Dr. William Rassman – Page 1775

July 14, 2006

12 Days After Transplant And Hairs Haven’t Fallen Out Yet – Hair Loss Information by Dr. William Rassman

First – thanks for a wonderful blog!

It’s been 12 days since the transplant procedure and while almost none of the transplanted hair have fallen out yet, much of the transplanted fat tissue (I assume) is still clinging in small beads to the hair. Is this the “crusting” that many people write about? Any suggestions as to how to remove it – or is it just a matter of time before it comes off.

Also curious is that the small hairs have not fallen out yet… assume this is normal and just be patient and wait for them to fall out? Seems like the key to this whole process is to get on with your life and check your head in 8 months!

The crusting by this time can be removed by washing and then with the hair wet for a good 10 minutes, layer conditioner on the crusts and let it sit there about 10 minutes. Then, gently with your finger tips, rub these crusts — you should see them fall out. There is little danger in losing the grafts at this stage in time as long as you are gentle. The little hairs will generally fall out between 10-25 days after the surgery.

July 14, 2006

How Long Does It Take To Go Completely Bald? – Hair Loss Information by Dr. William Rassman

Hi doctor, I started balding right around my 17th birthday. Both my grandparents and dad are bald, yet all of my 5 uncles have hair. I am almost 18 now, and i am on both propecia and rogaine. Exactly how long does it take to bald completely??? If it continues at this rate i will be completely bald in two years ( I had an absolutely enourmous amound of hair a year ago). I still have a lot of hair and none of my friends notice and think im crazy. I am just wondering how much time you think i have. I started taking propecia 1 1/2 months ago and rogaine this week. My hair loss rate has not decreased. I am very very anxious.

For genetic balding, the baldest of men on the Norwood chart (see below) know that they will be bald by the time they are in their mid-20s (VI and VII). Those with lesser balding patterns take longer to evolve and may not complete the entire patterns show here.

Mapping out your scalp for miniaturization will tell you what is about to happen to you. Find out!

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July 14, 2006

Missing Propecia and Minoxidil Dosages, in Theory – Balding Blog

A group of experts in the hair restoration field, were polled on the issue of dosing minoxidil and finasteride. What I am quoting below are some unofficial opinions that are not the standard FDA line for these drugs. I present them for the interested readers on this blog. The authors of these thoughts would rather not identify themselves, as these opinions are not in-line with standard treatment recommendations, even for the doctors who believe what is written below…

Comments on minoxidil:

Once a day topical dosing with minoxidil is probably close to, or equivalent to, twice a day. When given orally, minoxidil has a relatively short half like of several hours, but when topically applied, it has a half life of 22 hours in the skin. This makes once a day dosing a very reasonable option which I often suggest to patients.

Comments on finasteride:

Unfortunately, there are no references in the literature, that I am familiar with, concerning the “functional” half like for finasteride.

The serum half life of finasteride is only 4-6 hours. If we assume the worst, 4 hours, then there is far less remaining from a 5 mg dose 48 hours after dosing than there is from a 1 mg dose 24 hours after dosing. Similarly, a 2.5 mg dose does even less well. So, from a simple serum level of finasteride standpoint, every other day 2.5 or 5 would not maintain consistently high enough serum levels.

It gets interesting though when you consider the half life of the finasteride / reductase complex. The half life of this blocked enzyme complex is around 30 days. This is the most likely reason that when you stop taking finasteride (after chronic dosing), it takes 3 months for your DHT levels to return to baseline. This part of the story implies that, once you get up to steady state levels, every other day dosing would surely be enough..

I just think that there might not be enough of the drug around to keep the enzymes saturated using chronic alternate day dosing. These are the reasons that I recommend daily dosing but point out to my patients that it doesn’t matter if you miss a dose now and then.

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July 14, 2006

My Daughter’s Hair Won’t Grow – Hair Loss Information by Dr. William Rassman

My 5 year old daughter’s hair will not grow! I have tried almost everything and it still seems to be the same length since her birth-very short, course hair. I have recently resorted to extensions (braids) in an effort to give her hair a break from everyday styling, but nothing appears to work.

