Hi Dr. Rassman,

Thanks for this site. It has helped me with several of my questions on multiple occasions. My question is this: I followed one of the links on your site to Bernstein Medical and noticed that you have some pictures in your before and after sections that are of exactly the same people. The caption on his site reads: “view results of patients treated at our New York and New Jersey facilities using Dr. Bernstein’s pioneering hair restoration techniques.” Your website says that the pictures are all of NHI patients. Why do you have pictures of many of the same exact patients, and how does a customer know which patient was treated by which company?

These pictures are a big part of helping me decide where to get a transplant, and it is confusing seeing the same pictures on both sites so I really appreciate your answer.

Thanks.

Dr. Robert Bernstein was part of the New Hair Institute from January 1995 – December 2004. These patients were treated by Dr. Bernstein and the NHI staff during these years. When Dr. Bernstein and I divided up the practice, the NHI staff in the east coast offices (that he and I trained) stayed with him. I had no interest in opening up another office at this time and have been trying to simplify my life with less offices. The split between Dr. Bernstein was only a business separation, as we continue to work together, sharing everything we do in this field. Any breakthroughs that either of us make are shared or jointly developed. We have continued to write scientific and clinical papers together for publication. I believe that Dr. Bernstein and I are doing almost identical work and that is because we developed almost everything together and published what we did so that the world knew it was a joint development. The patients that are shown on both sites were done by Dr. Bernstein, but they were actually patients of the New Hair Institute when Dr. Bernstein was working exclusively with us. Therefore, the photos should be on his site as well as NHI’s site.

Is it true that eyebrow transplants do not behave like eyebrow hair?

Hair for eyebrow transplants come from the head. As such, they retain their head hair characteristics. There is some need to match head hair and eyebrow hair to see that it is appropriate to use it. This matching is critical. In the afro hair, the hair from the scalp is kinky, and if that hair is moved to the eyebrow, it might not behave as you would hope and the kinky nature of the head hair may not look right in the eyebrow. If the shafts of head hair are too thick, it is possible to thin down the shaft thickness in the hands of an experienced surgeon. Most significantly, the eyebrow hair will grow long and it requires trimming a few times a week because it will grow out ½ inch per month. Not trimmed, it could obtain a length of 3 feet (or whatever the maximum hair length might grow to), which is something that will not look normal.

Here is an example of a patient who had eyebrow transplants in the medial part of his eyebrow. He had forgotten to trim it for almost a month before he came in.

The photo on the left is before; the photo in the middle is 6 months after (with long eyebrow hairs); the photo on the right is also 6 months after (with eyebrows trimmed).

The patient had less than 20 single hair grafts in the area where the long hair is seen. Click each photo to enlarge.

 

I am a 55 year old woman within my 3rd year of full menopause. My hair is thinning noticeably at the crown and in the front, not so much in the back. I am concerned that I have inherited my mother and maternal grandmother’s hair loss; they had very thick hair until they reached my age and from there on it was a systematic hair loss. My father on the other hand had all his hair until he died at the age of 60.

My question is what can I do to stop the hair loss, and is there any treatment for recovering hair loss? Is there any promising treatment for women that does not involve surgery?
Thank you

The only medication that is proven to work for women is Minoxidil. It only works in some women. Many substances are sold with promises that just aren’t true. Hold onto your money and be careful not to get caught up in any scam.

I would see a doctor to be sure that you do not have other causes of hair loss and have your hair mapped out for miniaturization to be sure of the diagnosis. Female genetic hair loss has a unique pattern shown under high power visualization.

Hello there Dr. Rassman,thanks so much for your helpful blog. Here are 2 questions for you that I’m hoping you can help me with. I lost my full hairline (receding in temple area) when I was about 24. It receded for a couple of years and then stopped. I am now 33 and over the last 2 months has started again-very quickly!! It seems I can tell the difference weekly. I am now almost at just a strip in the center and this is quickly disappearing!! Is this normal or may other factors be at play. Also, does a 5mg Proscar pill cut in 4 have the same effect as Propecia?? Thanks for your help again, hope to hear from you soon.

