How Could Someone Be a Norwood 6 But Still Look Like They Have a Full Head of Hair?

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

Dear Dr Rassman,

I was reading your blog the other day and was interested to see you comment that a person may have a norwood six balding pattern but still look like they have a full head of hair and also that a person who shows a Norwood 3 balding pattern would almost never advance to a norwood 6.

I am confused because in another post of yours you stated that thinning can begin in different areas at different ages. Can you clarify? I really would like to get an idea of what my final norwood pattern would be if bulk analysis can do that but now I’m not sure it can (?) what do you mean when you say that someone with NW3 thinning will rarely ever progress to a NW6?

If someone had slightly thinning temples and a thinner patch at the crown does this mean they are likely to be a higher NW pattern?

Many Thanks

Norwood 6Men in the process of losing their hair in a Norwood class 6 pattern may not be thinning uniformly. They may be losing more of the frontal hair faster, yet have the overall pattern of a class 6 that may or may not become complete. Some men who take finasteride will arrest much of the class 6 pattern thinning, especially in the top and crown of the head, but their frontal balding could actually be advanced.

I like to tell patients where they are going with their balding pattern, and where they are now during the evaluation.

Tags: norwood, hairloss, hair loss, balding

Any Photos of Transplanted Younger Patients with Advanced Balding?

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

Hi Doc,
Could you be able to post some photos in HT on younger men (30-40) with advanced balding patterns (class 6 or higher) in your blog or at NHI site. I am 32 years old south asian considering HT with NHI, but I havent been able to find how younger patients fare with HT.
Thanks for this great blog.

Take a look at our patient photo galleries on the NHI site. There’s over 300 patients shown there with thousands of pictures. There are many young men on the site that fit what you’re asking for. I used the search box and found these to get you started: Patient LT, Patient EE, Patient XG, and Patient MU.

If you come to one of our Open House events, you will actually meet some men in their late 20s or early 30s who have been transplanted.

Tags: hair transplant, hairloss, hair loss, balding

In the News – Breast Implants Caused Hair Loss?

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

Snippet from the article:

A mother has suffered insomnia and hair loss after both of her breast implants ruptured – causing toxins to leak into her body.

Andrea Hayman, 38, has spoken out to highlight the dangers of Poly Implant Prothese (PIP) implants.

The distressed mother-of-two also wants to encourage women who have had similar breast enhancements to act immediately.

Read the rest — Mother reveals PIP implants have caused hair loss and insomnia

Poly Implant Prothese was a maker of silicone breast implants, which may still be in approximately 400,000 women around the world.

Tags: PIP, breast implants, hairloss, hair loss

Should I Decrease My Propecia Dose If We Want to Conceive?

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

Hi Dc William,

I hope this e-mail finds you in good health.

Actually, I have two questions and would appreciate your comments:

1) Im on Propecia and Roagine for almost two years, and Im planning to get married and having kids accorindgly. Do I need to stop Propecia, Is there any side effect on the baby? Shall I decrease the doasge to 3 times per week.

2) Can you pls provide us with some feedback on PRP & Acell treatment?

I thank you in advance for your reply.

Best regards

Propecia should not be an issue if you are trying to conceive. There is no significant trace of the drug in semen. The drug company (who is at great risk if anything goes wrong) does not have a warning on this for getting pregnant, just for women touching or ingesting the pill. Some doctors suggest that for drug related risks during pregnancy, you stop taking Propecia during the month that you are trying to conceive. This is most probably overkill, as it may have some impact on your hair loss/gain. Keep in mind Propecia’s half life in the blood stream is 4 hours. It may linger on in your tissue for about one week. If you have concerns, talk to your prescribing physician.

As for platelet rich plasma (PRP) — there is no study with respect to it producing any value. It may, theoretically, accelerate recovery after a hair transplant. The best thing I can say about it, is that it is a money maker for the doctor. I guess we are not good business people, because we refuse the join that bandwagon.

And as for ACell — it does not work for hair multiplication, as everyone hoped. It does seem to work for wound healing.

Tags: propecia, prp, acell, hairloss, hair loss, finasteride

Shouldn’t Hair Loss Exams By a Doctor Be Standard Care for Men?

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

Dear Dr. Rassman,

Do you believe it should become standard practice for men to be checked for hair loss either by their primary care physician, a dermatologist or another type of doctor every two or so years between ages 18 and 40? This could be done with observation, hair bulk analysis or a miniaturization study.

We know that Propecia is a powerful medication for postponing and delaying hair loss, especially if used when a man still has a good bit of hair. But it seems the problem is that many men don’t realize they have hair loss until they’ve lost a lot of hair and it has become visibly apparent. Then they start researching what causes hair loss and maybe get on Propecia within a few weeks or months.

