Why Isn’t FUE2 the Gold Standard?

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

Regarding the articles you posted recently about FUE versus strip procedures, I was wondering why FUE 2 isn’t the gold standard for transplant surgery. If the graft yield is just as good as strip from FUE 2, doesn’t that mean It has all the advantages of FUE and none of the drawbacks?

There is a series of reasons as to why FUE2 isn’t the gold standard, and I’ll list and expand upon that to address why the traditional FUE also isn’t the gold standard:

1- FUE2 is not available at this time for commercial use. We have not proven that the FUE2 can be as effective in 100 consecutive patients with comparable results, as we have shown in the two examples we demonstrated here. When we get it manufactured, it will have to compete with all of the other FUE drills out there, including the ARTAS robot. There will be a general reluctance for those doctors who feel comfortable with what they are presently doing, to switch to the FUE2.

2- I’ve discussed in great detail the limitations of traditional FUE in the hands of many surgeons (see part 1, part 2). Doctors may want to believe that FUE is better than strip surgery, something that I presently doubt with traditional FUE mechanical solutions. The strip harvesting produces the best quality grafts in most surgeons’ hands. I am certain there are many doctors who claim FUE expertise, that are not being honest with their patients. I know this because I often see the failures of FUE from known surgeons who claim expertise in this technique.

3- It is not generally agreed by many knowledgeable surgeons that the donor area can supply as many total grafts as strip surgery. In strip surgery, the surgeon always takes out the strip in the “sweet area”, which means its best concentration of quality grafts. This area can be harvested over and over again with only the risk of scarring. FUE, on the other hand, may produce irreparable damage to the donor area as the number of harvested grafts increase. In recent presentations given at physician meetings, there are suggestions that the donor area does get damaged as more and more grafts are excised with FUE.

Tags: fue, fue2, hair transplant, follicular unit extraction, hairloss, hair loss

If I Damaged My Follicles, Why Aren’t They Repairing After a Few Years?

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

So a few years back i had a scalp problem that involved flaking and i got into the habit of picking the flakes which also led to hair loss because of it. The hair never grew back but when i decided to shave my hair due to having patchy looking hairloss i noticed that in fact the hairs had grown back (well kind of). It was the exact same colour as the other hairs and not the blonde vellus looking hair i would have expected when damaged hair was growing back. But they were much thinner looking than the surrounding normal hairs and they also never grew past 1/2 a millimetre in length.

From what i have read once a hair follicle has been damaged it takes a long time for it too repair and that is why the hair is thinner and not growing like normal hairs ….. But these hairs have been like this for well over a year and have shown no signs of growing back any thicker and longer? but at the same time haven’t disappeared and left the areas bald.

So what is going on? are they gonna grew back or is the damage done and if so why are they still growing to half a millimetre

thanks

The normal hair cycle is somewhere between 2-4 years, so if your hair can recover, it might take that long to see it in its next hair cycle. Also, it is possible that the damage produced by picking has irreparably damaged these hair follicles (traction alopecia), so what you are seeing are miniaturized hair as a step towards total loss of these follicles.

Hair transplants can work very nicely in these areas if you do not have a massive hair loss, as the grafts would be transplanted from the back of the scalp and not subject to the old damage you caused from the picking. Have you seen a doctor for an examination?

Tags: hairloss, hair loss, hair transplant, traction alopecia

How Does a Doctor Know When Hair Loss Stabilizes Before a Transplant?

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

hi

i have two questions. i am planning on getting a transplant done. i have read on a couple transplant sites where the doctor has posted pictures of young patients under 35 saying “patients hair loss stabilized”. How exactly does the doctor know the hair loss has stabilized and no further loss will occur in a younger patient if he is on meds? is the doctor just pretending or assuming no more loss will occur?

my second question is about my own hair. My own hair under bright lights my hair looks terrible, thin and disgusting more so in the front. In pictures and normal light my hair is thicker and nobody can tell. so if I go for a procedure can I ask my doc doing the surgery to look at my hair under the harsh light and give me grafts according to the harsh lighting and so it looks thick under those lighting conditions?

