Month: January 2023

I had lung cancer and my last chemo treatment was in July of 2012. I finished radiation in October December 2012. I had some balding prior to the Chemotherapy that you might classify as a Norwood Class 6 pattern, but there was still hair throughout the head. It was just thinning. It has been almost two years and now my hair loss pattern is very clear and all of the thinning hair has not come back. I have a few sparse hairs all over my head, but they are very sparse. I am off my medications at this time. Will my hair come back and what can I do to help it. I have used Nioxin for two years and just recently started uses minoxidil. Are there vitamins to help? Just what can I do?

I do not know how to help you. You clearly had male pattern balding that was not complete and the chemotherapy stressed your fine, miniaturized hairs and finished the balding process in them. One of our patients had used the ‘Cold Cap’ when the took Chemotherapy and lost less than half of the hair. Few doctors are aware of this treatment. At this stage, I believe that you can expect that hair regrowth will not occur. We have a treatment that may be worth looking at, called Scalp Micropigmentation (scalpmicropigmentation.com). Many patients convert from a Class 6 or 7 pattern to a full looking head of hair by taking on a shaved look. Just like the star of Breaking Bad, many men look great with the shaved look and your case does parallel the main character’s appearance. This is something to consider. Many times I ask myself if SMP was available when I started to treat my hair loss, would I have chosen this option. The answer is yes, but at my age, this is not something that I would do considering that my hair loss is gone and my hair transplants were 100% successful in addressing by large crown loss.

Dear Dr. Rassman
I’m a 54 years old male. I had a hair transplant operation on 30 June 2014 by FUT method followed by FUE method on 1st July to complete the transplantation. From the second day after operation I noticed that a big area in recipient part between crown and front of my head, the skin is so irritated (fig.1) and after 1 week it became completely black and was necrosed (fig.2).

Photos: Figure 1, Figure 2

I rang to my surgeon to consult on this issue. He said at your age this problem sometimes happens and I should wait until the skin being repaired and to speed up this procedure I should put warm towel on the necrosis area as well as making it oily by Vaseline to avoid dryness. I really don’t believe in the opinion of my doctor to relate this problem to my age, so I would highly appreciate if you let me know your opinion regarding the reason of this problem, is there any special treatment for such necrosis?

As the recovery procedure of the skin is so slow as shown in figs 3 and 4, I’m not sure that the transplanted follicles are not damaged. I thank you so much if receiving your valuable comments.

Photos: Figure 3, Figure 4

Sincerely yours

I am not clear on your history as you note a FUT (as in strip surgery) and fue (as in Follicular Unit Extraction Technique). There are some doctors who combined FUT and FUE (called FIT by one particular surgeon).

In my 23 years in this industry, we have performed hair restoration surgery in over 15,000 patients (with as many as 8 doctors working for the New Hair Institute at one time), so my experience is in the thousands of patients we have treated at NHI. Although I have never personally seen this complication in any of our patients, I have been aware of this complication in patients who have either consulted with me or I have heard about it through other doctors’ reports at medical meetings. At the recent meeting at the beginning of this month, one doctor presented 5 cases like this so your experience has been replicated at other clinics. This problem was more common in the 1993-1996 time frame, as doctors were increasing the number of grafts they were performing and not reducing the size of the punch or slit equipment. These doctors devascularized the scalp because their wound areas were too large or put too much epinephrine with the Xylocaine that negatively impacted the blood supply to the mid-scalp.

The central area of the scalp (where your problem is demonstrated) was the place where this complication has been seen most commonly, although I have seen patients referred to me where the finding was present in the donor wounds from FUT (strip) surgery. The least vascular area of the head is probably at that exact location because it reflects the end of the blood vessels that come from the side, back and front of the head. As you may know, balding produces an atrophic skin that is thin and not vascular with little infrastructure (fat) under the skin (where a normal scalp would be rich in blood supply, with many nerves per follicle, many hair follicles, considerable amounts of fat, etc..). The reason that the skin becomes atrophic in balding men is because the bald scalp does not need a rich blood supply, so the body withdraws the blood vessels in response to lack of demand. When a hair transplant is done, the demand of the new hair increases the blood supply and eventually the scalp is no longer atrophic and becomes rich in blood supply again.

