I began to lose my hair in the frontal region of my head, shortly after beginning to take accutane. Is there any thing that will help?

Hair loss from Accutane is a known side effect. First you must weigh the options of stopping the Accutane. Your doctor should be able to help you make the right decision. The lost hair may return, so you need some time to observe what happens. If the hair does not come back within 8-12 months, then you might need a complete evaluation with a doctor like me, who specializes in hair loss.

I have previously discussed Accutane on my blog, which can be found below:

My 17 year old son has premature balding. He already has a very predominant receding hairline. He is very self-conscious of it. My dad and my dad’s half-brother both had hair loss at an early age but I’m not sure that it was as young as my son. We ran some bloodwork to rule out any physical problems and all were negative. Is there anything that we can do to slow down or improve his hair loss? I was told that he is too young for Rogaine but are there any other options?

Sometimes, hair loss occurs in very young people. As a male, he can take the drug Propecia which hopefully will stop the hair loss. First, get him examined by a competent doctor who will quantify the rate of miniaturization in his balding area. This is important, because when he starts on the drug Propecia we will want a starting point to determine if it is working and by how much. I would hold off on Rogaine until a good baseline is in hand and the rate of hair loss is documented. Please see my similar postings on age-related topics here: BaldingBlog – Age.

I had a brow lift and and a face lift. I lost a great deal of hair in the few months after the procedure. It is now 1 year since the surgery and I have had no return of the lost hair, and I have a very weakly defined hairline. The scar shows unless I comb my hair down in bangs. I would like wear my hair pulled back and show off the new younger me, as my face lift was very successful. Can you fix this?

Hair loss is a known complication of brow lifts and face lifts. The brow lift may accelerate the aging process with thinning of the hair in front of the scar in those genetically at risk. The skin in front of the ears can be removed in a face lift, wiping out sideburns (more common in the 2nd and 3rd face lift than the first).

Hair transplants are the ideal solution for this problem. This is the most common hair restoration process I perform in women. As men do not have face lift procedures as often, I do not see as many men as women with this problem. But the same complication is still there if there is a brow lift and / or a face lift. It can be done in one procedure in most people, but it takes a great deal of transplanted grafts densly packed to get the results in a single session.

What do you think about all of the vitamins and other things sold in the health food stores that claim that they reduce or reverse hair loss?

The word ‘claims’ in this usage, reflects the lack of scientific proofs for naturally produced substances sold in heatlh food stores. Many of the items sold are sold on their potential and a ‘hipe’ that is created by word of mouth. There is little regulation for natural food additives, so there is no way to determine the proof of the claims that are made. Some of the natural substances may have DHT blocking abilities, as claimed, but there is no proof of such activities.

It is common to find substances sold in health food stores that claim DHT blocking properties. There is no way to confirm or deny this, so it again becomes a ‘buyer beware’ issue, leaving the final action in the hand of those willing to spend the money on it. At least Propecia is a proven DHT blocker and we know that because it has been thoroughly investigated by the drug company to meet a high standard of FDA regulations. We also know about the side effects (very low) and long term use statistics. A large company behind this medication tells us that someone is accountable if things go wrong. I can not say that for most of what is sold in the health food stores.

For example, Saw Palmetto, is thought to be a natural DHT blocker, and there are various articles that purport to prove it is an effective DHT blocker. But, a recent article that I read in a well respected medical journal indicated that it was a very weak DHT blocker. Did you know that Saw Palmetto was added to the GI’s food in World War II battle zones to suppress the soldiers sex drive so that they would not get distracted? Now if you link these two (weak DHT action and sex drive suppressant), why would anyone want to take it?

I am a mature woman living in Florida. I have noticed that many of the ladies in the salons who are my age (over mmm.. let’s say 49), have thinning hair. Is there a bug going around that is causing women to lose hair? What can I do about it?

Female genetic balding affects possibly half of post menopausel women. All you have to do is go to the salons in retirement communities and look at what is going on. The hair stylists have learned that the best way to treat female genetic balding is to lighten the color of the hair (have you noticed how many women over 50 are blonde?) and to style it ‘puffed up’ (this is a man’s description of the process, sorry for my myopic male view). For most women, there are few options. A word of caution may be worthwhile here. Take anything that is offered to you in the solutions arena with a grain of salt. Believe less that what you hear and be skeptical of fixes, particularly those without first hand experience by people you know.

