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Hair Loss InformationIs an FUE Procedure a Less Successful Hair Transplant? – Hair Loss Information – Balding Blog

What do you mean by saying “FUE can be done in one surgery (our group did as many as 2600 in a single patient in a single session) or it can be done multiple day surgeries”? You said that this does not mean that FUE produces viable hair, so does that mean that you see less success in FUE procedures???

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Anyone can claim that they are an expert at a procedure, but where is the credibility? The results of an FUE procedure in good hands will be as good as the standard strip procedure, but yet all FUE grafts are not equal. In our original article, we talked about the candidacy of patients, where some patients were better suited for FUE than others. Now the non-candidacy group is smaller, but the quality of the grafts may become an even more important issue.

For the future, we can look to the past, as Dr. Jae P. Pak’s engineering work led to a robotic application and a U.S. Patent granted for the FUE technique in 2003 (U.S. Patent 6,572,625). We can expect to see a robotic application coming out in a year or two.

In brief, Follicular Unit Extraction (FUE) can produce damage that range from transection (cutting) of the hair follicles to avulsion of vital elements of the graft. The percentage of such damage should be under 10 percent. When compared to the traditional strip surgery, the follicular units taken under the microscope from the strip excision are mostly perfect. The FUE procedure is not as time efficient as the strip either. Local damage to each individual follicular unit depends upon:

  1. the skill of the doctor
  2. the instruments and techniques used
  3. the tissue characteristics of the patient

Most doctors do not classify the quality of each individual FUE graft nor do they calculate the transection rate, so the integrity of the doctor in making this assessment is just as important as his/her skills. Please note that nothing is 100% and always be wary of doctors or salesmen promising you 100% success rates, or a willingness to take on any patient for an FUE, or flippant comments like ‘our grafts’ do not get damaged. Always ask the doctor how he/she knows. Look at the picture of the three grafts below. The graft on the left is a normal FUE three hair graft with good fat and fibrous tissue surrounding the follicular unit, the one in the middle shows transection of one out of two hairs (only one hair may grow, but it is denuded of skin so it may not grow to its full bulk), and the one that is on the right is a three hair follicular unit which shows that the follicles have been stretched and the surrounding supportive tissue has been stripped away (these grafts will ‘probably‘ grow, but they may not have their normal width when they grow out). If this patient had coarse hair normally, the graft on the left would be coarse when it grows (like his normal hair), the one in the middle might be less than coarse (less than his normal) and the one on the right may be ‘finer’ hair. A coarse hair has better bulk and better coverage for this patient than a ‘fine’ hair and the results of the fine hair graft when and if it grows will almost certainly disappoint the patient when compared to what it should have been. Click the photo to enlarge.


For further reading about the FUE process, please see What Doctors Don’t Want You to Know About FUE.

Errors: http://baldingblog.com/photos/061214_fuegrafts.jpg is not accessible or supported filetype.

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Hair Loss InformationDoctors Only Record Their Successes, Not Failures – Hair Loss Information – Balding Blog

Have you ever had any failures in your practice of transplanting hair? Not just you didn’t fill in a portion here or there. But someone who was devastated?. It seems everywhere I search, doctors only records their successes. I think it is great that HT is often successful and am fully considering one for myself, but am of course afraid that there are people who have gotten a HT from credible doctors, and it made their life miserable.

Any thoughts?

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There are no guarantees in medicine. A doctor can not expect 100% of patients who had transplants to succeed 100% of the time. I’ve met with many patients who have had transplant failures at other clinics and have come to me for help. Many times the failures are produced by doctors who did not have the necessary experienced teams or underestimated the jobs that they took on. Some of the failures are caused by a failure to properly set expectations and when doctors use salesmen to ‘sell’ the transplant, then expectations may not be met because they were set unrealistically high to make the sale and close the deal. In many of these patients, I see graft growth roughly proportional to the number of transplants that they received, but a disappointed patient still sees the process as a failure. We solve this problem by holding open house events monthly where setting expectations and patient education are central to my agenda.

