Your hair loss questions, answered daily.


This patient had an FUE 5 days earlier. What I want our readers to note, is that there is not only no crusting on the recipient area, but the donor area is completely healed, I get emails frequently which show terrible crusting after a hair transplant in the recipient area. I tell everyone our routine, which I will now repeat here:

I don’t like the idea of anyone removing grafts that have scabs on them because we have published a paper in a formal medical journal, that when a person pulls off a scab (crust) from a recipient area in less than 12 days (possibly longer), the risk of losing the graft is very high. See the medical paper we wrote here:

In FUE or any transplant including a beard transplant it should be treated just like a regular hair transplant with regard to the recipient area, but if the donor area has open wounds (FUE), it requires daily washing with soap and water. Within 3 days of surgery, you can resume full activities, heavy exercises if you wish. The recipient area requires daily washes as well to keep the recipient area free of crusts. I generally recommend the use of a sponge and supply my patient with a surgical sponge to fill with soapy water and press on the recipient area daily in a rolling motion, never rubbing. By repeating this daily, all crusts can be washed off without any fear of losing grafts. IF any crust are present, use a Q tip and dip it into soapy water, and roll it on the crusts and that will lift them off without dislodging them, but never rub them, just roll the Q tip on the recipient crust. I like to see no evidence of any crusting in the recipient area and the crusts from the donor area gone in 5+ days with daily washing.



Today I had an 18 year old man visit me worried about early frontal recession. My eyes told me that he was developing a maturing hairline and not balding. So to confirm my suspicions, I ran a HAIRCHECK test on him. What I found was an unusual reading, where the hair which we measured in the back of the head (donor area) had less bulk than the front, top and crown areas. This perplexed me, so we discussed his hair hygiene today. He told me that although he washed his hair with water this morning, he put shampoo selectively only on the back of his head hair to get out the oily feel in the back of the head. This caused a reduction of bulk by about 40% which I attributed to the removal of oil in the hair in the donor area but not \in front, top and crown, area.

I was impressed that the measurements I took were able to detect the differences in the way he washed parts of his head. Imagine what it will do for you if you find yourself concerned about balding. This is the MOST sensitive test for balding on the market available anywhere.


I recently heard from a patient who heavily documented his balding with 18 microscopic photos at different parts of his scalp, but mostly in the mid-scalp. I have attached ome of these photos below. His questions related to the miniaturization he saw on the photos and wanted my opinion on his interpretation of the miniaturization. He counted each hair in each field and each follicular group and how many hairs each follicular group had.
microscoopic view (1)

Note that there are large hairs (we call these terminal hairs) and hairs with smaller hair shafts (we call these miniaturized hairs) and there are very small short fine hairs (we call these vellus hairs). Note in the photos that in the far left (middle) there are two follicular groups that have two hairs each, but one hair in each group is much smaller than the big fat ones next to them. These Follicular groups are in the process of losing one out of two of its hairs from genetic balding. Maybe these groups had three or four hairs at one time, but they might have reduced that number from 3 or 4 to 2, and now they are going down to one. This is how the balding process works, hair by hair.

I further told him: You are in some ‘state’ of the balding process. To find out where you are actually at, I perform a HAIRCHECK measurement on all of my patients and from this measurement I can tell to within 10% just how much hair you already lost by region. If you are not in California, find some doctor who has the HAIRCHECK instrument and can do the testing for you. Taking the drug finasteride is the single most valuable thing you can do provided you do not get the side effects; however, before making that decision I would get a HAIRCHECK test.


An Email sent by patient from Turkey who stated that he had a red, hot scalp 2 months after his hair transplant. The presentation he was discussing sounds like an infection but he said he cold not go back to who ever did it. I told him that “You must go to a skilled doctor, any good doctor to make the diagnosis commence treatment?


We have known for years that testosterone causes hair loss so people who take anabolic steroids with various types of dietary supplements put themselves at risk for hair loss if they are genetically prone to male pattern balding (present easily in half of the male population).

Recently the FDA has come away with more specific warning about testosterone and other anabolic steroids which include:
* Risk of hair loss or acceleration of existing hair loss
* Risk of hart attacks
* Risks of heart failure
* increase risk of strokes
* Depression
* Aggressive behavior
* liver toxicity
* Infertility

When men or boys who use such supplements, they often experience
* Depression
* Fatigue
* Irritability
* loss of appetite
* Decreased libido
* Major sleep problems

If you are on supplemental steroids, see your doctor about what you need to withdraw from them, don’t do it on your own.


A drug has been recently discussed in the Yale University news letter: “In 2014, King showed that tofacitinib, marketed as Xeljanz, could be used to treat alopecia areata. The new study confirms the validity of that report and builds a case for pursuing treatment of the disease with this and similar drugs.”

Some of my patients think that this will be used for standard genetic alopecia, but it will not

Read it here: ““This study demonstrates the drug is effective for treating alopecia areata,” said Dr. Brett A. King of Yale School of Medicine, who designed the study with Dr. Brittany Craiglow. In 2014, King showed that tofacitinib, marketed as Xeljanz, could be used to treat alopecia areata. The new study confirms the validity of that report and builds a case for pursuing treatment of the disease with this and similar drugs.”


One of my patients asked if I could treat the FUE scars using FUE graft into the scar through another FUE. I smiled at him and ask what we would do with the new FUE scars created when treating the old ones, He got it! The only answer to FUE scars is Scalp Micropigmentation which we do all of the time for this purpose (see:


The study was released by the Britich Medical Journal which reported that the association of finasteride and Erectile Dysfunction when used for Benigh Proetatic Hypertrophy stated: “Our findings should be reassuring that the risk of erectile dysfunction is not higher for men who are prescribed finasteride or dutasteride for BPH or finasteride 1 mg for alopecia. Clinicians should be aware that the longer a man has BPH, the higher his risk for developing erectile dysfunction,” Katrina Wilcox Hagberg of the Boston Collaborative Drug Surveillance Program at Boston University School of Public Health, told Reuters Health by email.

