Month: January 2006

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Hair Loss InformationPimples After Surgery Caused Skin Change – Hair Loss Information – Balding Blog

Dear dr. Rassman. Thank you for having time to answer questions concerning hair loss.

I am a black man. I had an FUE operation about 6 months ago. The donor area at the back of my head healed very well, but in the receiving area I got small pimples almost in every grafts incision (1000 grafts) in the front area of my head which looks different from the rest of the smooth skin. The hair is growing but it is not that dense to cover this area. These pimples are well seen especially from certain angles or according to the light reflection. I am really worried about if these skin changes will be permanent. What shall I do? Do you have any advice for me???

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Pimples can be caused by sebum collections below the skin edge, but should have gone away within the first few months. FUE grafts should be trimmed, for if they are not trimmed and divided into their respective follicular unit, they will contain too much skin. The added skin will produce a skin deformity at the recipient site like the cobblestonning I talk much about in my published articles. The way light is reflected is an indication that too much skin may be have been left on the FUE graft or that the FUE graft was not separated into individual follicular units. Rarely, people with dark skin will tend to cause more scarring than those with very fair skin. Changes in the recipient area with a hair transplant do occur if you had atrophic skin (skin that lost much of the supportive infrastructure from blood vessels to glands, muscles and fat) or your hair is coarser, or if the surgical instrument used was large (by large I mean greater than 1mm, as a slit graft) or combinations of any of these factors. Today’s surgeons will use very small cutting instruments to minimize the skin wounds, hence the pitting or skin changes that could occur when the wounds are made too large. Skin deformities in the recipient area are rarely detected with small cutting instruments. Without seeing you directly, it would be hard to determine if any of these factors (or other factors) are playing a role here. I would expect that most people should not have this complaint, but just the other day I met a patient who had surgery from another medical practice with a similar complaint and I barely could see what was bothering him. This man had a body dysmorphic disorder. To determine your situation, either come in to my office (if you are in California) or at the least, send photos to the address on the Contact page.

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Another Procedure to Thicken the Hairline – Hair Loss Information – Balding Blog

Hi. I have a few questions for you that I hope you can help with.

First off, I have had multiple transplants so I would ask you not to insult me by sending me advertisement-type answers. I found you by Google searching so I don’t know much about you.

As I stated I have had multiple transplants. Dr. X and then Dr. Y were the two physicians I met with. Dr. Y’s scars from the donor area are rather large, Dr. X’s less so. But I did have a problem with one large graft falling out that essentially left a small ‘holish’ scar on my bald spot in the back of my head. Something I am not happy about but it is not that bad.

My hair is thin. It always has been. I am 39 years old now. I do not think I have much hair left to give from my donor areas without the back of my head starting to look bald too. I am right at the brink of what is acceptable re-distribution of the hair from the back of my head to the front of it.

It seems like you are strictly a hair transplant outfit but I thought I would ask for your opinion anyway. I do not think of myself with a full head of hair, I just want enough up front and even on the bald spot to have a stronger looking hairline overall. What would you recommend? Thank you for your time.

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To address your question, you need to be evaluated directly. As you are local to Los Angeles, I ask you to please visit our open house on January 12 to meet some of the repair patients we have done. We have an open house event every month in our office if you can’t make this one. Read our repair articles published in respected medical journals, and get a private consultation to walk away educated with your options clearly defined. I will not insult you with propaganda and if you look at our website you will see that we are quite professional in the way we manage the medical hair restoration practice.

For more information about repairs, please read these articles:

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Hair Loss InformationThinning Hairline in African-American Woman – Hair Loss Information – Balding Blog

I am a 42 y/o black female. My hair started thinning around the hairline about 2 years ago. At first I thought it was some of the chemicals being used by my hair stylist. I have changed to another stylist, but the problem persits. I recently went to a dermatologist who started me on Rogaine. However, the site for Rogaine states that it is for hairloss in the top of the scalp. Is there any treatments that will help thinning hair around the hairline? I understand that this is uncommon for women? Please help, this has effected me emotionally.

