September 2014 – Page 2 – WRassman,M.D. BaldingBlog

I Have Low Hair Density, Am I Able To Have A Hair Transplant?

Sep 22, 2014/by William Rassman, M.D./2 /Density, Hair Loss Causes, Hair Transplantation

I have already gone for tricho analysis they told that I have a very low hair density I.e 100 per square cm. So now I would like to go for hair transplantation is it possible now

Low hair density means you will have less hair available for a hair transplant and your expectation and results will have to be discussed with your doctor. In general a normal hair density for a Caucasian male is 200 hairs in a square centimeter. It is also important to establish a diagnosis of your hair loss type and why you may have a low hair density. If you have a Class 3 pattern (just frontal corner loss), you should be able to have a hair transplant with your low donor hair. But if you have a condition such as diffuse unpatterned alopecia (DUPA) you will not be a candidate for surgery as the condition of the hair in the donor area is not healty. It is not normal to have 100 hairs per square centimeter. I never trust a single measurement, so you might have someone else reaffirm the density numbers.

Tags: low hair density, tricho hair transplant analysis, hair transplant

How Dense Can Hair Really Be Transplanted?

Sep 22, 2014/by William Rassman, M.D./2 /Density, Hair Loss Causes, Hair Transplantation

In a very recent question, asked about hair cloning, you mentioned that “theoretically you will have an endless supply of hair and your hair density can be as high or higher than what you started with”. In another entry of yours, Dr. Rassman, we read that “Hair can be transplanted at a density that approaches 35% of the original density in many people.” and that “the ability to place such densities depends upon many factors which include: hair thickness, skin characteristics, the size of the instruments for making sites, the skill of the surgical team at placing grafts tightly together and the processes that reflect the quality management of the surgical team.”

What is different about hair cloning different, which allows us to place the grafts so tightly together that you will end up with a density of 100%

Perhaps there is a misunderstanding that I would like to clear up.

There is no limitation on the density of transplanted hairs, except on a per session basis. How close you can put the grafts together during surgery depend on the width of the grafts (not hair). Some grafts can be 1/16 to 1/8 of an inch wide.

You must understand that hair transplant surgery involves moving hair from one location to another location. It does not create new hair. Let’s say that you got 35% of your original density in one session, then you want the same number of grafts transplanted again, assuming that the donor supply is as good, you can probably come close to doubling the 35%. Again, if you then wanted to do another 35% equivalent grafts, you will be getting close to 100% of the original density. There is actually some limits to this process, for example, what is the size of the donor area, the blood supply and the availability of grafts from the donor area. When grafts are placed very, very close together, we call this term “dense packing”, a term I defined in 1994 in the Hair Transplant Forum.

If you are a completely bald Norwood 6 patient and want your original density of 200 hairs in a square centimeter, where would the donor hairs come from? You only have a limited number of donor hair and the surgeon has to use judgement to create the most effective use with limited number of donor hairs you have. Unless there is cloning, putting in an unlimited number of hairs is impossible.

If you are a Norwood 3 and want the original donor hair density, then it may be possible with multiple surgeries.

Tags: Hair transplantation, high density hair cloning, transplant density

Can Driving Fast In A Convertible Cause Traction Alopecia?

Sep 22, 2014/by William Rassman, M.D./0 /Hair Loss Causes

Say you often drive fast in a convertible when on the freeway. Can all the wind blowing your hair around cause traction alopecia or otherwise damage the follicles?

Assuming this is a serious question: would driving on the freeway, with the top down cause, hair loss?

Seriously, the simple answer is: NO.

Scalp MicroPigmentation (SMP) Review with Depleted Donor Area, Scarring & Thinning – Before & After Photos

Sep 19, 2014/by William Rassman, M.D./0 /Hair Loss Causes

This patient had almost everything that could go wrong with hair transplantation including: Scalp reductions, multiple hair transplants and depletion of his donor area from the multiple surgeries in the past. More hair transplants were not an option. His results showed thinning but on the brighter side of things, he felt that he did not look bald when he kept his hair longer and styled it appropriately. He was still not satisfied with his hair and the coverage of his hair restoration procedures. He did not like the large multiple white scars on he back of his head which showed up on windy days or with swimming. He decided he would try Scalp Micropigmentation (SMP) to enhance his appearance, address the scars and have SMP under the thin hair on the top to make it look a bit thicker. He still has thinning hair but SMP helped hide the scar and gave him the illusion of more fullness on the top of his head.

Scalp MicroPigmentation to scar

NHI Hair Transplant Review of Mid 70 Year Old (Before & After Photos)

Sep 19, 2014/by William Rassman, M.D./0 /Hair Loss Causes

This is a review of a mid 70’s retired healthy active man who wanted to look like the way he felt.
He had 1657 grafts to the front areas to give him a younger non-balding frame to his face.
The results were better than the patient and his wife anticipated. Actually his wife complained that when they went on vacation people came up and asked if they were mother and son!

