We’re taking a few days off for the New Year holiday.
2015 marks the 10th year of Baldingblog with over 12,363 posts to date!
A special thanks goes out to all readers of this site with never ending hair loss questions.
We’ll be back in 2015!!!
Balding Blog – 2013 – Hair Loss Information
We’re off today and tomorrow, but we’ll be back on Thursday.
Balding Blog – 2012 – Hair Loss Information
We’re off today and tomorrow, but we’ll be back on Wednesday.
Balding Blog – 2011 – Hair Loss Information
I’m very seriously considering starting a course of propecia/proscar. But before I began I wanted to ask two questions.
1. It has been said that if you start propecia early the better chance you have of slowing down/halting hair loss, but that doesn’t tally with the propecia chart from studies which show that it generally peters out after 3 years. so surely you’d only save your hair for 3 years and then it would quickly regress, not making much difference how early you start because you only have 3 years of good hair.
2. I was wondering if you could recommend a good dermatologist/hair doctor in London, who I could have a consulation with before I begin taking proscar, do you know any who do miniturisation tests or some kind of form of monitoring on hair loss? There are a lot of snake oil merchants in London that are willfully telling you that you must get on medication and I just want to talk to who is honest and experienced.
I have many patients that have reversed their crown loss and held the reversal over 10 years. Everyone is different, but the official studies show that the expected maintenance should be about 5 years on average. That means that some men get better than 5 years and some worse results while on the drug. It depends upon how aggressive your genes are.
As to your second question about London-based doctors, Dr. Bessam Farjo is a contributor to this site. He and his wife are terrific doctors and worthy of a trip to their offices (in London and Manchester). They may be able to give you a referral if you call their office.
2011 ISHRS Meeting Review, Part 8 – Minoxidil
Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.
This is part 8… and final part. Thanks for sticking with me on this!
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Minoxidil as a systemic medication?
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Dr. Damkerng Pathomvanich (award winning doctor from Thailand) experimented with the use of minoxidil as a systemic medication on patients. This medication is used in many Asian countries as a treatment for hair loss. He commented that when spironolactone is added to systemic use of minoxidil, there is an enhancement of the hair benefits and a reversal of hair loss in many people. Although the reported side effects of this approach were small, there are still many side effects with these medications (e.g. significant drops in blood pressure, weight gain, fluid retention, rapid heart rate).
These systemic medications are not FDA approved in the United States for the treatment of hair loss, as well as many other countries. Minoxidil was originally used in the 1960s as a treatment drug for high blood pressure, but its impact was not consistent with lowering blood pressure. Many of these earlier patients developed a reversal of their hair loss and many women treated with it developed facial and chest hair.
Aspirin and hair transplantation?
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A hair transplant surgeon who is also a cardiologist suggested that a person on low dose aspirin can have a hair transplant without stopping the aspirin.
2011 ISHRS Meeting Review, Part 7 – FUE Robot
Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.
This is part 7. More to come…
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Robot assisted hair transplantation was introduced for sale at the meeting.
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It had been approved by the FDA earlier this year. There was considerable excitement generated by doctors, however, the high price tag ($200,000 plus $1/graft) certainly dampened the enthusiasm. This meeting was a come out party for Restoration Robotics’ hair restoration robot, a very impressive modern technology. The company believes that hair transplants will follow other minimally invasive and more precise surgeries such at the robot assisted surgery for the prostate, the heart, the uterus, the lung, and on and on. The hair transplant robot is called Artas® system, and will clearly standardize the quality of FUE grafts and minimize the damage when used by surgeons who are not as skilled in the manual techniques as some of the more experienced surgeons; however, all three of the first surgeons to buy the robot are experienced in the field of FUE. Restoration Robotics wants only the best surgeons to purchase and use the system.
One experienced hair surgeon, Dr. James Harris, has been testing the robot for some time for the company. Dr. Harris invented and marketed the most popular FUE harvesting tool (The SAFE System), which has been installed in over 200 hair transplant practices around the world. Although the two technique are comparable, Dr. Harris felt that the robot will minimize the tedium of doing the procedure for the doctor. I totally agree with him and I firmly believe that the new technologies like the robot will become the way of the future as FUE gains market share. The only question yet to be answered is “Who will pay for the higher costs of this procedure?“. As many of today’s hair transplant surgeons do not offer FUE, this opens the appeal for doctors to buy into the FUE technology to expand their service offerings. The unit is expensive, but should pay for itself easily in 4-7 years.
The Artas® system will generate more interest in FUE and many newcomers in the field will start to offer manual FUE at discounted prices to kick-start their business. All FUE techniques and surgeons are not equal and new doctors without extensive experience are bound to create significant transection of FUE harvested grafts causing more than their fair share of hair transplant failures. Unfortunately, the average prospective patient who does not do their research may fall trap into the pricing competition. The results will be (1) high transection rates with graft kill, (2) failure or the hair transplant to grow in significant quantities, and (3) large scale destruction of the donor area hair (something that is never reversible). This, as I have said before, is a buyer beware business for the potential FUE candidates looking for a bargain.
2011 ISHRS Meeting Review, Part 6 – Finasteride
Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.
This is part 6. More to come…
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Does finasteride induce mood and other psychiatric changes?
