August 2007 – Page 11

August 9, 2007

Confused About the FDA Clearance of the Laser Comb – Hair Loss Information by Dr. William Rassman

Hi. I’m a little confused about the FDA ‘clearance’ of the LaserComb. I’ve read on some websites that this only covers the safety of the product but there is still no proof that it is effective in regrowing hair. Is this FDA clearance conclusive evidence that the clinical trials are correct and the LaserComb does in fact regrow hair? Is there a difference between ‘clearance’ and ‘approval’?

I am not sure about the implication of clearance or approval but it seems to be more of a semantic problem. The FDA has approved / cleared the use of the laser for the purpose of hair growth, but I believe it was approved because the laser has been shown to be safe in predicate medical devices that are similar. I have written extensively about this matter before.

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August 8, 2007

I’m Seeing Hair Loss – Am I Overreacting? – Hair Loss Information – Balding Blog

Dear Dr,

I’m 24 and have had very thick hair all my life, though my father is bald and started losing his hair in his late teens. (My mother’s father was not bald, and everyone on her side of the family has thick hair). I’m spending this summer doing research in Egypt, and shortly after I’d arrived I noticed hair falling out while shampooing and drying my hair. I think the worst was about 10-14 strands in one shower. I’m wondering whether I’m starting to go bald, or whether I’m losing hair because of the climate (maybe it’s not falling out so much as drying and breaking?). I had been taking extra vitamin A (25,000 IU) for acne, but have stopped that because I read on the internet that large doses of vitamin A can cause hair loss. I have also started using “anti-hair fall conditioner” which they sell here, but not, so far as I’m aware, in the States. Over the two weeks after those first few days, I didn’t notice much hair falling out at all. Yesterday however about 10 hairs or so came out while shampooing and drying, and today maybe 5 or 6. Out of curiosity, I took a picture of the back of my head, and was surprised to notice what looks like a bald spot. Now, I don’t know many people here in Cairo, so I’ve got a bit of extra time on my hands to worry. Am I overreacting? Is this just climate related “hair fall”? In the pictures I’ve included, does it look like I’m starting to bald? Is that just what the back of my head is supposed to look like? (I hadn’t, before this concern arose, taken many pictures of the back of my head). One of the photos is of my frontal hair line. I’ve always had a pronounced widow’s peak, but maybe it’s been receding without my noticing? This worry has become a major distraction from my work. Please help me figure out if I am going bald or not. I’ll be here until August, and have no way of seeing a trichologist until I’m back in the states. Should I start Rogaine now (supposing I can get it here)? If I wait two months to start it, will I have missed the opportunity to halt the onset of baldness?

You can use my photos, but please conceal my face and don’t use my name. I realize it’s difficult to give a prognosis at a distance, but I really would appreciate your best guess on my condition. Not sure this is relevant, but I thought I should mention that when hair does come out while I’m washing, drying, or combing my hair, it often makes a kind of a pop or snap, which might be the hair breaking. Also, most of the hair that comes out is white at the scalp-side tip.

Thanks so much for your help

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First, thank you for granting me permission to use your photos.

I don’t think anything severe is going to happen to your hair for the next few months. Don’t stress yourself out about it. When you return to the United States, come visit me if you can (I’m in California) and I will map out your hair for miniaturization and that will let you know if you are truly balding or not. Not much else I can offer via the internet without examining you. The best FDA approved medication for treating hair loss is Propecia (finasteride 1mg). We lose 100 hairs/day and that is standard in everyone. You can hear your hair popping and snapping? That’s an interesting one, for sure.

August 8, 2007

Is Hair Club a Scam? – Hair Loss Information – Balding Blog

I just joined Hair Club and spent 2,000 to join because I notice hair loss on my crown. Did i waste my money? Is this a scam and are they allow to do this false advertisement? I just had my first appoitment but I did sign a contract. Just wondering if I got scammed

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You need to educate yourself before entering any program or signing any contract. It is not difficult to get information these days through the internet to compare different products and services. Hair Club is a company that offers systems (wigs) with various attachment mechanisms. These systems can be expensive over time. You should be able to meet with others who had the systems or treatments that are being offered to make the judgments you need. Hair Club also has a medical group that offers hair transplant services. Hair Club is a reputable organization offering many options for hair loss, but you should always do your research.

