Using Permanent Cosmetics to Disguise the Tiny FUE Scars?

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

Many are concerned about the aspect of small dot scarring after an FUE procedure. Would micropigmentation (permanent cosmetics) be helpful to disguise these tiny scars? If so, what would the methodology be to be most cosmetically effective. I think if this were an option to disguise any scarring, hair transplants would not be as scary to proceed with.

Follicular Unit Extraction (FUE) scars do occur, but they should be minimally detectable with any length of hair (1/4 inch). I do not have experience with permanent cosmetics other than tattoos, which have problems associated with them, including changing color. Actually, a change in hair color over time will impact visibility of permanent cosmetics.

Tags: fue, hairtransplant, hair transplant, scar, scarring, permanent, cosmetic, tattoo

Flu Season is Coming Up — Will Antibiotics Effect Propecia?

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

Doctor, I hope you find the time to answer this question. Today is my first day on propecia. I shave my head so my balding won’t be so noticable–for which I hope to stop after a few months(case being if propecia works). Does shaving the head limit the effectivness and growth of new hairs on propecia?

Next, you know it’s flu season. Right now i’m taking anti-biotics: Amoxicillin 500mg and PSE-GFN 120mg; does this affect propecia and the effectivness of it?

Thanks

Shaving your scalp will not impact the value of Propecia, but you will not see its effectiveness on the miniaturization issues to know if and to what degree it is working.

Antibiotics can be used with Propecia and there should be no reaction. The flu is a virus and antibiotics will not kill the virus, contrary to common belief.

Tags: flu, cold, drug, propecia, finasteride, hairloss, hair loss

In Memory of Dr. James Arnold

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

A great doctor died on November 3, 2007.

I knew James Arnold, M.D., for years, and merged his San Jose, California medical practice with my Atherton practice in 1999 so that he could begin his retirement. His thoughts struck me as profound, as he and I were the same age.

From his Legacy.com obituary:

“I’ve always felt if you’re not living on the edge, you’re taking up too much space. The sacrifice in my move is a loss of income, but the reward is a gift of time. My most immediate goal over the next few months is to start the year 2000 with a clean piece of paper and a new box of crayons.”

Jim has spent the following years camping, rafting, motorcycling and exploring the world with his beloved wife, numerous friends, and family. He enjoyed spending time with his granddaughter, drumming, collecting wild mushrooms, and writing poetry in his self-made cabin. He was a kind and generous man who shared his love and friendship with all he met.

He died on a motorcycle living life to its fullest. He was always a caring human being and had an air about him that reflected the warmth of his good soul.

Tags: arnold, james, doctor, physician

Are Minoxidil and Propecia Worth Using? (with Photos)

/by William Rassman, M.D./3 /,

Whats up Doc!

I am considering getting on rogaine but am wondering whether or not the benefits of it would be worth the annoyance of its daily use. Is Propecia better? Have you seen any substantial results on Rogain along from any of your patients? I am currently just looking to reverse some thinning in miniaturizing hairs on my crown. Also, is the shed that it mentions is a possibility of any significance, i.e. can you visibly notice a shed from the minoxidil?

Thanks in advance!

When there is a shedding from minoxidil or Propecia, the effects on fullness are rarely visible.

Here are photos forwarded to me (with permission to publish here) by Dr. William Parsley of a 40 year old male patient who had a great response to a combination of minoxidil and Propecia (finasteride 1mg). He had no hair transplants. These medications do work together and on some patients they can have a remarkable result. From his before pictures, there appears to be considerable miniaturization and I can not tell which medication was responsible for this outstanding response. When there are miniaturized hairs, they can often be stimulated so that the hair shafts will thicken and many studies show that when these medications work, the greatest response comes from these miniaturized hairs which become thicker. If you click on the photographs and compare the before and after pictures carefully, you can almost see the miniaturized hairs (without magnification in these pictures) showing the thickening in the ‘after’ picture. I have seen significant benefits from minoxidil by itself, though not as spectacular as these photos show. Please note that neither medication has proof that they work in the frontal area, yet seeing is believing here. Click the photos to enlarge.

Before

 

After (minoxidil and Propecia combination use for 7 months)

 

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

How Many Men Go Bald?

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

I was wondering if balding is common, or am I just singled out to be bald while most men are not?

