Could I Have Body Hair Transplants with a Strip Method?

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

Dear Doc,

I have heard of body hair transplants and read that they are not a reliable form of surgery due to the body hairs being weakened during extraction. However, because the body hairs are being removed with a hole punch type of instrument that may damage them, could significantly better results be attained if the body hair grafts were removed via a strip method? Let’s say the patient did not mind have a scar on their thigh as long as the strip provided enough grafts for his needs. In my case, I am thinning in the crown and anticipate that I will require far more grafts than my donor supply. Thanks

Body hair transplantation is not a gold standard method to transplant hair to the scalp, because body hair looks and behaves different than scalp hair. Damage isn’t the problem — hair growth cycles are. Only about 50% of the body hair is in growth stage at any one time, so the hair-for-hair yield is 50% rather than 90% plus as with the scalp donor hair. In other words, you won’t see most of the hair at the same time… and the hair that you do see will look different from actual scalp hair. Body hair does not grow long and has a different texture than scalp hair. To directly answer your question, yes you may find a doctor willing to do it, but the above material is presented to try to get you to think through that decision.

Tags: bht, body hair transplant, hairloss, hair loss, body hair

What Does It Take to Be a Good Hair Transplant Surgeon?

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

Dear Dr. Rassman. What does it take to be a good hair transplant surgeon, besides a medical diploma?

I could write a book on this subject (and actually, I did write two books). Simply put, the characteristics of a good doctor will always put the patient’s interests above his own and works relentlessly for the welfare of his patients without regard to money or time. The good transplant doctor will have an artistic skill as it applies to the field of hair restoration.

Tags: hair transplant, physician, surgeon, doctor, hairloss, hair loss

Experimenting with Arm Shaving

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

Hey doc, an experiment: i marked a section of my arm and shaved the hair with a razor after i repeated this a couple of times i noticed that the hair in each follicle multiplied. After a while all of the follicles multiplied hair counts. Why is this happening and why cant it be implied on the scalp?

I have trouble believing this. If you believe its true let me know the results when you try this on your scalp. If you shave your scalp, I doubt you will get more hair growing. Is this your goal?

Tags: shaving, hair growth

Hair Loss and Replacement for Dummies — The Reviews Are In!

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

Hair Loss and Replacement for DummiesI know this will just sound like a plug for my new book, Hair Loss and Replacement for Dummies, but I haven’t mentioned it nearly as much as I should. There’s a reason for this post aside from the obvious — renowned hair transplant surgeon Dr Richard Shiell, author of many article and classic books in the field has written his review, which I’ve posted below. It serves as a good overview of what you can expect from the book, which I might add is sold online for under $12 at Amazon.com, and makes a great gift for those that are essentially looking for a handy, printed version of BaldingBlog.

P.S. It’s now also available on your Kindle e-book reader (and iPhone), in case you’ve given up on printed books!

Dr. Shiell’s review starts here:

—

Apart from the textbooks, written for professional, there have been many books on hair loss and replacement written for members of the public. I have read at least a dozen of these over the past 30 years and they are all quite informative and, for their time of publication, reasonably accurate and helpful.

Hair Loss & Replacement is no exception in this but it is a considerable cut above the rest. Firstly it is very up-to-date and contains a vast amount of information all exceedingly well organized in 7 sections containing 18 chapters:

  1. Getting to Know your Hair
  2. The Root of Hair Loss
  3. Creative Techniques for Concealing Hair Loss
  4. Pharmaceutical, Laser and Topical Therapies
  5. Advanced Hair Loss Solutions (60 pages about hair transplantation)
  6. The Part of Tens (10 myths about hair loss, pros and cons for wigs, hair treatments and transplants)
  7. Appendices- this include a Glossary of scientific terms used in the book. In addition the reader is provided with the addresses of all the well known hair-loss websites and support organizations and many more. There is also an outstanding Index running to 16 pages.

Throughout the book important points to remember are clearly marked with an icon in the margin, as are tips and warnings. The reader is even alerted by another icon to technical paragraphs that he can safely skip without losing the thread of the chapter.

