Thinning on Sides and Back of Head

/by William Rassman, M.D./1 /

i’ve been using propecia for about 3 yrs now & minoxodil. for the first 2 yrs my hair stopped thinning & stabilized, but just this yr & more specifically the last 4-6 months. but heres the thing, im thinning on the sides & back corners where your usually not supposed to go bald or lose hair. this started right around the time i started using minoxodil & something from hair club for men on the sides cause before that i wasnt, so i stopped doing that, do you have any suggestions, thx for your time

You need to be evaluated by a good doctor that specializes in hair loss. Loss of hair from the sides and back is unusual in men and common in women. There are too many possibilities here to discuss and there is no substitute for a good doctor to evaluate you. You can contact a dermatologist that specializes in hair loss, or has an interest in this field. If I were to guess on your problem, I would have to make a list of possibilities and that may do more to confuse you than to help you.

Hair Transplant Repair

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

can you correct a hairline transplant already done? I have had a hair transplant done and had the hairline move down and now i don’t really like it and it does not cover the area i want it most. Can you help me?

Frontal hairlines that were transplanted in a manner that you do not like, usually can be fixed. I personally have many patients who have had old type of plugs, where I have repaired the hairline and now enjoy an undetectable, normal hairline. I have also moved hairlines up or down. We have published many articles in this area. Please see the following links for more info:

Generic Plan for Hair Loss

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

Could you send me a generic plan…I have been using propecia for two yrs.. might try avodart down the road but not until I hit the 5 yr mark. I would like to know what else I can do maximize .. keeping my hair… THANKS

If you’ve followed the many questions and answers on this blog, you will see that there really is no ‘generic master’ plan. The doctor must create a full map of your scalp loss status, the degree of miniaturization of the hair at each point on your scalp showing the balding and thinning area so that the progression will be clearly defined. As you move from class of hair loss to another, you need to have a good doctor who UNDERSTANDS exactly where you are and where you are going. Then and only then, can you have a plan customized for you and modified as you get older and progress with the hair loss that is a certainty in the years to come.

How Young Will Balding Start?

/by William Rassman, M.D./5 /

What is the % of white men that eventually go completely bald, and partly the worry about the male baldness is my son’s best friend is almost completely bald with very thin follicles on top at age 27, how young does one start to experience MPB to have this stage of loss by age 27, he’s literally NW 6 1/2 if that’s on the Norwood scale

The statistics are that about 45% of men will have some clinical balding by the time they are 45. I have seen the process start at 16 years old and some reports have placed it as early as 12 years old. Most of the really bald men see some sign of balding by the time they are 21 (clearly evident on high magnification views with miniaturized hairs with thin shafts). The real question still unanswered is can this all be stopped when the advanced balding young men start Propecia early enough. At the age of 27, the pattern in the man you are talking about will probably be a Norwood Class 7 balding pattern. Class 7 on the Norwood scale.

Body Hair Transplants

/by William Rassman, M.D./1 /

Can you use body hair (like from my back to graft into my head??) All I have left is straight black hair. The brown reddish wavey hair is elsewhere on my body. What about if I want my once wavy hair back?

Does one consider using grafts from the other body areas such as pubic area hair?? As a former Physiology major and Chemist, this in theory seems possible considering the technology being used at the moment yes? Thanks — I’ve many questions, appreciate your bearing with me.

Hair can be transplanted from most parts of the body to other parts of the body. Some of the best work in this area was done by a Dr. Kim from Korea, who transplanted head hair to his leg as part of his PhD project where he tried to get more than one hair from one hair. He succeeded to transplant these hairs to his leg but failed to get more than an one for one yield.

Today, there is much human experimentation in moving hair from legs, abdomen, back, chest and beard to the scalp. It appears to work, but the question is one of value. Is the hair valuable enough to achieve the goals of the patient. How long will it last? How long will it take to grow? What are the growth cycles of these hairs when moved to the scalp or eyebrows? There are many unanswered questions and some answers are appearing to show that these types of transplants work.

All of these body hair transplants are done with the FUE technique. There is not a mystery as to how to do this, but the problems I see are more in the many unknowns for routine clinical use.

