Hair Transplant Surgery Technician Certification?

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

I work for a surgeon. He wanting to provide hair transplant services- some in office. He had said something about having a technician to assist with the hair follicle grafts- Does this technician require certification and if so where do you obtain this?

CertificateThe International Society of Hair Restoration Surgery (ISHRS) has information about fellowship programs for physicians here. It is very difficult to train a good hair transplant technician. It often requires months of daily constant practice, the initial work under close supervision. I have trained a few dozen techs and many of them want to quit within days of starting training. Errors on the part of the technician can kill the transplants from a variety of causes, including drying of a graft (usually killed in 10-20 seconds of air exposure), rough handling, killing the growth center, poor placing, and depth control. The hand-eye coordination is really difficult for placing a graft. Ask your doctor to visit an experienced hair transplant surgeon and try out some of the process. If you wanted to become a hair transplant technician, that may just change your mind. For the patient, the worst thing he can have is a technician given too much responsibility during the training process, as many grafts will die as the technician learns the process. Remember, I said it may take six months to a year to get competent and years more to get really good. As a patient, I would want an experienced technical crew. There are very few doctors that developed the skills to train a hair transplant technician so one might wonder where they got their training from.

Long story short, there is no certification for this job… just lots of training time and constant, daily practice. If your doctor expects to get growth from a hair transplant, the worst thing he/she could do is to pass on the responsibility to you (no disrespect intended).

Tags: technician, hair transplant, surgery, hair restoration, hairloss, hair loss

Total Crown Renewal, Follow-Up

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

Dr. Mark DiStefano commented on my Total Crown Renewal post, and I’m highlighting it here:

It is truly regretful that Dr. Rassman was so scarred, both physically and emotionally by scalp reductions performed on him nearly two decades ago. I have known Dr. Rassman since I entered this field from Emergency Surgery almost 15 years ago. He has been a leader, entrepreneur, academician and teacher in the field of hair restoration.

When I entered the specialty of hair transplant surgery, Dr. Rassman had already established his practice and was experimenting with new hair transplant techniques.

With his help, the (then) modern use of the FUE (follicular unit extraction) procedure changed how we view the use of “plugs” or punches. Most hair transplant surgeons stopped using the punch 10 or more years ago . But with his invention of the FOXâ„¢ Megasession technique, he helped to lead the rest of us to today’s FUE method. When he started with this technique, many physicians were skeptical and discredited the “punch technique. But now, after continued development and refinement of technique, this has opened up an incredible area for donor hair and seemingly scarless (lack of linear scar in the donor area) surgery.

This, too, can be said for the Total Crown Renewal®. Although it may appear this procedure is based on the “old” scalp reduction, the Total Crown Renewal® utilizes different techniques to make dramatic final results.

With the old scalp reduction, the area of balding was pulled closed with from 1 or more scalp reductions. The problem with the “old” scalp reduction, was that it used mechanical stretch, (brute force), to stretch the hair bearing scalp together. This usually resulted in “stretch back, phenomena that resulted in production of excessive scar tissue in the area. Also when the number of scalp reductions was done to complete the process, there was a slot formed in the midline of the scalp and the hair was now going in the wrong direction.

[See Dr. DiStefano’s full comments here]

I thank Dr. DiStefano for his comments. The number of surgeons capable of performing the correction surgery for the deformity created by scalp reductions are very limited I have seen many doctors attempts at this corrective procedure and it was botched. For our readership, most surgeons are cocky about their abilities to see a single surgery and then with a book in hand, do it themselves. This corrective procedure is a rare example of the failed logic of this premise.

But basic to my problems with this surgery is the logic of the scalp reduction surgery itself. When the scalp is stretched (even with the well designed Frechet Extender discussed above), the hair that comes from the sides of the head is diluted so much that the density of the donor area is significantly depleted. This means that the available hair to treat the front and top of the head is reduced substantially (robbing Peter to pay Paul). Unless a person has an unusually high donor density and a reasonably loose scalp, there may not be enough hair to properly treat frontal balding. My second problem with Dr. DiStefano’s approach is that the procedure always produces a deformity when it is successful (the famous “slot deformity”) and the only way to manage this problem is with the Triple Flap Procedure that Dr. Frechet has personally defined. That would leave me asking, “Why would anyone want to have a Total Crown Renewal and get a deformity that still needs another surgery to correct?”. Certainly not me!

