Author: Dr. William Rassman

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2011 ISHRS Meeting Review, Part 2 – Female Hair Loss

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 2. More to come…

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What is the role of immunity in the development of androgenic alopecia in women?

    In men and women, it was suggested that there is an immune response in genetic hair loss that could either trigger the process or be an early sign that hair loss is about to start. Dr. Neil Sadick of New York has been following female hair loss for years. He showed his results from scalp biopsies of the scalp in women with hair loss. What he saw were findings that were similar to the conditions found in diseases like lupus (an autoimmune disease). He believes that female pattern hair loss is attributable to immune driven inflammation and he believes that this interferes with hair stem cell activity as they enter into the growth phase of the hair cycle.

    The earliest symptoms of many women and some men start with pain and itching of the scalp, a set of symptoms that reflect the inflammatory response that he believes is always present, but often ignored. He raises the issue that if the connection is correct, the scalp may respond to the use of steroids in the earliest phases of the hair loss process.


 
Double trichophytic closures

    Double trichophytic closures were demonstrated in a poster presentation, suggesting that this procedure can “wipe out” scars from FUE in 99% of patients. I personally doubt this claim. This reflects first time surgery patients only, as these patients are at a lower risk for significant scarring.
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2011 ISHRS Meeting Review, Part 5 – Finasteride

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 5. More to come…

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Does finasteride (Propecia) impact the body’s inflammation response in hair loss?

    Dr. Marty Sawaya produced evidence that there is a connection between genetic hair loss and inflammation of the hair follicle. She believes that DHT may have a direct impact on the inflammatory process. With this insight, other potential treatments for genetic hair loss and other hair and skin disease may evolve.

 
Are finasteride’s sexual side effects overstated?

    Despite internet complaints to the contrary, there are no case reports of sexual dysfunction that remained after finasteride was stopped in those patients who reported sexual side effects. The medical literature shows that sexual dysfunction is present in 40+ percent of men over age 50, so it was difficult to assess the 2% occurrence of sexual side effects in a comparable population. Despite this, changes in warning labels have been mandated in the United Kingdom, Sweden and most recently the US.

    One joke on the floor I overheard was that based upon the internet reports, the average 50 year old had a better than 40% risk of sexual side effects, but that reduced to only 2% for those reporting side effects from Propecia, making Propecia less risky for those side effects.

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2011 ISHRS Meeting Review, Part 8 – Minoxidil

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 8… and final part. Thanks for sticking with me on this!

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Minoxidil as a systemic medication?

    Dr. Damkerng Pathomvanich (award winning doctor from Thailand) experimented with the use of minoxidil as a systemic medication on patients. This medication is used in many Asian countries as a treatment for hair loss. He commented that when spironolactone is added to systemic use of minoxidil, there is an enhancement of the hair benefits and a reversal of hair loss in many people. Although the reported side effects of this approach were small, there are still many side effects with these medications (e.g. significant drops in blood pressure, weight gain, fluid retention, rapid heart rate).

    These systemic medications are not FDA approved in the United States for the treatment of hair loss, as well as many other countries. Minoxidil was originally used in the 1960s as a treatment drug for high blood pressure, but its impact was not consistent with lowering blood pressure. Many of these earlier patients developed a reversal of their hair loss and many women treated with it developed facial and chest hair.

 
Aspirin and hair transplantation?

    A hair transplant surgeon who is also a cardiologist suggested that a person on low dose aspirin can have a hair transplant without stopping the aspirin.
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2011 ISHRS Meeting Review, Part 7 – FUE Robot

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 7. More to come…

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Robot assisted hair transplantation was introduced for sale at the meeting.

    It had been approved by the FDA earlier this year. There was considerable excitement generated by doctors, however, the high price tag ($200,000 plus $1/graft) certainly dampened the enthusiasm. This meeting was a come out party for Restoration Robotics’ hair restoration robot, a very impressive modern technology. The company believes that hair transplants will follow other minimally invasive and more precise surgeries such at the robot assisted surgery for the prostate, the heart, the uterus, the lung, and on and on. The hair transplant robot is called Artas® system, and will clearly standardize the quality of FUE grafts and minimize the damage when used by surgeons who are not as skilled in the manual techniques as some of the more experienced surgeons; however, all three of the first surgeons to buy the robot are experienced in the field of FUE. Restoration Robotics wants only the best surgeons to purchase and use the system.

