Uncategorized – Page 281

January 1, 2023

FUE Caused Necrosis of Patient’s Donor Area

A report published by the Journal of Plastic, Reconstructive & Aesthetic Surgery a couple years back has recently come to my attention. Here’s part of the abstract:

Follicular unit extraction (FUE) has been developed as one type of follicular unit transplantation surgery, a widely accepted hair-restoration technique. FUE has many advantages, including a small donor area scar, less pain and a slender graft without extra surrounding tissue. Complications are uncommon in the literature. We describe a case of donor-site necrosis after hair restoration with FUE, leading to cicatricial alopecia in the left half of the occipital region.

Read the rest of the abstract — Necrosis of the donor site after hair restoration with follicular unit extraction (FUE): a case report.

I have seen the impact of large sessions of grafts using FUE on patients who came to our office over the past 10 years. Most of these necrotic areas were small, so they were easily addressed by good, traditional surgical care. I expect that we will see more of these severe complications as more and more doctors start pushing the number of grafts performed in a single FUE session, just as we saw when doctors who did not know enough about FUT caused similar degrees of necrosis. I believe that those doing FUE procedures and their patients need to be aware of this risk. This complication, however, was a disastrous problem for the patient referenced in the above report, as he lost part of his scalp.

The full article states, “One hundred ï¬fty cubic centilitres (cc) of 1/100 000 adrenaline solution was injected gradually into a 10 by 12 cm area in the left occipital region during surgery over 4 hours. Nine hundred ï¬fty follicles were removed using 0.8-mm punches connected to the end of an electrical driver drill“. So less than 1000 grafts were transplanted with a small punch and yet the complication occurred. This punch size should have minimized the risk. The article does not discuss the density of the punch holes in the donor area. On the surface, nothing was really done wrong.

The article further reports: “digital gangrene and ischaemic necrosis after the use of local anesthetics with adrenaline and chemotherapeutic agent extravasations have been reported.” Our operative consent discusses this risk. We forget that any hair transplant (FUE or FUT) is a surgical procedure and with it, there are risks that must be discussed with the patient. We have previously reported a patient death in a medical office a few miles away from our office, so necrosis is just another one of these rare risks. Clearly, the death that occurred years ago was probably the result of doctor incompetence, so some of the things that the patient must pay attention to when evaluating asurgeon is: their track record, their experience, and their reputation.

I respect the courage of the doctors in this necrosis case, because by reporting it to the doctors performing this in the field, we become aware that the doctors do not control every risk in every patient surgery. As we know very little about this particular patient’s activities after the surgery or his health before the surgery (e.g. was he a smoker?), I can not discuss the article further.

January 1, 2023

I Have Systemic Lupus and Have Scars on My Scalp. Can I Get a Hair Transplant to Treat These Defects?

People with autoimmune diseases like Lupus, LPP, FFA, alopecia areata, and alopecia totalis can’t be treated with hair transplants while the disease is active. For all of the diseases mentioned (except alopecia totalis, which is not transplantable), the disease must be inactive for 3 years. There is always a risk of recurrence even after 3 years, in which case, if it should happen, all of the transplanted grafts would then be lost.

January 1, 2023

FUE in the UK?

Hello,

i am thinking of having the fue procedure in the uk and would like to know which is the best surgeon to see. Trying to avoid surgeons that have a high rate of fue failure due lack of skill.

many thanks in advance for your help.

You’ll have to do your own research to be sure you’re getting exactly what you want and to be assured that you found a doctor you can trust, but Dr Bessam Farjo is a good place to start (offices in London and Manchester). You can also use our handy guide to selecting a hair transplant surgeon — here.

January 1, 2023

Taking Biotin to Prevent Hair Loss?

I am a 22 year old male, and have just recently started noticing minor thinning in the front of my hairline. Male-pattern baldness runs in my family. I consulted a stylist who told me that taking a supplement with Biotin can prevent hairloss. I am not worried about regrowing any hair, as it isn’t a problem yet, only maintaining what I currently have. I ordered 3 month supply of Provillus, which contains both Saw Palmento and Biotin. My plan is to see if it has any effect or not. Is this a good approach and also what else could I do if this doesn’t help?

