Hair Loss InformationWhat Is Body Dysmorphic Disorder? – Hair Loss Information – Balding Blog

My doctor told me that I was body dysmorphic. I looked it up and got upset with my doctor. It suggested to me that he thought I was crazy.

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There is a psychological condition know as “Body Dysmorphic Disorder” which cosmetic surgeons of all kinds (i.e. not just hair surgeons) have come to be familiar with. It is characterized by a feeling that one is deformed or very odd looking in some way when in fact one’s appearance is normal. Manifestations can range widely, from believing that one’s nose is malformed (anyone famous come to mind?), to perceptions of imperfection in one’s hairline. These patients have a preoccupation with their appearance that borders on obsession, and they often have multiple cosmetic surgeries to address the “problem”, often moving from surgeon to surgeon. Since the “deformity” is really a problem with self-perception, and not with the body itself, surgery rarely cures and often exacerbates and reinforces the individual’s feeling of deformity. The key to diagnosis is the dramatic disconnect between a normal appearance and the patient’s exaggerated feeling of being defective. A normal patient usually looks to improve their normal appearance, and they do not believe it is a deformity.

Some people (like Jimmy Durante and W.C. Fields – very old movie stars) played up their huge and pock marked nose deformities and exploited them for profit as part of their persona. This is not Body Dysmorphic Disorder, but just simple good business exploitation of a body part, similar to what Marilyn Monroe or Brigitte Bardot did to another extreme.

Hair Loss InformationAfter 7 Years of Propecia, Should I Take Avodart? – Hair Loss Information – Balding Blog

Dr. Rassman,
I have been on Propecia for about 7 years now. For a good part of that time it seemed to halt much of the hair loss and at times it appeared to grow some hair. Over the past year though, the hair loss has accelerated at an alarming pace. I do not use any minox as it iritates my skin almost immediately and causes uncontrollable itching. Is it time to get off the propecia and start Avodart in its place? Or is there a minox formula I can add that doesn’t cause irritation? I still have coverage all over with the usual magic and mirrors but I’m reaching panic stages regarding my next move. Your insight is greatly appreciated.

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First be assured that if you do have genetic hair loss, Propecia is the right choice. You should review all of the material on this blog with regard to Avodart. With these risks understood, a good doctor working with you, and a logical unemotional head, you can make the assessment of Avodart (which has been reported to pick up where and when Propecia becomes less effective). Remember, hair loss is progressive and either with Propecia or Avodart, sooner or later your genetic code will catch up with you.

Hair Loss InformationHair Straightener – Hair Loss Information – Balding Blog

Hi
i am eighteen years of age and am loosing quite alot of hair. it has been a month since this has been happening to me. i dont really know if it is cos im using a hair strightener 2-3 times a week and m washin my hair at least twice in a week. i am loosing my hair particularly when i am in shower. i am really worried and m not using a hair straightner at all during this christmas hoildays. Do u think that i should use my hair straightener once a week and wash it once too? i will really appriciate it if you write back!
Thanks a million!

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I am not 100% certain that a hair straightener can cause permanent hair loss, but if you are concerned, then you should stop its use and see if your problem goes away. That is the easiest and most logical thing to do. Sometime chemicals can cause your hair to become very brittle and break without actually destroying your root, therefore causing any hair loss to appear a lot worse than it actually is. It is normal to lose up to 100 hairs per day.

Size of FUE Procedure? – Hair Loss Information – Balding Blog

I have read the stories at your site and I think its a great idea to make this forum.

My question is: I am having a FUE transplant in 2 months, and have agreed to have 1500 grafts. How many grafts is it possible to move? Maybe it is an individual answer for each person. My situation is that i have had a strip transplant 7 years ago. It was okay but left me with the traditional scar in the back. I am not bald but my hair is thin from front to crown and now I will have a fill in with 1500 grafts if there are enough available, as my doctor says.

