Direction of Graft Growth

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

Hi Dr,

Can you explain how accurately a surgeon such as yourself can transplant grafts so that hairs grow in the same direction?

I have seen quite a few celebrity transplants where the hair still appears thin and the hair once grown out always looks messy because the direction of the grafts is not quite right.

How are you able to ensure that this doesn’t happen?

As someone with naturally fine and very straight hair then i imagine it would be essential that any transplant i had done should be performed by a top surgeon who is able to make sure that the angle of the transplanted graft is accurate. If i had thicker and naturally curly hair then i suppose this wouldn’t matter so much and is probably a part of the reason why those with curly make better candidates?

Thanks

Doctors have direct control of how the transplanted hair grows and how the transplanted hairs are distributed to give the most natural look. This is a very important point that most prospective patients do not take into account when searching for the right medical group for a hair transplant procedure.

You are correct in stating the fine straight hairs need careful attention to detail when undergoing a hair transplant procedure, but careful attention to detail is also a must for coarse hair, because each hair can have many times the bulk of a fine hair. A coarse hair put in the wrong direction will be more easily detected than a fine hair put in the wrong direction. Some surgeons, when placing the hairline, place the frontal hairs radially (like bicycle spokes). Is it possible that surgeons who do this do not understand the normal direction of the hair growth, just are ignorant of the facts? Sometimes I think so.

To be sure that these poor placement doesn’t happen to you, you have to do your own research and due diligence. There are many good doctors with great artistic skills. The best way to determine who these doctors are is to ask to meet some of their patients. My patients love showing off their results in the privacy of our office, so we set up circumstances once a month to allow this to happen. To me, this is just plain good medical education. This is why we have our monthly Open House events where anyone can come and see our former patients (up close) and speak with them face to face.

Tags: hair transplant, direction, hairloss, hair loss, surgery, artistic

Hair Transplant from Non-Permanent Zones?

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

Hi,

I’m in planning stages of surgery to fix some Norwood Class 3 corner recession, probably not more than 2000 grafts. Taking the grafts from the permanent zone has the disadvantage of setting me up for more surgery in the future, if finasteride doesn’t keep my hair, so I’m considering having the grafts taken from the midscalp instead. I will then have little to no need for additional surgeries, even if I keep thinning on top, as the transplanted hair will thin out along with
the rest of the hairs.

I understand that some might have a problem with a scar on the anterior mid scalp, but I already have a long scar there. It’s from an accident.

You need to discuss these issues with your surgeon and have a good basic concept of the Master Plan and future consequences. Mid-scalp harvesting can cause more scarring and an unnatural outcome. I do not know exactly what you are planning, but it does not sound realistic.

If the surgery is planned out well, you should not need more surgery because you continued to bald. You may look thinner over time, but it should still look natural, not prompting the need for another surgery. Wanting another surgery is a different story. Every surgery should stand on its own… at least, this has been my philosophy.

Tags: hairloss, hair loss, hair transplant

One Doctor Said I Had Miniaturization, Another Said it Was From Vitamin D Deficiency

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

I am 24 years old and noticed slight thinning at the top of my head. I went to a dermatologist who diagnosed it as, ” mild miniaturization”. I went to another doctor to get blood work who told me I am low in Vitamin D. At this point I am ready to take Propecia, but should I address the Vitamin D deficiency first? Could this be a possible effect of my thinning hair?

You need a good diagnosis before you treat a medical issue. If you are indeed vitamin D deficient, follow your doctors recommendation. If you have androgenic alopecia, follow your doctors recommendation. I am not your doctor. Vitamin D deficiency and androgenic alopecia are not related. They are two separate diagnosis and sometimes they exist in the same person.

Tags: hairloss, hair loss, vitamin d

Teenage Acne and MPB?

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

Hi Doctors,

Do you believe that there is a link between suffering from acne in early teenage years and male pattern baldness? Being as acne spots are based around the hair follicles and hormones also have something to do with it, I am curious.

