Avodart vs Hair Transplant

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

I was wondering if you give prescriptions for avodart. I had some frontal transplants in early 90’s but continued to lose behind transplant..i now wear a hair system and Have learned to live with it…i need to keep what hair i have in the back and on the crown so my systems do not have to be made any larger..I have been doing alot of research about avaodart..i was able to get a sample pack (2 weeks) from a dr friend..but need prescription to get more…

Avodart (dutasteride) should not be the first line for you unless you are sure that Propecia (finasteride) is not working. I would be happy to evaluate you, but the few times I have prescribed Avodart, I had good reason to do it. The side effects on Avodart are more than the side effects of Propecia. If you have a void now developing behind the old transplants, have you considered fixing this (it is relatively easy)? It may allow you to get rid of your hair system. In any event, you need to have miniaturization analysis before any treatment to know what is happening to you.

Tags: avodart, dutasteride, hairloss, hair loss, hair transplant, hair transplant, finasteride, propecia

Scalp Tunnels and Attaching Wigs to the Scalp

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

Received two semi-related questions, so I’ll answer them as one —

Hello,
Several years ago I had tunnel graft surgery and I’m now in need of the clips. Can you advise me on a source where I can find them? It’s been rather difficult to locate them

Someone told me that you could sew a wig into the scalp. Is that true and does it work?

Unfortunately, I do not know who might sell these clips.

For those of you who do not know what a scalp tunnel is, it is described in PubMed as:

A new procedure for attaching a hairpiece to the scalp is described. Two skin-lined tunnels in the anterior and posterior scalp are built, using a strip of free full-thickness donor skin fron the postauricular area. Silicone-coated metal clips, suitably fashioned from .062” Kirschner’s wire, are then attached to the hairpiece. The metal clips are inserted into the skin-lined tunnels and thereby anchor the hairpiece to the scalp.

These permanent tunnels (more like bridges made of scalp skin) are created to hold a wig (also known as hairpiece or hair system) in place instead of glues or tape. It is a barbaric and deforming process, not considered anyone’s standard of care today. Note that the description on PubMed is dated October, 1976.

There have been many things that people have done that are (in hindsight) a little nutty. There are three ways that I have seen the wig attached to the skull.
Sew scars

  1. The picture on the right was of a patient who went to a company in New Jersey who hired retired doctors to actually sew wigs through the scalp skin directly (see photo at right of patient with scars from this procedure). These almost always got infected and when the patient came back to the doctor, the stitches were switched to a non-infected part of the scalp. As you can see from the pictures, the scalp was heavily scarred from the infections. At one point, I was hired by the New Jersey Medical Board to prosecute the doctor, but the doctor was replaced by another who then went through the same legal process. When the State tried to shut this company down, the company closed down and opened under another name. I do not know if they are still playing this ‘cat and mouse‘ game with the State of New Jersey.
  2. A doctor actually drilled a metal connector into the skull. The wig had a male like clips that connected with a mechanical fit to the part that was drilled and cemented in the skull. The wig could be buttoned in and out with great ease.
  3. The art below shows skin tunnels (an old procedure that required a skilled surgeon to fashion in the scalp) which are use to tie ‘shoe laces’ that were attached to the wig. The process was promoted as simple as putting on and taking off your shoes (except you just did it with your wig).
Tunnel
Tags: scalp tunnel, surgery, wig, hairpiece, hair piece, hair system

Bumps Where My Hair System Attaches

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

I wear a hair piece (system) on the top of my scalp only. It is taped on and I love it. The top of my hair is fake and the bottom half is my own. No one can tell and no one knows, except my hair specialist. My problem is that I noticed a few weeks ago I have developed two little bumps on the front of my hairline (right where the tape is). These bumps do not move or hurt. When I remove the system for a few hours I noticed that the bumps lessen but not completely. Should I be worried. I can’t go to my doctor as I don’t want him to know about my hair situation and he’ll probably send me for tests which means more people will know my secret. (I’m very sensitive about my hair loss) When I check bumps/lumps on the internet it indicates tumor?

Should I be worried? My hair specialist thinks it’s because of the hair system and doesn’t think I should be worried.

These bumps sound like something caused by irritation, possibly from rubbing of your hair system. Get a doctor to see it or ask your hair system expert about it. I am sure that you are not the first to have it. I can not tell you what it is without seeing it myself.

