Hi Doctor,

I’ve sent a few blog questions through, so I do apologise for the influx of emails you’ve probably received from me.

I’m 21. I suffer from OCD, and I’ve recently been extremely worried about my hair. I’ve posted numerous pictures on various different forums to try and get an analysis of my hair, and I’ve been told my hair is fine. However, I’m still worried, but am unable to afford an appointment to go to a trichologist. So, I was wondering if you could take a look at my album of photo’s. There’s a fair few in here to get a decent look at my hair.

At first I was worried about my crown area/top of my hair, but was told that I’ve got a natural parting coming from my crown. Then I was, and am worried about my hairline, but was told I have a ‘mature’ hairline. Still, I was wondering if you could take a look for me and tell me how you think my hair and hairline is? What Norwood do you think I am. I also have seborrhoeic dermatitis so my scalp is quite inflamed/red.

Basically, do I need to worry, or is it just my OCD?

Oh, and feel free to post the picture album of my hair if this question get’s published. I don’t mind. Thanks.

Click the photos to enlarge:

Nothing I can say online is a substitute for a medical exam or seeing your doctor in person. As you state you suffer from obsessive compulsive disorder (OCD), I think you need to have that under control. Since you’ve posted these pictures on numerous forums and have gotten a reply that your hair is “fine”, I do not know how much more I can add. Your hair looks very good to me, but there’s only so much I can tell based on photos. Base don the pictures, the hairline looks strong and thick, as does the crown.

If you are still worried and your OCD is under control, make an appointment with a doctor you trust, especially one who can perform a HairCheck bulk analysis which gives a metric for the presence of hair loss. I’m not going to be able to assuage your OCD and hair loss paranoia, but I do thank you for letting us use your photos.

Doctors,

I have been taking proscar, religiously, cutting it up into quarters for the past 5 years. I have had moderate success in keeping what I have, but not any new hair growth. My temples have still receded and a little bit of the front part of my hairline has receded. However, in the past year and a half there hasn’t been any hair loss whatsoever. I am 29 years old, if I haven’t seen any hair loss in the amount of time I mentioned does that mean I have reached my final hair loss pattern and I will no longer experience hair loss, and I can go for a transplant procedure?

The last thing I want to do, go for a procedure and then all my native hair falls out and I am left with only transplanted hair. That is why I am sometimes confused as to how long one should wait to get a transplant and how would one know what the “final” pattern is at such a young age like mine.

The real question is: Is this your final hair loss pattern? You can guess at this, but at 29 years old, that might be difficult. Well-delineated patterns often show the final pattern. That means if you are (for example) a Norwood class 3 pattern, the area where the hair is should not have any miniaturization when looked at under a video microscope, and the hair behind it should not have bulk reductions as measured by a HairCheck instrument.

If you had clean borders and no loss of hair bulk behind your existing pattern then you could assume (not 100%) that for the moment, the hair loss should have stopped. The problem is that many people who see it stop may find that it picks up again years later. With the combination of what I discussed here with the continuation of the finasteride treatment, you may be one of the lucky few. If you are in Southern California, I would be happy to do these tests for you in my Los Angeles office.

I had the idea of combining SMP with the occasional use of hairpieces to basically give me the hair style options of any non balding man (at a much higher price of course.) This way, each would get rid of suspicion of the other; being able to grow hair and being able to shave it. My question is, would the glue used to bond the hairpiece to the head ever damage the SMP? I’d never excessively use hair pieces- just now and then for special occasions.

Wearing a hair piece or hair system will not damage the Scalp MicroPigmentation (SMP) pigment. If the glue does not damage your skin it should not damage the micropigment under your skin.

This is a video I received which shows the use of nails to dilate the incisions in the scalp. This was more common years ago when doctors were learning the process. The nails were used to force open the recipient holes so that the doctor or his staff could place the grafts into the balding scalp easily.

Few, if any other doctors, use these today and those that did do it, eventually learned to do so with more delicacy. The use of dilators reflect the doctor’s comfort with the technique of placing grafts.

