Dr. William Rassman – Page 1190

May 6, 2010

Finite Number of Hair Cycles? – Hair Loss Information – Balding Blog

Dr. Rassman,
Thanks for an amazing blog. I check it daily for updates. I wish I could fly to the US for a consultation one day, but it’s far away from Australia.

I have seen in a number of blog entries that you refer to hair going through a finite set of cycles (one cycle being Anagen, Catagen, Telogen). Is this based on research and/or from experience? Does all hair have a limit or does it not apply to the donor area?

Kind regards

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The anagen, catagen, and telogen phases are the well known life cycle of any hair. I think it is even taught in high school biology. For human scalp hair, the anagen (growth) cycle can last several years. This is followed by the resting phase (catagen/telogen), lasting several weeks to months. The length of time of the anagen cycle widely varies in people, but it is estimated to be anywhere from 2 to 8 years. If you take 3 years to be an “arbitrary” average, you can calculate your lifetime of cycles. If you have genetic balding or other hair loss conditions, the cycle of hair is obviously shortened (see apoptosis). The hair cycles apply to all hairs, but the pre-programmed genetic life of certain hair is variable. You really do not need research to see this… just look at all the bald men out there!

Now, I am not sure if I have completely answered your question, as I believe there may be some misunderstanding. For men most of the hair on the back of the scalp is considered “permanent” hair which will cycle and live on (see the Norwood 7 diagram at right). The hair you see in that diagram is considered the donor hair and this is a basis of hair transplant surgery for men. The research and experience you are asking about is evident on thousands of men who have had hair transplant surgeries. For example, see the hundreds of examples posted on our site showing patients we have performed surgery on over the last 18 years — the transplanted hair is still growing and cycling. Now the aesthetics and the natural appearance is what is highly variable, depending on who performed the surgery.

May 6, 2010

Hair Loss InformationHelp with Craniotomy Scar? – Hair Loss Information – Balding Blog

Hi there,

I’m hoping I can get some guidance on craniotomy scar issue I am having. I am a 27 year old male, and about 6 months ago I had a craniotomy for the removal of a benign tumor which was discovered shortly before the procedure. The surgery went well and all is good now health wise. However, I now have a 6″ long scar that is about 5/16″ wide in the back of my head.

I would now like to address how I can improve the aesthetics of the scar, as I prefer to keep my hair short. The good news is with longer hair (shown in the photo), I am able to cover the scar, but I’d really like to wear my hair shorter. I have visited 2 cranial plastic surgeons and one hair doc in the Bay Area, California. Here is summary of their recommendations on how to improve the scar:

– UCSF plastic suregon: Scar Revision and change scar to a zig zag shape.
– Stanford plastic surgeon: Standard Scar Revision. Advised against doing a zig zag as it would change hair growth directions and “make it look weird”.
– Hair Doc: Standard Scar revision and possibly hair transplant on scar if scar needs additional improvement.

Is it true that changing the scar to a zig zag shape would change the hair directional growth? If that is the case, why would the UCSF surgeon recommend that? Do any of you have any recommendations on the best way to improve aesthetics of the scar? My end goal is to not get rid of the scar completely, but to at least improve the aesthetics of it. I’d appreciate some feedback!

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I really cannot give you good, personal medical advice via the internet, so I’d suggest if you’re interested you can see us at our office in San Jose or Los Angeles (the consultation is free). We have transplanted hair into craniotomy scars with very good success. Many of these patients have had scar revisions that failed to resolve the cosmetic issues. You may need more than one transplant depending on the case, the size of the scar, and the location of the scar. Dr. Pak recently performed a FUE/FOX transplant into a craniotomy scar where a zig zag attempt was made. Sometimes a zig zag revision can make the scar worse.

Ask your surgeons for examples with before and after photos. Maybe it will help disguise the scar, but it’s still a scar nevertheless. Hair transplants to the scar does not mean the scar will be removed, but at least there is hair growing “ON” the scar and if there is enough hair in the proper direction, the scar will not easily be seen.

May 6, 2010

Taking Avodart Bi-Weekly To Avoid Propecia-Like Side Effects? – Hair Loss Information by Dr. William Rassman

Dr. Rassman:

Prior to reading this, thank you for your time. Your insight and knowledge is of great appreciation.

My situation is as follows:

I started propecia, was on it for a month, then underwent a HT of 1,900 grafts mainly in the front hairline. I continued to use propecia for 2 more months and began to experience some serious sexual side effects. I stuck it out for another 3 weeks however the side effects continued so I stopped the propecia. The sad part is that the propecia began to halt my hairloss however I could not deal with the sexual side effects.

