Will The Strip Technique Become Obsolete Soon?

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

Dr. Rassman,

Good day sir. Big fan of the blog and all the information you provide. I will keep it short and sweet.

With all the advancements in FUE harvesting, do you think the strip method will become obsolete in the not too distant future?

Thanks and have a good day!

I really believe there will always be a place for hair transplantation with the strip technique. Follicular unit extraction (FUE) is not always the perfect or a preferred surgery, as many people seem to think. Grafts extracted using FUE are not the same as grafts cut under the microscope, and the growth and success is definitely different no matter how good the surgeon is. I speak from experience, as I was the first to publish about the FUE technique in 2002. Shortly after that publication, surgeons all over the world quickly jumped on the bandwagon to adopt it in their practices with varying results. Over the years, I have seen FUE promoted and sold to naive patients as a “better” surgery than the strip, but this is mostly marketing hype and leads to misinformation.

The two techniques (FUE and strip) both have their own unique place in hair transplant surgeries. For example, if you have a Norwood Class 4-6 balding pattern, a strip method of 3000 to 4000 grafts would be a perfect surgery to achieve a full look in ONE shot with a relatively lower cost than the FUE surgery. The strip scar wouldn’t be noticed by anyone unless you decided to shave your head (and if you were going to do that, why even have the surgery). Plus, I would almost never advise a Norwood 6 patient to have the FUE surgery, because there’s a higher incidence of transected hairs in the grafts from that technique. This would be a liability to someone who can’t afford to lose a single hair! Now on the other hand, if you are a Norwood 2 or 3 and wanting your front corners filled in, an FUE surgery may be perfect — especially if the hair is worn buzz-cut short.

Even if the ACell auto-cloning technology proves itself, the strip surgery may still remain the ‘workhorse’ of transplant surgeries. We may be doing combination of all the techniques combined.

Tags: hair transplant, surgical techniques, hairloss, hair loss

DUPA and Body Hair Transplants?

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

Are people with DUPA candidates for a body hair transplant?

Body hair transplants (BHT) are not considered a standard method of hair transplantation and may not give you a normal amount of bulk. I realize some doctors perform BHT with success (depending on how you define it), but the visual appearance of the hair that grows is clearly not normal. Body hair simply does not grow like scalp hair and is not the same texture.

In my opinion, even if you are desperate for hair, I would be cautious with this approach and demand to see patients who have had it done before you agree to such a radical approach to your DUPA problem. Any surgery can make the situation worse, and that risk is real.

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

Could Retin-A Gel on the Face Cause Female Hair Loss?

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

I am 53 years old woman with thinning hair (front and upper middle scalp). I have been prescribed spironolactone tablets daily and am about to start the twice-daily 2% minoxydil (Rogaine) topical treatments. For a different problem (fine lines) I apply 0.04% retin-A micro gel to my face nightly (active ingedient tretinoin). Is there any material risk of adverse drug interactions? Could tretinoin aggravate my hair loss?

For starters, here’s what I said about Retin-A in a recent post that still holds true — “Hair loss is listed as a known common side effect of tretinoin (also known as Retin-A), but it is also used by some people in conjunction with minoxidil to grow hair.”

I really don’t have a right answer for you. These are the questions you really should ask your doctor, since you’re already under a physician’s care. Female hair loss is complicated and I know very little about you, have not examined you at all, and have no detailed history on your many health issues.

Tags: retin-a, gel, tretinoin, hairloss, hair loss

Miniaturization Within a Growth Cycle

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

Hi,

A lot of the hair I see falling out seem to be thick and black at the far end narrowing in diameter towards the root, turning thin and blond. Everything I’ve read, including posts on this blog, seem to say that miniaturization of hair follicles happens from cycle to cycle. Is it possible for hair follicles to miniaturize within a growth cycle or is that most likely caused by something else?

The newest part of the hair near the root may be thinner than the oldest part at the end of the hair shaft, but I am not sure that I would call this miniaturization without examining you. I would think that once a hair is miniaturizing, it will continue in that process with time.

