Here’s essentially a summary of what I’ve written in the past about miniaturization. This is just about as to-the-point as I can get with what the miniaturization mapping is and why it is important. For more in-depth text on miniaturization and mapping, please see: Miniaturization: Critical to the Master Plan for Hair Loss.

Miniaturization is part of the balding process where hair shafts become thinner over time before falling out. Thickness and the general health of hair can be measured by examining it under a special microscope, called a densitometer, for signs of miniaturization. Increased miniaturization in certain patterns, reflect a progression of balding. In addition, miniaturization and detectable hair loss is not evident to the naked eye until more than 50% of normal (non-miniaturized) hair is lost. As a result, many men/women do not seek help until significant miniaturization has already taken place.

At New Hair Institute, we feel that mapping the scalp hair for miniaturization is critical in establishing the guidelines for the treatment of hair loss. Mapping measures the miniaturization and density on different areas on the scalp, providing us with a ‘roadmap of data’ to quantifiably measure the current health of the hair. When a medical treatment (such as finasteride or Propecia) is started we can document its effectiveness with the initial and periodic measurements for miniaturization.

The responsiveness of each patient with drug treatment is different, so each patient must be diligent in acquiring follow up measurements to the degree of miniaturization and the location of the miniaturization by scalp area. Without quantifiable measurements for hair loss, there is no clinical science in the treatment, just hocus-pocus and blustering, a problem that is far too prevalent today.

If you are balding, you should have your scalp hair mapped for miniaturization to (1) estimate the pattern of hair loss now and for future loss, and (2) measure the starting point for miniaturization so that changes measured over time, can be followed. These measurements are very fast and easy. It is today’s Standard of Care that should be available to every balding patient wanting a Master Plan, for treatments appropriate to their future hair loss.



by Jae P. Pak, M.D., William R. Rassman, M.D.

Tags: hairloss, hair loss, miniaturization, hair mapping

Hello. I am a 19 year old male. When I was 16, I had a really bad infection on my chest (follicultis) which destroyed a lot of hair on my chest. Now that I am older, I am showing lots hair starting to grow, but because of the infection, its growing in clumps and patches, and looks HORRIBLE. Is there any sort of topical thing I can apply to my chest that can possibly restore these damaged hair follicles? A response would be GREATLY appreciated, sir.

You might try minoxidil. It should grow or stimulate hair growth on the chest. Give it a full 6-8 months before concluding that it is not working and use it twice a day. Chest hair can be transplanted from the scalp. I have done that before, but I would hold off on that until you are older (25 years old minimum), as chest hair is often delayed into the mid-20s and through the early 30s.

Tags: folliculitis, chest hair, hairloss, hair loss, minoxidil, rogaine

Is my risk of prostate cancer higher because I am balding?

Men with Male Pattern Balding (MPB) have a consistently higher incidence of prostate cancer compared with those without MPB.

In summary, we found a significantly increased risk for prostate cancer among men with MPB, independent of established risk factors including aging and race. Although remote from the prostate, MPB may represent an early, clinically obvious marker of susceptibility and may provide clues to the pathogenesis of prostate cancer.

(source: Male Pattern Baldness and Clinical Prostate Cancer in the Epidemiologic Follow-Up of the First National Health and Nutrition Examination Survey)

When finasteride is used, “cancer prevention should be recognized as an additional benefit of treatment“. When compared with alternative treatments, “chemoprevention may also provide an excellent strategy for diminishing treatment-related costs and adverse effects such as erectile and urinary dysfunction“.

(source: Should finasteride be used to prevent prostate cancer?)

Tags: hairloss, hair loss, prevention, finasteride, cancer, prostate

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?

EmergencyAs 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.

