Author: Dr. William Rassman

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A personal rant on Hair Loss from Reddit (12/12/19)

Just want to preface this by saying that I’m all for fighting hair loss in any way you want if it’s what you wanna do. I’m genuinely not here trying to sway anyone one way or the other. That’s why I’m not even gonna mention what I’m doing/not doing for my hair loss. Just wanted to comment on how some people in the hair loss community might have a bit of an unhealthy relationship towards balding and I think we all torture ourselves more then we need to.

I had to say that I had a very enlightening talk with my therapist and also spoke with some of the good people on the r/bald sub and it was quite enlightening for me. I’d realized that it was super unhealthy to obsess about image and my hair to the extent that I was doing it (in the back of my head at all times, sucking all joy out of my life at the worst moments)

realized that a key for me was to not catastrophiez hair loss more then it needed to be and to realize that even the one thing I was fearing most in the whole world (being bald) is not something that’s that bad.

If we wake up bald tomorrow our family will still love us, our friends will still be there, we will still enjoy every hobby, tv show, movie, video game, book, interest that we had prior. It will be an adjustment period sure, it’ll be weird to look in the mirror and you’ll have to relearn to like how look the same as when you had hair and also for a little while after our loved ones will have to get used to the new look. But then after a few months at most, life will go on just how it was before. Having that mentality of ‘whatever happens it’ll be ok’ is so important in this situation.

I think most people who lose hair young torture themselves much more then they need to by making the stakes in their head so high. If you think being bald is a death sentence then of course you are going to stress over it 24/7 and drive yourself mad. If you think balding is just a natural part of life that happens to many people, just like wrinkles or skin sagging or any other changes our body goes through over the course of our entire life. If you convince yourself that if it happens to you it won’t be a huge deal, then you will have a much healthier perspective and be much more comfortable, whether you decide to fight your hair loss or accept it. Bring down the stakes a little, it’ll be a weight off your shoulders:).

So yah I think this sub is great and that if you want to fight your hair loss then by all means, more power to you. I just think that some people on here could tone down the animosity and negativity regarding certain topics and I know that if people had a healthier perspective and relationship with their hair loss and overall body changes then they might be a lot happier and more calm with whatever they decided to do. Even the worse case scenario for us would be ok so we don’t need to be as terrified as we think.

Wanted to get this off my chest because I recognize a lot of myself in the people on here with how I see them stressing so much with this all or nothing mentality and making the stakes so high in their heads that they spiral into bouts of depression.

Again nothing wrong with taking finasteride or whatever other method if that’s what you want and you’ve balanced the sacrifice/reward in your head. Just want people to know that they should do this because it’s something they want that would bring them pleasure, not because they should feel like they absolutely have to or else their life will be over because that can lead to being in a bit of an unhealthy place mentally.

This is all, thanks to anyone who read this far, wish you the best

What you said is important for Reddit readers to understand. There is a lot of information on this site and opinions like yours are an important contribution to the readers evolving opinions. Hope spring eternal for those with hair loss and there are many people working to reverse the hair loss with either a simple treatment or a cure. A simple treatment may be closer than you think. We are working on it right now as I write this post. Thanks for sharing your thoughts.


2019-12-12 12:29:37A personal rant on Hair Loss from Reddit (12/12/19)

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A Hair System or SMP, what should I do?

22 y/o here with rapid mpb. i’m already too far gone for a hair transplant to look halfway decent so am looking into some alternatives. i rocked a buzzcut last year and thought it was ok but for my wildly receeded temples so smp has caught my eye but there are also some incredibly good hair systems out here. ideally, i want to not have my hair bother me anymore and have a frame to my face for my 20s! what do you reckon?

There is a huge difference between a hair system which requires annual maintenance, daily maintenance and social adjustments to get what looks like a full head of hair. With good hair systems, the look is a good as if you never lost hair, just like with a good hair transplant. With SMP, however, you have to determine if you want the look of a shaved head of hair with no actual hair. It has the advantage of minimal maintenance once it is done, but it is not hair. The good news is that if you have SMP done, you can always switch to a Hair System or a Hair Transplant. It is a personal choice.


2020-11-05 16:36:39A Hair System or SMP, what should I do?

