Month: January 2023

QUESTION FROM THE PAST Please help me – I’ve been suffering from hair shedding since Aug 2007. I was on the pill for 12 years and came off in august just after my wedding to conceive. I concieved straight away and am now 7 months pregnant. In Dec 2006, I was in hospital for a day with an infection which caused a hemorrhage. The shedding does seem to have slowed down now so losing about 25 after washes and I feel spiky bits all over my head. This has lasted about 7 months now and just wanted to know how long it usually last for and if it will stop? Will I ever get the thickness back in my hair?

I’m so depressed about this and would be grateful if you could help me. Thanks

You have many potential causes for hair loss, including:

• Pregnancy, which can cause hair loss that should reverse after about a year
• Changes in your hormones from the withdrawal of birth control pills
• Illness from the infection that put you into the hospital

It is likely that this process will reverse. You are not alone and the experience of others with this problem have been far from hopeless.

I have been reading various blogs and posts on hair transplants before I take the dive. Many doctors are using PRP, is this a valuable thing to use?

At the recent International Society of Hair Restoration Surgeons (ISHRS annual meeting), the subject of the use and value of using Platelet Rich Plasma (PRP) came up. Over the years, there have been many poorly researched reports on the use of PRP. Not only at the meeting did the papers reinforce the lack of value for using PRP, but the uses by those who advocate it make me wonder if this is a money thing for the doctor’s income. In performing PRP, the doctor draws blood from the patient and then spins the blood down to reveal the part of the blood that is known to be rich in platelets. It is not a complicated or a costly process. Platelets are the part of the blood that allows blood to clot when you cut your arm, or your beard when you shave. Not only is it valuable in clotting, but it supplies important elements for the healing process. The theory goes from there that if it helps healing from when you cut your face or arm, it must have strange healing powers, including stem cells that are derived by the platelets https://baldingblog.com/2013/05/30/lots-of-questions-about-prp-platelet-rich-plasma-and-acell-use/. I cannot say the results of any of the newest papers impressed me in any way.

So you might ask: Why do the doctors recommend using it? I really have a problem with answering this the way I feel, but I will tell you that most doctors who use it charge about $1,500 for a treatment of taking and returning your own platelets back to you. That is a good motivation for the doctor, but not necessarily for the patient (unless the patient don’t care much about the $1500).

I am personally not sure if I would try it on myself or even offer it for no significant expense since I have not been convinced of it’s scientific value. Anecdotal results are mostly what is out there.

I have FUT surgery scheduled in late late December. I am planning on taking propecia in Mid-November..so is this long enough to prevent shock loss. I do not want to go through this shock loss that others have reported.

The longer the better, but 4-6 weeks should cover you. Even a shorter period will work, but taking it is critical particularly if this is your first hair transplant and you are under 30 years old. Shock loss is most common in young men and after the first hair transplant. Stay on the medications until all of the results are achieved and then consider staying on the drug for life. Talk with your doctor about this.

I started to lose your hair this July. About that time I also went on hormones, DHEA, and antibiotics. Could these medications have caused my hair loss. I recently stopped taking these medications and think that the loss may have slowed and some reversal may be going on. Is this possible

I believe that considering the short period of use and the known relationships between DHEA and hair loss, it is reasonable to expect that the hair loss you had might be related to the medication. You think that the hair loss is reversing upon stopping the medication so it is reasonable to expect that your progress will continue. You need to determine the status of your hair in and around your head, get the hair and scalp mapped out for miniaturization and hair bulk with the HAIRCHECK instrument. From changes in hair thickness (in bulk) you will know where you are going with your hair loss and if it has stabilized. Good hair transplant doctors’ offices will do these test for you.

I just met with a Asian man with very low density, even for an Asian. He was considering the different harvesting techniques FUE vs strip surgery. He met with other doctors who represented that they could transplant 4000-5000 grafts in a single strip session and 3000 FUEs in a single FUE session. This poor man was confused when I suggested that his yield would be less than 2000 grafts with a strip surgery.

There is a great deal of hype on the Internet that people need to have a single large session of 6,000 grafts to get coverage and that is preferable to 3000 grafts in each of two sessions. I would agree if I did not know better. First let me state my qualifications for what I am about to say. I was the first doctor in the world to do 2000 grafts, then 3000 grafts than 4000 grafts in a single session back in 1992-4 and I have been doing larger sessions longer than anyone in the world starting back in 1992. I was using follicular units in large sessions before most of the doctors heard of the follicular unit, let alone the megasession. That would make me an expert on the subject of large sessions hair transplants and I doubt that anyone would challenge my expertise (see references below from prior to 1995). Add to that the fact that I practically invented the large session of small grafts. You may not know my training in surgery, but I am a board certified general surgeon who did everything from war surgery (in the Vietnam war) to extensive trauma, vascular and cancer surgery. That would make me more than qualified to perform a large session harvesting technique for modern hair transplantation.

