Author: Dr. William Rassman

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Hair Transplant Surgery by a Non-Licensed Physician – Hair Loss Information – Balding Blog

I just saw a person that had a hair transplant by a man claiming to be a doctor (who actually wasn’t). This fake doc opened up a practice for doing hair transplants, and I decided to write a brief note here to hopefully serve as an important reminder about verifying your doctor’s credentials.

So what does one do to verify if the person who claims to be a doctor is really a doctor? It may sound ridiculous, but you could ask to see his/her state identification (like a driver’s license, for example) to get the correct spelling of the first/last name and then look the physician up at the state medical board database. For California, check here — for other states in the US, I found this Medical Board Directory, and if you can’t find what you’re looking for in there, I’m sure a Google search will turn up results by state/country/region. Try using the keywords “medical board” followed by your state/country/etc. Granted, fake state identification might be relatively easy to get, so maybe then you need to get his/her licenses to practice medicine and their narcotic number, both of which are harder to falsify.

The particular phony doctor that prompted this blog entry had rented another doctor’s office to give himself some credibility and had a line-up of patients for surgery. I won’t get into how wrong it was for the doctor to have rented him the office, but what was particularly significant to me is knowing what would have happened if something went wrong with a surgery. One of the most common complications I see is a fainting spell brought on when the Vagus nerve is stimulated from the excitement of the procedure, slowing the heart down to possible unsafe levels. When the heart slows, there is often a temporary drop in blood pressure, but if this very simple process is not addressed quickly and the patient had atherosclerosis of blood vessels to the brain or heart, a simple drop in blood pressure can lead to or cause a stroke or a heart attack. This complication is easily prevented by lying the patient back with the head down and the feet elevated. In a few minutes of careful observation with the patient in this position, the heart rate usually goes back to normal on its own. If this is not done, what may have been simply practicing medicine without a license might turn into some murder prosecution if the patient died.

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Hairline Lowering Options? – Hair Loss Information by Dr. William Rassman

I’m a 26 year old male, with no sign of balding. Both sides of my family still have a full head of hair, but I do have a naturally high forehead. What are my options to lower my hairline, and is it advisable to even do so for a guy? Thanks for any information on any procedures I could undertake. Thanks.

If you knew for sure that you would not bald, then a hairline lowering procedure can give you a fairly fast result (immediately after the surgery). If your hairline went up because of frontal balding, a hair transplant can bring down the hairline quite nicely, though the results of which will not be seen for some months. The amount of hairline that can be lowered varies with the hairline lowering procedure, as it depends upon the looseness of your scalp. A hair transplant approach does not have this limitation. See the following links for more:

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Regrow Hair Lost from Triangular Alopecia? – Hair Loss Information by Dr. William Rassman

Hello,
I believe i have since my 20s (now 38) triangular alopecia – a small bald spot on one side of my head (above the ear). Thinning on top since early 20s. Been on minox 5% and finasteride for 1 yr. No change in bald spot apart from lots of vellus hair. Will it ever grow or is a transplant into that area the only solution. Many thanks

I would doubt that it would regrow from minoxidil. Hair transplants work well. See this previous post for more on triangular alopecia.

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Scalp Bumps on Top of Head, Mostly Near Temples – Hair Loss Information by Dr. William Rassman

Hello,

I am a male 26 years old…About a year ago I noticed acne like bumps on the crown of my head and generally all over my scalp, I went to a doctor and he prescribed a shampoo (tar) and the bumps went away temporarily, I have noticed that my hair is thinning out on top of my head and quite alot near my temples. Can the acne like bumps be a sign of hair loss? I am really concerned especially about my hair loss in my temples, and on top of my head….

Thank You

You need to have these bumps evaluated by a competent doctor. Any good dermatologist and many good family doctors are able to make that assessment. For the thinning of your hair, I would recommend that you get your hair mapped out for miniaturization to determine what is causing your hair loss.

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Shock Loss in the Recipient Area – Hair Loss Information by Dr. William Rassman

HI DR… I would like to know if there is shock loss after hair surgery what is your policy in solving the problem. thanks

I properly inform my patients of the risk, try to mitigate that risk, and am very supportive if it happens. I can not guarantee what will happen to the native hair that is there and which may react poorly to a hair transplant by undergoing shock loss. I have not had a case of shock loss for more than a year. I suspect it is because I prescribe finasteride on all those who are subject to that risk.

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Taking Propecia for Over 10 Years — Will My Hair Loss Still “Catch Up”? – Hair Loss Information by Dr. William Rassman

I read your last blog entry and I was wondering, I know people who have been on propecia for about a decade (they started when they were 19) and they still have a good amount of hair left (I know one of my friends has a large receding hair line but it is not that visible when he has long hair but when he has short hair he combs it down and you can tell). You talk about our genetic code catching up to us and eventually those hair losing people will lose all their hair even on propecia but the thing is when does the genetic code of those people on the medication for 10+ yrs catch up to them? Will they keep all their hair until they are 50 because they have been taking finasteride for so many years? Because I remember you mentioned one time that at the age of 30 baldness stops so If I take propecia until 30 and then stop the hair on my head will it stay forever?

