Month: May 2006

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My Crown Looks Like It Is Thinning – Hair Loss Information by Dr. William Rassman

Hi, I’m a 23 year old asian male with a norwood 2 hair pattern, I have been since I was 19. I was born with less hair on the crown than most, there’s a small hole there. I was wondering if an HT can cover that up and if it was safe to do so in say 2 years time? Is it also possible that I’m more ‘prone’ to hairloss because of it? I also wondered whether it was alright to have an HT to straighten the hairline? It’s only for cosmetic reasons I guess but I feel quite stupid with my hairline so I’m forced to put my hair out in the front. Thanks

If your hair is very straight and strong, what you are describing is the swirl in the back of your head. In Asians with strong, straight hair, the swirl will show. The swirl is created by the change in direction of the hair in front to the sides and behind it. Like water going down the drain, the swirl emphasized the hair flow and the eye can follow the hair shaft to the scalp. In most Asians, the light skin and dark hair make the swirl area look balding, when it is not actually going bald. Here’s a photo of the crown of our own Dr. Jae Pak, M.D. He is not balding in the crown, but what looks like balding is the result of (1) Asian straight hair that does little to cover the crown, (2) black hair on pale skin, and (3) low density hair, typical of Asians. In some Asians with hair that stands up on its own (like the spiked hair style that is popular today), there is the perception of thinning hair in the front, when that is actually not the case at all. The most difficult areas to get to be full looking therefore are the crown area (particularly in the center) and the frontal hairline where the light penetrates into the hair and the scalp (and when the skin is light and the hair is dark, the background lights up). As you may ascertain from what I have said here, there is a real ‘art’ to doing hair transplants, because the surgeon must understand the blend in color and contrast, hair thickness (like the brush strokes of a painting), the waviness of the hair, and the number of hairs available to fill in the balding area being transplanted. Like a portrait painting, you need to have a good artist doing it for it to look real, that is, unless you like the Picasso look.

If you wish to fill in the crown and make it fuller, you need to find a good hair transplant surgeon, one that is ethical and will be able to meet your goals without risking you to hair loss or deformities created by poor planning.

Anyway, here’s a photo of Dr. Pak’s crown, as mentioned above. Click the photo to enlarge.

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Hairline Regrew with Meds – Hair Loss Information by Dr. William Rassman

I’m a 27 year old with recession to a NW2 pattern, but thinning over a NW5 area. I’ve been using Propecia, Minoxidil and Spiro for roughly 1 year, and I’m noticing pigmented hair starting to sprout around my original NW1 hairline. However, the density on the top of my head appears to have gotten slightly worse. Maybe it’s a shed, I don’t know.

With success continuing on the hairline regrowth standpoint, do you think the thinning on top is just taking longer to grow in — or could it be possible I’ll end up with a NW1 hairline, but with a thin NW5 pattern? I understand that hairlines usually come back in (if at all) AFTER the crown and vertex have filled in…? It just seems odd to me to be having regrowth success in the one area people have a lot of trouble with, but be lagging behind in the areas that are meant to respond best to treatments.

My father has a NW4 recession/NW6 thinning pattern at 55, and my hair loss seems to be following the same pace and pattern as his did at my age. In the scenario that I don’t achieve desirable density on treatments in the next 12 months, is FUE an option to fill in the density of the thinning pattern? On that same note, if I were to have FUE done in the next 1-2 years, would it still be possible to pursuse Hair Multiplication when it became available? I can’t remember where I read it, but someone mentioned that previous HT patients would not be suitable candidates for HM for some reason. Or maybe I misunderstood/misread…?

Call it vanity or risk, but I’d rather have decent hair in my 20s and 30s, and the confidence that goes with it, and worry about my 40s onward if/when I get to them. What can I do NOW to achieve my goals, even if they’re temporary fixes until the next great drugs/procedures come along?

Thanks

Norwood Class 2

Norwood Class 1

I am very impressed with your questions, particularly the way you distinguish the difference between the way to classify recession and thinning patterns of hair loss. You are correct to assume that the impact of medication is different between the front and the top/back of your head. I do not understand why the treatments you are having are impacting the juvenile hairline (Norwood Class 2 pattern moving to a Norwood Class 1 pattern).