I am not sure what your doctor means by “stabilized”. In young men, the hair situation is progressive, so unfortunately stability is not the rule. After a hair transplant, some of the hair loss will increase (shock loss)… so a hair transplant is destabilizing. You should be on finasteride for a good few weeks before you get the hair transplant to help minimize this destabilization. You and your doctor should talk about the surgery that he plans on doing.

Your second question needs to be directed to your hair transplant surgeon, who should be sensitive to your desires for where the transplants will be done and in what quantity. Keep in mind that harsh lighting commonly makes hair look terrible, but your doctor should be able to create a Master Plan modified for your individual desires and your best interest.

Tags: hair transplant, hairloss, hair loss

Who Came Up with the Term “Scalp MicroPigmentation”?

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

I have seen a number of clinics that claim that they invented the term Scalp Micropigmentation. Who is the true inventor of the name.

Alvaro Traquina, M.D. used the term “micropigmentation of the scalp” in an article published in the Dermatologic Surgery medical publication back in 2001 (see Micropigmentation as an Adjuvant in Cosmetic Surgery of the Scalp). His title, text, and pictures clearly define the use of the pigment as a concealer.

We started using the term Scalp MicroPigmentation in 2010 and started referring to it as “SMP” and purchased the Internet domain names since the terminology was not being used. Since then the term “SMP” and “Scalp MicroPigmentation” caught on all over the world. We did apply for the SMP trademark and the (R) symbol with the U.S. Patent office but were denied trademarking a common terminology abbreviation. Thus no one can claim TM or (R) symbols.

For those who claim that they invented the SMP term or place the TM or (R) symbol, you know that they have poor moral character.

Tags: scalp micropigmentation, smp

Not Hair Loss News – Exercise and Cardiovascular Disease Linked?

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

Snippet from the article:

Two new studies published this week lend credence to the idea that when it comes to exercise, there apparently can be too much of a good thing.

In the first study, led by Dr. Nikola Drca (Karolinska University Hospital, Stockholm, Sweden), and published online May 14, 2014 in Heart, investigators report that men 30 years old, who exercised for more than five hours per week, had significantly higher risks of developing atrial fibrillation later in life compared to men who exercised less.

The report also showed that older adults who walked or rode their bicycle for about an hour per day had a significantly lower risk of atrial fibrillation compared with older adults who almost never participated in such recreational physical activity.

In the second study, led by Dr. Ute Mons (German Cancer Research Center, Heidelberg, Germany), also published in Heart, researchers studied the association of self-reported physical activity in 1038 subjects with stable coronary heart disease and confirmed previous findings of an increased risk of adverse events among inactive patients. However, they also found those who participated in daily “strenuous” physical activity had an increased risk of dying from cardiovascular causes.

Read the rest — Too Much Exercise: Studies Report J-Shaped Link Between Exercise and CVD Risks

I guess it boils down to: “Bike riding for older folks is good. Exercise for 30 year olds is bad.”

Tags: cvd, cardiovascular disease, heart disease, exercise, health

Can SMP Fix My Eyebrows?

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

My eyebrows are very thin and light, but my hair is black so I feel that I would like to darken by eyebrows. Would SMP be able to do this?

Scalp MicroPigmentation (SMP) may work well to fill out the eyebrows, provided that there is enough hair in the eyebrows and the hair on your eyebrows is dark. If you darken the skin underneath the eyebrow with SMP and the eyebrow hair is lighter in color than the pigment used below, it will be problematic as the dots will show through it (I am assuming that you want a fuller, darker eyebrow).

You can dye the eyebrow a darker color and see if it is full enough. If there is not enough hair in the eyebrow, an eyebrow transplant is the best solution, not a tattoo. Most of the eyebrow transplants I have done usually put in enough hair to fill it up. We often fix defects in the eyebrow or complete the entire eyebrow if there are missing parts.

