Posts

Posted on

Does Blow-Drying Accelerate Hair Loss? – Hair Loss Information – Balding Blog

Dr. Rassman,
Does blow-drying your hair accelerate hair loss? If so, is it worse if you use a brush attachment? Can you blow-dry transplanted hair?
If the plan is to transplant, say, 1200 follicles, how does the patient know that many were actually transplanted? Thanks, Doctor.

Block Quote

Blow drying does not accelerate the hair loss, but as the hair becomes miniaturized, the hair is more fragile and if one pulls too much or handles the hair roughly, then the hair may break off, giving the illusion that the hair loss is accelerating.

I really do not believe that you need to worry about the number of grafts you are paying for in our office. My finance office reconciles the patient accounting daily and routinely refunds money to patients who did not receive the targeted number of grafts. One of my patients, a well known actor, paid for 2500 grafts at my personal rate of $10/graft. When the accounting was finalized that day, he only got 1400 grafts, so we sent him a refund check for $11,000. After he got the check, he called me and argued with me, telling me that he did not care about the money and that I should keep the money. I refused to do so, saying that if he did not care about the money, he should give it to a charity, but that I had not earned it, so it was not mine to keep. He did make a donation of $11,000 to his favorite charity with my name on the donation. Integrity is either in a person or it is not and I was raised to believe that you can often tell the integrity of a man by his business dealings.

Posted on

Hair Loss InformationRemoving Scalp Tattoo – Hair Loss Information – Balding Blog

I have tried hair systems, weaves and all of these newest innovations in this field. Then I started getting transplants in 1987, with 5 scalp reductions and 7 hair transplant procedures. The more I did, the worse I looked. So I came up with the idea that I could tattoo my scalp and make it look like hair by putting brown dots the color of my dark hair. I then shaved my head. The tattoos were done on my scars as well. For a while they looked OK, but then the brown color started to turn green. Now I have a green head. Do you have a solution for this? Can the tattoo color be returned or can they just be removed? What would you suggest?

Block Quote

I have seen problems like this in the past. Creative people come up with creative answers to problems, but when the solutions fail, the consequences are sometime profound. I have had two such patients: The first had terrible scars that were treated with a balloon insert to stretch the normal scalp so that the tattooed scalp could be removed. The balloon was in inflated 2-3 times each week for 10 weeks before the scar was removed. It worked nicely and he was fortunate to have enough normal scalp to stretch the excised scalp defect. The second patient went through the same thing you did. He did not have a great deal of hair left, but he did have enough to start to cover some of the most prominent balding areas . The bad scars were improved with some scar surgery and the transplants did help. This second patient and his girlfriend were very grateful for the improvement and remain amongst the most happy of my patients. It was an important lesson for me – that working through problems with the patient as a partner with realistic goals, is the best way to make the best out of a bad situation.

Posted on

Scalp Psoriasis and Transplants – Hair Loss Information – Balding Blog

Does a history of scalp psoriasis (assuming it is under control with treatment) rule out using minoxidil or transplants to offset hair loss?

Block Quote

Psoriasis is an autoimmune disease that has a genetic preference in its victim selection. It comes in all degrees of activity. Simple dandruff may be a very low active state of psoriasis and as it becomes more severe, it takes on more of the characteristics of the disease state, where scaling of the skin and red areas in the affected area can become painful. Flaking of the skin can be easily seen when psoriasis affects the scalp. Baldness is also a genetic process but it is unrelated to psoriasis. Both processes can co-exist in the same person and both can be treated independently at the same time.

People with psoriasis often ask about transplanting the disease from one area of the scalp to another. Can, for example, skin taken from the area where psoriasis is active, move the disease to areas in the recipient area that are not showing signs of the disease? The answer here is no, as the disease seems to be localized in the area where the scaling exist and moving the hair from the scaling area does not impact the normal recipient area, assuming the recipient area is normal. Psoriasis can be aggravated in the area where the disease is active by any trauma and surgery is a trauma. Some people who tend to pick at their skin and hair can develop traction alopecia (hair loss) if they persist on picking over a prolonged period of time.

I generally tell my patients to use a topical treatment (steroids) on any active area of psoriasis prior to a hair transplant so that the scaling that occurs will be less bothersome during the transplant process. I try to get good control of any scalp psoriasis prior to a hair transplant.

With regard to minoxidil, if this medication does not produce skin side-effects, then one can use it with psoriasis. If side effects should appear or the psoriasis should become worse with minoxidil, then the medication may not be a good choice.

