In the News – Full Face Transplant in the US

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

Snippet from the non-hair-loss article:

A Texas construction worker badly disfigured in a power line accident two years ago has received the nation’s first full face transplant at a Boston hospital.

More than 30 doctors, nurses and other staff at Brigham and Women’s Hospital led by plastic surgeon Dr. Bohdan Pomahac performed the 15-hour operation last week on 25-year-old Dallas Wiens of Fort Worth, Texas. He was listed in good condition at the hospital today.

The electrical accident in November 2008 left Wiens blind and without lips, a nose or eyebrows. In Boston, doctors transplanted an entire new face, including a nose, lips, skin and muscles and nerves that animate the skin and give sensation. The donor’s identity was not disclosed nor would the hospital say exactly when the surgery was done for privacy reasons.

Read the rest — Boston Hospital Performs Nation’s First Full Face Transplant

An amazing story of perseverance. The problem that this poor man has is monumental, as is the surgery and the recovery process. His attitude and drive make him unique. We all wonder how we would respond to such an injury, asking ourselves if we are fighters or quitters?

Tags: face transplant, medical, surgery, boston

I Am a Bad Scar Former — Would FUE Be an Option?

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

I have hypertrophic scars from numerous cutaneous surgeries, and even under modest tension my scars tend to spread quit a bit. None of them have an adequate cosmetic result in my mind for a hair bearing region. As a result, harvesting grafts with a strip is something I am not considering. Given my propensity for making ugly scars, am I likely to have abnormally visible scarring from follicular unit extraction at the harvest or transplant site, or are these so small that hypertrophy and spreading are of little concern?

Nobody wants a bad scar, but for hair transplant surgery (or any surgery on the scalp), the scar should always be hidden under the hair if you keep it at a normal length (more than 2 inches). Even a bad scar can still be hidden after a haircut with a #3 clipper most of the time. I also realize many men would like to cut their hair very short in the back where the scar may be visible, and that’s when follicular unit extraction (FUE) may be a better option. However, if you have a tendency to have hypertrophic scars, then even the FUE may leave you with hundreds of noticeable dots.

As with everything in life, you need to have some perspective on what you are doing and what you are willing to give up. Nothing is perfect. There is no such thing as scar-less surgery. There are men who choose to have hair in the front and top, but sacrificing the gain with a scar in the back of their head. There are men who do not want any scars on the back of the head (linear or otherwise), and for them surgery is simply not an option. There has to be some give and take that you have to be comfortable with.

Think about cosmetic surgery on women: Women who want larger breasts will sacrifice their gain in cup size with a scar under the breast, around the areola, in the armpit, or in their belly button. Women who want a face lift will sacrifice a youthful face for a scar along the back of their ear and behind their front hairline.

Remember, keeping your hair very short after a hair transplant will not give you the best cosmetic results no matter how many grafts you transplant. A very short hair style will look much thinner than a longer hair style, which covers more of your head. This is because the surgeon is working with a limited number of grafts to cover a big area.

Tags: scarring, hair transplant, hairloss, hair loss, hypertrophic

In the News – Doctors Usually Don’t Report Incompetence

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

Snippet from the non-hair-loss article:

A quarter of doctors who know that a colleague is underperforming or incompetent do not sound the alarm, a confidential survey reveals. They fear retribution, believe that no action would be taken, or assume that someone else is dealing with the problem.

Martin Roland of the University of Cambridge and colleagues confidentially surveyed 3000 US and UK doctors in 2009. The results suggested that almost 1 in 5 doctors had direct experience of an incompetent or poorly performing colleague in the previous three years.

DoctorRead the rest — Doctors fail to report incompetent colleagues

In the March 12, 2011 issue of New Scientist, the journal quoted a University of Cambridge survey of 3000 US and UK physicians regarding their feelings about the competence of their colleagues. Poor performing colleagues who create errors in patient care reflected an alarming 21% of practitioners in the US and 13% in the UK!

