My Grafts Aren’t Growing — Is It Because I Got Sunburned on My Head?

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

Hi,

I had a hair transplant last summer (June 12, 2009) around 2,000 micro graft follicles. It has been nearly 9 months and I am not seeing any significant results yet. I can see/feel a few coming through but seems to be coming through rather slowly. I was wondering if I damaged or ruined my transplant for in August (two months after transplant) I sunburned the top of my head. It was quite red but I would not say severely burned, but burned nevertheless. Did I damage it or is it just taking longer than usual for my transplant to come through? Thank you for your time and help.

SunA sunburn will not damage the transplanted grafts as they are below the top (cutin) layer of the skin… that is, unless you burned it so severely that the skin heavily crusted after the burn. If the transplants did not grow, you should speak with your surgeon about that problem and see what he/she will do about it. You’re 10 months out of surgery, so I’d expect some decent growth by now.

Check these recent posts for other comments made from people whose hair did not grow after a hair transplant:

  1. I’m Not Seeing a Drastic Difference a Year After Hair Transplant
  2. If There’s No Growth a Year After My Hair Transplant, Should I Just Get Another One?
  3. Hair Transplant Failures and Survival Rates
  4. Haven’t Seen Much Growth 7 Months After My Hair Transplant
Tags: hair transplant, failure, sunburn, sun, hairloss, hair loss, hair growth, sunburnt

Excessive Rubbing and Eyebrow Hair Loss

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

About 6-8 months ago I noticed that my eyebrows appeared sparse compared to my youth, particularly on the outer third to half. No outright baldness just sparsity as they moved toward the outer edge. This alarmed me considerably and I went to see a doctor who had my thyroid tested. The results came back negative for any disorder. The doctor also explained that eyebrows can lose density with age and at 33 that should be something to consider. Well feeling self conscious about something tends to lend itself to fixation as it has in this case. Since my unsatisfying diagnosis I’ve taken to touching or gently rubbing my eyebrows – both in an attempt to stimulate growth and a tactile way of assessing further loss. As well I routinely add a tiny amount of hair sculpting paste to the brows which seems to add to their shape and give them the illusion of increased density.

Through my attempts at alleviating my anxiety over thin brows I’ve actually added a new fear – the fear of further loss resulting from brow manipulation. I’ve noticed that when I stoke the brow or apply the hair product brow hairs will appear on my fingertips. Not every single time I touch them but frequently and at least a few hairs daily, sometimes 8-10 hairs. Unlike hair loss on the head there isn’t much information on what is considered “normal” loss when it comes to brow shedding. I don’t pluck the hair nor aggressive rub the brow, these hairs fall out with little encouragement. Should I assume that these hairs will grow back unlike those of chronic pluckers? How long does it take for these hairs to replenish themselves? Are my actions causing this shedding or is this the natural cycling of brow hair? How many brow hairs are considered “normal” to lose daily? I really can’t find much information out there and would be greatly appreciative of your insight. Thank-you.

EyebrowEyebrow hair goes through a normal life cycle just like the hair anywhere else on your body, but this doesn’t sound like natural cycling based on what you describe. If you have been rubbing the eyebrows (more about the repetition as opposed to the aggressiveness), this can cause traction alopecia to the hair on the brow. This can result in permanent hair loss.

If you do not get the return of your eyebrows in another 4 months or so, then a hair transplant can work well. While you wait it out, you might try Rogaine (minoxidil) on the eyebrow to see if it might regrow hair there, but just be careful not to get it in your eyes.

Tags: traction alopecia, eyebrows, hairloss, hair loss, eyebrow

AutoloGel PRP Therapy

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

I just saw this press release and wanted to know your thoughts on AutoloGel. I know you’ve been critical of PRP recently, but I’m wondering if you’ve read the doctor’s article in the Forum magazine for doctors in the industry that you’ve mentioned.

Cytomedix’s AutoloGel(TM) System Highlighted in Hair Transplant Trade Journal

I did read the article about AutoloGel in the recent Hair Transplant Forum industry newsletter, but the science behind it didn’t impress me. The findings are worth discussing further, but it is just one doctor’s review. I am not a supporter of things like this that have not had proven peer-reviewed articles written about it. The use of PRP (platlet rich plasma) is all conjectural and adds to the complexity of the surgery, possibly increasing the risk of infections with its use.

You can read the article that the press release discusses here (PDF file).

Tags: autologel, prp, hair transplant, surgery, hairloss, hair loss, cytomedix

Fiber and Propecia

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

Hi, I’m currently taking fiber supplements as part of my diet. On the bottle there is a warning stating that a laxative should not be taken within 2 hours of any other medication.

Do you know if fiber can impact the effect of Propecia if taken within the 2 hour time span?