The incidence of balding varies with age, according to an article published by Dr. O’Tar Norwood in his 1975 male pattern baldness article in the Southern Medical Journal. This is reflected in the below diagram (and quoted text), borrowed from the textbook titled Hair Transplantation, by Dr. Walter Unger.

Diagram

“(A) Incidence of different degrees of male pattern baldness compared by age. (B) Differences in incidence of male pattern baldness between Hamilton’s and Norwood’s studies, with Hamilton’s findings being consistently 20% to 30% higher.”

The frequency of balding is dependent upon age. Dr. Norwood reported it at about 35% in the 50 year old male, Dr. James Hamilton reported it at about 55% in the 50 year old male. As age goes up, the frequency of balding is higher, peaking in both authors studies at about 65 years old (55% and 85% incidence of balding in Norwood and Hamilton, respectively). It should be noted that Dr. Hamilton introduced his hair loss classification scale in the early 1950s, and Dr. Norwood revised this some 20 years later.

Tags: hairloss, hair loss, hamilton, norwood, unger, hair transplant, hairtransplant, balding, bald

Is David Beckham Balding?

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

My daughter is a huge fan of Beckham especially now that he’s playing soccer in Los Angeles. She was looking at some Beckham photos and found this posting somewhere and forwarded it to me since she knows I’m all over the hair loss forums. Is this just bad lighting? It looks like he’s combing his hair forward a little but it could just be that his hair falls forward when its short. I know this is superficial, but I am just curious if you can tell between possible thinning or bad lighting (or a combination of the two perhaps). Thanks

David Beckham chatboard

BeckhamThe photographs in that link suggest that he is thinning, although I have seen many photos of him where his hair looks pretty darn good (see photo at right).

I would think that he would benefit from a miniaturization study and if he does have miniaturized hair, he could probably get a some kind of deal with Merck to become a Propecia advocate, particularly if that soccer thing doesn’t work out for him. Or as the rest of the world calls it, football.

Tags: propecia, finasteride, beckham, becks, hairloss, hair loss, thinning, football, soccer

Does a Hairline Visibly Mature?

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

I have an interesting question about the mature hairline:

When a hairline is “maturing” (receding of the hairline, like in your other article) , does it happen just like that (over a period of time of course) or can the person also SEE the miniaturization of the hair happening? (ex; under a bright light)

Thanks in advance

Sure, you can see and even feel the thinning miniaturized hair some of the time. Most men and women who are losing hair will comment that they notice their hair “feels” thinner in diameter and it often slows down its growth; maybe even stops growing before it falls out. The maturing hairline usually occurs prior to the age of 29 and may take as long as 10 years to appear.

For more on the maturing hairline, please see Maturation of a Hairline — Moving From Juvenile to Mature.

Tags: mature hairline, hairline, hairloss, hair loss

Son Is Losing Hair After Suicide Attempt

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

Good morning
My concern is for my son who has suddenly developed accelerated hair loss all over his head. Almost two years ago he got over a suicide attempt after taking many paracetemol. He is now being treated for stress and anxiety but over the last six months his once very thick head of hair is starting to thin all over. Can you point me in the right direction as how to help him with this. The whole situation is obviously not helping with his depression issues. His diet is also dreadful. Regards.

The issue is cause and effect and clearly he is complicated with many things that can accelerate hair loss (stress, medications, genetic balding). Assuming that he has genetic balding, the use of Propecia (finasteride 1mg) should be central to his hair loss management. That has a good chance of reducing or reversing the hair loss. Get a good doctor to manage this process.

Tags: finasteride, propecia, hairloss, hair loss, stress, suicide

Minoxidil Helped, But I’ve Stopped It Since Becoming Pregnant

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

Dear Sir,

I have been diagnosed with androgenic alopecia a couple of years ago, during which I have been on 5% minoxidil. I am 32. THis has helped, but now I am pregnant and of course, I discontinued the use of it. On the recommendation of my dermatologist, I used Thymuskin product for up to the 8th week of my pregnancy, but discontinued that as well, as advised by my Obgyn. I have noticed that in the first trimester, I lost a lot of hair, which can be either the cause of discontinuing minoxidil and/or hormonal changes in pregnancy, I guess. Now I am in the 2nd trimester and I am not losing a lot of hair, however, the hair is not that shiny and it seems to be thinner. Even though pregnancy should be a good period for the hair, I also read that pregnancy can trigger such hair loss in women with AGA that it sometimes is irreversible (on the frontotemplar area). I am of course extremely worried because I have experienced an improvement with minoxidil, but now with pregnancy I am afraid everything will go away and especially be irreversible on the front part (where my hair looks worst, to be honest). I am especially afraid of the post partum and breast feeding period, as I have read that then increased shedding will occur. Is there anything I can do now already during pregnancy to work against this or can you give me a word of consolation at least :).

