March 2009 – Page 12 – Balding Blog

March 4, 2009

Viviscal Before and After Photos – Balding Blog

This is an old post that slipped through the cracks and never got posted, so my apologies to the author of the email for taking so long to reply…

Dear Dr Rassman,

I am writing to you abaout my experiences with Viviscal (a.k.a Nourkrin). I have first noticed thinning at the temples at the age of 24, and looked for an expert’s advice. After the evaulation I was told that I am also thinning on the crown a little and I may lose my hair within two years. I was advised using Viviscal to prevent balding. However, what I have already lost at the temples could not grown back anymore. It only could have been prevented, if I had started the treatment at my late teens.

I have linked an interesting page about Viviscal with before and after photos. Haarmittel.com (German). The photos underpin that the hair loss at the front only can be prevented, but great results can be achieved on the crown, since follicles are not dead just inactive.

I am skeptical of the photographs and the changes shown make me doubt what the Viviscal marketing department wants me to see. Viviscal reportedly contains “special marine extracts and a silica compound” — and yet I’m to believe this will regrow hair? If these photos were real, the product would have taken over the market years ago.

I ran the page through Google Translate, so this link may be more interesting to my English readers — Viviscal photos.

March 4, 2009

Very Asymmetrical Hairline Is a Shared Trait In My Family – Hair Loss Information by Dr. William Rassman

Hi Doctor,

I have a very asymmetrical hairline (mature on the left corner, juvenile on the right) which I first noticed at 16 and concluded that I must be going bald. Happily, 11 years on, my hairline hasn’t moved at all. I’ve since noted that my father has the exact same hairline complete with the same degree of recession on the left corner. I was just wondering the significance of this shared trait – do you think it’s reasonable to expect my future hairline to bear some resemblance to his?

Thank you.

There is no significance. It is just the way you are. A few months back a patient of mine had a similar problem… at least, it was a problem to him. So he had a hair transplant procedure to make his hairline more symmetrical.

I do not know if this is a genetic trait per se, but I suppose it does run in your family. And with respect to your future hairline, I do not know. I can only assume after 11 years of having the same hairline, your hairline seems stable.

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March 4, 2009

I Had 5 Hair Transplants and 5 Scalp Reductions… – Hair Loss Information by Dr. William Rassman

Hi, (classification: Norwood 6)

I need some advice on scalp reductions please!!!

I started to lose my hair at the age of 17-18 and it had a profound impact on me. I went to a dermatologist who recommended a very good hair transplant doctor and at the age of 19, I had my first hair transplant which really helped my confidence. As the years progressed, I started to lose hair in the crown area and it was suggested to have a scalp reduction.

Well, i’m 33 years old and i’ve had 5 transplants and 5 scalp reductions. Along with some cover up, my hair looks pretty good! But i’m still losing hair in the crown area! My question is: Do scalp reductions really work? What about stretch back? I still wonder back to the days when I was 17, and wonder if I had just shaved my head bald!!

Your thoughts and opinions are appreciated, thanks.

Scalp reductions do not work well and have caused misery for many patients, including myself (having had three of them and ended up more bald in the crown then before I started). I went on a campaign to discredit that surgery and I believe that my opinion is now shared by most competent doctors. That is why scalp reductions are not the standard of care for balding men today.

You probably should not have had a hair transplant in your late teen years — and as you can see now, you’re probably out of donor hair and options. As you wonder back to your days, I agree with you. Sometimes bald is beautiful!

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March 4, 2009

Does Dutasteride Produce More Estrogen? – Hair Loss Information by Dr. William Rassman

Hi Doc,

I have been on propecia for 15 months with no results and less hair. I really want to try my luck with Advodart or Dutasteride. I just want to know if this produces more estrogen? If so is there risk for blood clots or stroke with dutasteride? I really would appreciate your opinion on the switch and lethal concerns . Thanks so much for your time.

It appears that there is a competitive effect of DHT and estrogen, so if you block DHT with any DHT blocker such as dutasteride or finasteride, the estrogen levels will rise. As far as I am aware, the increased risk of clots or stroke is negligible, but I’m not well versed in everything dutasteride as I do not regularly prescribe it at this point.

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March 3, 2009

In the News – Scientists Discover Cause for Gray Hair – Balding Blog

Snippet from the article:

Scientists may have figured out why hair turns gray, and their finding may open the door to new anti-graying strategies.

