About     Contact     Archives     Videos     Events     Hair Transplant

Hello Dr,

I have been following your blog for a while now and am definite that I am beginning to suffer MPB.I am 20,and my dad and brothers were all 16/17 when they started balding. They have all followed a pattern of continued receding from the front hairline untill it reached all over. My temples and frontal hairline however resemble a normal mature hairline. It is the hairs on top and mainly in my crown which when they fall out are noticably and quite a bit thinner than the rest of my hair, which otherwise is probably thicker than average! The crown also looks and feels thinner. MPB has appeared in most men on both sides of the family (just one uncle has escaped it), my genetics are against me!

Although I want to get the situation controlled, I cannot bring myself to go to the doctor, the embarassment is too much. Especially here in the UK it seems trying to beat hairloss has a lot of stigma and embarassment attached to it. Even my parents think I am ridiculous thinking that I am thinning (they think I am ok seeing as i don’t have the same pattern as father and brothers)…obviously not having read what I have here about minaturization and not necessarily following an identical pattern.

I came across this website and wondered what you thought. It claims to give a consultation with an online doctor and then to allow you to purchase propecia online if they authorise it. I wondered if you think this all looks genuine, as I am considering doing it, It does seem so!

The beginnings of MPB is ruling my life but I can’t face the embarassment of a doctor considering friends and family think I am being stupid, also there doesnt seem to be much knowledge on the subject here or specialised doctors/clinics.

Thankyou.

I do not generally condone strictly online consultations, but would not be against it if you can take Propecia to prevent the family hair loss problem following you into adulthood. Nothing compares to a one-on-one patient to doctor relationship. I don’t know if that site is genuine or if prescribing medication like that is legal in the UK. There is nothing wrong with being bald and there should be no embarrassment to request medications to stop the hair loss. I would do your research and find a doctor in your area and have a confidential consultation and examination.

I heard many excellent reviews about your work on Hair/eyebrow transplant, I wish to ask you a few question regarding a procedure. do you do eyebrow restoration? how often do you perform this procedure?. how much would it cost? I enclosed several photograph regarding the area, the scar is about 6cm long and 1/3 cm wide.

I done a procedure with another company back in June 27th, but they only put in 30 (as supposed to 100-150 recommended by most doctors). It’s almost 3 months since [my transplant], I already begin to see 10 follicle grow out. when do you think I can do a 2nd procedure? beside Rogain, is there any medication I can do to speed up the growth? I heard follicile transplanted to eyebrow usually grow faster then those transplanted to scalp? What’s the reason beside the difference?

Since scalp hair is different than eyebrow hair, what do you usually do to make the result look more natural? Thanks for your info!!

It sounds like you were given far too few grafts. Generally it takes 300-400 grafts to complete an eyebrow transplant. We charge about $3000 for eyebrows, but if I do it, it will be $4000 as my fee is higher. Dr. Pak is my associate and he is terrific and his work is impeccable. I would consider another transplant after 6-8 months. By that time all of the eyebrow hair will have grown in. Eyebrow transplants are with scalp hair and grow at about the same time as if it were transplanted into the scalp. In other words, it does not grow faster than when it is put into your hairline.

Snippet from the article:

In my 30years of experience, I have seen several economic situations, each one uniquely different but all the same. No matter the differences, one issue remained the same. If you wanted to endure, you needed to possess every attribute desired by your employer and prospective employer.

One constant is, how you look is as important as what you know. It’s as important to look youthful as it is to look experienced. Unfortunately looking older does not pay off, most of the time you are not perceived as experienced it’s simply perceived as old.

Read the full text at Examiner.com

The article goes on to talk about how important hair is, in that it adds confidence to the prospective employee. I’ve written about this before (and there was an LA Times article about it), but it’s good to get someone else writing about it from time to time. So do you agree or disagree that hair makes the man?

Dr. Rassman,

I’m a 25 year old male that noticed a few months ago that i was starting to thin on the crown of my head. I started using rogaine foam. About a month or so into using the foam I read about Propecia, and vistited my doctor who said that he thinks Propecia would work the best for me. My question is; since I’ve only been using Rogaine for two and a half months, do you think I’d be okay quitting the foam and just using Propecia (which I’ve been on for the last month)? I haven’t noticed any improvements with the rogaine yet(which makes sense to me since the package says it could take many months to start seeing results). I’m just wondering if I can quit the foam without losing hair. I figure I should be okay since I haven’t seen improvements yet.

Thanks so much, doctor. I appreciate your blog very much.

I would hope (though I am not sure) that you did not build minoxidil dependence on the miniaturized hairs. For men of your age, Propecia is a better choice.

My offices observe Memorial Day, so I will be enjoying a long weekend. I’ll be back Tuesday with more hair loss questions and answers. Thanks!

Dr Rassman,
You may or may not have seen this post on the online forums that you visit. Dr Shapiro was the only Dr to answer these questions and as a reader of the forums i wanted to see if you would answer them about NHI?

Do all NHI’s surgical technicians have valid, unrevoked, or unsuspended certificates/licences? Do they place the grafts in the receptor sites during HT surgery? And if they do, Is The surgeon in the room all the time with his HT patient,supervising that process of grafts transplant?