See these links below to find out just how important eyebrows are to one’s overall appearance:

Tags: eyebrows, smp, scalp micropigmentation, hairloss, hair loss, eyebrow transplant

Not Hair Loss News – Prostate Cancer and Chronic Inflammation Linked?

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

Snippet from the article:

Based on data from a new study at the Johns Hopkins Kimmel Cancer Center, men who demonstrate evidence of chronic inflammation seen in prostate biopsies stemming from chronic prostatitis may have close to twice the risk of developing prostate cancer compared to those without inflammation.

Prostate cancer is the second most common cancer in men in the US.

The link between developing cancer and having chronic inflammation was even more striking for men with aggressive or high-grade prostate cancer, reflected in a Gleason score between 7 and 10. The Gleason score is a numeric scale for assessing risk of developing invasive or high-grade prostate cancer based on microscopic evaluation of prostate tissue.

The research was published April 18 in the Journal Cancer Epidemiology, Biomarkers & Prevention.

The data from the current study is derived from information about men in the placebo arm of the Prostate Cancer Prevention Trial by the Southwest Oncology Group. The goal of the trial was to evaluate if the drug finasteride could prevent prostate cancer. Regardless of whether there were any concerning signs of cancer such as high prostate specific antigen (PSA) levels, the protocol called for biopsies to check for prostate cancer at the conclusion of the trial.

Read the rest — Is There A Link Between Prostate Cancer And Chronic Inflammation?

This was an observational study that shows an association between prostate inflammation and prostate cancer, but researchers can’t prove that inflammation causes the cancer. If it can be determined that inflammation leads to cancer, perhaps it can be prevented. In any case, much more research will need to be done.

Tags: prostate cancer, prostate inflammation, cancer, disease

A Study from a Decade Ago Says Green Tea Increases DHT in Mice!

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


I’ve started to drink green tea for its many benefits, but now i’m finding out in a lab study, it raised DHT levels in mice by 194%. The report is here.

Please set the record straight. Can green tea cause my hairloss to get worse? I drink about 1 cup a night.

I’ve been asked about this at least a couple times before (here, here), but I frankly do not know the answer in humans. The mouse story is told in the reference.

Male pattern baldness (MPB) is related to genetics, not green tea. I doubt that it would cause your hair loss to increase. Enjoy your tea.

Tags: green tea, dht, hairloss, hair loss

3 Months After FUE, I Still Have This Yellow Substance On My Grafts and It’s Very Itchy

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

Hi Doctor,

I underwent a FUE treatment 3 months ago, around 2000 grafts. i’m 38 and always had a good skin quality. All went well, but i remarked “yellow shadows” over the recipient area very early. My GP said it was all ok.

At 2 months post op i remarked i lost small 1cm hair, trapped in balls of dry sebum. Also had red pimples with pus for one week and itchy. Went to a dermatologist, he gave me antibiotics and a sebiprox shampoo. I had to stop the use of the shampoo because it made me lose a lot of hair very quickly. I still take antibiotics for 15 days now. No more red pustules, BUT still losing some hair trapped in sebum balls and recipient area still red and itchy.

You cannot see with natural eyes, but if you use a looking glass you can see that almost every pore that is hosting small hair is bathed into a yellow substance. Sebum i guess. I fear this will prevent the hair from growing and make it fall.

What should i do? the surgeon who operated on me said it was a skin problem not a follicle problem and told me to see the dermatologist! I dont know what to do! Thank you for your advice. I see some hair growing from the transplant and i dont want to lose them.

As it is nice to see and not infected can we exclude the terrible folliculis decalvans ?

Best Regards.

Click the photo to enlarge:

 

I don’t want to just brush your question off, but I don’t and I can’t diagnose medical conditions via the web. I think you should listen to your surgeon and make an appointment to see a dermatologist… or you could see another hair transplant surgeon or even your primary care doctor. This isn’t something I would want to guess about just based on a photo.