Tags: hair system, hair piece, hairpiece, wig, hairloss, hair loss, irritation, bump

Regulation for Wig / Hair Transplant Facilities

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

WigFrom Shakopee Valley News in Shakopee, Minnesota

“YOU’LL FLIP YOUR WIG: Rep. Frank Hornstein (D-Minneapolis) wants to create a new state bureaucracy to regulate “hair transplant facilities.” One of the purposes of investigating hair-weave artists is top make sure there is no “conduct which is likely to deceive, defraud, or harm the public.” (House File 1069) Maybe it’s time to bring back Ron Popeil’s spray-on baldness remover.”

I think what the author is trying to say, is that there are facilities/clinics/wig salesmen who pray on unsuspecting men. This is a consumer protection issue. These facilities may have deceived the public, which can result in a fraud that might harm them. The regulation of wig-makers may be at the root of the problem and although some hair transplant doctors may be also a focus of such legislation, I would like to believe that doctors would not be included in this group. There are laws that regulate what the doctor can and can not do. These laws exist in every state and these laws require the doctor to fully inform patients as to what can be done and what can’t be done with any particular treatment as well as alternatives to any suggested treatment (it is called ‘informed consent’).

I have been told horror stories by young men who respond to an ad in the newspaper (or TV) promising hair. Desperate for a solution to balding, the young, unsuspecting man goes into a wig facility and is sold some solution to his balding problem which is poorly defined. Before he knows it, he finds that the hair in the front of his hairline has been shaved off. The salesman says: “Don’t worry” and a wig is placed over the shaved area. There is no obligation to purchase a ‘system’, of course, but if the young man does not buy it, he must leave with a partly shaved head. The sale is easily made under such duress. This wig ‘system’ is attached with glue and it pulls out the hair the longer a person uses it. In effect such ‘systems’ accelerate the balding process and many wig salesmen understand that and make their money from the recurrent revenue produced by monthly adjustments to the systems and replacement systems. Sales are commission driven, so the sale is all important. The costs for the wig is a big business with wigs that sell for thousands of dollars. Everyone needs two wigs — one to use while one is being washed or repaired. I have been told that the cost for such hair systems run well over $10,000 over a five year period.

Could that be what this legislation is about?

Tags: wig, hairpiece, hairsystem, hair system, toupee, hairtransplant, hair transplant, law, legal, hairloss, hair loss

Almost Completely Bald from a Perm

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

Hi doctors,
Can a perm cause hair loss? My mother had her hair styled professionally a month ago and it now looks like she’s losing her hair. I don’t know if the style just made existing thin patches more visible or if the perm could actually cause the hair loss.

Thank you

SalonI saw a lady just the other day who was wearing a ‘full helmet’ wig. When she took it off, she had almost no hair anywhere on her head. She looked like she had just had extensive chemotherapy, but in reality she had a perm some 5 years ago. The perm brought on an immediate reaction with about 95% of her hair gone within a month. The hair never returned. Unfortunately, there was nothing I could offer her to help her. What impressed me was the totality of her hairlessness from something simple as a day visit to her hair dresser. She was so concerned about exposing her hairless scalp to me, that I did not ask her to allow the use of her photographs, even from behind.

As for your mother’s hair loss, I wouldn’t be able to know what the cause is just based on the email you sent. It is possible that she had existing hair loss, or the styling could’ve caused it. There are a number of factors that could be the reason for her thinning hair.

Tags: hairloss, hair loss, perm, style, female, woman, women

A Bald Spot in Female After Hair Extensions Removed

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

My 27 year old daughter just called me frantic about some bald spots that were found in her hair. Her story sounds nutty, but please listen and let me know what I might can tell her that will help to calm her down. She had cut her hair pretty short and truthfully loved it, but her husband thought it looked a little butch. Unfortunately, this made her feel self conscious, so she had longer hair added to hers. From what I understand the hair pieces were glued in. Those were taken out today and she is hysterical because she now has bald spots. So, can you possibly tell me anything we can do to help point her in a direction to try and seek some help.

It sounds like the glue pulled out hair. If this is just a short, one time episode, the hair should grow back. Constant traction over longer periods of time can cause permanent hair loss. I would recommend waiting 6-8 months and after the hair goes through a cycle (worst case) the hair should grow back. Otherwise, she should see someone within my specialty for consideration of a small hair transplant procedure, but waiting for up to a year is better just in case it does grow back. The usual wait time is under 6 months, but I say a year to be safe.

Tags: hairloss, hair loss, bald spot, glue, extensions, female, woman, women

I Didn’t Know Weaves and Wigs Would Make My Traction Alopecia Worse!

