Month: November 2009

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Hair Loss InformationIn the News – More Radiation Overdoses from CT Scans – Hair Loss Information – Balding Blog

Snippet from the article:

A second hospital in Los Angeles County has discovered that patients were receiving overdoses of radiation from CT scans used to diagnose strokes.

Ten patients at Glendale Adventist Medical Center this year accidentally got three to four times the normal radiation dose, hospital officials said Friday.

In August, Cedars-Sinai Medical Center in Los Angeles found that after being reprogrammed, a General Electric scanner began delivering eight times the normal dose to patients receiving the same procedure, known as a CT brain perfusion scan.

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Read the full article at the LA Times

While it is certainly an uncommon occurrence to get a radiation overdose from a CT scan, about 40% of the 260 Cedars-Sinai patients experienced some degree of hair loss from it. No word yet on how many people experienced problems from the second hospital’s mistake.

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Hair Loss InformationFixing Past Hair Transplant Mistakes (with Photos) – Hair Loss Information – Balding Blog

This is a patient who I just performed a corrective procedure on. There were many mistakes made here in the past with his other doctors and I wanted to share those problems with you. Knowledge is power, and I hope this will teach you what to look out for so you can prevent them from happening to you. So let’s jump right in…

The Problem

First, let’s take a look at the “Before” photos (click to enlarge):

 

  1. The patient had received around 3000 grafts total in three surgeries on the frontal hairline at another clinic.
  2. The hairline is harsh, without single hair grafts in front of the larger grafts. Plus, these were not follicular units, but the old type of minigrafts of 3-5 hairs each.
  3. The hairline was placed too low and too straight, creating an abnormal edge which made the transplants obvious to the patient.
  4. The surgeon made incisions in the scalp that were not kept in the same place, so the patient had two scars rather than one (see arrows in photo above). The second and third surgeries should have been performed at the same location as the first surgery. The location of the upper scar was too high as well, so transplanting into the upper scar made sense to me.

 

The Solution

Here are the “After” photos, taken just moments after the completion of his surgery (click to enlarge):

 

  1. I transplanted 1637 grafts total (1391 into the hairline and 246 into the upper scar in the donor area).
  2. I built a wide transition zone with only one-hair grafts to break up the leading edge of the hairline so that it would not look transplanted.
  3. I had to lower the hairline to get in front of the harsh hairline created by the other doctor. This brought the hairline almost back to its juvenile position, something that I rarely do, but was forced to in this situation.
  4. Those 246 grafts transplanted into the upper scar (see arrows in the photo above) should almost completely wipe out its visibility, so he’ll have one scar in the back of his head instead of two.

I find it amazing that this happened recently by a surgeon not far from my office who does a great number of such cases. If this patient had asked to meet some of that doctor’s patients, I am sure that this is the type of work he would’ve seen. People just don’t know or think to ask a doctor to meet with other patients ‘one-on-one’. There is no substitute for meeting patients directly and talking to them about their overall satisfaction. We offer an Open House every month to allow prospective patients the chance to meet up to a dozen of our patients who had surgery. A detectable hair transplant is not what you want and it is easy to see the quality of a doctor’s work by engaging with one-on-one patient interviews.

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Hair Loss InformationHair Transplants and Scar Tissue – Hair Loss Information – Balding Blog

I have some questions about hair transplant in skin with extensive scarring. I’ve tried looking for information on this online, but the vast majority of the information available is on transplantation into normal skin, and any information on scarring is generally limited to scarring as a result of the procedure itself. This seemed like a good place to ask.

A friend of mine was in a fire about 11 years ago and has had extensive skin grafts and reconstructive surgery. One of these procedures was an attempt to stretch the areas of his scalp that still grew hair to cover the areas that did not. However, the skin proved to be too thin to completely cover the hairless areas, and he was left with 2 areas of scalp with no or very sparse hair, each about 2″x3″. While he is comfortable with the grafts on his body, I know the hairless patches on his head really bother him. He has jokingly mentioned getting hair plugs in the past, but he doesn’t think his hair is thick enough to provide donor sites, and I think he worries that transplanting into thin or scarred skin would be impossible.

