In the News – Aderans and HairDX Team-Up in Japan

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

Snippet from the article:

Pharmacogenomics research and development innovator PharmaGenoma, Inc. and its subsidiary HairDX, LLC, pioneers genetic tests for predicting the risk of male and female hair loss, today announced an exclusive agreement with Aderans Company Limited of Tokyo to introduce the breakthrough tests in Japan starting on March 1, 2009. The HairDX test collection kit is listed with Japan’s Pharmaceuticals and Medical Devices Agency (PMDA) as a Class I medical device.

The agreement makes Aderans the sole Japanese distributor of HairDX’s revolutionary genetic tests, and further expands Aderans’ leadership in the hair care and medical fields. Aderans and its group of companies span over 17 countries worldwide, and in 2001 Aderans purchased Bosley, Inc., one of the world’s largest brands in hair transplant, to further solidify its global position as a leading company in the hair care industry.

Read the full article at MarketWatch.

Interesting news regarding the business side of genetic testing. Yet in my opinion, the diagnosis of genetic male pattern balding (MPB) probably does not require a genetic test as the diagnosis is self evident in the pattern of balding or miniaturization. Do you need a genetic test to tell you that you have blue eyes? I suppose you can make the argument that you can slow down the balding process or start a medical treatment plan (Propecia) earlier if you know you have the “gene” for balding. But in my opinion, starting treatment without having evidence of balding is not the proper thing to do.

Predicting a possible fatal disease like genetic testing for breast cancer may pick up the risks early (before the cancer appears), but we would not take off the breasts of a 15 year old just because she carries the gene. Clearly the older a woman becomes, the greater the risk becomes, so the decision on when to treat the genetic propensity is difficult. I am all for genetic testing and research, but my personal bias on the HairDX testing is that it is a marketing tool rather than a clinical tool, as it should not dictate treatment without showing overt balding or miniaturization.

Tags: hairdx, aderans, japan, hairloss, hair loss, gene, genetic, testing, pharmagenoma

Are Allergies Causing My Miniaturization?

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

Hello Dr. Rassman,

I am a 25-year-old male and I have been noticing a rapid thinning and recession for about a year now. 3 years ago I got on propecia cause I was shedding real badly. I stayed on it for a year, noticing less shedding and darker hair but that was it. I got off of it cause I thought it wasn’t doing much. Then I started to notice miniaturization forming at the front of my head. My family (both sides) has thick hair, really thick hair.

Fast forward to now and my entire front to mid scalp is miniaturized (looks like a thin doll hair forest) and I am continuing to recede. I tried starting up Propecia again; for 5 months a year ago but stopped cause I felt like maybe it was the cause of this thinning. This is also the time that I was diagnosed for Prostisitis and Epiditymitis. I still have prostititus and it’s been about nine months. I am also continuously shedding except now they are very fine hairs, most of them have bulbs on the end and my hair feels very brittle and dry all the time (even after conditioner)

What I do notice when with the receding line is that before I loose the hair and it goes further back, I get red bumps, kind of like pimples, they are really itchy I noticed it back when I first started receding 5 years ago. They usually cover the entire line then once I recede past, no bumps and the skin is fine. I have these little bumps all over my head and they itch and burn really bad. Almost like ant bites. (The bumps were also there while I was on Propecia). Do you think I have an allergic reaction to something? Can allergies cause hair loss and miniaturization? Or can it be the prostisitis causing something? Or the propecia?

Please note: I have been tested for STD’s, irregular kidneys, regular blood tests, urinalysis, testosterone levels, thyroid problems. They all came back negative. I’ve talked to one dermatologist and he said I might be allergic to dairy. But I have been drinking it all my life. Any type of info would be helpful at this point.

Thanks

Your case is not simple and one would want to know far more about you than this summary will allow. The most common cause of hair loss in men is genetic male pattern baldness, and while anything is possible, it is not too likely that allergies are causing your miniaturization (especially if you are thinning in the typical male pattern). If you think there’s a dairy allergy that suddenly came on as an adult, then avoid dairy and see if your hair grows back or hair loss stops. My guess is that it won’t make a difference to your scalp though.