Thanks for looking at my question!

Changes in hormones are what is responsible for teenage acne and androgenic alopecia (AGA). In boys under 16, we rarely see patterned genetic balding being expressed, yet we see a great deal of acne in this age group. There is no direct linkage that I know of.

Tags: acne, teenager, hairloss, hair loss

If Bimatoprost (Latisse) is Similar to Minoxidil, What Is the Big Deal?

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

Doctor,

Is bimatprost basically a vasodilator? If so I’m not sure what the excitement is about. I’d assume efficacy would most likely be limited as we’ve seen with minoxidil. Maybe a little better, maybe not. Even if it can deliver safely more an effective dose than 5% minoxidil.. its not like there have been miraculous results with say 15% minoxidil. Am I missing something?

Thanks again for taking the time for this site.

Clinical real life results are not the same as textbook conceptual hypothesis. The vasodilator issue may not be the cause of the benefit. Many times, like with minoxidil, the vasodilator does not cause the benefit, but rather the benefit is a side effect of the drug itself. We still do not know why minoxidil (Rogaine) works for hair or why bimatoprost (Latisse) works for eyelashes.

Some people have seen what they’d consider “miraculous” results from minoxidil, so a possible new option for treating hair loss with bimatoprost is why they’re excited (particularly for female hair loss, where drug treatment options are limited). I don’t get too excited about any treatment until I see the results for myself. There’s been too many misses over the years and very few hits.

There is an ongoing study of bimatoprost on the scalp that includes 300 female participants, but results have not been published yet. There might be other studies, but this is the one that came to mind. So whether it is proven safe and effective on the scalp remains to be seen.

Tags: minoxidil, bimatoprost, latisse, rogaine, vasodilator, hairloss, hair loss

My Father’s Advanced Prostate Cancer Treatment Is Regrowing His Hair

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

My father is a Norwood 6. He is 80 years old. He has advanced prostate cancer. Treatment includes medication that drops your testosterone levels because prostate cancer feeds off of testosterone. Besides treating his cancer, he’s had some hair regrowth. The meds have some listed significant side effects but he hasn’t really experienced them. Just wondering if anyone has studied the use of Lupron and Ketoconozole for hair growth or especially prevention of hair loss. He also takes Casodex for eliminating testosterone produced by the adrenal glands?

I guessing the problem is that the long term use of these drugs, although effective at dropping your DHT levels lower than current meds, will weaken your bone over time and make you osteoporotic.

Any thoughts? Thought there would be a way to manipulate the effects of these drugs and use them for hair loss prevention

I do not think taking medication for cancer treatment with all the side effects possibilities would be a worthwhile risk for the treatment of hair loss (which is not a life threatening condition). There are always risks and benefits that need to be weighed before taking a medication.

Ketoconazole is an anti-fungal medication that some people claim has positive effects on hair growth, but Lupron lists hair loss as a possible side effect. As far a research behind the drugs you mentioned for the treatment of hair loss, I am not aware of any.

Tags: cancer, hairloss, hair loss, medication, lupron

In the News – Identical Twins, but Only One Has Alopecia Universalis

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

Snippet from the article:

As girls, they insisted on matching outfits, right down to the ribbons in their blonde pigtails. And as teenagers, identical twins Gwennan and Elin Thomas were inseparable, even going to the same university.

‘We were, and are, best friends,’ says Gwennan. ‘I had a freckle on my forehead as a baby – which disappeared – and that was how our parents told us apart. Looking at some childhood photos, we still argue about who is who.’ Yet, in 2002, a shocking, inexplicable event would mark the sisters apart.

That year, Gwennan, then 25, was diagnosed with alopecia, a condition that causes hair loss. She suffers from the most extreme form, alopecia universalis, and has lost all body hair, including her eyebrows and eyelashes. Ten years on, she can still remember the morning she woke to find clumps of hair on her pillow. ‘I burst into tears,’ she recalls. ‘My hair had been thinning for a while but then it started falling out in clumps pretty much overnight.’

