Month: June 2005

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Avodart (Dutasteride) – Hair Loss Information – Balding Blog

Hi DOC… just wanted to know what you think about avodart for the treatment of hair loss? I have been on propecia and would like to switch. Does Propecia or Avodart stop mpb permently?

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The final story on Avodart safety and effectiveness are not out yet. All DHT blockers last only as long as they are active in your body. Propecia is ‘good’ for 24 hours only, so you must take it every day. Avodart lasts 3+ months (possibly in your body for over a year), however they recommend a daily dose for prostate problems, which makes no sense to me. I have gotten reports that Avodart is a better DHT blocker for balding than Propecia, using a slightly different mechanism of action. I have not yet prescribed Avodart, but I am presently reviewing the indications for doing so on a case by case basis. There are early signs that point to Avodart’s effectiveness, but there is more involved when one goes outside the FDA guidelines for prescription drugs.

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Your Pictures Are Too Bloody – Hair Loss Information – Balding Blog

I noticed that many of the photos show red head where the transplants are. Is that what I am going to look like and have to walk around with?

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The pictures we show that are ‘bloody’ red or pink, reflect the time that they were taken (usually minutes after the surgery). Most are in the first 24 hours after the surgery when we have access to the patients. After that, the patients wash their own hair and the pinkness goes away faiirly quickly. What I mean by fairly quickly is that most people with dark, medium, or olive skin color rarely show any red color within 24-48 hours of the transplant. People with very fair, pale skin tend to show more pink or red in the wounds, but these people fall into two categories:

  1. The first are the people who have what I am going to call ‘Histamine’ positive skin. These pale skinned people tend to develop redness in any scratch or trauma to the skin. They store higher amounts of the chemical Histamine at the ends of nerves which release to cause vaso-dilitation of the blood vessels. If you are one of these people, you can easily see it, just by taking your fingernail and scratching your arm. The people who are Histamine positive will develop a red-streak within a minute of the finger nail scratch. When we know that people are in this category, I treat them with two medications to minimize the redness and how long it lasts.
  2. The second group of people are those who are not Histamine positive and they will respond like all other people with the redness or pinkness gone in just a day or two.

If you come to one of our open house events, we usually have someone there who had surgery earlier in the week. This allows you to see the post operative wound and the issue of social detectability, within a week of surgery.

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Reversal of Plugs? – Hair Loss Information – Balding Blog

I have seen your articles on the net and have a video from NHI. I’m a victim of a bad hair transplant and would like your advice. The “Doctor” transplated doll looking hair in my hairline back in 1993. At the time, I was a naive kid at 23 and was afraid of losing my hair. Today I could care less if I was bald, but to deal with this freak looking hairline is an every day battle.

Basically, I’m wondering if there is any way to replace the grafts back where they were? Remove them from the front and replace them in the back again. Is this possible?

I keep my head buzzed now, and the scar on the back really looks horrid. Any advice would be appreciated. Thank you.

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The good and the bad news about hair transplants is that they are, for all practical purposes, permanent. The problem with attempting to wipe out that they were done is that you will have a ‘trail’ of scars showing each step of the process from creation to reversal.

I have written extensively on the subject of repairs. The better way is to fix it such that it does not show any more. There are many examples of this on the NHI site, and in the articles we published on the subject. I hope the photos do not scare you.

See the following links for the published articles:

Again, although you can remove the transplants, you may look like a person who had brain surgery. I hope that this answers your questions.

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Blood Pressure Medication and Minoxidil – Hair Loss Information – Balding Blog

Ron asks…

I am one of your patients ,I take high blood pressure medication would there be any advantages to taking Minoxidil orally in addition to or instead of my present medication?should I ask my doctor about this ? What dose would be effective ?

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Ron, thanks for writing. The question you posed is a good one.

Minoxidil was a poor anti-hypertensive when they produced it for that purpose in pill form. As a topical medication for hair, the absorbed dose rarely produces an effective drop in blood pressure. Controlling blood pressure is a science and it is critical for your overall health. Best to stick to medications that are known, have been tested in you and are reliable in you. Then, adding another drug will only lead to more risks for you, but with that said, topical use of Minoxidil should not impact your blood pressure when used as directed, twice a day.

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Hair Loss InformationHair Cloning, Revisited – Hair Loss Information – Balding Blog

It has been about six weeks since I’ve posted an entry about hair cloning, but I’ll revist the topic again because I get quite a few requests for information. People generally want to believe that cloning is just around the corner.

Why can’t we clone hair, since scientists can clone a sheep? When can we expect to get a cloning treatment and how will it be done?

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When it comes to cloning, hair follicles are in a tough spot. They are too complex to be simply cultured because follicles are not whole organisms like Dolly the sheep. The focus of cloning for hair is to move cells that can stimulate growth from a normal hair follicle, to an abnormal (genetically impaired) hair follicle. Although this is not actually cloning, the growth stimulating cells from the normal hair follicle can potentially be multiplied in a Petri dish and then moved to the area of genetically impaired hair. Some of these cells are capable of turning themselves into hair, bone or muscles and this has been shown in what I will call ‘uncontrolled experiments’. Because people who are balding always have some non-genetically impaired normal hair, we do not need a person to person transfer.