I doubt that the fiber will impact Propecia. I generally suggest taking Propecia upon waking up, first thing in the morning.

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

What To Do When You Don’t Like Your Patient?

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

Dr William RassmanThis isn’t a hair transplant related post, but it is a trip down memory lane for me. Allow me to indulge myself…

I was recently talking with a friend, and I was asked to think back on a case where I had a patient that I simply did not like. While I do get along well with all of my patients today, I thought for a few moments and remembered an experience I had in my first year in surgical practice (before my life as a hair transplant doctor). The chairman of the hospital board of trustees, a very fat, nasty, and ugly man, was an obstructionist to everything that the doctors, nurses, and local politicians wanted to improve, not only the physical facility, but he was also against changing policies that would make the hospital a more patient-friendly place. He was a political person with strong prejudices and he was despised by most of the doctors as he exercised power over them by vetoing everything they asked for. I remember wondering how I’d react if he came into the emergency room bleeding to death from some type of accident and I was be the surgeon on duty. Then one day, that wonder became reality as he was rolled into the emergency room with internal bleeding from a really bad car wreck.

There was no question how I was going to behave, how I must behave — that I would do my best to save this man’s life. This was no ordinary effort, as he had major bleeding from his liver and a ruptured spleen. By the time I got him to the operating room, his blood pressure was barely detectable. We pumped many units of blood into him, got his blood pressure up a bit, opened his abdomen, removed his spleen, and sewed up his liver. I got him out of the operating room barely alive. If he had died, his injury would have justified it… but not for me. I thought that my subconscious might have tried to work against him. I remember staying at the hospital for 2 days and nights, barely sleeping. I stayed at his bedside and did not go home for over 50 hours. Slowly, he got out of shock, remaining very sick for some days until eventually he recovered. When he came back to his chairman duties months later, he was changed. Anything I would say would become his cause célèbre, so when I endorsed various hospital agenda issues like any improvements in hospital policies, in the hospital’s physical plant, etc… he became an advocate.

This experience was unique for me. I knew if he died, I somehow might be responsible for his death. I did not give him any better care than I would give any of my patients, but my prejudices towards him made me so aware of how vital and important it was for me to be impartial.

Tags: healthcare, doctor, patient, medical, surgical

What Percentage of Men in Their Mid-20s Are Transplant Candidates?

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

Dr. Rassman,

I am 25 yrs old and I have a receding hairline. I understand that you can’t tell me whether I’m a candidate without seeing me, but can you tell me what percentage of men my age are candidates for a hair transplant? Also, what characteristics make these men candidates?

Assuming that you do not have a maturing hairline, then your candidacy for a hair transplant relates to how much the hair loss bothers you. Hair transplants are a cosmetic surgical procedure and are completely elective. I always tell my patients that if their hair loss does not bother them, do not consider hair transplant. If you are genetically balding, then drugs like Propecia (finasteride) will stop or slow the hair loss.

As to percentages of balding men at age 25, I would have to guess that some balding may be present in 10-25% of men at your age. Men over 45 years old have a 50% chance of showing some balding.

Tags: hair transplant, hairloss, hair loss

Loniten (Oral Minoxidil) and Hair Growth?

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

I have a question about Loniten (oral Minoxidil). This isn’t considering using it as a replacement for topical Rogaine, but does Loniten show ANY major scalp hair growth? I know it’s an unstable blood pressure medication, but if someone who was suffering from hair loss were to take it, would it show benefits? What dosage would you think it would take to show benefits? I’m always curious about knowledge ;)

LonitenI have no first hand experience with patients taking Loniten to really base an opinion on the amount of hair growth seen from it. I don’t even know the proper dose that would produce hair growth side effects, and I don’t believe that it is equal across all people, ages, and sexes.

I realize you understand this, but just as a warning to those that DO want to take a minoxidil pill to possibly regrow hair — the risks for taking this medication orally to treat hair loss would make it something I’d not recommend trying. If you’re going to use minoxidil to treat your hair loss, topical is the way to go.

Tags: minoxidil, loniten, hairloss, hair loss

My Recipient Sites Are Still Red After 16 Years!

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

Hi Doc! I have another question that I haven’t been able to track down an answer via search engines. I had my last transplant surgery 16 years ago, and all the recipient sites where they put the grafts are light red in color. Is this usually a histamine reaction or some kind of blood stain? It shows more after I get out of a warm shower. Please let me know what this is, and if there is a fix for it (laser resurfacing, etc.) Thanks a bunch!!

16 years is a long time for recipient sites to look anything but normal. Histamine response to heat may be possible, causing increased circulation with the shower heat… but I am just guessing and I’m not enthusiastic about that explanation. I would like to see you if that is possible, but if you’re located too far from my offices in California, I’d suggest you go see a good dermatologist.