Male pattern baldness is never normal for the young man who wants to be hairy, but it is normal for your genetics. You are probably experiencing further hair loss and it could go through bouts of rapid loss. It is best to visit a doctor for thorough evaulation of your hair loss pattern by using a densitometer or a magnifying video camera to determine the amount of miniaturization that is present. Proscar and Propecia are the same drug, called Finasteride. Propecia is dosed at 1 mg of Finasteride. Many people cut Proscar (5 mg) into 4 pieces equal to 1.25 mg of Finasteride and the only difference is that the dose may vary based upon the size of the cut pieces.

Once one has had their eyebrows transplanted, do you know of, recommend or sell any products such as eyebrow gel, clear mascara etc. that helps keep the eyebrows in place (ie. something with a strong, long lasting hold)? Any information or recommendations you may have would be greatly appreciated.

Please get back to me at your earliest convenience,

Thank-you

Most eyebrow transplants come from the scalp. I am assuming that the surgeon who did your eyebrow transplants put them in the correct direction and shallow enough to lay flat. Eyebrow transplants are a real art and they must be delicate and made up largely of single hairs.

Assuming that everything was done correctly, your new eyebrows will behave like head hair. If the character of your head hair is wild, unable to control easily, then the same will be the case for your new eyebrows. Relaxers for very wild hair may work, and using a good conditioner will relax it as well. You may have to put a fine wax on it. Speak to a good hair stylist for suggestions.

Dear Doctor Rassman,
I am a healthy 22 year old man. I was born with a naturally receding hairline. It has been with me since I was a kid. I am experiencing no hair loss and I use Revivogen to shampoo. My receding hairline has always bothered me since I can remember and I wanted to know of some remedies to get rid of this hairline that is natural to me. I have been recommended a hair transplant and would like some recomendations from a professional such as yourself.

At only age 22, you can not be sure if the hair loss may come on in the future. By age 30, you can tell by mapping out the hair for miniaturization. For this reason, we generally do not treat high hairlines, but that is a generality and is something that should be worked out with your doctor. I have transplanted the frontal hairlines in actors and male models your age, and would only do so after I had made a diagnosis and developed a Master Plan with them for a worst case scenario. I would consider this non-therapeutic and might consider doing it.

Hello. i’m 23 and had a 2000 graft procedure in new york on july 1st 2005. its been about 6 months and some weeks and i havent seen the dramatic results i thought i was suppose to see. I asked the doctor and he says its early and everyone is different, just wait and be patient. What do you think? I “feel” some hairs growing in different spots but not everywhere, and i have some slight cobblestoning, does that go away?
Thanks so much

I always tell my patients to wait a full 8 months before judging what the results look like. At 8 months, 80-90% of the transplants should have grown and much of them at styling length of 2 inches or so.

Be patient and wait it out. Significant changes will probably be evident in the next few months.

Hi i recently sent you a question about waxing. [see Hair Regrowth After Waxing Scalp]

For some reason the waxed area appears worse. I am worried that I may have developed folliculitis on my scalp as a result. My entire scalp itches. It would be helpful if you could give me some information about folliculitis as well as the differences if any between folliculitis and folliculitis decalvans. Also it would be helpful if you could tell me what to do to contain the hair loss to only the waxed area basically prevent it from spreading.

Folliculitis is a condition where the hair follicles get infected because of bacterial invasion, often secondary to some irritation or wound of the skin. Folliculitis can spread from one hair follicle to another by touching or scratching it, making it worse. It is a fairly common condition.

Folliculitis Decalvans is a rare condition affecting mainly the scalp leading to scarring alopecia. The cause of the condition is still unknown, abnormal host response to Staphylococcus aureus (a bacterial infection) has been postulated. Folliculitis Decalvans causes scarring with hair loss (alopecia). There are areas of “corn stalking” (grouped hairs arising within the area of alopecia), redness (erythema), crusting, and pustules. Due to severe scarring, permanent hair loss occurs in the involved sites.

As you may be aware, this is a diagnosis not for the amateur. Get a good dermatologist to take care of you, starting off with a proper diagnosis. Appropriate antibiotics will be recommended by the doctor, if indicated.


first:
i need your opinion concerning the placement technique of DHI Greece group.