There are problems that are yet to be solved. The primary problem is to identify which cells are to be moved. Other problems are once the cells have been identified. We must ask, “Can we successfully create enough of these cells to work with, and is there certainty that the cells that are created and moved will maintain their capability to stimulate growth in the genetically impaired hair follicles?” It is anticipated that whatever process we come up with, there will be a type of medical ‘soup’ which the doctors will inject into the genetically balding areas of the scalp. When they are injected into the balding scalp, they must consistently be able to stimulate hair growth. Unfortunately, the success of this entire process has been relatively low so far. There have been some successes, but these have not been replicable, suggesting that we do not have control of the process. We also have to be 100% sure that this process is safe. Do we know that these cells will not produce a cancer or other problem? Safety and effectiveness is critical for any FDA approval and it will take years for this to be worked out. Don’t hold your breath, no matter what you hear!

For more information, Dr. Bernstein wrote an article about hair cloning in our 2004 NHI Newsletter, available here. Adobe Reader is required to view the file.

To read more newsletters, medical publications, and the PDF version of The Patient’s Guide to Hair Restoration, please see the NHI Medical Publications page.

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Hair Loss InformationThinning on the Sides – Hair Loss Information – Balding Blog

i have noticed that on the side of my head my hair is very thin and i notice bald spots on the side. can you please tell me why? please tell me why?

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I would want to see pictures of your sides to differentiate between various forms of balding and skin/hair diseases. Please send me digital pictures to the address on the Contact page and I will give you feedback on what I see. Best if you could come to see me either in Northern or Southern California, where I have offices.

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Small Plugs – Hair Loss Information by Dr. William Rassman

I had a number of mini and micrografts done 10 years ago behind the hairline, so they weren’t visible. Now, because I lost more hair, these grafts are now visible and they look like a transplant. What can I do to fix the situation?

There are two basic approaches to repairing visible grafts. The first directly involves the old grafts. If they are small, you can punch them out using a 1 mm punch. This will remove the bulk of the hairs, leaving a few straggler hairs which look OK and there will be a tiny round scar. If the grafts are bigger, you can remove several small areas in each graft to break it up, or you can remove the entire graft with a larger punch or a strip excision. But the latter would leave a scar that would need to be filled in with follicular units after a couple of months. The second way is to do a transplant proceedure around and in front of the old grafts to hide and camoflauge them. If the grafts are small this works well. If the grafts are large, a more radical surgery may be needed.

For an example of the procedure, please see Dean’s Story.

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Hair Loss InformationIsland of Plugs – Hair Loss Information – Balding Blog

I had hair transplants 20 years ago. When I had them, my hair loss was just starting. Now I have an airport runway on my head and there are these plugs in the middle of my runway (rear of my bald area) like an island in the sea or an oasis in the desert. Can I take these out or do I have to get more transplants?

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Your problem is a common problem which we see wherever crowds gather such as airports and sporting events. This surgery was done in the early days of hair transplantation and as the balding progresses, the plugs are ‘abandoned’ by the surrounding hair. My suggestions would be:

  • You can have them removed if there are not too many, as it should look better than to leave them, but there may be scars remaining after the removal
  • You can have a modern hair transplant procedure performed and bury them in a full-appearing head of hair, assuming the hair supply is adequate. In this way you can finish what you started years ago. The good news here is that the modern hair transplant will not produce these types of results and if it has been 20 years since the last time you did it, I suspect that the hair loss is largely finished and you will therefore not become another moving target, chasing more change over time.

Your question addresses two important problems:

  1. The balding process is progressive in young men unless drugs like Propecia are used to slow or stop the progression. Anything you do that alters the course of your appearance will be modified by the progressive nature of the hair loss. When you had it done 20 years ago, there was probably only some crown thinning so that the transplants made you look fuller. As you continued to bald however, the older plug technique showed itself in all of its awfulness.
  2. These problems can and should be fixed. The good news is that repairs work in most situations to return a person to a normal appearance.

Here is a photo illustrating an “island of plugs” in the crown of a patient before we did his repair:

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Hair Loss InformationHigh Hairline in Teenage Male – Hair Loss Information – Balding Blog

Hi im 18 years old and i have had a high receded hairline all my life. Im thinking that a hair transplant might help lower it and fill in the gaps. Am i a good candidate?

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At 18 years old, that might be a problem because no one knows the status of your genetic balding. You would need to be evaluated by a hair loss specialist, to discuss your options. If you should bald as you age (a 50% chance in most men prior to the age of 45), then moving your hairline down today may be a problem for a long term normal look. Unless you make a living as a model or actor where a high hairline might compromise your earnings potential, I would suggest that you wait for 5-8 years before making a decision to have surgery.