May 2010 – Page 7 – Balding Blog

May 10, 2010

Airline Lost My Luggage with Propecia in It! – Hair Loss Information by Dr. William Rassman

My baggage was lost on a recent trip and I was without my Propecia for 8 days. Would this relatively short period of time without the mediction cause any problems or loss of hair that wouldn’t have occurred otherwise. Thank you. I appreciate your time and dedication.

There is some tissue fixation that lasts about 1 week so I would think that you would be alright. If we were your doctors, we could send you some temporarily or call into a pharmacy near where you are for a temporary supply. Check with your doctor in the future if it happens again.

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May 7, 2010

Hair Loss InformationCan I Get Rid of the Old Hair Plug White Scars in the Donor Area? – Hair Loss Information – Balding Blog

I had grafts put in about 12 years ago, the method that was used left me with many large white holes in the back of my head in the donor area. My goal is to shave my head completely and not see those white marks. Is there a way to get rid of them? Something you can do? What about Lasers as well? By the way, what are those white marks called? It is not a strip scar but it has another name.

Thank you very much….

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I suspect that you are talking about the drill holes that were the original way to harvest the grafts. Originally, the doctors used a hollow drill (maybe an old model of a Black and Decker) to make drill holes to core out the hairy donor skin. Some doctors never sutured these closed, leaving huge holes which filled in with white scar tissue that reflected that the wounds were left open (the process of healing is called secondary intention healing). There is little you can do about them.

They can be filled in with transplants taken out with the FUE technique or tattoos can also possibly work, but the problem is that when your hair turns white as you age, the tattooed hair will remain close to the original color (black or brown, perhaps) and over time I would suspect it’ll start to blur. In other words, I think that for a short term solution, you could create a long term problem with the tattoo.

May 7, 2010

Hair Loss InformationDoes Stress Aggravate Hair Loss by Elevating DHT? – Hair Loss Information – Balding Blog

Doctor,
I am turning 23 years old in May. I have noticed that I have been thinning on the back of my head around the vertex. The thinning seemed to have started this summer. After slightly noticing it, I asked my barber if he had noticed anything. He said that it has been relatively the same for the past 5 years that he has been cutting my hair. I have been monitoring the situation and noticed that it has thinned out a little bit more. Today when I got my hair cut, my barber said it seems to be thinning now. It is visible to me that I am most definitely thinning at the vertex especially after cutting it a bit shorter around that area. I have just entered pharmacy school and I am afraid that with stress elevated levels of DHT can affect my hair.

My question to you is, first, does stress aggravate hair loss by elevating DHT? Second, I would like to take Finisteride 5mg and cut it up into 4 pieces. That extra bit of Finisteride, is that ok? Lastly, should I use Minoxidil? My beef with that medication is that it is a vasodilator and I am afraid that I would have to use it forever, I would rather take Finisteride forever (or until I decide I just do not care). My hair loss is not noticeable; it looks like it is simply the separation of my hair. However, I know my own hair density. I believe Finisteride should be enough to at best stop any further thinning. Also, I can provide you with pictures if that would help. Thank you for your time and have a wonderful weekend.

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I would doubt that stress is elevating DHT levels. Men with hair loss and thinning at the top/crown are mostly likely to have genetic male pattern baldness. Yes, DHT is one of the factors, but your genes are ultimately to blame. Chances are, the loss you’re seeing is coincidental to your entering pharmacy school.

If you cut a 5mg finasteride tablet into 4 pieces, that’s 1.25mg per day (if you get the pill cut perfectly)… and that’s ok. Ideally, cutting the 5mg pill into 5 pieces would be best, but getting 5 equal pieces would be extremely difficult. Using minoxidil with the finasteride is up to you. Some patients like both medications, but it could feel like a daily chore that you need to keep up with.

May 7, 2010

Hair Loss InformationAderans Expands Clinical Studies – Hair Loss Information – Balding Blog

IÂ´ve found updates from Histogen and Aderans. What can you say about this? Thank you.

Histogen: Hypoxia Induces Stem Cell Gene Expression, Protein Production and Cell Surface Markers

Aderans: Aderans Research Expands Clinical Studies

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Thanks for sending these links. Each press release speaks for itself. The Histogen press release isn’t specifically about their hair loss treatment (they have multiple products unrelated to hair loss treatment), but the Aderans Phase 2 clinical trials expansion is for hair regeneration. Once the studies have concluded, they will hopefully be published with the FDA and then we will know better about what is offered.

