Ingrown Hair or Abscess?

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

I had an emergency c-section almost 9yrs ago.. prior to.. another c-section 7yrs ago thru the same vertical scar that never healed right..its very wide towards the bottom. my question is, i shave down there and ive noticed 2 ingrown hairs that have grown thru the bottom of my scar. They honestly have been there for about 6months.. because i didnt know what to do about them. But now, one is very badly infected and is swollen. so much infact, that my scar is looking more wide. its very sore and im scared and dont know what to do about it. how can i ease the pain and maybe help the swelling to go down so i can get a doctor to pull the hairs at my next appointment (aug 1st). thank you for your time.

You need to see a doctor. I do not know how bad your “ingrown” hair looks like, but you may have an abscess or a wider scale infection developing. Of couse, these are the worst case senarios. I would call your doctor to move up the appointment or visit a walk in clinic.

Tags: infection, hair, ingrown hair

The American Board of Hair Restoration Surgery

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

Dr. Rassman
Firstly let me tell you how much I have enjoyed your blog comments for the many young men and women suffering from hairloss. I am a 33 yr old male, who is scheduled for hair transplant surgery in a month. I have learned from your comments and want to ask you some questions. I have hair loss in the frontal/tempural area with thinning in the crown area. The thinning has improved since I started taking Propecia last year, no side effects thank God.

  1. Is 33 a good age?
  2. My doctor is Dr. [name removed] and he is a Diplomate of the American Board of Hair Restoration Surgery. Can you give me an opinion on this qualifications?
  3. I was concerned with scars, and felt comfortable since he is also a Plastic Surgeon, is my assumption correct?
  4. I am also concerned with shock fall. Is it permanent? How much help does Propecia offer?
  5. My doctor has not done a miniturization study on my scalp, that concerns me, although he did examine me the first time and I am scheduled for anohter consult. Should I request this?
  6. I also use Nizoral shampoo, and it seems to help, what have you heard about the benefits of this product if any?

Lastly, coming from a father that is a Vascular Surgeon, I know that confidence in the physician is important. I just did not get a second opinion, and have been trying to educate myself as much as possible. I feal my chances are pretty good, I hope to get strong results. I thank you again for your comments and help you offer on-line…..with the high pace life physicians lead its unlikely. I commend you for that.

Your father is correct in stating that confidence in your physician is very important. That being said, BaldingBlog is not a place for a medical second opinion. You should either address these issues with doctor or formally make an appointment with another hair transplant surgeon for the second opinion.

Credentials are important and being a member of the American Board of Hair Restoration Surgery may make it more probable that he is a good doctor. I am familiar with doctors with such credentials who I would not have as a surgeon, though. I, for example, have refused to become a member of the American Board of Hair Restoration Surgery because there is no formalized training for the accepted doctors and no peer review for what they do. When I received my credentials for General Surgery, I had completed 5 years of formalized, supervised training before I was allowed to take a series of written and oral examinations. The American Board of Hair Restoration Surgery credential only requires that the surgeon does 100 surgeries (without any supervision) and pass a written (very easy) examination. That does not make them qualified in my eyes. Now with that said, many of the doctors who have received the American Board of Hair Restoration Surgery credentials are good doctors and quite competent, while some are not. It continues to be a buyer beware situation for the hair transplant buyer (see: The Truth About Cheap Hair Transplants).

I have addressed shock hair loss before. Propecia in a balding male will reduce the risks of shock hair loss. If Nizoral shampoo is working for you, then use it. I feel strongly on the mapping out of the scalp for miniaturization. I do not like doing things blindly, because then I really could not lay out a good Master Plan.

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

Stem Cells in Hair Identified

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

Reprinted from UPI:

Scalp tissue might become stem cell source

PHILADELPHIA, July 12 (UPI) — U.S. researchers have isolated a new source of adult stem cells in scalp tissue that might be able to differentiate into several cell types.

