June 2006 – Page 14 – Balding Blog

June 8, 2006

Is It Necessary to Take Avodart Daily? – Hair Loss Information by Dr. William Rassman

hi dr, i just read on your site that you say avodart lasts 3 months in your system, i take it every day, is this necessary?

also i read that propecia will only be effective for 7 yrs,did i understand that correctly?

The point of having FDA clearance on the use of a drug for a particular condition is that the dose is defined. For Avodart in hair loss, the answer is that no one knows for sure. In theory, you should not need to take it daily. Will once a month do it? Frankly, I don’t know. This issue was raised at a recent hair meeting where dermatologists and hair experts from around the world addressed this. There was no general agreement on what the dose schedule should be. It was clear that the different doctors recommended different frequencies from once a day, twice a week, every other week, once a month. No one recommended less frequently than once a month, but that does not speak well for the general kn0wledge that is generally available to us.

Propecia continues to work, I suspect, for years. The 7 year issue is not that it stops working at 7 years, but that the data has not been published on patients followed for more than 7 years on the drug — even though the drug has been on the market longer than that. I am certain that the drug will continue to work, but you must keep in mind that genetic hair loss in men is a progressive process and that eventually the progression of the process will prevail over the effects of the drug. But if after 7 years you were to stop the drug, most men will experience a massive hair loss which is what I call ‘catch up hair loss’, meaning that all of the hair that Propecia saved would fall out in a few months time.

June 8, 2006

I Use Styling Wax — Does It Clog Pores, Causing Hair Loss – Balding Blog

Hi Doctor,

I am a 21 yr old Chinese male.

I have noticed quite a large amount of hair loss from me (it’s been on going for quite awhile now, perhaps months or a few years but I only become more concerned recently). I had rather thick hair so i was not worried until now. Although I can’t tell if my hair has thinned recently but I have become more self conscious about it, as the top seems ‘flatter’.

I know it is normal to lose 100 – 200 strands of hair daily, I don’t really count the strands that falls off daily so I have no idea if my hair loss is in that range, but it sure feels abnormal as i notice strands of hair on my clothings and around me quite often, and strands of hair always seems to fall out when I brush through my hair. My mother and brother also complains that places where I sit tends to have strands of hair left around the area.

I know from some posts in your blog that you say hair product does not cause hair loss, but I am rather concerned as I use styling wax(which is very difficult to wash off) on my hair for the past few years daily. I tend to rub them into my scalp(which I heard will clog up the pores and cause hair loss). Furthermore I get lazy sometimes and do not wash them all off. I have stopped using styling wax for the past 2 or 3 months, but the hair loss remains.

I had major surgery about 3 months back, but my hair loss problem is around even before that. I do not notice balding in my family or relatives.

What should I do? Thanks.

The heavy waxes can stick to the hair and when you try to get it off, it may continue sticking to the hair. When you comb hair that has heavy wax on it, I am sure that constant repetition of this can cause traction alopecia. You must wait out a period of 6 months to see what will happen. I think that a good examination of your scalp is important to understand what has happened and will show if you have genetic hair loss underlying the problem you are talking about.

June 8, 2006

I Think My Dad Has Alopecia – Hair Loss Information by Dr. William Rassman

hi dr rassman,
my dad i think has alopecia universalis, he has no hair anywhere visible, though he can grow remnants of a beard but ive never really seen it grown out enough to know how much, i read that this disease usually shows up when people are young & in round completely bald patches where the hair falls out in larger amounts than normal shedding. i asked my dad if this is how he lost his hair or gradually and he said gradually and he started when he was 25. does this make sense, is it possible that this could happen later in life, is there anyway to tell what genetic disposition you may have, your mother or father side, cause my dads hair was always very thin even when he wasnt bald im told, but i clearly have my moms hair its very thick, does that indicate whether or not i will go bald or not?

