Scar is Still Red a Year After Trichophytic Closure

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

I had a trichophytic closure performed on a scar just over a year ago. I think it is healing well but the area is still red not pink and some hairs have grown through accordingly but not nearly as much or what I was expecting especially after a year. Is it normal for the area to still be red? If the area is still pretty thin or still has bald areas can it still be improved? Thank you for your feedback.

Some patients have persistent redness at the donor scar area, even after one year. Follow up with your doctor and get a formal opinion. Sometimes the redness may subside over time (1-2 years).

Tags: hair transplant, scar, scarring

What If I Can’t Wrinkle My Brow?

/by William Rassman, M.D./6 /

Hi, I read your “Juvenile vs Mature Hairline” article I found it very informing. However, I am unable to wrinkle my forehead. Is there any other way to check if I’m getting a mature hairline or actually balding. I’m 19 by the way.

P. S. Is there a DIY way to identify miniturized hairs?

Face measurementYes, you can also measure the distance from the tip of your chin to the tip of your nose (#1). Knowing that distance, you can look between your eyes at the top of the nose (in the hollow between your eyes) and go up to the forehead using the measurement you got in #1. That usually points to the location of the mid-line lowest point for the mature hairline. Note in the image at right, the white and red lines are the same length.

When I look to determine the mature hairline in my male patients, I usually do both measurements. The wrinkled brow is 100%, while the alternative measurement method discussed above usually runs an accuracy of about 90%.

As for mapping your own scalp for miniaturization, we wrote a 3 part series about that.

Tags: mature hairline, hairline, hairloss, hair loss

Is Proscar Cut in Quarters The Same as Propecia?

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

I’ve been taking Propecia for 4 years and have been satisfied with the results. My new MD recently prescribed me to take generic Proscar and split the pills in 4ths as it would be cheaper with approx the same amount of finasteride. After a couple months i noticed more thinning and my hairline receding more. Can this be that generic proscar is less effective? Please offer your professional opinion on this matter, money is not an issue for me I’m willing to do whatever will produce the best results. Thank you

If the Proscar (or generic) is legitimate, it should be the same drug as Propecia even when it is quartered. Many people want the generic simply for cost-savings. You can always go back to name-brand Propecia if you are concerned. There are many counterfeit drugs on the market and some are even sold in legitimate pharmacies (though the risk is likely low), so you could also try a different pharmacy or different generic maker.

And for those readers that might be unfamiliar, Proscar is 5mg finasteride for treating the prostate; Propecia is 1mg finasteride for treating hair loss.

Tags: proscar, generic, propecia, finasteride, hairloss, hair loss

Why Do Doctors Think PRP is Helpful?

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

Dear Dr. Rassman

I hope you can help explain something to me regarding the treatment of hair loss with PRP. I was considering have a treatment of PRP + Acell but then read that one of the growth factors in PRP is TGF-B1 which has been claimed to be something that actually causes hair follicle death. Could you please explain to me how this growth factor supposedly helps when introduced to the scalp in PRP treatments? Is it somehow changed? or do the doctors using PRP not see it as harmful?

Thank you in advance for you answer and insight.

Regards

The use of platelet-rich plasma therapy (PRP) is a good way for a doctor to make money and probably not harm his patient. It’s the buzz du jour and is an excuse for some doctors to sell something extra. I’ve yet to see any satisfactory study that shows using PRP in a hair transplant has any value.

The NY Times wrote about PRP earlier this year — Does Platelet-Rich Plasma Therapy Really Work?.

Tags: prp, platelet rich plasma, hair transplant, hairloss, hair loss

Any Hair Color Breakthroughs?

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

I know that they have now discovered why hairs go grey, but are there any breakthroughs coming about getting or keeping hair from going grey biologically? I know that a person can dye their hair, but is there anything being worked on to get your natural hair color back?

Link: Grey hair in old age: Hydrogen peroxide inhibits the synthesis of melanin

I’m not familiar with any proven solution to gray hair other than coloring the hair. There are products that claim to “cure” gray hair, but I’m not so sure they work as claimed.

The last thing I recall reading about anti-gray breakthroughs was a month or so ago when researchers announced they had isolated a protein. We wrote about it here.

Tags: hair color, gray hair, grey hair, greying, graying

How Full of a Transplant Could the Baldest Pattern Yield?

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

There’s little I can do to make this question less vague, but if an average man, with an averagely sized head, and average hair density/ thickness, who has reached the worst class of male pattern baldness, ever be able to achieve a look of a full head of hair through transplants? I’m not yet there, but discovering hair transplants gave me hope. Discovering their limits kinda scared me a little.

