Author: Dr. William Rassman

Posted on

Measuring the Mature Hairline

I know you explained how to measure the mature hairline with the wrinkled brow but you didn’t say how exactly. Do I need to put a ruler in the middle of my forehead and measure that way (this way it shows my corners are 2 inches receded) or can I put in highest corner of my temple and measure downwards if I do it that way I get 1 1/2 inches but my hairline is only 0.4inches away which is good. I believe I’m on a NW2.

Also around my temples I have a chunk of short hairs but there thickness is pretty much the same like other hairs. My hair is kinda longish you know. But what worries me that they will fall off and then my corners will be quite big. Is this all normal?

I’m almost 22 years old and my temples started to recede slowly since late 17s but in the past year just jumped up fast.

A maturing hairline is a generalization of how a young male will have a slight recession of his hairline in his teenage years or early 20’s. If you follow this “rule” (it is actually my rule) then there are three elements of it. A mature male hairline exists when:

  1. the middle of the hairline is about 1/2-2/3 inches above the highest crease of the furrowed brow
  2. the shape of the hairline is convex
  3. the sides of the hairline will rise about 1.5 – 2 times higher than the middle of the mature hairline

If you continue to recede beyond this area then there may be a genetic component of androgenic alopecia. This presence of genetic causation can be seen by mapping out the hair for miniaturization and looking for miniaturized hair substantially behind the leading edge of the mature hairline. And not to confuse anyone, but even though I call it a “rule”, there really is no specific rule to this. You cannot go by an exact set of measurements, such as 0.4 inches. If you are worried about this matter, I would see a doctor for a good microscopic examination (miniaturization study) of your hair to determine if there is a pattern developing.


2008-07-23 15:03:44Measuring the Mature Hairline

Posted on

Maximum Number of Transplanted Hairs

HI DOC, what is the average number grafts a person has to transplant from the donor area???

This is a difficult question, because it depends upon donor denity and donor laxity (assuming the strip method of harvesting). On average, I would suspect that the total number of transplantable hairs is between 15,000 – 20,000 assuming an average density and average laxity. Those with high density and laxity may push these numbers to double (30,000-45,000 hairs). I gave this answer in hairs not grafts, so based upon an average of two hairs per follicular unit, that number may be half in grafts.

If the FUE technique is perfected, then this number might change, but without more clinical experience, I could not answer this part of the question as the technique changes.

Posted on

Medicated Shampoo and Hair Loss?

Hello Doctor

I know many people with hair loss that use ketoconazole 2% shampoo times a week, thinking it fights seb derm. Others use salycylic acid shampoos 4 – 5 times a week thinking it thickens the hair shaft

My question is: Could overusing active medicated shampoos for long periods, contrary to official recommendations lead to permanent hair loss?

Thank you

I don’t think shampoos will cause permanent hair loss per se, but you should not be using medications of any sort in ways they are not prescribed or recommended.

Ketoconazole shampoo (also known as Nizoral, among other names) does work in treating seborrhoeic dermatitis, but you should follow your doctor’s recommendation for dosing.


2011-07-04 07:56:07Medicated Shampoo and Hair Loss?

Posted on

Medications That Prohibit You From Getting a Hair Transplant?

i am on coumadin. is hair transplant possible?

Coumadin (warfarin) is an anticoagulant, also known as a blood thinner. Blood thinners are on the top of the list of medications which must be addressed in a patient who is about to have a hair transplant. I have done transplants on people who are on such medications, but take many steps in the process to assure safety. Generally, one can cut back on the Coumadin and then step it up on the day of transplants. Your general health is really the issue and the reason you are on these medications may allow you to stop them for a week or so. The answer therefore is an individualized answer depending upon the patient, his/her medical condition causing the use of such a medication, and the general state of the patient’s health.

I take a thorough patient history and review all medications that a patient is taking prior to performing a hair transplant.


2008-06-16 09:30:04Medications That Prohibit You From Getting a Hair Transplant?

Posted on

Medications for Diffuse Unpatterned Alopecia

Hello. I am 24 year old male, who believes I am suffering from diffuse unpatterned alopecia. My hair is thinning evenly over the top and the side of my head to from the classic horseshoe pattern of a Norwood class VII. I have been taking Propecia since January and i do not believe its working as the thinning has progressed. My dermatologist did not seem to concerned and told me to continue taking it for the full year before asking for any other options. Are there any other effective options available? I have read about Avodart and minoxidil, or the possibily of a chemical imbalance, but I do not know if they are effective for this condition.

I believe that DUPA can be reversed with Propecia. I see this in about half of the patients who are taking it. For those like you, it may be worthwhile, after trying Propecia for a year, to consider Avodart, but I have said many things about this drug which you should review.

Posted on

Medical Causes of Miniaturized Hair?

in regards to low testosterone and low lh question that was answered…..

Are other medical causes that would contribute to hair miniaturization other than DHT/aga?

Male pattern baldness is not the only cause of miniaturization, which could be seen in many other conditions, such as Diffuse Unpatterned Alopecia (DUPA). Most of the cases of miniaturization are chronic conditions with gradual thinning of the hair. In more acute balding conditions, such as stress related hair loss, fungal infections, or alopecia areata, you may not see any miniaturization.


2006-12-07 10:35:05Medical Causes of Miniaturized Hair?

Posted on

Medications and Hair Loss. Can You Beat the Hair Loss with Medications for Years?

