Why the Hat?

Posted by Sarah Sweetz Akhza On 4:57 AM 0 comments
A viewer asked why I'm still wearing a hat after Surgeonofnalts added 15-eyebrows worth of hair to my head... some facts about post-hair transplant growth...

Famous YouTube Guy Gets Hair Transplant

Posted by Sarah Sweetz Akhza On 5:17 PM 0 comments
Greg Benson, actor and "Mediocrefilms" and "Mediocrefilms2," got a hair transplant this week from SurgeonofNalts (Dr. Alan Bauman).

Now it's a race to see who can have the best forehead by spring. I have two months of a headstart, but Benson had a Bosley transplant when he was 30 (about 20 years ago).

On your marks. Get set. Groooowwwwww.

Well here's a 5-minute video that takes you through the 7 steps of a simple hair transplantation. Dr. Bauman and I documented the NeoGraft FUE procedure in layman terms... it's on the SurgeonofNalts account, and Greg Benson (Mediocrefilms) is the next candidate for a hair transplant this week.

We discussed this video during tonight's "Bald Truth" show. I hope you find this informative and mildly entertaining. :)

YouTube Star Gets Hair Transplant

Posted by Sarah Sweetz Akhza On 8:46 AM 0 comments
Greg Benson, actor and creator of "MediocreFilms" (one of the most-subscribed YouTube channels) is getting his second hair transplant next week with Dr. Alan Bauman. Dr. B was my hair transplant, and Benson participated in our live blogtv and stickam chats when I had my transplant 2 months ago.

Read more about it on "The Bald Truth" blog, and tune in Sunday (Nov. 1, 2009) at 5 Pacific and 8 EST to hear Dr. B, Benson, me and the show's host, Spencer Kobren. Kobren is the author of "The Bald Truth," a book that focuses on hair loss and what people can do about it.

Nalts Hairloss Videos & Hairloss Education

Posted by Sarah Sweetz Akhza On 2:40 PM 0 comments

I just finished editing a fun video that explains my procedure in my language, as well as in medical terms. The video -- hosted by me and Dr. Bauman -- is designed to help educate hair-transplant candidates through the various steps of a follicular unit extraction, and show how the NeoGraft left no scaring on the back of my head. Here's a photo of the back of my head 24-hours after surgery, and 2 months later. No incision scar because the hairs were taken from random spots! More importantly, because the donor hairs weren't from a single strip, Dr. Bauman was able to pick various grades of hair to create a forehead that's more natural... as opposed to that Frankenstein look. Which would be cute this weekend, but not beyond that.

I learned today that Bauman uses NeoGraft to, in fact, conceal transplant scars. So if you had a transplant and decide to enhance it... you can use some of your individual grafts to hide the scar. Cool.

Here are a bunch of the videos documenting the journey. Stay tuned for the educational one. Dr. Bauman is sharing that on his YouTube channel....

Don't Ask Your Doctor About Hairloss?

Posted by Sarah Sweetz Akhza On 9:53 AM 0 comments
Doctor Alan Bauman, who did my hair transplant, commented on my recent post about hair loss and it brings up an interesting issue:

Countless patients come through our doors each year after being shunned or even ridiculed by their dermatologist for wanting to do something about their hair loss. The most help any of them ever got from their Derm was a bottle of rogaine as they were sent out the door. Seek the advice of a trained medical professional who SPECIALIZES in hair restoration.

It's true that the majority of primary-care and dermatologists aren't interested in hair loss treatment, and find it a distraction. It's not covered by insurance, and a typical PCP or dermatologist won't profit from treating hairloss. More importantly, they often lack insight into a simple fact: if the patient had the courage to ask a physician, he likely is highly concerned about his hair-loss even if he appears otherwise. So when he's dismissed or ignored, he probably loses some trust for the physician.

That trust can undermine the doctor-patient relationship in ways the doctor never sees. Kinda sad, so here are some tips:

  1. See a specialist if you can. Even if you're not interested in a hair transplant, a physician who specializes in hair is ideal (if your dermatologist or PCP has hair-loss informational resources in the front office, you're probably safe).
  2. If you talk to your primary-care physician (or some derms), you're likely to do so at the end of an appointment discussing another medical issue... so don't wait until the doctor is reaching for the door handle.
  3. Educate yourself before going, and let the physician know what you've tried already. This will help him/her know you're concerned. Trust me: unless he's treating his own hairloss, he's not going to know you're concerned about yours if you're subtle.
  4. Ask for a recommendation and not options. Many physicians feel they're serving the patient if they list a variety of treatment approaches. While this demonstrates the physicians knowledge, the patient wants the doctor's advice.
  5. If all else fails, go to another doctor. It's a lot easier to find another doctor than to try to change your doctor's personality or methods.

Hair Today, Gone Tomorrow

Posted by Sarah Sweetz Akhza On 11:06 AM 0 comments
The Baltimore Sun did a piece Friday about hair loss and remedies, and ended with a nice quote:

Aside from the psychological implications, pattern hair loss has no negative health consequences. What you choose to do about it -- which may be absolutely nothing -- is a personal decision, best made after talking over the options with a dermatologist, family, and maybe some fairly objective friends.

The piece outlines the two FDA-approved remedies (Propecia and Rogaine), and offers some information about transplants. There's also some tips in regards to being "gentle" on hair, but I'm not sure I've seen enough reliable information about hairloss caused by scratching or towel drying. I think this is overstated because it's when we notice hair falling out.

No Scars on Donor Area of Transplant

Posted by Sarah Sweetz Akhza On 7:38 AM 0 comments

When you get a normal hair transplant, you have a big ol' scar on the back of my head. Check out this photo of my head the next day. Pretty clean, thanks to FUE (follicular unit extraction) and we did nearly 2,000 grafts.