Of course, if I could harvest 6000 grafts in a single session safely, I would do it more often. I have always had the supportive staff to carry out this type of surgery. But as safety is my guide in all circumstances, my judgments tell me often that taking out a strip which would yield 12,000 hairs (6,000 grafts) is often dangerous and would put the patient at risk to develop some complication. Please note that I clarified that a 6,000 graft harvest should yield about 12,000 hairs, so if a 6,000 graft harvest yielded substantially less than 12,000 hairs, then I might start thinking that smaller grafts were produced by sub-dividing follicular units which is a sin in my ‘ethical’ book. What makes it a sin is that as the fees are directly related to graft counts, sub-dividing follicular units as a routine accomplish two things (1) it raises the surgeon’s fee, and (2) they damage follicular units which tends to produce decreased hair survival.

A hair is not a hair. Fine hair has low bulk and when someone states that they can completely cover a bald man’s head with 6,000 fine hair grafts referencing a ‘gorilla’ result, they are just plain lying. Dr. Feelgood may market his god-like qualities, but Dr. Feelgood just ‘ain’t’ god.

I get rattled when someone tells me through the various internet forums that I should have given someone 6,000 grafts to manage his bald head and that if it was done by Dr. Feelgood, everyone knows that Dr. Feelgood always achieves high graft counts (no mention of the hair count of course). I would ask two questions, (1) what are the hair counts in such large sessions as a matter of routine, and (2) what do the donor wounds look like as a matter of routine. I know more than most what is possible and what is safe, and I know what is not. I use my judgment to ascertain safety and I really don’t believe for one minute that Dr. Feelgood would get 6,000 grafts (12,000 hairs) when I could only get 3,000 grafts (6,000 hairs), never, never, never. If a graft count in the 5000-6000 range is possible, I do them with the agreement of my patient.

The forum chat ‘folks’ who are not knowledgeable about the subtleties of a safe strip harvest and who believe in the marketing hype of some of the internet doctors can talk from their ‘armchair’ all they want. Either my patients are not typical and have tighter scalps and lower densities than Dr. Feelgood’s patients, or some of the doctors who claim these high numbers routinely are either lying to push up the numbers and claim a ‘mighty’ superman deed rewarded (of course) by making more money, or I am a monkey’s uncle.

Published References from prior to 1995 when almost every hair transplant doctor in the field was doing small sessions of large plugs:
# Rassman, W.R.; Bernstein, R.M. One of our greatest problems – lowballing! Hair Transplant Forum. 2(6); 1992.
# Rassman, W.R.; Pomerantz, M.A. The Art and Science of Minigrafting. International Journal of Aesthetic and Restorative Surgery. 1(1): 27-36; 1993.
# Rassman, W.R. A buyers guide to hair transplantation. Los Angeles, CA: NHI; 1993.
# Rassman, W.R. The minigrafts’ revolution, can we keep up ethically? Publication Journal of Cosmetic Surgery.
# Rassman, W.R. Everything you wanted to know about hair transplantation but were afraid to ask. Los Angeles, CA: NHI; 1993.
# Rassman, W.R. The fast track option: a common sense approach to hair transplantation. Los Angeles, CA: NHI; 1994.
# Rassman, W.R. Megasessions: Dense Packing. Hair Transplant Forum 4(3); 1994
# Rassman, W.R Concern about quality. Hair Transplant Forum 4(4); 1994
# Bernstein, R.M.; Rassman, W.R.; Szaniawski, W.; Halperin, A. Follicular transplantation. International Journal of Aesthetic and Restorative Surgery. 3:119-32; 1995.
# Rassman, W.R.; Carson, S. Micrografting in extensive quantities, the ideal hair restoration procedure. Publication to Journal of Dermatology, Surgery and Oncology, 1995
# Rassman, W.R. Follicular Unit Transplantation Megassessions, Hair Transplant Forum Intl. 5(5); 1995

I would like you to write a how to-guide on the topic “MINIATURIZATION”. I have a tool to zoom in on my scalp and hair. I was hoping to self-diagnose my miniaturization but I have no clue how to do it or what to look for. Please help!

