I Trust My Transplant Doctor, But I Think I Had Shock Loss

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

Firstly, I would like to thank you for your input on the website; I’m a daily reader. I have read your previous posts regarding preventative transplants. I am in my late 20’s and essentially had a first transplant done 1.5 years ago in what was pretty much a preventative measure. The transplant definitely had the impact of which you speak, namely causing native hairs to fall out, replacing miniaturized hairs with a lesser number of transplanted hairs. My transplant was only done in the front portion of the scalp, not touching the crown. I was not taking Propecia before the surgery, although there is doubt as to whether or not that would have prevented the shedding. Either way, I now am being told the following from my doctor, whom I trust and with whom I’ve developed a very good relationship:

  • The procedure was not wasteful as if we had waited 1-2 years, there would have been less hair to camouflage the procedure.
  • You did lose some pre-existing miniaturized hairs, but gained permanent, terminal hairs that give much more of a cosmetic fullness than miniaturized hairs.
  • It is disappointing that you did not get the full potential cosmetic fullness because of miniaturized hair loss so the relative change wasn’t as great as you had hoped. But if you had waited there would have been less hair to camouflage what we were doing, and you would have been perceived as having more hair loss going into the procedures.
  • For now you can go on Propecia for 6 months to help maintain hair and perhaps beef it up somewhat. Then you may have a 2nd and 3rd procedure at some point for the frontal half of the scalp to get the density you can get with transplants. You can also do a second procedure at any time, and I know you will feel that much better when that second session is in and growing.

My questions at this point are the following: Should I do another transplant now or should I wait longer? I’m told that 70% of the hair in that area now is transplanted hair and that I wouldn’t really get much if any shock loss from the next one as there are very few miniaturized hairs between the transplanted hair. Should I take Propecia before going to another transplant and if so for how long or does it not matter because there will not be anymore shock loss?

Thank you for your answer. I have had a great experience with my doctor so far and trust him to the fullest. I simply post as an educational measure for myself and for all other readers as I think this is a topic of great interest to younger men in the initial stages of hair loss.

I am a bit critical of your doctor for not using Propecia prior to your first surgery, as this probably would have prevented much of the hair loss you experienced. Propecia (finasteride) is very important in young men having transplants to protect against shock loss. Anytime after 8 months you can follow up with another procedure. Best this time to be on Propecia before hand.

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

2 Weeks After Hair Transplant, The Density Looks Better on One Side!

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

I recently underwent a 1700 FUT procedure in the temples with a very respected surgeon. I followed all post-op instructions. A day after the surgery I noticed that the incisions on the left side temple looked closer than the right and I could see more hair coming from them. It is now 13 days post op and all scabs are gone. It seems that the hairs are more dense on the left side of my head than right.

My question is if the density of the hair I see that was transplanted is indicative of the final density I will see? If the right side looked less dense a day after surgery and looks less dense 13 days after surgery does that mean it will likely be less dense in the final result or can small hairs be transplanted below the skin hence not being seen until they grow out?

What you see is what you will probably get. Ask you doctor about it — maybe he did it intentionally as part of a plan he had for you.

Tags: density, hair transplant, hairloss, hair loss

Why Is Dr Farjo Balding?

/by William Rassman, M.D./6 /

Not to be rude but I can’t help but ask, before i ask a more detailed question; why Dr. Farjo, a contributing writer appears to be having serious balding problem.

Look at this another way — should a plastic surgeon make a statement by not having a boob job or a face lift? My former associate, Dr. Robert Bernstein, was asked about his balding on national TV (he has a class 6/7 balding pattern) and simply put, his hair loss does not bother him. Like Dr. Bernstein, there are many men who look handsome with a short haircut and some advanced balding pattern. Decisions on having a hair transplant reflect upon personal choices. I’ve written about this before here and here (and probably elsewhere).

I know a man with a broken nose who never had it fixed. He came to see me for a hair transplant and he said his nose was not a priority for him and the cost of a repair exceeded his budget. He obviously felt different about his hair. As to the cause, I am sure Dr. Farjo’s balding reflects genetic pattern balding like most men.

Tags: farjo, balding, hairloss, hair loss

I’ve Experienced Shedding After 4 Months on Propecia and Now I’m Freaking Out!

