Category: Uncategorized

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Does Seborrheic Dermatitis Rule Out a Hair Transplant?

I have been on propecia due to MPB for about 2 1/2 months. In addition, I also have seborrheic dermatitis. I believe I am going through a shed however I can’t be sure as my seborrheic dermatitis has flaired up over the last month so I cannot totally tell which my accelerated hair loss is from. My questions are:

  1. When you shed from propecia, does shedding also occur in the hairline? If so, does this hair grow back?
  2. Hair lost due to the seborrheic dermatitis, does it regrow? I haven’t been scratching or picking at it, but hair has fallen out of parts of my scalp affected by it.
  3. Does having this condition make you a bad candidate for a hair transplant?

Thank you very much

  1. When you lose hair at the hairline, the hairs rarely grow back (even if you take Propecia). Propecia mainly slows down the shedding process.
  2. Seborrheic dermatitis is a skin condition, not a hair condition, so it shouldn’t cause hair loss. However, it might accelerate underlying MPB or you could be seeing loss if you are picking at your hair. Picking at seborrhea can produce traction alopecia, which can be permanent.
  3. I have performed hair transplant surgery on many patients with seborrheic dermatitis and there is no issue. Sometimes if it is severe, I will use a short course of topical steroids to calm it down.
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Reversing an M shaped hairline loss

I am using minoxidil, zinc, and biotin plus Dermaroll once a week. I believe that Minoxidil definitely works even without fin!

It would be unlikely to reverse this frontal M shaped hairline, but I would try with microneedling + minoxidil and use topical finasteride. After one year you will know. IF it doesn’t work a hair transplant is a good option.


2020-12-21 11:52:39Reversing an M shaped hairline loss

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Does the Follicle Eventually Just Stop Producing Hair?

Hi doc,
is it true (..or partly true under certain conditions) that the follicle will go through the growth, release and snooze phases a specific amount of times and then stop to produce hair?

If so, MSM and it’s claimed increase in hairgrowth speed would actually do more harm then good in the long turn.

It is normal to lose 100 to even 200 hairs a day (though the average would be closer to 100, I’d say). As hair falls out, there are hairs that are also starting to grow. Hair may also grow in cycles and you may notice more hair falling out at different phases and seasons of the month. Hair follicle cells have three phases of growth:

  1. Growth phase (Anagen phase) which lasts anywhere from 2 to 6 years. This is the phase where your hair is actively growing at approximately 10cm per year. 85% of hair is at this phase at any given time.
  2. Transitional phase (Catagen phase) which lasts about 2 weeks. This is the phase where the hair follicle shrinks and prepares to enter the resting phase.
  3. Resting phase (Telogen phase) which lasts about 1- 6 months. This is the phase where hair does not grow but stays attached to the follicle. Some hairs are shed at this phase, but at the end the hair follicle re-enters the growth phase to start the cycle over again. 10-15% of hairs are at this phase at any given time.

Eventually, as we age, some of the hair follicles will die and stop producing hair. But keep in mind the life expectancy for a hair follicle can be over 100 years (provided that you live that long). My great grandmother had a full head of hair at 114 years of age, so clearly the hair can live longer than we do. I’ve written about this before — At What Age Does Hair Stop Growing Naturally?

Finally, there are no products or medications proven to speed up or increase hair growth. Drugs like minoxidil are thought to prolong the hair cycles and that might mean, in the long term, that hair treated with minoxidil might last more years. I would be interested to see product results on half a scalp to see if that half has faster hair growth, longer cycles, or whatever.

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Risk of Post Finasteride Syndrome Reported as High as 1.4%

https://www.ncbi.nlm.nih.gov/m/pubmed/28289563/

CONCLUSION AND RELEVANCE: Risk of PED was higher in men with longer exposure to 5?-RIs. Among young men, longer exposure to finasteride posed a greater risk of PED than all other assessed risk factors.

Comment: I have prescribed finasteride since it was first introduced. I have never had a patient with this condition reporting to me that their sexual side effects did not go away. I am having trouble reconciling this data from my own experience in private practice with well over 20,000 patients prescribed finasteride by me and the doctors working for me over two decades.


2019-02-20 08:03:36Risk of Post Finasteride Syndrome Reported as High as 1.4%

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Doesn’t the Scalp Still Shine with SMP?

Hey Dr Rassman. i hope your day is treating you well. As i am a frequent reader of this ever informative blog of yours a few questions have sparked my interest over the last week. It is in regard to the new micro pigmentation service NHI is offering. Now in the past i have noticed you were quite the skeptic about this type of procedure. I recall reading a few comments made by yourself which made me think they were: wouldn’t the scalp still shine? The lack of a ”sandpaper feel due to there being no actual stubble on the scalp and hair is 3 dimensional a tattoo is not.

However I was doing some thinking and this came to mind. If a patient were to come and request to have as many grafts that their doner supply would allow then have the tattooing procedure done in between those grafts and also had the scar camouflaged in the back of the scalp wouldn’t it be nearly impossible to tell the persons head of hair from a non balding person ? It would eliminate all of those issues i previously mentioned. Like for those individuals with high donor densities if someone had 10,000 grafts placed on their scalp then had the micro pigmentation procedure done i would think they would be able to get close to their juvenile hairline back and they would also be able to grow their hair out to probably a number 1 clipper with out it looking to odd. What are your thoughts on this ?

as I presently support the shaved head look but my hairloss is progressing i like the look i would just like more coverage. I have been on finasteride for 3 years when i first started it i was 20 and an early norwood three now my hair is really thin through out the top half of my scalp. I totally anticipate being completely bald by the time im 25 whether im on the medication or not.

