Monthly Archive for April 2010
April 2 2010, 3:33 pm PT | Posted in: FUE + Hair Transplantation + Training
I’ve been thinking about the case I wrote about last week — “How Many FUE Grafts Actually Grew?” — about how a patient (we’ll call him Mr. Smith) came to NHI after feeling royally screwed over by another clinic he went to for his follicular unit extraction (FUE) procedure. It’s quite an interesting case of being scammed by a doctor that advertised super low prices, so I really suggest you read it if you have the time. Even so, I want to talk a little about value in surgery…
If you run the numbers, you will see that the actual growth of hair was only 25% of what he got transplanted. There were two consequences of this:
- Of great importance is the loss of your finite (limited) supply of donor hair. In the case of Mr. Smith, his surgeon killed 3 out of 4 hairs that were transplanted. These hairs are forever lost to the patient. I also believe that there was damage produced to the donor area, evident by a thin see-through appearance. His donor supply is significantly worse off following his FUE procedure than if a scar formed from a strip surgery, which could have been easily hidden by surrounding hairs. FUE is not always the answer to harvesting hair without post-surgical consequences, as seen in Mr Smith’s case.
- Of lesser importance, the cost per graft was multiple times higher than what the patient thought. Let’s assume that Mr. Smith paid $5/graft. When measured against growth, his actual costs were $15/graft for the work that was done. The rate he paid had nothing to do with the value he actually received (in his end result), as he really was paying more for less. That’s quite a bit of money out of his pocket.
The lesson here is that experience in a hair transplant surgeon and his team is directly related to the actual costs when measured by the yield of what actually grew from the hair transplant. My advice to prospective patients is to change the way you look at value! In our practice, we allow prospective patients to meet our patients to see what type of results they got. As these Open House events are open to all patients (or future patients), anyone with results like shown in Mr. Smith’s example will be as evident as the nose on your face. This will help you in the education and selection process. This type of surgery is forever, and unfortunately some patients have to learn the hard way when they try to pinch pennies by going to a surgeon that has no business messing with your hair.
April 2 2010, 2:34 pm PT | Posted in: Other Surgical Procedures
Again in the news this week has been the transplantation of a windpipe to a young boy from a donor. The have taken stem cells from the bone marrow of the child and coated it onto the windpipe. It is hoped that this will prevent the need for anti rejection drugs. Do you think it could be possible to try someting like this with donor hair follicle if they were coated with the recipients stem cells?
Stem cells give new windpipe to boy
We all want the future technologies to happen right now. This type of procedure is experimental (possibly the first of its kind?), and if this technology can be applied to hair, it would still be years away. This is interesting stuff though, and I do appreciate you sending the link.
I’m guessing the bone marrow stem cells were used here because if there are problems with the recovery there is still the option of using anti-rejection medications. A lifesaving procedure (windpipe transplant) is worth trying experimental technologies on, as health risks from anti-rejection medication make them not worth using in a cosmetic procedure (hair transplant).
April 2 2010, 12:33 pm PT | Posted in: Hair Transplantation + Scarring
I’ve always wondered why photos of hair transplant procedures never include a section of the donor area (elapsed over healing period)? I considered the transplant option years ago but I became very uneasy about scarring at the donor area. I have not seen one photo regarding this part of the procedure at any of the more reputable transplant provider sites. Why? Thank you for your insight.
It’s true that we do not routinely take scar photos, but we have posted photos of scars in the past:
Typically, donor scar will vary in each individual. It can be fine as a pencil-line or thick like the width of your picky finger (rare). Most scars are about 2 to 3mm in width. If you ever had a cut that needed stitches, you can use that as a baseline comparison. Some people are bad healers, some doctors use scar-minimizing closure techniques… so there are factors that can make scarring more or less severe.
April 2 2010, 10:33 am PT | Posted in: Drugs
I am just following up on a recent post I read on your Blog - I am 44. I have been on Propecia for almost 4 years - starting off as a Norwood 2.5, I have probably progressed to a Norwood 3 over this time. My hairfall seems to be less than a few years back, so I am not going to risk getting off Propeica - it is probably doing some good.
My question however is about the impact on body hair - I have probably seen a 30-50% reduction in body hair over the 4 year period. Is this likely to be related to Propecia, or is their some other factor. (FYI I am a regular smoker and accept that this may be impacting the benefits of Propecia)
It very likely could be the Propecia is causing your reduction in body hair. People have reported body hair loss with Propecia, and one rare occasions I have heard it go the other way. I wish I’d experienced the loss of body hair when I was taking the medication, but I wasn’t that lucky. I’d expect most patients would prefer to have this side effect, particularly those with excessive hair in undesirable areas (back, shoulders).
April 2 2010, 8:35 am PT | Posted in: Other
In non-hair-loss news, a new study on dietary fats shows what has been suspected for decades.
Snippet from the article:
Although for nearly 60 years people have been urged to decrease their consumption of saturated fats to prevent heart disease, until now there has been surprisingly little scientific evidence that doing so actually decreased the risk of coronary heart disease events. A new study by researchers at Harvard School of Public Health (HSPH) provides the first conclusive evidence from randomized clinical trials that people who replace saturated fat in their diet with polyunsaturated fat reduce their risk of coronary heart disease by 19%, compared with control groups of people who do not.
Read the full article — Replacing Saturated Fat With Polyunsaturated Fat May Cut Heart Disease Risk
Our younger readers think that their body is a castle capable of standing up against all diseases, so there is often little consideration for preventive diets that will preserve lifestyle. This reference just points out how simple a preventive diet can be. For further reading on the various fats, see Mayo Clinic.