New research shows that hair turns gray as a result of a chemical chain reaction that causes hair to bleach itself from the inside out.

The process starts when there is a dip in levels of an enzyme called catalase. That catalase shortfall means that the hydrogen peroxide that naturally occurs in hair can’t be broken down. So hydrogen peroxide builds up in the hair, and because other enzymes that would repair hydrogen peroxide’s damage are also in short supply, the hair goes gray.

Read the full article at WebMD.

This article was pointed out to me by a member of the BaldingForum, so my appreciation goes there for drawing my attention. If you have a hair-related news item, please send it!

March 3, 2009

In the News – Aderans and HairDX Team-Up in Japan – Hair Loss Information by Dr. William Rassman

Snippet from the article:

Pharmacogenomics research and development innovator PharmaGenoma, Inc. and its subsidiary HairDX, LLC, pioneers genetic tests for predicting the risk of male and female hair loss, today announced an exclusive agreement with Aderans Company Limited of Tokyo to introduce the breakthrough tests in Japan starting on March 1, 2009. The HairDX test collection kit is listed with Japan’s Pharmaceuticals and Medical Devices Agency (PMDA) as a Class I medical device.

The agreement makes Aderans the sole Japanese distributor of HairDX’s revolutionary genetic tests, and further expands Aderans’ leadership in the hair care and medical fields. Aderans and its group of companies span over 17 countries worldwide, and in 2001 Aderans purchased Bosley, Inc., one of the world’s largest brands in hair transplant, to further solidify its global position as a leading company in the hair care industry.

Read the full article at MarketWatch.

Interesting news regarding the business side of genetic testing. Yet in my opinion, the diagnosis of genetic male pattern balding (MPB) probably does not require a genetic test as the diagnosis is self evident in the pattern of balding or miniaturization. Do you need a genetic test to tell you that you have blue eyes? I suppose you can make the argument that you can slow down the balding process or start a medical treatment plan (Propecia) earlier if you know you have the “gene” for balding. But in my opinion, starting treatment without having evidence of balding is not the proper thing to do.

Predicting a possible fatal disease like genetic testing for breast cancer may pick up the risks early (before the cancer appears), but we would not take off the breasts of a 15 year old just because she carries the gene. Clearly the older a woman becomes, the greater the risk becomes, so the decision on when to treat the genetic propensity is difficult. I am all for genetic testing and research, but my personal bias on the HairDX testing is that it is a marketing tool rather than a clinical tool, as it should not dictate treatment without showing overt balding or miniaturization.

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March 3, 2009

Could FUE2 Replace the Strip Method? (Part 2) – Hair Loss Information by Dr. William Rassman

This is Part 2 of 2. If you missed Part 1 from yesterday, that can be found here.

—

What is FUE2?

Ever since we announced the FUE2 technique a few months back, people have asked me how it is different from the traditional FUE procedure I invented and published in the medical journals back in 2002. The basic difference is the addition of a water jet for enhancing the dissection of the excised graft. The pressure of the water jet adds to creating a plane of dissection which produces clean grafts as good in most situations as strip harvested grafts (the golden standard for follicular unit transplants).

What is better, the strip or the FUE2? First lets assume that the FUE2 produces comparable quality grafts to the strip harvesting method. When the donor density is low, the missing follicular units from FUE2 become obvious when the hair is cut short. There can be a moth eaten look in these low density people. In high density people, the FUE does not show up so there is generally not a moth eaten appearance, but the many white dots created by the FUE scar can be seen and this will absolutely limit a shaved head. When a strip is performed and a good wide lower trichophytic closure is created, the scar is less in most patients than any scar from FUE. The problem is that most FUE doctors have created illusions around what they do and produce hype that will never be substantiated in most patients, particularly those with low to average densities and a high number of FUE grafts. I always tell the patient that I get 50% more $$$ for an FUE procedure (graft for graft), so if I recommend the strip as a viable alternative, it is clearly not a financial issue for me. The results of the evolution in my thinking is based upon following many patients (mine and other doctor’s patients) with regard to scarring.

THE FUE2 is a better procedure than the standard FUE, but not better with regard to strip harvesting in quantity and quality. FUE fails to grow at the 90% plus rate much of the time in most doctor’s hands, but strip grafts do not. I am afraid to tell you that honest doctors who do FUE are few and far between, but they do exist. With our FUE2 procedure, we clearly can do it better than most doctors. And as our survival rate following FUE2 is comparable to strip harvesting and significantly better than traditional FUE, the choice with us is clearly in the hands of the patient. I try to present a balanced approach in the analysis when patients come to my office and ask about FUE.