Posted on

Photos – Day After Hair Transplants – Hair Loss Information – Balding Blog

I have thin hair in front. I am in the public eye and can not take off more than a day or two. What will I look like after a hair transplant?

Block Quote

To answer your question, I took some pictures of a person who is 50, who had a hair transplant (1,046 grafts) and came in for a hair wash by us the next day. He has enough hair to cover the transplants. Good washing will guarantee, as much as possible, that any scabbing is removed. With the use of medications, we can keep swelling on most people to undetectable levels. He can go out in public the day after surgery without any real detection.

The photo on the left was taken before his procedure — the photo in the middle and the photo on the right are 1 day after.





Update: Oops, I originally posted the wrong patient photos with this entry. I apologize for the confusion. The correct photos are what you see above.

Posted on

Hair Loss InformationUsing Cover-Ups After Transplant – Hair Loss Information – Balding Blog

How soon after a transplant procedure can you resume using cover ups such as, Couvre or GLH, until your newly transplanted hair grows in?
Thank You!

Block Quote

The use of Couvre and other scalp coloring agents, which tend to be powdery, can be safely used after the scabbing is gone. Scabbing is gone as early as 1-2 days on the short side, and 5-9 days on the long side. The difference between the short and long side reflect two controllable variables and one non-controllable one. The controllable ones are (1) size of the wounds, the smaller the wounds the shorter the healing time, and (2) the washing technique used at the surgery, the end of the surgery and the next day or two after the surgery. Good aggressive washing gets rid of scabs (in many of our patients) in a day or two. We offer hair washes for all of our patients after the surgery and as often as they feel that they are helpful. Patients are rightfully afraid to be too aggressive with the wash, out of fear that the grafts will be washed out of their recipient site. The non-controllable variable is the patient’s individual and unique reaction to the surgery. Some patients tend to exude more ‘transudate’ from the wounds (the yellowish fluid that brings blood-coagulating elements will often form scabs) and some patients may have microscopic bleeding at the wound site after the surgery (forming clots). All of these scabs and clots can be washed off the next day with properly administered washing techniques.

After the scabs are gone, these powdery agents can be used until the new hair wipes out the need for them (usually 5-8 months after the surgery).

Posted on

Scalp Flap Experience – Hair Loss Information – Balding Blog

I am a patient of yours and I read a previous blog question and response from you the other day where you worked the problem out with the patient. I came to you 13 years ago with a problem that others could not help me with. After I explained the problem to you (which you listened carefully) I went into my solution. Although I prefer you not to use my name, you might want to tell your audience my story. I have been forever in your debt and grateful.

Block Quote

I remember you very well. You came to me after having done two flap procedures where sections of your scalp were moved from the back and sides of your head to cover the front (like a banana peel). This was an operation invented by a man from Argentina (Jury Flap) that was popular amongst certain surgeons in the late 1980s. This left the patient with an unnatural hair line, hair lying in the wrong direction and a hair line that (on my particular patient in question) was located far too high. You had gaps in many areas of your frontal hairline and there was no hair behind the flaps, leaving you bald in the mid-head. The donor area was depleted of substantial amounts of good movable hair so the supply was very limited and you lost much of your native neck hair as a result of the stress of the procedure.

I remember our first conversation and what you told me. You said (out of context): “I have been thinking about this problem for a few years now. I have met with doctor after doctor and when I finally figured out a way to manage the problem, none of the doctors who I visited would do what I asked them to do.” You went on to explain that your hair had a very strong wave and character to it (Italian hair of medium weight) and that if some hair was placed in front of these flaps, far in front of the flaps, then you could style your hair with a comb-back and a pompadour (like Elvis but much more subtle) and an angled combing style would hide your problem. You told me that you used gels and blow drying to achieve your looks; and you were convinced that this solution could solve your problem if I could find enough hair to transplant. After the first surgery (which was experimental on my part) and the ensuing 12 months it took for the hair to grow out to a good styling length, the results were fantastic. Your creative styling did wonders for the 600 grafts we put into your frontal hairline area. The good news was that we performed four surgeries over the 8 years we worked on you and you got enough hair to address, not only the frontal defects, but also the balding in your neck hair, which was a complication of the flap procedure. Today, you still must spend a few minutes every morning styling your hair, but even my eye can not pick out any defect on you- you looked great when last we met for dinner at one of your restaurants! Thanks for allowing me to share your experience.