At the New Hair Institute, our technicians were all internally trained by me. They are not certified by any state agency. If you check with Dr. Shapiro, you will find that I was the doctor who trained him in FUT. Our technicians do both cutting and placing of the grafts and the surgeon is either in the room or close by checking on the progress of the technicians frequently. As these technicians have been trained by me, I know what is happening at all times. I am supervising everything that goes on before and during the surgery. Either Dr. Pak or I usually see the patient the next day when we wash the hair and make sure that the scalp is clean of all crusts (mostly done on the day of surgery).

The quality of the technicians determine the results you will get after 8+ months have passed. I recently met with a patient who had over 4000 grafts from an experienced doctor (at another clinic) with what I suspect was a very weak and inexperienced team. When I viewed his results 1 year after his procedure, it was evident that there was easily a 90% failure of the grafts to grow. If the surgeon does not have absolute control over the technical process minute by minute and the technicians and nurses are not very experienced, these large sessions often fail. Here I am just questioning the quality of the technician work in this particular patient. Many doctors have difficulty in hiring experienced people, particularly if they attempt these large sessions and hire inexperienced people. The sloppy work by many itinerant technicians reflects poor training and the patient becomes a victim, never aware of what is happening to him. Even the technicians are victimized by the heavy workload of a very large surgical case and few can manage the tedious work for hour upon hour (e.g. often 7-9 hours for a 4000 graft case with a highly experienced and competent team).

The tragedy here is not just the wasted money (for many people their life savings) but the depletion of the donor hair supply (an invaluable and non-replaceable resource). I warn patients all of the time that as they do their diligence, they should command the ‘team’ nature of this surgery and not go for the least expensive bargain available. This patient paid $2/graft and lost a considerable amount of his donor supply. To say he got what he paid for would be insensitive on my part.

(female)
Dear Dr. Rassman,

The hair on the back of my neck is disappearing and I have no idea why. It started in the end of January 2009. It’s getting thinner from the middle and outwards and creates a parting in the shape of a crooked L (down and off to the side. The hair at the very base is short and thinner and doesn’t seem to grow (at least not very long terminal) I’m not sure if this description is enough for you, but I am at a loss of what to do! Do you think this will subside with time and then the hair will grow back again? I know neck hair tends to grow slower.

Neck hair genetics are different than scalp hair genetics and unfortunately there is little that can be done other than the possible use of minoxidil. I do not believe that I have seen anything written in the medical literature on the loss of female neck hair, but there are many men who show it so why not women? Send me a series of photos and maybe I will understand more of your problem.

• What is your age and state of health?
• Are you taking birth control pills or other medications that can cause hair loss?
• Could it be that you had a tight hair style that pulled on the hairs at the base of the skull, causing traction alopecia?

You get the idea here — a single description of a problem without my ability to ask questions with a good medical history leaves me in a difficult position to help. Consider a visit to my office and then at the least, I can perform my usual extensive examination of your scalp and neck.

You said before that Propecia/finasteride has no effect on sebum. And some people have complained that Propecia has increased their acne. I was on Propecia for 58 days and I didn’t notice my acne getting any better or worse. This being said, is it safe to say that acne is not caused by DHT? Sure, DHT might be present but maybe it’s caused by something on the surface of the skin, such as skin cells not being sloughed off fast enough.

According to Wikipedia, “[acne] is a common skin condition, caused by changes in the pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland via androgen stimulation.”

The pilosebaceous unit (hair, gland, and follicle) become infected as they are colonized by bacteria that destroy some of the microscopic anatomy. The output of sebum just feeds the areas which become infected and the circulating androgens. The list of causes are listed here, as well as descriptions of the social impact of the process in its teenage victims. DHT is just one of the androgens that contribute to acne so the use of drugs like Propecia usually fail to solve the acne problems.

Well, I have been reading some of the information on your site and even checked the details of the LLLT device you had in your office: Revage 670. I think taking one more objective look at LLLT would be a good idea rather than discarding it. I can tell you have a big readership on your site and I will recommend you check out what is being done by ordinary people these days without even going to a clinic to use an over-expensive and under-powered, under-performing laser. Please check out: regrowth.com. Then, see the tons of information about LLLT at OverMachoGrande.com.

Lots of pics of ordinary people using home-built LLLT can be seen by following the links on: regrowth.com.

Thanks.

In my clinical experience, laser light therapy for hair growth did not work on the many patients who used it in my office. I even offered its use at no charge. I do not run a research institution so I can not afford to create a formal study on this subject. I returned the laser to the company. Of course, one can argue that its just my personal experience and opinion, but I do not have any financial motivation for such claim. Plus, I find it somewhat troubling when the author of such study sells and promotes the very item he’s studying.

Im a 20 year old male. At the beginning of the year, I had some pretty major peeling of my scalp along the left side of my hairline. The peeling caused the hair in that area to come out as well. I finally went to the doctor and he prescribed me some special shampoo and the peeling has been gone for approximately 4 or 5 months. However, there has been nearly no hair re-growth in the area the peeling occurred, just some small hairs that recently began growing. How long will it take this hair to re-grow or could this loss be permanent?

This sounds like a form of seborrheic dermatitis or possibly psoriasis, though I’m not entirely sure what you mean by “peeling”. Go back to your doctor and ask him/her about these conditions. Generally speaking (without reference to your “peeling”) either of these conditions should not cause hair loss unless you picked the skin and pulled out your hair. I would keep waiting to see if the hair will regrow.