Category: Uncategorized

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Was all of the donor hair removed permanent hair? (photo)

The permanent zone is measured from the base of the skull a distance up of approximlately 3 inches at most. If the donor area is larger than 3 inches on the sides or back, then this hair may eventually fall out in the years to come. You have gray hair suggesting that you are probably over 50, so that might make the risk of loss less, if your recession of the hair in the back has stopped. If it did not stop, then you may see the ‘white dots‘ associated with the FUE extraction once you lose the hair on the upper fringes.

 

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Running Out of Donor Hair

I’m an existing patient of yours and had great results on the front of my scalp with the last session 2 years ago. I’m starting to get a little thin on the crown of my head and a little forward of that. If it stopped where it is now, I wouldn’t be concerned but continued loss would be unnerving.

My issue now is that I’m pretty much out of donor hair. Has any progress been made with something I read about a couple of years ago called hair cloning? Also, I have a few old fashioned plugs that could be thinned and dispersed I suppose.

Nice to hear from you. Please look at the other comments in this blog on hair cloning. There is nothing new that would apply to you. As you are near our Northern California office, visit me there and I will personally assess your balding pattern. You are correct that taking hair from old plugs works, but the problem is total supply versus need. We would have to determine whether there is enough supply from all sources to meet your need for coverage.

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Double Follicular Unit Grafts (DFU)

Why don’t you offer double follicular unit grafts (DFU)?

Double follicular units (DFUs) are 3-4 haired grafts that have a slight gap containing skin between the hair follicular units (the natural growing anatomical units). Some people claim that if they use them, they can get more density per square cm and that the advantage is that more density can be created with fewer incisions… which means less grafts/cost to the patient.

DFUs are essentially the old type of minigrafts and the problem with them is not only a slightly pluggy look (for those people with dark hair and white skin), but also that there is skin transplanted with the follicles. This skin becomes depigmented and forms a whitish plaque on the scalp on close inspection, particularly noticed if you have a tan or olive skin. So while it is true that this can provide more density at less financial cost, the price is in a lesser quality transplant. The older large plugs had the highest densities, so if one takes the logic that DFUs are less expensive than follicular units and are the way to go, you can also look like you have doll’s hair for about a tenth of the cost of a fdu. You get what you pay for; do not lose sight of the fact that this is a surgical procedure on your head.

So to answer your question about why we don’t offer DFU, to be blunt, it’s because we don’t offer grafts that can be detected as a hair transplant, even on close inspection. The question should be, would I do it if someone specifically asked me to do it, to which my answer would be that I would consider it if there was complete informed consent present at the time the decision was made.


2008-03-14 14:02:06Double Follicular Unit Grafts (DFU)

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Saw Palmetto, Seborrhoeic Dermatitis

Hi doctor,

Does Seborrhoeic dermatitis causes thinning of the hair on the frontal and temporal areas or it just causes the hair to fall without thinning? I have noticed an increase in acne production in my scalp in addition to my noise and behind my ears and i am noticing a major thinning of my hair, so i am concerned if Seborrhoeic dermatitis is causes of these side effects. Also does DHT trigger the increase of acne production of the sebum glands, which are similar to the consequences of Seborrhoeic dermatitis? I currently stopped the use of propecia due to a severe sexual dysfunction and I am taking saw-palmetto and monoxidil 5% without any significant positive results but a major thinning all over my head. What is your comment on using saw-palmetto as a DHT inhibitor? Shall i wait till my hair sheds and then transplant some hair instead of taking a risk and play with my hormones? I am in a dilemma please help me. Thanks a Lot Doctors

Young men with genetic balding are best treated with finasteride (Propecia). Saw palmetto does not work for preventing hair loss and contrary to some promotion, there is no evidence that it is a DHT blocker. Minoxidil is less effective in genetic hair loss, but it may work. Seborrhoeic dermatitis does not cause hair loss nor does acne, provided that you do not pick on your hair. Acne medications do cause hair loss. If you get infections, then that could cause localized hair loss unless it is treated by a good doctor.


2007-02-02 12:35:25Saw Palmetto, Seborrhoeic Dermatitis

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Dr. Rassman, What Do You Need to Finally Accept PRP?