University of Pennsylvania School of Medicine scientists say if their research proves to be safe and effective in animal and human studies, it might eventually provide the tissue needed for treating such disorders and peripheral nerve disease, Parkinson’s disease and spinal cord injury.

“We are very excited about this new source of adult stem cells that has the potential for a variety of applications,” said senior author Dr. Xiaowei Xu, an assistant professor of pathology. “A number of reports have pointed to the fact that adult stem cells may be more flexible in what they become than previously thought, so we decided to look in the hair follicle bulge, a niche for these cells.”

Xu and colleagues report their findings in the American Journal of Pathology.

Many people who are doing work with hair regeneration or cloning are working on the areas that contain these stem cells. In fact, many of the experiments that are successful in producing some hair, also produce other organ tissues like bone and muscle. But the real value of the hair for a health focus is the easy access to stem cells, that is, if we can really harvest them and get them to just replicate themselves. If hair stem cells can grow a heart or liver, or fix an injured spinal cord, or repair a brain in a stroke patient, that value will be far greater for society that just growing hair on a bald man. The value of this article shows that stem cells from hair has great promise for medicine and human health. It will be far easier for legislators to approve organ regeneration as an application for hair stem cells than for vanity purposes in cloning hair.

Tags: stem cells, hair, science

Patient Letter to Dr Rassman

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

Every now and then I’ll receive an email from a patient years after seeing them and it brightens my day. I thought I’d share this one I just received…

Dear Dr. Rassman,
I am [name removed for privacy] and I had a procedure for almost 2 years now (2280 grafts).

WELL!!! By looking at every single FOLLICULAR UNIT you had transplant onto the front of my head, I couldn’t tell that I had a hair transplant. Man, that is how good you are. I am so glad I got you as a Doctor. It changed my life forever because I feel more comfident about myself now and a lot more of the man I know I am because of you, Dr Rassman.

You know what my dream is Dr. Rassman? My dream is to have another TRANSPLANT from you but my girl friend doesn’t let me because she witnessed what I been through and she was so scared. To me I feel great and I would do it over and over again. I guess she just cares for me too much and I thank you GOD for that. Who ever reads this, please bear with me. It sound like I am a super pussy. Maybe, I will do it again without letting her know. If you do my surgery, that would give me more motivation to convince my girl friend to let me have another procedure.

Thank you for all the staff. You are part of my life.

What a nice letter. I can not tell if you are worried about pain from the surgery or from your girlfriend who may not be backing you for a second surgery. If you are worried about any pain, since your last surgery, we have made substantial changes in the anesthesia protocol we use with the use of a medication called Versed. This medication is a type of narcotic which does make the local anesthesia far less painful if you had trouble with it before. We have also added a stronger narcotic for the first night when the muscle spasm hits so that the first night is more tolerable for those who experienced pain. With these changes, you should think twice about any pain fears that I think you are expressing here. With regard to your girl friend, well most men either have wives, girlfriends or significant others and these folks do get involved in decisions we make like undergoing still one more transplant.

For the blog readership: this patient has agreed to let me post his photographs and he will be coming to see me shortly so that we can not only discuss the email posted here, but also take recent post-surgery photographs so that we can all know just what he is sooooo excited about.

Tags: patient, letter, hair transplant, rassman

Using Straight Razor to Shave Head Stimulates Growth?

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

My hair has been thinning since I was about 18. But it seems to have accelerated in the last year or so since i grew my hair long. (I am now 23) I decided to shave my head, and boy did that reaffirm my receding hairline. When it grew back it looked a little bit odd to me. My left side had no border; it has basically a 2 1/2 by 2 1/2 inch patch of thin hairs (with more density towards the top) with hugh gaps between them from my “peak” in front to the side areas. On my right side it is thinning but there is a border and it is a lot thicker and less receding. There is a major difference. How many years could have stress and growing it long accelereated my hair loss, if what I described is normal. Secondly, I used a straight razor to shave my head thinking that would stimulate hair growth, eventhough i was told about it scarring and or killing the follicles.

