2011 ISHRS Meeting Review, Part 8 – Minoxidil

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

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 8… and final part. Thanks for sticking with me on this!

***

 
Minoxidil as a systemic medication?

    Dr. Damkerng Pathomvanich (award winning doctor from Thailand) experimented with the use of minoxidil as a systemic medication on patients. This medication is used in many Asian countries as a treatment for hair loss. He commented that when spironolactone is added to systemic use of minoxidil, there is an enhancement of the hair benefits and a reversal of hair loss in many people. Although the reported side effects of this approach were small, there are still many side effects with these medications (e.g. significant drops in blood pressure, weight gain, fluid retention, rapid heart rate).

    These systemic medications are not FDA approved in the United States for the treatment of hair loss, as well as many other countries. Minoxidil was originally used in the 1960s as a treatment drug for high blood pressure, but its impact was not consistent with lowering blood pressure. Many of these earlier patients developed a reversal of their hair loss and many women treated with it developed facial and chest hair.

 
Aspirin and hair transplantation?

    A hair transplant surgeon who is also a cardiologist suggested that a person on low dose aspirin can have a hair transplant without stopping the aspirin.
Tags: hair loss, hairloss, ishrs, alaska, minoxidil, rogiane, aspirin

2011 ISHRS Meeting Review, Part 7 – FUE Robot

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

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 7. More to come…

***

 
Robot assisted hair transplantation was introduced for sale at the meeting.

    It had been approved by the FDA earlier this year. There was considerable excitement generated by doctors, however, the high price tag ($200,000 plus $1/graft) certainly dampened the enthusiasm. This meeting was a come out party for Restoration Robotics’ hair restoration robot, a very impressive modern technology. The company believes that hair transplants will follow other minimally invasive and more precise surgeries such at the robot assisted surgery for the prostate, the heart, the uterus, the lung, and on and on. The hair transplant robot is called Artas® system, and will clearly standardize the quality of FUE grafts and minimize the damage when used by surgeons who are not as skilled in the manual techniques as some of the more experienced surgeons; however, all three of the first surgeons to buy the robot are experienced in the field of FUE. Restoration Robotics wants only the best surgeons to purchase and use the system.

    One experienced hair surgeon, Dr. James Harris, has been testing the robot for some time for the company. Dr. Harris invented and marketed the most popular FUE harvesting tool (The SAFE System), which has been installed in over 200 hair transplant practices around the world. Although the two technique are comparable, Dr. Harris felt that the robot will minimize the tedium of doing the procedure for the doctor. I totally agree with him and I firmly believe that the new technologies like the robot will become the way of the future as FUE gains market share. The only question yet to be answered is “Who will pay for the higher costs of this procedure?“. As many of today’s hair transplant surgeons do not offer FUE, this opens the appeal for doctors to buy into the FUE technology to expand their service offerings. The unit is expensive, but should pay for itself easily in 4-7 years.

    The Artas® system will generate more interest in FUE and many newcomers in the field will start to offer manual FUE at discounted prices to kick-start their business. All FUE techniques and surgeons are not equal and new doctors without extensive experience are bound to create significant transection of FUE harvested grafts causing more than their fair share of hair transplant failures. Unfortunately, the average prospective patient who does not do their research may fall trap into the pricing competition. The results will be (1) high transection rates with graft kill, (2) failure or the hair transplant to grow in significant quantities, and (3) large scale destruction of the donor area hair (something that is never reversible). This, as I have said before, is a buyer beware business for the potential FUE candidates looking for a bargain.

Tags: hair loss, hairloss, ishrs, alaska, fue, hair transplant

2011 ISHRS Meeting Review, Part 6 – Finasteride

/by William Rassman, M.D./4 /

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 6. More to come…

***

 
Does finasteride induce mood and other psychiatric changes?

    A case report and literature review showed a connection between finasteride and mood changes. In one case presented, a patient suffered from severe disabling mood changes on finasteride, which ceased within a week after stopping the medication. After a short time period he restarted finasteride, and the mood changes returned within a few days. Other cases were reviewed with similar problems. There is little doubt that in some patients, mood changes and other psychiatric problems appeared with the use of finasteride.

    I believe that these case reports are the exception to what we commonly see and that finasteride is generally safe, but if a patient feels that they have changes in their personality or mood since the drug was started or if a family member sees changes in their mental state, they should meet with their doctor to discuss the appropriateness of their continued use of the drug.

