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    Avoid the Scam – Doctors Selling Grafts That Can’t Possibly Be Delivered!

    Aug 21, 2009/by William Rassman, M.D./0 /Hair Transplantation

    Scam AlertA man of Chinese descent came into the office this week. He had a Norwood Class 4A balding pattern (see art below). He told me that in surfing the Internet, he found and contacted a couple of doctors, sending pictures of his balding pattern to them via email. Conversations with both doctors suggested that he receive 4000-5000 grafts. First of all, he is an Asian, which means that his average density should be around 1.7 hairs per mm square (Caucasian average is 2.1) and he was probably born with 80,000 hairs on his head. But when I measured his density, it was low for a Chinese man, measuring 1.3 hairs per mm square (total hair count on his head before he lost hair was in the 60,000 range). His hair was black and straight with an average weight. His skin laxity was average.

    Norwood 4ATo get 4000-5000 grafts, it might require more than a 3 cm width excision and that would put him at risk for problems in his donor area, possibly not being able to close the wound. These two medical groups made promises that were completely unrealistic. Of course I can not tell what they would have done had he come into their offices for the surgery. Would they have sold him 5,000 grafts and split the grafts into one hair units? Even that, with a 1.3 density, would doubtfully yield that number of grafts. Would they have charged him for 5,000 grafts and delivered only 2,000 (or less) single hair grafts?

    What is irking me is that the promises over the phone were either misrepresenting what can be done, or it was part of a market scam. I stick to my pitch: Let the Buyer Beware!

    Tags: asian, chinese, hairloss, hair loss, scam, hair transplant

    This Can’t Be Real – An iPhone App to Grow Hair?!

    Aug 21, 2009/by William Rassman, M.D./1 /Hair Products

    I thought you might enjoy this….. Here is a snippet:

    You can return the Rogaine–your iPhone holds the power to keeping your hair looking good. Hair Clinic For Man and Woman claims to be the “world’s first mobile hair clinic system.” Its makers say the app generates inaudible frequencies that “promote blood circulation around hair roots.” All you have to do is move the handset around your scalp while the app sends the frequencies.

    Here is the link: NetworkWorld.com

    iPhone Well, it certainly is fitting that this iPhone application shows up on Network World’s “most idiotic” list. It also shows up on Fortune Magazine’s “10 dumbest” list, has a hilarious review on Krapps.com, and is probably appearing on multiple other lists of the most-stupid/dumb/idiotic/ridiculous apps. Keep in mind that this is considered one of the top 10 dumbest… out of over 50,000 apps available. Quite a feat! While it will not regrow hair, it will help to make you the laughing stock of the office if you’re caught rubbing your phone on your head in the hopes of hair regrowth… and you get bonus laughs when people find out you paid money for the privilege. Here’s the official site for this app, which is worth taking a laugh at — Sociag.com.

    Has anyone heard of similar types of therapies? I remember the magnetic helmet that succeeded in doing nothing, unless you consider “wasting your money” to be a success.

    Tags: iphone, ipod, apple, app store, hair clinic, frequencies, audio, hairloss, hair loss, fortune, funny

    My Crown is Responding Well to Propecia, But My Hairline Is Going Fast

    Aug 21, 2009/by William Rassman, M.D./2 /Drugs, Hairlines

    Hello Dr.

    I’d like to start by saying that your blog has been such a great source of info and i thank you and your team for that . I’m a 35 year old man and i take propecia daily , I’ve only been on it since last November and i have no side effects so i plan to continue.

    I fully understand that propecia rarely has a impact in the frontal area but , i hoped that it would at least slow the loss. My crown seems to be responding fairly well. Lately noticed my frontal area getting worse . I wake up in the morning missing more hair than i had the night before . Is it normal for this to happen at such a rapid pace and in such large amounts?

    Thanks for your time .

    I think you answered your own question. Yes, it is normal for you to continue losing hair in the front hairline as Propecia will not restore it in most cases. Propecia mainly works on the crown/top areas, rarely in the frontal area… and that goes for regrowth and stopping the hair loss. Obviously if you’re a good responder to Propecia in the crown area, you should continue taking the medication for as long as you want to keep that hair. For the front area you may consider a hair transplant surgery, but unfortunately there is no drug out there that can restore the hairline.