    One experienced hair surgeon, Dr. James Harris, has been testing the robot for some time for the company. Dr. Harris invented and marketed the most popular FUE harvesting tool (The SAFE System), which has been installed in over 200 hair transplant practices around the world. Although the two technique are comparable, Dr. Harris felt that the robot will minimize the tedium of doing the procedure for the doctor. I totally agree with him and I firmly believe that the new technologies like the robot will become the way of the future as FUE gains market share. The only question yet to be answered is “Who will pay for the higher costs of this procedure?“. As many of today’s hair transplant surgeons do not offer FUE, this opens the appeal for doctors to buy into the FUE technology to expand their service offerings. The unit is expensive, but should pay for itself easily in 4-7 years.

    The Artas® system will generate more interest in FUE and many newcomers in the field will start to offer manual FUE at discounted prices to kick-start their business. All FUE techniques and surgeons are not equal and new doctors without extensive experience are bound to create significant transection of FUE harvested grafts causing more than their fair share of hair transplant failures. Unfortunately, the average prospective patient who does not do their research may fall trap into the pricing competition. The results will be (1) high transection rates with graft kill, (2) failure or the hair transplant to grow in significant quantities, and (3) large scale destruction of the donor area hair (something that is never reversible). This, as I have said before, is a buyer beware business for the potential FUE candidates looking for a bargain.

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21 and shaved my head, what to do?

You are a great candidate for medications and microneedling. Your age means that the hair loss is recent and your chances of reversal of the hair loss are good.


2021-06-01 06:49:1521 and shaved my head, what to do?

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Balding Blog – 2011 – Hair Loss Information

I’m very seriously considering starting a course of propecia/proscar. But before I began I wanted to ask two questions.

1. It has been said that if you start propecia early the better chance you have of slowing down/halting hair loss, but that doesn’t tally with the propecia chart from studies which show that it generally peters out after 3 years. so surely you’d only save your hair for 3 years and then it would quickly regress, not making much difference how early you start because you only have 3 years of good hair.

2. I was wondering if you could recommend a good dermatologist/hair doctor in London, who I could have a consulation with before I begin taking proscar, do you know any who do miniturisation tests or some kind of form of monitoring on hair loss? There are a lot of snake oil merchants in London that are willfully telling you that you must get on medication and I just want to talk to who is honest and experienced.

Block Quote

I have many patients that have reversed their crown loss and held the reversal over 10 years. Everyone is different, but the official studies show that the expected maintenance should be about 5 years on average. That means that some men get better than 5 years and some worse results while on the drug. It depends upon how aggressive your genes are.

As to your second question about London-based doctors, Dr. Bessam Farjo is a contributor to this site. He and his wife are terrific doctors and worthy of a trip to their offices (in London and Manchester). They may be able to give you a referral if you call their office.

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21 and thinking about a hair transplant

i’m only 21 so i can’t really get a hair transplant until down the line. i got put on 2.5 mg minoxidil earlier this year and i passed on using fin. i’m fine with using this pill for the future because it hasn’t really affected my day to day life in any way and my health is fine, but i was just wondering if it’d even be worth getting a hair transplant down the line if my balding is genetic and it will keep slowly spreading, wouldn’t i have to get like several transplants over time?

I make my living doing hair transplants, but I almost never have done it on someone of your age. I wait until 25-6 before even considering it. Maybe the oral minoxidil will work and you will not bald. Give the drug a chance and stay on it.

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Balding Blog – 2015 – Hair Loss Information

http://www.pressreleaserocket.net/the-aesthetic-surgery-journal-publishes-groundbreaking-study-on-nape-hair-for-fue-hair-transplantation/328237/

Taking neck hair, which is often finer than scalp hair, has problems with it. These problems include:

(1) more prominent scarring occurs in the neck and the neck area is very visible so such scars will be detectable as punctate scars

(2) neck hair is often not permanent hair as scalp hair is, so if one transplants the frontal hairline with these finer hairs, they may disappear with age.

This is a warning to those who see this press release. They must know the risks associated with a neck hair donor area.