December 2006 – Page 6

December 14, 2006

Hair Loss InformationIs an FUE Procedure a Less Successful Hair Transplant? – Hair Loss Information – Balding Blog

What do you mean by saying “FUE can be done in one surgery (our group did as many as 2600 in a single patient in a single session) or it can be done multiple day surgeries”? You said that this does not mean that FUE produces viable hair, so does that mean that you see less success in FUE procedures???

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Anyone can claim that they are an expert at a procedure, but where is the credibility? The results of an FUE procedure in good hands will be as good as the standard strip procedure, but yet all FUE grafts are not equal. In our original article, we talked about the candidacy of patients, where some patients were better suited for FUE than others. Now the non-candidacy group is smaller, but the quality of the grafts may become an even more important issue.

For the future, we can look to the past, as Dr. Jae P. Pak’s engineering work led to a robotic application and a U.S. Patent granted for the FUE technique in 2003 (U.S. Patent 6,572,625). We can expect to see a robotic application coming out in a year or two.

In brief, Follicular Unit Extraction (FUE) can produce damage that range from transection (cutting) of the hair follicles to avulsion of vital elements of the graft. The percentage of such damage should be under 10 percent. When compared to the traditional strip surgery, the follicular units taken under the microscope from the strip excision are mostly perfect. The FUE procedure is not as time efficient as the strip either. Local damage to each individual follicular unit depends upon:

the skill of the doctor
the instruments and techniques used
the tissue characteristics of the patient

Most doctors do not classify the quality of each individual FUE graft nor do they calculate the transection rate, so the integrity of the doctor in making this assessment is just as important as his/her skills. Please note that nothing is 100% and always be wary of doctors or salesmen promising you 100% success rates, or a willingness to take on any patient for an FUE, or flippant comments like ‘our grafts’ do not get damaged. Always ask the doctor how he/she knows. Look at the picture of the three grafts below. The graft on the left is a normal FUE three hair graft with good fat and fibrous tissue surrounding the follicular unit, the one in the middle shows transection of one out of two hairs (only one hair may grow, but it is denuded of skin so it may not grow to its full bulk), and the one that is on the right is a three hair follicular unit which shows that the follicles have been stretched and the surrounding supportive tissue has been stripped away (these grafts will ‘probably‘ grow, but they may not have their normal width when they grow out). If this patient had coarse hair normally, the graft on the left would be coarse when it grows (like his normal hair), the one in the middle might be less than coarse (less than his normal) and the one on the right may be ‘finer’ hair. A coarse hair has better bulk and better coverage for this patient than a ‘fine’ hair and the results of the fine hair graft when and if it grows will almost certainly disappoint the patient when compared to what it should have been. Click the photo to enlarge.

Grafts

For further reading about the FUE process, please see What Doctors Don’t Want You to Know About FUE.

Errors: http://baldingblog.com/photos/061214_fuegrafts.jpg is not accessible or supported filetype.

December 14, 2006

Texture Change Over 5 Years — Is This a Hair Loss Indicator? – Hair Loss Information by Dr. William Rassman

As of now I don’t have any apparent signs of male pattern hair loss. However I am 25 now and my hair is definitely not as dense as it was 5 years ago. There is also a texture change from 5 years ago as well. The texture of my hair back then was thicker and harder and now it’s a lot softer. Is this an indication that my hair loss is occurring at a very slow rate? Also why am I able to pull out more hair from the crown vertex area of my scalp when tugging lightly as opposed to the front of my scalp? In the frontal area I can never see as much when lightly tugged on. Is this a sign that I may go bald in this area of the scalp? You’re answers are greatly appreciated. Thank you Doctor.

If there is a ‘texture’ change when you compare the back to the top or crown areas, you may be experiencing early hair loss. The best way to tell is to have your scalp mapped out for miniaturization and then the diagnosis will be evident, one way or the other. The loss of crown hair from pulling or brushing may also be a sign of early hair loss. The drugs like Propecia (finasteride 1mg) for those early in the process in your age group can be miraculous and you should see a change in the amount of daily hair loss within a few months of starting a drug like Propecia, assuming the diagnosis is confirmed.

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December 14, 2006

Losing Hair on Back of Head – Hair Loss Information by Dr. William Rassman

Doc, I’ve recently taken notice that along with my frontal hair loss, I’ve been losing way more hair from the back side of my head. Since that is the permanent zone, could this have an effect on any future hair transplants? I’ve been on Proscar cut into quarters taken daily since January. And can hair length increase or influenece hairloss (as mine is just about shoulder length)? Thanks

I must sound like a broken record. To make a diagnosis, you need to have your hair mapped out for miniaturization to determine what is actually happening. If you are losing hair from the ‘permanent’ zone and you are a male, then you may have Diffuse Unpatterned Alopecia (DUPA) (see Follicular Transplantation: Patient Evaluation and Surgical Planning?). If you are a female, then this is not unusual, especially if you have genetic female hair loss. Get to a good doctor and find out what it is and then what to do about it.

December 14, 2006

I Want to Take More Finasteride Each Day – Hair Loss Information by Dr. William Rassman

I’ve been on Propecia for 9 months with little sign of improvement and i’ve been seriously considering Dusteride or increasing my dose to 2mg instead of 1. What are your thoughts on this?

