Month: January 2010

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Hair Loss InformationHair Transplant Doctors That Charge By the Session vs By the Graft – Hair Loss Information – Balding Blog

Can you please translate this.

I always thought that most hair loss surgeons charged by the graft. However, I noticed the following on a certain surgeon’s website. The surgeon is very well known and highly respected, so I don’t believe he is playing a pricing game, but I have no idea of what is meant by “charging by the session and NOT by the graft.”

Also, how could charging by the graft be misleading, like the wording claims? Please explain what he is trying to say and clarify how you charge.

From a certain surgeon’s website: “At (name removed), we try to keep hair surgery affordable. We charge by the session, not by the graft or hair, which can be misleading and overly expensive.“

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CountingMost hair transplant clinics do charge by the graft. I think the surgeon who made the above statement clearly believes session charges are less misleading and have a greater value than graft charges. At one time, I entertained the idea of doing a session charge rather than a per graft charge, but I ran into a problem working through the details of the charging mechanism. For example, if a person had a session charge for 400-800 grafts and then another charge for 801-1200 grafts, would the person who paid for 801 grafts feel cheated when he knew that someone else paid a lesser price for 799 grafts? I think that a patient would want to know just what they are getting and per graft charges really reflect, in my opinion, the amount of work done and the value in transplanted hair to the outcome. Iin this example, there is almost no difference between a charge by the graft for 799 vs 801 grafts, compared with a big step up in pricing for a session charge.

Charging by the graft is like a lawyer charging by the hour. If the lawyer is honest in his hourly billing, the client actually pays for what he gets; likewise, if the surgeon actually delivers the grafts that he says he transplanted, the same question of honesty is raised by the patient who should ask, “How do I know what I purchased in number of grafts were actually delivered?”. Here’s a few posts about ethics in graft counting that may interest you:

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Hair Loss Information24 Year Old Has Hair Loss After Losing Weight (with Photos) – Hair Loss Information – Balding Blog

Hello Dr.Rassman. Your site is really informative and I really thank you for the work you do.

I’m a 24 year old male and over the past couple months the front (and to some degree various spots behind it) of my hairline have fallen out at a rapid pace. Now I’m not sure if this is due to stresses on my body (lost 50 pounds in 4 months) or just MPB (limited history of it in my family, or even a maturing hairline its hard for me to tell. I’ve already been to a dermatologist and she wasn’t sure and doesn’t check for miniaturization so while i search for one that does i would greatly appreciate your opinion.

I’ve included a couple pictures of the front and side. You may use these on your site if you wish, i don’t mind.

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First of all, I appreciate allowing me to publish these photos. Click each photo to enlarge.

 

The thinning can be related to stressed induced by the rapid weight loss, a known cause of hair loss in both men and women. The short term loss may be reversible in your case if the miniaturization is extensive and the hairs are still there, just miniaturized. Stabilizing the weight situation (work that out with a good nutritionist) and taking Propecia (finasteride) might help. You won’t know for a good year or so, but you might see a slow reversal towards normal. It is worth a try. Get your hair and scalp mapped out for miniaturization so that you have a basic number for comparison a year from now.

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Hair Loss InformationDoes Transplanted Crown Hair Grow Slower Than Other Scalp Areas? – Hair Loss Information – Balding Blog

Hello Dr. Rassman. I got a ht done just under 6 months ago and i’ve noticed that the crown has shown little to no growth while the top front half of my head has shown a significant amount of growth. Could it possibly be the crown is the last place that sees the new hair growth?? the difference between the front and crown is very drastic and looks as if no hair was even transplanted in the crown. Im on week 25 so should the new hair in the crown have grown by now or is still too early? also, i still have those little red dots on my crown area but nowhere else on my scalp.

thanks in advance

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Little red dots on your recipient area may reflect folliculitis and this can, on occasion, kill the transplants if not treated in a timely manner. You need to discuss this with your surgeon as he/she has a vested interest in your outcome.

I have often seen differences in the rate of growth from front to back or right to left. I would not worry a great deal if this is a rate dependent variable, unless you do not see the results you expect by the 8th month. I would expect some growth in most patients by now, but again, see your surgeon and discuss your concerns.

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Hair Loss InformationCan You Honestly Tell Me Side Effects Are in My Head? – Hair Loss Information – Balding Blog

I see you often dismiss permanent side effects from Propecia on here. You rationalize them away, usually blaming them on psychological conditions or naturally occurring ED. Care to rationalize my situation. Pre-fin I was a healthy 21 y/o male with a raging sex drive and no difficulty with erections. I took 1mg daily for 12 days when I began to notice sexual side effects. I’ve been off for 3 months now and can count on one hand the number of erections I’ve had in that time period and my libido is non-existent. Can you honestly tell me its all in my head? Or that the fact that it happened during and after my time on propecia is merely coincidental?

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I feel for you. I have no explanation to your complaint as I have not seen patients with this complaint. I am not minimizing your problem. I do not and never underestimate what a patient tells me and I always try to help to the best of my ability. Your anger at me seems misplaced. I would honestly try to help you if I knew what to do.

Finasteride is a prescription drug, and I hope you’ve discussed these side effect issues with your prescribing physician.

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Hair Loss InformationReceding Hairline Without Miniaturization? – Hair Loss Information – Balding Blog

Hello Doctor,

I have an important question about miniaturization. Is it possible to have a hairline that keeps receding pass NW2 and still show no miniaturization? Also, NW3 is considered early balding but is that only when miniaturization is present? If someone is at NW3 or NW4 with no miniaturization would Propecia be recommended or not? Also, why is it that some young adults start losing hair early?

