Category: Uncategorized

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Hair Loss Medication Side Effects

Hello Dr. Rassman
I have always thought about doing something for my loss of hair which is mainly in the front. I hear about all these products (propecia, procede, avacor) they all sound so great but it’s hard to trust on any of them since they don’t mention any possible side effects. I read about the gentleman who loss a lot of his hair when he used procede and I’ve heard that propecia may cause low sperm count. Are these side effects common? Is there any place where I can find such information? I guess most products (like medicine) have possible side effects. I just need to know how common this occurs. Thank you

I have no direct knowledge about ProCede. Avacor’s main active component appears to be minoxidil, which is cheaper if you buy it as generic minoxidil. Propecia does not reduce the sperm count, but can reduce the volume of the ejaculate that goes with the orgasm. Your sperm count should be as potent for getting your lady pregnant as before you took Propecia. The good news about Propecia is that it stays in your body less than a day (90% is out of your system in a day and effectively 99% is out in the second day). Keep priorities, do your research, and get a good examination by an expert doctor.

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Treatment with finasteride? (photo)

You reported one year of treatment. The photo shows a perfectly normal hairline. The presence of the widow’s peak and the flat hairline to the sides suggests that you have a left-over component of your juvenile hairline still showing. I have seen or treated many men like you. If you want a consultation with me, my email address is williamrassman33@gmail.com. Please send me your post before you started treatment so I can understand what was reversed after a year of treatment.

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I am 27 years old. Can I transplant what you see here and how many grafts?

What I need is a frontal picture with your hair pulled back and your eyebrows lifted high so that your forehead creases. That shows me the anatomic points that allows me to determine the proper place of the hairline. Then your question can be answered. This picture suggests hair loss in the front as well as the large crown loss shown in the picture you supplied. You should send photos of the frontal area as well so that we don’t give you half an answer to your question.


2017-09-15 15:19:15I am 27 years old. Can I transplant what you see here and how many grafts?

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Trigrowthic Suturing Technique

Dear Dr. Rassman,

I’ve asked you this question before but had not received an answer. I recently read about a so-called new “trigrowthic” suturing technique that promises to leave no visible scarring post strip op. Have you looked into this procedure before and is it to be believed? Thanks.

“What’s in a name? That which we call a rose
By any other word would smell as sweet.”

-From Romeo and Juliet (II, ii, 1-2)

The use of trichophytic closures have been around for years — in fact, that closure has been used in plastic surgery for more than two decades. The hair industry adopted it recently as a standard of wound closure. You could change its name and correctly say that you invented that name, but it would be improper to say that you invented the procedure. The doctors you have referenced here are recycling techniques under a new, original name and as such, if they are claiming inventiveness, then they might be deemed dishonest.

There is NO such technique that can provide results with no visible scarring. ALL cuts on the skin will leave a scar and the scarring is unique to individual patients. Some patients have minimal scarring, while others have more scarring — it is dependent on their genetic makeup, which no one can tell with just a physical examination. Some of our patients heal well and have very minimal scarring that is hard to detect with a regular hair style, but even these patients will have a visible scar if they shave their head bald.

We routinely use a trichophytic closure which I assume is similar to what you have read. For more information about the trichophytic closure, please see:

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Hair Obsession

i have had a full head of thin, wavy hair most of my life, and am now 53 years old. I had some loss many years ago from using alcohol based mousse, and had one transplant(okay). Recently, I had some hair color (nasty alcohol based stuff from Walgreen’s)in my hair for Halloween 2004. Anyway, I left it in for a day(extremely stupid), and then had several weeks of an itchy scalp in December, which I treated with tea tree/jojoba oil. I noticed some hair loss in January, had 1000 grafts put in and now I just had another ” greater loss” bout in July and August of this year, which I am extremely unhappy about. I now have a minor tingling on the left side of my frontal area, and I am extremely parnoid I am losing more. I am using tea tree oil shampoo/conditioner. I went to back to the doctors who did my transplants, who told me I would look worse if I had not been given the 1000 grafts, which I have a hard time seeing where they are.(as some were supposed to be put in the area that has receded!)I asked to possibly get my old hairline back, and the doctor said that only celebrities and media people only wanted a “1”, and now me. They offered to put in another 1000 grafts for $4/graft, but I want an effective job this time, asI do not have unlimited donor area. The more I think about it, the more I am insulted. The doctor said I had no infection/disease in the scalp. I want more work, but done right. PLEASE, PLEASE ADVISE.