Second:
i had a transplant with famous doctor in Australia, he is very good in FUE (body & head) but the placement is not good & transplant hair nature is changed. i think his way with washing hair not before one week of tranplantation is not good for hair, i need your opinion for that.

finally:
i think you are the best doctor in this field but i have 2 problems to proceed with you:
1- getting the VISA, my application was introduced from 18 months & there is no answer. i know this is not your fault, but this is the situation
2- i am Norwood 5 to 6, i prefer to use BODY HAIR & untill now you do not proceed with this option

finally thank you for this valuable website, i know everydetails of hair transplatation & made me have standard for quality procedure

Thank you for the faith that you expressed in my skills. To answer the first part of your email about DHI, please take a look at FUE / FIT — Minimally Invasive Hair Transplants.

It sounds like although you did your research, the “Buyer Beware” axiom still failed even after considerable research. If you are a Class 6 pattern balding patient,l the best and probably only real good source of donor hair is from the back and sides of your head and you need to exploit this first before you consider body hair transplants (most people never need them). You have clearly recognized that the art of placement is critical to the final result, which is something that many people do not differentiate from medical clinic to medical clinic. As the inventor of the Follicular Unit Extraction (FUE) technique, I know that it is not always the best procedure for those who are extensively bald. I personally think that you must focus upon the quality of the transplanted hair, and body hair does not have that same quality or quantity as head and scalp hair. Performing body hair transplants will produce a poor quality hair transplant (when compared to a good transplant with scalp hair), which may be what you are observing and blaming on your shampoo and washing technique.

Please send photographs to the address on the Contact page as a starting point of a dialogue.

My maternal grandfather was bald and my father, who’s almost 60, has substantial thinning around his crown and a receded hairline. I just turned 27, and I don’t seem to have much if any thinning. The temples of my hairline have receded an inch or so in the last couple of years but everything else seems to be in place.

How long can my luck hold out? I have plenty of friends my age who have already lost substantial hair but I have not even though I’m certain I’ll lose substantial hair because of genetic inheritance.

As a general rule, you may follow your family pattern not only with balding but with the onset date. When did your dad start balding? You can have your scalp mapped out for miniaturization to see if you have early signs of genetic hair loss, but if you do not see it, I would not even go that far.

Hey. I’m 20 years old and I have also had a further back hairline, but only on the side. it looked fine. A year ago i asked my doctor about it because it was a little thin on the right side and he prescribe propecia. Well i had been taking propecia for about 8 months every other day, when all of the sudden my hair was coming out like 15 hairs at a time. when i ran my fingers through my hair tons came out. I lost about an inch and a half on my hairline in 2 to 3 months. My hairline was fine before but it was just thin on the right side. It crazy its bother me alot. So i quit taking the propecia a little less then a month ago. I mean i cant even grow facial hair. so it feels weird that im losing my hair. PLease help. Could this be temporary?

Dealing with someone like you over the internet is very difficult or almost impossible. As I have said many times on this blog, you first need a working diagnosis. Getting your hair and scalp mapped out of miniaturization should at the least establish a proper diagnosis. Having someone with my experience, for example, is critical in making the judgments you need. Questions that stand out for me include:

  1. Are you going through accelerated hair loss?
  2. Do you have other causes of hair loss?

I would want to go through an extensive history on your overall health and the family tree in terms of balding, hair growth (when and where), etc. Get a good doctor and do not treat yourself. It has been said that “A person who treats himself, has a fool for a doctor”.

Hi Dr. Rassman,
I started using Rogaine almost 2 months ago. My hair was getting very thin and each year I had less hair. Before using Rogaine, I never saw a hair in my shower drain, but somehow I was losing hair. After using Rogaine, my hair loss did not get worse in the first 2-3 weeks, but now, after almost 2 months of using Rogaine, I noticed a lot of hair in my shower drain every day. what shoud I do now? should stop using it? or should continue? I use twice a day, a little more than 1ml of 5% Rogaine.
Thank You

Shedding of hair may occur shortly after starting Rogaine. I would suggest that you ride out this phase considering the short period of time.

I’ve had Laser treatments to remove the hair on my back and reduce the hair on my chest. I now have very little hair on my back and less on my chest.

