Water Jet in FUE

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

Dr Rassman,

This following thread discussed one of your patents: hair-restoration-info.com

Now in the patent there is a discussion of fluid being introduced during the procedure to separate the follicles. This is the same discussion that i saw on a hairloss forum you gave about the new FUE2 procedure which you said uses a water jet principle.

What i wanted to know what are your thoughts on Dr feller’s comments that

  1. Because the follicles are tiny, no amount of suction is powerful enough to actually grip and pull the graft out with any appreciable traction.
  2. The second is that FUE practitioners acknowledge that appreciable amounts of fluid are NOT required for FUE as once breifly thought in 2004. In fact, the less fluid the better.

Thanks

The patent mentioned in that forum was actually built by Dr. Jae Pak when he worked for me as a biomechanical engineer (before he became a doctor) and it was proven to work. The patent was eventually purchased by Restoration Robotics and there is an actual robot that does the FUE extraction (still in development, as far as I know). The patent they are referencing in that thread is not FUE2.

  1. Before all of this, there was another device designed by Dr. Boudjema in the late 1990’s that incorporated suction for the FUE. It did grip the follicle and pull the grafts out with traction, but it was not efficient.
  2. FUE is highly variable in terms of how it is performed and who it is performed on. There is no rule. Less fluid does not mean it is better. Sometimes more fluid works on some patients.

Since I introduced the FUE technique to the ISHRS meeting in 2002, FUE has blossomed and took a life of its own with different techniques and opinions by doctors all over the world! I believe it is a wonderful thing, as doctors will continue to innovate the technology and technique. To date, there is no one standard accepted universal method for the perfect FUE and that means that no one technique seems better for all of the doctors and all of the patients. Variability in technique is not good for patients as the concept of standardization just does not materialize, which is the sign of a mature technology.

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

The Corners of My Hairline Are About 2 Inches High

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

Good afternoon Doctor! I just want to thank you for this site.

Im an 18 year old boy, and since i was around 17 my hairline changed into what it now is today. However I’m not sure where to class ito n the norwood scale. The frontal hairline is, like you say in the normal place, exactly half an inch above the furrowed brow, however my concern is asscociated with the corners of the hairline. From the highest wrinkle, if i place a tape measure to the furthest point of the corner of the hairline it measures around 2 inches.

My question is with a corner reccession like this, could i still be placed in the Norwood 2 section? Because if you look at the stage 2 of the Norwood scale, the measurements found on this site for the mature hairline don’t appear to fit with it. The front of the hairline and the corners appear to have a far greater gap than the ‘norm’ of 1 – 1.5 inches…..

And just as a last question, if i start on Propecia at this age, is there a chance i could keep this hairline for the rest of my life? I hope i’ve been clear in what i’m saying. THanks alot and i look forward to your reply.

I’d stop trying to categorize yourself into a particular Norwood class. Perhaps you are a class 2 or class 3, but I really do not know (photos might help). Are you measuring at an angle? Assuming you’re seeing 2 inches when measuring perfectly vertical from the brow to the corner, it sounds like it’s past the Norwood class 2 level. But it seems more like things are changing and evolving as you are maturing. You’re 18 years old, and a maturing hairline is definitely not uncommon at that age. The real issue is finding out if you are actually balding or not.

Before thinking about Propecia or putting yourself into a category, go see a doctor and get your scalp mapped out for miniaturization. If you are indeed thinning, Propecia may be an option to halt further loss.

Tags: hairline, hair loss, hairloss, norwood, propecia

I Saw My Hairline Recede After Less Than 2 Weeks on Prednisone!

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

This past February I was prescribed a two week cycle of Prednisone to address a headache that would not go away. Though it was successful in treating the headache, I noticed my hair line receding at my temples after about a week and a half. I was finished with the Predisone just a few days later, but my hair has not come back after 5 months. I believe it may have even receded further.

I do not appear to have any hair loss on my crown, nor have I noticed any shedding on my pillow or in the shower. I have relatively fine hair, cut short at that, so it’s possible any shedding may go unnoticed. Should I wait to see if my hairline naturally restores itself, or should I try a Minoxidil product? Is it worth it to speak to a hair transplant doctor, or is that getting ahead of myself?

Corticosteroids (like prednisone) can accelerate hair loss in some, but I can’t say for sure if that is what you’re experiencing. You should get your mapped out for miniaturization (or learn how to map it yourself). You will probably find out that you have genetic balding and might want to see a doctor for a possible finasteride prescription. Minoxidil likely won’t regrow any hair in the hairline, and I don’t know enough about your hair loss pattern, age, or history to know if a hair transplant is in the cards for you at the present.