There are no studies that go out more than 10 years. My own experience takes me to ten years. As long as you take it, if there were ever benefits, they will be retained to some degree over the lifetime that you take the drug.

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Hair Loss InformationDoctors Only Record Their Successes, Not Failures – Hair Loss Information – Balding Blog

Have you ever had any failures in your practice of transplanting hair? Not just you didn’t fill in a portion here or there. But someone who was devastated?. It seems everywhere I search, doctors only records their successes. I think it is great that HT is often successful and am fully considering one for myself, but am of course afraid that there are people who have gotten a HT from credible doctors, and it made their life miserable.

Any thoughts?

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There are no guarantees in medicine. A doctor can not expect 100% of patients who had transplants to succeed 100% of the time. I’ve met with many patients who have had transplant failures at other clinics and have come to me for help. Many times the failures are produced by doctors who did not have the necessary experienced teams or underestimated the jobs that they took on. Some of the failures are caused by a failure to properly set expectations and when doctors use salesmen to ‘sell’ the transplant, then expectations may not be met because they were set unrealistically high to make the sale and close the deal. In many of these patients, I see graft growth roughly proportional to the number of transplants that they received, but a disappointed patient still sees the process as a failure. We solve this problem by holding open house events monthly where setting expectations and patient education are central to my agenda.

In my practice I have seen a rare failure of grafts to grow. There are many causes of graft growth failure that are not caused by the doctor, some of which include:

  • severely atrophic skin in a very bald person
  • autoimmune diseases that were undiagnosed (a common cause)
  • chronic telogen effluvium and the presence of a variety of scarring alopecias
  • infection
  • severe diffuse unpatterned alopecia (DUPA)

DUPA is a relatively common cause of failures, because the condition is often not properly diagnosed, even though it is easy to diagnose when the donor area is mapped for miniaturization).

So yes, you are correct that doctors do not want to publicize failure. I don’t know of a doctor in any field of medicine that proudly shows off unsuccessful procedures. It is just never good for business. Could you imagine a breast cancer specialist telling how many of his patients died, or a psychiatrist tell his depressed patients how many of his patients committed suicide?

You ended your question with a suggestion that a hair transplant from a credible doctor would make their lives miserable. Modern hair transplants should not make anyone worse off. Even a theoretical complete failure should leave a person to where they were prior to the transplant (less whatever scar was in the donor area, which should be minimally detectable).

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Is Saw Palmetto a Good DHT Blocker? – Hair Loss Information – Balding Blog

Hi doctor my hair have been thinning for about 3 years (now i am in my late 22 of age), but i didnt notice till now shedding in the temporal area (only receding in the frontal hair line ), i am confused some are telling me that I have “Seborrhoeic dermatitis” but other dermatologists are telling me that I have male pattern hair loss -Alopecia. My question is does Seborrhoeic dermatitis cause the hair to thin like the dht effect or only makes the hair fall-knowing that in addition to my thinning I have some acne production especially on my nose and face areas-I am using Nizoral Cream 25 and Squad med shampoo to control Seborrhoeic dermatitis which is controllable using these medications. Does possible that I have both Seborrhoeic dermatitis and Male Pattern Hair Loss – I used monixidil 5% which resulted in few tiny hairs and I used propecia but i quiet it after 6 months due its sever sexual dysfunction and i am shifting now to Saw Palmeto —What is your comment doctor on saw palmetto on inhibiting DHT!! Thanks A lot Doctor”

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It is certainly possible that you have both seborrhoeic dermatitis and male pattern hair loss. The two are not connected and seborrhea does not cause hair loss. Saw palmetto is not a good DHT blocker, as is claimed by many. There are only two DHT blockers that are proven to work (finasteride and dutasteride). You need to be managed by a good doctor.

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Hair Loss InformationPlease Clarify The Effectiveness of Smaller Finasteride Doses – Hair Loss Information – Balding Blog

Dr. Rassman,

You indicated that 0.5mg of propecia was about 80% as effective as 1 mg. I believe you indicated that Dr. David Whiting informed you of this?

Then, someone posted “0.2mg of Finasteride is Almost As Effective as 1mg?” on September 8th which indicates that 0.2mg (not 0.5) is 80% as effective and you said that was the first you had heard of this report and you would look into it.

Would you verify which is correct. I take 1/2 a pill of propecia (for cost mainly) and I would like to know if it is as effective as 1 whole pill, since according to the FDA studies, 0.2 is 80% as effective as 1 whole.

Thanks

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I do not want to confuse you. The official dose of 1mg is what I recommend. Even if Dr. Whiting is correct about the 80% effectiveness of 0.5mgs of finasteride, 80% is not as good as 100%. With regard to the lower doses I published, please note that this was just a posting of information I received to stimulate thought. I would not change my dose to a lower dose, because it would put you at risk for hair loss. With the generic Proscar now available on the market, costs are reasonably in reach for most people.