With regard to filling in a thinning pattern — that would depend upon many things. There are many doctors who would gladly sell you hair to fill in a thinning pattern, but there is always the really important question to ask: Will the gain off-set any loss from the transplant? Many unscrupulous doctors would like to tell you that this is preventive hair transplantation to stop the balding. When I hear that statemen (preventive hair transplants) I know that the doctor has ethical problems and $$$ are getting in the way of his/her judgment for good patient care. To get a proper answer to that question, you MUST find an ethical doctor who will answer it from your perspective. Judging that you are focusing upon a Norwood Class 1 pattern, I might think that you are overly worried. If you choose to have an FUE or a conventional strip procedure, that is an independent decision to having a transplant in the first place.

Any transplant you *or any person having them) might have will not interfere with the advances in hair cloning or hair multiplication that may come up in the future. You are worried about what you will look like in 13 years, but I would ask you to have you scalp mapped for miniaturization and if you really are thinning in the patterns you discussed above, then the drug of choice is Propecia/finasteride and that could do more to fix the thinning problem than any hair transplant you can do.

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Angry Emails About Hair Products – Hair Loss Information by Dr. William Rassman

it would seem to me, if it worked as good as you say on TV, all the news media, talk shows, and anyone reliable else, would be backing this product. An infomercial is paying the TV. If It was as good as you say, you wouldn’t have to pay to have is broadcast. Remember, just because you say it’s so, doesn’t make it so.

Where do I begin? I was able to determine that this email came from someone that found the BaldingBlog by looking for ScalpMed on a search engine and just assumed that I was the one responsible for promoting this product. This is sadly not the first email I’ve received like this. Some people just seem a little angry about the ScalpMed product. I’ve never seen the TV commercial and I’ve never claimed ScalpMed is good. In fact, I haven’t promoted myself or my company in almost 10 years and I’ve never promoted a hair loss product on TV, ever. Folks, just because you found this site by searching Google for something you saw on TV, it doesn’t mean I made the commercial promoting it or had anything to do with the company or the product. I understand there is anger over products out there claiming to do things that you have not experienced, but your anger is misplaced if it is directed towards me.

I do agree with the writer of the above email though — if a product is as miraculous as they each believe is more than hinted at being a wonderous cure or treatment for hair loss, you would see as much information EVERYWHERE as you surely did when Viagra was made available to the public. Stop to think of the Viagra marketing launch and try to apply that to any magic bullet pill advertised to treat hair loss. Viagra was everywhere, and a topic like sexual dysfunction is far more embarassing for many people to talk about than hair loss. So if a miracle pill for hair loss did exist, I would think you’d see it even MORE than Viagra. You’d be getting 50 spam emails a day (with multiple misspellings) talking about selling it at a discount. You’d see it on the cover of Newsweek. You’d certainly would see it in magazines and newspapers. Hair loss is a big deal to many people.

With nearly 50% of men losing their hair, the market for a wonder drug that claims to do it all for your hair is wide open. I do recommend Propecia, because I’ve seen it work and it is FDA approved. The same recommendation goes for minoxidil, although to a lesser extent — but again, it is approved. Propecia doesn’t work for everyone all the time, and minoxidil has its faults as well. As a physician, I have a hard time recommending any product that I am not convinced works. I have no experience with ScalpMed, but there does seem to be a very polarized group of emailers who do not take a positive view of their experience with this product. If you are included in this group, could you take a few minutes and write down your experience and let me know if you were happy or unhappy, and why? I will be happy to share rational people’s emails with the readers of this blog.

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Analytical Questions From a 21 Year Old Balding Man – Hair Loss Information by Dr. William Rassman

Respected Sir,
I am very happy to see the service you are providing. My name is nabeel hussain .My age is 21.5 years. I have started getting bald when I was of eighteen. Now on THE NORWOOD/HAMILTON SCALE I am at 3V position. I have met a dermatologist he recommended me genesis and minoxil2%. I was told that initially I will lose hair + I have to use these medicines for whole of my life. Sir please answers my following questions I will be highly thankful to you.

