Doctor can you please help me with this topic. A few days ago I had my first HT procedure for 4300 grafts. My Doctor told me that the hair under my ear is thinning therefore not leaving me with the best of donor hair. How is it possible that hair from the back is falling out?

There are some inconsistencies in what you’ve told me. 4300 grafts in one surgery indicates that the donor area is very rich with hair and the densities are high. That is not consistent with problems in the donor area, which can be seen in diffuse unpatterned alopecia (DUPA), for example. People with DUPA never can get yields like you have received. When I learn of a single procedure of 4300 grafts, I assume one or more of the following:

1. Very high densities
2. Loose scalp
3. Grafts cut down into one hair grafts — which means in normal densities, you got about 2300 grafts (and paid more money for less actual grafts)
4. Doctor who is dishonest and lied about the numbers to rip the patient off

That last item is far more common than I would want to see. The times that I get 4300 grafts (usually over 9,000 hairs) from a donor site (without cutting the grafts into 1-hair grafts) are substantially less than 5% of all patients. As the originator of the megasession, I feel this makes me an expert on the subject.

Poor donor hair under the ears almost always reflects upon donor hair in the back of the head to some degree. The existence of a poor donor supply on the sides of your donor area should be similar to the hair in the back of your donor supply and as such, 4300 grafts just does not calculate in my book. I wrote the original articles in the medical literature dating back to 1993 on this very subject (see NHI Medical Publications).

For your sake, my fingers are crossed that your grafts grow in nicely and you got the 4300 grafts you paid for… and I am hopeful that you did not get screwed.

Hi Doctor Rassman and Staff, thank you for this informative blog. I am 19 years old and I was wondering if you guys would consider filling in temples and creating a lower hairline for a person my age. I know you say you do not do this because of future balding, but I would rather have this done so I can have a few years with a nice hairline, than have no years at all. I am in college and I am forced to wear my hair long and for the most part no one realizes I am starting to bald. I just want to be able to have a short hair style again.

Thank You

Before I could give you an opinion, I would need to see you and probably even meet you. I would then be able to determine if you are just experiencing a maturing hairline, which would be likely at your age, or actually have male pattern baldness. There is no substitute for an in-person examination, and over the internet does not meet my needs as a doctor. Some of the doctors in this business would want to rush you into the surgery even if you are just evolving into a maturing hairline. Any doctor too enthusiastic about performing a surgery on you might not be honorable.

Whoever you take on as your doctor, make sure that they are not just doing it to make a buck. Think long term! The great majority of 19 year olds aren’t candidates for a hair transplant because most are experiencing changes of the maturing hiarline, and there are dishonest doctors who will prey upon someone with cash in hand… like you, who may not want to accept the maturing hairline. A young man with a maturing hairline can cut his hair short, so first find out what is going on with you before you jump into a life time of hair transplants chasing what you may never catch (your 13 year old hairline).

How can one tell if pseudopelade is in remission ? If in remission, must medication continue ?

I would imagine that you are being treated by a doctor and this is a question that you should ask him/her. I would need to know what medications you’ve been prescribed. Is it topical steroids? The question you asked is complex and for me to start probing what I need to know here on the BaldingBlog is not appropriate. I can not contribute much, as I know very little about you, your disease, and the course of it over time.

Hi,
one week after relaxing my hair my scalp is still itching and burning. It seems as if the burning spot is getting bigger. Even my forehead, neck and shoulder is now burning. And it seems to react to heat. I have read some of your comments and you keep advising to go to a dermatologist. But do you also know what the dermatologist can perscribe to stop this chemical process? Here the Dutch doctors have never heard of Hair relaxers, so they do not reconise this problem and don’t even see it as a problem. They advise to use a body lotion to cool the itching/burning spot.

Can you please help me?

A good doctor should be able to make a diagnosis on the degree of balding. For chemical burns, hair loss can be permanent so I would imagine you would want to know. Maybe topical steroids can help reduce the degree of burn, but I don’t have experience with them in this situation. I’m not a dermatologist, so all the possible methods of treatment aren’t known to me.

Dear Doctor,

i started using ZMA, a supplement which contains zinc, magnesium and vitamin B6. It is considered to be helpful for athletes, as it increases muscle strength. It is also claimed, that it increases testosterone levels. Since i take 1/4 proscar daily,i would like to ask you if it is possible possible to counteract with finasteride.( dht etc)

i thank you in advance.

With a good finasteride block and your adherence to daily use, the supplements you are talking about should not impact the value of the finasteride.

hi Dr,
i just had a FUE procedurefor 1500 grafts a few days ago. I am very worried now because of some mistakes that took place during the surgery. I overheard the surgeon making comments like ” How come i insert in follicle with 3 hairs, but 1 hair is left outside?” Eventually, the problem is caused by her assistant failing to insert the graft properly into the special insertion tool. I think the affected grafts are quite an an amount cause she took some time to find out the cause of the problem. I dont dare to question her as i am scared she might be offended. I also didnt know if the surgeon did took out the “wrongly inserted” grafts and reinsert it back properly. If that is case, how much will it affect the grafts survival rate??