In my practice I have seen a rare failure of grafts to grow. There are many causes of graft growth failure that are not caused by the doctor, some of which include:

  • severely atrophic skin in a very bald person
  • autoimmune diseases that were undiagnosed (a common cause)
  • chronic telogen effluvium and the presence of a variety of scarring alopecias
  • infection
  • severe diffuse unpatterned alopecia (DUPA)

DUPA is a relatively common cause of failures, because the condition is often not properly diagnosed, even though it is easy to diagnose when the donor area is mapped for miniaturization).

So yes, you are correct that doctors do not want to publicize failure. I don’t know of a doctor in any field of medicine that proudly shows off unsuccessful procedures. It is just never good for business. Could you imagine a breast cancer specialist telling how many of his patients died, or a psychiatrist tell his depressed patients how many of his patients committed suicide?

You ended your question with a suggestion that a hair transplant from a credible doctor would make their lives miserable. Modern hair transplants should not make anyone worse off. Even a theoretical complete failure should leave a person to where they were prior to the transplant (less whatever scar was in the donor area, which should be minimally detectable).

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Hair Loss InformationHair and the Effects of Flat Irons – Hair Loss Information – Balding Blog

Hi I am 29 years old, male. Do flat irons cause permanent hair loss? My hair dresser started using a flat iron on my hair 3 years ago, since my hair was wavy, he showed me how I can make it straight. About 2 months after using it (usually once or twice a week) I noticed that my hair was drying out. I stopped, only to use it once in a while. Today I find that my hair is receding on the sides and my crown is thinning. Is this from the use of the flat iron? I’ve stopped using it for about 6 months now but I still find that my hair falls out everytime I wash and style it. I researching on the net about the side effects of flat irons but never found any concrete proof about the consequences of using them. I hope I didn’t ruin my hair for good! What can I do?

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Let’s think logically about this. When hair has grown beyond the scalp, it is no longer a living tissue. Only the hair organ below the skin is living. Hair is made of compressed fibers and a shingle type of structure made up of shed skin cells called cutin. These shed skin cells are in effect the same ‘stuff’ that produces the scales we see in dandruff and may reflect higher turnover of the skin on our scalps. As these shed cells are compressed above the fibers in the hair shaft, they form a layered array just like the shingles on a roof would form to keep out the water. But below the skin, the hair organ puts lipoproetin layers into these scales of cutin that give the hair the character that you have. The presence of fat on the outside of the hair shaft is what brings out ‘luster’ in the hair. Once the hair exits the skin as it grows , it enters the hostile environment of air, wind, weather, heat, etc… and it no longer is subject to what your body can do for it. As the hair exits the surface of the skin, the sebaceous glands secret a waxy sebum that may find its way onto the hair shaft, giving some people an oily hair.

When you iron your hair with heat, you do change the character of the hair and change the configuration of the varying layers of compacted cutin and the fibers that make up the structure of your hair. Heat takes away the luster (shine) from hair, burns away the waxy covering, may denature the lipoproteins on the surface of the hair shaft and it is this that protects the hair from the environment. Heat may damage the core of the fibers inside the hair as well. High heat applications can damage the hair so that it cracks, breaks, and even become fragile, producing broken ends from hair that breaks too easily. Take a look at this illustration of an enlarged hair shaft here (illustrated by Norm Nason). Note the layering of the cutin shingles. Look at the center of the shaft and see the fibers that form the backbone and the strength of the hair shaft. When these fibers are broken, or the shingled cutin is removed, damaged or burned, a pealing process may begin which would reflect the damage to the foundation of the hair shaft, and it can become permanent. When the hair is damaged, then gentle handling is critical to maintain and hold it on your head. You can, of course, cut it off and new hair coming from below the skin which should not grow out damaged, will eventually replace the weak hair. The hair exiting the skin is normal and undamaged so you can and should expect that once you cut off the damaged hair, the new hair will grow to whatever your normal should be. Good cosmetology can hydrate the hair and it might bring back some of its luster and strength. For those of you interested in high powered microscopic views of the hair system below the skin, see here.