The same was suggested in men who used the drug for hair loss, which they said “Similarly, in the cohort of men with alopecia (n=12,346), the risk of ED was not increased for users of finasteride compared with unexposed men with alopecia (IRR, 1.03; OR, 0.95).”.

What this says is that these drugs do not cause Erectile dysfunction. I am not sure that I believe this as some of the patients who I ahve treated have reported real one-on-one relationships between ED, libido and the drug finasteride, and when they stopped it, the symptoms always went away.

Here is the article which you can read for yourself.


I’ve been trying to find the best ARTAS doctor but I am still confused. Some doctors say NeoGraft is the best surgery. It’s hard to choose or believe which is better. Where can I find the best doctor for this?

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ferrari hair transplant

Follicular Unit Extraction (FUE) is a basically a harvesting technique in hair transplant surgery. FUE is a way for doctors to “take out” your donor hair. The other method is oftern called a “strip” method or Follicular Unit Transplant (FUT). The strip method harvests the hair follicles by taking a small linear cut of your scalp. You often see horrific hair transplant scars on the Internet related to strip scars. However this is not always the case.

The ARTAS robot is basically a tool or an instrument a doctor uses to harvest donor hair follicles using the FUE method. Instead of a doctor doing the surgery, an automated robot takes out the hair follicles. You still need the doctor to design and make the recipient sites to implant the hair. In other words, ARTAS does NOT perform the critical part of the surgery. The part that matters. The part that give you a new hair line. A great ARTAS robot that is used in surgery may still give you a horrible result if the doctor is not a skilled artist and surgeon. There have been cases where doctors (gynecologists or pediatricians) that are NOT hair transplant surgeons, doctors that have never performed a hair transplant surgery, buy the ARTAS robot believing they can be a great hair transplant doctor. Can you be a great cook if you buy the best cooking knives, pots, and pans? Can you be a great football player if you have expensive football gear?

The Neograft system is also an instrument a doctor use to harvest donor hair. The Neograft system has not been traditionally popular with hair transplant doctors. Instead, the Neograft system is sold to cosmetic surgeons and dermatologist who do not specialize in hair transplant surgery. In many cases there is a Neograft team of technicians that are contracted to come on the day of surgery to harvest the hair for the doctors. These people are called “ICs” Independent Contractors. Most ICs are not even nurses or hold any medical degree. This (ICs doing surgery) is illegal in certain states and a grey area in the field of hair transplant surgery. After the grafts are harvested, the contracted team usually place the grafts for the doctor. Some doctors who perform hair transplant surgery on a regular basis may have their own team but it is rare for a doctor to actually do the harvesting with the NeoGraft. You may want to ask about this when you are interviewing doctors. You may want to ask how many hair transplant surgery they perform a week. You may want to ask who does the actual FUE harvesting. There are cases where patients never see their doctor on the day of surgery because the entire surgery is performed by the IC or the technician.

Doctors who specialize in hair transplant surgery may have their own FUE instrument or automation device. Some examples are Dr. Harris who use his own SAFE system, Dr. Umar who use his own UGraft system, Dr. Shaio who use his own 4DFUE system. The ARTAS, 4DFUE, and Safe system are used at NHI by Dr. Pak and Dr. Rassman since they hold key U.S. Patents or technology used in the ARTAS. Dr. Pak also uses his own unique FUE device as well.

In the end, the best FUE surgery outcome should be judged by the final artistic result. The final result is NOT about the technical method of taking out the grafts (hairs). The ARTAS or Neograft are just machines or instruments. You cannot make a great football player with fancy uniform and a state of the art stadium. You don’t become a great race car driver because you own a Ferrari. It just means you can boast (advertise) about the Ferrari (ARTAS, Neograft) to draw patients in.


I have been on Finasteride for 4 years and my hair didn’t really change much. I did, however stop the drug for the past two months, but am back on now. 1) could my hair have changed in those two months? 2) what pattern do I appear to be? 3) a reputable IAHRS surgeon consulted me and recommended 1200 graft FUE , what are your opinions on that?

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FUE 1200 grafts recommended by one doctor

If you trust your doctor then go with it!
The Internet is not a place to receive a second opinion.
If you would like a second opinion it is best to consult with another doctor in person.

Photo(s) are not a good way to determine if you are balding or if you “need” surgery for the following reasons:

1) There is no way to know your history in detail. This involves a dialogue between a doctor and patient. A consultation usually involves 30 minutes or more.
2) There is no way to examine your hair under a microscope to understand how much miniaturization you may have (to plan for a possible surgery). What will you do if you have further recession or balding after the surgery? Are you prepared to have another surgery to fill in the gaps? You need a Master Plan.
3) Photos do not convey your understanding or expectation of a hair transplant surgery. Someone with your hair loss may be happy with 1200 grafts. Another person with the exact same hair loss may not be happy with 1200 grafts.
4) Photos do not convey your goals. Someone with your hair loss may want a drastically low hair line where 1200 may not be enough. Another person with the exact same hair loss may want a very conservative hair line where 1200 may be too much.
5) FUE or Follicular Unit Extraction is just a harvesting technique. It has nothing to do with the end result. In fact FUE may give you a suboptimal result over a FUT (Strip) surgery. Did your doctor tell you this?
6) etc


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