Author: Dr. William Rassman

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Hair Not Growing Back After Chemotherapy

Dr. Rassman,
I am a woman who finished an intense bout of chemotherapy and radiation about a year and a half ago. Since then most of my hair has grown back on the sides and back of the head. The center top and crown is still very bald. My dermatologist says it is a typical female balding pattern. Can you give me feedback on this subject? Is it possible I could be a candidate for hair transplants? Thank you.

Your dermatologist sounds correct. Some women develop patterned loss, which is less common than unpatterned loss. Hair transplants work better in patterned loss, assuming that your donor hair is adequate in quantity and quality. If there is diffuse thinning in the sides and back, you may not have enough supply for a transplant. A good assessment by a competent hair surgeon will give you insights into your supply for quality hair transplants.


2005-10-24 15:53:55Hair Not Growing Back After Chemotherapy

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Hair Multiplication Won’t Give a Full Head of Hair

Hello Dr,
I have been looking at articles in relation to hair cloning recently and something caught my attention. Researchers are warning that the first available hair multiplication procedures won’t give a full head of hair. If this is the case do you think hair multiplication will be able to give a full head of hair in the near future? Do you think these kinks will be ironed out? Your views on this would be much appreciated.

The solution where one hair can make many, is years away. We really do not understand the process and can not replicate it at this time. Too much hype, in my opinion and years away from a solution. When ever I report this, I get many emails that knock my pessimism — but I can’t please everyone.


2006-11-09 09:08:33Hair Multiplication Won’t Give a Full Head of Hair

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Having hair is often an issue of self-confidence

I hear about the self-confidence issue all of the time. You would not believe how many wealthy, very successful people I have performed hair transplants on and the reason driving them is almost always the issue of “self confidence”. A few well known people in the world of tech, some CEOs of fortune 500 companies and some very famous actors, had hair transplants by me in the very early part of their career. We have become friends and the actors, as a good example, absolutely believe that the hair transplants transformed them in terms of their “self-confidence” giving them the freedom to be themselves and to do what they do best without worrying about hair loss. Issues of self-confidence is not something men talk about to just anybody, but to the man in the mirror, they tell it the way it is. Even Donald Trump has a hair problem and I am sure that is part of his insecurity. The post below from Reddit shows the importance of family and friends in opening up and talking about hair loss problems.

Received the first “OMG your hair comment” from tressless


2017-08-25 08:55:02Having hair is often an issue of self-confidence

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Hair Plugs in the Modern Era (with Photos)

This patient received 250 grafts just a few years ago (not from me, obviously). He knew things were going wrong when the doctor put wooden toothpicks (which could leave behind splinters) into the recipient sites which were made on his head. He overheard the staff chuckling at how he looked. He told me that before selecting his original doctor, he researched the field over the internet and had a few doctor consultations. He selected the original doctor because he was promised a great result and he believed that promise. As the hair started to grow, he became very self conscious and progressively depressed. Going out into social situations made him uncomfortable, even just going out of his house (something he rarely did once the grafts started to grow).

Cosmetic surgery of any type reflects people and their innermost feelings about themselves. I wonder if doctors understand how substandard cosmetic surgery like this can impact a person’s life. This nice young man’s life was in ruins and his fear of going to still another doctor who could possibly do even more harm, did not drive him to learn how to correct the problem until very recently when he ran into us on the internet. First, we spoke over the phone and then he set up a surgery with me and flew in. When I saw him this week, he was frightened with flashbacks of his original horrific experience

Just to be sure everyone is clear — the photos that are shown below are of this man’s substandard work and an example of what a doctor could do if he/she does not use state of the art hair transplantation technology. The term “hair plugs” is still incorrectly used for the modern technology we invented, but the lingering images (reinforced by patients such as this) are hard to abandon. Looking at the results that were once commonplace, one can clearly see that referring to this old technique as “plugs” is not out of line. Fortunately, I took steps to correct the appearance of these plugs by coring some of them out and transplanting more hair to fill in the entire frontal area. All of the plugs that were removed were cut into follicular units, and then re-transplanted into the scalp. I expect that he’ll be much, much better off after this first procedure with me of 2600 grafts grows in, which was done this week.

Here are the photos of his pluggy look referenced here (click to enlarge):

 

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Hair Plug Removal?

Dear Dr. Rassman:

I am a 44 year old male with obvious hair plugs. I had three sessions from strip grafts back in 1995. In considering all of my repair options, I would like to just be naturally bald. Two surgeons have dissuaded me from having plug removals claiming that scarring would be a limiting factor. I was wondering how you would feel about a staged FUE removal of individual hairs over time allowing healing between sessions. I noticed that you replied to another inquirer that individual graft removal take a week to heal. Therefore, why not just space out the sessions to allow for adequate healing in the meanwhile? I’m not averse to small scarring as anything would be better than my current state. I am not interested in additional grafting as I’m convinced I am continuing to bald and will eventually have an island on the top of my head.

