Why do I have a bunch of tiny bald patches? (photo)

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

My hair has been thinning out gradually over the past 4-5 years (I am 26 currently), with follicle density and hair thickness both reducing. Recently shaved my head and discovered that I haven’t been thinning as evenly as I thought, I actually have a ton of these tiny patches that are more thin/bald than other parts. You can see my scalp is almost entirely covered in a dotted pattern.

This could be a condition called diffuse alopecia areata or a fungal disease. See a dermatologist who may biopsy one of these patches.

I’m 27 y/o female taking finasteride and photos show 3 months results, discouraged! (photo)

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

It is difficult to tell but the photos on the left looks a little fuller than the one on the right. This is probably photograph problems rather than real. You should see an expert like me. I offer women with thinning something like this: https://scalpmicropigmentation.com/gallery/smp-for-women/

It works wonders for women and solves the thinning look.

If you pull out some hair, can you damage the follicles?

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

Today my GF cut my hair and well, she tear some hair (without intention) a couple of times.

The thing is that I’m thinking of doing a hair transplant, and because of that I’m trying to take care of my donor area, which is the area where my GF tear riped hair without intention. Taking a look I didn’t see anything wrong, nothing like some white spot or something, however I’m wondering if because of action like that the folicle can be damage in a way that the hair that has been teared doesn’t grow back again.

You can pull out a hair and it will return within 6 months or less but if you keep pulling it out, then eventually it will not return.

Shaved my head and now it doesn’t grow back

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

Hello I am a 24 year old American male and I shaved my head not too long ago recently. I have noticed that the hair on top of my head is not growing back as fast or as strong as the hair on the sides of my head even though my hairline is okay I seem to have thinner hair than before. What could be the cause of this? I’ve been taking zinc and a multivitamin for a few weeks now but I haven’t noticed a huge difference yet. And I’m thinking about starting finasteride and minoxidil thanks in advance.

You probably shaved off miniaturized hairs that were not growing and these didn’t come back, just an educated guess

Hair growth on finasteride- how much have you measured?

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

This is but no means super important but I´m curious. I´ve read several studies about hair regrowth on finasteride and minoxidil. The amount of regrowth of course differs, but how much regrowth have you seen on your best responding patients? From what I´ve read its common to lose up to 50% hair on the scalp before it comes noticeable, meaning around 50 000 hairs. Do you have any idea if the best regrowth cases that lost around 50% recovers back to around 100 000 hairs? Or are we talking full recovery as in maybe 60 000 hairs on the scalp in total? I am fully aware that 100 000 hairs is not needed to make it look like its a full head of hair.

The studies I´ve read mentions that in 2 years on finasteride around 66% percent get some kind of regrowth, but if I remember correctly there was no graph showing how much hair that could be in the best cases.

Hope you understand my question and I fully understand if you have better things to do than answer it, because I guess it doesnt matter really. I´m just asking out of curiosity.

I have discussed the work of Dr. Marritt in the 1980s where he pulled out every other hair on one side of the head and then found that neither photos or an expert could tell which side was hair depleted in a black haired white skin individual. I have done a HAIRCHECK on a patient who had partly reversed their hair loss after finasteride so that part of that question I know.  Most people just sustain their hair at the baseline levels, but some do reverse it.

FDA wins in court against stem cell company

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

https://www.washingtonpost.com/health/fda-wins-groundbreaking-case-against-for-profit-stem-cell-company/2019/06/03/498373fa-864e-11e9-98c1-e945ae5db8fb_story.htm

June 4, 2019 at 8:50 a.m. PDT   In a decision expected to send a chill through the booming stem cell industry, a federal judge ruled in favor of the Food and Drug Administration on Monday in a lawsuit against a Florida-based stem cell company whose treatments have blinded at least four patients.   Judge Ursula Ungaro agreed that the FDA has the authority to regulate a procedure that has become widespread in the burgeoning industry — using patients’ fat to create a stem cell treatment.  The judge ruled that the FDA is entitled to an injunction ordering U.S. Stem Cell to halt the procedure……………. read more
https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes

