January 2011 – Page 6

January 12, 2011

Hair Loss InformationPermanent Finasteride Side Effects Article in Journal of Sexual Medicine – Hair Loss Information – Balding Blog

Dr. Rassman, et. al, the Journal of Sexual Medicine has recently published an article describing the permanent sexual side effects of using finasteride. I quit taking propecia approximately 2 weeks ago and am terrified that I have permanently damaged myself. What are your thoughts on the article?

Adverse Side Effects of 5?-Reductase Inhibitors Therapy

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Many of my patients have been taking Propecia for over a decade without side effects. I have yet to meet a person in my practice who complains of permanent side effects associated with Propecia after they stopped the drug. The few that do have side effects at all elect to stop taking the medication and the side effects have subsided as their hair tumbles to the ground. But that is just my humble experience.

The article itself doesn’t provide anything new, just reviewing previously published reports from a subset of men that raises the possibility of a casual relationship. They did report a single case of a man with total sexual function loss, but that sounds peculiar and I’m not convinced. I would wait for confirmation by other investigators on claims of permanent damage from finasteride. The Journal article was digested by the Boston Globe here and even mentions what we’ve been saying for years about the percentage of those that saw side effects:

“In one trial, about 1.9 percent Propecia takers who took the drug for up to two years experienced a loss of libido compared to 1.3 percent of placebo takers; 1.4 percent of Propecia users had erectile dysfunction and 1 percent had an ejaculatory disorder compared to 0.9 and 0.4 percent of the placebo takers.”

For most of the frightened men, I wonder what they’re so terrified about. Did they actually have side effects? Are these men willing to risk balding over a 1-2% chance of side effects? As I’ve often said, the medication is completely elective. You don’t have to take it and I am not trying to convince anyone to do so. I am just presenting my opinion based on experience. The Mayans predicted the world will end in 2012, so I would be more terrified about what will happen in 11 months!

January 12, 2011

NASA Pioneered Chemotherapy Hair Loss Prevention Decades Ago? – Balding Blog

Snippet from the opinion article:

I read with interest your article Chemotherapy Hair Loss Invention From Sweden Might Help Patients Keep Hair but it really is old news !

Around thirty years ago, Dr. Bill Williams, of NASA, conducted research on thermo control of body temperature (very important to astronauts in space suits). He patented his invention of the “Cool Head and Cool Neck Band”.

Read the rest at the Epoch Times — Chemotherapy Hair Loss Prevention Pioneered by NASA, Thirty Years Ago

The above is part of a letter by a retired NASA researcher, and it should be noted that it is in the opinion section.

It basically says that a NASA scientist helped develop a cooling system for helmets, and although the headline might lead you to believe there’s more info about hair loss and chemo, it only briefly mentions an “experiment to save the hair of chemotherapy patients“. But that’s it. Unfortunately, it doesn’t discuss the study or what that experiment was… and I’m coming up empty when trying to find if the study was ever published. Anyone?

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January 11, 2011

Do Eyebrow Transplants Look Normal? – Balding Blog

Hello Dr. Rassman,
I was considering eyebrow transplant surgery after many years of overplucking and abuse to my once bushy brows. I have read that as a side effect the hairs may be “raised” or grow in awkward directions. I was wondering in your experience how often does this occur? Say in 150-200 grafts how many may grow this way? And can they be “trained” over time to grow correctly? Thanks

Eyebrow transplantation is a delicate art and even for skilled medical groups it is never perfect. As you correctly state, the eyebrows can grow slightly raised and grow in slightly different directions, regardless of how precisely you pay attention to detail. And since the focus is right above your eye, the eyebrow transplant subtleties are not as forgiving as with hairs transplanted on the scalp.

I can’t give you a generalization of what to expect, as each and every person is different. It depends on hair texture, curl, shaft diameter, follicle length, orientation around its central axis, how it lays down, etc. I can say that male eyebrow transplants are more forgiving, as men have bushier eyebrows. My eyebrows seem to be admired by many men who request eyebrow transplants, as mine are the spitting image of Albert Einstein (see right).