I do not believe using a straight razor will stimulate hair growth. If that is true, I would be in the hair shaving business!

You make an interesting observation of being able to see the pattern of hair loss with the short shaved head. What you are seeing is the miniaturized hair, which has less bulk than normal hair. This is fairly difficult to see in patients with average men’s hair lengths. That is why I often write about mapping your scalp for miniaturization with the densitometer that we routinely use at New Hair Institute. Alternatively, if you can not find a doctor able or willing to map your head for miniaturization, you can get a very short hair cut and see with the eye where the miniaturization is.

Tags: hairloss, hair loss, miniaturization

Are the Propecia Site Photos Altered?

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

dr. Rassman,

I read one of your articles about laser light therapy and the results of the pictures from the LLT could be altered or they could have been touched up to make it look as if more hair growth occurred. Saying that, how do we know that the people on the propecia.com website didn’t alter their images or the images you see from propecia or avodart results are altered?

Yeah, propecia could work, but to what degree and I personally thing propecia just maintains what you have unless you use minoxidil. What do you think?

The studies that show the benefits of Propecia used in Merck’s material are the results of well controlled and audited scientific studies, some of them done under FDA guidance. I would trust official Propecia photographs from Merck, but I would not trust many of the commercial photographs that are produced just to ‘prove’ that the changes are real. If you look carefully on many photographs used for the various potions, lotions, and herbal solutions for hair loss, the lighting, the hair length, the view — they are all different. On some photographs I have even seen scalp coloring agents used in advertisements, particularly for the crown shots on many commercial products.

So, always check the authority of photograph sourcing. For hair transplantation, I offer open house events at both of my offices just because even from the photographs on our website, the average person may have difficulty in determining just what the change really is. When you meet a patient face to face, what you see is reality and not the best view or an illusion created by the person taking the pictures. Of interest, at each of our open house events, we often have a person present who had created all of the benefits on Propecia alone (no transplants) and they have their before shots to prove where they came from. I still believe and preach: Let the Buyer Beware.

Tags: hairloss, hair loss, finasteride, propecia, photo

Is DHT Produced in All Men?

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

So DHT is the hormone that causes male pattern baldness? And that hormone is produced in all men who will experience from male pattern baldness after puberty? So is DHT only produced in men who will experience male pattern baldness or is it produced in all men? And if DHT is produced in all men after puberty do they only start experiencing baldness when another gene triggers it? How do you tell if you are genetically going to have male pattern baldness? My dad does and so did his dad and so did my mums dad but my uncles (on my dads side and my mums side) dont and both have full sets of hair at 55 and 58? So how do i know if i too will experience it ?

All men produce DHT, unless they are born with a genetic defect and missing a particular enzyme that makes DHT. There is no way (at the moment) to tell who has the gene for hair loss and if they did know, they wouldn’t know if or when it will be expressed in the lifetime of any particular man.

Tags: hairloss, hair loss, dht

Drugs in Our Foods

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

I thought this was interesting and worth sharing. Over and over again, we are becoming more and more aware that what we eat impacts us. This article shows that the fish we treat with drugs impacts our medical care:

“More than 70 per cent of the bacteria that cause hospital-acquired infections are resistant to at least one of the antibiotics most commonly used to treat them. The report published in Environmental Microbiology, July 2006, details the common practices that occur in the fish industry, particularly in developing countries, where large amounts of antibiotics are used to prevent infection. The antibiotics used are often non-biodegradable and remain in the aquaculture environment for long periods of time. This encourages the growth of bacteria, which can survive in the presence of these antibiotics, acquiring a resistance that is passed on to subsequent generations. The danger is these bacteria can be transferred to human and animal pathogens, leading to increased infectious disease in fish, animals and humans alike.”

Teen Has Graying Pubic Hairs

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

I am 15 years old and i want to know why my pubic hair is turning gray in some places. I thought i was too young for that to happen. But when my pubic hair falls off it just looks like dots of white or grey stuff. Can you please help?

