December 2005 – Page 13

December 8, 2005

Transplanted Hair Characteristics – Hair Loss Information by Dr. William Rassman

Hi Dr Rassman,
Does hair from the neck change structure when it gets on the top of the head? And how long will that take if it does ? I mean does hair fit in properly with your original hair in the front of your head or is there a permanent difference ? The micro “scars” you will get in recipient area will they ever heal 100 % ? If you later in life choose to shave your head can one notice something on the skin in recipient area ? Best regards

Scars are scars and they always show. Depending upon what type of scars and where they are placed, the scars may be less obvious. Scars in the neck always widen and are always visible. The neck hairs used for transplants are often lost with time as these hairs are not permanent like the hair above, in the back and sides of the head. Transplanted hairs usually follow what they looked like from where they were taken. On rare occasions, the hair becomes wavy or curly. I remember one case where a patient’s transplanted hair became kinky, and he loved it. It was what he wanted and that made me happy because I always want to please the patient (but I personally did not like the look). Clearly, the grown characteristics are not in the control of the doctor when a hair transplant is done. The good news is that changes beyond what the original characteristics of the hair are rare.

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December 8, 2005

Revising Donor Scar – Hair Loss Information by Dr. William Rassman

I had a strip hair transplant done a couple of years ago, was unhappy with the results, and now shave my head. The scar on the back of my head is 5-6″ long. What are my best bets for revision?

Many thanks

A scar, which is present in 100% of all patients who have strip harvesting, is usually under 3mm in width and although noticable with a shaved scalp, they can be well covered with any reasonable hair length. With that said, if your scar width exceeds 3 mm, then you should consider seeing an expert to have the scar removed and the incision closed with a ‘fascial’ closure and without another hair transplant, minimizing the tension on the wound. If the scar is 3 mm or less, than an FUE procedure would be a good technique to use for your scar revision, which would transplant hair directly into the scar from the surrounding areas. The FUE technique, which has been defined by us, will eventually cover the scar, but it might take a few small procedures to get there.

December 8, 2005

Lateral Slits and Transplanted Hair Direction – Hair Loss Information by Dr. William Rassman

Suppose a patient has had two non-lateral slit transplants by doctor A (who is reputable), and goes for a third operation with doctor A (who now advertises use of lateral slit)-should doctor A perform a lateral slit transplant on the same patient, or continue with the same method of the previous two surgeries? Also, does the lateral slit method deserve the positive “hype” it receives on hair transplant sites? Or, is the difference slight and subtle and even overrated? Finally, when a transplant has been completed and the required one year waiting period ends, if hairs appear to grow straight up from the scalp, would you deem this to be a poor transplant? In my case, it appears that the hairs come straight out of the scalp, but lean or lay down-perhaps because of the weight of the hairs and also because of how I comb the hairs.

Switching between lateral and vertical slits are not a problem, but the learning curve for staff is a problem and those with experience in vertical slits will not just simply become experts in lateral slits without some experience.

I like the idea of lateral slits because it forces a bend of the hair as it exits the scalp forward and downward. In addition, the concept of fencing (where hair within a follicular unit appear like a fence/wall) should enhance the value of the grafts. Now with that said and the great theory, the realities are that no one has really demonstrated the value of lateral vs vertical slits, side by side. I have massive experience transplanting with vertical slits beyond 4 years ago, however I do lateral slits because it makes sense and it is in vogue, not because I am convinced that the results are better than those of the vertical slits.

If transplanted hairs grow straight up or to the sides, it usually reflects the way the surgeon put them in. I have seen people who had radial placement of hair with straight, strong hair and the hairlines look like bicycle spokes — not a normal hairline. Last week, I saw a patient where the hair was put in pointing to the right. The patient wanted to comb his hair back but because of a strong hair character, it always pointed to the right creating an unnatural appearance. This is a problem of strong haired people, not soft haired people. Hair characteristics tend to dominate in some people, impacting the way hair can be groomed.

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December 8, 2005

Is Chlorine in Water Causing Hair Loss? – Hair Loss Information by Dr. William Rassman

Hi,
I came to Dubai 2 months back and from the beginning I am losing my hair very fast. When my hair is wet during the shower, it falls out even when I just touch them. I never had any problems with my hairs in my life. My hairs were very strong but dry without dandruff. After a month in Dubai I was feeling a little itching and I saw I was having dandruff, although I don’t have much dandruff now, but it has started. I heard Dubai water is not good for hair because it contains chlorine. I don’t want to lose my hairs and want to grow them big. I was using Vatika shampoo before Dubai and now here I have started using Sunsilk egg and also use oil to keep my hairs soft. My hairs are just falling, how to stop them and make them dark, strong & black. Which shampoo should I use. How is Head & Shoulders? Help me.