I am certain that age is not an issue. Smoking may contribute to this problem. My oldest patients have been in their 80’s and we routinely operate on men in their 60s and 70s. I have done surgery on diabetics and in these people, I have not seen vascular problems either, but I often do not ‘dense pack’ these diabetic people for fear of such a complication. I personally had a hair transplant two year ago (at the age of 70) with no issue. I had an atrophic scalp resulting from 3 scalp reductions done in 1991-1992 that left my skin very, very thin and atrophic, yet I suffered no vascular effects from the transplant into my atrophic skin.

Some doctors believe that there is a risk for people who smoke, so if you are an active smoker, then this could be a contributing factor. If your surgeon used instruments that were larger than 18 gauge needles, then this could be a contributing factor. I have also seen necrosis when the doctor accidentally switched the routine medications used for anesthesia from a benign medication to a toxic medication; however, yours does not appear drug induced, because the necrosis would have been more immediate and more wide spread than your earlier pictures showed.

My educated guess is that there was a blood supply issue to the top of the scalp where blood supply is reduced in atrophic skin (something that you probably had based upon the photos you sent). How that happened is unclear. There are reports of necrosis in the donor area from FUE recently, and this is probably caused by taking the extracted hair follicles out too close to each other.

The treatment for this type of complication could be a problem. Usually, small areas of necrosis shed the dead skin and the wounds heal from the sides; however, large areas of necrosis puts you at risk for damage to the bones of the skull, so an experienced surgeon who knows of such risks should be consulted. Skin grafts may be necessary to protect the bone.

Please note that what I have stated here is NOT to be taken as a second medical opinion, but just an informational view from a well informed and experienced hair restoration surgeon. To evolve this into a formal second opinion, I would have to personally see you and examine you. If you would like a second medical opinion, please find and see a physician in person.

“Japanese cosmetic company Shiseido expects to have baldness cure on the market by 2018“

The use of this technique proposes the creation of stem cells and shows how it is done.

The FDA regulates laser devices and the inks used to remove tattoos. Some Lasers have been cleared for use in tattoo removal.

The FDA has cleared several types of lasers as light-based, prescription devices for tattoo removal. A Massachusetts company recently received FDA clearance to market its laser workstation for the removal of tattoos and benign skin lesions. Baldingblog has mentioned, in a previous post, that 21% of people who have tattoos, regret having them done. As such, this 21% of those who have tattoos, are candidates for Laser Tattoo removal. Once the ink is placed in the dermis of the skin, these inks will mostly stay in place for a person’s lifetime. Tattoos are intended to be permanent.

The laser pulses a high-intensity laser energy pulse through the epidermis targeting the pigments below the epidermis. “The laser breaks the pigment into smaller particles, which may be metabolized or excreted by the body, or transported to and stored in lymph nodes or other tissues”, says FDA’s Mehmet Kosoglu, Ph.D.. “Lighter colors such as green, red, and yellow are the hardest colors to remove, while blue and black are the easiest.”

According to the American Academy of Dermatology, the procedure requires multiple treatments (typically six to ten) depending on a tattoo’s size, colors, and depth. and requires a few weeks of healing time between procedures.

In Scalp Micropigmentation, we use darker colors and when performed correctly, keep the volume of the ink small and placed in the upper dermis. If the ink would be placed too deep in the dermis, it would not be a dot, but rather a blob. Doing this correctly requires a specialized skill that takes many months to master. Unfortunately, the poorly done tattoos on the scalp, place the inks too deeply and a large volume is often used, making it more difficult to remove them. This material is summarized from an article which appears in the FDA’s Consumer Updates, January 30, 2013

Can I Swim After I Have SMP?

You have to wait about 3 days before you go swimming (ocean, lake); however, if there is chlorine in the water (typical swimming pool) you should wait at least 30 days to be sure there is no connection between the pigment and the water. When SMP is properly done, the pigment settles below the epidermis within 30 days, so the chlorine from the swimming pool can not reach the pigment. Chlorine can bleach the pigment and change its color. Ocean or lake water should be fine.

