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Hair Loss InformationScarring After Hair Transplantation – Hair Loss Information – Balding Blog

I had a transplant at your L.A. Clinic in November 97. I have been reasonably happy with the results & would consider another transplant but I’m concerned about the scarring. Could you tell me what the extent of a 2nd transplant might have on the existing scar.

Thanks

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Scarring is becoming less of a problem with the new method of closure we instituted a year and a half ago. Even for those who usually develop heavy scarring, we now have ways to treat these scars.

The new technique for preventing scars is what I call a modified fascial closure to the area where the scar might be a problem. I now use this technique in all of our patients. If a scar should occur, although it is rare with this new technique, we will attempt a scar revision (as the sole surgery without a hair transplant) at no charge. With a scar revision of any existing scar, the chances of improvement are as follows: 60-80% of patients will show some improvement, 50% will show a moderate-good improvement, 10% will show no improvement, 5% run a ‘risk’ of making the scar worse and 1-2% run the risk of making the scar much worse (although I have not seen that occur over the past 18 months or so since I perfected this new technique). The key to minimizing risk is to be conservative with the surgery, yet radical with the repair.

These are my three approaches to scars:

  1. Scar revision with a modified fascial closures
  2. Transplants into the scar with the Follicular Unit Extraction (FUE) technique (this is applicable and can work well in almost all patients)
  3. A balloon reduction (a radical approach to severe scarring usually caused by burns, car accidents, and following brain surgery)

With all of that said, I would doubt that scarring is a significant risk, but you can do a FOX Procedure (also known as FUE) which is removing one follicular unit at a time. The scarring is punctuate (small round 1mm wounds) that can only be seen if you shaved your head, but not with a close crew cut.

For more information on FUE / FOX Procedure, please see:

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Remaxx – Hair Loss Information – Balding Blog

2 quick questions…
I am currently taking propecia but have been reading on the web about the effectiveness of avodart which seems to be substantially better than propecia. Would you advise taking it if I could get my hands on it?(it seems like I could get it from overseas UK pharmacy’s)

Also, have you ever heard Remaxx products? I went to a Dr. for a consult and he said post-op that they have a couple of products that would be beneficial. Basically, a shampoo, conditioner, and replenisher. Have you ever heard of this co.? Any help on these subjects would be great.
Thanks

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Avodart is discussed heavily on this site. You can see all of the articles referencing Avodart here.

Remaxx products show an extreme and unrealistic / unbelievable before and after photo. When they look unbelievable, I generally take a dim view of the company and its products. These products are just another offering in a mass market of claims galore for hair regrowth.

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Finer Hairs at Hairline – Hair Loss Information – Balding Blog

Hello Dr.Rassman,
I am a 29yr old caucasian male who has over the last few years been dealing with questions of hairloss. Thus far there is nothing dramatic to speak of – no noticably thinning or balding areas. There is however one thing that has led to a good deal of concern – it can best be described as light or whispy hair around the frontal hairline (from temple to temple). My hair has always been quite fine in nature and until a few years ago a light brown color rather than the dark brown it has become. In recent years I have grown my hair out quite long – opting for the ‘rocker’ look as friends call it. If I pull my hair back I dont notice any loss at all – it looks like a regular hairline – but the hairs that make up the first cm (rough estimate) are lighter in pigment and fine in composition compared with hairs deeper in the scalp. Aside from the minor difficulties this phenomenon creates when attempting to style my hair I’ve been wondering if this is an example of the ‘miniaturization’ process that you have described. I have no signs anywhere else of this phenomenon – just the fringe of the frontal hairline. No crown thinning, no overall diffuse thinning, no temple thinning – and that is what is driving me crazy! If it were more extreme I would be prone to take some action be it drugs, topicals or other treatments. With this said however the lack of action kills me just as much because I wonder if I’m not acting when I should be – nipping my possible hairloss in the bud so to speak. Please let me know if you feel this is an example of ‘miniaturization’ or not and any course of action I should consider taking. Thank-you.