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

I’m a 38 yr old black female. My hair started thinning in the crown about 10 yrs ago. I started braiding it to keep out the chemicals. About 3 1/2 years ago I was diagnosed with traction alopecia. Had never heard of it before. I started wearing weaves and wigs to cover up the ugliness. I never realized that this would make my situation worse. Now the balding has spread to the top and front of my head. Is it too late for a hair transplant that would work. The hair on the sides and back is relatively thick, but it seems so unhealthy. At the rate I’m going I feel like I should just shave my head bald and call it a day. I feel so ugly. I did see a dermatogolist for the diagnosis, but I never got any advise on what I should do to help the situation. Can you recommend anyone to see on this side of the country??

If you are diagnosed with traction alopecia, you need to keep your hair short with no weaves and wigs. After stopping the insult, you should wait for at least six months and see if your hair regrows. In many cases, traction alopecia may cause permanent damage to the hair follicle and may not reversible. Repeating the evaluation of your hair after this period of time will show the areas of permanent hair loss. At that point, a hair transplant specialist can evaluate you for further treatment options if the hair failed to grow back. Then, if you are using a wig, be sure that it is converted to clips to prevent the transplants from developing traction alopecia.

Tags: traction, alopecia, hairloss, hair loss, weave, wig

Considering BioMatrix at Hair Club

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

I visited doctor Rassman for a consultation on two occasions: the first time was about 6 years ago, the second time about three years later. On both visits Dr. Rassman advised against transplant surgery because of limited donor hair. I appreciated his honesty and have adhered to his advice.

I recently visited the Hair Club in LA. I am considering their biomatrix procedure. I would appreciate any advice you could give me. Thank you

I did write about the Bio Matrix before, but I am still not too familiar with it, so it would be unfair for me to give you solid advice. You were kind enough to come into my Open House on February 3rd to ask me this question after you already submitted it to the BaldingBlog. It was a pleasure meeting you. Your examination showed you have Diffuse Unpatterned Alopecia (DUPA), and based on the Hair Club’s website, the Bio Matrix product appears to be interwoven with your own hair or placed on a bald head (the actual picture they used was man with frontal balding). If they actually weave it into the existing hair, I feel it may actually make you balder from traction. Be very careful with any product that could pull on your hair and deplete your current good hair supply.

Tags: hairloss, hair loss, dupa, biomatrix, bio-matrix, hairclub, hair club

Why Does Propecia Take Months to Show Benefits?

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

Doctor,

You have the best website by a mile! I have a couple of unrelated questions:

1) Why does Propecia take 8-12 months to show hair regrowth ?
2) Any comments on hair club for men’s biomatrix process (which is advertised on their website). I believe it is a hoax but wanted to confirm.

Thanks

Thank you for your compliment!

  1. It takes months 6-12 months for finasteride (Propecia) to show its effectiveness, because it is dependent on the hair growth cycle which takes about that long just to ‘switch gears’. Then hair grows at 1/2 inch per month.
  2. I believe Hair Club’s Biomatrix is a type of wig applied with a special process. Sometimes it is difficult to tell what it is that is being sold.
Tags: biomatrix, hairclub, hair club, propecia, finasteride, hairloss, hair loss

Why Do All Young Hollywood Actors Have Great Hairlines?

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

Hi!

Do you think that it is common that young and famous persons take propecia prior to any experience of hairloss?

The reason for my question is that I am so astonished that rather young people in hollywood (say between 20-40 years), all seem to have a full head of hair! I cannot even come up with almost any names of young actors with an obvious receding hairline (as they get older), except Jude Law!

If they do not use propecia, how could this kind of luck of a full head of hair even excist, when balding is such a common problem amongst “ordinary people”??

There is no difference between vulnerability of Hollywood actors to keeping hair and the normal population. If there was, I would imagine all balding men would be taking acting lessons to get the positive benefits of that profession. I think that those men blessed with good hair have better opportunities for acting than balding young men. Once they make it, they do what they need to maintain good hair. That might include wigs, transplants, or Propecia.

Tags: hairloss, hair loss, hollywood, actor, hairtransplant, hair transplant, propecia, finasteride

Female Hair Systems in the UK?

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

Dear Dr Rassman,
Your blog site is very interesting and I came upon it by chance.

I’m a customer of Farrell systems and was wondering where else I can buy as good a unit with that natural front. Can you direct me to another similar company, preferably in the UK? It seem hard to find systems as natural, am I right?

