April 2016 – Balding Blog

April 29, 2016

Finasteride, Low Sperm Count, Pregnancy And Child Deformities – Hair Loss Information – Balding Blog

This is an excerpt from the FDA website from 2010 on finasteride (https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020788s018lbl.pdf). Dr. Ed Epstein, from the Bosley Medical Group is a urologist by training and has kept up on the latest information on the impact or lack of impact of the drug finasteride on risks for an unborn fetus. “I am not aware of new studies on amounts of finasteride in semen or vaginal absorption data” that reflect increased risks for fetal abnormalities induced by finasteride other than what is written in the FDA white paper referenced above.

Some doctors are concerned that patients who go on finasteride should get semen analysis to keep track of semen levels in case these level dropped while a patient was on the drug finasteride. Dr. Epstein said: “Concerning getting semen analysis on child bearing age men starting finasteride, I totally disagree. Typically a male infertility workup is suggested after one year of unprotected intercourse. The subgroup of men who have low sperm counts on finasteride are those with preexisting conditions and appear to respond to discontinuation of finasteride.”

In other words, he feels that a young man should not worry about either low semen counts caused by finasteride, but that they could always stop the drug and if there was a causal relationship, it would reverse. He also suggested than men with low sperm counts while on finasteride, probably had it before they started the drug and should get any low sperm count evaluated by an expert.
The FDA while paper referenced above showed that studies on semen in sperm were either not present or when present were so low as it not cause a risk to a pregnant woman or a woman who is expecting to become pregnant. “Semen levels have been measured in 35 men taking finasteride 1 mg/day for 6 weeks. In 60% (21 of 35) of the samples, finasteride levels were undetectable (<0.2 ng/mL). The mean finasteride level was 0.26 ng/mL and the highest level measured was 1.52 ng/mL. Using the highest semen level measured and assuming 100% absorption from a 5-mL ejaculate per day, human exposure through vaginal absorption would be up to 7.6 ng per day, which is 750 times lower than the exposure from the no-effect dose for developmental abnormalities in Rhesus monkeys and 650-fold less than the dose of finasteride (5 ?g) that had no effect on circulating DHT levels in men”

Block Quote

Another opinion can be found here: http://www.medpagetoday.com/Endocrinology/Infertility/41424

April 20, 2016

Healthcare Service Stinks Says Stossel – Nothing Like NHI Routine Services Says Dr. Rassman – Hair Loss Information – Balding Blog

I could’t help but think about what we do in our practice vs what Stossel talked about in this article. “the hospital’s customer service stinks. Doctors keep me waiting for hours, and no one bothers to call or email to say, “I’m running late.” Few doctors give out their email address. Patients can’t communicate using modern technology”.

http://www.foxnews.com/opinion/2016/04/20/stossel-have-lung-cancer-medical-care-ive-received-is-excellent-but-customer-service-stinks.html

At the New Hair Institute, every patient:

Has the doctor’s cell phone number.
Does not wait more than a few minutes before being seen.
Service reviews are fantastic nearly 100% of the time.
The service is personalized because we do not run a hair transplant ‘mill’ and care about our patients as human beings with a problem.
Sterile condition and safety are top priority (not an infection in over a decade).

April 14, 2016

Scalp MicroPigmentation for FUE Scar – Hair Loss Information – Balding Blog

Scalp MicroPigmentation to fix FUE Scar

is now a well known method to hide old hair transplant linear scars. You can view many before and after photos on my website. Nowadays there is an uptick at my clinic in Los Angeles where I am seeing many unhappy patients with FUE scar. These unhappy patients are finding out FUE is NOT a scar-less or “no scar” surgery often advertised on the Internet and misrepresented by their doctors. Look at the FUE scar before photo and Scalp MicroPigmentation treated after photo. The before photo shows the result of a mottled, moth-eaten appearance, the consequence of a about 1000 graft FUE session. This condition which is now springing up all over the world as more clinics offer large FUE sessions ranging up 3000 or 5000 grafts a session. There are reports of skin necrosis and open wound infection. If you add up the total wound from a 3000 graft FUE surgery the collective open wound would be the size of a baseball. Imagine a bleeding open wound the size of a baseball on the back of your head. When you put it this way, FUE is not necessarily a minimally invasive surgery after all. While I’ve always been an advocate for large “Mega-Sessions” during the 1990s with strip surgery, you must think twice about FUE Mega-Sessions. These large FUE Mega-Session depletes the donor area and many men often complain about the see-through look on the back of their head. In an attempt to avoid a linear scar, these patients inherited another set of problems. In certain cases, the FUE scars can be treated with Scalp MicroPigmentation but the low density issue still remains. In my practice we try to limit the FUE session well below the 3000 graft range to avoid the moth eaten appearance of the resulting FUE scar.