The US Food and Drug Administration (FDA) has authority to regulate regenerative medicine products, including stem cell products and exosome products. There is a lot of misleading information on the internet about these products, including statements about the conditions they can be used to treat. FDA is concerned that many patients seeking cures and remedies may be misled by information about products that are illegally marketed, have not been shown to be safe or effective, and, in some cases, may have significant safety issues that put patients at risk. FDA wants to help consumers be informed about how these products are regulated, and what to look for when considering treatment with one of these products.

I get a lot of inquiries about stem cells and the growth of new hair follicles arising out of stem cells.  These two articles addresses the problem and challenges in this field. Stem cells have yet to be approved by the FDA for hair loss treatment.

Interesting new drug to prevent hair loss

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

https://www.sciencedaily.com/releases/2020/09/200928125008.htm

Abstract: A team of researchers from Cologne and Helsinki has discovered a mechanism that prevents hair loss: hair follicle stem cells, essential for hair to regrow, can prolong their life by switching their metabolic state in response to low oxygen concentration in the tissue. The team was led by Associate Professor Sara Wickström (University of Helsinki and Max Planck Institute for the Biology of Ageing) and the dermatologist Professor Sabine Eming (University of Cologne), and included researchers from the University of Cologne’s Cluster of Excellence in Aging Research CECAD, the Max Planck Institute for the Biology of Ageing, Collaborative Research Centre 829 ‘Molecular Mechanisms Regulating Skin Homeostasis’, the Center for Molecular Medicine (CMMC) (all in Cologne), and the University of Helsinki. The paper ‘Glutamine Metabolism Controls Stem Cell Fate Reversibility and Long-Term Maintenance in the Hair Follicle’ has been published in Cell Metabolism.

Why is FUE recommended more than FUT?

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

I have an appointment at Dr XXX’s office today, and I’m wondering why people always recommend FUE?  His office tells me than FUE has a lower graft survival rate and leaves the back of the head looking thin. I think I’d rather have a tiny linear scar on the back than a less dense donor area? I’m a NW2 that’s thinning and I’d probably need 2000 grafts to bring back my density and restore the hairline.

That is not true. In good hands, survival of FUE is as good as the strip surgery. In our practice we do 50% FUE and 50% Strip surgery. This is because there are good solid reasons to do a strip surgery or FUE as follows (some tips):

  1. Do a strip surgery if you had a previous strip surgery

  2. Many of the newer doctors only learned FUE and can’t perform a strip surgery so that they recommend what they know, the only surgery that they know how to do.  There is a place for both.

  3. If you are going to be very bald. A strip surgery for a large number of grafts will not produce a see-through donor area common when FUE is over-harvested.

  4. FUE is good when the total short term needs is less than 3500 grafts total in a person with medium weight hair and an average donor density. Many men with class 3 balding can easily get a great FUE session with great survival of the grafts

  5. FUE is good for men who will not be very bald and want to keep their hair very short in the back of their head.

  6. FUE has a very short recovery time and very little post-operative pain. Most young men don’t look at FUE as a surgery (which it is).

  7. At our monthly open house events, former patients come in, some had FUE completely, some had Strip followed by FUE, and some had FUE followed by strip surgery. You can meet these patients and judge for yourself what is real and not real.

 

This is classic DUPA (photo)

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

Yes, this is a classic look of the magnified donor area that you want to see with 50% or more miniaturized hairs. We actually classify DUPA (Diffuse Unpatterned Alopecia) once the miniaturized significantly exceeds 20%.  Most DUPA patients have much higher miniaturization in the donor area and elsewhere on the scalp. The single best treatment is the drug finasteride which is less than 50% effective at controlling the progression and less effective at reversing the process. I don’t know of anyone who has reversed the process with any treatment.