In my case, I noticed I was losing hair, mostly in the crown, at age 26. I was shocked to see how much I had already lost. I went for a study and it was confirmed. I’ve gone on Propecia and it’s done a reasonably good job preventing noticeable further loss.

But at age 24, or age 22, when my hair follicles started to shrink, it would have been great had it been standard practice for a physician to take five minutes to look for hair loss. I would have had the choice of getting on Propecia then and, hopefully, postponing my ultimate genetic fate that much longer. Or I could have observed more closely, and when I saw the hair loss was continuing, got on Propecia.

Your thoughts on making a hair loss exam as standard for men as a testicular exam?

Practically speaking, unless your health insurance pays primary doctors for hair loss exams, it will likely not be on the agenda. Hair loss is seen as a cosmetic issue and most doctors don’t know much about it. Perhaps if the majority of patients are willing to pay the doctor for a hair loss exam it would be more widely available.

We have many young men taking Propecia/finasteride, so obviously there are many that realize they are balding in time to do something about it. The internet really helps and it is free.

Tags: hairloss, hair loss, propecia, finasteride

I Need a Second Opinion About My Propecia Dosing

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

I reached out to you awhile ago for Propecia advice, and just had a few more questions. Thank you for taking the time to help me.

I tried using Propecia several years ago for 3 months. I was taking the 5mg pill and quartering it, effectively taking approximately 1.25mg per day. I quit at the three month mark because I felt it was causing definite side effects. I am not so sure they were legitimate or psychological.

I decided to try it again in 2011, but started with smaller dosages. I cut the 5mg pill into eighths, and took .625mg on Monday, Wednesday, and Friday. I tried to put all worries to the back of my head, and work through what I believed to be mental side effects. I feel like I am getting through this, and if I am experiencing side effects that they are indeed in my head. The last two weeks I have done my best to cut the 5mg pill into 1mg pieces, and have taken approximately 1mg on Monday, Wednesday, and Friday.

My question to you is what dosage should I be working up to? I know that the kosher dosage is 1mg a day, but many people have stated that they find this to be unnecessary. When I went to Dr. Hasson in Vancouver for a consultation he gave me a prescription for Propecia, and it was prescribed that I should be taking 1.25mg on Monday, Wednesday, and Friday. If you wouldn’t mind, I’d appreciate a second opinion. Would it be better to take 1.25mg on MWF, or perhaps 1mg every other day or even .5mg everyday?

Lastly, plenty of hair is still falling out in the shower. I can’t say I have seen any benefits thus far, but I have only be taking .625 to 1mg MWF for a little less than 4 months now. I know they say it takes a full year to determine whether or not it is working. Do you believe that the lower dosage is significantly preventing results in halting the hairloss?

Thank you so much for your time,

The standard dose of finasteride is 1mg/day for treating hair loss. Less than that or alternating daily doses will give you some type of result, but I can not tell you what dose you should take or how to work up to it. You need a relationship with a good doctor, not one over the internet. I can’t give you a second opinion, as I’m not your doctor.

You should have bulk measurements to see where you are in the hair loss process and where you are going over time. Anything less that that is second class medicine, something I do not offer my patients.

Tags: hairloss, hair loss, finasteride, propecia

Is Buying Cheap Hair Transplants Really in Your Best Interests?

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

Cheap ain't goodI’m sure you’ve heard the saying, “You get what you pay for.” With offerings in the dollar store, are you getting real value? Those who purchased cheap toothpaste at bargain stores a few years back obviously didn’t know that it was toxic with lead or antifreeze, or those that bought imported pet food filled with chemicals to make plastics had no idea they could potentially be killing their pet… but fortunately the FDA came to our rescue. For those that buy cheap hair transplants, there is no FDA, medical board, or attorney general to tell you if you are getting what you are going to pay for. Even if the doctors had a better than 90% failure of the transplants, what is your recourse? You can ask for your money back, but it’s doubtful you’ll get it. I just read a recent post on a hair forum from one poor fellow that had an almost complete failure of the transplants and was refused any money back.

Recently I met with two men. One had 2000 grafts done about 8 months ago by a Los Angeles doctor with a survival rate of the grafts at about 20% (my estimate). That means that his $2/graft pricing really was $10/graft based upon survival of the grafts. Not only did the grafts that survived cost more, but there was significant damage to the donor area with 1600 graft with at least 3000 hair equivalents lost from his donor bank. What was the negative value of that loss? Incalculable in my humble opinion, as these hairs are gone forever.