I am sorry, but I am in California and my network to wig makers in the UK does not extend to the one-on-one associations I have here. If there are any suggestions from those that are reading this, please feel free to post a comment. Thanks.

Tags: wig, hairsystem, uk

Matthew McConaughey’s Hairline… Revealed?

/by William Rassman, M.D./4 /,

I knew his hair looked too perfect for it to be real. I mean even a hair transplant wouldn’t bring back ALL your hair you had back when you were your teens. And Matt seemed to get ALL his hair back in such a short amount of time. So, it is safe to say matt is wearing a gold old hair peice. Matts hair looked to perfect for it to be his. If everybody could get hair like his through a transplants (assuming he had some work done), everybody would be getting a hair transplant and you would be on of the richest men in America. LOL. Am I correct? I am not saying transplants don’t work but I have seen people with hair transplants and they just don’t seem to cover up a whole lot. That is why so many people are probably just shaving their heads because they know you have to keep on spending a lot of money on transplants to get your so called “desired look” and even then there are still balding spots that are visible. And don’t get me started about propecia. I think it is honestly BS. E-mail me and let me know what you think. Please, post this on your web-site. The pictures at least.

Article at – PerezHilton.com

Matthew McConaugheySince this site’s first blog post on Matthew McConaughey, we seem to be taken up with all of the focus on his hairline. I am not into sensationalism, even though I have elected to share what has been sent to me. I do respect a person’s need for privacy, yet there seems to be no let-up on the probing about Mr. McConaughey’s hairline. Many women think that McConaughey is the best looking man in Hollywood and one would ask if that opinion would persist if his hairline was kept ‘au natural’. Some members of our culture do judge the book by its cover.

One of the local doctors here in the Los Angeles area let the word out that he had done McConaughey’s hair transplant. Was it because McConaughey has done such a good job at presenting the perfect hairline image? I even commented privately to my staff that the claim that this doctor did McConaughey’s ‘transplanted’ hairline could be believed because work of great quality is often done by the best hair transplant surgeons in the business.

Based upon the photographs at the link the blog reader sent, then compared to our first posting about this, there appears to be no change in McConaughey’s hairline from the mugshot taken in 1999. It would be in poor taste and a violation of the patient’s rights to even admit to performing the surgery without the express permission of the patient — not to mention that it would be outright fraudulent for any doctor to take credit for a stylist’s apparent hairpiece.

Update, Sept 29 2006: Another reader just sent this article that has apparently more recent photos of Matthew McConaughey, where his hairline can be seen (for those that are interested) — Splash News Online.

Tags: hairloss, hair loss, hair transplant, hairtransplant, hairline, mcconaughey, celebrity

High End Wigs

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

I did recently hear about a company that offered “high-end” wigs attached by some kind of inverted preasure. Do you know anything about this?

I do not know what you are referencing here. There is one company that offers ‘high end wigs’ for a starting fee of $50,000. They use small clips to attach the hair system to the hair that is still there, one by one. There is a great deal of maintenance as the hair grows, the attached artificial hair must be advanced one by one to the growing hair to make up for the growth. If you want a referral to this high end wig maker and can afford $50,000, call my office. This company has offices in Beverly Hills, New York and Paris, although I do not recommend them as a rule.

If you send me more information on the ‘inverted pressure’ attachment system, I will give you an opinion.

Tags: wig, hairpiece, hairsystem, expensive, hairloss, hair loss

Problem with Wig Leads to Heart Attack

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

Sounds like a hairpiece can be stressful, in more ways than just worrying about it falling off. Here’s an interesting case of man that felt he was wronged by a wig maker, and it ended up causing him much more emotional and physical distress than a wig is worth.


Milford man counter-sues in hairpiece lawsuit

A city man claims in a lawsuit seeking more than $15,000 in damages that he suffered a heart attack after refusing to pay for a hairpiece that was not only the wrong size but also the wrong color.

Paul Lewis filed the counter suit in Superior Court after Paula’s Wig Boutique in Orange filed a small claims action seeking $1,200 in payment for the hairpiece.

Lewis says in the lawsuit that he suffered a heart attack in December 2004 after Paula Wood, the owner of the Boston Post Road wig shop, threatened to call police because he refused to pay, court records state.

You can read the rest of the article at Connecticut Post Online.

Tags: hairpiece, hairsystem, hair system, wig, hair piece, toupee, lawsuit, legal