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FUE in the 1500 graft range is a big procedure. Follicular Unit Extraction (FUE) is a procedure you must be careful of when considering a hair transplant. A graft removed by FUE has a risk of being damaged when it is extracted. That damage can come from:

  1. grafts that have many transected hairs when they are taken out, producing fewer hairs removed
  2. grafts that are buried inside and left behind, which can cause infections and foreign body reactions
  3. grafts that lose the fat that surrounds them, making them vulnerable to fast drying or growth center damage which will impact graft survival and hair growth

More and more doctors are performing FUE, but few have the skills to do them with a very high hair (not graft) yield. For example, if you take out a 4 hair graft, but three hairs are transected and one comes out, does that reflect 100% success or 25% success? This is a very important focus for the individual who is purchasing FUE, as some doctors call such a graft as 100% successful because one hair came out, as it would have in a one hair graft. I would call it 25% success and a kill of 75% of valuable donor hair. Whatever doctor you are considering, please check this point out by asking for a direct answer to this.

At a meeting in the past year, a series of doctors demonstrated their skills in FUE and each had claimed expertise in the art, but alas, only one had good hair yields. This is no surprise to me, no surprise at all. Some doctors claim expertise with limited (or no) experience, and some claim experience without any audit of hair yield in place for each procedure. When I published the first paper ever published on this technique, a doctor who had built no significant presence in the field announced expertise within 60 days of my publication, announcing to the world that he invented the procedure. I remember him well, because he called me to ask me how to do the procedure and I gave him advice on some of the details he wanted to know. When I read about his self-declared expertise, I felt sorry for the patients who would fall into the “spider’s web”.

For more information about FUE, please see:

Hair Loss InformationThe “Sean Connery” of Hair Restoration? – Hair Loss Information – Balding Blog

Hello, doctor. I do not mean any disrespect in my question, but I do believe it is an important one. I am considering surgical hair transplantation, and I’ve heard that you are one of the better surgeons in Los Angeles. My concern… my question is, how old are you? I ask this for two reasons. (1) Have you passed your surgical peak? (2) Will you be there in a couple of years when I may conisder another procedure?

Thank you. Again, no disrespect intended, but I am looking for a relationship with a physician who is not only qualified but who will be there when I need them.

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What crystal ball does anyone of us have? Do you know when you cross the street that you will make it to the other side and not get hit by a car?

I am 63 years young. I have performed surgery on a couple of billionaires this past year and a number of top celebrities, one head of state, many CEOs of large companies, four patients from the TV show Extreme Makeover, construction workers, a bus driver, a grandmother and a mother of 7 kids, and many others who asked similar questions. My health is good, my maternal grandmother lived to 114, my maternal grandfather died at work when he was 102, my father’s grandmother lived to 99, and many uncles and aunts lived into their 80-90s. Like Sean Connery, I like to think that I get better with age. Mr. Connery turned 75 a few months ago, so he’s got many years on me yet.

I received the hair restoration industry’s equivalent to the Acadamy Award for Best Actor, called the Golden Follicle Award in 2004 at age 62, published the FUE technique when I was 59, and am probably one of the few doctors world-wide who does it well today. The FUE technique has to be the most taxing surgery in hair restoration that there is. I wrote chapters in text books and published scientific and other papers in the past 18 months numbering about a half dozen. I can not run the marathon (nor could I when I was 23), bench press some 500 pounds (also not able to do it when I was 23), or sprint the 100 yard dash (no comment is needed here but for that I am clearly out of shape). However, I ski regularly, scuba yearly to depths of 100 feet, ride my bike about 16 miles a day when I am not over-working and can play the piano for hours (my fingers, at least, hold up well). I can work longer hours than any of my staff and can get along on 3 hours of sleep per night if I must. If you get a younger doctor, ask to see patients of his/her which were done this year. I can show off many of my patients (which we do monthly) at our open house events and have done it for 14 years consistently. I tend to take my responsibility seriously, and have often helped my patients through many personal health crisis that were unrelated to their hair transplant. One patient of mine stands out (age 44) when he discovered that he had John Ritter‘s vascular diagnosis (actor known best for his role in “Three’s Company”). Mr. Ritter died just a few days from his 55th birthday from a rupture of his ascending aortic, so I became involved in the diagnoses and open heart surgery decisions that saved my patient’s life from Ritter’s fate. There is no doubt that had this patient not had a hair transplant, his diagnosis would probably have not been made and as his cardiac surgeon told him, he probably would have died in a year or so. If you would like, I can ask this patient for a reference that would back up this claim.

When you get to my age, you appreciate people for their value, hopefully gain wisdom, and with wisdom should come temperament that allows an artist to perform finer work, perfect his art, and refine and hone judgments that generally take years to define (just like Sean Connery has done for acting). I believe that what I bring is judgment and wisdom to my patient’s problem and potential surgery, and provided that my vision holds out and my hands remain as steady as they have for the past 35 years of doing surgery (from war torn Vietnam, to orthopedic, vascular, and general surgery), I fully expect to be doing hair transplants for some time, at least, on a selective basis.