Dutasteride Versus Finasteride

Posted by Sarah Sweetz Akhza On 5:53 PM 0 comments
I never paid much attention to the Dutasteride (Avodart) vs. Finasteride (Propecia) when I worked on Propecia. Avodart isn't approved by the FDA for hairloss treatment. But I do remember the conferences where some physician always seemed to have an agenda to prove Dutasteride was better (I assumed they were part of the Avodart studies, or trying to get selected as paid "thought leaders" by GSK, which markets Avodart).

Turns out there was a study on it, but I don't know much more than I've read here.

Seems .1 mg of dutasteride had similar hair improvement at 24 weeks to finasteride 5 mg. But I'm kinda perplexed as why they didn't use finasteride 1 mg (which is the dosage of Propecia) and why they jacked up the dutasteride in one group to friggin' 2.5 mg, which gave 9 of the poor study participants a lowered libido.

Why study the extreme, when most of the hairloss benefits (and lower side effects) is realized at lower dosages? The incremental benefit in hair growth (or reduced loss) seems to be offset by the side effects... of either drug. So I'm glad I'm taking Propecia not Proscar (5 mg).

That said, it would appear that too much of these medications can drop your libido, which is always something I thought preciously was overstated. But this generally resolves after you stop (and many side effects of pharma drugs resolve after your body adjusts to it).

The thing about sexual side effects is that if you're told you'll get them, your odds of getting them increase significantly. It shows the power of expectations. Remember that, in early clinical trials, Propecia saw one group of men who dropped treatment more often, citing adverse reactions. That group, it turns out, was the one taking the placebo (sugar pill). See the Propecia Q&A for more information. It took me months, but I finally promoted that little-known fact from its hiding-place in the PI (prescribing information) to the Q&A... because I found it charmingly interesting. Of course now I can't find it, but here's the Q&A.

What Celebrities Have Hair Plugs?

Posted by Sarah Sweetz Akhza On 5:14 PM 0 comments

Here's another website (http://famewatcher.com/category/celebrity-hair-transplants) that "outs" some of the celebrities with alleged hair transplants.

Again- tough to tell without seeing a really close before/after picture, and even those can be deceptive. We've all seen old and new photos where our hair looks good and bad... lighting, growth and moisture can alter appearances.

My favorite rumor... Kevin Costner made the director use computer-generated imagery (CGI) to give him a better hairline. Kevin, a hair transplant would have kept Waterworld's budget in a better place.

Italian Prime Minister "Comes Out"

Posted by Sarah Sweetz Akhza On 5:05 PM 0 comments
Well we've started a fad. Seems Italian Prime Minster Silvio Berlusconi has "come out of the closet" with his hair transplant, and has become "the poster boy for male hair transplants and their age-defying benefit." (Source: Financial Times).

This excerpt is interesting. It puts the technology progress in layman terms, and gives you some insight on what guys go through before getting a transplant, which Beacon (see below) calls "no less painful than going to the dentist." I beg to disagree. It's a hell of a lot easier than going to the dentist. For starters, hair-transplant physicians are slightly less socially awkward.

But today’s hair transplant technology is as far removed from yesterday’s as the iPhone is from the clunky 1980s car phone. Brian Beacom, a 53-year-old journalist and author of Diary of a Hair Transplant: A Journalist’s Search for David Cassidy Hair (Phantom), waited more than two decades before going ahead with the procedure, watching the technology develop until it had been perfected. Beacom says: “Going bald really highlights the ageing process. You look 10 years older if you haven’t got hair, and you can look 10 years younger if you have it. Now people react to me differently, especially bald men who don’t know I have had a transplant; they look at me with a certain amount of envy.”

Why Can't You Give Blood While Taking Propecia

Posted by Sarah Sweetz Akhza On 4:15 PM 0 comments
Alex asked in recent comments about Propecia being on the list of drugs that exclude you from donating blood. I was always bothered by that when I worked on Propecia, because it made it sound toxic.

The issue is simply that women can't take Propecia (no studies on women, and potential for birth defects). They can't even handle them (even though they're coated). They can't even smell Propecia, or be within 10 miles of the pills (mkay I'm having fun now). I didn't take Propecia when I was having kids, even though no research has shown that finasteride can travel to the women via the sperm. I've heard indirectly that scientists say it would take about 7 gallons of seamen for this to be a risk, but not a risk I wanted to take. Then again- I was probably passing along far more toxic things than finasteride. Like martini olives.

Why can't they identify the blood donoations as "for men only"? I dunno. Then again, I used to have blood-donor cards with multiple listings of my blood type. So I guess the system isn't perfect.

And as a Propecia user, I see this as a benefit. I can guilt-free avoid giving blood, which I despise (see proof in this, one of my least-viewed videos).

So ladies (especially those in child-raring years) are gonna have to stick with the rogaine/minoxidil (there's even a ladies dose of that for reasons I don't quite now). Or you could try some folk remedies. Here's a recent StopAgingNow article on what women can do.

Managing Patient Expectations After Hair Transplant

Posted by Sarah Sweetz Akhza On 4:05 PM 0 comments

Here's a great example of why managing patient expectations is really important. Per this picture, I'm seeing my regular hair growing out pretty fast. But the transplant area (and other thin areas) aren't growing out as fast or as dense.

Some people are saying, "dude your transplant didn't work." But Dr. B explained that post-transplant you don't see immediate results. In fact, even in 6 months I'll only see half the benefit.

But in a year, we'll see most of the improvement. As they say, "it takes a while to lose hair, so growing it back isn't overnight." They also say "I wish martini glasses had higher edges so they didn't spill in the bus." I think the latter is more funny.

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Bald Guy Gets Followed Around Internet

Posted by Sarah Sweetz Akhza On 3:56 PM 0 comments

Yeah, it's called "site retargeting." You do a web search for hairloss, balding or something related. Or maybe you buy a hair-loss book or visit a Bosley website.

