FUE: More Automation and Physician Integrity (Part 4 of 4)

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

This is the last part in the series about follicular unit extraction (FUE). Here are the previous posts in this series — part 1, part 2, and part 3.

—

Neograft:

We have heard a great deal about the Neograft automated system. This system has two components to it:

  1. A sharp drill that provides controlled torque. It is a manual system requiring a very skilled operator.
  2. An implanter is part of the Neograft system and it uses an implanter invented by Rassman (patent #8062322) that works nicely.

The advantage of the Neograft system is that an implanter is offered, which is not present in the ARTAS system. Traditional implantation with forceps requires specialized skills and the greatest cause for failure or death of the grafts occurs during the implantation process. The neograft implanter, can be used effectively by an inexperienced person, therefore it is relatively easier to learn when compared against the use of forceps. The inexperienced surgeon or technician will probably get better graft survival with the implanter. When compared with a skilled experienced technician’s competence with forceps, I suspect that the two techniques will be comparable.

The manual drill requires expertise, and with the unit as designed the grafts have a tendency to dry out, possibly killing them before they get implanted as they are held in a chamber that has a high hair movement in it. As discussed before, air kills grafts as they dry and this killing process may take only seconds when there is substantial air flow in graft held in a chamber. Neograft associates with a private group of technicians that perform much of the procedure for the unskilled doctor, creating the illusion that the doctor is skilled in the process. If these technicians drill out the follicular unit, they will violate the laws in most states. Most doctors who use the Neograft system depend upon the technician teams to do the actual transplant procedure.

Other drills are supplied by a variety of device manufacturers. Dr. Harris employs a dull drill and his device is amongst the most popular of the devices that are manually driven with great success. He offers training for doctors who purchase his system. Drills with sharp edges are many and they differ only marginally from each other. Extraction speed varies with each surgeon and each instrument. There is no substitute for skill, and the skills for all instruments on the market (other than the ARTAS system) requires possibly years to perfect. Speed of extraction depends upon the surgeon’s skills and it varies between 200-1200/grafts per hour on average. The damage to the grafts varies with the surgeon, so speed tells you little about the skills of the doctor as some doctors kill more than 50% of the grafts in the extraction process.
Read more

Why Don’t Some Men Just Take Propecia At the First Sign of Hair Loss?

/by William Rassman, M.D./8 /

Doctor there was a topic about pro hockey player ryan getzlaf.

this is my question:

if ryan getzlaf had taken propecia at the first sign of hairloss, do you think he would still be to where he is today? or is there a good chance he could of of maintained what he had or freezed the hair loss clock by a decade or so?

my other question is: how come alot of people who show the first sign of hairloss dont go on propecia? I mean its proven to work, why not take it? how come they just let the thinning continue? I see alot of celebrities young males and pro athletes who are losing hair, and why not just take propecia? I mean they can afford it.

Propecia is an elective medication and it is only available after consultation with a physician after a good examination and understanding of its limitations, risks, and benefits. It may not always happen this way, but it should be. Propecia does not necessarily stop hair loss or reverse hair loss completely, but it does work to buy time for most. In the end, your genetic predisposition will eventually catch up and you may lose hair despite being on Propecia. This does not mean the medication is not worth taking or that the medication has stopped working.

Finally, it is not as simple as taking Propecia at the first sign of hair loss. You need to be followed by a doctor who can give you a Master Plan for the hair loss.

Tags: propecia, finasteride, hairloss, hair loss

In the News – Teenager with Alopecia Traveling to Great Wall of China to Raise Awareness

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

Snippet from the article:

Alice FrostA teenage alopecia sufferer from Northamptonshire will complete a trek of The Great Wall of China to raise awareness about the condition.

Alice Frost, aged 16, of Denton, has been suffering from the condition, which causes severe hair loss, for about three years. She will take on the nine-day expedition with her 18-year-old sister, Sally, in September, and the pair hope to raise £7,200 for the trek and for the Alopecia UK charity.

Alice first lost a large amount of her hair while on a school trip to China and she said the expedition would take her back to a fitting place.

Read the rest — Teenage alopecia sufferer in China trek

The article wasn’t clear on what kind of alopecia she has, but it appears to be totalis or possibly universalis. I congratulate young Ms. Frost on her courage and her desire to raise awareness.

Tags: china, alopecia, hairloss, hair loss, awareness

FUE: Surgical Skills and Robots (Part 3 of 4)

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

So far, we’ve looked at the history of FUE in part 1 and graft quality/survival in part 2…

—

FUE Today:

The FUE market may reflect as much as 40% of the total hair transplant market today. I believe that 20% of the doctors offering FUE, are skilled in the process; however, a majority of the doctors who offer FUE today are not skilled in the process. With such a large gap between skilled and unskilled doctors doing FUE, one would ask what the doctors are doing about it, because no doctor wants to be second class. The doctor must get the expertise that they need… somehow.

