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Hello Dr. Rassman,

Thank you so much for the service you provide the public with this site. It must be alot of extra uncompensated work for you, I appreciate it.

I got a 1300 hair graft about 9 months ago to the area that I roughly outlined in red (on both sides of my head of course, I am only showing one side). As you can see it is growing at nearly a 90 degree angle on my head whereas my natural hair falls forward. Even though I cut my hair at the same length, the transplanted area looks twice as long because it is growing directly ‘up’. My two questions are this: 1. Is this a lack of skill on the doctors part that it is growing at an unnatural angle? and 2) if I keep trying to comb it forward can you gradually adjust the natural angle of the hair so that it matches with the rest of my hair as to the angle that it grows (or will the transplanted area permanently be at odds with my natural hair growth angle)?

My doctor recommends a second procedure because as you can see the transplanted area looks quite thin. I am 26, do you see any concerns with having a second procedure done with this doctor, or do you sense a lack of skill and I should look elsewhere? I have minor thinning in the crown area as well, but I do not plan on transplanting anything to that area. I have been on propecia for 9 months, and while it has not totally regrown the crown area, I am hoping that it will prevent further loss in that area.

Many thanks, and feel free to post the picture.

Thank you for permission to post your photo. Please click the photo to enlarge.

You are correct. It seems your hair was transplanted at different angle than your native hair. The surgeon planning for the correct angle and direction of hair is a very important factor in a hair transplant procedure. Unfortunately, this is very difficult to correct and relatively impossible to reverse. Your transplanted hair will always grow in that unnatural direction. One of your options is to have another transplant procedure and make sure that the new transplants are in the correct direction to “blend” in with your hair.

With respect to a second surgery with the same doctor, you need to be able to trust the doctor before having any procedure. Doctors are human beings and they can make mistakes or misjudge the many decisions that are before them in a treatment plan. If you and your doctor have a good trusting relationship, I am sure he/she will see the difference in angle and your concerns and will be more than happy to accommodate accordingly. The key here is to directly discuss this with your doctor first, and then make decisions on the value of the doctor/patient relationship.

I am a 38 year old mail in good health and good physical condition, however like most men my hair has begun to thin. I saw the infomercial for “ScalpMed” and it looked promising, so I thought…what the heck, i’ll give it a try. Now, my question is this, it appears that I shed more hairs in the morning when I wash my hair (using a a ph balanced DHT reducing shampoo) after using this product. Can minoxidil cause one to shed more hair since I know this product contains this? If I don’t use scalpmed at night, the next morning when I wash my hair I have fewer hairs in the tub– about 14 without Scalpmed, and 20-40 with Scalpmed).

I also would like to make a comment to the medical industry. If one wants to try and find a cure for baldness, maybe they should research the italians or greek bloodline and see why the majority of those men have their hair way into their 40’s, 50’s, if not later years. Maybe they should research those genetics???

Thanks for your time and insight.

It is normal for one to lose 100 to 150 hairs a day. It is also normal for one to be concerned about hair loss and be proactive as you to try with products such as “ScalpMed”. Unfortunately there is no way to tell if these products actually work. That is why most are not sold as medications or FDA approved products. If ScalpMed is causing you to lose hair, I can not comment on it for there is no real information on the issues of safety or effectiveness.

Minoxidil has been studied as a topical treatment and shows good promise of hair growth in some individuals. To date, there are only two medically proven ways to treat male pattern baldness where it is not really ‘hit or miss’.

1. Hair transplant, which works 99.9% of the time
2. Propecia drug regimen (which may or may not work for you but it met strict FDA requirements) is more reliable, the earlier the hair loss is seen. In men under 30 with thinning and not recession, the reversal in my experience is significant. Reversal of a receding hairline, however, is highly unusual (even in the young man). The key to this drug is to start on it early if you have genetic balding and get to the hair while it is miniaturizing and before it falls out.

To more specifically answer your question, counting 14 vs 20 hairs lost per day seems insignificant (at least from a medical perspective). As stated, we normally lose on the average 100 to 150 hairs a day. ScalpMed may be contributing to the extra 6 hairs that you are losing, but there is no way to really tell.

Finally, the hair loss gene spans all races and cultures. The study of Italians and Greeks has already been done and there it still almost 50% of men in these ethnic patterns that have hair loss.