Tags: hairline, prednisone, steroid, hairloss, hair loss

I Got My Propecia Prescription Filled at a Different Pharmacy and Now I See Results!

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

Hello Dr. Rassman-
I have been taking propecia for over 4 years. I am a transplant patient and have had success with that but wanted to keep the rest of my hair also. I was never really convinced of the quality of results from propecia which had been supplied by the transplant doctor only, but kept at it. Recently, I had to get a new prescription and decided to fill it locally at my local pharmacy. It has been almost two months, and I now seem to be getting the results I was expecting. Is it possible that previous filled prescriptions could have included inferior sources of propecia? I’ve not seen or heard of anyone else with a similar experience. Have you? Thank you for your time

I’ve not heard of a situation like this. I really don’t have any reason to believe the Propecia supplied by your doctor is any different than the Propecia from your local pharmacy. If you are concerned, I would get the two different samples and contact Merck with your concerns. They have anti-counterfeiting procedures in place, which you can find out more about here. Did your local pharmacy provide you with Propecia or generic finasteride, because perhaps the dosing is different?

Tags: propecia, finasteride, pharmacy, doctor, hair loss, hairloss

Ruling Out Hormones and Malnutrition for Male Hair Loss?

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

Dr. Rassman,

I know you have stated which common blood tests you think females should have to rule out hormonal imbalances and malnutrition as a cause of their hair loss, but how would the list be different for males to rule out things like hormonal imbalances/malnutrition/etc. to help determine if they have MPB or not? Thanks.

It is easier to rule out non-genetic hair loss causes in men than it is in women. The existence of patterned balding is an almost absolute rule for genetic hair loss.

Tags: hormones, malnutrition, gene, genetic, hairloss, hair loss

Adderall and Propecia

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

Hello Doctor,

I recently started taking 1mg of finasteride (approximately 3-4 months ago) and I’m seeing some noticeable hair growth.

A couple days ago I started taking some adderall and noticed that it was causing my hair to shed. Since the 1mg dosage is meant for men with normal testosterone and DHT levels (and considering the fact that adderall increases testosterone plasma levels, which translates into more DHT production), would an increased dosage of finasteride negate this increase in testosterone, and thus, DHT levels?

Also, when would be appropriate time to take the finasteride so that the drug’s effect will coincide to provide maximum efficacy against the increased DHT production from the adderall? How many hours/minutes before or after taking the adderall?

Thank you

AdderallI can understand your concerns, but you need to know the basics of hair loss. Chasing DHT levels is not the answer and this medication may have a direct impact on your hair, independent of any genetic contributions. If your hair loss is genetic (otherwise known as male pattern baldness or androgenic alopecia) there is no definite cure. Drugs such as minoxidil (Rogaine) or finasteride (Propecia) do work, but they do not STOP or CURE hair loss! Results vary among individuals. And even if you regrow hair, over the course of your lifetime you will still slowly lose hair. Taking these medications will help by minimizing the hair loss.

With respect to Adderall, it may have an effect on hair loss. Even if it did, taking more finasteride will likely not help. Studies have indicated that it does not make a huge difference between taking 1mg or 5mg of finasteride (aside from higher side effect risk). In some rare cases, I have recommended 2.5mg finasteride for patients, but I’ve yet to see any gain or slowing of hair loss as of yet (likely too soon to tell). I don’t mean to sound bleak, but DHT is not the only answer to hair loss. We have not discovered the complete mechanism for the way in which the genes work at the hair growth metabolic level… yet!

Tags: adderall, hairloss, hair loss, finasteride, propecia, dht, amphetamine, dextroamphetamine, adhd

In the News – Man in Ireland Awarded €70,000 for Bad Hair Transplant!

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

Snippet from the article:

THE HIGH Court has awarded €70,000 damages to a sales and marketing manager over a botched hair transplant which left him disfigured.

Mr Justice John Quirke made the award to Niall Clancy (32), Scholarstown Park, Rathfarnham, Dublin, over the procedure which was carried out in the UK on January 12th, 2004.

The award included €30,000 general damages plus €40,000 for medical expenses to repair the damage.

Mr Justice Quirke also said Dr Maurice Collins, the surgeon who treated Mr Clancy after the transplant, had given him “very poor advice” not to have reconstructive surgery until after the court case was completed.

