If You Trash Your Competitors, You Will Get Dirt on Your Shirt

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

I read with disgust your piece the other day (Doctors, Crooks, or Con Men — How Do You Tell the Difference?) which attacked doctors in such a way that your readers will get an unfair view of the doctors who do good hair transplants and are honest and caring. There are many doctors with high integrity who try to get the best for their patients. Why don’t you promote them and talk about the wonderful things that we can do today, rather than dwell on the few rotton apples out there?

From time to time, I just get overwhelmed by some issue and my frustration is shared with all of you. This is my blog, which is like a personal journal that I share with all of my readers. Sure, I answer hair loss questions that are written to me, but from time to time I also treat it as a place to express my thoughts and even vent my anger in hopefully some constructive way. The piece from the other day was clearly precipitated by one particular patient, but unfortunately, it was not such an unusual occurrence for me to see this problem come up. Of the four doctors who gave him opinions, two of them actually do good quality hair transplants that I have seen in my office, but the decisions they made when meeting this poor man were not necessarily driven by his agenda nor his welfare. I know, unfortunately, that many of the doctors in the hair transplant industry spend huge amounts of money promoting their hair transplant expertise. A 2 x 3.5 inch ad in the Los Angeles Times, for example, costs between $1300-2700 for each day it is run (depending on the day of the week and length of the contract), so when ads are run daily, the costs become staggering and the doctor is as much driven by his/her ability to support his ad budget and his staff salaries, as by his/her desire to be honorable and righteous. Does one agenda conflict with the other? I believe that they, unfortunately, do conflict.

To handle a high number of people responding to these ads, these doctors hire salesmen (often disguised as someone with medical expertise) who become physician extenders, often screening callers to find out who has enough money to afford a hair transplant. Salesmen earn commissions, and although commissions are illegal in California, the commissions in some form still are what drives the sales process. Every potential candidate is screened for his ability to pay the large fees, just as the prospective patient was quoted the other day. That patient had the money so I think that the blood hounds sensed it so the price incentives that were offered by one doctor had some sense of urgency to it. The process I just defined is sleazy and it is something that I have written about, much to my detriment in this heavily market-and-sales driven process. Unfortunately, this is not just a California problem, it is an industry-wide cosmetic surgery problem and some doctors from around the world fit well into the amoral mold I have defined here. But there are many good doctors out there as well, so shopping before you buy a hair transplant will probably lead you to a better choice than taking the first doctor you meet. Watch out for sales tactics that look like a used-car sales lot. Do not accept seeing anyone but the doctor who is going to do the work and never, ever accept anything that you are told unless the person is qualified to give you an opinion and can back up what the doctor tells you.

The doctor who wrote the above comment to me today does bring up some very important things. The surgery we can do today is almost miraculous and 6 of my family members who’ve had hair transplants think that I am God-like for how natural the work looks. I think that too many people have expectations of the deforming, pluggy, doll-look with corn rows, so it is a difficult road for today’s doctors to educate the public on today’s high quality reality. A hair transplant was not only good enough for my immediate family, but I also had it done. As I’ve shared before, I have performed surgery on the politicians, billionaires, CEOs of big businesses, celebrities, the Royalty of countries that my readers have read about, and a few probable mafia members from other countries who would not have allowed me to live had it not worked out and met their expectations. I am not the only doctor who can do this type of quality hair transplant, so please forgive me for yesterday’s and today’s diatribe. To complete my answer to the doctor who posed the comment to me, I must remind the doctors who are reading this blog that we have taken an oath to uphold our patients’ interests about our own. If our oath is not enough, most governments that license doctors require doctors to report any infraction in ethical behavior that we observe as a condition of licensure, something that even I do not adhere to, to the spirit and the letter of the law.

