May 2006 – Page 12 – Balding Blog

May 10, 2006

Laser Comb and Transplants – Hair Loss Information by Dr. William Rassman

Hi there. I am a 25 year old UK doctor (straight black hair/olive skin). I first noticed hair loss about 4 years ago. It has progressed at a slow rate. I have not receeded at all but am a diffuse thinner – the main areas are at the front-top of my head (about 1.5 cms behind my adequately thick frontal hairline) and also at the crown.

My hair looks quite thin in these areas when wet (with very visible scalp) but if I blow dry my hair and wear it choppy/spiky/drawn towards the middle, it still looks good and my friends/family don’t think I look bald. I started propecia (with full compliance) 2 years ago with a good result – pretty much halted hair loss and possibly even grew back a little hair in the thinning areas.

However, over the last couple of months I have started to thin a bit further in these areas. I am considering buying a laser comb. (Not keen for topicals).

My questions to you are:
1. I know the laser comb currently has no FDA approval for hair loss but does have good(ish) reviews – do you think it is the most logical next step or should I go for minoxidil?

2. Transplants – (which I realise would be a bad decision at my current level of hair loss): It sounds like for a successful transplant I will have to endure a period of going almost entirely bald first in order to assess what needs filling in and to avoid just losing original hair around the transplants over the following years – is this true or can you transplant around thinning hair?

Thanks

From your writing, it appears to me that you are experiencing male genetic hair loss which has responded to Propecia. I am glad to hear that you have been compliant on Propecia for 2 years, but as you know, Propecia may not solve the problem completely. The science is out on the various laser treatments including the laser comb/brush. As for the minoxidil, you can try it, but I would not recommended stopping the Propecia.

In terms of the hair transplant, there is a delicate balance of timing here. People do not have to go bald to get hair transplants, but preventive hair transplants are not indicated unless the thinning has moved past a particular point (something that a good, honest doctor who specializes in this field should be able to tell you). Patience is a virtue, but failure to make a timely decision is a liability. Quite a balancing act! You need to have your scalp hair mapped out to find out how far back the miniaturization is going, so that you can develop a Master Plan before attempting any surgery.

May 10, 2006

Fuller Hair Volume – Hair Loss Information by Dr. William Rassman

I am aged 23 years old and i am a African American. My hair is long to some sort. It falls to my mid upperback. But i have one problem, its thin. I do not have full thickness and on each side is thin as well. I have never dyed it but have used perms. I may perm 3 times a year about every 4 months. I tried hair thickness oils and all the hair volume supplies u will find in a beauty supply store. What can I do to receive full volume and to cease the thinning on the sides.

The things you are doing may be damaging your hair and causing hairs to break off, making the bulk appear less full and giving the appearance of a finer, thinner hair shaft. The more you treat it and abuse it, the worse it will get. There are hair thickeners that will cause the hair shaft to absorb water, making it appear thicker. Check with your hair stylist for recommendations. This is not a doctor problem.

May 10, 2006

Diet To Help Promote Healthy Hair? – Hair Loss Information by Dr. William Rassman

K doc, I know balding is damn near inevitable. I was wondering, do you encourage a specific diet to help nourish hair? For example, do you want us to avoid certain foods that is bad for our hair or eating a certain food (not drug) help promote healthy hair?

If you are in a civilized country with any reasonable diet, there should be no impact on your hair one way or the other. A poor diet is one that may be deficient in vitamins or calories. Any weight loss of a significant degree can produce hair loss, particularly if it is rapid or chronic.

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May 10, 2006

Continued Balding After a Hair Transplant – Hair Loss Information by Dr. William Rassman

What happens if you continue to bald after you have had a hair transplant?

There is no doubt that everyone that has had a hair transplant will continue to lose some hair. The question is not if, but when and by how much. It has to be put into perspective with your appearance over time. The correct answer to the question is that the first transplant must be done according to a Master Plan, one that anticipates further hair loss so that the look you evolve into will always look natural. If the look is not going to be natural, for whatever reason, then your doctor MUST tell you this at the time he/she performs the transplant. There is a logic to both the balding process and the transplant process and these two processes must be coordinated. I can not go into all of the possibilities of this on the blog, but I wrote a book on the subject which covers the process in great detail, titled The Patient’s Guide to Hair Restoration. Mapping out the scalp for miniaturization may tell you something about what the future has in store for you and you need to have as much anticipation of what may be as you can get.

Just the other day a young man came in to show me his progressive hair loss since his hair transplant at NHI nearly 5 years ago. Much of the remaining frontal hair (going back about 4 inches) is transplanted, but the non-bald areas are receding further back behind the transplanted frontal hair (he moved from a Norwood Class 4A pattern, more towards a Class 5A pattern). He had been told that this could happen and was put on Propecia to minimize either the possibility that this will happen or at the least, the speed by which it might happen. Unfortunately, he had stopped taking Propecia after the transplant was done, because he felt it was not helping grow more hair and since his transplant looked so good he had a false sense of security. Had he continued taking the drug, the progression may not have happened. I don’t know that for sure, though. He elected to now go on Propecia again to prevent further progression, but may be stuck having to undergo another transplant to fill in the areas he lost if the drug does not reverse it in the next 8 months or so.

