August 2009 – Page 7 – Balding Blog

August 13, 2009

Hair Transplant – Multiple Procedures or One Large Procedure? – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

With regard to future donor density/yield, what is the better option:

Several small strip procedures or one very large procedure?

What I’m basically asking is which one would be more detrimental to your donor supply for future transplants (possibly affecting laxity)?

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I have to speak in generalities, something that I do not like to do as every situation is different. Generally speaking, the less the number of surgeries the better for the donor supply, but as larger and larger sessions are tackled, the surgical team is as critical as other items such as donor density and laxity. Each surgery has a built in waste factor (I estimate it in a good doctor’s hands at about 4-5% in a strip surgery) so two surgeries will produce more waste (a relatively small amount of waste). In the hands of a surgical team not designed for very large sessions (over 2000-2500 grafts), the larger session might cause a longer surgical time, more time for the grafts to be out of the body, and more time for dessication (drying of grafts causing graft death). Longer surgeries require more anesthesia and a skill in managing the anesthetic requirements is critical for larger sessions. In the rush to keep pace among the field’s leaders, many groups try to offer larger sessions (3000-5000 follicular unit graft range) even though they are ill prepared for this service. Some groups dishonestly sell these larger sessions and do not deliver on them, yet do charge for them… causing a fraudulent transaction (more common than most doctors will admit to, i.e. “It’s the other doctor, not me!”).

You were right to ask about the future donor supply. Very large sessions may reduce your donor supply very significantly when they are done, so it is good to understand what the session will do to the Master Plan for the patient. Running out of donor supply could be a critical error if it is done in one session. Look at today’s 12:31pm post (2 down from this post) and look at the real donor supply. Any hair taken outside this rim of hair is not permanent so if the doctor goes too high or too low, you may find out in the long term that what you received is not permanent.

August 13, 2009

Hair Loss Information100% Donor Scar Elimination? – Hair Loss Information – Balding Blog

Dr. Rassman,

Do you think that 100% elimination of donor scars will be possible in the future? Technology is always improving and it seems like scars could be emliminated. Are there any other possibilities other than Juvista and Acell that are being researched? Thank you for all the helpful information.

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Scarring happens as a result of all surgeries. There is no such thing as 100% elimination of a scar and treatments like Juvista and Acell will not dispose of scars entirely. The key to dealing with scars is to keep them very, very small. In the case of a donor scar, it can be as small as 1mm wide naturally in good healers, or reduced to that level on occasion. For bad healers, there really is no solution. By “bad healers” I mean those people who stretch their scars after the wound has healed.

Techniques such as the trichophytic closure repair of a wound in the donor area works well in many, but not all patients. For more info on the trichophytic closure technique, see here and here.

August 13, 2009

Hair Loss InformationWill Finasteride Cause My Facial Hair to Stop Developing? – Hair Loss Information – Balding Blog

As a young man I value my hair very much, both scalp and facial hair. My facial hair hasn’t yet become a full out beard but I see new hairs sprouting on my face soon after every shave, my question is will the use of Finasteride cause my facial hair to stop thickening and developing into a full beard? I would hope that I wouldn’t need to choose between my facial hair and scalp hair but frankly the scalp would win every time.

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Well, I’ve never gotten a report about Propecia-related problems with facial hair development from a patient. With that said, anything is possible, but if it did happen to you, you could (I suspect) stop the drug and get the full beard growth return. I don’t know how young of a man you are, but some men just do not grow full facial hair due to genetics, unrelated to any medication they may or may not take.

August 13, 2009

Woman Grew Fine Facial Hair with Rogaine – Balding Blog

(female)
A few years back I used Rogaine for women to stop my hair loss. Then I stopped after I noticed a good amount of hair regrowth and also because I grew fine unwanted facial hair. Now I’m starting to loss hair again! I would rather have fine unwanted facial hair than go bald. I’m thinking about using Rogaine for women again.

So my question is: Is it OK to continue using Rogaine if fine unwanted facial hair develops? I read on some websites than you MUST discontinue use if unwanted facial hair develops.

THANK YOU for taking the time to reply to my hairloss question.

What you see is what you get and if you can live with fine facial hair, then take it as needed. The decision to use minoxidil/Rogaine is up to the consumer (be sure to read the information provided with the medication), which is why the FDA allows it to be sold over-the-counter.

August 13, 2009

How Much of the Donor Strip is Actually Used? – Hair Loss Information by Dr. William Rassman

When a strip from the doner site is harvested, what percentage of the hair from the strip can generally be used (the rest being wasted or damaged?)

Can the donar site be in the back corners of the scalp? In my case it seems more loose there and more tight directly in the back.

Norwood 7 The donor area is that portion of the scalp that is seen in the Norwood Class 7 balding pattern (see image at right). This is the only permanent hair in men, assuming no other disease is present, such as alopecia areata.

There is a general rule hair transplant surgeons use which states that half of the donor area can be utilized for hair transplantation without impacting the integrity of the donor area. When a donor strip is taken, fully 100% of the hair should be harvested in that strip of scalp (short of a few damaged hairs, usually less than 4% of the total amount) and all of it should be used.

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August 12, 2009

Avocado and DHT, Propecia Costs, Generic Finasteride Fillers – Hair Loss Information – Balding Blog

Doctor,

Is there anything that can be done to stop the progression from Norwood 2 to 3? Is there any thinning in the temporal area for Norwood 2? When a maturing hairline begins will it eventually get worse leading to MPB? Also, does a maturing hairline and MPB follow a similar pattern since the hairline recedes ,etc.?

I read somewhere that avocado may reduce DHT, but is it really true (I doubt it, but I will still ask)?

Is there a critical period to start Propecia? Usually in the U.S. how much does Propecia cost? Also, do you prescribe Propecia and Proscar? Is a consultation in your center free, and usually what is done?