Suddenly days and weeks and months later, everywhere you go on the web you get reminders of your sad fate. Here's a Bosley ad that appeared while I was searching Super Mario Galaxy 1 (hint: you don't need the 1).
Coincidence? I think not. Embarassing? Maybe for some, but not for a guy who did hair transplant live on the web. Smart marketing? I'd say yes.

Of course super smart marketing would be excluding guys that are already "hearting" their current surgeon... surgeonofnalts.

My Hair Transplant Video Got Squirrel Bombed

Posted by Sarah Sweetz Akhza On 1:14 PM 0 comments
Not familiar with JimmerSD's term "Squirrel bomb"? It's kinda like getting rickrolled I guess.

Nalts Hair Grows...

Posted by Sarah Sweetz Akhza On 2:30 PM 0 comments

Here's a couple "after" photos to show my new hair. It's kinda hard to see because they aren't next to "before" photos that match. The first was taken August. 26 and the second on August 30 (my surgery was August 18). Whatya think?

Most people think the hair-transplant procedure results are immediate, but it takes about 6 months to see 50% of the benefit, and a year to see 90% of the benefit. So I'm taking my Propecia and dabbing on my minoxidil (what Bauman calls the "sugar and caffeine).

Let it grow, let it grow, let it grow!

Live, Public Hair-Transplant Follow-Up Appointment

Posted by Sarah Sweetz Akhza On 2:23 PM 0 comments
Hey, if I'm going to broadcast my hair transplant live, why not the follow-up? In my first real live-broadcast (I've done 800 plus videos online, but the live thing always terrifies me), I conduct a live & public follow-up consult via Stickam with someone from Bauman Medical. And I try to stay focused as I read the myriad of insults so common on Stickam. :)

War Veterans Get "Welcome Home" Hair

Posted by Sarah Sweetz Akhza On 2:16 PM 0 comments
In an unusual publicity campaign, Bosley is offering free hair transplants to 19 lucky war veterans. Time to lose the buzz cut?

Aztarnet.com reports:
An international chain is aiming to change that with a contest offering free baldness cures to veterans of the Iraq and Afghanistan wars. Bosley Hair Restoration, based in Beverly Hills, Calif., recently launched a marketing push to provide free hair transplants to 19 war vets nationwide — one at each of its regional surgery centers, including the one in Arizona.
To apply, troops or their loved ones must submit a letter describing the service member's wartime work and "what a new, restored head of hair would mean to him/her." Southern Arizona personnel are eligible to enter, but the winner would have to travel to Bosley's Scottsdale clinic for the procedure, which normally costs $5,000 to $8,000.

To learn more, see "Bosley Gives Back."

Propecia: One of Most Faked Drugs

Posted by Sarah Sweetz Akhza On 4:38 PM 0 comments
Propecia, my former brand, is indeed one of the most counterfeited medications... perhaps rivaled only by the erectile dysfunction drugs. Via a recent post by TheBaldingBlog, here's a dated by interesting article by UKMedix that reveals the scam. Why does it work?
  • It takes months before the effect (or lack of effect takes place), so that's plenty of time to cash in.
  • Some men to feel embarrassed to go to a doctor to speak about their hair loss.
The article estimates that thousands of men around the world have stopped using Propecia believing that it doesn’t work for them... when in fact if they had used a real version of Propecia (made by Merck) they would have experienced good results and possibly hair regrowth.

Here's a discussion on HairlossTalk (a forum) with more information about counterfeit Propecia. Even better, check out this FDA warning on fake pharmaceuticals.

Before & After Photos RACKET

Posted by Sarah Sweetz Akhza On 2:43 PM 0 comments

Now that I've watched a few hair loss videos, YouTube is constantly serving me more as a recommendation. Today I ran into this classic by Spencer Kobren (I was on his radio show last night). This is a fun game...

Look at this picture (or see it in the video) and tell me if you're impressed with the results. Before and after. Then watch the video, and you'll be amazed by the secret behind it.

I never cared much for before/after photos to promote Propecia, because the non-regulated drugs can pull these tricks, and Propecia couldn't. Instead I liked Terry and Perry's video in the bottom, left quadrant of this page (twins with one who took Propecia and one who didn't).

Herbals and Vitamins

Posted by Sarah Sweetz Akhza On 2:38 PM 0 comments
There's a placebo effect with almost any condition, and I'm sure hair loss is no different. If I told you I was giving you a magic pill to help depression or grow hair, a sugar pill would likely help.

But as someone who worked in pharmaceuticals, I'm a bit surprised the FDA doesn't restrict health claims of this category. It really leads to a lot of B.S. Like anyone, I really want to believe that herbs and vitamins can cure diseases more safely and with lower side effects. But I feel like if they make health claims, they need to prove it.

Do vitamins help fight hair loss? Maybe in some tiny way, but I'd like to see the double-blind study that shows before/after photos or hair counts on this list (from an article today in 24 Medica).

The following nutrients are considered to be very important for dealing with and preventing hair loss: essential fatty acids, raw thymus glandular, vitamin B complex, vitamin C with bioflavonoids, vitamin E, zinc, coenzyme Q10, DMG, and kelp. Additionally, the following nutrients are helpful in dealing with hair loss: copper, grape seed extract, l-cysteine, MSM, and silica. The following herbs can also help prevent and deal with hair loss: apple cider vinegar, sage tea, ginkgo biloba, horsetail, green tea, pygeum, saw palmetto, and tea tree oil.