Some doctors try one of the various instruments that promise great success with the FUE process. Some instrument entrepreneurs try to convince the doctors that if they purchase a particular instrument, great success will befall them and every new doctor purchasing these system, want to believe it. I admire Dr. Jim Harris, who pioneered a special instrument because he offers training on human volunteers to physicians who want to master his unique approach. I have participated in his course and own one of his instruments. There are instruments that:

    (a) drill out the follicular unit with a slow variable drill
    (b) that vibrate and/or rotate when they drill the hair graft
    (c) have variable depth control to minimize damage to the deep portions of the graft
    (d) claim that their punches are sharper than all other drills or punches on the market
    (e) are made dull intentionally to minimize transection, etc..

Drilling is the most popular way of performing the FUE and most doctors seem to favor the drill. Prices for these drills (the doctor’s costs) run as low as $1200 to as high as $220,000 plus $1/graft. Each vendor claims some advantage over the other.

With the discrepancy between $1200 and $220,000, let’s see what value comes with each package.

Read more

Worried About My Hairline, And I Don’t Have Local Access to a Hair Doctor (with Photos)

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

Hi,
I would greatly appreciate some feedback regarding my frontal hairline. It appears that my corners have thinned/ receded during the last couple years. I am 23 years old male. I’m concerned about my hair line at the moment and questioning what would be an appropriate approach to take. Would Propecia and Rogaine be a smart idea? I currently live in an area which does not have local access to a physician regarding hair loss, although this is something I’m looking into. Thank you for your time and consideration.

Click the photos to enlarge:

 

It does appear that you are experiencing early hair loss with a Norwood class 3 pattern showing at this time. There is erosion of the corner hairline with thinning present. At your age, the best treatment would be finasteride (Propecia or the generic form of it) as it would be likely to stop the process. Your family doctor can prescribe finasteride 5mg to you and then you would cut them into quarters and take 1/4 per day.

Tags: hairline, hair loss, hairloss

Trichotillomania-by-Proxy?

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

My neighbor is in his 50s with no known history of hair loss until about 5 years ago when he first noticed he was developing gray hair. He had his wife pull out every gray hair he could see daily, and it could’ve been as many as 20-30 hairs a day over the years! His daughter researched the condition of trichotillomania and does not feel he fits the diagnosis as the pulling was not done by him.

He claims he is not compelled or driven to have his hair plucked, and that as soon as he realized he was visibly thinning, he had his wife stop doing it. At that time he began to color his hair at the suggestion of his daughter. He states there has been no plucking for the past 2 years now and he has more hair on his head now than 2 years ago, when the plucking was stopped.

This sounds like maybe trichotillomania by proxy (like Münchausen syndrome by proxy, a well known phenomenon)… but I’m not sure that would fit either.

It usually takes quite a few “pulling sessions” to produce the traction required for permanent hair loss, often over years. So if his hair has regrown over the past 2 years, it sounds like he was lucky that the loss wasn’t permanent.

Tags: ttm, trichotillomania, hairloss, hair loss

FUE: Graft Quality and Survival (Part 2 of 4)

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

This is part 2 of my series of posts about follicular unit extraction (FUE). I discussed the history of FUE yesterday in part 1.

—

When I made the decision to have another hair transplant procedure some 8 months ago, I asked Dr. Pak to do it with FUT (strip), not FUE, and the rationale for this is outlined below. I had no noticeable scar from this FUT, even though it was the third procedure I had at the exact same location. Before I get into the FUE in more depth, it is important to compare the FUT grafts with the FUE grafts:

Graft quality:
The FUT grafts are tightly controlled with regard to the quality of the graft, and the consistency is totally dependent upon the experience of the team and the quality controls put into place by the surgeon as the grafts are taken from the strip. The FUE graft quality is dependent on the wide variety of tissue connections and different types of collagen that surround the FUE graft. The grafts are cored with an instrument, never seeing the graft until it is removed. The surgeon who uses hand instruments and gets good at them, ‘feels’ the instrument as it works its way through the scalp. Everyone is different in regard to their tissue makeup so that every person reacts to the FUE coring differently. If a surgeon claims 2% damage straight across the board, he is selling himself, and in my opinion he is not telling the truth (see here and here).

