Would Mini-FUE Be Ideal for Treating Possible Triangular Alopecia?

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

Good day Dr Rassman,
I wonder if i would be an ideal candidate for your new FUE harvesting technique!

I have been in contact with you before. I am a 44yr old male with a small (1 inch) bald spot on my right side in front of the ear. i have never seen anyone else with this particular condition, i wonder if you have. i can resend pictures as no doubt you are unlikely to have the ones i sent to you some years ago. Hair miniaturised in this area probably at the start of my balding process (was gone by the time i was 30 i think). Many years of propecia and minoxidil have had no effect whilst they have had some effect on the top of my head.

A consultation with a dermatologist diagnosed triangular alopecia (although that was simply by looking and he may have just have piggy backed onto my suggestion that it was!!). A course of steroids both topical and injections have had no effect.

i wonder if this new technique could be the answer. My only concern is that if this is an immune system rejection of hair in that area, then i assume placing more hair there will be rejected as well but i am no expert just looking for a solution. many thanks

If you have a 1 inch area on one side of your head, a mini-FUE would possibly be ideal.

Before assuring your candidacy for surgery, I’d of course have to see precisely what you’re referring to and I’d want to know for sure what the diagnosis was. I don’t know why you’d think your immune system would reject hair transplanted into an area of your scalp.

Tags: fue, m-fue, triangular alopecia

Will Drinking a Lot of Water Dilute Propecia’s Effectiveness?

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

Hi,

I have recently started taking Propecia and was concerned that the amount of water I drink daily may potentially be washing the medication out of my system too quickly. Can drinking water dilute the effectiveness of the medication (I drink about 3 litres a day) or once taken does the drug metabolise in other organs in the body and therefore remain relatively unaffected?

Much appreciated.

Nope. 1 cup, 2 cups, 3 liters… your body is still getting the medication. Just like if you eat a hamburger with 1 glass of water or 1 gallon of water, you still get the same calories.

Tags: propecia, water, dilute, finasteride

Avodart Dose for Male to Female Transsexuals?

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

Dear Dr., I am Male to Female Transsexual who’s been on (finasteride 5 mg, Spironolactone 100 mg, Estradiol and Progesterone) for 14 months now. I am 30 y/o, my body is responding well but my hair isn’t. I get some tiny hairs on my hairline but I loose them, I go through phases of shedding. Recently, I started to read a lot about Avodart but I am debating with my Dr. on the dose.

The 0.5 mg is not intended for Hair loss but higher doses are more effective. Is 1.0 mg better or shall I go with the 2.5 mg? Or is the 0.5 mg effective in my case since my T levels are low? I mentioned my case because my case is unlike any other cases, my body Chemistry is a woman’s but I did not have the Testosterone factory removed yet so I am pretty confused.

Please, I really need your kind advice. My Dr. is unfamiliar with Avodart and for financial issues, I cannot see anyone else. Thanks so much and kindly accept my gratitude.

I’ve answered a related question years ago — Transgender Male-to-Female Taking Dutasteride.

As you aren’t my patient, I am unable to give you specific dosing advice on how to use the various drugs which have an anti-androgen effect. This treatment for balding may not work at all if you triggered the hair loss when you had androgens working in your system. Avodart (dutasteride) may not reverse the hair loss, particularly since you’re looking to regrow the hairline, but it may slow down the loss process, possibly more than finasteride.

I have treated male-to-female transsexuals with hair transplants and provided that the balding pattern is not too advanced, the results are pretty good. I have not treated MTF patients with Avodart, though.

Tags: avodart, dutasteride, hairloss, hair loss, male to female, lgbt

What Do You Tell Patients That Don’t Respond to Propecia After a Year?

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

doctor rassman, for the patients that you have that do not respond to propecia after lets say 1 year or so, do you tell them to stop taking it?

Response to Propecia comes in various flavors:

  1. reversal happens, often in the crown
  2. slows down the hair loss process
  3. stops the hair loss completely

Most young men will experience B, some will experience C, and few experience A. I tell these men it is hard to detect anything but reversal, and they should assume that slowing it down is the presumed course. So provided that there are no side effects, I usually tell them to stay on it for at least 2 years.

Tags: propecia, finasteride, hairloss, hair loss

Off Topic — Water Wigs Photo Series

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

Water wigsHey doc,
Have you seen these cool photos that have gone viral? A photographer made a series called “Water Wigs” where he used a high speed camera to capture water balloons bursting on bald heads.

The results are really really cool. here’s an interview with the photographer and some photos from the series.

Link: Tim Tadder’s Photo Series “Water Wigs” Captures Beautiful Intersection Of Baldness And Water Balloons

These are amazing photos by Tim Tadder. Very neat idea.

Tags: water balloons, water wigs

Patient Results – 4149 Grafts Restored His Hairline (with Photos)

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

This patient with straight, medium fine hair had presented a Norwood class 3A pattern when I first met with him years back. His first hair transplant surgery was 1927 grafts, and while it gave him a hairline that he had been missing for years, he decided to have another procedure (of 2222 grafts) a year later to fill it out a bit more. No further procedures are planned.

Click the photos to enlarge.

After (4149 grafts total over 2 procedures):

 

Before:

 

Tags: hair transplant, hairloss, hair loss, photos

Press Release – ISHRS Celebrates 20th Anniversary

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

Snippet from the press release:

As the International Society of Hair Restoration Surgery (ISHRS) prepares to kick off its 20th anniversary this October with a look back at the significant improvements made in the art and science of hair restoration surgery, millions of men and women around the world have better hair to show for the tremendous growth in this specialized field of medicine.

“Over the last 20 years, the ISHRS has grown to over 1,000 international members working in collaboration to establish the highest quality standards and best practices that have led to the modern-day hair transplant,” said ISHRS President Dr. Jennifer H. Martinick. “Now, results are natural looking and virtually undetectable, and ISHRS members are committed to pushing new frontiers in scientific research to further enhance results and possibly even reverse or delay the onset of hair loss.”

Read the rest — 20th Anniversary of World’s Leading Hair Restoration Medical Society Spotlights Greatest Advances in Combating Hair Loss, Potential Future Breakthroughs

Tags: ishrs, hairloss, hair loss, anniversary

Transitioning from a Juvenile to Mature Hairline — Is That Considered Balding?

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

Dear Doc,

I’m 21 years old and have 2 questions.

1. if someone had slight miniaturization only between his former juvenile and his (strong appearing) mature hairline without further thinning, would he be considered balding?

2. you earlier stated that, in the transition from juvenile to mature, you wouldn’t expect the frontal hair to thin before falling out. My juvenile hairline disappeared all at once (within months) without thinning, but some of these hairs returned as finer and shorter hairs. Could this be an effect of propecia, since maturing still is DHT related and medication would give these hairs one last cycle? Thanks

Transitioning from a juvenile hairline to a mature hairline is not balding. Sometimes the hair in the zone between the mature hairline and the juvenile hairline will fall out and die quickly. This process is called apoptosis.

Get a good doctor to examine you. The diagnosis is not that difficult in the hands of an expert and it sounds like an expert is what you need.

Tags: hairloss, hair loss, hairline

How Was Dutasteride Developed?

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

If finasteride is based off of a tuber plant, what is dutasteride based off of? The same tuber?

As far as I know, GlaxoSmithKline (GSK) developed dutasteride… but my knowledge of its origin pretty much ends there. I’m not familiar with their processes of discovery.

I do know that dutasteride works in similar ways to finasteride and is used to treat certain prostate problems. Dutasteride is not yet approved for the treatment of male pattern baldness, though.

Tags: dustateride, avodart, gsk

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