You are hair obsessed. Please don’t take this comment the wrong way, but you are probably causing your own problems because of this obsession. I too would be insulted if the doctor who precipitated reactive hair loss with the second transplant (that is what it sounds like), told me that I needed another one at a discounted price to solve the failure of the last transplant (which was supposed to solve your problem). Sounds more like a huckster is playing you for your hair obsession and selling you hair like you needed a new car.

On this blog, I often say that you need to have a good doctor make an assessment of what is really happening to you. This is a buyer beware field and it is easy to sell hair to a hair obsessed person like you. I am not saying that you did not need a hair transplant, but it sounds like you were not clearly informed of what you were buying into. I often take a stand against transplants when I am not convinced that hair transplants will address the problem. I am rarely wrong but some of the patients who I turn down just go to another doctor who might be enthusiastic to take his money. Talk to a good doctor, not a huckster and find out what happened and what is going on with your hair problem.

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Turkish technicians opened clinics in Germany

The report I got said:

“A Turkish doctor called from Germany and said that approximately 16 clinics in Germany and the Netherlands where Turkish technicians perform hair transplants have been inspected by health authorities, and many of them have been temporarily closed; the equipment used was said to be not CE Compliant or nut sufficiently sterilized. Some technicians were also deported as they were on Visas that didn’t allow them to work.”

Another source echoed this story for France and Belgium. I have also been informed that many of the 5000 clinics in Turkey are shutting down for similar reasons and due to a doctor’s absence.

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Hair Restoration Society Credentialing

I read on a doctor’s resume that he is a member of the International Society of Follicular Unit Extraction Surgery. Can you shed light on the value of this society on the doctor’s resume?

In the past, to develop expertise that is unearned, a doctor would create a society and possibly become its only member. That could make him/her the founder of the society, president of it, director or it, or whatever he/she chooses to be. For the less than knowledgeable buyer, the name of the society implies, as is here, some international expertise, some special training and certification, some special recognition by peers in the industry (like an Academy Award Society). The International Society of Hair Restoration Surgery (with hundreds of member physicians) has looked at creative societies with disdain and so should the buyer. There is a suggestion of a ‘slight of hand’ when one invents expertise for themselves or a group of like physicians. As the inventor of the follicular unit extraction technology and the doctor who published the authoritative article in the field, I was never invited to join that society, speak before it, or review contributions by its members in the field. I would find that strange if it were a legitimate society.

Expertise should be earned. Inventiveness is something that should be published or proven. Put the doctor and his society to that test and you will see if it meets this criteria.

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Two studies on ketoconazole in balding men

At the recent ISHRS meeting last week in Bangkok, the value of ketoconazole shampoo was also echoed by one of the guest experts in the field of hair loss.

https://www.tandfonline.com/doi/abs/10.1080/09546634.2019.1573309?scroll=top&needAccess=true&journalCode=ijdt20

In a 21-month study for 39 male patients aged 21 to 33 years with Hamilton Grade III AGA, treatment with 2% KTZ shampoo two to four times weekly resulted in progressive increase in pilary index (defined as hair shaft diameter in µm 1.5 cm from bulb obtained from computerized MOP Videoplan Kontron image multiplied by percentage of hairs in anagen phase obtained from trichogram) while unmedicated shampoo demonstrated slow linear pilary index decrease. 61 In another sixmonth study on 150 patients aged 18 to 65 years, 1% KTZ shampoo two to three times weekly increased hair shaft diameter significantly, but did not significantly modify mean hair density.45 A final study described the Accepted Manuscript Page 9 of 33 comparison of oral finasteride 1 mg/day only and 2% topical minoxidil only to combination therapies of oral finasteride with 2% topical minoxidil and oral finasteride with 2% KTZ shampoo for a year in 100 male patients with Hamilton Grades II to IV AGA. Oral finasteride with topical KTZ demonstrated significant clinical improvement compared to oral finasteride or topical minoxidil alone (p<0.01) and was comparable combining oral finasteride and topical minoxidil (p=0.3).

