Author: Dr. William Rassman

Posted on

A Week After Transplant, I See Small Hairs Falling Out With the Scabs

Hi, I had 500 grafts to the temples 12 days ago. I have been washing the recipient area almost every day, and gently dabbing the shampoo on and off but some scabs still formed. I began very gently running my fingers over them when dry (but certainly not pulling them) by about day 7 and noticed some easliy fell out but with small hairs attached. Is this my grafts coming out?

We all worry about losing hair grafts after the surgery and that is the basis of your question. It is an important question; so important that NHI did a major study on the subject and the best answer to this question is for you to read our article on this subject — Graft Anchoring in Hair Transplantation (PDF file).


2007-11-28 10:36:33A Week After Transplant, I See Small Hairs Falling Out With the Scabs

Posted on

Acne, Dandruff, Hair Loss, and the Unexplained Mysteries of the World

I believe acne and dandruff and hair loss are related. They are all caused by cells that go through their cellular life cycle at much faster rates than normal. How can this be denied?

I believe Bigfoot, the Yeti, and the Loch Ness monster are all related. They’re unexplained mysteries that can’t be proven. How can my claim be denied?

Honestly, it is very easy to deny something and much harder to prove something. Show me scientific proof and I won’t deny your theory.

Posted on

Accuracy of Miniaturization Mapping?

How accurate is miniaturization analysis? My trichologist said unless you examine hair bulbs and shafts under microscope, you cannot determine the exact cause of hair loss. She also said that any thinning looks like male pattern baldness. What do you think of her opinion and the microscopic hair analysis?

A miniaturization mapping is just looking at the hair under a microscope and comparing it with normal hair that is often in the general area you are studying! I have never understood what the trichologist is looking at under the microscope. The accuracy of our mapping process is regional, based upon the changes that occur in miniaturization (often progressive) with genetic balding. More importantly we evaluate the pattern of miniaturization (under a microscope) at different areas of the scalp to determine how extensive it is in areas where future balding will occur, which will always miniaturize prior to becoming bald. Early in the process, the naked eye will often be unable to pick up the changes in thinning, so the mapping here has great value. And in case you missed it, I’ve provided tips on performing your own miniaturization mapping:

  1. Mapping Your Own Scalp for Miniaturization, Part 1
  2. Mapping Your Own Scalp for Miniaturization, Part 2
  3. Mapping Your Own Scalp for Miniaturization – VIDEO

To answer more specifically to what your trichologist said, you don’t need to examine the hair bulbs and shafts under a microscope to determine the exact cause of hair loss. The cause of hair loss is genetic balding in probably 99% of men. We use a miniaturization study to find out if there is early balding and then quantify it as well. We also use a miniaturization study to plan for treatment (medical or surgical) and follow the progress of such treatment plan. Drugs like Propecia may reverse miniaturization.

Finally, if you do not have male pattern baldness (women, for example) looking at hair or its bulb under a microscope wouldn’t tell much unless there is a telogen effluvium. Generally after taking a good medical history and examination, doctors do a scalp biopsy in women (as a last resort) to determine if there is a pathological process or order blood tests to see if there is an underlying medical issue.

Posted on

Accutane for Acne, Propecia for Hair Loss

Hi Im 22 years old and my hair has been thinning really really bad for like the last year or so.

I just started on my second month of propecia and I know its too early to see any changes, but my problem is that I also have an acne problem and my dermatologist is going to put me on Accutane. I know accutane contributes to hair loss also so i just wanted to know if I could be taking both at the same time? or just any advice you can give me.

I doubt that Propecia (finasteride) will protect against possible hair loss from Accutane (isotretinoin). There aren’t known interactions between the two medications, but this subject needs to be discussed with the treating doctor, not with us over the web.


2010-07-30 08:47:29Accutane for Acne, Propecia for Hair Loss

Posted on

A Week After Highlighting, I Have a Bald Spot!

(female) I had my hair highlighted approx 1 week ago, i thought everything was fine, but i now have a very sore bald patch at the top of my head,do you think this was caused by the hairdresser at all,i have had my hair done in this way many times ,but have never had anything like this happen before!

Thanks

PS, im really scared that all my hair is gona fall out!!!

Ouch! Chemical burns from dyes start off just like you’re describing. You may want to see a dermatologist to find out if the burn did indeed go deep enough into the skin to cause the problem.


2008-09-23 14:38:45A Week After Highlighting, I Have a Bald Spot!

Posted on

A Year After My Hair Transplant, I Still Look as Thin as Before!

Dr. Rassman. I’m 41 years old. I got a hair transplant done in April 2006. After the transplant i was vcery happy with the quantity of hair that i got transplanted. I know the doctor told me that i would loose my hair because of the body reacting to the surgery. Now it’s Jan 2007 and i find that the amount of hair that was transplanted is not as much regrown. Now that i’m approaching my one year period soon, why is it that the amount of hair that was planted as not all regrown back. I was expected a least twice of what i see. When i comb myself i still look like someone who is loosing is hair, and i hate it, especially when i go under a light or out in the sun. What is your suggestion to my situation.

Setting expectations is as much the ‘art’ of what I do as doing the surgery. That is why I have open house events every month, so that people who are going to have surgery can see and meet someone with a similar balding pattern and hair color. Then, and only then, will expectations be set properly. If you expected too much, then the error was on setting expectations. If the hair did not grow, then the question should be ‘what went wrong?’. You can always get a second opinion, but first, ask the doctor who did it and find out if your doctor’s expectations were met.