Now a warning. Although this book is designed for those with little prior knowledge about hair, it is certainly not recommended for “dummies”. It is a very well written and technical book, authored by two of the acknowledged “gurus” of our field, Bill Rassman and Bob Bernstein, The previous scientific writings of these two men are already at the top of any reading list on hair replacement surgery. Far from being a text for the “everyman” the book would be an ideal primer for any doctor wanting to know more about hair loss and its replacement, before committing many months to a specialized training course in hair replacement surgery.

Every aspect of hair growth, hair loss and hair replacement is covered concisely in this book in reasonably simple language and I could find few faults within the text. Perhaps even then, they were just minor differences of opinion between experts, rather than faults.

There is no attempt to “talk down” to the lay reader and in fact the only concession to the layman is that each of the 18 chapters is fairly well self-contained and if he only wants to know about, diseases that cause hair loss, hair transplantation or hairpieces, then he can be well informed in a self-contained section.

Summary
This is a really outstanding book for the beginner who has a considerable degree of education but no place for a true “dummy” to be browsing. Perhaps someone will do a 50-page comic-book version for these individuals who, judging by popular book sales and TV ratings, make up a considerable proportion of our population.

—
Reviewed by Dr Richard C. Shiell, M.B., B.S., Melbourne, Australia

Tags: hairloss, hair loss, dummies, book, rassman, shiell, review, hair transplant

My Hairline Was Transplanted Too Straight

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

Hi Dr Rasman – many thanks for the very appreciated blog.

2 years ago I underwent an aggressive hairline FUE procedure – 3,000 grafts all in the hairline with temple closure.

I’ve recently started shaving my head and, despite the white-dotted donor area, I feel much better about myself. I’d love to continue shaving my head – the problem is the recipient area. My recipient hairs, though not particularly dense, are much thicker than the natural hair behind them and begin with a very sudden, ‘flat’ line. The texture of the skin is bumpy and *may* form a small ridge at the start of the hairline; it’s difficult to tell whether it’s scarring, or just hair follicles pushing up the skin.

If I were to remove the grafts, is there any hope of restoring a natural-looking, albeit bald area where my current transplanted hairline is? If so, what sort of treatments would you suggest?

Thanks again for the site

Oh wow! 3000 grafts to the hairline and temples does sound very aggressive, if not impossible from my personal experience. The bumpy skin texture you describe can be scarring from your surgery and if it is scarring there really is no treatment for it. I am not implying you had a bad surgery, but hair transplant surgery is not reversible. Hair transplant surgery is permanent and you need to have a good foundation and understanding of what you are getting yourself into, as well as the long term complication and issues (such as scarring and shaving) before you regret the decision.

There are doctors who do 3000 grafts routinely in a small area of the frontal line and I have seen the work. The hairlines I have seen are straight and many times I doubt that the patient actually got the 3000 grafts they paid for, which makes me question the integrity of the doctor. These hairlines can be repaired by creating a good transition zone in front of the harsh tight hairline, but that assumes that the hairline was not placed too low in the first place. Often in some of these patients the hairline is too low, making a good repair very difficult. Each case is different and I would love to see you either in consultation or good digital photographs of your frontal hairline.

Tags: hairline, hair transplant, hair restoration, hairloss, hair loss

Where Is the Topical Finasteride?

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

Hi
Great blog you have, really useful. I have a question about topical Finasteride. I take 1mg Finast and think it might be holding my hair loss + scientifically expect it probably should be, therefore very much don’t want to stop. However, I am convinced that I get sexual side effects whereby my penis is just not as full and pumped (flaccid and erect) when I take it. I’ve tried experiments of washing it out for 3 weeks and then going back on it and I’m pretty sure there is quite a marked difference.

This has left me in a dilema and I was very glad to see a recent Indian paper in which they’d compared topical Finasteride with oral for a few months and found that, though the effect took longer to come on, it seemed as strong after 6 months.

Do you know how far away we are from topical Finasteride being available? Whether there is any other data on efficacy? Whether there is any data on whether systemic absorption occurs? And whether one has to apply it for long periods which would make it problematic to use? Many thanks for any light you can shed!

I’m not sure which Indian paper you’re referring to, but to my knowledge topical finasteride doesn’t have proven value. It would require special formulations for topical use and some drug company would have to push it through the FDA before it was determined safe and effective. Some doctors sell it online and armchair chemists on hair loss forums have their own tips on how to make your own, but I’ve not read any formal studies that show topical finasteride works the same as the oral finasteride. I’ve written about this before.