Recently I’ve had a CATSCAN. My lymph nodes are irregular and I’m having a biopsy. I’ve been told I may have to do chemo.

I’m aware I can lose much of my hair during these treatments. I realize this is usually temporary. Will this have an effect in reversing any changes made by the Laser on my back and chest?

Thanks.

If the laser succeeded and the hair on the back and chest has been gone for more than a year or two, then the chemotherapy should not impact any regrowth of the body hair that has been removed. The reason I am saying this, is that laser hair removal (when it succeeds) kills the ‘root’ of the hair so that it will not regrow. As you probably know, the laser is about 50% effective at killing each hair, so after one treatment 50% of the hair will return within a few months of the treatment. With each successive treatment 50% of the treated hair dies, so after the second treatment 25% returns, and after the third is 12.5%, then 6%, then 3%, and so on. This assumes that modern hair lasers are used.

Your head hair (if you lose it with chemotherapy) has not been killed off, but rather a chemically induced telogen process will have been precipitated. Chemotherapeutic agents go after the faster growing cells of the body (cancers, hair, certain blood cells, sometimes intestinal cells) and that is the common thread that produces the side effects you may experience with such agents (anemia and white blood cell depletion, bleeding from depleted platelets, diarrhea and nausea from intestinal cell impact). The telogen process from chemotherapy is in the hair follicle and it usually reverses in a few months after the chemo stops. The drugs used vary and not all people lose their hair with some of the chemotherapy agents. Some of the newer chemotherapy agents are more targeted at the cancer and some of these other fast growing cells may not be impacted.

Dear Dr. Rassman

I am 33 and suffered from depression and anxiety attacks over a period of years and took numerous antidepressants including Zoloft and Surmontil. In addition I took sedatives such as Xanax and Temesta. During that time I did not notice any hairloss, even though I experienced a huge amount of stress. I am on the way to recovery now and stopped taking the antidepressants over 6 months ago and am weaning myself off the Xanax. For the last 6 months I have been experiencing mild hair loss, especially noticeable on the front hairline. Gaps are appearing in the hairline, which was normally full. I wash my hair about 4 times a week and comb my hair when washing it. In total I notice about 20-30 hairs on my hands and comb every time, which I never did before. I have no family history on either side of baldness. I have the following questions:

1) Is it possible that I could be experience temporary hair loss as a result of a history of using antidepressants and huge stress, and am having something of a delayed reaction? If so when can I expect hair to start growing back, if at all?

2) Does hair generally become thinner and recede in any case with age?

3) How can the loss of 50-100 hairs a day be normal? It seems like such a huge amount. Even given that new hairs are growing, that is around 30,000 hairs a year.

Thanks for any advice.

Kind Regards

Stress and antidepressent medications can cause hair loss. In some people, the hair shafts become finer (rather than coarser) and develop less densities of the hairs themselves with age. Most people lose about 100 hairs per day and they grow back about the same number of hairs each day.

Does hair age?

Of course hair shows the effect of aging and it will often change as we get older. Look at the huge crop of large diameter hairs in the ponytail of a twenty two year old women and think of the meager, thin hair of some 80 year old women. Hair often gets smaller in diameter and fewer in number as we age.

The process of getting finer shafts (or lower densities of the hair) with age occurs insidiously over many years, starting in some people in their early 20s (male and female) and progressively becoming more frequent with each decade. We just notice the changes when we look at an isolated 80 year old in a nursing home and we think ‘Old’. The medical profession calls this type of thinning ‘senile alopecia’ (doctors have to use some Latin to create a medical mystique to it). Most people will notice that their adult hair changes in character as their age advances. This change in character may be from wavy to straight, or from thick gorilla hair to a see through appearance where the scalp can be seen in reasonably bright light (htat may never have been the case in that same person when they were 20). I would suspect that the thinning of hair densities occurs in fully 1/3rd of the adult population (male and female) at some time during their lifetime and I see this process in some men who are in their early 20s, which we now call ‘diffuse unpatterned alopecia’, yet another abuse of the latin language of olden days.

By Drs. Jim Arnold and William Rassman