I Had Multiple Brain Surgeries and the Scarring is Causing Depression

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


I’m 26 I had 3 brain surgeries 5 years ago and have a large scar the shape of a horse shoe on the left side of my head. this is causing severe depression. I’d like to know who can I see and what I can do to cover this scar. my hair is no longer thick enough to cover the bald spot and I simply can’t wear a hat all the time. I’m looking for information on doctors in the boca raton area or near palm beach that can help.

thank you so much. this is my prayer to look normal again.

Scars from brain surgeries, as you describe, can be addressed with a hair transplant surgery or with Scalp MicroPigmentation (SMP). Treating brain surgery scars take some experience, as hair that is transplanted into the scar tissue may not fully grow. Be sure that the doctor you see has experience with transplanting into scars.

I would recommend that you not limit yourself to just your immediate area. See as many doctors as possible to get a good idea about what is possible and what the expectations should be. There are many hair transplant surgeons in Florida, and you can find doctors in your area by using the physician search at ISHRS.org. Just be sure to do your research and meet with doctors to form your own opinion on who has the best results.

Tags: brain surgery, scarring, hairloss, hair loss

Why Do Doctors Think PRP is Helpful?

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

Dear Dr. Rassman

I hope you can help explain something to me regarding the treatment of hair loss with PRP. I was considering have a treatment of PRP + Acell but then read that one of the growth factors in PRP is TGF-B1 which has been claimed to be something that actually causes hair follicle death. Could you please explain to me how this growth factor supposedly helps when introduced to the scalp in PRP treatments? Is it somehow changed? or do the doctors using PRP not see it as harmful?

Thank you in advance for you answer and insight.

Regards

The use of platelet-rich plasma therapy (PRP) is a good way for a doctor to make money and probably not harm his patient. It’s the buzz du jour and is an excuse for some doctors to sell something extra. I’ve yet to see any satisfactory study that shows using PRP in a hair transplant has any value.

The NY Times wrote about PRP earlier this year — Does Platelet-Rich Plasma Therapy Really Work?.

Tags: prp, platelet rich plasma, hair transplant, hairloss, hair loss

DUPA and BHT

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

hello mr Rassman long time reader here, you doing a great job here i must add. my question today is regarding my Diffuse Unpatterned Alopecia (DUPA). i’ve had dupa since the age of 17 im now 24 and i still have a decent amount of coverage.

i was thinking about a possible body hair transplant in the future and was wondering if hairs in the beard, pubic area and chest are viable as im looking for the fullest coverage. i for one don’t care about growing this hair out i would plan on keeping it very short shaved. as i am still 24 and still going through changes in terms of body hair i want to wait till im in my 30’s so i have more hair to harvest

what do you think of my chances in terms of having a transplant like this? would i need to take meds after this to maintain the new hair? is the hair permanent? thank you for your time

Body hair may or may not be permanent. I have never done a complete body hair transplant for a DUPA patient so I can not talk with experience under my belt. I suspect you can find someone willing to experiment on you to achieve the goal you defined above, but it would not be my recommendation.

Tags: bht, body hair transplant, dupa, diffuse unpatterned alopecia, hairloss, hair loss

Prosthetic Follicles?

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

Do you have any knowledge or opinion about prosthetic follicles? I was imagining a tiny hypo- or non-allergenic device of plastic, silicone, etc that could even eject broken hairs and be reloaded. If they can replace heart valves and if they can make silicon wafers with microscopic transistors, artificial follicles hardly seems unfeasible. I googled my idea and actually found something:

A hair prosthesis consisting of allogeneic hair and polypropylene mimicking follicular units: long-term result and histocompatibility in rabbits

This sounds wonderful for balding or bald rabbits. There’s still a lot that needs to be done before it is shown to be safe for humans.

There is reasonable experience in artificial hairs and the history is not pretty, with infections that really mess up the scalp. I have personally seen the results of artificial hair over the years and have removed them in patients I’ve seen, but the problems never seem to clear. They look good when they are initially done, but hopefully people will live long enough to regret the decision to do this.

Tags: hair loss, hairloss, allogeneic, artificial hair, prosthetic hair

BHT for African Americans

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

Dr. Rassman,

In many of your posts regarding body hair transplant, I see that you tend to discourage the use of body hair for transplants. Some of the reasons include the fact that body hair is curly and does not grow long enough. I am a black person who grows a short Afro. I have a bald spot of the right front side of my scalp which I have managed to concealed with my own pubic hair. It just so happens that my pubic hair is just as curly and has the same texture as my scalp hair. So what I do from time to time, is cut my public hair, wash it thoroughly and then get it entangled with my scalp hair in the balding area. The entangling is due to the curliness of the hair and it holds even in the wind.