Tags: hairloss, hair loss, miniaturization

Press Release – Aderans Completes Part of Their Phase 2 Study

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

Snippet from the press release:


Aderans Research Institute (ARI) recently completed the first of seven protocols of a hair regeneration Phase 2 clinical study, and the results are in: more than half of study participants showed significant hair growth one year after the cell product treatment was administered. “The results indicate that our scientific approach, our research and understanding of follicular cell and hair regeneration is headed in the right direction,” said Vern Liebmann, Vice President Operations. “The fact that an increase in hair growth is apparent as far out as one year after treatment indicates our process has staying power. Nobody we know of has produced results like these.”

Aderans ResearchRead the full press release — Half of ARI Study Participants See Hair Growth After 1 Year in First Protocol

Results like what are reflected in the announcement from Aderans are very exciting. It is a good thing that many different paths are succeeding lately and, like any lottery, there can be more than one solution to the hair loss problem.

I do not look at the various solutions that are presently being tested as a competition between one technology and another. I look at the millions of dollars that have been spent to solve the hair loss problem and the promise of an exciting future for better and possibly more natural solutions for the various forms of alopecia.

I know from speaking with many prospective patients that some men will now consider postponing traditional hair loss treatments (like the use of finasteride or hair transplantation) in favor of waiting for an “Aderans solution”, but it is important for those who are impacted with early balding not to ignore realistic treatments that do work. For example, a fast-moving balding problem in a young man who may be destined for an advanced hair loss pattern should not allow his loss to progress while he waits for future treatments to become reality, particularly when there are very effective medications available to slow the process down today.

Tags: aderans, ari, hairloss, hair loss, hair multiplication

Could Autocloned Hair Suddenly Become Sensitive to DHT Years Down the Line?

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

Dear Dr Rassman

Is that possible that the Acell autocloned hair, from plucked hair from DHT resistant donor area, stay DHT-insensible for let’s say 10 years, and after that develop sensitivity to DHT ?

If many people stay bald free even up to 50 years old like the balding genes was inactive for decades… I suppose maybe something like that could happen to autoclone hair, like their balding genes could just wake up after many years, in some few cases.

We do not know the answer to this question. One would expect that the auto-cloned hair would be resistant to DHT and grow on just like the donor hair normally does. Apoptosis (cell death) is programmed in the balding hair follicle, but not in the hairs found in the donor area… but still, no one really knows.

In the case of general cloning, I recall there have been reports that the life span of a cloned animal is shorter than expected. It all has to do with something called telomerase, which may or may not apply to the hair. The short answer is: I simply do not know.

Tags: auto-cloning, hair cloning, acell, dht, hairloss, hair loss, telomerase

Any Real Solutions for Female Hair Loss?

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

Hello, I am a recent transplant from New York City to Istanbul. I was a model for 10 years and have been losing my hair since my late teens. As a woman, and one paid for her looks, I do not have to belabor the point of how this has ruined my life. I have worn every possible type of hair extension and now a custom made hairpiece covering my crown and hairline in addition to extensions in the back. I have lost roughly 70 percent of my hair and the remains resemble a troll doll’s fluff. The cost (approximately 300.00 every 2 months) and the constant fear that the extensions will fall out or move in such a way that my scalp will show have left me feeling so hopeless.

I am in my late 20s and can hardly imagine what I will have to face in 20 years when the wig and extensions will cause traction alopecia and pull out the rest of my hair. I cannot wear full wigs since I cannot pull them back into ponytails when working out and they are just not a livable solution. I have traveled all over the world for consults regarding transplantation but I just don’t have enough hair to make the operation worth the expense. Does anyone have any suggestions regarding real solutions – realistic hairpieces, best extensions, etc? I think that I also ran through all of the possible drugs too, up to and including Proscar – I do not plan to have children. Drugs don’t seem worth it either as it is not just about preserving the hair that I have but the fact that I will never have a normal amount of hair to begin with.

It is also noteworthy, I suppose, that my hairloss is both genetic and I know discovered due two 2 courses of Accutane in high school that was prescribe like candy to kids that had minuscule amount of acne (I grew up in the entertainment industry…) Thank you for reading and I would be so grateful for any thoughts or advice.