Avodart – An Update

/by William Rassman, M.D./2 /

I would like to know what you found out in regards to Avodart at the hairloss convention. Please get back to me when you get a chance.

There is a strong suggestion that Avodart will work better than Propecia from what I heard at the meeting. There are, however, many questions not answered such as:

  1. What is the appropriate dose considering that there is a half life of 6 weeks for the medication in your body? Nobody seems to have a good answer to this question.
  2. Some think that Avodart may stay in the tissues for over 6 months, so what effect could this have on your system?
  3. What is the long term safety of Avodart taken by young man? All of the documented studies are on men over 50 (old-‘farts’ like me)

These are the reasons that most doctors do not want to prescribe Avodart ‘off label’ (not FDA approved for hair loss treatment). From a medical-legal point of view, as well as a licensing issue, I can not really prescribe it. Also, my expertise is in surgery, not medications (although I try to use medications I command and know forward and backward). There are some dermatologists, internists, urologists and family doctors that would prescribe this medication, and if you want to go that route, you should try to find one of them to prescribe it for you. With an off-label use, the issues of safety are risks that you must take.

The preliminary studies that were presented indicate that it works to grow hair when Propecia fails to do so. Still, Propecia should be the first line for the medical treatment of hair loss. What does concern many doctors, however, is that there may be a Vioxx type of hidden side effect in the young man that is not known. Will it produce cancers or heart disease or some other problem that is not yet identified? This is the reason we look to the FDA, to define safety and effectiveness for us. So far, the safety is not clear and the effectiveness appears to be coming into view through unofficial channels.

Lost Leg Hair

/by William Rassman, M.D./44 /

i have lost the hair on the front of my lower leg below my knee. the rest of my legs have hair except this part. can you tell me why this is and ways to get the hair to grow there again. i am a 35 year old male. thank you.

This is unusual. You should start by checking your Testosterone and DHT levels. Body hair is a ‘benefit’ of DHT. That includes leg hair (and the appropriate target genes), nose and ear hair, and body hair. Many men in our modern society do not look forward to the increase in these hairs!

Checking with a good dermatologist would be a start for leg hair loss. Is this a pattern in your family?

Maximum Number of Transplanted Hairs

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

HI DOC, what is the average number grafts a person has to transplant from the donor area???

This is a difficult question, because it depends upon donor denity and donor laxity (assuming the strip method of harvesting). On average, I would suspect that the total number of transplantable hairs is between 15,000 – 20,000 assuming an average density and average laxity. Those with high density and laxity may push these numbers to double (30,000-45,000 hairs). I gave this answer in hairs not grafts, so based upon an average of two hairs per follicular unit, that number may be half in grafts.

If the FUE technique is perfected, then this number might change, but without more clinical experience, I could not answer this part of the question as the technique changes.

How Many Grafts Per Procedure?

/by William Rassman, M.D./2 /

Hi Dr Rassman,
I have lost my hair since i was 25. I had 2 procedures so far with xxxx Medical Group for a total of about 1700 grafts and it seemed like every time after i had a procedure, my hair fell out even more. I am class 4 now and i am not really happy at all with my results. I am now interested in another procedure and I wonder how many grafts you can do per procedure? Please respond and thank you for your time.

Hair transplants in young men, often accelerate hair loss unless they are on some protection like the drug Propecia. The hair loss associated with a hair transplant impacts the original hair and is called an Anogen Effluvium. After the first transplant, an Effluvium rarely occurs again provided the second transplant is performed in the next 2-5 years.

In my practice, we can perform as many as 5000 grafts in a single session provided that the scalp is loose and the densities are very good. We routinely perform at least one procedure each day in excess of 2500 grafts, but this is a matter of matching donor supply and recipient area need. The correct balance between these two, will minimize just how many surgeries one might need. We do like to put the highest densities in each session to minimize the number of sessions. Most people get what they want in one or two sessions, unless they are really extensively bald.

Los Angeles Open House

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

Just a reminder to those in the Los Angeles area —

We are having an Open House at the New Hair Institute office in LA tomorrow. This is a good chance to meet many past NHI patients and see a live procedure. Plus, attendees get a $200 discount off their procedure (please ask an NHI rep for full details).

