Did Actor Ray Liotta Have a Hair Transplant?

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

Dear Doctor.

Did Actor Ray Liotta get a hair transplant? If you compare the pic 1 with the pic 2 and 3 it looks as if he did. What is your view?

Thank you.

Photo 1 – Photo 2 – Photo 3

What I see could be a transplant, but I have no firsthand knowledge. His hairline certainly appears thicker in photos 2 and 3, but there are no dates on these. The lighting in these images are also different. It could be that with styling and color (and better lighting), it’s the same hairline. Maybe he’s using a concealer to give it more visual bulk. I really don’t know, as the photos are pretty small and difficult to compare.

How Many Balding Men in the US Have Hair Transplants Each Year?

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

Hi Dr. Rassman:

Do you have any statistics on the number of hair transplant surgeries that are done each year in the US, and what percentage of men with male pattern baldness that represents?

From just casual observations, it seems the vast majority of men with MPB never treat it and have no interest in treating it. As you know, many either shave their heads, wear their hair short, or just ignore it.

I’ve been told not to bother treating my hair loss, that it looks fine as is, and that if you have a nice face you don’t need hair restoration anyway. Any thoughts?

Thanks for the great site!

The ISHRS released their census with extrapolated figures, showing over 100,000 hair transplant surgeries in the US were performed last year. You can find all their released stats here (PDF file).

Hair restoration is a personal choice. If you don’t want to have surgery and don’t mind your hair loss, then by all means don’t have the procedure. It’s a lifelong commitment, and it certainly isn’t for everyone. It can also be cost prohibitive for many people.

Tags: hair loss, hairloss, hair transplant, statistics

Best Way to Dry My Hair?

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

Hello, I was wondering if you recommend blow drying, towel drying, or air drying hair when one is suffering from male pattern baldness and is thinning out/losing hair? For purposes of getting ready in the morning, air drying is not really an option. Thank you!

If your hair is coming out because of the balding process, you must be gentle with the drying process. Do not rub your hair with a towel. Just pat it dry. When using a blow dryer, be sure not to use it on a hot setting, as it is best with low heat or no heat at all.

Tags: hair dryer, blowdryer

Did I Actually Get All the Grafts I Paid For? (with Photos)

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

Dear Dr: can you help me estimate the number of grafts and hairs I receive based on the following photos? feel free to download and use them.

The doctor said, in a very random manner, he did 2900 grafts. Then plus post-op meds, this number exactly matches what I have paid before the surgery and we do not owe each other a penny. I won’t argue about it if there’s only a little discrepancy.

Thanks for sending the photos and allowing me to post them. I’ve chosen one photo to post that will give readers an idea of what you had done. Click to enlarge:

 

I have actually counted the grafts on patients that have doubts like you expressed in your question. If peace of mind is what you want, then a visit to a doctor who is willing to count the grafts is probably a good idea. On a few of the patients where I counted the grafts, wide discrepancies have been found, confirming their suspicions.

But counting the grafts in the photographs or counting them after the third day of the surgery will not get you what you want. You should have written to me right after the surgery and then I could’ve given you an accurate count within 1% of what you got.

Tags: hair transplant, post-operative, graft counting, hairloss, hair loss

SMP to Fill In Scalp Scars?

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

I have several scars on the back of the head, a recent procedure gave me yet a big new one to cover and deal with..

I am concerned about the look, once my hair is wet- these now are very visible, unnatural and difficult to explain-a subject I’d rather not discuss at all. Is the Micro Pigmentation a possible “fill in fix” to these scars, and if so, how do I deal with the way my hair color will look in say, 10 years when I am completely grey/white and thinning yet even more in the back? Matching skin, hair color is important.

I currently have dark brown/grey hair which I dye for the time being. Thank you.

The pigments have their limitations, but are particularly good for men who want their hair shaved to almost scalp level (closely cropped). You are correct that as you gray, the pigment may produce problems, but usually these pigments gray a bit anyway. I would have to see you, at least see the pictures of your scars and their locations before rendering more thoughts.

Repair of scalp scars takes experience and your situation of having a surgical correction that made it worse is common when the surgeon does not really understand scalp repairs. I have seen many scar repairs by well known plastic surgeons and still they get wider after the surgery. If you are in the Los Angeles area, there is no substitute for a good examination, as it may be possible to fix these scars.

