Month: May 2005

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Hair Loss InformationAn Answer to a Patient’s Questions – Hair Loss Information – Balding Blog

Dear Dr. Rassman,
Thanks for taking the time the other day to visit with me and also for the very informative follow-up letter and your recommended plan for my hair transplantation. Over the last two months I have been seriously looking into the hair restoration field and have read three credible books and studied every web site of every accredited hair doctor. I also consulted with doctors that I felt were very respected in hair restoration. My conclusion is that I need to stay on Propecia consistently to preserve the hair I have right now and use the follicular unit transplantation (FUT) technique exclusively, to replace the lost hair.

But I am confused by the number of grafts recommended. So far, I have heard various numbers ranging from 1,000 to 3,000. After visiting with you and hearing your recommendation of 2500 grafts, I wrote back to a very reputable doctor who had recommended a session of 1,500 grafts and told him that another clinic had recommended 2,500 grafts. He then told me that 1) each person has very limited donor supply and one must plan a session based on future hair loss, and 2) the survival rate of transplanted grafts deteriorates as the number of them placed close to each other is increased, as is done in megasessions. He told me that other clinics have no guarantee or refund policy if the hair follicles don’t grow back, so they just transplant as many as possible, even if not safe for the patient.

So my questions are:

  1. What does ‘limited donor supply’ mean in my case? You saw my hair, how many good donor grafts in total do you think I have for now and the future? What would it be if Propecia did not work and I continued to lose hair?
  2. Have you seen any side effects with larger sessions such as more noticeable scar in the donor area, loss of transplanted grafts, excessive swelling of the forehead or longer recovery periods?
  3. Do you or can you guarantee a certain survival rate for the transplanted grafts?

I appreciate the time you have taken to help me with my hair loss problem. I guess I can’t help it, I am a natural engineer, and this being the most important decision I probably ever make I have just been researching the hell out of it! I am confident, however, that I am talking to the best source there is out there.

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Part of what is important about being a doctor is the concept of mutual respect. The person who wrote the email to me on this blog, is analytical and clearly fully aware of the subject material. Good communication produces respect so a doctor should spend an appropriate amount of time and focused attention to address your concerns at the interview and in followup to that interview. I would welcome a call from you to elaborate on this blog answer.

  1. Some people do not have the donor supply and when that will be an issue, I tell them. The amount of donor hair is a calculation of density in the donor area plus laxity of the skin. Finally, the size of the bald area and the final worst case pattern must be taken into account. As measurement is critical to this process, one must make direct measurements of the density in the donor area. I was the first to publish on the measurement of the donor supply and the instrument I invented to do this is now used by every competent doctor in this industry. There are no other instruments that are used for hair measurements that do not fall under my U.S. Patent. The average patient has about 6,000-12,000 grafts to move but the wide spread reflects the many variables discussed above.
  2. If you come to our free open house events, you will meet people who had thousands of grafts and see for yourself what happens. The key to understand the safety of large sessions is to meet directly with many people who had them. I would not be doing large sessions if they were not as good or better than multiple smaller sessions. With good decision making by the doctor, large sessions should not scar more than multiple smaller sessions but there may be a cost for aggressive decisions in large session transplantation if the doctor is not experienced in such procedures.
  3. This type of complaint usually reflects the act of denial which most people exercise when they forget what they looked like ‘before’ the started the hair restoration process. Sometimes, people continue to loose hair and think that the new hair loss reflects a transplant failure when it really reflects the unpleasant idea that balding continues. To address the growth of the transplanted hair, wWe guarantee our work. Anything that does not grow, we will replace at no charge. This almost never happens, so I rarely discuss it unless asked.

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Hair Loss InformationYouthful Hairlines – Hair Loss Information – Balding Blog

I am 34 and in the music business. Like the email from your model, I am in a position where I wish to look like I’m in my late 20 for a few more years-Its more business then vanity. My hair looks how it should for 34 (I am a type two), never the less, I wish to have the sides of the front filled in a bit (as well as the hariline reconstructed).

