Category: Uncategorized

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Dealing with Unhappy Patients

Dr. Rassman, how do you deal with patients that are not happy with their results, or suffer complications, such as shock loss, grafts not growing, and incorrectly misplaced hair. How often do you encounter this? Thanks.

My philosophy on patient care is that a doctor and patient relationship should be a partnership. Both parties should understand one another and treat one another with respect. I found that through the years from my days as a surgeon, mutual respect and partnership have always kept my patients happy. Setting realistic expectations are much of it, and listening to what people are telling you helps work through the partnership. We have had monthly open house events for the past 14 years where patients who have had surgery show off their results and prospective patients can talk to them and see what they got. Prospective patients can also see a live surgery (just imagine that we were doing this for 14 years on monthly basis in every office we had). Of course there have been unhappy patients along the way, but the partnership and respect goes a long way in resolving any unforeseen issues and a good dialogue usually does not pit one side against the other.

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Possible DUPA

This man wanted a hair transplant and came to a colleague asking for one. If his donor area was examined under a hand microscope, it would show either very low density or DUPA. In either case, he would be an unlikely candidate for a hair transplant.


2020-11-04 08:46:19Possible DUPA

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Can Dandruff affect growth from a hair transplant?

No, Dandruff is common and more pronounced after a hair transplant because skin turns over more frequently (skin shedding). If you are concerned about the growth and you are at least eight months since the surgery, then go back and speak with your doctor comparing your expectations to your doctor’s expectations.

poor growth

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Post-Operative Care and Scalp Flaking

Dr. Rassman, I think you are running a brilliant blog. After reading several posts, I am encouraged to share my own views and ask a question. I recently got a FUE megasession done in Europe and am pleased with the results, atleast till now (just 2 weeks post-op). While going through this website, I personally felt that it would be a great idea to start a new category called ‘Post-Operative Care’ since I am going through this phase myself and can feel the need to interact with others out there on the topic. Don’t worry, I don’t think it will scare away any prospective patients. It will only lend credibility to the transplant procedure.

On that note, I also have a question. I am using Minoxidil 5% to help with the growth of new hair. But my scalp in the recipient area shows considerable dryness / development of flakes when the scalp is dry. I was recommended to apply a hydrating lotion on the scalp. Would you agree with this advice and can you recommned a good hydrating cream /lotion meant for hair?

Thanks in advance.

Thanks for your kind words and for the new category idea. I’ll add a Post-Operative category now.

The results of the FUE will take 5-8 months to show, so then and only then, will you know the value of what you had done. Minoxidil does cause dryness and flaking. Any non-alcoholic creams will work. Also, try a variety of hair conditioners as well. Take risks until you find the right one. Ask your hair dresser, as they may know the best that is available in your country.

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Pregnant on finasteride for 8 months!

I wanted to say that my wife is 8 months pregnant and I have been on fin for ~ 16 months.
No issue whatsoever! I don’t believe that there are any reports that I have read that suggests that men on finasteride will negatively impact a pregnant woman or the health of the fetus
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Is DHT and 5 Alpha Reductase Related to Its Receptors For Male Pattern Balding Catastrophe?

so dr? i interpret from your blog that 5a reductase is responsible for MPB and sensitivity of the receptors have nothing much to do with such catastrophe?

Male pattern balding MPB is not a catastrophe. It is the cards that we are dealt when we are born just like the color of your eyes, shape of your nose, or the way you look. As stated in numerous posts, GENETIC inheritance is responsible for male pattern balding.

One of the mechanism of this genetic predisposition we know of is dihydrotestosterone (DHT). There may be other mechanisms other than DHT but it has not been discovered.

Scientists have found that if you block DHT, male pattern balding can be altered/ halted/ slowed/ temporarily reversed. Male pattern balding is not curable but it can be managed with drugs or surgery.

Blocking DHT is accomplished (as we know it) by slowing down the production of DHT. This is accomplished by inhibiting an enzyme called 5a reductase. 5a reductase is responsible for producing DHT from Testosterone. I suppose there may be another way to block DHT by blocking the receptors for DHT (not the enzyme that produce DHT). This will be new type of drug – yet to be discovered. Another drastic way to address MPB is castration to stop most of the testosterone production thus stopping most of DHT production but this will be drastic.

My point here is that it isn’t about DHT or 5a reductase. It is a genetic issue. So for those looking to completely block DHT with stronger medication such as Dutasteride (Avodart), it does not work as one may hope. Mainly because (I say again) it is a genetic issue. Another way to put it is that if you do not have the genes for MPB, you can have a very high DHT level and you will not be bald.

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Preventing hair loss after a hair transplant

I have MPB which has hairs receding from temple region.I went to a dermatologist today and she said even if you do hair transplant, the hair in the middle section of your head will continue to fall. So she said take Finastride 1mg every day for 3 months along with mintop 10% twice a day everyday and vitamin 3 tablets. Also she said she would do PRP once a month for 3 months which will most probably bring some hair back in the temple region.

I would like some opinion on the medications that she has given and the PRP. Please help.

When it comes time for a hair transplant, the drug finasteride will usually protect the native hair including the miniaturized hairs on the head. As far as PRP, I have written about it here: https://baldingblog.com/go-looking-prp-used-hair-transplant-good-thing/. Minoxidil is a good medication, but 10% concentrations tends to produce more side effects than the traditional 5% and 10% it is not a standard dose.


2021-08-08 20:47:28Preventing hair loss after a hair transplant

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Did Finasteride Stabilize Dr Rassman’s Hair Loss?

Hi.

I seem to recall reading a message of yours where in a reply to a reader you mentioned that you personally discontinued your usage of finasteride. You felt it had stabilized your hair loss.

What confused me is that you seemed to imply finasteride stabilized your hair loss and you could thusly stop treatment. (or at least chose to and wasn’t any worse for it). It was my understanding that hair-loss will always resume once treatment is discontinued. Is this not true? Or did I misunderstand your message?

Thanks.

SeniorYou’re right that once you discontinue Propecia (finasteride 1mg) treatment, your hair loss resumes. For me though, since I originally had crown loss, I tried finasteride to see if I could increase the hair in the crown. At that point, my crown was clearly stable and I did not gain anything from the finasteride.

Considering that I was about 60 years old when I started taking the drug, I probably had as much hair loss as I could expect for my age. There are advantages of being a senior besides discounts in the movie theaters and on public buses. I hope that clears up any confusion!

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Progaine Shampoo

Doctor, you mentioned in one of your recent posts that you supply one bottle of Progaine Shampoo to your patients after the surgery. I use Progaine a lot but can only find the Progaine Volumizing Shampoo available. The other Progaine products do not seem to be available at this time over the internet or in stores. Do you know why only one Progaine product is available at this time? When would the other products under the brand name be available again? If you could provide any information, it would be appreciated very much!

Progaine is just a volumizing shampoo like any other volumizing shampoo. It does not grow hair. There were other formulations, but I believe they’ve been discontinued. I just did a quick search online and you’re right -only the volumizing shampoo seems to still be for sale.

But… um… I must’ve had a temporary memory lapse when I said that Progaine was what I give to patients after their hair transplant surgery. I used to provide Progaine, but for years now I’ve provided GraftCyte shampoo (which contains copper peptide to promote better healing). You can find more info about that here. Sorry for the confusion!


2009-06-12 12:34:10Progaine Shampoo