Thanks

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Miniaturization sometimes is not the forerunner for balding at the Norwood Class 3 or 4 stage, but it usually is present if looked for. The change for a Class 2 to an early 3 pattern may not have miniaturization, but the further back the pattern becomes evident, the more miniaturization will be seen.

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Hair Loss InformationPropecia and the Morning Wood – Hair Loss Information – Balding Blog

This blog is an excellent resource; I studied it extensively and used it to decide on Propecia as a course of action 3 years ago. I have a question with respect to Propecia and nocturnal erections. You mentioned in a previous post that, “the lack of morning erections is a known problem with Propecia.” Why is Propecia associated with lower quality/quantity of nocturnal erections? I am trying to assess the safety of prolonged propecia use, as the results are excellent. Could this side effect be a fast track to ED?

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WoodGetting an erection is important if it occurs when you want it. Nocturnal or morning erections are often just part of the overhead of being a man. Now that I am in my 60s, I can look at this problem differently than when I was 15 years old when my morning erections went from the time I woke until 3pm when school let out. A morning woody is OK, annoying at times, but it is important (morning or night-time) when it is called into action by the appropriate circumstance. I don’t believe that a reduced morning or night-time spontaneous erection frequency is a problem for men of any age, providing that the plumbing works when needed.

If Propecia (finasteride) reduced the frequency of morning or nocturnal erections and at the same time reduced your penis’ erection capability, then Viagra or other such drugs may be the best way to manage that problem. I suspect that the nocturnal or morning erections will be less frequent with people on this drug, but I never did a study of this for statistical analysis nor have I seen such a study elsewhere. Many men use Viagra even when they are not taking finasteride, and I believe that erectile dysfunction (ED) is a problem for 30% of men between the ages of 30-40, and 40% for men between age 40-50, and better than 50% for men over 50 years old. So the use of Propecia does not set up a man for this eventual problem, just his aging process does.

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Hair Loss InformationActor Jon Hamm’s Hairline – Hair Loss Information – Balding Blog

Hello Doctor,

I can’t remember if I asked this already but it didn’t seem to be answered. I was curious if you would characterize the actor Jon Hamm as a textbook NW2? He clearly has a mature hairline at least, but I can’t see any frontal balding.

I recently got a hair transplant and I believe my hairline will mimic his, which is quite promising considering I am about five years his junior. My wife seems to think he’s very handsome, and he clearly does not have a juvenile hairline, so there’s hope for us NW2’s eh?

Thanks!

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Jon HammMany of the photos I found of Jon Hamm show his hair longer and covering the corners of his hairline (like this one), but I was able to find a photo that shows what appears to be a Norwood Class 2 pattern (like here or here). In other words, he doesn’t have any real hair loss, just as you described. He appears to have a great head of hair.

To be sure of that NW2 though, I’d need to see his wrinkled brow and from there I can make the appropriate measurements from the highest crease of his wrinkled brow… or see photos from when he was 10 years old and compare the shape of that hairline to those that show in the reference images. But for the sake of this blog, I’ll just take it at face value.

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Hair Loss InformationCan Propecia Save My Weak Hairline? – Hair Loss Information – Balding Blog

started propecia 1 month ago have a receding hairline. have lots of miniature hairs still there. will propecia help these hairs grow thicker?

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Each case is different, and I can’t give you a 100% guarantee that Propecia will save those hairs in your hairline. I don’t even know where your loss pattern is or how old you are. I can tell you that the younger you are, the better the chances for reversing or really saving the hairline with the medication. I’ve found that men under 25 years old in your situation do better with Propecia than men over 35.

Get your hair and scalp mapped out for miniaturization to establish the baseline measurements you need. Then you can go back 6 months later with another mapping to actually have metrics and see where the Propecia helped.

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Hair Loss InformationReader Believes Estrogen is Cure to Hair Loss – Hair Loss Information – Balding Blog

Okay, this might sound ignorant, but I believe the only natural cure for hair loss is Estrogen. This is why a lot of women don’t lose their hair as bad as men, because they primarily carry the Estrogen hormone. So if scientists or whatever were to reverse the tables when actually dealing with Male Pattern Baldness and how Testosterone (the male hormone)converts into DHT, then it’s obvious that the male individual lacks the estrogen hormone which is a key factor of healthy hair growth.

For instance, if a man were to get castrated, he will grow a full head of hair because of the fact that his male reproductive organs were cut off. And having a penis and testicals is a key factor in producing testosterone in men, thus having less estrogen in their systems.

Yeah, I know this might sound ridiculous, however, I think that a man who suffers from MPB should take estrogen injections to the scalp in hopes that it will wake up his dead hair follicles and produce new ones, thus, have a full head of healthy hair. What do you think?

Oh, and I enjoy the blog…Much success and God bless…

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You are partly right. Estrogen does protect against hair loss in women, but not in men who have much higher testosterone levels. More testosterone means more DHT and for male genetically impacted hair follicles, that is death to some of the hair in the pattern of balding. Having the testicles removed will save you from more hair loss, and although you can keep your penis (as that is not part of the hair loss formulae), I wouldn’t recommend this route.

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Hair Loss InformationHBP and Body Hair Loss? – Hair Loss Information – Balding Blog

My husband has high blood pressure and he for some reason he is loseing the hair on his leg’s could that have anything to do with his blood pressure? or is the loss of the hair on his legs from something else?

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If he is taking medication for his high blood pressure, that is known to cause hair loss in some individuals, but I am at a loss to explain the hair loss on this legs as an isolated finding.