Dr.Rassman, I’m thinking of trying Propecia. In your medical opinion can taking it long term also decrease total testosterone and bioavialble testosterone? I’m worried about it causing problems to my endocrine system.

Propecia is used by millions of men everyday and there does not appear to be any issues with their endocrine system. Testosterone levels often rise when a person is on Propecia.

Repeat From Archive

We have been getting a great number of questions about hairline hair loss. Basically the questions relate to the slow appearance of the mature male hairline. The pictures in this post show a young man in transition between his juvenile hairline and his mature hairline. Note that the corners are moving up and that there is some thinning of the leading edge of the hairline. What you see here is not balding, just maturing the hairline.

Please note that we do not generally diagnose hair line questions. However due to the increasing daily emails with photos of young men concerned about their hair line, we will soon be rolling out a new website where you can submit your photos and have others rate the hair loss. Stay tuned!

Hey doc, there is a new hair laser on the market. What do you think?

This space age design and the small case “i” in-front of the name does not add value. The FDA clearance means that it is safe. I really do not understand the FDA as effectiveness has not been proven in the one example mentioned in the article. I have not seen any definitive clinical research that proves that these lasers have any value at regrowing hair. Even the recent article in the Dermatology journal stated “further study is needed”.

Since we invented the FUE (Follicular Unit Extraction’s first scientific paper written in 2002 by Rassman, et. al.), the use of this technique has become more prevalent at each and every year’s convention. What is impressive, is the inroads many physicians have made using this technology in their practice. In 2011, the Artas® Robot was introduced into the hair transplant community and as of this date, 100 robots have been purchased by doctors from around the world. The FUE procedure has become more and more popular by patients wanting a hair transplant. Although we believe that the Strip graft procedure (Follicular unit transplantation) produces better grafts, the public seems to demand more and more FUE procedures and I would’s be surprised that the FUE might reflect between 30-40% of all hair transplant procedure across the world. For the new physician learning about hair transplantation, FUE requires less staff and when it is combined with the commercial ‘hair implanters’, the skills to produce quality work throughout the world seems to be a goal more easily achieved than with the traditional FUT (strip) procedure. There are three elements of the FUE that must be mastered, (1) the actual coring of the grafts from the back of the head with enough skill not to damage or transect these grafts while coring and removing them, and (2) the implantation process itself (carried out with the commercial ‘implanters’ or manual techniques like we use at the New Hair Institute, and (3) the many nuances for quality control that allows the grafts to survive the surgical procedure (drying of the grafts or damage to the grafts on handling and implantation).

One group of Indian doctors showed long hair FUE, just like we do. The ability to do this impressed us, as few doctors I am aware of, have developed the skills for this technique.

I was very impressed with the skills developed in various Asian countries (e.g. India, Thailand, China) where considerable numbers of patients with substandard work was performed in the past. Many videos were presented that showed that the skills for #1 and #2 were comparable to what we are doing at NHI. That was a pleasant surprise. Few of those doctors from third world countries could afford the high price of the Robot (more than $250.000) so the manual skills were essential to develop. I actually viewed more videos this year from India than any previous year.

On the negative side, complications of FUE abound with significant scarring in the donor area, far worse than I have seen before. Infections of the FUE donor area seemed more common than in my experience (where it is rare), and folliculitis of both FUE donor and recipient sites were reported as not uncommon. Clearly, there is more present in these surgeries than ‘meets the eye’ through the video offerings. Doctors clearly will show their best work for the videos. Time will tell just how well these cases turn out. Despite this statement, I believe that FUE will become more and more popular world-wide. We have already seen a significant growth in the FUEs in Europe as fewer and fewer doctors entering the business adopt the Strip technique.

Some doctors are combining both FUE and Strip surgery to increase the donor yield for a hair transplant. This makes sense if the doctors and their teams are skilled in both techniques, but it does push the envelope. I welcome comments from our readership.