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Hair Pieces Are Booming

Posted by Sarah Sweetz Akhza On 2:31 PM 0 comments
Here's a very fresh article about hair pieces. This isn't an option I'd consider primarily because of an early childhood traumatic experience. I'm at a Saints game in the Superbowl and I'm maybe 10 years old. A guy two rows back has a few too many $2 beers, and topples over and lands practically on my lap. His hair piece came off, and I just stood in shock. I hadn't heard of such a thing, and pretty much resolved that I'd pass... although they're not much more expensive than season tickets anymore.

See IndyStar article about an entrepreneur ("Custom Hair Pieces by Sarah") who has found her niche. Subtitled "Her Business Thrives on the Overhead." Not bad, writer Jenny Elig. And if you had some help on that headline, I think you'd better give them credit.

Hey, Sarah... you need a website. I'll build you one for a hair piece to tide me over until the transplant kicks in!

Vlogging for Hair: Awareness Campaign

Posted by Sarah Sweetz Akhza On 12:41 PM 0 comments
Here's a recent story about our "cause" to make people aware of treatment-options for hair loss and balding. I'm looking forward to 8 pm tonight (Aug . 23, 2009) when Spencer Kobren, Dr. Alan Bauman and I discuss these issues live on The Bald Truth, via web, Stickam and Sirius Radio.

Hey- it's still hair-loss awareness month!

Hair-Transplant Fun: The Videos

Posted by Sarah Sweetz Akhza On 12:51 PM 0 comments
Here are the first two videos, documenting my hair transplant! Now let's see if we can get a real celebrity to "come out." Don't forget to join me on "The Bald Truth" on Sunday at 8 pm EST.

Web Savvy Physician?

Posted by Sarah Sweetz Akhza On 11:36 AM 0 comments

How many web-savvy physicians do you know? My surgeon, Dr. Alan Bauman, has a YouTube account, a Twitter account, and Blogtv and Stickam accounts. He sends me an FTP file to upload video (almost ready to post first footage of my transplant), and today sends me a batch of photos from the event on Flickr.

Check me out! Note- you don't have to shave your head like I did, but it makes it easier and faster. Given that I was running around getting footage and broadcasting the surgery to hundreds via Stickam and Blogtv, I wanted to ensure the surgery didn't go too long.

Won't see the full benefits until 6-12 months, but already I have a hairline that looks like it's going to resemble my 1996 wedding photo. :)

Celebrities With Hair Transplants

Posted by Sarah Sweetz Akhza On 11:14 AM 0 comments
"It's okay to do something about your hair loss," says Spencer Kobren in this teaser for this Sunday's 8 EST "The Bald Truth" radio and web show. I hope you'll join us, as we discuss my transplant and the odd stigma around getting a transplant or being concerned about hair.

I'm far from a celebrity, but I do play one on YouTube (with nearly 100,000,000 views and 136,000 subscribers).

When you talk among hair-transplant physicians, they won't reveal their celebrity patients. But they know who's had a transplant, and you and I don't. According to this website, they include Kevin Costner, Brendan Fraser, Tom Hanks, John Travolta, and Matthew McConaughey. I'd add Matt Lauer and Mel Gibson to that list. And Tiger Woods is often mentioned.

For goodness sakes, look at these photos and decide for yourself, then join the Hair Loss Help forum and start your own rumors!

10 Tips to Pick the Best Hair-Transplant Doctor

Posted by Sarah Sweetz Akhza On 8:08 PM 0 comments
It's hard enough to decide whether to get a hair transplant and how to afford one. Choosing the right doctor can be overwhelming. A Google search reveals countless objective and biased sources, and who has time to sort them all out?

Here are a dozen sample resources on picking a good doc, in no particular order. But I've summarized practical guidance below in 10 tips, so you don't have to go on a web safari to find the key considerations.

  1. WebMD: Picking a Surgeon
  2. US Hair Restoration
  3. OmniMedical Search
  4. Hair Restoration Advice
  5. Skin Treatment Guide
  6. eHow: How to Rate Them
  7. International Hair Surgical Group
  8. International Society of Hair Restoration Surgery: a leading organization with the world's worst logo.
  9. Life Tips: Finding a Hair Restoration Doctor
  10. International Alliance of Hair Restoration Surgeons
  11. American Hair Loss Association

Whew- that's a lot of content to "comb over." Now before I give you my own top 10 approaches, I should explain my two potential biases. First, I title this blog "The Hair Insider" because I gained some inside perspective while working as Product Director of Propecia (the only prescription product proven to save and grow hair). I met many of the leading physicians -- some made me cringe, while others seemed sincere. Still, I'm more likely to have a favorable view of those larger affiliations like MHR or Bosley (mostly due to the impressive Medical Director Ken Washenik, who struck me as a well regarded leader, despite a whole anti-Bosley site).

Second, I'm obviously partial to (Bauman Medical) because I had a positive experience with Dr. Alan Bauman this week (and I didn't need to pay full price because I am helping him market via online video). But in my own due dilligence (2 years considering getting a transplant), Dr. Bauman and his team in Boca Raton, Florida came highly referenced, well credentialed on television and print, and were often identified by peers as the guy they would choose. I felt like that mattered more than anything.