Sadly my hair is shedding. After another apt with my hair restoration doctor, he suggested I take Avodart 0.5mg twice/week. He had mentioned that some of his patients who were having side effects from Propecia took the Avodart bi-weekly, (due to the drugs long half life) and were able to halt hairloss but did not experience the side effects which I was experiencing from my daily 1mg Propecia regiment. I have read all of your posts in regards to Avodart and I understand that it is not FDA approved nor do you prescribe it to your patients.

My main question to you and issue at hand:

I know that when people start taking Avodart they experience a shedding phase which generally kicks in after the first month or two of starting the drug and can last a few months there after. My first question – If I am only taking the drug twice a week and have only been off of propecia for 4 weeks will I also experience a shedding phase? I am confident that the shedding phase is the transition to a greater good…as the weaker hairs fall out months later they are replaced by stronger, new hairs. My problem is that I am in the entertainment industry and will be starting a one month taping of a TV series from June 30th-July 30th. I would like to have as much hair as possible by that time so would I be better off waiting to take the Avodart after the taping is complete, or should I start now and hope that the avodart will not cause a drastic shedding phase and help me stabilize the hair that I currently have? I guess this really comes down to a game of timing.

It will be 5 months since my HT when the taping starts in June so I am hoping that the transplanted hair will already be popping up. Also, most of the hair that I am losing is from the front hairline and temples. The crown seems to be doing ok.

Thanks again for your time and I would also be interested in undergoing a transplant with your team following the taping.

I really do not have a clear answer to your situation. In general, Propecia or Avodart will not be as effective on your front and temple areas. They each work best on the top/crown areas of your scalp. I do not know if you will have more or less shedding as everyone has different results, different side effects, etc. Shedding isn’t seen by all men that start the medication. Really, only time will tell and there is no clear way to predict this.

It would be interesting to know if Avodart did indeed change your sexual side effect issues, as I would expect that it would not make it better. There’s not enough reported about Avodart dosing in the treatment of hair loss for me to suggest that bi-weekly pills are the way to go.

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May 5, 2010

I Pull Out My Hair and My Doctor Recommended Propecia – Hair Loss Information by Dr. William Rassman

hello doctor,
my hair is thin and i dont know if all the hair that falls out is because of the telogen stage. my family has no balding but my hair getting thinner and always falling out. i keep on pulling it out all the time and i am always stressed about it so i am all day pulling and freaking out. i went to a doc but she recommend me propecia right away. i dont know if i wanna be on a medication. what should i do? thanks!

Did you tell your doctor about your hair pulling before the Propecia was recommended? Propecia might help if you are a man with genetic hair loss, but it won’t stop you from pulling the hair out.

It sounds like what you’ve got is an obsessive compulsive disorder called trichotillomania. I’m not an expert on OCD, but a good place to learn more and seek treatment help is at the Trichotillomania Learning Center.

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May 5, 2010

My Doctor Wants to Give Me Steroid Injections for My Female Hair Loss! – Balding Blog

Hello, im hoping you could kindly help me please? Ive been suffering hair thinning and balding patches for the last two to three years, gradually becoming worse, i have naturally long dark curly hair. I have had been given all sorts of treatments to try and im under the care of a Trichologist and a Dermatologist, ive finished my Minoxodil 4% as the 2% wasnt strong enough, but unfortunately it has not worked, so i went back today to see the consultant dermatologist and he told me he would like to try the steroid injections into the scalp, but i would like to have hair transplant as it is affecting my confidence and feel ugly and constantly compare myself to other women.

Im 28 years old, female, and studying to become a doctor, so i just put the hairloss down to stress but its been over to years now and its worse, please help! Is my doctor correct in trying the injections? he said the transplant would not work. my hairloss and thinning is on my temple area and around the size of the bottom of a mug (cup) and hair thinning on my roots. Thank you for your help.

You need a real diagnosis, and I really can’t help you without that. There is no definitive medical solution for genetic hair loss in women in most instances. You are wasting money by seeing all these specialists and you may end up worse off after these invasive procedures that may not work. Steroids have never been proven to work for genetic female hair loss, but do work for particular diseases like alopecia areata. Plus, steroid injections to the scalp often cause hair loss.

As you say you are studying to be a physician, empower yourself by educating yourself on women’s hair loss issues and treatment. Hair loss in women can be from a variety of reasons, some of which are listed here. As for hair transplants, many women just are not candidates, but I couldn’t specifically say whether you are or not as I’ve never examined your loss.

May 5, 2010

My Young Children Aren’t Growing Hair! – Balding Blog

Yes i have two daughters ages 2, and 3. when they were born they had hair. as my oldest got a few months old all her hair was gone. both of my daughters have very light almost white peach fuzz as i call it. it isnt even half an inch long. i have consulted thier doctors and they have never seen it. i dont know what to do. i just found out im pregnant again and i would like to find out what condition my daughters have so i can correct it. At least know what is causing it so i can become more educated in the matter. My oldest realizes there is something different about her and even asks mommy why dont i have hair like you, as a mother this is breaking my heart. Please help!