So, if you have hair loss or thinning of new hair, it is possibly a new problem, and you need to have your hair analyzed by a doctor like me.

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A Good Hair Transplant Made Great (with Photos) – Hair Loss Information – Balding Blog

Once you have a follicular unit transplant (FUT), if the procedure was done with care, there is no question that the results can’t be detected in any casual encounter, or even on close inspection in most circumstances. Yet with that said, there is still a difference between patient results that go beyond the characteristics of (1) hair shaft thickness, (2) hair character, and (3) hair color.

Let’s take a look at a patient who had two hair transplant procedures. The patient is Dr. Jon Perlman, the well-known Beverly Hills plastic surgeon that has been featured on ABC’s television show, Extreme Makeover. After his first session, he had good results that nicely framed his face when his hair was groomed. But on close examination, his hair was somewhat see-through. Dr. Perlman has very fine hair, so the bulk of each hair shaft was lower than average. By undergoing a second procedure, the bulk was doubled and the results shown in the pictures below say a great deal about the change he experienced. He was more-than-satisfied after the first procedure and thrilled after the second one. A good transplant became a great transplant.

Sometimes patients will tell me something like, “I don’t want it too thick and I am afraid if I put too much hair there, it will look unnaturally thick.” In all of the years of doing this surgery, I have never, ever had a patient who told me that I had made the hair too thick in a single session. We have seen many of our patients (initially satisfied, but wanting more hair) receive another transplant and become transformed back in time to their youthful look. By performing NHI’s pioneering dense packing procedure, we can increase the density of hair in a single procedure, often reducing the number of procedures needed to obtain results like the one shown here, but when the hair is super fine (like the example below) then two sessions may be needed. For many people, hair is like money — the more you have, the better it is.

Click the photos to enlarge.

Before and After 2 procedures (2890 grafts total):

 

For more photos, click “read more” —

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Before (left) and immediately after surgery (right):

 

After 1st procedure (1529 grafts):

 

After 2nd procedure (1361 grafts):

 

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Hair Loss InformationHow to Tell if You’ve Found the Right Hair Transplant Doctor – Hair Loss Information – Balding Blog

What is the difference between doctors and the various medical groups performing hair transplants. There appears to be a great deal of competition and as I go between groups, I get confused and overwhelmed.

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If you were looking for a good family doctor or plastic surgeon, you would most likely use certain criteria for selecting one over the other. Fundamentally, you would look for a well credentialed, caring, competent doctor who you like and feel comfortable with. Be sure that the doctor values you as a patient by spending time with you and discussing your agenda freely. Ask yourself if the doctor listened to what you were saying or lectured you about his/her ideas. That doctor must be trustworthy to take on your welfare or your family’s welfare, and not only must you believe in his/her skills, but you should also like him/her as a person. Although the various family doctors and plastic surgeons use physician’s assistants or nurse practitioners to help them manage patient’s needs, the doctor is always ultimately the person in charge, the one whose skills you will eventually depend upon. As most doctors practice in groups, you should feel comfortable with the doctors who work with your doctor in the group that you selected, as sometimes your doctor may be on vacation or off-call when you need him/her the most.

You should expect that physician extenders should be educated as physician extenders (nurses or certified physician assistants, not salesmen). Hair transplantation differs from standard family practice and cosmetic surgery procedures in that there is a team approach to performing surgery. Doing refined follicular unit transplantation takes a team of 3-6 people working together for hours, so the doctor’s team is as important as the doctor is. An old cliché says that a chain is only as strong as its weakest link, so the skills of the doctor as one link of that chain can easily be offset by inexperienced technicians in the surgical team or sloppy processes that are not put together carefully and not focused on the many detailed nuances that produce quality hair transplants. You should feel confidence in the doctor and the team and you should feel ‘integrity’ and trust in soul of that doctor.

