Author: Dr. William Rassman

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20 Month Old With Possible Alopecia

I have a 20 month old who I am suspecting may have alopecia. Can you recommend a physician in the Chicago area who sees children and specializes in alopecia? Thank you for your time.

Look to the ISHRS website for a hair specialist, or even the American Academy of Dermatology for a listing. Best for you to consult your pediatrician as there are many causes of balding in young children that he/she should be able to treat and if necessary, make an appropriate referral to a competent specialist in the field.

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20 years after a hair transplant

There is no doubt that this man, now in his mid-50s, looks younger than his balding before state. I did his surgery 20 years ago and it is always a pleasure seeing my older patient. He maintains his hair situation from progressing by taking finasteride which he has been taking since 2002. He has no side effects. I want those of you who are looking at his hairline and see if you can see that this man had a hair transplant. I can’t tell even today. His hair transplant shows the value of a 1/4 inch transition zone made up with around 350 single hair grafts in front of the 2 and 3 hair grafts that bring on hair bulk. This shows that the hairline is not a ‘line’ and it should never be. The transplant does not need the finasteride to hang in for his lifetime because these hairs came from the back of the head where the hair is lifetime hair.

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20 year old wants a hair transplant

I am a 20 year old male and I want to discuss about hair transplant. I Started noticing hairloss since around age 19 and since then I have been using rogaine to help me with it(about 7 months now), I have also just started finasteride a month ago. Although I only have a small amount of recession, I want to get a small hair transplant done so that my hairline looks good. I am a model/actor hence I am in front of the camera a lot and I need to keep my hair looking good in order to maintain a few of my upcoming roles. After doing a bit of research I came across the fact that hair transplant is usually done on people above the age of 25. But I am fine with getting it done two or even three times in the next decade as long as I can keep my hair! I also think it is worth mentioning that money is not an issue for me in the sense that having good hair would be an indirect investment into my career. What would you advise me?

Please look at these pictures: https://baldingblog.com/need-master-plan-think-hair-transplants-photos/ and see the need for a Personalized Master Plan that will not include a hair transplant until you are at least 25. This is clear because your balding will change and if you use us your donor hair now, then you might end up without enough to follow your future balding pattern.


2021-03-11 07:38:1120 year old wants a hair transplant

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I am 21 and just got an FUE to the frontal 2cm of my hairline and my crown. Should I transplant everything else now?

This is a terrible question as it reflects a doctor who is not ethical and a patient who is naive. A 21 year old might have early crown hair loss and frontal hairline loss along the hairline (Called a Norwood Class 3 Vertex pattern) which is not uncommon in a young man under 23 years old. Most of these men can stop their hair loss on the drug finasteride, but of course the doctor can’t make money that way, so this poor fellow had a hair transplant and will be destined to continue having hair transplants until is final balding pattern is evident (about 26 years old). If he does not have the donor density for this, he will look freaky as he runs out of hair chasing possibly the impossible. Ethical doctors are in the business so if you are under 25 and have hair loss, see on of the ethical doctor who does not rush you into surgery to pay for his new car.

Norwood Class 3

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Balding Blog – 2006 – Hair Loss Information

What is the scratch test you mentioned in a previous post?

Block Quote

I refer to the test as one used to discover a histamine positive skin type. The simple test is done by scratching the skin with a finger nail (for example) with moderate pressure, but not enough to cut into the skin. The skin will develop a red-streak within a minute surrounding the finger nail scratch. This, I believe, is local release of vasodilators at the skin edge. I have noted in my practice that people who react to the scratch with a red streak are the ones who tend to remain more pink after a hair transplant. When I transplant these patients, I will often use copper peptide dressing, which I have found gets the pink out sooner in these patients. I have had patients who were positive to the scratch test who were not treated after their first surgery and then when I did their surgery a second or third time, the addition of (1) copper peptide dressings after surgery and (2) the use of high dose steroids at surgery has helped minimize the pink discoloration over time. My view of copper peptide is not shared by many doctors, suggesting that what I observed have not been their observations and their experience.

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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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2000 year old man with hair (From Reddit)

The head of the ‘Osterby Man’, a Germanic warrior of the Suebi who died around 100 AD. He was struck by a blunt object before being decapitated and his head thrown into a bog. His hair has been perfectly preserved, tied in the distinctive Suebian knot worn by men of his tribe.


2021-02-14 06:59:152000 year old man with hair (From Reddit)

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2011 ISHRS Meeting Review, Part 6 – 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 6. More to come…

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Does finasteride induce mood and other psychiatric changes?

    A case report and literature review showed a connection between finasteride and mood changes. In one case presented, a patient suffered from severe disabling mood changes on finasteride, which ceased within a week after stopping the medication. After a short time period he restarted finasteride, and the mood changes returned within a few days. Other cases were reviewed with similar problems. There is little doubt that in some patients, mood changes and other psychiatric problems appeared with the use of finasteride.

    I believe that these case reports are the exception to what we commonly see and that finasteride is generally safe, but if a patient feels that they have changes in their personality or mood since the drug was started or if a family member sees changes in their mental state, they should meet with their doctor to discuss the appropriateness of their continued use of the drug.

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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.