Female hair loss question

/by William Rassman, M.D./0 /
I have a question regarding womens hairloss. Is that also treated with finasteride? Or is Minoxidil the only method?   I’m asking for my sister who has a lot of loss in density and has a visible spot on her scalp near her forehead. I’m also curious if oral minoxidil is as effective as topical assuming that is the only method for treatment in women.
Sounds like she needs to see a doctor who specializes in hair.  There are many things that can cause the problem you described, so first get a working diagnosis. 

Derma Stamp vs Dr. Pen for microneedling

/by William Rassman, M.D./0 /

I’ve been doing 1.5mm every week using a dermastamp. I don’t press down too hard. Sometimes I do get some pinpoint bleeding, now a lot. I was wondering though, that even if I barely bleed or don’t really see redness/soreness the day after, that I could still be damaging my skin/hair follicles. Is there any other signs I should be looking for?

The Dr. Pen is a better instrument. When you buy it, get the 36-needle version and set it to a depth of 1.25mm. Hold it firm against your skin for 10 seconds and then move it to the next area. Only apply the microneedling where you have lost your hair, but do not go so low that you go below the mature hairline. The Stamp doesn’t give you the control you need.

Itchy, tight and sore scalp with hair loss

/by William Rassman, M.D./0 /

I want to say for the past 4.5 years my scalp has been having problems that I am not sure if it is due to hair loss, is causing the hair loss or what. The top part of my scalp is often (has been worse) sore and feels stiff. It is itchy sometimes, and is oily when I don’t wash it after a day. If I push my hair up, it feels weird and uncomfortable, especially if my hair isn’t in a natural resting position. There was a comment I saw about someone scratching their scalp and the dandruff would stick to the underside of the nails. I honestly thought that was normal. My temples have receded quite a bit, with diffuse thinning going on in the area that I just mentioned. In the last year and a half, the diffuse thinning has become more noticeable. There are miniaturized hairs and different sizes.

Some men who get itching associated with hair loss have an associated autoimmune disease of the scalp. A dermatologist should be able to recognize this by taking a biopsy of various areas of the scalp as well as performing a detailed trichoscopy. There are diseases that are known to cause this and these diseases must be ruled out. These diseases include psoriasis, lichen plinoplaris, seborrheic dermatisis and others. Are you sure that you are not scratching your scalp to produce the soreness?

Topical minoxilidil and finasteride no response (photo)

/by William Rassman, M.D./0 /

I’m 24 and have been on topical minoxidil and 0.3mg finasteride for 1 year now with no response. I’m depressed and see no future for myself. 

60% of men will not respond to topical minoxidil. but 100% will respond to oral minoxidil. Men taking 0.3mg of finasteride are not getting the full benefit of this drug.  Move it up to 1mg/day.  Speak with your doctor about switching to the oral minoxidil. You may get a response. Move up your finasteride to 1mg.  If you are treating yourself, that is also a problem, as you are not an expert. 

Shock Loss

/by William Rassman, M.D./0 /

If somebody adds grafts to a transplanted hair line is shock loss to these prior transplanted hairs likely?

Shock loss impacts miniaturized hairs, so transplanted hairs very rarely get hit by it.  I believe in thousands of patients I have performed surgery upon, maybe two have had shock loss of previously transplanted grafts.  I remember them well and their hair returned within less than 6 months. Also, the first hair transplant on a person not taking finasteride, can produce shock loss impacting all of the miniaturized hairs on the head.  For a person having two surgeries, the first takes the toll, the second does not.

Am I a candidate for a hair transplant?

/by William Rassman, M.D./0 /

You may or may not be a candidate for a hair transplant. However, good surgeons need to evaluate your donor supply and paint a realistic picture of the results that can be achieved. I wrote an article in the most prestigious journal for Plastic Surgery on how to get a hair transplant, with good results in almost 100% of men, even with the most advanced balding patterns, provided that the donor area is healthy. That is what you need! You can reach me at williamrassman33@gmail.com, and I would be happy to talk with you.

PCOS in Femae

/by William Rassman, M.D./0 /

I have PCOS and don’t know what to do.  