Tags: total crown renewal, frechet, distefano, hairloss, hair loss, flap, hair restoration

I Didn’t See Shedding, But My Hair Is Thinner After Starting Minoxidil

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

I have read through this blog but cannot find a question that is very similar to mine. Much appreciate an answer.

I’m 40, been balding slowly for many years now, and when the middle part of the scalp started showing up, decided to do something about it. The dermatologist prescribed fin-minoxidil combo. But I have been only on minoxidil for over 6 weeks now. For the first five, I’ve been applying about 1.5ml twice daily; then I realized I was reading the meter on the injector wrong, and have been doing 1 ml twice a day since.

My hair has thinned at a much faster rate after starting the treatment. I know that some people experience minoxidil-induced shedding initially, but here is what perplexes me: I did not notice any visible shedding. By ‘visible shedding’, I mean that I did not see hairs falling off, but the appearance on the scalp is one of heavy loss. In fact, visible shedding has come down quite a bit. My hairs are thick, and prior to beginning the treatment, I would see a lot of hairs on the floor at workplace, or on the pillow, or in the bathroom sink. I see far fewer hairs now after minoxidil. Yet, overall, my hair definitely has thinned at a much, much faster rate.

I am not sure what to attribute this to. Should I assume that minoxidil is working, and that thinning has happened because I shed miniaturized hair that naked eye couldn’t quite spot well? Or am I experiencing a rare adverse reaction due to first 5 weeks of overdose?

Is it possible that minoxidil can cause permanent hair loss that wouldn’t otherwise have occurred without the drug? Thank you very much.

First, you should meet with the doctor that recommended the treatment. I would have mapped out your scalp for miniaturization so without those baseline measurements, I would not know what is going on with you.

Is the finasteride/minoxidil combo a 2 step approach (oral finasteride, topical minoxidil)? Either way, two months is a short time for these medications to give you an effect, but your doctor should check you out to be sure you are not harming yourself (doubtful).

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

Folliculitis 2 Years Ago Caused Crown Hair Loss?

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

I was diagnosed with folliculitis 2 years ago that caused hairloss at the crown. I noticed it got much worse everytime I took a haircut. After a rigorous course of antibiotics and avoiding the barber I am seeing improvement and regrowth of hair. This regrowth, however is exceedingly slow. The doctor recommended hair force to help but its still quite slow. Given such a lengthy time frame of 2 yrs. do you think my hair will fully recover?

Without examining you, I can not give you an answer to your question. What you need to know is whether you have genetic balding. This can be answered with a genetic test to see if you have the balding genes (HairDX) or a miniaturization mapping of your scalp which will show if the hair is in the process of balding. With the history of folliculitis, I would suspect that you precipitated a genetic balding process, but without examining you, I can not tell.

Tags: folliculitis, hairloss, hair loss

I Don’t Want Hormone Changing Drugs, But I Want to Stop Hair Loss

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

Hi,

What if we do not want to take propecia (too many side effects). Can we still do a hair transplant? I am not happy taking hormome changing drugs for life, but want to stop hairloss.

Thanks

I can’t offer you more advice than I have already posted. See these posts:

Tags: propecia, finasteride, hormones, hairloss, hair loss, hair transplant

DHT and Estrogen?

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

Hi Dr. Rassman!

I have a question regarding DHT and its effect on estrogen.

Isnt it true that DHT is essential to keep estrogen levels at bay? And by removing up to 70% of DHT with a drug like finasteride youre exposed to amounts of estrogen not normal to a male body. That could make for ex building muscles harder, cause you to develop gyno (male breasts) and or other feminine atttributes? What can be done to keep the estrogen levels normal when youre on a drug like finasteride.. or does it matter much if estrogen is roaming freely? whats your opinion Dr. Rassman.

This is a huge concern of mine. Thank you

Your questions are all over the map and many of your facts just don’t fit together. You do not wipe out 70% of DHT, you just block 70% at the hair follicle level. There is no feminizing effects of taking a DHT blocker and if by rare chance you got breast enlargement, it is thought of as an idiosyncratic reaction, not a feminizing process.

Tags: dht, propecia, finasteride, estrogen, hairloss, hair loss

Has Anyone Died from Using Minoxidil?