HeadlubeYour scalp can shine with the oil that your scalp produces, so scalp micropigmentation (SMP) patients often use matting products available at cosmetic stores. There’s various brands of shine control lotions for the scalp, including HeadLube.

SMP has a use with some negatives and some positives. There is a natural symbiosis between hair transplants and SMP in some individuals. SMP is far less expensive than hair transplants, but you can not have it both ways (SMP in part with a limited hair transplant) unless the Master Plan takes into account what is happening to you now and later. There is a balance between SMP and hair transplants, but I can not give you an opinion over the internet.

It sounds like you need a Master Plan (I know I talk about that a lot), because you are changing with regard to your hair loss. Whatever you do, it should fit into the life plan; if you do go really bald, you’ll want to have a plan for what you’ll look like in the future if you make decisions about today’s problem. Come see me.

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Rogaine Foam Ruined My Hairline Within a Month — Should I Wait for It to Regrow?

Doctor..

Had slow diffuse thinning for years. Just turned 60 with what many thought was a full head of hair. Though i knew it was thinning. Thought I was years away from needing a transplant until switched to Rogaine foam which devastated my hairline within a month. Lost years in days. The company told me to stop using it. So the question is, should I consider a transplant now or wait to see if the hairline grows back? Read a lot about minoxidil shed hair grows back (though all I did was switch brands) and am on another brand now, but grow back at the hairline? I highly doubt it. What do you think?

Without an exam, this is a highly subjective question to answer. Moreover, we do not give medical recommendations on BaldingBlog.

Rogaine (minoxidil) can sometime cause initial shedding, but it should generally reverse over time (should wait at least 1 year). You may see the reversal in as early as 3 months.

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Donor grafts as high as 15,000, please discuss

In your assessment of my donor supply, you noted that I can bald to a Norwood 7 and still get hair. I’m not a NW7 but out of curiosity, I know different factors are involved, like head size and stuff but how many grafts would a Norwood 7 typically require for adequate coverage at an average transplant density? I know I’ve seen photos online from another doctor in California you’ve probably heard of or maybe even know (Dr. Umar), who specializes in the use of body hair grafts. Some of the Norwood 7’s he’s restored required over 15,000 grafts! One of the clients in particular, transplanted 9,000 grafts from just his beard alone! (how many follicles are even on a man’s face because he still was able to grow a beard, albeit just much less dense); the results were pretty impressive, regardless. Granted some of those clients requested really aggressive/ juvenile hairlines and had a lot of thin/single-haired grafts harvested from their back and legs which probably accounted for the need for a higher graft harvest

I wrote an article in the Journal of Plastic and Reconstructive Surgery in 2017 which discussed that almost anyone can get a full head of hair if they combine FUE with SMP. I didn’t discuss beard hair, but the use of beard hair significantly adds to the donor supply. I believe that body hair has much less value for two reasons (1) the hair is fine, and (2) the telogen cycle is long, which results in only half of the hairs growing at any one time while the other is in telogen phase.
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Running and Hair Loss

Is there any truth to the fact that running will help with Baldness? Since increase in blood circulation.

Also, what can i take to increase my blood circulation?

Where do these urban legends come from? No, there’s no truth to running as a treatment for hair loss. And before someone asks, running won’t make you lose hair either.

With respect to blood circulation, as long as you can feel the tips of your fingers and toes and it’s warm, I suspect you gave good blood circulation. Hair loss is not related to blood circulation — it is genetics.


2010-09-10 10:15:59Running and Hair Loss

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Dot Scarring from a Large FUE Procedure (with Photo)

I (Dr. Rassman) have had a total of 2200 grafts in three strip surgeries over the past 20 years, the last one being 6 months ago. If you were to look at my single linear scar, most people (even with a comb in their hand looking for it) can’t locate it. My strip scar is certainly far less significant than the mottled scars from follicular unit extraction (FUE) in this patient below. To be fair, if the patient had let his hair grow slightly longer, the scars would be less visible.

This is not my FUE patient, but I was told that he had 2500 grafts extracted in one session four years ago (and saw extremely poor growth). FUE scars like these are very common, and as most people get FUE procedures because they want the option of cutting their hair very short without a linear scar, many of them can’t do so when these dot scars are so detectable. Click the photo to enlarge:

 

I grant that some patients will have visible scarring from a traditional strip procedure, but now with Scalp Micropigmentation (SMP) the linear scars can be made undetectable. The same treatment can make these ugly FUE scars undetectable.

My point for this post is that scarring occurs with all types of surgery. Scarring should not be the motivator for the choice of FUE over strip surgery. Considering the cost differential between strip and FUE surgery, this is just part of the calculation each person must do in making the decision between strip and FUE surgeries.

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Saw Palmetto (Questions for a Reader)

Did it do anything for you? Did you get side effects (because it reportedly blocks 30% of DHT, half of what Finasteride is doing)? Is it an alternative treatment? After all, it doesn’t need to be prescribed by an MD, because it is over the counter, so bad side effects would be quite f***** up for something like that. Interestingly, people reported having side effects compared to Finasteride on this sub, which should pretty much unleash a big scandal because, as mentioned, it is an over the counter drug. I can’t figure out if these people actually got side effects or if they are nuts though.

Saw Palmetto is a very weak DHT blocker, and I don’t believe that anyone has had a reversal of hair loss on this drug.


2018-07-19 05:55:31Saw Palmetto (Questions for a Reader)