Posted on

Hair Loss InformationHair Piece Blues – Hair Loss Information – Balding Blog

My earlier post about smelly hair systems generated a lot of good responses…

I loved yesterday’s question on the smelly hair system. It does not even compare to my problem. I have already found the secrets to keeping it from smelling decent, but that does not deal with the ladies when they want access to my head. I am working the internet dating scene and this problem is killing me. I find myself fearing the intimacy that I fantasize about. Now it is not fantasy, but a pending nightmare each and every time I start up a new relationship. If I do not wear the hair piece, I can not be myself. How does one deal with the no-touch zone that puts the fear of God into the rug wearer when a woman wants to run her fingers through the piece?

Block Quote

When a man embraces a woman, there is a tendency for the woman to want to run her fingers through her man’s hair. This is a deal breaker for hair system wearers and it puts them on-guard every time they establish a new relationship, often impacting behavoir as the wearer tenses up during intimate moments. I have spoken to many men and this is a common problem. The answer is that the rug wearer needs to keep one hand free at all times to fend off the roaming hands of the woman. It does put the kybosh on the freedoms one wants in real intimacy and it excludes such activities as bathing, swimming and the like. I have found that these problems are not addressed well in long term relationships either. I have done hair transplants on men whose wives have told me that they have never seen their husband without his wig on, not even after 30 years of marriage. I am afraid there is no real answer. Every hair system can be felt, even with the best of weaves. The only real answer to this question is a good hair transplant.

Posted on

Hair Loss InformationWhy Did I Create This Blog? – Hair Loss Information – Balding Blog

I was wondering why you are running this baldingblog.com site rather than participating in one or more of the many chat groups on the internet?

Block Quote

The chat groups have a scattered agenda. Many are using it as a magnet for doctor advertising, charging doctors a fee for participation and favoring those that participate. Some of these sites have a combination of content focused on hair loss and chat activities. These sites are frequented by many of the same people who dominate the chat agenda, so it is less focused upon subject content and more focused upon selling something. With the anonimity of the internet, you can not always be sure which of the posters are honestly trying to help and which are trying to line their own pockets. Some of these sites thrive on things that go wrong. In our practice, things rarely go wrong, so a site that focused on the exceptions rather than the rule, gives a false impression of the process to the new inquirer who wants to learn about the reality of today’s modern hair transplant process. I have always liked to have free forums where new people can get answers without intimidation or salesmen hawking their every move. In my office, I started having open house events and hotel seminars 13 years ago with patient participation long before a hair transplant recipient ever came ‘out of the closet’ where he hid his hair transplants. We never used a salesmen anywhere in our business model. In those days, the ‘standard of care’ was the pluggy graft, so showing off a patient without plugs made our seminars and open house events very successful. Those who came, expected to see pluggy patients and what they saw were normal looking people where the hair transplant could not be seen. At these events, I always held an open forum, allowing interruptions as the audience fell into the tempo of the subject material and conversations. It was the audience that ran the ‘show’ not me. The BaldingBlog.com site allows the type of freedom that I have in our seminars and it put the agenda into the hands of the questioner. I am more a responsive participant as a content expert. I have had many emails that I do not put on the BaldingBlog because I am frequently responding to a follow-up question that may not have a public interest.

I have in the past experimented with participating in these chats, but many of the aggressive participants love to go after a doctor who is not paying his ‘right of way’ for immunity in the for-profit sites. Some of the comments have been tasteless. Hearsay comments dominate. If I go down in the mud with those that are hair obsessed or angry, I generally get frustrated. Arguing with an irrational person is akin to a Jerry Springer milieu rather than an educational and informative framework. The worst part of anonymous free speech is that some of these chat groups don’t care if any statement can’t be proved to be true. One can say that Dr. X is a murderer, a heartless transplant mutilator, a mercenary who is driven by the almighty dollar, and if there is no recourse to identify the person who sends out such comments, then you can not necessarily believe anything you read. I have seen people say that they have personally seen patients of Dr. X …. Or that they are a patient of Dr. X and certifies to the crime personally. Defending oneself from baseless attacks are pointless and a wasteful use of time. I would doubt that any of this audience would want to read the JerrySpringerBaldingBlog.

Posted on

Hair Loss InformationBody Hair Transplantation – Hair Loss Information – Balding Blog

In reply to my post titled Hirsute Men and Head Hair Loss, Duke writes…

That is fascinating but it prompts a few thoughts. Why not use body hair for transplant processes?