I can also say that if you don’t like a certain eyebrow hair in the mix, just pluck it out! Often times patients usually have at least two eyebrow transplants to get it just right.

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January 10, 2011

Do Norwood 7 People Start Balding Earlier? – Hair Loss Information – Balding Blog

Do the people who are destined to become a Norwood 7 start balding early? i mean around what age do they usually start balding?

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Norwood 7 Yes, I do believe that the advanced balding patterns like a Class 7 pattern does start to show up earlier.

The best step for you if you think that you are in that category, is to get miniaturization studies and bulk measurement studies done on various parts of your scalp. Any early miniaturization or bulk studies will help you follow the changes over the years with good measurements… and best of all, it will tell you what the diagnosis is and how you are doing with any hair loss medication you’re using.

January 10, 2011

Hair Loss InformationHow Does DUPA Look When It Starts? – Hair Loss Information – Balding Blog

Doc,
Do most patients dealing with DUPA hair loss start thinning out everywhere evenly in your experience. I’ve thinned out on top and a bit on the sides but the back under where the crown thinned is still thick and dense. Is it possible to have partial DUPA or can the thinning above the ears be stress related or due to some other external factor? Thanks

PS – Thank you so much for the blog and I decided to make a move and actually go to an open house event at NHI. Keep up the good work!

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I do not mean to seem sarcastic, but DUPA looks like as the name implies — diffuse and unpatterned. In general, the back of the scalp (the male donor area) would be affected if you have DUPA. With genetic male pattern baldness, it wouldn’t be typical for the donor area to be impacted in the same way.

January 7, 2011

Why Do People Risk Getting a Bargain Hair Transplant? – Balding Blog

I’m going to rant for a moment, even though I know I’m running the risk of repeating myself. I’m disheartened by the amount of emails I get from people that are upset about the “bargain” hair transplant they got at various clinics around the globe. Of course, we realize that usually it’s the negative results that are the subject of such communications and we do not often hear from those patients with great results, but I felt I needed to post this as a reminder to the regular readers and hopefully something fresh for new visitors.

I believe that finding a good hair transplant doctor is like locating a good heart surgeon. Yes, heart surgery is more important than a cosmetic surgery… but I’m referring to the process of selecting a doctor. There are many qualified surgeons, but only a handful are capable of producing consistent, high quality results. In the heart field (I started out as a cardiac surgeon), you simply die when you select the wrong surgeon or get the wrong surgical team.

I’m sure I’ve mentioned it before on this site, but I remember a patient who came to see me (with his two kids) for a consultation. He then selected another doctor just a couple of miles from my office to have a transplant at the low, low price of $1.75/graft. When costs are too cheap, the quality of care tends to be low and corners are cut. That patient died during the transplant. It was the only death from a hair transplant that I’ve heard of. Granted, this was an extreme case of a hair transplant gone wrong. The usual result from a hair transplant that does not go perfectly will be with you for the rest of your life, and if the process is done without a focus on details and the art of the transplant, you will end up advertising your poor decision to everyone you meet. So please, please read this easy how-to guide on selecting your transplant doctor — here.

Some of the public is misinformed when it comes to doctors who offer hair transplantation. Just because a doctor is offering it, it doesn’t mean he can actually do what he’s selling you. The results from a hair transplant takes 6-8 months to grow, so by the time the results are evident, the patient’s check has cleared the doctor’s bank account and as many patients find out, there is little recourse to getting their money back from a failed hair transplant. Or worse, the results are clearly unnatural and detectable. Remember to research, meet patients, and be a smart shopper. I know the economy isn’t great for a lot of people right now, but don’t forget that this surgery is forever.

Further reading on this topic can be found here:

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January 7, 2011

I Stopped Perming My Hair Months Ago and Still Have Bald Spots – Balding Blog

For the last couple of months my hair has been falling out all over my head. I have bold spots everywhere and i dont know what is going on. I stopped putting perms in for about 2 months know and i dont know what to do. Can someone please tell me something that i can do im young and i have a daughter.

