Month: November 2006

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Hair Loss InformationDoctors Only Record Their Successes, Not Failures – Hair Loss Information – Balding Blog

Have you ever had any failures in your practice of transplanting hair? Not just you didn’t fill in a portion here or there. But someone who was devastated?. It seems everywhere I search, doctors only records their successes. I think it is great that HT is often successful and am fully considering one for myself, but am of course afraid that there are people who have gotten a HT from credible doctors, and it made their life miserable.

Any thoughts?

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There are no guarantees in medicine. A doctor can not expect 100% of patients who had transplants to succeed 100% of the time. I’ve met with many patients who have had transplant failures at other clinics and have come to me for help. Many times the failures are produced by doctors who did not have the necessary experienced teams or underestimated the jobs that they took on. Some of the failures are caused by a failure to properly set expectations and when doctors use salesmen to ‘sell’ the transplant, then expectations may not be met because they were set unrealistically high to make the sale and close the deal. In many of these patients, I see graft growth roughly proportional to the number of transplants that they received, but a disappointed patient still sees the process as a failure. We solve this problem by holding open house events monthly where setting expectations and patient education are central to my agenda.

In my practice I have seen a rare failure of grafts to grow. There are many causes of graft growth failure that are not caused by the doctor, some of which include:

  • severely atrophic skin in a very bald person
  • autoimmune diseases that were undiagnosed (a common cause)
  • chronic telogen effluvium and the presence of a variety of scarring alopecias
  • infection
  • severe diffuse unpatterned alopecia (DUPA)

DUPA is a relatively common cause of failures, because the condition is often not properly diagnosed, even though it is easy to diagnose when the donor area is mapped for miniaturization).

So yes, you are correct that doctors do not want to publicize failure. I don’t know of a doctor in any field of medicine that proudly shows off unsuccessful procedures. It is just never good for business. Could you imagine a breast cancer specialist telling how many of his patients died, or a psychiatrist tell his depressed patients how many of his patients committed suicide?

You ended your question with a suggestion that a hair transplant from a credible doctor would make their lives miserable. Modern hair transplants should not make anyone worse off. Even a theoretical complete failure should leave a person to where they were prior to the transplant (less whatever scar was in the donor area, which should be minimally detectable).

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Is Saw Palmetto a Good DHT Blocker? – Hair Loss Information – Balding Blog

Hi doctor my hair have been thinning for about 3 years (now i am in my late 22 of age), but i didnt notice till now shedding in the temporal area (only receding in the frontal hair line ), i am confused some are telling me that I have “Seborrhoeic dermatitis” but other dermatologists are telling me that I have male pattern hair loss -Alopecia. My question is does Seborrhoeic dermatitis cause the hair to thin like the dht effect or only makes the hair fall-knowing that in addition to my thinning I have some acne production especially on my nose and face areas-I am using Nizoral Cream 25 and Squad med shampoo to control Seborrhoeic dermatitis which is controllable using these medications. Does possible that I have both Seborrhoeic dermatitis and Male Pattern Hair Loss – I used monixidil 5% which resulted in few tiny hairs and I used propecia but i quiet it after 6 months due its sever sexual dysfunction and i am shifting now to Saw Palmeto —What is your comment doctor on saw palmetto on inhibiting DHT!! Thanks A lot Doctor”

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It is certainly possible that you have both seborrhoeic dermatitis and male pattern hair loss. The two are not connected and seborrhea does not cause hair loss. Saw palmetto is not a good DHT blocker, as is claimed by many. There are only two DHT blockers that are proven to work (finasteride and dutasteride). You need to be managed by a good doctor.

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Hair Loss InformationPlease Clarify The Effectiveness of Smaller Finasteride Doses – Hair Loss Information – Balding Blog

Dr. Rassman,

You indicated that 0.5mg of propecia was about 80% as effective as 1 mg. I believe you indicated that Dr. David Whiting informed you of this?

Then, someone posted “0.2mg of Finasteride is Almost As Effective as 1mg?” on September 8th which indicates that 0.2mg (not 0.5) is 80% as effective and you said that was the first you had heard of this report and you would look into it.

Would you verify which is correct. I take 1/2 a pill of propecia (for cost mainly) and I would like to know if it is as effective as 1 whole pill, since according to the FDA studies, 0.2 is 80% as effective as 1 whole.

