June 2009 – Page 8 – Balding Blog

June 12, 2009

What Does It Take to Be a Good Hair Transplant Surgeon? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman. What does it take to be a good hair transplant surgeon, besides a medical diploma?

I could write a book on this subject (and actually, I did write two books). Simply put, the characteristics of a good doctor will always put the patient’s interests above his own and works relentlessly for the welfare of his patients without regard to money or time. The good transplant doctor will have an artistic skill as it applies to the field of hair restoration.

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June 12, 2009

Progaine Shampoo – Balding Blog

Doctor, you mentioned in one of your recent posts that you supply one bottle of Progaine Shampoo to your patients after the surgery. I use Progaine a lot but can only find the Progaine Volumizing Shampoo available. The other Progaine products do not seem to be available at this time over the internet or in stores. Do you know why only one Progaine product is available at this time? When would the other products under the brand name be available again? If you could provide any information, it would be appreciated very much!

Progaine is just a volumizing shampoo like any other volumizing shampoo. It does not grow hair. There were other formulations, but I believe they’ve been discontinued. I just did a quick search online and you’re right -only the volumizing shampoo seems to still be for sale.

But… um… I must’ve had a temporary memory lapse when I said that Progaine was what I give to patients after their hair transplant surgery. I used to provide Progaine, but for years now I’ve provided GraftCyte shampoo (which contains copper peptide to promote better healing). You can find more info about that here. Sorry for the confusion!

June 12, 2009

Experimenting with Arm Shaving – Hair Loss Information by Dr. William Rassman

Hey doc, an experiment: i marked a section of my arm and shaved the hair with a razor after i repeated this a couple of times i noticed that the hair in each follicle multiplied. After a while all of the follicles multiplied hair counts. Why is this happening and why cant it be implied on the scalp?

I have trouble believing this. If you believe its true let me know the results when you try this on your scalp. If you shave your scalp, I doubt you will get more hair growing. Is this your goal?

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June 12, 2009

Could This Be Shock Loss Behind My FUE in the Hairline? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,

First I would like to take this opportunity to thank you for this great website.

I have two questions and i would be very greatful if you can answer them :

1. I had an FUE procedure done on the front area (frontal hair line)with approx. 1200 grafts before three months ago, the strange thing that i am experiancing is some hair loss in the area behind, which is in the mid-scalp area, is this shock loss? shedding period? or the normal genetic hair loss pattern? and how can i tell the difference between them?

2. If your answer to question no.1 is shock loss then can you tell me what is the solution for it? and is there any chance of hair regrowth for those that were lost? (By the way i have used propecia for 12 months before a few years ago but with no success and i experianced terrible testical pain)

Thank you and Best Regards.

If you were not on finasteride when you had your FUE procedure, it would almost be certain that you had shock loss. You should have worked this through with your doctor prior to having the surgery. I always assess the status of the hair behind the transplant recipient site and if it showed significant miniaturization, one could have predicted this outcome. I would need to see you and understand what the loss area shows now.

I would also have considered lower doses of finasteride, which may have allowed you to use the drug without the complication. One quarter of a pill finasteride (0.25mg) can be effective at minimizing hair loss from shock.

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June 12, 2009

Could I Have Body Hair Transplants with a Strip Method? – Balding Blog

Dear Doc,

I have heard of body hair transplants and read that they are not a reliable form of surgery due to the body hairs being weakened during extraction. However, because the body hairs are being removed with a hole punch type of instrument that may damage them, could significantly better results be attained if the body hair grafts were removed via a strip method? Let’s say the patient did not mind have a scar on their thigh as long as the strip provided enough grafts for his needs. In my case, I am thinning in the crown and anticipate that I will require far more grafts than my donor supply. Thanks

Body hair transplantation is not a gold standard method to transplant hair to the scalp, because body hair looks and behaves different than scalp hair. Damage isn’t the problem — hair growth cycles are. Only about 50% of the body hair is in growth stage at any one time, so the hair-for-hair yield is 50% rather than 90% plus as with the scalp donor hair. In other words, you won’t see most of the hair at the same time… and the hair that you do see will look different from actual scalp hair. Body hair does not grow long and has a different texture than scalp hair. To directly answer your question, yes you may find a doctor willing to do it, but the above material is presented to try to get you to think through that decision.

