Hair Loss Information at Balding Blog

Your hair loss questions, answered daily.


This is a review of a SMP procedure performed at New Hair Institute Medical Group. This is a female patient who had traction alopecia from wearing her hair pulled back too tight. She also had a component of triangle alopecia. SMP diminished the contrast between skin and hair. Note: patient also colored her hair on the after photo.

SMP to traction alopecia

SMP to traction alopecia

Tags: traction alopecia, triangle apolecia, smp alopecia repair


Dear Dr Rassman

I have been using Minoxidil once per day since November 2013 on the temples and hairline (as well as finasteride)

I haven’t ever experienced a noticeable shed, or any regrowth. My hair has continued to get slowly worse. I have continued using Minoxidil as I thought that maybe it could at least be contributing to help slow down the MPB process – but I am unsure if this is the case

The Rogaine website states that treatment should be stopped if no results (i.e. regrowth) are seen within one year. My questions are therefore

1) Is it best that I quit using minoxidil?
2) Is there a risk that healthy hair would have become dependent on minoxidil, and fall out if minoxidil is stopped?

I look forward to hearing from you.


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If you hair loss is just the frontal hairline and the temple peaks, I would not expect to see hair regrowth in thise locations. The maturing hairline does not respond to minoxidil or finasteride. If you are sure that there was no benefit from the use of minoxidil, then stopping it should not make a difference; however, if there was some benefit, stopping it might cause loss in those hairs that benefited (something I doubt). So it really is important to be sure.

Tags: hairloss, hair loss, minoxidil, rogaine


I’ve been taking Propecia for many years (generic over the last year), and my hairline has remained stable ever since. I just noticed a nickel-sized bald spot on my crown. I thought Propecia worked better on the crown than on the hairline, so what gives?

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Propecia is a medication for the treatment of genetic male pattern balding also known as androgenic alopecia. It works best for treating the thinning / balding on the top and crown areas of your scalp. It does not work as well for the front hair line. Propecia is not a cure and its response is different in each individual. You may still have thinning or continue to lose hair. The point is that it should slow down the hair loss. There is no cure for genetic balding.

You should see your doctor. A bald spot the size of a nickel could be the result of other causes like alopecia areata. A clearly defined bald spot is not a presentation of genetic male pattern balding so you must be assessed by your doctor.

Tags: generic propecia, propecia androgenic alopecia, propecia alopecia


I always have thin hair when I was young. However, I noticed that the vertex of my head is really sparse. I am only 20 this year. Asian.

The thing is my family has NO HISTORY of balding. Both paternal and maternal side. However, my mom and dad hair are thin probably due to age.

Will I go bald eventually?

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Genetic balding in men happens after the puberty years in their 20’s and 30’s. Most hair loss falls into one of the Norwood hair loss patterns. Not everyone who goes bald will fit into one of the many patterns. Of note only 7 to 8% of men go completely bald.

You do not need to have family history of balding to inherit the genes for balding as mutations or gene expressions can cause this to show up. It can skip generations and the exact inheritance pattern is not well defined. If you think you are balding, you can see a doctor for an examination. Some doctors can do the Bulk test of even Miniaturization studies. There is no way to predict if you will go bald. We are not fortune/misfortune tellers.


I started to lose my hair at 19 due to MPB. After a year or so, my hair texture started to change rapidly and my hair changed from normal hair which you can style to pubic-like hair.

It looks horrible.

My question therefore is: what can you do about acquired progressive kinking. I am already taking finasteride which seems to do little against it.

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Generally when you lose hair from genetic balding, your hair thins out (miniaturize) and fall out. It generally does not change in texture to a point it starts to kink. Maybe you should see a dermatologist as there may be a series of genetic hair diseases that can cause kinking.


I am a 33 year old male. I had been using Propecia for 3 years and switched to Dutasteride approximately 6 months ago. Since switching to Dutasteride, I am experiencing less sexual side effects than Propecia, even at 1.0mg daily dose (twice the dose which is recommended in treating BPH) – I am also experiencing more hair regrowth than Propecia. I am wondering how and where you draw the inference that Dutasteride has the potential to cause sterility. Any firm evidence, clinically?

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Just like your positive hair growth experience with dutasteride there are others who have negative experience with sterility and sexual side effects.

I cannot find a study or firm evidence, but I always try to balance risks and benefits. If you are never planning to have children, then it may not matter but if you are, why would you want to risk it? In addition dutasteride is not approved for the treatment of genetic balding and there is also no clear evidence it is much better than Propecia (despite your personal experience). If you want to know if you now have a problem, your doctor can order a sperm count which will show a problem if there is one.


I know dr.rassman has mentioned a few times that if a person is genetically balding their hair has a certain lifetime (example 5 or 10 years) , with or without the use of finasteride, before it completely dies. If that is the case, what is the point of taking finasteride if the hair is going die anyways within 5 or 10 years? Could finasteride prolong the hair from falling out early?

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The point is you have the extra 5 to 10 years or possibly more of good hair. Imagine being 20 years old in your prime and you notice thinning. Imagine taking a drug that can postpone this until you’re 30 or 40. To some this may be worth while.


This is a review of a hair transplant result performed at New Hair Institute by Dr. Jae Pak. This is a patient in his 60’s who looked 70’s before he had a hair transplant. His grey hair actually helped with the overall result. Grey hair on fair skin helps disguise the thinning by the low contrast between hair color and skin color. We think that the hair transplant makes him look at least 10 years younger than his real age!

He is currently thinking about another hair transplant versus a SMP procedure for fullness. There is no right answer or choice. Real hair is always better, but SMP is not surgery and there is no recovery with instant results! He may choose both like this patient HERE.

Before and After 2491 Grafts

Before and After 2491Grafts


This is a review of a hair transplant surgery performed at New Hair Institute by Dr. Jae Pak.

This is a young 30 year old professional who lost his hair in his 20s. He had a 2100 graft hair transplant surgery that gave him a non-balding “frame” to his face. He will continue to lose his hair on top and may need future surgeries but the transplanted hair in the front in permanent and he now looks his age and feels better about his new look!

Hair Transplant at NHI 2100 grafts

Hair Transplant at NHI 2100 grafts


Similar results to the TV Reality show Jon Gosselin’s results in terms of number of grafts received and the balding pattern. Both patients did not have follow up surgery for their crown area (for their own reasons).


This is a review of a hair transplant to address scars from plastic surgery. This patient had a face lift scar on her hair line which also gave her a slightly high forehead. While the scar itself was not prominent, she wanted to wear her hair up without worrying about the scar. She also wanted a more rounder (feminine) hair line. She had about 600 grafts to accomplish her goals.

Hair Transplant for face lift scar

Hair Transplant for face lift scar


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