Author: Dr. William Rassman

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Was My Hair Transplant Scar Too High? – Hair Loss Information – Balding Blog

Dr. Rassman,

Thank you for your informative blog. I wanted to ask two questions. I had a hair transplant recently with a well-recommended surgeon. Two things concern me. First, the scar feels awfully high. It’s right above the ridge at the back of the skull. Second, one side has grown in much faster than the other. The surgeon said asymmetrical growth was normal, but I’m not sure.

Thanks for your feedback.

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NW7The location of the incision should be within 1/2 cm above the notch on the back of the skull in the midline and then if it needs to be longer, taken to about 1 inch above the ears. The permanent fringe area is seen in the Norwood class 7 patient (see diagram) and measures 2 1/2 inches high. If the surgeon takes the strip above this 2 1/2 inch point in the midline, it would not reflect the permanent hair.

As for the asymmetrical growth, I don’t know how long it has been since your transplant, but give it some time and it should even out.

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Dry and Flaky Skin After Starting Rogaine – Hair Loss Information – Balding Blog

I’ve been on finasteride for about 4-5 years now. In addition to that, my doctor recently told me to start using the liquid Rogaine drops once a day. (I have frontal balding/thinning & am 29 years old.) I started with Rogaine a few weeks ago. Almost immediately I started noticing dry, flaky skin in that area of my hair. It doesn’t really resemble dandruff (which I’ve never had) so much as the kind of skin that sheds after a sunburn heals.

Is this normal? How long do you think this will last? (I am experiencing no other side effects so far.)

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Known side effects of minoxidil (Rogaine) include itching, redness, dryness, and scalp flaking, so what you are reporting is not out of the ordinary. It may last for as long as you use it. It is sometimes dose related, but I’m not sure what strength you’re using (common is 2% or 5%). If you’re using the 5%, you may be able to tolerate the 2% better.

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Hair Loss InformationRecommending Finasteride Despite Web Forum Outrage – Hair Loss Information – Balding Blog

Good day Dr. Rassman,
I´ve read many of your posts considering Finasteride as generally safe treatment and that IF side effects occur they are withdrawn by discontinuing the drug. So, you imply that any problems caused by Fin are not permanent.

After browsing through propeciahelp.com and reading literally thousands of very sad stories, I must blame you for not mentioning some very important informations, including prevalent loss of libido, impotency, brain fog, muscle atrophy and many other serious complications which exist many years after taking the last dose, and it is not known if they will ever subside. Why are you so very keen on recommending Fin despite these facts?

To say it bluntly, do you sacrifice one man´s balls, muscles and brain so another 99 can have their hair?

Have you already forgotten your Hippocratic Oath?

your reader

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OathI’ve written about this issue many times before on BaldingBlog (some examples are here, here, and here). There are no peer-reviewed, published studies to back up what you’re claiming, and anonymous people on internet message boards just don’t cut it. Anyone can go on and complain about issues they have that might be real, but unrelated to the use of the medication. Don’t get me wrong, forums can be a great place to discuss things (I have my own hair loss forum), but you need to take the information you gather from anonymous people with a grain of salt. If some random guy you’ve never met just walked up to you on the street and screamed that Coca-Cola was made out of cabbage, you’d just dismiss him as crazy… but if someone posted it in an online forum, you might give it some consideration (or research it further). I wonder why that is, but I hope you get my point. The claims of permanent side effects are unproven and seem to be popular amongst forum posters that look to point the finger without basis or just folks trying to steer you to another product that they just happen to be selling.

I’m keen on recommending the medication because I’ve seen it work. Make no mistake, I don’t downplay side effect risks… but the truth is, those risks are quite low and reversible in every case I’ve seen. It’s also important to remember that while I do recommend finasteride for treating hair loss, it is ultimately up to the patient and his prescribing physician to decide if it is the right course of action. To sum it all up, nobody is forced to take this medication (it is elective — hair loss isn’t a death sentence), and there has not been any proof to your claims of seeing side effects “many years after taking the last dose“.