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June 11, 2009

Where Is the Topical Finasteride? – Hair Loss Information by Dr. William Rassman

Hi
Great blog you have, really useful. I have a question about topical Finasteride. I take 1mg Finast and think it might be holding my hair loss + scientifically expect it probably should be, therefore very much don’t want to stop. However, I am convinced that I get sexual side effects whereby my penis is just not as full and pumped (flaccid and erect) when I take it. I’ve tried experiments of washing it out for 3 weeks and then going back on it and I’m pretty sure there is quite a marked difference.

This has left me in a dilema and I was very glad to see a recent Indian paper in which they’d compared topical Finasteride with oral for a few months and found that, though the effect took longer to come on, it seemed as strong after 6 months.

Do you know how far away we are from topical Finasteride being available? Whether there is any other data on efficacy? Whether there is any data on whether systemic absorption occurs? And whether one has to apply it for long periods which would make it problematic to use? Many thanks for any light you can shed!

I’m not sure which Indian paper you’re referring to, but to my knowledge topical finasteride doesn’t have proven value. It would require special formulations for topical use and some drug company would have to push it through the FDA before it was determined safe and effective. Some doctors sell it online and armchair chemists on hair loss forums have their own tips on how to make your own, but I’ve not read any formal studies that show topical finasteride works the same as the oral finasteride. I’ve written about this before.

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June 11, 2009

My Hairline Was Transplanted Too Straight – Balding Blog

Hi Dr Rasman – many thanks for the very appreciated blog.

2 years ago I underwent an aggressive hairline FUE procedure – 3,000 grafts all in the hairline with temple closure.

I’ve recently started shaving my head and, despite the white-dotted donor area, I feel much better about myself. I’d love to continue shaving my head – the problem is the recipient area. My recipient hairs, though not particularly dense, are much thicker than the natural hair behind them and begin with a very sudden, ‘flat’ line. The texture of the skin is bumpy and *may* form a small ridge at the start of the hairline; it’s difficult to tell whether it’s scarring, or just hair follicles pushing up the skin.

If I were to remove the grafts, is there any hope of restoring a natural-looking, albeit bald area where my current transplanted hairline is? If so, what sort of treatments would you suggest?

Thanks again for the site

Oh wow! 3000 grafts to the hairline and temples does sound very aggressive, if not impossible from my personal experience. The bumpy skin texture you describe can be scarring from your surgery and if it is scarring there really is no treatment for it. I am not implying you had a bad surgery, but hair transplant surgery is not reversible. Hair transplant surgery is permanent and you need to have a good foundation and understanding of what you are getting yourself into, as well as the long term complication and issues (such as scarring and shaving) before you regret the decision.

There are doctors who do 3000 grafts routinely in a small area of the frontal line and I have seen the work. The hairlines I have seen are straight and many times I doubt that the patient actually got the 3000 grafts they paid for, which makes me question the integrity of the doctor. These hairlines can be repaired by creating a good transition zone in front of the harsh tight hairline, but that assumes that the hairline was not placed too low in the first place. Often in some of these patients the hairline is too low, making a good repair very difficult. Each case is different and I would love to see you either in consultation or good digital photographs of your frontal hairline.

June 11, 2009

If Propecia Takes Months to Start Working, Why Did My Loss Stop After Only a Month? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,

I’ve now been on Propecia for a little over a month and a half and it appears that I’ve noticed a slow down in shedding since before I started taking it. I know that on average we lose 50/150 hairs a day and I’m positive that I don’t notice all of the hairs that I lose over the course of the day (that would be impossible), but I am almost certain I’m not losing 100 a day, and it appears I’m shedding much less than before.

Is it pretty common for Propecia to start working noticeably a month and a half into treatment? I’ve read that it takes three months at least for it to start slowing down hair loss. I still have a pretty full head of hair (with some thinning at the crown and slight recession in the front. Not seeing as much hair shedding has me feeling really good that Propecia might work really well for me. Thank you, Dr!