So far no one seems to notice. In fact, when I first saw a hair loss doctor, he was amazed at how well I concealed my hair loss.

In any case, I think transplanting hair from the pubic area for African Americans may be a viable option since both the pubic and scalp hair in African Americans is curly and perhaps has the same texture in most African American(as is my case). In any, what is your take on this issue.

I have done a few pubic hair to scalp transplants and they work very well. I recall one African American fellow in particular and a few Caucasian patients that had this done over the past many years. The FUE technique may have a good role here.

I have also seen another person who used pubic hair to entangle with their afro to add bulk with the same observations you demonstrate. It’s certainly not for everybody, and I still say scalp hair works best.

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

Face Transplant Patient Also Got a New Hairline

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

This is the article about the face transplant patient: Face transplant patient ready to go home

From the pictures in the article, the picture on the left shows his mid-scalp area has no hair at all due to his injury, and the after picture shows him with ample amount of hair in the mid-scalp area. The article points out, ‘even the hair on Wiens’ head, from the mid-scalp area, is part of the donor skin (the hair on the back of Wiens’ head is his own).’

Is there a possibility scalp transplants will be available in the near future?

Dallas WiensI’ve received more than a few emails about this case where people have excitedly pointed out that this patient also received hair. Yes, full face transplants are possible thanks in part to some amazing surgeons, and yes, it’s possible to have part of the donor scalp and hair survive during this type of procedure. But surgery like this not practical or safe for someone that just has genetic hair loss and wants a head of full head of hair from a donor.

The key issue preventing person-to-person hair (and scalp) transplants is with the anti-rejection medication he must take. For the face transplant patient the risk is worth the reward, but for someone that wants to have hair harvested from someone else, the side effect risks from these immunosuppressive drugs are quite serious. The risks include massive infections and even cancer.

However, let’s look at this from a realistic point of view. Who would even volunteer for a scalp transplant just to treat genetic balding? Keep in mind that the scalp has to come from someone… and that someone is likely a cadaver.

Tags: face transplant, scalp transplant, surgery

Transplanting Pubic Hair to the Scalp

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

If pubic hair is transplanted on the scalp will it grow due to the fact the nourishment and exposure will become different. Does apocrine gland still remain active when transplanted on head? A doctor in Delhi does carry out such procedure FUE technique and is affordable. However I still want to have all the facts..If any one has done then it will be good?

If pubic hair were transplanted to the head, it would grow and be very curly. I actually performed a pubic hair transplant to a patient. The pubic hair was mixed in with scalp hair and placed into the crown in a person who had a very limited donor area. It worked well. I have also done beard hair to the scalp that has worked well, particularly when mixed with regular scalp donor hair. These are rare and special circumstances, though. Many doctors are transplanting body hair from the abdomen, chest, and back with mixed results.

But while these procedures are technically possible, surgery on your body should NOT be driven by costs. If there is good donor hair from the scalp that is available (as it most probably is), this should be the first source… not the pubic area. The hair that is transplanted will usually retain its original characteristics so pubic hair on the scalp will be very curly, underarm hair will bring with it an odor from the accompanying apocrine glands, and body hair will usually be characteristically fine and not grow out to be very long. One of your goals should be to have the results look as natural as possible, and body hair transplants (BHT) make that difficult.

Remember, any decision you make will be with you for the rest of your life, so be careful what you choose.

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

Transplanting the Follicle’s Dermal Sheath Cells?

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

Hi Dr. Rassman, In a recent article i found that it is actually possible to transplant the follicle’s dermal sheath cells from one person to another which can lead to new hair growth.

To view the full article please check the below link and let me know you thoughts about this: ScienceNetLinks

Thanks!! appreciate the work you are doing!!

We know that the body will reject hair transplanted from one person to another, but the very reputable Dr. Angela Christiano is quoted in this article and her experimental technique shows feasibility (I did not verify her work for this review).

So to answer your question, in research this is possible, but real world applications aren’t quite there. It’s early experimentation with the bigger picture being focused on generating joint cartilage for arthritis patients.