Biases disclaimed, I'm a former journalist who is sincerely trying to give fellow male-pattern hairloss folks thorough and objective advice to picking the right doctor or practice. Here is "the least you need to know":

1) Nothing beats a reference. True, I can't compare my Bauman experience with other doctors, but I was treated well, liked the staff, and I fully expect positive outcomes. If I hadn't heard so many positive things about Bauman, I would have wanted to speak with his patients -- both the ones who returned, and the ones that might have had a less positive experience, assuming they exist. If you get a reference, put the most stake in the one that comes from someone who had the transplant a year earlier, and can vouche for not just the experience but the ultimate outcome. And put less stake in the references you get from the practice, since those are clearly not drawn randomly.
2) Listen to "The Bald Truth" by Spencer Kobren, an author and founder of IAHRS. Kobren charges doctors for the exhaustive work he conducts to weed out the wackos from the credible surgeons with good reputations and patient experiences. I'm not sure all of the best surgeons are part of IAHRS, but I doubt many hacks are among them. Initially I called Spencer for a reference, but then decided to go with my gut, and called the guy I had met and had been well referenced by my colleagues as somone sincere, progressive, and talented.
3) Remember what's important.
If someone is pitching you hard on a specific doctor, take a step back. Don't shop by price-per-graft, or you'll get what you pay for. You want an experienced physician not a noob, but you also one who's not so late in his career that he's unlikely to keep current on the latest technology.
4) The doctor isn't the only factor. Hair transplantation involves a variety of roles: a doctor, a counseler, technicians, specialists, assistants. A good surgeon keeps his staff, and they become a well-oiled machine. Although the responsibility rests in the hands of the physicians, the tech team does a variety of critical work... from harvesting to implanting the hair. It's a team job, so ask about the entire team and don't get woed by the doctor alone. Now consider this tip when you assess the Bosley's or MHR. They've probably got good training, but ultimately the franchise name is less important than the doctor and team you get.
5) Don't worry about location. Hair transplantation can be done anywhere, but proximity isn't vital. It's convenient to have someone close, but far more important that you find the right team. The cost of a flight is trivial in the grand scheme.
6) Don't get pressured by the "consultants." These guys are important to keep doctors doing what they do best (surgery) and they can help you assess your needs. But they're often glorfied sales people, and they want to close the deal. I could not fathom approaching a chain via a consultant, because I'd feel like I was buying time share.
7) Look for passion not profit pursuit. My surgeon, who is about my age, always knew he wanted to be a hair transplant surgeon, and found his calling after dabbling briefly in cosmetic surgery. But there are other physicians that were doing general medicine, and decided they were sick of managed care and wanted the hours and money of cash-paying cosmetic patients. That's not the ideal profile for me.
8) Plunge into a community (Kobren's is called the The Bald Truth Talk forum). Here's a nice post that has some advice for the noobs. Another is the Hairloss Help Forum. These forums will help you learn from people that have, or are currently in your same boat. If you're the guy that likes Consumer Reports and ePinions, then you'll want to conduct thorough reference checks and ask loads of questions. But the references are certainly hand picked by the practice, and who has time for that? I believe in crowdsourcing, so if I see lots of posts and threads that are favorable about a doctor, I'll hope it's not someone "gaming the system" but real patients praising the best doctors (or slamming the worst).
10) It's a Buyer's Market. The transplant industry is not booming like breast augmentation or Botox, and some of the poor surgeons are fading away... while even the good ones are eager for new cases. That doesn't mean you want to haggle or shop and compare, but it means you don't need to feel rushed or pressured.

I long for a day when physicians can be rated by patients on such key attributes as "bedside manner" and "technical excellence." Indeed, perhaps there's a Trip Advisor for hair surgeons that isn't really a disguised pitch for one group or practice. Let me know, and good luck!

It's really hard to tell the difference in this photo, but it's one I just took from my laptop as an interim update (I'm editing the footage from the hair transplant currently). I ended up with nearly 2,000 grafts transplanted on Monday, but many follicles contained 2-4 hairs each (so we're talking about maybe 5,000 new hairs). In fact, the challenge was to find single-hair units for a tapered front line.

Here's more detail than you may want, but this describes the innovative new type of transplant I had (versus the traditional strip-harvest where they gotta take a chunk of your scalp off).

  • Notice how Dr. Alan Bauman gave me a circular recession, rather than a flat front (which looks abnormal). 
  • You'll see I volunteered to shave my head (optional) because I knew it would make things easier, and all of my camera hijinx and live web casts interfered with the otherwise efficient process of a hair transplant. Maybe half of people prefer not to shave the head, presumably because they don't want people knowing they had a transplant.
  • I had an FUE (follicular unit extraction), which means I had no surgical incision that's known as a "strip harvest." That means I'll have no visible scar on the back of the head, I experienced less pain, and benefited from a variety of different transplanted hairs (a range of densities) that aren't found in one strip. And nobody has to dissect the harvest strip into individual follicles. 
Hair transplants are basically moving "donor" hair to the forehead or crown from the back of the guy's head, where the hairs are higher density and not prone to harm by DHT, the nasty little substance that kills off hair. 

  • In an FUE, which is relatively new, they randomly grab follicles (containing 1-4 hairs each) with a tiny, sharp rotating knife tube (like a circular cookie-cutter). No pain. Then they quickly pluck 'em (or use suction) and place 'em in dishes until they're counted and sorted. Wanna see some photos of the FUE? It's not something I'd look at over breakfast, but trust me it's better than looking at a harvest (see gross picture).
  • Those little individual rice-sized hair follicles are later inserted into the tiny slits that Dr. Bauman carefully decorated on my forehead to resemble the natural pattern and angles of a normal hairline (in one of my videos, you'll learn this is the real art that separates the good transplant doctors from the ones that give you a Frankenstein or pencil-troll look).
  • Candidly, I'm glad I didn't do the normal "strip harvest" incision because it's an older and more invasive approach. Although strip harvest has advantages (you can do 3000-5000 follicles at one time, it's faster and less expensive), it's kinda freaky to think of a chunk of my scalp getting chopped off and dissected. FUE was once dismissed by transplant physicians because it's time consuming and (if they're not trained well) some of the hairs get chopped and don't grow. But if you're skilled at using an FUE tool, and have an auto rotating machine (Bauman used a "cutting edge" and expensive NeoGraft machine), then the process is quick and the success rate is high. 
  • My sense is that FUE will become the standard of care, especially for touch ups and folks that lack good donor hair along the back of the scalp. The trick is that surgeons need to be trained to do it quickly, but there's almost nothing but upside (besides cost) for the patient getting FUE. And FUE is easier to learn and do, so newer physicians and dermatologists are more likely to use them than fussing with incisions and strips (which have risks if you cut too deep, and fail if you cut too shallow).
  • I have a significantly lower hairline now, and it's going to be much more dense than before. I'll need to wait for the hair to grow out, and the maximum benefits won't be realized until 9-12 months or longer. Most of the new grafts will grow soon, then drop (maybe 30 percent will hang). Eventually, they'll get back into the normal hair growth pattern.
  • I can't wait to share the "behind the scenes" footage, because it's informative and really fun. I had a blast, and experienced very little discomfort (mild and short pain with the first anesthesia shots, and while some of the hairs being slid into the mini incisions toward the end of the day). Lots of post-operative treatments helped-- oxygen foam, bruise-reducing herbals, prednisone, pain medication, and even a pressurized oxygen tank -- where I watched a whole movie inside a 7-foot tube enjoying medical-grade pure oxygen (this heals, and has loads of other benefits). Harvest patients usually complain about the pain from the donor scar, but I can lay comfortably on a pillow because the only tender area is on my forehead.

