Month: January 2023

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Dr Cole’s Body Hair Transplant Instrument

Dear Dr. Rassman,
I am interested in body hair transplantation. Dr. John Cole does this procedure using special instruments he invented that have improved the results of BHT somewhat. What is your opinion of this procedure and how well do you think it works?

Body hair transplantation is still considered experimental in my opinion. Furthermore, body hair does not have the same growth cycle as scalp hair and most of the body hair is dormant (not growing). Thus, the success or growth of a body hair transplant is highly variable and rarely will more than 50% of the body hair be growing at any one time. Body hair also has a finite length of growth and a different texture than scalp hair. These factors make body hair transplants somewhat controversial. With respect to the instruments, there are many doctors who invent specialized instruments for their practice. I do not know enough of Dr. Cole’s particular instrument to comment on its efficacy other than to quote Shakespeare, “There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy.” — From Hamlet (I, v, 166-167).

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Dr Bernstein’s Comments About SMP

Snippet from the article:

For readers that are not familiar with it, Scalp Micropigmentation (SMP) is a permanent cosmetic tattoo that mimics the very short hairs of a closely shaved scalp. I think that Scalp Micropigmentation (SMP) is a useful new adjunct to hair transplantation with interesting potential and I am pleased to see that doctors in our field, particularly Dr William Rassman and Dr. Jae Pak, are spearheading the development of expertise in the technique and promoting the technology to make it more widely available to patients.

One of the things that was apparent from their presentation at the ISHRS is that SMP is an “art” and that proper technique is extremely important in getting an aesthetically satisfactory result. This includes: the angle that the instrument is inserted, depth control, the amount of pigmented deposited, and color match – not to mention proper patient selection.

Read the rest — Scalp Micropigmentation at the 2012 ISHRS Scientific Meeting – Dr. Robert Bernstein Provides His Input

I meant to post this last month, but better late than never…

Our friends at the Hair Transplant Network posted a good bit of feedback from Dr. Robert Bernstein relating to his thoughts on SMP and our presentation at the ISHRS (International Society of Hair Restoration Surgery) Scientific Meeting, including the applications and the planning that should be considered for those that are interested in having the technique done.

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DPA vs MPB

I have a question regarding Diffuse Patterned Alopecia (DPA). My hair loss follows this diffuse pattern, with no loss on sides and back. I was wondering is the success rate for DUA treatment with propecia the same as typical norwood pattern hair loss? Also does DPA typically progress more rapidly than norwood patterns?

If the sides and back are not miniaturized, then you may have a form of MPB, which in young men responds usually very well to Propecia (finasteride). Diffuse unpatterned alopecia (DUPA) usually does not respond to finasteride, but a rare few cases I have seen have gone against the grain and responded to lessen the amount of miniaturization, although some of it did remain. DUPA is essentially not treatable and we really do not understand what is happening in those who have it.

On the other hand, with diffuse patterned alopecia (DPA), this is a form of male patterned balding that is genetic and can be effectively treated with finasteride. The presentation is more generalized in the pattern of balding and rather than lose hair from the front to the back in a progressive manner, the hair loss is subtle and generalized, but ends up at the same point as if it were classic patterned balding.

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Double Follicular Unit Grafts (DFU)

Why don’t you offer double follicular unit grafts (DFU)?

Double follicular units (DFUs) are 3-4 haired grafts that have a slight gap containing skin between the hair follicular units (the natural growing anatomical units). Some people claim that if they use them, they can get more density per square cm and that the advantage is that more density can be created with fewer incisions… which means less grafts/cost to the patient.

DFUs are essentially the old type of minigrafts and the problem with them is not only a slightly pluggy look (for those people with dark hair and white skin), but also that there is skin transplanted with the follicles. This skin becomes depigmented and forms a whitish plaque on the scalp on close inspection, particularly noticed if you have a tan or olive skin. So while it is true that this can provide more density at less financial cost, the price is in a lesser quality transplant. The older large plugs had the highest densities, so if one takes the logic that DFUs are less expensive than follicular units and are the way to go, you can also look like you have doll’s hair for about a tenth of the cost of a fdu. You get what you pay for; do not lose sight of the fact that this is a surgical procedure on your head.

