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Dr. Rassman,

I appreciate you answering the last few questions I’ve sent over. But to follow up, when I see hair shedding as a result of minoxidil and/or finasteride, can I read anything into the quality of the hair that is shedding? Does it mean one thing if the hairs are long and dark as opposed to miniaturized and light?

I believe that you are reading too much into the shedding, but I have not examined shed hair so I really do not know what is happening. The shedding appears to be a shifting into another hair cycle, nothing more.

Dear Dr Rassman:

I’m a 27 year old who has long suffered from Fibrous Dysplasia (I’m not sure if you are familiar with this disease). Due to my ailment, I have incurred over 30 medical surgeries over my lifetime. My hair was thick up untl high school, and then it really began to thin. The only ancestors of mine that have been bald were only two of my great-grandfathers. I was wondering if all of the major surgery I have had would have caused my hair loss. Also, I have been on propecia since November of last year and am having some back surgery next week. Would the shock of surgery or the medications used cause my hair loss to increase? Also, because I may be missing a couple of days of propecia doses would this affect the progress of the drug in combating my hair loss?

I’m familiar with fibrous dysplasia (it is a very rare bone disease), but I do not know what surgery you have had or what medications you take. Your question is very general and it is not something I can give you an answer to in this format. You need to see a physician and have a complete history and examination.

In most cases, hair loss in men is caused by genetics. If you have an autoimmune disease like a form of a scarring alopecia, surgery done in these conditions can be dangerous and produce failures of the grafts and further scarring of the scalp. Any medical illness or surgery that is a stress to your body can cause hair loss (sometimes permanent). But to distinguish that from genetic causes is something that only a thorough examination with a physician can provide. You are looking for a cause and effect type of relationship and I really cannot help you with the limited information I have.

This is in response to My Hair Transplant Made My Skin Cobblestoned!

So, Selective removal of the grafts via FUE is not an option to reduce the cobble stoning? I too have this issue, and I only Have a few hundred grafts, not all of them are cobble stoning, maybe a total of 200 are cobblestone. I know FUE leaves a small scar, but would the removal of 2-300 grafts over my entire scalp really be that noticeable? Why do you say more hair transplantation is the only option?

Follicular unit extraction (FUE) is done with very small punches where a follicular unit is removed one at a time. Cobblestoning is a whitish scar with no hair in it. If you want these white scars punched out, then they will form new white scars, i.e. no gain. Removing the entire larger graft with the cobblestoned skin is the only real way to do this, and the scar that may be formed will probably be less detectable than the cobbled area. Depending upon the location of the cobblestoned area, camouflaging it with a hair transplant may be needed.

This is a very difficult question to answer without seeing just what you are concerned about. Please send me photos and I can be more pointed in my answer to you.

I had cancer a couple years ago and it has left my hair much thinner then it used to be. where its has got thin the most is on the top of my head. the top of my head used to be the thickest part. Ive heard that going through chemo causes scarring. Is there anything out there i can take or apply to help with the scarring and/or maybe get my hair back to the way it used to be? or should i just do some minoxidil and hope for the best?

Chemotherapy does not cause scarring. What happens when the hair falls out secondary to the chemotherapy, is that as the hair population decreases, so does the blood supply. When we transplant those people who are balding, the blood supply is often lower than on those people who have a thick head of hair, but with transplants, for example, the blood supply comes back as the hair grows. I would have to examine you if you wanted an opinion on the status of your scalp and hair.

I have heard Biotin can aid in hair growth. Is this true? If so what daily dosage do you recommend?

I do not believe that biotin can aid hair growth, but I’m sure I’ll get plenty of emails or comments from people disagreeing with me. There’s a lot of websites out there that go on and on about the virtues of taking biotin for hair growth, but I’ve yet to see a credible site that isn’t pushing supplements for sale talk up those virtues.

i have scalp acne or pimples its scattered all over specially the back of the head…im losing hair and im really depressed…i really don’t know what should i do ? and is there a chance that i could have my hair back ?? thanks

You need a doctor to make a diagnosis and then treat your problem. Hair loss associated with infections of the scalp is not uncommon, but this is when you need a good dermatologist to take charge of the problem. I don’t know enough about your case to provide any real comfort here. Sorry.

My question is about the sox21 gene. I was ecstatic when the news broke that scientists have discovered the “hair loss gene.” I am wondering if there has been any progress with this, or even any attempt. Who is doing the research to further understand this gene and search for its connection with the cure for hair loss? Although its been less than a year, and the hair loss prevention field of science seems to move extremely slow, I still figured we would have heard more about this in the news.

I understand if you have no insider information on the subject, but I don’t know where else to go for the latest in hair loss related news. thanks.

The following response is by UK-based physician Dr. Bessam Farjo:

Response by: Dr Bessam Farjo United Kingdom

Of course it is very exciting whenever there is news about scientific discoveries in our field. However, do keep in mind that hair loss and restoration are very attractive subjects in the media, and I find some scientists or institutions take advantage of that to attract publicity and hopefully additional funding for their research. My understanding was that the group who studied the sox21 gene were not investigating hair loss nor were they interested in this subject. The study was on mice, not humans, and showed a relationship between this gene in the mouse and TOTAL body hair loss in it. This does not necessarily mean there is any relationship with inherited patterned hair loss in humans.

The researchers were speculating as a result of their findings that this may help in the future with hair loss research in humans. Significantly they also stated that they had no intention of investigating this further. As far as I know there has not been any further results or conclusions with regards to sox21.

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Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

what is the normal eyebrow hair loss per day? what does alopecia areata look like in the eyebrow area? is it a sudden hair loss?

The eyebrow telogen cycle lasts about 9 months, so for hairs that fall out, it would take up to 9 months for them to return. I suspect that the growth phase is also shorter than scalp hair, possibly 3-6 months, which means that the growth of eyebrow hair occurs in short periods of time. We see the same with body and leg hair (long telogen cycles and short growth cycles). For more about hair cycles, see here.

The appearance of alopecia areata may occur in spotty areas or parts of the eyebrow. A biopsy of the edge of such spots of balding is the way to make the diagnosis. These patchy areas often start small and then enlarge.

I just ran across a collection of photos on some celeb gossip site. I never realized Joel McHale from The Soup and Community had hair issues, but his hair looks good now. What do you think, did he have a hair transplant?

The change you see in the photo on the left (with an isolated forelock and hair loss around it) to the photo on the right (with a full frontal hairline) is often what I see when I do a hair transplant. I would think that he had a good transplant job done. Now it looks like a mature hairline as opposed to someone going through frontal hair loss. If I were the surgeon, I would have produced a slightly less concave shape bringing down the corners about another 1/4 inch.

Can you post a picture of a male who received a hairline lowering procedure? I can’t find any only females. Thank you!

I have never done a hairline lowering procedure on a man because of the risk of further balding, but there would be no difference in the technique between this procedure on a male or on a female.

On Dr. Sheldon Kabaker’s site, he’s got just 2 male patients out of 32 patients shown, likely because it isn’t as common of a procedure in men. The male hairline lowering patients he’s posted can be found here and here.