More coming via the magic of video!

I "Came Out" of the Closet: Kobren and Bauman

Posted by Sarah Sweetz Akhza On 3:31 PM 0 comments
Below is a great (and short) video clip featuring Spencer Kobren (who's an author, national association leader, and host of "The Bald Truth") talking with my hair-transplant surgeon Dr. Alan Bauman (Bauman Medical in Boca Raton, Florida)... it was a live broadcast before yesterday's surgery, and they talked about my journey to break hair-treatment stigma.  I've been invited by Spencer as a guest on next Sunday's "Bald Truth" ( to discuss the treatment, and explore why hair treatment is still not "okay" enough for the 100s of celebrities who have been treated to come forward!

Join Spencer and me on "The Bald Truth" this Sunday, August 22 (2009) at 8 pm EST and call in!

It's odd and disappointing that caring about your hair and treating hair loss is still seen as taboo. It's no secret that balding is no sign of pride, and it's surprising that treating hair loss is viewed as vanity or insecurity. Pu-leeze. I am really excited to be a part of demystifying it, and Kobren and Bauman have made it their life calling.

One of the most exciting moments during our live broadcast of the surgery (see excerpt on Bauman's Stickam account) is when my friend and YouTube superstar Greg Benson called in, and "admitted" that he too had a transplant. 

I'm hoping Kobren (who has a great forum mentioned in this video) and Bauman (also on Twitter) can tap Benson for the cause. Benson talked about getting a transplant days before his commercial shoot (see his reel on his new daily vlog channel). Greg also has a really cute dog who reminds me of my new "Fred." 

Look... Hair loss isn't cancer, but male-pattern hair loss effects millions of people in far deeper ways than most realize. Women usually treat without reservation. But I've seen men distressed, depressed, paralyzed or in "avoidance" mode. Primary care doctors (and even dermatologists) are, as quantitative and qualitative research shows, largely disconnected from the impact on men. Some men learn not to care, or decide a shaved head's the way to go. I respect that a lot if it's genuine and not "gunny sacking." I also admire people that choose to treat when it bothers them enough. My heart goes out to the people that feel it's inevitable, and are just bummed out each time they look in the mirror.

Not everyone can afford a transplant, and there are medications that may delay or reduce the need for one. 

I can say two things about this experience:
1) I wish I had started taking Propecia when it launched. I just picked up a ProPak from Bauman's office this morning.
2) I can't believe I delayed getting a transplant. It was so much easier than I thought.

Today's the day. Off to Bauman Medical in Boca Raton, Florida, to get my hair transplant!

If you'd like to watch live... Alan (fallofautumndistro) will be MCing a 30-minute session from 12:30-1:00 EST at this blogtv.com.

See you there!

Another Reason to Fight Balding?

Posted by Sarah Sweetz Akhza On 7:52 AM 0 comments

According to the Onion, balding makes the penis smaller.

Hair Restoration & Celebrities

Posted by Sarah Sweetz Akhza On 7:44 AM 0 comments
I was reminded of this ISHRS survey from this recent article about the "hair-raising costs of restoration."

The ISHRS website survey revealed that 54.8 per cent of men and 45.3 per cent of women would be “more inclined to consider having a hair transplant” if celebrities were “more open” about hair surgery

So maybe a few more people will consider it next week, even if I'm not exactly a celebrity... I just play one on YouTube. :)

I'm Hairy High and Low

Posted by Sarah Sweetz Akhza On 2:01 PM 0 comments
Thanks, Jan, for sending me this delightful song. I wonder what these cats look like today.

Bald Penguins Treated With Style

Posted by Sarah Sweetz Akhza On 12:38 PM 0 comments

But if you're a penguin, balding isn't so bad. This guy, Ralph, got himself a cool new wet suit when his molting went a little overboard. His keepers thought it would help him avoid sunburn, and it only took a while before his penguin buddies allowed him back in the crowd.

Missing Sox Can Cause Hair Loss

Posted by Sarah Sweetz Akhza On 12:30 PM 0 comments

Well your male-pattern hair loss may be caused by missing socks. Sox21 genes to be precise. That's the news from the National Academy of Sciences this week.

"Between day 20 and day 25, these mice eventually lost all of their body hair, including the whiskers. Intriguingly, new hair regrowth was initiated a few days later but was followed by renewed hair loss."

Rough time for mice... the 20s. Beyond day 30 can be even more traumatic for the balding mice, who rarely get hired in their less-cute no-fur alien skin.

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What's Hair Loss Feel Like?

