Author: Dr. William Rassman

I started to lose my hair at 19 due to MPB. After a year or so, my hair texture started to change rapidly and my hair changed from normal hair which you can style to pubic-like hair.

It looks horrible.

My question therefore is: what can you do about acquired progressive kinking. I am already taking finasteride which seems to do little against it.

Generally when you lose hair from genetic balding, your hair thins out (miniaturize) and fall out. It generally does not change in texture to a point it starts to kink. Maybe you should see a dermatologist as there may be a series of genetic hair diseases that can cause kinking.

I am a 33 year old male. I had been using Propecia for 3 years and switched to Dutasteride approximately 6 months ago. Since switching to Dutasteride, I am experiencing less sexual side effects than Propecia, even at 1.0mg daily dose (twice the dose which is recommended in treating BPH) – I am also experiencing more hair regrowth than Propecia. I am wondering how and where you draw the inference that Dutasteride has the potential to cause sterility. Any firm evidence, clinically?

Just like your positive hair growth experience with dutasteride there are others who have negative experience with sterility and sexual side effects.

I cannot find a study or firm evidence, but I always try to balance risks and benefits. If you are never planning to have children, then it may not matter but if you are, why would you want to risk it? In addition dutasteride is not approved for the treatment of genetic balding and there is also no clear evidence it is much better than Propecia (despite your personal experience). If you want to know if you now have a problem, your doctor can order a sperm count which will show a problem if there is one.

I know dr.rassman has mentioned a few times that if a person is genetically balding their hair has a certain lifetime (example 5 or 10 years) , with or without the use of finasteride, before it completely dies. If that is the case, what is the point of taking finasteride if the hair is going die anyways within 5 or 10 years? Could finasteride prolong the hair from falling out early?

The point is you have the extra 5 to 10 years or possibly more of good hair. Imagine being 20 years old in your prime and you notice thinning. Imagine taking a drug that can postpone this until you’re 30 or 40. To some this may be worth while.

This is a review of a hair transplant result performed at New Hair Institute by Dr. Jae Pak. This is a patient in his 60’s who looked 70’s before he had a hair transplant. His grey hair actually helped with the overall result. Grey hair on fair skin helps disguise the thinning by the low contrast between hair color and skin color. We think that the hair transplant makes him look at least 10 years younger than his real age!

He is currently thinking about another hair transplant versus a SMP procedure for fullness. There is no right answer or choice. Real hair is always better, but SMP is not surgery and there is no recovery with instant results! He may choose both like this patient HERE.

This is a review of a hair transplant surgery performed at New Hair Institute by Dr. Jae Pak.

This is a young 30 year old professional who lost his hair in his 20s. He had a 2100 graft hair transplant surgery that gave him a non-balding “frame” to his face. He will continue to lose his hair on top and may need future surgeries but the transplanted hair in the front in permanent and he now looks his age and feels better about his new look!

Similar results to the TV Reality show Jon Gosselin’s results in terms of number of grafts received and the balding pattern. Both patients did not have follow up surgery for their crown area (for their own reasons).

This is a review of a hair transplant to address scars from plastic surgery. This patient had a face lift scar on her hair line which also gave her a slightly high forehead. While the scar itself was not prominent, she wanted to wear her hair up without worrying about the scar. She also wanted a more rounder (feminine) hair line. She had about 600 grafts to accomplish her goals.

It appears FUE has become the treatment of choice among patients. My goal would be to receive as many intact grafts of “terminal” hair as I could get from a transplant. I may be off but it seems to me strip surgery comes closest to that goal. I’ve read up to 25% of grafts could be damaged at some point during FUE procedure. And considering the wide donor area I would think some grafts could from from an area more likely to thin than from where a strip is performed. I could be off here too, but I would think FUE would leave the donor area more thin looking than strip where it’s just one spot and the hair above would cover evenly.

If you have more than one strip surgery that means another long scar for each surgery?

There are some misconceptions in your question. FUE is not the treatment of choice. FUE is a great alternative to strip surgery since it does not leave a linear scar. FUE leaves thousands of 1mm circle dot scars. Patients who have FUE over strip are the ones who want to keep their hair very short or don’t want the “idea” of a linear scar despite never being able to see it (as their hair will always cover the scar). Many patients after weighing in the pros and cons end up choosing strip surgery over FUE as they realize no-one will ever see the scar as they keep their hair relatively long (up to a 3 guard).

FUE has some disadvantages in that the harvest and growth rates do vary widely among patients as well as the doctor’s experience. FUE can also leave the donor area looking much thinner than the strip. Finally many patients do not realize you can have multiple strip surgeries over the same scar – effectively having just one scar overall.

This is a review of a Scalp MicroPigmentation performed at the New Hair Institute Medical Group. The following patient had a eye brow scar indent which he tried to mask with tattoos many years ago. He also had a hair transplant that did not work out well for him as he continued to lose hair. He did not want to have another surgery and just wanted to keep his hair shorter for a younger look. The problem was the hair transplant scar and the generalized thinning all over. He also was self conscious about his eyebrow thinning and eyebrow scar.

SMP was performed over his short hair cut (without shaving the head). In addition Juvederm was injected the the indent in his eyebrow scar to smooth out the edges. Finally, SMP was applied to his eyebrows for a full eyebrow appearance.

