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Hi!

I was wondering what the procedure is to apply for a fellowship at your facility. I tried to speak to the ISHRS but as of the last 8 months, apparently all their programs are currently inactive so yours might be the only one still training people.

Please let me know.

Thanks

While we have trained many doctors in the past, at this time we are not offering training for hair transplantation skills. Sorry.

For those that missed part 1 of this series, please read up here.
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Ho Shou Wu, although not studied by western medicine, has a long history in Chinese medicine as a pro-hair herb. I have no idea if the shake would perform any better than a placebo. There are so many ingredients in his formulation that one might suggest that something in there will positively impact hair loss. To me, it is like a shotgun approach to the problem. It may actually work, but it is expensive and it is an unproven treatment. If I hear that there is a demand for his shake from our patients, I can order it for them. I’m interested in anything that makes outcomes better, regardless of the source.

We have seen people taking every imaginable supplement known to man, including antioxidants, HGH (human growth hormone), steroids, as well as those who use lasers and even PRP (protein rich plasma)… yet everyone doing these things are still losing their hair.

When doctors have compared identical twins, occasionally we see twins with different degrees of hair loss. Causes for this could include: smoking, exposure to sunlight, stress, and dietary/lifestyle differences. It is not that doctors have ignored these other epigenetic factors, but it reflects the medical profession’s ignorance of how these factors impact the genes we are dealt with. It appears clear to me that there are dietary and lifestyle factors that are influencing the epigenetics of male genetic balding and if we knew more, we could do more than prescribe finasteride and Rogaine to change them. It may also be the reason that laser light appears to have some influence, even from a placebo perspective.

Diet clearly is a very important factor. There was a mouse study that showed a fat yellow mouse placed on a particular diet became thin and gray, and in turn had thin, gray babies. Those offspring had thin gray babies on the same diet, but when the fat yellow mice who had turned thin and gray were again fed the original diet, they became fat and yellow again. This study illustrates the heritability of epigenetic influences and also the impact of diet in influencing the genetics of these mice. This opens up a whole new Pandora’s box for doctors. All of the treatments we have written off as “snake oils” or placebo effects often come from our patients or this blog that report that their hair grew better on such oral supplements. Could they have actually worked? Although I believe that DHT is a huge player in male genetic hair loss, it may not be the only important factor.

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Part 3 (the finale) will be published tomorrow.

This post was in part taken from an email sent by the brilliant Dr. Sharon Keene in Tucson, Arizona.

Dear Dr. Rassman:

I thank you for the useful information on this blog and your ethical approach in giving honest answers even if they are not financially beneficial to your practice. My question is the following: Do you utilize a sliding scale when quoting prices for patients? For example, if a one person earns a $60,000.00 salary and if another person earns a $160,000.00 salary, would the person who earns $60,000.00 be quoted a reduced fee?

If you purchased a car, whether a Chevy or a Mercedes, the price reflects the cost to deliver a quality product… not the income of the buyer. My staff is well paid and this reflects their skills to deliver a quality service, so the entire package of labor, surgical supplies, and the costs to run a surgical practice reflect the charge to the patient. The surgeon’s fee component is actually relatively low compared to the rest of the costs for the surgeon.

So to answer your question directly, the income of the patient does not reflect the fees we charge.

Snippet from the article:

She describes motherhood as ‘amazing’, but Selma Blair has candidly revealed she is experiencing an unwanted side affect. The Cruel Intentions actress, 39, who gave birth to son Arthur Saint four months ago, has revealed she is suffering post-partum hair loss.

‘This is so not glamorous, but it’s true: I need to take longer showers so that I can collect the hair that falls out and throw it away so I don’t clog the drain,’ she tells People magazine.

‘Why do actresses never talk about that?’ She continued: ‘It just started falling out at the three-month mark. And I’m not a girl who likes extensions, so Selma’s going to be bald!’

Read the rest — Selma Blair reveals she’s suffering hair loss after birth of son

I’ve written about hair loss after pregnancy before, and it can be a normal occurrence caused by hormonal changes. Obviously, celebrities are not immune to this. There is little that can be done to prevent it, but more info can be found at the American Pregnancy Association.

My daughter is 15, she has not had a perm in 3 years or more. Just recently her hair began breaking off on the ends and around the edges of her scalp. She uses biosilk shampoo and conditioner and she does flat iron and blow dry her hair at least 3 or four times weekly. What can we do to stop the breakage and promote the growth of her hair? We are african american.

The use of the flat iron could still contribute to damage, but this is best managed by a good hair stylist with lots of experience with African hair types.

This is a lengthy post that will probably lead to more questions, but while most topics have been covered on this site over the years, one topic hasn’t had much attention until now.

There is a field called epigenetics that addresses those heritable factors, other than our DNA, that impact how we express our genes. We have long suspected that diet plays an important role, but the science that backs this up has been lacking. We know, for example, that there are some known dietary anti-androgens out there like turmeric (spice used in many Indian and Asian dishes), as well as the omega 3 fatty acids, which may be why a diet higher in fish/fish oil may impede hair loss and why the Westernization of diets in Asia may have accelerated it.

