHT is not the end all, cure all.

Tags: propecia, proscar, finasteride, dht, immunization

If I Start Using Propecia on the Day I See My Hairline Start Receding at All…

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

Dr. Rassman,

I am in my early 20s with no signs of hair loss. My father has a receded hairline with somewhat thin hair at the top at the age of 55. My mother’s father died at a young age (say 33) but was losing his hair at the time. My mother has 3 brothers, one of which has lost his hair at an early age with the other 2 retaining full thick heads of hair well into their 40s. My mother, however, has shown some signs of female pattern hair loss. At what age should I expect (if ever) to see signs of hair loss?

Also, what kind of results can someone expect from Propecia if they begin using it literally the first day they see their harline recede even the slightest bit.

Kind Regards

Propecia is not a magic pill. It does not completely stop balding. So if you use it on the first day of hair loss, that does not mean it will stop it completely. It may slow down the rate of hair loss and in patients who have lost hair in the past 2-3 years, it may reverse it. Furthermore, Propecia is more effective on the top and crown areas of your scalp. Propecia does not seem to work as well for preventing hairline recession.

Tags: propecia, finasteride, hairloss, hair loss

Minimum Fees for Transplanting Hair Into a Small Facial Scar

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

Dear Dr.,
I recently emailed you about adding hair to a scar on my cheek. On your fee’s page I see that there is a minimum 3000$ fee. If I needed a lesser amount of grafts for this smaller procedure, would I still have to pay that 3k minimum?
Thanks

Yes. There is a $3000 minimum per procedure because other factors such as anesthesia, medication, post op medication, nursing staff, operating room, follow-up, and administrative costs must all be factored in. In other words, even if you have a 100 graft surgery or a 1000 graft surgery the set up and logistics and the orchestration of a surgery is still the same. On occasion, a modification of our minimum fee rule is made.

Tags: hairtransplant, hair transplant, fee, cost, price

Can Propecia Help My Hair Grow Long Again?

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

Hi,

I have just started taking Propecia to combat MPB and early results look promising. As it starts to reverse hair miniaturization does that mean the hair will also grow for a longer period (and so achieve longer length) before it stops growing then falls out to start another cycle? And if I continue with Propecia can this growth phase eventually be brought back to the normal length (for me it was about 4 to 5 years) so I can grow long hair again?

Note: I’m not asking if it WILL … just if it can!

Thanks

Some people will note that the hair that is impacted with miniaturization will stop growing prior to falling out from genetic hair loss. Propecia may reverse this ‘failure to grow’ process, but there is no way to be sure. Usually, hair that slows down prior to falling out, will not completely reverse back to its original growth rate, even on Propecia.

Tags: finasteride, propecia, hairloss, hair loss

American Athlete Taking Finasteride Fails Drug Test in Japan

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

From the Associated Press:

A former Triple-A pitcher from California has become the first player in Japanese baseball history to flunk a drug test.

Rick Guttormson, who played in the San Diego and Seattle minor league systems, was suspended for 20 days Friday after testing positive for a banned substance. His team, the Fukuoka SoftBank Hawks, was fined $63,000.

Japanese baseball officials said a postgame test July 13 showed Finasteride in Guttormson’s system. Finasteride was in a hair-growing agent the 30-year-old Guttormson had been taking for two years. It’s banned because it can be used as a masking agent.

Read the full article here — American pitcher becomes first player to fail drug test in Japan

Tags: finasteride, guttormson, japan, japenese, baseball, sports, athlete, hairloss, hair loss

Follow-Up: Are Doctors Promising More Grafts Than Can Possibly Be Delivered?

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

Re: Are Doctors Promising More Grafts Than Can Possibly Be Delivered?

Hi Dr. Rassman, I appreciate you addressing this very important issue. However, I think you missed the questions on this post. It seems to me the poster is asking if there is really 10,000-15,000 grafts available for transplant in the average male rathar than how many can be transplanted in a single session. I have noticed an increasing number of doctors who are saying this and using it as a basis for giving young men very aggressive hairlines. Can you expound on the issue of how many grafts are typically available?

The available number of hair follicles for a hair transplant is different in each person. Some of the factors that affect the number of hair grafts are:

  1. Density of hair in donor area. Average density is 2.0 hairs per square millimeter. It could vary significantly from person to person and between different ethnic groups. The actual donor area may represent 30% of your original hair (the rim around the head) of which half are possibly harvestable (in theory). This would reflect about half of the 30% of the original or 15,000 hairs (reflecting about 8000 grafts).
  2. The size of the head also affects the size of donor area. Bigger heads with similar hair density have larger numbers of donor hair. Unfortunately, bigger heads have larger baldikng areas.
  3. The average number of hair in each follicular unit is also important. People with higher density will have less single hairs and more groups of three and four hairs. In those who may have densities of 3 hairs per mm2 (150,000 hairs on such a head) the harvestable hair will be higher and may run as high as 45,000 hairs or 22,000 grafts (theory of what can be harvested). Actually harvesting these high numbers is more the exception than the rule.

Considering all these above factors, you can calculate the possible number of grafts and add to it the effectiveness of those hairs in producing appearance of fullness. It is true that in an average man with an average sized head, with average hair density (2.0 per mm2), and an average number of hairs per each follicular unit (~2), you can remove about 10,000 grafts safely, but this number can vary significantly and other factors should be considered in this equation.

This number is driven from a simple calculation that needs to be done for every patient when planning a hair transplant. Obviously since there are a lot of variables involved, this number can vary significantly, but is still easily assessable.

You asked about using such numbers for justifying an aggressive hairline. I occasionally have to create a thinner hairline due to scarcity of donor hair considering all of the above factors. I strongly believe that normal placement of a hairline in the ‘mature position’ is the correct location for a hairline. The Master Plan I keep talking about determines the distribution of harvestable hair in a worst case scenario, so that no matter what happens to the patient, no matter how much hair loss occurs with age, the patient will ALWAYS look normal. The quality of the donor hair is also very crucial for making the decisions in the Master Plan. I will, once again, list the factors that make up the elements for calculating transplant grafts in a solid Master Plan:

  1. Hair thickness (the thicker the hair, the more volume it will produce, so less hair is needed for a given result).
  2. Hair curliness (the curlier hair generally appears fuller and less hair is needed to produce the same appearance).
  3. Contrast of the hair color and skin tone (the higher the contrast the more hair is needed to produce the appearance of fullness).
  4. Donor density and scalp laxity will determine the ‘number of grafts’ that are available at any one point in time.

As you see, decision making is complex and many factors are involved. So available hair follicles are only part of this and other factors, including hair quality, should be taken into account. I also have to mention the importance of patients having a real expectation and is involved in making decisions on how aggressive we should design the Master Plan. See Medical Publications on the NHI site for more.

Tags: hairloss, hair loss, doctor, physician, hairline, surgery, hairtransplant, hair transplant