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Wow…just wow…they really are making people believe this stuff can prevent hair loss and “help hair color retention”…

kronos.glow.com

I hope no one wastes money on this stuff.

I haven’t heard of Kronos, but with their “patent-pending t-sfere technology” how could you go wrong? The product looks to be another of the many volumizing shampoos on the market. Nothing special I can see, aside from the aforementioned “t-sfere”, whatever that is. My dictum, as to paraphrase your comments, is “let the buyer beware”!

I am having a hysterectomy July 31st and was instructed to stop taking my birth control pills which I did as of March. In the meantime, I ruptured both of my achilles tendons and had major surgery. I started losing my hair not too long after the surgery and thought the hair loss was due to the surgery. After reading some comments online, I realized that the hair loss is probably due to having stopped taking the pill. Now I’m concerned that with this major surgery and another coming up soon, I will continue to lose more and more hair. Is there anything I can do to stop the hair loss? I am terrified of going bald!

I doubt that you will become bald. Reactive hair loss after a major surgery is often cyclical and often will return if you are one of the unlucky people to experience. There is no way to prevent this in those that have experienced it in the past.

I saw two patients recently that are worthy of discussion here…

Patient #1:
He had a typical result from the hair transplant surgeries of the 70s, 80s and early 90s. He had hair transplant plugs in the early 90s which gave him a doll-like hairline in the frontal area. I have worked with him over a 10 year period with four surgeries to remove and thin out the 3 inch wide plugs, redistributing the hair from the plugs to other adjacent areas in an attempt to make them less detectable. He is about 80% closer to his goal over what he had when he first came to see me and now wears a crew cut, but he is still frustrated over the remaining plugs which still bother him when he looks into the mirror every morning. I will continue to work with him, thinning out more plugs until he is satisfied that he looks normal. He shared what it has been like over the past many years, as too much of his life focus revolved around his head and his freaky pluggy look. Fortunately he and I put together a Master Plan 10 years ago to get him back to a normal appearance, and even now, after a decade of my working on him, the process will continue.

Patient #2:
This man has a far worse story. This young man (in his 30s) has had hair transplant work by many doctors over 10 years. Unlike patient #1, he never had a Master Plan and always sought out the best doctor who promised him a quick fix and he believed what the doctors told him. In the midst of the process, he even had a brow lift to raise a hairline that was too low, leaving him scarred in the hairline area. A series of transplants to fix the hair loss from the brow lift in the frontal area failed, compounding the problem further. The donor strips that were taken in the back of his head were all taken in different areas of the scalp and they all stretched and widened substantially. It seemed that the doctors just kept on removing donor hair from different areas to avoid the wide scars previous doctors created.

This man paid tens of thousands of dollars and each successive surgery seemed to leave him worse off. The recent transplants apparently did not work and he asked me if there was something wrong with his skin and recipient areas. I asked him if he called the doctors who did the failed procedures and he said he did call them over and over again, but they never returned his calls. Now he is massively scarred in the back of his head with at least three wide scars each measuring over 1/2+ inch in width. He received body hair transplants into the scar, but the difference was marginal. Each “fix” addressed one problem in isolation of the other problems, resulting (at times) with him being left worse off in the total scheme of things. I don’t know what he will do, but I suggested that he consider working with just one doctor, and building a Master Plan to deal with his problems. One option might be balloon expansion of his scalp to remove the scars in the back of his head by stretching the normal scalp in the crown of his head. The use of balloons to stretch the scalp will take at least 8 weeks of constant inflation of the balloon. If he wanted us to do it in California, he would either have to move to California for the period that the balloon expansion was being done or find a local doctor willing to do the incremental expansion of the balloon in his home town. We have done similar patients with outstanding results, but the commitment of time is substantial. What I gave him was a Master Plan to get him back to a manageable state. Anything short of such a radical approach will just victimized him again and again by some of the doctors who see $$$ in each successive procedure that they can offer him. Too much of his life is being centered around his scalp and the various poor choices he made.

Conclusion:
I often end with the statement: “Let the Buyer Beware,” which is so appropriate in this situation. Doctors are not immune to being scummy. I unfortunately see horror stories like this almost every week, and I post these as a way to educate you (the consumer) so that you can make informed decisions and avoid being taken advantage of.

