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Dr. Rassman,

Good day sir. Big fan of the blog and all the information you provide. I will keep it short and sweet.

With all the advancements in FUE harvesting, do you think the strip method will become obsolete in the not too distant future?

Thanks and have a good day!

I really believe there will always be a place for hair transplantation with the strip technique. Follicular unit extraction (FUE) is not always the perfect or a preferred surgery, as many people seem to think. Grafts extracted using FUE are not the same as grafts cut under the microscope, and the growth and success is definitely different no matter how good the surgeon is. I speak from experience, as I was the first to publish about the FUE technique in 2002. Shortly after that publication, surgeons all over the world quickly jumped on the bandwagon to adopt it in their practices with varying results. Over the years, I have seen FUE promoted and sold to naive patients as a “better” surgery than the strip, but this is mostly marketing hype and leads to misinformation.

The two techniques (FUE and strip) both have their own unique place in hair transplant surgeries. For example, if you have a Norwood Class 4-6 balding pattern, a strip method of 3000 to 4000 grafts would be a perfect surgery to achieve a full look in ONE shot with a relatively lower cost than the FUE surgery. The strip scar wouldn’t be noticed by anyone unless you decided to shave your head (and if you were going to do that, why even have the surgery). Plus, I would almost never advise a Norwood 6 patient to have the FUE surgery, because there’s a higher incidence of transected hairs in the grafts from that technique. This would be a liability to someone who can’t afford to lose a single hair! Now on the other hand, if you are a Norwood 2 or 3 and wanting your front corners filled in, an FUE surgery may be perfect — especially if the hair is worn buzz-cut short.

Even if the ACell auto-cloning technology proves itself, the strip surgery may still remain the ‘workhorse’ of transplant surgeries. We may be doing combination of all the techniques combined.

Are people with DUPA candidates for a body hair transplant?

Body hair transplants (BHT) are not considered a standard method of hair transplantation and may not give you a normal amount of bulk. I realize some doctors perform BHT with success (depending on how you define it), but the visual appearance of the hair that grows is clearly not normal. Body hair simply does not grow like scalp hair and is not the same texture.

In my opinion, even if you are desperate for hair, I would be cautious with this approach and demand to see patients who have had it done before you agree to such a radical approach to your DUPA problem. Any surgery can make the situation worse, and that risk is real.

I am 53 years old woman with thinning hair (front and upper middle scalp). I have been prescribed spironolactone tablets daily and am about to start the twice-daily 2% minoxydil (Rogaine) topical treatments. For a different problem (fine lines) I apply 0.04% retin-A micro gel to my face nightly (active ingedient tretinoin). Is there any material risk of adverse drug interactions? Could tretinoin aggravate my hair loss?

For starters, here’s what I said about Retin-A in a recent post that still holds true — “Hair loss is listed as a known common side effect of tretinoin (also known as Retin-A), but it is also used by some people in conjunction with minoxidil to grow hair.”

I really don’t have a right answer for you. These are the questions you really should ask your doctor, since you’re already under a physician’s care. Female hair loss is complicated and I know very little about you, have not examined you at all, and have no detailed history on your many health issues.

Hi,

A lot of the hair I see falling out seem to be thick and black at the far end narrowing in diameter towards the root, turning thin and blond. Everything I’ve read, including posts on this blog, seem to say that miniaturization of hair follicles happens from cycle to cycle. Is it possible for hair follicles to miniaturize within a growth cycle or is that most likely caused by something else?

The newest part of the hair near the root may be thinner than the oldest part at the end of the hair shaft, but I am not sure that I would call this miniaturization without examining you. I would think that once a hair is miniaturizing, it will continue in that process with time.

Snippet from the press release:

Aderans Research Institute (ARI) recently completed the first of seven protocols of a hair regeneration Phase 2 clinical study, and the results are in: more than half of study participants showed significant hair growth one year after the cell product treatment was administered. “The results indicate that our scientific approach, our research and understanding of follicular cell and hair regeneration is headed in the right direction,” said Vern Liebmann, Vice President Operations. “The fact that an increase in hair growth is apparent as far out as one year after treatment indicates our process has staying power. Nobody we know of has produced results like these.”

Read the full press release — Half of ARI Study Participants See Hair Growth After 1 Year in First Protocol

Results like what are reflected in the announcement from Aderans are very exciting. It is a good thing that many different paths are succeeding lately and, like any lottery, there can be more than one solution to the hair loss problem.

I do not look at the various solutions that are presently being tested as a competition between one technology and another. I look at the millions of dollars that have been spent to solve the hair loss problem and the promise of an exciting future for better and possibly more natural solutions for the various forms of alopecia.

I know from speaking with many prospective patients that some men will now consider postponing traditional hair loss treatments (like the use of finasteride or hair transplantation) in favor of waiting for an “Aderans solution”, but it is important for those who are impacted with early balding not to ignore realistic treatments that do work. For example, a fast-moving balding problem in a young man who may be destined for an advanced hair loss pattern should not allow his loss to progress while he waits for future treatments to become reality, particularly when there are very effective medications available to slow the process down today.