I remember in 1994, I spoke before hundreds of doctors attacking those whose ethics reflect the worst of the sleaze in the business. I openly called them ‘sleazy crooks’. I also remember that the audience stood up and applauded my comments because the large majority of doctors were also disgusted with those who dragged down this struggling new industry, making it particularly hard to break the monopoly that had been horded by a select few marketers. I felt good about my comments because I sensed that many of the doctors in the audience fully supported the victimized men we were focused upon helping. After many private congratulations in the hallway over my vocal position, one well known doctor waited on the sidelines. As the crowd that surrounded me thinned and dispersed, that well known doctor came over to me and said, “I did not like the way you talked about me.” He stomped off and I thought for a moment, remembering that I never named a name and the closest I came to identifying anyone was the label “ sleazy crook,” which seemed to have struck a sensitive cord with him. I think I remember saying, “If the shoe fits, its yours,” but I think that he walked away from me too fast to have heard my retort.

I hope that the doctor who posed his query to me here reflects those who supported my position in 1994 and would support this long winded commentary by me as well.

Tags: hair transplant, doctor, hairloss, hair loss, hair restoration

Trichoscan for Measuring Density?

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

Dear Dr. I am 29 year old Indian. I want to measure my hair density before undergoing hair transplantation. My doctor has trichoscan with him. I want to know if it is as accurate as your densitometer. Please reply.

Probably yes, assuming that he can see the individual hairs. Ask him to show you the miniaturization so you will know as much as your doctor knows.

Tags: trichoscan, density, hairloss, hair loss, miniaturization

Doctors, Crooks, or Con Men — How Do You Tell the Difference?

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

I just met a patient who, while doing comparative shopping, came to me as the fifth doctor on his shopping list. He was 46 years old and had some thinning in his crown. He lost the first inch of his hairline, but his hairline did not bother him and therefore was not his focus. He was fine with where the frontal hairline was. He was able to see through the crown for the first time in years. Below, is the spirit of what he told me his experiences were, I simulated quotes of a conversation to demonstrate what he described to me —

Doctor #1:
“You are going bald in the crown”, he was told. He was quoted a surgery cost of $12,000 for 1400 grafts.
“Will I lose any hair from the transplant?”, he asked.
“It happens sometimes,” the doctor answered, “but if it does happen, it will grow back”

Doctor #2:
“I can fix it with 800 grafts for $3,000 and if you do that now, I will throw in another 100 free grafts”.

Doctor #3:
The man had researched this doctor and found that there were reputation problems evident through industry-specific bulletin boards and in internet reference sites. He felt that the visit to this doctor reeked of sleaziness.

Doctor #4:
On the visit, he met a patient in the crowded lobby. The patient (who already had surgery) warned him to stay away for his own good. When he visited the doctor, he was told that for $12,000, he could get 2000 grafts into the crown and it would make his crown appear full.

Dr. Rassman (Doctor #5):
I mapped out his scalp for miniaturization and found that less than 50% of the crown hair was miniaturized (no other doctor did this). The frontal area had 80% miniaturization just behind the balding area, suggesting that his hair loss will continue in the frontal area. I told him that with only 50% miniaturization in the crown, a drug treatment would be the best approach, not surgery. When the hair is 50% miniaturized, there is usually reasonably good cover and surgery runs the risk of causing irreversible hair loss (which usually does not grow back in men). If this happened, it could make his crown more see through than it was now. I recommended against any surgery.

I was personally frustrated with my colleagues in the hair transplant field, particularly for what appeared to be a lack of moral fiber in managing this man’s problem. I have always believed that doctors should put their own welfare behind the patient’s welfare. What the above cases clearly showed me was that the first four doctors were behaving like used car salesmen, selling this man the car driven by that little old school teacher who never abused it. I have no difficulty condemning the opinions of these other doctors and their behavior. Every one of the four wanted to take this man’s money and preyed upon his vanity.

Of interest, when he first started talking with me, he was at first baffled by the wide discrepancies between the recommendations and the pricing, but after receiving my explanation of the miniaturization assessment (something that none of the other doctors did on his examination), his confusion cleared up. His initial question to me was why was there such a wide descrepency between the estimates of work and price. That was not his focus after the consultation with me. In his case, good comparative shopping saved him from being victimized by doctors who behave like crooks and con men. They are still out there.

Again and again, I warn people, ‘Let the Buyer Beware!’