Again and again, I tell my patients that they need a diagnosis. You are grasping for straws until you get properly evaluated with a mapping of your scalp for miniaturization. Please see a good doctor first, get examined and have a proper diagnosis in hand, then look for causes if the hair loss results from other outside factors. This, a good doctor can tell you. Chlorine should do no more harm to your hair in normal therapeutic doses than water without the chlorine.

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December 8, 2005

Hashimoto’s Thyroiditis and Hair Loss – Hair Loss Information by Dr. William Rassman

Dr. Rassman,
I am very concerned about my hair loss. I am 19 years old. I have been diagnosed with hashimoto’s thyroiditis; however, according to my most recent blood test a few weeks ago, my hormone levels are currently at a normal level (and have been for almost 6 months). The levels have been moving up and down over the past few years (hyper/hypo/normal). I am still experiencing a lot of hair loss to the point where there are some bald patches. The level/amount of hair loss actually has seemed to be increasing over the past few months. I am on no medication. Do you have any suggestions/advice? Would going on synthroid be a good choice? I am in college in Washington DC and am originally from Connecticut. Can you recommend a doctor or specialist for me either in DC or CT or a surrounding area? Thanks so much!

I would recommend Dr. Robert Bernstein in New York and New Jersey. You clearly need a good clinician to help you evaluate the various contributing factors associated with the fluctuating hormones and the patches of hair loss, which might point to other autoimmune causes of hair loss.

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December 7, 2005

Hair Loss InformationScarring After Hair Transplantation – Hair Loss Information – Balding Blog

I had a transplant at your L.A. Clinic in November 97. I have been reasonably happy with the results & would consider another transplant but I’m concerned about the scarring. Could you tell me what the extent of a 2nd transplant might have on the existing scar.

Thanks

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Scarring is becoming less of a problem with the new method of closure we instituted a year and a half ago. Even for those who usually develop heavy scarring, we now have ways to treat these scars.

The new technique for preventing scars is what I call a modified fascial closure to the area where the scar might be a problem. I now use this technique in all of our patients. If a scar should occur, although it is rare with this new technique, we will attempt a scar revision (as the sole surgery without a hair transplant) at no charge. With a scar revision of any existing scar, the chances of improvement are as follows: 60-80% of patients will show some improvement, 50% will show a moderate-good improvement, 10% will show no improvement, 5% run a ‘risk’ of making the scar worse and 1-2% run the risk of making the scar much worse (although I have not seen that occur over the past 18 months or so since I perfected this new technique). The key to minimizing risk is to be conservative with the surgery, yet radical with the repair.

These are my three approaches to scars:

Scar revision with a modified fascial closures
Transplants into the scar with the Follicular Unit Extraction (FUE) technique (this is applicable and can work well in almost all patients)
A balloon reduction (a radical approach to severe scarring usually caused by burns, car accidents, and following brain surgery)

With all of that said, I would doubt that scarring is a significant risk, but you can do a FOX Procedure (also known as FUE) which is removing one follicular unit at a time. The scarring is punctuate (small round 1mm wounds) that can only be seen if you shaved your head, but not with a close crew cut.

For more information on FUE / FOX Procedure, please see:

December 7, 2005

Remaxx – Hair Loss Information – Balding Blog

2 quick questions…
I am currently taking propecia but have been reading on the web about the effectiveness of avodart which seems to be substantially better than propecia. Would you advise taking it if I could get my hands on it?(it seems like I could get it from overseas UK pharmacy’s)

Also, have you ever heard Remaxx products? I went to a Dr. for a consult and he said post-op that they have a couple of products that would be beneficial. Basically, a shampoo, conditioner, and replenisher. Have you ever heard of this co.? Any help on these subjects would be great.
Thanks

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Avodart is discussed heavily on this site. You can see all of the articles referencing Avodart here.

Remaxx products show an extreme and unrealistic / unbelievable before and after photo. When they look unbelievable, I generally take a dim view of the company and its products. These products are just another offering in a mass market of claims galore for hair regrowth.

