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A recent review of a study done by Michael-John Milloy at the University of British Columbia in Vancouver (reference New Scientist, 3 June 2017) about using cannabis.

The group reviewed 3,000 people with a history of drug use. They asked these patients if they started to use cannabis to help them reduce their cravings for crack. Of this group, 122 crack users admitted to using marijuana to help them get off crack. They found that 28 percent of those questioned who knowingly used marijuana were off crack. This was a single, non-scientific study that suggests a role for cannabis in treating crack addicts.

 

The FUE Megasession seems to be more and more common lately and will lead to depleted donor area hair enough to produce balding. Newer doctors n the field seem to be offering larger FUE sessions once they think that they have mastered the FUE. It has become a marketing tool as many doctors from around the world (Turkey, India, Iran) are now routinely performing 3000-6000 FUE graft procedures at low prices. Large session FUEs is a way to control this expanding market for their services. The questions you as a consumer should ask:

1- Will the patient be bald in the back of his head due to large number of FUE grafts and what can go wrong?

2- What is the risk of necrosis in the donor area?

3- What does this do for the future needs of the patient who continues to bald?

Most of the patients who have these large procedures (3000-6000 graft FUE procedures) will develop a see-through donor area and many of them will become, frankly, almost bald in the back of the head. The risks of scalp necrosis is high when grafts are extracted that are too close to each other. I just published an article in the HAIR TRANSPLANT FORUM that addresses these issues. People of Asian, African or middle eastern decent are at greater risk for the above listed problems (because of their lower hair densities in the donor area) than Northern Europeans. I have written this post as a warning to my readership that everything you read about Large FUE Sessions is fraught with problems.  See the following posts that show some of these problems:

  • https://baldingblog.com/2016/12/13/fue-forms-punctate-small-scars-100-time-sometimes-scars-large/
  • https://baldingblog.com/2017/05/12/4000-fue-grafts-now-balding-back-head/
  • https://baldingblog.com/2017/05/09/picture-depleted-donor-area-fue/

I also showed the recipient area. Note that the grafts have a wavy line pattern, like soldiers lined up in an empty field. This can be seen when the hair grows out in people with a strong hair character. An artist knows that hair grafts are naturally randomly distributed throughout the scalp without any pattern. Only doctors or inexperienced technicians make patterns in the recipient area.

 

4000 FUE grafts4000 grafts like soldiers

 

I have a friend who just turned 36, who says that he had a “thinning” phase when he was around 22-23 where he said his hair noticeably changed in texture (became thinner and weaker). He’s not on Finasteride or anything but for some reason his hair loss essentially stopped and he hasn’t receded or thinned any further. Is this possible?

Yes, people can start balding at different rates and at different ages. Some men may not even start until they are 50 (unusual but it does happen).

 

I was hoping that you’d be able to give me some feedback on my situation. I have been on Finasteride for the last 12 months of so, to counteract frontal loss. I have continued to thin out all over in the past year. I tried to remain diligent.. In this 12 month period, I’ve had a couple of 2-3 week breaks, changing from 1mg to 1mg  and then 0.5mg. I was curious as to whether you feel that this could be the cause of my thinning? Otherwise, am I a non responder? and in this case, do I have anything to benefit from trying avodart? Currently, i’m not taking rogaine as i do not want to be reliant on using it. My current plan is to use 1mg finasteride EVERY day, for the next three months, to hopefully see some benefits. Thanks for your insight, it’s incredibly appreciated.

On people who do not respond to finasteride, I may try dutasteride, but usually the non-respoders don’t respond to dutasteride either. You may be getting some benefit, like slowing down the thinning, but it is possible that you can’t break the cycle you are heading to. That is why hair transplantation works, especially in those people who can’t get response from medications.

 

This patient had two previous hair transplants at another clinic and did not achieved his goal. Not only were the results of these transplants thin and see-through but the leading edge of the hairline had two and three hair unit grafts that made it look “pluggy” and abnormal.  The hair behind the leading edge of the frontal transplanted hairs were thin, as the pictures show.  About one month before the most recent set of photos, he finally came to see me to have his hair transplant repaired. The entire frontal area was covered with 1,402 grafts. The end result speaks for itself.