Thursday, Sept 8 from 4pm – 7:30pm (TOMORROW)
9911 W. Pico Blvd, Suite 301, Los Angeles CA 90035
Click here for driving directions, courtesy of Yahoo Maps

Any questions, please feel free to call us at 1-800-NEW-HAIR. I hope to see you there.

If you aren’t going to be able to make it to this event, we have events like this every month in our Los Angeles and San Jose, California offices. The event list can be found here: Upcoming events.

Dealing with Hair Loss

/by William Rassman, M.D./1 /

i’m a 32 y/o male suffering from hair baldness. i still have some good quantity of hair on the top side of my head. i am using now saw palmetto trying to stop hair loss, i am now very interested to use your method and looking to strength the hair i still have. can you please tell me whats your procedure to deal with hair loss and does the hair you transplants grow like a normal hair

To answer this question would take a book, which I have already written. In fact, you can receive the book, The Patient’s Guide To Hair Restoration, which is available from me free of charge by mail or by download in PDF format.

Baldness can be treated with medications and surgery. Medications slow down, stop and sometimes regrow the hair. Hair transplants move hair that is permanent (from the side and back of the head) to the balding area. As a general rule, these transplanted hairs grow naturally and last your life time. The problem with hair transplants is that people often lose more hair than they can transfer with a hair transplant so that the supply of donor hair is inadequate to meet the need of the balding area.

You need to arrange for a visit to a good doctor who specializes in this type of field to find out what are your options and balance them against your need and your budget.

Can Scars Be “Cured” with FUE?

/by William Rassman, M.D./1 /,

Can scars be cured with FUEs?

I do not like your use of the word ‘cured’. FUE (Follicular Unit Extractions) can be used to fill in scars found in the scalp, eyebrow or beard. The more that are placed and the closer they match the surrounding hair, the more they will cover a scar. Scars do have a different vasculature than normal skin, so at times we must reduce the densities of scars to get the best growth.

Can I fix my high hairline?

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

I’ve had an abnormal hairline from birth. It is at least one and a half inches too far back. I have to wear wigs and extensions to cover it all the time. How can this be fixed? Can my hairline be brought forward like everyone else in my family? I would love to be able to wear my hair back without bangs for a change.

High hairlines are common in women and men and moving them down is basically a surgical procedure. With progressive balding, moving the hairline down is best performed with hair transplants because if more balding occurs more transplants can solve the problem. For most women the hair transplant fix is permanent and they don’t have to worry about progressive balding so that (in most cases) a reverse brow lift type of surgery works best.

If you still have any questions, I highly recommend you look at some of our other postings on this subject.

Microscopes in Hair Transplantation

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

There is a lot of talk about the need / not the need for microscopes in hair transplantation, but as I visited various groups performing transplants, only a few use the microscope. Is it really important?

We published an article about 7 years ago, (Dissecting Microscope versus Magnifying Loupes) which showed that using microscopes reduces waste, which means that more viable donor hair is available from every square inch of scalp that is harvested. The wastage is not a minor issue; those with white hair may find as much as 40% more hair can be obtained by using a microscope for dissection. The average person gets 20-25% more usable donor hair if a microscope is competently used in the dissection process. For those who are very bald, once hair is lost or damaged through inefficient dissection, that precious hair is never retrievable.

Do Linear Donor Scars Widen?

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

Do linear donor scars stretch (widen) over time?

You are asking about hair transplant scars from the rim of permanent hair that is found around the back and sides of your head. This area (donor area) is generally not prone to stretching if the incisions are made in the horizontal plain (side to side). The scalp has some degree of redundancy so that there is ‘extra’ scalp which you can easily slide up and down on the back of your head. This makes the scalp loose in most people so when some of it is removed, there should be enough excess scalp to close without tension on the wound. When there is minimal tension on the wound, it usually will close without stretching in people with normal healing tissues. If either the scalp is tight, or the body’s tissues are not strong, then these wounds may stretch. The more surgeries you have, the more the potential to develop stretched scalp scars.