The Story of a 3,000 Graft FUE Procedure Failure

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

Story time! Although I can’t provide photos (by patient request), I’ll do my best to paint the picture…

A man in his early 20’s flew to Los Angeles from Alaska to see me last month. He already had two hair transplant procedures using the follicular unit extraction (FUE) technique — one surgery of 1,000 grafts, and another of 3,000 grafts — by two different doctors (that I won’t name) who each claim expertise in this process. The 1,000 FUE case by the patient’s estimate was about 50% successful, while the 3,000 FUE case had, according to the patient, no growth after a year. The donor area was heavily scarred from the FUE extractions and were easily seen by lifting up the hair. A strip procedure would have produced less scarring than this patient showed now. To compound the problem, those hairs that did grow from the first surgery were placed in a radial direction (like the spokes of a bicycle wheel) and the hair pointed to the sides, not the normal frontal position. So not only was he dealing with a huge failure of growth, but now he had to deal with poor placement for those grafts that did grow! Imagine a person with hair growing out of his head like the spokes of a bike?

This patient most certainly had a low donor density to start. I recommended a strip surgery to harvest the most grafts he can get and with the reduced donor density, I recommended about 1,300 grafts, which is possibly the most I can harvest. Fortunately, his hair loss was only in the first 1 1/2 inches of the hairline and by taking Propecia he might hold the rest of his hair in place, although there is miniaturization behind the frontal 2 inches, suggesting that he might bald further over time. He wanted to look normal, but I could only suggest that I would try to make him look better.

FUE is not a panacea for scars. As I have said here before, the follicular holocaust that is seen in FUE is substantial, even in the hands of those who claim success. This is a buyer beware market. You should always ask to see a number of patients who had the procedure and look carefully at the donor area. Another FUE procedure on this patient will be disastrous (even in my hands), as scarring is clearly a problem.

Tags: fue, hairloss, hair loss, hair transplant, propecia, finasteride, failure, surgery

Reader is Sick of Hypochondriacs on Hair Forums

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

Hi Doctor,

I know you’ve touched on this about a year ago but it wasn’t really answered so I’ll ask again, plus I’m sick of reading and hearing from all these hypochondriacs who seem to clog all Hair Loss forums telling me how I’ve ruined my sex drive forever!

Im 23 and I’ve been on Propecia for 4 months. I’ve noticed I’ve gradually lost my libido so I cannot tell you exactly how long it has been a problem for – possibly a month or 2? If I skip a day’s dosage it returns almost back to normal. I do not want to stop taking it as it has stopped my hairloss and i think even thickened my hair – not to mention it’s positive physcological effects!

My questions are:
– Does my libido return to normal while still taking Propecia or is it a permanent side-effect? and,
– Are there any pills I can take (perhaps Horny Goat Weed) that will counteract this loss of libido until (if?) it returns to normal?

Thanks Doctor.

Merry Xmas and a Happy New Year!

Loss of libido with Propecia occurs in about 1% of the male population. Of those unfortunate men who experience it, many will see that is disappears in a few months. Taking half the dose still gives you the benefits at the 80% level of a full dose, so cutting a Propecia tablet in half may be a solution for those that see (or think they see) side effects. Check with your prescribing doctor.

I do not know much about Horny Goat Weed, but then again, I have not treated any horny goats lately. Har har. As for libido pills, well, I don’t have much to offer so I’ll open the floor to the readers. If anyone has any libido remedies that you’ve tried (including supplements, potions, etc), I encourage you to post about it in the comments below. I’m curious to see what people have tried. Keep the purely spam comments out though, please.

Tags: libido, propecia, finasteride, horny goat weed, hairloss, hair loss

I Want a Hair Transplant, But I Love Cocaine

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

Hi

I’m thinking of having a hair transplant done but I have a question before I bother to consult with you.

I attend college and with college come wild parties. I spend most of my time studying but I do go to atleast one part per month. I usually like to do cocaine at the party. I do this recreationally and it’s only one time per month at most.

I don’t think I would be able to give up my one party per month for a hair transplant. Is it safe to get a hair transplant if you know you are going to be doing a gram of cocaine every month for the post operative period?

CocaineOh boy. So as a physician, did you expect that I’d be fine with telling you its alright to use cocaine at any point, let alone during your post-op period after a hair transplant procedure?! Come on, now. The obvious answer is to stop using illicit drugs, even if it’s just once a month. Cocaine is not only illegal, but it can also kill you.

I’m not your doctor, but I expect any doctor you talk to will have the same reaction to your question. Now that I’ve given my mini-lecture, here’s a link to another site where another physician has his take.

Tags: cocaine, drugs, illegal drug, hair transplant, surgery

I Still Have Redness After My Hair Transplant Years Ago!

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

I had my first transplant almost four years ago and my second one last October. I STILL have redness on my right side from the FIRST transplant. It is almost as if I got sunburned and that area stayed burned. It is not really bad, but it is bad enough that the transplant area still looks “outlined” making it look a little unnatural. The other aspects of the surgeries are spectacular, just have this one issue. Is there anything I can do about it? Thanks!