The grafts are pulled from the extraction site once they are cored and this pulling is most often the cause of the denuded distal end of the FUE graft. Almost 100% of FUE grafts lose the fatty covering at the bottom of the graft, exposing the hair follicular bulb to the air around it (this is never present in FUT created grafts). This can be a problem because drying (the number one cause of graft death) is accelerated as the grafts are moved from the donor area to the bath they are stored in, and then from that bath into the recipient area. Meticulous attention to keeping the graft very moist and protecting it from the air in the room is critical to graft survival and this is probably the single largest cause of FUE failures once the graft has been removed from the donor site.

Read more

If I Want to Have a Very Short Hair Style Forever, Can I Use BHT?

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

Happy New Yr Mr. Rassman.

Currently, I shave my sides with a trimmer to 0.25 number and keep the little existing hair on my scalp shaved at 0.5 number. This is because I dont have hair to show off anyways, so might as well give it a shaved look. Even though I have some donor area, I am sure it wont be enough for hair transplant to give it a long full hair appearance.

As an alternative, I would like to have a shaved look but without SMP / using chemicals. I would like to achieve this with BHT but I do see from your previous posts that you are not a big fan of BHT because of the different texture and the growth rate of hair.

So my idea is to use the body hair on the the top of the scalp. It may not grow in the same pace / texture with the rest of the existing hair but what if I want to keep shaving it (or trimming to 0.5 number). Will it help? My logic says if I am shaving it / trimming it, it would probably.

My concern is:
1) ARE THERE ever SCARS in the recipient area? This question is relevant here because I will be shaving / keeping my scalp hair very short (0.25 or 0.5 number on the trimmer)

2) In your experience, while transplanting hair (whether hair from back of the head or body hair) into the recipient area, can existing hair get damaged?

Thanks for all your good work, may the force be with you.

I will be direct to your questions.

1) Visible recipient site scars are rare if the instrument is very small and a slit is used. But with any surgery, there is a small (rare) risk of keloid and scarring.

2) Existing hair is rarely damaged, unless perhaps there is shock loss, which is typical of young men under the age of 30 who do not take the drug finasteride. (This is not an absolute rule as some men decline to take finasteride. It is a case by case basis.) In general, the younger they are, the greater the risk of shock loss.

Tags: body hair, bht, fue, scarring

Do You Think Propecia Will Be Available Over the Counter?

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

Do you think Propecia will ever be available over the counter, without a prescription? Isn’t that the next logical step now that finasteride 1mg is for sale as a generic?

I mean Rogaine is readily available at most pharmacies and even in the supermarket, and many other OTC medications have much higher risks of side effects than Propecia does. Thoughts?

I doubt Propecia will be available over the counter. It is a medication that really needs to be prescribed by a physician. It is only meant for the treatment of a specific kind of hair loss (androgenic alopecia) and may not be good for some women. There are many medications that remain prescription only, even though a generic is available.

Tags: propecia, finasteride, otc, prescription

FUE: History of Follicular Unit Extraction (Part 1 of 4)

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

I received a question from a patient after an extensive meeting (over an hour) about the options of FUE vs strip (FUT) procedures, and he asked which of the newer FUE systems was best. He was particularly confused by the promotions of the ARTAS and Neograft systems. That prompted me to start writing. I’ve split this post up into four parts and will post one per day. Let’s begin…

—

History of FUE:

I would consider myself an authority on FUT, the megasession (I published extensively on these procedures in 1993-1996), and I introduced Follicular Unit Extraction (FUE) to the medical community in a series of publications in well known journals. My experience with FUT and megasessions is large. Although the FUE technique was introduced by us in 2001 in a medical publication and in 2002 at the ISHRS world congress, I was developing FUE since 1995. On each and every patient, with their permission, I performed about 20 FUE within the strip area and got pretty good at doing them.

Back in 1995-1999, the problem I came up with was a lack of constancy in each patient’s extraction results. In some patients we were able to get 20 out of 20 perfect grafts and when that happened, we felt like masters of the FUE process. Sometimes, however, our success rate was less than half of our best results. I was humbled by the difficulty of the process. To address the problem, Dr. Pak and I developed many types of instruments and punches (between 1995-2000), some with controlled depth, some with larger and smaller diameters, some open on one side, some not circular, some with serrated edges, etc… We tried to correlate the quality of the results with the instrument design. We tried to correlate the quality of the results with the instrument design and there was clearly more value in some of the instruments over others. The serrated edge, in some of its iterations, seemed to produce the most consistent results in our hands. By 2000, we stabilized our technology with the serrated punch and continued to develop the FUE2 method which we successfully patented.

Read more

How Long Until I Can Use a Sauna After a Hair Transplant?

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

Hi doctors,
How long after a hair transplant until I can use a steam room / sauna? And how about a tanning salon? Thanks

You should address any post operative questions with your doctor, as each doctor has their own recommendations. In general, most patients can resume normal activities in two to three weeks after a hair transplant surgery — including a sauna.