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

Whats up Doc?
I am 25 and in the early stages of balding, almost 4 months on propecia (112 days to be exact) and the front of my hair line, not at the temples, but the the middle, is noticeably worse/thinner than it was when I started. Now here are my questions: Is it just that it hasnt started to work yet (I know its still early). Or am I experiencing a shed? Or at the worst case scenario is it making my hair worse! I dont really see any hairs on my pillow or shower drain or anything, but im def losing them. In all of your years of experience, is this normal at around the 4th month mark? I know I have to wait a year, to start seeing results but, the hair loss seems to be quickening! I go to a dermatologist who is convinced it will work for me, but at the same time doesn’t really seem to know what they are talking about when it comes to hair loss. I am aware that you can’t make a diagnosis over the internet but how about an educated guess? Ive read on some sites that this is normal and that new thick hairs will grow in, but im still starting to get a little freaked out here. THANKS!

It could just be a shed situation. Many men will lose hair after a hair cycle is complete (ending in catogen) and not restart another cycle right away due to the genetic situation. This could be what you’re experiencing. I wish that I could be of more help, but you will probably know for yourself in another 4-6 months.

For me, the measurements that I take when I start a patient on Propecia (miniaturization mapping) are good for comparison purposes down stream, when there is a change going on. Change tells a great deal with regard to miniaturization and I would hope that the miniaturization that you had present when you started the drug has reduced, rather than increased. I like all of the insights I can get to render a prediction as to where a patient’s hair loss pattern is going.

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

Online Doctor Consultation and Propecia Purchasing

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

Hello Dr,

I have been following your blog for a while now and am definite that I am beginning to suffer MPB.I am 20,and my dad and brothers were all 16/17 when they started balding. They have all followed a pattern of continued receding from the front hairline untill it reached all over. My temples and frontal hairline however resemble a normal mature hairline. It is the hairs on top and mainly in my crown which when they fall out are noticably and quite a bit thinner than the rest of my hair, which otherwise is probably thicker than average! The crown also looks and feels thinner. MPB has appeared in most men on both sides of the family (just one uncle has escaped it), my genetics are against me!

Although I want to get the situation controlled, I cannot bring myself to go to the doctor, the embarassment is too much. Especially here in the UK it seems trying to beat hairloss has a lot of stigma and embarassment attached to it. Even my parents think I am ridiculous thinking that I am thinning (they think I am ok seeing as i don’t have the same pattern as father and brothers)…obviously not having read what I have here about minaturization and not necessarily following an identical pattern.

I came across this website and wondered what you thought. It claims to give a consultation with an online doctor and then to allow you to purchase propecia online if they authorise it. I wondered if you think this all looks genuine, as I am considering doing it, It does seem so!

The beginnings of MPB is ruling my life but I can’t face the embarassment of a doctor considering friends and family think I am being stupid, also there doesnt seem to be much knowledge on the subject here or specialised doctors/clinics.

Thankyou.

I do not generally condone strictly online consultations, but would not be against it if you can take Propecia to prevent the family hair loss problem following you into adulthood. Nothing compares to a one-on-one patient to doctor relationship. I don’t know if that site is genuine or if prescribing medication like that is legal in the UK. There is nothing wrong with being bald and there should be no embarrassment to request medications to stop the hair loss. I would do your research and find a doctor in your area and have a confidential consultation and examination.

Tags: propecia, finasteride, consultation, doctor, physician, hairloss, hair loss

Growth After Eyebrow Transplants

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

I heard many excellent reviews about your work on Hair/eyebrow transplant, I wish to ask you a few question regarding a procedure. do you do eyebrow restoration? how often do you perform this procedure?. how much would it cost? I enclosed several photograph regarding the area, the scar is about 6cm long and 1/3 cm wide.

I done a procedure with another company back in June 27th, but they only put in 30 (as supposed to 100-150 recommended by most doctors). It’s almost 3 months since [my transplant], I already begin to see 10 follicle grow out. when do you think I can do a 2nd procedure? beside Rogain, is there any medication I can do to speed up the growth? I heard follicile transplanted to eyebrow usually grow faster then those transplanted to scalp? What’s the reason beside the difference?

Since scalp hair is different than eyebrow hair, what do you usually do to make the result look more natural? Thanks for your info!!

