Dr. William Rassman – Page 1878

January 13, 2006

Miniaturization? – Hair Loss Information by Dr. William Rassman

I have gone to a number of doctors and asked, as you have advised, to map my scalp for Miniaturization. They do not know what I am talking about? What should I do? Are you the only one who does this? How important is it?

There are a series of hair metrics (measurements) that any good doctor must do for a proper analysis of your scalp. First, if the doctor waves his/her hand over your head and says that you have a fine hair density, run for the hills. Good metrics require scientific measurement and the science of densitometry as I have defined it in scientific publications (such as this article from 1993 which discusses densitometry) .

If you step back for a moment, you will see that if you do not know just how much hair you have and the value of each hair, then you do not know much about the way your hair (or lack thereof) will meet your needs as you replace it. Metaphorically, think about a house, where half of the house has been eaten by termites and you need to replace the wood that is not any good. Then you want to add a room on at the same time. It would be crazy to try to do this job without assessing just how much wood is rotten (miniaturized hairs), how much wood is available from the lumber yard (assuming that you have a limited amount of wood/hair from the donor area), and how much area you intend to build up from scratch (the balding area which needs to be restored). If you can not measure any of these factors, you can not determine your needs, which must be matched against supply. It is not very complicated when you know what you are doing.

It would be absurd for a doctor to tell you that measurements are not important in determining early balding (miniaturization). It would be as if he/she is saying that the pending termite damage is irrelevant, and to just wait until the house caves in. Crazy? If you do not know if your wood supply is in 2×2’s, or 4×4’s then you do not really know the value of the essential replacement resources you have. If you have miniaturized hairs in the donor area, then you might have a disease which will contradict a hair transplant, but without measurements you can not say. If the termites have invaded the wood supply (miniaturized hairs in the donor area which is a disease in men and a common finding in women with genetic hair loss), then you can not build a house (trusses and all) with 2×2 studs alone (damaged or otherwise inadequate in quantity), you need wood beams and 18 on center 4×4 studs to support a wall properly. Likewise, you can not put in single hairs or damaged hairs into the transplant to do what god’s follicular units are doing for you now like when you were young.

So, to conclude, a doctor adds very little value to your Master Plan to help you determine what you must do over time, when the doctor does not use measurements to determine:

what the status of your scalp is at the time he starts Propecia with regard to miniaturization and in predicting your final hair loss pattern
what you are losing
what you have for supply to replace what you are losing or lost

This is not about the doctor making money doing hair transplants to all balding men, but rather using a full arsenal of treatments available to you, determining the value of those treatments over time and using his/her skills to your overall benefit. You have must a real clinical scientist / caring physician on your team who puts your benefit and goals above all else.

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January 13, 2006

Psoriasis and Rogaine – Hair Loss Information by Dr. William Rassman

I have scalp psoriasis and consequent thinning patches. Would using Rogaine aggravate the psoriasis?

Rogaine (minoxidil) can cause skin irritation and may aggravate your psoriasis. You might try it and see. The worst case is that you make the psoriasis worse for a few days. Many people with psoriasis have to experiment on how to manage the disease. It behaves differently in different people.

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January 13, 2006

Remember to Vote for Balding Blog – Hair Loss Information by Dr. William Rassman

I need your help!

This is the last reminder to please vote for Balding Blog in the annual Medical Weblog Awards! When you click the link below, find the little circle to the left of “Balding Blog” (4th in the list), then click the Vote button. It just takes a few seconds of your time and is very appreciated.

Thanks again for your support!

UPDATE: Voting is now over. I’ll make a new post about it when I know the results.

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January 13, 2006

Tachycardia from Minoxidil? – Hair Loss Information by Dr. William Rassman

What is the likelihood minoxidil caused an episode of tachychardia where patient is a healthy 48 year old female with no cardiac history or risk factors who used it on her scalp for a week prior and whose symptoms did not recur upon cessation of use?

There may be a direct association between tachycardia (fast heart rate) and minoxidil (which is a hypotensive agent that drops blood pressure). Many people complain of dizziness with this drug and what they are probably experiencing is a small drop in their blood pressure. When blood pressure drops, the first thing the body does to compensate for it is to increase the heart rate, so your symptoms fit nicely into the physiology of the cardiovascular system.

January 12, 2006

Hair Loss InformationThe Value of Hair Transplant Experience – Hair Loss Information – Balding Blog

Is hair transplantation an art form? Does one doctor really get better results than another? If it is only technicians putting grafts into holes in a head, how is it worth the money that you doctors charge?

