Question about DUPA

You know how with senile alopecia or DUPA, the hairs miniaturize but don’t (usually anyways) actually shrink to the point where they fall out and stop growing altogether? They miniaturize to a certain extent but then stabilize in a miniaturized state and are still retained (hence why you don’t see people with DUPA develop totally bald scalps because the hair is still there, just much thinner). Well, can the same thing occur with patterned hair loss? Where the hairs in the thinning areas of the scalp (vertex and/or hairline depending on the Norwood level) miniaturize to certain degree but then stabilize at that point and don’t continue to miniaturize to the point that they fall out and totally stop growing altogether? Or in patterned hair loss, miniaturizing hairs in a thinning area of the scalp will most definitely shrink to the point of no more growth?

You are drawing a lot of conclusions about DUPA. DUPA may be another form of Senile Alopecia or just a variation of genetic hair loss? I don’t know, but I doubt it. DUPA might progress over time, possibly leaving very little hair on the head. i have seen this in women but never seen a man with such advanced DUPA that his entire head became very thin. DUPA is different because it impacts the Donor area and every other place on the head. Someone can have genetically patterned hair loss and then develop DUPA, which I have seen. These men are in a tough spot, as their patterned hair loss may progress to full balding, leaving a fragile donor area.

Doctor Suggested Rogaine, But Should I Ask for Propecia?

I’m an 18 year old male and was recently told by my dermatologist that I am starting to bald. My dermatologist told me that I should just take Rogaine, since I was able to catch the balding early. However, the thinning is happening in spots just behind the hairline, and I know that Rogaine has not been proven to work in that spot. Should I go back and ask for Propecia?

If your only concern is hair loss at the hairline and the immediate area behind it, you should be aware that most of the studies, which documented positive effects of Propecia, were done on crown and vertex area. This is also true about Rogaine. With that said, Propecia is the best medical treatment for genetic balding, but you need a diagnosis by mapping out your scalp for miniaturization to determine if this is indeed genetic balding or just the maturation of your frontal hairline. One reason I usually recommend finasteride (Propecia) to my male patients, because of its ease of use (one pill a day rather than applying Rogaine solution to the bald area twice a day).

In the office yesterday, I saw a young man who was started on Propecia a year ago. He responded well in the frontal area, reducing the miniaturization from 70% to 30% and he had more hair in the frontal area from picture comparisons we had of him and his own assessment. What this means is that just because the official line is that Propecia may not work in the frontal area, clearly we all respond differently. He was smiling (certainly not complaining) about all of that new hair in the frontal area.


2007-02-02 12:40:10Doctor Suggested Rogaine, But Should I Ask for Propecia?

Questions About SMP – Graying, Number of Sessions, Length of Sessions and Touch-ups

How many hours does it take for each SMP sessions and how many sessions will it take? I understand it is permanent ink and was wondering if it fades after time and would need additional touchups? What happens when my hair turns gray? Will I need additional touch ups at that time? How many additional treatments after graying would be recommended?

Yes, there are between 2-4 procedures over a time span of a few weeks (you work that schedule with us). A full head SMP takes between 20-30 hours and we like to see some spacing between the procedures so that if it is going to fade, we can adjust for the fading on the subsequent session. The cost is $7,000 for an entire head SMP and we generally cover it until you are happy with the results. If it fades more than most people, we will do extra work at no charge. Touch-up may occur after a year or so at a cost of $500/tough-up. Most of our patients have not come back for touch-ups. We use a variation of gray/black or gray/brown in the inks and if you turn gray, worst case years down the road (and the inks did not fade enough for you) you might want to color your hair. You can expect that the pigment will fade over long periods of time. The absolutely best way to know the answer to your questions about graying over time, is to come to our Open House and we usually have a patient with gray hair so that you can see the answer for yourself. I hope that this answers your questions.

bad_concealer_Bad Concealer (Too Much)

no_SMPNo Concealer , No SMP

grey_SMPWith SMP

This patient was 87 year old with SMP who had Toppik plastered on his head and he looked ghoulish. We just washed the hair and then did an SMP on his whole head (see attachment). A different man who is now dating again. Age does not mattern.

Doctors Rassman and Pak Were Just Issued A New US Patent

The US patent office just issued Dr. Rassman and Pak a new US Patent called “Apparatus and Method for Mapped Hair Metric” Publication number US20120148127 A1

We continue to innovate in the field of hair restoration and this device is another diagnostic tool that may come to market in the near future.

patent Dr. Pak, Dr. Rassman

SUMMARY OF THE INVENTION
Prior art systems are available for obtaining measurements of hair to determine the degree of hair loss in areas measured. U.S. Pat. Nos. 5,331,472 and 6,253,771 and 4,807,163 and 7,098,910 and 7,006,657 and 6,993,851 are examples of such systems. Commercial software packages are currently available (TrichoScan by a Germany company Tricholog, and Folliscope by a Korean company Hairscience) for such purpose. But in order to provide a reliable metric by which to evaluate hair loss and even the effect of treatment, the status of hair loss has to be determined at different times over the same geographic area.