Tags: scar repair, smp, scalp micropigmentation, pigment

Hair Stuck in Scabs After Hair Transplant

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

Hello,

I wanted to ask a question about scabs. I am 33 year old African American male and I had surgery done for 1000 grafts about 15 days ago. After the surgery, I was told not to wash them until the next day. I was told I was “poppy” which mean, I bled alot when the surgery was being performed. These forms little round beads of blood when I left, but I could see my hair transplants nicely.

When I washed my head, I was careful not to move them, so I just dabbed them and rinsed. Over the next week, these turned into scabs.

Now, my scabs are falling off when I take a shower, or when I lightly move them, with no bleeding. However, what I am noticing is there is hair stuck on them. I am so afraid that they are taking with them the hair follicles.

Is there a way I can find out instead of waiting 3 months. I still have some scabs remaining and it is exactly 2 weeks since I had surgery.

How can I be sure that my anchors are still in place.

Any ideas, thoughts appreciated.
Thank you

Everyone experiences hair in the scabs when they come off. The key to good management is to get the scabs off immediately after the surgery. Now you should wait until the scabs come off with gentle shampooing of your hair. The hair you see in the scabs should not be the grafts, unless the grafts were not seated correctly on the time of the surgery. Talk to your surgeon about proper aftercare.

Tags: hair transplant, hairloss, hair loss, scabs

Best Topical Concealer?

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

I have general thinning in the crown area in an otherwise mostly full head of hair. I find that what works best for me is one of those masking agents that you spray on to color your scalp to match your hair color. In fact, it works so well that one of my friends examined my scalp closely and still couldn’t figure out why my hair seemed thicker. The problem is that this stuff rubs off too easily. You have to be extremely careful to not let your head touch anybody’s pillows or furniture for fear of leaving a large brown (or black) spot.

Is there a product out there that stains the scalp so that it will not wash or rub off and remain on the scalp until it wears off?

DermMatch will not rub off. Scalp MicroPigmentation (SMP) will not rub off either…. but it is permanent. DermMatch is cheaper and will wash off.

Tags: dermmatch, smp, concealer, camouflaging agent

What is FOX Negative?

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

What does FOX negative mean?

Thanks.

We coined the term “FOX” at New Hair Institute back in 2002 for FOllicular unit eXtraction. We thought FOX sounded better than FUE. We also published a paper on follicular unit extraction, describing how some patients are good FOX/FUE candidates and some are not.

I realize FUE is performed at many clinics without any pre-testing on all patients who want to have the surgery, however at NHI we pre-qualify potential patients with a FOX/FUE test to see if they are good candidates. A very small percentage of patients will have high transection rates with FUE and these are the FOX negative patients we are talking about.

We generally do not recommend FOX/FUE surgery if the transection rate is approaching 20% or more. If the patient is FOX negative, it is an inherent problem to the patient (not the doctor or clinic or machine). As we wrote about our experience with NeoGraft a week ago, the machine could not successfully harvest a known FOX negative patient.

Tags: fue, follicular unit extraction, hair transplant, hairloss, hair loss

Hair Falling Out Near Scar from Scalp Injury a Decade Ago

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

Hello, I was in a car accident in 2002. When it happened my scalp was pulled from my head and I am left with a U-shaped scar on the side of my head. The hair around the sar fell out and then grew back. But now my hair is getting thinner an falling out around the scar. It ha been almost 10 years and it is starting to fall out now. I was going to get scar revision to make he scar less noticeable but now that the hair is falling out around the scar I don’t know what to do.

You need a good examination from a doctor that can give you a better assessment of your condition. Maybe you are losing hair around the scar (as part of genetic balding), or a change in your hair thickness has occurred and you are noticing the scar even more. I really couldn’t say, as I haven’t seen the scar.

Scar revisions in general do not completely get rid of scars, but how much improvement depends on where it is and the direction of the scar. Scar revisions in the scalp may reduce the scar by 25 to 50%, but sometimes they can make the scar worse. Speak with your doctor.

Tags: scarring, hairloss, hair loss, scar

Is There a Hair Loss Age Deadline?

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

Hello Drs:

Thanks for taking my question. By what age can a man be (relatively) certain that he will not be balding in his lifetime?