You are correct that alopecia universalis generally appears in the younger men, but that is just an ‘expression’ of the gene and the tie to age may not be absolutely chronologically determined — so it can appear at any age. The ‘complete’ disappearance of hair may also not occur immediately and at times, some hair may be present on the beard for example. To answer what your future has in store, there are people who can do genetic testing for the gene. Maybe you can find this on the referenced links below. As you may know, there is clearly a relationship between alopecia universalis and alopecia areata, so looking at both diseases has relevance. The genetics of the process is nicely outlined in the first reference below:

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June 8, 2006

Can Extracted Hairs Regrow in Donor Area? – Hair Loss Information by Dr. William Rassman

Can hair ever grow back in the donor areas from which follicular units have been extracted? (Similarly, would hair ever grow back if I combed out a follicle?) I assume follicles don’t regenerate.

When hair is extracted with Follicular Unit Extraction techniques (FUE) the root and growth center of the hair is removed and relocated, so it will never grow back. If the hair is pulled out, the root is always left behind, so that it will always regrow.

You are born with an average of 100,000 hairs. When they are moved, the number will remain at 100,000 (minus whatever you’ve lost from genetic balding) if they are not damaged with the move. In the hands of a good hair transplant doctor, moving hair around is just a relocation process.

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June 8, 2006

Buzzed Hair Style After Transplant – Hair Loss Information by Dr. William Rassman

Dear Dr.Rassman,

At age 30 I had three procedures with a doctor in Pittsburgh.The results were excellent.The focus areas were creating a hairline and giving me forward density.The scar seems almost invisible now through the hair. My question is I’m now 40 and would like to shave my head with a number 2 clipper.With the hair cut short is it common for the donor scar to be visible? Greatly appreciate your thoughts on the matter.

Each and every person is different. Some people with no scar can not cut their hair with a number 2 clipper if their hair is straight and coarse, because there can be a subtle difference in angle above and below the area that was cut. Small scars may not be seen with the same shave if the hair character is good and the scar is minimal, yet larger scars may behave differently. Best to try it on a vacation with your hair cut short and see what you got. We can speculate, but the ultimate test is to just try it out. I have many patients who cut thier hair short, even to a crew cut after a hair transplant with no problem at all.

June 7, 2006

Hair Loss InformationWeight Loss/Gain and Hair Density – Hair Loss Information – Balding Blog

Hello Dr. Rassman… I am now 4 weeks post op and I seem to be on track, thanks to you and your team. My question is about losing or gaining weight in relation to density/fullness of one’s hair on their head. When a person loses a significant amount of weight this weight lost is evident through out the whole body even the person’s head. With significant weight lost would hair on the head appear more dense or full? And vice-a-versa, would significant weight gain cause hair on the head to appear less dense or full? This question may sound rather odd and funny but I got the idea from a ballon with prints on it. When the ballon with prints was semi-blowned-up it appeared all covered up with prints but when it was blown-up to a nice size ballon it appeared less covered and gaps between the prints were very evident. The reason why I’m asking this question is of course I need to lose a significant amount of weight for health reasons and to get your professional opinion to satisfy my master plan of hair restoration.

I believe that your blog is of great service to many people. Keep up the good work and God bless!!!

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I am glad your surgery at NHI went well and that you are pleased.

With respect to weight loss and hair density and your analogy to a balloon, it is an interesting question. However, your head is not a balloon and I suspect when you lose weight your head won’t shrink and it would not have any significant impact on the density of your hair.

I hope to see you on your 8th month follow-up a few pounds lighter and thousands of hairs fuller. Thank you for writing.

June 7, 2006

Itchy Scalp from September to April, Every Year – Hair Loss Information – Balding Blog

Dear Dr. Rassman,

Thank you for having a site where a consumer can ask questions about there concerns and worries about hair disorders and hair systems. I am a professional cosmetologist of over 23 years. I specialize in non-surgical hair replacement and a retailer of fine wigs and hair pieces. http://www.afoxintl.com/ Over the years I have witness several women loose their hair, it appears to be widespread. Does not matter the ethic background, I have seen in all races. Although Dr. Rassman, I have noticed women of color experiece itchy scalp on the crown area. Not the typical cases of braid, ponytail, high lift colors and weaves. These ladies hairloss starts on the lower crown,but above the occipatal bone.
No medications, never braids-weaves or such. Starts itching in September and goes through winter months to about April, win hair starts to grow back. I have witness this with new clients who have come to me based on recommendation of being able to have the Growing Hand. During this winter dry period I use essential oils, olive oil, moisture conditioners with and without heat, tends to help stop iching somewhat. All have seen dermatologist…they prescribe Biotin and Nizoral, even as sugest to one fugal infection…strange she get fungal same time every year Sept to April. Afterward hair grows great in summer, no itching….What are your thoughts?