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March 3, 2009

Concensus Among Doctors About Hair Transplant Aftercare? – Balding Blog

I will be undergoing a transplant in the near future and am wondering if there is any consensus on post op care, shampooing etc. Please elaborate on the difference between crust formation and what it is and the ideal of not dislodging the graft if you may. I did read some earlier posts referencing a study which advocated frequent “showering” after the procedure. Does this mean a gentle stream of water on the head or irrigations with say a bowl of water on the head etc. I am very interested in the current consensus. PS I am also a MD. Thanks so much.

Good washing requires a balance between mechanical washing and suds. Frequently wetting in the shower will not do the job. I do not believe that doctors have a consensus on this subject.

I suggest you buy my book, Hair Loss and Replacement for Dummies, for an in-depth discussion of the very issue of patient aftercare (buy it at the Hair Outlet Store, powered by Amazon).

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March 3, 2009

Are Allergies Causing My Miniaturization? – Balding Blog

Hello Dr. Rassman,

I am a 25-year-old male and I have been noticing a rapid thinning and recession for about a year now. 3 years ago I got on propecia cause I was shedding real badly. I stayed on it for a year, noticing less shedding and darker hair but that was it. I got off of it cause I thought it wasn’t doing much. Then I started to notice miniaturization forming at the front of my head. My family (both sides) has thick hair, really thick hair.

Fast forward to now and my entire front to mid scalp is miniaturized (looks like a thin doll hair forest) and I am continuing to recede. I tried starting up Propecia again; for 5 months a year ago but stopped cause I felt like maybe it was the cause of this thinning. This is also the time that I was diagnosed for Prostisitis and Epiditymitis. I still have prostititus and it’s been about nine months. I am also continuously shedding except now they are very fine hairs, most of them have bulbs on the end and my hair feels very brittle and dry all the time (even after conditioner)

What I do notice when with the receding line is that before I loose the hair and it goes further back, I get red bumps, kind of like pimples, they are really itchy I noticed it back when I first started receding 5 years ago. They usually cover the entire line then once I recede past, no bumps and the skin is fine. I have these little bumps all over my head and they itch and burn really bad. Almost like ant bites. (The bumps were also there while I was on Propecia). Do you think I have an allergic reaction to something? Can allergies cause hair loss and miniaturization? Or can it be the prostisitis causing something? Or the propecia?

Please note: I have been tested for STD’s, irregular kidneys, regular blood tests, urinalysis, testosterone levels, thyroid problems. They all came back negative. I’ve talked to one dermatologist and he said I might be allergic to dairy. But I have been drinking it all my life. Any type of info would be helpful at this point.

Thanks

Your case is not simple and one would want to know far more about you than this summary will allow. The most common cause of hair loss in men is genetic male pattern baldness, and while anything is possible, it is not too likely that allergies are causing your miniaturization (especially if you are thinning in the typical male pattern). If you think there’s a dairy allergy that suddenly came on as an adult, then avoid dairy and see if your hair grows back or hair loss stops. My guess is that it won’t make a difference to your scalp though.

Starting and stopping the Propecia means that you are acting like your own doctor. Stopping that drug will kick start the hair loss again and restarting it again may do less good each and every time that you make a change. The red bumps you describe on your head just confuses me more, as I can not put it all together. You should seek out a second opinion from another dermatologist in your area and have him/her examine those itchy bumps on your scalp.

March 2, 2009

Hair Loss InformationWhy Are Some Transplant Scars More Noticeable Than Others? – Hair Loss Information – Balding Blog

How come some people’s scarring on the back shows up so noticeably, and others don’t? Does it all depend on how many grafts you use?

Block Quote

Scarring is a complex problem related to:

The healing properties of the patient
The size of the strip
The techniques used at the time of the surgery
The skill of the surgeon

We are all different, so assuming you compare 100 of my patients (where I did all of the surgery) that only received 1000 grafts, for example, the variation in healing will become evident, assuming that the exact same technique was used on each closure.

When I performed general surgery and did an appendectomy, I used to brag how wonderful my scars were, and how you could rarely find them. That was the case in 19 out of every 20 patients. The 20th patient would be excluded from my bragging. Get it?