Blood Flow to Grafts After Multiple Hair Transplants?

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

Is there any research that shows that blood flow to the grafts could be compromised or growth delayed with multiple procedures as compared to the first procedure? Is it possible that multiple procedures can outstrip the blood supply necessary to insure maximum growth and thus limit graft survival?

Does every patient with multiple procedures always see a stubble of erupting hair coming in between their hairs after 3-6 mos.?

The reason I ask is that I don’t recall seeing any stubble on my 2nd procedure and am concerned as whether I will see any for my 3rd. It was easy to see on my first procedure.

The blood supply on the third procedure should be as good as the first procedure.

The presence of any immediate stubble reflects retention of the hair shafts after a hair transplant, not growth. Growth should come in at about 4-5 months and the stubble that you detected after the first hair transplant, if it did not fall out by the time the hair grew, will be forced out by the growing hair. I don’t know anything about your procedures, but it’s possible that it was easy to see growth after the first transplant simply because you had less hair in the area.

Tags: hair transplant, hairloss, hair loss, blood supply

I Have Balding on Both Sides of My Family and I Want to Prevent It For Me

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

Hello,
I have a history of balding from my mother and father’s side. I have two brothers, one of which is 22 and balding, the other 24 and not balding. I have similar hair to the one who is balding, and I am worried about balding. I am 16, and have not noticed any balding, but I was wondering what preventative steps I could take now to slow down or prevent the balding from happening.

Thanks, any help appreciated.

There’s really nothing you should do until you see the earliest signs of hair loss. Genetic balding can skip generations, so even if you’ve got a family history of hair loss on both sides, it doesn’t guarantee you’ll experience the same. If you do see early hair loss, talk to your doctor. You shouldn’t take medication “just in case” for something that you might not even have.

Tags: balding, hairloss, hair loss, preventive

Chewing Tobacco and Propecia?

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

So I have just started taking propecia and was wondering if chewing tobacco or rather smokeless tobacco(skoal, kayak etc) would have an adverse effect on treatment, or hurt the treatment in any manner…thanks!

There are no interactions that I’ve aware of, but few patients I have had even mentioned chewing tobacco.

Tags: finasteride, propecia, tobacco

Is There Research Into Manipulating Body Hair Growth Cycles?

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

Hey good sir I hope your day and your new year are treating you well. I recently read on your blog that you were in Antartica. Just out of curiosity how was your trip? Would you recommend visiting there? I am just curious because I never hear of anyone going down to Antarctica electively.

Also I had a hair related question. Instead of trying to create completely new hairs from an existing scalp hair, why dont researchers work on manipulating the growth cycles of body hair and other sources of donor hair extraneous from scalp hair? I understand that this hair maybe contextually different but would it not offer the patient some sort of cosmetic value?

My trip to Antarctica was interesting, to say the least. Lots of penguins of all sizes and colors, a few seals and whales, and some very nice scenery. There were long periods at sea, so I sat down with a good set of books on my Kindle and filled the days well.

As for body hair transplantation, some doctors have been doing hair transplants to the scalp using body hair and the results are less than ideal. Leg hair, for example, has a 60% telogen cycle… which means that these hairs stay “sleeping” most of the time. While they are sleeping, they are not visible above the skin. To the point of your question — I don’t know who, if any, research groups are working on changing the hair cycle in body hair.

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

I’m Due to Have a Bilateral Orchiectomy

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

Hi Doc,

I am due to have a bilateral orchiectomy soon for medical reasons. However I have heard that one of the few benefits of such a procedure is that it will benefit my hair.

Is there any truth to this? I am 24 years old and have some very mild baldness starting to appear. Is it true that the procedure (assuming I don’t need HRT in future) would prevent any further MPB developing. I am not expecting to regrow anything but am I guarenteed to never suffer from further hairloss caused by MPB?

If this is the case, after the procedure could I safely terminate my finasteride use? Also, assuming what I have heard is correct, if I ever decided to have a HT, could I have a perfect hairline restored without having to worry about future thinning/losses?

Thank you for taking the time to read my email. I should point out that this procedure is not driven by a desire to prevent baldness (that would be crazy), it is necessary for medical reasons (which I will not go into). Having said that I would understand if you didn’t put this on the blog, but if you could get back to me via email that would be fantastic.

I would appreciate your thoughts. Also thank you for providing this wonderful service.

Kind Regards

For those not aware, a bilateral orchiectomy is the removal of both testicles. If you do not have testicles, the balding process should be arrested provided that you do not take testosterone supplements. You will not need finasteride after the surgery.

