Category: Uncategorized

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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)

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Dr. Rassman talks about hairline and the good and bad about hairlines (video)

Dr. William Rassman discusses how to and how not to design a hairline. As a consumer, you must know what to expect and this short video covers what you need to know about what a hair transplant must look like so it is undetectable. Dr. Rassman pulled some photos from his files to show some of the things that have gone wrong with transplants performed by physicians or illegal technicians who don’t know the basics of the art and science of FUE or FUT. Be careful, as there are many illegal hair transplant clinics worldwide who care about making money and are not capable of focusing on natural results. here: https://youtu.be/qvr951TNlaM


2019-10-02 13:22:11Dr. Rassman talks about hairline and the good and bad about hairlines (video)

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Scalp DHT, Propecia, and Androcur

Dear Dr. Rassman,

Article at hairlosstalk.com includes the following statement of “Spironolactone effectively prevents DHT from attaching to the receptor sites on the hair follicles. As a result, the follicles no longer atrophy and can mature again to their normal size. And it does so without decreasing the circulating levels of DHT in the body.”

1. Is it sufficient just to block scalp DHT levels, or serum DHT reduction also necessary to combat MPB? If scalp DHT inhibition is sufficient for MPB, is serum DHT inhibition dangerous for the body as claimed by this doctor?

2. You’ve told in one of your comments that propecia is a anti-androgen, but the prospectus states that it does not have an anti-androgenic effect. Could you please clarify?

3. It’s mentioned that Androcur is the best against MPB. Is this the case?

Your reply will be much appreciated.

Finasteride needs to go through the blood stream to get to the hair follicles. When it gets to the hair follicle it then fixes to the tissue and blocks the DHT. Finasteride is not dangerous to the scalp.

Finasteride blocks DHT and when it does this, the testosterone levels often rise. If the body would not produce testosterone in response to a DHT block, then one would say it is anti-androgenic, but it is foolish talk like that because testosterone needs to be present to have DHT made by the body (DHT being a byproduct of testosterone).

Drugs like Androcur are good blockers of androgens and can produce major side effects on the male sex drive, something I would not recommend for patients with male patterned genetic balding.


2009-03-17 16:39:58Scalp DHT, Propecia, and Androcur

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Dreadlocks Causing Hair Loss in Woman?

I have a dear friend, young, beautiful girl (caucasian) who has come to believe that her really long dreadlocks – which she has been growing for 7 years…is causing perhaps permanent bald spots on her scalp. She is really beside herself about it, and wondered what she could do to be sure, and if so – to cure the problem.

Dreadlocks can produce traction alopecia (hair loss from constant pulling). The best thing for her to do is to get rid of them and then wait for recovery of the hair. After 7 years, the hair loss may be permanent, but until the pulling stops, you will not know one way or the other. Recovery from traction alopecia may take up to a year.

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Dutasteride (Avodart) Risks

My husband is 33 years old and is losing his hair, he also suffers with body dysmorphic disorder and is desperate to do something about his hair loss. He has already tried many different lotions and potions to try and halt the hair loss because we can not afford for him to have a hair transplant. The problem that I need advice about is Dutagen (Dutasteride soft gel capsules) he has purchased a 6 month supply of this drug from the internet but I noticed the warnings about dangers to pregnant women and the risks to male foetuses. The problem is I am 7 months pregnant with our second son and I have great concerns about my husband taking this drug knowing that there are risks to our unborn son. We also plan to have more children in the future and I am extremely worried about the risks to me and my baby now and for any unknown problems that may arise in the future regarding having more children. What information is available to me to put my mind at rest about my husband taking this drug while I am pregnant and future fertility considerations associated with taking this drug?

Dutasteride is a known DHT blocker. I am not familiar with this drug’s concentration in the sperm and how much of it could cross into the baby. If it follows the experience with Propecia, it should be safe in this regard, but without first hand knowledge, I can not tell you the answer to this question for sure. There is a theoretical problem if it did cross the placenta and into a baby’s body, it might affect the baby’s sexual development as the drug has a very long half life. You might ask your husband to use a condom until the baby is born.

Soft Gelatin Capsules, because of the possibility of absorption of dutasteride through the skin of people who handle this drug and the potential risk of a fetal anomaly to a male fetus in a pregnant woman who absorbs any amounts of this drug, could impact gonadal development. This is a risk that is not well defined for this drug. For this reason, women should use caution whenever handling Dutagen Soft Gelatin Capsules. Your physician should inform you and your husband that the ejaculate volume might be decreased during treatment so that for women wanting to get pregnant, this might also pose risks, particularly for the fetus if the sperm contains the drug and the drug last months inside the sperm (and possibly inside the fetus).

The known side effect of a decrease in sperm volume (with Propecia and Avodart) does not appear to interfere with normal sexual function in most men, but in clinical trials, impotence and decreased libido, considered by the investigator to be drug-related, occurred in a small number of patients treated with this drug. I hope that your husband’s body dysmorphia is being managed by a good physician.

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Scalp Necrosis from a Hair Transplant

These photos show the resulting scalp necrosis caused by a bad hair transplant. During a hair transplant procedure, if the hair grafts are packed tightly next to each, there is not enough blood supply to feed the center of the scalp. The center of the scalp receives blood via small tributaries from larger blood vessels at the front, back and sides of the head. These tightly packed grafts have a chocking effect and prevents the area from receiving enough blood and the flesh ultimately dies.

This is a devastating complication reflecting poor judgement on the part of the doctor. The treatment for this is balloon expanders as described in this link from a previous post https://baldingblog.com/2017/06/02/necrosis-poor-hair-transplant-technique-treatment-works-2/

I have seen patients in consultation for this problem many times in my 27 years of practice in the field of hair restoration surgery. Fortunately, in the 15,000+ surgeries my medical group has done, we have never seen such a problem.

prescalpnecrosis scalp necrosis