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Flu After a Hair Transplant

Dear Sir,

First of all, congratulations for this site and all the usefull info that comes with it.

Im in my 15 day after my mega FUE sesion and i got flu with some fever. Is there any chance that this will interfere with my process due to the high temperature or the use of medication like antibiotics and ibuprofene?.

Thanks in advance for your attention and work.

You’re safe. Neither the flu nor those medications will interfere with the growth of hair transplant grafts. There’s no impact on future growth from getting sick.

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Sudden Hair Loss — Was it Stress, Fish Oil, Hair Product, or Genetics?

Dear Dr. Rassman,

I think it is great that you have this blog. I am sure I should come in to see you for a consultation, but first I’d like to see if you can shed any light on my particular circumstance. I am extremely healthy, eat mostly fresh fruits, salads and soy protein powders, but also eat meat, whole grains et cetera. I have worked-out for 25 years and handle stress better than anyone I know (all my friends and family say that too). At the end of June, 2006, I returned from vacation and my THICK, beautiful hair started falling out FAST. In one month I had lost so much it looked like I was going bald and one could easily see my scalp, which was an impossibility before that. The only 3 things I could think of as a cause for the rapid fallout were the following: 1. a very STIFF, THICK, HARD hair product which I had begun using 2 months prior. 2. I had begun taking 12,000 mg’s of fish oil daily upon returning from vacation. 3. A stressful life incident, but I have had so many of those, it doesn’t seem likely that another would affect me. Anyway, I stopped the product, stopped the fish oil, and my stress has increased if anything. By about 6 months out, my hair started to return, but no where near what it had been. People who look at me think I have a good head of hair, but I know it is not what it was. I want it back. Super thick like before. In what I wrote to you, can you identify anything that may have caused this rapid fallout? Or do you think it is best I just come in so you can see my scalp?

Thank you for your time, and have a great day.

I really do not have a good answer for you. Your hair loss could be due to many factors and sometimes a stressful event (emotional, physical, chemical, etc) can trigger a hair loss process. Nobody really understands why, but it is thought that a genetic ‘switch’ is turned on and once it is turned on it is difficult to go back to your original state. If your hair loss is due to genetic causes, there are medications such a Propecia (for men only) than can slow the process or even partially reverse the process in the best case (though it will rarely bring your hair back completely).

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Following your balding genetic tree

The nice thing is my great grandpa didn’t even need it. Since his stopped in a decent NW3 position. My uncles on the other hand, lost more over time. From what I can tell my uncles didn’t have crown loss, so I either have my grandfather’s or great grandfather’s hairline. My cousin has our grandfather’s full-on baldness. If I can get a clue as to how early it happened for him and in which pattern. I think I might be able to crack this.

You are going about trying to find out your final pattern of balding correctly!

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Surgery Error — Hey, We’re All Human

Here’s a quick story I felt was important to share…

Eight months ago, I performed a surgery of about 2500 grafts. The day following the surgery, I noted that the hairline was not in balance (the right side was 1/4 inch higher than the left side). I mentioned it to the patient and suggested that we could modify the surgery and balance the hairline better. He was surprised when I told him of my error, because he did not see the imbalance. What we agreed to do was to wait until all of the hair grew in and then address the imbalance.

The patient came in this week. I reminded him of the problem. We looked at it carefully and he said that he still did not notice the problem and was fine with it the way it was. I have always had a rule that if something goes wrong, I will always tell the patient when I realize the problem. No one is perfect and even under the most careful watch, things can go wrong. Honesty is always the best policy and I have found that my patients recognize the honesty as a good trait, one that builds confidence.

So while the problem may have gone unseen by the patient, it was my duty as his doctor to share my error with him, no matter how minor it may have been.


