Happy New Year!

Once again, I am taking a few days off, so today’s entries will stand until more updates are entered on Tuesday, January 3rd, 2006. I have enjoyed the many questions asked of me and I hope that my words are comforting and educational to the readership.

A special thank you goes out to all readers of this site for helping to make 2005 such a great success. In just 8 months since this blog launched, there are now over 750 posts! I just hope that you have found BaldingBlog.com to be an informative (and possibly even entertaining) daily source for hair loss related discussion. 2005 was a great year for both the blog and the New Hair Institute. 2006 should prove to be even better!

I wish everyone a safe and Happy New Year! Now it’s party time!


The photos below are of a father and son duo that I treated. The father had advanced balding with fine hair, while the son had early balding. The father got a nice result, but because he lost about 50,000 hairs over his lifetime and got back about 10,000 hairs from me, he could never have the same head of hair like his son. The son started on Propecia and with his average weight hair, he has had wonderful results. Hopefully, with Propecia continuing for years to come, he will hold on to the hair that his father lost in the pictures shown below. Click the photos below to enlarge.

The son’s before photos are here (the first photo was taken immediately after surgery):

The son’s after photos, which were taken after one procedure of 1,295 grafts, are here:

With the son’s use of Propecia, I believe that he will not follow in has father’s foot steps with regard to his hair. Since the son is in the family business, now the new leadership will be hairier than the old one.

The father’s before photos are here:

The father’s after photos, which were taken after two procedures totalling 4,879 grafts, are here:

Since male balding is genetic, it is not unusual that I work on family members, in fact many of our patients are from these extended families. Once I had the privilege of performing hair transplants on three generations of individuals in the same family. Usually, one member starts it off and when they are satisfied, other family members follow. I have done 17 members from one overseas family who flew here every few months after the patriarch was satisfied with his results. Usually, the father has it done first, then the son, followed by the uncles and grandfathers. However, I remember one particular movie producer who sent his son in for a hair transplant ‘test’ and he watched the change occur over the next year. When he saw how great his son’s finial results were, he felt it was safe for him to have the transplant so he came to surgery with the confidence he apparantly needed. We do offer family pricing when they come together, extending the hairy appearance into the balding clans, a few patients at a time and hair by hair.

I just had a FU mega-session 7 days ago. I have been very careful with daily washing of the 3000+ grafts that I had. I have been washing and rinsing only through a washcloth. I have been using the post-op copper peptides etc. I have been so careful that I have not really lost any of the scabs or crust associated with grafts. I even have been sleeping with moistened guaze under a surgical cap at night.

I am needing these (scabs etc.) to be gone so that I can return to work. In a previous posting you mentioned advocating “aggressive washing”. How should I be washing the grafts at 7 days post-op, in order to expedite the scab removal. I haven’t been picking at them but maybe I have been too careful…….Please help.

Your sight and advice are very valuable and I thank you for them……

Washing is something that must be started at the time of the surgery so that when the patient leaves the surgical suite, the recipient area should be clot and blood free. A good thorough washing the morning following the transplant is critical as it will impact the appearance on all subsequent days. Good washing protects most people against folliculitis and infections of the donor wounds so daily or twice daily washes are critical. There is a washing art form, one which we teach our patients at the time of the surgery and on the day after, when most patients return for a hair wash administered by us. After 5-7 days, the scabs should be gone. If they are present to a significant degree, then you must be gentle with them for if you pull one out, the graft may come off with it. Mostly, if the wounds are small and the scabs are already shedding, you can wet your hair, cover it with a good conditioner when wet, leave it on for 10-15 minutes to allow the scabs to soak up the moisture, and then wash your hair using your finger tips to gently try to get the scabs off. Dr. Robert Bernstein and I just wrote a scientific paper on this to show that when the scabs are off, the grafts are safely anchored. The scabs anchor to the grafts, so if you pull on a scab the graft can come out with it. If you follow the washing technique I just outlined the scabs should come off in a day or two, providing that they are not anchored too tightly to the scalp.

Dr. Rassman,
I had undergone a surgery at NHI, San Jose in 2003. I must say the transplant has been one of the best decisions I’ve taken in life. Thank you and your awesome staff! I could see my photograph is now featured in the NHI website. Wow!

After the holiday season, I am going to seek an appointment to evaluate the present state of scalp. However, I just came across a “cosmetic” hair-product called Procede that claims to “increase diameter of hair shaft”. However, they also say it’s “not going to work for persons who already had undergone Hair Transplantation”. That, frankly, sounds a bit weird to me.

