Hair Transplant for Patient with Diffuse Patterned Alopecia (DPA)?

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

Hi, i am almost 20 years old and have seen a few derms regarding my hair loss, it looks like a have DPA, strong hair on frontal tuft, sides and back, my thinning hair is blonde and on the remaining areas of my scalp. i am on propecia, but would like to know your opinion on what surgical advice you could give me. I know its best to wait as long as possible but when would be the appropiate time to schedule a surgery? also, do you recommend FUE for patients with DPA?
thanks so much

I would need to examine you myself and perform a miniaturization study to determine what you actual diagnosis is. I can not offer you surgical advice without understanding the diagnosis, where your hair loss is at the moment, and more about your overall history (including family history). In other words, each patient is different, so I really can’t give you a clear cut time without an exam.

As you indicated that you’re in Southern California, I invite you to call 800-NEW-HAIR to setup a free consultation in my Los Angeles office.

For those curious about DPA, I’ve written about it before:

Diffuse Patterned Alopecia (DPA) is an androgenetic alopecia characterized by diffuse thinning in the front, top, and vertex of the scalp in conjunction with a stable permanent zone. Diffuse Patterned Alopecia is usually associated with the persistence of the frontal hairline represented by the hairline position of the Norwood Class II or Class III patient.

Tags: dpa, diffuse patterned alopeca, dupa, diffuse unpatterned alopecia, hairloss, hair loss, hair transplant, hairtransplant

I’m Unhappy with the Growth of My Facial Hair

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

Dr. Rassman,

I am 25 years old, and my beard only grows on my neck and under my chin. Only a few stray hairs appear on the cheeks and face. The beard growth is of low-medium density, but with very thick hairs (the hair on my head is also thick.) I also have a moustace that grows under my nose and above the lip, but it abrputly stops and does not continue at all past the lower lip. In short, I have a beard only under my chin (not on the chin) to the base of the neck, and only above the upper lip.

What could cause this?

Different patterns of hair growth in the scalp and facial hair are usually inherited. There are some dermatological disorders that can cause patchy hair loss in those areas, such as alopecia areata, but it does not seem to be the case in the way you describe yours. If there is no one else with this pattern in your family, I’d suggest seeing a hair specialist/dermatologist to rule out other causes of hair loss. If you are diagnosed to have a genetic pattern of hair loss in those areas, you may be a candidate to restore your facial hair with hair transplantation.

Tags: alopecia areata, patchy, facial hair, hairloss, hair loss, moustache, mustache, beard

The Best Procedure for a 22 Year Old That Wants His Hairline Back?

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

hello, i am a 22 year old male who has had hairloss for about 3/4 years now, a year ago after noticing quite bad thinning i started using regaine and procerin combined, my hair thickened slightly but not much so 3 weeks ago i swapped the procerin for finpecia (generic finasteride) i now have lots of hairs in my hairline but they seem to stay the same length, realising that these medications don’t re grow hair in the receding hairline area i have been considering some form of surgery, baffled by the procedures and sites recommending certain types only i was wondering if you could tell me what the best procedure is for a young man who just wants to fill in his hairline slightly and maybe help thicken the front as well?

regards

I do not quite know what you are asking. If you are considering a hair transplant procedure, you need to see a hair transplant doctor for a good physical examination and his/her evaluation. Generally, hair transplants in a 22 year old man is approached with great caution for two key reasons —

  1. You may have further balding in the future
  2. A surgical procedure like this may accelerate the balding process

A good Master Plan must be created to account for your hair loss worst case scenario so that whatever is done today, will continue to look good as you get older. The best hair transplant procedures use follicular unit grafts by experienced teams.

Tags: hairtransplant, hair transplant, hairloss, hair loss, propecia, finasteride, procerin, finpecia, hairline

Post-Op Questions After Hair Transplant 6 Weeks Ago

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

I recently had a hair transplant (approx 6 weeks ago). The doctor cut 5 strips and transplanted into the vertex and front hairline, leaving the top of the head alone.

Since then I have noticed a lot of shedding (counting about 50-60 hairs in the shower as opposed to the typical 10 before). I realize there will be shedding after a procedure, however, I notice considerable thinning directly on the top of my head. A lot of the hairs that are shedding are long and thick.

I have 2 questions:

  1. Is it common for hair not in the donor site or the recipient site to shed so much?
  2. How much longer is this going to keep going on for?

Assuming you are male, then you may be experiencing shock loss, as it seems to relate to your recent hair transplant. Shock loss in young men often does not reverse. Were you taking finasteride (Propecia) which tends to protect against shock loss? Most importantly, I think these questions should be addressed to your doctor who performed your surgery and/or these things should have been explained to you in advance. At the very least, they should’ve been written out in your pre and post operative hand out.