May 7, 2010

Hair Transplant Results with No Detectable Scar (with Photos) – Balding Blog

This patient stopped by my office to show off his remarkable results from his single hair transplant less than 8 months ago of only 1336 grafts in the frontal area. Before photo on the left, after photo on the right; click to enlarge:

He also had no detectable linear scar as shown in the photos below. The absence of the linear scar really reflects the patient’s healing ability as much as the surgeon’s skills. I usually don’t take credit for great scars as I always do the same procedure with the same precision on every patient. Interestingly, we elected not to use a trichophytic closure on this patient and the donor scar is still undetectable. Some people just heal better than others. Why didn’t we use that closure technique? Well, he planned on having a 2nd surgery in the future, but his results were so impressive that he won’t need another procedure. Click the photos to enlarge:

May 6, 2010

Finite Number of Hair Cycles? – Hair Loss Information – Balding Blog

Dr. Rassman,
Thanks for an amazing blog. I check it daily for updates. I wish I could fly to the US for a consultation one day, but it’s far away from Australia.

I have seen in a number of blog entries that you refer to hair going through a finite set of cycles (one cycle being Anagen, Catagen, Telogen). Is this based on research and/or from experience? Does all hair have a limit or does it not apply to the donor area?

Kind regards

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The anagen, catagen, and telogen phases are the well known life cycle of any hair. I think it is even taught in high school biology. For human scalp hair, the anagen (growth) cycle can last several years. This is followed by the resting phase (catagen/telogen), lasting several weeks to months. The length of time of the anagen cycle widely varies in people, but it is estimated to be anywhere from 2 to 8 years. If you take 3 years to be an “arbitrary” average, you can calculate your lifetime of cycles. If you have genetic balding or other hair loss conditions, the cycle of hair is obviously shortened (see apoptosis). The hair cycles apply to all hairs, but the pre-programmed genetic life of certain hair is variable. You really do not need research to see this… just look at all the bald men out there!

Now, I am not sure if I have completely answered your question, as I believe there may be some misunderstanding. For men most of the hair on the back of the scalp is considered “permanent” hair which will cycle and live on (see the Norwood 7 diagram at right). The hair you see in that diagram is considered the donor hair and this is a basis of hair transplant surgery for men. The research and experience you are asking about is evident on thousands of men who have had hair transplant surgeries. For example, see the hundreds of examples posted on our site showing patients we have performed surgery on over the last 18 years — the transplanted hair is still growing and cycling. Now the aesthetics and the natural appearance is what is highly variable, depending on who performed the surgery.

May 6, 2010

Hair Loss InformationHelp with Craniotomy Scar? – Hair Loss Information – Balding Blog

Hi there,

I’m hoping I can get some guidance on craniotomy scar issue I am having. I am a 27 year old male, and about 6 months ago I had a craniotomy for the removal of a benign tumor which was discovered shortly before the procedure. The surgery went well and all is good now health wise. However, I now have a 6″ long scar that is about 5/16″ wide in the back of my head.

I would now like to address how I can improve the aesthetics of the scar, as I prefer to keep my hair short. The good news is with longer hair (shown in the photo), I am able to cover the scar, but I’d really like to wear my hair shorter. I have visited 2 cranial plastic surgeons and one hair doc in the Bay Area, California. Here is summary of their recommendations on how to improve the scar:

– UCSF plastic suregon: Scar Revision and change scar to a zig zag shape.
– Stanford plastic surgeon: Standard Scar Revision. Advised against doing a zig zag as it would change hair growth directions and “make it look weird”.
– Hair Doc: Standard Scar revision and possibly hair transplant on scar if scar needs additional improvement.

Is it true that changing the scar to a zig zag shape would change the hair directional growth? If that is the case, why would the UCSF surgeon recommend that? Do any of you have any recommendations on the best way to improve aesthetics of the scar? My end goal is to not get rid of the scar completely, but to at least improve the aesthetics of it. I’d appreciate some feedback!

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I really cannot give you good, personal medical advice via the internet, so I’d suggest if you’re interested you can see us at our office in San Jose or Los Angeles (the consultation is free). We have transplanted hair into craniotomy scars with very good success. Many of these patients have had scar revisions that failed to resolve the cosmetic issues. You may need more than one transplant depending on the case, the size of the scar, and the location of the scar. Dr. Pak recently performed a FUE/FOX transplant into a craniotomy scar where a zig zag attempt was made. Sometimes a zig zag revision can make the scar worse.

Ask your surgeons for examples with before and after photos. Maybe it will help disguise the scar, but it’s still a scar nevertheless. Hair transplants to the scar does not mean the scar will be removed, but at least there is hair growing “ON” the scar and if there is enough hair in the proper direction, the scar will not easily be seen.

May 6, 2010

Taking Avodart Bi-Weekly To Avoid Propecia-Like Side Effects? – Hair Loss Information by Dr. William Rassman

Dr. Rassman:

Prior to reading this, thank you for your time. Your insight and knowledge is of great appreciation.