Some patients get infections and some have bad skin issues. You may or may not have both. Usually, within a few days, the evidence of a hair transplant in the recipient area is gone. Good washing techniques are critical to that process. At two months, you should be washing your hair, but not with too much pressure. Leave the shampoo on for around 5 minutes before you wash it off.

Tags: hair transplant, infection, hairloss, hair loss, hair restoration

Not Hair Loss News – Blood Cancer Wiped Out With Massive Dose of Measles Vaccine

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

Snippet from the article:

Stacy Erholtz was out of conventional treatment options for blood cancer last June when she underwent an experimental trial at the Mayo Clinic that injected her with enough measles vaccine to inoculate 10 million people. The 50-year-old Pequot Lakes mother is now part of medical history.

The cancer, which had spread widely through her body, went into complete remission and was undetectable in Erholtz’s body after just one dose of the measles vaccine, which has an uncanny affinity for certain kinds of tumors.

Erholtz was one of just two subjects in the experiment and the only one to achieve complete remission. But the experiment provides the “proof of concept” that a single, massive dose of intravenous viral therapy can kill cancer by overwhelming its natural defenses, according to Dr. Stephen Russell, a professor of molecular medicine who spearheaded the research at Mayo.

Read the rest — Mayo Clinic trial: Massive blast of measles vaccine wipes out cancer

The two trial patients were injected with 100 billion infectious units of the measles virus (the normal vaccine contains 10,000 infection units). Clearly more research must be done before these findings can be confirmed in large randomized clinical trials.

Tags: cancer, blood cancer, measles, vaccine, medicine

If I Want Dense Packing, Is There Any Benefit to Several Surgeries vs One Large Surgery?

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

I had about 1200 grafts transplanted into my frontal third (an area i roughly estimate to be 10 square inches, which i figure the amount of hair transplanted to be about 20% of the original density).

My question regards dense packing. I’m looking to get 800 more grafts transplanted there, but the thing is i still have a considerable amount of native (miniaturized) hairs in the area. I realize I’m running the risk of damaging the native hairs but do I run as high of a risk involving the growth of the new grafts in two surgeries compared to one?

To sum all of that up, is there any benefit of having several surgeries instead of one large one in regards to the growth of grafts in dense packing?

If you have significant miniaturization in an area that you’re looking to have transplanted, you do run the risk of surgical shock loss occurring that could wipe those hairs out. Finasteride may protect you from shock loss, but you should discuss this with your surgeon. You don’t want to end up having a hair restoration surgery that causes hair loss.

As for the transplanting question — I generally will perform the largest surgery reasonable to minimize the number of surgeries. Dense packing, something I originated in 1993, may not result in growth as well as traditional grafting spacing.

Although it has not been my experience, reports by doctors in our field with side-by-side comparisons on volunteer patient have shown a lesser growth rate when grafts are packed at greater than 60 grafts per square cm. This should also be discussed with your surgeon.

Tags: hairloss, hair loss, hair transplant, dense packing

I Have Significantly Less Body Hair After Taking Propecia for Years

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

Hello,

I’m 29 and started taking finasteride (Propecia) three years ago, a couple of months before I turned 26. Since that I have seen a significant loss of body hair, especially on my legs. At first I didn’t pay much attention to it, but then I started getting comments from friends and relatives. Can’t say it bothers me too much, but you may find it interesting to know that my body hair loss has become rather pronounced.

One thing that might be relevant, is the fact that I have elevated estradiol levels. Part of the reason that I ordered a test to evaluate my hormonal profile in the first place, is this reduction in body hair. I suspected low testosterone, but my testosterone was actually quite high, which could possibly in turn explain the rise in estradiol. Anyway, I’m still on finasteride and have no plans to quit.