Tags: hairtransplant, hair transplant, hair loss, hairloss, shock loss, doctor

Management of Progressive Balding

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

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 on. I am curious what his Norwood classification was before he had the corrective transplants. Is balding in this particular pattern common? 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, so I would not expect his pattern to advance much at all. If he was 25 years old he could lose hair behind the transplants, which may require another procedure, but taking Propecia (finasteride 1mg) may help to prevent that. 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.

Tags: hairtransplant, hair transplant, hairloss, hair loss, norwood, hairline

How Long For Grafts to Take Hold After a Hair Transplant?

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

I have a question after the procedure of a hair transplant.

How many days does it take for the bulb/graft to take and settle? So even if the scabs and hair fallout it won’t be a problem.

THANK YOU FOR YOUR TIME

Dermatologic SurgeryDr. Bernstein and I wrote an article in the February 2006 issue of Dermatologic Surgery that essentially says that when the ‘scabs’ come off, the grafts are anchored. That can take 3-14 days and is determined by the aggressiveness of your washing process. The abstract of the article is available here — Graft anchoring in hair transplantation.

In an ideal world, the grafts are relatively permanent after the first 48 hours unless you actually work them out. In the real world, I would generally say about a week (just to be safe). If you are determined enough, I am sure you can get a tweezer and pick them out, though I’m sure you are trying to avoid doing.

Tags: hairtransplant, hair transplant, graft, hairloss, hair loss

The Value of Double vs Single Follicular Unit Technique

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

I have seen on the internet, the promotion of a double FU technique. Can you explain it to me and tell me about the value of a double follicular unit technique.

Follicular units (FUs) have one, two, three or four hairs each. When they are placed in the recipient area, they are graded in the frontal hairline (FUs with one hair each up front). There are times when the doctor wants to have more two or three hair grafts and the donor area yielded too many one hair grafts (common in Asian patients). In this situation, two single hair grafts (or one single and one double hair graft) are placed into a single recipient site and that is what is referred to as a ‘double FU technique’.

A bald man may get between 250-500 single haired FUs at the leading edge to create a soft, transitional hairline zone. All other FUs should contain more than one hair each to produce value. As each person has a different distribution of single hair FUs out of a harvested strip, the number of single hair FUs are determined by the anatomy of the patient (not the surgeon). So to get more than a single hair FU to place behind the leading edge transition zone, one might have to double up the single hair FUs to get reasonable bulk. More bulk can be obtained by putting a single hair FU with a two-hair FU to create a three-hair FU so that there is a way for the surgeon to determine and control the bulk of the hair that is transplanted.

Tags: hairtransplant, hair transplant, follicular unit, graft, hairloss, hair loss, doctor

I’m Considering Laser Chest Hair Removal — But What If I Want to Use Chest Hair for BHT?

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

I’m 30 and a Norwood Class 2. My dad is almost a Norwood class 6 and I have a feeling I’m heading in that direction. I am considering laser removal of chest hair but am having second thoughts wondering if body hair transplant will someday become more successful. (I have read your postings on BHT so far and understand that the results have been limited). Do you see a more promising future for BHT? And thank you maintaing such an informative site. Glad to have fumbled upon it.

I do not endorse body hair transplantation (BHT), because it is not the standard of care in hair transplant surgery. Body hair does not grow the same length or texture as scalp hair. Furthermore, the growth cycle of body hair is much slower and different than scalp hair. The growth phase for the hairs is much shorter from body hair and the sleep (Telogen) cycle is longer. If a doctor transplanted 100 hairs, then as many as 40-60% of them will be in sleep mode reducing the total number of hairs that grow at any one time. These are some of the reasons why I do not recommend body hair transplant to my patients. I am sure that there are doctors and patients who claim benefits and success with body hair transplants, but I am not one of them. If you are a Class 2 at 30 years old, you most probably will not become a Class 6 as your father is, but if you map out your scalp for miniaturization and show miniaturized hairs in the Class 6 pattern, then you might follow your father’s class. Mapping is good for that reason, to give your reassurance one way or the other. To answer your question though, I don’t see a more promising future for BHT. The hairs on your body are different from the hairs on your scalp.

Tags: bht, body hair transplant, body hair, hairloss, hair loss, laser, removal, hair removal, chest, hairtransplant, hair transplant

I’m 18 and Want a Lower Hairline

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

I have a naturally high forehead. I want to lower it somehoe but I am only 18 and no one seems to want to deal with me. WHat can I do??