This sounds like a genetic disorder. I would want to know about your family and the father’s family history. Has this type of lack of hair been seen before in either side of the family? I really can’t help you much more through the internet without taking a careful history where, I suspect, you will find what is wrong.

A pediatric dermatologist would be the best place to visit first. There’s a group that focuses on pediatric dermatology, and they have a physician locator that might help point you in the right direction.

May 4, 2010

FUE Megasessions? – Hair Loss Information – Balding Blog

if this is answered in your blogs forgive me and just send a link. i am clear i want a ht. i have done much research and am still meeting with docs. i can do in thailand, uk, usa. my one reservation has been the scarring and after effect, plus temporary nerve damage on the head. after realising FUE could be done in a megasession i feel this is it for me, (told i need 3-4000 hairs/grafts). as i research so many are careful, sceptical of it. i have come across you (dr. Rassman) and dr. cole. i understand a skilled physician is necessary. will FUE of 3-4000 grafts megasession handle it for me (norwood 3v to a 4)? do you recommend it more than strip or not? is it a very viable option? with dr. cole or you? thank you.

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A skilled physician is necessary for any surgery you have, and one that specializes in the cosmetic surgery you’re looking into is absolutely something I’d recommend. If you’re asking me whether you should go to me for your hair transplant or go to another surgeon, well, I think the answer would be pretty obvious. However, I cannot recommend surgery options for you at this point, as I have not examined you or know of your medical history. Everyone is different and all surgery has its risks and benefits (FUE vs strip, etc).

What I can tell you is that I have never performed a 3000 to 4000 graft follicular unit extraction (FUE) procedure in one session. I think I can say this with some authority, as I was the one who introduced the FUE technique to the international community in 2002, but an FUE procedure of that size will likely lead to a higher transection rate due to physician fatigue.

I realize it has been 8 years since the technique was introduced and other physicians have performed and tried to perfect the technique, but there are factors that the general public do not know of in such surgery. To the general public, FUE sounds slick and the best of all worlds (you get hair with minimal scarring). But there are some thing you need to look out for. Please read about these in my post from a few years back — What Doctors Don’t Want You to Know About FUE.

May 4, 2010

I Want to Move Every Hair from the Back and Sides to the Top! – Hair Loss Information – Balding Blog

Hi…I was wondering if this was possible. Say I wanted all my hairs on the back and side of my head to be transplanted to the top of my head. Not just the 9 thousand graphs or whatever donor supply most people have, but all your permanent hair on the back and sides, would you be willing to do this? Then the hairs on back and the side can be tattooed to look like a hair buzzed with a 0 clipper and the top can be clipped to a one or two.

What do you think of this?

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Kid N Play I love the creativity of some of you that write in. You’re wanting to move every hair from the donor area (sides and back of the head) up to the top of your head and then tattoo hair all along the formerly-hairy donor area? That just isn’t possible. It sounds like you’re looking for one of those hairstyles that was popular in the late 80s or early 90s…

To move every single hair from your donor to the top of your head would create tremendous scarring. And if it was possible, I wouldn’t want to perform this procedure anyway, because even if you are enthusiastic about the results today, you will likely regret it tomorrow.

May 4, 2010

How Bad Could the Hair Loss Be After Stopping Propecia? – Hair Loss Information – Balding Blog

Hello Dr.,
Thank you for answering all questions and thank you for this blog.

You have mentioned that catch up hair loss could be very dramatic after stopping propecia. Do you have any examples that you can provide us? (i.e a NW 2 going to a NW6).

Thank you

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Let’s say you now show a Norwood Class 3A pattern and have been on finasteride for 10 years. Upon stopping the medication your hair could remain the same… or you could begin to show progress to a Norwood Class 5, 6, or even a 7. The catching up of the hair loss just means you’ll go to the pattern you would’ve been had you never taken the medication in the first place. So what you are asking is a look into your future, but you’ll need to see an experienced gypsy for that.

May 4, 2010

In the News – Prostate Cancer Vaccine is FDA Approved – Hair Loss Information – Balding Blog

Snippet from the article:

A vaccine treatment for prostate cancer has become the first therapy of its kind to win approval for use in U.S. patients.

The U.S. Food and Drug Administration approved Provenge, a novel technique for fighting prostate cancer, on Thursday. The treatment involves taking a patient’s own white blood cells and using a drug that trains them to more actively attack cancer cells.

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Read the full article — ‘Landmark’ cancer vaccine gets FDA approval