Author: Dr. William Rassman

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Hair Loss InformationWhy Are Some Transplant Scars More Noticeable Than Others? – Hair Loss Information – Balding Blog

How come some people’s scarring on the back shows up so noticeably, and others don’t? Does it all depend on how many grafts you use?

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Scarring is a complex problem related to:

  1. The healing properties of the patient
  2. The size of the strip
  3. The techniques used at the time of the surgery
  4. The skill of the surgeon

We are all different, so assuming you compare 100 of my patients (where I did all of the surgery) that only received 1000 grafts, for example, the variation in healing will become evident, assuming that the exact same technique was used on each closure.

When I performed general surgery and did an appendectomy, I used to brag how wonderful my scars were, and how you could rarely find them. That was the case in 19 out of every 20 patients. The 20th patient would be excluded from my bragging. Get it?

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Hair Loss InformationCould FUE2 Replace the Strip Method? (Part 1) – Hair Loss Information – Balding Blog

This is a long piece, so I’m breaking it up into 2 separate parts. Here’s part 1, with the 2nd part coming at the same time tomorrow…

Do you believe that the FUE 2 (or standard high yield FUE) process could completely replace the strip method of hair transplantation? Why or why not?

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There are practical problems with the FUE2 method of harvesting. First, the patient must have his hair clipped widely if he wants/needs extensive grafting above 600-800 grafts (the number of grafts which can be taken from a small area is very density dependent). Most people will not allow us to clip their hair that short and certainly people who have had previous strip harvesting will often not want to have their hair clipped that way either. Many patients who come for FUE end up switching to a strip technique, because of the haircut issue alone.

The FUE’s maximum number of grafts, compared to a strip harvest, will produce less hair with FUE. The strip method of harvesting obtains the donor hair from what the surgeon calls the sweet spot. The FUE can not get the number of grafts from the sweet spot as well as the strip, but the FUE may be limited at each surgery. I read a great deal about the reported FUE megasessions and although I am convinced that much of the hype of 3,000 graft FUE sessions are misrepresented and promoted based upon false claims by less than honorable doctors, the public wants to see this happen and they are ready to believe almost anything a slick doctor tries to sell.

So for the patient who is bald and needs a high numbers of grafts, the strip harvesting method is superior because more hair can be moved in a single session, minimizing the number of sessions when compared to FUE harvesting. For those people who want to get the job done quickly and they need graft numbers in the thousands of grafts, the strip method is far more time efficient.

On the other hand, a new dynamic can be created where people take multiple sessions of 500-800 grafts every 6-8 months until they add enough hair to create what they want. A slow approach has many advantages including:

  1. Spreading the costs over a longer time
  2. Developing a changed image very slowly so that nobody will ever recognize the change
  3. Minimal pain and very fast recovery without limitations on any activities from weight lifting to scuba diving, and so on.

There is a place for both choices and for those men who are not very bald, the ability to achieve reasonable results in one or two sessions are a practical approach to the problem.

Check back for part 2 tomorrow…

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Generic Finasteride in the US? – Hair Loss Information – Balding Blog

Dr. Rassam,

Finasteride Generics in 1mg dosage are available in Europe and I wanted to know if you are familar with the products being available in the US? Is generic Finasteride the same as Propecia?

THanks

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Generic finasteride 1mg is not available in the US legally due to patent laws. Generic finasteride 5mg is available in the US. There are a variety of makers of the product overseas, and I’ve written about it before here. Just make sure that the generic finasteride is 1mg — sometimes it is sold as 5mg to treat the prostate (and it needs to be cut into 4-5 pieces for treating hair loss).

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Does Propecia Strenghen Miniaturized Hairs Or Grow New Ones? – Hair Loss Information by Dr. William Rassman

If Propecia gives you regrowth, will it first shed out the miniturized hairs and then grow healthy hairs or make the miniturized hairs just normal again?

Propecia increases the diameter of the hair shafts that are miniaturized, and one tends to see the most beneficial response in those hairs that are recently miniaturized. Some people see shedding after starting Propecia, and that could be due to speeding up the hair cycle so new, healthy hair grows. That’s just an educated guess shared by many doctors at this point, and not something that has been proven (as far as I’m aware).

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Graft Count Estimates – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman,

I am a 32-year old male who had HT surgery in San Francisco in 2002. At the time they intended to do only 600 grafts, but since my car got towed during the consultation, the doctor threw in 100 free grafts, for a planned total of 700.

Interestingly enough, when they harvested the strip from the back of my head, they had 800 (!) grafts available, and of course all of those got put in. I have a very nicely shaped hairline and some diffuse crown thinning, but I have been taking propecia since 2002. My father is 67 next month and has a full head of black hair, but my mom’s father was bald by 25.

