Author: Dr. William Rassman

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My Doctor Told Me Propecia is a Feminizing Drug – Hair Loss Information – Balding Blog

A dermatologist prescribed propecia to me, telling me it looks like I have MPB, but my GP told me that I shouldn’t take it because it’s just a “feminizing” or “demasculinating” drug. I have hesitated using it out of fear of both the reported side effects and the limited long term studies done on this hormonally-influencing drug. Can you comment on these concerns? What is your advice? Where can I go to get a thorough and proper examination? And about how much does that cost?

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I do not like using the word “ignorant”, but according to the Merriam Webster Dictionary, your GP is “lacking knowledge or comprehension of the thing specified”.

Propecia (finasteride 1mg) is a drug that inhibits testosterone from being converted to dihydrotestosterone (DHT). DHT is responsible for male pattern hair loss. Propecia will not make you into a woman or produce changes that are characteristic of women. Some of the side effects of Propecia are an increase in libido (possibly is frequently 1 in 10 people in the first few months of treatment as the testosterone rises) or decrease in libido (1 in 100). The long term (5+ year) studies done on Propecia shows benefit for male pattern hair loss, thus it is the only FDA approved drug for that purpose.

If you need further information and an evaluation of your MPB diagnosis, I would be happy to see you and answer all your questions in person at my NHI office in Los Angeles. Just reference this BaldingBlog post when you see me.

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How Many Follicles Required to Fill in This Scar? – Hair Loss Information – Balding Blog

Hi, I was just wondering about how many follicles would be needed to fill in an inch long and a few mm wide area of scalp?

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Tootsie PopHow many licks does it takes to finish a Tootsie Pop? In other words, I couldn’t tell you how many grafts would be required just by the simple question you asked. It depends on what you mean by a few millimeters — two, three, five?

It would also depend on:

  • the location of the scar
  • your hair shaft thickness and the scar thickness
  • the contrast of your hair color to your skin color to minimize the appearance of the contrast
  • the character of your hair (wavy, curley, straight)
  • the length of your hair (very short hair will require more densities than longer length hair)

Generally you can achieve a good cosmetic effect with about 20 to 40 follicular units per square centimeter, but that number does not reflect the local skin dynamics or how the surrounding hair may lay.

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Woman Losing Hair and Possibly Her Husband – Hair Loss Information – Balding Blog

Hello,
I’m a 26 year old female. I have been losing hair for the past 10 years and tried many things to improve it. AFter researching extensively about hair loss I’m now taking Biotin and B-Complex supplements. But I still have not seen any result. My husband has lost interest in me because of this. I don’t want my marriage to break because of my hair loss. Is there any way to prevent hair loss . My mom and my brother have a similar hair problem. is it hereditary? Is there any medication to improve my Hair loss. Please Help.

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There are many causes of female hair loss. Before any treatments, you must find the correct diagnosis. More importantly, you must rule out any treatable medical causes of your hair loss. You may want to see a medical doctor who can do blood tests and/or evaluate your hair for any miniaturization pattern. I realize that in our society hair loss is a very emotional process for men and women. We identify much of our sexuality with our hair. It is not normal to lose a husband so I suspect there may be deeper relationship issues and that hair loss is not the sole cause of that problem.

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Bald at 3 Years Old – Hair Loss Information – Balding Blog

I am most pleased to contact you from Tbilisi, Georgia. I am male, 24 years old.

I would like to tell you about my problem which occurred at the age of 3 when my hair started falling out (circumscribed alopecia) which has resulted in full baldness and continues till today. It should be noted that a genetic factor is absolutely excluded as far as no one in my family have ever had similar pathology. My parents associate this disease with a strong stress and fear. The treatment which I have undergone over many years in my country yielded no result and therefore, I am kindly asking you to assist me.

I learned about your clinic a week ago and I was greatly delighted as after many hopeless years, I am filled with strong hope. Please advise me if you are able to cure me at your clinic and let me know terms and conditions of treatment.