I suspect that these numbers are far worse in fields of medicine like hair restoration, because of the absence of peer review of the activities of these doctors. I could name names, but because of the legal system in the US there is no protection against slander lawsuits lodged against me… so instead I speak loudly about the problem and report to the medical boards those physicians who I know are involved in illegal and immoral acts against patients.

Tags: physician, doctor, incompetence

Sun Exposure After a Hair Transplant

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

Dr. Rassman,

I appreciate all of your feedback on a variety of issues. It really is so helpful for all of us.

I had a HT 3 weeks ago (FUE) with a top notch doctor. Everything went fine. At day 15 post op I was exposed to the Florida sun without a cap or sunscreen, but with hair covering the recipient area, for a total of 10-15 minutes — also during a car ride the sun was shining. I know you have written on this issue, and I have read all of the sun-related posts. However, I would like your thoughts on my situation please.

I noticed some slight pinkness, and the blotchy white and pink spots that I have read about, and some minor sensitivity to the scalp after the sun exposure. I did not have any blistering, and have not yet had any peeling in the area. I am now, since, using sunscreen 70 spf. My question is: is it likely that I affected the grafts, and their growth by this limited exposure (not a severe “red” burn) to the sun?

Please say “No”, but otherwise be objective, and thanks again.

“No”, I do not think you affected the graft.

Most doctors generally recommend protecting the skin from sun exposure (especially after any surgery), because the UV light can cause discoloration of the scar. I would think 15 min in the sun or riding in a car would not be an issue.

Tags: hair transplant, sun, sunlight, uv light, surgery

The Internet Rumor Mill Says Dr Rassman Was Paid By Merck

/by William Rassman, M.D./35 /

This is part of a comment someone posted that I wanted to address:

I was disheartened last night to read that Dr. Rassman was paid to present to a Merck Committee which could perhaps explain his bias. I don’t know how much he was paid, how often it occurred, or if the company used any psychological manipulation on him, but I am starting to feel he’s lost for good. It is a very scary world in which we live, if one can trust their own animal instincts over the educated and experienced opinions of doctors.

JeezTo clarify, I was never paid by Merck. Anyone can post comments on forums, but this is bordering on slander.

Over the years of writing my BaldingBlog, I have come across a select group of critics who have an issue with Propecia and I address those issues here without censorship. To clarify again, I prescribe Propecia, the only FDA approved oral medication for genetic androgenic alopecia (AGA) to my patients who have been diagnosed with AGA. The risks and benefits are explained to them as an optional medication.

I do not make money from selling Propecia, as I sell it in my office for almost my cost (just enough extra to cover stocking costs). In fact, most of my patients go to a drug store to get the generic finasteride 5mg, which they cut in quarter doses. I have nothing financially to gain from recommending Propecia (finasteride). Since I make most of my income from hair transplant surgery, it would actually be advantageous for me NOT to recommend Propecia. So where is my bias?

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

Removing Only Part of the Follicle

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

Hello Doctor

There is a dutch clinic that advertizes the following method

“The most significant difference between the HST method and traditional hair tr*nspl*nt techniques is that with HST, only a tiny part of the hair follicle is removed, leaving the majority of it in the donor area where it will produce a new hair. This preserves the donor area for future treatments, which is why this technique should actually be referred to as hair multiplication, rather than tr*nspl*ntation.”

A very famous dutch soccer player ( Snejder ) supposedly undergone this procedure . Anyone who saw the Bayern Munich – Inter Milan game this week definately noticed the difference on his head

I’m not sure why “transplant” is censored on that clinic’s site…

I know who you’re referring to and I have heard this doctor speak on the subject of partial unit extraction. One of the problems — there was never any physicians actually looking at what he was doing, and as such, there is no peer review or comments by other qualified academic doctors that could back up the claims that he actually has growth of full healthy hairs from fragments of hairs. This very subject has been extensively studied by other physicians and the ability to grow full, healthy normal hairs is clearly not possible. I do not believe that what this doctor is reporting is real.

Past posts about this here and here.

Tags: hair transplant, partial unit, hairloss, hair loss

Would Cosmetic Eyebrow Tattooing Cause Further Loss?