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A case report and literature review showed a connection between finasteride and mood changes. In one case presented, a patient suffered from severe disabling mood changes on finasteride, which ceased within a week after stopping the medication. After a short time period he restarted finasteride, and the mood changes returned within a few days. Other cases were reviewed with similar problems. There is little doubt that in some patients, mood changes and other psychiatric problems appeared with the use of finasteride.
I believe that these case reports are the exception to what we commonly see and that finasteride is generally safe, but if a patient feels that they have changes in their personality or mood since the drug was started or if a family member sees changes in their mental state, they should meet with their doctor to discuss the appropriateness of their continued use of the drug.
2011 ISHRS Meeting Review, Part 5 – Finasteride
Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.
This is part 5. More to come…
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Does finasteride (Propecia) impact the body’s inflammation response in hair loss?
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Dr. Marty Sawaya produced evidence that there is a connection between genetic hair loss and inflammation of the hair follicle. She believes that DHT may have a direct impact on the inflammatory process. With this insight, other potential treatments for genetic hair loss and other hair and skin disease may evolve.
Are finasteride’s sexual side effects overstated?
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Despite internet complaints to the contrary, there are no case reports of sexual dysfunction that remained after finasteride was stopped in those patients who reported sexual side effects. The medical literature shows that sexual dysfunction is present in 40+ percent of men over age 50, so it was difficult to assess the 2% occurrence of sexual side effects in a comparable population. Despite this, changes in warning labels have been mandated in the United Kingdom, Sweden and most recently the US.
One joke on the floor I overheard was that based upon the internet reports, the average 50 year old had a better than 40% risk of sexual side effects, but that reduced to only 2% for those reporting side effects from Propecia, making Propecia less risky for those side effects.
2011 ISHRS Meeting Review, Part 4 – Surgical Techniques
Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.
This is part 4. More to come…
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Which is better: FUE or FUT (strip)?
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I (Dr. Rassman) moderated a panel of 6 doctors to debate the merits of follicular unit extraction (FUE) over the more traditional strip harvesting transplant procedure (FUT). I started the sessions showing a case of what I called “follicular holocaust”. It was a case of 6840 FUE grafts performed over two sessions. I showed that the failure was not only on the growth of the grafts, but also on the destruction of the donor area. In all recipient sites and donor sites, there was a loss of 26,000 hairs and a massive failure of the FUE procedure.
The debate followed this foreboding case study with the following insights:
- FUE is gaining popularity and seems to be demanded more and more by prospective patients. The graphs showed that the number of FUE procedures will surpass the number of FUT procedures in the next few years.
- FUE is safe in the hands of good doctors. The group all agreed on this because they were amongst the best doctors offering FUE. My only comment is that I can’t imagine any doctor putting themselves in the “bad doctor” category as shown in my presentation of “follicular holocaust”.
- FUE graft damage is being reduced with building experience resulting in better growth.
- Dr. Bradley Wolf demonstrated a patient who had 1000 grafts on each side of his head (total 2000 grafts) after 7 months of growth. The two sides seemed to be about equal. The patient reported no significant pain with either procedure (done one day apart) and the scars in both sides healed with minimal scarring.
- Dr. Suddleson argued that FUT supplied as many grafts as are needed, while FUE was more limiting in a single session. He argued that many of the advocates of FUE routinely offered FUT to their patients and that the FUT was the gold standard by which FUE would be compared. He generated a laugh when he pointed out that at least one doctor promoting FUE on the panel had reported his excellent results on the FUT strip based procedures.
FUE and ethnicity
- I’m often asked if there a difference in FUE patient candidates based upon ethnicity. This question was raised and answered by a doctor from India who showed that there are clear differences in the Indian population based upon skin types and some geographical areas of India where the skin is much thicker than others with thinner skin. He believes that these differences clearly can impact the difficulties of FUE and the results of transplanted graft growth.
Also of note — it seems that the incidence of balding in the Indian population of India is much higher (62%) in men between the ages of 21-61 years old, than in the Caucasian population from comparable studies done in other countries. The use of finasteride was found to be in the 1% range for these men, while the use of various snake oils seemed to dominate the treatments of many Indian men.
I’ve got much more to post, so check back next week for topics on finasteride, the Artas® FUE robot system, and minoxidil.
2011 ISHRS Meeting Review, Part 2 – Female Hair Loss
Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.
This is part 2. More to come…
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What is the role of immunity in the development of androgenic alopecia in women?
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In men and women, it was suggested that there is an immune response in genetic hair loss that could either trigger the process or be an early sign that hair loss is about to start. Dr. Neil Sadick of New York has been following female hair loss for years. He showed his results from scalp biopsies of the scalp in women with hair loss. What he saw were findings that were similar to the conditions found in diseases like lupus (an autoimmune disease). He believes that female pattern hair loss is attributable to immune driven inflammation and he believes that this interferes with hair stem cell activity as they enter into the growth phase of the hair cycle.
The earliest symptoms of many women and some men start with pain and itching of the scalp, a set of symptoms that reflect the inflammatory response that he believes is always present, but often ignored. He raises the issue that if the connection is correct, the scalp may respond to the use of steroids in the earliest phases of the hair loss process.
Double trichophytic closures
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Double trichophytic closures were demonstrated in a poster presentation, suggesting that this procedure can “wipe out” scars from FUE in 99% of patients. I personally doubt this claim. This reflects first time surgery patients only, as these patients are at a lower risk for significant scarring.