Thanks

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I do not want to confuse you. The official dose of 1mg is what I recommend. Even if Dr. Whiting is correct about the 80% effectiveness of 0.5mgs of finasteride, 80% is not as good as 100%. With regard to the lower doses I published, please note that this was just a posting of information I received to stimulate thought. I would not change my dose to a lower dose, because it would put you at risk for hair loss. With the generic Proscar now available on the market, costs are reasonably in reach for most people.

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Hair Loss Information6-OXO Steroid Caused Hair Loss? – Hair Loss Information – Balding Blog

Your info site is really helpful. I am currently taking a nutritional supplement which is called 6-OXO. It is supposed to increase your testosterone levels. after taking it for 4 weeks, I definitely noticed something, (increased energy, strength, better mood, increased libido, muscle hardness and mass) but I also noticed an excess loss of hair. Now I’m 31 and have a full set of hair, but I’ve noticed this excessive hair loss start about 3 weeks into me taking the 6 OXO. Should I seek medical advice? What doctors specialize in these types of problems, and do you have any referrals in the LA or Orange County area in California.

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The symptoms you present do reflect increased testosterone, including the hair loss you are experiencing. We have offices local to you in Newport Beach and Los Angeles. You should get your scalp mapped out for miniaturization at the time of your visit to shed light on the underlying cause of the hair loss and the possibility that you have a latent genetic balding problem brought on by the increased testosterone.

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Hair Loss Information » Vitamin A Poisoning? – Balding Blog

Hi,

I am a 21 year old male, and I’ve had a very healthy scalp and a full head of hair, until this month. I started taking multivitamins, which contain what I now see as too much Vitamin A (10,000 IU; my weight is low, so that dose is high for me, I weigh 57kg).

There is now a small bald spot (about 1.5in diameter) on the back of my head, and its onset was sudden enough that I do not think this is male pattern baldness. My hairline has not begun to recede.

I’ve stopped taking the pills today, as I’m quite sure the excess Vitamin A is the cause of this, but I would like to ask you if I am right about this.

Also, in the event that this was Vitamin A poisoning, can you tell me if it’s possible for my hair to start growing in that bald spot again? I’m worried this might be permanent.

Thank you for your time.

Hair loss is seen in both vitamin A deficiency, and vitamin A excess. I think you are right about the fact that your hair loss could be related to overuse of vitamin A. It is good that you stopped taking the pills. You may want to use other multivitamin pills with lower doses of vitamins A in the future or the ones without vitamin A. The hair loss is usually reversible and disappears with discontinuing the medication but one always must be aware that anything that causes hair loss can ‘flip the genetic switch’ and it may not be reversible. Give it a few months and your hair will hopefully grow back if you don’t have any other underlying causes.

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Tried a Different Shampoo, Made My Scalp Flake and Peel – Hair Loss Information by Dr. William Rassman

I am a 20 year old male. About a month or 2 ago i started using a new shampoo, which around that time my scalp began to have a significant amount of flaking and peeling. It was mainly along the hairline on the left side of my head. This flaking continued until recently when i switched back to the old shampoo i was using. The flaking is almost completely gone, but on the side of my head where the flaking was occuring, the hair is thinner. Was the thinning caused from having such a dry flakey scalp and will it grow back as my scalp recovers?

As I have not examined you, nor do I know enough about the products you used, I can not answer the question about your scalp flaking. What I can offer is a small tip — if you wait out a period of about 6 months, the hair should return back to its original thickness, that is, unless you have some ’cause’ that requires a doctor’s attention. There is never a substitute to being examined by a good, caring doctor. Since you are concerned, I would seek out a dermatologist’s examination.

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Body Hair Questions – Hair Loss Information by Dr. William Rassman

Dr. Rassman & Dr. Pak-

I want to first thank you both for providing this blog. After looking online for some quality information and only coming across gimmicks – this is the first website I’ve found that I feel like I can trust.

Ok, here’s my question: I know you said you do not typically do body hair to scalp transplants. But bear with me here…

1) Does where the hair is growing determine the amount of pigment and texture of the hair? If body hair was moved to the scalp – does it continue to look like body hair?