Thanks for sharing your story. Body hair growth in men is stimulated by DHT, and since finasteride inhibits DHT, reports of body hair loss after taking finasteride are not unusual. Having less leg hair is nothing you should be concerned about, unless of course you really want that hairy leg look.

Slightly elevated serum estradiol levels from finasteride have been noted as far back as 1999 — “Slight increases in serum estradiol levels were seen but, like testosterone levels, these remained within the normal physiological range and the ratio of testosterone to estradiol was unaltered.”

Tags: finasteride, propecia, leg hair, body hair, dht, estradiol

Not Hair Loss News – Dogs Can Detect Prostate Cancer 4 Times Better Than Traditional Tests

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

Snippet from the article:

Dogs are renowned for their keen sense of smell, and researchers have tested their abilities and have found they are almost four times better at detecting prostate cancer than traditional tests. These specially trained animals, known as Medical Detection Dogs are trained in Buckinghamshire, UK, and have the ability to accurately detect the cancer 90 percent of the time.

“MDD’s trained dogs can detect cancer before noticeable symptoms and others have been trained to recognize dangerously low sugar levels in diabetics. In short, this wonderful charity is training dogs to save lives,” said Betsy Duncan Smith, a trustee of the Medical Detection Dogs charity.

Read the rest — Dogs Can Detect Prostate Cancer 4 Times Better Than Traditional Tests, With Low False-Positive Rate

Man’s best friend vs man’s worst disease.

Tags: cancer, prostate cancer, dog, canine

I Was Diagnosed with MPB After a Scalp Biopsy

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

Greetings Dr. Rassman,

I’m age 26, Male. I was diagnosed with MPB through a scalp biopsy. My hair loss is not evident to anyone who is looking at my head. I believe I have only lost a bit of density on the top. My hair loss started about 6-7 months ago. I first noticed a loss of density and then an increase in hair fall during normal activities. I was proscribed finasteride and am taking it.

My hair is relatively long (approx 3 inchs in length). Many of the hairs that I find while combing and shampooing appear to me to be thinner and are definitely less pigmented at one end than at the other. The “older” top inch of the hair is jet black while traveling down the shaft you will find it becomes brown in color at the “bulb” end. It also appears to be slightly thinner at the bulb end. I can tell this with the naked eye but comparing both ends of the individual hair on a white piece of paper.

Can miniaturization take place in one hair cycle or do hairs become less pigmented and smaller in shaft diameter as they enter the telogen phase?

In general, androgenic alopecia / male pattern baldness (MPB) is not diagnosed from a scalp biopsy. A scalp biopsy is usually only used to diagnose and confirm scarring types of alopecia (not MPB). MPB is diagnosed by looking for a pattern in one’s hair loss… which explains why it’s called male “pattern” baldness.

Individual hairs are never followed by tagging them so I really can’t answer your question. I believe that a single hair cycle can be miniaturized at a follicular unit level or die off at that level after telogen occurs. Pigment often is reduced in miniaturized hairs, but not as they enter the telogen phase if they were good, solid terminal hairs prior to that cycle.

I would stick with the finasteride, as per your doctor’s recommendation. I’ve seen many, many cases of this drug working very well for treating early hair loss at the top of the head, like you’ve described.

Tags: finasteride, propecia, hairloss, hair loss, biopsy, scalp biopsy

Can Venlafaxine (Effexor) Cause Hair Loss?

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

EffexorI am currently taking venlafaxine for depression and finsateride for hair loss. I have noticed my hair is starting to thin a bit more. Can venlafaxine cause hair loss?

Yes, hair loss is a known rare side effect of venlafaxine (also known as Effexor). While finasteride does protect you from the progression of your genetic hair loss pattern, it isn’t likely to protect you from hair loss due to medication.

You can learn more about the side effects of venlafaxine here. If the side effects are concerning, you should talk to your prescribing doctor.

Tags: antidepressant, depression, effexor, venlafaxine, hairloss, hair loss, finasteride, propecia