I recently saw you on channel 4 news describing a new procedure of hair transplantation where there is no incision done.I have had procedures done going back 15yrs.Approximately 5500 of the old grafting technique.my frontal hairline and down the middle needs to be enhanced.I still have gaps and have lost more hair since my last procedure 8 yrs ago.Could you please tell me a little bit about the new procedure or where I can read up about it. I should also set up a consultation appt.

You are referring to the news item from April on the FOX Procedure, also known as Follicular Unit Extraction or FUE. This is a technique that I introduced in the medical literature in the summer of 2001, and published in 2002 in an article titled Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation. The procedure essentially removes the follicular unit one by one without a traditional incision. More information can be found on newhair.com: FOX Procedure, FOX Megasession, and Medical Publications. Newhair.com is probably the most comprehensive hair restoration-related site in the world, with the greatest amount of original content and patient photographs, so please poke around the site to see exactly what we offer.

The FOX Procedure is an exciting new technique for minimally invasive hair transplant surgery, but it is not for everyone because:

  1. the costs are higher
  2. it is better for less bald people
  3. it is very difficult to perform and very few doctors are willing to step up and build the expertise
  4. not all patients are good candidates for this procedure because of the type of collagen that they have in their connective tissue (10% of people are in the category).

The procedure has the advantage of having almost no post-operative pain, and very fast healing with full activities within days of the surgery.

As you are local, I would recommend that you visit me in my Los Angeles office, which is only about 8 miles away.

Does wearing a baseball cap every day or using a wig increase a man’s chances of going bald?

No, balding comes from within the scalp, from the genes that initiate each hair to grow. Even wearing a baseball hat for years and never taking it off and all you will have is a scaling, dirty full head of hair if your genetics are not ‘balding genetics’.

Is it true that sun burns on the bald scalp causes skin cancer? Can hair transplants solve this problem?

Sun is a known carcinogen, which means in simple English that heavy doses of sun exposure can cause cancer in susceptible people. Susceptibility varies with skin color and the type of skin you have, but if you have a full head of hair, skin cancers are far less common than on someone with a bald head. I remember that my bald spot would burn during the summers when I went on vacation. After having my hair transplanted into the crown, I do not remember getting a sun burn. I have had many dermatologists send me patients who have had many skin cancers on the balding scalp. The patients echo my own experience and I am often told that the hair transplant helps to reduce the sun burn. I suspect that anything that reduces sun burn will help deal with the cancer problem, but hair transplants alone may not be adequate cover, especially if the supply / donor ratio is low.

I am 44 and have just started to lose my hair. I have lost 70% of the first inch of my hairline and the back of my head started to thin as well. I started Propecia when I started to bald along with many other vitamins and minerals as well. Now I want to get all of my hair back. I visited a doctor who thought that the hairline I wanted was too low so he recommended that I put it higher. I don’t like what he said because the hairline he showed me was not me. My friends want to see me and I want to see me. Can I dictate where the hairline should be or must I listen to what the doctor wants.

Not having you in front of me is a problem, but I can make certain assumptions. At 44, with hair loss in the front and crown, you will probably not get very bald. However, since your hair loss started late in life, this assumption may not be an accurate reflection of your perception of the hairl loss you will see over time. What you must ask is the following question: “Given the worst case for hair loss in your future, can you live with the hairline that you have asked for?” If the answer is yes, then you must convince the doctor you will select to see it your way. I often argue with the patient but it is always a pro-patient argument challenging the patient to look at his new hairline many ways. Hair transplants are permanent, so that is both the good news and the bad news. In a consultation, you might say ‘black’ and I might respond with ‘white’, not because I believe ‘white’ but I want to make sure you understand all of the choices and consequences of selecting ‘black’ as the option. Clearly the relationship and trust you develop with your doctor will point you and your doctor to the correct decision. There are no absolute rules here, just judgments which we hope will be kind to us as we get older. Isn’t that what life is about?