It sounds like you were given far too few grafts. Generally it takes 300-400 grafts to complete an eyebrow transplant. We charge about $3000 for eyebrows, but if I do it, it will be $4000 as my fee is higher. Dr. Pak is my associate and he is terrific and his work is impeccable. I would consider another transplant after 6-8 months. By that time all of the eyebrow hair will have grown in. Eyebrow transplants are with scalp hair and grow at about the same time as if it were transplanted into the scalp. In other words, it does not grow faster than when it is put into your hairline.

Tags: eyebrow transplant, eyebrow, hairloss, hair loss, hair transplant

In the News – Hair Makes the Employee?

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

Snippet from the article:

In my 30years of experience, I have seen several economic situations, each one uniquely different but all the same. No matter the differences, one issue remained the same. If you wanted to endure, you needed to possess every attribute desired by your employer and prospective employer.

One constant is, how you look is as important as what you know. It’s as important to look youthful as it is to look experienced. Unfortunately looking older does not pay off, most of the time you are not perceived as experienced it’s simply perceived as old.

Read the full text at Examiner.com

The article goes on to talk about how important hair is, in that it adds confidence to the prospective employee. I’ve written about this before (and there was an LA Times article about it), but it’s good to get someone else writing about it from time to time. So do you agree or disagree that hair makes the man?

Tags: hair, job, employment, hairloss, hair loss

Can I Quit Rogaine After a Couple Months And Switch to Propecia?

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

Dr. Rassman,

I’m a 25 year old male that noticed a few months ago that i was starting to thin on the crown of my head. I started using rogaine foam. About a month or so into using the foam I read about Propecia, and vistited my doctor who said that he thinks Propecia would work the best for me. My question is; since I’ve only been using Rogaine for two and a half months, do you think I’d be okay quitting the foam and just using Propecia (which I’ve been on for the last month)? I haven’t noticed any improvements with the rogaine yet(which makes sense to me since the package says it could take many months to start seeing results). I’m just wondering if I can quit the foam without losing hair. I figure I should be okay since I haven’t seen improvements yet.

Thanks so much, doctor. I appreciate your blog very much.

I would hope (though I am not sure) that you did not build minoxidil dependence on the miniaturized hairs. For men of your age, Propecia is a better choice.

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

NHI Surgical Team

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

Dr Rassman,
You may or may not have seen this post on the online forums that you visit. Dr Shapiro was the only Dr to answer these questions and as a reader of the forums i wanted to see if you would answer them about NHI?

Do all NHI’s surgical technicians have valid, unrevoked, or unsuspended certificates/licences? Do they place the grafts in the receptor sites during HT surgery? And if they do, Is The surgeon in the room all the time with his HT patient,supervising that process of grafts transplant?

NHI TechsAt the New Hair Institute, our technicians were all internally trained by me. They are not certified by any state agency. If you check with Dr. Shapiro, you will find that I was the doctor who trained him in FUT. Our technicians do both cutting and placing of the grafts and the surgeon is either in the room or close by checking on the progress of the technicians frequently. As these technicians have been trained by me, I know what is happening at all times. I am supervising everything that goes on before and during the surgery. Either Dr. Pak or I usually see the patient the next day when we wash the hair and make sure that the scalp is clean of all crusts (mostly done on the day of surgery).

The quality of the technicians determine the results you will get after 8+ months have passed. I recently met with a patient who had over 4000 grafts from an experienced doctor (at another clinic) with what I suspect was a very weak and inexperienced team. When I viewed his results 1 year after his procedure, it was evident that there was easily a 90% failure of the grafts to grow. If the surgeon does not have absolute control over the technical process minute by minute and the technicians and nurses are not very experienced, these large sessions often fail. Here I am just questioning the quality of the technician work in this particular patient. Many doctors have difficulty in hiring experienced people, particularly if they attempt these large sessions and hire inexperienced people. The sloppy work by many itinerant technicians reflects poor training and the patient becomes a victim, never aware of what is happening to him. Even the technicians are victimized by the heavy workload of a very large surgical case and few can manage the tedious work for hour upon hour (e.g. often 7-9 hours for a 4000 graft case with a highly experienced and competent team).

The tragedy here is not just the wasted money (for many people their life savings) but the depletion of the donor hair supply (an invaluable and non-replaceable resource). I warn patients all of the time that as they do their diligence, they should command the ‘team’ nature of this surgery and not go for the least expensive bargain available. This patient paid $2/graft and lost a considerable amount of his donor supply. To say he got what he paid for would be insensitive on my part.