New Hair Institute Review of 1657 graft Hair Transplant

New Hair Institute Review of 1420 graft Hair Transplant

Sep 19, 2014/by William Rassman, M.D./0 /Hair Loss Causes

This is a review of a mid 30 year old who wanted to have his hair line back. He had 1420 grafts to establish a hair line. He will likely return to make the corner areas more dense.

New Hair Institute Review of 1420 graft Hair Transplant

Did LeBron James Get a Hair Transplant or SMP?

Sep 18, 2014/by William Rassman, M.D./1 /Hair Loss Causes

Lots of speculation! I don’t know.

Is It Possible To Stop My Maturing Hairline?

Sep 18, 2014/by William Rassman, M.D./0 /Hair Loss Causes

I am 18 years old and I am seeing my hairline rising. Can we stop this change with Propecia?

The mature hairline is present in about 90%+ of men as they mature. I don’t have any experience with stopping the hair loss in the very front of the hairline that is typical of children. At 18, without seeing you, I don’t know where you are in the process; however, I don’t believe that the zone between the leading edge of your juvenile hairline and the place where a mature hairline will end up (see reference above) is mediated by the balding gene as this is not balding in the typical sense of the word. These hairs undergo Apoptosis (cell death) and that is programmed into your genetics. I have had young men on Propecia in the past, and I do not remember any of them where the transition from juvenile hairline to mature hairline was stopped by this drug.

Anti-Depressant Medication and Balding

Sep 17, 2014/by William Rassman, M.D./0 /Hair Loss Causes

Thank you for providing this opportunity to ask questions.

In many related posts, you sort of make the make the blanket statement “anti-depressants cause hair loss”.

Many manufacturers indicate 1-2% or even less risk of this occurring.

1. Do you feel that, perhaps anecdotally or in your practice, the incidences are actually higher?
2. Do you feel that men with AGA are even more prone to this side effect?

I would really like to start an AD treatment and I can accept the manufacturers stated risks, but considering how concerned I am about my AGA, your more experienced and specific opinion is very valuable to me.

On the contrary I generally make a blanket statement that genetics are responsible for hair loss in men. This is not common and as you said 1-2% is a reasonable informed guess based upon what has been published. I rarely see these issues in my practice, more so in emails and blogs. Actually do no not recall anyone I’ve seen at my practice complaining of hair loss from anti-depressant medications.

My standing “blanket statement” is that genes cause hair loss in men (androgenic alopecia – AGA is genetic). Drugs such as anti-depressants cause other well known side effects such as sexual dysfunction, decreased libido, etc more so than Propecia. Hair loss side effect from anti-depressants is likely what the manufacturers claim it to be.

I Am 50 Years Old and I Look over 60. What Can I Do?

Sep 17, 2014/by William Rassman, M.D./0 /Hair Loss Causes

I am 50 years old and balding. My neck droops, my joules show, by face is the opposite of tight and I have bags under my eyes. Can facial surgery and hair transplants fix these problems. Will these congeries cause scars that everyone can see?

If you feel you are looking older because of Jowls or a turkey neck or creases on your face and bags under your eyes that make you look old, you could be a candidate for a face lift and surgery on the bags under your eyes. Good hair on the sides is important to cover up face lift incisions where scars might form scars. The symptoms you listed can be addressed by working with a good hair transplant surgeon (for a hair restoration) and a good plastic surgeon. Hair covers incision scars from a face lift, even short hair provided that there is hair in front of and behind the ear where the incisions are made for the face lift. The bags under your eyes can also be treated with a good plastic surgeon and these surgeries usually do not scar. Good planning with your plastic surgeon is important.

Most men tell me that the hair transplant makes them look 10 years younger. Add to that the work on your face and your eyes, and you might be looking 30 again. If course, you did not comment on your ‘got’ and I am assuming that you are not heavy or looking for a liposuction.

Scalp MicroPigment SMP Review of Hair Transplant Scar

Sep 17, 2014/by William Rassman, M.D./0 /Hair Loss Causes

This is a review of a patient who was happy with his hair transplant results but his linear hair transplant scar bothered him when he wore his hair short.
We kept his hair long (not shaved) and performed the SMP procedure under local anesthesia. The following results were immediately after the first session. He will need a follow up session for better blending.

How Do I Use Rogaine If I Am Using It On The Front And Crown?

Sep 16, 2014/by William Rassman, M.D./0 /Hair Loss Causes

Apologies in advance for yet another question on this drug, but I cannot seem to find a good answer to it!

I am just wondering how the dosage of minoxidil has an impact on the hair. The Rogaine 5% minoxidil foam I use recommends 1g twice a day. This seems to be based loosely on expected application to the vertex/scalp.