Generally hair transplants for 18 year old males are approached with caution since they have further balding and a hair transplant may accelerate the balding process. For women, hairline lowering with a hair transplant is well proven with great results, even at the age of 18, because the worry about balding (male pattern balding) is not a factor in females. You should start with a miniaturization study of your scalp to see if you have early signs of balding. After all the risks and benefits of surgery are presented to you, it may be a consideration.

Tags: hairline lowering, hair transplant, hairtransplant, hairline, hairloss, hair loss

I’m Not Hairy Enough in the Pubic Area!

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

i have a pretty fair amount of chest, stomach, and etc.. hair. but my pubic area is not very hairy. what can i do to increase the hair in that area? im 37, in good health, just so you know if it matters

Hair transplant to the pubic area is a relatively common procedure that is not well publicized. Surprisingly, many Asian women have pubic hair transplants with good results. There is no reason why men cannot have the same procedure. We are an equal opportunity surgery center.

Tags: hairtransplant, hair transplant, hairloss, hair loss, pubic, body hair

I’m 19 And Losing My Hair — Taking Finasteride and Minoxidil, But I Want Faster Results

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

Hello

I just turned 19 and am about a III on the Norwood scale. I noticed a slight receding hairline at 17 and began using Rogaine and taking saw palmetto supplements. My father was V on the Norwood scale by the time he was 28, but his balding was not as accelerated as mine at such a young age. I have been taking finasteride (5 mg dosages cut into 4 pieces) daily for about 5 months and have continued to use Rogaine foam, and my hairline continues to rapidly recede. As I am so young this is very detrimental to my self confidence and image. I was wondering if you think that I should try dutasteride, as the finasteride seems to have had no effect (my balding wasnt progressing this fast before I went on it), or maybe even consider hair transplants to fill in what I’ve lost.

It seems you are very proactive about your hair loss. As such, you need to start with seeing a good, qualified doctor for your hair loss options.

Saw palmetto is associated with improving prostate health and as such the natural supplement community now seems to link it to hair growth, because finasteride (Propecia / Propecia) is associated with prostate health. However, there is no ‘metric’ on the value of saw palmetto that would say just what does blocks DHT.

You need a miniaturization study before you start any medication so that you have a baseline measurement prior to taking any medical treatments. Photographs and general assessments may seem good enough, but you do not know what is going on at a microscopic level without a miniaturization study.

Avodart (dutasteride) is not FDA approved for treating androgenic alopecia (AGA). Just because it is said to be a stronger blocker of DHT does not mean it will be better than Propecia (finasteride). I always point out that the drug dosage is not documented, so every doctor that prescribes Avodart to treat hair loss should be wondering the correct dosage to prescribe. If/when it is finally FDA approved for treating hair loss, the decision to start this medication should not be frivolous.

Finally, hair transplantation in a 19 year old with Norwood Class 3 balding is not recommended. Give it at least a few more years to see where your hair loss pattern is evolving to before considering surgical options.

Tags: hairtransplant, hair transplant, avodart, dutasteride, finasteride, propecia, hairloss, hair loss, rogaine, minoxidil, saw palmetto

Surgery vs No Surgery

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

RassmanI just had a patient (a 26 year old with very early class 6 thinning) who really does not look bald at all. I wish I could show you his photos, but I respect his wishes to not have his images published at this time. Anyway, he went to another hair transplant clinic (one of the chain operations) and was told that he needed 1,500 grafts. He had minimal thinning and looked good to me. I discussed it with him and he wanted to know if it would be a bad decision if he decided to just do nothing. I told him that his miniaturization was in the 30-40% range and that with his hair color and texture and considering that it really did not bother him, that just Propecia (finasteride 1mg) alone could be adequate until such a time that his situation changed. I recommended no surgery at all. He was happy to get that advice and was a bit frightened at the urgency created for a surgical procedure at the other clinic. As my consultations are free, my only satisfaction was that I saved him from unnecessary surgery or even accelerated hair loss due to shock loss after a surgery.

The reason I wrote this brief post was to point out that as a doctor, my priority is whatever is in the patient’s best interest. I’m not trying to line my pockets. I’m not trying to sell unnecessary procedures. I don’t split grafts to charge the patient more money. Unfortunately, not every physician follows this same line of thinking.

Yes folks, honesty is absolutely the best policy. Please remember this when choosing your hair transplant doctor. If you feel pressured, take a step back and remember that you aren’t buying a car, you’re having a consultation about cosmetic surgery.