Do you have any idea what this is?

I am happy to hear about your nice results. Your photos are very impressive and the change must make you quite happy. It certainly made my day reading your email. For those interested, this patient’s photos can be seen on the NHI site as Patient NO.

I’ve written previously about Procede here. As to why they say the product is not suitable for people who have had hair transplantation, I can not imagine why it would be harmful. However, if that is their warning it suggests to me that there may be something toxic about the product. I have no inside knowledge about this product or its potential toxicity.

Hello Doctor
Does Propecia help with the Frontal Hair loss. My Hair loss is more in the fronal top part of the forehead. My right and left side has no hair loss.

Propecia slows or stops hair loss throughout the head. In some cases, it will reverse the hair loss. These select cases are often younger men, but on occasion we see return of hair in older men, mostly in the crown.

In answer to your question about frontal hair loss, Propecia slows or stops hair loss everywhere you are impacted by the genetic balding process. The reversal is less frequent in the frontal areas, however. On occasion, I have seen complete reversal of hair loss in the front, top, and crown area in some young men.

For photos of Propecia’s regrowth results, see past blog entries:

My doctor told me that I was body dysmorphic. I looked it up and got upset with my doctor. It suggested to me that he thought I was crazy.

There is a psychological condition know as “Body Dysmorphic Disorder” which cosmetic surgeons of all kinds (i.e. not just hair surgeons) have come to be familiar with. It is characterized by a feeling that one is deformed or very odd looking in some way when in fact one’s appearance is normal. Manifestations can range widely, from believing that one’s nose is malformed (anyone famous come to mind?), to perceptions of imperfection in one’s hairline. These patients have a preoccupation with their appearance that borders on obsession, and they often have multiple cosmetic surgeries to address the “problem”, often moving from surgeon to surgeon. Since the “deformity” is really a problem with self-perception, and not with the body itself, surgery rarely cures and often exacerbates and reinforces the individual’s feeling of deformity. The key to diagnosis is the dramatic disconnect between a normal appearance and the patient’s exaggerated feeling of being defective. A normal patient usually looks to improve their normal appearance, and they do not believe it is a deformity.

Some people (like Jimmy Durante and W.C. Fields – very old movie stars) played up their huge and pock marked nose deformities and exploited them for profit as part of their persona. This is not Body Dysmorphic Disorder, but just simple good business exploitation of a body part, similar to what Marilyn Monroe or Brigitte Bardot did to another extreme.

Dr. Rassman,
I have been on Propecia for about 7 years now. For a good part of that time it seemed to halt much of the hair loss and at times it appeared to grow some hair. Over the past year though, the hair loss has accelerated at an alarming pace. I do not use any minox as it iritates my skin almost immediately and causes uncontrollable itching. Is it time to get off the propecia and start Avodart in its place? Or is there a minox formula I can add that doesn’t cause irritation? I still have coverage all over with the usual magic and mirrors but I’m reaching panic stages regarding my next move. Your insight is greatly appreciated.

First be assured that if you do have genetic hair loss, Propecia is the right choice. You should review all of the material on this blog with regard to Avodart. With these risks understood, a good doctor working with you, and a logical unemotional head, you can make the assessment of Avodart (which has been reported to pick up where and when Propecia becomes less effective). Remember, hair loss is progressive and either with Propecia or Avodart, sooner or later your genetic code will catch up with you.

i am eighteen years of age and am loosing quite alot of hair. it has been a month since this has been happening to me. i dont really know if it is cos im using a hair strightener 2-3 times a week and m washin my hair at least twice in a week. i am loosing my hair particularly when i am in shower. i am really worried and m not using a hair straightner at all during this christmas hoildays. Do u think that i should use my hair straightener once a week and wash it once too? i will really appriciate it if you write back!
Thanks a million!

I am not 100% certain that a hair straightener can cause permanent hair loss, but if you are concerned, then you should stop its use and see if your problem goes away. That is the easiest and most logical thing to do. Sometime chemicals can cause your hair to become very brittle and break without actually destroying your root, therefore causing any hair loss to appear a lot worse than it actually is. It is normal to lose up to 100 hairs per day.

I have read the stories at your site and I think its a great idea to make this forum.

My question is: I am having a FUE transplant in 2 months, and have agreed to have 1500 grafts. How many grafts is it possible to move? Maybe it is an individual answer for each person. My situation is that i have had a strip transplant 7 years ago. It was okay but left me with the traditional scar in the back. I am not bald but my hair is thin from front to crown and now I will have a fill in with 1500 grafts if there are enough available, as my doctor says.