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A review on the use of Minoxidil (oral and topical – scientific article)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/

Conclusions of article: Minoxidil is a common medication prescribed for treating hair loss-related problems. It provides remarkable benefits to patients with hair disorders. To date, the FDA has approved minoxidil only for AGA. However, minoxidil is used off-label for treating several hair disorders as well as increasing body hair growth. Although topical minoxidil is considered an effective and safe treatment option for various hair disorders, additional evidence-based data are needed for some applications.

Other mention: Salicylate and aspirin can inhibit sulfotransferase. A recent study showed that the follicular enzymatic activity decreased following 14 days of low-dose aspirin use. Thus, prior or concomitant use of aspirin decreases the clinical response to topical minoxidil.

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A Remarkable Change Made from SMP on a Thinning Scalp (with Photos)

This patient came to see us after having a hair transplant (from another clinic) that still left him not a full as he would like. We offered Scalp MicroPigmentation (SMP) as an alternative option to having further transplant surgeries. He took this alternative option and the transformation was very exciting.

It would have taken between 3500-6000 grafts had he gone the hair transplant route and the results would have taken possibly 16 months for two procedures. The results you see here were instantaneous — no waiting period — although he had some touch-ups after the initial session.

Click the photos to enlarge:

After:

 

Before:

 

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A Perfectionist’s View of Transplants

I am 50 with early gray coming on the sides and black hair in the front. I have had 10 hair transplant procedures over the past 8 years [not at NHI]. I go from happy about them (when I had bald areas and then they went away) to unhappy (now). I am bothered about my left frontal hairline in particular. It is obvious to me that it is transplanted. I am not an expert, but I know it is not right, yet it is not the pluggy look like your book shows in the back section. I comb my hair forward to cover the hairline which I should be showing off, not hiding. What is wrong with it and can it be fixed with 100% certainty?

It is clear that you are a perfectionist, for only a perfectionist would notice your problem. The problems are that the grafts in the frontal line are two hairs each, the hair seems to point outwardly, rather than forward and the frontal grafts are a straight line that line up like soldiers. These two problems are not uncommon when a transition zone of single hairs is not created at the leading edge of the hair line. The concept of a hair line should not be taken literally, for there is no ‘line’ in a natural hair line. You were created with a zone of single hairs that transition from a bald forehead to a full frontal hairline presentation. A good hair transplant doctor must create the same transition zone to accomplish the natural look. With your black hair, these changes are more noticeable than if your hair color was lighter, making it easier to detect a transplant. As the gray hair moves forward, the problem will become less noticeable, but I suspect that you do not want to wait a decade or more for that to happen.

The second problem is outward directional growth of the transplanted hair. Judging from your photos, that problem is the result of a radial placement of some of the recipient sites when the procedure was first done. The direction of the hair growth is totally controlled by the surgeon who made the recepient sites. Additional grafts placed in a better position and direction might influence the hair that is growing outwardly. Using the concept of ‘following the crowd’, the normal direction of the new hair can be transplanted to influence how the existing hair will lay.

The third problem is the ‘line-up’ of the hairs in a straight line that is easily detected. The frontal hairs should be irregularly placed so that no line is evident.

The last point of your question talks about certainty in outcomes. Any surgical procedure has risks of failure, so certainty in medicine is more an act of God than an act of a doctor. In my experience, the success rate for building a good transition zone is very, very high. The hope would be to complete the transition zone in one session with 500-600 single hairs in the front. Sometimes more is needed, particularly if your hair is coarse, black and straight. What you need is comfort and that is established with a visit to the doctor’s office. As a perfectionist, you will interview your potential new doctor with an open mind, but keeping some skepticism and doubt, so the doctor will have an uphill battle for your confidence. Ask the doctor to show you people he has done with black hair, you can look at the transition zone and see if you see a ‘line’ in the hairline. I always say, what you see is what you are ‘gonna’ get.

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Abdominal Pain And Hair Loss

Hello Dr Rassmann,this blog is great.
Sir suppose a person has genetic hairloss for around last 3 years. If he also has abdominal pain for around last 6 months, so is it possible that his abdominal pain can increase/accelerate his genetic hairloss but without causing acute/chronic telogen effluvium?

stomach

I am not sure how you can make a correlation between abdominal pain and hair loss. Abdominal pain is not related to genetic hair loss or any other type of hair loss from my experience.