Tags: propecia, finasteride, hairtransplant, hair transplant, surgery

Can Shock Loss Be Permanent?

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

Hello Doctor

I have a question for shock loss after an HT procedure. You always say that healthy hair (not miniaturized hair that MPB did not so far affect and neither will in the future ) lost due to shock loss should come back after a few months ( even without the use of propecia ? ) Why do you use the word ‘should’ and not the word ‘will’? Is there a chance that shock loss could make healthy hair permanently die , and if so what is that chance ? Let’s of course exclude the case that the transplant doctor makes mistakes and accidently scars the healthy follicles.

The use of the word “should” rather than “will” is a way of predicting the future. Let’s not play language games here. Shock loss, when it occurs in men with genetic hair loss, can (not “will”) accelerate the hair loss process by a few years and this can (again, not “will”) be prevented with the use of Propecia (finasteride 1mg). Each person is different, and as such, each person reacts differently to various drugs, procedures, stresses, etc.

Tags: shock loss, shockloss, hairloss, hair loss, finasteride, propecia

I Had a Procedure with You in 1994, But Wasn’t Satisfied

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

Dear Dr. Rassman:

I don’t know whether or not you’d be interested in this message. Nevertheless, I would be interested in your reaction to it …

I was a patient (age 34 at the time) of yours in August of ’94. You transplanted about 2,000 grafts from the back of my scalp to the top of my head. My overall reaction was that the density wasn’t near enough. And there was no way I could afford a second trip through the mill.

While I thought the newly transplanted hairs themselves looked okay, I concluded that your procedure fell far short of my expectation. To be blunt, my head resembled a coconut. So I ended up going to a company that provides rather costly “hair systems” (the gentle term for wigs). They look great – full and natural. It’s an ongoing “expense” that’s become a part of my life. But I thought of you the other day.

The idea of finally just shaving my head and being done with the high cost of masking my hair loss crossed my mind again. So when I took another good look at the white scar that traverses the back of my head from ear to ear, I dropped the shaven head idea.

Maybe when head tattoos are commonplace, I’ll put one right over the scar; a picture of a “bald eagle” or something.

Your reaction to this would be appreciated.
Thank you, sir.

Thank you for contacting me. I had the opportunity to review your photographs and your medical record. Hair loss is a progressive process and it is clear that the communication between us failed. I care about my patients meeting their expectations (first being sure that these expectations are realistic) and following up with a good Master Plan to follow the hair loss over time. I did this in 1994 as well. A single hair transplant procedure of 2000 grafts may have filled in some of your thinning, but it was not enough to cover the complete hair loss pattern that probably evolved. As hair loss is a progressive process and your pictures showed that you were in the process of losing hair at the time of the transplant, clearly you were a moving target. I must have failed to explain that process to you. Drugs like Propecia (finasteride) were not around in 1994, so unfortunately, in those days, I worked with a handicap watching helplessly as people lost their valuable hair over time. As you may know by experience, hair transplants (without the protective effects of drugs like Propecia) can accelerate the hair loss and even produce shock loss, which means that the hair loss process probably accelerated.

I can suggest that you arrange a visit with me and let’s discuss your present status and your goals. There have been many advances in managing scars if that is your main focus today. Nevertheless, I do care and the best I can do is offer my advice and reconnect with you again after all of this time. My office can be reached at 800-NEW-HAIR. Please do give us a call so that my staff will be able to get your next visit arranged.

Tags: hairtransplant, hair transplant, hairloss, hair loss, nhi

Why Would Shock Loss Cause Permanent Hair Loss?

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

Why does the hair that you lose from shock loss not regrow? I asked my dermatologist about my shock loss and he said he expects that the hair will grow back and that it would be unlikely that the scalp would just stop working and stop growing hair because of the surgery.

Nobody really knows for sure. Shock loss in a man with genetic hair loss often just accelerates the hair loss process. In women, a telogen (sleep) phase occurs and the hair almost always grows back. In men, it is thought that hair lost from “shock” after a hair transplant surgery is mainly the weaker miniaturized hairs that were already predestined to fall out as part of the male pattern balding. The “shock” from the surgery would cause these hairs to fall out earlier than normal just as any stressful event (even an appendectomy). Thus Propecia (finasteride 1mg) has a protective effect on preventing some hair loss from “shock” loss in miniaturized hairs. This is the reason why younger men who are actively losing lots of hair are at an increased risk for shock loss and must use finasteride to protect themselves from the awful complication.

Tags: hairloss, hair loss, shock loss, shockloss, hair transplant, hairtransplant, propecia, finasteride