FUE in the 1500 graft range is a big procedure. Follicular Unit Extraction (FUE) is a procedure you must be careful of when considering a hair transplant. A graft removed by FUE has a risk of being damaged when it is extracted. That damage can come from:

  1. grafts that have many transected hairs when they are taken out, producing fewer hairs removed
  2. grafts that are buried inside and left behind, which can cause infections and foreign body reactions
  3. grafts that lose the fat that surrounds them, making them vulnerable to fast drying or growth center damage which will impact graft survival and hair growth

More and more doctors are performing FUE, but few have the skills to do them with a very high hair (not graft) yield. For example, if you take out a 4 hair graft, but three hairs are transected and one comes out, does that reflect 100% success or 25% success? This is a very important focus for the individual who is purchasing FUE, as some doctors call such a graft as 100% successful because one hair came out, as it would have in a one hair graft. I would call it 25% success and a kill of 75% of valuable donor hair. Whatever doctor you are considering, please check this point out by asking for a direct answer to this.

At a meeting in the past year, a series of doctors demonstrated their skills in FUE and each had claimed expertise in the art, but alas, only one had good hair yields. This is no surprise to me, no surprise at all. Some doctors claim expertise with limited (or no) experience, and some claim experience without any audit of hair yield in place for each procedure. When I published the first paper ever published on this technique, a doctor who had built no significant presence in the field announced expertise within 60 days of my publication, announcing to the world that he invented the procedure. I remember him well, because he called me to ask me how to do the procedure and I gave him advice on some of the details he wanted to know. When I read about his self-declared expertise, I felt sorry for the patients who would fall into the “spider’s web”.

For more information about FUE, please see:

Hello, doctor. I do not mean any disrespect in my question, but I do believe it is an important one. I am considering surgical hair transplantation, and I’ve heard that you are one of the better surgeons in Los Angeles. My concern… my question is, how old are you? I ask this for two reasons. (1) Have you passed your surgical peak? (2) Will you be there in a couple of years when I may conisder another procedure?

Thank you. Again, no disrespect intended, but I am looking for a relationship with a physician who is not only qualified but who will be there when I need them.

What crystal ball does anyone of us have? Do you know when you cross the street that you will make it to the other side and not get hit by a car?

I am 63 years young. I have performed surgery on a couple of billionaires this past year and a number of top celebrities, one head of state, many CEOs of large companies, four patients from the TV show Extreme Makeover, construction workers, a bus driver, a grandmother and a mother of 7 kids, and many others who asked similar questions. My health is good, my maternal grandmother lived to 114, my maternal grandfather died at work when he was 102, my father’s grandmother lived to 99, and many uncles and aunts lived into their 80-90s. Like Sean Connery, I like to think that I get better with age. Mr. Connery turned 75 a few months ago, so he’s got many years on me yet.

I received the hair restoration industry’s equivalent to the Acadamy Award for Best Actor, called the Golden Follicle Award in 2004 at age 62, published the FUE technique when I was 59, and am probably one of the few doctors world-wide who does it well today. The FUE technique has to be the most taxing surgery in hair restoration that there is. I wrote chapters in text books and published scientific and other papers in the past 18 months numbering about a half dozen. I can not run the marathon (nor could I when I was 23), bench press some 500 pounds (also not able to do it when I was 23), or sprint the 100 yard dash (no comment is needed here but for that I am clearly out of shape). However, I ski regularly, scuba yearly to depths of 100 feet, ride my bike about 16 miles a day when I am not over-working and can play the piano for hours (my fingers, at least, hold up well). I can work longer hours than any of my staff and can get along on 3 hours of sleep per night if I must. If you get a younger doctor, ask to see patients of his/her which were done this year. I can show off many of my patients (which we do monthly) at our open house events and have done it for 14 years consistently. I tend to take my responsibility seriously, and have often helped my patients through many personal health crisis that were unrelated to their hair transplant. One patient of mine stands out (age 44) when he discovered that he had John Ritter‘s vascular diagnosis (actor known best for his role in “Three’s Company”). Mr. Ritter died just a few days from his 55th birthday from a rupture of his ascending aortic, so I became involved in the diagnoses and open heart surgery decisions that saved my patient’s life from Ritter’s fate. There is no doubt that had this patient not had a hair transplant, his diagnosis would probably have not been made and as his cardiac surgeon told him, he probably would have died in a year or so. If you would like, I can ask this patient for a reference that would back up this claim.