Starting and stopping the Propecia means that you are acting like your own doctor. Stopping that drug will kick start the hair loss again and restarting it again may do less good each and every time that you make a change. The red bumps you describe on your head just confuses me more, as I can not put it all together. You should seek out a second opinion from another dermatologist in your area and have him/her examine those itchy bumps on your scalp.

Tags: propecia, finasteride, allergy, hairloss, hair loss, dairy, bump

Are My Temples Miniaturizing Because of a Mature Hairline or MPB?

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

Hello Dr. Rassman,

I’m in my early twenties and recently went to the dermatologist who said that I had a little bit of miniaturization by the temples, and that I could be in the early stages of MBP. He also told me that I had pretty thick hair, and not to worry, but he did not say if the hair would keep receding. He then told me that he had some temporal hair loss but it had reached an equilibrium and been that way for the part 10 years. I am wondering if miniaturization of the hair means MBP, or because is it is slight so far could it be part of the hairline naturally maturing, and stop? If the genetics help in your answer (My father has a full head of hair, My mother’s father had a full head of hair, I have two maternal uncles, one of them is bald and started at around 18, and the other one has a full head of hair in his 50’s.) Thank you for taking the time to help.

Take a look at the Maturation of a Hairline posting and see how this conforms to what is happening to you. If you miniaturize behind the area where the mature hairline is developing, then you have genetic balding. This is a very simple process to undergo and then you will have the insights into your own balding pattern if it is present.

Generally speaking, if you’re losing hair in the temples, that is not a maturing hairline. It is also possible that your genetics will cause your temples to recede a little and that will be the only hair loss you have. I’ve seen this in some patients.

Tags: miniaturization, mature hairline, maturing, hairloss, hair loss

Could FUE2 Replace the Strip Method? (Part 2)

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

This is Part 2 of 2. If you missed Part 1 from yesterday, that can be found here.

—

What is FUE2?

Ever since we announced the FUE2 technique a few months back, people have asked me how it is different from the traditional FUE procedure I invented and published in the medical journals back in 2002. The basic difference is the addition of a water jet for enhancing the dissection of the excised graft. The pressure of the water jet adds to creating a plane of dissection which produces clean grafts as good in most situations as strip harvested grafts (the golden standard for follicular unit transplants).

What is better, the strip or the FUE2? First lets assume that the FUE2 produces comparable quality grafts to the strip harvesting method. When the donor density is low, the missing follicular units from FUE2 become obvious when the hair is cut short. There can be a moth eaten look in these low density people. In high density people, the FUE does not show up so there is generally not a moth eaten appearance, but the many white dots created by the FUE scar can be seen and this will absolutely limit a shaved head. When a strip is performed and a good wide lower trichophytic closure is created, the scar is less in most patients than any scar from FUE. The problem is that most FUE doctors have created illusions around what they do and produce hype that will never be substantiated in most patients, particularly those with low to average densities and a high number of FUE grafts. I always tell the patient that I get 50% more $$$ for an FUE procedure (graft for graft), so if I recommend the strip as a viable alternative, it is clearly not a financial issue for me. The results of the evolution in my thinking is based upon following many patients (mine and other doctor’s patients) with regard to scarring.

THE FUE2 is a better procedure than the standard FUE, but not better with regard to strip harvesting in quantity and quality. FUE fails to grow at the 90% plus rate much of the time in most doctor’s hands, but strip grafts do not. I am afraid to tell you that honest doctors who do FUE are few and far between, but they do exist. With our FUE2 procedure, we clearly can do it better than most doctors. And as our survival rate following FUE2 is comparable to strip harvesting and significantly better than traditional FUE, the choice with us is clearly in the hands of the patient. I try to present a balanced approach in the analysis when patients come to my office and ask about FUE.

Tags: fue2, fue, hairtransplant, hair transplant, hairloss, hair loss, technique, strip

Concensus Among Doctors About Hair Transplant Aftercare?