December 7, 2005

Finer Hairs at Hairline – Hair Loss Information – Balding Blog

Hello Dr.Rassman,
I am a 29yr old caucasian male who has over the last few years been dealing with questions of hairloss. Thus far there is nothing dramatic to speak of – no noticably thinning or balding areas. There is however one thing that has led to a good deal of concern – it can best be described as light or whispy hair around the frontal hairline (from temple to temple). My hair has always been quite fine in nature and until a few years ago a light brown color rather than the dark brown it has become. In recent years I have grown my hair out quite long – opting for the ‘rocker’ look as friends call it. If I pull my hair back I dont notice any loss at all – it looks like a regular hairline – but the hairs that make up the first cm (rough estimate) are lighter in pigment and fine in composition compared with hairs deeper in the scalp. Aside from the minor difficulties this phenomenon creates when attempting to style my hair I’ve been wondering if this is an example of the ‘miniaturization’ process that you have described. I have no signs anywhere else of this phenomenon – just the fringe of the frontal hairline. No crown thinning, no overall diffuse thinning, no temple thinning – and that is what is driving me crazy! If it were more extreme I would be prone to take some action be it drugs, topicals or other treatments. With this said however the lack of action kills me just as much because I wonder if I’m not acting when I should be – nipping my possible hairloss in the bud so to speak. Please let me know if you feel this is an example of ‘miniaturization’ or not and any course of action I should consider taking. Thank-you.

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To really answer your question directly, you should be examined and have your scalp mapping of your hair for miniaturization, which is best done under magnification with a visualizing high power microscopic tool, like our densitometer. Fine hairs often exist in the very front of the hairline, but in regards to what you refer to, I am not sure if you mean the mature hairline that has probably evolved from your child hairline (age 10 or so), which is often lower and thicker. I would want to see pictures and possibly meet with you in person to make such assessments. If you’d like to send photos, you can email them to the address on the Contact page.

December 7, 2005

Why Does Accutane Cause Hair Loss? – Hair Loss Information – Balding Blog

Hello Dr. Rassman. I’m a 25 yr old female and I recently took accutane for 6 months(have been off it now for 7 months). I knew hairloss was one of the side effects but I took my chances. My hair was fine during the whole treatment…didn’t have any thinning whatsoever. About 5 months ago, however, my hair started thinning and has gotten progressively worse since then. It’s especially thin on the sides above my ears, and my hairline is much thinner. The top of my head is much thinner also. I don’t know what to do. I don’t know what accutane does to actually cause the hairloss, it would probably help to start there. I’ve been reading online about what others in my situation are doing and I started on the Nioxin hair system, started taking milk thistle for my liver, and a B-Complex vitamin to help with the hairloss. My doctor said to wait it out and that it should be temporary. I don’t really like that idea. It keeps getting worse and I want to put a stop to it. Please help me! I’d appreciate any information you could spare…thank you so much

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I am not certain of the specific mechanism causing hair loss by Accutane. The package insert of Accutane stated that this drug may lead to alopecia, but it was rare. Accutane causes dry skin, skin fragility, erythematous rash, vasculitis, and decreased red blood cell formation which may contribute to hair loss. In general, Accutane may contribute to hair loss by creating a not so optimal environment for hair growth and it clearly does impact the glandular elements of the hair, which will make the hair dry and fragile as the amounts of sebum production drops. Rogaine may help improve hair loss, but it also drys the scalp further. I recommended that you see a dermatologist to evaluate your hair loss in person. However, there are many causes of hair loss which also must be evaluated, such as thyroid problem, eczema, infection, autoimmune problems, weight loss, stress, etc.

December 7, 2005

Natural Looking Hairlines – Hair Loss Information – Balding Blog

Dr. William Rassman,
is it possible to restore the original hairline through hair transplant since my hairline had receded so much but not completely bald & its really affecting my self confidence. is it too early for me to undergo this procedure or should i go ahead? whats the best hair transplant method that gives a more natural looking hairline? thanks

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You did not state your age and without a photo it is impossible to go into detail about whether a procedure is right for you or not. Hair transplantation today can be and should be undetectable and able to produce a completely natural hairline. The appropriateness of the surgery depends on the individual assessment of each person. There are hundreds of patient hairlines on our website, and you are invited to come to one of our open house events in Los Angeles and San Jose to meet patients directly, so you can see for yourself what can be achieved.

For a great example of what is possible in hair transplantation, please see the Steve Hartman feature on the NHI site. There are larger photos available on the previous blog entry, Where Are the Celebrity Transplant Photos?.