Read the rest — One sister has alopecia and the other has a full head of hair

Identical twins… yet one has alopecia universalis and the other doesn’t. One of the leaders in alopecia research is Dr. Angela Christiano, and the rest of the article talks about how this case is causing her to rethink how this might occur in just one twin. Dr. Christiano said, “There may be something, for example reaction to stress, that causes the gene to express itself in one twin but not in the other.”

Tags: alopecia universalis, hairloss, hair loss, twins

I Had Gynecomastia As a Teen – Would Propecia Make It Come Back?

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

my case is i had gynocomastia on my left breast since i was 14 and had it removed recently at the age of 18, and im thinking about taking propecia and im afraid i will get gynocomastia again. what would be your advise?

My best advice would be to discuss these issues with your doctor and go over your risks. Gynecomastia is a rare side effect of Propecia and may have nothing to do with your previous history.

Tags: gynecomastia, propecia, finasteride

I Take Excessive Retinoids and Have Hair Loss

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

I’ve been taking excessive retinoids for quite some time now. I started coincidentally thinning (just a little bit to the point of being 100% unnoticeable) around the end of last summer. I stopped taking the acne medications towards the end of the first semester of college (which was right around October/November). Then I went back on the retinoids in February, but developed a full, thick head of hair. I eventually upped my dosage and went on a more intense medication.

Side note: I also went vegan right before college. Second semester I ended the veganism. I was also taking a medication called doryx, which had reported side effects of hair loss, on and off. My slight hair thinning continued throughout the rest of the semester. I went to a dermatologist who didn’t really look at my hair, but prescribed propecia and rogaine. It completely ruined my hair and made it 70% thinner, more brittle, and with bald spots within 2 months. I took propecia and rogaine together for a total of 29 days.

My hair is still falling out rapidly. I also was taking acne medication throughout that period, but stopped in the middle of my propecia dose. I am no longer a vegan and no longer take retinoids or doryx, but my hair is still falling out severely. My dad started having thin hair in his 40s–same with my grandpa. I am only 19 years old. What exactly is going on?

Oral retinoids have been linked to hair loss if you take excessive doses (source), but there’s really no way for me to pinpoint what the exact cause of your loss is considering the medication you took, the change in diet, and your age. I don’t know your complete family history, and just because your dad lost hair in his 40s, it doesn’t necessarily mean that you would too.

You may have the genes for balding and the diet change or medication caused the loss to begin sooner. Or your genetics alone could be responsible for the hair loss starting at 19. Or you don’t have genetic male pattern balding, but the medication or supplements are causing it.

There’s just too many variables that make it impossible to come to any definitive cause.

Tags: hairloss, hair loss, retinoids

I’m Losing Hair All Over My Scalp, Including the Sides and Back of My Neck

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

i’m 29 years old. i lost all my hair from all parts of my head, the sides the back down of neck. it began slowly about 5 years ago. the quality of my hair has become horrible. i want to know is this an androgenetic alopecia because it affect all my head hair !!

You are asking of a diagnosis based on a short description, which is impossible. I can say that in general, hair loss on the neck and all parts of the head (including the sides) is not considered androgenic alopecia / male pattern balding. There might be some form of alopecia areata, but I couldn’t diagnose your condition via the Internet.

You need to see a doctor for a specific diagnosis.

Tags: hairloss, hair loss, alopecia

Does Fine Hair Recede Faster Than Thicker Textured Hair?

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

Hi! I’m just curious to know….
Let’s say that hypothetically, 2 men have the same balding pattern BUT one has fine hair and the other has thicker hair texture. Would they recede at the same rate because of genetics? Or will the fine hair textured man recede faster?

It is not about hair texture. It is about genetic predisposition. Having fine hair would make the balding look worse (because it does not provide coverage as well as thicker textured hair), but the hair character isn’t going to determine the rate of your hair loss.

Tags: hair loss, hairloss, hair character, texture