Tags: topical, finasteride, propecia, fda, hairloss, hair loss

Cialis and Hair Loss?

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

I occasionally take a treatment for erectile dysfunction called CIALIS (tadalafil). The tablets belongs to a group of medicines called phosphodiesterase type 5 inhibitors. The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. I was wondering a few things. First and foremost would such a tablet such as CIALIS increase my hairloss, which i do have. I am receding and have slight crown hair loss. Is it possible (if you know anything about this type of medicines) that it could increase DHT. Secondly is it ok to take propeica or avodart if you are taking this drug. I dont really know if taking a drug such as CIALIS which inhibits type 5 inhibitors could cause a reaction with the main chemical in propecia and dutasteride and stop it working or even worse make it dangerous. with the knowledge you may already know, or if not i would like your expertise and suggestions to wether or not its ok to take both or wether it could increases hair loss. Thank you very much

Cialis I don’t see why Cialis would increase hair loss, and hair loss is not listed as a side effect (see list). In many cases medications like Cialis, Levitra, and Viagra may be prescribed to counteract any erectile dysfunction side effects from Propecia (finasteride) and Avodart (dutasteride), and I’ve not heard any cases where they negate the benefits of the hair loss medication or make it dangerous. It’s best to talk to your prescribing doctor, of course, and make sure he/she is aware of your other prescription medications in case there is a concern.

Tags: tadalafi, cialis, hair loss, hairloss, viagra, levitra

If Propecia Takes Months to Start Working, Why Did My Loss Stop After Only a Month?

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

Dear Dr. Rassman,

I’ve now been on Propecia for a little over a month and a half and it appears that I’ve noticed a slow down in shedding since before I started taking it. I know that on average we lose 50/150 hairs a day and I’m positive that I don’t notice all of the hairs that I lose over the course of the day (that would be impossible), but I am almost certain I’m not losing 100 a day, and it appears I’m shedding much less than before.

Is it pretty common for Propecia to start working noticeably a month and a half into treatment? I’ve read that it takes three months at least for it to start slowing down hair loss. I still have a pretty full head of hair (with some thinning at the crown and slight recession in the front. Not seeing as much hair shedding has me feeling really good that Propecia might work really well for me. Thank you, Dr!

Many people will report a reduction in shedding within the first month of taking the drug. I don’t know the hows or whys of it, but the medication doesn’t work exactly the same for everyone. In your case, it sounds like you’re seeing a positive result in a short amount of time. That’s good news!

Tags: propecia, finasteride, hairloss, hair loss

Hair Loss from Herbal Essences Hello Hydration Shampoo?

/by William Rassman, M.D./12 /

Hi, I recently tried out a new shampoo and conditioner set called Herbal Essences Hello Hydration. It has silicone in it, and can help improve shine quality in your hair, so I gave it a shot. I noticed afterwards more hair coming out after I rinsed the shampoo and conditioner out, but thought it was just natural. I switched shampoo and conditioner for a bit, came back to the Hello Hydration set, and when I rinsed out a clump of hair immediately came out between my fingers.

Is this coincidence, or do you think there is a relation??? Please help!!!

Maybe it is a coincidence. If the shampoo actually causes hair loss, I am sure it would have never been introduced/sold. I have personally used the shampoo before and did not experience anything different. If you believe there is a relation, then I would suggest not using it.

Tags: herbal essences, herbal, shampoo, hairloss, hair loss

FUE2 vs FIT

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

I’m 32 years old with near norwood 4 loss and am still confused over both these techniques. There were two previous posts that you replied stating that both procedures are identical but according to Dr. Coles website he claims that FIT is much better than FUE.

My personal search has led me to either pursue your new FUE² or Dr. Coles but I’m at a standstill and not sure which path would be better. IF both procedures are the same then the only criteria left for me in my decision would be $ cost per graft. My last question would be how much you charge per graft for a shaved head for a FUE² procedure? Thank you!

FUE2Follicular unit extraction (FUE) is the core terminology that I used to define the surgery when it was first published and is the recognized term worldwide. Could there be marketing hype used here? I would think so (my opinion). The tools have been overblown and unless the technique is substantially different, an FIT is an FUE. The FUE² is different from the FUE in the basic technique deployed, because it uses a dissecting technique with high pressure fluid to assist in the extraction.