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A Whole Lot of Eyebrow Transplant Questions

Dear Doctor:

I have thin patches in my eyebrows and want them treated, preferably by means of an eyebrow transplant. Dr Rassman is one of my three short-listed doctors and I have several questions, which I would be extremely grateful if they could be answered.

Many thanks in advance

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Questions re FUE/FUT, yield etc.
1. Does the doctor recommend FUE or FUT for the eyebrow and why?

2. How does Dr Rassman avoid shock loss when implanting grafts amongst existing eyebrows?

3. How does he optimise yield of transplanted grafts?

4. What determines which follicles Dr Rassman selects for an eyebrow transplant?

5. What is unique about Dr Rassman’s approach for eyebrows as compared to similar leading transplant doctors?

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Questions re physical apperance of eyebrow

6. What is to prevent the hair turning grey later on, with age etc.?

7. How can you properly trim eyebrow hairs if they are growing horizontally?-with a simple nail scissor this would not be possible.

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Questions re preparation for operation:

8. How can you ensure the recipient area is in a healthy state to accept transplanted hairs? Should creams be used to ‘disinfect’ the area?

9. What factors would make an eyebrow transplant unsuitable for a patient?

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Side effects:

10 . Can having an eyebrow transplant affect the muscles around the brow, leading to future risk of a descending brow?

11. Is it risky operating on an eyebrow from the perspective of harming arteries etc. close to the eye? Can this harm the eyes? Have any patients experienced this?

12. In what percentage of cases, is the patient dissatisfied with his results?

13. Many of Dr Rassman’s patients travel from abroad and so can only avail themselves of an online transplant prior to the op. Upon closer inspection on the day or the day before the operation it may transpire that the patient is not a ‘good’ candidate for a transplant. Does the doctor in these cases advise against going through with a transplant? How many times this year, for example, has the doctor turned down a patient on the day or the day before an operation?

14. What controls does the doctor put in place to measure the performance of the various technicians?

15. Does the doctor, have a feedback system with a standard feedback form for post-op patients?

Now that is some due diligence! Below are the answers to your questions.

  1. Either FUE or FUT will be fine. The key is to prepare one-hair grafts and put them at the correct angle, lying flat so that they do not stick up.
  2. I have never seen shock loss of the existing eyebrow hair when doing an eyebrow hair transplant. The transplanted hair often fall out and then regrow in 3-5 months.
  3. There is no yield problem with experienced surgeons like me. I would expect close to 100% growth from the grafts.
  4. The doctor and team look for one-hair grafts and makes sure that they are trimmed correctly. If the grafts are taken by FUE, preferably one-hair grafts are removed, but it it is taken by strip surgery, then the team may have to reduce a two-hair graft into two one-hair grafts to keep the process delicate.
  5. I have a great deal of experience doing eyebrow transplants, as do a handful of other experienced hair transplant surgeons.
  6. Eyebrows will turn gray with age if those particular hairs are genetically programmed to turn gray, and other than dyeing them, the color is what nature gives you.
  7. I would advise you to get a good set of iris scissors to trim the eyebrows, as they do grow long. Twice or three times a week may be needed to keep them the length you desire.
  8. I suggest the use of Hibiclens soap for antibacterial application. As this is toxic to the eyes, it must be handled carefully with the eyes closed when applied.
  9. Unrealistic expectations.
  10. Not when done properly.
  11. No such problems have ever been seen in my patients.
  12. I do not remember any dissatisfied patient.
  13. About twice a year we turn down a patient who has flown in a long distance, mostly because of unrealistic expectations.
  14. Careful quality control is exercised in every case.
  15. All of my patients have full 24/7 access to me (or Dr. Pak). We encourage feedback such as this post.

For more information on eyebrow transplants see:

  1. Female Eyebrow Restoration After Cancer Surgery
  2. Eyebrow transplant – Patient BG
  3. Baldingblog search results – “eyebrow”

Do not hesitate to call my office @ 800-NEW-HAIR to setup a phone consultation with me if you’re not local.


2012-04-05 12:10:29A Whole Lot of Eyebrow Transplant Questions

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A Patient’s Hair Transplant Done by a Non-Physician

You can see that this man had a poorly designed Scalp Micropigmentation procedure with a straight hairline, and then a hair transplant on top of it. Much of the hair appears to have failed to grow. It was done at a bargain price.


2020-03-10 12:57:27A Patient’s Hair Transplant Done by a Non-Physician