Dr Masumi Inaba of Japan wrote two books in the early 1990s (Androgenetic Alopecia and Human Body Odor), which were translated into English and published by Springer around 1996. He always claimed that there had been a significant increase in hair loss in Japan post-WWII and he attributed this to increased fat in the Japanese diet due to Western influences. This was back in the late 1980s. Again, the shadow of diet and hair loss is interwoven. As an aside, Inaba was also the first person to describe his FUE technique in detail.

At the last ISHRS meeting, a “power shake” that increased hair growth in those impacted with genetic hair loss was discussed. Dr. Jerry Shapiro presented his “power shake” at the meeting (PDF here), which is essentially a whey protein concentrate formulation loaded with a variety of elements that have been reported to help all people grow their hair faster after a hair transplant.

What about the individuals who are nutritionally deficient? Are we all nutritionally deficient in some way? The basic questions raised by many doctors is that those individuals who are known to have poor nutrition (e.g. alcoholics) have not shown to demonstrate significant hair loss apart from the general population. One might suggest that these particular individuals metabolize testosterone differently than non-nutritionally deprived people by producing estrogen instead of DHT, thereby protecting their hair from the ravages of genetic balding. There is intriguing data on cysteine/glutathione and hair, which would be boosted by the undenatured whey in his power shake. Kudzu root has known anti-inflammatory properties.

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Read part 2 here.

This post was in part taken from an email sent by the brilliant Dr. Sharon Keene in Tucson, Arizona.

Dr. Rassman,

Thanks for the good work of educating us on hairloss on this website. You may not recall but I came to your clinic in December last year. One of the main questions I asked was whether it was possible to do FUE without shaving the donor area. You showed me a picture of a patient with “stripped shaves” as a way of hiding the surgery.

Recently, I came across Dr.Cole’s website. The website talks of a technique in which FUEs can be harvested without shaving your hair. I find this an interesting prospect as I would not want to have evidence of my transplant when I go to work.

Is this something that you may consider doing at NHI?

Here is the link: Forhair.com

I must be missing something. I read the link you suggested, but it sounds like what we’ve been doing for years… which is to clip a small area of the donor to extract the grafts. It allows those having FUE to maintain their same hair style, as the hair just above the donor area will cover the clipped part. The link you sent seems to just talk about how Dr. Cole’s patients now don’t have to shave their entire head.

At NHI, we do not completely shave the head to do FUE, as shown in the photos here.

Hello,

After using minoxidil for a year, I’m noticing an increased shedding similar to the first dread shed. Is this normal? After shedding a lot during the initial use, i had solid head of hair without losing a single strand. But now, I’m shedding a ton a year later. Is this normal?? I’m 26 years old.

The hallmark of genetic balding is the lack of stability of the process. Genetic balding is a progressive process that can come in spurts. Maybe that is what is happening to you. Not everyone experiences shedding from minoxidil use. See a specialist in this field and maybe he/she can shed some light on your problem.

Dr. Rassman,

In regards to hair transplants, I believe that you’ve written that around 25% of the original density can be enough to provide coverage, and that as the graft density of a HT procedure increases (above 40%?) the transection rate goes up and one gets diminishing returns, etc.

So, I was wondering how this relates to “dense packing” of the frontal area — how dense can the grafts be when you do this?

Thank you for giving so much information and comfort to people in need of it.

Every patient is unique, and their goals and expectations will be variable. For those who want high density, “dense packing” it is attainable, but as you state there are issues of the diminishing returns observed by several doctors who reported growth findings in dense packing studies. I believe your concern for transection of neighboring hair in the recipient site is valid and it may contribute to this diminishing return phenomenon. However, surgeons who know what they are doing rarely will produce transection in adjacent hairs in a second or third procedure. Transection in the first procedure is never a problem unless we are talking about remnants of ‘original’ hair that is present (miniaturized or not).

Transection rates in strip surgery occurs on the edges of the excised strip and this is estimated to be no more than 5% in the hands of the average surgeon. For FUE, on the other hand, the transection rate ranges widely depending upon the surgeon’s skills. The FUE must be done by the surgeon (not assigned to a technician) by law in all 50 states. That means that the surgeon should have the skill to do this, but my experience from seeing the results of many FUE surgeries suggests significant failures in the hands of many doctors. Although the Artas hair restoration robot is designed to minimize transection (keeping it under 10%), the studies so far have not followed the damage as those grafts are manually removed from the scalp and handled by the technicians when moved to the recipient site. Just keeping the grafts exposed to air for 20 seconds will kill them, even though there will be no evidence that damage has been done (other than the graft will never grow hair).

What are the symptoms of bacterial and fungus infections.Can they permanently destroy your hair and leave you with thinning hair?

Some symptoms of bacterial or fungal infection of your scalp may produce (but not all) some of the following symptoms: pain, irritation, itchiness, foul smell, discharge, fever, and hair loss. These are very general and vague symptoms and the main point you should take away is to see your primary care doctor if you are concerned about an infection!

The Internet is a horrible way to self diagnose or self treat medical issues (even hair loss). If you leave infections untreated, you can possibly lose your hair permanently.