Thank you, Dr. Rassman. I know I am definitely thinning. Especially after shaving my hair. In certain lighting it looked like I had no hair in my corners and I could see straight through to the scalp. I have been using minoxidil with a bunch of hair sprouting along the hairline. And a great change in density. I did have a question for you though, how long would minoxidil keep my hairline? And if I start on finasteride, how long would that keep my hairline. I am being optimistic but I am hoping it extends my current density for the next decade if I use both together. I am also very hopeful that there will be better alternatives in the next decade, or quite possibly a cure.

I also would rather not consult my doctor as I know it is very obvious I am experiencing hair loss. I mean, I will have to when I go for finasteride. But I am someone who participates in homeopathy up to a point. So I would rather not alter my hormones unless it is my last resort.

Combining both minoxidil and finasteride will give you the best opportunity to hold on to your hair. I always tell my patients to look at hair loss as a ‘tug of war’, with treatment on one side and the hair loss process on the other side. As long as the pull from the medications is stronger than the genetic pull, you win. When the pull reverses, hair loss is the consequence.


2018-06-19 10:16:31Medications and Hair Loss. Can You Beat the Hair Loss with Medications for Years?

Posted on

Mechanism of Male Pattern Balding?

Can you explain more in detail the actual mechanism of MPB? I know that some hair follicles are sensitive to DHT and somehow the DHT causes miniaturization, but how does this actually work? Also, any wisdom on why some hairs develop later in life even where there were no (or not visible?) follicles. Like pubic hair and hairs on the chest and back as men age?

I am not going to write a book to answer your question but here is a quick summary: People who have the genes for hair loss, when exposed to DHT (normal for men to have this) trigger the process called Apoptosis (the progression of cell death) for hair follicles carrying the genes. DHT works directly on the growth center in the impacted hairs. Drugs like finasteride or dutasteride block this process so it slows down the effects of the DHT and the balding that occurs.

Posted on

Medium vs Medium Coarse Hair

Dear Docs,

is there any way to determine one’s hair shaft thickness (whether coarse or medium etc) without microscopic measurements? Some websites suggest that coarse hair needs more time to dry than normal, others claim that fine hair reflects more light and can’t be felt between thumb and index finger. Are these statements true? Sometimes I realize that even in my donor some hairs vary in colour and thickness, cant remember if this has always been the case. On top of that, whats the difference between medium and medium coarse?

Thanks

I suppose you can use a micrometer and caliper to measure the shaft diameter, but I wonder how this information will be helpful to you? If you have fine, medium, or coarse hair, that is just who you are. Hair can vary in thickness depending on what stage of the growth cycle they are in.

As for defining medium and medium coarse, it sounds pretty self-explanatory to me. Medium hair thickness is the middle of the spectrum, and medium coarse would be just between medium and coarse.

Posted on

Medscape and Dr. F. Perry Wilson questions the value of stems cell treatments and relates it to doctors making money

Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I’m Dr F. Perry Wilson.

I want to start with a compelling narrative being told to patients across the country. It goes like this: We physicians are going to use cutting-edge science to unlock the healing potential of your own cells to treat your chronic medical conditions. Sounds amazing, right? And it can all be yours for just about $5000 per treatment.

I’m talking about stem cell therapy. Stem cells are cells with the potential to differentiate into a variety of other cells or tissues. And to date, the FDA has approved their use in a number of hematologic malignancies and hematologic genetic conditions—and that’s it.

Stem cells are not FDA-approved for joint pain, cataracts, depression, autism, dementia, or heart disease, and yet hundreds of stem cell clinics around the country are offering them for these very conditions, as shown in this study appearing in Stem Cell Reports,[1] which documented the activities of 169 stem cell businesses in the United States.

These for-profit companies charge patients thousands of dollars for unproven treatments. Patients bear the brunt of the costs, as most insurance companies won’t cover the therapies.

Up until recently, this was basically unregulated, though the FDA has started to change that.

The Stem Cell Reports study characterized 169 stem cell clinics in the Southwestern United States to systematically measure just what they are selling and who is running them.

As you can see here, the range of conditions being treated is incredibly broad, with inflammatory and orthopedic conditions topping the list.

From Frow EK, et al. Stem Cell Reports. 2019;13:1-7.

Who’s running these places? The majority are run by MDs, though there is a smattering of other providers, as you can see here.

From Frow EK, et al. Stem Cell Reports. 2019;13:1-7.

What raises my hackles a bit are the clinics where the training of the provider doesn’t match up with the services offered. It’s one thing for an orthopedic surgeon to offer stem cell injections into arthritic knees, but the authors documented clinics run by cosmetic surgeons offering treatment for lung disease and autism.

Are these clinicians providing cutting-edge treatments or is it a shameless cash grab? Maybe both? These treatments are not entirely benign. In 2017, several patients went blindafter their own adipose-derived stem cells were injected into their eyes. Infection remains a risk as well, as the cells are removed from the body, processed, and reinjected.

There is a reason that we demand well-conducted, randomized clinical trials before we embrace new therapies. In no small part, it’s to ensure that we are abiding by our Hippocratic Oath to first do no harm. Can these providers honestly say that they are meeting that standard? Look, I’m not saying that stem cell therapies are modern-day snake oil. They really may work. But we don’t know if they work and we don’t fully understand the risks. Why are certain individuals — MDs — willing to expose patients to risks they don’t fully understand?

Well, I can think of about 5000 reasons.


2019-08-08 07:38:59Medscape and Dr. F. Perry Wilson questions the value of stems cell treatments and relates it to doctors making money