By a ‘full’ head of hair, I am aware that the original density will never be achieved, but is it possible to perform a procedure giving the appearance of a full, even head of hair with no signs of balding? Thank you.

Norwood 7The appearance of a full head of hair (just what you said) is what this is about. If you look at this patient, you will see a fully advanced Class 7 pattern, which is about as bald as you can get. He had almost 10,000 grafts to get this coverage (about 25,000 hairs transplanted). Considering that the average man you discussed above has 100,000 birth hairs, that means that the patient in the link would have moved his entire donor area to cover his head, leaving him almost bald on the side and back of his head. Obviously, this did not happen here, because this patient had a very high density to start (probably born with 200,000 hairs). I know that because with his high density, he could have had another 5000 grafts transplanted if he needed it.

I did not present this man to confuse you, but rather to show you what the worst case balding could look like if the supply of donor hair has very high. Many of our patients with advanced balding may only have 7,000 grafts of donor supply, which then must be distributed artistically by a skillful, experienced surgeon to create the illusion of a full head of hair.

I would suggest that you look at our website and the hundreds of patient examples shown in our Patient Photo Galleries. If it is said that a picture is worth a 1000 words, here’s 1000 pictures that are clearly worth more than that.

Tags: hair transplant, patients, density, hairloss, hair loss

Correcting a Bad Hair Transplant

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

What if my transplant is bad and I’m scarred badly?

I really don’t have enough info about what is bad about your transplant, but since I’m sure I’ve answered questions about repairs before, perhaps another physician’s opinion would be valuable to the readers of this site. Coincidentally, I recently read a post on the IAHRS site from Melike Kulahci, MD that answers your question about corrective procedures — Is It Possible To Have a Normal Looking Head After a Bad Hair Transplant?

Side note: I have met Melike Kulahci, MD at the various physician meetings and she is clearly one of the outstanding doctors in this field today. We have shared some stories from time to time and we agree on most of the clinical issues before us.

Tags: hair transplant, corrective procedure, hairloss, hair loss

In the News – Interview with Hair Club Founder, Sy Sperling

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

Snippet from the article:

Sy Sperling is more than just the founder and former president of Hair Club, the hair-loss treatment company celebrating its 35th anniversary this year. “I’m also a client,” he says, just as he did decades ago on camera for TV commercials that made the business a household name. Today, Mr. Sperling holds another title— retiree, as he sold the brand he built from the ground up in 2000 to a private-equity firm for $45 million, which sold it in 2005 to publicly traded Regis Corp. for $210 million. But the 70-year-old will be making an appearance this fall—sporting a chestnut brown coif—at Hair Club’s New York City birthplace for an event commemorating the company’s anniversary.

Read the rest — Hair Club: A Lifeline For the Balding Man

I remember a time where you couldn’t go one day without seeing Sy Sperling on television. The link above contains an interview with Sy where he reveals how he got into the business of selling hair systems, why he’s no longer with the company he founded, and how a professional baseball player helped get the whole business off the ground.

Tags: sy sperling, hair club, hairloss, hair loss

Is There Professional Jealousy of Dr Gho’s Technique?

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

Comment received in response to the recent post about Dr Gho’s technique:

Sorry doc, but the difference between his procedure and yours is that his does not deplete the donor. He has proven this over and over again both with patients and peer reviewed journal articles. He uses a smaller, wave tipped needle and a special storage solution to make this possible. I would suggest that you look into his procedure further before making blanket assumptions and accusations out of what appears to be professional jealousy? With respect.

I have no professional jealousy here. When I watched his video at one of the medical meetings where he presented his technique, what I clearly saw was FUE. I polled the doctors that viewed it (unofficially) and most people agreed that what they saw, looked like FUE to them. On my next trip to Amsterdam, I will call and ask him to allow me to view his technique up close.

Tags: gho, hst, stem cell, fue, hair transplant

Scars from Strip Harvesting Surgery

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

I have a terrible scar from a previous hair transplant in the donor area. What can be done about it?