Comment:  There is an art to performing a hair transplant and not every doctor offering this service has the artistic talents to manipulate the technology to produce such results.

unhappy hairline

after hairline repair

 

Background
I have had 4 hair transplants (three strips and one FUE) sum totaling north of 10k grafts over the last 10 years. I was also on Propecia. I was pretty happy with my hair post HT #3, however I always had the jitters in public. Due to a temporary health issue I had to stop Propecia because it significant diminished ability to recollect memories while on the medication and I decided to stay off completely. Fast forward to today and I again was not happy with my hair. I have always hated the balding look; I want either a shaved head with no hair, or hair. Due to the strip scar shaving my head was no longer an option. I have been wearing a hat 90% of the time when going out of the house for the past 3 years.

I had seen pictures of SMP and did some casual research a couple of years back. However, in January, I decided to go forward with SMP. I live in San Diego so I visited two clinics, a non-medical place and then Dr. Pak at New Hair in Los Angeles and both a few miles from each.

I visited the non-medical place and spoke with practitioner there, a very nice guy who actually sold me on the procedure (he had it done himself). He did remind me more of a tattoo artist than a medical professional. He instructed me that there would be two 4 hour sessions to achieve good results and also gave me a price.

I also saw Dr. Pak, who was also very pleasant, but wasn’t necessarily positively on SMP. He answered my questions, showed me some results, and told me that it would take 2 to 3 sessions to achieve good results. Unlike the first place, Dr. Pak’s sessions took 6-8 hours each.

I was really leaning toward the non-medical place because of the years they have been in the business. However, I decided to go with Dr. Pak (even though he was more expensive) because of two reasons: (1) it was a medical office (vs a nice tattoo parlor) and (2) I have the option of anesthesia.

I shaved my head a few days in advance and one of my daughters commented that I looked like I was wearing a bald cap (even with 10,000 grafts placed there over many years). Honestly, I was really shocked by the width of my scar.

(more…)

 

Hi Dr Rassman, I wondered how your trials using ACell and autocloning are? How many patients have you enrolled? How large are the session sizes? Are you transplanting 100-200 hairs or more? Also do these plucked hairs treated with ACell behave as normal transplanted hairs i.e. they shed and begin growing after 3 months? Thanks.

ANSWER:
The ACell study that we conducted at NHI some years ago consisted of about 30 volunteers.  These patients received approximately 100 plucked hairs. Since the study started we never saw any growth so we stopped doing this experimental treatment.

 

I’ve currently been on Finasteride for 3 months now, and Minoxidil for 5. My hairline is starting to regrow extremely slowly, but at the same time i’m not sure it will come back. I also would like to see if it would be possible to lower my hairline with FUE procedure as well as filling in a bit of the horshoe pattern as well that is receding. I contacted a facility in Miami, FL on Saturday I believe and was wondering how long it usually takes to schedule a consultation etc etc… I do realize i’ll probably have to get 1-2 or even 3 more hair transplants by the time i’m 40 but right now at age 20 my only fear is that when I go to college started this year, i’ll have missed out on my college social life due to my insecurity of my high and receding hairline.

At 20, you shouldn’t get a hair transplant. Medication is better. The reason is simple, you are very early in a progressive process and if you start now, you may end up chasing the balding.  Any doctor who does surgery on a 20 year-old male is after the money and not the welfare of the patient.

 

http://www.medscape.com/viewarticle/880910?nlid=115421_1381&src=WNL_mdplsnews_170602_mscpedit_surg&uac=128368AK&spon=14&impID=1360157&faf=1

This was a very impressive achievement for both the surgical team and the patient. Feeling good about oneself is critical in driving such a surgical procedure.

 

Is it normal for hair to thin towards the root in a single strand during the balding process?  Looking at the photo below, can you tell if there any miniaturized hairs?

Let’s say the hair is on average 10 inches long and that you can easily tell towards the root it is a lot thinner than at the tip.  You can also see there is a lot less pigmented towards the root.

You are very observant. The thinning hair closer to the root may be the effect of early miniaturization.  This occurs at the most recent part of the hair that is growing. I believe if you observe this over time, more and more hairs will become miniaturized and reflect the genetic balding process that is taking place. Of the two hairs in the photo, the one on the right is miniaturized.  It is thinner and has less pigment in it.  I am fairly certain that it took longer to grow as well because miniaturized hairs grow slower and then either fall out or stop growing altogether.

 

two hairs

 

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