Dr. Rassman,

I understand your skepticism and reluctance to accept or recommend PRP on the scalp. I was wondering though, what would it take to establish a definitive verdict in regard to effectiveness (or lack thereof) of PRP? There have been some very promising sounding testimonials and pictures that some doctors have produced. But nothing that I guess would qualify as a comprehensive medical study.

I would need a well-controlled scientific study and if it proved to have value, I would likely become a convert. I generally keep an open mind about new techniques and love to see things progress as long as they’re safe and effective. The last thing I want to do is give false hope and waste anyone’s time or money.

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Scalp Exercise Device?

As an innovator in the field and with many patents to your name I am curious as to whether you have ever given thought to inventing a “scalp exercise” device. Imagine a motorized device strapped around one’s head moving the scalp up and down to increase one’s laxity in preparation for a future transplant. It would basically work as a scalp massage.

For a couple hundred dollars I’m sure many transplant patients would invest in one to maximize their graft numbers. Doing these exercises with the hands can get quite exhausting just after a few minutes.

It’s a good idea, but there have been a few patients who have came up with their own scalp exercise ideas that they are pursuing. In the grand scheme of things, scalp exercises are not the rate limiting step, nor do the exercises have a drastic impact on the success or planning of a hair transplant procedure in most situations.

Believe it or not, if I were to create a device for scalp massages and claimed it could loosen the scalp, it would be a medical device from the FDA’s perspective. It would then have to be proven safe and effective, a tall and expensive undertaking I might say.


2012-06-10 10:59:16Scalp Exercise Device?

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Dreadlocks and hair loss

I am white female in my early 30’s. I had dreadlocks for 10 years and cut them off because of the same problem, the twisting and weight was too mich and caused permanent damaged.
I loved my hair it grew down my calves and to cut it was a hard decision. I cut them 7 years ago and the problem has not gotten better. Now i have thin hair and very little my hair line is higher and higher every year…it could maybe just make 1 lock. I lost hope. Traction alopecia seems not to have any cure coming up soon since they scalp hets scarred and the follicules are lost. I don’t know what to do, I wear wigs now without it I look 20 years older because of my hair loss. I loved my dreads and I hate to say they destroyed my hair.

Hair transplants are another alternative that you might look into. It requires a visit to a hair transplant doctor like me to determine if you are a candidate for this type of procedure.

 

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Dutasteride dosing

I was reading up on a few dutasteride studies and was curious what your thoughts were about the recommended dosage of dutasteride given it’s rather extended half life.

https://academic.oup.com/jcem/article/89/5/2179/2844345 for example.

Clark noted that the DHT suppression in patients after drug cessation for .5mg dutasteride only had a minor deteriation after 2 weeks with greater DHT in the following weeks, and I’m just wondering what the medical benefits would be from continuing on the recommended .5mg daily when there doesn’t appear to be a specific clinical benefit?

Just curious, not taking this as medical advice. I just have questions and no friends in medicine to ask.

This is a complex issue. Do you really want a 94% or high reduction of your DHT? The article indicates it is possible with dutasteride. The recommended daily dose is .5/day, but I suspect that same benefits might be reasonable at a dose of once a week but since I do not prescribe this medication, I would rather not weigh in on the dosing issue. Most articles I have read indicate that the DHT block is 85% with dutasteride and 70% with finasteride

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Scalp Pain and Hair Loss

I have shedding/thining all over my top of head with no family history of MPB. I have an intense burning sensation in my scalp that is very painful. I have gone to three different dermatologists who have perscribed topical steroids and still no relief of pain or from thinning. Nerologists perscribed amitriptyline for the pain but is has worked very little. Is there any rational explaination for this hairloss and pain?

Head painYou need to be evaluated by a hair specialist to determine the pattern and type of your hair loss. You may be experiencing a typical pattern baldness that is aggravated by other medical disorders. Some medical conditions such as iron deficiency or skin inflammatory conditions can accelerate the hair loss in pattern baldness. If this is the case for you, treatment of the underlying cause may stop or slow down your hair loss. The next step is to get to the root of your underlying problem. I think your primary care doctor and dermatologist are the best people to start with.