How do I end a post like this positively? Well, today’s hair transplants in the hands of good and honest doctors are spectacular. At last night’s Open House event in our LA office, Steve Hartman (CBS Sports announcer and radio show host) who is himself a hair transplant patient, told me that not only was his procedure undetectable, but that he and many of the patients who were there looked like they never lost a hair on their head. Those horror stories I wrote about above rarely happen today. There are rotten applies in every barrel, but there are many really great doctors also in that barrel. You just have to do your research before you jump.

Dear Dr. Rassman,

First I would like to take this opportunity to thank you for this great website.

I have two questions and i would be very greatful if you can answer them :

1. I had an FUE procedure done on the front area (frontal hair line)with approx. 1200 grafts before three months ago, the strange thing that i am experiancing is some hair loss in the area behind, which is in the mid-scalp area, is this shock loss? shedding period? or the normal genetic hair loss pattern? and how can i tell the difference between them?

2. If your answer to question no.1 is shock loss then can you tell me what is the solution for it? and is there any chance of hair regrowth for those that were lost? (By the way i have used propecia for 12 months before a few years ago but with no success and i experianced terrible testical pain)

Thank you and Best Regards.

If you were not on finasteride when you had your FUE procedure, it would almost be certain that you had shock loss. You should have worked this through with your doctor prior to having the surgery. I always assess the status of the hair behind the transplant recipient site and if it showed significant miniaturization, one could have predicted this outcome. I would need to see you and understand what the loss area shows now.

I would also have considered lower doses of finasteride, which may have allowed you to use the drug without the complication. One quarter of a pill finasteride (0.25mg) can be effective at minimizing hair loss from shock.

Doctor, you mentioned in one of your recent posts that you supply one bottle of Progaine Shampoo to your patients after the surgery. I use Progaine a lot but can only find the Progaine Volumizing Shampoo available. The other Progaine products do not seem to be available at this time over the internet or in stores. Do you know why only one Progaine product is available at this time? When would the other products under the brand name be available again? If you could provide any information, it would be appreciated very much!

Progaine is just a volumizing shampoo like any other volumizing shampoo. It does not grow hair. There were other formulations, but I believe they’ve been discontinued. I just did a quick search online and you’re right –only the volumizing shampoo seems to still be for sale.

But… um… I must’ve had a temporary memory lapse when I said that Progaine was what I give to patients after their hair transplant surgery. I used to provide Progaine, but for years now I’ve provided GraftCyte shampoo (which contains copper peptide to promote better healing). You can find more info about that here. Sorry for the confusion!

Dear Doc,

I have heard of body hair transplants and read that they are not a reliable form of surgery due to the body hairs being weakened during extraction. However, because the body hairs are being removed with a hole punch type of instrument that may damage them, could significantly better results be attained if the body hair grafts were removed via a strip method? Let’s say the patient did not mind have a scar on their thigh as long as the strip provided enough grafts for his needs. In my case, I am thinning in the crown and anticipate that I will require far more grafts than my donor supply. Thanks

Body hair transplantation is not a gold standard method to transplant hair to the scalp, because body hair looks and behaves different than scalp hair. Damage isn’t the problem — hair growth cycles are. Only about 50% of the body hair is in growth stage at any one time, so the hair-for-hair yield is 50% rather than 90% plus as with the scalp donor hair. In other words, you won’t see most of the hair at the same time… and the hair that you do see will look different from actual scalp hair. Body hair does not grow long and has a different texture than scalp hair. To directly answer your question, yes you may find a doctor willing to do it, but the above material is presented to try to get you to think through that decision.

Dear Dr. Rassman. What does it take to be a good hair transplant surgeon, besides a medical diploma?

I could write a book on this subject (and actually, I did write two books). Simply put, the characteristics of a good doctor will always put the patient’s interests above his own and works relentlessly for the welfare of his patients without regard to money or time. The good transplant doctor will have an artistic skill as it applies to the field of hair restoration.

Hey doc, an experiment: i marked a section of my arm and shaved the hair with a razor after i repeated this a couple of times i noticed that the hair in each follicle multiplied. After a while all of the follicles multiplied hair counts. Why is this happening and why cant it be implied on the scalp?

I have trouble believing this. If you believe its true let me know the results when you try this on your scalp. If you shave your scalp, I doubt you will get more hair growing. Is this your goal?

I know this will just sound like a plug for my new book, Hair Loss and Replacement for Dummies, but I haven’t mentioned it nearly as much as I should. There’s a reason for this post aside from the obvious — renowned hair transplant surgeon Dr Richard Shiell, author of many article and classic books in the field has written his review, which I’ve posted below. It serves as a good overview of what you can expect from the book, which I might add is sold online for under $12 at Amazon.com, and makes a great gift for those that are essentially looking for a handy, printed version of BaldingBlog.