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

    Why Does Miniaturized Hair Shed?

    Aug 21, 2009/by William Rassman, M.D./0 /Hair Loss Causes

    Hi doc, can you explain this answer that you gave to a person that told you that he was shedding lighter and thinner hairs:

    “Don’t focus too much on the hair that you lost. In normal periodic hair shedding we may lose both miniaturized and normal hair, since most adult men (50%) experience some degrees of balding at some time.”

    So my question to you doc, is why do people shed miniaturized hair???

    All hair sheds as it goes through their hair cycle. The “not visible” phase (telogen) lasts about 6 months. The weak hair that is miniaturized is more fragile and falls out with brushing and in those hairs, the hair growth and loss cycle is more active… and the hairs that are miniaturized have a short growth phase (and if they regrow at all, will have a longer telogen phase).

    Tags: miniaturization, hairloss, hair loss, hair cycle, telogen

    Is 2% Minoxidil Effective for Men?

    Aug 21, 2009/by William Rassman, M.D./0 /Drugs

    Is minoxidil 2% even effective for men?

    It should be effective to some degree for men with light thinning, but 5% is the generally recommended dose. I guess you can try it and let me know!

    Tags: minoxidil, rogaine, effectiveness, hairloss, hair loss

    Where is the Donor Area and How Much Donor Hair Do I Have?

    Aug 20, 2009/by William Rassman, M.D./0 /Hair Transplantation, Training

    Hey Doc, generally speaking where does the donar site begin and how much donor hair do I have. It obviously ends in the back of the neck. But where at the back of the head does it start, speacially if your a early norwood recipient.

    This answer is going to be a little long and technical, but hopefully some find interest in this…

    Donor Area:
    Norwood 7The donor area is always the rim of hair that is seen in the Norwood Class 7 patient (see art at right). It starts at the occipital prominence of the skull (back of the skull) and goes up in the midline to a height of about 2 1/2 inches. It runs from the temple prominences by the forehead from one side to the other. The total measurement depends upon the size of the head. Large heads might have a 15 inch measurement from temple prominence to temple prominence and let’s say 13 inches to be safe, of which 1/2 inch on each side is not usable because any hair extraction from that close to the forehead will show as a thin donor area or a scar from the frontal view. So if you were to harvest the donor area (either by strip or FUE) the donor area would measure 12 inches long multiplied by 2.5 inches high or 30 square inches of scalp in a person with a typical size head. Half of that 30 square inch number would produce 15 square inches of usable donor hair. Each square inch in a Caucasian’s scalp with average hair density contains 1250 hairs which if multiplied times 15 square inches (half the donor area) would give 18,750 permanent movable hairs or in theory 9,375 two hair follicular units (grafts). I know this estimate is high, because the side rim of the donor area usually has a lower donor density than hair in the main part of the scalp.

    Density:
    We must really talk about the amount of hair that must be left behind after harvesting not the hair we are going to take out. In the average Caucasian with average hair density, both residual and donor hair amounts are equal so that we will not be able to ‘see through’ the remaining donor area after the maximum number of transplants are taken; however, the lower the donor density, keeping the 18,750 hairs in place (to prevent a see-through look) causes the surgeon a problem and in removing the donor strip, the remaining donor skin will almost certainly stretch, reducing the remaining density.

    Hair Character:
    When a typical Asian patient comes for a hair transplant, the removable hair is substantially reduced (it will leave behind 80% of 18,750 hairs or 15,000 hairs). Let’s go through the calculations again for a typical Asian patient with 20% less donor density than a Caucasian. The Asian patient would have 15 square inches of usable donor hair and 15,000 remain after the donor strip is harvested. The total supply of the donor area for the hypothetical Asian would be 15,000 hairs or 7,500 grafts. If we then go to a person of African heritage, that number reduces even further (densities in the African can average as low as 60% of a Caucasian’s density). The removable donor area will yield 11,250 hairs or 5,625 grafts. As the donor area is harvested, it will stretch, reducing the remaining density substantially for future procedures.

    It should be evident to the reader, that the size of the bald area is a critical determinant (need vs availability), a conundrum of clear proportion as the real donor hair availability becomes apparent. The quality of the hair (thin vs thick) the character of the hair (straight vs wavy or kinky) and the color of the hair and skin (donor contrast between hair and skin color) must play a significant role in the art of the hair transplant and where to put what hair is available. Make no mistake, this is an art form.