Could she have a medical problem?

Hair on the scalp grows in cycles. They have three phases of growth:

Growth phase (Anagen phase) which lasts anywhere from 2 to 6 years. This is the phase where your hair is actively growing at approximately 10cm per year. 85% of hair is at this phase at any given time.
Transitional phase (Catagen phase) which lasts about 2 weeks. This is the phase where the hair follicle shrinks and prepares to enter the resting phase.
Resting phase (Telogen phase) which lasts about 1- 6 months. This is the phase where hair does not grow but stays attached to the follicle. Some hairs are shed at this phase, but at the end the hair follicle re-enters the growth phase to start the cycle over again. 10-15% of hairs are at this phase at any given time.

I do not know why your daughter’s hair has not grown in 5 years. There is a peculiar genetic condition that impacts children of her age causing hair loss and balding. There may be variants of this condition worth exploring. You should discuss this issue with her Pediatrician and determine if she has any medical conditions that may be contributing to such slow hair growth. The use of hair extensions may cause the hair she has to fall out from the traction it causes. If her hair is not growing as you reported, then she may become bald at the point the ‘extensions’ are attached.

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July 14, 2006

Reducing Visibility of Transplant Scar – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

I had 1 hair transplant procedure 2 years ago. I am only 22. I feel like the propecia is not working and I am ready to shave my head, but I want to reduce the appearance of the scar from the procedure. I am currently using Mederma. Are there any other products you could suggest to reduce the visibility of the scar? Thanks!

If you had only one transplant procedure, you should not be facing a significant scar. I am bothered not only about your scar, but your age. What drove you to have a transplant at 22? A good, honest, and competent transplant doctor should look at your scar and advise you. Consider sending me digital photos and maybe I can help, but send me photographs of your entire head as well (your photos will be kept confidential and will not be shown on this site). As well, please reference this blog posting when/if sending the photos.

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July 13, 2006

I Think I Have a Diffuse Alopecia – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I’m a 20 yr old white male and I’ve seen my beautiful dense hair reduce it’s volume to about 40% over a 7 months period. It all started about a month after I relocated to another city. 2 months ago I went to a dermatologist. She gave me this treatment: Hairgrow 2% Minoxidil, Ducray Sabal shampoo and some vitamins. I don’t think it’s working because I’ve analyzed my scalp and I have less hair than 2 months ago. The thing is, I don’t have MPB but rather a diffuse alopecia. I honestly have no idea what the cause is because I have a healthy life style with balanced meals and workout. My father has MPB so in the worse case I should have developed MPB as well.
I would be forever grateful if you could shed some light on my problem. Thanks in advance.

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When you describe a diffuse alopecia, I really do not know what you are seeing. When I describe a diffuse alopecia, I expect to see miniaturization of hair throughout the scalp, including the rim of hair around the sides and back (we call this the permanent hair zone). When miniaturization occurs in the permanent zone in a man, this is a very bad omen for long term deteriorating hair loss, something that is not easily managed with drugs and certainly not transplants. Rather than go into the complex area of the real diffuse alopecias, their diagnosis and management, I would suggest that you get your scalp mapped for miniaturization to find out what is really going on. Is this real? Is this a disease that you are manifesting?

July 13, 2006

Hair Loss InformationVirtual Reality Hair System – Hair Loss Information – Balding Blog

You seem like a wonderful person to spend so much time answering people’s questions and helping us. My question is about “Virtual Reality Hair”. This seems to be a hair system that claims to be undetectable to the sight as well as feel. The base is suppose to be like a contact lens…very very thin. The maintenance is very high and it is expensive. Can you let me know if it is unhealthy for the skin? I am only 23 with a receding hairline or a maturing hairline and this would save my social life if it works. Thank you for your time.