Thanks a million!!

It sounds like the team used the Choi Implanter, which is as instrument that makes the recipient site and puts in the hair at the time the instrument is withdrawn (see image at right). It requires proper insertion of the graft into the instrument and it takes considerable dexterity to do this. These instruments are used throughout Asia and Europe, and in the hands of many doctors, the grafts often do not grow for a number of reasons, including:

1. Improper insertion of the hair graft into the instrument
2. Placing the grafts too deeply into the recipient area
3. Trimming problems in preparing the grafts for the instrument with removal of the hair growth centers
4. Graft drying, as it may be in the air for more than the 10-20 seconds it takes to kill the graft

I have seen a fair number of failures in this technique. I never understood why the surgical teams in these countries did not develop the ‘manual’ skills used in the United States, where the results may be more predictable. This instruments work in the hands of a few who developed the needed skills to overcome the above problems, but the use of these instruments suggests to the novice doctor that placing grafts into the recipient site is very, very, very simple.

I always say that doing a hair transplant is conceptually simple, but getting a successful hair transplant whatever technique or instrument the doctor uses will be seen in 8 months when the results are evident, one way or the other. A successful transplant is the sum of a whole ‘lot of steps and techniques’. The picture of the instrument shown here suggests simplicity, but by the time 8 months have gone elapsed and if there is poor graft growth, the doctor has your money and the rest can be just a nightmare of dashed hopes.

With regard to your other points, you can be meek and take the failures that may occur, or you can be proactively aggressive and let the doctor know of your dissatisfaction or your concerns. Be direct with your doctor and his/her answers should likewise be direct and to the points of your concern. In California, the state medical board or the courts protect patients. You indicated that you live in Singapore, and because I’m not familiar with the laws there, I don’t know what recourse you have.

I have read that finasteride is successful in slowing/stopping hair loss in the crown and mid-anterior scalp areas of the head and in some instances stimulating regrowth. I notice that there are many statements saying that there is no statisitcally significant evidence in showing that finasteride works in the temple area of the scalp. Why is this? Don’t these follicles miniaturize as an effect of DHT in these areas as well? Thanks for your time.

I do not believe that the drug companies have studied the frontal area with enough effort to help us define what you are talking about. Why? I have no idea. But just because there are no studies, it does not mean that the medication is not helping in the frontal area. I believe that reversal of miniaturization does occur in the front, as well as the more frequent observation that hair loss slows or stops in the front with finasteride. Most of the time the hair that is saved with finasteride is in the crown where early thinning starts and has more miniaturization than frontal hair, but I’ve seen hair reverse in the frontal area as well.

With regard to the temple prominences on the side of the head, I suspect that a prevention of hair loss occurs there, but there is no evidence one way or the other to back up my suspicion that I can point you to.

Hey Doc.,

I have a question regarding the shedding after quitting propecia. Why is it that when one quits propecia the shedding occurs much more rapidly then the natural progression of hair loss? That is, why don’t we go through the same “minituarization” that normally occurs with hair loss?

You cannot escape genetic balding. Hair has a normal life expectancy (see this post) so when the Propecia is withdrawn, the apototic process kicks in. Medications such as Propecia slow this process down by preserving or strengthening the dying miniaturized hairs (the hairs that are genetically programmed to die and fall out). When you no longer take the medication, all the genetically predisposed hairs that should have fallen out naturally will no longer be supported by Propecia. As such, they will fall out. That is a simple way of thinking about catch-up hair loss. In other words, you didn’t stop the time line of genetic hair loss by taking Propecia.

I have a NATURAL RADIAL INCLINATION of my hairs and i’d like to “fill” some low density areas. Could it be a problem with a transplant or any skilled doctor should be able to match the inclination of my hairs?

I am not sure what you mean by a natural radial inclination. The only place where one has hair that points in a radial type of direction is the crown or vertex area. If this is the case you need to have a Master Plan of what you want accomplished with hair restoration surgery. If the area of low density is only in the crown area you may benefit from Propecia or minoxidil and may not need hair transplant surgery initially.

Need your comments on laser assisted hair transplant: http://www.hairscalplaserclinic.com

I had an opportunity to review this technology and in my opinion it is a bogus technology looking for Star Wars type recognition. This also reflects comments on the website for stem cells doubling hair somehow magically achieved from the donor area.

In his video on the website he talks about stem cell for doubling hairs with limited donor hairs. Need your thoughts about that.

There used to be a laser sold which made holes in the head for graft placement and most competent doctors have abandoned it. I never used it because it produced more damage than benefits. The procedure that is defined at the website you linked to, defies medical common sense. Seems to be more science fiction than science fact. As far as I’m aware, there is no such thing as laser assisted hair transplantation and certaintly I am not aware of any competent doctor who uses the laser.