Tags: dermal sheath, hairloss, hair loss

In the News – Fake Cosmetic Surgeons Kill Woman in Nevada

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

Snippet from the non-hair-loss-related article:

The death of Elena Caro, which police say came at the hands of Colombians who flew into Southern Nevada posing as medical practitioners, has left Las Vegas plastic surgeon Dr. Julio Garcia wondering who set her up for what turned out to be a fatal buttocks enhancement.

“Who is marketing Las Vegans to these people?” he said. “You know they didn’t come all the way here if they weren’t assured patients. And they’re sure not advertising any normal way. I feel whoever is telling people they can get cheap plastic surgery from these people is as guilty as the guy who did it. They’re taking advantage of people in their community. More has to be done to fight this medical fraud.”

At a news conference Monday, Homicide Lt. Lew Roberts said Caro’s death was not an isolated case of a “makeshift doctor” illegally treating patients, although this was the first fatality he could recall.

Read the full story — Backroom surgery death raises questions about ‘makeshift’ doctors

This is an unfortunate result that could’ve been avoided. Safety was ignored in favor of a low cost, but the ultimate price was paid.

The article even mentions other ways in which people have been horribly scarred by surgeries done by fake doctors, including butt enhancement by using floor wax and industrial strength silicone injections.

Tags: death, cosmetic surgery, plastic surgery

Scalp Lacerations – Follow-Up

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

This is a follow-up to our post from earlier this month: Scalp Lacerations Required Staples — Will Hair Regrow There?

Thank you for responding so concisely to my query regarding hair regrowth surrounding a scalp laceration closed with staples.

The orientation of the wounds seems to be almost perfectly aligned with the Langer lines (the wounds are located upon the occipital protuberance and are titled stightly from being perfectly horizontal). From your commentary, I find this encouraging.

Also, to remove the guess work of assumption, the wounds were stapled about 1 hour after initial injury, the wounds were created by the fist of a criminal assailant, and no infection has henceforth appeared. I even went so far as to have the staples removed by a plastic surgeon so as to avoid further damage caused by clumsiness.

I gather, from your comment, excision is contra-recommended. How many follicular hair units am I looking at to fill the described area via hair transplant if there is not satisfactory hair regrowth?

The size of the wound and the character of your hair will dictate the number of grafts. If the infrastructure of the skin is intact, one session should be adequate, but if there is no infrastructure (can feel the skull) then sometimes two smaller sessions are needed.

There is no substitute for a direct examination, which then relies on the judgment of the surgeon and his/her experience.

Tags: scalp surgery, injury, laceration

Could My Scalp Reductions Be Preventing Transplanted Hair From Growing?

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


I’ve previously had scalp reductions and a flap hairline performed in the early 1990’s.

I recently in Feb 2010 had a 2000 hair (not graft) procedure performed by the same doctor who was responsible for the scalp reductions and flap hairline in the 90’s to address the lack of hair behind the flap which looked strange. It is now 12 months since the procedure and it appears only half of my hair in the triangular area behind the flap has grown, it is very patchy and is more scalp than hair. Could the fact that the previous scarring from the scalp reduction and flap hairline be causing this skin zone to not grow transplanted hair properly?

The funny thing is that several of the hairs transplanted into the actual scars have grown quite well and show thick well developed hair shafts. But as mentioned before the triangular shape of bald scalp behind the flap is completely surrounded (an island of forelock scalp) by scarring from the old surgery. Could this zone be of limited blood supply due to these scars or does the scalp still get enough blood supply anyway? Also could 12 months be too soon for me? The island of scalp behind the flap hairline has sensation although somewhat reduced sensation but the skin goes white than straight back to pink when pressed. I have compared my post op photos with my current photos and it appears that only half of the hair has grown. I can email a couple of photos if you wish, I have not been back to the doctor since my 1 week post op check up (for personal reasons). it was about 1000 grafts I think. I will get back to him when I feel ok about it, thanks

Prior scalp reductions are not a reason why a hair transplant surgery would not work. Many patients that had scalp reductions in the 1980s and early 90s followed them up with hair transplantation with relative success (growth was fine, but they were the pluggy look from back then).

I think the best thing for you is to follow up with your doctor when you are ready. Maybe you took pre-operative photos, but your doctor should have one (or more) as well and it may be useful to compare what you have now and what you had then. There are many factors that can be the cause of a hair transplant failure and that is why you need to see your doctor for a better understanding.

Tags: scalp reduction, hair transplant, hairloss, hair loss

Sedation and Hair Transplant Surgery

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

Dr. Rassman,
I enjoy your blog! One questions I had was if any hair transplant surgeons use level 2 sedation? I recently found a blog where a surgeon uses level 2 sedation instead of injection. What are the differences or risks for each one? Is one more preferred than the other?