Any thoughts? Thank you.

I can not really address your specific issues, particularly when it comes to scarring, without at least seeing what you’re dealing with. You can use follicular unit extraction (FUE) to extract the big hair plugs, but sometime excision of the plugs work well. It all depends upon the extent of your problem. How many plugs do you have and where are they located (photos should tell me the answer)?

Sometimes if the frontal hairline is very pluggy and there is a concentration, removing the frontal hairline does not leave much scarring in many people. Is it your intention to be go completely slick bald (very difficult) or just a repair (much easier to do)? Send me good digital photos (reference this post when sending) and then we can set up a telephone consultation.

For those interested in seeing the difference a repair can do for a pluggy look, take a look at this patient.

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Hair Pieces and Advancing Hair Loss

I live in Brasil, I’m 41 year old and my grade of baldness is 6 / 7. I use a hairpiece for 18 year and i want to get free of this, but i have a problem, because when i started using , i was able to avoid peolple noticing that was a hair piece, as was very natural and my baldness was class 2/3 and as i used to travel a lot i didn4t see people so frequently. My case i believe is needed a scalp reduction for a start, but i’m afraid of procedures go wrong and i cannot remove the hairpiece to much in advance. Please help me . I can travel to NHI if necesary but I can forward photos to a better evaluation of my case
Thanks

Your story of how one starts with a hair piece and then gets caught in a cycle of more and more dependence as the hair loss advances, is a common story. Many of our patients have been where you are now. The problem for advanced hair loss patterned people is the availability of supply. The basic point is to find out if there is enough donor hair, when combined with good styling, to produce the type of coverage you want or need. That depends upon many factors, of which the number of hairs available for transplants is only one of these factors:

  1. A better match of hair and skin color will work to your advantage, wavy hair and coarser hair also will work to your advantage if that is what you have. What is your skin and hair color?
  2. How loose is the skin in the back and sides of your scalp. For those who have loose skin, the availability of donor hair is generally higher.
  3. Is your hair wavy or straight?
  4. Is your hair coarse or fine?

Sending me a good set of pictures is important for me to establish a good baseline. Please answer the questions above for me in your responsive email. You can use the form or my email address on the Contact page.

In answer to your other point, the idea of using scalp reductions, I will just say that this procedure has fallen into a bad reputation and most good surgeons do not do them anymore. The problems are that there is severe scarring on many patients and thinning of the donor hair to such a degree that there is not enough donor hair to restore the frontal area. Although there are some patients that may do well with them, there are far too many risks for the average patient. I know about these risks because I had three scalp reductions in the early 90s and was left with scars and a return of my entire balding area. I eventually got transplants and had enough donor hair to fill in the crown defect. Best of all for me was that I had no frontal hairloss. Had I been a Class 6-7 balding pattern, I would have been in trouble. So in conclusion, cutting out the bald spot is a risky surgery with many things that could go wrong. The key to a good hair restoration procedure is low risk and a normal, hairy outcome in a reasonable time-frame.

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Hair Potions and Lotions

What do you think about all of the vitamins and other things sold in the health food stores that claim that they reduce or reverse hair loss?

The word ‘claims’ in this usage, reflects the lack of scientific proofs for naturally produced substances sold in heatlh food stores. Many of the items sold are sold on their potential and a ‘hipe’ that is created by word of mouth. There is little regulation for natural food additives, so there is no way to determine the proof of the claims that are made. Some of the natural substances may have DHT blocking abilities, as claimed, but there is no proof of such activities.

It is common to find substances sold in health food stores that claim DHT blocking properties. There is no way to confirm or deny this, so it again becomes a ‘buyer beware’ issue, leaving the final action in the hand of those willing to spend the money on it. At least Propecia is a proven DHT blocker and we know that because it has been thoroughly investigated by the drug company to meet a high standard of FDA regulations. We also know about the side effects (very low) and long term use statistics. A large company behind this medication tells us that someone is accountable if things go wrong. I can not say that for most of what is sold in the health food stores.

For example, Saw Palmetto, is thought to be a natural DHT blocker, and there are various articles that purport to prove it is an effective DHT blocker. But, a recent article that I read in a well respected medical journal indicated that it was a very weak DHT blocker. Did you know that Saw Palmetto was added to the GI’s food in World War II battle zones to suppress the soldiers sex drive so that they would not get distracted? Now if you link these two (weak DHT action and sex drive suppressant), why would anyone want to take it?