Thanks for attention! It is interesting to me, what result have been received at treatment total alopecia(circumscribed alopecia) in your clinic. Whether in my case probably treatment in your clinic and what result will be received? How many will manage the treatment in your clinic?
Thank’s for your attention

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I believe what you are describing is a condition we call alopecia universalis. There is a population of people who have this condition appear at about 3 years old. The hair falls out in clumps and takes less than a year to complete. The end results are bald children and the condition is not curable. Please send me pictures of yourself now and if you have pictures of you at 3 years old, that might be helpful.

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Hair Loss InformationWhat Procedures Has Dr Rassman Had? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I’m wondering if you could tell us a little about what you’ve personally gone through? I’ve managed to gather, based on reading about half of all your entries (i’m aiming to get through all of them!) that you’ve had a full transplant and that you’re currently on Propecia, but I was wondering if you could elaborte.

Cheers

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In the early 1990s I had three scalp reductions for balding in my crown. I realized after the third (about 8 months had passed) that I was worse off after the three surgeries than before I had them done. Worse off because:

  1. my bald spot returned larger than before I started the first procedure
  2. the skin was fragile, bleeding easily
  3. the scar looked like a Mercedes emblem on my head

I was not angry with my doctor because he had done what others were doing, practicing a standard of medical care that was sub-standard. What angered me was a phone call I had made. I called the authority on this surgery, explained what happened to me and found out that it was a common outcome for many patients. I remember clearly that when I asked him one simple question: What was this outcome not published? His answer was: It would be bad for business. I was sickened. I had personally performed 8 of these surgeries myself, one of them on my first cousin. He was the only one who had the complications of scars and the emblem on his head. We joke about it today and he never loses the opportunity to be dramatic about the impact of the scar I gave him. I transplanted his crown three times to try to make amends, and although he now has great results, he still teases me over his suffering.

Like him, I had hair transplants performed into the scar in the back of my head. I no longer belong to Mercedes and am a free man with a good head of hair. My crown (1600 grafts later, see below) is still slightly thin, but few people notice it unless I call their attention to it. I use a comb-back and the hair in front of the thinning hair covers the bald spot reasonably well.

 

Click the photo to enlarge.

Because of the scalp reductions I had, it was not reasonable to replace the swirl in my crown so I accepted a change in hair positioning for each of the grafts to enhance the comb-back styling that I had gotten used to. I often do this in people who have a supply/demand mismatch, where the supply is short and demand is high. On some patients where there is no demand mismatch (like with Patient CL and Patient OR), we can replace the swirl.

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My Transplanted Hairline Was Too Low – Hair Loss Information – Balding Blog

im 22 and had 500 grafts done in my receding temples about 6 months ago. i experienced severe MPB at 18-19 and hairloss had been stable since then. the hairline was carefully marked by myself before the surgery so i cannot blame the doc, but now i feel it could have been 1/2 further up. the hair are very fine and not very dense, just as i wanted them on temples(not too dense, just enough to cover). in the future can these be moved 1.2 up??

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Not really. It is very difficult to move transplanted hair. I tell patients that transplanted hair is always permanent and that is why it should be done right the first time. If removal was to be attempted, it would have to be done with a Follicular Unit Extraction (FUE) technique. You can have a brow lift which will give you a higher hairline, moving the transplanted hair upwards, but that is fairly radical surgery for someone of your age.

I am disturbed that some doctor would transplant a 22 year old and that the hairline would be placed low. The fact that there were only 500 grafts also disturbs me, because it indicates that the balding is not severe. Were you on Propecia? If not, then there is clear malpractice here. You need an expert to assess your situation.

A hair transplant is for life. That is why I constantly emphasize the Master Plan in hair restoration. To achieve the maximum cosmetic benefit from hair restoration surgery, a personalized Master Plan should combine the best information available with a realistic assessment of what your future hair loss may be. It is an integral part of the patient-doctor relationship.