Tanning salons are not generally recommended for health benefits and high dose UV rays can potentially discolor skin during the healing process, which can take up to 6 months. This does not mean you have to keep out of the sun, just use a sun blocker.

Tags: tanning, sauna, steam, hair transplant, surgery, tan

Hairline Density

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

Hello Dr.Rassman and team. Just wanted to say you guys are doing an excellent job educating people like myself about hair loss and what available options are out there to cope with baldness.

I had a couple questions regarding hair density. Lets say for example two men have a hundred hairs on their hairline. Could one of the individuals hairline seem thinner then the others even though they have the same amount of hair at the hairline? As well, lets say one person has 50 hairs on their hairline and another has 100. Could the person with the 50 hairs still appear to be thicker hairline then the one with 100 hairs?

I understand it depends on hair type for example straight vs. curly hair. The curly hair would appear thicker even though there is less hair. But I want to know in individuals with black hair which is slightly wavy.

Thank you once again for your excellent work.

I think you answered your own question. Hair density is not just about numbers when it comes to the look of fullness. It all depends on skin to hair color contrast, hair style, length, diameter of the hair shafts, wave, and distribution.

Tags: hairline, density

Legitimacy of Body Hair Transplantation?

/by William Rassman, M.D./9 /,

Hey Dr Rassman, I noticed that Dr. Umar was considered for recommendation on the Hair Transplant Network. The site also featured patient examples of his FUE procedures which combined body hair harvested from numerous locations and scalp hair. The results look pretty impressive.

Has your stance changed at all in regards to the legitimacy of body hair in transplantation?

There are obviously differences of opinion here, but to be endorsed by a website that is supported by and paid for by the physician (the doctors pay a monthly fee to be on that site) does not make it a new standard.

Plain and simple — today, body hair transplantation (BHT) is not a Gold Standard in treatment for hair loss. Other doctors still have a right (as licensed physicians) to offer this. I do not believe in using body hair transplants for most cases, because I have seen many cases where after it is transplanted, the body hair still looks like body hair sitting on the scalp. The shaft thickness of body hair is thinner than scalp hair in most people, so on a value comparison between scalp and body hair, you are miles ahead with scalp hair transplants. BHT is best used when you are out of donor hair and the body hair can be placed as a fill-in to traditional transplanted areas.

Remember, the body hair has long telogen cycles and depending on which body part, the telogen cycle is often longer than the anagen cycle. That means the hair will not grow in these telogen cycles. Also, body hair does not usually grow long like scalp hair.

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

Will Wearing Wigs Damage My Scalp for Future Hair Transplantation?

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

Hello.

I am 18 years old and by looking at my family history, I’ll start losing my hair between 20-22.

I have decided not to take propecia (I know the percentage of side effects is rather small, but I dont wanna risk any sexual side effects, and definitely not any brain fogs, as my brain is my main asset). I’ve contacted and visited a guy here in London, who’s wearing a hair system, and its actually not visible, even if you put your eyes like 2cm from the hairline. And you wear it 24/7, usually for a week.

Now, I would imagine wearing a hair system till like 30, so till in 12 years, and then go for an intelligent combination of treatments (hair cloning -replicel,aderans etc + body hair transplantation + several GHO sessions) to turn my NW6 to NW2.

THE QUESTION i’m asking is if like 6-7 years of wearing wigs, which include like putting glue on your scalp and cleaning it off with alcohol and putting it back on weekly, will damage my scalp skin and thus make a hair transplantation difficult.

Thanks. Please answer. Bye

You are getting way ahead of yourself here. You need to first get a diagnosis from a physician and then discuss your options in a Master Plan for treatment. If you are scared to take a medication due to potential side effects, that is up to you and your doctors to decide.

Finally, wearing hair systems long term can cause scalp irritation, scarring, and localized hair loss from traction alopecia. Many wig wearers have balding areas at points of attachment. Not to mention the expense of maintaining the hairpiece, which is something many people don’t consider.

Tags: hairpiece, wig, hairloss, hair loss

Any Bimatoprost Study Phase 2 Results Yet?

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

Doc

Have you heard anything or have any idea when the phase 2 bimatoprost studies will be out?

Happy new year to you and your staff.

You’re referring to the study comparing bimatoprost and minoxidil for use on the scalp, which completed the phase 2 a few months ago. The results haven’t been posted yet, as far as I can find.

Check it our at the ClinicalTrials.gov site — Safety and Efficacy Study of Bimatoprost in the Treatment of Men With Androgenic Alopecia.

Tags: hairloss, hair loss, bimatoprost, lumigan, latisse