Merck, the makers of Propecia, have created a new marketing campaign called The Stunners, which includes 2 commercials (so far) that are wildly amusing. I thought I’d show them for your enjoyment –
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First Six Months After My Transplant Was Textbook, Then It All Thinned Out – Hair Loss Information by Dr. William Rassman
Dear Dr. Rassman,
I am beside myself. I have tried everything including minox and proscar to no avail. I held out transplants as my last resort to save my hair. However, after my first transplant, though it seemed it was text book up to six mo., after this, it began to thin back out as if it were my normal scalp hair!My transplants were done by a well known surgeon here in San Diego.
My Doc had no answer. My drmatologest thought it might be inflamation but was not 100% sure. Thinking it was a fluke, I opteted for a second transplant in the same area, and the same thing happened! What is going on? Is there anything I can do?
I did have dermatitis prior, durring, and after the transplants, and was battling some infected teeth, which unbeknownst to me were sending out low level infection to the rest of my body for years.
I am in good health otherwise.
Have you seen this before? Do you have any answers, or can you recommend anyone who could address this situation?
I really do not know where to turn to next.
Thank you for your help.
Firstly, I must restate that BaldingBlog is not intended to establish a medical diagnosis or offer a second medical opinion. Furthermore, I do not have the benefit of seeing you in person. Now with that being said, I can answer this in a general way.
If a hair transplant fails or is associated with hair loss, we can attribute it to two generalized causes:
- Poor technique and human error (not in your case, because you reported that everything grew out and was good for 6 months).
- Medical conditions that you acquired or that you did not know of that contributed to the hair loss.
I often stress the importance of measuring the miniaturization of scalp hair for the correct diagnosis and quantifying the degree of miniaturization so that if something like this were to occur, another measurement would be helpful in rebuilding a picture as to what happened to cause the hair loss.
I have had one patient tell me a story like you just told, but I believe that not enough time passed for me to draw conclusions on the matter.
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Hair Loss InformationListing of African American Dermatologists? – Hair Loss Information – Balding Blog
Is there a way to find a national listing of African-American dermatologists? I am especially interested in those that deal with Seborrheic Dermatitis in African-Americans. I have had this condition since high school and I am now 27 years old. I am seeking an African-American simply because other dermatologist seem to have shampoos/treatments they want me to use on a daily basis. As an African-American woman, I cannot do that or my hair will be damaged. My hope is to find someone who has researched alternative treatments due our hair type.
Thank you.
The listing services do not go by race, so that would be a difficult distinction to make. You might see Dr. Pearl Grimes, an African American Dermatologist extraordinaire here in Los Angeles if you are on the West Coast or would be willing to make a trip to meet with her. Dr. Grimes is the Director of the Vitiligo and Pigmentation Institute of Southern California, and is also a Clinical Professor of Dermatology at UCLA.
Using Toppik After Hair Transplant – Hair Loss Information by Dr. William Rassman
I had my transplant done 2 weeks ago and wanted to find out if using Toppik on the transplanted area cause the grafts to not obtain enough oxygen thus not grow. Toppik worked really well for me prior to the surgery and would like to continue using it until my new hairs come. Thank you in advance for your response…
If all of the crusts (scabs) are gone, you can use it! For those of you who do not know about Toppik, it is a scalp cosmetic for darkening the scalp skin. See their site Toppik.com for more info.
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Protopic Ointment for Moustache Hair Loss? – Hair Loss Information by Dr. William Rassman
Hi, Recently I start having a problem of moustache hair loss. I visited a dermatologist last December and he prescribed me a topical ointment called PROTOPIC 0.1%. I’ve been applying it twice a day for the past six months but it doesn’t work all. I even discovered other new spots coming up. This week I visited the doctor again and he told me that he can not help me any longer and it is beyond his ability. Shocking! He suggested to try a medicine prescribed for a regular skull hair loss but he said it will damage your face because it is more sensitive. I did not want to take that risk and add another problem but I still feel like there should be a solution somewhere somehow. Anyway,I am so frustrated with the medical profession here in US. I found your website from the internet and I’m asking your help. How about the ointment he prescribed for me? Is it something well known and effective? If so, for how long I have to apply it before seeing results? What is exactly the cause?
The practice of medicine is not an exact science. That is why it is called a “practice”. Sometimes doctors do not have all the answers.
Protopic (tacrolimus) ointment is indicated as second-line therapy for the short-term and non-continuous chronic treatment of moderate to severe atopic dermatitis (AD) in non-immunocompromised adults and children who have failed to respond adequately to other topical prescription treatments for atopic dermatitis, or when those treatments are not advisable. [source: protopic.com] It is my opinion that Protopic will not address your hair loss unless your hair loss is related to atopic dermatitis.
If you are losing hair, you may consider visiting a doctor who can view your hair on a microscopic scale (under a densitometer) to see if there is a pattern of miniaturization. Is there hair loss in the scalp as well? Do you have spots of hair loss in the scalp or in other hairy parts of your anatomy. The presence of other such areas may indicate other local skin disorders such as alopecia areata. I can not write a text book here, as I don’t have the time — but find a good doctor. They are out there.