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

I will be undergoing a transplant in the near future and am wondering if there is any consensus on post op care, shampooing etc. Please elaborate on the difference between crust formation and what it is and the ideal of not dislodging the graft if you may. I did read some earlier posts referencing a study which advocated frequent “showering” after the procedure. Does this mean a gentle stream of water on the head or irrigations with say a bowl of water on the head etc. I am very interested in the current consensus. PS I am also a MD. Thanks so much.

Good washing requires a balance between mechanical washing and suds. Frequently wetting in the shower will not do the job. I do not believe that doctors have a consensus on this subject.

I suggest you buy my book, Hair Loss and Replacement for Dummies, for an in-depth discussion of the very issue of patient aftercare (buy it at the Hair Outlet Store, powered by Amazon).

Tags: aftercare, hairloss, hair loss, hair transplant, shower

In the News – Scientists Discover Cause for Gray Hair

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

Snippet from the article:

Scientists may have figured out why hair turns gray, and their finding may open the door to new anti-graying strategies.

New research shows that hair turns gray as a result of a chemical chain reaction that causes hair to bleach itself from the inside out.

The process starts when there is a dip in levels of an enzyme called catalase. That catalase shortfall means that the hydrogen peroxide that naturally occurs in hair can’t be broken down. So hydrogen peroxide builds up in the hair, and because other enzymes that would repair hydrogen peroxide’s damage are also in short supply, the hair goes gray.

Read the full article at WebMD.

This article was pointed out to me by a member of the BaldingForum, so my appreciation goes there for drawing my attention. If you have a hair-related news item, please send it!

Tags: catalase, gray hair, grey hair, genetic

Graft Count Estimates

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

Hi Dr. Rassman,

I am a 32-year old male who had HT surgery in San Francisco in 2002. At the time they intended to do only 600 grafts, but since my car got towed during the consultation, the doctor threw in 100 free grafts, for a planned total of 700.

Interestingly enough, when they harvested the strip from the back of my head, they had 800 (!) grafts available, and of course all of those got put in. I have a very nicely shaped hairline and some diffuse crown thinning, but I have been taking propecia since 2002. My father is 67 next month and has a full head of black hair, but my mom’s father was bald by 25.

I’m considering going in for another 2000 grafts to really increase the density in the front and maybe lower the hairline if it’s appropriate. I’m going to be running for public office in 2010 (I don’t want to say which office to preserve my anonymity, but suffice to say this would be a career change). One doctor told me he felt I had a donor density of around 120 grafts/cm2 and another consultant (not a doc) said I probably had 7000 grafts available in my head. Would 2000 grafts deplete my donor density or does 7000 sound really likely? Moreover, what are the chances of them going to take out 2000 and getting like 2300, based on my previous HT.

Thanks!

You need an experienced doctor, not a salesman, to tell you what your density is and what your reserves are like. This conforms to the Master Plan I continuously talk about. Depleting the donor supply can occur with 2000 grafts, so you must be confident that your doctor levels with your and it honest about your future.

To estimate the number of graft, one must know the density of the donor area. A density of 2.1 hairs per mm square will produce approximately 100 follicular units per square cm. The calculation is relatively simple by figuring out the number of grafts one needs and plan on excising that size of a strip that conforms to the above density. There are adjustments that are required which reflect the amount of tumescence (fluid and local anesthesia) that is injected into the donor strip. As the density goes up by 20%, then the yield will go up by 20%. The same is true for 20% reductions in density (as occurs in the average Asian). The adjustments must be made and tied to the measured density of the donor area as seen in a number of sampled areas. I published the formulae for this process in International Journal of Aesthetic and Restorative Surgery back in 1995 (see article).

Tags: hair transplant, hairloss, hair loss, density, donor supply

Why Are Some Transplant Scars More Noticeable Than Others?

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

How come some people’s scarring on the back shows up so noticeably, and others don’t? Does it all depend on how many grafts you use?

Scarring is a complex problem related to:

  1. The healing properties of the patient
  2. The size of the strip
  3. The techniques used at the time of the surgery
  4. The skill of the surgeon

We are all different, so assuming you compare 100 of my patients (where I did all of the surgery) that only received 1000 grafts, for example, the variation in healing will become evident, assuming that the exact same technique was used on each closure.