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

Ive been using minoxidil for some months now then I started experiencing prolonged chest pains. Reading the other questions posted here I’m just wondering: Has anyone died from using minoxidil? Or at least are there cases when users developed drastic health problems from its use?

Chest painI’m not aware of any reported deaths from using minoxidil, but I did find that there was something published in the Journal of American Academy of Dermatology over 20 years ago titled, “Deaths associated with topical minoxidil therapy“. The problem is, I can’t find any text from it, nor have I found anything referencing minoxidil related deaths since then… so the title could be misleading. It has been reported to kill cats though.

Minoxidil was originally an oral blood pressure lowering medication. When you put it on the scalp, it can be absorbed in to the blood stream and cause low blood pressure related symptoms which could restrict coronary and brain blood flow (in theory) causing a heart attack or stroke. If you are having chest pains, it may not be related to minoxidil and could just be coincidental… or you may be unmasking a serious heart related issue. I would urge you to go see your doctor and have your heart checked out.

Tags: minoxidil, chest pain, heart, hairloss, hair loss, death, health, rogaine, regaine

My Hair Thickened and My Depression Disappeared

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

Hi I have a question about medications. I have been with a hair company called Ashley and Martin and I have been using their hair products. These being saw palmetto, proscar, and their special hair solution which has minoxidil in it. Also before I had been using these products I had depression, anxiety and my sexual libido(appetite) was not around. Since taking these medications for hair loss I feel great, my hair has thickened, my depression has disappeared, and my sex appetite is very high. I’m just a bit scared of getting off the medication in case I start losing my hair and also go into depression again. Also are these medications ruining my health? I need your help and would be very thankful for a reply

First off, you said that you’re taking Proscar (finasteride). I hope you’re cutting the pill if you’re taking it to treat your hair loss. Proscar is 5mg of finasteride — you only need 1mg daily to treat hair loss (marketed as Propecia).

You’re seeing good results from the combination of treatments, but if you stop them you will lose the hair you gained from the medication. Minoxidil and finasteride are proven hair loss treatments (and the only FDA approved medications for that), and stopping them will cause any benefits you saw to disappear and your hair loss to resume. Could losing your hair lead to depression? It’s possible. If you’re not seeing negative side effects, I don’t see how the medications could be ruining your health. Like I said, the minoxidil and finasteride are FDA approved to treat hair loss, and they are proven both safe and effective.

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

I Want a Teenage Hairline Permanently!

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

Hello,
I am 20 years old and my hairline seems to be receding. There is miniaturization in a clear line, and then thick normal hair also in a clear line. I am wondering If this is a sign of my hairline settling into a mature widows peak sort of line(I went to talk with a specialist at at a clinic in New York and they said I wasn’t even the first part of the Norwood in the receding section, though I notice a lot receding at the temples.

Could this be the end if the miniatrization is that clear or would taking finasteride(probably finpecia since I am currently unemployed) be a smart option. I am opting for a teenage hairline permanantly seeing as I plan on doing sort of gender bending performance art and want a hairline that can he feminine as well.

I am willig to do anything to get ride of the receding hairline, I never want a mature hairline. This might sound naive or childish, but I do not feel comfortable looking manly at all, and never will, so I am DESPERATE. I know my options, would I have luck with finasteride?

At 20 years old, you might be a good responder to finasteride… but as for expecting it to regrow a maturing hairline and go back to your 10 year old line, it won’t do that. What you’re asking for is likely going to require surgery (as drugs will not reverse frontal balding), and at 20 years old it doesn’t sound like you made up your mind wanting your 10 year old hairline back. Hair transplants can be done to give you that, but do you really know where you mind is when you are 30 or 40. You get the picture? I never say never, but you need to bond with a good doctor, not one that just wants to take your money in these difficult financial times and become realistic with regard to what may happen to you over time.

Tags: propecia, finasteride, mature hairline, hairline, hairloss, hair loss

Woman’s Hair Loss Worsens Even With 2 Years of Laser Comb Use

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

i am using laser comb for about 2 yrs now and my hair loss continues to worsen. am wondering if you have heard of any negatives about its use in women? i cant help but wonder how much worse it would get if i quit using the comb. any comments please????

Sorry, but recent articles and studies show the various laser combs and laser treatments for hair loss are not as good as once thought. The science I have seen is flawed. In other words, lasers do not work as promised. For those of you who spend hundreds or thousands of dollars on this and many other illusive cures for hair loss, remember one thing — “let the buyer beware!”