    Keeping Some Doctors Honest:
    By the above calculations, the Asian patient or the African patient has substantially less hair that can be used for hair transplantation. These calculations assume that the looseness of the scalp is not a variable (of course this is not really true) and that scarring is not a problem (everyone scars to some degree and those that scar worse are in a difficult situation for taking larger number of grafts).

    Maybe you will understand better why I get so angry when doctors say that they can transplant numbers of grafts that are in the stratosphere. Some of the recommendations I hear smell of dishonesty or a naivety of the doctor to the basic mathematics of the hair transplantation process.

    Tags: hair transplant, hairloss, hair loss, donor area, hair restoration, technical

    Single Hair Transplant Session (with Photos)

    Aug 20, 2009/by William Rassman, M.D./4 /Hair Transplantation, Hairlines, Photos

    This patient was amazed by the results he saw from his single session hair transplant (2750 grafts). It’s been 3 and a half years since his procedure took place and in that time he’d forgotten what he started with. When he and his family member came in for a visit this week and saw his before pictures, neither of them believed that it was him. He’s allowed me to post these here so you can see why he was so pleased when comparing the before and after photos.

    I used a hair band to keep his hair back when taking the after photos, since it has a tendency to fall forward on its own. His hair is fine so another session to thicken it up is indicated and is something we wants. The reason I only took out 2750 grafts, was because that was the maximum ‘safe’ amount to remove. Any larger amount would have produced wound problems. His scalp is still slightly tight, so he will exercise his scalp for 3 months and then he should be loose enough to get out another 2500+ grafts. Click the photos to enlarge.

    After hair transplant of 2750 grafts

     

    Before

     

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

    In the News – Woman Pulls Six Cars With Her Hair

    Aug 20, 2009/by William Rassman, M.D./0 /Other

    From the very tongue-in-cheek post at automotive blog, Jalopnik:

    In China, hair-pulling is, counter-intuitively to Western conventional wisdom, a male-dominated sport. This makes Zhang Tingting the Danica Patrick of the strange competition of pulling cars with her hair.

    Hair pulling cars

    See more photos — Chinese Woman Pulls Six Cars With Her Hair

    This looks painful. But… um, congratulations?

    Tags: china, chinese, hair pull, hair pulling, cars, auto

    I’m In My Mid-30s and I Have No Hair Loss

    Aug 20, 2009/by William Rassman, M.D./1 /Age, Hair Loss Causes

    If I have all my hair at 35 (going on 36) and its thick, do not take after my father side of the family genetically. He’s was dark haired, brown eyes had some sort of pattern baldness. Mom is blond hair, somewhat fair and has green eyes. I am somewhat fair, blonde, blue eyes and have a thick head of hair. Will I keep most of my hair for a while? Or would you need more info to make a better determination? Does sexuality play a role also?

    If you are 35 years old and there is no hair loss, then statistically your chances of going bald are very, very slim. To be sure, map out your hair and scalp for miniaturization and it should record a number of miniaturized hairs under 20% of what you have on your head.

    As for sexuality… if you are asking if you will lose hair from a sex drive in overdrive, the answer is no.

    Tags: sex drive, hairloss, hair loss

    Unusual Balding Patterns?

    Aug 20, 2009/by William Rassman, M.D./0 /Hair Loss Causes, Hairlines

    Hi Doc,

    Im a 30 year old male. Theres a history of MPB in the family, I have recently noticed a strange thinning in my hair which is not the typical MPB progression. The thinning is effectivley a ‘line’ which starts in the centre of my fringe and moves back about 3 inches from centre to the right of my head. My hairline is no different than it was in my teens and the thickness of hair on my head is great, my question is, do you ever get baldness patterns which differ from the usual MPB ?

    PS Ive been on Propecia for 7 years as a ‘preventative’ measure and up until now have been very happy.

    Thanks for your help.

    Sometimes men bald in atypical patterns, often one side ahead in the balding process from the other side. What you have may be just an unusual variant of MPB. It’s hard to tell without seeing what you’re talking about, though.