August 8, 2007

Normal Daily Hair Loss Occurs In Shower? – Hair Loss Information – Balding Blog

Dear Dr. Rassman,

Thanks for taking the time to run this blog. It has been very helpful to me in understanding hair loss.

I’ve looked through the archives but have been unable to find any answers to a particular question I have. I know that it’s normal to lose between 100 to 150 hairs per day. Of course, the most obvious times for discovering this hair loss is when taking a shower (looking at your hands after putting shampoo in hair, seeing the hairs on the shower floor) or when waking up from a night’s sleep and seeing hairs on the pillow. By counting these hairs, I suppose it gives some indication of how many hairs one is losing, but hair must be falling out throughout the day as well. My question is what percentage, on average, of normal daily hair loss falls out during hair washing? It seems like I expend about 50% of my daily allowance of normal hair loss in the shower. What a amount of hair loss is normal when washing hair, in your estimation? I think knowledge of this might help alleviate some anxiety about whether the amount of hair loss I’m experiencing is normal. Since it’s difficult to know how much hair is falling out during other parts of the day, it would at least be helpful to know how much is normal during those times when hair loss is easier to guage.

Also, I know that you recommend a miniturization study to truly determine whether atypical hair loss is occurring, but, to my knowledge, I don’t have access to anyone who can do such a study anywhere near where I live. So, I’m hoping your response to this question will give me some indication about the normality of my hair loss.

Thanks for your time and efforts.

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Hair shedding is uniform, but clearly when you massage the hair (in the shower) or abrade it on your pillow, the loose hair that is about to fall out, will fall out a few hours ahead of your genetic schedule. That is why we suggest that you do not really rub hard in the shower and use a wide-tonged hair brush for combing, as it does not pull on the hair. I am sure that if you paid attention to what comes off in the comb or on your fingers in the shower, you are seeing more for that period of time when compared to never washing your hair.

August 8, 2007

I’m Advancing Toward a Norwood Class 6 or 7 – Hair Loss Information – Balding Blog

I have been balding since the age of 18 and am now 29. I have been taking propecia and then dutasteride for 5 years and although the process is still continuing I’m sure I would be completely bald by now if I hadn’t gone on the medication. I can see I am am advancing to a 6-7 norwood. I have thick blonde hair which sticks up and has lots of body, when i had a full head of hair as a child the barbers all commented on how thick it was and it was a nightmare to style. I would say presently i have about 20-30 hairs per square cm, less at the front and the coverage still looks ok. could i achieve good coverage from transplant procedures with a naturally looking but thin hairline?

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Look at the previous blog post titled, Difference Between Norwood Class 7 Patients. In that post, you will see a man (Patient BF) that became a Class 7 patient over 10 years. He started getting transplants in the front initially and then progressed to a Class 7 after the transplants were done. So yes, you can get a transplant and continue to maintain your look.

August 8, 2007

I Developed a Widow’s Peak – Balding Blog

Hi there doc., I have developed a widows peak in the last 2-3 years (18-21) however I have had no recession of the temples and my hair doesn’t seem thin at all. My brother has had a widows peak all his life and DID lose his hair, I did not have a widows peak all my life… is it possible I just have maturing hairline? can it mature IN to a widows peak? I don’t want to start propecia unless I need it.

Thanks a ton

I am not sure if what you are describing is a widow’s peak or a persistent forelock. We can speculate on what is really going on and if it is a maturing hairline, but in the end you should see someone who is an expert and get a miniaturization study to determine if there is genetic balding that is creating some interesting ‘art’ on your head. Please send me a photo with your eyebrows lifted high and showing the “widow’s peak” so I can then give you a better opinion. Reference this blog post when sending.