This is the type of question you should be asking your surgeon. Redness can be helped with the judicious use of topical steroid, but this is not a good idea without medical supervision as the body can absorb the steroids if you use too much of it. Also, the redness should not last that long — certainly not years, as you describe. Please discuss this with your surgeon.

Tags: hair transplant, hairtransplant, redness, healing

My Doctor Won’t Prescribe Proscar to Cut

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

Hi,
My Dr gave me a prescription for propecia for my hair loss. He was not willing to write for proscar for me to split. What options do I have? Can I send my script to be rewritten to someone out there who is willing to write for the proscar?

You can always seek another opinion from another doctor. There are those that focus on patient finances and those who do not and tend to be more rigid (a proper approach, of course). Proscar and Propecia are the same medication in different dosages, but it is up to the doctor to prescribe it to you.

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

I Make Minimum Wage and Want to Make Monthly Payments on a Hair Transplant

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

i was wondering if it would be possible to start hair transplant as early as 19, ive been losing since i was 17 and am currently taking propecia, propica has stopped most to all thinning around the tops of my head but my hair line is really embarrassing, i barley want to leave my house because of it, and when i do i wear a hat, i have long hair so this is really a stress

also i was wondering if you new of any hair transplant clinics that accepted monthly payments instead of one big down payment, i work a minimum wage job and really have been wanting to get this.

First you’ll need to get an assessment by a doctor to see if you’re a candidate for surgery. Rarely will a teenager be accepted for a hair transplant. We have loans in our office for those people who do not have enough money to pay for the procedure, but that requires good credit.

Tags: hair transplant, hairtransplant, surgery, payment, layaway, propecia

Does Propecia Work Better if You’re Thin?

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

Does 1mg of Propecia work better in smaller, skinnier men than in taller, bigger men?

There is no study that I’m aware of focusing on the size of the person taking the drug and its effect. If you were unusually heavy, I might prescribe a slightly higher dose if the 1mg dose did not work for you.

Tags: propecia, finasteride, size, weight, hairloss, hair loss, thin, skinny, tall, short

Did My Eating Disorder Trigger My Teen Hair Loss?

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

(male)
I hate to admit it, but I used to have an eating disorder.

For about a year I was bulimic, I purged just about every day after dinner. I had periods where I tried to stop, the longest I went without purging was a month. After a while though, I noticed significant hair loss (a spot on my crown so thin it’s almost bald). I stopped my bulimia about a month ago, and no hair has grown back and it still seems to be falling out! Now, I am a male so it may be male pattern baldness right? But I’m only 17!

As for genetics, all the men on my mom’s side of the family still have hair, and the only person on my dad’s side that’s gone bald is my father himself (he started going bald at 26).

Will I regrow my hair? Or is this male pattern baldness beginning to rear its ugly head?

Bulimia can certainly cause nutritional deficiencies that may cause many health issues, with hair loss being one of them. The most common cause of hair loss in men, however, is genetic male pattern baldness (MPB) — otherwise known as androgenic alopecia (AGA). Hair loss from nutritional deficiencies is diffuse (you lose hair all over your scalp), but in some men with AGA, bulimia can trigger the genetic process, though this is rare in males under the age of 17. Hair loss from male pattern baldness is in a specific pattern (as the term implies).

From your perspective, it does not really matter if your mom’s or dad’s side of the family has hair loss, because if you have the gene, you have the gene. It can skip generations, but it can also be passed down directly from your father to you. I can’t tell you that you will regrow your hair, because as I said, the bulimia could’ve triggered the process early. The only way to really tell what’s going on is to map your scalp and repeat the process over time to see how your hair loss is progressing.

Tags: bulimia, bulimic, eating disorder, hairloss, hair loss

Large FUE Case?

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

Dr. Rassman

What is the largest number of grafts you recommend to be transplanted in one session using FUE? What is the maximum number you guys at NHI have done in one shot using this technique?

Thank you and Happy Holidays to you and your staff.

The largest case we did was 2,800 grafts. The large follicular unit extraction (FUE) cases require high densities of the hair in the donor area. Those individuals who have lower densities generally have from 20-40% less hairs per square inch, so one could expect that yields may be as low as 700 – 1,000 grafts for most — and that is generally people from Asia (like Indians), many from the middle east, and those with African hair. In a Caucasian with an average density, we have done 1300-1500 FUE grafts.

I think that many of you have seen comments made by me — comments of disbelief about the number of FUE grafts claimed to be performed by some dishonest doctors. I’d like to see some more honesty in the industry, but the almighty dollar is more important to some.