http://libgen.lc/scimag/ads.php?doi=10.1080/09546634.2019.1573309

So 20 years after the 1998 study, and we only got 2 more studies. Not super duper definitive, but very promising. I’m basically convinced to ad it to my routine.


2019-11-21 10:21:01Two studies on ketoconazole in balding men

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Hair Thinning Where Hair Extensions Are

Hi,
I have been wearing hair extentsions for 3 years now. The areas in which I have been wearing them seem to be thinning. I was wondering if the hair will grow back. Also, my scalp is itchy and burning in these areas. Sometimes it’s even painful. Should I go see a dermatologist?

The hair extensions were clip in so are they safe? I thought clip in extensions were safe and wouldn’t damage my hair.

If your skin/scalp is irritated and ‘itchy”, you should see a doctor. Hair loss from hair extension is relatively common and is called traction alopecia. Most of the time if the insult has been ongoing, the hair may not grow back. Anything that pulls on the hair, even clip-ons, can cause traction alopecia. If you are now seeing thinning, then it is safe to assume that you are losing hair from the hair extensions. Best to stop using them now.

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Unfortunately, Some Hair Transplant Doctors Are Crooks

Last week, I met with two patients who came to me with thinning hair. One was 19 and the other was 22. The 19 year old had very early miniaturization, evident by the measurements that were taken of his scalp, and I built a Master Plan for him and advised him to go on Propecia. The 22 year old had clear thinning in the frontal 2 inches of his hairline with 40-50% miniaturization and a thin type hair shaft. The thin hair shaft made his miniaturization look worse than if his hair had been more coarse.

Both of these young men went to these doctors before they came to see me (and no, I won’t name names). In my opinion, both patients should not have hair transplants at this time; certainly the 19 year old is not a candidate at all and probably will not be for years, and the 22 year old may become a candidate if the Propecia does not stop or reverse his hair loss to meet his goals. However, the 22 year old might be able to avoid a hair transplant if the Propecia works well for him. The lack of ethics of the two doctors who viewed both men and gave them both recommendations of 3000 grafts each reflect the ‘scum’ of the hair transplant industry. I know I’ve written on this topic a few times before, but it truly outrages me and demands this repetition. Performing surgery when it could be avoided with a simple daily medication shows that the doctors were chasing their patient’s pocketbooks, not pursuing their patients best interests. Fortunately, both patients liked my advice and will see me for a follow-up in a year or so. I am sure that they will get calls from these two doctors and/or their sales staffs and I strongly advised them to resist sales pressures to sell them what they do not need.

To make matters worse, in my normal examination I measured the hair density of the donor hair on these patients and found them both to be lower than average. That means that they might be limited as to what they can expect from a hair transplant when and if they balded. Both of the doctors that they met with just ran their hands over the patients’ scalp in the back of their heads and magically reported that they were unusually blessed with “lots of donor hair”. Neither of these doctors made a measurement of the donor density on either of these patients and as if by magic — *poof* — they had enough hair to meet the doctor’s income requirement. These scams are unfortunately common in this industry and I always warn patients that if the doctor does not precisely measure the donor density, they should run for the hills when told that their donor supply is good. Worst of all is the fact that if these men had undergone hair transplantation, their donor hair (which was limited in the first place) would be depleted, wasted, and worse yet, put in the wrong place. Over and over again I warn patients to do their diligence on the doctors they see and choose. This again, is a Buyer Beware market.


2007-10-12 16:08:16Unfortunately, Some Hair Transplant Doctors Are Crooks