Regards

Nitrous oxideLevel 2 sedation scale is considered: “cooperative, tranquil, and oriented” according to the Ramsay scale. To some this can be achieved with no drugs. To some this can mean a shot of Vodka. In the doctors office this can be a shot of a sedative or a pill (like Xanax). It can also be breathing in laughing gas.

Level 2 sedation is not anesthesia.

At NHI we have evolved our sedation and anesthesia routine. We offer nitrous oxide (laughing gas) for sedation. In addition we also offer a single shot for sedation or a Xanax pill to take by mouth. Some patients choose all of the above and have a great Level 2 sedation experience. The laughing gas has the most immediate on/off response, followed by the injection. Finally the oral Xanax takes the longest for a patient to reach the Level 2 sedation.

We do monitor the breathing, oxygenation status, and cardiac status during the procedure, and if the breathing slows down, an alarm goes off. Level 2 sedation can quickly turn disastrous if the physician or the clinic is not prepared to handle the consequences of the medications.

To achieve Level 2 sedation your surgeon should be certified in ACLS (Advanced Cardiac Life Support) and the facility should be equipped to handle emergencies. Luckily Dr Pak is also Board Certified in Emergency Medicine so we are well prepared for any medical emergencies.

For Level 2 sedation we also take an additional voluntary step to be accredited by the AAAHC (Accreditation Association for Ambulatory Heath Care) as an out patient surgery center. Very few hair transplant clinics have this AAAHC rating (something to ask about when doing your research).

So that’s what we do. I can not comment on other doctor’s drugs and uses.

Tags: surgery, sedation, hair transplant, hairloss, hair loss, sedative, surgical techniques

Male Eyebrow Transplants (with Photos)

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

Hello Doctors
I am a 39 year old man and had a problem with my eyebrows since I was probably in my 20s. My eyebrows aren’t very thick. I never plucked them and do not know why they appear thin around the edges or when it exactly happened ,but I wanted to talk to you about what a transplant looks like in that area for men. My hair is otherwise great on the scalp and I have a strong hairline. Have you done any man eyebrow transplants? Thanks

Here’s a male patient we haven’t shown before, with some beautiful eyebrow transplant results. I placed 189 grafts into his eyebrows with almost all single hair grafts taken from the scalp using follicular unit extraction (FUE).

In general, eyebrows are difficult to get control of the direction of the hair as it exits the skin, but these results turned out great! The after photo was taken about 7 months following his hair transplant.

Before photo on left // After photo on right. Click to enlarge.

 

Tags: eyebrow transplant, hair transplant, fue, eyebrows, thinning eyebrows

Hair Loss After Mammaplasty

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

I had a reduction mammaplasty under general anaesthesia for 6 hours in early June. In early October, my hair suddenly started to fall out more at first and only got worse till now (24th December). Could this be TE? How long is this expected to last?

I am aware that some patients report diffuse hair loss after a major surgery. If it is telogen effluvium, then it may take 6 to 12 months to recover. However, I have often noticed that many patients do not fully recover (or regrow) all of their hair. It is my general advice that one gets a good physical examination by their physician to rule out other causes of hair loss as well.

I realize you (like many others) are looking for answers on the Internet, but I doubt you will find it… even here on BaldingBlog. This may be a good place to start, but as you explore the web you will be lost and confused, possibly ending up in a well-designed website promising you a cure for just three easy payments of only $19.95 (as an example). As I stated many times, seek out your medical issues with your doctor, one on one.

Tags: mammaplasty, hairloss, hair loss, telogen effluvium

Removing Brain Surgery Scars?

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

Hey. I’ve had brain surgery back in 2000 and an additional one in 2004. I have a scar on the front of my scalp going from my right side of my head to the top of my forehead. Its not from left to right but almost there. And I have some kind of missing spot on the back of my head. I dont know where that came from. But I was wondering if u had any suggestions on getting hair to grow inside my scars so I have no noticible scars?

We (NHI) have been treating scars of all types on the scalp with hair transplants (especially brains surgery / craniotomy scars). The process is as simple as a hair transplant on the scar itself.

The entire process may take more than one procedure to fill in the scar, as hairs are transplanted directly on the scar and may not fully grow. Whether or not the scarring remains noticeable will remain to be seen. I wouldn’t want to make any wild promises without seeing you.

Tags: brain surgery, scarring, hair transplant