Now, like so many people out there, I predominately use it on the hairline (though I know results can be hard to come by here). I have some moderate, uneven recession which may just be maturing, but I know maturing can quickly shade into MPB, and I have balding in the family.

Since the corners of the hairline make up a smaller area than the vertex/crown, is it still appropriate to use the full 1g? Does it matter if the full 1g is used in a more concentrated, smaller area? Does using more than the recommended 1g per application dosage ONLY increase the risk of side effects, or can it also have adverse effects on the hair?

In other words, is 1g simply the limit they set to to achieve maximum effectiveness whilst limiting side effects (similar to how 1mg is used daily for finasteride), or does going beyond that have adverse effects?

I only ask because I tend to use the full 1g (half a capful) to cover both corners (0.5g each corner), sometimes more, and I worry this may do more harm than good if I am using too much!

On the flip side, I wonder how people with more advanced/diffuse thinning manage to use half a capful to cover all the effected areas, and achieve good scalp penetration? It doesn’t seem enough!

I think it should be quite simple by using the medication as directed. Rogaine 5% is a topical medication and it is to be used twice a day on the area of balding on the scalp. Applying it, unfortunately, is not a science especially when you have to put it one in areas you can not see easily. It is used for balding on the top and crown areas where it is most difficult to apply and it probably does not really work well on the frontal corners. I realize some people use it for growth on the frontal corner areas in hopes it may work. There is nothing wrong with this. If your head is big or the balding area is big, I would use more to cover the areas needed. I do not think there is an absolute limit that you can realistically apply and what you apply needs to get on your scalp, not your hair. I also realize if you use too much you may have some side effects such as a drop in your blood pressure so use your good judgement.

Can You Still Have Hair Transplanted to Thinning Areas If You Are Not Completely Bald?

Sep 16, 2014/by William Rassman, M.D./0 /Hair Loss Causes

I am going bald in a pattern for sure but still got hair on the balding area, just thin hair! Can you transplant in to an area which still has hair. On my head I don’t see much space to put new hairs in. Would a transplant damage the hair I still have? So do I have to wait? I am mid 40s

You can transplant hairs to thinning areas and the hairs will grow. But your miniaturized hairs that are at the end of their life, may fall out as a result of the transplant. But you and your doctor need to discuss the potential for shock hair loss, how to prevent it and its risks versus the benefits. You need to be examined by a doctor and have a Master Plan for what you are trying to accomplish with the correct set of expectations. Hair transplants may or may not fit into you Master Plan.

Flax Seed and Fish Oil Cause Hair Loss?

Sep 16, 2014/by William Rassman, M.D./0 /Hair Loss Causes

It took me 4 months to figure out that flax seed and fish oil can cause the most severe shedding I’ve ever experienced in my life. I lost so much long beautiful hair that it hurts. I will work on restoring it now with onion and ginger juice rub and other supplements. Thank u for having this website.

I am not sure how onion and ginger juice can restore hair loss, but I also am not sure how flax seed and fish oil can cause hair loss either. Maybe it was coincidence?

There are many anecdotal stories on the Internet but I just want to make it clear that while personal experience and stories may be true to the individual, such results may be coincidence for you and it not necessarily mean it is true for others. There is no scientific basis for hair loss or hair growth from fish oil, flax seed, ginger, or onion. Sorry.

Are Wigs The Only Viable Option For A Person With DUPA

Sep 15, 2014/by William Rassman, M.D./0 /Hair Loss Causes

I’ve had DUPA for around 8-9 years now, during that time I’ve tried finasteride and Minoxidil for periods over 12 months with no success. I’m not that hairy so even a BHT is out of the question. Lately I’ve been visiting some wig stores, i must say, I’m very impressed by what i saw and tried on, my only worry is traction alopecia, i was wondering if shaving my head could help prevent any damage caused by wearing the wig? the type of wig I’d go for would be a full wig (including nape and sides) glue and tape would be used to secure the wig.

I often get similar questions asked about finasteride and minoxidil use with DUPA. They do not usually work. Hair transplants might work if the balding area is relatively small (like a Class 3 balding pattern). Using FUE, one can select the good hairs from the donor area and use them in the small recipient area.

Wigs are one alternative for men and women with hair loss. But as you point out you may get traction alopecia and there are no particular wigs or tapes that I know of that can prevent it. You can also shave your head (as you point out) or apply tape to affix a wig (hair system) to your scalp but some people get scarring and discoloration with long term use of any device that affixes a wig to your scalp.

Another alternative to wigs is scalp micropigmenation (SMP) if you like the shaved look. You will not make your DUPA worse with SMP and if some new treatment or cure comes out in the future, you can always take such a treatment. If your hair is thin, SMP may also make it look thicker. For more information you can see my website here.

123 4

Page 2 of 4