Why experiment when we know that if the diagnosis of genetic hair loss is confirmed, then finasteride works? Every day, every month, and every year you experiment, you will allow your irreversible hair loss to get worse and worse and worse and worse. Stop playing Russian Roulette. Biotin is no answer to your problems, unless you are deficient of biotin.

January 1, 2023

FUE: Surgical Skills and Robots (Part 3 of 4)

So far, we’ve looked at the history of FUE in part 1 and graft quality/survival in part 2…

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FUE Today:

The FUE market may reflect as much as 40% of the total hair transplant market today. I believe that 20% of the doctors offering FUE, are skilled in the process; however, a majority of the doctors who offer FUE today are not skilled in the process. With such a large gap between skilled and unskilled doctors doing FUE, one would ask what the doctors are doing about it, because no doctor wants to be second class. The doctor must get the expertise that they need… somehow.

Some doctors try one of the various instruments that promise great success with the FUE process. Some instrument entrepreneurs try to convince the doctors that if they purchase a particular instrument, great success will befall them and every new doctor purchasing these system, want to believe it. I admire Dr. Jim Harris, who pioneered a special instrument because he offers training on human volunteers to physicians who want to master his unique approach. I have participated in his course and own one of his instruments. There are instruments that:

Drilling is the most popular way of performing the FUE and most doctors seem to favor the drill. Prices for these drills (the doctor’s costs) run as low as $1200 to as high as $220,000 plus $1/graft. Each vendor claims some advantage over the other.

With the discrepancy between $1200 and $220,000, let’s see what value comes with each package.

ARTAS:

The ARTAS system made by Restoration Robotics is the $220,000 unit for FUE harvesting. The sole function of the ARTAS system today is to core grafts from the scalp, leaving them in the scalp until they are manually removed. Their ARTAS system does the coring with a high degree of accuracy. It does this with robotic efficiency using optical siting technology (initially designed and patented by Rassman and Pak — Patent 6,572,625). The ARTAS uses a sharp punch to score the skin and then a dull punch (designed and patented by Dr. Jim Harris) measuring 1.2mm each. The hair shaft lies mostly below the scalp surface and the angle of ‘attack’ by the robotic punching system is calculated by knowing both the angle of the hair stubble above the skin and an estimate of the bend in the hair follicle found below the skin. The hair is left with stubble when the scalp is shaved so the part of the hair shaft that is exposed allows the optical siting system to establish the needed alignment for the extraction. The bend below the skin is consistent in adjacent grafts, but vary in different parts of the head and constant adjustment is needed as the instrument moves from one area to another. The robot can not ‘feel’ the graft, so the extraction is done by science and math, while all of the other instruments on the market allow for the ‘feel’ of the graft as the instrument plunges into the scalp.

A skin stabilizer (invented and patented by Rassman) is used to stabilize the skin for the extraction that follows. The ARTAS leaves the graft in the scalp and moves from one location to another until the entire drilling process is complete (speed of drilling is about 300-400 grafts per hour). About one graft is excised out of every 5 in a single field of view and this variable can be dialed into the ARTAS controls. The robot is very efficient in making the calculations to remove 20% (or 25%….) of the follicular units in any one field of view. The coring is where the automation ends. Once the grafts are cored out, the rest of the process, including the removal of the grafts is a hand process.The ARTAS damage to the follicular units from the drilling part may range in the 5-10% in each patient. The variations by the team or with the patient dictates most of the variables and most damage occurs when the grafts are transected or ripped out after the drilling process.

Restoration Robotics intends to automate the entire hair transplant process some time in the future. They are estimating that the complete automation may be accomplished in 2-4 years. When they complete the automation for implantation, the art of the hairline has to be dealt with and I am interested in seeing how they go about the rest of the automation process. The ARTAS system requires the least training for the mechanical extraction of any instrument available today. In fact, once the diagnosis is complete and the plan is laid out, the surgeon becomes superfluous to the process. As the doctor pays $220,000 for today ARTAS and $1/graft, these costs must be put into the final price for the consumer making the ARTAS FUE possibly the most expensive technology for the consumer today.

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The final part of this series will be posted tomorrow, where we’ll discuss Neograft and manual processes for FUE.