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Propecia and Blood Pressure Medication – Hair Loss Information by Dr. William Rassman
Hi Dr: I am a 36 year old male. I have experienced hair loss and I would like to try Propecia (Finasteride). However, I am a heart patient and I take Toprol, Altace, Zetia, Plavix, Lipitor. Will the propecia interact with any of these? I have read that it may interact with blood pressure meds.
Thank you
If you are taking finasteride at the 1mg dose (Propecia), I would not worry about cross-reactivity. The official site does not mention a problem with the medications you listed. Minoxidil on the other hand, is an anti-hypertensive agent so if you mix it with the anti-hypertensive medication you take, you could drop your blood pressure further. For general information on drugs and pharmacologic vs. Toxic Effects, see: http://www.hpisum.com/downloads/Downside.pdf
Is Minoxidil More Effective If Treating Early Hair Loss? – Hair Loss Information by Dr. William Rassman
Dr. Rassman,
You truly have a very informative site here! I don’t know where I would be without it. Anyways, in one of your responses to a question you stated that when you first start treating hairloss it is better to start off with propecia for 8-12 months, then if not satisfied move to Rogaine (minox). If a person wanted to keep/re-grow as much hair as possible wouldn’t this be a mistake as the Rogaine would cease to be as effective as it would’ve been if used in the very beginning?
From my experience, I have found that Propecia (finasteride) is more effective than Rogaine for men with genetic hair loss, particularly in the crown if it is early and/or they are younger (under 30). Technically, you may not need to use Rogaine at all while being on finasteride. I have noticed that most patients do equally well being on finasteride alone vs. finasteridewith Rogaine. The most important message which I wanted to get across is that you should always start out using finasteride as early as you can. You can always add Rogaine (minoxidil) if you are not satisfied with the results of the finasteride.
Heradone: Hair Growth Fertilizer or Snake Oil? – Hair Loss Information by Dr. William Rassman
Can you tell me if this new Heradone product has any value? It sounds like an ad for another snake oil, but it appeared in Google News when searching for hair loss news so I wanted your opinion.
The claims of the producers of this product are: “New Hair Loss Solution That Promotes The Natural Balance of Your Scalp While Stimulating Blood Flow To The Root Of Your Thinning Hair!”
There has never been any evidence that increasing the circulation to the scalp increases hair volume or numbers. The reason that balder people have less circulation to the scalp is because there are less hairs and those that are there are smaller needing less blood flow, so the body only supplies what is needed to support what is there. Our body is very smart when it comes to that. The muscles of a bodybuilder have more blood supply than that skinny, flabby guy at the beach who never exercises. That is because the bodybuilder’s body (muscles) knows what is needed. The same is the situation for runners, bikers, swimmers, etc…
I find claims like ‘natural balance of your scalp’ are ridiculous. It uses that claim on the product’s website. Does that mean that the scalp is balancing something like what a ballerina would be doing when she is up on her toes? What does natural balance mean?
Just reading the press release should be enough to give you the answers you’re looking for — there’s no doctors mentioned by name, yet they exclaim “medical experts say [Heradone] is packed with natural vitamins and nutrients.” So they are experts, yet none can attach their name to the product? I guess just taking a look at the Heradone website answers the final questions I’d have –
“These products are not intended to diagnose, treat, cure, or prevent any disease.”
Yeah, that sounds about right.
“The individuals shown are paid models, and not necessarily Selmedica Healthcare customers.”
Exactly.
Remember, buyer beware.
Braids and Traction Alopecia – Hair Loss Information by Dr. William Rassman
Hello. I’m a 32 year old african american.I’ve read your artical about braids and pulling of the hair and I do understand.I love to wear braids cause it is easier to maintain with my busy schedule. I have noticed that there are small white specks at the end of my hair where it is braided. Possibly the root i guess. I was wondering if it is the root will my hair ever grow back.
Sounds like you are pulling out the hair with the braids. They will grow back, but if the hair continues to be pulled out, then it may not grow back one day. I’ve treated many African American women for traction alopecia with hair transplants.
Miniaturization: Critical to the Master Plan for Hair Loss – Hair Loss Information – Balding Blog
Miniaturization occurs in men and women who are balding. Miniaturization is the process where a normal thickness hair shaft becomes thinner and thinner over time due to the genetically determined effects of aging and/or androgenic hormones on the terminal (normal) hair follicle. The process of miniaturization is a slow process in genetic balding. Hair shafts may lose 10% of their diameter, then 20%, then 30% and so on. Each degree of increased miniaturization reflects further progression of the genetic balding process. The instruments that measure miniaturization were invented (and patented) by me in the early 1990s (patent ) and they are in wide spread use today. Socially detectable hair loss is not evident until more than 50% of average weight hair has been lost (more with fine, high contrast skin/scalp color hair and less with coarse, low contrast skin/scalp color hair) and as a result, many men do not seek out expert help until they see some evidence of balding (which they too often deny).