Your questions are not uncommon and your history is typical of many women. There is little that doctors can do for you unless you have an identifiable hormone defect or medical problem like thyroid disease. I wish there was more I could offer.

As for realistic hairpieces, extensions, etc — If any readers have advice for this young lady, please leave a comment!

Tags: female hair loss, hair loss, hairloss

Does Finasteride Taste Sweet?

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

Hello Doc, I have a question. I just got a new packet of Proscar from a known pharmacy. However, I’m thinking I’ve gotten fake Proscar. Does Proscar taste sweet? Because I cut the tablet into quarter and when I crushed part of it (due to bad cutting) and dissolved on my tongue it tasted sweet like it just a sugar tablet.

If its fake what should I do?? Thanks doc!!

There’s no taste chart for finasteride that I know of, and I’ve never chewed it, so I couldn’t tell you if it’s fake based on taste. I would always swallow my pills with a water chaser. Any readers have finasteride taste stories?

There’s a survey I just read about regarding pill color and perceived taste that you might find interesting — How Does The Color Of A Pill Affect Its Efficacy?.

Tags: finasteride, propecia, proscar, taste, sweet

Would Black Henna Block Minoxidil?

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

Dear Dr. Rassman,

As a female prone to hyperkalemia, I can’t use spironolactone so I can only use Rogaine. Since I have a pale scalp and thinning black hair, I was hoping to dye/stain my scalp black with indigo and henna to mask the hair loss. Do you think that this would block the absorption of minoxidil?

Thanking for your time

HennaWith regular henna ink, I would not think so. Henna ink is essentially henna powder mixed with eucalyptus oil and coffee/tea, and none of those will stop the absorption. It’s commonly used for temporary tattoos (see right).

On the other hand, I’ve read about the dangers of black henna, which isn’t usually henna at all, but rather indigo mixed with chemicals. Ingredients of various black henna products can vary, and the FDA has sent warning letters (like this) about the dangers.

I’m not a henna expert by any means, but I’ve read that so-called black henna can cause severe allergic reactions and skin sensitivities, so I’d suggest researching this stuff a bit more before diving in. You don’t want to end up causing larger problems for yourself.

Tags: black henna, henna, dye, hairloss, hair loss, female hair loss, minoxidil

Finasteride and Prostate Cancer

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

Doc, i have another question. Since I am a healthy 25 year old (who takes propecia), with no family history of prostate cancer, does that mean that I should start having annual PSA and prostate exams right now at this young age as well?

I have have another question. Does finasteride directly causes high grade malignancy in some patients. or does it just delay the diagnosis of cancer cells which if left end up being high grade?(meaning that finasteride doesn’t cause cancer itself but just delays the diagnosis of early stage prostate cancer which later become more aggresive).

At 25 years old, it would be very, very unusual for you to develop prostate cancer.

With regard to the risk of developing a high grade malignancy from taking finasteride, I would doubt that the answers are in yet. The finding of the higher grade malignancies reported may reflect prostate shrinkage. We would need to know what the survival rate of these men who have reported higher grade malignancies is. If those that have the reports have a higher mortality rate than other men with known cancer of the prostate, then I’d believe that there is real risk, not just interpretive risks classified by pathologists.

Tags: prostate, finasteride, propecia, proscar, hairloss, hair loss, cancer

Seborrheic Dermatitis on Eyebrow

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

(female)
Hello Dr. I was recently diagnosed with seborrheic dermatitis in my left eyebrow, in which I have lost a lot of hair density. I was wondering how long I should wait to see if the hairs come back? As a general rule of thumb what is the standard time I should allow them before determining they wont grown back and opting for a brow transplant? Thanks!

Many patients who suffer from eyebrow hair loss find hair transplantation may be a good option. Generally, I would wait at least one year to see if your eyebrows would naturally regrow before considering a transplant. You should also realize that when you transplant scalp hair to the eyebrow, the hairs will continue to grow like scalp hair. In other words, you would need to trim your eyebrow every week or so. You may also need more than one surgery to achieve the “perfect” eyebrow.

