Category: Uncategorized

Posted on

2011 ISHRS Meeting Review, Part 4 – Surgical Techniques

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 4. More to come…

***

 
Which is better: FUE or FUT (strip)?

    I (Dr. Rassman) moderated a panel of 6 doctors to debate the merits of follicular unit extraction (FUE) over the more traditional strip harvesting transplant procedure (FUT). I started the sessions showing a case of what I called “follicular holocaust”. It was a case of 6840 FUE grafts performed over two sessions. I showed that the failure was not only on the growth of the grafts, but also on the destruction of the donor area. In all recipient sites and donor sites, there was a loss of 26,000 hairs and a massive failure of the FUE procedure.

    The debate followed this foreboding case study with the following insights:

  1. FUE is gaining popularity and seems to be demanded more and more by prospective patients. The graphs showed that the number of FUE procedures will surpass the number of FUT procedures in the next few years.
  2. FUE is safe in the hands of good doctors. The group all agreed on this because they were amongst the best doctors offering FUE. My only comment is that I can’t imagine any doctor putting themselves in the “bad doctor” category as shown in my presentation of “follicular holocaust”.
  3. FUE graft damage is being reduced with building experience resulting in better growth.
  4. Dr. Bradley Wolf demonstrated a patient who had 1000 grafts on each side of his head (total 2000 grafts) after 7 months of growth. The two sides seemed to be about equal. The patient reported no significant pain with either procedure (done one day apart) and the scars in both sides healed with minimal scarring.
  5. Dr. Suddleson argued that FUT supplied as many grafts as are needed, while FUE was more limiting in a single session. He argued that many of the advocates of FUE routinely offered FUT to their patients and that the FUT was the gold standard by which FUE would be compared. He generated a laugh when he pointed out that at least one doctor promoting FUE on the panel had reported his excellent results on the FUT strip based procedures.


 
FUE and ethnicity

    I’m often asked if there a difference in FUE patient candidates based upon ethnicity. This question was raised and answered by a doctor from India who showed that there are clear differences in the Indian population based upon skin types and some geographical areas of India where the skin is much thicker than others with thinner skin. He believes that these differences clearly can impact the difficulties of FUE and the results of transplanted graft growth.

    Also of note — it seems that the incidence of balding in the Indian population of India is much higher (62%) in men between the ages of 21-61 years old, than in the Caucasian population from comparable studies done in other countries. The use of finasteride was found to be in the 1% range for these men, while the use of various snake oils seemed to dominate the treatments of many Indian men.

 
I’ve got much more to post, so check back next week for topics on finasteride, the Artas® FUE robot system, and minoxidil.

Posted on

In the News – Hair Loss Gene Identified?

Hey doc, how’s it going? I’ve stumbled across this article on MSNBC.

I don’t want to get my hopes up too high, but the identification of a gene linked to hair loss sounds like an important discovery. What’s your take on it?

I had many people send me that MSNBC article yesterday, and my take on this is the following —

I think it is great that a possible hair loss gene may have been identified, but that does not necessarily solve the problem of genetic balding in the short term. It will help focus the research on the mechanism that have heretofore not been well understood. It is a step in the right direction, for sure. I’m looking forward to seeing where this discovery will take us.

Other articles about this can be found here:

Posted on

Female Has Hair Transplant a Year Ago and Very Happy with Results

Nice comment and congrats. Many women with hair loss are not good surgical candidates, but it seems that you were. I would caution many women reading this post to be careful when considering a hair transplant, for hair loss in the female is not like male hair loss.


2019-12-17 08:24:51Female Has Hair Transplant a Year Ago and Very Happy with Results

Posted on

In the News – Man in Ireland Awarded €70,000 for Bad Hair Transplant!

Snippet from the article:

THE HIGH Court has awarded €70,000 damages to a sales and marketing manager over a botched hair transplant which left him disfigured.

Mr Justice John Quirke made the award to Niall Clancy (32), Scholarstown Park, Rathfarnham, Dublin, over the procedure which was carried out in the UK on January 12th, 2004.

The award included €30,000 general damages plus €40,000 for medical expenses to repair the damage.

Mr Justice Quirke also said Dr Maurice Collins, the surgeon who treated Mr Clancy after the transplant, had given him “very poor advice” not to have reconstructive surgery until after the court case was completed.

LawRead the full article at Irish Times – Man wins €70,000 damages over botched hair transplant

The online currency converter tells me that’s over $99,000 (USD)! I’ve not seen the botched work, but when the doctor told the patient to not have the repair work done until after the case was settled (which took years), it just added to the money the patient was awarded in damages. It is unfortunate that the transplant was so disfiguring, but without seeing photos I’ll have to rely on this article and the court’s decision for my source of case information.

Always remember to do your research on the clinic and physician before getting yourself into a permanent procedure like this. Perhaps this disfiguring hair transplant could’ve been avoided. See:

  1. Selecting a Hair Transplant Doctor
  2. How to Avoid Dishonest Hair Transplant Doctors
  3. Why Should You Visit Us?
Posted on

22 years old 2000 graft hair transplant, any thoughts? (photo)

Yes, I am concerned. 2000 grafts is about 25% (possibly more) of your entire donor supply used for just the frontal ½ inch of hairline. The doctor should have known better, so yes I am critical of the decision the two of you made. What is your Personalized Master Plan if you should develop advanced balding as this man did: https://baldingblog.com/need-master-plan-think-hair-transplants-photos/. Note that he wasn’t very bald at 22 but evolved into a bald man. I don’t want to panic you, but you need to think this through as you would be this man shown as he aged. Balding is progressive in 100% of men.