In my hair restoration practice, I add many elements to build confidence and establish trust. I have an open practice, where new, potential patients can meet completed hair transplanted patients one-on-one. This offers the opportunity for new patients to probe the process and see up front what they will be getting if we perform the surgery. I focus heavily on patient education, not only by providing copies of some of the important medical articles I have written, but also in spending time with each potential patient (doctor and patient in a private room without a salesman). Then after the visit, I provide a detailed letter summarizing what I learned about the patient’s objectives, and a written Master Plan for what I think will happen to that patient. Fees are openly discussed by the doctor and quotes for surgical fees are put into writing. By far, most of our patients do not have surgery and can be spared surgery with appropriate medications.

NHI is unique in that we have a fully accredited surgical center where all of our surgeries are performed, ensuring safety for patients to the highest national standard. Our surgical center is audited regularly for following hospital quality processes and procedure. Very few (if any) hair transplant facilities adhere to such rigorous standards. Why is that important? Well, it is the patient’s assurance that our sense of quality is judged against the best healthcare facilities in the nation. When you select a medical group for your hair transplant procedure, you should not only know the facility, the staff competence, and longevity of that staff, but also the history of the doctor. Has the doctor been disciplined before the medical board for infractions in any form of conduct? What does the public and his colleagues think about the doctor (available through internet sources)? What is the doctor’s malpractice record? Have you met or spoken to his/her former patients, and if so, what do they tell you about their research prior to taking on this doctor as their doctor-of-choice?

I always tell my patients (and have written on this blog many times before) that there is good news and bad news for the hair transplant patient — simply put, hair transplants are absolutely permanent. Getting it done right the first time is far easier that trying to fix what might not be fixable if it is done wrong. By following this selection process, finding a good doctor should not be difficult. There are many good doctors out there, just be careful not to end up in the wrong place.

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Hair Loss InformationTreatments Available for Female Hair Loss – Hair Loss Information – Balding Blog

Over the over again, women from all over the world are writing to me asking, “What can be done for me?” I will list alternative options below, but I want to warn those of you who are reading this material to recognize that none of this is proven to solve the hair loss problems of most women. If it works, it may work in selective women, those that have a more clear androgenic (male-like) component of their hair loss. In addition, some women with combined genetic hair loss and Polycystic Ovaries (PCO) develop male-like patterned hair loss and could be candidates for the hormone treatments discussed below. I am loathe to recommend these treatments, because I do not personally feel comfortable with recommending hormone altering therapies, as some of them may impact ovarian, breast, and uterine cancer risks — so with that warning, please read on.

Finasteride use in women:
There have been articles on the failure of 1mg of finasteride to impact women’s hair loss. Now, for the use of higher dose finasteride than normally prescribed in men, the Iorizzo article (see references below) concludes, Sixty-two percent of the patients demonstrated some improvement of their hair loss with the use of finasteride, 2.5 mg/d, while taking the oral contraceptive. It is unclear whether the success was due to a higher dosage of finasteride (2.5 mg instead of 1 mg) or to its association with the oral contraceptive containing drospirenone, which has an antiandrogenic effect. These two drugs may complement each other and to get the effect, they both may be needed. Further studies are necessary to understand which patterns of female pattern hair loss respond better to this treatment, for I am sure that all women will not respond the same way. The article leaves us confused. It is not clear which are those who can be treated and there are no statistics on safety and side effects (this was not the focus of the article, however). The entire article is based upon conjecture, something that the authors recognize is the problem that the limited study creates. What concerns me is that with the promise that 62% of women may be helped by Propecia, desperate women with the help of inexperienced doctors will start taking finasteride without understanding the long term impact of these drugs on women. Maybe downstream, we may see a Vioxx type side effect with regard to cancer. With that said, there is a suggestion in this article that finasteride may have value for women and if this can be seen with better, more controlled studies, then this may be a breakthrough. I suspect that women with a ‘male pattern’ to their hair loss may experience more benefit over those without it. This is conjecture (an educated guess) on my part.