I’ve written about laser treatments many times before, so please search for LLLT to read more.

Tags: lasercomb, laser, lllt, hairloss, hair loss, female hair loss

I Felt Testicle Pain Within 2 Days of Taking Propecia

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

Dear Doctor,
First I would love to thank you for your informative website which is really helpful.

Two month ago I started Finastride 1 mg as my doctor told me to do. I felt a testicular pain within two days of using the medicine. It got worse everyday till the 6th day that I got annoyed so, I stopped taking the pill and the pain disappeared within a week. now I started again with 0.25 mg of the medicine as my doctor said to lower the dosage. Again the second day I felt the pain. I was wondering if it is harmful to wait for a while? and how long is the time that I can wait without being harmed by the drug, assuming that the pain is bearable?

There are reports of testicular pain with finasteride, although rare. Your history suggests a one to one relationship between the two. If half the dose (0.5mg Propecia) does not work and your doctor examined your testicles and they are normal, then you may not be able to tolerate the drug. Speak with your doctor before making that decision.

Tags: testicle, pain, hairloss, hair loss, finasteride, propecia

Finasteride Side Effects — Readers Asks People to Get a Grip!

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

How come people can’t get a grip?

There is so much hysteria out there about the sexual side effects of Finasteride on all the balding forums and blogs that I though I should link a couple studies that might calm some of this down.

  1. Medscape (*Editor’s note: requires login)
  2. Journal of Sexual Medicine

Both of those independent studies were done with the 5mg dosage and both are aimed at explaining the occurrence of sexual side effects from taking the drug. The second one is especially interesting because it involved splitting users into two categories, ones who were told about the sexual sides and one who were not…big surprise; the ones who were informed of the sides reported side effects at a MUCH greater frequency then the people who were oblivious.

Both studies conclude that side effects are very rare and in most cases are psychological. Archives of Dermatology (PDF file)

Then there is this study done recently at the University of Bologna by Dr. Antonella Tosti where:

“The IIEF, a brief, reliable questionnaire, was self-administered to 236 patients taking Propecia® and 236 age-matched males attending the Department of Dermatology of the University of Bologna”

She concluded that sexual dysfunction is actually less common then reported in the literature and there was no real statistical difference in sexual dysfunction between the men on Propecia and the men who weren’t on anything.

I am someone who was considering taking Propecia but I was on the fence after all the horror stories I read, finding these articles really helped put my mind at ease and I hope they can help others as well.

I thank you on behalf of all the visitors to this site who are in a panic or undecided about this subject, which you so nicely elucidated!

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

Traction Alopecia and Hair Transplants

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

I am 20 years old as of January of this year and I am female. I always had very long very full very beautiful and healthy hair but in my later years of high school i began doing a lot of processing to change the color on numerous occasions, this resulted in, while still long, very damaged stringy hair. One day I made the decision to cut it and it was more healthy than it had been in a very long time and very very full, however I was not confidant with the length and made the incredibly stupid decision to get hair extensions, of course I only know how stupid it was now that the damage is done. The type I had were individual pieces adhered by small metal tubes that were then clamped to stay in place, and I would say I had approximately 200 of them in at one time. I have noticed an incredible loss in the fullness of my hair not just in the ends but in my scalp. I feel that I’ve lost approximately 50-70% of my hair which I hope is me overreacting but I have lost many nights of sleep and it’s taken a toll on my sanity and my life. I am exploring the option of hair transplants since they say that is the only solution for traction alopecia which i’ve diagnosed myself with. I will be seeing a dermatologist in a few days so I will have more details but I was hoping you could tell me a few things about the transplants. From what I’ve read they are said to have good to excellent results in patients with traction alopecia but I would like to know:

  1. Will the transplanted hairs have the capacity to grow to the desired length?
  2. Some transplant doctors practice a method where they are able to put grafts in between existing hairs which is what I will require since the thinning is all over. I am wondering, will it be necessary to cut the existing hairs short? I am hoping this is not the case.
  3. The only hair that has not been touched by the extensions and is healthy enough to be used as donor hair is in the front and is not a very large section. I am wondering, can the same donor area be used more than once if more hair is required to fill the missing spaces than the donor area can create at one time?
  4. This hair is 100% certain to grow back just as full as before, yes?
  5. Is there any scarring that will arise as a result of this? Do the risks for scarring increase if the donor area is used more than once?