The second man was an old hair transplant patient of mine from about 13 years ago. He had terrific results and loved his transplanted hair, which lasted to the present time. A friend of his wanted a procedure done and found a doctor willing to do it for $2.50/graft. My patient referred his friend to me, but wanted to know if I would match this price point. It just so happened that the doctor offering this cheap rate was the same doctor that had the 20% survival on the other patient! [note – It’s our policy to not speak unfavorably about doctors by name on this site, so please do not ask me to reveal his name (do your research and you can probably figure it out though)]

I told him to look over our Selecting a Hair Transplant Doctor guide, and invited him to our next open house event. We had 6 of our former patients come to that event to show off quality results. That other doctor never showed off the quality of work he does. Does that mean that he has no patients worth showing? The only way you can really get an idea of what is going to happen to you is to see results first-hand. We wrote the how-to guide on selecting a doctor, because we want you to become smarter shoppers. This is surgery on your scalp! I fail to understand why someone would risk having this procedure look completely fake or risk the loss of valuable donor hair. Ask yourself, do you really want a discount store hair transplant?

Tags: hair transplant, hairloss, hair loss, surgery, risks, discount, bargain

I Saw Benefits for Months from 0.5mg Finasteride, But Effectiveness Has Died Down

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

Hi,
I am a 25 year old male. I got my first transplant when I was 22years old. At that time my hair grew out well but I experienced side-effects from Propecia so decided against the drug. As a result I wasn’t able to maintain the results I got from the first HT. Fast forward 3 years and I am at a worse stage than I was when I was 22.

For the last 8 months I have been taking .5mg of Propecia, the side effects are still prevalent but on far rarer basis which I can handle. The problem is during the first 2-3months I saw significant benefits from 0.5mg of Propceia with regards to hairloss, but for the last 6-8 weeks the effectiveness of the drug has died down and I am losing hair hand over fist. Do you have any advise/suggestions?

I suspect the short term benefits you noticed in the first 2-3 months since restarting the lower dose Propecia are related to stopping active hair loss, not reversing much. I can’t explain what you’re seeing, unfortunately. Have you talked to your prescribing doctor about his/her thoughts?

I would get a bulk measurement of your scalp hair and then follow-up with another measurement in 12 months. You want to know what is really happening to your hair and this measurement will tell you once you compare the results from the two measurements one year apart.

Tags: hairloss, hair loss, propecia, finasteride

I Recently Started Propecia and Want it to Regrow Hair in My Temple

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

Over the past 5 years ive noticed a general thinning of my hair overall but never really thought it was that bad as plenty of people i went to high school with are already bald or visibly showing signs of recession etc. i usually wear my hair up and over the past 2 years my right temple has thinned out a lot. the v shaped hairline is something ive had from my youth.Although the shape is still there i can see where the eventual receding hairline will be.

Ive recently joined belgravia hairloss centre and they have put me on propecia. So will the hair grow back? the left temple is fine or a lot thicker at the moment anyway! if ive started on propecia would it be silly to maybe have my temple filled in at 26 or should i maybe add minoxidil into the mix? As that is my only real issue at this moment in time!

Propecia rarely regrows hair in the temple peaks or frontal hairline, but it could prevent you from losing more hair at those locations. Minoxidil also rarely works at the front of the hair (it works best in the crown) but it could be worth a try. I usually recommend to my patients that they initially stick with one medication at a time for now to see what kind of response you get over the course of the first year.

Tags: propecia, hairloss, hair loss, temples

I Obsessively Rub and Pick at My Scalp

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

I am 28 years old and I have been obsessively rubbing and picking my head for around 15 years. I have noticed that my hair line has moved back and that my hair overall has become thinner. No bald “spots” but an overall thinning. My question is if I stop now will my hairline return to normal and will my head become fuller again?

What you describe sounds a lot like trichotillomania, a psychological disorder of picking at the hair/scalp that often produces significant balding. In general, hair lost from this picking does not grow back due to years of trauma, as the impacted hair has been killed off.

Tags: trichotillomania, trich, ttm, hairloss, hair loss

Hair Transplant Post-Operative Risks and Complications

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

Can you please tell me about the post-operative course I can expect after a strip and FUE surgery?

If you wash your hair twice a day starting the next day after surgery, most of the scabs and redness should be gone and you should be left with a 1/4 inch stubble of hair on the front after 2 weeks. I suppose if you are really looking at it you may be able to tell something was done. Cosmetically it should not be an issue. For those with transplants to the hairline or frontal area, if your exiting hair is long and you comb it forward to cover it, then it should not be noticeable.