Everything I read implies that this is a bad idea, because my hairline will look too low when I am 45. If I brought my hairline back down to where it was 5 years ago, would it look stupid in 15 years?

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Clearly, you understand this subject, so I will not repeat much of what I have said in previous blog entries. First, Bill Clinton has the same hairline today that he had when he was 12 years old. His hairline does not look weird to me. It just reflects a small number of Caucasians who keep their juvenile hairlines into adulthood. IF you are not balding and you’re examined throughout each area of your scalp, looking for miniaturization and none is found, then it is not unreasonable to assume that you would be in the 55% of the population that does not bald at all. Putting back the frontal hairline will just make you look like Bill Clinton, Ronald Reagan, actor Andy Garcia, and many others like them. They looked good with their low hairlines. On the other hand, if you should start to bald, a discussion with your doctor needs to lay out a worst case scenario for you to consider along with the statistical possibility that this might happen.

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Hair Loss InformationRegenix – Hair Loss Information – Balding Blog

Dr.Rassman,
Have you heard about this hairloss product called Regenix? The actor Matthew McConaughey was on the David Letterman show and he said that he was losing his hair until he used Regenix, and now he has as good a hairline as when he was 18. What do you think?

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Regenix has been around for years and they can make the hair thicker appearing (therefore fuller) with many of the things they use. The change that our actor shows suggests that either he has an unusually good result from Propecia or he had a good hair transplant surgeon in conjunction with what Regenix is doing. Two pictures of him on the web (see links below), show what appears to be a remarkable turn-around. I tend to be skeptical in believing everything I see or read about celebrities. If Matthew should read this blog, please come in for a private consultation. I will not post about the visit, I promise.

Here are links to two photos that display the dramatic change in Mr. McConaughey’s hairline:

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Hair Loss InformationVery Early Balding – Hair Loss Information – Balding Blog

I have a doubt. I am 20 and my hair was fine until now,but I feel that my hair is not that dense as it was when I was 10 or 12. Although my hairline is not receded, my dad is bald. Is this a sign of balding or it is natural for eveyone. Also I shampoo my hair once every 3 days with a mild shampoo. Does this have any effect?

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A good thorough examination of your scalp with high magnification may show if the early signs of balding have begun. If they have, preventative treatment with Propecia may be indicated. There is no certainty that you will follow your father’s hair loss pattern, but it is a good idea to keep a close eye on it with a good doctor advising you. Shampooing once every three days, once a day, several times per day, or once a year will probably not impact your balding pattern.

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Hair Loss InformationAppreciation – Hair Loss Information – Balding Blog

Yesterday I had a visitor from Saudi Arabia, a well known woman who is actively involved in the womens’ rights movement. She was sent to see me for thinning hair by a former patient I did some 10 years earlier. She came with a message for me, “Tell Dr. Rassman that for the past 10 years, I have been enjoying the hair that he gave me more than I would have ever expected”.

This message epitomizes what I experience every day, a sense of worth communicated by heartfelt patient appreciation.

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Hair Loss InformationHair Loss From A Hair Transplant – Hair Loss Information – Balding Blog

Thanks again for your rapid reply. I have a question regarding “telogen effluvium” mentioned in an article authored by yourself and Dr. Bernstein, ‘Follicular Transplantation, Patient Evaluation and Surgical Planning’. (This was a very informative and helpful read) In the article you mention that existing hair in the recipient area could potentially be shed as a result of transplant surgery due to telogen effluvium. You conclude that “it is probably important to transplant enough hair to overwhelm any possible telogen effluvium that might occur so that the net effect of the transplant will be a positive one.”

My question is what exactly causes “telogen” effluvium? And whether there is anything one can do before, during or after the surgery to reduce this side effect and hence achieve better denser results. Since
this article was published in 1997, I was wondering if there has been more studies in this area and if anything can be done to prevent or reduce it.