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Chemical Burn from Foil Highlight – Hair Loss Information – Balding Blog

A customer is claiming she recieved a chemical burn in my salon but I don’t think it is the correct diagnosis. She claimed that several days after she recieved a foil highlight with bleach she noticed a bald spot in her hair. She was not burned on the skin and the hair is not broken off but a bald spot is present. She felt nothing unusual during the service but insists it is from the foil. Is it possible we are responsible even with no scalp irritation or does it seem more likely there is another explanation.

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Your question is a delicate matter in terms of liability and almost certainly will have legal implications. All chemicals and or medications may have a potential for side effects. It is impossible to know the cause of your customer’s hair loss without examining her scalp and hair. We all look for a cause and effect relationship, but sometimes the two may not be related and be serendipitous in terms of cause and effect. It is possible that the bald spot was there at the time of the bleaching (and not noticed) or that it would have developed, even without bleaching. Unfortunately, this person has control over what they will do about the bald spot. Aggressive lawyers may see $$$ while a doctor may look for a diagnosis like alopecia areata. The decision on her response is clearly out of your hands. In conclusion, there may or may not be a relationship with the bleaching she underwent. Even if there is a relationship, you may have done nothing wrong.

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15 Year Old Losing Hair From Sides and Back of Head – Hair Loss Information – Balding Blog

For the past year I have been noticing my hair loss, and it is getting to the point where I can’t hide it. The part that scares me is that I am only a 15 years old male. Could this be male patterned baldness at 15? It is not just falling off the top of my head but also falling out the sides and the back. Is any of this normal?

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While it may be normal (but rare) to be affected with male pattern hair loss at the age of 15, it should not affect the sides and the back of your head. You may consider visiting a medical doctor who can evaluate you for any treatable medical causes for hair loss, because your hair loss may be secondary to a medical issue. If you had a ‘typical’ case of genetic hair loss, there will be patterns of miniaturization seen in the distribution patterns typical of those defined in the Norwood chart. Mapping your head and scalp for miniaturization will show this if that is the case. Otherwise there are rare conditions such as alopecia areata or diffuse unpatterned alopecia (DUPA) which are generally not easily treatable conditions.

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Grafts Growing in Scarred Tissue – Hair Loss Information – Balding Blog

Does a graft always have the potential of growing? Even in an area of scarred tissue? Or where a hair has been extracted?

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If the scar tissue is healthy scar, it will support follicular units. Healthy scar actually bleeds when cut. Scars often have a rich vascular network, but some skin grafts (split thickness grafts) and burn scars may not have enough vascular support for a hair transplant. A healthy graft will grow anywhere it is placed when the blood supply is adequate. For example, a follicular unit placed on the end of the nose will grow to pony tail length.

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Hair Loss InformationFUE and Hair Cloning – Hair Loss Information – Balding Blog

I’ve been reading many of the blogs on your website, and they have come in quite handy, but one question I have, I could not find. I asked this question before on your website, but I didn’t get a response. I wanted to know if you extract a hair follicle with FUE, and then if something better came around such as hair cloning or something like that, then could I then replace the extracted hair. (e.g- If you extracted a hair, does it have the capability to grow another hair if a hair is then implanted back to that same spot? -Would really like to know. Thanks

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If you had a FUE procedure, where an individual hair follicle is taken from the back of your scalp one at a time and reimplanted to a balding part of your scalp, you would be left with a small punctate scar which would be virtually undetectable. It would be impractical to reimplant a hair follicle back to the FUE site, because the scars are too small. To the human eye, the FUE site would not even look thinner, because it takes over 50-60% of hair loss to detect any thinning.

To put it straight, if you could get a hair follicle or a follicular unit, or a cloned hair for that matter into an FUE scar, it would almost certainly grow.