The prior art systems, even those employing imaging systems, determine the status of hair loss that is difficult to compare at different time intervals because the area of interrogation is not well defined geographically. Generally the areas under interrogation are in the order of 10 to 50 square millimeters. Since the total area of scalp is 50,000 square millimeters, the need for accurately accounting for the geographical location of individual measurements that only covers 10 to 50 square millimeters is paramount.

The prior art incorporates relatively small static images over a relatively large area for analysis. The present invention is based on the recognition that a streaming video analysis can also be incorporated to provide more data points in the algorithm.

The present invention is based on the recognition that a metric for hair loss can be produced by imaging areas of any hair bearing skin which are sufficiently large (i.e. 50,000 square millimeters of the human scalp) that the focal areas can be later revisited reliable where any offset in positioning would introduce only acceptably small errors. A map of the hair bearing skin or scalp can be generated by a compilation of the images to provide a reliable metric of hair loss status for comparison with the metrics previously generated. The invention provides a method and apparatus for geographically mapping user defined locations of hair bearing skin area with a bulk metric output. The metric values may be used to compare different user defined locations to quantify relative differences by location. The metric values may also be used to compare user defined locations at different time intervals to quantify relative differences over a period of time. The mapping and the metrics can be achieved more specifically by automated means by the analysis of multiple static pictures or the analysis of a live video covering a larger area than a single, static field of view. It also provides a method and apparatus for sorting and characterizing the relative diameter of a hair shaft by automated means in which the total cross sectional area of all the hair shafts in the interrogated field can be calculated. The automated method of obtaining this metric can be effectively used to acquire the bulk of hair over user defined locations and time intervals.

Hair on the scalp that is susceptible to androgenic influence may exhibit a relative decrease in shaft diameter and number. This phenomenon is sometimes described as miniaturization of hair as is described above. Miniaturization of hair may also be due to various disease states as well as the natural life cycle of hairs. The present invention incorporates a device to interrogate an area of hair bearing scalp. The image(s) are digitized and processed by a pre-programmed algorithm to differentiate the hairs against its background. This differentiation is quantified by automated means to express a value of number of hairs per area and Density (D). Furthermore, the aforementioned image is processed by another pre-programmed algorithm to differentiate the differences in hair shaft diameter (or its thickness) within the image field(s). This differentiation is also quantified by automated means to express a value of Miniaturization (M).

For the purpose of simplicity in demonstrating aforementioned concept, the Density (D) may be expressed as a relative number that is the sum of the area that all the hair (?H) occupies in an image divided by the total area (A) of the image field (D=?H/A). The Miniaturization (M) may be expressed as a relative number that is the sum of the areas occupied by hairs with a smaller diameter (?h) divided by the sum of the area that all the hair (H) occupies in an image (M=?h/?H)

In effect, this automation produces metrics for Density (D) and Miniaturization (M). It also provides metrics for the bulk (B) of hair that is expressed as the total cross sectional area occupied by hair divided by the area under interrogation. This provides a quantifiable value in assessing the state of hair density, miniaturization, and bulk for the purpose of diagnosis. The variation of (M), (D), and (B) over different location and at different times will provide valuable information to the end user for the diagnosis and progression of hair loss or hair gain. The pattern of hair loss can also be determined with the aforementioned metrics. It is this ability to map out a metric based system for the status of hair loss at multiple locations sufficiently large to be accurately revisited and in a relatively short time window (seconds or minutes) that is the essence of this invention. When longer time intervals are used (weeks. months and years) an assessment of change in hair bulk can be measured. This method and apparatus would be particularly useful for documentation of hair loss or gain progression over time and/or hair gains in bulk after treatment regimens have had time to work. Drugs like finasteride (Propecia) are but one example of such a treatment regimen.

Another embodiment of the invention consists of a hand held device which a user moves from front to back along the scalp to establish a path of sufficient size to permit accurate measurements. The end user points the sensor end to the location of interest to obtain readings as the sensor is moved. The bulk of hair may be expressed in many ways depending on the aforementioned metrics and may incorporate the cross sectional area the hair shafts occupy in a field of interrogation. In this particular embodiment, a relative ‘hair bulk’ number may be expressed so that the end user can compare the value to the value at other locations or compare the value to other references on the individuals anatomy over time. This embodiment would conveniently have a recording and analysis function to keep track of the different data and reference points with dimensional locations mapped out. It could represent various static images or a ‘video like’ device that enables a person to sweep the hair bearing area along a series of tracks in a pattern that will, in effect, produce a more detailed map of hair bulk in the scalp, by area. In practice the device may be adapted to keep track of the velocity of movement and reference of a user defined location and record the time of data acquisition.