When I performed general surgery and did an appendectomy, I used to brag how wonderful my scars were, and how you could rarely find them. That was the case in 19 out of every 20 patients. The 20th patient would be excluded from my bragging. Get it?

Tags: scarring, scar, hair transplant, surgery, hairloss, hair loss

Does Propecia Strenghen Miniaturized Hairs Or Grow New Ones?

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

If Propecia gives you regrowth, will it first shed out the miniturized hairs and then grow healthy hairs or make the miniturized hairs just normal again?

Propecia increases the diameter of the hair shafts that are miniaturized, and one tends to see the most beneficial response in those hairs that are recently miniaturized. Some people see shedding after starting Propecia, and that could be due to speeding up the hair cycle so new, healthy hair grows. That’s just an educated guess shared by many doctors at this point, and not something that has been proven (as far as I’m aware).

Tags: propecia, finasteride, miniaturization, hairloss, hair loss, hair growth

Could FUE2 Replace the Strip Method? (Part 1)

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

This is a long piece, so I’m breaking it up into 2 separate parts. Here’s part 1, with the 2nd part coming at the same time tomorrow…

Do you believe that the FUE 2 (or standard high yield FUE) process could completely replace the strip method of hair transplantation? Why or why not?

There are practical problems with the FUE2 method of harvesting. First, the patient must have his hair clipped widely if he wants/needs extensive grafting above 600-800 grafts (the number of grafts which can be taken from a small area is very density dependent). Most people will not allow us to clip their hair that short and certainly people who have had previous strip harvesting will often not want to have their hair clipped that way either. Many patients who come for FUE end up switching to a strip technique, because of the haircut issue alone.

The FUE’s maximum number of grafts, compared to a strip harvest, will produce less hair with FUE. The strip method of harvesting obtains the donor hair from what the surgeon calls the sweet spot. The FUE can not get the number of grafts from the sweet spot as well as the strip, but the FUE may be limited at each surgery. I read a great deal about the reported FUE megasessions and although I am convinced that much of the hype of 3,000 graft FUE sessions are misrepresented and promoted based upon false claims by less than honorable doctors, the public wants to see this happen and they are ready to believe almost anything a slick doctor tries to sell.

So for the patient who is bald and needs a high numbers of grafts, the strip harvesting method is superior because more hair can be moved in a single session, minimizing the number of sessions when compared to FUE harvesting. For those people who want to get the job done quickly and they need graft numbers in the thousands of grafts, the strip method is far more time efficient.

On the other hand, a new dynamic can be created where people take multiple sessions of 500-800 grafts every 6-8 months until they add enough hair to create what they want. A slow approach has many advantages including:

  1. Spreading the costs over a longer time
  2. Developing a changed image very slowly so that nobody will ever recognize the change
  3. Minimal pain and very fast recovery without limitations on any activities from weight lifting to scuba diving, and so on.

There is a place for both choices and for those men who are not very bald, the ability to achieve reasonable results in one or two sessions are a practical approach to the problem.

Check back for part 2 tomorrow…

Tags: fue2, fue, hairtransplant, hair transplant, hairloss, hair loss, technique, strip

Generic Finasteride in the US?

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

Dr. Rassam,

Finasteride Generics in 1mg dosage are available in Europe and I wanted to know if you are familar with the products being available in the US? Is generic Finasteride the same as Propecia?

THanks

Generic finasteride 1mg is not available in the US legally due to patent laws. Generic finasteride 5mg is available in the US. There are a variety of makers of the product overseas, and I’ve written about it before here. Just make sure that the generic finasteride is 1mg — sometimes it is sold as 5mg to treat the prostate (and it needs to be cut into 4-5 pieces for treating hair loss).

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

Nanogaine

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

What are your views on nanogaine?

Nanogaine’s active ingredients are Superoxide Dismutase, Capilecti, and Lo-Seb, but there is no proof that this substance works on hair regrowth or even prevention of hair loss.

Tags: nanogaine, hairloss, hair loss