July 2009 – Page 10 – Balding Blog

July 7, 2009

My Hair Transplant Made My Skin Cobblestoned! – Hair Loss Information – Balding Blog

Ive had a transplant 6 mnths ago.The hair that has been transplanted on the front top of my head has made the skin look bumpy cobble stoned appearance. I want to shave my hair short to blade 0 and not have the bumpy look. What procedures can be carried out to solve my problem. I do not wish to have another transplant so im looking on ways to make my linear scar fade away to. Is laser treatment good for the scar.

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Cobble stone Of course, I will start by saying I want to see what your hair looks like and if you can visit California (we have two offices here) it would be best to let us examine you directly. The second option (and probably most convenient if you’re not local) is to send me good photographs of what you are referring to with good lighting. Be sure to include photos of the scar where the hair was taken from.

Cobble-stoning is usually the result of the larger grafts which have a reasonably sized skin disk with it. The skin from the graft does not align with the scalp skin around it so that it appears bumpy. If that is what you have, your doctor used an obsolete technique and these just can not be fixed by shaving down the scalp skin with dermabrasion, which only makes the visibility worse with depigmentation of the scalp skin. The only solution is to put more hair around these bumps to hide it in the ‘forest’ of normal hair (more hair transplants, but this time by a well skilled doctor using modern techniques). Laser treatments do not work either and the linear scars from the donor area can be difficult to fix, but again, I would need to see it to understand the problem.

July 7, 2009

Hair Growing in Different Directions After Accutane Use? – Hair Loss Information – Balding Blog

Hi,

I was wondering if it was normal for hair to grow out in different directions? I took a month course of Accutane 2 years and in conjunction with the hair loss, my hair feels a lot more brittle and different in texture. Specifically my scalp, I have this dime sized spot on my scalp that grows opposite to what the rest of my hair does. I know this sounds weird but it becomes even more noticeable when my hair isn’t shaved down.

Did Accutane do something to change how my hair grows?

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Accutane (isotretinoin) does impact the quality of hair that grows, but it should not change direction. I would suspect that because of the changes in your hair character, the different direction of hair in one area was more easily noticed by you.

July 7, 2009

Why Are Vellus Hairs Normal at the Hairline? – Balding Blog

Hi doctor, I just have two questions. Why in the beginning of normal hairlines the existence of miniaturized hairs and vellus hairs is normal?

And the second question is that how can you distinguish them in your hairline?

The very frontal leading edge of the hairline has more vellus hairs per square centimeter than other parts of the scalp. If you get a video microscope (see here), you can then study them and maybe understand what is growing out on your head better. It’s normal, because that is the way it is. It’s genetics. It’s a transition area from nothingness to a head of hair. Vellus hairs are usually short while miniaturized hairs can grow long, so they usually can be distinguished from each other that way.

July 7, 2009

The Great Propecia Debate — Merck vs Message Boards – Hair Loss Information by Dr. William Rassman

Reading some message boards, I see a lot of disgruntled people with regards to Propecia and saying the drug destroyed their hairline, hypandrogenicity, etc. It makes you think everyone suffers from severe hyperandrogenicity because they get a zit. I know you’ve mentioned in the past that people with negative things to say usually are the most outspoken. But it is easy to get an impression reading these boards Propecia is awful because the negativity outweighs the positivity when Merck proclaims the opposite.

My question is: in your practice, have you seen people suffer from in your own practice? And with those patients on Propecia, what percentage elect to stay on it and are generally content with the performance of the drug?

Thanks Doc!

The Propecia side effects statistics from Merck are in line with what I see in my practice. It really is very minimal. I agree that the message boards bring your attention to the agenda of the posters, which may not be pure and objective like mine. I really have nothing to gain by telling people about Propecia, a drug which can regrow hair and halt hair loss (I am, after all, a hair transplant surgeon).

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July 7, 2009

How Many Grafts to Fill in an Area the Size of a Quarter? – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

I have two specific questions for you:

1) How many grafts/what would the cost be to fill in a moderately thin area about the size of a quarter?
2) Do you have any suggestions for good, reputable doctors in Rhode Island?

And I have two non-specific answers for you:

A quarter sized area might take a variable amount of hair, depending upon where in the scalp it is located. It may possibly take between 100-200 grafts. Cost per graft varies per doctor, and many have a minimum fee for surgery. Without having your age, history, or really much information at all, it’s difficult to make recommendations — but assuming your thinning area is in the crown, you should talk to your doctor about Propecia or even getting some minoxidil (Rogaine). You might be able to avoid surgery altogether.
I don’t have any physician recommendations in RI, but if you don’t mind a little drive, Dr. Robert Bernstein is in Manhattan and he’s the best doctor on the East Coast. I would recommend him if you can manage a trip to New York. He should be able to do a telephone consultation with you by looking at good digital photographs, and then you can do it in one trip all in the same day.

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July 6, 2009

Young Daughter Lost Hair After Radiation to Brain Tumor – Hair Loss Information by Dr. William Rassman

I’m hoping you can help us. When my daughter was 20 months old, she was diagnosed with a brain tumor. After numerous brain surgeries and chemo, we decided to have a bone marrow transplant just before her fourth birthday. Thankfully, this saved her life. She also had focal radiation to the tumor site – on the right side of her head – and unfortunately most of the hair on that quarter of her head did not grow back.

She has worn hair pieces since she has been five years old. We’ve talked to people about hair transplants in the past, but were told there was too much area to cover and also, that hair transplants do not work on the side of the head.

I’m wondering if this still holds true for this procedure. I could send you some photos so you could see the extent of the hair loss if you think that would help. Please let me know your thoughts.