I hope that you will reply to this message because I am very distraught and extremely depressed which I’m beginning to fear may lead to further hair loss caused by stress, and am rigidly searching for answers to this problem. Thank you for taking the time to read about my story and I’m hoping to hear from you soon.

You’ve likely seen your dermatologist by now and have a better idea of the degree of your hair loss, but I hope these answers to your questions help a bit.

  1. Yes. Transplanted hair will grow to the same length as the hair in the back of your head, since that is where the hair is being moved from.
  2. No. We routinely leave the recipient area long and do not cut the areas where we are going to do the transplant.
  3. Unlikely. Hair for transplantation is taken from the side and back of the head. I would have to evaluate your alopecia before giving you an opinion.
  4. Almost. Nothing in this world is 100% certain, but I would expect that hair transplants will grow at a 98% confidence factor.
  5. Yes. The donor area does scar and the degree of scarring depends upon many things, including:
    1. the number of surgeries
    2. the size of the donor strip
    3. tissue factors unique to each person
    4. the surgical technique used
Tags: traction alopecia, alopecia, hairloss, hair loss, female hair loss

Is Singer Fergie Balding?

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

I just saw this photo of the singer Fergie from Black Eyed Peas and don’t know what to make of it. is she just under bad light or do you think she could be losing her hair? it kinda looks like a female pattern huh.

Examiner.com – Fergie might be balding

FergieIt does appear in the photo that the singer known as Fergie has got some thinning in the female pattern… but to what degree, I couldn’t say. Does she have actual loss or is it just bad lighting or something else entirely? No clue. I’ve never met her and this one photo makes it difficult to form an opinion.

Hair loss in women is not uncommon, particularly if she’s in the entertainment business and relies on wigs and hair extensions to change her look from day to day. Extensions can create traction on the hair, resulting in something like what you’d see in that photo. Also, chemical processing of the hair can lead to this… and she’s certainly changed her hair color and character over the years. Here’s an example patient of mine that can give you an idea of what Fergie might look like if she is suffering from female genetic balding from the top looking down — here.

Tags: fergie, black eyed peas, hairloss, hair loss, female hair loss, singer, celebrity

How Many Months Does it Usually Take for Regrowth from Propecia to Occur?

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

Dear Dr. William Rassman,

First I want to thank you for your updated and truthful blog. It has surely helped me and obviously many others understand the many things about balding. I am a 25 year old male with what I would perceive as a Norwood III. I have significant loss in the hairline but no baling spot in the back or top the head. I’m not going crazy about the loss of hair but surely want to do whatever it takes to try and stop it from becoming worse.

After reading your blog I know that I have pretty much three current options that I am comfortable with: finasteride, minoxidil, and of course surgery. I don’t feel as though its bad enough to go for surgery right now and find that topical solutions just don’t outweigh the effort (id rather shave my head instead of having to apply the stuff daily), so i started finasteride about three months ago. I have very little if any side effects from the finasteride and have no problem taking it daily. As you know, three months isnt a long time to be on finasteride and its hard to tell if it is actually working for me. however, I plan on taking it for at least a year before I come to a conclusion.

I know that finasteride’s focus is to prevent further hairloss and any regrowth should be looked at as only a positive benefit but my question is that if I were to see any regrowth, how long do you think it would take? Again, I am not taking finasteride with the assumption that it will result in regrowth, I am just wondering when it would be noticeable it regrowth were to occur.

To give you a little background of my family history, there are a few people on both sides of my family that have receding hairlines and thinning on the top of the head. However, there is no one (and i even asked some elders) in anyone’s recollection in my family to have a completely shiny “chrome dome” scalp.

I realize that thing email is particularly long for such a small question but I wanted to give you as much information without pictures as possible. Thanks for any reply you might give and thanks again for having such an informative blog!

Graciously,
Anonymous

Norwood Class 3I am sorry, but you will likely not see regrowth on your front hairline (or front corners) if you are Norwood Class 3. It’s very rare for those areas to improve from medication. If regrowth happens it is mostly on the top crown areas where there is miniaturization. The best outcome for you on Propecia is slowing or cessation of hair loss in the front. If this happens it would take about 6 to 12 months for you to appreciate.

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