I’m considering going in for another 2000 grafts to really increase the density in the front and maybe lower the hairline if it’s appropriate. I’m going to be running for public office in 2010 (I don’t want to say which office to preserve my anonymity, but suffice to say this would be a career change). One doctor told me he felt I had a donor density of around 120 grafts/cm2 and another consultant (not a doc) said I probably had 7000 grafts available in my head. Would 2000 grafts deplete my donor density or does 7000 sound really likely? Moreover, what are the chances of them going to take out 2000 and getting like 2300, based on my previous HT.

Thanks!

You need an experienced doctor, not a salesman, to tell you what your density is and what your reserves are like. This conforms to the Master Plan I continuously talk about. Depleting the donor supply can occur with 2000 grafts, so you must be confident that your doctor levels with your and it honest about your future.

To estimate the number of graft, one must know the density of the donor area. A density of 2.1 hairs per mm square will produce approximately 100 follicular units per square cm. The calculation is relatively simple by figuring out the number of grafts one needs and plan on excising that size of a strip that conforms to the above density. There are adjustments that are required which reflect the amount of tumescence (fluid and local anesthesia) that is injected into the donor strip. As the density goes up by 20%, then the yield will go up by 20%. The same is true for 20% reductions in density (as occurs in the average Asian). The adjustments must be made and tied to the measured density of the donor area as seen in a number of sampled areas. I published the formulae for this process in International Journal of Aesthetic and Restorative Surgery back in 1995 (see article).

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Hair Loss InformationIn the News – Propecia Prevents Prostate Cancer – Hair Loss Information – Balding Blog

Snippet from the article:

For the first time, leading medical groups are advising millions of healthy men who are regularly screened for prostate cancer to consider taking a drug to prevent the disease.

The advice stops short of saying men should take the drug finasteride, sold in generic form and as Proscar. It is already widely used for urinary problems from enlarged prostates as men age. Merck and Co sells it as the baldness remedy Propecia. However, it has not been widely prescribed as a cancer preventive, and it may carry some risks. The new guidance tells men to talk to their doctors and decide for themselves if the good outweighs the bad. This advice is bound to be confusing, doctors admit. For one thing, it doesn’t apply to men who choose not to have screening with PSA blood tests, which no major medical groups recommend.

In men who are regularly screened, finasteride can cut the odds of being diagnosed with prostate cancer by about 25 percent.

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See the full article: FOXNews.com – Medical Groups Advise Men to Take Baldness Drug to Prevent Prostate Cancer

For those that already take finasteride, it’s likely not news to you that the medication has prostate cancer prevention benefits (I’ve mentioned it as far back as 2005). Finasteride was at first used as a prostate treatment called Proscar (in 5mg dosage), with Propecia becoming available as a hair loss treament a few years later (in 1mg dosage). Still, it is important to point out the health benefits of this drug.

Here’s the National Cancer Institute’s page about their Prostate Cancer Prevention Trials, since there’s bound to be questions — Prostate Cancer Prevention Trial (PCPT).

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Hair Loss InformationHair Thickening, Thinning, and Thickening Again from Minoxidil – Hair Loss Information – Balding Blog

Doctor

Just read a recent post regarding someone who notices his hair thickens and thins and thickens again. I’ve noticed that for years and just assumed it was from Rogaine. That it was either synch shedding which happened after first using the drug and just continued through the years or that at times realized I’ve been missing areas and after reapplying those areas came back. But again that was Rogaine not Propecia which the previous post was on. Wonder if other minox users noticed this.

After reading your reply made me wonder if TE tends to reoccur in people. It would make sense if it is in response to a stress. People who have physical ailments in response to stress tend to have the same physical responses repeat throughout their life. I wouldn’t be surprised if some people are predisposed to TE under stress. Just as some develop IBS that comes and goes.. acid reflux.. back pain.. IF TE happened once it will probably happen again under stress.

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Thanks for your comments. I’m posting this to hopefully get other readers to share their experience with back and forth shedding from minoxidil, as you describe.

To put this all together, a good relationship with a doctor is a good idea. Yes, telogen effluvium can reoccur in some people. See eMedicine for more info.

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Just Turned 18 and My Facial Hair Is Growing While My Scalp Hair Falls Out! – Hair Loss Information by Dr. William Rassman

I’m a male who has just turned 18. In the last 4 months, I have had growth in my facial hair, but am losing hair on my head as fast as I am gaining it on my face. As soon as my facial hair started thickening, my pattern baldness got aggrivated. The hairs on the edge of my hairline are thin, small and weak (like a baby’s hair). Why is this happening now?

What you are describing is the unfortunate results of DHT (dihydrotestosterone) doing its job on growing your beard and taking advantage of your genetic defect in causing hair loss. Your facial hair isn’t the reason for your hair loss or vice versa. If genetic hair loss is the case and you confirm it, then the drug Propecia (finasteride 1mg) will be the best approach to this problem. Don’t wait, as time appears to be working against you. You should see a doctor to find out if you have genetic hair loss, as Propecia is only available by doctor’s prescription.

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