Another embodiment of the device utilized the same instrument without cutting the hairs to a small length. By using a combing device. The hair can be separated (parted) such that the scalp is exposed with hair on both sides, visualizing only the point where the hair exits the scalp before it is combed aside by the separating comb-like element. Standardization of the combing process is necessary in any one person and this can be accomplished by mechanical (comb) or pneumatic (air blowing) means.

Another embodiment of the device incorporates a miniaturized probe, like a ball point pen, which can be advanced over a section of scalp, separating the hairs as the probe moves through the ‘forest’ of hair shafts by mechanical or pneumatic (air blowing) means.

Rarely, hair transplants don’t last the life time of the patient

There is an autoimmune disease called Lichen planopilaris (LLP) which appears to be a rare inflammatory condition that results in patchy progressive permanent hair loss mainly on the scalp. From time-to-time this disease, which may be present when we perform a hair transplant and is not evident with any of the modalities available, can reactivate and could then kick out the hair that was transplanted. Some patients might have signs that LLP participated in their frontal balding, possibly overlying the genetic component of the hair loss.


2017-11-19 15:59:39Rarely, hair transplants don’t last the life time of the patient

Does Adderall Increase Testosterone?

Can Adderall increase testosterone in men? Thanks drs

To my knowledge, Adderall does not affect testosterone levels. Adderall is prescribed for patients with ADHD and its mechanism of action has to do with dopamine uptake.


2012-10-24 10:05:10Does Adderall Increase Testosterone?

Reader Tells Others to Calm Down Over ACell Inquiries

Hey Dr Rassman i hope your day is treating you well.

Being a hairloss sufferer myself i can relate to the extraordinary anticipation and hype surrounding the new buzz word in the field of hair restoration ”Acell”. However i also realize that this is far from establishing itself as a practical solution to genetic alopecia(if it even makes it that far). As a hair restoration physician i imagine you grow tired of those ”cure” type perennial questions. In my opinion readers need to recognize that when the hairloss community is equip with innovators like yourself Dr Rassman it provides us with the best chance possible of making the most out of these types (Acell) situations.

Being a daily reader of this blog i have nothing but good things to say about it. There is not a doubt in my mind that Dr Rassman and the other physicians that contribute to the blog will be efficient at posting occasional updates. So for a lack of a better term just ”chill out” time will tell…..

Thank you for your support! I don’t mind the large amount of emails I’ve received with ACell questions, as I kind of expected that… but I don’t want to give anyone the wrong idea about what it can do (we’re still trying to figure it all out).

We will most definitely update the readers of this site on our progress as we can.


2010-12-07 11:03:21Reader Tells Others to Calm Down Over ACell Inquiries

Does DHT Type I Cause Hair Loss?

Finasteride lowers type II DHT while Avodart lowers both type I and II. Does the amount of type I DHT have any effect on hair or it is only type II that may cause hair loss?

Thanks.

We answered this years back here. Short answer — it’s been proven that type II is linked to MPB, but type I hasn’t been linked.

Recent Transplant in 19 Year Old

I would like to get some information on hair loss. I’m 19 and lost my hair on the temples. It’s not that bad because I can cover it. It’s the only hair loss problem.I had hair transplants in that area done by Dr [name removed], 250 grafts on each side. it’s been 2 and a half month’s now,can’t see any results yet. also the Doctor prescribed propecia for me but he say’s it only stops the hair loss in the crown area and there my hair is full and is in my family as well!!! I have been taking it for 5 months now and am not sure if should continue taking it!!! What would you recommend? I don’t want to lose anymore hair and also after I see the results from the transplant I had and want to still fix my hairline I really like what you are offering!! Please email me on your suggestions!! Thank you

If it has only been a few months since the transplant, you must wait this out. I suspect that you had 250 grafts in each corner, similar to a Norwood Class 3 pattern. The full benefit of Propecia will take 8-12 months, and the transplant should show 80% of the benefit in 8 months. Keep on the course you have started and do not stop the Propecia.

I am concerned that you had a transplant at the age of 19. If you are in Los Angeles, please come by and introduce yourself for a second opinion. You need to have your scalp hair mapped out for miniaturization and you need a Master Plan in hand, particularly now that you already started the process.


2006-02-25 08:15:34Recent Transplant in 19 Year Old