As for the guarantee you’re looking for — I would say that you will never suffer from genetic alopecia, but you can’t be guaranteed no further hair loss from any cause, ever. Hair loss is a consequence of other factors such as thyroid disease, cancer chemotherapy, malnutrition, some drug side effects, and on and on. Good luck.

Tags: hair loss, hairloss, testicles

What Controls the Expression of the Balding Gene?

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

Hi Doctors,
As an avid reader of this blog I have developed a pretty broad understanding of the genetic balding process and the various treatment options available, and for that I thank you. The one question that has recently surfaced involves gene expression. I know your not a geneticist, however,with your knowledge in both biology and and androgenetic alopecia I’d assume this would be within your general fund of knowledge. An individual can carry the gene for genetic hairloss, but not express it.

My question is what is controlling the expression? I’m assuming environmental variables are involved (stress, maybe nutrition to a certain extent) but is there a biological explanation? From my brief studies in biology, I remember hearing something about the role of transcription factors in the expression of particular genes. Your thoughts are much appreciated.

You said about what I know of the mechanisms for gene expression. It’s beyond my scope. You can use Google to find articles and theories about gene regulation, but I’m posting this in case a geneticist (or armchair geneticist) would like to contribute in the comments.

Tags: genetics, hairloss, hair loss, genes

Association Between Early MPB and Prostate Cancer?

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

Snippet from the abstract:

Results: Our study revealed that patients with prostate cancer were twice as likely to have androgenic alopecia at age 20 [odds ratio (OR) 2.01, P = 0.0285]. The pattern of hair loss was not a predictive factor for the development of cancer. There was no association between early-onset alopecia and an earlier diagnosis of prostate cancer or with the development of more aggressive tumors.

Conclusions: This study shows an association between early-onset androgenic alopecia and the development of prostate cancer. Whether this population can benefit from routine prostate cancer screening or systematic use of 5-alpha reductase inhibitors as primary prevention remains to be determined.

Read the rest — Male pattern baldness and the risk of prostate cancer

I was recently asked by a reader of this site about a link between developing early genetic balding and having prostate cancer somewhere down the road, so I researched it a little and found the above article. I don’t think we wrote about it before, but this study was published in the Annals of Oncology a little over a year ago.

The MPB / prostate cancer connection seems to be present, but what to do about it, if anything, remains to be seen. The suggestion that the 5 alpha reductase inhibitors like finasteride, may have a role in reducing the risk for prostate cancer, but that process is not well understood and the long term risks of such drugs are presently under a cloud of controversy.

There were 669 patient studied, of which 388 had a history of prostate cancer. There was no association on the degree of balding, just the presence of genetic balding patterns earlier in life. Men under the age of 30 and those who have developed vertex (crown) balding seem to have a higher prostate cancer risk. The study was taken in many countries and each patient answered questionnaires, from which the data was extracted.

Tags: prostate cancer, hairloss, hair loss, balding

What Would You Do if Propecia Was Hypothetically Pulled from the Market?

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

Always great to see this site up and running. Thank goodness you did not pull a “Merck.” Let me segue then into the question: Let’s say that you were practicing HT’s ten years from now and it turned out data showed that finesteride’s long term effects were more detrimental to libido, erectile issues, etc. than previously reported, and the drug was pulled from the market as a hair loss fighter. All things being equal to today’s other hair loss products, would this alter your approach to certain patients?

There was no Propecia on the market in the early 90s, so young men would get hair transplants anyway and many would suffer from shock loss (especially those under 25 years old). Then the doctors chased the hair loss as the eventual pattern of each patient emerged. I guess the same would happen in 10 years or hair transplants would become a dying industry. Knowing some of the less honorable doctors, denial of the accelerated hair loss might be a pattern to keep up payments on big houses and expensive cars, but for the most part, I suspect that the demand for many repeat procedures will become the trend in the long term.

As long as we’re playing with hypotheticals, I’d hope that in the next decade there would be advances in treating balding that might make medication unnecessary.

Tags: propecia, finasteride, hairloss, hair loss

Hair Transplant Now, Shaved Head in the Future

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

I don’t mind shaving my head in future when hair loss develops, but not now. What I want to have is a hairline to frame my face even if I shave my head.

Is there any technique performed by any surgeon which does not leaves VISIBLE scarring on the back of your head? If I want my head shaved in future, what do you advice me?

I’ve thought of FUE + (ScalpMicroPigmentation on the tiny dots) when I finally shave my head. What do you think about it?

Not everyone will have very visible scarring, but any wound to the scalp will leave a scar to some degree. Just to what degree you will scar, I have no way to know.

The combination of follicular unit extraction (FUE) and Scalp Micropigmentation (SMP) does work… but with that said, you need to be evaluated by a real expert to know where you stand.