My situation is as follows:

I started propecia, was on it for a month, then underwent a HT of 1,900 grafts mainly in the front hairline. I continued to use propecia for 2 more months and began to experience some serious sexual side effects. I stuck it out for another 3 weeks however the side effects continued so I stopped the propecia. The sad part is that the propecia began to halt my hairloss however I could not deal with the sexual side effects.

Sadly my hair is shedding. After another apt with my hair restoration doctor, he suggested I take Avodart 0.5mg twice/week. He had mentioned that some of his patients who were having side effects from Propecia took the Avodart bi-weekly, (due to the drugs long half life) and were able to halt hairloss but did not experience the side effects which I was experiencing from my daily 1mg Propecia regiment. I have read all of your posts in regards to Avodart and I understand that it is not FDA approved nor do you prescribe it to your patients.

My main question to you and issue at hand:

I know that when people start taking Avodart they experience a shedding phase which generally kicks in after the first month or two of starting the drug and can last a few months there after. My first question – If I am only taking the drug twice a week and have only been off of propecia for 4 weeks will I also experience a shedding phase? I am confident that the shedding phase is the transition to a greater good…as the weaker hairs fall out months later they are replaced by stronger, new hairs. My problem is that I am in the entertainment industry and will be starting a one month taping of a TV series from June 30th-July 30th. I would like to have as much hair as possible by that time so would I be better off waiting to take the Avodart after the taping is complete, or should I start now and hope that the avodart will not cause a drastic shedding phase and help me stabilize the hair that I currently have? I guess this really comes down to a game of timing.

It will be 5 months since my HT when the taping starts in June so I am hoping that the transplanted hair will already be popping up. Also, most of the hair that I am losing is from the front hairline and temples. The crown seems to be doing ok.

Thanks again for your time and I would also be interested in undergoing a transplant with your team following the taping.

I really do not have a clear answer to your situation. In general, Propecia or Avodart will not be as effective on your front and temple areas. They each work best on the top/crown areas of your scalp. I do not know if you will have more or less shedding as everyone has different results, different side effects, etc. Shedding isn’t seen by all men that start the medication. Really, only time will tell and there is no clear way to predict this.

It would be interesting to know if Avodart did indeed change your sexual side effect issues, as I would expect that it would not make it better. There’s not enough reported about Avodart dosing in the treatment of hair loss for me to suggest that bi-weekly pills are the way to go.

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May 5, 2010

My Young Children Aren’t Growing Hair! – Balding Blog

Yes i have two daughters ages 2, and 3. when they were born they had hair. as my oldest got a few months old all her hair was gone. both of my daughters have very light almost white peach fuzz as i call it. it isnt even half an inch long. i have consulted thier doctors and they have never seen it. i dont know what to do. i just found out im pregnant again and i would like to find out what condition my daughters have so i can correct it. At least know what is causing it so i can become more educated in the matter. My oldest realizes there is something different about her and even asks mommy why dont i have hair like you, as a mother this is breaking my heart. Please help!

This sounds like a genetic disorder. I would want to know about your family and the father’s family history. Has this type of lack of hair been seen before in either side of the family? I really can’t help you much more through the internet without taking a careful history where, I suspect, you will find what is wrong.

A pediatric dermatologist would be the best place to visit first. There’s a group that focuses on pediatric dermatology, and they have a physician locator that might help point you in the right direction.

May 5, 2010

My Doctor Wants to Give Me Steroid Injections for My Female Hair Loss! – Balding Blog

Hello, im hoping you could kindly help me please? Ive been suffering hair thinning and balding patches for the last two to three years, gradually becoming worse, i have naturally long dark curly hair. I have had been given all sorts of treatments to try and im under the care of a Trichologist and a Dermatologist, ive finished my Minoxodil 4% as the 2% wasnt strong enough, but unfortunately it has not worked, so i went back today to see the consultant dermatologist and he told me he would like to try the steroid injections into the scalp, but i would like to have hair transplant as it is affecting my confidence and feel ugly and constantly compare myself to other women.

Im 28 years old, female, and studying to become a doctor, so i just put the hairloss down to stress but its been over to years now and its worse, please help! Is my doctor correct in trying the injections? he said the transplant would not work. my hairloss and thinning is on my temple area and around the size of the bottom of a mug (cup) and hair thinning on my roots. Thank you for your help.

You need a real diagnosis, and I really can’t help you without that. There is no definitive medical solution for genetic hair loss in women in most instances. You are wasting money by seeing all these specialists and you may end up worse off after these invasive procedures that may not work. Steroids have never been proven to work for genetic female hair loss, but do work for particular diseases like alopecia areata. Plus, steroid injections to the scalp often cause hair loss.

As you say you are studying to be a physician, empower yourself by educating yourself on women’s hair loss issues and treatment. Hair loss in women can be from a variety of reasons, some of which are listed here. As for hair transplants, many women just are not candidates, but I couldn’t specifically say whether you are or not as I’ve never examined your loss.