Thank you very much for your reply

Focus on your pregnancy and your baby. Hair changes do occur in pregnancy and much of it reverses after the baby is born. The recent hair loss does sound like minoxidil withdrawal.

Tags: minoxidil, baby, pregnant, pregnancy, hairloss, hair loss, female, women, woman

I’m 56 Years Old — And My Hair Just Started Thinning About 6 Months Ago

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

Hi Dr. Rassman,

I’m 56,male and have seen my hair become generally thinner over the past 10 years. However, with exception of some recession at the temples I’ve had mostly a full head of hair until about 6 months ago. In the past 6 months my hair in the front has become rapidly thinner. Several months ago I started taking Propecia and using Procerin at the same time but I’ve not seen any results thus far. I have been coloring my hair for about 15 years and continue to do that the same as in the past. Those are the facts to date. Any ideas? Am I simply hitting old age with a crash, rather than easing into it? Thank you

Old age does not cause hair thinning — just look at Ronald Reagan at the end of his life. Hair loss starting at your age is highly unusual. You should be evaluated for your concerns and as you are in Southern California, I invite you to come see me at my Los Angeles office, where I will map out your hair and scalp for miniaturization and hopefully define the cause of your hair loss.

Tags: age, hairloss, hair loss

I Had a Hair Transplant, But I Have DUPA!

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

This is my story. I went to Dr. [name removed] because my front was thinning more than the rest of my hair. The doctor recommended 2489 grafts in the frontal 1 inch. He lowered my hairline because he said it was the sexy look and at 26 years old, that was a good look. After 9 months, the hair in the front was still very thin so the doctor told me to have another transplant. I purchased another 1804 grafts which did not appear to have grown out after another 10 months. I went back to the doctor and he told me that I needed more grafts. The area that he took the grafts from was very, very thin after the second transplant. I did not feel comfortable with this recommendation, so I went to another doctor to get a second opinion. He told me that I have DUPA and that the entire hair on my scalp was thin and see through. My scar is very visible. This second doctor told me that I should not have had the surgery and that I was in a bad place to do anything but wear a wig. So I went to a wig place and the wig was totally unnatural. The hair on the top was thick, the side hair was not covered by the wig and looked transparent. What do I do? Is there a place to complain about my surgical care? Do I go to a lawyer and if so, how do I find a good lawyer?

JusticeIt sounds pretty clear that by having Diffuse Unpatterned Alopecia (DUPA), you were never a candidate for surgery. Hair transplant surgery in men such as yourself is a disaster and no you will probably always show this deformity. It seemed that the doctor must have needed your money and did not care about your welfare. First of all, I would like to see you, possibly get pictures from you so that I could ascertain for myself if you had DUPA. I would try the use of dutasteride (only if you really have DUPA), which would be an off-label use of this drug. I have seen some men with DUPA get a response from finasteride, but high doses of dutasteride may have value. The problem with this drug is the issue of sexual drive and low sperm counts from its use. These would be things we would have to talk about and you certainly should not consider having children anytime soon if you try this route.

Your recourse includes:

  1. Complaint to the medical board of your state.
  2. Seek out a lawyer by going to the state bar for assistance in finding one.

The courts are generally not victim-friendly when dealing with hair transplants, because they do not see significant damages so the monies collected in the few cases that went to court have been pretty low. For the readers out there, please keep in mind that the doctor you choose should be ethical, honest, and competent. Try to identify the larceny in the doctors before you bet your appearance on someone you don’t know and can’t research.

I would be happy to help you, but we must first somehow meet.