    Tags: hairloss, hair loss, unusual, balding pattern, mpb

    Resveratrol, Curcumin, and Hair Loss

    Aug 19, 2009/by William Rassman, M.D./1 /Drugs, Hair Products

    Hello, i am slightly confused, i read how resveratrol can increase test levels, is this true and would it worsen my hairloss?

    But i also recently read a contradictory study on the combination of resvaratrol with curcumin, which is claimed to help with hairloss. Do you think this is a posibility? An italian company were seeking a patent on a pill that contained these two .

    Also i take finasteride, can the res/cur, affect the absorption of fin? I take fin in the morning.

    Red grapesHere’s what I just learned from Wikipedia —
    Resveratrol is a chemical produced naturally by several plants (including red grapes). As suggested, it gives the heart beneficial qualities of red wine. Curcumin is found in Indian spice turmeric, which is a member of the ginger family.

    So in essence (let’s cut out all the nebulous scientific names), you want to know if natural extracts from grape and ginger can be beneficial to your hair. There are THOUSANDS of these natural concoctions people have tried to help with hair loss throughout history. I really do not know if it will work, but in the end it becomes a “buyer beware” market and your experience with how your body responds is the final answer you need for you. In my opinion, I doubt it will have an impact on your hair, but more so on your wallet and time. I don’t know anything about the study you’re referencing, so I can’t really give you any insight into their findings.

    Tags: resveratrol, curcumin, grapes, ginger, hairloss, hair loss, herbal, grape, finasteride

    About a Decade After My Hair Transplant, It is Falling Out

    Aug 19, 2009/by William Rassman, M.D./0 /Hair Loss Causes, Hair Transplantation

    I had a transplant procedure about 12 years ago done by a great physician and personal friend, the late Jim Arnold. During the past couple of years I have had more dramatic hairloss including the loss of my new hairline. I thought that transplants lasted forever. Would I be fighting a losing battle to go ahead with another procedure?

    I have seen what you described before, but there could be many reasons why you have this happening. I don’t know much about you (I’m limited to your single email) and I need to learn more. When we say that hair transplants that come from the fringe area around the head are permanent, we mean that in 99% of patients. The hair in this fringe area will stay the lifetime of the person, but we do know that there are general diseases that are seen (such as DUPA) which can appear at any age.

    I would want to understand what is happening to your donor area now and an examination with a high powered video microscope will allow me to evaluate that donor area. What you are seeing in the grafts may very well be in the donor area as well. Without an examination, I can not tell you what to look for. Please call my office at 800-639-4247 and set up an appointment. As you likely know, I acquired Dr. Arnold’s practice and see many of his patients. He was a wonderful man and a wonderful doctor, loved by his peers and his patients as well.

    Tags: hair transplant, hair loss, hairloss, dupa

    Persistent Rash from Generic Finasteride?

    Aug 19, 2009/by William Rassman, M.D./0 /Hair Loss Causes

    Thanks for providing this invaluable site. I am a 22 year-old male, Norwood 2. I have been experiencing a rash over the last month and I’m concerned it is related to finasteride. I do take Cipla’s Fincar (~1.25mg daily for 5-6 months), ordered from one of the semi-legal internet pharmacies, you know the deal. I realize this complicates things. The rash seems to flare up for a period of hours on a near daily basis. It usually appears on my arms, legs, torso and pelvic region. It is in the form of a series of raised bumps surrounded by a reddened patch of skin. It has a strong itch and is sort of painful when scrathed, more so than a mosquito bite. I have tried stopping the Fincar for a week and the rash did seem to stay away. I am concerned because I had one outbreak on my right pelvic region where I broke the skin from scrathing and that left a bad patch of swollen open bumps for days.

    I am now trying to get the dose down to 1 to .75mg. On the higher dose I had testicular pain and a notable increase in libido as well as what seemed like a pretty miraculous cessation of shedding, this all after only two months. This makes me think the Fincar probably does contain finasteride though I know there is no way to be sure. I would like to know if you have ever heard of such a persistent rash from propecia in one of your patients. I know its listed as a side-effect… If it sounds like the Fincar is the source do you know if this type of reaction ever resolves over time or if lowering the dose might help.