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

Hello dr,
I was considering getting my eyebrows filled in with a tattoo. I have a decent amount of hair but have some sparse areas due to overplucking as a teen. I was wondering if tattooing the area will make the hairs fall out? I hear that it doesn’t from the techs who perform it but not sure if they are just saying that to get more business. I would love your thoughts as a hair loss expert on this matter. Thank you

The use of hair transplantation is probably the best solution available today for eyebrow restoration. Take a look at this post from last month and you will see the absolutely natural appearance of an eyebrow transplant.

I wouldn’t expect the tattooing to cause eyebrow loss, but I’d be more concerned about the tattooed eyebrows looking natural, particularly on close inspection. I guess it depends on the color of your brows and how sparse they currently are.

Tags: eyebrow, tattoo, hairloss, hair loss, eyebrow transplant

In the News – Singer Lady Gaga is Losing Hair?

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

Snippet from the article:

Lady GagaLady Gaga has revealed her beauty secrets and confessed she is losing her hair.

The singer, who has become a style icon with her outrageous outfits, said she dyes her hair so much it falls out. Naturally brown the 24 year old is known for her trademark platinum blonde.

Lady Gaga, who has dyed her naturally brown hair since launching her singing career, says she misses her dark hair when she has to ‘get a chemical haircut because my blonde hair is falling out’.

Read the rest — Bottle blonde Lady Gaga reveals her hair is falling out because she dyes it so much

Lady Gaga. Well, there’s a name I didn’t think I’d ever write about on this site. It isn’t a surprise to me that she’s losing hair from chemical damage caused by bleaching her hair, but it generally isn’t talked about by celebrities in the press.

Tags: lady gaga, singer, entertainment, hairloss, hair loss, bleach, dye, chemical

If I Can Only Afford 1 Transplant Procedure, But I Might Need More?

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

Hello Doctor,

I am a hair loss sufferer, but my hair loss is more of a diffused type, with thinning across the scalp. I am considering hair transplant but would like to get your opinion before I make the decision since I am living in India and will be traveling to US for the transplant and want to make sure the trip is worthwhile.

I have been saving for a hair transplant for the last few years and at this point I can afford a little more than 2000 grafts. Do you think hair transplant is the right option for someone if they cannot afford any follow up procedures after the first transplant? Do you think I should keep saving for some more time so that I can get maximum amount of grafts in one go that can last me for a much longer period without having to go for a second surgery for a very long time?

All my calculations are based on $5 per hair graft that I got from your site for prior fixed appointments. Also is the $5 per graft inclusive of all charges or are there some overheads as well.

Thanks

MoneyAt NHI, our fees are fully inclusive without any additional charges. The $5/graft fee you mentioned is for Dr. Pak’s standby rate, so you’d need to be a little flexible with the scheduling. We do offer a travel discount, too.

Indians generally have lower hair densities than Caucasians by about 20%. Assuming that you take the pill finasteride and you are under 30 years old, the following may apply:

  1. Class 3 pattern — may work well with between 1300-1800 grafts, depending upon hair shaft bulk. Coarse hair is better than fine hair.
  2. Class 4A pattern — can be filled nicely with about 2000 grafts.
  3. Class 5, 6, and 7 patterns — you may not have enough hair to cover the crown.

Many men elect to have one surgery and be done with it, or have multiple surgeries over time. It’s up to you. I haven’t seen you, so keep that in mind. I’m not sure how many grafts you’d actually need or what your hair loss pattern even is. You should send me photos if you’re considering surgery and I’ll be able to hopefully tell you a little more.

Photo credit: Origami artist Won Park

Tags: hair transplant, fees, hairloss, hair loss

SMP for High Contrast Scalp and Hair

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

Dr. Rassman,

For patients who have high contrast scalp and hair (ie. dark hair and fair skin). Wouldn’t a combination of SMP and surgery help minimize some of that contrast and maybe achieve a more fuller look?

Yes! It would be advantageous to complement the scalp micro-pigmentation (SMP) with a hair transplant for a full and realistic (3-dimensional) look. No one treatment is perfect. Hair transplantation can never give you the complete fullness you once had, since it is just rearranging what you currently have. But hair transplants can give you a good hairline, adequate coverage, and even almost normal densities if the area covered is small.