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There are a few important issues to address in your question. The first thing to note is that all salons use similar chemicals so you might want to stop chemically treating your hair altogether for several months to see if it recovers. The second issue is whether or not you have a tight braid/ponytail type of hairstyle or have had recent facial plastic surgery (like a brow or a face lift) since both of these can result in the hairline thinning you describe. You are correct in that women rarely lose their hairline with female pattern/genetic hair loss, but it can happen and that is why you should be examined by a doctor who specializes in hair with an indepth assessment for miniaturization.

Finally, Rogaine has been studied best at the top of the scalp, but I have seen some hairline results in women so it is worth a try. Unfortunately for women, there are no medical alternatives for thinning hair other than Rogaine. It is also noteworthy that hairloss can profoundly affect a woman’s emotional health, much more so than with men although men suffer hairloss more commonly. I would urge you not only to proactively address the hair loss, but to take steps to treat the emotional impact it is having on you as well.

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Waxy Substance Attached to Lost Hairs – Hair Loss Information by Dr. William Rassman

Hello, i am a 21 yr old male who has been noticing hair loss for about 3 years. It is becoming evident now more then ever. My hair line is reciding and thining on top. One thing i have noticed is when i look at the hairs that have fallen out of my head there is always a tiny white/light yellowish waxy ball attached to the bottom of it. I also notice them in my hair. What could it be? I have talked to my doc about propecia and will probally start that.

thank you very much!

That little ball at the end is either the bulb of the hair, a normal part of the hair that is often present when it falls out, or a tiny plug of sebum (waxy protective substance produced by the hair follicle) which is also normal.

By the way, contrary to popular belief, plugging of the hair follicles by sebum, oil, or other substances is not the cause of genetic/male pattern hair loss. Often people think this because when they start to lose hair they also start to see the shininess of their scalp which was previously covered. You will be addressing one of the main causes of hair loss (DHT attacking and weakening the hair) by taking Propecia so that is a good first step.

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Transplanting to Thinning Areas – Hair Loss Information by Dr. William Rassman

I am 21 and had wavy hair that is receding and thinning on top and in back. I worry that if I get this transplant procedure done to early that it will not look right. I am not bald but yet but the recede bothers me. How do you cope with filling in thin areas where hair is still falling out around it.

First, you need a diagnosis with a good mapping of your scalp for miniaturization to find out for sure that you have genetic hair loss. You are correct that surgery is not the first stop along the path to deal with your hair loss, but probably the last. There are effective medications. Please get a diagnosis first, then a master plan on what to do next.

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Transplanting a Norwood Class 2 – Hair Loss Information by Dr. William Rassman

Dr. Rassman,
I am 21 years old and I have been losing my hair since I was 16. I am now a solid norwood II and I am getting to the point where my hairloss is a cosmetic issue. I started using propecia, but I experienced the side effect of gynocomastia which fortunately subsided when I stopped using the product. Unable to use propecia, I feel a hair system or a transplant are my only options. Am I a candidate for a transplant considering that my hairloss will have to be chased across my head with multiple and frequent transplants? Thanks for your site. It offers a much needed service.

There is a need to establish a good solid relationship with a good doctor for someone like you. Having tried Propecia and developed a side effect, clearly you are doing the right things. A good baseline for miniaturization needs to be mapped on your head. Both you and your doctor must be able to command just what is happening to you and project what might happen and when. With that relationship in hand, you will be in a better position to analyze your situation. I personally think that if you start off with a hair piece, you will absolutely accelerate the hair loss process. Again, get a good doctor and work with him/her before undergoing something as radical as a hair transplant at your age. With that said, anything is possible if it is well planned out with a good Master Plan for your future in hand.

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Masturbating and Hair Loss, Again – Hair Loss Information by Dr. William Rassman

How do you conclude that mastrubating will not effect hair fall (baldness). After that you body generates a lot of heat.. so i think even that may lead to baldness ?

