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Hair Loss And Chemotherapy – The Cold Cap

I am about to undergo Chemotherapy for breast cancer and I have been told that I will lose my hair. Is there anything I can do to prevent this?

We have written about a device called the Cold Cap before HERE

Many patients over the years have written to us about the successful use of the Cold Cap at preventing hair loss from Chemotherapy. You can review our previous posts on the subject. For reasons unclear to me, I have been told that many cancer oncologists resist this approach under the analysis that if there is metastasis in the tumor, the reduction of blood flow to the scalp limits the amount of chemo-drugs to the scalp skin. The value of not loosing ones hair seems far more advantageous to a remote risks that were brought up by some opposing doctors.

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The American Board of Hair Restoration Surgery

Dr. Rassman
Firstly let me tell you how much I have enjoyed your blog comments for the many young men and women suffering from hairloss. I am a 33 yr old male, who is scheduled for hair transplant surgery in a month. I have learned from your comments and want to ask you some questions. I have hair loss in the frontal/tempural area with thinning in the crown area. The thinning has improved since I started taking Propecia last year, no side effects thank God.

  1. Is 33 a good age?
  2. My doctor is Dr. [name removed] and he is a Diplomate of the American Board of Hair Restoration Surgery. Can you give me an opinion on this qualifications?
  3. I was concerned with scars, and felt comfortable since he is also a Plastic Surgeon, is my assumption correct?
  4. I am also concerned with shock fall. Is it permanent? How much help does Propecia offer?
  5. My doctor has not done a miniturization study on my scalp, that concerns me, although he did examine me the first time and I am scheduled for anohter consult. Should I request this?
  6. I also use Nizoral shampoo, and it seems to help, what have you heard about the benefits of this product if any?

Lastly, coming from a father that is a Vascular Surgeon, I know that confidence in the physician is important. I just did not get a second opinion, and have been trying to educate myself as much as possible. I feal my chances are pretty good, I hope to get strong results. I thank you again for your comments and help you offer on-line…..with the high pace life physicians lead its unlikely. I commend you for that.

Your father is correct in stating that confidence in your physician is very important. That being said, BaldingBlog is not a place for a medical second opinion. You should either address these issues with doctor or formally make an appointment with another hair transplant surgeon for the second opinion.

Credentials are important and being a member of the American Board of Hair Restoration Surgery may make it more probable that he is a good doctor. I am familiar with doctors with such credentials who I would not have as a surgeon, though. I, for example, have refused to become a member of the American Board of Hair Restoration Surgery because there is no formalized training for the accepted doctors and no peer review for what they do. When I received my credentials for General Surgery, I had completed 5 years of formalized, supervised training before I was allowed to take a series of written and oral examinations. The American Board of Hair Restoration Surgery credential only requires that the surgeon does 100 surgeries (without any supervision) and pass a written (very easy) examination. That does not make them qualified in my eyes. Now with that said, many of the doctors who have received the American Board of Hair Restoration Surgery credentials are good doctors and quite competent, while some are not. It continues to be a buyer beware situation for the hair transplant buyer (see: The Truth About Cheap Hair Transplants).

I have addressed shock hair loss before. Propecia in a balding male will reduce the risks of shock hair loss. If Nizoral shampoo is working for you, then use it. I feel strongly on the mapping out of the scalp for miniaturization. I do not like doing things blindly, because then I really could not lay out a good Master Plan.

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I Just Started To Lose Hair Possibly From Taking Hormones

I started to lose your hair this July. About that time I also went on hormones, DHEA, and antibiotics. Could these medications have caused my hair loss. I recently stopped taking these medications and think that the loss may have slowed and some reversal may be going on. Is this possible

I believe that considering the short period of use and the known relationships between DHEA and hair loss, it is reasonable to expect that the hair loss you had might be related to the medication. You think that the hair loss is reversing upon stopping the medication so it is reasonable to expect that your progress will continue. You need to determine the status of your hair in and around your head, get the hair and scalp mapped out for miniaturization and hair bulk with the HAIRCHECK instrument. From changes in hair thickness (in bulk) you will know where you are going with your hair loss and if it has stabilized. Good hair transplant doctors’ offices will do these test for you.

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The Hair on the Sides of My Head Started Thinning at 17 Years Old

Hello Dr. Rassman

I have a question about a condition I’ve had since the age of 17. During school i first noticed that the hair on the sides of my head started to thin, i then noticed general thinning of my entire scalp hair, i noticed the thinnest hair coming from the crown. as a few years pasted i noticed slight recession on both sides of my hairline.

What i find bizarre is that I’m now approaching 26 and still have pretty good coverage, the only thing I’ve noticed in the last 3 years is 2-3 tiny bald spots in random locations across the scalp (no conventional pattern) my crown thinning has not to my knowledge progressed

What i can tell you is that i am a male, my mother also has entire scalp thinning, but even thinner than mine but no slight recession. i always remember my mother having hair like this.