May 10, 2006

Aspirin and Prostate Cancer – Hair Loss Information by Dr. William Rassman

Below is a medical publication which shows that aspirin or similar nonsteroidal anti-inflammatory drugs taken daily reduce cancer of the prostate risks in elderly men. If it does that on elderly men, think of the great value it would have for younger men who take it for a longer period of time. The link between daily aspirin for prevention of colon cancer and heart attacks have been well documented and generally recommended for all men who do not have a bleeding disorder or specific contra-indications. The saying that ‘An Apple A Day Keeps The Doctor Away’ might be changed to ‘An Aspirin A Day Keeps The Doctor Away’.

ARTICLE: Cancer J. 2006 Mar-Apr;12(2):130-5. Association between nonsteroidal anti-inflammatory drugs and prostate cancer occurrence. Dasgupta K, Di Cesar D, Ghosn J, Rajan R, Mahmud S, Rahme E., Research Institute, Department of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada; Department of Medicine, McGill University, Montreal, Canada.

Prostate cancer is the most common malignancy among men in Western nations. Previous studies indicate that nonsteroidal anti-inflammatory drugs have an inhibitory effect on prostate cancer cells. We evaluated the association between frequent use of nonsteroidal anti-inflammatory drugs and prostate cancer occurrence.

METHODS

We conducted a nested case-control study using medical administrative databases. All men older than 65 years of age who had filled at least one prescription for nonselective nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors (coxibs), aspirin, or acetaminophen between January 1999 and December 2002 were eligible. Among this group, we identified men who underwent prostate biopsy between January 2000 and June 2002 and did not have a diagnosis of any cancer in the preceding 2-year period. Cases were those with a diagnosis of prostate cancer. Controls were those who did not receive a diagnosis of any cancer. Logistic regression models were used to determine associations between prostate cancer occurrence and frequent exposure (more than 4 months) to nonsteroidal anti-inflammatory drugs/cyclooxygenase-2 inhibitors or aspirin during the prior 2 years in comparison with no exposure to any of these drugs, adjusting for age and prior finasteride use.

RESULTS

We identified 2025 cases and 2150 controls. Older men were at greater risk for developing prostate cancer. Exposure to nonsteroidal anti-inflammatory drugs/cyclooxygenase-2 inhibitors was associated with a reduced likelihood of prostate cancer (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.58-0.86) as was exposure to aspirin (OR, 0.84; 95% CI, 0.74-0.96).

DISCUSSION

Our results suggest that among men 65 years of age or older, frequent use of nonsteroidal anti-inflammatory drugs/cyclooxygenase-2 inhibitors and use of aspirin are associated with a reduced risk of prostate cancer.

May 9, 2006

Hair Loss InformationStatus of Hair Regeneration Today – Hair Loss Information – Balding Blog

Most people in the know believe that Drs Walter Unger and Jerry Cooley have stood at the doorstep for the emerging arena of hair regeneration. They have both spoken at various medical meetings on the subjects of hair regeneration and hair cloning and they have been kind enough to comment on the history and status of the field. Included are comments on the company Intercytex from England, the company which has generated a great deal of hype and excitement in the field today, the company I have previously commented on in various postings.

The following segment is written by Walter Unger, M.D.

Having been a consultant for various medical investigations over the years, I know that companies can misrepresent, in a variety of ways, the results of studies and your collaboration with them. We therefore shouldn’t think of the company’s promotional statements as necessarily scientific or formulated/agreed to by the medical consultants that are working with them. Some doctors also use exaggerations in their own promotional material so we probably shouldn’t be too harsh about a company’s promotional zeal.

To put in perspective the results of this company and others it may be worthwhile to remember: when I was doing the cell therapy studies, we could successfully grow the hair follicle cells that we were interested in, in 100% of the cases, growing millions of cells from a single cell with no problem at all. We also could successfully transfer those cells into athymic mice and in almost 100% instances, grow hair on the mice. I was very excited when we got to that stage because I thought for sure we could use the same cells in the human donor and grow hair on them if we could grow their hair on the mice. In fact this didn’t happen; we grew hair on 1 of the first 10 patients and 3 of the 13 in the second study. But the numbers of hairs and quality of hair was not nearly as good in the second group as in the first. It was at that point that we ran out of funding as the sponsor took ill and ultimately died from that illness. What I’m trying to say and what I think most investigators in this field will agree with is that it’s a huge step from laboratory studies to actually getting consistent hair growth in a human. There is some missing factor or factors. I’ve concluded that this project will require some luck rather than just knowledge and hence my relative disinterest in doing further studies at this time.

The following segment is written by Jerry Cooley, M.D.

“I have worked with Intercytex for the past five years. Everyone I’ve met from the company seems very reputable and has a sterling reputation; their staff includes almost 50 at this point and they’re very well funded. They have projects going for skin substitutes, soft tissue augmentation, and even renal failure. By the way, I am not a spokesman for Intercytex and have no equity in the company. My role is to offer clinical input for their product development.