2006-10-12 14:46:24Surgery Error — Hey, We’re All Human

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Freezing donor hair for future balding

For someone paranoid about balding, but currently too poor to do anything about it aside from fin/min (oral+top) and derma-stamping, is there any way to somehow save donor area hair for the future? I worry that if financial security ever comes, it’ll be too late as far as my donor area is concerned. Any cheap solution to this? Do I just scalp myself and toss it in the freezer? (Kidding).

The donor area remains intact in most men throughout their early years until 60. After 60, some men start losing their donor area hair. This is a normal process and nothing to worry about. Freezing hair for future use sounds extreme to me and not practical today.

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Switching from Rogaine to Propecia

Hello sir,
I am currently 20 and have over the past year and a half witnessed my hair line gradually recede. I am finding it hard to keep positive and confident, although it is not at an extreme. I am in constant fear of what the future could hold. There is no sign of baldness on my mother’s side yet my father and my grandfather are both completely bald. My brother who is only four years older than me started wearing a wig at the age of 21. I am not completely sure of what kind of level baldness he is at but I’m sure it’s not pretty. I fear that I am to walk the inevitable genetic path placed in front of me, which is getting me rather down.

I am currently using rogaine extra strength for men, which I’ve been using for around 5 months now and am still seeing a gradual thinning of the hair line and am not sure if it is working or not, or even going to work at all. I was thinking of perhaps using propecia, yet if I do I cannot afford to maintain using both treatments. I’d be very interested in what you’d have to say about my situation and whether making the jump from rogaine to propecia could have consequences.

Thank you very much.

Propecia has been shown to have better results than Rogaine in treatment of hair loss from male pattern baldness in young men. You need to get your hair and scalp mapped out for miniaturization to have a proper diagnosis, so that your doctor can develop a Master Plan for your overall situation. Both Rogaine (minoxidil) and Propecia are good treatments, but the actions are different. As you have been on Rogaine for 5 months, I would hold off until you get the examination complete. Then add Propecia (assuming the diagnosis is confirmed and metrics are in hand), and then follow-up with another examination 8 months after to see where your hair loss is at.

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Taking 0.5mg Finasteride Twice a Day

Hi Sir,
I take Proscar and break the pills in 1/4. Considering the fact that finasteride remains only a few hours in the body, would it be better if I’d break the pills in 1/8 and would take it twice a day?

thanks

What you say may be true. The problem is that the 5 hour half life is a reflection of blood levels for the drug (5 hours drops the concentration in the blood by half). The more important number may be tissue level of bound drug that binds to the receptor targets. I believe that this number is much longer than 5 hours (maybe a few days). Thinking this through is an intellectual exercise only:

  1. The pill might be able to be taken less often, rather than more often.
  2. A smaller dose might be just as effective. I was told in a personal communication some years ago with Dr. David Whiting (who was involved in the original Merck studies to determine the best dose to use) that half of a Propecia (0.5mg) is 80% as good as a whole pill.

It may be in nobody’s interest to really solve this problem for you so your guess is as good as anyone. I tend to stay with what is known and that happens to be Merck’s story on the commercial pill. Other than saving some money, I am not sure that for most men without any side effects of the drug that taking less of a dose has any advantage over the recommended dose.

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FUE: More Automation and Physician Integrity (Part 4 of 4)

This is the last part in the series about follicular unit extraction (FUE). Here are the previous posts in this series — part 1, part 2, and part 3.

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Neograft:

We have heard a great deal about the Neograft automated system. This system has two components to it:

  1. A sharp drill that provides controlled torque. It is a manual system requiring a very skilled operator.
  2. An implanter is part of the Neograft system and it uses an implanter invented by Rassman (patent #8062322) that works nicely.

The advantage of the Neograft system is that an implanter is offered, which is not present in the ARTAS system. Traditional implantation with forceps requires specialized skills and the greatest cause for failure or death of the grafts occurs during the implantation process. The neograft implanter, can be used effectively by an inexperienced person, therefore it is relatively easier to learn when compared against the use of forceps. The inexperienced surgeon or technician will probably get better graft survival with the implanter. When compared with a skilled experienced technician’s competence with forceps, I suspect that the two techniques will be comparable.