Antiandrogen treatment for hair loss in women:
The second article (see references below) starts off, “It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy.” This opening correctly set the tone of the article. Two different medications were used: spironolactone and cyproterone acetate. Neither was clearly better than the other. Discussion of the authors said, “The treatment under a doctor’s care went for 16 months. 44% had improvement, 44% had no improvement and 10% had further hair loss“. Many dermatologist are presently using spironolactone and cyproterone acetate and there is selective enthusiasm for these drugs, but it is not universally accepted as the mainstay for treating women’s hair loss. Doctors come under a great deal of pressure to do something. The question here is will spironolactone and cyproterone acetate treatment provide enough benefit for the costs and the pain of the injections that are required with repetitive treatments over a prolonged period of time?

References:

  1. ARCH DERMATOL/VOL 142, MAR 2006: Matilde Iorizzo, MD; Colombina Vincenzi, MD; Stylianos Voudouris, MD; Bianca Maria Piraccini, MD, PhD; Antonella Tosti, MD, Titled Finasteride Treatment of Female Pattern Hair Loss
  2. British Journal of Dermatologist 2005, Article by R. Sinclair, M/ Weweromle amd D. Jolley from Australia titled: Treatment of female patterned hair loss with oral antiandrogens

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Hair Loss InformationWhat is Dandruff and Why Do I Have More of It Than My Friends? – Hair Loss Information – Balding Blog

What is dandruff and why do I have more of it than my friends? I can’t wear any dark shirt without snow on my shoulders. What can I do about it? Please help me understand what is happening to my scalp!

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Skin is not static. It changes and we shed it like a snake sheds its skin, but we do this a little each and every hour of the day. In two weeks, the average person will shed their entire skin surface and replace it with new skin. Scalp skin takes about a month to turn over, so the process is a bit longer. To understand dandruff, let’s take a quick look at psoriasis. “Psoriasis is a skin disease that causes scaling and swelling. Skin cells grow deep in the skin and slowly rise to the surface. This process is called cell turnover, and it normally takes about a month. With psoriasis, it can happen in just a few days because the cells rise too fast and pile up on the surface.” (source: NIAMS). Dandruff is like psoriasis in that the skin turnover is faster than normal (not anything as fast as psoriasis) and before it can be shed, it cakes up to form the flakes that you are observing and complaining about (dandruff).

Skin on different parts of the body shed at different rates and as we age, it is the genes in our body that determine how quickly the normal aging process occurs in our skin and the turnover rate of that skin for our age. The rate of aging and the daily changes in our skin can be influenced by extrinsic factors that can act together with the normal aging process to prematurely age our skin. Sun exposure is one of the most important factors that cause our skin to age but the way we use our body also impacts us. Exposure to varying environments will change the rate of skin turnover as well as the moisture that our skin has in it. Other external factors include things we do, like smoking, which has a duel effect, not only aging the skin and changing the water content of our skin, but it also decreases blood flow to some part of our skin anatomy (scalp). Over time, exposure to the sun damages our skin and impacts our ability to repair itself. Much of the damage is probably related to our exposure to ultraviolet (UV) light which damages our skin’s ability to repair itself. The skin which envelops our body becomes loose as we age and this process is accelerated when we do not protect our skin from sun exposure. The rate of skin turnover varies between people and dandruff is probably a reflection of the rate of skin turnover of our scalp skin for the flakes of dandruff are actually pieces of our skin which are shed prematurely. The higher the turnover rate, the worse the dandruff and the more frequent will be our complaints (e.g. itching, dryness) which plagues many of us.