When a doctor views the scalp hair with high magnification, the degree of miniaturization and the location of the miniaturization are both critical to establishing (1) the diagnosis and (2) the rate of the process, which progresses over time. Because miniaturization is a relative measurement at any one time (comparing finer hair to the thickest hair), it takes substantial experience before this measurement can be useful to the individual clinician. In our experience, from examining and following tens of thousands of patients with the hair densitometer (video microscope), we have found that assessing the degree of miniaturization has useful predictive value when evaluating the risks of hair loss and in establishing hair loss patterns. The amount of miniaturization in each section of the scalp tells the physician just how far the balding is progressing or has progressed. In men who show more and more areas of miniaturization over time, the genetic balding can be considered active. In men treated with finasteride, if the miniaturization is reduced or the hair count is increased, it can be assumed that the balding process is coming under medical control.
We know that hair loss occurs in patterns (see Norwood Chart), but these patterns are what the eye can see. When the naked eye picks up these patterns, the miniaturization is always in a more advanced state. The balder the patient is, the worse is both the absolute hair count (density or healthy hairs) and the relative fullness of the miniaturized hair shafts. Clearly, miniaturized hairs that have a reduced hair circumference of 10% will have more bulk value than a hair circumference reduction of 70%.
In our practice we use a video densitometer to map each patient’s scalp. We typically map and digitally photograph a series of discrete areas on the scalp that reflect the balding and non-balding areas. The non-balding donor area (back and sides of the head) reflect the numbers of hairs per square inch the patient was probably born with. By comparing the donor area with other areas that might be balding, we will have very relevant numbers that will reflect the eventual balding that the naked eye will pick up as the balding progresses.
As an exercise in thinking out the process that the skilled doctor performs, follow the thinking on the following case example: Miniaturization in the recipient area (front, top and crown) can often delineate which areas of the scalp are most likely to bald and which are stable, anticipating the patient’s future Norwood hair loss classification. If a 38 year old man has most of the miniaturization in front and very little in the mid-scalp and none in the crown, then the physician may safely assume that the eventual hair loss pattern will probably not go much beyond a Class 3A or 4A pattern (worst case scenario). View the diagram below and click the button for a view of the degree of miniaturization of the patient illustrated here. From this, a Master Plan can be derived depending upon how the existing hair loss is bothering the patient. If the hair loss is just showing some thinning, it may be logical to treat it with finasteride alone, while if the hair loss is more advanced, looks like it is balding and it bothers the patient, then it could be treated with a hair transplant. Because the doctor knows the miniaturization pattern and the age of the patient, he may confidently predict this patient’s worst case and with that information, the patient can budget his time and money to do or not to do a hair transplant. That is why I say that the future management of hair loss needs a Master Plan. In Patient QQ, this is just what happened. He had one hair transplant procedure 10 years ago and because he had limited miniaturization to the frontal area, I could predict that he would probably not need further work for some time. If his situation was to evolve differently (such that he lost more hair than I had predicted) then he could always have had another transplant (if he needed and/or wanted it). He was close to 50 when he came to see me, near the end of his hair loss process. Now his experience with me is just a fond memory of a difficult time in his distant past.
We feel that predicting the short-term loss (the extent of miniaturization in the recipient area, as well as the rapidity of the loss) is critical in establishing the guidelines for treatment, whether it is a hair transplant or drug intervention. In the very early stages of hair loss (the man in his early-mid twenties), findings of increased miniaturization can anticipate future balding even before any loss can be seen to the naked eye. Often, the reason a person seeks a consultation from a hair restoration expert is that there is some change in the “rate” of his hair loss (often more hair seen on the pillow or in the shower). A patient who is very gradually losing his hair is less likely to seek help, compared to a patient who suddenly has acceleration in the rate that he is losing hair. Usually large numbers of hairs undergo miniaturization before any are actually lost and the time the drugs are most effective is in this early phase. In men, DHT is the hormone responsible for these changes.
Ideally, if you are balding, you should take finasteride after mapping your scalp to identify if you have male pattern baldness. The focus upon mapping for miniaturization is to (1) estimate the pattern of hair loss, and (2) measure the starting point for miniaturization so that changes caused by finasteride can be measured over time. Although it takes around 6 to 8 months before you can see the effect of finasteride visually from hair length, it is highly possible that the impact of finasteride on the emerging hair will be earlier than the projected 6-8 months. The measurements are very fast and easy to get from a hair transplant physician and it is today’s Standard of Care that should be available to every balding patient wanting a Master Plan for their future hair loss and hair loss management (medical or surgical).
With successful medical (drug) treatments like finasteride, the miniaturization may be reversed (partly or completely). The responsiveness of each patient is different, so each patient must be diligent in acquiring follow up measurements of the degree of miniaturization and the location of the miniaturization by scalp location. The same diagnostic criteria should and must be followed in women. Without good, reproducible measurements for miniaturization, there is no clinical science in the treatment of hair loss, just hocus-pocus and blustering, a problem that is far too frequent today.
Click each zone or area in the image below to see a microscopic view of the miniaturization (or lack thereof) in a typical balding male:
PZ = Permanent Zone
T1, T2 = Temples
F1, F2 = Frontal
M = Middle
V = Vertex
The below image is a guide to see examples of normal, moderately miniaturized, and advanced miniaturized hair. Click to enlarge.
