Hair Loss InformationRepost – Follicular Unit Extraction (FUE) Patient Guide – Hair Loss Information – Balding Blog

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

FROM THE ARCHIVE (Originally published on October 3, 2008.)

Dr. William RassmanI wanted to call your attention to yesterday’s announcement relating to follicular unit extraction (FUE). As the ‘inventors’ of the procedure, publishing the first authoritative article in the Journal of Dermatologic Surgery in 2002, I have taken a keen interest in the way this procedure is delivered throughout the world. Much of what I have been observing has been disturbing. Too many doctors with little experience, and skills that have not been refined, have entered the field with heavy marketing programs offering FUE. My experience, however, has shown that some patients are not good candidates for this procedure and damage to the harvested grafts can be substantial in most surgeon’s hands. The key here is graft yield and unfortunately, this is an assessment made either after the procedure is performed with careful surgical monitoring and record keeping (by recording hair damage within each graft), or 8 months after the procedure when the patient can judge the success or failure of the results on his or her head.

I realize there is a delicate balance between what we want and what we buy. Our progress in reinventing the FUE process is discussed here — new FUE breakthrough. I really hope everyone considering having an FUE surgery (or anyone just curious about how it works) will read our new guide to evaluating Follicular Unit Extraction Techniques.

So what prompted me to write a new FUE guide? A while ago, I had the opportunity to view a well known doctor extract approximately 20 FUE grafts under my direct observation. While he boasted that he had mastered the procedure, what I saw reflected far less than such mastery and the doctor obtained a significant transection/amputation rate of the hairs in the graft. That doctor is prominently offering FUE today.

The surgeon’s technical skills take years to acquire and perfect, and although there are now some very fine doctors who I believe have truly mastered the technique and can deliver a quality service, I believe that they are in the minority of those offering it. There is a substantial worldwide demand for this minimally invasive hair transplant (virtually painless during the post-operative period, the patient can return to full activities in a week including all types of exercises, and there is no linear scarring). The problem for the patient, however, is in selecting a doctor where the FUE technique does not produce a “follicular holocaust” causing a substantial loss of donor hair and a failure of the procedure. This insight seems to be hidden from most buyers, because prospective patients want to believe in the marketing hype that is prevalent on the Internet and they are sold the technique by professional marketing pitches. There is no way to determine in advance, the skills of the doctors offering to perform the surgery.

In our new FUE guide, we have defined a way for patients to examine the various doctors offering this procedure, giving them an idea of what questions to ask and what things to look for. There is no site to offer guidance in the doctor selection process so the consumer must arm himself with the knowledge and skills to make the proper judgments themselves. Hopefully, our writings will appropriately arm the readers interested in this technique.

Hair Loss InformationBaldingBlog is Taking a Week Off! – Hair Loss Information – Balding Blog

Announcement:

This week, we’re going to take a break from publishing new content so that we can re-feature some of our favorite archived posts that didn’t get the attention we thought they initially deserved. We’ll post 2 or 3 longer articles from the archives each day.

For nearly six years, we’ve posted new blogs every weekday (excluding holidays)… and we don’t intend to stop. Not to worry, we’ll have new content again starting next Monday, February 14th, otherwise known as Valentine’s Day.

As always, thanks for visiting! The first archived post will be up in just a bit…

Hair Loss InformationCan’t Doctors Remove Old Hair Plugs One By One? – Hair Loss Information – Balding Blog

Hi Doctor. Thank you for having this great site!!

About 25years ago I had a HT using the hobby drill method. Now I have 3 rows of white plugs. I am like most of the others on this site and want to shave my head. I was wondering if you have ever considered a procedure to re-drill the plugs and suture them closed similar to the way you show it being done to patients for the top of their heads. I have spoken to other doctors and they want to cut the entire area out and suture it closed. They also state that it would take two or three procedures. Why can’t someone just re-drill and suture shut the area?

Block Quote

We have done what you described — taking each of the old style hair plugs out one-by-one and suturing each wound closed. We have also cut out the entire row and sutured it all closed. And we’ve even done a combination of both. Here’s a step-by-step story of the process one man took to repair his pluggy hairline. It took multiple surgeries to complete his repair, with the first procedure being a removal of a row of plugs, and the second procedure being individual removal of some of the remaining plugs.