April 1 2010, 3:31 pm PT | Posted in: Drugs
Hey Dr Rassman
First of all I would just like to recognize all the the individuals who help make this site what it is. Its great. I love it! To be honest it distracts me at school a lot. I keep saying to myself, okay read one more post and thats it! But now for the serious part. I’m just wondering about the progress which is being made in the development of new drugs for male pattern baldness. I know you are probably getting sick of these questions, but are companies researching the working mechanisms of the approved drugs minoxidil and finasteride and building off what they already know?
Also, who is the youngest person that you have performed surgery on, not including young children with burns, but with male pattern balding and if so what do these results look like? I am also pleased to say that I will be scheduling a visit with you in May to meet with you….. I’m very excited as I am from Canada and have never been to LA before. I hope it lives up to the hype!
I don’t know much about new drugs in the drug pipeline of the pharmaceutical companies, but as I do find out anything I try to post it on this site quickly. Sometimes I get emails from people alerting me to medications in the pipeline that I hadn’t heard of before. Contrary to popular belief, I’m not a drug insider that knows timelines on when medications are coming to market. Treating hair loss is a billion dollar business, so while I don’t know this to be 100% the case, it would make sense that some drug companies are working on the next possible medication to regrow hair.
In the treatment of male pattern baldness, I made a mistake once by taking on a 17 year old patient with strictly frontal balding. He had a very fast moving hair loss progression and eventually went on to a Norwood class 7 pattern. This was around 1993, years before Propecia was on the market and it was early in my hair career. Today, I generally wait for:
- Advanced pattern progression that does not respond to Propecia
- Ages of 22 or higher
- Adequate or high densities of the donor hair
- Maturity… and many other characteristics tied to hair and skin color, hair density, coarseness of the hair, character of the hair, and family history
I look forward to meeting with you. Los Angeles is a great city and I am sure you will enjoy it if you gave yourself enough time for touring.
April 1 2010, 2:33 pm PT | Posted in: Drugs
A recent publication in the New England Journal of Medicine shows that Avodart (dutasteride) reduces the risk of prostate cancer along the same lines as finasteride did in earlier studies. The study also shows that in those men on Avodart, there was an increased incidence of heart failure.
Here’s a snippet from the Associated Press article:
Full results of a big study testing a drug for preventing prostate cancer show a higher risk of heart failure, a surprise finding that could dampen enthusiasm for expanding its use.
On Monday, GlaxoSmithKline PLC asked the federal Food and Drug Administration to approve its drug Avodart as a cancer preventive for men at higher-than-normal risk of the disease. The drug is already sold for urinary problems, and no heart failure risks have been seen with that use, doctors say.
Results of a study testing it as a cancer preventive were given at a medical conference last year, but the heart risk information had not been analyzed at that time so only the main results of the study were presented, a Glaxo spokeswoman said. Full results are being published in Thursday’s New England Journal of Medicine.
The study involved 6,700 men with high scores from PSA blood tests but no sign of cancer on biopsy. They were given Avodart or dummy pills and new biopsies four years later. Prostate cancer was found in 25 percent of those on dummy pills and 20 percent of those on Avodart.
Read the full article — Study finds possible heart risk with prostate drug
As the article does mention, the heart risk could be a fluke, but it is important to study this further. Just another reason why I can’t endorse dutasteride for users that wish to take it for treating hair loss.
April 1 2010, 12:35 pm PT | Posted in: Hair Loss Causes
I’ve been wearing a tight fitting beanie or toque as we call them here in Canada fairly regularly for about four months now. Often it will be all day, morning till night (so approx 12-14hrs). Quite frankly I just forget its on my head. I’d always had a full head of hair but have noticed some minor thinning at the hairline which I swear was not there some months ago before I started this beanie trend. I know you’ve spoken against hat or headgear wearing as a contributor to hair loss however some still suggest there may be a small correlation between the two.
I don’t believe excess dirt or sebum would contribute to hair loss but what about the notion of your hair/scalp needing oxygen? or vitamin D as produced by exposure to the sun? In regards to tight headgear, what about the idea of a decrease in circulation? Or a form of traction alopecia as the hair gets pushed or pulled in different directions for prolonged periods of time? Your insight would be appreciated.
Traction alopecia is certainly a possibility from wearing a beanie or anything tight on your scalp for extended periods of time. Problems with blood supply and oxygen levels aren’t going to cause hair loss, though they were once thought to be causes many years ago.
Hopefully, any vitamin D you’re not getting from sunlight is covered by your diet. It is my opinion that the hair does not have to get washed and sebum build-up will not impact hair growth, however, not washing your hair could cause your head to eventually stink.
April 1 2010, 10:33 am PT | Posted in: Hair Products
I understand that there are products in the market that can slow down the hair loss. What do you think about coconut oil, and also I have seen people using hair mask with Egg and yogurt and lemon?
Are these good for for scalp treatment and conditioning? thanks
Those all sound delicious, but they won’t slow down your hair loss.
Coconut oil is used as a hair conditioner (apparently this is common in India), and I read that the yogurt/egg combo is also used as a conditioner by some. I can’t vouch for how well they work as hair conditioners, as I just use a bottled brand.
April 1 2010, 8:34 am PT | Posted in: Hair Transplantation + Other
Hi Dr. Rassman. You’ve written that after miniaturization mapping you can do a good job predicting what balding pattern a person will likely develop. If I’ve already had a hair transplant a few years ago and have been on Propecia, and mapping wasn’t done beforehand, is there no way for me to predict where I’m headed? Thanks.
I believe a miniaturization study is a good measurement of your hair status at one given point in time. It’s like taking your blood pressure or pulse when you go see your doctor. Even if you had a hair transplant, this should not matter. So to answer your question — no, it’s not too late.