Author: Dr. William Rassman

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How can I tell if my minoxidil and dermroller is working?

Ive been using 5% minox for about a month now along with dermarolling once a week and anti dandruff shampoo. My hairline hasnt improved much but i noticed lots and i mean LOTS of small hairs around the hairline after shower today. I heard hairs shrink before they fall out, the little hairs actually lay flat on my forehead so they mask my slightly receded temples nicely. Are those new hairs or are they about to fall out (i hope they dont because there really is a lot of them)

The best metric for measuring your progress of lack of progress with minoxidil or finasteride is the HAIRCHECK test (see here: https://baldingblog.com/haircheck-test-how-it-is-done-video/) . Hair is too important to take hair loss any way but serious. A man from Reddit came into my office today because he was very worried about the hair loss he saw in the shower. He also was worried about his hairline, so I did a HAIRCHECK test and told him he was not balding at all, and his hairline was just maturing. He smiled as he left the office because I took a weight off of his back.


2020-11-05 12:45:26How can I tell if my minoxidil and dermroller is working?

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How Can Necrosis Occur After a Hair Transplant if Antibiotics Are Used?

Dear Doctor,

i would like to ask you about necrosis and skin infection. Since each patient is given a post-op course of antibotics, how can this happen?
i thank you in advance.

There is no connection between necrosis (this is a vascular problem to the skin) and infection (this is something that can happen after necrosis occurs, or can happen without necrosis).

If you have necrosis, tell me a bit more about it: When after the surgery did it happen? What was the size of the necrosis? Where was it located (donor or recipient area)? Did you have FUE of FUT. Without this information and some good photos, there is little help I can offer.


2013-03-04 10:50:42How Can Necrosis Occur After a Hair Transplant if Antibiotics Are Used?

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How Can I Tell if Propecia is Working for My DUPA?

Hello Dr.Rassman i have been taking propecia for 8 months in the hope that it will help my DUPA hair loss, and i was wondering how i can tell if its working? i wear a light woolie hat on most of the time, would the hairs on the hat after each day be a good indication of if its working? because i don’t notice more that 15 or 20 a day.

well thank you for your time doctor

The right answer is a twofold approach:

  1. Follow the photos of your hair from various perspectives with the hair cut to the same length — and do this yearly.
  2. Rely on the science of metrics (measurements), which is best done with mapping out your scalp for miniaturization and then get a number each year on what is happening with the miniaturized hairs.

If your diffuse unpatterned alopecia (DUPA) is responding to treatment, the number of miniaturized hairs will be proportionally less.


2008-03-24 15:37:46How Can I Tell if Propecia is Working for My DUPA?

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How Can I Tell if New Hair is Growing After TE?

Hello Dr Rassman, I was wondering how you can tell if new hair is growing. I had Telogen Effluvium starting in october or so and it has stopped and i can only see new growth right at my frontal hair line. I am also using retin A and it gets applied around there so im not sure if it is the retin a regrowing the hair or my hair is growing everywhere. IN SHORT: Is it possible to see new hair growth mid scalp amongst long hair.

Also, Im unclear about when people say hair may not regrow from TE. Is this only if the people were going to bald within the next few years, in other words will hair always grow back from TE so long as you have no predisposition to genetic balding .

With telogen effluvium (TE) you will likely regrow the hair, but in some people it may not always grow back to the full thickness you once had. In your case though, you stated that you are seeing new hair growth. So there you go! If you want to see it under a video microscope, these new hairs show up well. Logically if you are seeing short hair growing amongst long hair that would be new hair growing, right? There is no big secret to seeing hairs grow.

With respect to Retin A, I doubt that is causing the hair growth, as it is an irritant.


2009-06-12 15:15:23How Can I Tell if New Hair is Growing After TE?

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How Deep Do You Make the Holes When Placing Hairs?

Thanks for the great site and the time you put into it. I have a couple questions. First of all, I watched the episode of John and Kate plus Eight and thought it was very informative.

I would like to ask that when you make the sites for the grafts, how deep do you go into the scalp? Second question, I receive finasteride from a doctor here in Canada. The pills are a capsule not a tablet. Do you have any knowledge of finasteride being sold in capsules? I’m just curious if i’m getting the real thing.