My girlfriends and I don’t think that they have hair loss problems (at least not yet), but we would LOVE to have fuller hair so that we wouldn’t need to use hair extensions (which I assume all the celebs use because no one has hair like that!). Could transplants do this for us too?

It is important to understand that many of the accoutrements that adorn our bodies arose from our more primitive, less sophisticated past. The use of wigs date back to the Egyptians in the years between 4000-300 BC. They were used extensively by men and women. The Greeks were the first to popularize wigs and braids and they began the long torturous route to hair styles that cycled in popularity for the next few thousand years. In the middle ages (1200-1400 AD), single women showed their health and vitality by demonstrating full heads of hair, much of it coming from animals. Once married, only the husband could see the head uncovered, so it was the young single, female that had to appear healthy and capable of producing healthy children. As the populations started to concentrate more and more, the disease tuberculosis, took its course on the malnourished females whose heads were uncovered, so advertising ones health required hiding (1) a thinning head of hair with a wig or with braids and (2) the absence of significant body fat with clothing. Sexual attractiveness and a healthy appearance were inextricably linked. Paintings since the late renaissance, show women with much abundant body fat and full heads of hair. As tuberculosis is blind to socioeconomic conditions, the successful artisans were engaged by wealthier clients to create the illusion of health with abundant hair and lots of braids. As the hair became thicker, it hid elements of the face that may have reflected the signs of illness or malnutrition. Braids became common place and the use of wigs and other hair extensions remain part of our cultural heritage.

Now to directly answer your question, no, hair transplantation should not be used to increase the fullness of a normal head of hair, but the use of hair extensions and other such devices come with a price. That cost can be hair loss caused by the continuous pulling that these devices produce on the hair as they are attached. Hair loss from such attachments (Traction Alopecia) can be permanent. My advice to you is to respect your hair and watch carefully for any signs of Traction Alopecia.

Dear Dr. Rassman,
Thanks for taking the time the other day to visit with me and also for the very informative follow-up letter and your recommended plan for my hair transplantation. Over the last two months I have been seriously looking into the hair restoration field and have read three credible books and studied every web site of every accredited hair doctor. I also consulted with doctors that I felt were very respected in hair restoration. My conclusion is that I need to stay on Propecia consistently to preserve the hair I have right now and use the follicular unit transplantation (FUT) technique exclusively, to replace the lost hair.

But I am confused by the number of grafts recommended. So far, I have heard various numbers ranging from 1,000 to 3,000. After visiting with you and hearing your recommendation of 2500 grafts, I wrote back to a very reputable doctor who had recommended a session of 1,500 grafts and told him that another clinic had recommended 2,500 grafts. He then told me that 1) each person has very limited donor supply and one must plan a session based on future hair loss, and 2) the survival rate of transplanted grafts deteriorates as the number of them placed close to each other is increased, as is done in megasessions. He told me that other clinics have no guarantee or refund policy if the hair follicles don’t grow back, so they just transplant as many as possible, even if not safe for the patient.

So my questions are:

  1. What does ‘limited donor supply’ mean in my case? You saw my hair, how many good donor grafts in total do you think I have for now and the future? What would it be if Propecia did not work and I continued to lose hair?
  2. Have you seen any side effects with larger sessions such as more noticeable scar in the donor area, loss of transplanted grafts, excessive swelling of the forehead or longer recovery periods?
  3. Do you or can you guarantee a certain survival rate for the transplanted grafts?

I appreciate the time you have taken to help me with my hair loss problem. I guess I can’t help it, I am a natural engineer, and this being the most important decision I probably ever make I have just been researching the hell out of it! I am confident, however, that I am talking to the best source there is out there.

Part of what is important about being a doctor is the concept of mutual respect. The person who wrote the email to me on this blog, is analytical and clearly fully aware of the subject material. Good communication produces respect so a doctor should spend an appropriate amount of time and focused attention to address your concerns at the interview and in followup to that interview. I would welcome a call from you to elaborate on this blog answer.