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Hair transplantation is a discipline that includes a sense of artistic balance, a sense of meticulous organizational skills, good judgments, and lots of experience. I know this because I see too many hair transplants that reflect failures of these elements. For example:

Artistry: I can tell that a person had a hair transplant just by the location of the hairline. There is a range of normal locations, yet many doctors tend to place the hairline too high, in order to conserve hair, when the location is clearly not ‘right’. The eye catches something is not normal, and even when, on close inspection, the grafts meet the follicular unit golden standard for today, you know that something is wrong.
Teamwork: Poor growth may reflect poor organizational skills and less than experienced staff. Many doctors use itinerant staff, brought in and paid by the hour. They were trained in different offices with different standards and learned habits and techniques that may not conform with the same standards as other team members. Many of the technicians who were terminated from NHI, now work as itinerant technicians who move from office to office. They bring with them the same bad habits that caused them to lose their job with me. Unless a doctor’s team has been working with that doctor for years and are self disciplined with a common focus using strict quality control processes, the team’s work will often reflect the weakest person working on the case. It is critical to recognize that today’s modern hair transplant standards are a team effort, not the output of a single individual, doctor or nurse.
Judgment: The problem with balding people is that hair loss is a moving target, progressive over time. For the hair transplant surgeon it is also a matter of balancing supply of donor hair and the ‘moving’ demand of balding. A surgeon must work in the present time using what hair is reasonable to move today, while preserving hair for future hair loss so that the patients always looks normal. I have seen people who have had grafts placed in a 2 inch bald spot in the crown, which then advances to a 5 inch bald spot in the crown. They had an island of hair like an oasis in a bald desert. The same is true for frontal balding in the young man who has corner recession and gets them transplanted only to find that the corner recession advanced to full frontal balding. He comes to my office with ‘wings’ protruding out at the corners and a bald area around it. Both of these men looked freakish, so that any short term benefit they received was offset as their balding progressed. The unfortunate fact is that too many young men do not recognize that their bodies (and balding patterns) will change over time.
Experience: I can not say that experience is king here, but I can say that experience means that mistakes should be minimized and #1, 2 and 3 above, have been incorporated into the routine of the transplant surgeon. I am fortunate to have become the doctor’s doctor in the Beverly Hills plastic surgeon community. These surgeons have had their transplants done by me or they have sent their patients to me and have seen the results we get. I have focused much of my professional career to publish the lessons I have learned over the years in the most prestigious medical journals and text books. Often I have had patients come to me saying that Dr. X told them that he invented ‘blah, blah and blah.’ I always tell the patient to have the doctor prove that they are the inventor and most of the time what they can’t get the information they are asking for. Falsely claiming authority or inventor status should not be taken lightly, as it is a measure of the fabric of the surgeon. Look up his/her credentials and experience and only believe what you can verify.

I can go on an on here, but to see what I am talking about, visit my website. There are over 200 patients with before and after photographs on the site and copies of much of what I have written and published is in the medical literature. Yes, hair transplantation is expensive, but would you want people to immediately say, “Nice hair transplant”? No one should even know.

January 12, 2006

Low Iron and B12 Causing Miniaturization? – Hair Loss Information – Balding Blog

Hi,
First I would like to thank you for providing this site, it has help me a great deal. Here is my question. I am a 31 year old female suffering from hair loss, and as of yet I do not know the definite cause. My question is concerning all that I have read about the possibility of vitamin deficiency causing hair loss in women. My doctor runs routine bloodwork every year, and for approximately the past 10 years I have had low iron, low B12, and my last set of tests, last year, did show that I also have an overactive thyroid. Throughout this time I have never taken the supplements that were advised by my doctor, I am now regretting that, and have since started. Now to the question, with being low in iron and b12 for so long cause miniaturization? I have miniaturization hairs throught my entire head, and very thin on the crown, and this is why I am questioning the effects of vitamins and hair loss. From what I have read miniaturization and thinning at the crown usually indicates AGA, however I did read once that low iron could mimic AGA with miniaturization. And I am hoping that this hair loss that I have is from low vitamins for a long period of time, and not AGA.
Thank you so much in advance.

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Yes, low iron and B12 can cause hair loss. Get a good doctor to take charge of you, as that is the best approach to the problem.

January 12, 2006

Can I Have Thicker Hair After Transplant? – Hair Loss Information by Dr. William Rassman

I am a young teenager who is not balding (yet.) I am worried about hairloss, because every male in my family is totally bald, except on the sides and back. I probably will have it by the time I turn 25 or 30(never asked anyone in my family when they started to lose hair, but I know my uncle started to lose hair at about 27 or 28.) But I have a question about my hair now. My hair has always had these various areas where there is really thin hair. They are like lines, not spots and seem very thin. I really don’t want to take pills or other applications to keep the hair I have, but am considering hair transplants when I do start to experience male pattern balding. If I do get hair transplants will there be an option to make my hair thicker? If not, will taking propecia after a hair transplant session make it thicker, or at least make the thin areas seem thicker? Please respond. Thank you for your time.