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Hair, Politics, and Career

In the days of Abraham Lincoln, few people actually met or saw the people they voted for. Stock photos in newspapers of the 1700s and 1800s were used, often supplied by the men themselves to reflect the image that they wanted to portray. But today, image is thought to make the man and the images can not be so easily controlled by those being portrayed. In politics, 90% or more of successful politicians have hair (though balding is present in 50% of all men). When focus groups are put together, it is clear that prejudice against balding men is commonplace. We have images of the balding, fat, beer guzzler with a pot belly. What does balding have to do with beer guzzling or obesity? Some people feel that balding men are not trustworthy or dynamic. Why? On my radio show, The Inner Man, we asked Los Angeles listeners to call in and tell us what they thought of the balding man. Between this radio program and other forums I have seen, heard, or participated in, I find these comments humorous, yet sad. Here are a few comments:

  1. Balding men are older, right?
  2. I would never date a bald man because I don’t date older men!
  3. Balding men look shifty; they have beady eyes.
  4. Bald men are smarter because they have to be just to survive.
  5. Bald men are not good in bed.
  6. I don’t find bald men sexy.
  7. I find bald men very sexy.

The most interesting comment I heard was from a bald man who called into my radio show responding to prejudice. He said when given the choice in hiring, he would rather hire a man with hair than one without. When we confronted him on this very issue, he said that even though he was bald, it was unfortunately true. We was open about his overt discrimination against balding job applicants, and he was the Senior Vice President of a company.

So in the days of Lincoln (1800’s), men wore top hats to cover their balding, and a bald politician could keep this secret. Today it might be a baseball cap, but there are few secrets to the camera as the paparazzi find their way even into the bedroom. But the real secret is the balding man’s secret. Their views of their balding situation cover a wide range of self esteem issues, inner secrets that are never discussed with anyone. Balding and aging do go together. With 50% of men having some degree of clinical balding by mid-life (45 years old) and balding progressing with age, a look at the man in the mirror constantly reminds him of his aging process, his mortality and his changing body. For some bding bald is a good alternative to the death option. For other more courageous men, they visit me and get their hair back.

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Hair Regrowth After Waxing Scalp, Part 2

Hi i recently sent you a question about waxing. [see Hair Regrowth After Waxing Scalp]

For some reason the waxed area appears worse. I am worried that I may have developed folliculitis on my scalp as a result. My entire scalp itches. It would be helpful if you could give me some information about folliculitis as well as the differences if any between folliculitis and folliculitis decalvans. Also it would be helpful if you could tell me what to do to contain the hair loss to only the waxed area basically prevent it from spreading.

Folliculitis is a condition where the hair follicles get infected because of bacterial invasion, often secondary to some irritation or wound of the skin. Folliculitis can spread from one hair follicle to another by touching or scratching it, making it worse. It is a fairly common condition.

Folliculitis Decalvans is a rare condition affecting mainly the scalp leading to scarring alopecia. The cause of the condition is still unknown, abnormal host response to Staphylococcus aureus (a bacterial infection) has been postulated. Folliculitis Decalvans causes scarring with hair loss (alopecia). There are areas of “corn stalking” (grouped hairs arising within the area of alopecia), redness (erythema), crusting, and pustules. Due to severe scarring, permanent hair loss occurs in the involved sites.

As you may be aware, this is a diagnosis not for the amateur. Get a good dermatologist to take care of you, starting off with a proper diagnosis. Appropriate antibiotics will be recommended by the doctor, if indicated.

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Hair Pull Test

Dr. Rassman,

If propecia has been successful treating my Diffused Patterned Alopecia, should I still have a positive result from the Hair Pull Test (i.e., still find hairs after conducting the Test in the balding areas)?

Thanks.

The hair pull test should be done by the physician, and not by the patient, as it is more complex than the name makes it out to be. Just pulling on some hairs and seeing clumps of hair fall out does not mean you have a positive hair pull test. The hair pull test is performed by taking a few strands of hair between the thumb and forefinger and pulling on them gently. Hairs in anagen (growing) should remain rooted in place while hairs in telogen should come out easily. You then figure out what percent of the hair is in the telogen stage. For more information on the cycles of hair growth, see Hair Follicle Cells Growth Stages.

Shedding of hair can be variable from day to day and is greater in certain seasons (spring and autumn). Washing you hair prior to having a hair pull test can also affect the results. Genetic hair loss does not cause a positive hair pull test. And it should go without saying, but the image to the right is NOT the actual hair pull test, and you shouldn’t have to worry about your doctor doing this to your head when conducting the test.