P.S. It’s now also available on your Kindle e-book reader (and iPhone), in case you’ve given up on printed books!

Dr. Shiell’s review starts here:

—

Apart from the textbooks, written for professional, there have been many books on hair loss and replacement written for members of the public. I have read at least a dozen of these over the past 30 years and they are all quite informative and, for their time of publication, reasonably accurate and helpful.

Hair Loss & Replacement is no exception in this but it is a considerable cut above the rest. Firstly it is very up-to-date and contains a vast amount of information all exceedingly well organized in 7 sections containing 18 chapters:

1. Getting to Know your Hair
2. The Root of Hair Loss
3. Creative Techniques for Concealing Hair Loss
4. Pharmaceutical, Laser and Topical Therapies
5. Advanced Hair Loss Solutions (60 pages about hair transplantation)
6. The Part of Tens (10 myths about hair loss, pros and cons for wigs, hair treatments and transplants)
7. Appendices- this include a Glossary of scientific terms used in the book. In addition the reader is provided with the addresses of all the well known hair-loss websites and support organizations and many more. There is also an outstanding Index running to 16 pages.

Throughout the book important points to remember are clearly marked with an icon in the margin, as are tips and warnings. The reader is even alerted by another icon to technical paragraphs that he can safely skip without losing the thread of the chapter.

Now a warning. Although this book is designed for those with little prior knowledge about hair, it is certainly not recommended for “dummies”. It is a very well written and technical book, authored by two of the acknowledged “gurus” of our field, Bill Rassman and Bob Bernstein, The previous scientific writings of these two men are already at the top of any reading list on hair replacement surgery. Far from being a text for the “everyman” the book would be an ideal primer for any doctor wanting to know more about hair loss and its replacement, before committing many months to a specialized training course in hair replacement surgery.

Every aspect of hair growth, hair loss and hair replacement is covered concisely in this book in reasonably simple language and I could find few faults within the text. Perhaps even then, they were just minor differences of opinion between experts, rather than faults.

There is no attempt to “talk down” to the lay reader and in fact the only concession to the layman is that each of the 18 chapters is fairly well self-contained and if he only wants to know about, diseases that cause hair loss, hair transplantation or hairpieces, then he can be well informed in a self-contained section.

Summary
This is a really outstanding book for the beginner who has a considerable degree of education but no place for a true “dummy” to be browsing. Perhaps someone will do a 50-page comic-book version for these individuals who, judging by popular book sales and TV ratings, make up a considerable proportion of our population.

–
Reviewed by Dr Richard C. Shiell, M.B., B.S., Melbourne, Australia

Hi Dr Rasman - many thanks for the very appreciated blog.

2 years ago I underwent an aggressive hairline FUE procedure - 3,000 grafts all in the hairline with temple closure.

I’ve recently started shaving my head and, despite the white-dotted donor area, I feel much better about myself. I’d love to continue shaving my head - the problem is the recipient area. My recipient hairs, though not particularly dense, are much thicker than the natural hair behind them and begin with a very sudden, ‘flat’ line. The texture of the skin is bumpy and *may* form a small ridge at the start of the hairline; it’s difficult to tell whether it’s scarring, or just hair follicles pushing up the skin.

If I were to remove the grafts, is there any hope of restoring a natural-looking, albeit bald area where my current transplanted hairline is? If so, what sort of treatments would you suggest?

Thanks again for the site

Oh wow! 3000 grafts to the hairline and temples does sound very aggressive, if not impossible from my personal experience. The bumpy skin texture you describe can be scarring from your surgery and if it is scarring there really is no treatment for it. I am not implying you had a bad surgery, but hair transplant surgery is not reversible. Hair transplant surgery is permanent and you need to have a good foundation and understanding of what you are getting yourself into, as well as the long term complication and issues (such as scarring and shaving) before you regret the decision.

There are doctors who do 3000 grafts routinely in a small area of the frontal line and I have seen the work. The hairlines I have seen are straight and many times I doubt that the patient actually got the 3000 grafts they paid for, which makes me question the integrity of the doctor. These hairlines can be repaired by creating a good transition zone in front of the harsh tight hairline, but that assumes that the hairline was not placed too low in the first place. Often in some of these patients the hairline is too low, making a good repair very difficult. Each case is different and I would love to see you either in consultation or good digital photographs of your frontal hairline.