So, Dr. Rassman, it’s the day after my surgery and I don’t think I’ll be able to sleep for a few days. No, it’s not because of any pain or discomfort; rather, what you and your team did today will forever change my life.

As you know, my journey began in late 1993 in Beverly Hills. One scalp reduction and two 100-graft sessions later, even I could tell my ‘Master Plan’ at the time was bunk, BS, a no-go situation. And I’m no doctor, mind you.

Because I was still losing hair and now my large grafts began to show, I entered the world of hair systems ala Hair Club for Men two years later in the fall of 1995. The cover charge for entry into Sy Sperling’s party was a steep $2625.00, however, and that took me by surprise. Funny thing is, I now look back at those photos from that period of my life, and the hair looks shiny and oh-so-fake. Kind of like a horse’s tail. Maybe it was? No, that’s too harsh. I’m sure it was farmed from ladies in the far east, stripped of its cuticle and dyed to my hair color. It just had this otherworldly sheen to it and in no way did it appear real. Man, I wonder how many people knew?

Flash forward to the year 2000. I joined the Directors Guild of America (DGA) that year, was making union wages as an Assistant Director, and then stepped up a notch to a Richard Farrell hair system. Farrell reminds me a lot of you. He blows the lid off the hair replacement industry, and has a completely transparent salon. His systems are indeed the best, but no matter how much they appear to be growing out of your scalp, they are not. Further, they never will. My first two systems in August 2000 were just over $3000.00, reasonable for the quality I was getting. Since the lace bases were very sheer, they eventually ran their course and were replaced. In 2005 I did just that, except the cost of two systems at that time was $5000.00 (inflation of course). So, that’s $8000.00, excluding the monthly servicing, coloring, hair additions and haircuts I received. When you include those items, I spent $16,2000 from August 2000 through January 2006. OUCH!

Of course, the sad truth is I work in the film industry on set as an Assistant Director. I had the good fortune of working with Scorsese, Coen Brothers, Clint Eastwood, and directors of that caliber who attract similarly-accomplished crew members. I was unfortunately busted wearing a hair system by the hairstylist of a prominent Hollywood actor by none other than George Clooney’s personal hair stylist, a guy named Waldo Sancez. He is a cool cat, and he personally didn’t make fun of me or even let one that he knew (a class guy). He simply relayed to me that the entire hair and make-up trailer was abuzz because they were convinced I wore a hairpiece. When I was in the dressing from, he looked at my hairline the entire time, and never asked me if it was true. Conclusion: They all knew. OUCH!

Don’t get me wrong, if I were an accountant, mortgage broker, etc, I could have gotten away with a system of Farrell’s quality. It’s a completely different story, though, when you are standing eye-to-eye with an Oscar-winning hair and make-up artist giving warnings to the actors sitting in the chair getting ready for set.

After Waldo’s revelation, I was never the same AD. My self-confidence deflated like the proverbial balloon. I wore a ballcap every single day on set since 2000. All the while paying thousands of dollars to upkeep the systems that were supposed to allow me to NOT wear a ballcap. Irony anyone?

Flash forward to today, Feb 23, 2006. NHI is the real deal! You are every bit as caring and accomplished as any doctor I’ve met. I’d even hire you as my primary care physician if you moonlighted on the side. Bottom line: Your patients come first; your company’s earnings are secondary to the end result (and safety!) of those who enter 9911 Pico Blvd. looking for help.

I CAN NEVER THANK YOU FULLY for what you did for me-hell, and my career, for that matter-today. I am in the queue for a HUGE movie later this fall, and I know my confidence will be at an all time high. You can’t put a price tag on that. It’s about value, and what you’ve done for me far exceeds the “price” of what I paid NHI yesterday.

This fall, I can’t wait to knock on the trailer door, look the hair department head in the eye and proclaim, “Camera will be ready in 10 minutes. What’s your best guess on having actor _______ ready?”

I edited this letter before publishing it here, because it contained things that should not be the focus of such a letter (even for humor). I always believe that if you have nothing good to say about someone/something, best not say it. This man was a delight to work with and we bonded in a very special way (I always seem to develop a special bond in this strange world of the hair transplant repair process). Many repair patients have a unique type of pain that they live with, a type of pain that fortunately does not happen much with the modern techniques used today. The bonding requires building trust where none existed because of the history of the bad experience, well defined by this patient. I was humbled by reading his letter as I am every day working in this field.

William Rassman, M.D.

I started using Minoxidil 5% twice a day. I didn’t experience any side effects, so a year later, I substituted the 5% Minoxidil with 12.5% at night. I still didn’t feel any side effects. I switched to Xandrox 5% (minoxidil with azaelic acid) last December since I have PCOS and it was recommended to help stop the miniaturization of my hair. Within a couple of weeks (maybe even a week), I experienced heart palpitations. Is it possible that people can become hypersensitive to Minoxidil after a period of time (for me, 2 years)? Or could it be coincidental and related to something else?

Thanks

I have never recommend 12.5% topical minoxidil, as it can have serious systemic side effects (just as you described). More importantly, heart palpitations can be a harbinger to a serious and life threatening condition. I strongly recommend that you follow up with a physician for an examination. Minoxidil can cause a drop in blood pressure in a limited number of people.