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I cannot comment specifically on the Virtual Reality Hair system, as I have not seen it and have no experience with it. Generally though, these hair systems should not be “unhealthy” for the skin. However, sometimes these systems may cause local irritation or even contact dermatitis in rare cases. The way such systems fit to your hair and scalp can cause traction alopecia from the rubbing of the hair system and the pulling upon your hair. You should also be aware that as you wear them for periods of time, you will sweat and need to clean and maintain them from developing that worn-in odor (as with your favorite hat). As you stated, the maintenance cost is very high and expensive.

July 13, 2006

Propecia and Androgenicity – Hair Loss Information by Dr. William Rassman

I have been on propecia for the last three month. I am bout to end month three and have noticed that my temple hairs have become noticably thinner than before I started propecia. I have increased sex drive and more morning erections. For a while I was having some scalp irritation which has gone away. Is it possible I am being affected by androgenecity? Prior to taking propecia I had my total test. checked and it was at about 250. I am 24 years old. I am hoping that my temple hairs have been pushed into telogen and this is why I have thinned in these areas. I have a good amount of hair on my head and want to maintain it. What do you think? Also, many of my hairs that have been falling out look to have a white type of pulp on the end near root.

Your report of an increased sex drive is a well known side effect of Propecia (most people seem more concerned and worried about the decreased sex drive which occurs in 1/100 to 1/200 patients). Men generally get an increased testosterone level of about 18% on Propecia in the initial month or so. This often returns to normal after 1-3 months. Testosterone is a far more potent that DHT as a male hormone for sex drive.

Your hair loss may just be a normal progression of your male pattern hair loss and Propecia may actually be slowing its progression (even if it seems you are losing hair). If you are concerned about hair loss, you may consider visiting a hair specialist who is able to quantitatively record the miniaturization of your scalp hair and perhaps even determine the degree of future hair loss.

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July 13, 2006

Rapid Growth in Frontal Area, Slow Growth in Crown After Transplant – Hair Loss Information by Dr. William Rassman

I had a 1565 follicular unit transplant 3.5 months ago and I seem to be experiancing a more rapid pace of growth on my frontal hairline compared to that of the growth on my crown. I am curious to know weather of not this is common and if the number of hairs within each follicular unit impacts the rate of growth? The doctor who operated on me put 3 and 4 hair follicular units on the crown and 1 and 2 hair units in the frontal region.

Almost every patient will experience varied rates of growth by where in the scalp you are looking. I have seen the crown exceed the frontal growth rates and visa versa. You must have patience. Generally you can expect newly transplanted hair to grow within 8 months. You seem to have a relatively early growth and I suspect the transplanted crown area to catchup.

July 13, 2006

Rapid Weight Loss and Gain Caused Female Hair Loss? – Hair Loss Information by Dr. William Rassman

(female) I have been on Topamax 200mg twice a day for over a year now, I have also been taking Ritalin 20mg twice a day for the same lenght of time, and taking Xanax 2mg three times a day and Baclofen 20mg three times a day for about six months. I have also had a problem with anorexia and Bulimia for quite a number of years now and been up and down on my weight from about 72 pounds to around 145 to being stable at around 90 pounds for quite awhile now. I am a strick vegetarian and am now taking 65mg of iron twice a day and drinking a protien drink every morning. But for about the last four months my hair has been falling out all over the place, it falls out when I shower,in my sleep, when I run my fingers through it, blow dry it, brush it, on my clothes, ect..I am taking all the vitimans I can think to take but it just keeps falling out…and I had stopped taking my medications to see if that was the problem but it hasn’t helped. Could you please advise any helpful information on what I can do to stop the hair loss and get it to regrow, your help would be greatly appreciated.

You have “been there and done that” with things that are known to cause hair loss, including the medications, severe changes in diet with weight loss, and dietary problems that could lead to a variety of vitamin deficiencies (too many to list here). These stem from your weight problems. Looking over your list, I would not know where to start. I think that you should find a good doctor that you trust and can form a bond with, and then tackle your hair loss problem as a matter of focused attention. This is not something for internet medicine. I wish I could offer more, but I’m limited to what I can do through text on a screen.