FUE Scar

Moth Eaten appearance of a FUE scar Before and After SMP

April 13, 2016

Hair Line Lowering Reviewed with FUE vs STRIP Surgery – Balding Blog

This is a photo of a female patient who had a hair line lowering and rounding hair transplant surgery. This is sometimes known as forehead reduction surgery. Dr. Jae Pak performed the surgery at New Hair Institute Medical Group in Los Angeles.

female hair line lowering before after photo

*CLICK TO ENLARGE PHOTO

This patient did not like her square high forehead with receded corners. She thought her hair line looked too masculine. She considered a forehead reduction surgery to lower the hair line. However, she was worried about the hair line incision scar. She also wanted the hair line corners to be more rounded in appearance which a forehead reduction surgery could not achieve.

FOREHEAD REDUCTION Surgery:

Forehead reduction surgery for women with a high forehead has been popular since the late 1990s. Dr Sheldon Kabaker in Oakland California is a well known and prominent surgeon who has been offering female forehead reduction surgery for many years. It sometimes requires the use of tissue expanders to drastically lower one’s hair line. Since 2006 Dr. Gal Aharonov in Beverly Hills California has been offering a slightly modified approach to the forehead reduction surgery. His method has gained great popularity from all over the world. With third party review sites such as RealSelf.com, the hair transplant community saw a demand for women seeking an alternative to forehead reduction. Potential problems of a forehead reduction surgery were the visibility of a scar along the hair line, and the limitations of creating an oval or rounded appearance. While patients were happy with the drastic reduction in their forehead size, some were self conscious about their scar and would not wear their hair pulled back. They addressed this with make up and sometimes a limited hair transplant procedure.

HAIR TRANSPLANT for hair line lowering:

An alternative for those women who did not want to undergo a forehead reduction surgery was a standard hair transplant procedure. Hair transplant procedure involves harvesting donor hair from the back of the head to individually relocate single follicles to the front. The limitations of a hair transplant procedure was that the results were not instantaneous. The transplanted hairs need to grow out from its roots. The advantage was a natural shaped hair line dictated by the artistry of the doctor creating the hair line. There was no scarring along the hair line.

The results for this hair line lowering patient were achieved using Follicular Unit Strip Surgery (strip surgery) sometimes referred as Follicular Unit Transplant (FUT). If Follicular Unit Extraction (FUE) method was used, it would have required shaving the back of the patient’s head. This is something few women would accept. There is no shaving involved with the strip surgery and the incision around the donor area (back of head) is covered by the patient’s hair. Even with the hair wet or hair up, the incision line (scar) will rarely, if ever be noticed. This incision may be an issue for men who keep their hair very short.

FUE vs Strip scar on the day of surgery

If the incision is an issue for a patient, the alternative method of harvesting hair is known as Follicular Unit Extraction (FUE). FUE harvesting is carried out manually by a highly trained surgeon or with an aid of the ARTAS robotic FUE instrument. There are other machines available such as Dr. Harris’s SAFE system or the NeoGraft machine you may have seen advertised in airline magazines. FUE method of donor hair harvesting may seem attractive for many patients because it is heavily marketed and advertised as a “no scar” surgery. This is NOT an accurate statement and is shunned by doctors since FUE does leave thousands of permanent round scars. Many patients have their FUE scars as well as strip scars camouflaged with Scalp MicroPigmentation.

Moth Eaten appearance of a FUE scar Before and After SMP

This reinforces the fact that the latest technology and fancy robots are not always the best choice. For most women, a small linear scar on the back of their head may be a better option than shaving their head for thousands of FUE “dot” scars. Think of a C-section scar under long hair vs a moth eaten appearance on the back of a shaved head.

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