So, basically, my questions are, can living hair be transplanted into large areas of scar tissue? Can hair follicles be harvested without causing other noticeable thin spots, or can it be donated from another person with similarly textured and colored hair?

Thank you!

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Yes, hair can be implanted into scar tissue to provide a cosmetic benefit. We have done that on many occasions, but the status of the skin is critical in making the determination to go forward. Skin grafts, for example, with no thickness to them may not be able to tolerate hair grafts. Your friend’s issues are not unique and there are patients who have had hair transplant surgery to cover the bald areas from such tragedy. We have done many with neurosurgery scars and face lifts scars that easily support hair grafting, but each and every patient is very unique and can pose challenges.

I really cannot answer your question without seeing the patient in person or at least seeing a photograph. If your friend is considering options, I would have them make an appointment with a good hair transplant surgeon to discuss those options. (Also, “hair plugs” is a term used for the outdated procedures done in decades past. Current techniques can create an undetectable result without a pluggy look.)

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Hair Loss InformationThe Majority of Hair I Lose in the Shower is From the Front and Top – Hair Loss Information – Balding Blog

Dr.Rassman, you have written that it is common to lose between 100-150 hairs per day. You have also stated that it is common to see a lot of these hairs when showering as you loosen dead hair follicles and hairs trapped with styling products. In a recent post (Oct.27th) an individual wrote in regarding his shed high shed count. You asked if he had noticed area specific shedding – ie. top of the head as opposed to the sides or back as this could be an indication of genetic balding. I wonder if you could elaborate on this for me.

I too have high shed counts and have for years now, I would say on average I lose between 60-80 hairs per shampoo session – over 100 if I go days without washing my hair. I also use a heavy, sticky texturing salon product and frequently wear a hat all day long if I haven’t kept up on the shower regimen. So whenever the alarm bells sound as I get the old hairy palms in the shower I chalk it up to those factors and try to accept my precious follicles washing down the drain. This is difficult because you’re never quite sure if this is “normal” or early signs of hair loss.

When you spoke of area specific loss this got me interested. I have noticed when shampooing that the vast majority of the hair that comes off on my hands originates from the front/top of my scalp. Assuming that shedding is within the normal range does this area specific loss still suggest pattern balding? Could there be other factors at play that would make hair loss appear greater in that area? Is it normal to shed more on top than the back/sides? Your insight on this issue would be greatly appreciated.

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I concur, it can be difficult to determine whether you’re seeing just normal cycling or early signs of hair loss, but I really do not know the answer to your question. Your hair should shed evenly throughout your scalp, but it could be that you apply more of the sticky hair product to the top of your head for styling purposes and it traps the normal cycled hairs from falling. Couple that with not washing your hair for days,and you’ll notice the shed hairs will accumulate on your head. Then, of course, washing the hair will show the accumulation since the last wash. Wearing a hat will also increase the accumulation of shed hairs, which normally would blow away on their own.

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Hair Loss InformationFinasteride, Dutasteride, and Sperm Count – Hair Loss Information – Balding Blog

Hello Dr Rassman,

While scouring some medical journals, I came across this 2007 clinical study that involved a comparison between Finasteride, Dutasteride and a Placebo. The subjects were 18-55. And the study seemed to confirm your suspicions concerning sperm count; however, not to the extent that may have been feared. Please find link below:

Journal of Clinical Endocrinology & Metabolism

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Thanks for bringing this study to my attention. What is needed is a double blind approach where sperm count is high on the list of targeted outputs. Without such a study, the safety of dutasteride (with regard to fertility) may be a problem for young men wanting children.

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Hair Loss InformationCan I Get a Trichophytic Closure After My 2nd Hair Transplant? – Hair Loss Information – Balding Blog

I am considering my second hair transplant as I have developed some baldness since the first procedure. My question is, can the old donor scar be made into a tricophytic scar during the second procedure?

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Yes, the trichophytic closure can be done on the second or even third procedure to try to make the scar smaller. I haven’t written much about the trichophytic closure in recent months, but essentially it is a technique to minimize donor area scarring for those that have a hair transplant using the strip method. You can find photos here and here.