  1. I don’t want to do this hectic and frustrating job of using medicines. As it is temporary and as I will stop using them my hair will lose more rapidly. Apart from that they have side effects also. Am I right? Will medicines have some negative effect on my donor area?
  2. I want to go for hair transplantation. but one doctor told me that doing so at an early age of 21.5 is not a good option because I will continue losing my hair and I will be again bald at a age of 30.and the previous transplantation will become fruitless. Is it right?
  3. I want to transplant hair because I have a concern about my donor area that it might not diminish if I postponed my transplantation. Is it could be the case?
  4. Can we take hair from the side of our head as donor hairs?
  5. What is period of complete bed rest after transplantation?
  6. At what age should I go for transplantation?

I have asked you a lot of questions but I hope and am certain that you will answer them all as you are very co operative.

Kindly recommend a better solution for me.

  1. If you are balding from genetic causes, then there is a good reason to be using finasteride 1mg (marketed as Propecia), which you must take for the rest of your life ( that is, until a cure for balding is discovered).
  2. The doctor who told you that you are too early for transplants is probably correct, but I have not seen you so I am drawing this conclusion based upon no objective findings, just the average 21 year old who is in the early stages of the balding process.
  3. Hair transplantation may not be the answer for you because you do not know how bald you will become and if the supply of your donor hair will meet the demands of your eventual balding pattern. You could end up depleting your donor hair for the short term gain at the expense of your long term look without a Master Plan for hair loss in your hands.
  4. The donor area is on the side and back of the head as you indicated.
  5. Hair transplantation does not require any bed rest after the surgery. You can walk around and within 5 days, even run a marathon.
  6. Generally, balding patterns are clearly evident by the age of 25-26. The later you can delay the decision, the more mature the hair loss pattern will be.

You are asking good questions. Take the advice of the good doctor you have already seen.

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One Area Of My Hair Has a Different Texture – Hair Loss Information – Balding Blog

Like the guy who says that his hair grows to 1/2 inch then falls out I’ve also had the problem of my hair growing to a certain length then falling out. This only occurs on the lower left region of my head. I’m 22 now and began having this problem when I was about 14 or so. I went to a dermatologist about it 4 years ago who told me that it may have come from overprocessing and suggested that I cut my hair off and regrow it or wear lose braids. I chose the braids of course and now I have a full head of natural hair. Recently though, I’ve noticed that the hair in this lower left side is a little shorter and almost has a little bit of a different texture than the other sections of my hair. Also every now and them, I get an itching sensation in this area or it’ll feel a little sore. I want to go back to relaxers but do you think this would be ok or would it fall out again? I actually have an appointment to see a dermatologist again but what tests would you suggeest I ask them to run to see if its ok?

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Wait until you see your dermatologist. It does sound like you are obsessing over subtleties in your hair. I wish I could add more, but I’d let your dermatologist do his/her thing and please feel free to let me know what the findings are. Please reference this posting when you reply.

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Another Patient Returns (with Photos) – Hair Loss Information – Balding Blog

I met with a patient who had one procedure of 1,541 grafts a little over a year ago. We sat down and reviewed his pictures together and he completely forgot that the man from a year ago ever existed. I share with you his wonderful results and I thank him for allowing me to show his face and post these photos. Click the photos to enlarge.

Before:



After:



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Here’s My Stats – Why Is My Hair Falling Out? – Hair Loss Information – Balding Blog

Dr. Rassman,

  1. 18 Year old male
  2. Hair loss started around the age of 13
  3. This was when i first started geling my hair
  4. This occured with dandruff
  5. After a while this stopped, although hair remained very thin and became see through when wet
  6. About 1 month ago, started to loose about 20 to 30 hairs every time i shampooed or brushed my hair (no dandruff)
  7. Individual hairs can be pulled out fairly easily
  8. Started using a new hair gel a few weeks before the problem started
  9. During the period between my previous hair loss and now, i used gel in small amounts but these did not have any effect
  10. My hair gets very oily and weak when my nails grow for more than a week without trimming
  11. I had a blood test done and this only showed a very mild iron deficiency which the doctor said was not enough to make the hair fall out
  12. I had a very high fever about 4 months ago (New Year’s Eve)
  13. No history of hair loss in the family

Can you think of any reason why this is occuring and if so, is it treatable?