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The telogen effluvium that we have seen with what we used to call ‘Hair Transplant Shock Hair Loss’ can be largely prevented today with Propecia, with which we had little experience in 1997 when the articles were written. We have found that this drug will protect much of the hair that is impacted by genetic balding against the ‘shock hair loss’ we used to see. If the hair that falls out is the permanent hair (which happens rarely), it will usually come back. If “shock hair loss” occurs in women, I have never seen it not return. The cause of telogen effluvium is not known. Most of my views on it are empirical ones that, from a scientific viewpoint, are not proven but it allows me to explain the process to patients and to myself.

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Hair Loss InformationPolycystic Ovarian Syndrome – Hair Loss Information – Balding Blog

i have pcos, i have hair loss in the front of my skull, there are still some left but only a pathetic few. what should i do , i used to have this long black great hair. can i get it back.. thank you for your time.

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Dr. Robert Bernstein (Hair Restoration Surgeon in New York) was kind enough to supply a thorough answer to this question for you…

Polycystic Ovarian Syndrome (PCOS), originally called Stein-Leventhal disease, represents a number of conditions where ovulation is inhibited and, as a result, the ovaries become cystic and secrete more androgens than normal. The most significant of these androgens is testosterone, but other related androgens such as dihydroepiandosterone (DHEA) may be produced as well. Testosterone is converted to a hormone called dihydrotestosterone (DHT). If women have a genetic predisposition to balding, this hormone will cause the follicles on the scalp to shrink (miniaturize) and eventually disappear.

There are a number of treatments for hair loss related to PCOS. The first is the drug finasteride. Although not FDA approved for women, finasteride blocks the production of DHT (this is the same medication that has been approved for treating hair loss in men under the name Propecia) and thus will decrease or reverse the process of miniaturization. Weight loss (if this is appropriate) may also be helpful as this will decrease the body’s production of testosterone. Spironolactone, a diuretic, blocks testosterone and can also be useful. Finally, birth control pills, because they contain estrogen, will lower testosterone in the blood stream and thus decrease the amount of DHT produced. Please remember that these treatments should only be used under a doctor’s supervision.

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Hair Loss InformationScalp Reductions – Hair Loss Information – Balding Blog

I met with a doctor last week who suggested that I take out the bald area. I am very bald so the bald area is very big. Is this a good idea?

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Removing the bald area (scalp reductions) were very popular surgeries 10+ years ago. Thousands of men have had it done. You might even see them at airports, where they have a scar down the middle of their head, like they had brain surgery. Starting with that as my answer, I think that you will see (from everything else I am about to write here) that I am not open minded about this surgery. First, I should state that I am a victim of this surgery, having had three such surgical procedures to remove my bald spot (much smaller than yours, I suspect). I was scarred, but I got lucky in that I did not pursue more than the three surgeries, for had I done so, I would have been really deformed.

These surgeries have many, many problems associated with them and they have been largely abandoned over the past 10 years, largely because of the efforts of myself and a small handful of other doctors who have brought the complication of this surgery to the public. The most important issue to remember here is that when you are considering a hair restoration procedure, you want low risk and high certainty in the outcome. These scalp reductions produced many, many risks and the outcome was only occasionally successful. This is not a good procedure to do. For more information, please see Scalp Reductions on the NHI website.

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Hair Loss InformationPain with a Hair Transplant – Hair Loss Information – Balding Blog

I don’t like pain so I have stayed away from hair transplants. If I take the plunge, how much will it really hurt?

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Pain is relative. When I discuss pain, I always discuss safety at the same time, for it is not worth putting someone’s health at risk to wipe out pain. Some people handle pain better than others so there are no absolute rules here. Most people tell me that it is like having your dentist making an injection in your gums, but the pain comes in two flavors:

  1. The pain from the administration of the anesthesia itself (like what the dentist does to numb your gums and nerves)
  2. The post operative pain. There is no pain once the local anesthesia takes effect, most patients either fall asleep or just relax and watch a movie during the procedure.