Just a few days ago, I posted a blog entry on Masturbation and Hair Loss. We all sweat from jogging and exercise and yet that does not cause balding. You are misguided here, but as I said, don’t stop masturbating or having sex in the hope that hair loss will not occur. Masturbation and our sexuality is part of being a normal sexually active man and sex is one of the fruits of life.

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Hair Loss InformationTidbits: Balding in Indians and Asians – Hair Loss Information – Balding Blog

A few times each month, I will post some random hair-related information, which I’m calling “tidbits”. I spend hours each day writing responses to questions I receive on this blog, so it is a nice change of pace. For example…

American Indian

The American Indian (or Native American, if you prefer) has no genetic balding if their ancestry is from the Alaskan Bridge. American Indians that came to North America from Central America can have genetic balding. There has been no explanation why the American Indian does not have genetic balding, making him unique amongst all men (except those born with genetic defects in the DHT making enzyme or those who eat large amounts of DHT blockers in their diets, a group of primative people from the Central American rain forest).

The observation that men from Asia, India, or China have less balding is certainly not a reality today where the wig business is thriving. A theory put forward by Dr. Masumi Inaba in his 1996 book “Androgenetic Alopecia” claimed that there was more baldness in the post WWII Japanese men than in the earlier generation to which he belonged. I think that he attributed this to dietary change and in particular, to more saturated fat in the Japanese diet. The same theory, if true, could apply to Indians, who have only a small meat intake back in India (strict Hindus eat no meat at all). Dr. Inaba’s theory never gained any credence then or since, but history shows that if his theories are proven correct, he would not be the first scientist to be proven right a decade or more after his death.

History points to insights as we get further away from the facts as we see them. Dr John Snow back in the mid 19th century proclaimed that Cholera came from contaminated water while most other “experts ” believe it was transmitted by bad smell (the “miasma”). The entire London sewerage system was designed to get rid of the stench that permeated the city every summer (and coincided with cholera outbreaks) . The sewerage system was an engineering marvel with the worlds largest pumps and miles of brick lined tunnels. It got rid of the smell and coincidentally got rid of the source of water contamination and cholera became very rare. The cholera organism and its lethal effects were not discoved until many years after Snow was dead and buried. (This last paragraph was written by Dr. Richard Shiell of Sydney Australia)

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Hair Loss from Tuberculosis? – Hair Loss Information – Balding Blog

My 17 years old daughter was diagnosed with inactive tuberculosis about 8 months ago and has been taking INH. However, about 18 months ago she started losing her hair. Could this be caused by the tuberculosis alone?

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I have written on this medication with tuberculosis before (see Tuberculosis Drug and Hair Loss). The disease itself is a wasting disorder which is known to produce hair loss, as with other wasting disorders. The same recommendations I made before apply: good diet and appropriate vitamin therapy. A full work-up for female hair loss is in order here as there are many diseases that cause hair loss in women (see Female Hair Loss category). Read these pages carefully and seek out a good doctor to follow through with a thorough examination of your daughter. Also, you might want her to see a hair specialist who will study her for female genetic hair loss and assess the miniaturization of her hair to see if the pattern is typical of female genetic hair loss.

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Coverage with FUE – Hair Loss Information – Balding Blog

I’ve heard that 20 to 40 fue per centimeter is recommended.Is this true? Does this give someone enough coverage? What do you recommend? I hope I asked the question correctly.

Thank You

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This is a good, but difficult question to answer. What you are really asking is: “What density of follicular units is enough to give you good coverage?” Whatever the harvesting mechanism used, (FUE or standard strip harvesting) the amount of density achieved reflects fullness as modified by hair and skin color, hair thickness of each hair shaft, and the character of the hair (curly or straight). The health of the scalp determines just how close you can place the grafts (for scalp that is atrophic and lost its infrastructure of blood vessels, glandular structures and fat less densities are often better).

The normal density of a person is 100 follicular units per square centimeter (200 hairs), so clearly the amount that is placed will depend upon what you buy, the size of the balding area, etc. For blonde people, low density is often able to look full, while in a black hair person with white skin, higher densities are often needed.