LawRead the full article at Irish Times – Man wins €70,000 damages over botched hair transplant

The online currency converter tells me that’s over $99,000 (USD)! I’ve not seen the botched work, but when the doctor told the patient to not have the repair work done until after the case was settled (which took years), it just added to the money the patient was awarded in damages. It is unfortunate that the transplant was so disfiguring, but without seeing photos I’ll have to rely on this article and the court’s decision for my source of case information.

Always remember to do your research on the clinic and physician before getting yourself into a permanent procedure like this. Perhaps this disfiguring hair transplant could’ve been avoided. See:

  1. Selecting a Hair Transplant Doctor
  2. How to Avoid Dishonest Hair Transplant Doctors
  3. Why Should You Visit Us?
Tags: hair transplant, repair, damages, hairloss, hair loss, ireland, irish, uk

I’ve Noticed My Hairline Recede and Thin

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

Hello, I am a 23 year old African American male my hair has thinned drastically over this last past year. In 2007, I had a full head of hair. Later that year, I noticed my hair line slowly recede, but my hair remained full. Currently, my hair is thin and I have a nearly bald spot in the front of my head. Can you please recommend any treatments? Are there specialists I can see? Can this be the result of stress or does it signal some other sort of health issue? Thank you very much for your assistance and have a wonderful day.

Stress loss isn’t usually limited to the hairline. It sounds like you’ve got genetic male pattern baldness. Treatments include Rogaine (minoxidil) and Propecia (finasteride), though they aren’t known to work that well in the hairline. The Propecia could prevent further loss, however. You can try to find a doctor in your area by checking the physician search at ISHRS.org… and though the listings are for hair transplant surgeons, I’m not suggesting you should rush into surgery. These doctors are knowledgeable about hair loss in general, so either try them or a dermatologist.

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

I’ve Got Thinning On the Sides and Back of My Head

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

Hello Doctor,
I would really appreciate it if you could answer my question. In the past 5 years I have started thinning slowly. My question is are there “unconventional” balding patterns for men. I have a receding hairline and a thinning crown which points to mpb, but recently the sides of my head as well as the back have started to shed and thin a bit. If my destiny is severe mpb (as it might be since I’m only 23) can this happen, or could it be some other health problem? Thank you very much for your time!

You need to be examined by a good doctor and get a miniaturization mapping to find out if what you think is happening is actually happening. If the sides and back are indeed thinning, that is not typical genetic loss and could point to disease or maybe an allergy. I could guess all day, but you should get to a doctor to find out what’s going on.

Tags: hairloss, hair loss, sides, thinning, mpb

I’m a Norwood 2 with Family History of Hair Loss, But I Want My Hairline Thicker

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

In the norwood scale, I beleive that I am a 2. Frontal hair line receding. I’ve done some research about hair loss, and It’s said that there’s nothing I can do to bring back my hair. Now, I can still see some thin short hairs on my hairline where its receding I was told that If I take an “ext therapy” (ext is based on shampoo,conditioners with midoxil and midoxidil pills)I will see some results. since the hairs are thin and not dead, they say that I will get results.If I can just make these little hairs thicker, I will be ok.I just dont know who to believe. And I would hate to spend $3k. Can anything make my hairline thicker? I am currently taking propecia for 3 months. I am 27yrs with history of hairloss in family. I am also considering an fue transplant, since I keep my hair really short, it’s said that that is my best option, since I am in a scale of 2, I dont really want surgery.

Without seeing you right up close and mapping out your hair for miniaturization, I really can not render an opinion. I have seem many men who are afraid of their family balding pattern, fearful that it may hit them. Some, obsess over it and want to jump into the hair transplant process way too early for me. Why are you so motivated to fill the doctor’s wallet? I make my living doing hair transplants, so I don’t make money when I turn down a patient for surgery, and yet I turn down people for surgery all of the time because it is moral to do so. Any hair transplant surgery in a typical Norwood Class 2 patient is not only unethical from the doctors perspective, but also bad for the patient both short and long term. Starting a hair transplant guarantees a long term plan with more transplants if and when the balding occurs.

What is your total hair donor supply? That is a critical question for anyone undergoing a hair transplant so that a reasonable Master Plan can be created to keep the patient looking normal for their entire life. Having some degree of balding is normal, but becoming a freak because you may have jumped the gun and used up your donor hair (especially if the donor supply is low) is the wrong thing for young men.

I would suggest that you find an ethical, competent doctor who will treat you like you were one of his sons. I am glad that you ended the post with “I don’t really want surgery,” but many doctors who chase your money will try to talk you out of that position and scare the hell out of you with visions of balding that may not even be in your future. Just be careful.