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In the News – 12 Year Old Girl’s Battle with Alopecia – Hair Loss Information – Balding Blog

Snippet from the article:

Sophie NixonWhen football fanatic Sophie Nixon started losing clumps of her hair, no one in her family knew that bullying at school was making the youngster ill. Now the 12-year-old from Lowestoft has spoken out about her alopecia to encourage other young people to seek help if they are being bullied.

Sophie’s hair started falling out two years ago and she soon lost her eyebrows and eyelashes. It was only when her parents took her to see a doctor that she told them she was being teased at school and she was diagnosed with the condition, which causes sudden hair loss.

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Read the full article at the UK’s East Anglian Daily Times.

She’s quite brave to speak out about her condition and I wish her well. This story reminded me of an article from a couple years ago, where a young girl’s hair loss was triggered by bullying (see here).

There are genetic disorders that cause hair loss at the young age, starting at 2-4 years old. This can be alopecia totalis or a form of ectodermal dysplasia, which are often genetic in origin.

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Why is My Hair Loss from Alopecia Areata Cyclical? – Hair Loss Information – Balding Blog

(female) About 1 year ago, I found out I had Alopecia Areata. I went to the doctor right away and got the steroid injections to the bald spot I had. Well, in about 5 month, i got all my hair back, but it starting thinning out. Now after full 10 months, I noticed a very small bald spot on my scalp again. So, my question is why am I loosing hair after almost 1 year again. Please suggest something.

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Alopecia areata is an autoimmune disease and based upon your history, it sounds like it is active. It has been known to return after disappearing spontaneously or with treatment. Read up about the disease at the National Alopecia Areata Foundation site.

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Optimal Age for a Single Hair Transplant? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,

Thank you very much for your helpful book and web site. I am a 29 year old male planning to get a hair transplant. You have recommended waiting until the thirties before getting a transplant due to the risk of shock loss before hair loss has slowed.

One question I have is does using Propecia push back the age in which shock loss is still a risk? Since Propecia generally slows the hair loss process I would think that the age in which hair loss stabilizes would be later. Can a hair transplant surgeon figure out whether shock loss is a possibility just by examing your hair?

A second question, if I were interested in getting just one transplant in my life, what would be the optimal age? Or, if I were willing to get two, what would be the best times? Again, is this something that a surgeon needs to address on an individual basis?

Thanks so much for your help!

Propecia will certainly slow down the timeline for your hair loss. Shock loss does not happen following surgery in most men who are taking this drug. There’s no guarantee though, and determining the risk isn’t something that can be done by an exam.

I generally tell patients to wait until at least the age of 25 before considering a hair transplant, but questions about the ideal age reflect where you are in the balding process and if it bothers you. There is no ideal age for a transplant and only your needs should be a consideration. Be sure that you are on Propecia first and for everyone else reading this, if by chance you are under 25 years old, then trying the drug for a year is very important in building a Master Plan for you.

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Reversing Laser Hair Removal? – Hair Loss Information by Dr. William Rassman

My girlfriend has been going through laser treatments for removing pubic hair before she met me. she has gone through four treatments (she was supposed to do 12)and I convinced her to stop because to me lack of pubic hair seems completely unnatural. since she has stopped I noticed some slight regrowth but it is in strange patches and not even. Has the laser completely destroyed these areas? will minoxidil help regrow the hair? is there any way to reverse this process or is a transplant the only way?

Laser hair removal does not work 100% of the time. Part of the problem is the long telogen cycle of body hair, which means that all of the hair is not growing at the same time (it is in a sleep phase)… so a hair that has been sleeping (in telogen) may have not been present as a mature hair when the laser removal treatment was done. I tell patients that they can expect 50% of the treated hairs to be destroyed and 50% to return every time there is a treatment.

If a hair is killed by a hair removal laser, then it is gone forever. Bringing back the dead (even a dead hair) is not possible with anything, including minoxidil.

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ProFollica – Hair Loss Information – Balding Blog

Hi Dr.Rass . Please go through the following website and give your comments.