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

Sex After a Hair Transplant?

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

Hello,

I recently received a transplant of 2500 graphs. The day after the transplant I had sex and was wondering if the increase in blood pressure to the head may have dislodged any of my graphs.

There was no unusual bleeding nor was my transplant area touched.

As with all your first time hair transplantation-ees, I am concerned that I may have adversely impacted the recover process.

Comments?

I doubt that any problems were produced. I generally tell my patients if they must undergo sex right after a hair transplant, try to be a bit more passive in the process. Full active sex is safe after about 3 days.

Tags: sex, hair transplant, surgery, hairloss, hair loss

Long Term 1mg Finasteride Study Shows Good Results

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

Snippet from the abstract:

Finasteride 1 mg is indicated for the treatment of men with androgenetic alopecia (AGA). However, more than 5 years efficacy and safety has not been previously reported. To assess the efficacy over 10 years in different age groups of men with AGA. 118 men, between 20 and 61 years, with AGA receiving finasteride (1 mg/day), were enrolled in this uncontrolled study.

Read the rest from the July/August 2011 issue of Dermatologic Therapy

I don’t remember if we posted about this before (it was first published last summer), but this is the longest study on the effectiveness of finasteride over a 10 year period of time. Side effects included reduced libido in 5.1%, reduced ejaculate of semen volume in 1.7%, and erection problems in 3.4%. Gynecomastia and depression were not among the reported side effects.

Of those individuals who had a good initial result and long term use, the overall results were better. This may be a predictor of long term benefits. Better hair growth in the long term was reported in men over 30 and in men over 40, as the drug remained effective (unlike what had been reported — that men who took the drug for long periods of time experienced reduced effectiveness). What was most impressive was that in 110 men who took the drug for 10 years, there was only significant degree of hair loss in 14% of the men studied.

Tags: propecia, finasteride, hairloss, hair loss, study

If Nikola Tesla Castrated Himself, Is That Why He Didn’t Bald?

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

TeslaI’ve read in a hairloss forum that Nikola Tesla castrated himself so he doesn’t get distracted from his research. Maybe that’s the reason he didn’t go bald. I’m amazed from what you can read today in the internet.

If one is castrated, they will stop their balding process where it was at the time of castration. Taking testosterone can reverse that, producing balding in men with the genetic traits for hair loss (even without testicles).

If Nikola Tesla was castrated (I am not sure about that), then he will not be balding… as shown in these photos at Neatorama. The man was a genius, but he looked like hell with considerable weight loss as he aged (as seen here). He did seem to maintain his hair pattern, even with the weight loss.

Tags: engineer, tesla, inventor, hairloss, hair loss, castration

Female Hair Loss After Lap Band Surgery

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

Great blog, Dr. Rassman! Quick question. My Cousin had the Lap-Band surgery in August 2011. Since then she has lost almost 60 lbs. She has also lost almost all of the hair in the front half of her scalp. Does this hair have a chance to return if she supplements with a vitamin or has her Lap-Band loosened so that she can eat more? She never had hair loss before the surgery. Thanks!

Women who lose hair from rapid weight loss may have accelerated a genetic pattern for hair loss that is present. These women may never return to their preoperative hair thickness, but some of it may reverse. If there is no genetic pattern present, then the hair loss may reverse upon balancing her diet.

Tags: lap band, lapband, hairloss, hair loss, weight loss

Is Scarring Common at the Recipient Sites?

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

Thank you for the time and effort you put into answering all of our questions. My question regards scarring. I have heard some people say that scar tissue forms where the hairs are implanted during a transplant, and that this can result in bumps or raised spots on the hairline. Is this true? If so, is it common? If not, why don’t scars form where the hairs are implanted? After all, a wound of sorts must be made to implant the hair, so how would do you prevent hundreds or thousands of scars from forming after a hair transplant?

With the technique we pioneered, we do two things that minimize recipient site scarring —

  1. We make very small wounds in the skin, essentially slits that approximate the size of the grafts. These heal very fast.
  2. When preparing the grafts for implantation, we cut off the skin disk at the skin level. To minimize the skin disk, we remove the top layer of the graft skin from the surface of the graft. This prevents the skin from surviving the transplant which could, in some individuals, produce the bump seen in recipient areas. The same process is done with grafts taken from strip surgery.

When doctors use grafts that have a larger surface area than what I described above, the bumps you referenced get more prominent. We have seen from the old days when plugs were done and the graft sizes ranged from 3-5 mm across, the skin always was deformed. Clearly the more skin that survives at the top of the graft, the more detectable will be the existence of the transplanted graft.

Tags: hairloss, hair loss, hair transplant, scarring