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To really answer your question directly, you should be examined and have your scalp mapping of your hair for miniaturization, which is best done under magnification with a visualizing high power microscopic tool, like our densitometer. Fine hairs often exist in the very front of the hairline, but in regards to what you refer to, I am not sure if you mean the mature hairline that has probably evolved from your child hairline (age 10 or so), which is often lower and thicker. I would want to see pictures and possibly meet with you in person to make such assessments. If you’d like to send photos, you can email them to the address on the Contact page.

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Why Does Accutane Cause Hair Loss? – Hair Loss Information – Balding Blog

Hello Dr. Rassman. I’m a 25 yr old female and I recently took accutane for 6 months(have been off it now for 7 months). I knew hairloss was one of the side effects but I took my chances. My hair was fine during the whole treatment…didn’t have any thinning whatsoever. About 5 months ago, however, my hair started thinning and has gotten progressively worse since then. It’s especially thin on the sides above my ears, and my hairline is much thinner. The top of my head is much thinner also. I don’t know what to do. I don’t know what accutane does to actually cause the hairloss, it would probably help to start there. I’ve been reading online about what others in my situation are doing and I started on the Nioxin hair system, started taking milk thistle for my liver, and a B-Complex vitamin to help with the hairloss. My doctor said to wait it out and that it should be temporary. I don’t really like that idea. It keeps getting worse and I want to put a stop to it. Please help me! I’d appreciate any information you could spare…thank you so much

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I am not certain of the specific mechanism causing hair loss by Accutane. The package insert of Accutane stated that this drug may lead to alopecia, but it was rare. Accutane causes dry skin, skin fragility, erythematous rash, vasculitis, and decreased red blood cell formation which may contribute to hair loss. In general, Accutane may contribute to hair loss by creating a not so optimal environment for hair growth and it clearly does impact the glandular elements of the hair, which will make the hair dry and fragile as the amounts of sebum production drops. Rogaine may help improve hair loss, but it also drys the scalp further. I recommended that you see a dermatologist to evaluate your hair loss in person. However, there are many causes of hair loss which also must be evaluated, such as thyroid problem, eczema, infection, autoimmune problems, weight loss, stress, etc.

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Natural Looking Hairlines – Hair Loss Information – Balding Blog

Dr. William Rassman,
is it possible to restore the original hairline through hair transplant since my hairline had receded so much but not completely bald & its really affecting my self confidence. is it too early for me to undergo this procedure or should i go ahead? whats the best hair transplant method that gives a more natural looking hairline? thanks

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You did not state your age and without a photo it is impossible to go into detail about whether a procedure is right for you or not. Hair transplantation today can be and should be undetectable and able to produce a completely natural hairline. The appropriateness of the surgery depends on the individual assessment of each person. There are hundreds of patient hairlines on our website, and you are invited to come to one of our open house events in Los Angeles and San Jose to meet patients directly, so you can see for yourself what can be achieved.

For a great example of what is possible in hair transplantation, please see the Steve Hartman feature on the NHI site. There are larger photos available on the previous blog entry, Where Are the Celebrity Transplant Photos?.

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Seborrheic Dermatitis in Women – Hair Loss Information – Balding Blog

I had curly very thick hair all my 56 years. now out of the blue i got seborrheic and it is in my scalp. my hair is falling out. I’m going to the dr. but not much you could do but creams and hard shampoo. it’s not getting better. what can I do? it has been over five weeks. The dr. said this is something I have to live with. I’m not upset. I’m very blessed then other people. thank you if you can give me some feedback. God Bless

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Please read the many entries on this blog for female hair loss. First and foremost, you need to have yourself and your health checked out. There are many diseases that can cause hair loss in women and you have to make sure that you do not have one of them. Women, like many men, can get genetic hair loss. In women, it usually is diffuse and not in one of the typical patterns that men show. Women generally thin out, but do not get bald. Some develop a pattern of thinning that can be treated more successfully with Minoxidil and possibly even hair transplants under certain conditions. First, get your self checked out medically and then find a good dermatologist or hair expert physician.