Many people will report a reduction in shedding within the first month of taking the drug. I don’t know the hows or whys of it, but the medication doesn’t work exactly the same for everyone. In your case, it sounds like you’re seeing a positive result in a short amount of time. That’s good news!

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June 11, 2009

Hair Loss from Herbal Essences Hello Hydration Shampoo? – Hair Loss Information by Dr. William Rassman

Hi, I recently tried out a new shampoo and conditioner set called Herbal Essences Hello Hydration. It has silicone in it, and can help improve shine quality in your hair, so I gave it a shot. I noticed afterwards more hair coming out after I rinsed the shampoo and conditioner out, but thought it was just natural. I switched shampoo and conditioner for a bit, came back to the Hello Hydration set, and when I rinsed out a clump of hair immediately came out between my fingers.

Is this coincidence, or do you think there is a relation??? Please help!!!

Maybe it is a coincidence. If the shampoo actually causes hair loss, I am sure it would have never been introduced/sold. I have personally used the shampoo before and did not experience anything different. If you believe there is a relation, then I would suggest not using it.

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June 11, 2009

Hair Loss and Replacement for Dummies — The Reviews Are In! – Hair Loss Information by Dr. William Rassman

I know this will just sound like a plug for my new book, Hair Loss and Replacement for Dummies, but I haven’t mentioned it nearly as much as I should. There’s a reason for this post aside from the obvious — renowned hair transplant surgeon Dr Richard Shiell, author of many article and classic books in the field has written his review, which I’ve posted below. It serves as a good overview of what you can expect from the book, which I might add is sold online for under $12 at Amazon.com, and makes a great gift for those that are essentially looking for a handy, printed version of BaldingBlog.

P.S. It’s now also available on your Kindle e-book reader (and iPhone), in case you’ve given up on printed books!

Dr. Shiell’s review starts here:

—

Apart from the textbooks, written for professional, there have been many books on hair loss and replacement written for members of the public. I have read at least a dozen of these over the past 30 years and they are all quite informative and, for their time of publication, reasonably accurate and helpful.

Hair Loss & Replacement is no exception in this but it is a considerable cut above the rest. Firstly it is very up-to-date and contains a vast amount of information all exceedingly well organized in 7 sections containing 18 chapters:

Getting to Know your Hair

The Root of Hair Loss

Creative Techniques for Concealing Hair Loss

Pharmaceutical, Laser and Topical Therapies

Advanced Hair Loss Solutions (60 pages about hair transplantation)

The Part of Tens (10 myths about hair loss, pros and cons for wigs, hair treatments and transplants)

Appendices- this include a Glossary of scientific terms used in the book. In addition the reader is provided with the addresses of all the well known hair-loss websites and support organizations and many more. There is also an outstanding Index running to 16 pages.

Throughout the book important points to remember are clearly marked with an icon in the margin, as are tips and warnings. The reader is even alerted by another icon to technical paragraphs that he can safely skip without losing the thread of the chapter.

Now a warning. Although this book is designed for those with little prior knowledge about hair, it is certainly not recommended for “dummies”. It is a very well written and technical book, authored by two of the acknowledged “gurus” of our field, Bill Rassman and Bob Bernstein, The previous scientific writings of these two men are already at the top of any reading list on hair replacement surgery. Far from being a text for the “everyman” the book would be an ideal primer for any doctor wanting to know more about hair loss and its replacement, before committing many months to a specialized training course in hair replacement surgery.

Every aspect of hair growth, hair loss and hair replacement is covered concisely in this book in reasonably simple language and I could find few faults within the text. Perhaps even then, they were just minor differences of opinion between experts, rather than faults.

There is no attempt to “talk down” to the lay reader and in fact the only concession to the layman is that each of the 18 chapters is fairly well self-contained and if he only wants to know about, diseases that cause hair loss, hair transplantation or hairpieces, then he can be well informed in a self-contained section.

Summary
This is a really outstanding book for the beginner who has a considerable degree of education but no place for a true “dummy” to be browsing. Perhaps someone will do a 50-page comic-book version for these individuals who, judging by popular book sales and TV ratings, make up a considerable proportion of our population.

–
Reviewed by Dr Richard C. Shiell, M.B., B.S., Melbourne, Australia

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