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Hair Loss InformationIn the News – Dr Farjo’s Plea for Age Limits on Hair Transplants – Hair Loss Information – Balding Blog

Snippet from the article:

One of the UK’s leading cosmetic surgeons is calling for age restrictions on hair transplant surgery, after seeing an alarming rise in the number of teenage boys wanting to go under the knife.

Dr Bessam Farjo, co-founder of The Farjo Medical Centre and past President of the International Society of Hair Restoration Surgery, has seen a 23 per cent increase in enquiries coming from men aged 20 years or under over the past 12 months. Some of the enquiries the centre has received have come from the parents of boys as young as 16-years-old.

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Read the full article Plea For Age Limits On Hair Transplant Surgery

I’m glad Dr. Farjo is speaking out about this. I get quite a few emails from teens asking for surgical advice, but you must understand that hair transplantation should not be an option until you’re an adult. It’s not like getting a nose job, where once it’s done, it’s done. Hair loss is progressive.

I’ll give you an example: You know how you can see those old, ugly hair plugs on some men that had surgery many years ago? They likely didn’t see those plugs of doll’s hair at the time, but as the hair loss progressed around the plugs, those very plugs that were adding fullness to their hair eventually became the focal point of their scalp. Granted, today’s techniques are different in terms of appearance, but my point is that your hair loss will likely progress to some extent and you don’t want that touch-up work that you had at an early age be the only thing you have on your head as an adult. This is exactly why I mention the need for a Master Plan. Think long term!

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Hair Loss InformationI’ve Tried Nearly Every Hair Treatment and Am Still Losing Hair – Hair Loss Information – Balding Blog

Hi Dr

I just want to check with you on treatments other than Propecia and Minoxidil. I am 28 this years and have tried Laser, herbal treatment, proscar, minoxidil and even acupuncture on the scalp. Currently i am on proscar, minoxidil and Nizoral cream and still i am losing hair, is there any other way i can try to get some of my hair back. I am desperate now and hair transplant is my last resort. What do you think of Avodart , i am worried of the side effect like sterility that might happen. Please advise.Thanks

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Even drugs such as Propecia (finasteride) and minoxidil have limitations, as they will only slow the process down or grow some hair. Nizoral (ketoconazole) is an antifungal treatment and hasn’t been proven to my satisfaction to treat hair loss. I do not recommend Avodart (dutasteride) until more studies on safety are completed and can be reviewed.

I understand you are desperate, but you need to educate yourself and make intelligent choices. Remember, there is no cure for hair loss. You now belong to millions of men and women out there that have paid lots of money and time and effort to find such a cure with no luck, only to contribute to the economy of capitalism. I don’t know enough about your history (how long you’ve been taking the medications, your degree of hair loss, etc.) to provide much help here.

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Hair Loss InformationIn the News – Chicago Hair Growth Firm Sued for Fraud – Hair Loss Information – Balding Blog

Snippet from the article:

A Chicago-based company that claims its combination of laser therapy and scalp treatments can regrow hair is being sued for allegedly making false statements based on unsubstantiated scientific claims.

Atty. Gen.Lisa Madigan filed a lawsuit Tuesday in Cook County Circuit Court against Natural Hair Growth Institute, claiming the company has failed to provide consumers with full refunds for services that average between $8,000 and $12,000.

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LawsuitRead the full article — Lawsuit alleges hair growth firm’s claims are bald

Update: The original article is offline, so here’s a similar report —
Lawsuit brought against Illinois hair regrowth institute

From what I gather, a hair laser and snake oil sales clinic promised results in 6 months and offered a full money-back guarantee, of which they decided to conveniently disregard. They also falsely claimed that their laser was FDA Approved (in fact, none of the hair lasers are “Approved”). Now they’re being sued for the cost of the services plus $50,000 for each violation of the Illinois Consumer Fraud Act.

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Hair Loss InformationWrinkled Scalp, Like a Shar Pei – Hair Loss Information – Balding Blog

My scalp is very wrinkly, almost like a shar pei dog. What is this and how can I fix it?

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Shar peiThis is called cutis verticis gyrata (CVG). The cause is unknown and there’s no known cure (though cosmetic surgery might be an option).

Basically, the condition is when a great deal of skin, far more than is needed to cover the skull, is generated by the body. I have seen a few mild cases of this condition and have written briefly about it a couple years ago. Look at Google for more examples.