Tags: hygiene, hairloss, hair loss, pulling, alopecia, traction alopecia

I have about 2 1/2 inches of hair, im a 21 male and when i shed, i see short hairs and long hairs, is this normal? and also get about 5 to 10 new pimples every other week or so on my scalp, they are tiny and usually filled with white pus. i wash my hair everyday before i goto work, in the mornings and sometimes at night. could the pimples be causing the different length of hair to be shedding, and do pimples cause damage or hair loss? thanks to whomever read this, would really be appreciated

If you are experiencing folliculitis (pimples filled with pus) then it could be causing your hair shedding. You need to be examined by a good dermatologist and I am certain that once that doctor examines you, he/she will know what is wrong and how to treat it. I can not do this over the internet.

Tags: hairloss, hair loss, pimples, folliculitis

Hello Dr. Rassman! First off, I would like to thank you for the time you take to give hairloss info/advice. My question is: I have been on Proscar .5mg daily for several months and have had several side effects such as mental cloudiness, fatigue and a drop in blood pressure. I am 29 years old. I always have to give my body a break from the Finasteride where I go off it for 3 days and My blood pressure goes back to normal. If I take 1mg every other day, will that still provide results while cutting down side effects? I really, really would like to keep my hair although the sides are really tough for me and Minoxidil inflames my scalp to no end. I understand the Finasteride is the best treatment. It know it is important for me to speak with my Dr. however I know he will just tell me to stop the Proscar altogether. Thank you and look forward to hearing from you!!

Sounds like you are trying to be your own doctor. As the saying goes, a person that treats himself has a fool for a doctor. You are doing things that are not clear. One place you say you are taking 0.5mgs Proscar a day (1/10th of a pill?). The side effects you are discussing sound psychosomatic. Did you really record a drop in blood pressure? If so, you have problems that are probably not finasteride related. I’ve seen drops in blood pressure with minoxidil — but never with finasteride.

If you take 0.5mgs of finasteride (1/2 of a Propecia pill, or 1/10 of a Proscar tablet) the overall effect of the drug is estimated to be 80% of the full 1mg dose. Anything less than 0.5mgs will reduce the effect of the drug significantly. If there are side effects from the drug, the smaller dose might work for you.

Tags: hair loss, hairloss, finasteride, propecia

I lost 3/4 of my hair due to lithium. How do I get it back?

Many drugs are known causes of hair loss. If you stop taking it, your hair might come back — but at what price? Speak with the doctor who is prescribing lithium about alternative drugs.

Tags: lithium, hairloss, hair loss

Dear doctor,
how do i find out if my hair loss has started or not? (my dad starting to lose his hair when he was 50, he has not lose all his hair yet but he you can see his scalp after washing his hair) … u think it is a good idea/time to start taking proprecia? i have been taking proprecia for nearly 3 months. what happen if i find out that my hair loss has not start, will i trigger the hair loss if i stop taking proprecia? Please teach me what to do. thank you so much for your time.

Get your hair mapped out for miniaturization and you will know for sure if the balding process has started. I doubt that Propecia will completely prevent the balding process if taken preventively. If I assume you saw no benefit yet on the drug, I would doubt that you would lose hair by stopping it now.

Tags: propecia, hairloss, hair loss, finasteride

I have had some surgery (face lift and hair transplants) and my face gets swollen from time to time. When it was swollen last, I went to my plastic surgeon who said that he did not see any swelling, but I know it is swollen because my hat is too tight when the swelling is there. Can you help me?

I suspect that you may be seeing a very subtle type of swelling. This is a condition more often seen in the legs or arms, called lymphedema. If it is very subtle and does not produce symptoms, leave it alone. If it is in the legs, then compression stockings may help. For leg swelling, you must worry about heart disease and dependent edema from right sided heart failure. This is not the case with lymphedema of the face or scalp.

Massage works and it feels good. Compression at night with a compression bandage will reduce the scalp component of it. Lymphedema can be a result of surgical or cancer therapy, and irradiation. It can also reflect tumors and metastases of tumors. I have seen patients present with lymphedema of the face and scalp as the first sign of tumors that invade the lymphatics of the neck, where head and neck tumors tend to migrate or even in Hodgkin’s disease (which are a type of lymphoma/cancer). If there are no cancers in consideration (you are not a smoker and have never been one, do not chew tobacco and never done that, have any other symptoms around the face, nose or neck, and no swelling in the nect and it is not bothering you) you might just wait it out. I am slightly concerned because you said you had a face lift and that would imply that you may be over 50, when these types of cancers are more common. Certainly, get yourself cleared by a good doctor because cancers of the head, neck and problems in the lymphatics of the abdomen sometimes present the way you are telling this to me.