The best way to manage your skin is to develop a sensible skin care routine. The scalp is no different. The use of moisturizers will soften and wet our skin; conditioners made for dry skin and dry hair will help restore moisture that is lost from the shampoos we use, which remove many of the protecting oils made by our sebaceous glands (sebum) that are designed to hold in moisture. Most important of all is the way you protect your skin from sun exposure, which can produce structural changes in your skin that are permanent. Older skin does not hold on to water very well, so older skin dries easily. Our outer skin layer (stratum corneum) may shed less as we age and the normal texture of the skin changes to reflect the loss of the supporting structures below the top skin layer. An older person’s skin appears dry and crinkly and this reflects a slowing down of collagen production as well as the fibrous elements that we call elastin. Elastin brings the recoil that returns the skin back to its normal position if we pull on it. In the typical aging person, the skin does not recoil very well when pulled upon and as such, it stands up after being pulled upon and it is also more fragile to injuries and environmental factors. Aging is a continuous process that normally begins in our mid-20s when most of our skin is healthy and hopefully not yet damaged by environmental factors. Dead skin cells do not shed as quickly and turnover of new skin cells will decrease as we age. The signs of aging are typically not visible for decades and this reflect the fact that our skin can take considerable abuse before it shows its age.

The dandruff on your head reflects many of the elements discussed above and the scalp skin is constantly exposed to drying from air and UV exposure, building up more damage over time.

Our body’s ability to replace itself varies significantly by body part and organ. For example, the outer layer of our skin completely replaces itself in about 2 weeks (scalp 4 weeks), while the lining in our intestine does it every 5 days. Our red blood cells replace themselves every 4 months (about 1/120th per day) and our bones about 10 years. Our chest muscles last 15 years, and our brains, well the part of it reading this blog, is as old as you are. So next time you get frustrated over the dandruff, think about what you have learned here, as it is a lot easier to moisturize and protect your scalp skin from sun damage than to simply ignore it as most of you do now.

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Hair Loss InformationIf You Trash Your Competitors, You Will Get Dirt on Your Shirt – Hair Loss Information – Balding Blog

I read with disgust your piece the other day (Doctors, Crooks, or Con Men — How Do You Tell the Difference?) which attacked doctors in such a way that your readers will get an unfair view of the doctors who do good hair transplants and are honest and caring. There are many doctors with high integrity who try to get the best for their patients. Why don’t you promote them and talk about the wonderful things that we can do today, rather than dwell on the few rotton apples out there?

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From time to time, I just get overwhelmed by some issue and my frustration is shared with all of you. This is my blog, which is like a personal journal that I share with all of my readers. Sure, I answer hair loss questions that are written to me, but from time to time I also treat it as a place to express my thoughts and even vent my anger in hopefully some constructive way. The piece from the other day was clearly precipitated by one particular patient, but unfortunately, it was not such an unusual occurrence for me to see this problem come up. Of the four doctors who gave him opinions, two of them actually do good quality hair transplants that I have seen in my office, but the decisions they made when meeting this poor man were not necessarily driven by his agenda nor his welfare. I know, unfortunately, that many of the doctors in the hair transplant industry spend huge amounts of money promoting their hair transplant expertise. A 2 x 3.5 inch ad in the Los Angeles Times, for example, costs between $1300-2700 for each day it is run (depending on the day of the week and length of the contract), so when ads are run daily, the costs become staggering and the doctor is as much driven by his/her ability to support his ad budget and his staff salaries, as by his/her desire to be honorable and righteous. Does one agenda conflict with the other? I believe that they, unfortunately, do conflict.

To handle a high number of people responding to these ads, these doctors hire salesmen (often disguised as someone with medical expertise) who become physician extenders, often screening callers to find out who has enough money to afford a hair transplant. Salesmen earn commissions, and although commissions are illegal in California, the commissions in some form still are what drives the sales process. Every potential candidate is screened for his ability to pay the large fees, just as the prospective patient was quoted the other day. That patient had the money so I think that the blood hounds sensed it so the price incentives that were offered by one doctor had some sense of urgency to it. The process I just defined is sleazy and it is something that I have written about, much to my detriment in this heavily market-and-sales driven process. Unfortunately, this is not just a California problem, it is an industry-wide cosmetic surgery problem and some doctors from around the world fit well into the amoral mold I have defined here. But there are many good doctors out there as well, so shopping before you buy a hair transplant will probably lead you to a better choice than taking the first doctor you meet. Watch out for sales tactics that look like a used-car sales lot. Do not accept seeing anyone but the doctor who is going to do the work and never, ever accept anything that you are told unless the person is qualified to give you an opinion and can back up what the doctor tells you.