Profollica.com

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ProfollicaYou want my comments about their website? Sure. The generic sounding “ProFollica” name reminds me of so many other hair products, which they probably chose to capitalize on the other treatments that advertise more. Their website has a nice blue color behind the content, but the main background looks like the floor of a fraternity bathroom after a night of binge-drinking and eating Skittles. It looks like a rainbow exploded. I’m also not a fan of the prominent use of stock photos of smiling, well-coiffed men (or the other photos of pensive men with great hair, perhaps considering a purchase of this garbage). The site tries to debunk some myths in its filler content, but it gets some of them wrong. One of the myths it correctly debunks was one I hadn’t heard before in all my years of working with hair loss patients — the one about hair loss not being caused by “thinking too much”. They’re right, using your brain can’t harm your hair. Thanks for clarifying that, ProFollica team!

But I suppose when you asked for my comments, you wanted my 2 cents on the product itself. I could point you to probably a dozen past blog entries about these “treatments” that aren’t FDA approved and aren’t going to do what they claim… but I’ll just break down the three main ProFollica selling points from their site, followed by my commentary:

  1. They claim their shampoo removes sebum. Sounds good, except sebum doesn’t cause hair loss.
  2. They claim their shampoo and lotion will reduce scalp DHT. Wouldn’t it make more sense to inhibit the DHT rather than just washing it away after the fact? Also, scalp DHT is only 1 of the 2 types of DHT.
  3. They claim their supplement will help blood flow to the scalp. Again, sounds good, but blood flow to follicles isn’t the cause of genetic hair loss.

Before the parade of “they can’t get FDA approval because it is too expensive” emails come in, just realize that they can’t get FDA approval because they make grandiose claims that can’t be backed up. The FDA would require companies to outline all side effects and provide actual factual information about success rates — something products like this gladly avoid, because if you had the real facts you’d be less inclined to waste your money. Luckily for them (and unluckily for you), since these products are considered supplements they aren’t required to go through the approval process like pharmaceuticals would be.

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I Stopped Rogaine After the Makers Told Me It Would Only Work in the Crown – Hair Loss Information – Balding Blog

I’ve been using Minoxidil for a number of years but wasnt sure if it was working. I definitely lost hair in the crown area even though I was using the product so I got hair transplant. I called the makers of Rogaine to see if using the product would be an issue with the transplants and was told it only works for the crown area anyway. With that in mind I figured I would stop using. That was probably a mistake as I now see the rest of my head thinning out rapidly and can only assume its from stopping using Rogaine. Would you suggest going back on Rogaine and what should I be mentally prepared for if I do? I would be devastated if more hair is lost as a result of going back on it. They do say to expect hair loss at the beginning of use. Please help! thanks

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RogaineMinoxidil, when used and then stopped, can result in “catch-up” hair loss. Since you were already using the Rogaine for years, it was probably retaining your crown — if you hadn’t used it, your crown hair could’ve been gone already. It’s hypothetical, of course, since I have no way of knowing what might’ve happened to your scalp had you not used the treatment for so long.

I don’t know what type of mental preparation you should try, but just hope for the best. These medications don’t work the same for everyone, so I can’t tell you for sure what will happen. The hair may or may not come back, but there is little downside for trying. Keep your fingers crossed and your hopes high.

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Scarring Amongst Different Races? – Hair Loss Information – Balding Blog

I am a 40 year old asian male with slowly thinning hair. I’ve been using minoxidil for 4 years and propecia for 2 years now. They seem to help maintain what I have. Eventually I would like to consider surgery, but I am not bald enough according to the doctor I have seen. My question is:

1. is it better to wait until I am more bald, and, if so, why?
2. Is it true that FUT generally causes more scar in asian men? While I prefer FUE, I was told that the result is much better with FUT than FUE.

I would much appreciate your professional opinion. Thank you.

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Without seeing you, I can not address your concerns about when the best time is for your hair transplant. I generally tell patients that when it bothers them a lot, the surgery may be appropriate provided that the doctor agrees that you are a good candidate for it.

FUT (strip) and FUE are both good harvesting mechanisms. There may be better growth with FUT, but in good hands the FUE should be a fine alternative provided that you have a biopsy and are what we call “FOX positive” (see this article for more about the FOX Test). Scarring is not a racial thing except in keloid formation, which is more common in dark skinned people. If you have a scar on your body and it did not heal well, discuss this with your doctor.