My point is, everybody is different and every treatment plan for each individual is unique. In the end, find the doctor that you trust and ask to see some before after results of these repair procedures. You may even ask to speak to their former patients or meet them. Good luck.

Hair Loss InformationHow Far Back In My Family Tree Should I Look for Balding? – Hair Loss Information – Balding Blog

You’ve said before that balding comes from both sides with a tiny bit more weight on your mother’s side. When looking through a family tree for traits and patterns of hair loss (which I’m sure every visitor to this site has done over and over), how far back or in to your extended family should you look (cousins, uncles, great uncles, etc.), or can it spring up out of anywhere? I understand there are many environmental factors as well, but I ask because I have some unique traits I can’t attribute to anyone I have photos of in the past two generations or my second cousins even.

Block Quote

Genetic hair loss will likely be visible somewhere in your family tree, but I really cannot give you a definitive way to predict if you have the hair loss gene just by looking at your family members. The best way to know is look in the mirror… or see a doctor for a miniaturization study and/or hair bulk analysis.

The genes can be determined by genetic testing to 70% accuracy (see HairDX), but the test doesn’t tell you at what point the genes will be expressed, if at all.

Could the Donor Scar Become Visible from Senile Alopecia? – Balding Blog

Hello Dr. R and all.

Thank you for your blog, I’m sure everyone would agree with me that it’s a venerable resource. With regard to strip surgery in a typical male who is losing hair to a NW5 pattern at 40 years of age (eg. William Hurt like) when would you anticipate the donor scar to become potentially visible due to senile alopecia?

ElderlyThe reason why hair transplants work in men is because men don’t usually bald in the donor area (back of scalp). And since men don’t bald in the back of the scalp, the scar from strip surgery isn’t shown.

Senile alopecia does NOT occur in all men. It is a rare entity where the hair thins considerably in the elderly. If you end up with senile alopecia in the donor area, I suspect the donor scar will still be well hidden, because you likely wouldn’t bald completely and the donor scar is very minimal. Of course, this depends on how this area thins out.

We must all look at the pros and cons of anything we do in life. Having a hair transplant surgery is a great option for balding men. The donor scarring, possible senile alopecia, or even balding from chemotherapy is something to think about, but in most men the benefits outweigh the risks. The other option is do nothing. It is like staying home locked up on a perfectly sunny beautiful day because you are afraid it may rain (despite a beautiful forecast).




Related Posts Plugin for WordPress, Blogger...

Balding Forum - Hair Loss Discussion

Is It Legal for Physicians to Prescribe Proscar to Cut Up? – Hair Loss Information – Balding Blog

First of all, I just wanted to let you know that I have found your blog very useful.

I am a 24 male and for the last couple of years I have noticed my hairline receding and then my hair getting much thinner. I look back at pictures from 3 or 4 years ago and I am in awe at how much my hair looks different. Anyway, I have tried rogaine for about 4 months and have not seen much of a difference, plus it is kind of a pain to use. In fact my hair seems to just continue getting thinner.

I would like to try Propecia, however, I am in medical school and I really cannot justify using that much loan money for propecia, if you know what I mean. I have noticed that you and others suggest using 5mg generic Finasteride normally used for BPH as an economic alternative. I would like to ask my doctor about this option. My question is whether this is considered ethical/legal and how physicians usually respond to this.

Thank you for your time

Block Quote

There are no ethical or legal issues associated with prescribing finasteride for androgenic alopecia. There is however a financial issue, as finasteride 5mg is about $30-$60 for 90 pills and finasteride 1mg is about $150 to $200 for 90 pills. If you cut the 5mg finasteride in four parts, the 90 pills should last you 360 days! This drastic difference is based on U.S. Patent laws that give protection to Merck, as they have the rights to manufacture the 1mg dose of finasteride up until mid-2013. The 5mg finasteride is available as a generic because the 5mg patent expired already, so the prices are way, way lower.

As far as doctors are concerned in prescribing medications, as a medical student, I hope you will soon find that there are hundreds of medications with generic versions that are exactly the same and just as effective as their branded counterpart. Consider this when you prescribe branded medications to patients after the drug companies wine and dine you.

On a final note, there is an ethical issue to the patient if they decide to cheat the system by getting the generic finasteride 5mg using their insurance card. The insurance companies may approve finasteride 5mg thinking you are treating a prostate problem. Finasteride used for androgenic alopecia is not covered by insurance.