The doctor who wrote the above comment to me today does bring up some very important things. The surgery we can do today is almost miraculous and 6 of my family members who’ve had hair transplants think that I am God-like for how natural the work looks. I think that too many people have expectations of the deforming, pluggy, doll-look with corn rows, so it is a difficult road for today’s doctors to educate the public on today’s high quality reality. A hair transplant was not only good enough for my immediate family, but I also had it done. As I’ve shared before, I have performed surgery on the politicians, billionaires, CEOs of big businesses, celebrities, the Royalty of countries that my readers have read about, and a few probable mafia members from other countries who would not have allowed me to live had it not worked out and met their expectations. I am not the only doctor who can do this type of quality hair transplant, so please forgive me for yesterday’s and today’s diatribe. To complete my answer to the doctor who posed the comment to me, I must remind the doctors who are reading this blog that we have taken an oath to uphold our patients’ interests about our own. If our oath is not enough, most governments that license doctors require doctors to report any infraction in ethical behavior that we observe as a condition of licensure, something that even I do not adhere to, to the spirit and the letter of the law.

I remember in 1994, I spoke before hundreds of doctors attacking those whose ethics reflect the worst of the sleaze in the business. I openly called them ‘sleazy crooks’. I also remember that the audience stood up and applauded my comments because the large majority of doctors were also disgusted with those who dragged down this struggling new industry, making it particularly hard to break the monopoly that had been horded by a select few marketers. I felt good about my comments because I sensed that many of the doctors in the audience fully supported the victimized men we were focused upon helping. After many private congratulations in the hallway over my vocal position, one well known doctor waited on the sidelines. As the crowd that surrounded me thinned and dispersed, that well known doctor came over to me and said, “I did not like the way you talked about me.” He stomped off and I thought for a moment, remembering that I never named a name and the closest I came to identifying anyone was the label “ sleazy crook,” which seemed to have struck a sensitive cord with him. I think I remember saying, “If the shoe fits, its yours,” but I think that he walked away from me too fast to have heard my retort.

I hope that the doctor who posed his query to me here reflects those who supported my position in 1994 and would support this long winded commentary by me as well.

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Hair Loss InformationHow Propecia Works on Hair and Why Miniaturization Mapping is Important – Hair Loss Information – Balding Blog

Authors: Price VH , Menefee E, Sanchez M, Kaufman KD. Department of Dermatology, University of California, San Francisco published an article in the J Am Acad Dermatol. 2006 Jul;55(1):71-4. Epub 2006 May 3.

This is an important article which shows the impact of finasteride (Propecia) on the miniaturization process. It is clear from this study that Propecia produces much of its value by reversing the miniaturization process, making the hair shafts thicker, more so than growing new hair follicles. That is why it works well in people who still have hair that is being impacted by the genetic balding process, while being minimally effective in those men who lost most of their hair. The article concluded:

“CONCLUSION: Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs, such as increased growth rate (length) and thickness of hairs, contribute to the beneficial effects of finasteride in treated men.”

I know that many of my readers may be tired of the constant references to mapping out the scalp for miniaturization. This scientific study, by a prestigious university, shows that the degree of miniaturization in the drug treatment for hair loss is where the benefits lie. Mapping the scalp absolutely shows from ‘whence your hair came to where your hair is going’. The measurements of miniaturization is the diagnostic backbone for the diagnosis of genetic balding, particularly when it occurs in patterns (male pattern balding or MPB). Even female genetic hair loss has distinctive patterns of miniaturization and the skilled diagnostician who commands that knowledge, is more effective in giving advice and building the Master Plan that I keep talking about. The doctor should:

  1. make the diagnosis by mapping the scalp and analyzing miniaturization
  2. document the pattern of hair loss and miniaturization
  3. use his/her knowledge to predict what should happen when a person is treated with drugs on miniaturized hairs
  4. observe what happens when the drug is used on the miniaturized hairs by repeating the mapping process periodically over time
  5. build a Master Plan based upon the degree of miniaturization and its response to drugs and/or time
  6. get to know the patient and his/her goals
  7. evaluate the transplant option when appropriate
  8. learn how the treatments (transplants or drugs) impacts the patient’s goals and the balding process based upon successive scalp mappings, and
  9. re-evaluate the Master Plan based upon the knowledge of what has happened in 1-8 above.