January 1, 2023

Taking Propecia and Viagra

First off I have learned alot from your web site. I’m sure all your readers are very greatful. I know I am!! My question is If someone already suffered from impotence and taking viagra or a simaler product for this would mixing propecia with it for hair loss be a problem. Is it a safe mixture in other words?

There is no difficulty taking Viagra and Propecia. They do not interact with each other. This way you can enjoy both good sex and great hair. That is a winning combination.

January 1, 2023

Full Head of Hair with Shedding

My hair right now is very thick, and my hairline is a Norwood 0-1.5 depending on who looks at it. But sometimes when I’m showering and also when I put gel in my hair, I notice that some of the hairs that shed are very thin. They are so thin that they are hard to see unless you are looking for them. Other hairs that shed are very thick and can be felt on my hands, while the thin ones can’t. Is this a bad sign?

You may be seeing miniaturized hairs that are falling out. Miniaturization is part of the early balding process. A good video microscope purchased from Amazon for under $20 can tell you if you are miniaturizing. You can read my many posts on miniaturization on BaldingBlog.com (https://baldingblog.com/?s=miniaturization+hand+microscope&x=0&y=0).

2018-02-16 06:07:592018-06-22 13:00:06Full Head of Hair with Shedding

January 1, 2023

Tangled Hair From Styling Products Used to Cover Bald Spot

Dear Dr. Rassman,
First of all thank you for caring enough about all our concerns to have this blog. I’m writing to ask you about tangled hair. I have kept the top of my hair long for many years now to comb back and cover the balding crown but my hair is coarse and somewhat curly. For some reason when I shampooed I began being unable to wash out all the build up of gel and hairspray and it was difficult to comb through. At the beginning I used to force the issue and would pull out lots of hair. Now I’m much more gentle but its still frustrating to not be able to comb through. I’m afraid I’m damaging my hair more and more. What would you recommend? Any shampoos that could clean this build up? What about detanglers?I haven’t fared better with them either. On another note, several years ago I had a transplant which I believ was good. But I now am planning to have another and am certain you or your staff at NHI will do it. I received your materials in the mail (Thank you), I’ve heard about your excellent reputation from other sources also.I like that you’re not ONLY interested in the $$$ but you have a passion in an artistic sense as well as a humanitarian love. God bless you and I look forward to hearing from you. Let me see you! A round trip from Las Vegas is very inexpensive now as the summer season comes into swing.

I’d see a good hair stylist with experience in African hair (they understand tangling and how to untangle the hair without pulling it out). It sounds like you need to get styling control on what you use and how you use it. Traction alopecia can occur with pulling on normal hair, but imagine if you can lose normal hair by pulling on it — what would happen to weak hair that is miniaturized from the genetic balding process? Bad news.

Visit me in Los Angeles if you want a hands-on examination. I will map your scalp for genetic hair loss and give you a glimpse into what will happen to you in the future (by developing a Master Plan for you).

2006-06-23 08:34:002006-06-22 12:31:09Tangled Hair From Styling Products Used to Cover Bald Spot

January 1, 2023

Gay man asks if Dutasteride shrinks the prostate

Will Dutasteride will shrink your prostate even if it’s NOT enlarged? Will it shrink a normal-sized prostate? If not, why not? I’m taking it for MPB, and as far as I’m aware, I have a normal-sized prostate… but I’m gay, and prostate stimulation is an important part of the pleasure of gay sex. So if Dutasteride does indeed shrink normal-sized prostates, you can see why I might be concerned. It wouldn’t stop me taking it, but I would like to know.

Dutasteride was developed to treat or often shrink the prostate when it is enlarged from prostatic hypertrophy-a problem in men over 50. I doubt it will have an effect on a normal size prostate.

2020-02-11 04:00:002019-07-17 14:42:15Gay man asks if Dutasteride shrinks the prostate

January 1, 2023

Tegretol and Hair Loss?

Dr Rassman
My doctor is talking to me about putting me on Tegretol for anxiety. I asked him if this med causes hair loss and he told me he does not no any one had this from Tegratol but i think i read that it does. Can you tell me if you saw any people that came into you office that while taking this drug had any hair loss from it.
Thanks

I have no memory of treating anyone that lost hair as a result of taking Tegretol (also known as carbamazepine, a seizure medication), but I’ve read claims online that it could be a rare side effect. It isn’t officially known as a side effect, however.