Some people turn gray at very young ages. If it concerns you, there is nothing to do but to dye it.

Tags: pubic hair, teen, grey, gray

Bald is Sexy, Right?

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

I think that you can be bald and sexy. Don’t you agree?

Patrick StewartI do not believe that only hairy men (that is, men with hair on their heads) are sexy. For example, most people would agree that Patrick Stewart, Evan Handler, Michael Jordan, Bruce Willis, and Tyson Beckford reflect some very sexy and handsom men. For others, balding does little to enhance facial features on men like Jason Alexander, Phil Collins, Larry David, Michael Bolton (circa 1997). Could it be that with hair, these men would look sexy? Well, I would rather not answer that question. Look at my picture on the right and even with 1600 hair transplants done a few years ago, I am not in Sean Connery’s class of good looking men.

Tags: hairloss, hair loss, bald, celebrity

Laser Therapy, Unknown Pills Without Side Effects

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

Hi Dr. Rassman,
I’m 27 year old male suffering from inherited male pattern baldness. I have tried propecia for 5months but had to stop due to loss of sexual drives. Now I’m attending Advanced Hair Studio in Australia (have you heard about this company?) and paying a lot of money for laser therapy, some unknown pills that they claim doesnt have any side effects (what are these??), minoxidil, shampoo and topical hair thickener. I have read about lasercomb. Do you think this laser salon is just a waste of big money and can be replaced with lasercomb and minoxidil? I desperately need to do something about hairloss but can you recommend any other drug to replace propecia??
Thanks for your time.

The story is out on the laser for hair loss. One company here in Los Angeles has embarked on a courageous FDA controlled study to answer the question — what does the laser actually do? I have read hundreds of medical articles which support laser treatment for hair loss as a valuable addition, yet good scientific numbers are just not there. I have tested the laser treatment on multiple patients and some report a gain from it, but that is subjective. For my patients I do not charge for the laser so that I can develop a somewhat objective view and have taken photographs over time to document any potential changes. The problem is that many of my patients are also on Propecia, so I can not distinguish between any possible benefits from the drug and the laser. Possibly the laser comb and minoxidil may work, as it is probably a less expensive approach than the laser salon route.

Tags: lasercomb, laser, hairloss, hair loss

Mole on Scalp

/by William Rassman, M.D./3 /,

I have a mole on my scalp. This mole has been frozen several times only to grow back in length and size. I had the mole surgically removed and it grew back again. I went through another episode of freezing that still proved to be of non-effect. In the mean time my scalp is itchy and feels like something is crawling under neath the surface of my scalp. I have loss halp of my hair already. I had to have my hair cut to cover up the long strains from the holes from hair falling out. What is this? P.S. When I had the surgical removal of the mole, it was tested. The results were that it was just a mole. (Female)

Sometimes the doctor does not cut out the entire mole (assuming it is benign) so what is left behind just grows again. Some of these moles are caused by a virus, so cutting them out may not cure it, because the virus could be in the normal skin adjoining the mole (or growth). You need to go back to your doctor and get the answers to your questions. Clearly this is not something I can do on the internet.

Tags: mole, skin, dermatology

When Does Hair Loss Stop?

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

Dr.
I am an African American male who is 37 years old and started noticing my hairline receding at the age of 27. My hair loss at this point is not bad (probably class II). At the moment, I have no balding in the crown area but as I said earlier, my hairline is receding. My mom side of the house (brothers have full heads of hair) and my dad still had his hair before he passed at the age of 43. I have a few questions

1. At what point if any does your hair loss (receding)stops?
2. I decided a few years ago to take propecia after I started taking some other DHT blockers (procerin, kevis, follicure etc…). I even visited the hair club for men. Is there anything right now that I can do (laser therapy) that will continue to reduce hair loss.
3. Has avodart been approved for hair loss yet and would you recommended it?
4. Are there any good Dr’s you could recommend from my area (Hampton Roads are of Va)