Come meet with me and judge for yourself:

  1. if you like me
  2. if you respect me
  3. if you trust me
  4. if you think that I will be around for the duration of your needs

Your call, of course. When and if you come, please refer to this blog answer as I would love to connect with you, see the smile on your face and understand your motivation for writing this question to me. At the least, I enjoyed writing this answer, and at the most, maybe we will have things in common. I have made many friends amongst my patients, including many who did not ask traditional questions when they met with me.

Hair Loss InformationPhone Consults for Prescriptions? – Hair Loss Information – Balding Blog

Do you offer phone consultations for prescribing propecia? If so…what is the cost? I have been on it in the past but my script ran out some time ago. I really do not want to go to my family doctor for this again.

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Before starting more medications, you should get a metric (measurement) by having your scalp mapped out for miniaturization to determine if you have premature genetic balding. I prefer that you visit in person for a Propecia renewal so that I can evaluate your hair better. However, if you can not come by, then I don’t mind doing phone consult with proper photographs. My charge for this assessment is $85.

Hair Loss InformationTissue Expansion – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

I have read in a few your blog responses about a procedure called Tissue Expansion involving the insertion and inflation of a balloon into the scalp to create new tissue allowing for a effective scar reduction. Are you familiar w/ patients w/ HT scars that have used TE and if so have they been successful?

I’m interested in learning more about this procedure and it’s viability. I live in LA – would it be possible for you to refer a Dr. who perfroms TE?

Thank you for your insight.

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I would be happy to see you myself, where I would first assess your scarring problem. One must command the problem before recommending a proper treatment. I have been involved with tissue expansion for the past few years, but it is not the solution for everyone. If I can not manage the process, my ego would not get in the way; I would then refer you to an appopriate expert, that is, if you needed another opinion. First, let’s start with a visit to my Los Angeles office. Please call 800-NEW-HAIR to setup a free consultation.

Hair Loss InformationFirst Step for Teen with Thinning Hair – Hair Loss Information – Balding Blog

Hi doctor, I have been recently been encountering certain problems with my hair over the past 5 months, I am 16 years old (male) and currently starting my first year of college. First signs of change were with the texture and build of the hair, as it started to become much drier and thinner. Then the amount of hair that started to fall out naturally started to drastically increase, although I have naturally thick hair the changes that I am experiencing seem too unnatural, one example is the fact that I never really used to be able to see my scalp, now I am really feeling concious about it. I have great foundations of friendship in the school that I go to and the worry of acceptance isn’t preying on my mind too much. I have asked my best friend about it and she seems to see no difference in the appearance of my hair, but I still believe there is something wrong.

My grandfather had troubles with baldness as a teenager and was completely bald on the top of his head at age 20. Confident self image is something that I always like to pursue, I style my hair using straightening irons and using gel based products, which I have been widely recognised at school for, for the past two years. A balding head it something that is not really seen around my social groups, and I’m not quite sure how my friends would react. I haven’t consulted my doctor about it and I would really like some impartial, friendly advice on what to do next, whether I should consult my family or keep it quiet and hope it will go away. I would really appreciate your help in this matter as I have only spoken to one person about this and I haven’t been able to research it myself much. Thank you

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Go get your head mapped out for miniaturization, which will show if you are in the early phases of genetic balding. Especially at your age, it is too important to guess or work the answer blindly through the internet.

Hair Loss InformationRemedies for Psoriasis? – Hair Loss Information – Balding Blog

Iam a 40 year old male that has only suffered from Psoriasis for the last 4 months. Previously I have very thick hair, but already my hair is thining down the front centre of my scalp. What causes this is hair loss? is it the thick crusts of skin or the red lesions ?

What course of action would you advise for me as this is now starting to really affect my day to day life ? Are there partucular shampoos or remedies you would suggest above others ?

Many thanks in anticipation

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Psoriasis can cause hair loss due to stress, scratching and picking it, and from normal genetic process that run in parallel to it. The best person to treat your psoriasis is your dermatologist. I recommend that you learn more about Psoriasis at the National Psoriasis Foundation site. Also, please review previous blog entries regarding this.