PropeciaI do not know about the capsule form of finasteride. There are many phony drugs on the market. Only Propecia, which has a distinct look (see photo at right), is guaranteed to contain 1mg of finasteride, because the drug company Merck controls the patent on it and no one else can legally manufacture and sell it in North America. The only way is to send it off to a laboratory for analysis.

With respect to how deep I make the incision (or holes) — they are about 5mm-6mm deep, which is about the length of the hair follicle. Some people (like Asians) have longer follicles than Caucasians. One of the most important jobs of the surgeon is to make sure that the incisions are uniform and deep enough to take the full follicular unit, as well as control the direction and the angle of the incisions. The hairs will grow in the direction that the incision was made. Sometimes when doctors do not make the correct angle, your hair may grow out in an improper direction making it difficult to manage and may be unnatural looking.


2008-07-25 14:09:37How Deep Do You Make the Holes When Placing Hairs?

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How Can Someone With No Family History of Balding Lose Hair?

Hey I had a quick question,

I am sure this has been answered before but can you explain how someone with no history of balding on either sides of their family can go bald? And vice versa how someone whose entire family is bald can keep their hair their entire lives?

Thanks

Genetics should be studied back a few generations to outline the real incidence of balding in the family line. Balding can skip a generation or two. In some families, a child may be adopted and not be told, so the genetic line may not be pure. In any case, I hope you are not going to blame your grandparents for the balding you may be experiencing.

As for how someone can keep their hair with a great incidence of balding in their family — well, it’s just how their genetics played out.

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How Can Shock Loss Be Avoided If You Transplant Into a Thinning Area?

Doctor, I just watched a video of a transplant and I don’t see how you avoid shock loss or at least loss to hairs in the recipient area when filling in a thinning area as opposed to a bald area. Propecia or not, that’s a lot of trauma. There has to be some TE going on there. Maybe you have techniques that can minimize it but I have to believe you can’t avoid it. And you’re going to lose some nearby hair after a procedure.

Again I’m talking about a thinning area not bald. Maybe 30% or more of original hair left. You say it doesn’t happen much anymore because of Propecia, From what I just watched just doesn’t seem possible to me. it would certainly seem it would accelerate loss to any hairs that are miniaturized or about to be.

I speak from my experience over 23 years. In the days before Propecia, when we did a hair transplant, almost every patient developed some degree of shock loss. It was so common that I always told the patient to expect it, and that if it happened (which it usually did) we might have to do another transplant just to address the shock loss. I often increased the number of grafts just to address this possibility.

When Propecia came on the market and many patients who eventually asked to have a transplant after the drug failed to meet their expectations, I noticed quickly that the shock loss problem was far less frequent that on those patients not on the drug. Although I never reported this in a medical journal publication, it was not just my own experience, but the experience of many other doctors as well.

Hair loss following a hair transplant procedure is most often in the hairs that are miniaturized, or at the end of their normal life span. These hairs, I suspect, are far more sensitive to the trauma of the anesthetics and/or the surgery. The use of finasteride (Propecia) is not foolproof for preventing shock loss, but it is darn good.

As we don’t really see the hair loss and/or miniaturized hairs in the parts of the scalp that doesn’t look like there is balding present, even since I have been performing bulk analysis of the hair, I know now with absolute certainty what I suspected for many years — in many men, 50% of the hair that may be in a miniaturized state to some degree is where the shock loss occurs. I call this clinical observation by a questioning mind, like mine.

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How common in PFS?

Post Finasteride Syndrome is very uncommon. In my practice of 27 years, I have prescribed this drug on tens of thousands of men, although I did hear reports of sexual side effects in between 2-4% of these patients, I have never had a single case of PFS discussed with me. I have very good relationships with my patients and I am absolutely sure that if their sexual side effects would have persisted, I would have been part of the solution for these patients and been involved in their management of the problem.


2018-12-08 09:02:08How common in PFS?

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How Can You Ridicule the LaserComb But Support Rogaine?

Hello Dr Rassman.