If you find that you have a scar from your donor harvest that you find is unacceptable, these options need to be discussed with a competent doctor. The scar often has ridging from the nature of the closure and that will be determined by the doctor who evaluates you. Scars from the donor area are not uncommon and when the surgery is done by a competent surgeon doing standard of care work, scars may still form and be the result of the way your body heals. The treatment of scars are as follows:

  1. Do nothing
  2. Perform a scar revision with a surgeon who can do trichophytic repairs and use ACell in the wound to give you the best opportunity to heal it.
  3. Have FUE into the scar. This can fill in the scar, but hair direction may not be controlled by the surgeon, making the results often disappointing. Two sessions into the scar may be needed.
  4. The use of Scalp Pigmentation has been a significant breakthrough in our hands. Risks include change of color (unusual for the back of the head where hair covers the pigmented area protecting it from the sun). This will not address any ridging in the scar area.
Tags: scar revision, scarring, hair transplant, smp

ISHRS – Comparing Strip Harvesting and FUE

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

For whatever reason, we seem to receive questions about the same topic in clusters. One week, I’ll get a bunch of Rogaine questions… the next week, it’s Propecia time. This week, I got a few about the strip technique versus follicular unit extraction (FUE).

I found a nice article on the ISHRS site that compares strip harvesting to FUE, which I hope will answer some of those questions I’ve got in the past few days. Topics include graft survival, scar formation, and technical expertise.

Link: Comparison between Strip Harvesting and Follicular Unit Extraction: A Fair and Balanced View

Tags: fue, hair transplant, hairloss, hair loss

LLLT for Temples?

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

Hello! I am writing you because I have thinning hair in the temple area. I am a 25 year old black male that hair in the temple area have been thinning. I have not tried any medicine to date, but am looking for a good doctor in my area to go see for information on a way to regain my hair. Also wanted to know is laser therapy a good way of doing this and what is the average price range? Thanks in advance!

I have written about the laser hair therapies in the past, and I’ve been unimpressed with the results compared to the promises and claims the companies make. This goes for the in-office large machines and the at-home handheld lasers. I’ve yet to see regrowth as claimed.

You can read those past posts on the blog, listed under LLLT (low level laser therapy) here.

Tags: laser, hair laser, lllt, hairloss, hair loss

Dutasteride Recommendation for a 27 Year Old?

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

I need to know what dosage of dutasteride you would recommend to a 27 year old patient who has been on propecia for 5 years and is still experiencing hair loss even on the propecia (1mg/daily). I fear that the propecia is just not strong enough. I want to zero the DHT some days so the follicles in my frontal area can have a shot at regrowing. I am not able to accept hair loss and am willing to do whatever it takes to stop the DHT which is hurting my DHT-sensitive follicles. Please help!!

I can tell you’re desperate to maintain your hair, but I do not recommend dutasteride at this point, as the dosage is still unknown for treating hair loss. I hope you are under the care of a doctor, as these are prescription medications… and in that case, your prescribing doctor should have the answer for you.

Tags: dutasteride, hairloss, hair loss, finasteride

Roundup of Questions Asked Many Times Before…

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

hi,

i’m 18 and i have hairy shoulders and chest. could that affect my hair ? because all the hairy people i know are all (or almost all) bald.

is it true that you have to look at your grandfathers to see wether your hair is going to fall? because my grandfather didn’t have hairloss and my father has it :/

i have a high hairline in the shape of a V kinda is that a result that i’m loosing my hair?

are masturbation & hairloss directly correlated ?

We get questions like these all the time, and the answers don’t seem to change. Here we go:

1. The amount of body hair you have doesn’t relate to the amount of scalp hair you lose.

2. Hair loss can skip generations, so you can’t just look at your grandfather (from either side of the family) to know what your pattern might be. It’s not that easy.

3. Your high V-shaped hairline could be hair loss, a mature hairline, or just you having a high hairline. I don’t know anything about your hair loss history to make that determination.

4. This is one I’ve probably written about it at least a dozen times on this blog — masturbation and hair loss are not linked. People love to tell me I’m wrong about this one, and that’s perfectly fine. But if you do or do not masturbate, it won’t make a difference to your hair. It’s a myth.

Tags: masturbation, hairloss, hair loss, hairline, family tree, body hair

All Men on Both Sides of My Family are Bald!

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

Dear Doc,

I am 18 years old. Every single male in my family is bald except for me. From my father, older brother, both grandfathers, uncles and cousins on both my mother and fathers side. Everyone! I should be concerned right? Is there anything I can do to prevent going bald before it has begun?

Thank you in advance.

You should connect with a good doctor and have your hair bulk measured for a baseline measurement, and then have that done every year to be sure that the balding did not kick in.

I would not recommend the use of drugs like finasteride unless or until you actually show a decreasing hair bulk. This is a very sensitive way to follow your course. If most of your family is balding, keeping your hair forever doesn’t look to be in the cards.

Tags: hairloss, hair loss, genetic, family tree