My Connection to Merck

Can you please make disclosures of your connections with manufacturers of Propecia?

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I have no connection to Merck. I do not own any Merck stock and am not reimbursed in any way from them with regard to my medical activities. I do sell Propecia in my office, but it is sold at cost plus a handling and stocking fee of $4.32. I only sell Propecia as a service to our patients.

Any Hair Cloning Update Yet???

I am a 42 year old woman. I have androgenetic alopecia. Its diffuse but now its getting see-through right in the front. What I need is hair cloning because I probably don’t have reliable donor hair from the back. Do you have any suggestions of how I could add more hair to my hairline especially. Is hair cloning getting any closer for all of us. I would appreciate any advice you could give me.
Thank You.

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I recently had a conversation with my associate Dr. Robert Bernstein, who in turn spoke to the most prominent hair cloning expert in the world today, Dr. Angela Christiano. The gist of their conversation was that there is nothing new on the horizon at this time that has changed the prospects for hair cloning anytime soon.

Please see our fairly extensive coverage from the past few months in the Hair Cloning category.

Female Hair Loss

Hiya, I am a 35 year old female and heartbroken. January of this year my hair changed from healthy, quite greasy really, to dry as a bone and unmanageable. Getting worse at every wash, dryer and dryer. Had all the tests done by my gp. Hormone, thyroid, everything was ok. Now my hair pulls out with the gentlest of brushing, snaps in my hands, and my scalp is showing on my part. My fringe has shriveled to nothing and my hair looks like it has been burnt mainly at the front. I have developed a receding hair line in a classic M shape, and have thick black hairs that seem to just grow everywere all over my head. The texture is that of pubic hair. My hair no longer feels like hair, it is so dry when i touch my scalp it crunches. I have conditioner on it, but nothing seems to help. I have started taking vitamins and my hair feels like it is coated with a sticky dry residue now. Seems to be able to help. I am not a vain person, I am nothing special, but to see myself like this is breaking my heart. Please can you offer some idea as to what the problem is? I am spending hours just sitting in front of the mirror in tears. I no longer recognise the person looking back any more. My marriage is suffering and i am finding it difficult to go out. I feel like everyone is looking at me. My self image is on the floor. Please please can you give any ideas as to what the problem is? My hair seems to be shrinking, not growing, apart from the back which seems to be unaffected. So far you are my last hope. Please please can you help?

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This is not something that I can manage over the phone or through an email. You need to be managed by a competent doctor and possibly a good/great hair stylist for the topical management of the fragile hair. Please, find the appropriate people to look after you. Do not become your own doctor or hair specialist. I would suggest using the ISHRS site as a good place to search for a local doctor.

Deformed Hair Plugs — I Just Want to Be Bald

I have been mutilated by your hair transplant community and I am angry as hell about it. It has forced me to modify my life to address the deformities of my hair, so I do not and can not have a normal life. I have lived in hats and closets for years, and now I just want to go bald and look bald. How do I do that? I have scars on the back of my head that is wide and long (5 of them), holes in the back of my head from the first surgeon who drilled them out before the second surgeon cut them out, I have pits in my head in the front and top and my hair line looks like a Frankenstein movie part that am auditioning for.

I was told about FUE-extraction but I know that it will lead to more scars. Another doctor told me to do a second step would be to do a scar revision as well, but with than number of scars, I really can not imagine that this can be done. I want to shave my head every day and want my head to be smooth. I have very little money and that makes the problem worse.

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There are many things you could do to come out of the ‘closet’ that you are forced to live in. Technology and your decisions processes of ‘old’ (many years ago I suspect) meant that you made decisions at the time that were not wise in hindsight. You can and should get out of your situation and with today’s technology, you probably can.

I am sorry to say, but your plan may just get you in a worse situation than you have now. Scar revisions can be done but you will need to camouflage the new scars (which you will have) with longer hair. There are lots of tricks to make the scars better, like a trychophytic incision which allows hair to grow up from the scar from the edges, but no single solution short of FUE (at the proper time) can address the tendency for scars to widen. Dr. Nordstrom in Helsinki has developed a special suture to address these scars and he is a reputable surgeon, but you have many scars, so that this approach is not a good one unless you get it down to a single scar. Balloon expansion of your scalp, where you will look very bizarre for up to 3 months as your head is expanded to the size of a soccer ball, can deal with the multiple scars, reducing them into a single scar with reasonably assurance of success hopefully achieving only a single small scar is a reasonable approach for multiple scars in the donor area. With the pitting you describe, the scars and the progressive hair loss, adding dermabrasion will be a disaster producing still another set of problems, more than you need.