A multitude of labs have consistently regenerated hair follicles in animals and there have been a scattering of reports in humans-Colin Jahoda, myself, Aderans, Walter Unger, PheonixBio in Japan, etc. There is a wide gulf between animal research and human experiments at this point in time. But that’s pretty typical for the biotech pipeline. That animal research is making definite and exciting headway, for example in showing that ‘cloned’ hair does cycle, and that multiplications of 100 fold are possible from third passage cultured human Dermal Papilla cultures.

Not being directly involved in running a biotech company, I can only imagine that there is tremendous pressure on these people to generate media coverage for their ventures to keep the public and especially investors interested. You don’t get very far by telling reporters, “I’m not really sure how all this is going to turn out”. Many pioneers in surgical procedures created exuberant publicity for their techniques even before they were perfected, and it often had its unsavory aspects. Nevertheless, that publicity led to greater public interest and ultimately acceptance of follicular unit transplantation and megasessions. Perhaps we will see the same pattern play itself out with cell therapy.

May 9, 2006

Where Do Doctors Get Hair Transplant Training? – Hair Loss Information – Balding Blog

Where do doctor’s get hair transplant training? What credentials should I look for?

Block Quote

Since I wrote this extensive answer to a similar question in the past, the International Society for Hair Transplant Surgeons have attempted to address the problem with little success. Although standards are now known, training is still an unsolved problem.

Please see my post from April 2005, Hair Transplant Doctor Training for the previous response.

May 9, 2006

Thank You Dr Rassman – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

I had a hair transplant about 5 weeks ago. After decades of “living” (and I use that term loosely) with Ludwig 1-2 FPB, I cannot tell you how excited I am.

This note is just to thank you for all the information on this website. You cannot imagine how helpful you have been.

God bless.

Gratitude is the best part of the business I am in. Anticipating hair growth is part of the excitement. I hope that you get what you expect, but do not forget that when I do the surgery, you have a partner in the process and I, like any good partner, is there for better or for worse. The good news about this business is that most of my experiences are for better, and that type of outcome is because I take extraordinary lengths to be sure that the expectations of each patient is properly set.

Thank you for your nice note.

May 9, 2006

More on Cipla’s Generic Finasteride – Hair Loss Information by Dr. William Rassman

After the post from yesterday (Fincar, Forcan, and Candid-B), I dig some more digging and found that Cipla is a pharma company in India that does not honor US patents. Apparently, as of late 2005 the country has agreed to enforce patents for new products, but not for products already pirated. So Cipla produces its own version of Proscar to be sold in India. This product is illegal to be used or sold in the US, and there is no way to verify that the product is manufactured by Cipla or even contains finasteride when the product is bought over the internet.

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May 9, 2006

I Lost My Hairline to a Mascara Brush – Balding Blog

i’m a 26 yr. veteran cosmetologist and surprisingly i lost my hairline to a mascara brush trying to cover the gray hairs! i thought i was being gentle by using no hairdyes and no relaxers,but with my luck i guess the curly hairs caught onto the brush wand.i don’t wear weaves,braids or ponytails.never in 43 yrs. have i had a problem with my hair falling out.i’ve been massaging these areas and using nioxin ,i’ts been almost 7 months and no hair in sight.also why is it that i can pluck my chin hairs several times a week and they grow back overnight?what’s the difference in these hair follicles vs.the scalp hairs?i did see a few white bulbs at the end of some of the hairs but didn’t pay it any mind cause the gray was covered! my girlfriend told me that a doc. gave her clobetasol cream to rub on her scalp when her hairline fell out from ponytails and she said it took her months to get to a doc. after the baldness and it grew back.last guestion if you still see a hole where the hair came from and the skin is not fused or scarred shut does that mean it is a possibility that the hair can grow back because it is not nickle smooth?

In answering this, I will first assume that this writer is a man — I apologize in advance if I’m mistaken. It is unusual that one plucking of a hair will result in permanent hair loss. I would certainly wait a year before assuming that the hair loss is permanent and with a pore present, that might suggest that the follicle may yet return. If it does not come back, you might have plucked out part of your juvenile hairline, which in many men is not permanent. Plucking out non-permanent hair like this or hair that is impacted by male genetic hair loss, may not return. For a woman, the juvenile hairline is called a female hairline and is stable for most of a woman’s life, so although I would still wait a year or so, the causes for failure of hair to return are not as well defined here.

With regard to clobetasol, it seems that this is part of the homeopathic drugs that are not well documented in their benefits. Lots of chatter about it on the internet, nothing firm from any credible source.

I have many questions for you: Are you male or female? Are you balding? Is the entire frontal hairline plucked out, if so how far back? I would expect that some of the frontal hairline must still be present. Did you use some harsh dye that could have damaged the hair follicles? The benefit of the FOX/FUE technique is that it cause no noticeable linear scar in the donor area. In term of shock loss, I believe that it is due more to making site at the recipient area than the harvesting area in the back of the head. I have seen diffuse hair loss due to the stress of the surgery. It is hard to predict shock loss, though the pattern has been more common in patients who have an active process of hair loss going on.