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This is a hair transplant patient who wanted his hair thicker, but had depleted his donor supply so that more transplants would not be productive. Many doctors would try still another procedure, but this was not my approach. Instead, I put pigment into the areas where he wanted more thickness. He loved the results of his transplants for his Norwood class 6 pattern and over the years he received a total of 6,905 grafts for that pattern, but as with many patients who have advanced hair loss, the supply did not eventually sustain the demand for hair.

With the addition of scalp micro-pigmentation (SMP) to augment the fullness, he felt that the results were exceptional. After his first SMP session he used a hat, but slowly and cautiously he showed off his shorn scalp to his friends without creating much fanfare. In a social setting, his friends saw the new look and all he got was compliments on how good he looked with his new hairstyle.

The first photo (left) is of the patient’s hairline after all of his transplant work (last procedure was almost 4 years ago); The next photo (middle) is immediately after shaving his head; The last photo (right) is 2 weeks after his first SMP session. Click the photos to enlarge:

He came in for his second touch-up SMP procedure, but this time we went a little denser with the pigment. The key in the plan I put together was that the SMP would be placed in behind the leading frontal hairline that we created with transplants so that he could let his hair grow out whenever he wished. As the interval between the first and second procedure was 2 weeks, he let his hair grow out over that time to sense what it would look like when he let it grow out long. He could not have been more pleased with the result! I’ll post some photos of the results in the coming weeks.

Since my post from last week, I have come under fire on some forums and even on this site for changing my stance on scalp pigmentation (from being somewhat negative in past posts to my current enthusiasm). Really, the change in my view reflected a better command on the art, something that I hadn’t previously seen when I made my earlier comments about the tattoos that I saw in my office over the years. I realize now that I should’ve been more open-minded to possible advancements.

Nothing is perfect in this world. This patient would have rather gone the transplant route or have taken a magic pill that would get him his hair back, but it was not a reasonable option for him… so as a second best option, SMP more than met his goals. Now I must note that due to his nearly 7000 grafts that were transplanted, he does have a linear scar in the back of the head. We’re still working with him to cover it with SMP and will post resulting photos soon.

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Update Mar 8, 2011: More photos here!

I am an 18 year old male who’s hairline has receded recently. I would consider myself a Norwood 1.5 on one side but the other side still maintains its juvenile perimeter. Due to my paranoia, I recently attempted to initiate a homemade miniaturization test. I plucked a hair from the corner of my receding temple and from the vertex of my head and found the corner to be slightly thinner. I then proceeded to compare with hairs on the sides of my head and hairs on the sides of my vertex. I found them all to be thinner then the thick mane that runs through the dead center of my head all the way to the hairline.

My question is, is it normal to find hairs to be slightly thinner on sides and corners than the very top of head?

What you are doing on a one-hair-at-a-time basis, is what we do for a 1 square inch area that will clearly define your hair bulk and find out with accuracy if you have less bulk on the sides than on the top. You should have good numbers (metrics) put to your observations and then you will be able to tell what is happening. If what you’re noticing is confirmed by measurements, then I’m really at a loss.

What you’re describing is unusual and almost the opposite of genetic male pattern baldness (which would mean the top thins while the sides remain thick). An examination would be critical for me to draw any conclusions at all.

Snippet from the non-hair-loss-related article:

Of those who took painkillers regularly, 64 percent said they could never get an erection, compared with 36 percent who did not routinely take NSAIDs.

After accounting for factors like age, weight, high blood pressure and cardiovascular disease, the researchers still found a 38-percent higher risk of ED among men taking painkillers.

Read the rest — NSAIDs Linked To Higher Risk Of Erectile Dysfunction

The study, published in Journal of Urology, looked at nearly 81,000 men aged 45-69 and found that of those that took aspirin, acetaminophen, ibuprofen, and similar NSAIDs, there was significant risk of developing erectile dysfunction.

USA Today also has the story.

I have noticed that it is much easier for me to pluck/pull out a single hair from the top of my head than from the back of my head, where hair loss wouldn’t occur. I have thick hair, no thinning on the crown but I have a norwood 2 hairline for sure. Does this mean that I will likely lose the hair on top? Thanks

One might assume that if the hair in a certain area of the scalp is easier to pull out than other areas, that means you’re going to lose it there… but in actuality, there’s no connection that I’m aware of.

(female)

I have in the past gone to HRC and lost my hair on the entire crown of my head due to the gluing of the hair pieces on my scalp. I also had a consultation with Bosley who informed me that I am not a candidate for transplantation as there isn’t enough donor hair. When cloning happens, I would really wish to have it happen for me. Is there hope for my hair loss?

Getting a second opinion is always a good idea as I offer this as a service, but I would need to see you to make such an evaluation worthwhile. You’re not far from my LA office. Many women have this problem with sufficient donor hair, but that can be determined upon examination of the scalp.