Tags: hair transplant, hairloss, hair loss, histamine

Transplanting Body Hair Into Strip Scar from Previous Surgery

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

Hi! Been reading your blog for quite a while now. I know that you are against body hair transplants onto the scalp, BUT — I don’t want to have body hair transplanted anywhere but into my strip scar. The reasons I saw you give in the past for avoiding body hair transplants were because body hair doesn’t grow out very long, so it would be bad for styling. Well, I would like it transplanted into my scar so I can cut my hair much shorter than I currently can without it being noticeable.

I have looked at my chest hair, and they’re not curly. I plucked out a few and compared them to my scalp hair. They’re quite similar. Is this still a terrible idea? I honestly don’t want to FUE scalp hairs because in case this simply doesn’t work and I end up deciding to just say “Screw it…I’m shaving my head and i’ll live with a visible strip scar,” I would then also have to live with little white dots all over the back of my head. I know, they’re not supposed to be very visible, but I don’t want to add to more scarring on the back of my head. I really don’t.

It’s actually not a terrible idea. I am not against using body hair to repair a scar on the scalp, provided that you realize that the telogen (resting) phase is very long… which means only about 50% of the hairs will be growing at any point in time. I would want to evaluate you first if you want me to do this.

Tags: bht, body hair, hair transplant, scarring, scar, hair loss, hairloss, hair restoration, fue

Olux and Elevated Testosterone Levels

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

I am currently a 27 year old male who has been taking the following medications for hair loss.

1) Rogaine (5%) for 3 years
2) Propecia for 1 year
3) Nizoral (2%) for 3 years
4) Olux Foam 8 months

My hair loss had began to slow down for several months but as of recent it has increased dramatically and I had a blood screen. It showed that my testosterone levels are elevated and slightly out of range (most likely due to propecia). My dermatologist did not know what to do and has told me to continue and see an endocronologist. I was hoping you could tell me if this is commonly seen and what solutions there may be.

OluxI am not your doctor, so what I can tell you without examining you is fairly limited. Olux (clobetasol propionate) is a powerful synthetic corticosteroid and with chronic use, can contribute to balding (along with many other issues). It’s generally used as a psoriasis treatment, so I don’t know why you’d be using it to treat hair loss. When you use steroids, there can be an impact on other hormones like testosterone, and perhaps this is causing your elevated testosterone.

Rogaine and Propecia are good to use for the hair loss, and Nizoral is good if you have dandruff (though some believe it is a hair loss treatment in itself). If you have genetic balding, the first thing you should do for diagnosis is to have your hair mapped out for miniaturization, which will clearly show you the existence of balding and the pattern you are likely to pursue. You do not need an endocrinologist for this. See a doctor who specializes in hair (transplants) and they can help you with a diagnosis. Do not rush into surgery without knowing what you have and developing a Master Plan for your hair loss.

Tags: hairloss, hair loss, testosterone, propecia, finasteride, olux foam, olux, psoriasis, nizoral

My Hair Loss Got Worse After Restarting Propecia

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

Dr. Rassman,

Thank you for maintaining this blog, its great to have a free trustworthy resource in a world full of scammers and misinformation.

I’m a 24 year old man and have been experiencing loss since age 18. I started on Propecia at 20 and was able to maintain my hair and score some regrowth. Unfortunately I stopped taking the drug for 10 months starting about two years ago. I started back on Propecia last May(2009).

My problem is that in the past 10 months, while back on Fin, I have experienced significant loss. My hair has gone from a solid norwood 2.5 with full density in the mid scalp and mild thinning in the crown to a norwood 3v with profound diffuse thinning all through the pattern. I have added Nizoral shampoo and some multivitamins to my regimen a few months ago. Still, my hair is getting progressively thinner. Do you think my situation is attributed to the catch-up loss phenomenon or could it be that my body has stopped responding to Propecia…or something else?

Thanks for your advice.

Thank you for following the site, but unfortunately, I really cannot give you a definitive answer.

You are likely losing hair due to genetics, but the degree of your balding is yet to be determined. Maybe you are destined to be a Norwood Class 3V and will stop there. Maybe it’ll get worse. I really couldn’t say. The key point I want you to understand is that there is nothing to stop your genetic fate at this point. Propecia will only slow things down, but I don’t believe your body stopped responding to it nor do I believe it necessarily stopped working. In fact, you may have experienced “catch-up” hair loss after stopping Propecia for 10 months. You could’ve experienced a shedding after restarting the medication or it could just be coincidental timing as the progression of your hair loss was in full swing.

In the end, I would suggest you follow up with your prescribing doctor and continue on with the treatment plan (Propecia).

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

Did Propecia Cause Anxiety, Cramps, Mood Swings, and Great Hair?