Tags: hair loss, hairloss, ishrs, alaska, propecia, finasteride

2011 ISHRS Meeting Review, Part 5 – Finasteride

/by William Rassman, M.D./4 /

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 5. More to come…

***

 
Does finasteride (Propecia) impact the body’s inflammation response in hair loss?

    Dr. Marty Sawaya produced evidence that there is a connection between genetic hair loss and inflammation of the hair follicle. She believes that DHT may have a direct impact on the inflammatory process. With this insight, other potential treatments for genetic hair loss and other hair and skin disease may evolve.

 
Are finasteride’s sexual side effects overstated?

    Despite internet complaints to the contrary, there are no case reports of sexual dysfunction that remained after finasteride was stopped in those patients who reported sexual side effects. The medical literature shows that sexual dysfunction is present in 40+ percent of men over age 50, so it was difficult to assess the 2% occurrence of sexual side effects in a comparable population. Despite this, changes in warning labels have been mandated in the United Kingdom, Sweden and most recently the US.

    One joke on the floor I overheard was that based upon the internet reports, the average 50 year old had a better than 40% risk of sexual side effects, but that reduced to only 2% for those reporting side effects from Propecia, making Propecia less risky for those side effects.

Tags: hair loss, hairloss, ishrs, alaska, finasteride, propecia

2011 ISHRS Meeting Review, Part 4 – Surgical Techniques

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

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 4. More to come…

***

 
Which is better: FUE or FUT (strip)?

    I (Dr. Rassman) moderated a panel of 6 doctors to debate the merits of follicular unit extraction (FUE) over the more traditional strip harvesting transplant procedure (FUT). I started the sessions showing a case of what I called “follicular holocaust”. It was a case of 6840 FUE grafts performed over two sessions. I showed that the failure was not only on the growth of the grafts, but also on the destruction of the donor area. In all recipient sites and donor sites, there was a loss of 26,000 hairs and a massive failure of the FUE procedure.

    The debate followed this foreboding case study with the following insights:

  1. FUE is gaining popularity and seems to be demanded more and more by prospective patients. The graphs showed that the number of FUE procedures will surpass the number of FUT procedures in the next few years.
  2. FUE is safe in the hands of good doctors. The group all agreed on this because they were amongst the best doctors offering FUE. My only comment is that I can’t imagine any doctor putting themselves in the “bad doctor” category as shown in my presentation of “follicular holocaust”.
  3. FUE graft damage is being reduced with building experience resulting in better growth.
  4. Dr. Bradley Wolf demonstrated a patient who had 1000 grafts on each side of his head (total 2000 grafts) after 7 months of growth. The two sides seemed to be about equal. The patient reported no significant pain with either procedure (done one day apart) and the scars in both sides healed with minimal scarring.
  5. Dr. Suddleson argued that FUT supplied as many grafts as are needed, while FUE was more limiting in a single session. He argued that many of the advocates of FUE routinely offered FUT to their patients and that the FUT was the gold standard by which FUE would be compared. He generated a laugh when he pointed out that at least one doctor promoting FUE on the panel had reported his excellent results on the FUT strip based procedures.

Read more

2011 ISHRS Meeting Review, Part 3 – ACell

/by William Rassman, M.D./8 /

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 3. More to come…

***

 
Dr. Hitzig and ACell

    I had breakfast with Dr. Hitzig, known for popularizing the use of ACell for plucking hairs. For those unfamiliar, the idea was that by plucking a hair and keeping some of the genetic material in the original donor area, that plucked hair would grow into a full hair (with the use of ACell), along with the regrowth of the hair in the donor area. Essentially getting two hairs out of one.

    I shared my experience with him (100% failure to have plucked hair regrow into new hairs in a balding area of the scalp). After considerable discussion, Dr. Hitzig seemed to retract his stance that ACell works with plucked hairs in a bald scalp. His present view is that these plucked hairs have to be put into an area where there is already hair present. This appears to be a 180 degree turnaround position from his previous reports that it can grow hair.

    Of course, if it can not grow a hair, then obtaining two hairs from one is not possible, and the hair multiplication process is improperly named for this technique. I was a bit angry, considering that I offered this procedure to multiple patients (at no charge of course).

Tags: hair loss, hairloss, ishrs, alaska, acell

2011 ISHRS Meeting Review, Part 2 – Female Hair Loss

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

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 2. More to come…

***

 
What is the role of immunity in the development of androgenic alopecia in women?