Dear Dr Rassman

Is that possible that the Acell autocloned hair, from plucked hair from DHT resistant donor area, stay DHT-insensible for let’s say 10 years, and after that develop sensitivity to DHT ?

If many people stay bald free even up to 50 years old like the balding genes was inactive for decades… I suppose maybe something like that could happen to autoclone hair, like their balding genes could just wake up after many years, in some few cases.

We do not know the answer to this question. One would expect that the auto-cloned hair would be resistant to DHT and grow on just like the donor hair normally does. Apoptosis (cell death) is programmed in the balding hair follicle, but not in the hairs found in the donor area… but still, no one really knows.

In the case of general cloning, I recall there have been reports that the life span of a cloned animal is shorter than expected. It all has to do with something called telomerase, which may or may not apply to the hair. The short answer is: I simply do not know.

Hello, I am a recent transplant from New York City to Istanbul. I was a model for 10 years and have been losing my hair since my late teens. As a woman, and one paid for her looks, I do not have to belabor the point of how this has ruined my life. I have worn every possible type of hair extension and now a custom made hairpiece covering my crown and hairline in addition to extensions in the back. I have lost roughly 70 percent of my hair and the remains resemble a troll doll’s fluff. The cost (approximately 300.00 every 2 months) and the constant fear that the extensions will fall out or move in such a way that my scalp will show have left me feeling so hopeless.

I am in my late 20s and can hardly imagine what I will have to face in 20 years when the wig and extensions will cause traction alopecia and pull out the rest of my hair. I cannot wear full wigs since I cannot pull them back into ponytails when working out and they are just not a livable solution. I have traveled all over the world for consults regarding transplantation but I just don’t have enough hair to make the operation worth the expense. Does anyone have any suggestions regarding real solutions - realistic hairpieces, best extensions, etc? I think that I also ran through all of the possible drugs too, up to and including Proscar - I do not plan to have children. Drugs don’t seem worth it either as it is not just about preserving the hair that I have but the fact that I will never have a normal amount of hair to begin with.

It is also noteworthy, I suppose, that my hairloss is both genetic and I know discovered due two 2 courses of Accutane in high school that was prescribe like candy to kids that had minuscule amount of acne (I grew up in the entertainment industry…) Thank you for reading and I would be so grateful for any thoughts or advice.

Your questions are not uncommon and your history is typical of many women. There is little that doctors can do for you unless you have an identifiable hormone defect or medical problem like thyroid disease. I wish there was more I could offer.

As for realistic hairpieces, extensions, etc — If any readers have advice for this young lady, please leave a comment!

Hello Doc, I have a question. I just got a new packet of Proscar from a known pharmacy. However, I’m thinking I’ve gotten fake Proscar. Does Proscar taste sweet? Because I cut the tablet into quarter and when I crushed part of it (due to bad cutting) and dissolved on my tongue it tasted sweet like it just a sugar tablet.

If its fake what should I do?? Thanks doc!!

There’s no taste chart for finasteride that I know of, and I’ve never chewed it, so I couldn’t tell you if it’s fake based on taste. I would always swallow my pills with a water chaser. Any readers have finasteride taste stories?

There’s a survey I just read about regarding pill color and perceived taste that you might find interesting — How Does The Color Of A Pill Affect Its Efficacy?.

Dear Dr. Rassman,

As a female prone to hyperkalemia, I can’t use spironolactone so I can only use Rogaine. Since I have a pale scalp and thinning black hair, I was hoping to dye/stain my scalp black with indigo and henna to mask the hair loss. Do you think that this would block the absorption of minoxidil?

Thanking for your time

With regular henna ink, I would not think so. Henna ink is essentially henna powder mixed with eucalyptus oil and coffee/tea, and none of those will stop the absorption. It’s commonly used for temporary tattoos (see right).

On the other hand, I’ve read about the dangers of black henna, which isn’t usually henna at all, but rather indigo mixed with chemicals. Ingredients of various black henna products can vary, and the FDA has sent warning letters (like this) about the dangers.

I’m not a henna expert by any means, but I’ve read that so-called black henna can cause severe allergic reactions and skin sensitivities, so I’d suggest researching this stuff a bit more before diving in. You don’t want to end up causing larger problems for yourself.

Doc, i have another question. Since I am a healthy 25 year old (who takes propecia), with no family history of prostate cancer, does that mean that I should start having annual PSA and prostate exams right now at this young age as well?

I have have another question. Does finasteride directly causes high grade malignancy in some patients. or does it just delay the diagnosis of cancer cells which if left end up being high grade?(meaning that finasteride doesn’t cause cancer itself but just delays the diagnosis of early stage prostate cancer which later become more aggresive).

At 25 years old, it would be very, very unusual for you to develop prostate cancer.

With regard to the risk of developing a high grade malignancy from taking finasteride, I would doubt that the answers are in yet. The finding of the higher grade malignancies reported may reflect prostate shrinkage. We would need to know what the survival rate of these men who have reported higher grade malignancies is. If those that have the reports have a higher mortality rate than other men with known cancer of the prostate, then I’d believe that there is real risk, not just interpretive risks classified by pathologists.