My father who’s 69 has still got quite a lot of hair, in fact he only started losing a bit of hair around his early 60’s.

If i do in fact have DUPA what does the future hold for me in terms of further hairloss?

I do not know what you have, but if you have diffuse unpatterned alopecia (DUPA), then in the future you will have diffuse thinning in no particular pattern. I have no way to know how much more you will lose hair though, as everyone is different.

There is a cosmetic treatment for DUPA patients, called Scalp MicroPigmentation (SMP). It is not a cure by any means, but it can make you look fuller. In any event, you should see a doctor and get a diagnosis.

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A Review of An Interesting Letter From a Patient in 2006

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.

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The Problem of Popping

I would very much apreciate it if you could explain what “Popping” is all about. As I understand it, it limits the amount of hair that can be successfully transplanted.

Popping is a technical term referring to a problem with placing grafts into the recipient sites in the balding area in a hair transplant. The grafts are placed and then do not stay in place, ‘popping’ out of the site. In the early days when we didn’t trim the grafts as closely and the recipient sites were larger, the bulk of the graft was so large relative to the surrounding tissue, that the graft would not be held in place. When the surgeon placed another graft next to the one that was only a couple of millimeters away, the ‘mass’ from the graft into this next site, pushed the last graft that was placed out of the wound. You can imagine a cascade effect, you place one graft and then another and the first pops out. Then you finally get both the first and second secured and place a third when the first two then pop out. That was the way it used to be.

Today things have changed. When we introduced the microscope in 1994, it was evident that smaller and more accurate dissection meant better results than dissection with other less powerful magnification tools. The grafts are smaller and can be more carefully dissected, so that the bulk of today’s follicular units is less than the old minigraft. The recipient sites are much smaller today, we use needles in the 0.8 – 1.0 mm range to make the sites. The results of the smaller site is that the ‘hole’ that is made tends to ‘hug’ the graft and the ‘bulk’ of the graft is of less consequence in the hands of an expert graft placer. Today the best surgeons have staff whose skills have built over years, allowing the grafts to be placed without disturbing the last graft placed. So, popping which was a major problem when we were getting the number of grafts from 500 up to 2000 in 1993, became less of a problem as we moved into the 3000-4000 grafts per session size.

To conclude, your question of popping is more of a historical question than a problem today. What is still relevant today, however, is that surgeons who use larger sites (greater than 1.2mm in size) to manage their grafts, are still practicing older techniques and popping (which is not a problem for us) still remains one for those less skilled in the art of today’s techniques.

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Going on Holiday with No Finasteride

Im a 17y/o M and I’ve been taking fin and minoxidil from March with great results but I’m going on holiday with friends and my fin isn’t coming on time and all I have is minoxidil will it be enough to maintain my results for 2 weeks, also I expect my minoxidil usage to be inconsistent due to the nature of parties and hangovers do u guys think I’ll be ok.
Finasteride holds its value, even after you stop it for up to 10 days. Never a good idea to stop it. It is small enough to take it with you on vacation, don’t mess with it.


2020-05-04 12:44:30Going on Holiday with No Finasteride

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Graft Anchoring After a Hair Transplant

Hi,

I am confused by some of your answers in the forum relating to graft anchorage.

Specifically, in your study with Dr. Bernstein, you conclude that from the 6th day, it is not possible to dislodge a graft by pulling the hair. Similarly, this is not possible by the 9th day by pulling a scab attached to the scalp/hair.

However, on some of your answers to questions related to graft integrity, you mention that as long as the scab is present, there is risk to the graft coming out (e.g. you advocate not wearing a hat until scabs come out, etc.).

So, are you saying that from the 9th day onward, the graft will not come out even if the scabs are scrubbed off, wearing a hat, etc. and the only time to worry about losing grafts due to scabs is in the first 9 days? Or is it possible to still dislodge a graft after the 9th day?

The reason I ask, is that I have a lot of scabs and started trying to remove them on the 11th day, and am wondering if the grafts would have set permanently by then, scab or no scab.

Thank

The graft pull study (PDF file) was done to determine when the removal of the graft, really meant that the entire growth center of the graft was removed.

We found that in the first six days, although the physical graft could be pulled out, the graft growth center probably remained (reflected the sleeve of the graft itself). We generally felt better when the graft pull was done at 9 days, but that did not mean that the graft growth center could be removed at the 9th day.

We are big on post-operative correct washing to minimize the scabs present. Some doctors do not give the patient the instructions on proper washing and scabbing may remain for very long periods (as long as 3 weeks). Although pulling out the grafts (at say 20 days) would still have what appears to be graft material in the pulled samples, there is little doubt that the graft growth center did not come out with these pulled grafts at 14 or 20 days.