    In men and women, it was suggested that there is an immune response in genetic hair loss that could either trigger the process or be an early sign that hair loss is about to start. Dr. Neil Sadick of New York has been following female hair loss for years. He showed his results from scalp biopsies of the scalp in women with hair loss. What he saw were findings that were similar to the conditions found in diseases like lupus (an autoimmune disease). He believes that female pattern hair loss is attributable to immune driven inflammation and he believes that this interferes with hair stem cell activity as they enter into the growth phase of the hair cycle.

    The earliest symptoms of many women and some men start with pain and itching of the scalp, a set of symptoms that reflect the inflammatory response that he believes is always present, but often ignored. He raises the issue that if the connection is correct, the scalp may respond to the use of steroids in the earliest phases of the hair loss process.

Read more

2011 ISHRS Meeting Review, Part 1 – Hair Tools

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

ISHRS 2011

The annual meeting of hair surgeons was in held in Alaska this past week. The meeting was very well organized, but because of the location, many physicians chose not to travel the long distance. The weather was ideal, as good as California in its best season. About 15% of the 260 doctors who registered were new to the field and used this meeting as an educational opportunity to enter the world of hair restoration.

The following review is very selective and is biased by the things that were interesting to me (Dr. Rassman) and what I thought could be interesting to some of the readers. Since there’s so much to cover, I’ll break this up into multiple posts to make things easier. Stay tuned for more.

There were many innovations in surgical tools that may be too technical for most, so I won’t discuss them too much here. That said, I did write a little about some tools that might have some interest, so let’s begin with those…

***

 
Tool for measuring scalp laxity

    A new instrument for assessing the safety of strip excision as it correlates to the size of a donor strip was introduced by Dr. Parsa Mohebi. He presented the second version of his Laxometer, which should be used to measure the limits of the width of a donor strip.

 
Using HairCheck for bulk measurement

    The HairCheck hair bulk analysis system, which we have been using for a year or so, was reported by many doctors as a positive tool for measuring the hair mass of scalp hair. Readers of this site probably know how much we’ve mentioned hair bulk analysis, and it’s good to see it finally gaining some traction in the physician community.

    The reason we like it is because it enables doctors to compare results over time with real numerical values, which shows the value of drugs like finasteride, and allows physicians to make the diagnosis of genetic hair loss in young men now more certain. Many young men with hair loss in the family who are concerned that they will also inherit the hair loss gene can now be evaluated for the presence of hair loss in its earliest stage. Proper diagnosis should cut down on unnecessary use of hair loss drugs.

 
Keep checking back for much more.

Tags: hair loss, hairloss, ishrs, alaska, tools

Large Donor Area?

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

Recently, when at the barbers, I was told that the hairline at the back of my head was very low. Like most guys, I’d never put ‘hairline’ and ‘back of head’ together. Now that I have, i’m wondering: does having a low hairline at the back of my head mean I have a larger donor area, and the potential for more grafts if needed?

Thanks

Are you referring to hair at the nape of the neck? I’m a little confused as to what you mean by a low hairline at the back of the head. Neck hair may appear thick in some men, possibly even as thick as the hair in the true “donor area”. For people who have the narrow band of hair seen on Norwood 7 patients, there may be a limitation of your donor hair. However, you may have a very high density of hair, or your scalp may be very elastic, or your neck hair is very thick.

Neck hair is not considered permanent, as a substantial number of men will lose their neck hairs with age… so no matter how good your neck hair is, this should not be considered part of your donor area.

So there is no universal answer to your question without an actual examination by a physician. In matters of surgical recommendations, I would trust a doctor over a barber.

Tags: donor area, hair transplant, hairline, neck hair

Minoxidil Made Me Bald in Under 2 Months

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

Dr Rassman,
minoxidil is the worst product ever in the world. I started using it 1 and half month ago and then my hair loss reached a shocking amount .I quit minoxidil 15 days ago. My hair loss reduced but still there is some shedding. Now I am look like really bald. I am really worried about it. My social life also is affected. I dont wanna go outside or do something with people. I am really depressed. At the same time I am using propecia but as I said I am bald right now.

My questions are, will my lost hairs be replaced? If it will,how long it will take? I am 20 years old and my hair is really important to me. please help me.

Hair is really important to a lot of men, so you’re not alone. I am sorry you are experiencing hair loss. Unfortunately, hair loss is mainly due to genetic causes and many men in their late teens or 20s will go through what you are going through.