This 9 step process is the standard of care today and anything less than this is less than what every hair loss victim should accept.

Too many times, readers of this blog tell me that they have gone to their doctors and asked to have their hair mapped out for miniaturization and the doctors they speak with essentially call mapping ‘hogwash’ or BS. As you can see from what I wrote here and the published article I referenced above, mapping out the scalp for miniaturization is possibly the most important part of the doctor’s evaluation of hair loss. Too many doctors look at the scalp hair, run their hands through it and make a diagnosis and a recommendation based upon a naked eye evaluation (as if to suggest that there is a microcope on the ends of their fingers), but this approach brings no sophistication, little added value, and no clinical science to the ‘hocus pocus’ that has been associated with hair loss and its diagnosis. The standard of care dictates that the 9 step process outlined above is the basic minimum a patient should expect when he/she visits an expert in hair loss. The metrics of miniaturization is the foundation for the clinical diagnosis of hair loss.

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Hair Loss InformationEmail from Inventor of Rejuvx – Hair Loss Information – Balding Blog

I am the inventor of Rejuvx and after selling thousands of bottels of my product i guess i must have a formular that must give some results other wise people would not keep on buying it, my product has never been sold to regrow hair as i belive as a chemist that is never going to happen but it has helped thousands of people have a fuller healthier head of hair

Regards Edward Horton
Presient c.e.o RejuvX

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Soap BoxThank you for the letter and finding BaldingBlog. First, I need to point out to readers that I have no way to verify if this is a legit email from the actual inventor of Rejuvx, but I have no reason to think otherwise so I’ll take it at face value.

I am a bit confused that your letter states Rejuvx has “never been sold to regrow hair“, because I just visited your website which states: “Within weeks of using Rejuvx, people experiencing hair loss will notice improved growth“. There may be a fine line from a legal FDA point of wording here, but that is not my specialty.

Back in the late 1980’s and early 1990’s the Helsinki Formula was advertised to treat hair loss and was one of the best selling products for hair grwoth on the market at the time. What most people do not know is that the Federal Trade Commission (FTC) in accordance with the Federal Trade Commission Act of 1914 filed a suit against the makers of Helsinki Formula stating their advertising constituted a deceptive trade practice. The court concluded that the product had a “placebo effect”. In other words, many companies have sold great amounts of product and have yet to do what they claim, so pointing out that you have sold “thousands of bottels [sic]” really holds no meaning but suggested value.

There may be laws and regulations, but manufacturers advertise what consumers want to hear. Desperate people spend money in hopes that a cure for balding is as easy as 1, 2, 3. Most of these claims will go under the radar of the Federal Trade Commission, because there is an art to stating certain claims without breaking the law and the FTC cannot possibly prosecute all of those that are in violation (they pick and choose their battles).

The Rejuvx website states, “The abandonment of artificial ingredients additionally makes Rejuvx prescription free, since it does not cause any significant side effects.” — No significant side effects imples there are SOME side effects and I would love to know what they are and so should potential buyers for proper disclosure. If there are side effects of any type, then I would be happy to contact the FDA’s enforcement arm to look into the language you are using and in pursuing a full disclosure so that the public will know the safety factors about your product. I believe that the FDA is empowered to investigate and report on the safety of products sold that have side effects and only they can judge what is and what is not significant.

I am pleased you have a successful business. It illustrates the fact that we live in a society obsessed with hair loss, and the appearance and worship of youth. While my statement may trigger a spectrum of theories and opinions about our vanity, it is also a catalyst for many to profit from our insecurities. My ultimate point is that it is (and it always will be) a buyer beware market.