Thank you

Most people with large defects are treated with balloon expanders, which stretch the normal scalp to cover the defective areas. There are a few doctors who are very skilled in this specialized technique and although I have assisted in this type of surgery, I would not consider myself at the lever of expertise needed. I have seen these expanders done in children, but every person and every situation is different. I would suggest that you send me photographs and I will forward them on to such a specialist. I have seen some miraculous results from this type of reconstructive surgery.

Usually, at the end of the expansion surgery, hair transplants are done to refine the work and cover remaining scars.

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July 6, 2009

Woman Experiencing Nerve Problems in Scalp After Hair Transplant – Balding Blog

(female)
I have skin cancer which required graft closures. I have had MOH’s surgery and grafts twice and once (one year ago this past March) I had hair transplantation from the nape of my neck. Approximately two months after the surgery the right side of my scalp regained feeling but the left side did not. It still hasn’t so I told my plastic surgeon and he injected a steroid thinking it was scar tissue. While he was examining my scalp (after the injection, which did not work) he touched an area of my scalp on the left side that shot pain up to the top of my head probably right on the occipital nerve (greater). He didn’t know what to do so I went to see a neurologist who told me that some of the lesser occipital nerves are not as deep and are in fact at scalp level. My scalp (at the donor site) is so tight it is difficult to move my head to the right and down. Now he says I have cervical dystonia. I don’t believe that because in my research I found nothing that even resembles what I am feeling or going through. What do you think?

Persistent pain and/or numbness is a relatively rare risk of hair transplant surgery from small nerve damage. It is always stated in our pre-surgery consent form that we go over with our patients. Tightness of the scalp is also a side effect of a hair transplant surgery. The more surgeries you have, the more risk you may have of tightness or nerve damage. As your neurologist explained to you, some of your nerves may have been cut/irritated during the surgery and this may be contributing to your problems. I really have no way of knowing, though.

July 6, 2009

Switching from Cut Proscar to Propecia – Hair Loss Information by Dr. William Rassman

Hi,

I’ve been going for hair transplant surgery last 2 months and after the surgery the doctor recommend me to take propecia to maintain my existing hair as i was indicated of suffering from Male pattern hairloss. Just 3 days ago i start to apply Proscar and split it into quarter 1.25 mg as financial problem and use it daily without side effect so far. Surprisingly my hair stop to fall off immediately as only used for 3 days..

My question is now i am taking 1.25 mg of proscar daily, and i plan to switch to Propecia 1 mg after 2 years from now on. Is there any case of intensive shedding happened if switching from Proscar 1.25 mg to Propecia 1 mg? As most of the cases is only mentioned switching from Propecia to Proscar for cost saving.

Thanks for your sincere advice.

Cheers.

Proscar and Propecia are both the drug finasteride just at different doses. Switching between them is no problem at all. The difference in the 1.25mg dose and the 1mg dose is relatively insignificant.

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July 6, 2009

Do Men Tend to Overanalyze Their Hair After Starting Propecia? – Hair Loss Information by Dr. William Rassman

Hey doc, In your experience, do you feel that lots of guys tend to over analyze their hair after starting a treatment like propecia? For instance im 5 1/2 months in, for the last week i was convinced it was starting to see some hair come back, then today i look and it looks awful. I go through these mood swings all the time, since i started propecia. I should have listened to you and got a minuturization test done but my derm just gave me the meds, so now all I have to go off of is my memory of what it looked like when i started. Secondly between what months do most your patients see improvement in their hair, or become convinced that propecia is working in some form or another?

What was the phrase — a watched pot never boils? If you’re taking a pill to treat hair loss, of course you’re likely to watch your hair with an intense focus. It’s not unusual, but you shouldn’t stress yourself out about it. It generally takes 8 to 24 months to see the benefits of Propecia (finasteride). Full benefits may take the full 24 months.

The reason I suggest mapping the scalp for miniaturization is well defined by your comment. Our memory is not objective, but scalp miniaturization mapping is objective… so you do not have to rely on your memory.

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July 2, 2009

World’s First Accurate Baldness Calculator? Not Quite! – Hair Loss Information – Balding Blog

Snippet from the article:

The ‘baldness calculator’ – said to be the world’s first reliable tool for predicting hair loss – has been a huge hit with men in other countries.

The program calculates the exact age at which someone will go bald or have lost most of their hair or provides reassurance by predicting that they will still have a full head of hair in old age.

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Read the rest at Telegraph UK

Bad calculations A PR firm sent me the press release and apparently the Telegraph in the UK got the same release and ran with it, presenting the article above. This “baldness calculator” is a clever way to market a caffeine-based shampoo called Alpecin, but I don’t know how this thing can claim to be accurate. It’s guessing the year you’ll lose your hair based on these factors you feed it — age, number of hairs lost daily, current hair loss pattern, scalp dryness, how often you wear a hat (???), stress, activity level, family history of hair loss, location (which apparently is limited to the UK), marital status, and career. Most of the questions are yes/no, and some have zero relevance. And surprise, surprise — when the answer is “calculated”, the solution is a special shampoo! I am completely and utterly SHOCKED (note sarcasm)!

For fun, I asked one of my employees to go through the steps of the “calculator” to see where he’d end up. It determined he’d go bald at 60 years old (though he’s not in the UK, so he had to choose a region that he doesn’t live in and probably has never visited). How’d it come up with that age? Your guess is as good as mine. He’s got miniaturization on the top of his scalp already (he’s been taking Propecia to maintain it), so clearly 60 years old may be completely wrong (who really knows).

My verdict: Fun way to try to sell you a shampoo, but to call this “accurate” is completely ridiculous. In fact, it’s laughable. Determining the age you’ll go bald is just not that simple, folks. If you want to try it yourself, go here, but keep in mind what I just wrote about the accuracy. Perhaps their claims for the shampoo are equally as accurate?