Tags: surgery, lymphedema, facelift, hair transplant, swelling, cancer, compression

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.

Tags: hairloss, hair loss, trichotillomania, bald spots, alopecia, ringworm

I am 21 years old and I have about 15 white hairs around my temples… I used to have about 3 or 4 last year but a lot of stress over this past year has spread the white hairs. I have been told that plucking out the white hairs will cause for the white hairs to spread. Is this true? Also, are there any spray on dyes or temporary touch up dyes that are available on the market? Any information would be helpful, thanks!

Plucking hairs produces traction alopecia and may cause permanent loss of the hair if you persist on doing it. Plucking hair in one area will NOT cause hair to be lost or gray in another area. You will almost certainly see more white hairs over the years. I would put my money on genetic causes, not stress.

As for hair dyes, you should ask your local hair stylist.

Tags: hairloss, hair loss, plucking, white hair, gray hair, grey hair

Dear Doctor Rassman;

Thank you for your advice and for taking our questions. I had 2700 FUs done this past February. I’m very happy with the results. I’m thinking about doing a follow up surgery to thicken the front area some more around mid December. I’m afraid about all of this talk about Shock loss. I’m 48 years old, male, and in very good health. I’ve been taking Propecia since January of this year and have noticed some improvement on the crown area. Please let me know your Opinion on this matter of Shock loss. I’m a bit confuzed and I don’t want to worsen my frontal area.

Thank you and Kind Regards.

I would doubt that you would experience shock loss because:

  1. You recently had a transplant and had not experienced it
  2. You are on Propecia
  3. You are over 40 years old
  4. Don’t worry, be happy… and don’t be confused. Go for it!

    Tags: shock loss, hairloss, hair loss, hair transplant, propecia

hi was just wondering whenever i get stressed i start to feel the right side of my head above my ear area get warm and tingly so ive just noticed recently that whenever it happens i tend to scratch/rub that area i ahave very bad thinning now on that side and also my right eyebrow for same reasons will these hairs ever grow back ? thanks

Chronic scratching will produce traction alopecia. What you are describing is a variant of a condition previously discussed on this blog, trichotillomania. It may grow back if the damage is not severe and you stop picking at it. Only time will tell you the answer.

Tags: hairloss, hair loss, tingle, stress, trichotillomania

Hi- I’ve recently noticed a bald spot above my right ear, which has little baby hairs still remaining in some parts. The spot is maybe an inch tall and 2 inches wide. I have been through stress the past two months, and have been experiencing variations with my emotions as well, sometimes, even more than usual. Should I go see a dermatologist or wait it out and see if my hair returns? I’m afraid that I will lose more hair and that would be worse than what I have now. I am 26 years old and a female. I recently moved to the northwest from the midwest and am beginning graduate school. I tried a new shampoo earlier this week and it could be a combination of things. I’d love to hear your thoughts. Thanks,

Hair loss from above the ear may reflect a genetic problem. There are some types of hair loss that run in families and are found above the ear. Other conditions must also be considered such as Alopecia Areata. See a good dermatologist and rest your concerns.

Tags: hairloss, hair loss, doctor

I had a gash on my head about an inch and a half that required 7 stitches. I received immediate medical attention and I now have a scar on that spot. It is close to my hairline, will hair eventually grow back?

If the ‘gash’ repair produced a scar, then the scar will not grow hair back. If the scalp repair was done scalp to scalp, it may grow hair back. The direction of the scar has a lot to do with what it may look like. Front to back scars near the hairline tend to do worse than side to side scars at the hairline. As you are in Los Angeles, pay me a visit in my LA office and I can tell you that answer after examining your scalp and scar.

Tags: hairloss, hair loss, scar, stiches, medical