I am not your doctor, but going to 2mgs of finasteride should not be a problem. Discuss this with your doctor, though. The ideal dose of 1mg finasteride is an average for average people with average hair loss. I can not imagine that twice the dose should be a problem provided that there are no side effects noted. There are some doctors who actually suggest 2mgs, but there is no evidence that I know of which shows that 2mgs is more effective than the 1mg dose. The statistics on effectiveness were based upon general populations and large numbers, and clearly this would have some bell curve variation, so it would not be unreasonable to assume that some people will be more or less sensitive to the benefit. If you take 2mgs, take one mg twice a day (12 hours apart morning and evening).

December 14, 2006

I Want To Harvest Facial Hair for Transplanting Into My Scalp – Hair Loss Information by Dr. William Rassman

i am a 25 year old male with some male pattern baldness. I still have quite a bit of hair, but just want to have a full head of hair. I am interested in harvesting from the donor area near the back and sices of my head, but also was interested in hair from my beard (my chin). do facial hair transplants have just as low hair regrowth as body hair. also how many hairs can be transplanted from your chin with just one prcedure.

It would be malpractice for a surgeon to do beard to scalp hair transplants in a 25 year old. If you are committed, please do the standard thing and do not invent your own surgery. The price you will pay will have nothing to do with money.

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December 14, 2006

I Take Prescription Drugs — Are Any Causing My Hair Loss? – Hair Loss Information by Dr. William Rassman

I am a 29 year old male ive been on propecia since my was 20 my hair desity and hair line stayed the same until recently. moved to another state and started on a taking xanex for anxiety and stress i started noticing a great deal of diffuse hairloss all over the top of my head i stopped the xanex and got on dut,minox,spiro,tricomin and thought that if the hairloss was due to the drugs it would grow back to the way it was previously but it did not seem to change i am now on klonopin and think i am noticing more loss are benzoziapines known for hairloss and if so would stopping them revert my hair to its old appearance?

Xanax is not yet blamed for hair loss, but stress is. Some of the other medications you are taking could cause hair loss. Stress may have been accelerating the act of your balding genes. Although hair loss is reported with use of some prescribed medication, it is not easy to hold them solely responsible for hair loss and a combination of factors are involved. Hair loss is stated as a rare complication of Klonopin, but could it be the cause of your hair loss? Hard to tell!

Get your hair mapped out for miniaturization and make a distinction between genetic hair loss and drug induced hair loss. If there is a genetic pattern, the miniaturization study will show that clearly.

December 14, 2006

Hairlines and Race – Balding Blog

I was curious why less minorities lose their teenage hairline then white caucasion males? They eat similiar diets, why could this be?

There are clear genetic differences that must be responsible for the different shapes of the hairlines when comparing one race over another. African and Asian (all of Asia) have flatter hairlines (more convex shape) and may retain more of their frontal hairlines than Caucasians (where 95% of males lose their childhood hairlines and recede upward, particularly in the corners taking on a concave shape). It’s in the genes.

December 14, 2006

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

Dr. Rassman,
Which types or brands of antidepressants are reported to be more notorious in causing hair loss.

I do not know of any study which compares the hair loss impact of one antidepressant vs another. Each and every person is different and many people do not lose hair with these medications. There is no certainty one way or the other.

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December 13, 2006

Hair Loss Information » Taking Biotin to Prevent Hair Loss? – Balding Blog

I am a 22 year old male, and have just recently started noticing minor thinning in the front of my hairline. Male-pattern baldness runs in my family. I consulted a stylist who told me that taking a supplement with Biotin can prevent hairloss. I am not worried about regrowing any hair, as it isn’t a problem yet, only maintaining what I currently have. I ordered 3 month supply of Provillus, which contains both Saw Palmento and Biotin. My plan is to see if it has any effect or not. Is this a good approach and also what else could I do if this doesn’t help?

Why experiment when we know that if the diagnosis of genetic hair loss is confirmed, then finasteride works? Every day, every month, and every year you experiment, you will allow your irreversible hair loss to get worse and worse and worse and worse. Stop playing Russian Roulette. Biotin is no answer to your problems, unless you are deficient of biotin.

December 13, 2006

My Teenage Son Has Alopecia and Wants Laser Hair Removal – Hair Loss Information by Dr. William Rassman

My son, has had alopecia since age 13, when he turned 19 this year he started having laser treatments on his scalp to permantly remove the rest of his hair in order to look more uniformed and without patchiness. After 6 treatments already, the patchiness still exist, but permant damage was done in some areas. Is he now scarred for life @ age 20. Please help!!! He would like all of his hair removed nice and smooth skin, I wish he never would have had laser to begin with and had hoped for hair to regrow. Is regrowth ever possible now?

Regrowth of hair in the presence of active alopecia areata is likely not possible. I would need to evaluate him to understand the complex process and findings you are telling us about. Am I correct to assume that the lasers produced skin damage? Was it skin discoloration or is it real scarring? Is your son also balding from genetic causes? What was the last time he had a diagnosis for determing if the alopecia areata is active now? There are a number of doctors who specialize in the treatment of alopecia areata — has he seen any? It seems your son wants to be bald. There is nothing wrong with being bald (or shaving the head), but being scarred is a problem. Please send me photographs and if they are good quality, I can review the problem with you.

As an aside, bald has been coming into style in recent years and has been more accepted by the “hip” young men of today. It should be clear to most people that the option to shave the head may be lost if you have a hair transplant procedure performed. Anyone with a good hair transplant that uses strip harvesting would have a noticable scar if the head was shaved, even if the scar was only 1mm width in size. This is also true even with the minimally invasive follicular unit extraction (FUE) technique where punctate scars (1mm in size) may be present. The presence of a Master Plan is critical in whatever you do.