When you get to my age, you appreciate people for their value, hopefully gain wisdom, and with wisdom should come temperament that allows an artist to perform finer work, perfect his art, and refine and hone judgments that generally take years to define (just like Sean Connery has done for acting). I believe that what I bring is judgment and wisdom to my patient’s problem and potential surgery, and provided that my vision holds out and my hands remain as steady as they have for the past 35 years of doing surgery (from war torn Vietnam, to orthopedic, vascular, and general surgery), I fully expect to be doing hair transplants for some time, at least, on a selective basis.

Come meet with me and judge for yourself:

  1. if you like me
  2. if you respect me
  3. if you trust me
  4. if you think that I will be around for the duration of your needs

Your call, of course. When and if you come, please refer to this blog answer as I would love to connect with you, see the smile on your face and understand your motivation for writing this question to me. At the least, I enjoyed writing this answer, and at the most, maybe we will have things in common. I have made many friends amongst my patients, including many who did not ask traditional questions when they met with me.

Do you offer phone consultations for prescribing propecia? If so…what is the cost? I have been on it in the past but my script ran out some time ago. I really do not want to go to my family doctor for this again.

Before starting more medications, you should get a metric (measurement) by having your scalp mapped out for miniaturization to determine if you have premature genetic balding. I prefer that you visit in person for a Propecia renewal so that I can evaluate your hair better. However, if you can not come by, then I don’t mind doing phone consult with proper photographs. My charge for this assessment is $85.

My 4 year old has developed an almost circular spot on the back portion of his head. It seems almost bald. What is it?

There are many causes of such balding, including genetic factors such as alopecia areata (or variations of this), fungal infections, etc. You need to take your 4 year old to see a dermatologist specializing in children and/or hair loss.

Hello Dr. Rassman,

I have read in a few your blog responses about a procedure called Tissue Expansion involving the insertion and inflation of a balloon into the scalp to create new tissue allowing for a effective scar reduction. Are you familiar w/ patients w/ HT scars that have used TE and if so have they been successful?

I’m interested in learning more about this procedure and it’s viability. I live in LA – would it be possible for you to refer a Dr. who perfroms TE?

Thank you for your insight.

I would be happy to see you myself, where I would first assess your scarring problem. One must command the problem before recommending a proper treatment. I have been involved with tissue expansion for the past few years, but it is not the solution for everyone. If I can not manage the process, my ego would not get in the way; I would then refer you to an appopriate expert, that is, if you needed another opinion. First, let’s start with a visit to my Los Angeles office. Please call 800-NEW-HAIR to setup a free consultation.

Hi doctor, I have been recently been encountering certain problems with my hair over the past 5 months, I am 16 years old (male) and currently starting my first year of college. First signs of change were with the texture and build of the hair, as it started to become much drier and thinner. Then the amount of hair that started to fall out naturally started to drastically increase, although I have naturally thick hair the changes that I am experiencing seem too unnatural, one example is the fact that I never really used to be able to see my scalp, now I am really feeling concious about it. I have great foundations of friendship in the school that I go to and the worry of acceptance isn’t preying on my mind too much. I have asked my best friend about it and she seems to see no difference in the appearance of my hair, but I still believe there is something wrong.

My grandfather had troubles with baldness as a teenager and was completely bald on the top of his head at age 20. Confident self image is something that I always like to pursue, I style my hair using straightening irons and using gel based products, which I have been widely recognised at school for, for the past two years. A balding head it something that is not really seen around my social groups, and I’m not quite sure how my friends would react. I haven’t consulted my doctor about it and I would really like some impartial, friendly advice on what to do next, whether I should consult my family or keep it quiet and hope it will go away. I would really appreciate your help in this matter as I have only spoken to one person about this and I haven’t been able to research it myself much. Thank you

Go get your head mapped out for miniaturization, which will show if you are in the early phases of genetic balding. Especially at your age, it is too important to guess or work the answer blindly through the internet.

Iam a 40 year old male that has only suffered from Psoriasis for the last 4 months. Previously I have very thick hair, but already my hair is thining down the front centre of my scalp. What causes this is hair loss? is it the thick crusts of skin or the red lesions ?

What course of action would you advise for me as this is now starting to really affect my day to day life ? Are there partucular shampoos or remedies you would suggest above others ?

Many thanks in anticipation

Psoriasis can cause hair loss due to stress, scratching and picking it, and from normal genetic process that run in parallel to it. The best person to treat your psoriasis is your dermatologist. I recommend that you learn more about Psoriasis at the National Psoriasis Foundation site. Also, please review previous blog entries regarding this.