Tags: eyebrow, hair transplant, eyebrow transplant, seborrheic dermatitis

NHI’s ACell Program

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

When will your clinical trial on ACell start? When will the first patient get hair transplant using ACell? Thanks!

The ACell trial we’re conducting started a few weeks back and a few patients have already had treatments. As for when it will be PROVEN and be offered as a standard procedure, it will be at least one year (if it succeeds).

Tags: acell, nhi, hair transplant

I Was Told I Needed 5,000 to 12,000 Grafts

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

Dear Dr,
I have a large patch of baldness and when I discussed with different Drs they said from 5000 to 12000 grafts. How do we know how many follicles are transplanted? Of course it is not possible to count. Is it the area of strip? Then how many units will be there if a 10cm strip with 1.5 mm width contain? Price varies with the number of units, thats why i posed this question. kindly reply

I am very curious which doctors you spoke to, because getting 5,000 to 12,000 grafts from one surgery would be considered impossible. Maybe you are confusing grafts with hairs. One graft can contain 1, 2, or 3 hairs. So 2500 grafts can contain 5000 hairs (for example).

In general, an average Caucasian male with a 2 hairs per square millimeter donor hair density and an average scalp elasticity has about 5,000 to 7,000 grafts to donate in their lifetime (but not at once). You simply cannot harvest 12,000 grafts in one surgery. An average maximum or upper limit of a hair transplant surgery is around 3,000 grafts. I only recall a few patients in my 15 years where I was able to harvest 5,000 grafts in a single surgery, and those patients had abnormally high donor hair densities. There are some doctors who split the grafts into smaller units and this will push up the graft count, not the hair count. I tend to think that the doctors that split grafts are only doing so to charge the patient more (if they charge per graft).

You need to ask your questions to these doctors and have them explain what they are talking about to you in detail. I do not know your hair density or how flexible your scalp is, but if you were to get 12,000 grafts in a single session, you would be alone amongst all patients I have encountered.

Tags: hairloss, hair loss, hair transplant

NFL Player Tom Brady’s Hair Loss?

/by William Rassman, M.D./3 /

I am a big fan. I have been following y’all for quite some time now. I was hoping you would offer your assessment of recent reports that Tom Brady is experiencing hair loss. As a guy experiencing hair loss and a football fan, I am skeptical that Tom Brady is losing his hair. Apparently there are reports that he went to a hair loss treatment center in RI. Anyways, below is a CBS News article on the subject. I am interested to hear your thoughts/assessment.

CBS News – Is Tom Brady Losing His Hair?

Tom BradyI don’t know about any possible hair loss treatment center visit by NFL quarterback Tom Brady, but the photo in that CBS News article (see right) shows his hair falling forward and covering the hairline. There’s not much I can tell from that. I did see some photos that appeared to show some hairline corner recession for Mr. Brady, but I’m unable to find any kind of timeline on the images I’m finding in Google. Some photos show him with a very juvenile looking hairline, and others appear to have a mature hairline. Perhaps styling is what has helped his hairline in the past.

So could it be that he’s losing hair and wanted to cover up a receding hairline? Possible. Could it be that he just wanted to grow his hair out? Sure. Or could it be a combination of both? Absolutely.

Tags: nfl, football, tom brady, patriots, new england, quarterback, sports, celebrity

Low Testosterone, Higher Chance for MPB?

/by William Rassman, M.D./3 /

In another post, I read that men with lower testosterone have a higher chance of MPB. This seems to make no sense from a logical standpoint. How can having higher testosterone decrease the chance of having MPB? Can you explain this?

Testosterone is not the main cause of male pattern baldness (MPB). The mere presence of testosterone produces DHT (the trigger point for MPB), but it is genetics that will ultimately determine if you’re losing hair.

I’m not sure which post you’re referencing, but I would think logically that higher testosterone (in men predisposed to MPB) would have accelerated balding. Note that I used the word “accelerated” rather than “increased”. This is because even if you have lower testosterone you would likely become bald the way you were programmed genetically, because what testosterone you have will be converted by your body to DHT.

Tags: testosterone, dht, hairloss, hair loss