Some patients with fair skin may get persistent redness for weeks after surgery. The redness will look like you have a slight sun burn. Most patients do not. Risk is higher in fair skinned individuals. As a rough rule of thumb test, to see if you may get the redness after surgery by scratching your forehead with your fingernail. Wait a few minutes to see if your scratch mark is bright red. If that happens, then your risk of redness after the transplant is higher than most people.

Some patients get forehead swelling on the 3rd day after surgery and it may last a couple of days, up to a week. For your social needs, 14 days should be no issue. Risk of swelling is about 1 in 30 and it is completely random. Once in a while some people get swelling so bad it may shut your eyes and cause bags under your eyes. We give corticosteroid to minimize the risk, but the risk is still there (although very small).
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Bionike Defence

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

Hi

I’ve discovered this new product at the pharmacy – Bionike Defence Hair

It seems to do the same work as minoxidil 5%, but as opposed to minoxidil, I can actually feel a definite tingling sensation on my scalp with Bionike the moment I apply it(as if it may work more effictively).

What’s your opinion on this product? Does it have the same chemistry as minoxidil and is it maybe even beter?

Thanks

From the list of ingredients (Adansonia Digitata, aesculin, ximeninic acid, amino acids, superoxide dismutase), there’s nothing that appears to be proven as a hair regrowth treatment. The description claims that it blocks the conversion of testosterone to DHT, but a topical spray like this has yet to show results that come close to the oral DHT blockers. It likely doesn’t have the same chemistry as minoxidil.

I don’t recall ever hearing of the product before your email, but if it works for you, that’s great news! To my knowledge there is no connection between tingling and reversing the hair loss process… so you could just be experiencing a reaction to the ingredients (whether it is positive or allergic, I couldn’t say).

Tags: bionike, defence hair, hair loss, hairloss

Reader’s Experience with Dermaroller

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

I have had expierence with the dermaroller. Depending on the length of the needle it can be pretty discormforting although I hear that it stimulates certain growth factors by wounding the area applied. Old news in terms of methods used in Medical fields but new to hair.

Follica has a method however I have not heard much on their progress. Does it work? Well I did not use it long enough because of some concerns in terms of what you mentioned sterile needle. I do however believe that one of your contributing writers has marketed this type of product. Its suppose to make rogaine more absorbable like Retin A in which removes the upper layer of skin. Even Platelet Rich Plasma therapy used for hair loss uses a product similiar to the derma roller. Unproven? Well there was a case of female hair loss that was quite impressive with this therapy. If you are interested I can see if I can find the link. Keep on educating the public Doctor Rassman.

The contributor you’re referencing is Dr. Farjo, as his name was attached to something called the Scalproller in a press release. At the time, he said, “I can not endorse the Scalproller device itself until further clinical research is at hand.” You can read his full response here.

A single case doesn’t necessarily meet the standard for calling something a proven treatment, but I would be interested in reading about it if you have the link. Please keep me informed and thanks for sharing!

Tags: hairloss, hair loss, dermaroller

Taking Photos of My Hair with Different Lighting

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

Hello.

I am curious about hair/scalp contrast, and camera flash vs natural lighting when taking looking at pictures of my hair.

I have a very inflamed scalp, which is also quite scabby. I’ve tried many shampoo’s and ointments, but nothing has been able to clear it up. When I take pictures of my hair, my scalp can be noticeable, since my hair is very fair and when am using flash on my camera it stands out even more. If flash is off, the only noticeable part of my scalp you can see is my crown.

So, what gives the best evidence of hair loss with pictures? Flash, or natural lighting? As I said, natural lighting my hair looks fine, with flash it looks a bit ‘iffy’. My family have said my hair looks like the natural lit pictures, in ‘real life’. My GP says I have no hair loss, but the pictures can make me question hair judgment.

Thanks

Camera flashesI would rather not discuss photography issues (I’m not a photography expert), but it’s pretty common for direct/harsh light to make your hair appear thinner than it is. Just as various light sources can make someone appear older, angry, or even make your hair look a different color, lighting can also make your hair appear thinner than it is. Why, I don’t exactly know. Photography isn’t my field of expertise, but I’m hopeful there a reader of this site has a logical explanation. Direct light isn’t going to be a crystal ball in determining your future hair loss, though.

Other people are telling you that you don’t have a problem with your scalp and/or hair, but if you still believe you are losing hair, then see an expert (photography or hair loss) and find out what is really happening. At the very least, see a dermatologist to treat your inflamed, scabby scalp.

Tags: camera, flash, photography, hairloss, hair loss