Women have two potential problems with pCOS, female unpatterned hair loss and the hormones associated with PCOS.  The use of finasteride sometimes works in women with PCOS, but you can’t get pregnant with it.  A cosmetic solution is Scalp Micropigmentation (see here: https://baldingblog.com/i-just-finished-my-smp-on-my-crown-area-today-see-before-and-after-photos/), which will make your hair look much fuller as it did for me in the link I attached here. 

17 years old and depressed feeling hopeless

/by William Rassman, M.D./0 /

I am only 17 and already Norhood3 I have long hair before and yesterday I decided to buzz it with 5 setting I messed up more I look like 40 year old uncle with huge tample recession and I looks like I don’t have any hair . I visited derma about 8 Months ago so I am on Minoxidil topical it is not beneficial for me and two months ago I added Fin 0.5 Mg I know it is dangerous but what else can I do , I am already Norhood3 like a uncle I already said. My entire teenage life is ruined can’t really have fun also everyone look at my hair. So far I don’t have any sides with finasteride I am giving it a time. But no body understand how difficult and depressing problem hair loss is at this age my cousins friend have full thick head of hair, my dad and moms brother is bald so I have strong balding genetic but at this age of rocking different hairstyles I feel like lost. Hair can enchanes your looks 100 times better your whole face shape is also depends on it. Looking here for your advice and help if anyone needs picture you can DM me. I am trying to Post here but it doesn’t allow me..

Please please help me give advise to me I am genuinely depressed. 

17-year-old men will respond to finasteride or other modalities of treatment in the hands of someone like me, who knows what to do. As you are 17, I need your parent’s permission to treat you appropriately. If you would like my help for a free consultation, I need to see some photos to show your balding, and one of them should be a frontal view with your hair pulled back and your eyebrows lifted high so that the creases on the forehead show up.   This will show me anatomical landmarks to measure where your hairline belongs and more about what a normal hairline should look like. Please tell me what you don’t like about your hairline and overall hair situation. The photos are confidential.  Please include your phone number and the best times to reach you, as I like to establish a good relationship with my patients, in your case, along with a letter from your mom or pop.  I will also need your parent’s permission in writing with a copy of their driver’s license. 

 

Female with poor results from hairline advancement

/by William Rassman, M.D./0 /

So my hairline looks bad/weird is due to mild (but noticeable to me) thinning in the front plus a very straight appearance due to a scar (I previously had my hairline lowered due to hair loss). Because I’m female, it’s possible to cover this insecurity through styling, but I know I’d look way better with a nicer hairline. Plus, even when my hair is blown-out/styled I can see my scalp through my hair just in the very front, which ages me. (I’m not currently losing any hair btw, I just had an eating disorder at a young age that caused most of my hair to thin/fall out.)

So I think I’m just going to ask him to fill out the density, fill in the temporal peaks, cover the scar, and give me a natural-looking hairline. But is that too vague? I wonder if I should be more specific, i.e. providing reference photos of what I’m looking for… I’ve been looking at hairlines online lol and the most beautiful ones to me have lots of little irregularities, I mean I’ve seen some truly beautiful ones…but I also wonder if it’s best to keep it simple and stick close to what I’ve got. He quoted me 1000 grafts and touched up my eyebrows (one of my eyebrows looks like it got singed off, so I figured, why not do that too).

Any suggestions are very much appreciated. I’m hearing from other patients that it’s good to come in with a specific game plan of what you want, plus questions, as they are quite busy of late.

I have written a definitive article two times, defining what a female hairline should look like. Here are some interesting posts on my Baldingblog.com website that will show what you don’t want and what is normal: https://baldingblog.com/?p=54926&preview=true (don’t want these hairlines) and https://baldingblog.com/hairlines-for-men-and-women-photos/ (shows comparison between normal female shaped hairline and male hairline. Many surgeons, unfortunately, give women a male hairline. Here is a female hairline one day after the surgery: https://baldingblog.com/young-women-want-lower-hairlines-photo/ and here: https://baldingblog.com/customized-transplanted-female-hairline/

Female hairlines require a skilled, artistic, experienced surgeon. I have done many of them, enough to become an authority on the subject. In your situation, you have a significant recession, and you have lost your entire temple mounds. 1000 grafts probably will not work, but if you saw an experienced surgeon, you need to sit down with that surgeon and get a clear plan. If you have more questions, you can write to me at williamrassman33@gmail.com