2007-01-10 07:27:39A Year After My Hair Transplant, I Still Look as Thin as Before!

Posted on

About a Year Ago, I Met with a Doctor That Was Still Doing Minigrafts!

First of all I want to thank you for this great site.

In Dec. of 2006 I went to a T.P. doctor, mainly to get a prescription for propecia and to hear what he had to say about how good of a candidate I would be for a hair transplant. I found out at that time that he still used the mini & micro minigraft procedure, with magnification and backlighting.(no steroscopic microscope). In Dec. 2007 I was looking at his web site,and to his credit, is now doing follicular unit grafting using stereoscopic microscopes.

My question is this,how difficult is it for his staff to learn to use microscopes and to be cutting in follicular units instead of minigrafts? I guess what I really want to know is how much time should I give them, to learn the “new” procedure before I go back for another consultation?

Do you have any photos that show the difference between minigrafting and folicular unit graphing on the scalp?

Thanks again.

P.S. How much does a stereoscopic microscope cost? This doctor has been doing hair transplants for 14 years and is now just getting some.They must cost alot!

Cost for hair transplant at New Hair Institute… as low as $5 per graft.
Cost of microscope at a local scientific store… around $500.
Cost of a well done follicular unit hair transplant… priceless.

The difference between minigraft and follicular unit transplantation is small, but can be significant when you look closely at the growing hair. Minigrafts and micrografts transplant skin between the hair follicles and this skin can produce changes in the scalp at the point the hair exits the skin. There may be cobblestoning from the transplanted skin. Follicular unit transplantation only transplants the natural occurring units of hair as they exit the scalp and most of the skin edge is removed so that the point of exit of the hair is normal.

More importantly, the difference when using a microscope for dissection is that you do not waste good follicular units since you can see minute details (under the microscope).

For more details, read our published articles on the subject:

Posted on

A Specialist Recommended Scalp Reduction Surgery For My Small Bald Spot

Hello,

After having a bald spot on the left side of my head for 28 years, I’d like to do something about it. The bald spot is circular in shape and 2cm in diameter, about 7cm directly above my left ear. The hair fell out when I was 2 and the bald spot has remained the same size for as long as I can remember. I am able to cover it with hair surrounding it, but it does take an emotional toll on me as I see it every day and I have to be very careful every month when having my haircut. I saw a dermatologist about a year ago who told me it’s triangular alopecia. He was not able to locate any hair follicles under the skin, and told me the chance of regrowth is slim to none, especially as there has been no hair there for 28 years. He suggested we first try cortisone injections which did not work, and then referred me to a specialist. I went to see a specialist and he recommended scalp reduction surgery given the small area and lack of hair follicles.

I’ve done some reading on scalp reduction surgery, on your blog and others. The risks seem to be significant (stretchback, slot scaring, hair angled incorrectly, etc.) and it’s clear you’re not a proponent. I’ve also been unable to find any success stories/testimonials online. I’m going to ask the specialist to share more information (# of surgeries he’s done, before/after photos, # of surgeries I’ll need, risks, type of incision, etc.), but before doing so I’m hoping to get your advice.

Given the small area (2cm in diameter) and being able to cover with existing hair, do you think this is a case for a successful scalp reduction surgery? If not, are there any alternatives you’d suggest (e.g., Rogaine, hair transplant)? Both my dad and grandpa have full heads of hair, so I’m not really worry about the hair on the left side of my head receding back to the site of the bald spot.

Thanks for your help!

You are correct in that I am not a proponent of scalp reduction surgery. This is because over the years I have never seen it work well. I’ve written about this type of procedure before here.

A scalp reduction could be very tempting to the surgeon and the patient, because it makes logical sense — just take out the bald spot — but the best you would get is maybe 50% improvement. Or you might get considerable scarring from this, depending on the location.

There are other options, such as a hair transplant using the follicular unit extraction (FUE) technique into the small area you described. This is a more predictable result, particularly for the small area.

Posted on

About a Decade After My Hair Transplant, It is Falling Out

I had a transplant procedure about 12 years ago done by a great physician and personal friend, the late Jim Arnold. During the past couple of years I have had more dramatic hairloss including the loss of my new hairline. I thought that transplants lasted forever. Would I be fighting a losing battle to go ahead with another procedure?

I have seen what you described before, but there could be many reasons why you have this happening. I don’t know much about you (I’m limited to your single email) and I need to learn more. When we say that hair transplants that come from the fringe area around the head are permanent, we mean that in 99% of patients. The hair in this fringe area will stay the lifetime of the person, but we do know that there are general diseases that are seen (such as DUPA) which can appear at any age.

I would want to understand what is happening to your donor area now and an examination with a high powered video microscope will allow me to evaluate that donor area. What you are seeing in the grafts may very well be in the donor area as well. Without an examination, I can not tell you what to look for. Please call my office at 800-639-4247 and set up an appointment. As you likely know, I acquired Dr. Arnold’s practice and see many of his patients. He was a wonderful man and a wonderful doctor, loved by his peers and his patients as well.


2009-08-19 17:40:19About a Decade After My Hair Transplant, It is Falling Out