Tags: hairloss, hair loss, doctor, hair transplant, hair restoration

Of Mice and Men

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

Here is an article which shows how well we seem to be doing in solving the mouse hair and fur problem. The bigger picture for my readers to understand is that the mouse model does not translate into human replicas. What applies to mice today, does not seem to apply to men. But, it is potentially a step in the right direction…

Tags: hair growth, mice, mouse, science, baldness, fur

Average British Woman Spends Big Money On Her Hair

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

The following is a note sent from a patient of mine who reads BaldingBlog from time to time.

I hope things are well with you! I happened to see the following article today, that was linked up on the Drudge Report, and I thought perhaps you might want to share it with your “Baldingblog.com” readers:

“The average British woman spends an astonishing £36,903.75 on her hair in a lifetime, according to new research. She will spend the equivalent of just under two YEARS of her life washing, styling, cutting, colouring, crimping and straightening her locks in salons or at home.”

Wow, that’s over $70,000 US! I wonder what the statistics are for men (hair transplants excluded). I also wonder how this may differ from the average US woman. Any thoughts by my readers?

Tags: hair, women, female, woman, british, uk, united kingdom, london

Miniaturization and Hair Loss – More Than Meets the Eye

/by William Rassman, M.D./14 /,

Here’s essentially a summary of what I’ve written in the past about miniaturization. This is just about as to-the-point as I can get with what the miniaturization mapping is and why it is important. For more in-depth text on miniaturization and mapping, please see: Miniaturization: Critical to the Master Plan for Hair Loss.

—

Miniaturization is part of the balding process where hair shafts become thinner over time before falling out. Thickness and the general health of hair can be measured by examining it under a special microscope, called a densitometer, for signs of miniaturization. Increased miniaturization in certain patterns, reflect a progression of balding. In addition, miniaturization and detectable hair loss is not evident to the naked eye until more than 50% of normal (non-miniaturized) hair is lost. As a result, many men/women do not seek help until significant miniaturization has already taken place.

At New Hair Institute, we feel that mapping the scalp hair for miniaturization is critical in establishing the guidelines for the treatment of hair loss. Mapping measures the miniaturization and density on different areas on the scalp, providing us with a ‘roadmap of data’ to quantifiably measure the current health of the hair. When a medical treatment (such as finasteride or Propecia) is started we can document its effectiveness with the initial and periodic measurements for miniaturization.

The responsiveness of each patient with drug treatment is different, so each patient must be diligent in acquiring follow up measurements to the degree of miniaturization and the location of the miniaturization by scalp area. Without quantifiable measurements for hair loss, there is no clinical science in the treatment, just hocus-pocus and blustering, a problem that is far too prevalent today.

If you are balding, you should have your scalp hair mapped for miniaturization to (1) estimate the pattern of hair loss now and for future loss, and (2) measure the starting point for miniaturization so that changes measured over time, can be followed. These measurements are very fast and easy. It is today’s Standard of Care that should be available to every balding patient wanting a Master Plan, for treatments appropriate to their future hair loss.

Miniaturization

 

by Jae P. Pak, M.D., William R. Rassman, M.D.

Tags: hairloss, hair loss, miniaturization, hair mapping

Prostate Cancer Risks and Male Pattern Balding

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

Is my risk of prostate cancer higher because I am balding?

Men with Male Pattern Balding (MPB) have a consistently higher incidence of prostate cancer compared with those without MPB.

In summary, we found a significantly increased risk for prostate cancer among men with MPB, independent of established risk factors including aging and race. Although remote from the prostate, MPB may represent an early, clinically obvious marker of susceptibility and may provide clues to the pathogenesis of prostate cancer.

(source: Male Pattern Baldness and Clinical Prostate Cancer in the Epidemiologic Follow-Up of the First National Health and Nutrition Examination Survey)

When finasteride is used, “cancer prevention should be recognized as an additional benefit of treatment“. When compared with alternative treatments, “chemoprevention may also provide an excellent strategy for diminishing treatment-related costs and adverse effects such as erectile and urinary dysfunction“.

(source: Should finasteride be used to prevent prostate cancer?)

