Category: Uncategorized

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Hair Transplant Review of Norwood 5 Patient Before After Photos

This is a review of a hair transplant result performed at New Hair Institute by Dr. Jae Pak. This is a patient in his 60’s who looked 70’s before he had a hair transplant. His grey hair actually helped with the overall result. Grey hair on fair skin helps disguise the thinning by the low contrast between hair color and skin color. We think that the hair transplant makes him look at least 10 years younger than his real age!

He is currently thinking about another hair transplant versus a SMP procedure for fullness. There is no right answer or choice. Real hair is always better, but SMP is not surgery and there is no recovery with instant results! He may choose both like this patient HERE.

Before and After 2491 Grafts

Before and After 2491Grafts

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Using Nizoral and Propecia Together

Hi Dr.,

I have a question concerning Nizoral shampoo. I take Propecia once a day, and have been using Nizoral every few days for the past month since there seems to be a great deal of praise for it as a supplemental item when using a treatment like finasteride (no decent clinical studies to back that up, I know). My question is, have you come across any recent evidence that suggests it has negative consequences/interactions as part of being on a regimen like Propecia.

Thanks

NizoralThe use of both Nizoral (ketoconazole) and Propecia (finasteride) together seems to have great popularity to many of this site’s visitors. I have not seen negative reports from using both of these products together, so that’s good. There was a small study published in Journal of Dermatology in August, 2002 about using a ketoconazole and finasteride combination. From the study:

    “One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel-group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups.

    Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year.

    At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. “

There are possibly more recent studies on using ketoconazole as a hair loss treatment (there’s one from 2007 with no abstract available), but this one from 2002 includes combining the medications and was the first such study I could find. If anyone using both treatments together has a story to share, feel free to send it or leave it in the comments section.

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Hair Transplants by John Lord

i was googling the address for John lord when I got your article. im in my 40’s and want to inquire about hair transplant. someone i knew went to him and was happy about the result and it was also inexpensive. wanted to try it but very scared about his history, outcome if i were to go elsewhere and the amount i will end up paying. my hair is thin and i just want a thicker full hair especially front area.

John Lord is not a doctor, but somehow owns a surgical hair transplant clinic. This is illegal in California, but he was able to skirt the law. His clinic was responsible for the only reported death in the history of hair transplantation just a few years ago. The patient who died came to see me a couple of weeks before he had the transplant that killed him. Our clinic fees were a bit higher so to save money he ended up at John Lord’s clinic. And well… you know what happened next.

Our facility is fully accredited with the AAAHC (Accreditation Association for Ambulatory Health Care), which guarantees that our processes are first rate, infections are very rare, and safety is paramount as it is built into our system. We are audited every three years and all of our records are reviewed by this agency for safety and poor outcomes. We’re one of the very few hair transplant clinics to go through this rigorous auditing and accreditation.

I had the opportunity to see a few of the patients from John Lord’s clinics and the results were clearly substandard. Maybe the bad transplants are the only ones that came to see me for repairs. As for the cost of hair transplantation, that depends on how much hair needs to be moved. I’m in Los Angeles if you’d like to make an appointment (it’s free).


2010-03-12 08:31:36Hair Transplants by John Lord

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Using Toppik for Norwood 6 or 7 Patients That Can’t Have Full Coverage from a Transplant

Dr. Rassman,

What is your opinion on using products such as Toppik to enhance a hair transplant on a Norwood 6 or 7 patient who cannot achieve full coverage? Obviously the need to use a product like Toppik long-term may not be ideal, but for a man whose hair loss is too extensive to achieve full coverage from donor hair, a keratin hair-binding product combined with a hair transplant may be the most effective and natural looking solution for a lot of men with extensive balding.

A bald Norwood class 6 or 7 patient does not do well with a concealer like Toppik, which works better with some hair. Many men who use this product without hair in the bald area will actually show the Toppik itself, which is often irregular in the way it is put down. If used to enhance a hair transplant that is not thick enough, it might work if it can be applied so that the Toppik can not be detected. The keratin hair granular product has significant disadvantages, as it can come off on your clothes, your sheets and pillows, and when someone runs their fingers through your hair.

There is another treatment which is a permanent concealer that can thicken up a hair transplant look — Scalp MicroPigmentation (SMP). If you look at the SMP site, you will see examples of this type of concealer and most of these patients (who have hair that is just not thick enough) can avoid another hair transplant with the SMP alone. We have successfully used this SMP technique to address individuals whose balding patterns are too large and the transplants too few to get the coverage they want.

As everyone is different, I would suggest that you request a virtual consultation with me and send photographs in good lighting so that I can understand your problem as you see it. Also, please include a phone number.

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HairCheck vs Miniaturization Mapping

Hello Doctor Rassman,

first of all thanks for your website and for all the precious information!

I have a question related to the haircheck methodology (re. a post on Aug. 8, 2011). Is the haircheck methodology related to miniaturization or is it a different methodology? I.e., would haircheck reveal an early stage of miniaturization, which would not be usually seen with the traditional magnifying camera that you and Dr. Pak use when visiting patients? I ask this because, when doctor Pak visited me in San Jose 2 months ago, he said that at 30y I don’t have any sign of miniaturization, but I still have the “impression” that the hair on the top of my hair has lost volume over the last year. Maybe just a little paranoia :-)?