  1. Most people start their balding process in their early 20s, some like you in the late 20s and a few after 30. The general rule is that for those who have hair loss in their 20s, most of it will slow down by the mid 30s and by the time the person reaches 40-45, it should slow down even further. There are no real rules other than what you see. You can anticipate it by mapping out your hair for miniaturization to see what the future may hold for you.
  2. There is only one FDA approved, proven DHT blocker, however with that said, many products claim DHT blocking effects without the science behind those claims. You must, of course, make your own decisions. I’ve written about laser treatments quite a bit — see Low Laser Light Theraphy and the general “laser” keyword search.
  3. I do not prescribe Avodart, because it is not FDA approved to treat hair loss. It is doubtful that the drug company which produces it (GlaxoSmithKline) will seek FDA approval for hair loss.
  4. For doctors in your area, I would intervew those who are on the ISHRS.org website, for at least they are interested in education for themselves.
Tags: hairloss, hair loss, avodart, laser, fda, dht, ishrs

I Want to Sue My Dermatologist, Part 2

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

Dr. Rassman, I’m the poster of “I Want to Sue My Dermatologist” and I think you misinterpreted a few things in the post. First off, I’m already 18 and have already been taking propecia for 2 and a half months, and yet the problem seems to be getting worse. I would also like to mentione that when I saw my first dermatologist, I was 15 years old and walked in to the office looking for a treatment, not a diagnosis. I was very aware that I was losing my hair and wanted to stop it from progressing, however this first dermatologist denied that I was actually balding, thus my reason for wanting to sue would be an incorrect diagnosis. You yourself said that you would prescribe propecia to someone who was balding under age 18, which my (initial) dermatologist did not do.

Now I am 18, and the (new) doctor I saw 2 and a half months ago indeed confirmed that I was balding, thus prescribing propecia. I know it can take months to have an effect, but it has already gotten much worse than it was even as little as 2 weeks ago. I want to sue my initial dermatologist under the grounds of mis-diagnosis (thus causing severe psychological damage) in order to pay for a hair transplant, so I won’t need to walk around walk around like this any longer.
As far as needing a final hair loss pattern, I already have that- my brother… my 22 year old brother. His situation is nearly identical to mine and his hairline along with thinning on the top are the same that I am experiencing.

Now for the anxiety/depression. I have had a history of therapists that have done nothing, prescriptions that were effective as sugar pills, and all that jazz. Problem is, I’m a science-type person. My brain can’t go a second without making a qualitative analysis of my condition. What do I mean by this? I mean to say that any attempt to “make my problem better” doesn’t work at “making my problem better” because I’m still losing my hair. There is no such thing as coping, but rather deceit, tomfoolery, a jedi mind-trick. The only way I will get out of this is to get what I want. End of story.

What I ask of you is to inform me whether or not I honesty could win a lawsuit on this to afford my transplant, because I don’t really know the law when it comes to medical issues.

LawThe basic grounds for a successful lawsuit against a doctor must show:

  1. Damage as a result of the doctors action (inaction is much more difficult and in your case in particular it would be an uphill battle)
  2. Not meeting the standard of care (it might be successfully argued that the experience in genetic hair loss for the 15 year old is NOT prescribing Propecia and this may be a reasonable standard for most doctors).

Doctors generally prevail most of the time in any malpractice action unless there would be deforming or life threatening situations caused by the doctor’s action.

To take a trial before a jury, you would have to get the jury’s sympathy and understanding. They would have to look at you (at the 15 year old young man you were) and ask if you were their child, what would they have done. It would take a masterful lawyer’s argument to prevail in such a situation, so to answer your question in a nicely bullet-pointed way —

  1. I do not think that you would find any lawyer willing to take this case on with a contingency fee
  2. You would probably not win
  3. And if you did win, the damages would be very small

As far is your continued hair loss, wait this out for a few months and hopefully you will see some benefits of taking Propecia at this time.

Tags: propecia, finasteride, hair loss, hairloss, lawsuit, law, doctor, malpractice