Tags: dupa, alopecia, diffuse, hairtransplant, hair transplant, hairloss, hair loss, law, legal

Concerned About Redness After Hair Transplant

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

I am a 30-year old male and one week ago, I had a FUE Hair Transplant along my front hairline. I am concerned that there may be lingering redness in this area which will make it obvious that I had a procedure performed to co-workers.

In addition to products such as Vitamin-E, Aloe Vera, etc. to reduce redness, what are your thoughts about using a self-tanning lotion along the top of the forehead/hairline to blend the redness in this area to my natural skin color (assuming I used the tanning lotion on the rest of my face as well and didn’t go overboard with it)?

Assuming I waited a couple of weeks after the surgery, would the tanning lotion in any way harm the future growth of these grafts or pose any other risks?

In those patients who have a tendency to become red (and hold on to the redness after a transplant), I treat them with a copper peptide treatment. This works to reduce the redness and shorten the ‘red’ time, but if not started immediately, it will not have value. The use of steroids are routine for my post-operative period and when they are started at surgery, they do reduce the redness.

As for the other products you asked about:

  • Tanning lotion — I do not believe that this will work
  • Vitamin E — this may have limited value when used topically
  • Aloe vera — this does not help manage the redness

These are really questions that your transplant doctor should be addressing. I can not offer you much real advice without knowing more about you, but I may be able to come to a solution if I saw you in person.

Tags: fue, red, redness, hairtransplant, hair transplant, aloe vera, vitamin e, copper peptide, hairloss, hair loss, surgery

Experimental Drug VN/14-1 Fights Prostate Cancer

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

From the Washington Post:


In mice, an investigational agent called VN/14-1 proved effective in treating human prostate cancer, say researchers at the University of Maryland in Baltimore.

The five-week study found that daily injections of VN/14-1 in mice implanted with human prostate cancer cells resulted in up to a 50 percent reduction in tumor volume.

It is interesting that research in one area often reveals insight into other areas. Like in the discovery of penicillin, where Scottish scientist Sir Alexander Fleming noticed a mold growing on a Staphylococcus plate and suppressed the bacteria, it could be an observant researcher following a path that could lead to a cure for prostate cancer. Maybe a cure for balding will be discovered in a similar way?

Full article — Experimental Drug Fights Prostate Cancer

Tags: vn/14-1, prostate, cancer, drug, experiment, penicillin, hairloss, hair loss

2 Weeks After Starting Finasteride, A Bald Spot Appears

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

I am a 47 year old male who has been using rogaine for 4 years to “contain” male pattern thinning. I recently started taking finasteride to see if that would help more. I started taking 2.5 ( 1/2 of the 5mg pills) for a couple of weeks and have noticed a small but very noticeable bald spot develpoing at the very front of my hairline! ( it was always thick there) Is is possible that the finasteride could cause this? I have started to cut the pills into quarters as it seems like 1mg daily is the recommended dosage. Should I stop the finasteride? I am about to start taking synthroid as my T-4 totals are a bit low and I know that the thyroid can cause hair loss but I think it has something to do with the finasteride.

The recommended dose of finasteride for the treatment of male pattern baldness (MPB) is 1mg orally each day. Taking more will not have a greater benefit. I doubt that taking 2.5mg a day has caused you to lose hair on the front and I would not recommend stopping the medication without discussing these issues with the doctor who prescribed you the medication. There may be other causes of hair loss that you are not aware of and your doctor will be able assess this as he/she is able to physically examine you.

Tags: finasteride, propecia, proscar, hairloss, hair loss, bald spot

4 Years Ago, Doctors Said We Were 10 Years From a Hair Loss Cure

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

3 or 4 years ago I found myself attending lectures on hair loss. The belief at the time, was that any sort of “CURE” for hair loss was approximately 10 years away. The same answer was given by several doctors. Now I completely understand that a cure will only come when it comes and that a doctor telling me that a cure is 10 years away, does not mean that I should set a timer and count the seconds, but I’m curious if science and technology supports that response? Has our knowledge and science progressed enough that a cure could be,….7 or 8 years away? or are doctors still saying 10?

It seems 10 years is a good round number and far enough away that we can promise these cures and just let the timeline slip. In reality, nobody really knows. I do not think anything significant has happened in the last 2 or three years to say the “cure” is 7 to 8 years away.

Tags: hairloss, hair loss, cure, balding, baldness