SMP can give you the look of fullness but it will not be real hair, since it is like using concealers (think DermMatch or Toppik) but without the daily applications because it is permanent.

Tags: smp, scalp micro-pigmentation, pigment, hairloss, hair loss, hair transplant

I Have a Good Amount of Hair and Want SMP To Fill In Thin Areas

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

Regarding your new SMP procedure I am very interested. I have been thinking about it for years and actually still have a good amount of hair and have had a hair transplant, which was not a great experience. I feel like the SMP can fill in the areas that are thinner than other, also covering up the linear scars? what is your opinion on that? Also, since I live in NY, what is the likelihood that your friend Dr. Bernstein will be offering this service? Thanks for all your help and keep up the good work!

Scalp micro-pigmentation (SMP) has had great success in camouflaging scars on the scalp (see here).

At this time, we are the only physicians offering SMP in the United States. We have a travel reimbursement program for those who wish to fly out to Los Angeles for a day to have the treatment.

Dr. Bernstein is not presently offering this service.

Tags: scalp micropigmentation, smp, hair transplant, pigment

I’m Seeing Increased Hair Loss After Changing to Generic Proscar

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

Hello Doctor,
I am 26 years old and have been taking Propecia 5mg for almost 2 years. Till last month I used to get prescription refilled from Duane Reade. Then I came to know about Target Pharmacy they give 30 tablets for 10$ only. To save some bucks, I had last prescription refilled from Target, but for last two days, I am experiencing more hair fall. Is it just a coincidence or something else?

Thanks

PillsI would say it is coincidence, mostly because nothing changes in the matter of days. And generic finasteride 5mg should be same everywhere, unless it is a counterfeit medication that is widely sold through the internet. There was just a segment on the 60 Minutes TV show about the fight against counterfeit drugs. But… seeing as how you bought it at a large New York based pharmacy chain, I wouldn’t think fake meds would make it into their system.

Generic aspirin or Tylenol (acetaminophen) works just the same no matter where you buy it or how much money you spend, but I would assume there is a negative placebo effect where people believe a product is not as good when you pay less. Think about that when you buy expensive brand name shoes or clothes. I have heard from a few readers that say they’ve had similar problems to what you’re experiencing after switching to generic, but there is very little information on it.

Tags: proscar, propecia, generic, hairloss, hair loss, placebo, counterfeit

New Propecia Persistent Sexual Side Effects Study Published

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

Snippet from the study abstract:

Methods. We conducted standardized interviews with 71 otherwise healthy men aged 21–46 years who reported the new onset of sexual side effects associated with the temporal use of finasteride, in which the symptoms persisted for at least 3 months despite the discontinuation of finasteride.

Results.  Subjects reported new-onset persistent sexual dysfunction associated with the use of finasteride: 94% developed low libido, 92% developed erectile dysfunction, 92% developed decreased arousal, and 69% developed problems with orgasm. The mean number of sexual episodes per month dropped and the total sexual dysfunction score increased for before and after finasteride use according to the Arizona Sexual Experience Scale (P < 0.0001 for both). The mean duration of finasteride use was 28 months and the mean duration of persistent sexual side effects was 40 months from the time of finasteride cessation to the interview date. Study limitations include a post hoc approach, selection bias, recall bias for before finasteride data, and no serum hormone levels.[/bq] Read the full abstract — Persistent Sexual Side Effects of Finasteride for Male Pattern Hair Loss

This is new to me. We always try to follow publications, but remember that just because an article is published does not mean it is FACT and everyone needs to understand how the results were compiled. This was a paper based only on interviews of 71 men with sexual side effects only. I’m unsure about what lengths they went to find any underlying health issues or even conducting physical exams.

If this is true, then those men who develop sexual side effects will have a difficult decision. This has not been my experience in using and prescribing this drug for over 14 years. We have to make our decisions not just based on what we read, but also the methods of how the conclusions were based.

More info can be found at Time.com.

Tags: propecia, finasteride, sexual side effect, libido, persistent, hairloss, hair loss