Dr Rassman,

I appreciate your reponse regarding sebum question in whether it causes hairloss. You responded by saying it doesnt cause hairloss but it may cause your hair to be stuck to your scalp, then pulled out when combing or brushing, which leads me to 2questions.

1) IF hair is pulled out, would that loss of hair be permenant or would you regrow it once consistant washing resumes?

2) To put simply can hygiene like my case of not washing my scalp consistantly for 4yrs cause permenant hairloss? Like I said, its possible I went up to a month w/o washing with shampoo although the scalp got wet everyday because I did take a shower daily. Are all the factors that contribute to hairloss below the scalp, so even if a scalp was dirty or oily, it wouldnt make a difference?

As I said in my last response to you, not washing your hair will not cause hair loss, even for years.

If hair is pulled out once, twice or just a few times, it will usually regrow. If it is consistent, we call the hair loss traction alopecia (caused by pulling) and it can be permanent.

I remember a patient of mine with a beautiful hair transplant (one time surgery). He was mugged and the gang that mugged him, held him by his hair while they beat him and robbed him. After they finished with him, they yanked out his transplanted hair, laughed and left him with a broken nose, lacerations on the face, torn lip and scalp bleeding. He was taken to my office looking like a train wreck because he refused to go to a hospital Emergency Room. He only cared about the hair that was pulled out and gone. I told him that his hair would come back and sent him on to a hospital emergency room with the ambulance that brought him to my office. Later that year, he told me that all of his hair grew back within 4-6 months.

Hello. I am a 17 year old male that maybe hair transplantation is the answer to my problem. So heres what happaned. This was about 6-7 years ago when i was a young boy i used to pull on the front part of my hair. I know thta is one of the hair problems children face (Alopecia Trichotillomania), but i was doing that for a really short period of time. After about 2 weeks of pulling I had completely stopped pulling on my hair. After a long period of time most but not all of my hair grew back. Its been 6 to 7 years now and i have a few bald spots that have been bothering me ever since. I have one a little less than a dime, and my hairline isnt shaped right, and scattered mirco tin bald areas. Also, I would like to know from an estimate, how much it would cost for this procedure, and what is the difference betweeen FUE, FUT, and a hair transplant. I live in the los angeles area. I really want to fix my hair problem. Thank you.

Your first step should be to get a diagnosis. Small bald spots may reflect alopecia areata or ringworm and neither of these should be transplanted. There is no substitute for a diagnosis by a good doctor.

Assuming that you are a candidate for a hair transplant, it is difficult to estimate the cost of something that I have not seen. If you can send me pictures or give me some way to understand the size of the bald areas, maybe I can estimate the job. If it is small, use coins to tell me (e.g 3 dime size areas or one silver dollar size area). On that basis, I can estimate the job. Picking or pulling out the hair (trichotillomania) must be under absolute control or it will happen again. The picking must be solved before you transplant it. I can always tell if there is active picking going on in your head.

As you are in the Los Angeles area, pay me a visit and I will determine what the problem is, its scope, and what to do next.