When it comes to medication for hair loss is “what you pay is what you get”? Therefore, a generic of finasteride will not be as effective as Propecia? Is there anything added to generic finasteride that is not in Propecia (i.e., any filler substances)?

P.S. I know you can’t respond to all emails, but I would appreciate if you respond to my questions.

Thank You

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Avocados

The mature hairline progression is not balding. If your hairline goes further back than the mature hairline, then you are balding. Most non-balding Caucasian men have a maturing hairline. Temporal recession is possible in Norwood 2. You can find full Norwood class descriptions here.
Everything I can find online about avocado and DHT says it “may” help treat hair loss, but allow me to end the speculation now. Avocado is a delicious fruit, good to make guacamole, but not good to treat hair loss either by application to the head or eating it.
The first consultation in my office is free right now, and I set aside a full hour for first timers. We’ll discuss your hair loss, I’ll map your scalp for miniaturization using a video microscope, and we’ll go over treatment options. If you’re likely to be a finasteride candidate (starting it in the earlier stages of hair loss is best), I’ll likely prescribe it. Propecia costs $190 for a 90 day supply in my office. I don’t know how much other doctors or pharmacies charge, but I believe we’re on the lower end of the price scale.
Generic finasteride is less expensive than Propecia, but otherwise as long as it really contains finasteride, the generic is just as good. The issue of fillers is not relevant.

Image Courtesy of California Avocado Commission

August 12, 2009

Various Researchers Blame Hair Loss on Different Genes? – Hair Loss Information by Dr. William Rassman

Dear Doctor,

I’ve just been reading about your info from Amsterdam.
In addition to this, I was wondering if you in the nearest future see any new drugs against baldness?

I’ve read about some new test.

1) Some Japanese researchers blame the Sox21 gene for baldness.
2) Some researchers blame the wnt gene for baldness.
3) Some researchers blame the P2Y5 gene for baldness.

Because of my research for hope of any new treatments, I’ve become confused. All these different tests and scientists blame different genes for baldness. Can there really be so many genes, which cause baldness? And where does this leave Propecia, if all this new research blame something else then just DHT for baldness?

I hope you understand my wondering mind.

Best regards.

There are many, many genes for balding and only some have been recognized. A few on the X chromosome have been highlighted by the company HairDX, but genes are constantly being found on chromosomes beyond the X chromosome. Genetic hair loss is very complex (not like the eye color of the fruit fly) and it is the many genes that make the discovery of an effective new drug. Propecia just blocks the DHT hormone and does not address the various genes and approaches you asked about above.

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August 12, 2009

How Would You Find Out You’re Sterile If You’re Taking Dutasteride? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,

reading your ISHRS-post concerning the korean Avodart study left me a bit confused and raised several questions/remarks: You talked about a colleague of yours reporting two of his patients have become sterile on the drug. Luckily, this sterility turned out to be reversible. First of all, after thinking about this a little while, I wondered how they have even found out to be sterile given that under no circumstances you should have unprotected sex while on dutasteride due to a potential risk of harming unborn life.

Secondly, there is a study discussing the effect of both active ingredients, finasteride and duasteride, on semen paramaters in healthy men. I´m citing from the abstract that can be found on PubMed.org: “In both treatment groups total sperm count was significantly decreased at 26 wk (D, -28.6%; F, -34.3%) but not at 52 wk (D, -24.9%; F, -16.2%) or the 24-wk follow-up (D, -23.3%; F, -6.2%). At 52 wk, semen volume was decreased (D, -29.7%; F, -14.5%, significantly for D) as was sperm concentration (D, -3.2%; F, -7.4%, neither significant).”

The study dates from May 2007 and was conducted by scientist of the University of Washington, Seattle.

Now my question is: Given the results stated above as well as the information you got directly from Merck, posted earlier on this blog, don´t you think the sterility the two men faced was due to the intake of dutasteride IN COMBINATION with some genetic predisposal to fertility problems if the changes in semen parameteres aren´t that dramatical?

And second: Is there any evidence or even theory this sterility could be irreversible?

Many thanks in advance!

I just reported what I was told by my colleague who was concerned about the sperm count of his son, so he did a test to determine what it was after the dutasteride was give for 6 months. He did it with another one of his patients (maybe more, but he only told me of two) and no sperm were seen on the count.

I don’t want to panic people reading this who are on dutasteride, but I might suggest that they check their sperm count maybe once a year or so. If the Korean dutasteride study had included the sperm count, it would’ve saved us the focused concern on sterility as a complication of the drug (temporary or permanent).

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August 12, 2009

Full Contact Sports After a Hair Transplant – Balding Blog

I train regulary in full contact fighting sports. How long would I be out from training after a hair transplant???

If your surgery was done using the FUE technique, 7-10 days should be adequate (or until the scabs have gone away) before resuming your training. For a surgery done using the strip technique, I would wait 4-6 weeks.

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August 12, 2009

Can Rogaine or Propecia Change Hair Character? – Hair Loss Information by Dr. William Rassman

Hello, Dr. Rassman…

I am curious about Propecia and/or Rogaine. Do these medications change the CHARACTER of your hair over time? In other words, do they make for healthier hair in general? You know, thicker, fuller, more lustrous? I have noticed as I have entered my early 40’s that my hair seems to be finer and drier than it used to be. I typically use product to add some lustre to it. Do thees medications help in that regard, or do they basically “freeze” the hair loss and the character of the hair remains the same?

Thanks so much for your time!

Propecia works on the miniaturized hairs, thickening them. That will change the character of the hair, making it look more like it did before the impact of genetic balding that caused the miniaturization in the first place. Many people who take Rogaine report similar results. This is all good.

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