There have been cases of initial shedding from minoxidil use, but this is usually temporary. I can’t say for sure how long it’ll persist or if those shed hairs will regrow. I do not know anything about you (e.g. age and family history). Please follow up with the doctor who prescribed you Propecia and discuss further options.

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

If Minoxidil Regrew Hair, Could Starting Finasteride Cause it to Shed?

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

I have been taking minoxil for roughly 8 months and have had decent results in the hairline area, especially the corners. I’m going to start finasteride soon however I have a question about shedding. As I understand it, the shedding that can happen on finasteride is due to the follicles that are DHT damaged shedding the hair to grow back stronger.

My question is: is hair grown back solely with minoxidil more likely to be shed when starting finasteride?

The initial shedding is noted with the use of Rogaine (minoxidil) way more often than Propecia (finasteride). I’ve only rarely seen this problem in patients after starting finasteride, but I am seeing growing concerns from readers about it. It’s interesting how various claims can be given so much acceptance when it’s not something widely noted in large scale studies or amongst doctors with patients on the drug.

So unfortunately I don’t have an answer to your question, since I don’t have enough of a patient history that have experienced it.

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

Genetics vs Medication Tug of War

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

Hello Dr. Rassman,

When a person’s genetics finally wins the tug of war against finasteride or/and minoxidil, will the hairloss then reassume in the form of a slow, steady process, or will the hair maintained by the drugs come off in large amounts within a short period of time?

Thank you for your time.

The genetic progression of hair loss while on these medications (the “tug of war”) would likely be slow, in the order of months or years. It does not happen over a few days or weeks.

Tags: hairloss, hair loss

Off Topic – Heart Disease Contributors

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

Dr. Rassman,

Off topic, but as a former doctor working in the heart field and as a doctor who worked in the cardiac field what do you think are the biggest contributors to heart disease? Is there any one variable (e.g., high cholesterol, smoking, diabetes) that is most dangerous?

CardsThis is not a simple answer for a blog post. I will give a cursory answer to it nonetheless in the hope that what I have to say will help someone and possibly could even save a life. Apologies to those that come here for hair related posts, but this isn’t one of them.

Putting aside congenital heart disease, the things that are most dangerous for developing heart and vascular disease are the lifestyles and diets we have. There’s no one factor that I would be willing to pinpoint. What I tell people who ask heart related questions is that we are dealt a set of genetic cards… and if we win, it reflects the way we play those cards. If we keep ourselves healthy (good diet, exercise, no poisons in our system like cigarette smoking or excessive alcohol) we will live longer.

Some people are genetically programmed for high cholesterol and high body fats, so we must take control of those bad cards by going that extra mile. For example, the vegetarian who eats fruits and vegetables daily will have a lower cholesterol and lower body fat than the meat eater who sucks in daily milkshakes instead of water and consumes excessive calories with Big Macs a few times each week. Even the insulin dependent diabetic can improve his card deck with a good exercise program and controlled diet under good medical supervision. I’m not blowing any minds by saying this, I realize, but perhaps there’s one person out there that it’ll click with.

Just remember, life is fragile and you never realize it until you are given the bad news (like a cancer that you ignored when you notice rectal bleeding over the past few years or develop chest pain with your first heart attack). Those of you who think that your body is impenetrable, waking up with chest pain may indicate that you could be too late.

Tags: heart, cardiac, health

Treat a Norwood 7 with Scalp and Body Hair Transplants?

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

Is it possible to treat a Norwood 7 (not a head full of hair but a decent result) using Hair Transplant + Body Hair Transplant?

Thank you!

At NHI, we do not recommend body hair transplants (BHT), as the results are highly variable and unpredictable.

We do have patients in our Photo Galleries that were Norwood 7 and had great hair transplant results from using scalp hair, but I must point out to the readers curious about hair restoration that every patient is different and the fullness will never be over the entire scalp. It’s about creating the illusion of a full head of hair by using the available donor hair efficiently. You just need to have a clear understanding of what “decent” result you are expecting.

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

Eltroxin and Female Hair Loss?

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

Does Eltroxin used for hypothyroidism cause hair loss. I am 47 yrs old and have menopause. Does low estrogen level cause hair loss. Will I need to take some preparation of Estrogen to prevent hair loss?

Eltroxin (levothyroxine) is known to cause hair loss in some, though it is usually temporary (see side effects).

Low estrogen can also cause hair loss. You should talk to your doctor about these issues.

Tags: eltroxin, levothyroxine, estrogen, female hair loss