    Thanks again for your help

    It certainly sounds like an allergic reaction, but I couldn’t tell you if its from the medication or something else entirely. You may be allergic to finasteride or possibly the one of the fillers in the pills (though that would be very unusual). The fillers do vary from manufacturer to manufacturer so you might switch to see the impact. I don’t recall a patient reporting a rash from finasteride, though.

    Since you ordered from one of those “semi-legal internet pharmacies” am I to assume that you aren’t under the care of a physician? You might want to pay a visit to a dermatologist to find out more about your rash.

    Tags: finasteride, propecia, proscar, cipla, hairloss, hair loss, rash, fincar

    Is Dimethicone in Shampoo Preventing Minoxidil Scalp Penetration?

    Aug 19, 2009/by William Rassman, M.D./5 /Drugs, Hair Products

    I just had an epiphany regarding why minoxidil may not work for the majority of men. I would like your expert opinion on this. I think I may have just discovered something.

    I have been using minoxidil for about a year along with an herbal shampoo containing all natural ingredients. I recently switched to a fancy shampoo that has many other ingredients, including dimethicone and various other ingredients that are commonly used in most shampoos to improve texture and increase thickness.

    I noticed, after using this newer shampoo, that when I applied the minoxidil, it beaded up on my scalp. I immediately realized that dimethicone is a form of silicone. After reading the label of the shampoo and the matching conditioner, I noticed that they also contained other silicone-based ingredients. The ingredients are used in almost all shampoos and conditioners to coat the hairs, to add shine and improve the texture, etc.

    As you may know, silicone is also the primary ingredient in auto polish, car wax and many other similar products. Silicone adds a layer of protection to surfaces and protects them. It causes water to bead up on a car’s paint, etc. This is why I noticed, I’m sure, the minoxidil beading up on my scalp after using the shampoo and conditioner containing the dimethicone. If silicone can cause water to bead up on a car’s paint, I’m sure it can also cause minoxidil to bead up on one’s scalp. It certainly appears to have that effect. If it’s beading up, I’m sure it isn’t properly penetrating. No penetration = no results!

    So … here is my epiphany. We all know that minoxidil does NOT work for the majority of men. And if it does, it usually only works minimally. Now, since the majority of shampoos and conditioners contain dimethicone and similar ingredients, which prevent or hinders the penetration of minoxidil, couldn’t this be the reason why most men do not respond to minoxidil? Furthermore, there is a small percentage of men known as “responders.” These are men who respond very well to minoxidil. Maybe the reason they respond so well is something so simple that it has been overlooked, i.e., they are simply the ones using dimethicone/silicone-free hair products allowing the minoxidil to actually penetrate and do its job unhindered.

    What do you think? Has this been addresssed before? If not, do you think my “theory” has any merit? I really think it does. Let me know what you think.

    It is an interesting theory, but the dimethicone in the shampoo should not block the absorption of minoxidil, unless perhaps you leave the shampoo on your scalp without rinsing. You should apply minoxidil after you wash off any shampoo and conditioner and the scalp is warm from the hot shower you take, with the scalp pores open. That is when the absorption occurs.

    Tags: dimethicone, silicone, hairloss, hair loss, minoxidil, rogaine, shower

    How Long Do I Need to Wait After Injury Heals to Transplant Into It?

    Aug 19, 2009/by William Rassman, M.D./0 /Hair Transplantation

    Hello Doctor,
    Maybe a slightly unique question here… I have about an inch forehead scar in the hairline(above right temple side of head) I received from injury back in April, and had it revised with a scar revision procedure in June. Results are good (about 2 months into the healing/remodeling phase), but I’m facing facts here: I want the hair back where the incision-line scar is, no matter how less/ or barely visible the scar is overall…

    My question would be at the 3 month mark here in September (if 3 months matters, as that is when I have my follow-up with the plastic surgeon who performed the revision at that time as well), would I be able go forward with the minor transplant without jeopardizing the healing scar? It’s primary (main) healing phase is already complete, right? So, would I be safe in getting the procedure done? Or could I jeopardize the scar or general healing phase of the area at all? Thanks so much for your help; I read your blogs frequently.

    I would have no hesitation to transplant the area after 3 months have passed, but might be concerned at less than that time period. The basic scar healing should be complete by then. For those curious about the various phases of wound healing, check out this article.

    Tags: wound, injury, hair transplant, hairloss, hair loss, healing
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