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Dishonest Doctors and FUE

I have published an article recently in the Hair Transplant Forum International (an industry newsletter, see below) that warns of doctors who perform Follicular Unit Extraction and produce a Follicular Holocaust, killing off many of the hair follicles and then charging the patient as if all of the follicles were actually transplanted. This process is unfortunately more the rule rather than the exception, because doctors just do not count what they actually deliver. This is a double ‘insult’ to the patient who pays for 100% of what the doctor says he is transferring and actually receiving something in the order of 25-50% of that quantity. The second part of the insult is the loss of the hair which may be irretrievably lost from the patient’s limited donor supply for life. So, the surgeons who engage in this process are cheating the patient and at the same time destroying valuable donor hair.

I have just participated in a Regional Workshop for the International Society for Hair Restoration Surgeons where I was one of the faculty, teaching the FUE technique on patient volunteers to some 25 doctors from around the world. A few of the better known self promoted doctors were invited to attend, but they did not take up the invitation. Most of the doctors who attended the course came with an open mind to learn state of the art FUE technology from more experienced physicians who have been doing FUE successfully for years. I learned that the reports of dishonesty that I reported in the article I wrote continue to be a real problem. I received confirmation of what I discussed in the article, which appears to be widespread, over much of the world. I applaud doctors who take formal approved courses to learn or enhance their skills for new technologies by spending the time and the money to come from Korea, Japan, Western and Eastern Europe, North America and the Middle East, but I continue to be disgusted by physicians who would rather develop experience by experimenting on patients and damaging/cheating fellow human beings. I admire the courageous balding people who want to get the benefits of new technologies, but when dishonest doctors promote their expertise with no real basis, they behave like hucksters, only distinguishing themselves from other crooks selling products or services by having an M.D. after their name and a ‘doctor’ for a title. Clearly, for the FUE buyer, the buyer must beware!

Here is the editorial I wrote addressing problems of ethics in hair transplantation surgery, which was published a few months ago in the Hair Transplant Forum International, January/February 2006, Volume 16, Number 1:

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Do DHT Levels Change Over Time?

Dear Doc,
I was just curious to how the levels of DHT change in the body over time. Do DHT levels rise to some sort of critical level before the onset of baldness? or do the follicles just become less resistant to DHT as one ages? Also is there a difference in DHT levels in bald and not-bald males?

thanks

Yes, DHT levels change as we age, but the level of DHT does not necessarily correlate with balding or androgenic alopecia (AGA). It is your genes that makes you susceptible to the DHT impact on hair that produces balding. In other words, you can have a high level of DHT and if you do not have the gene for AGA, you will not lose hair. Or you can have a very low level of DHT and have the gene for AGA and be bald. As DHT comes from testosterone, it is your testicles that are the supplier of the hormones that cause baldness. If you did not have testicles, then the balding process would stop, but your hair would not come back.


2007-09-05 13:33:30Do DHT Levels Change Over Time?

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Propecia Side Effects and the Placebo Effect

Hey Dr.Rassman,

What do you think of the placebo effect in regards to side effects associated with taking Propecia? This snippet from Wikipedia on the placebo effect got me thinking about alot of individuals that have expectations/concerns on getting potential side effects from the medication.

Snippet:
Expectancy and conditioning

“In 1985, Irving Kirsch hypothesized that placebo effects are produced by the self-fulfilling effects of response expectancies, in which the belief that one will feel different leads a person to actually feel different. According to this theory, the belief that one has received an active treatment can produce the subjective changes thought to be produced by the real treatment. Placebos can act similarly through classical conditioning, wherein a placebo and an actual stimulus are used simultaneously until the placebo is associated with the effect from the actual stimulus. Both conditioning and expectations play a role in placebo effect, and make different kinds of contribution. Conditioning has a longer-lasting effect, and can affect earlier stages of information processing. The expectancy effect can be enhanced through factors such as the enthusiasm of the doctor, differences in size and color of placebo pills, or the use of other interventions such as injections. In one study, the response to a placebo increased from 44% to 62% when the doctor treated them with “warmth, attention, and confidence”. Expectancy effects have been found to occur with a range of substances. Those that think that a treatment will work display a stronger placebo effect than those that do not, as evidenced by a study of acupuncture.”

Sometimes I feel like alot of us convince ourselves we have these side effects when in reality they are non existent.

I have no doubt that many of the problems with sexual side effects reported while taking finasteride, are impacted by the power of suggestion. Also, some men have erectile dysfunction prior to ever starting the drug finasteride, so it is easy to blame the drug for that problem if they exercised denial. Thanks for sharing this with us.

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Do I have DUPA?