People use the word “thickness” to describe various contributors to ‘fullness’ that reflect very different aspects of hair; (a) the diameter of the hair shaft (i.e. the mass of the hair), (b) the density of the hair per square centimeter of scalp, (c) the character or wavy nature of the hair, (d) the color and contrast between hair and skin color (the lower the better). Propecia can improve the diameter of the hair shaft in a balding area, stop its eventual loss, or possibly make it regrow making the area thicker. Transplants can add donor hair (from the back) in between native hair (at the top or wherever the thinning area is) to increase the density of the hair in a particular area, also making it thicker. It is a little more complicated then this explanation, but not much. Doing both together (Propecia and Transplants), as you might imagine, will have an additive effect – that is, it will look even better. But doing both may not always be the right thing, if the anticipation of the results of Propecia alone may achieve the results without a hair transplsnt. Then you get the benefits without a surgery. That means that when you get evaluated by a doctor who can transplant your hair, you want a doctor with high integrity, one who will not recommend surgery if there is a reasonable possibility that Propecia alone will do the job.

As an aside, every male (and even some females) in my family also has some degree of hair loss, so I know where you are coming from. First and foremost, please get an assessment of miniaturization in order to detect when and if the genetic process started. A yearly check with a good doctor should show that to you. If and when you start balding, you may want to reconsider your decision not “to take pills or other applications to keep the hair I have.” Recent studies indicate that patients get the most improvement and are happiest when they keep the hair that they have, in addition to replacing what they have lost. As a surgeon I can tell you that nature does it a lot better than any doctor can – keeping what you’ve got is truly the best course of action overall.

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January 12, 2006

Covering Up a Bad Haircut? – Hair Loss Information by Dr. William Rassman

I cut my bangs too short in the front and now I have a bald spot. what do I do to cover it up besides a hat? HELP

The good news is your hair will grow back, the bad news is that it will take time. Other than a hat, I often suggest color-matched Toppik to help cover areas with hair loss where the scalp shows. Honestly, though, if you have a good sense of humor, that is the best way to cope. You might also try a professional hair stylist to avoid the problem in the future.

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January 12, 2006

Hair Doctor? Hair Specialist? Hair Consultant? – Hair Loss Information by Dr. William Rassman

I understand that miniaturization is the first step for most people to begin understanding hair problems. But this procedure seems very exclusive as I have not often seen this on the internet for searches in my area.

I live in montreal Canada and I don’t even know who to look for to consult: Hair Doctor? Hair Specialist? Hair Consultant? I do not know the name of the profession so finding someone to help me is difficult.

What am I looking for exactly? And do you know if this procedure is availible for my area?

Visualizing instruments that magnify the detailed microscopic view of hair follicles, allow the viewer to estimate the miniaturization of all of the hair as compared to the healthy hairs in the field of view. The term ‘miniaturized hairs’ have been around for decades and they are the hallmark of genetic balding. I (Rassman) invented a practical instrument which I called the “Densitometer’ and patented it in the early 1990s so that every doctor could do the analysis. The tool was eventually sold by Radio Shack as a hand microscope for about $12/U.S. There are hair transplant surgeons in Canada, several good ones actually, and you should look for just that, a “hair transplant surgeon” who looks for the health of the hair and makes projection of the long term hair loss pattern with this hand held instrument. If the donor area has significant miniaturization, then the patient may have a poor outcome from a transplant. Now, my $12 hand held instrument is hooked up to video monitors and computerized for about $6,000. Still, although I use the video versions of it that are commercial (I paid about $5000 for mine), I still use the $12 hand version for measurement.

Choose a doctor who does hair transplantation exclusively (not on the side) and who has a good reputation among their patients. Often these people will call themselves a “hair doctor” but it is okay to question someone about their practice if you are unsure. “Hair Specialist” or “Hair Consultant” is likely to be a non-medical professional (in North America), usually knowledgeable about the procedure but not medically trained. I suggest you check their website, visit the doctor’s office and ask to meet many of his/her patients. At our offices in Los Angeles and San Jose, we hold open house events every month, which allow prospective patients to meet actual completed transplant patients, for we always say, what you see is what you are going to get. I personally like photographs, but photographs have the limitation of showing you what the photographer wants you to see. When you actually meet patients you can trust your eyes. Our upcoming Open House event schedule is available on our site. Also, go to the ISHRS site to find a listing of doctors who focus in this specialty and in your area.

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January 12, 2006

High Doses of Nutritional Supplements and Hair Loss – Hair Loss Information by Dr. William Rassman

Dr Rassman
Can you please tell me if its know whether mega doses of nutritional supplements (other than Vitamin A) can contribute to hair loss?
Thank you

This is a very broad question and one that this blog gets asked often. Unfortunately, since nutritional supplements are not regulated by the FDA, there is often very little information in the medical literature regarding side effects and/or scientific studies about how/if they work. You are correct that Vitamin A toxicity is known to cause hair loss so you should avoid doses greater than 50,000 IU. It would also be a good idea to avoid anything which alters your metabolism (thyroid is often a buzzword there) or your hormone levels. Some high protein diets have noted hair loss as a side effect, too. In the final analysis, it is just not possible to know without a specific analysis of a particular nutritional supplement.

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