Tags: hairloss, hair loss, prevention, finasteride, cancer, prostate

Head Swelling

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

I have had some surgery (face lift and hair transplants) and my face gets swollen from time to time. When it was swollen last, I went to my plastic surgeon who said that he did not see any swelling, but I know it is swollen because my hat is too tight when the swelling is there. Can you help me?

I suspect that you may be seeing a very subtle type of swelling. This is a condition more often seen in the legs or arms, called lymphedema. If it is very subtle and does not produce symptoms, leave it alone. If it is in the legs, then compression stockings may help. For leg swelling, you must worry about heart disease and dependent edema from right sided heart failure. This is not the case with lymphedema of the face or scalp.

Massage works and it feels good. Compression at night with a compression bandage will reduce the scalp component of it. Lymphedema can be a result of surgical or cancer therapy, and irradiation. It can also reflect tumors and metastases of tumors. I have seen patients present with lymphedema of the face and scalp as the first sign of tumors that invade the lymphatics of the neck, where head and neck tumors tend to migrate or even in Hodgkin’s disease (which are a type of lymphoma/cancer). If there are no cancers in consideration (you are not a smoker and have never been one, do not chew tobacco and never done that, have any other symptoms around the face, nose or neck, and no swelling in the nect and it is not bothering you) you might just wait it out. I am slightly concerned because you said you had a face lift and that would imply that you may be over 50, when these types of cancers are more common. Certainly, get yourself cleared by a good doctor because cancers of the head, neck and problems in the lymphatics of the abdomen sometimes present the way you are telling this to me.

Tags: surgery, lymphedema, facelift, hair transplant, swelling, cancer, compression

How Long Should My Hair Be For Miniaturization Mapping?

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

I shave my head because I’m going bald. I want to get a consultation but I should probably let my hair grow out a little so you can do the miniaturization map right? How long should I go without shaving my head? 2-3 weeks?

A couple of weeks of growth will work. I like to have about 1/4 inch of hair length to make the measurements.

Tags: hairloss, hair loss, miniaturization

Should I Get Another Opinion?

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

I found a great hair restoration Doctor, who has been in the business for over fourty years! I was just wondering if I should get a second or third opinion from other doctors in the area, or is it not needed since I really like this surgeon?

If you found a good doctor and:

  1. like him/her
  2. researched his/her patient results
  3. researched his/her techniques
  4. he/she uses follicular unit transplantation

…then stick with that doctor.

Tags: hair transplant, hair restoration, doctor

Loss of Neck Hair

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

This man has a not-uncommon finding that shows the difference between scalp hair and neck hair. I always tell my patients that neck hair is not permanent, and even at 30 years old, this person’s neck hair is already disappearing. Too many surgeons use neck hair for a hair transplant with the idea that it is finer hair and makes for a better frontal hairline. But as you can see from the picture below, had neck hair been used for the front of his transplant, it would be falling out already. Even worse, neck incisions tend to produce wide scars. If this patient had recieved a hair transplant using his neck hair, he would have been deformed and would probably regret that he ever had done anything to begin with.

The key to good transplants is that every transplant stands on its own, and that no transplant can be seen as a person ages, loses more hair, or changes his hair style restricting his freedom. Please click the photo below to enlarge.


Is Miniaturization Mapping Like a Scalp Biopsy?

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

Hello, Dr. Rassman…

Thank you fot the informative blog! I know you keep referring to “getting your hair mapped for miniaturization”. What is involved in this? Is it like a scalp biopsy? Also…what is the typical cost for this procedure? I am male, 37 years old, and i am noticing a lot of hairs in the drain, and a some recession in the temples. I plan on being in L.A. in September, can I come to your office to get “mapped”? Thanks.

I will be happy to see you in September — just call or email to setup an appointment. Mapping of the scalp does not require any surgery and is nothing like a biopsy. What we do is take photographs of the hair at the hair level, then count those hairs in the field of view that are miniaturized, compared to those that are normal. Each part of the head can be mapped accordingly. Miniaturization mapping is free, and is part of the consultation process.

Tags: hairloss, hair loss, biopsy, miniaturization, mapping