Clip your hair to a pea size spot in different areas of your head:

1. frontal area in midline
2. corners – one inch behind both
3. top of the head (area determined by a line from between the ears)
4. the crown area (where the swirl is) including one inch in front of the swirl and one inch behind the swirl
5. to the sides of the head about 1-2 inches from the midline

Using a video microscope, count the total hair population in the visual field no matter what the shaft thickness of the hair. That number will give you a density of the hair, particularly if you can measure the size of the visual field.

For a miniaturization map of the area, count the hair shafts that have a smaller diameter than the large hair shafts.

Use this formula:

Miniaturization Factor = small hair shafts÷total hair shafts

The mapping is done by recording the miniaturization factor for each area of hair you cut.

The projection for balding in the future will be determined by the area where miniaturization exceeds 20 percent (there are about 20 percent normal vellus hairs that look just like miniaturized hairs but are not). Miniaturized hairs have arrows pointing to them in the middle picture. Click to enlarge.

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I am a medical student and was wondering how finasteride works to give people a fuller appearance of hair.

In the Journal of the American Academy of Dermatology July 2006, Volume 55, Dr. Vera Price summarized the action of finasteride as follows:

“Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs, such as increased growth rate (length) and thickness of hairs, contribute to the beneficial effects of finasteride in treated men.”

This is important, because what she implies is that the miniaturized hairs reverse. That is why it is so important to map out the scalp for miniaturization and to perform bulk measurements with the HAIRCHECK instrument. These two approaches used prior to starting finasteride (Propecia) gives us a baseline metric to determine the value of the treatment. I have seen people with miniaturization in the 80% range, reduce substantially to almost normal levels (under 20%). This is why everyone taking finasteride should be evaluated prior to starting the treatment by a doctor who understands this process clearly.

I started using Minoxidil 5% twice a day. I didn’t experience any side effects, so a year later, I substituted the 5% Minoxidil with 12.5% at night. I still didn’t feel any side effects. I switched to Xandrox 5% (minoxidil with azaelic acid) last December since I have PCOS and it was recommended to help stop the miniaturization of my hair. Within a couple of weeks (maybe even a week), I experienced heart palpitations. Is it possible that people can become hypersensitive to Minoxidil after a period of time (for me, 2 years)? Or could it be coincidental and related to something else?

Thanks

I have never recommend 12.5% topical minoxidil, as it can have serious systemic side effects (just as you described). More importantly, heart palpitations can be a harbinger to a serious and life threatening condition. I strongly recommend that you follow up with a physician for an examination. Minoxidil can cause a drop in blood pressure in a limited number of people.

I had a hair transplant 3 weeks ago and the scabs are still present. I can not take off my hat. As an executive of a large company, I took off the first 2 weeks, and had to go to work with a baseball hat on. Having a hair transplant was a terrible decision. Whey don’t you guys tell people like me what to expect? I think you can tell that I am angry as hell.

I am certain that we did not do your hair transplant as our patients are devoid of any major scabs after about a week if washed twice a day. More importantly we make every effort to educate our patients of what to expect.

In fact, my wife (Mrs. Rassman) had a hair transplant in the frontal hairline just a few weeks ago, and the transplant was barely detectable by the first day after surgery. The key to keeping a hair transplant less noticeable is to have a washing program that keeps the scabs off. Most of our patients leave the operating room without much evidence of the surgery because we wash the scalp very thoroughly before leaving the operating room. We have the patient usually come back the next day and we wash their hair ourselves and instruct the patient in the washing process. The old adage that cleanliness is close to godliness, applies here in the post operative care of a hair transplant. Your doctor should have explained this to you.

I’m 28 years old. I got a hair transplant done in November 2013. After the transplant, I lost some hair and seemed to be more hair loss in the first three months. Now that i’m approaching my one year period soon, why is it that the amount of hair that was planted has not grown? I was expected a least twice of what i see. When i comb myself i still look like someone who is losing is hair, and i hate it, especially when i go under a light or out in the sun. What is your suggestion to my situation.

Setting expectations is as much the ‘art’ of what I do as doing the surgery. That is why I have open house events every month, so that people who are going to have surgery can see and meet someone with a similar balding pattern and hair color and ask them about their experience. It is possible that you lost a considerable amount of hair from the hair transplant surgery and the transplants actually grew but because of your shock hair loss, the net gains was zero (worst case). If you were on the drug Propecia (finasteride) it may have helped but that is hard to tell.

If the hair did not grow, then the question should be ‘what went wrong?’. Maybe it did grow but your expectation was unrealistic and the communication between you and your doctor may have been an issue. You can always get a second opinion, but first, ask the doctor who did it and find out if your doctor’s expectations were met and ask him/her to examine you for the results of the hair transplant.