About     Contact     Archives     Videos     Events     Hair Transplant

Do the people who are destined to become a Norwood 7 start balding early? i mean around what age do they usually start balding?

Yes, I do believe that the advanced balding patterns like a Class 7 pattern does start to show up earlier.

The best step for you if you think that you are in that category, is to get miniaturization studies and bulk measurement studies done on various parts of your scalp. Any early miniaturization or bulk studies will help you follow the changes over the years with good measurements… and best of all, it will tell you what the diagnosis is and how you are doing with any hair loss medication you’re using.

Dear doctor, I would like to know whether Propecia interacts with L-Montus.

I have been using Propecia for almost 1 year and it really did wonders to my hair. My hair texture is thickened and it covered almost all my thinning areas. Thanks for all the education you provide through this website.

I wasn’t familiar with the name L-Montus, so I researched it and found that it’s a nasal congestion medication made by Indian pharmaceutical company Fourrts. The medication is actually levocetirizine and montelukast.

Montelukast is more commonly known as Singulair, and levocetirizine is more commonly known as Xyzal. I don’t see any interaction problems for these medications with Propecia (finasteride), but double check with your prescribing physician.

Doc,
Do most patients dealing with DUPA hair loss start thinning out everywhere evenly in your experience. I’ve thinned out on top and a bit on the sides but the back under where the crown thinned is still thick and dense. Is it possible to have partial DUPA or can the thinning above the ears be stress related or due to some other external factor? Thanks

PS - Thank you so much for the blog and I decided to make a move and actually go to an open house event at NHI. Keep up the good work!

I do not mean to seem sarcastic, but DUPA looks like as the name implies — diffuse and unpatterned. In general, the back of the scalp (the male donor area) would be affected if you have DUPA. With genetic male pattern baldness, it wouldn’t be typical for the donor area to be impacted in the same way.

I’m going to rant for a moment, even though I know I’m running the risk of repeating myself. I’m disheartened by the amount of emails I get from people that are upset about the “bargain” hair transplant they got at various clinics around the globe. Of course, we realize that usually it’s the negative results that are the subject of such communications and we do not often hear from those patients with great results, but I felt I needed to post this as a reminder to the regular readers and hopefully something fresh for new visitors.

I believe that finding a good hair transplant doctor is like locating a good heart surgeon. Yes, heart surgery is more important than a cosmetic surgery… but I’m referring to the process of selecting a doctor. There are many qualified surgeons, but only a handful are capable of producing consistent, high quality results. In the heart field (I started out as a cardiac surgeon), you simply die when you select the wrong surgeon or get the wrong surgical team.

I’m sure I’ve mentioned it before on this site, but I remember a patient who came to see me (with his two kids) for a consultation. He then selected another doctor just a couple of miles from my office to have a transplant at the low, low price of $1.75/graft. When costs are too cheap, the quality of care tends to be low and corners are cut. That patient died during the transplant. It was the only death from a hair transplant that I’ve heard of. Granted, this was an extreme case of a hair transplant gone wrong. The usual result from a hair transplant that does not go perfectly will be with you for the rest of your life, and if the process is done without a focus on details and the art of the transplant, you will end up advertising your poor decision to everyone you meet. So please, please read this easy how-to guide on selecting your transplant doctor — here.

Some of the public is misinformed when it comes to doctors who offer hair transplantation. Just because a doctor is offering it, it doesn’t mean he can actually do what he’s selling you. The results from a hair transplant takes 6-8 months to grow, so by the time the results are evident, the patient’s check has cleared the doctor’s bank account and as many patients find out, there is little recourse to getting their money back from a failed hair transplant. Or worse, the results are clearly unnatural and detectable. Remember to research, meet patients, and be a smart shopper. I know the economy isn’t great for a lot of people right now, but don’t forget that this surgery is forever.

Further reading on this topic can be found here:

• Could I Die During a Hair Transplant Procedure?
• Why Is Surgery So Expensive?
• Even Today, The Quality of Hair Transplant Work Can Be Less Than Marginal (with Photos)

Snippet from the article:

Stem cells produce progenitor cells, or so-called workhouse cells.

“If we figure out a way to wake up those stem cells, get them to make hair for progenitor cells, that would go a long way toward developing a treatment,” Dr Cotsarelis told ABC News.

Researchers predict they’ll be able to do that within a decade. But until then, millions of customers will be left waiting, and spending.

Read the full story at ABC — Baldness Breakthrough: Scientists to Find a Cure to Male Balding in 10 Years?

The article itself just rehashes what was written about the recent stem cell announcement, except with this additional sentence — “Researchers predict they’ll be able to do that within a decade.” Which researchers? When was this prediction made? What was the basis for the prediction? Seems like more lazy reporting.

To me, the interesting part was about the stem cells, yet the headline was about a single sentence that had no further information attached to it; an obvious attempt to be sensational and attract eyeballs. While I hope the cure will be here within 10 years, I see this type of proclamation every few months as the timeline moves again and again.