Tags: surgical, technician, hair transplant, doctor, physician, hairloss, hair loss

Female Hair Loss in the Back of Neck

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

(female)
Dear Dr. Rassman,

The hair on the back of my neck is disappearing and I have no idea why. It started in the end of January 2009. It’s getting thinner from the middle and outwards and creates a parting in the shape of a crooked L (down and off to the side. The hair at the very base is short and thinner and doesn’t seem to grow (at least not very long terminal) I’m not sure if this description is enough for you, but I am at a loss of what to do! Do you think this will subside with time and then the hair will grow back again? I know neck hair tends to grow slower.

Neck hair genetics are different than scalp hair genetics and unfortunately there is little that can be done other than the possible use of minoxidil. I do not believe that I have seen anything written in the medical literature on the loss of female neck hair, but there are many men who show it so why not women? Send me a series of photos and maybe I will understand more of your problem.

  • What is your age and state of health?
  • Are you taking birth control pills or other medications that can cause hair loss?
  • Could it be that you had a tight hair style that pulled on the hairs at the base of the skull, causing traction alopecia?

You get the idea here — a single description of a problem without my ability to ask questions with a good medical history leaves me in a difficult position to help. Consider a visit to my office and then at the least, I can perform my usual extensive examination of your scalp and neck.

Tags: female hair loss, hairloss, hair loss, neck hair

Is Acne Caused by DHT?

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

You said before that Propecia/finasteride has no effect on sebum. And some people have complained that Propecia has increased their acne. I was on Propecia for 58 days and I didn’t notice my acne getting any better or worse. This being said, is it safe to say that acne is not caused by DHT? Sure, DHT might be present but maybe it’s caused by something on the surface of the skin, such as skin cells not being sloughed off fast enough.

According to Wikipedia, “[acne] is a common skin condition, caused by changes in the pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland via androgen stimulation.”

The pilosebaceous unit (hair, gland, and follicle) become infected as they are colonized by bacteria that destroy some of the microscopic anatomy. The output of sebum just feeds the areas which become infected and the circulating androgens. The list of causes are listed here, as well as descriptions of the social impact of the process in its teenage victims. DHT is just one of the androgens that contribute to acne so the use of drugs like Propecia usually fail to solve the acne problems.

Tags: dht, acne, dihydrotestosterone, propecia, finasteride

Take One More Objective Look at LLLT

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

Well, I have been reading some of the information on your site and even checked the details of the LLLT device you had in your office: Revage 670. I think taking one more objective look at LLLT would be a good idea rather than discarding it. I can tell you have a big readership on your site and I will recommend you check out what is being done by ordinary people these days without even going to a clinic to use an over-expensive and under-powered, under-performing laser. Please check out: regrowth.com. Then, see the tons of information about LLLT at OverMachoGrande.com.

Lots of pics of ordinary people using home-built LLLT can be seen by following the links on: regrowth.com.

Thanks.

In my clinical experience, laser light therapy for hair growth did not work on the many patients who used it in my office. I even offered its use at no charge. I do not run a research institution so I can not afford to create a formal study on this subject. I returned the laser to the company. Of course, one can argue that its just my personal experience and opinion, but I do not have any financial motivation for such claim. Plus, I find it somewhat troubling when the author of such study sells and promotes the very item he’s studying.

Tags: lllt, laser, laser comb, hairloss, hair loss, revage

Scalp Peeling Left Me with Hair Loss

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

Im a 20 year old male. At the beginning of the year, I had some pretty major peeling of my scalp along the left side of my hairline. The peeling caused the hair in that area to come out as well. I finally went to the doctor and he prescribed me some special shampoo and the peeling has been gone for approximately 4 or 5 months. However, there has been nearly no hair re-growth in the area the peeling occurred, just some small hairs that recently began growing. How long will it take this hair to re-grow or could this loss be permanent?

This sounds like a form of seborrheic dermatitis or possibly psoriasis, though I’m not entirely sure what you mean by “peeling”. Go back to your doctor and ask him/her about these conditions. Generally speaking (without reference to your “peeling”) either of these conditions should not cause hair loss unless you picked the skin and pulled out your hair. I would keep waiting to see if the hair will regrow.

Tags: seborrheic dermatitis, dandruff, psoriasis, hairloss, hair loss