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  1. At 18 years old you may have the beginning of male pattern hair loss
  2. At 13 years old, as your puperty hit, you may have had some juvenile hair loss or a change in your hair character which is normal (not male pattern hair loss)
  3. Using a hair product, such as gel, does not cause or accelerate hair loss
  4. Dandruff is not associated with male pattern hair loss
  5. 20 to 30 hair loss during a shower is normal (we lose about 100 hair a day)
  6. Stop pulling at your hair, it will cause permanent hair loss
  7. Again, using hair styling products does not cause hair loss
  8. Oily hair is not related to hair loss (you can try using shampoo for oily hair)
  9. Your doctor was right — mild iron deficiency does not generally cause hair loss and it is easy to correct
  10. High fever on New Year’s Eve won’t generally cause hair loss. Any one day is no worse than any other day
  11. No, family history does not necessarily mean you will not have male pattern hair loss (there is no absolute rule)

If you had a complete medical workup and you are still concerned about hair loss, you should make an appointment with a hair doctor (a good dermatologist) to map your scalp hair with a densitometer to look for miniaturization and pattern of hair loss.

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Hair Loss InformationKenalog and Female Hair Loss – Hair Loss Information – Balding Blog

I’m a 32 year old mother of 3 and first noticed an increase in the amount of hair I was losing on a daily basis about 2 1/2 to 3 years ago. I had a lot of hair so I wasn’t too worried about it at first, but the hair loss continued and now I have a significant decrease in hair volume. I went to see two dermatologist. The first one told me it was hereditary and to use Womens Rogaine. He didn’t even touch or look closely at my scalp. He also said if I did’nt tell him what was wrong that he would never guess I was losing hair, which didn’t make me feel better because I can tell the difference. I never tried the Rogaine. The other diagnosed me with telogen effluvium and recommended I take a injection of Kenalog. Which after about a year of weighing the benefits and risks decided to get the shot. It’s been about three months now and haven’t noticed any decrease in hairloss or any regrowth. It sure has messed up my menstral cycle though. I really would appreciate any advice you might have. It is really depressing as a young woman to go through hairloss. Thank you for your time.

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Telogen effluvium generally has a spontaneous recovery in 6 to 12 months. It is precipitated by hormonal, emotional, or medical stressors. Aside from seeing a dermatologist, you may want to get a complete medical physical to rule out other medical causes of female hair loss (such as eczema, malnutrition, autoimmune disease, drug reactions, infections, genetics).

Kenalog is sometimes used for hair loss, however its efficacy is not well studied and I do not believe that it works unless the hair loss is in the autoimmune category. Telogen effluvium and steroids are poorly linked for benefits, and as you said, it is messing around with your hormone balance and menstrual cycle. Unfortunately, even with a good diagnosis, you may still find that there are no suitable treatments available. At least you will be educated and can then avoid ineffective medications or treatments so that you do not have to suffer from adverse drug effects. Don’t get ahead of yourself though. See a doctor to have other causes ruled out first.

“Knowledge is power.” –Francis Bacon

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Hair Transplants or Propecia – Hair Loss Information – Balding Blog

I have been on Propecia for 6 years now and have decided to get off of it due to potential unknown long term side effects and even short term side effects that I seem to notice more as I age(Libido, minor Gyno, etc). My question is how long do you recommend I go before I consult for a potential hair transplant since it is difficult to say what my potential future loss will be right now since Propecia did have a positive effect on my loss and I would have almost certainly lost more. Im currently 30 years old and have probably a Norwood 3V and more of a Norwood 2ish in the Temporal/frontal region which hasnt changed to much since I started Propecia. Ideally I would love to get a transplant now to basically keep my existing hairline(which im ok with even though its receded a fair amount) and fill in some of my vertex while I can still conceal it with exising hair but Im worried about not being able to plan correctly since I wont be taking Propecia. Any advice will be most helpful.

Thanks

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You need to be evaulated. If you density is good and there is miminal miniaturization in the top (area between front and crown), then you may be a good candidate for hair transplants. At 30, your pattern should be evident when your scalp and hair gets mapped out for miniaturization. From that a Master Plan needs to be developed which will take into account your worst case hair loss scenario and then the supply/demand for hair transplants becomes a measurement to base a safe decision in the long term planning for any transplant process that you undergo. Stopping the Propecia is something that you should think carefully about, a lengthy discussion with your doctor to see how this decision may alter that long term plan I am talking about.