Added detail: I am a 26 year old man, with a slight mature hairline, but no balding anywhere else. I am just wondering what age I will be when I can rest assured that, if I have not already gone bald, I probably won’t. (My father and eldest brother are bald, but my two other older brothers are not).

Thanks.

Around 50% of the male population will not bald. If you want to know if there is any suggestion of balding at your present age of 26, the bulk and density measurements in our office will give you a good idea.

Some people lose hair in their 20s, some in their 30s, some in their 40s, etc, etc. It depends on your genetics if you’ll experience male pattern baldness and what age you’ll see it.

Tags: hairloss, hair loss, age

Could a Healthy Lifestyle Change Result in Hair Loss Acceleration?

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

I have decided that I really need to start eating more healthily and working out. Could this change in lifestyle have any effect on my hair for example having an accelerating effect on the balding process?

I don’t know if you are looking for an excuse not to be healthy, but living a healthier lifestyle shouldn’t accelerate hair loss. Eat right, work out, be happy.

Tags: hairloss, hair loss, healthy living

Site Stuff – Is It Time to Ban Some Commenters?

/by William Rassman, M.D./41 /

Dr Rassman

As a hair transplant patient, physician, and clinical scientist, your site is a model of providing responsive, measured, accurate, educational (and sometimes humorous) information about alopecia. How you have the time to do this essentially volunteer service and your other activities is just amazing. I am a believer in freedom of speech and comments on your blog run the entire gamut of the well-informed to the misinformed. Such is life. Indeed, even posts with far-out, alternative ways of looking at things can be of value.

However, over the past year, one particular blogger has made continuous personal attacks on you ranging from the naïve (questioning your cardiovascular fellowship based on a conversation he had with a “friend”) to the absurd. It is non-stop. He makes similar personal attacks on others who objectively disagree with him and seems to have a bias against intellectuals, those familiar with clinical data, those who understand the biopharmaceutical industry, and anyone who does not think that Propecia is not an evil drug and that Merck is days away from “being in great trouble” for “hiding” data (paraphrasing).

Most of his posts invoke conspiracy theories. His arguments are littered with enough semi-scientific information (never substantiated) to make the scared and uninformed reader possibly confused. However, my biggest concern is the almost incessant stream of misinformation from this blogger and the significant amount of time others have to respond (only to receive the inevitable name-calling response). Several sources have also suggested that this blogger is a shill for a website involved in recruiting Propecia patients in a class action lawsuit. In the name of constructive censorship (common on blogs), isn’t it time to put his abusive posts to rest (i.e., ban him from this site).

The posts on my blog are opinions (of myself and contributing editors). The site is not meant for diagnosis or treatment and we’ve posted that disclaimer on every page. If any readers want a professional or personal medical consultation they can always contact us.

I do occasionally follow some of the comment threads and I realize that anyone can write false information, including making wild (and comical) accusations about me. I know there are a few people that are very vocal and leave comments on nearly every Propecia posting, and I think the average reader can decide what they want to believe if they actually followed those lengthy comment diatribes. If someone gets obscene, the comment is removed. It’s happened, but it’s not something I deal with too often. We do reserve the right not to post some of the comments we receive, but we do allow the great majority of comments through (besides spam and completely off-topic stuff).

If anything, I find the volley of comments entertaining, but perhaps you’re right. Perhaps it is time to limit the comments that are not meant to be constructive. It’s something I’ll consider, for sure.

Tags: baldingblog, site stuff

I’m Losing Pubic and Scalp Hair, But Chest Hair Remains

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

Doctor,

In the past year I’ve had hair loss all over my body — including my pubic hair. My pubic hair, which used to be extremely dense and coarse, is now soft and (comparatively) sparse. This I don’t mind very much — what concerns me is that at the same time, my scalp hair starting falling out diffusely at first, then, over about a year, developed to a Norwood 2. I understand that testosterone is responsible for pubic and axillary hair growth. Is it possible all this is happening because more of my testosterone is being converted to DHT? I’m just trying to understand the connection between the two. If it helps, the hair on my chest and belly has remained pretty much the same.

Also, I’m considering Propecia. Does the hair that you lose during the months before Propecia takes effect (including Propecia-induced shedding) come back, or does the drug only maintain the hair you have at the time its benefits kick in?