Tags: fue, hair transplant, hairtransplant, hairloss, hair loss

Hair Falling Out in Permanent Zone

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

Hi Doc,
My hairline appears to be following the pattern of my grandfather’s whose hairline stopped at a NW 3 with a persistent forelock. However, my hair appears to also be falling out equally throughout the scalp, even in the permanent zone. I’m looking at the pictures of my grandfather, and he still had thick hair in his 60’s. Is it possible to have my grandfather’s hairline, while still having hair fall throughout the scalp even the permanent zone?

I suppose anything is possible, but it is rare to have hair loss from your permanent zone unless you have diffuse unpatterned alopecia (DUPA). If you feel you are losing hair diffusely, you may not have genetic male pattern baldness. You would need to see a doctor for a good diagnosis.

If I haven’t beat the following concept enough to a point of sounding like a broken record… a miniaturizationstudy would be helpful to see what is really going on. You can even map your own scalp using the tutorial I wrote, provided you have the proper tools.

Tags: permanent zone, donor area, hairloss, hair loss, alopecia, dupa

In the News – More Women than Men Suffering Hair Loss in Taiwan?

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

Snippet from the article:

Job loss stress and anxiety seem to be causing an increasing number of people in Taiwan to lose their hair, with a higher incidence of the condition occurring among females, medical doctors in northern Taiwan said Wednesday.

Li Cheng-hung, a dermatologist at the Buddhist Tzu Chi General Hospital in Taipei, told reporters that among his patients, more women than men are suffering from alopecia areata, a skin disorder that causes the hair to fall out in round or oval patches.

Read the full article at Taiwan News.

Stress can trigger hair loss… that has been known. Alleviate the stress and you might see your hair regrow, particularly in women where MPB isn’t a factor. For men, stress may just trigger the genetic hair loss you would’ve experienced down the line anyway. The article doesn’t get into any actual studies though, and just says that some doctors say female hair loss rates are on the rise. I’d like to see more proof, but the article is what it is.

Tags: women, men, hairloss, hair loss, taiwan, stress

Had a Hair Transplant a Couple Weeks Ago and Now I See Raised Bumps

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

In mid Dec 08, I had an FUT of 1150 grafts to restore my hairline. Scabs have come and gone and I’ve been left with raised, bumpy, partially numb skin that makes a line across my forehead where the hairs were inserted. Under lighting, this elevated skin is extremely visable and odd looking considering there is no longer any hair there.

Suggestions?

Go see your doctor who performed your surgery. Unfortunately, there is no way to tell with just your descriptive words. More over, I have no way of knowing how your surgery was performed or what technique was used. It may be Follicular Unit Transplantation (FUT), but not all doctors or medical groups perform the same quality surgery.

Tags: technique, hair transplant, aftercare, bumps, surgery

I Have Alopecia Areata and White Hairs are Growing in Bald Spots

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

about a month and a half i was diagnosed with alopecia areata and since then my hair has become alot thinner and i have about 5 main bald patches and a alot of small ones! small hairs have started to grow around the bald patches and i have started to grow white hairs on the patches! is this normal?

At one and a half months, there is not much you can say about the resolution of your alopecia areata. If you see hair growing inside the bald areas, that is good news (even if it is white hair). Maybe the process will burn out on its own. Good luck.

Tags: alopecia areata, hairloss, hair loss, bald spot

I’ll Be Backpacking for 2 Weeks in Hot Weather — Should I Bring My Rogaine?

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

Hi Doctor,
This is a pretty urgent question I suppose, and I’m hoping you could answer it before I go. I’m going to be doing field work and backpacking through Costa Rica. My question is, is it worth it and even possible to bring rogaine and keep it in my backpack while I’m hiking in 70-90 whether. I want to continue to gain the benefits but I’ll be gone for about 2 weeks and don’t know what the best plan of action is. any help would be appreciated. thanks!

Take your Rogaine with you. I don’t see why it wouldn’t be possible to keep it in your backpack. The package says to store it between 59-86 degrees F, so you should be fine.

Tags: rogaine, minoxidil, temperature, hairloss, hair loss

Isn’t a Hair Transplant Still a Good Fix for the Average Person?

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

Hello Dr.
With all of this Talk of new technology, isn’t a hair transplant still a very good fix for the average person? Do most people that you see have a donor density large enough to counter at least 80 percent to all of a completely bad male(Norwood Class 6)?

Fake ElvisI wouldn’t say hair transplant is a “good fix”… it is an individual choice, because you do not have to “fix” anything if you are bald. Haven’t you heard the saying, “Bald is beautiful”?

For those men who do not like becoming bald, they can take medications to slow or stop it, and with regard to their predicament of being bald, hair transplantation works for some and may not work for others. That is why it is a medical process requiring a doctor, not a hair stylist.

Most men I see have enough donor hair to achieve their goals (as long as they are realistic in their expectations), but rarely will it require 80% replacement of the lost hair in a class 6 pattern balding. I cannot make you look like an Elvis impersonator unless you are an early class 3 patient and in these, I have made Elvis lookalikes… at least hair-wise.

Tags: hair transplant, hairloss, hair loss, elvis