May 2006 – Page 13 – Balding Blog

May 9, 2006

I Can’t Take Propecia, I Don’t Want to Bald – Hair Loss Information by Dr. William Rassman

Dr. Rassman, what approach do you take with young men who are not able to take Propecia. Do you never do transplants in them? Do you sometimes do transplants? I am a norwood 2 going on a norwood 3. I am considering getting small transplants to keep up with my hairloss starting in about a year when I will be 23 years old. Is is a bad idea? Going bald is not an option for me, so its either transplants or a system.

I hope you read the blog entry from last week where a patient whom I did not recommend getting a hair transplant was not happy with my recommendation and got a hair transplant from another doctor. Now he is worse off and more bald because he lost more hair due to shock loss.

I would not normally recommend a hair transplant to a Norwood class 2/3, but every patient is different and it would be impossible for me to give you personal medical advice without a person to person consult. You may be a Norwood 2/3 now but without a good exam and a good medical history, there is no way of knowing what Norwood class you would be at the age of 50 (this is where the Master Plan comes in). If you have miniaturization in the areas behind the frontal corners (like the top and crown of your head), then it would be suggestive that you are in for a lot of balding in your future and fixing a Class 2 pattern may not be good timing just now. Alternatively, if there is no miniaturization in the rest of your head and your family history does not show advanced balding, then maybe with the right doctor / patient relationship, a hair transplant could be considered. I am not excited about the idea of doing a hair transplant on someone with such a pattern and at your age, because the pattern of your future hair loss is not going to show up for another few years.

I would also question why you are not able to take Propecia.

May 9, 2006

Hair Loss in UK – Hair Loss Information by Dr. William Rassman

Everything in the following article is not completely accurate, but worth reading if just to get another cultural variation to discussing hair loss. In reference to comments in this piece about Elton John’s hair transplants, I believe that he does wear a hair system (wig) and did not have a successful outcome for hair transplants as he received them in the early days when the technology was deforming. They call him a toupee wearer, but also say that his transplant was effective. I guess it could be weaved into his hair system to keep it on his head, thereby being effective in that way. Aesthetically though, it can’t be good.

From Mirror.co.uk on May 4, 2006 – Keeping Your Hair On

May 9, 2006

Difference Between FUT and FUE – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman,
Thank you for the very informative blog. My question: what is the difference between FUE and the strip surgery? What are the advantages and disadvantages to each? And do you perform both procedures?

Briefly, FUE is more expensive and time consuming and will yield less hair grafts due to the longer procedure time and technical complexities. FUE, however, does not leave a linear scar seen in the “strip” surgery. The traditional “strip” surgery is more suited for large hair transplant sessions. It does produce a linear scar, but with new scar reducing techniques such as the trichophytic closure, it is a great surgery for patients who want the most hair in one session.

Finally, our surgeons at NHI are very proficient and well trained in the FUE and the “strip” procedure. In fact we wrote the pioneering medical article on Follicular Unit Extraction (FUE). And way back in 1998, Dr. Jae Pak (with his engineering background) and I had developed an automated video FUE technique, which was awarded a U.S. Patent.

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May 8, 2006

Hair Loss InformationTransplanting Chest, Leg, and Thigh Hair – Hair Loss Information – Balding Blog

I have read some doctors preaching the use of chest and leg hair for hair transplants. I have also read your comments and general lack of enthusiasm for this. What is behind your strong opinions against this?

Block Quote

Scalp hair is better understood and tested for over 50 years. Although the art form has only been reasonable for the past decade or so, the facts concerning hair growth from a scalp source as donor hair are well understood. It is always important for me to inform patients about their risks, expected growth rate, and reasonable results that they should target. We have no body of evidence that hair taken from body or leg parts will work to any reasonable degree, but there seems to be (as P.T. Barnum said) a sucker born every minute. I do not want to be part of such a process, at least until it is clarified as something real.