The manual drill requires expertise, and with the unit as designed the grafts have a tendency to dry out, possibly killing them before they get implanted as they are held in a chamber that has a high hair movement in it. As discussed before, air kills grafts as they dry and this killing process may take only seconds when there is substantial air flow in graft held in a chamber. Neograft associates with a private group of technicians that perform much of the procedure for the unskilled doctor, creating the illusion that the doctor is skilled in the process. If these technicians drill out the follicular unit, they will violate the laws in most states. Most doctors who use the Neograft system depend upon the technician teams to do the actual transplant procedure.

Other drills are supplied by a variety of device manufacturers. Dr. Harris employs a dull drill and his device is amongst the most popular of the devices that are manually driven with great success. He offers training for doctors who purchase his system. Drills with sharp edges are many and they differ only marginally from each other. Extraction speed varies with each surgeon and each instrument. There is no substitute for skill, and the skills for all instruments on the market (other than the ARTAS system) requires possibly years to perfect. Speed of extraction depends upon the surgeon’s skills and it varies between 200-1200/grafts per hour on average. The damage to the grafts varies with the surgeon, so speed tells you little about the skills of the doctor as some doctors kill more than 50% of the grafts in the extraction process.

Technology vs Skill:

The New Hair Institute uses a specially designed serrated system that is not connected to a drill. This instrument was designed by Dr. Pak and it is made by a machine shop that specializes in fine stainless steel instruments. We have gotten good value with this tool, pacing ourselves at over 1000 grafts per hour and producing little damage. Our speed of extraction in 80% of patients, exceeds the speed of almost all other such extraction tools in our hands.

All too often, patients focus on the technology, not the skill of the surgeon. Only the ARTAS system does not require surgeon skills as the robot cores out the hair grafts with minimal involvement by the surgeon as the robot does it all once it is set up. The ARTAS system does require manual graft removal and the difficult job of graft placement must be done by people with extensive experience in the field using forceps or possibly an automated commercial system called the Choi Implanter. Generally, it takes between 1-3 years to develop placing techniques that allow speed and minimize damage to the grafts.

I can not end this story without discussing the integrity of the doctor. Doctors tell you what they want you to hear — that they are the best at FUE, that they get less than 2% transection rates, that their vast experience makes them better than everyone else. Can you or should you believe what the doctor is telling you? I know for certain that many doctors claim expertise in FUE, promise minimal damage to the grafts, or even close to 100% growth rates, etc. The reality is that every patient getting FUE differs in their results and we published these differences in patient dynamics in a medical journal publication, which is the only such formal publication out there. I have seen some awful results with FUE and failures close to 90% in some patient. The proclamation of the doctor’s skills by the doctor is a reflection of their integrity. There is an old adage that if it sounds too good to be true, it is.

So in conclusion — be skeptical, use your skills in evaluating your doctor’s integrity as your guide as to what you can believe and what you can not believe. I look forward to comments from our readership.

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Taking Estrogen Blocker with Propecia

I had a transplant done 2 months ago at a hair transplant office. Right now I’m in the waiting period to see any growth. I’m also on propecia for one month. I love working out, but I have some preexisting gynomastica (not sure how to spell it). I have ordered and estrogen blocker to help prevent anymore possible gyno. I was wondering if taking this product will at all interfere with any propecia results or results from my transplant? Any info would be greatly appreciated. This estrogen blocker also acts as a testosterone booster as well. That is what makes me wonder the most. Thank you for your time.

The permanent hair from the donor area is usually not affected by hormones, so I would expect that it would not impact your hair transplant, but it might impact the other hair in the vicinity (the original hair is at risk here). Any testosterone booster will work against your goal and contribute to more hair loss. Get in touch with your doctor and get his guidance.


2006-05-25 08:38:14Taking Estrogen Blocker with Propecia