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How to Get Propecia – Hair Loss Information – Balding Blog

Hi,
im 24 and ive been slightly receeding for several years now, however it has sped up in the last 6 months, ive also notice the front of my hair beginning to thin. I have read many things about propecia on your site but have no idea how to go about getting it or how much it costs. ive also read a bit about DHT, which sounds like the cause of my loss. Do you have any suggestions, and any suggestions on someone to see, obtain propecia from the vancouver area
thanks

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You may obtain Propecia by asking your physician to write you a prescription and then purchasing it at a pharmacy. Prices in the United States run between $53-120/month for 30 pills, depending on where you buy it from. Being from Canada, you may be able to obtain Propecia at a better price than in the US. You may also obtain Propecia from my company if you become a patient. Our pricing is presently at $160 for a 3 month supply. If you are one of our patients we can ship it to you, but if you are not in California (Los Angeles or San Jose) to be evaluated, just see your family doctor and ask him/her.

Hair specialists who will often write Propecia prescriptions can be found at ISHRS.org.

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Body Hair Transplants, Revisited – Hair Loss Information – Balding Blog

I am interested in transplants using body hair. Does it work and do you do it? Thanks

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Chest hairs and pubic hairs can be harvested for hair transplantation. However, you must realize that body hairs are not ideal for transplants because they tend to be shorter than hairs from your scalp, there are not many of them despite the sense that a very hairy chest is hairy by density, and these hairs do not grow in large groupings like scalp hair does. Body hair transplants must be considered experimental at this time, until some well published sciences stand behind them. Most people who ask me questions about body hair transplantation have depleted donor supplies from the scalp. Is this what you are facing? If it is not, body hair transplants would be completely inappropriate. Since you are in Los Angeles, I want to mention that we have a local office to you, if you would like to setup a free consultation. To schedule an appointment, please call 800-NEW-HAIR or visit the Request Additional Info page at the New Hair Institute website.

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Hair Loss InformationPost-Operative Redness and Sebum – Hair Loss Information – Balding Blog

Dr. Rassman, thanks for starting the ‘Post-Operative’ section. It has been 5 weeks now since my FUE megasession. In the past 2 weeks, I have shed abt 30-40% of my transplanted hair…a condition I had been told is normal, does occur but am happy it has now stabilised. The only hair that I still lose now are those that come off with these thick crusts that form on my scalp every morning after I have applied Minoxidil the previous night. I have been using the 5% strength Minoxidil for abt 4 weeks. I now see redness on the scalp and the area around the red spots is sticky. I won’t call them pimples as another person writes in his message (pimples in transplanted area). But your inference in that post that ‘The more likely cause is the remnants of the sebaceous glands which survive and grow while the hair has not yet started to grow’ seems true to me.

I don’t know why there is this extra sebum production on those reddish areas and why it dries up to form a thick crust? By hit and trial, I found that instead of pealing of this crust if I just wash my head with a pH neutral or baby shampoo, there is much relief. What about your recommendation in that post about frequent soaks…do you mean something like applying a damp towel to the scalp? And could there be any relation between Minoxidil generated redness and sebum production? I don’t use Finasteride, so stopping Minoxidil is difficult for me though I am thinking of going in for reduced strength if this redness aggravates. Pls advise Dr. Rassman.

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If you have lost the recently transplanted hair from the FUE, this is normal. The hair that remains may continue to grow. At 5 weeks, I would have expected that all of the crusts would be off. In my practice I get the crusts off in a week or less (often in the first few days with good washing daily). You should take them off in the shower with baby shampoo by gently rubbing them with your fingers.

Redness around a graft may be a sign of infection (folliculitis), so be sure to see your doctor relatively quickly as these may cause permanent loss of the transplanted follicle. Sometimes when crusts stay behind, bacteria will invade through the crusts into the skin and cause local inflamation. Soaks with a damp wash cloth placed on your head prior to shampoo will work for removing the crusts. Minoxidil is an irritant and it may cause increased sebum as your body responds to irritation. I can not advise you on Minoxidil and how to take it. Focus upon the red spots and the scabs that need to come off. That might solve all of the problems. If I were you, I would speak directly to your doctor about these problems and pay him a visit if it is possible, sooner rather than later.