In the book by Elise A. Olsen, Disorders of Hair Growth, the rest cycles of hair are stated. Although I can not attest for the science of these figures, let’s take them at face value for a moment and see what it means if correct. All hair cycles go through various growth phases, so the length of these growth phases are critically important to understand. For head hair, growth cycles range from 2-7 years, with a sleep period of 3-6 months. Generally it is believed that head/scalp hair is in its resting phase for about 10% of the hair population, which means that of all hairs growing on the head, another 10% is lying dorment awaiting its growth phase.

Leg hair has a cycle between 7-12 months, but between 62-88% of these hairs are in their dormant phase.
Thigh hair has a cycle of 3-5 months, but between 64-83% of these hairs are in their dormant phase.
Arm hair have a cycle of 3-7 months, but between 72-86% of these hairs are in their dormant phase.

With chest, arm, and body hair, the above numbers suggest that there is a large number of sleeping follicles at any one time. If this is true, then there will be questionable value from a hair transplant using these body parts from fullness or coverage point of view. Add to that the pain of hundreds or thousands of small wounds created all over your body might produce. I wonder about the doctors who are routinely performing this type of surgery and ask about their motives. I have concluded that any doctor who offers this must let his patient know that this is not a tested procedure, falling in the experimental rather than the clinical hair transplant offerings. I’d also hope they reveal the figures related to sleep cycle of the hairs from the various body parts as discussed above so that their patients are well informed.

May 8, 2006

Redness and Hair Loss After Transplant – Hair Loss Information by Dr. William Rassman

I had a transplant one month ago and am now very nervous. I was told that shock was NOT permanent yet on one of your blogs from 2005 there is mention of shock loss in balding areas as most likely being permanent. Yet if you took propecia prior to surgery, this shock could be prevented. I had not been given that instruction and have not only been experiencing shock loss in the frontal area, but still have redness that I thought would be gone after 7-10 days.

Is there a risk that the redness is permanent? Was I given bad advise about the prevention of shock loss (does propecia work in the frontal area). I wish I didn’t sound like I’m going off the deep end but this is all pretty unfamiliar territory for me. Please let me know your thoughts.

Redness will almost certainly go away with time. You might try hydrocortisone cream 0.05% and apply it to the red area in three or four 12 hour applications per week. Do not use it chronically, because steroid creams do get absorbed by your body.

If you are a young man and had transplants without taking Propecia, you run a high risk of shock hair loss that can be permanent. The loss usually commences with surgery or a few weeks after the surgery and runs its course over a few months. If the loss is in the area where the transplants were done, or in an area where you were balding prior to the surgery, the risks are higher. You might try to get a prescription for Propecia and maybe you can still save some of that hair.

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May 8, 2006

Paxil and Hair Loss – Hair Loss Information by Dr. William Rassman

Hi Doctor,
I started taking Paxil about 3 months ago and have recently been expieriencing increased hairloss. Prior to taking paxil I hadn’t expierienced hairloss for about a year. Do you think there is a connection between the paxil and the hairloss, and is the hairloss irreversible if it is?

It is not clear if you are male or female, which is important in the way I construct the answer. I will assume that you are a male. If you had hair loss 1 year ago when you were not on Paxil, maybe this a coincidence, maybe not. Hair growth and hair loss both go in cycles, so perhaps you just kicked in the loss cycle.

As I stated in a blog entry from just last week, but it is worth repeating –

I have three important points to make with regards to medications causing hair loss:

Before identifying a drug as a possible cause of hair loss, you should find other medical causes.
People take medications for a health problem. You should not stop taking a medication just because you think it may be causing hair loss. Your health should come before your hair (especially if you are not certain that the medication is causing the hair loss).
Most importantly, you should follow up with your doctor for medication changes and concerns.