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

Hi there

I’ve been using Propecia for nearly eleven months and minoxidil for the same amount of time. In the first three months of the treatment I experienced severe hair loss (shedding) and a succession of side effects such as anxiety, depression, stomach cramps, mood swings and slight swelling of my pecs. After this my hair became thicker and looked like the head of hair I had when I was sixteen.

However, recently I’ve noticed further shedding. The side effects have gone which bothers me as I feel my body might be getting used to the Propecia and is fighting the drug. What furthers my guess is that I don’t feel any pains in my testicles or any absentmindedness which I experienced in the first nine months.

Could you advise as I’m worried about this. Kind regards

I really cannot comment on what you are experiencing. You may have other issues unrelated to Propecia. You list a wide variety of complaints that seem random and unrelated. In addition, as much as I believe in Propecia, the drug does not necessarily give you a head of hair of a 16 year old as you describe and all of a sudden cause thinning (all within 11 months?!). Something does not sound right. I would see a physician for a follow up and a complete examination.

Tags: propecia, finasteride, hairloss, hair loss, cramps, mood swings, depression, anxiety

In the News – Coffee Is Good for Your Heart?

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

In non-hair-loss news, here’s a snippet from the article:

Good news for coffee drinkers—new observational data presented last week at EPI|PNAM 2010, the Cardiovascular Disease Epidemiology and Prevention and Nutrition, Physical Activity, and Metabolism 2010 Conference, suggests that multiple cups of Joe are associated with a lower risk of arrhythmias.

“A lot of people think they have palpitations from coffee, and doctors commonly tell people not to drink it, but there are very few actual data, and the data that are available suggest no relationship,” said lead investigator Dr Arthur Klatsky (Kaiser Permanente Division of Research, Oakland, CA). “We went into this study thinking there would be no association, but to our surprise, there was actually an inverse relationship. It could be protective, although one observational study doesn’t prove anything yet.”

Read the full article — Coffee associated with lower risk of arrhythmias

In a significant article recently published, the benefits of coffee include a reduction of arrhythmias and other antioxidant properties. The story goes on to point out that it could be caffeine that is the key, but this is all observational data and needs to be studied further. It is interesting reading…

Tags: coffee, heart, arrhythmia, medical

Is Excess Sebum from MPB or from the Propecia?

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

I’ve been noticing hair loss across the crown of my head for about 18 months now. I have been taking Propecia for close to 8 months with continual shedding and thinning of my hair. More recently in the last month I have started taking Regaine as part of my fight against hair loss and though I have noticed less of the burning feeling on my scalp my hair continues to shed – though im pretty certain its not at the rate it did a year ago. One thing I have noticed since using Propecia is a phenomenal amount of sebum in my scalp. Is this simply as by-product of MPB, or is it possible that the Propecia and Regaine are causing this?

I only wash my hair now every third day in the fear that I will lose more hair doing this and i struggle to massage thoroughly the scalp of my crown, worrying that more hair will be lost by this. I tend to just massage the back and sides and just rub shampoo on the top of my head hoping it will trickle into my scalp.

Any advice would be deeply appreciated…

Washing more frequently (like once a day) should solve the sebum issue as it will not be building up. Use a shampoo that says it is good for oily hair. Neither Propecia (finasteride) or Rogaine/Regaine (minoxidil) has any impact on sebum production.

Tags: sebum, hairloss, hair loss, mpb, propecia, finasteride

When is Balding with Fine Hair Considered Noticeable?

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

I hate to keep bothering you, but I’m full of questions! With fine hair, how much hair can be lost before it is considered noticeable? 25%? 50%? I am 4 months into using Propecia, and have new hair sprouting all over. I am surprised, as I have been losing hair for 20+ years. I am going to see where Propecia takes me, then finish it off with transplants.

In general, you need to lose about half (50%) of your original hair density (in even distribution) to notice social thinning but that also reflects your hair and skin color. In those with platinum blonde hair, you might be able to lose 80% before it is socially detectable. On the other hand, if you had black hair against white skin, a loss of 20% might be socially detectable. In other words, you need to lose between 20-80% of your original hair density to have others notice that you are thinning and this is based upon hair and skin color and the character of your hair. Of course, you (yourself) would notice that you are losing hair much sooner. This is generally if you lose hair evenly everywhere (and not in a pattern).

For those who respond well to Propecia, it takes about 8-12 months to see early differences… but it will not regrow all the hair you lost. Propecia mainly works to sustain what you ALREADY have and make those finer (miniaturized) hairs thicker and healthier. This will make it look like you have more hair as your hair diameters are thickening. You see, it’s not only about the numbers. Also be careful and note that Propecia should not be considered a cure to balding, but rather it slows that process down (dramatically) in some patients.

Tags: propecia, finasteride, balding, hairloss, hair loss, thinning