The key here is to establish reasonable goals with a good surgeon who has lots of experience dealing with people in your situation. I think that your goal should not be to shave your head or to restore you to a hairy man, but to restore you to a normal looking balding male without a freaky, man-made look. With a frame built to your face that is normal looking, and the plugs removed, camouflaged, and properly dealt with, you can achieve this goal. Trying to go bald with what you tell me you look like, will make the scars obvious. A hair system (wig) could be considered as well, though I generally recommend to stay away from those for a variety of reasons.

Be careful not to step off another cliff. You have a bad problem, but if you look at our war stories (see Dean’s Story link below), you might realize that others have been there and fixed that under my care. Get a good doctor first, bond with him/her and then develop a plan that you can afford and live with. Then stick to it.

For more repair information:

Will Flat Irons and Blow Dryers Damage Hair?

Hello, I am 20 years old, and I now notice that my frontal area is starting to thin a little bit. But by everyone else who looks at me, they wouldnt even be able to tell that I am losing hair. So I have been taking Propecia in the mean while to halt or slow down the hair loss, until I am old enough to get a transplant. And my father had a hair transplant.

I just want to know, since I work as a actor for commercials and a model, the people who style my hair, they tend to use flat irons(hair straightener) and blow dryers at high heat in where I have the donor area. Because after 6 months of them using the blow dryer and flat iron on me constantly, I decided to have them stop using it and it has been 3 months eversince I stopped. Will this damage and reduce the number of hairs or grafts or FU’s that are transferable or are they safe to use?

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Sounds like you really need a good doctor to take charge of your situation. This site is riddled with stories, questions, and inquiries about potions/lotions for hair loss. You need to be smart about decisions going forward. Don’t be foolish with your hair; take command by bringing in a good doctor as a partner for your hair loss problem.

To answer your question — yes, flat irons may damage hair and blow dryers which are too hot can also damage the hair that is there.

FUE / FIT — Minimally Invasive Hair Transplants

Hello Dr Rassman,
Firstly I would like to congratulate you on this website. Its very helpful. I am due to have a FUE transplant (1000 follicles) next month at DHI in Athens. I have read your comments relating to DHI and the importance of a good surgeon.

I know that you normally refrain from doing this but I would really appreciate it if you could please recommend a paticular doctor (whose work you know of) at DHI. I am really freaking out now about getting an incompetent surgeon working on me. I realy dont want to make a wrong decision. I will not dislose your recommendation in any way at all to anybody. Thank you.

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I do not know any of the doctors at DHI, so unfortunately I can not help you with that. I am told that they have switched completely to FUE and away from strip harvesting. Frankly, that makes me nervous, because of the complete absence of biopsies to qualify patients. DHI was taught by Dr. Cole, who calls his procedure Follicular Isolation Technique (FIT), which is a sub-set of what I call FUE. Dr. Cole, along with DHI, tell me that 100% of patients qualify. The FUE techniques are a series of processes that are fine tuned in each patient, as each process works uniquely in different patients. Dr. Robert Bernstein and I just wrote a chapter in a new text book on this very subject (due to be published shortly). FUE is an intricate process that requires a series of approaches, each matched to the patient’s tissue characteristics. Last week, for example, I performed an FUE procedure and prior to that procedure on an earlier visit, I used four different methods to optimize the process. One tool worked consistently at 100%, while others methods had failure rates in the same patient ranging from 90-20%. At the time of the surgery, the actual success rate was 88% based upon hair counts. For this very reason, I am absolutely convinced that biopsies are needed to qualify patients and match the techniques that work on that patient prior to the actual FUE surgery. On a few patients, FUE surgery is either not possible or so inefficient (taking a few hours per hundred grafts harvested) to make the process not a reasonable alternative to strip harvesting. Depending upon the technique used, patient eligibility ranges from as high as 95% of all patients in some doctor’s hands (very few doctors fit into this category and this group includes those patients who may not be efficiently harvested) to less than 30% in others.