More research into the Red Indian genetic heritage us surely required.

And why does the balding gene only impact on the top of the head and not the sides.

Block Quote

This is a fun question. First, why the top of the head. Leonard Shlain’s book, “Sex, Time and Power: How Women’s Sexuality Shaped Human Evolution,” had an interesting insight into the cause of balding. He postulates that our tribal heritage arose when man lived amongst his peers constituting 100-150 people. When looking at that the hunters (the healthy and fit men) in the light of certain qualities, there was a distribution of 4 traits that would pencil out to an 8% rule. He believed as animals learned to be afraid of man, the 8% of the hunters who were bald did not frighten the animals because they did not have the typical framed face of a hairy man, so animals would not run from them. They fulfilled the role of the spotter in the hunting party. Likewise, 8% of men were color blind and could see the animals in the bush missed by normal color visioned men, 8% were left handed and they threw the spear from the left side of the hunting group and 8% were gay so that they would stay home with the women and become more involved in their activities yet retain the strength to protect them. Fathering of children, while the heterosexual man were away hunting, was therefore not a concern.

If you take the 100-150 tribe hypothesis into the Red Indian, it would be relatively easy to see that with a small band of Indians that moved over from the Alaskan Bridge and down the Canadian countryside (they initially migrated to what would become the western American territory) it is possible that selective extermination of a sub-set (based upon the balding trait for example) of Indians over some generations during hard times, might have wiped out that genetic characteristic. This hypothesis for the Red Indian has been made by some, but without the presence of a written language or other documentation of their history, such assumptions might be a dangerous precedence to be proposed by a hair transplant surgeon.

Now, regarding body hair transplantation:

Experimentation is presently occurring on the use of body hair in some transplant centers (they just do not call it experimentation). As body hair grows in singular numbers (not follicular units of more than 1 hair each as in scalp hair) and length is not as long, and the hair cycle is possibly much shorter and the sleep cycle much longer, the use of body hair for transplantation might leave much to be desired.

Posted on

When Will I Go Bald? – Hair Loss Information – Balding Blog

i am 20 yrs old,and my dad is bald,although he started losing his hair only when he was 37 yrs old,i just have the fear that i may also get bald like my dad,so far now,my hair is ok,just that i have some dandruff .is there any specific age that i wil start balding,or how can i keep my hair healthy and ever long lasting.is it mandatory that i may also lose hair as well as i grow old

Block Quote

Balding almost never hits men under 18, so I have set up a model for the balding process to give some insights into men on the balding process. If you imagine that we are born with different types of baby hair that changes as we get into our first year. Then it changes again through childhood and then again around puberty (11-13). I suspect that these changes are influenced heavily by the hormone DHT. The hair undergoes another change between 18-29 years old.

The changes are two fold. The first part of the process is the advancement of the frontal hairline into the mature position. The typical juvenile hairline of the 12 year old boy is no different than the hairline of the 12 year old girl, but as men (typically 95% of Caucasians) move into a mature pattern with the central area rising about ½ – 3/4th inch above the central crease and the sides move up about 1-1½ inches, giving a slightly receded corner. A small percentage of men (Bill Clinton and Ronald Reagan) keep their 12 year old hairlines through life. Many young men mistake the mature changes in the Caucasian hairline for balding. Such changes are normal, but for the soap actors who must retain their baby face, such changes are devastating, so on rare occasions I have restored this juvenile hairline on famous actors.

Secondly, the balding process may start anytime after this change starts (about 18 years old). Since real balding starts at about 18 years old (caused by the impact of DHT on the susceptible genes associated with genetic hair loss) the faster the fall out occurs, the worse the prognosis. There is some protection against DHT that holds until 18, but when that protection is gone, the faster the fall out, the more is the indication that balding will be severe. On a visit to my office, I will put the hair of the patient on a TV, so that they can look at the hair shaft diameter variability. Normal (non-balding) hair has equal diameter while genetically impacted hair starts to become finer and finer, reducing the diameter to smaller and smaller sizes (miniaturization is the term that doctors use) until it becomes threadlike and just disappears. The drug Propecia blocks the impact of DHT on these impacted hairs, often slowing, stopping or reversing the process over time. The best way to change the course of this hair loss is to take Propecia which means that you must stay on the drug for life. Short of that medication, there is no effective proven medication or treatment. There is no doubt that the hair loss will still pick up again (even on the drug) but it will be a slower process.