2) I am a hairy guy, body hair wise. Head hair, I’m thinning. What if my body hair growth cycles are just different? Do they slow down over time? I trim my chest hair about once every 3 weeks. It would probably grow a half inch per month if I let it.

Btw, I’m a 25 caucasion male.

I read a great deal, so here are my answers based upon my understanding. Hair moved will look like the hair did at the source (donor site), but it may grow longer based upon recipient sites influences. Body hair on the scalp will continue to look like body hair on the scalp.

The length of time that body hair transplants being studied seem to be about 8 years or so. There appears to be an increasing growth rate possible when hair is moved (say from the leg to the scalp). Hair cycles may also change, but not enough to compete with scalp hair (king of hair growth length and cycle times of up to 6 years or so). If you let your body hair grow to length, I doubt that it would continue to grow longer and longer. Every body hair has its growth cycle which dictates the time the hair will be in anagen. If a body hair grows 4 months at a rate of 1/2 inch a month, it would grow out to 2 inches maximum before falling out. I am sure that if you checked your bed sheets and your body hair is dark (easiest to see with white sheets), you will see a constant shedding on your sheets if you let your body hair grow out.

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Hair Loss Information » 5 Year Old Daughter’s Hair Won’t Grow — What Can We Do? – Balding Blog

My 5 year old daughter’s hair will not grow. The sides (around her ears) grow longer than the very back and top of her head. We have tried trimming it, (she does not have enough to trim any more than an 1/8 of an inch at a time), we have tried shampoos to strengthen it etc. When I run my hands through her hair, it comes out. We have taken her to a local doctor who had no answers for us. She is almost six and we are scared that this is going to become an issue with her soon. We do not know where to go at this point? Any suggestions?

There are a number of genetic diseases that could be responsible. A good dermatologist should evaluate her. An example of a genetic disease can be read about here — Gene Glitch May Up Inherited Hair Loss.

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Things That Can Go Wrong in Hair Transplant Surgery – Hair Loss Information – Balding Blog

Thank you for this illuminating website. I would like to know that when you are doing a hair transplant, what are the things that can go wrong and what can the surgeon do to prevent them?

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I can write a book answering this question. Everything seems so simple. When a visitor comes to one of our open house events, they are amazed as to how simple it appears to be (we have a closed-circuit television setup where visitors can see the procedure as it happens). Alas, the beauty of what we do accounts for many of the things that you asked about and it is buried into the process. I will make a list, but the list may not be inclusive of every nuance. I will not discuss anesthesia right now, but will commit another blog entry to address that subject at some future time.

  1. For donor area harvesting using the strip method, the issues are (1) damage to the important structures of the scalp (nerves, blood vessels, attaching muscles must be carefully avoided in the incision process) and (2) damage to the hair follicles as the strip is removed which can occur along the blade that is used to incise the scalp. When the wounds are closed, the tension at the time of the closure reflects the size of the donor strip. High tension closures tend to cause a higher degree of scars.
  2. The hair follicles are dissected from the donor strip under a microscope and great care must be exercised to avoid damaging them as they are separated into 1, 2, 3, and 4 hair follicular units. The use of a microscope with a skilled staff guarantees the least amount of damage. The grafts must be kept moist at all times, as drying for even less than a minute will kill the delicate follicular units. Graft placement must be timely, for if the grafts are kept out of the body for more than 6 hours the survival decreases with each additional hour. The use of cold solutions can keep grafts alive for longer periods of time.
  3. Graft handling is critical, because crush injuries are common if the grafts are not handled very gently. The long term tenure of our staff is what minimizes graft damage during placing the grafts.
  4. Graft placement is critical. These grafts must be placed so that the top of the graft is flat to the skin. Placing them too deeply will kill the grafts.
  5. Recipient site distribution, direction, and the type of instrument used dictate which direction the hair will grow and if it will be normal in texture. The graft direction and distribution reflect the experience of the surgeon. Improper direction or distribution will produce less-than-ideal aesthetic results. The closeness of the grafts vary between patients. Those with less blood supply should not have close packing of the grafts, while in some patients close packing densities can easily and safely be achieved.
  6. Great care must be taken to fill each and every empty site with an appropriate size (# of hairs) graft. Stacking one graft on top of another graft is a common problem (piggybacking) in a less than experienced staff and it is the cause of folliculitis in many practices.

I hope this helps.