Posted by Sarah Sweetz Akhza On 12:15 PM 0 comments
Spencer Kobren, who has a show, a website, and a book about hair loss, discusses what hair loss feels like for some men. In this recent show (here's an excerpt, and about 3:00 in) he talks about the impact hair loss had on him and has on others. If you're a YouTube user, his channel name is baldtruthradio (the name of his popular radio show).

In his most popular video, Kobren, founder and president of the American Hair Loss Association, discusses how to pick a hair-loss surgeon.

Here's a guy who became aware of hair loss while he was young, and spent his career helping others.

Hairloss Myths

Posted by Sarah Sweetz Akhza On 9:00 AM 0 comments
I'm always amazed by the myths of hairloss. Wear a hat, lose your hair? Please. Hair loss comes from the mother's side? Nope. Hair loss is inevitable? Not true.

Here's a site I inherited while at Merck, and it has some nice myths and facts. Probably my favorite regulatory/legal meeting ever was when an attorney asked for citation on a myth. How do you cite a myth?

Stress can cause hairloss, but it's not the same as male-pattern hairloss. It would typically be in patches in odd places, and that's also caused by other medical issues. Typically hair loss is simply genetics (from mom or dad's side) and treatable... with medication. There are a bunch of causes of hairloss, but if it's slow and progressive, it's usually genetically caused "male pattern hair loss." I haven't been wildly convinced of the efficacy of shampoos or products beyond minoxidil or finasteride. But maybe others have had better experiences with Nioxin or other lotions/potions. Some vouch for laser therapy, and that seems to be one of the few interesting innovations in an otherwise quiet marketplace.

Hats don't cause hairloss. Neither does rubbing the head. The hair follicles just die over time.

Best comment from a guy in our research:

"My mama said to use cayenne pepper on my head. It turned it red." Cayenne pepper might improve some blood flow, but I think mama got the last laugh.

My Nalts Video Introducing This Blog

Posted by Sarah Sweetz Akhza On 2:37 PM 0 comments
This is my video announcing my hair transplant. See the transplant LIVE from Dr. Bauman's office (August 17, 12:30 EST). It will be in FallofAutumnDistro's Blogtv.com channel.

I'm sure it's not the world's first live surgery, but how cool!? You know you want to see follicular extraction and implantation for yourself. Yey!

The post below (previous) has an extended Q&A: Why are you doing this? What's involved? Are you vain or insecure?

The Journey Begins: Nalts Hair Transplant

Posted by Sarah Sweetz Akhza On 8:05 AM 0 comments
Hi. I'm Kevin "Nalts" Nalty (one of the most-viewed people on YouTube, with 90 million views on 800 plus videos). I run a blog called WillVideoForFood.com, but I'm taking this hairloss information here because the content is so different.

I'm setting up this interim blog to document my hair transplant next week, and the experience before/during/after. If you discover this early enough, you can watch it yourself: Monday, Aug. 17, 2009... it's being done in Boca Raton, Florida by a leading physician in the field. If you'd like to watch part of it live, Alan (fallofautumndistro) will be MCing a 30-minute session from 12:30-1:00 at this blogv.com location. I'm writing my book about online-video marketing (likely publishing with Wiley) and Alan has written "YouTube: An Insider's Guide to Climbing the Chart." More importantly, Alan is savvy with the whole live-broadcast thing, and it intimidates me (unlike getting a hair transplant live for the world).

If anything changes regarding timing, look for this post, or check Twitter for updates.
A few Q&A about this:

Are you serious, dude? You're always pranking, so I don't know if this is real.

Yes! It's real. I broadcasted my anaphylactic fit via online video, and my doctor's visit when I thought I was pregnant (turns out, thanks to a comment from a viewer on this video, I discovered I really needed a spinal fusion. It's not a HIPAA violation if the when the patient consents, silly. So why not share a hair transplant with the world?

Which one are you? Vain or insecure?

A lot of people feel like treating hair loss (via Propecia, Rogaine, lotions & potions, or hair transplantation) is a sign of insecurity or vanity. Often they'll say "you don't need to treat your hair loss... you look fine the way you are." But that's little consolation to someone bothered by hair loss. In a recent online survey conducted by the International Society of Hair Restoration Surgery (ISHRS), 59.8 percent of people who were asked whether they would rather have more hair, more money or more friends chose more hair. By comparison, only 26.2 percent of respondents chose more money and 13.9 percent said they would rather have more friends! My research revealed that many guys would give up most of their favorite electronics for it.

Does this have anything to do with your former role as Propecia's Marketing Director?

Nope. This is completely unrelated to Merck. Not Merck sponsored, not compensated by Merck, not Merck reviewed, and not designed to annoy Merck. But darnit, it's the first time in 3 years I can talk freely about hairloss without worrying about attorneys or the FDA! Weeeeee. As a Propecia Marketing Director (a role I left this summer to pursue online-video marketing full time) I did learn a lot about hair loss, and met some of the best hair-transplant physicians in the country. One caught my interest. He's Dr. Alan Bauman (www.baumanmedical.com) and has his own YouTube channel, where he showcases his regular media appearances on NBC, ABC and CBS. I approached him because he came well recommended by colleagues at Merck, and I felt an instant rapport. He reminds me of Doogie Howser (Neil Patrick Harris). Other hair-transplant physicians turn me off because they're clearly in it for the money and gave me willies. Dr. Bauman is not paying me to promote this experience, but generously offered me a transplant for less than he normally charges. Had he not been interested, I might have approached Dr. William Rassman, who runs a really nice blog about hairloss, but I didn't know him as well. More likely, I'd rationalize my concern into submission. Hair Club for Men and Bosley are better known hair-transplant "brands," but I trust and like Bauman.

By getting a hair transplant, are you implying Propecia doesn't work?