The first minute is worth watching… the ending part is an advertisement that I do not endorse. I’ve embedded the video below:

I understand that you do not like the results of body hair transplants but do you think it would be an option for patients that were interested in keeping their hair cut very short and did not want the scar from FUT surgery?

Body hair transplantation (BHT) should be considered as a last resort (if you’re out of scalp donor hair, for example). It’s not just an issue of growth cycle, but the texture of body hair is different than that of scalp hair. The idea is to have the most natural looking result on your head, and I’ve yet to see anyone that has had BHT with a perfectly natural look.

If you don’t want the linear scar from traditional strip surgery, you can look into FUE, which uses scalp hair and would provide a better visual result than BHT would.

Hi,
I read in March of this year on this blog you were soon to be trialling a new SMP pigment that was possibly reversible in one laser treatment. Are there are further developments with this?

Thank you

The initial laser-reversible pigment we obtained was tested on a very limited basis and in small cases. Unfortunately, we were unable to obtain more than the test supplies and have been unable to find a substitute… so it’s not something we pursued much further.

We currently only use permanent pigment in SMP sessions.

Hey Doc,

Just a quick question (trying to understand more about MPB). Would it be possible for a 30 year old with a juvenile hairline to be a norwood 7 by age 40? Just wondering.

Thanks

I don’t recall ever seeing a patient that had a juvenile hairline at 30 years old go to the baldest Norwood class 7 within a decade.

So to answer your question — it’s very doubtful!

Hey Doctors,

I already saw the post from 2005 concerning bandannas and hair loss but I would really like some clarification. I am 21 and have been wearing a bandanna around my head since I was 16 every single day. My mom called me out this past weekend at home concerning a receding hairline I seem to have developed, despite having absolutely no family history of hair loss on either side.

I imagine this must be linked to my bandanna, but what I need clarification in understanding is whether or not the hair loss is actually related to my bandanna. I question this because my bandanna sits right above my eyebrows under my hair

Thanks for allowing me to post the photo you sent. Click to enlarge.

From the looks of it, it appears that you have typical hairline recession commonly seen in genetic hair loss. If it was due to extreme bandana wear, you would likely have some form of traction alopecia where the hair loss would occur around the tight pressure spots where the bandana constantly rubbed on your scalp. I don’t think you wear the bandana that high up on your hairline, so I wouldn’t expect traction is the cause.

Overall it seems strange that you would wear a bandana every single day and I wonder if you wore this due to early perceived hair loss recession. Finally, having no immediate family history of hair loss does not necessarily mean you are immune from genetic hair loss.

Dear Doctor.

Did Actor Ray Liotta get a hair transplant? If you compare the pic 1 with the pic 2 and 3 it looks as if he did. What is your view?

Thank you.

Photo 1 - Photo 2 - Photo 3

What I see could be a transplant, but I have no firsthand knowledge. His hairline certainly appears thicker in photos 2 and 3… but there’s no dates on these and the lighting is different. It could be that with styling and color (and better lighting), it’s the same hairline. Maybe he’s using a concealer in there to give it more visual bulk. I really don’t know, as the photos are pretty small and difficult to compare.

I’ve presented the photos 1 and 2 below for easy viewing:

Hi Dr. Rassman:

Do you have any statistics on the number of hair transplant surgeries that are done each year in the US, and what percentage of men with male pattern baldness that represents?

From just casual observations, it seems the vast majority of men with MPB never treat it and have no interest in treating it. As you know, many either shave their heads, wear their hair short, or just ignore it.

I’ve been told not to bother treating my hair loss, that it looks fine as is, and that if you have a nice face you don’t need hair restoration anyway. Any thoughts?

Thanks for the great site!

The ISHRS released their census with extrapolated figures, showing over 100,000 hair transplant surgeries in the US were performed last year. You can find all their released stats here (PDF file).

Hair restoration is a personal choice. If you don’t want to have surgery and don’t mind your hair loss, then by all means don’t have the procedure. It’s a lifelong commitment, and it certainly isn’t for everyone. It can also be cost prohibitive for many people.