2020-01-30 08:58:3322 years old 2000 graft hair transplant, any thoughts? (photo)

Posted on

In the News – Patient History is Key to Assess Hair Loss

Snippet from the article:

When patients present with hair loss, dermatologists should focus most heavily on patient histories, according to an expert who spoke at the 72nd Annual Meeting of the American Academy of Dermatology.

Many dermatologists perform a cursory exam and order a battery of blood tests, says Leonard Sperling, M.D., chairman and professor of dermatology, Uniformed Services University of the Health Sciences, Bethesda, Md. Dermatologists often dread these encounters, he adds, because they can burn daylight and often reveal problems that can’t be treated successfully.

Read the rest — Patient history is key when assessing hair loss

Few dermatologists use the modern tools for assessing hair loss (hand microscope to map for miniaturization and the HairCheck device for measuring hair bulk). Most dermatologists don’t like to do hair assessments if they can not tell if a patient is balding or not.

NW7A good example was in a 17 year old that came in to see me last week. I had seen him a year ago at the age of 16 where I did the HairCheck bulk analysis. His family history is significant as his father is a Norwood class 7 patient and two of his three brothers are also balding. One year ago, his bulk analysis showed 55% loss of hair in the front and 30% loss on the top. The crown showed no hair loss. On the visit last week, bulk measurements showed that his hair loss in the front increased to 75% and on the top it increased to 60%. Most significant was his hair loss in the crown, which was 50% of his bulk.

His hair was black, his skin was white, and the hair was medium-coarse, so that to the naked eye he showed only frontal hair loss. I already know that he will probably be a class 7 pattern balding patient like his dad. Without these instruments, I would not have seen any hair loss last year if I had not measured it, but even a year ago, it was evident that he was balding. Last week, we knew what pattern of balding he will probably be developing. He was placed on Propecia 1 year ago, but it did not stop his hair loss. He took the news well and we spent some time discussing a future Master Plan on what he might want to do as his hair loss becomes more evident. Shaving his head once he gets into college might be an option (with or without SMP).

Posted on

24 year old female with corner hair loss and some hairline early elevation

This is a common finding in some women, although it is more common as women get older. I have treated many of these women with a hair transplant to put back the rounded hairlines typical of the female hairline. You should be look at my an expert to make sure that you don’t have an autoimmune disease like Frontal Fibrosing Alopecia. a diagnosis that is easy to make when your doctor is skilled in the examination of a female hairline


2019-05-10 12:38:4324 year old female with corner hair loss and some hairline early elevation

Posted on

In the News – Singer Robbie Williams Had a Hair Transplant But Didn’t Need One?

Snippet from the article:

Singer Robbie Williams has revealed he had a hair transplant despite not needing one.

The 39-year-old made the admission while chatting about how living in Los Angeles had rubbed off on him during an interview on The Graham Norton Show, which airs on Friday evening.

He said: ‘I’ve lived in LA for a long time and they say, ‘If you sit in a barber’s shop for long enough you will get a hair cut.’ Well, if you live in Los Angeles for long enough you’re going to get some surgery.

Read the rest — Robbie Williams reveals he had a hair transplant despite not needing it after succumbing to LA lifestyle

Nobody really needs a hair transplant (it is an elective cosmetic procedure), but it looks like his hairline corners were going back a little before the surgery and are now filled in. Either way…


2013-12-02 10:34:33In the News – Singer Robbie Williams Had a Hair Transplant But Didn’t Need One?

Posted on

27 Year Old Male Has Many Questions About Hair Transplants (From Reddit)

You need to sit down with a good doctor and get an examination that might predict your hair loss pattern. If that can be predicted (I often do this with the HAIRCHECK test), then your course after a single hair transplant might be anticipated. There is never certainty as I use the tools I have to give people the best assessment of their course over time. At our Monthly Open House events we have patients who had one or two hair transplant sessions and did not need anything after. If you come to one of these events, you can meet these patients one-on-one. The older you are when you start, the more predictable the risks, but if you wait, then you will learn to live with balding while you are younger, something most men who see me don’t want to do.

Considering a hair transplant but thinking about long-term commitments post-op from tressless

Posted on

In the News – The Placebo Effect Works

Snippet from the article:

There’s little doubt that the placebo effect’s real, but it has always been argued that a person feels better because they think the pill is the real deal. But what if it works even when you know it’s a fake?

According to Ted Kaptchuk at Harvard Medical School and his colleagues at least one condition can be calmed by placebo, even when everyone knows it’s just an inert pill. This raises a thorny question: should we start offering sugar pills for ailments without a treatment?

In the latest study, Kaptchuk tested the effect of placebo versus no treatment in 80 people with irritable bowel syndrome. Twice a day, 37 people swallowed an inert pill could not be absorbed by the body. The researchers told participants that it could improve symptoms through the placebo effect.

While 35 per cent of the patients who had not received any treatment reported an improvement, 59 per cent of the placebo group felt better. “The placebo was almost twice as effective as the control,” says Kaptchuk. “That would be a great result if it was seen in a normal clinical trial of a drug.”

Read the full story at Gizmodo — Placebos Can Work Even When You Know They’re Fakes

I am certain that the placebo effect also applies to side effects. If you hear you may get erectile dysfunction from taking a drug, how many people will report the side effect from taking the placebo?