Nope. Propecia worked for me, both helping me grow hair on my crown (top/vertex) and slow down hair-loss progression (see Norwood Hamilton scale for typical male-pattern hair loss progression). I believe I also grew some hair on my forehead, even though it's not "indicated" for that. If you're concerned about hair loss you really need to take Propecia before you start losing hair (talk to your doctor first, blah, blah, blah). So hopefully some of my video viewers who are 20 will learn the easy way. I would look dramatically different, I believe, had I started in my mid 20s or 30s and kept taking Propecia daily. Check out "Terry and Perry," identical twins from the Propecia television ads you may recall years ago (see video window at this page on Propecia.com). It's worth noting that Propecia's best advocates are, it might surprise you, hair transplant physicians. They typically urge their patients to treat with Propecia to help the new hairs and prevent additional hairloss (which would looks silly, since the donor hairs from the back of the head will otherwise outlive the forehead). A good hair-transplant physician helps the patient understand what to expect while taking Propecia, and how important it is not to stop. I tried Rogaine for a few months, but it made my hair sticky and rubbing it on my scalp was always a depressing reminder of my baldin head. I may go back on Rogaine after the transplant.

What? You want plugs?

Common reaction. Because we've all seen "hair plugs" that look like a doll, most people think that today's hair transplants are ridiculous looking. News flash. Plugs are the ancient method, and now individual hair follicles are extracted from the back of the head and placed individually on the forehead or other site (I'm getting an FUE- more on that later). So the people who have had recent hair transplants are invisible to you. A YouTube friend asked me if I'd know if I saw someone with a hair transplant, and I said no. He smiled and pointed to his head. And the actors, newscasters, athletes on television and film? It's a small industry... I know who they are, and I wish they'd just acknowledge it!

Why are you getting a hair transplant?

I have two agendas. First, duh, I would like to have hair and look younger. My brother (7 years older and 20 years wiser) has an xtreme receding hairline. But he's a priest dwelling higher on Maslow's Heirchy of Needs than I. Second, I'm hoping to help break the taboo around treating hairloss. My research while at Merck of men with "male pattern hair loss" (MPHL) gave me a deep appreciation for how a portion of the 40-million MPHL men are deeply bothered by hair loss. No kidding- some people see hair as their identity, and are very depressed losing it. The national hair loss society (ISHRS) has some nice statistics on hair loss transplantation (nearly 100K people had one in the US in 2008). But here's the amazing thing. I knew of many celebrities that have had transplants but don't discuss it. Now that's vanity.

Why is it okay for guys to talk about "erectile dysfunction" bot not hair loss?

That's a question that confounded me during my 3 years marketing Propecia. Pfizer and Bob Dole used big bucks and TV to create ED as a socially acceptable condition, but I also think people are okay "admitting" they're treating ED because it's code for "I'm still getting some action." But mention treating your hair loss and you're either vain or insecure. The cause of a flaccid wiener could be medical or psychological, but there's no disputing that hair loss is genetic (not caused by wearing hats, butthead) and can be medically treated.

So this is a public service effort?

Of course that's not my only goal. I wear the old "Nalts" hat because I'm bothered by my Burt-like forehead, and I wouldn't get a hair transplant just for fun or as a cause-marketing alone. But I do hope by treating my hairloss in public I might do -- albeit on a smaller scale (social media not television) -- what Bob Dole did for erectile dysfunction (ED). It became okay to treat, and I believe hair loss should be the same. It always confounded me that a celebrity wouldn't boast proudly about a hair transplant like many do when they treat with Botox. Are they afraid of ridicule?

Are bald people losers?

While it's true that society has a stigma about balding men (look no further than your choice of television or film), I have a lot of respect for people who age with dignity. They focus inward and don't worry about their appearance. "God made so many perfect heads, and the rest he covered with hair." In my marketing Propecia, I was very careful not to suggest people should be concerned about hair loss. Rather, IF YOU ALREADY ARE, then you shouldn't be embarrassed or afraid to treat it... right? I expect a lot of comments on my videos from men who are balding, and feel like me promoting treatment is an insult to their being "one with baldness." To each his own.

What does your wife think about this?

Oprah got a standing ovation on her show when she said "I'd love my man the way he is." That's admirable. But so is being supportive when a spouse wants to take reasonable means to improve his or her health or appearance. Jo (wifeofnalts) would never urge me to treat hairloss, and like many spouses felt obliged to "talk me out of it." I'd probably do the same thing if she considered plastic surgery, botox or a boob job. It would be my way of telling her (and I'm sincere on this) that her outward appearance is not as important to me as her inner happiness. But if it made her happy I would support it.

Dude- this is unnatural. Are you mental?

There was a part of me that considered how odd it is to combat the natural progression of aging. And when I saw Joan Rivers on her recent "Roast" or Michael Jackson's face in recent tributes, I was reminded how sad it is when people fight aging so hard they look unnatural and frightening. Anything in moderation. If you see me looking like Dick Clark in 30 years then I've gone off the deep end. In the meanwhile, however, hair loss is a pain. It's a sad but true reality (as evidenced in research you're welcome to Google) that people with hair are more likely to get a job, make friends, be a leader, and the list goes on. That's not something that will soon change.

How much does a hair transplant cost?

I probably would have gotten a hair transplant years ago, but when you're in debt and not saving enough for the kids' college, it doesn't seem fair to shell out $5,000-$20,000 for myself. Hair transplant prices vary, but ultimately the profession price competes on a "per graft" (unique hair) charge. Rassman (who wrote "Hairloss and Replacement for Dummies,") quotes $3,000-$10,000. It's not for everyone, and I certainly wouldn't shop by price. Many men get multiple transplants over time.

What's next?

This blog is an interim one. I'll post about the journey... answer questions. Try to keep from annoying those regular viewers and readers who don't give a hoot about hair. And hopefully reach, via this blog, some new people who do.

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