Tags: hairloss, hair loss, surgery, hair transplant

Dandruff Shampoo, Ethnicity, and Other Hair Loss Questions

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

Hi, I’m a 21 year old male of white American (european?) and Bangladeshi (father’s side) descent. I feel that I’ve been shedding hair at a fast rate, but I honestly can’t tell. Hair loss does run in my family. My father is bald and some distant relatives on my mother’s side are as well. I’m a fairly hairy person overall, and I’ve been wonder if that’s also correlated with scalp hair loss.

I tend to have a lot of dry scalp problems for reasons that I’ve never understood. Often, showering using new water makes my head so dry that the area of dry skin creeps to more apparent parts of my forehead. On the whole though, it usually doesn’t — staying on upper scalp area overall (as opposed to sides and back).

There was a time that I suffered a few anxiety attacks and I lost an IMMENSE amount of hair that time and was sure I was experiencing hairloss. I hope that’s enough background. Here are my questions:

  1. Is there a particular pattern of male-patterned-baldness that I should be looking at? From looking at me, at least not to my eye or anything else’s, I have a full head of hair. However, I’ve been losing a lot of hair lately, and I definitely do feel that it’s noticeable in the front crown area.
  2. Do you think I am a decent candidate for propecia?
  3. Do you have any idea why anti-dandruff shampoo works sometimes and not others? Does that impact my hairloss?
  4. Generally speaking, is the hair on the back and sides of a head always thicker than that on top? I don’t know how to view my ethnicity in this regard, because of the mix.
  5. Does length of hair affect hair loss?

Thanks.

  1. You may inherit the genes from one side of your family, so what you can expect will reflect the inheritance pattern, which varies widely in different family lines.
  2. Young men with hair loss (and miniaturization) will find that Propecia (finasteride) will slow down the genetic component of hair loss. I can’t specifically say whether you’re a good candidate without seeing you first, at least in photographs.
  3. There are different types of dandruff shampoos. If one doesn’t work, try another one. Some are just more effective than others (see Wikipedia for treatments). Dandruff does not cause hair loss.
  4. The hair in the back and sides of your head will not miniaturize and therefore, if you have genetic balding of any degree, will be thicker than on the front and top.
  5. Hair length does not dictate how much hair you will lose unless you abuse it.
Tags: hair loss, hairloss, dandruff, genetics, propecia, finasteride

In the News – Man with HIV Denied Hair Transplant

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

Snippet from the article:

A South Florida man claims he was refused a hair transplant because he is HIV positive, and now he’s suing the doctor who denied him the new do for discrimination.

Diego Del Rio went to the Age Defying Surgical Center in Fort Lauderdale to approve his appearance, but Dr. Brett Bolton turned him down once he learned of Del Rio’s condition.

“Their medical staff told me ‘We will not do the procedure because you are HIV positive.’ I told them, ‘This is discrimination,’ and they stated ‘No it’s not,'” Del Rio said.

Read the full article — Man With HIV Denied Hair Transplant

Yes, it’s discrimination and in violation of a state law. I’m not familiar with the doctor or the clinic, but based on what I’ve read about this in various articles, it doesn’t sound good for them. I’ve said it before, but a healthy person who is HIV positive may be as good a hair transplant candidate as an HIV negative person. Here are some past related posts I’ve written:

  1. HIV and Hair Transplants
  2. HIV Positive and Hair Transplants
Tags: hiv, hair transplant, hairloss, hair loss, florida

Accuracy of Scalp Biopsy for Hair Loss?

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

How accurate are scalp biopsies in diagnosing hair loss?

Scalp biopsies are not accurate for the diagnosis of hair loss. The best way to diagnose hair loss in men, is with miniaturization mapping and pattern determination for the hair loss.

You can also have the gene detected (see HairDX), but that will only tell you have you are carrying the gene… not if you have active hair loss.

Tags: scalp biopsy, biopsy, hairloss, hair loss

Female Reader Likes Men with a NW3 Hairline

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

Doc,
Odd question,
I’ve noticed that some men tend to actually look good when their hairline recede to a NW3. Hollywood has a few examples with Christian Slater, Thomas Jane, Josh Lucas, and Patrick Wilson. I’m just curious is there any way of telling who will be good looking with a balding pattern prior to the baldness? BTW, I’m a woman, so I do think those men are good looking!

Your opinion has been noted. If you have a fella and want to find out what he would look like with a NW3, then you can ask him to shave his hair to conform to that look. Or use Photoshop.

Tags: hairloss, hair loss, hairline