If there’s chemical burns on your scalp from the perms, it could take up to a year to see regrowth… if it will grow at all. I have no idea what’s going in your particular case though, so I’d suggest you see a dermatologist in your area to get to the bottom of it. The bald spots could be related to the chemicals or could be something else entirely.

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January 7, 2011

ABC News Says Balding Cure is a Decade Away? – Balding Blog

Snippet from the article:

Stem cells produce progenitor cells, or so-called workhouse cells.

“If we figure out a way to wake up those stem cells, get them to make hair for progenitor cells, that would go a long way toward developing a treatment,” Dr Cotsarelis told ABC News.

Researchers predict they’ll be able to do that within a decade. But until then, millions of customers will be left waiting, and spending.

Read the full story at ABC — Baldness Breakthrough: Scientists to Find a Cure to Male Balding in 10 Years?

The article itself just rehashes what was written about the recent stem cell announcement, except with this additional sentence — “Researchers predict they’ll be able to do that within a decade.” Which researchers? When was this prediction made? What was the basis for the prediction? Seems like more lazy reporting.

To me, the interesting part was about the stem cells, yet the headline was about a single sentence that had no further information attached to it; an obvious attempt to be sensational and attract eyeballs. While I hope the cure will be here within 10 years, I see this type of proclamation every few months as the timeline moves again and again.

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January 6, 2011

Dense Packing of the Hairline (with Photos) – Hair Loss Information – Balding Blog

What is the average distance between each hair at the hairline and about a half inch behind it on a non balding adult male? And what is the smallest distance between each graft you can safely transplant at the hairline? When you normally transplant grafts at the hairline is the distance between the grafts always larger than the native hair of the person. I know only single grafts make up the first few rows of the hairline to give a natural looking transition but if they are not packed closely enough the hairline looks almost “see through” or whispy looking. I have noticed this on alot of transplant photos. Is there anyway to avoid this and give a very dense looking hairline transition even using single grafts?

I am a male with minor female pattern balding with very little temple recession but my hairline transition has become thin and whispy and looks similar to the hairlines created with a hair transplant in a totally bald area? My goal would be to thicken up the transition area so it looks thicker and dense similar to the hairline of Brad Pitt or Tom Cruise since I am in their age bracket. Is that even possible?

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First off, I’d like to think I am a good surgeon, but I highly doubt I can make you look like Brad Pitt or Tom Cruise.

Second, a hair transplant cannot give you back the same hair density as you once had. Think about the simple fact that the surgeon has to get your OWN hair from the back of your head and move it to the front. In other words, the surgeon isn’t creating any new hair, just moving hairs around. If you move too much hair from the back you will be bald in the back (so to speak). Thus, the main goal for a hair transplant surgery is to give you a non-balding hairline and good enough coverage. But a hair transplant cannot give you back the fullness of Brad or Tom. Maybe another way to understand this point is to know that an average non-balding head has over 1250 hairs in a square inch (or 625 follicular units in a square inch).

The only exception to this is if you do not have too much hair loss (like Norwood 2 or 3) and understand you will not achieve the FULL look with one surgery alone. You need multiple surgeries to fill in the ‘gaps’ to achieve the fullness. You must also consider conserving the remaining donor hair available in case you continue to lose hair at the top and crown. This is what we refer to as the Master Plan.

There are several patients that come to mind who requested precisely what you are asking for. The patient below is one such example of a Norwood class 3 pattern patient that had two surgeries with me in a very small area. Click to enlarge.

2 years after two hair transplants totaling 3182 grafts:

Before:

January 6, 2011

Shock Loss from Eyebrow Transplant? – Balding Blog

(female)
Hello Dr,
I was wondering if shock loss occurs in cases of eyebrow transplantation? Also, are there any other side effects that could potentially occur? Thank you for your time.

Shock loss can also occur with eyebrow transplantation. The main side effect (if it can be called a side effect) is lifelong trimming of your eyebrow, as it will continue to grow like your scalp hair. For the original viable eyebrows that falls out from what I will call hair transplant shock, these may not grow back and it can result from damage induced at the time of the surgery. Original eyebrows seem to be sensitive to trauma more so than head hair.

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