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Without examing a person, it is difficult to blindly produce a diagnosis. Sound like the right treatments with oils and the like. The dermatologist joke is: “If it is dry, wet it! If it is wet, dry it!”

Fungal infections can cause itching and flaking but it requires the skilled eye of an experienced doctor.

June 7, 2006

Can I Crush Finasteride To Take With Water? – Hair Loss Information – Balding Blog

Is it ok to use a pill crusher to turn Proscar (finasteride 5mgs) into a powder to take with a glass of water?

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I would imagine that as long as you keep it dry and store it in a air proof container, you can crush it and take it with water. I would not put a few days supply in water, for it may lose its potency. I have no first hand knowledge on the answer to this question and came up with it on a logical basis only (I have no direct experience crushing the pill nor has any patient told me about it).

June 7, 2006

Using Hair Oils And Protein Creams – Hair Loss Information by Dr. William Rassman

i am 19. my hair is straight and fine…

my hair was usually very full and thick when i was younger. however, i have been using hair oils like amla, almond, amla and black seed.

i shampoo my hair daily with himalaya anti-dandruff shampoo because if i dont, my scalp becomes very itchy. and then i apply the oils after shampooig and keep it for day. is it alright to use hair oils daily? and is light liquid paraffin bad for the hair (i know that mineral oil and petroleum damage the hair)? sometimes i apply a generous amount of himalaya protein hair cream on my hair and scalp… i dont know how much to apply, maybe i am apply alot. basically, my hair is a little thin on the front and middle of my scalp. however, on the back and sides they are full…

i wanna know how to get my hair back. and if using hair oils and protein creams daily and in generous quantities have good/bad effects on my hair.

note: i have seen some improvement after using hair oils…

I am not sure what you are asking. The use of oils and creams on your hair will probably not hurt but the directions on the products will tell you how to use them — hopefully they are safe. The question should be: Will it help deal with male pattern hair loss? From genetic balding, your hair will likely not come back once it is lost and treatments like those that you are using may only slow down the correct way to stop the loss. There are drugs such as finasteride (Propecia) that may prevent further hair loss or may bring some hair back. However, you need to see a medical doctor for the correct diagnosis, get your hair mapped out for miniaturization to establish the diagnosis, and have a prescription to start Propecia if the diagnosis of genetic hair loss is confirmed. It is my medical opinion that the quantity of hair oil or creams that you are using is NOT likely the cause of your hair loss.

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June 7, 2006

Stretching Wounds and Scars – Hair Loss Information by Dr. William Rassman

How will these new wound closures you discussed in this blog impact people who have scars that stretch? I have scars that stretch every place I have had a surgery, including my hair transplant scar.

A trichophytic closure will not work if the wound widens more than 2-3 mm, because the hair growth from the trichotomy will only grow up to 2-3 mm from the edge of the wound where the trichotomy was done. The stretching may be helped by a sub-fascial closure below the occipitals muscle fascia. The tension reduction of such closures has value in reducing the wound size, but not necessarily in obliterating it. You might have some form of Erlos Danlos Syndrome (see here, here, and here), which comes about from defective collagen by its very nature. The story of EDS is not black and white, for I believe that some people have small amounts of this defective collagen and these people are the ones that may get stretching of the scars. In such situations, even the sub-fascial closures will not work, because eventually the body must heal the wound and as the sutures dissolve, the value of the sutures that hold the wound together will decrease over time.

Scars are at times a price one pays with surgery. For strip harvesting, this could be a price you will pay. If you have FUE harvesting (Follicular Unit Extraction), then this stretched scar problem should not become an issue with regard to your healing, as there is no large line scar to stretch.

Now with that said, putting the scar issue in perspective, the scar only exceeds 3 mm in about 5% of cases. If that happens and it bothers the patient, then I make this my problem as well and we work to solve the problem with whatever it takes.