Keep up the great work!

Best regards

I discussed your case with Dr Pak and he remembers you well. You have absolutely no sign of balding. There was less than 10% of miniaturized hairs all over your scalp. There was no balding pattern identifiable. If you would like, you can send us a photo and permission for us to post it. You are 30 years old with a Norwood 2 hairline.

You are one of those people who had so much hair when you were younger, that you probably never saw the skin on your scalp. As you aged, you probably had some thinning (not balding), and when your hair was cut short and you were under bright lights, the whites of your scalp could be seen. It was the perfect storm.

The bulk measurement can be used to assess the VOLUME of hair at certain areas (top or crown) of your scalp and make a relative comparison of that value to the measurement from the back (donor) area of your scalp. This test cannot be done if you have lots of product (gel, mouse, pomade, hair spray) on your hair, as it will add to the bulk, nor can it be done if you have very short hair, because we need to grab a section of your hair in each area of the scalp. The bulk measurement is like counting the number of hairs in a certain area (density) and multiplying it by the cross section area of each hairs.

The miniaturization mapping measurement can be used to assess the condition and distribution of miniaturized hairs around certain areas of your scalp. The proportion of miniaturized hairs to non-miniaturized hairs can be compared to your own donor hair to see if there a pattern to the miniaturization (thinning). In your particular case, you had absolutely no miniaturization all over your scalp.

By the way, thank you for the bottle of wine!


2011-08-11 17:37:59HairCheck vs Miniaturization Mapping

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Very Irregular Periods a Cause for Female Hair Loss?

Hello there….I am a 29 year old female experiencing frontal and temporal hairloss. I am upset and not sure what to do. I have VERY irregular periods. I may have one 1-2 times a year. Will this cause hairloss? I know a decrease in estrogen will cause it, but I am young and wonder if a very rare period would contribute to it. I have had my thyroid checked and it was ok. Not sure what causes the irregular periods either. I would greatly appreciate a reply to help my questions. I am a nursing student who will be graduating this coming May and would like to look nice for pictures. Thank You

There may be no relationship between your hair loss and your periods. There are conditions like Polycystic Ovarian Syndrome (PCOS), where infrequent periods and hair loss go together. You can see this at 4woman.gov or PCOSupport.

I am not suggesting that this is what is wrong with you, but the diagnosis of female hair loss is complex and requires a complete examination by someone who can evaluate your periods and your hair loss in partnership with you.

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I Had My Hairline Lowered and Now Have This Terrible Scar with Balding Behind It (photo)

One of the complications of a ‘hairline lowering’ or ‘hairline advancement surgery’ is hair loss. When it occurs, it exposes the scar from the advancement surgery. The best and only treatment for this is a hair transplant which can effectively bury the entire scar and fill in the thinning area behind the scar as well. Hair loss can be very extensive, losing the entire frontal area back up to 3-4 inches from the incision, but on the rare times that this happens, in women, this always reverses and the hair loss returns


2018-04-20 19:50:26I Had My Hairline Lowered and Now Have This Terrible Scar with Balding Behind It (photo)

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Video Showing Implantation at a Density of 200 Grafts/cm Square (from Reddit)

I would bet that your normal density is not 200 follicular units per square cm. These numbers are unrealistic because it would deplete your donor area so much that as you continue to bald, which you will, you will have no hair to use in the donor area. These numbers, although they can be done as shown here, are unrealistic from a Master Plan approach to hair transplantation.

I was the first doctor to define dense packing of grafts in 1993-4, and I published it in the Hair Transplant Forum. However, I used it only on single hairs in the leading frontal edge. Today, I no longer use these number in the leading edge and I get terrific hairlines with a more reasonable density.

200 GRAFTS PER SQUARE CM!! THAT’S WHAT I’M TALKIN ABOUT. MHTGA from tressless


2018-07-19 05:46:57Video Showing Implantation at a Density of 200 Grafts/cm Square (from Reddit)

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My hairline is uneven, what should I do?

Uneven hairlines in men usually indicate that recession from genetic balding has started. Showing up on only one side is not uncommon but eventually it will impact the other side and more recession of the entire hairline is very probable. See a doctor who can make the correct diagnosis. If you are over 25, you can transplant it to correct the uneven appearance but you should also take the drug finasteride to stop the progression of the balding process.

 


2018-01-24 07:30:20My hairline is uneven, what should I do?

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Vitamin D saved my hair

So a few years ago I started to lose my hair and develop dark circles and facial wrinkles. I tried minoxidil for a while with limited results, then gave that up. Then on a hunch I read up on vitamin D deficiency, and found out that one of the symptoms was hair loss.

I started taking 4000 IU of D3 every day, and 6 months later my hair is almost completely restored – like nothing happened. Also my dark circles are getting much better, and my energy and mood have improved.

What can I say that you didn’t say! It is worth sharing here. Be careful at that dose as it may eventually cause overdosing.


2020-11-16 09:26:17Vitamin D saved my hair