Many men have written to me to ask me if they had Diffuse Unpatterned Alopecia (DUPA), which I defined in the literature with Dr. Bob Bernstein in 1996. This is a “female type of pattern” where the hair in the donor area has significant miniaturized hairs. In men, it is also called Senile Alopecia when appearing in aging men, but here, the hair is uniform in thickness, so miniaturization is not present. The basic premise in hair restoration surgery is that the donor area (a rim of hair about 2 1/2 inches above the ears and around the base of the skull) is privileged hair protected against the genetic of balding. The Norwood Classification shows this area in the Class 7 patterned patient.

The diagnosis is critical because the donor area is no longer protected from the balding process. We don’t believe that DUPA is necessarily inherited, but we don’t know. Sometimes, this donor area miniaturization will respond to finasteride but often does not. If any surgeon dares use this as a source of hair for a hair transplant, the hair transplant will fail, which is a classic malpractice, in my opinion. But for those impacted, controlling their hair loss becomes a real challenge. We have seen the existence of genetic patterned hair loss with DUPA also present, so these men are unfortunately double challenged.

This link shows a classic case of DUPA (https://baldingblog.com/do-i-have-dupa-photo/), so I ask all of my patients to get a hand microscope and cut the hair short in the area, just enough to use the hand microscope and get a good picture as shown in the above post.

Another man just wrote to me, got a hand microscope, and showed me photos of his donor area. I told him he didn’t have DUPA now, without a doubt. See the photos he sent me below. Very few miniaturized hairs are present, certainly not enough to reach the 20% threshold I use to diagnose DUPA.

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Propecia Withdrawal and Massive Hair Loss

I have been on Propecia for 10 years. I was out of the country and lost the bottle, so was off of it for 5 weeks. When i got back I started up again, but now obe month into restarting I am losing a ton of hair throughout the scalp. It is now very noticeable. Does that mean I lost the “propecia hair” for good after stopping for only 5 weeks? Will it come back now that I am back on it?

It may not all come back, but hopefully most will. The important lesson here is to stay on Propecia unless you want to undo the hair maintaining or regrowth benefits you received.


2007-10-12 09:35:32Propecia Withdrawal and Massive Hair Loss

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Do I Need to Use Saw Palmetto Forever?

Hey Dr. Rassman, I was just wondering if I took saw palmetto and saw some results and then stopped using it, would that have the same effect as taking propecia and then stopping its use. I know after one stops taking propecia all that hair is lost, would that be the same outcome of stopping saw palmetto?

Thanks

If the claimed DHT blocking occurs with saw palmetto, then I suspect that if/when you stop it, the maintained hair would be lost under the exact same mechanism as Propecia (finasteride).

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Prostate Cancer Prevention Trial (PCPT) and Finasteride

Hi Dr Rassman, have you seen the latest findings on the prostate cancer prevention trials? The current info seems like good new for finasteride users.

see link — Finasteride Reduces the Risk of Low-Grade Prostate Cancer in Men 55 and Older

Yes, this is a consistent finding by the government sponsored studies.

Here’s the summary:

“Long-term follow-up results from a phase III trial called the Prostate Cancer Prevention Trial (PCPT) continue to show that regular use of finasteride (Proscar®) for up to 7 years decreased the risk of low-grade prostate cancer in men age 55 and older compared with that in men who received a placebo. Although high-grade cancers were more common in the finasteride group, the finasteride and placebo groups had similar 15-year overall survival rates.”

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Do Thin Eyebrows Mean a Thyroid Condition?

Hi doctor, I see that you mention that a thyroid condition may cause balding. I’ve read that one of the symptoms of a thyroid conditions is thin eyebrows. If I’ve always had thin eyebrows since I was a kid (especially on the outer edge), does that mean I have a thyroid condition – or that I just had naturally thin eyebrows?

Thin eyebrows just means you have thin eyebrows, especially since you report having this as a child. It doesn’t necessarily mean you have a thyroid issue. If you think you have a thyroid condition, then you should see your primary care doctor. It is a simple blood test.

If you want thicker eyebrows, you can always consider an eyebrow transplant, which takes hair from the back of the scalp. We’ve successfully transplanted eyebrows for many patients with great results, but the patient has to remember to trim their new eyebrows regularly since the hairs will continue to grow like it would on the scalp.

There’s some examples of eyebrow transplants here, here, and here.

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Pseudopelade and Hair Loss

Please supply info on pseudopalade and what are the chanches of hair transplants. This diagnosis was made by a local dermatologist in South Africa where I live.

Pseudopelade is a peculiar form of scarring alopecia resembling alopecia areata. It is unclear if it is immunologic (your body thinks your hair is foreign and kills it) or genetic in nature. Unfortunately the condition is not amendable to hair transplantation, because you would run the risk of more hair loss and failure of the transplanted hair to grow.


2006-07-19 07:19:48Pseudopelade and Hair Loss