Advancements in scientific technology are happening every day. Stem cell research, cloning and more recently advances in hair multiplication will become alternatives to traditional hair transplants in the future. Just how soon that future is, I can’t say. It is an exciting time science-wise, but the enormous amount of data and its implications are still not fully understood.

There is every reason to hope that there will be something in the field of hair loss regarding cloning in the future if the traditional second opinion backs up your first consultation. We are far from the finish line and it will take time and a great deal of patience.

I took Propecia for 7 months before developing erectile dysfunction over night and a low libido that onset more slowly. I immediately discontinued my use of the drug. Unexpectedly, one year later I still have erectile dysfunction and low libido, and my hairloss has not resumed!

I had my hormone levels tested by a neuroendicronologist and it was found that my DHT levels were far below the normal range for adult males. I had an appointment with a sexual psychologist and she determined it was a physiological issue. Is there anything I can do to restore my body to where it was before I took Propecia?

I have difficulty believing that you just developed erectile dysfunction (ED) overnight after taking the medication for more than half a year. You need to see an expert in sexual dysfunction. I have seen a few patients who had your symptoms, though none of them with rapid onset and all of them who stopped the drug saw a complete reversal in less than a week.

ED will likely lead to your confidence going down, which in turn causes the gradual of libido… but I do not believe that the ED can be blamed on Propecia if you have been off of it for some time.

Dear Dr. Rassman -

Just thought it might be worth flagging up with your readers that the new rogaine foam is scent free. That is, it no longer smells like grandma’s hair spray. I know the awful smell kept me from using it in the past, so maybe other readers out there would benefit from knowing the change.

While we’re on the topic, can I ask a Rogaine question?

I’ve stopped taking propecia because I was one of the few with side effects and was curious whether you thought Rogaine was worth it in isolation. So, what I mean is would you take it on it’s own or is the impact of taking it in isolation limited. I ask because I don’t really want to go through a shed and the hassle of taking it regularly if it doesn’t seem worth.

Certainly curious about your other readers’ experience with the product.

Thanks for the tip about the foam now being available in unscented. I found this press release about it for those interested. But really, Rogaine Foam is now scent free. That’s all the press release really says.

As for your question — I have seen patients in the past who use Rogaine with good results, but most men are not creatures of habit and the compliance of applying it twice a day makes it a challenge over the months/years.

Hey guys I hope you are doing well. Could one of you please explain the pros and cons of trying out a PRP only treatment for Diffuse Patterned Alopecia. The pictures you see on line look like the treatment is beneficial, and it seems like if done on a yearly basis it could really help in the uphill battle which is hairloss.

I’ve still yet to see a shred of evidence that platelet rich plasma (PRP) will benefit those with alopecia. I’ve written about PRP before.

This patient is in his mid 40s and is thrilled with his results from taking Propecia daily for a little over a year. The corners of his hairline appear to be a little bit stronger and certainly there is noticeable regrowth in the crown area.

No surgery was performed on this patient, and I must note that the lines you see drawn in the before photos were where a hairline might’ve been placed if he elected to have surgery. Click the photos to enlarge.

AFTER PROPECIA (no surgery):

BEFORE PROPECIA:

Snippet from the study abstract:

PURPOSE: This post hoc analysis of the Medical Therapy of Prostatic Symptoms trial examined the effect of finasteride alone compared to placebo on the clinical progression of benign prostatic hyperplasia in men with a baseline prostate volume less than 30 ml, or 30 ml or greater.

MATERIALS AND METHODS: Men were randomized to placebo (737), 4 to 8 mg doxazosin alone (756), 5 mg finasteride alone (768) or doxazosin plus finasteride (786) (average followup was 4.5 years). Approximately 50% of patients had a baseline prostate volume of 30 ml or greater. The present analysis was based on the finasteride alone and placebo arms only, and included patients for whom baseline and end of study data were available. We examined the effect of treatment on the cumulative percentage of men who did not experience clinical progression of benign prostatic hyperplasia by study end.

Read the rest — Long-Term Treatment With Finasteride Improves Clinical Progression of Benign Prostatic Hyperplasia in Men With an Enlarged Versus a Smaller Prostate: Data From the MTOPS Trial.

This was new data mining of a previous study that included over 2200 men with an average followup of 4.5 years. The new study concludes:

“Long-term treatment with finasteride led to a significant beneficial effect compared to placebo on the clinical progression of benign prostatic hyperplasia in patients with lower urinary tract symptoms with an enlarged prostate (baseline prostate volume 30 ml or greater). Finasteride had no significant effect compared to placebo on the clinical progression of benign prostatic hyperplasia in patients with lower urinary tract symptoms with a smaller prostate (baseline prostate volume less than 30 ml).”