  1. Some people do not have the donor supply and when that will be an issue, I tell them. The amount of donor hair is a calculation of density in the donor area plus laxity of the skin. Finally, the size of the bald area and the final worst case pattern must be taken into account. As measurement is critical to this process, one must make direct measurements of the density in the donor area. I was the first to publish on the measurement of the donor supply and the instrument I invented to do this is now used by every competent doctor in this industry. There are no other instruments that are used for hair measurements that do not fall under my U.S. Patent. The average patient has about 6,000-12,000 grafts to move but the wide spread reflects the many variables discussed above.
  2. If you come to our free open house events, you will meet people who had thousands of grafts and see for yourself what happens. The key to understand the safety of large sessions is to meet directly with many people who had them. I would not be doing large sessions if they were not as good or better than multiple smaller sessions. With good decision making by the doctor, large sessions should not scar more than multiple smaller sessions but there may be a cost for aggressive decisions in large session transplantation if the doctor is not experienced in such procedures.
  3. This type of complaint usually reflects the act of denial which most people exercise when they forget what they looked like ‘before’ the started the hair restoration process. Sometimes, people continue to loose hair and think that the new hair loss reflects a transplant failure when it really reflects the unpleasant idea that balding continues. To address the growth of the transplanted hair, wWe guarantee our work. Anything that does not grow, we will replace at no charge. This almost never happens, so I rarely discuss it unless asked.

I am 34 and in the music business. Like the email from your model, I am in a position where I wish to look like I’m in my late 20 for a few more years–Its more business then vanity. My hair looks how it should for 34 (I am a type two), never the less, I wish to have the sides of the front filled in a bit (as well as the hariline reconstructed).

Everything I read implies that this is a bad idea, because my hairline will look too low when I am 45. If I brought my hairline back down to where it was 5 years ago, would it look stupid in 15 years?

Clearly, you understand this subject, so I will not repeat much of what I have said in previous blog entries. First, Bill Clinton has the same hairline today that he had when he was 12 years old. His hairline does not look weird to me. It just reflects a small number of Caucasians who keep their juvenile hairlines into adulthood. IF you are not balding and you’re examined throughout each area of your scalp, looking for miniaturization and none is found, then it is not unreasonable to assume that you would be in the 55% of the population that does not bald at all. Putting back the frontal hairline will just make you look like Bill Clinton, Ronald Reagan, actor Andy Garcia, and many others like them. They looked good with their low hairlines. On the other hand, if you should start to bald, a discussion with your doctor needs to lay out a worst case scenario for you to consider along with the statistical possibility that this might happen.

Have you heard about this hairloss product called Regenix? The actor Matthew McConaughey was on the David Letterman show and he said that he was losing his hair until he used Regenix, and now he has as good a hairline as when he was 18. What do you think?

Regenix has been around for years and they can make the hair thicker appearing (therefore fuller) with many of the things they use. The change that our actor shows suggests that either he has an unusually good result from Propecia or he had a good hair transplant surgeon in conjunction with what Regenix is doing. Two pictures of him on the web (see links below), show what appears to be a remarkable turn-around. I tend to be skeptical in believing everything I see or read about celebrities. If Matthew should read this blog, please come in for a private consultation. I will not post about the visit, I promise.

Here are links to two photos that display the dramatic change in Mr. McConaughey’s hairline:

I have a doubt. I am 20 and my hair was fine until now,but I feel that my hair is not that dense as it was when I was 10 or 12. Although my hairline is not receded, my dad is bald. Is this a sign of balding or it is natural for eveyone. Also I shampoo my hair once every 3 days with a mild shampoo. Does this have any effect?

A good thorough examination of your scalp with high magnification may show if the early signs of balding have begun. If they have, preventative treatment with Propecia may be indicated. There is no certainty that you will follow your father’s hair loss pattern, but it is a good idea to keep a close eye on it with a good doctor advising you. Shampooing once every three days, once a day, several times per day, or once a year will probably not impact your balding pattern.

Yesterday I had a visitor from Saudi Arabia, a well known woman who is actively involved in the womens’ rights movement. She was sent to see me for thinning hair by a former patient I did some 10 years earlier. She came with a message for me, “Tell Dr. Rassman that for the past 10 years, I have been enjoying the hair that he gave me more than I would have ever expected”.

This message epitomizes what I experience every day, a sense of worth communicated by heartfelt patient appreciation.