Our fees for FUE are as follows:

  • $10/graft for procedures done by Dr. Pak
  • $15/graft for those done by me (Dr. Rassman)

Some doctors charge more if the head hair is not allowed to be clipped close (shaved), though our fees are the same. At the moment though, by not allowing us to clip the hair, the total number of grafts available will be less.

Tags: follicular unit extraction, fue, fue2, hairloss, hair loss, hair transplant

Receding Hairline Corners — Is It Just a Mature Hairline? (With Photos)

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

Dear Mr. Rassman,

First of all, thank you for your very informative and helpful site.

I am 30 years old, and lately, I started worrying about my temples. I have a feeling that I have receding temples and want to take action if this is the case. Unfortunately, I do not have old photos taken from the right angle to compare. Could you please tell me what you think and what my Norwood class is, according to the attached photos? I do not have any balding or thinning on top.

By the way, you can use my photos on your blog if you please.

Kind regards.

Click the photos to enlarge:

 

First of all, thanks for allowing me to publish these.

What I believe you’re talking about are the corners of the hairline, not the temples. The temples are below the corners (above the ear), and those look fine in the photos you provided. People seem to get the temples and corners confused all the time when labeling them.

It appears that your hairline is now convex in shape and the central area does meet the side areas, suggesting that the maturing hairline is locking into place. If there is no miniaturization present, I would do nothing other than observe your hairline yearly. This is a Norwood Class I or II.

Tags: hairline, hair loss, hairloss, corners, mature hairline

Folliculitis and Hair Loss in the Crown

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

I have folliculitis which has caused hairloss at the crown. Will minoxidil regrow this hair? If it does, will the hair be lost once application has stopped or will the hair continue to survive on its own as my dermatologist says I have no MPB only the folliculitis.

There is a condition called folliculitis decalvans, which is an autoimmune disease that often reflects extensive hair loss. First, one would have to make a diagnosis (something I can not do without seeing you myself). If it is just a small patch from the infection of a few hair follicles that caused hair to fall out and does not reflect an underlying disease, then it might regrow. Minoxidil may help. I can’t say much more without knowing much more about you, what it looks like, and more of your history with the folliculitis. There’s a lot of info and photos of folliculitis decalvans here.

Tags: folliculitis, decalvans, hairloss, hair loss, infection, minoxidil

Prilosec (Omeprazole) and Hair Loss

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

I too am taking omeprazole and finding that my hair is thinning severely. I want to weigh in on this because I see other comments to this effect on your site and others. I think you should not be too hasty to dismiss the connection.

On researching this, I did find references to a rare connection between Prilosec (omeprazole) and hair loss. As I’ve explained before, it is difficult to conclude whether omeprazole is the cause of your hair loss, as hair loss is quite common due to genetics. Hair loss reported from the medication is in less than 1% of cases. See eMedTV for more.

Tags: prilosec, omeprazole, hairloss, hair loss

Some Months My Transplanted Hair Looks Thick

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

I had a hair transplant nearly two years ago now. every 6 months or so it looks thick and occasionally some months it doesnt. Now becuase the transplant to place maybe as the rest of my hair was at a resting phase, could the hair transplant section and the rest of the hair always be at a different rate of growth as in resting phase. I was wondering whether this was the reason for certain months it looking thick and more hair and other months lacking as much hair. Also as the transplant section isnt as dense and compact could it be that when some hairs fall out in order to be replaced it just isnt as thick?

Thanks NHI TEAM

The general hair cycling is somewhat random when we look at it. I can not imagine why your hair looks better sometimes than other times. We’ve all heard of a “bad hair day,” so maybe that is what you are talking about. Are you doing anything different with your hair during the periods in question?

Tags: hair transplant, hair loss, hairloss, thickness

Does Sensitive Skin Mean Sensitive to DHT?

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

Hello Dr. Rassman.

I have a theory, can the type of skin (texture, etc) determine if a person will go bald? Sensitive skin equals sensitive to DHT? For example a Caucasian male can freckle easy and have allergies easily.

Thanks.

I suggest that you scrap that theory. I assume by “sensitive to DHT” you’re equating it to mean genetic hair loss. What is below the skin and what is above the skin (what it looks like) are very different things.

Tags: dht, hair loss, hairloss