This is an excellent discussion of how to apply a traditional body tattoo. Posted by Destin at SmarterEveryDay

This is an excellent discussion of how to remove a traditional body tattoo Worth a viewing. Posted by Destin at SmarterEveryDay

Scalp Micropigmentation (SMP) is essentially a specially applied tattoo where a pigment is deposited under your skin. I think that everyone who is going to undergo any tattoo, like Scalp Micropigmentation (SMP) view these videos. The traditional tattoo moves the ink deeper than SMP does so colors can be blended with each other as an illustration is made. With SMP, every “dot” is controlled with regard to depth, time in the wound that is made and the angle of placement. The goal with SMP is to make every dot look like a follicular unit. With the limited volumes used in SMP, the migration of the pigments should be significantly less than with traditional tattoos.

Dear Dr Rassman,

Your blog entry of 17 July 2007 includes before and after pictures of a man with a receding hairline who has been transplanted. I am curious how you would mange his follow-up care if he was 30, 40, 50, 60 or 70?. Is balding in this particular pattern common in younger or older men? Am I right in assuming that most men with this kind of hair loss will need more transplants later on as the balding progresses?

His before photo is on the left; after photo on the right. Click the photos below to enlarge. For more photos, see Results After a Single Session.

This patient has a Norwood Class 3 balding pattern, and yes, it is quite common. He is over 50 years old but we commonly see this pattern in men in their 20s and 30s,. The older they are, the more stable is their hair loss. As he is 50, I would not expect his pattern to advance much at all. If he was 25 years old he could lose hair behind the transplants particularly if the balding pattern was really much worse. Many men like this develop crown balding (a Norwood Class 3V pattern) which may require another procedure. For men with only frontal hair loss like this patient (age 50+), I would probably not use Propecia (finasteride) but in men 20-40, that would probably not be my position. By taking Propecia (finasteride 1mg) the hair loss pattern may not progress very fast and is more likely in younger men. I don’t like surprises and nor do my patients, which is why miniaturization mapping and a good Master Plan in the hands of a caring, experienced and focused doctor go together hand in hand.

Dear Dr. Rassman
I’m a 54 years old male. I had a hair transplant operation on 30 June 2014 by FUT method followed by FUE method on 1st July to complete the transplantation. From the second day after operation I noticed that a big area in recipient part between crown and front of my head, the skin is so irritated (fig.1) and after 1 week it became completely black and was necrosed (fig.2).

Photos: Figure 1, Figure 2

I rang to my surgeon to consult on this issue. He said at your age this problem sometimes happens and I should wait until the skin being repaired and to speed up this procedure I should put warm towel on the necrosis area as well as making it oily by Vaseline to avoid dryness. I really don’t believe in the opinion of my doctor to relate this problem to my age, so I would highly appreciate if you let me know your opinion regarding the reason of this problem, is there any special treatment for such necrosis?

As the recovery procedure of the skin is so slow as shown in figs 3 and 4, I’m not sure that the transplanted follicles are not damaged. I thank you so much if receiving your valuable comments.

Photos: Figure 3, Figure 4

Sincerely yours

I am not clear on your history as you note a FUT (as in strip surgery) and fue (as in Follicular Unit Extraction Technique). There are some doctors who combined FUT and FUE (called FIT by one particular surgeon).

In my 23 years in this industry, we have performed hair restoration surgery in over 15,000 patients (with as many as 8 doctors working for the New Hair Institute at one time), so my experience is in the thousands of patients we have treated at NHI. Although I have never personally seen this complication in any of our patients, I have been aware of this complication in patients who have either consulted with me or I have heard about it through other doctors’ reports at medical meetings. At the recent meeting at the beginning of this month, one doctor presented 5 cases like this so your experience has been replicated at other clinics. This problem was more common in the 1993-1996 time frame, as doctors were increasing the number of grafts they were performing and not reducing the size of the punch or slit equipment. These doctors devascularized the scalp because their wound areas were too large or put too much epinephrine with the Xylocaine that negatively impacted the blood supply to the mid-scalp.

The central area of the scalp (where your problem is demonstrated) was the place where this complication has been seen most commonly, although I have seen patients referred to me where the finding was present in the donor wounds from FUT (strip) surgery. The least vascular area of the head is probably at that exact location because it reflects the end of the blood vessels that come from the side, back and front of the head. As you may know, balding produces an atrophic skin that is thin and not vascular with little infrastructure (fat) under the skin (where a normal scalp would be rich in blood supply, with many nerves per follicle, many hair follicles, considerable amounts of fat, etc..). The reason that the skin becomes atrophic in balding men is because the bald scalp does not need a rich blood supply, so the body withdraws the blood vessels in response to lack of demand. When a hair transplant is done, the demand of the new hair increases the blood supply and eventually the scalp is no longer atrophic and becomes rich in blood supply again.

I am certain that age is not an issue. Smoking may contribute to this problem. My oldest patients have been in their 80’s and we routinely operate on men in their 60s and 70s. I have done surgery on diabetics and in these people, I have not seen vascular problems either, but I often do not ‘dense pack’ these diabetic people for fear of such a complication. I personally had a hair transplant two year ago (at the age of 70) with no issue. I had an atrophic scalp resulting from 3 scalp reductions done in 1991-1992 that left my skin very, very thin and atrophic, yet I suffered no vascular effects from the transplant into my atrophic skin.