I have a slight bone to pick with you, regarding some interesting comments made about the Lasercomb. In one of your articles you mentioned the line “I still go by my gut feeling, an application three times a day by a comb going through the hair just does not sit right with me and my intellectual judgment (which dictates a great deal about why I think that way)”. I would like to point out the ridiculous parallels of this comment to a certain other product called Rogaine. Firstly no one actually knows how Rogaine works (the company readily admits this on there website) Secondly I dont think its any more absurd or outrageous to think a comb with lazers is any less effective than putting an alcohol like solution called “Roagine” which no one really knows ingredients of and how and why it really works on your head everyday. Or for that matter Propecia. They all take an element of FAITH! But at least the lasers have a basic theory of stimulation of the hair follicle. How the hell does alcohol going to do any better?

To answer to your question, I need to explain a bit about medical research, which could be found behind almost any new treatment modality in medicine. Any new drug needs to go through different phases of testing before becoming approved for use in humans. The LaserComb did not go through such testing, but rather got FDA approval because other such devices were approved in the past (predicate device).

New treatment modality first needs to go through preclinical testing, which involves using new treatments in the lab, including cell cultures followed by its use in animals for its efficacy and safety evaluation. If it proves safe and effective in animals, a clinical trial follows.

Clinical trial is the direct application of a new drug on humans and has four phases:

  1. Phase one is the first stage of testing drug in a small group of volunteers. This phase is done to prove safety and tolerability of drug.
  2. Phase two is performed on larger groups of patients to assess the efficacy of the new treatment and its possible side effects. This phase usually last a few years.
  3. Phase three is a randomized controlled trial on larger groups of patients (a few hundreds to thousands of subjects). It is done to define the value of a new treatment in comparison with other available treatment options. If medication passes this phase it could be offered for its general use.
  4. Phase four is performed on a longer period of time, and involves post-launch safety evaluations, long term adverse effects and technical support of a drug.

Minoxidil is a medication that was initially used for the treatment of high blood pressure. This medication was first studied for one of its side effects, “increase of hair growth” in the early 80s. After its effectiveness for treatment of androgenetic alopecia was confirmed by initial studies, it was studied on cell cultures, animals, and humans in different concentrations. Several research centers and universities studied the effectiveness of this medication and its comparison with other modalities. Since the experiments in the early 80s, minoxidil was first suggested for its use for treatment of androgenetic alopecia. It has been studied for different groups, sexes, ages, and races. Numerous research projects directly evaluated the effectiveness of minoxidil since early 80s. The result of these studies is over 100 articles that are published in major peer reviewed medical journals.

Although the application of laser for treatment of baldness sounds glorious, so far there is no reliable research papers in peer reviewed journals to prove its effectiveness for hair loss treatment. A physician, unlike a sales person, needs to see solid based research published in peer reviewed medical journals before being able to use or recommend a new treatment modality. For the LaserComb, none is available at this time.


2007-03-09 15:37:56How Can You Ridicule the LaserComb But Support Rogaine?

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How Common is Hair Loss Following Gastric Bypass?

Hello Doctors,

I just read an article from a writer for the local paper about her 100 pound weight loss following gastric bypass, which is something I’ve considered doing for myself. One thing that stuck out to me was that she says, “One common post-surgery side effect is hair loss. And I have been losing my hair. I knew about this before surgery, so I am dealing with it. I don’t like it, but it will grow back, and I have also lost most of my eyebrows, but that too will grow back.” See article here.

So my question is, how common is this loss? Scalp hair loss is a problem in itself, but to lose my eyebrows too would be devastating. How long could something like this take to regrow (or will it not regrow)? My husband visits this site quite frequently and when I mentioned the story, he suggested I write to you. Thanks for your help.

A gastric bypass surgery causes weight loss and in many cases can produce signs of malnutrition. Weight loss is often associated with hair loss, particularly in men who have genetic hair loss. For women who do not have genetic hair loss, the hair loss may reverse as nutrition gets better and the weight stabilizes, but for men with genetic hair loss, it often accelerates the genetic process. For men in this situation, it’s best to take finasteride prior to having the gastric bypass, and maintaining this drug for life. Even with the DHT block offered by the drug finasteride, hair loss may still occur.

The good news is that hair transplantation can be used to replace the lost hair in the same way as in a person with hair loss that didn’t have the gastric bypass. As far as eyebrow loss, it would be unusual, but again, hair transplants into the eyebrow easily can solve that problem as well.


2009-10-27 15:05:47How Common is Hair Loss Following Gastric Bypass?