So to answer your question about why we don’t offer DFU, to be blunt, it’s because we don’t offer grafts that can be detected as a hair transplant, even on close inspection. The question should be, would I do it if someone specifically asked me to do it, to which my answer would be that I would consider it if there was complete informed consent present at the time the decision was made.


2008-03-14 14:02:06Double Follicular Unit Grafts (DFU)

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Dot Scarring from a Large FUE Procedure (with Photo)

I (Dr. Rassman) have had a total of 2200 grafts in three strip surgeries over the past 20 years, the last one being 6 months ago. If you were to look at my single linear scar, most people (even with a comb in their hand looking for it) can’t locate it. My strip scar is certainly far less significant than the mottled scars from follicular unit extraction (FUE) in this patient below. To be fair, if the patient had let his hair grow slightly longer, the scars would be less visible.

This is not my FUE patient, but I was told that he had 2500 grafts extracted in one session four years ago (and saw extremely poor growth). FUE scars like these are very common, and as most people get FUE procedures because they want the option of cutting their hair very short without a linear scar, many of them can’t do so when these dot scars are so detectable. Click the photo to enlarge:

 

I grant that some patients will have visible scarring from a traditional strip procedure, but now with Scalp Micropigmentation (SMP) the linear scars can be made undetectable. The same treatment can make these ugly FUE scars undetectable.

My point for this post is that scarring occurs with all types of surgery. Scarring should not be the motivator for the choice of FUE over strip surgery. Considering the cost differential between strip and FUE surgery, this is just part of the calculation each person must do in making the decision between strip and FUE surgeries.

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Dostinex (Cabergoline) and Propecia

Dear Dr. Rassman,

I’m a 28 year old male. About 6 months ago I was diagnosed with a rare pituitary condition called hyperprolactinemia. This disorder is genetic in my family, and mine is a very mild case. The treatment is a single half-dose of cabergoline (marketing name Dostinex) taken once a week.

Male pattern baldness also runs in my family and I’m starting to show thinning on the crown of my head. My dermatologist suggested I try the propecia/rogaine route. Since propecia affects the endocrine system I am a bit reluctant to take it without knowing more about possible side effects or interaction with the cabergoline. I don’t think it should and my dermatologist said she wasn’t aware of anything and I haven’t found anything about it on the web, but I wanted to get another opinion before I started propecia. I also read online that minoxidil from rogaine may have a side effect of increasing prolactin – the condition I have too much of. Do you know of any cases like this? If so, should I reconsider starting propecia, rogaine, or both?

Thanks!

At this point, it is very difficult to accurately assess the cause of your thinning hair. As far as I know, cabergoline does not have hair loss listed as a potential side effect, however, this does not mean that this drug can not cause this in you. Also, certain diseases / stresses to the body have also been known to cause hair loss. Lastly, as you have mentioned, male pattern baldness could be the cause of your thinning hair. You definitely need a miniaturization study to determine the extent and locations of most of your hair loss (i.e. does it correspond to MPB?).

There have been reports that minoxidil may be related to the development of hyperprolactinemia, definitely something you don’t need more of (see Drugs.com – Interactions between cabergoline and Minoxidil). The main point here should be that before you start any medication, whether it be Propecia or Rogaine, you should have a coordinated discussion between your physician that is treating you for the hyperprolactinemia and your dermatologist. To answer your question though, I haven’t read about Propecia (finasteride) and cabergoline interactions, but again, please discuss this with your prescribing physician.


2008-01-15 13:12:15Dostinex (Cabergoline) and Propecia

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Dosing oral minoxidil

Is there a known correlation between patient size, weight, height and appropriate oral min dosage or does it vary regardless you think?

I am not familiar with weight or height considerations for oral minoxidil. A dosage between 1.25 and 2.5 mgs daily is the correct dose with the least potential cardiovascular side effects

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Don’t You Get Tired of Answering Questions on Propecia?

What question do you get tired of being asked the most on this forum?

I’m guessing it’s about propecia. I think you should have a Q&A page on the drug on this site.

When I first started BladingBlog, I thought the same thing. You’d be surprised how many different ways one can ask a question on Propecia and hair loss in general.
I believe we have at least 800 different questions and answers on the topic of Propecia: see HERE and HERE

You can also search for “Best of Balding Blog” on top and popular Topics on the right side of the screen.