What bothers me is that some doctors have a loose definition of FUE success. Some doctors may classify 100% success as his/her ability to extract at least one hair in an FUE graft. That does not cut it for me, because I classify success by hair count. That means that if a 3 hair graft was excised with FUE, some doctors would call a single hair extracted and two hairs killed off as 100% success while I would call it 33% success (actually this does not quantify the loss of hair, the negative value of hair that is lost forever). Probe the doctor’s definitions here and get an accurate count of what he did when he does the procedure, as you are entitled to that as part of your medical record. If the doctor does not give it to you or tells you that it does not matter, run for the hills. It may sound like technical talk, but the realities of what you get and what you pay for and what is destroyed by the process all come into the value equation. Again, as I always say, let the buyer beware!

I’m 21 and Balding — What To Do?

Dear Sir:
I’m 21 years old , i’m suffering from hair loss , its not that much till now but i have a feeling that if i just ignored it , it will be very bad later , & i realy care sooooooooooo much about my Look. So please tell me what can i do , Do you prefer surgery for me , or Drugs ( if yes mention one ) i used to use REGAIN EXTRA STRAINGTH . but i stopped. because i wanted a faster solution . please reply as soon as possible . thanks so much

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It is very difficult to evaluate hair loss without at least pictures, and an in personal consultation is better. I don’t recommend hair transplantation as the first option to solve your balding problem. First, you would have to be evaluated to map out your hair loss as it progresses by determining the degree of miniaturization that is in every part of your scalp. Then, providing you are a male, I would likely have you on Propecia for a year or so, then reassess the miniaturization and your observable pattern of hair loss (if any) or reversal of hair loss. From there, transplantation might be right for you, but only an in-person evaluation will be able to determine this. If you’d like to email photos to me, please use the email address on the contact page.

Very Short Celebrity Hair Style

Hi, I am just wondering, I am balding and I want to get a short haircut just like the actor Jason Statham, what number do you think he takes when he buzzes his hair? Thank you very much. All the Best

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Here’s a photo of Jason Statham I found on IMDB, for those that are interested in who we’re referring to. I don’t know the particular number clipper that he uses, but I’d suggest that you buzz your hair with a high number first (try a 6), then go one level down at a time until you get the look you want. This way you will not overdo it and lose your chance at your short haircut goal. If I had to estimate though, I’d say that he probably uses a #2 setting (just quess work).

Waxing Transplanted Hair

HI,
I am about a #7 on the baldness scale and I have about 200 (2-3 hair) plugs on the front hairline. I now want to go bald and was considering waxing (although painful) in the plug area. (There is nothing really wrong with my transplant, I just like the bald look better on me). My question: Will waxing do any damage to this area or the plugs themselves? Your advise is greatly appreciated.

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Waxing may eventually produce traction alopecia and as such, it may in the longer term cause these ‘waxed’ hairs to fall out. If the plugs are really plugs in the old doll’s head view, there are better options including excision, FUE extraction, and laser hair removal. The problem with the doll’s head plugs is that there is often skin changes associated with them, such as cobblestoning and depigmentation, which may stand out if you go bald. Take a look at our newhair.com site and search for “plug” to see and learn much from the many pages of information on this subject.

From an Irrational, Mad as Hell Doctor

As a doctor in the hair transplant field, I take affront to this blog, the general tone of it and your almighty view of ethics that you published last week. You are forgetting your roots. Your ego-centric sanctimonious approach gets me sick. I hope your readers can see your self-serving motives here and I sincerely hope that you become a victim of your words.

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I normally would not publish this type of statement, but it looks like it illustrates the points I made in my blog entry from just last week, The Truth About Cheap Hair Transplants. I think that this doctor is forgetting his roots, which lie in the Hippocratic Oath taken when he became a doctor. Maybe his Mercedes and mansion mortgage burdens are clouding his priorities.

I’ve been reminded that my blog posting from way back in June entitled Doctor Availability, may have also contributed to this doctor’s rage.