Hi Dr.Rassman,

I got a crazy idea, not sure if it will work though, I need your thoughts. Is it possible to filter rogaine to a point where it is very pure or highly concentrated to a point where it is beyond 5% say 50%+ and inject it into a balding area with a syringe for direct/better absorption rate. Do you have a hypothesis on how it will affect the balding area? Better yet what if I mixed it with propecia and have a rogaine/propecia substance? would this be more effective?!!!

Do not inject minoxidil! Rogaine (minoxidil) is a blood pressure lowering medication when taken orally. In an extreme case, injecting it could kill you. If you inject it in to your blood stream, skin, or muscle you may have a very dangerous adverse side effect with no hair growth.

Do not play mad scientist in your body. Use medications as directed, please!

For the last couple of months my hair has been falling out all over my head. I have bold spots everywhere and i dont know what is going on. I stopped putting perms in for about 2 months know and i dont know what to do. Can someone please tell me something that i can do im young and i have a daughter.

If there’s chemical burns on your scalp from the perms, it could take up to a year to see regrowth… if it will grow at all. I have no idea what’s going in your particular case though, so I’d suggest you see a dermatologist in your area to get to the bottom of it. The bald spots could be related to the chemicals or could be something else entirely.

What is the average distance between each hair at the hairline and about a half inch behind it on a non balding adult male? And what is the smallest distance between each graft you can safely transplant at the hairline? When you normally transplant grafts at the hairline is the distance between the grafts always larger than the native hair of the person. I know only single grafts make up the first few rows of the hairline to give a natural looking transition but if they are not packed closely enough the hairline looks almost “see through” or whispy looking. I have noticed this on alot of transplant photos. Is there anyway to avoid this and give a very dense looking hairline transition even using single grafts?

I am a male with minor female pattern balding with very little temple recession but my hairline transition has become thin and whispy and looks similar to the hairlines created with a hair transplant in a totally bald area? My goal would be to thicken up the transition area so it looks thicker and dense similar to the hairline of Brad Pitt or Tom Cruise since I am in their age bracket. Is that even possible?

First off, I’d like to think I am a good surgeon, but I highly doubt I can make you look like Brad Pitt or Tom Cruise.

Second, a hair transplant cannot give you back the same hair density as you once had. Think about the simple fact that the surgeon has to get your OWN hair from the back of your head and move it to the front. In other words, the surgeon isn’t creating any new hair, just moving hairs around. If you move too much hair from the back you will be bald in the back (so to speak). Thus, the main goal for a hair transplant surgery is to give you a non-balding hairline and good enough coverage. But a hair transplant cannot give you back the fullness of Brad or Tom. Maybe another way to understand this point is to know that an average non-balding head has over 1250 hairs in a square inch (or 625 follicular units in a square inch).

The only exception to this is if you do not have too much hair loss (like Norwood 2 or 3) and understand you will not achieve the FULL look with one surgery alone. You need multiple surgeries to fill in the ‘gaps’ to achieve the fullness. You must also consider conserving the remaining donor hair available in case you continue to lose hair at the top and crown. This is what we refer to as the Master Plan.

There are several patients that come to mind who requested precisely what you are asking for. The patient below is one such example of a Norwood class 3 pattern patient that had two surgeries with me in a very small area. Click to enlarge.

2 years after two hair transplants totaling 3182 grafts:

Before:

Snippet from the article:

An inability of stem cells in the scalp to develop into the type of cells that make hair follicles may be an underlying cause of male-pattern baldness, according to a new study. The discovery gives hope that people who are bald could regrow their hair with a future treatment, said study researcher Dr. George Cotsarelis, a professor of dermatology at the University of Pennsylvania.

In people who are bald, hair follicles have shrunken and become microscopic, Cotsarelis said. And scientists long thought that bald people also had a depletion of hair follicle stem cells, which are necessary to grow hair.

But the new study shows that bald people have the same number of stem cells as those with hair. So if scientists could coax the stem cells into producing more hair follicle progenitor cells, then it would be possible to generate bigger hair follicles that could grow hair, he said.

Read the full story at Livescience.com– Balding may be a stem cell problem

Our work on using plucked hair to grow a new hair in the balding area may touch on the subject material mentioned in that article. With new hairs growing from plucked hairs, does this mean that the new hair came from the plucked hair and its stem cells — or do the stem cells in the recipient plucked hair area stimulate the original hair to grow from “the stem cells which were unable to complete their normal development and become hair follicle progenitor cells“?

There is still much to learn here, but we have suspected for a long time that the bald areas contain the elements that can grow hair, but because of various defects that are described in brief in the reference here, they just don’t grow. I can imagine that some day we will harvest stem cells in enough quantity such that injecting them into the bald skin may bring back the original hair and cure baldness permanently. More research is surely needed and being done as this is the big lotto hit.

(female)
Hello Dr,
I was wondering if shock loss occurs in cases of eyebrow transplantation? Also, are there any other side effects that could potentially occur? Thank you for your time.

Shock loss can also occur with eyebrow transplantation. The main side effect (if it can be called a side effect) is lifelong trimming of your eyebrow, as it will continue to grow like your scalp hair. For the original viable eyebrows that falls out from what I will call hair transplant shock, these may not grow back and it can result from damage induced at the time of the surgery. Original eyebrows seem to be sensitive to trauma more so than head hair.