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May 8, 2006

Oxycodone and Hair Loss – Hair Loss Information by Dr. William Rassman

My husband is taking oxycode 40 mg. twice a day for his illness, but is losing a lot of hair. He is also on a few other meds for high blood pressure and cholesterol, and narco for pain. Could this be causing the tremendous hair loss?

If his illness is a chronic illness, I would think that this is the first place to look for hair loss causes. I need to know more about his chronic disease to answer your question intelligently. Oxycodone is not the most common drug that is known to cause hair loss, but it has been reported to have hair loss as a rare side effect.

May 8, 2006

Laser Brush vs Other Laser Treatment – Hair Loss Information by Dr. William Rassman

Is the laser hair brush as effective as the laser treatment (sitting under the laser light) which is available?

Unfortunately, there is no information on either the value of the big sit-down laser units, the different type of sit down units or the laser brush/comb, let alone a comparison between the them. Sorry, but I can not help you here but hope that some objective studies will be presented to help us all out.

May 8, 2006

I Lose Hair In The Shower, But My Friends Say They Don’t – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,
Im 17 an i have been noticing when i shampoo im losing quite a bit of strands, i know its common to loss up to 100 strands but i ask my friends if they lose any strands of hair in the shower an they all say no. Also none of my family members have ever gone bald, so does this mean that i can or cant go bald?

Shower You are correct in that 100 (and even as many as 200) hairs a day and is normal to lose. Hair grows in cycles, so sometimes you may notice more hair loss. If your hair loss is within that range, I wouldn’t be worried. Your hair may be in a cycle where it is in its shedding phase, but when we go into a hair loss cycle associated with genetic hair loss, the loss in the shower may be higher. The best way to judge is to:

compare what you are seeing to what you had been seeing in the past
see a good doctor who will map our your scalp for miniaturization looking for the findings that are always present in genetic hair loss

Hair loss in your genetics can skip generations, so even if you do not see it in your immediate family, it does not necessarily mean that nobody in your family has experienced balding to some degree. And chances are that your friends do lose hair in the shower and it goes down the drain. I couldn’t tell you for sure though — I do not shower with your friends.

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May 8, 2006

Fincar, Forcan, and Candid-B – Hair Loss Information by Dr. William Rassman

heloo sir, Well i am 21 yrs of age. 2 years back i had thick shiny and straight hair. then suddenly one day my hair started off falling very severly. i ignored it thinking it was the after effect of some new shampoo but then even after using my normal shampoo the problem continued. i let it go thinking it will get solved by itself. but then after 2 years leaving it untreated one day i saw that my scalp had become visible and my hair became thin and dry. i then went to a dermatologist. he advised me the following.

candid B lotion (made by Glenmark)
forcan 150mg (made by Cipla)

after using this for a month my hair loss stopped completely. now the problem is that i am not getting my lost hair back. and my hair is dry and thin. can i regrow my lost hairs or am i too late to do anything. please help me cause it affecting my confidence. please. reply urgently. thank you.

I looked up Cipla and found that they make a generic Proscar: Fincar launched by Cipla is a hair loss pill, indicated for male pattern hair loss or Androgenetic alopecia. Even though Cipla’s Fincar contains the exact same chemical Finasteride as Proscar (5mg of finasteride), its cost is significantly less than that of Proscar. Each film-coated capsule of Cipla’s Fincar contains Finasteride 5 mg.

Assuming this is correct, the Finasteride 5mg is a much heavier dose of finasteride than is needed to control hair loss and would therefore have more side effects unless the pill is divided into 1/4 or 1/5. I am surprised that this can be obtained in the United States, because I am under the impression that this is covered by U.S. Patents from Merck.

Forcan is an antifungal medication, which suggests to me that your doctor thinks that the hair loss may be do to a fungal infection. The use of steroid/antibiotic combinations like candid B lotion are often used to reduce the inflamation from infections, although this is not my area of expertise. If you have any questions about what your doctor is doing and why, just ask him. An open line of communication with your physician is a good step to take.

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