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How many procedures does it take to lower a women’s hairline?

There are two types of procedures for lowering a woman’s hairline. One, is a surgical excision of the upper forehead followed by the downward advancement of the hairline up to an inch from where it was prior to the surgery. To accomplish this, the entire scalp from the frontal hairline to the very back of the crown, is lifted up and pulled forward. When this is done by an experienced surgeon, the hairline can often be advanced about 2/3rd – 3/4 inch as there is enough looseness when this lifting process is done. This procedure is often complete in one surgical session; however, it may not address receded corners of the hairline if the corner recession is significant. A great advantage of this surgical approach is the immediate impact of the procedure on hairline location with healing usually complete in a week or so. Sometimes this procedure produces a scar in front of the hairline, and if this is this is the case, a hair transplant in front of the hairline can address the scar. Hair transplants take 7-8 months to fully grow out.

The second type of hairline lower procedure is done through hair transplantation. The number of sessions varies by the thickness of the hair, were women with thicker hair, might do this in a single session. With finer hair, it often takes two sessions. The time to see the impact of a hairline lowering hair transplant procedure is 7-8 months and if a second session is required, it will take another 7-8 months to wait for full growth.

We have discussed that Erectile Dysfunction (ED) is a known side effect of Propecia (finasteride) and Avodart (dutasteride) in the range of 2% of men taking Propecia (finasteride). The side effect occurs in 1-2% of men. We have also stressed that ED is common in men not taking these drugs. In general ED affects 20% of men in their 20s, 30% of their men in their 30, 40% in their 40s, 50% in their 50s, 60% in their 60s and so on with an impact on 150 million men. ED can also be a sign of vascular disease or other systemic diseases such as high blood pressure or diabetes. Outside of the hair loss topic in BaldingBlog, many medication (other than Propecia) can cause ED or other sexual related issues. Vitamin D deficiency is one of the causes of ED that is easily treated. More notable are the anti-anxiety or anti-depressant medications as well as blood pressure medications. There is also a psychological component to ED where the lack of erection can be attributed to the mind. This is the reason that doctors are needed to diagnose and prescribe the medication.

When a patient is so worried or express anxiety that they may have ED from taking Propecia I can almost predict that they WILL have a side effect as the mind can be a powerful motivator. These patients I tend to generally not recommend Propecia (despite my effort at educating them) since they would be more preoccupied with the side effect than its benefit.

When on occasion a patient report back with some side effect, we decide on the course of action together. They can stop the medication or consider other options such as lowering the dose or taking a medication that may help with the erection problem. We also explore other extraneous causes such as their health, other medications that they may be on, and other emotional factors in their lives. To some, hair loss in it of itself can be a horrible and debilitating emotional trauma. On a few occasion, I have referred patients to a psychiatrist because hair loss affected them to a point of clinical depression and thoughts of suicide.

When a patient is in good mental capacity with extraneous factors accounted fand the patient still expresses the desire to take Propecia, we explore the option of medications to help with the ED. The following medications are used in general to treat ED (irrelevant of Propecia or its side effects).

Tadalafil Mylan (Generics UK Ltd) is used for the treatment of men with erectile dysfunction (ED) and benign prostatic hyperplasia (BPH). It is a generic of Cialis (Lilly), which has been available since mid-November 2002. All of these drugs that I will discuss below require sexual stimulation to work. It is reported to last 48 hours with a slower onset. Some doctors recommend a daily dose of 5mg and this may have positive effects on your prostate as well as your ED.

Avanafil has been approved by the FDA for ED as early as about 15 minutes before sexual activity, although the official time to use it might be 30 minutes which makes the onset much faster than the other drugs.

Viagra was the first drug introduced for ED. It may be the strongest of the medications and many men report that when these other drugs fail, this one works.

There is no good scientific study reflecting men with ED from finasteride using the above treatments, but my personal appraisal and my experience prescribing these medications, these approaches can satisfactorily treat ED even while on finasteride.

Taken from Huffington Post:

Eating hair is common in animals in their grooming process and they normally create Hair Balls which are either vomited up (those of you with cats see this all of the time) or they pass through the intestine and come out through defecation, Eating hair is part of a neurosis found in some people who will have the same problem as in other mammals. It is interesting to note that it does happen with humans.

I just recently quit taking finasteride due to experiencing some sexual side effects that did not decrease when trying a smaller dose. My doctor advised me to stop finasteride for six months to see if my sexual symptoms improved. I took my last pill a month ago.

I was on finasteride from age 24 to 27, and, while not improving my hair loss, it at least kept further loss from occurring. I’m starting to feel anxious about the catch-up hair loss that could come within the next few months. Would minoxidil help prevent this catch-up loss from occurring, or is it more or less inevitable?

Finasteride (Propecia) and minoxidil (Rogaine) works in different ways. Rogaine will not necessarily stop catch up hair loss that sometimes occurs after stopping Propecia.

There is no cure for genetic hair loss in men (Male Pattern Balding). These medications (and even surgery) help address the balding. Medications can postpone the hair loss to varying degrees in individuals and each individual has different results and experiences with Propecia / Rogain / and any medication for that matter.