If the hair transplant is performed completely under local anesthesia, the risks to your health are almost non-existent. You almost never hear of a person dying from filling a cavity in a dental office, but many die crossing the street. Laughing gas, prior to the local injections of Xylocaine, helps with reducing the pain from the injections but doesn’t eliminate it. In some cases, the doctor will administer stronger medications that will block even more pain and will allow the patient to more fully relax. The risks to health of being “put out” completely are slightly higher than putting up with subdued pain with laughing gas. The choice is made between you and the doctor. I have found varying reactions to the injection pain, from “no big deal” to the other extreme. The pain from the injection rarely lasts more than a minute. During the surgery we make sure that you are kept pain free, and the medications given last for about a four hour period after you leave the office.

If there is pain following the transplant, it occurs the first night. To deal with that pain, we do give you medications to take with you that will block the pain. These medications are strong and I recommend that they be used for night use only. A sleeping aid is also given for you to use. The use of simple over-the-counter pain medications will work during the daytime. Rarely are there many complaints of pain after the first night.

Getting hair is far less painful than the emotional pain of going bald- at least, that is what my patients tell me. I feel that pain is a non-issue since we have effective ways to deal with it, most of them pleasantly.

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Hair Loss InformationHair Attachments for Women – Hair Loss Information – Balding Blog

My girlfriend and I don’t think that we have hair loss problems (at least not yet), but we would LOVE to have fuller hair so that we wouldn’t need to use hair extensions (which I assume all the celebs use because no one has hair like that!). Could transplants do this for us too?

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Historical Perspective: It is important to understand that many of the accoutrements that adorn our bodies arose from earlier, less sophisticated times. The use of wigs date back to the Egyptians in the years between 4000-300 BC. They were used extensively by men and women. The Greeks were the first to popularize wigs and braids and that began the long torturous route to hair styles that cycled in popularity for the next few thousand years. In the middle ages (1200-1400 AD), single women showed their health and vitality by demonstrating full heads of hair, much of the hair manufactured from animals. Once married, only the husband could see the head uncovered, so it was the young single, female that had to appear healthy and capable of producing healthy children. Even back then, women were packaging themselves for the marriage process. As the populations started to concentrate more and more in the cities, the disease tuberculosis, took its toll. For the malnourished females whose heads were uncovered, their hair showed a window into their core health. Those women who were not sick but had the misfortune to have a fine hair, appeared sickly. So women with a thin head of hair wore a wig or used braids to increase the fullness of their hair, thus appearing healthier. Sexual attractiveness and a healthy appearance were inextricably linked early in our evolving society. Paintings since the late renaissance, showed women with abundant body fat and full heads of luxurious hair. As tuberculosis is blind to socioeconomic conditions, the successful artisans were engaged by wealthier clients to create the illusion of health with abundant hair and lots of braids. The concepts of portrait art, showed what the person wanted to look like, not what they actually looked like. As the hair became thicker, it hid signs of illness or malnutrition. Braids became common place and the use of wigs and other hair extensions remain part of our cultural heritage, as our question suggests.

No, hair transplantation should not be used to increase the fullness of a normal head of hair, but the use of hair extensions and other such devices comes with a hidden cost for some people. That cost can be progressive hair loss. When it happens, it is caused by the continuous pulling that these devices produce on the hair at the point where they are attached. If you weave your existing hair into the matting of the extension to hold it, then the constant pulling from the attachment can produce Traction Alopecia (hair loss from pulling) and it can be permanent if the process continues. I have seen women with patches of hair loss or hair thinning from these extensions. What they do to manage the proble, is put in more extensions around the thinning area. This successfully masks the thinning area while it damages the healthy area nearby. Eventually, these damaged areas become confluent. My advice to you is to respect your hair and watch carefully for any signs of Traction Alopecia. Make sure that you are not starting a cycle that worsens with time.