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August 8, 2007

Do the Corners Recede First in a Maturing Hairline? – Hair Loss Information by Dr. William Rassman

hi doc.with regards to a mature hairline, do the corners recede first and the middle afterwards or should the hairline all recede at the same time? as the corners recede further than the centre i am assuming they recede first,is this correct?? Thanks

A maturing hairline is not related to balding. It occurs as early as in the teenage years to the early twenties and may complete as late as 30. It may start from the corners or from the middle or both. In general, the corners seem to recede or thin out slightly faster causing one to panic and think they are going bald. The Norwood Class 3 balding pattern does have corner recession as well. When I see these patients in my office for a miniaturization study, I find that most of the time the miniaturization of their hair is only limited to the very front (indicating that they are likely not balding) if it is just a maturing hairline.

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August 7, 2007

Donor Scarring, Suture vs Staples, and Other Hair Transplant Questions – Hair Loss Information – Balding Blog

Hi, Dr. Rassman.
Some more issues:

Your book says the Monocryl suture can produce a fine surgical scar superior to metal staples and is less painful and more convenient to remove (since it doesn’t have to be removed…) If this is the case, why would stapling even still be used? Is it a matter of closing the wound as fast as possible?

Regarding scarring of the donor site, if scalp laxity can be measured before hand, why do people even end up with donor sites that cannot be completely closed?

Do you always remove a 1 x 15cm strip, and use all the FU’s, however much that turns out to be? Somewhere it is written that if I leave the session open-ended, more hair can be harvested. But don’t you close the donor site before proceeding with the transplants?

Tell me some more about the risks and the rates of complications. What percentage of the grafts transplanted at NHI typically grow? How much variability is there?

I am, as you would say, “doing my homework…”

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Good questions!

I have changed my mind on the use of staples. The Monocryl did produce some reaction in some patients which may have increased scarring. With regard to laxity measurements, there is presently no instrument available that will measure it (other than one we are presently testing) and laxity is often a judgment call by the experienced surgeon.
The size of the donor strip depends upon the number of grafts you need and this is a math calculation based upon the density of the hair (see Patient’s Guide — How Many Grafts Will I Need?).
I tell people to keep it open ended if possible so that a more generous strip may yield more grafts and then we can place higher densities.
With regard to the risks of any transplant surgeon, I wrote a book on this and can not replicate that book here. Our informed consent document defines those risks for our surgery patients in enough detail to manage what MIGHT happen, not what probably will happen. Most, if not all, of the grafts should grow after a transplant with a good surgeon and experienced transplant team.

August 7, 2007

Using Rogaine for 15 Years — Just Developed an Allergy? – Hair Loss Information by Dr. William Rassman

Hi Doc,

Taking Rogaine for 15 years. Have had a lot of shedding the last year. I stopped the rogaine for a week and noticed a definate decrease in shedding almost immediately. Could Rogaine be irritating the scalp and cause shedding? After so many years would Rogaine still be effective? If it does become less effective over time is it safe to stop without more loss?

Thanks

There is no way to tell with anecdotal accounts. It may just be coincidental. Generally, I would doubt Rogaine has been causing hair loss, but you might have developed a skin allergy to the drug. Generally speaking, some drugs may lose its effective clinical value over time, but it should not lose all of its potency.

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August 7, 2007

My Hair Falls Out After Dying It – Hair Loss Information by Dr. William Rassman

I have died my hair brown to black and when my roots came back I died it black again and now everytime I take a shower or brush my hair some of it falls out. I cant afford to go to a salon and have it done. What do I do?

Dying hair should not cause hair loss unless your skin develops reaction to the chemical components of the dye or you are damaging the hair. Any skin reaction or inflammation of the scalp can cause hair loss or precipitate the underlying genetic hair loss process. Make sure you are using a good and reputable brand when you want to dye your hair. If it is an allergic reaction it may happen with any brand. If your hair loss is due to a reaction to dye, you should grow it back in about 6 months unless you burned the hair root (then it would not grow back).

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