Transplanting the Hairline First, Then the Crown Later – Hair Loss Information – Balding Blog

Hi,
I have a question. I am willing to do hair transplantation both back area and front area as well. I was deciding first to go front area and then back area. How many months or days gap should be given between two surgeries. Kindly help with information. Regards

Block Quote

First, you need to have your supply and demand understood. If your donor density is enough to address the balding problem, then starting in the front is the best way to go about the process. Will you be doing an FUE or a strip method for harvesting the grafts? That may be important in the timing.

Strip wounds will heal easily in 3-4 months and likewise, FUE wounds may heal in less time. As the areas of your focus are different (front and crown) you can have the second procedure as early as 3-4 months following the frontal surgery, provided everything is well healed.

My Dermatologist Prescribed Me 2.5mg Finasteride for Preventive Measures – Hair Loss Information – Balding Blog

Dear doctor,

I am a male of 22 years old. I am experiencing very slight recession of my hairline at this moment almost invisible for the human eye. I also have some shedding which freaks me out a lot(not an understatement) because I always have got extremely thick hair and never noticed any shedding. My dermatologist prescribed me minoxidil and the second appointment because I was still worried gave me a prescription for Finasteride 2.5 mg. She said I could take it ‘preventive.’ Is this true? My pharmacist forgot to write the dose on the box so I have been taking 5 mg for one month. Is this dangerous; should I start taking the right dose now(i.e. 2.5 mg or just keep on with the 5 mg.

Thanks a lot in advance

Block Quote

What you are doing (taking 5mg finasteride daily) is not dangerous, but it is not the right dose. For the treatment of androgenic alopecia, the correct dose of finasteride is 1mg a day.

In your case, there is nothing you are telling me that you were even diagnosed with androgenic alopecia! You should not be taking any drug for preventive measures. Perhaps you need to find another doctor and a pharmacist.

Head and Shoulders Opinions – Hair Loss Information – Balding Blog

In December 14 2005, someone wrote that he started losing hair soon after beginning to use Head & Shoulders shampoo. At the time, you advised that, to your knowledge, the shampoo did not contribute to hair loss. However, in 2008, you posted a fair amount of reader commentary, much of which linked the readers’ hair loss to that shampoo by their own account. Does your opinion remain unchanged from that of 2005?

Block Quote

Yes, my opinion on Head and Shoulders causing hair loss is unchanged. Maybe there’s an allergic reaction or something else entirely… but generally speaking, shampoos won’t cause hair loss.

I don’t shy away from posting reader comments on products, but it is their opinions and/or experiences.

Hair Loss InformationDid Nicolas Cage Plan Poorly When Treating His Hair Loss? – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

How did the holidays treat you and your staff?

I had a question about keeping up with hair loss. Have you ever had a young or middle aged patient run out of donor hair? I saw this picture of Nicholas Cage and shuddered. I don’t mean to pile on the Cage/Hair issue but I think it helps illustrate what poor planning can lead to. He had some work done and now, despite his fame and fortune, he is a prisoner in his own body.

Will the equipment that NHI uses to calculate future hair loss (miniaturization mapping, hair bulk analyzer) pick up on advanced patterns like this one?

Thanks and enjoy your day!

Block Quote

Nic CageThere’s been rumors circulating for years in the gossip rags that Nicolas Cage had a hair transplant, but until he comes out and says one way or the other, it’s just speculation. I honestly don’t know when his loss started, how it progressed, or what his goals are/were. Actors will commonly have high end hairpieces/wigs used in their movies (depending on what the role calls for), so creating a timeline to note his hair loss progression is sketchy.

It may seem to you or others that his hair restoration process was due to poor planning, but to others and (himself) it may be what he wanted. Without good pictures, it is impossible to tell just where is hair loss is and what he had done. You also don’t realize maybe he may continue on with another hair transplant to seek more fullness. I do not know! It is all speculation.

Looking at the photo at right (full size here), his hairline is high… too high for a normal look. It should be located in the mature position, and if it were so located, it would not look transplanted.

As for the miniaturization mapping or bulk analyzer tool, neither will predict the future, but both do help us keep track of hair loss and the treatment progress. They’re just tools we use to come up with our Master Plan for each individual.

And to answer your first question… the holiday season was nice. Thanks for writing!