A little background: I’m 21, my family on both my mother’s and father’s side (including mother, father, uncles, grandfathers well into their nineties, an older brother) has no history of balding. When I first started losing my hair I was introduced to something that caused severe, constant stress and depression that lasted about 6-7 months. In the beginning, like I said, the loss was diffuse. In fact, it fit the bill for telogen effluvium exactly, and I assumed it was this. At this point it’s hard to deny it’s just androgenetic alopecia, unless TE sometimes behaves this way. (?) Also, I’ve smoked for about three years — no other male in my family does.

I know that this is a long question but I’ve been searching for answers for months and have had no success. Your site is the best I’ve stumbled upon! Keep it up.

All the best

Stress could cause hair loss, particularly severe and constant stress with depression. Or there could be MPB (or a combination of stress-induced and genetics). Cases like yours are particularly difficult to diagnose, manage or get involved with over the internet. This is not what we do.

I wish I could provide more comfort or help, but I really don’t have the slightest idea as to what is causing your pubic hair to thin. You really need to see a good dermatologist to assess you and your problem.

Tags: hairloss, hair loss, stress, body hair

Could Griseofulvin Cause Hair Loss?

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

I am interested in your opinions in regard to Griseofulvin. I know it is used to treat fungal infections of the skin/hair/scalp, but have you heard of or encountered any cases where this drug actually causes hair loss?

I have read several reports of drugs like Lamisil and Diflucan causing hair loss, so would Griseofulvin be any different? Also, is this really the best option to treat a “black-dot” ringworm case of tinea capitis?

Thank you.

I haven’t encountered any cases where griseofulvin caused hair loss, but it is a treatment for tinea capitis (also known as ringworm)… and that does cause hair loss if not treated.

Please see your doctor to treat your medical issues.

Tags: ringworm, griseofulvin, hairloss, hair loss, infection

How Data is Collected and Interpreted in Clinical Trials

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

Note: This post comes from one of our favorite readers (he has requested to remain anonymous), who has contributed posts in the past about FDA issues. He provides some insight into clinical trials, and sent this in to answer some of the questions/concerns posted in our comments section about Propecia data.

Finasteride side effects are a hot issue on various forums and on our own site, so hopefully this can clear up some of the hysteria that perpetuates online:

—

Post by Guest Writer

    A recent post impressed me by referring to Propecia data from a FDA hearing (more updated and accurate information is in the U.S. Product Label) but may have been confused by how data is collected and interpreted in clinical trials. I am a veteran of overseeing clinical trials resulting in drug approvals.

    1. The poster notes that the “rate of sexual side effects is 3.8 percent with finasteride versus 2.1 percent with placebo.” Actually, following the Advisory Committee hearing and in further review of the data, the US Product Label shows that in Year 1, decreased libido was 1.8% for the 945 men receiving finasteride and 1.3% for the 934 men receiving placebo (placebo-adjusted rate of 0.5% or 1 in 200 cases). Similarly, erectile dysfunction was reported in 1.3% of men receiving finasteride and 0.7% of those receiving placebo (placebo-adjusted rate of 0.5% or 1 in 200 cases). Approximately 1.2% of men receiving finasteride and 0.9% of men receiving placebo discontinue the study drug due to sexual side effects. No cases of irreversibility of sexual dysfunction were reported.

    2. The poster asks (given that the reporting was “self-reporting”) whether the results “are scientific”. This latter sentence makes me wonder if the poster wonders if clinical trial data is collected similar to the uncontrolled self-selected questionnaire surveys often cited in other situations. It is not. Unlike self-selected questionnaires, where one does not know the denominator (how many patients are receiving the drug, only those reporting a complaint) or period of observation, a clinical trial is different. In a clinical trial, the physician investigator asks every participating patient at regularly scheduled visits through the entire study (and predetermined) follow-up whether they are having or have had any new or worsened effect in any organ system. By definition, this reporting has to come from the patient. But, it is as scientific as one can get (it is solicited rather than self-selected). In addition, any report of a side effect is attributed to the drug (active vs. placebo) regardless of the causality. That is, if a person gets hit by a car and sustains trauma and is on an active drug, trauma is tabulated under the drug (although an investigator may causally relate it to something else). This conservative approach is taken to capture any possible relationship (i.e., maybe the drug makes someone drowsy and more prone to accidents).
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