I have seen on the internet, the promotion of a double FU technique. Can you explain it to me and tell me about the value of a double follicular unit technique.

Follicular units (FUs) have one, two, three or four hairs each. When they are placed in the recipient area, they are graded in the frontal hairline (FUs with one hair each up front). There are times when the doctor wants to have more two or three hair grafts and the donor area yielded too many one hair grafts (common in Asian patients). In this situation, two single hair grafts (or one single and one double hair graft) are placed into a single recipient site and that is what is referred to as a ‘double FU technique’.

A bald man may get between 250-500 single haired FUs at the leading edge to create a soft, transitional hairline zone. All other FUs should contain more than one hair each to produce value. As each person has a different distribution of single hair FUs out of a harvested strip, the number of single hair FUs are determined by the anatomy of the patient (not the surgeon). So to get more than a single hair FU to place behind the leading edge transition zone, one might have to double up the single hair FUs to get reasonable bulk. More bulk can be obtained by putting a single hair FU with a two-hair FU to create a three-hair FU so that there is a way for the surgeon to determine and control the bulk of the hair that is transplanted.

Tags: hairtransplant, hair transplant, follicular unit, graft, hairloss, hair loss, doctor

I’m 30 and a Norwood Class 2. My dad is almost a Norwood class 6 and I have a feeling I’m heading in that direction. I am considering laser removal of chest hair but am having second thoughts wondering if body hair transplant will someday become more successful. (I have read your postings on BHT so far and understand that the results have been limited). Do you see a more promising future for BHT? And thank you maintaing such an informative site. Glad to have fumbled upon it.

I do not endorse body hair transplantation (BHT), because it is not the standard of care in hair transplant surgery. Body hair does not grow the same length or texture as scalp hair. Furthermore, the growth cycle of body hair is much slower and different than scalp hair. The growth phase for the hairs is much shorter from body hair and the sleep (Telogen) cycle is longer. If a doctor transplanted 100 hairs, then as many as 40-60% of them will be in sleep mode reducing the total number of hairs that grow at any one time. These are some of the reasons why I do not recommend body hair transplant to my patients. I am sure that there are doctors and patients who claim benefits and success with body hair transplants, but I am not one of them. If you are a Class 2 at 30 years old, you most probably will not become a Class 6 as your father is, but if you map out your scalp for miniaturization and show miniaturized hairs in the Class 6 pattern, then you might follow your father’s class. Mapping is good for that reason, to give your reassurance one way or the other. To answer your question though, I don’t see a more promising future for BHT. The hairs on your body are different from the hairs on your scalp.

Tags: bht, body hair transplant, body hair, hairloss, hair loss, laser, removal, hair removal, chest, hairtransplant, hair transplant

I have a naturally high forehead. I want to lower it somehoe but I am only 18 and no one seems to want to deal with me. WHat can I do??

Generally hair transplants for 18 year old males are approached with caution since they have further balding and a hair transplant may accelerate the balding process. For women, hairline lowering with a hair transplant is well proven with great results, even at the age of 18, because the worry about balding (male pattern balding) is not a factor in females. You should start with a miniaturization study of your scalp to see if you have early signs of balding. After all the risks and benefits of surgery are presented to you, it may be a consideration.

Tags: hairline lowering, hair transplant, hairtransplant, hairline, hairloss, hair loss

My 4 yr old son was taking Griseofulvin for 4 months for scalp ringworm with no results. When the dermotologist stopped the Griseofulvin she gave him a topical treatment. The bald spot spread rapidly and became very large. A culture then showed that he no longer had ringworm. The doctor had a chunk of his scalp analyzed-no infection. She then gave him pills for fungus. No result. This is now on the 7th month of treatment. His scalp is as clean as a whistle, no bumps, no hair at all and no signs of hair growing back. The doctor said keep giving him the pills. I’m scared to stop the medication, scared to continue the medication (with blood tests every 2 weeks). Will his hair ever grow back? and should I try stopping the medication? When will I know that he has permanent hair loss from ringworm? and that the ringworm is all gone?

Perhaps your son needs a second opinion from another doctor. I am not his doctor and I cannot tell you if your son’s hair loss is permanent or what is responsible for it, particularly without an exam. I can only make guesses, but your son deserves more than just a guess. He needs a good diagnosis. Find another dermatologist for a second opinion.

Tags: ringworm, hairloss, hair loss, child, children, dermatology


Does your clinic do transplants to recreate temple points to be blended into a hair system? Though I am only twenty, the severity of my hair loss is such that I am not a transplant
candidate. Therefore I am considering doing FUE into the temples and at the nape of the neck, where a hairpiece can then be integrated. Have you heard of or done such a procedure before?

Yes, we can do what you are asking, but I would want to know much more about you and why you are looking to do this., particular at the age of 20. I am a doctor first and foremost, so I must make my own determination on what is in your best interests. We may not agree, yet we might!

Tags: fue, hairloss, hair loss, hair transplant, temples, hairtransplant, hairpiece, hair piece, hair system

hi doctor,

i read in a recent post that a person who has been off propecia for 2 years may have permanenlty lost its benefit. i was told to cycle on and off of propecia elsewhere on the web (6 months on, 1 month off). does starting and stopping make my body more resistant to the effects of finasteride?

I’m 30. balding at temples and thinning on top.


Propecia should be taken every day. I do not generally recommend “cycling,” since the medication is out of your blood stream after one day and what this cycling guarantees, is balding. The recommended dosage for treating hair loss is 1mg daily.

Tags: propecia, hairloss, hair loss, finasteride, cycle

i have a pretty fair amount of chest, stomach, and etc.. hair. but my pubic area is not very hairy. what can i do to increase the hair in that area? im 37, in good health, just so you know if it matters

Hair transplant to the pubic area is a relatively common procedure that is not well publicized. Surprisingly, many Asian women have pubic hair transplants with good results. There is no reason why men cannot have the same procedure. We are an equal opportunity surgery center.

Tags: hairtransplant, hair transplant, hairloss, hair loss, pubic, body hair


I just turned 19 and am about a III on the Norwood scale. I noticed a slight receding hairline at 17 and began using Rogaine and taking saw palmetto supplements. My father was V on the Norwood scale by the time he was 28, but his balding was not as accelerated as mine at such a young age. I have been taking finasteride (5 mg dosages cut into 4 pieces) daily for about 5 months and have continued to use Rogaine foam, and my hairline continues to rapidly recede. As I am so young this is very detrimental to my self confidence and image. I was wondering if you think that I should try dutasteride, as the finasteride seems to have had no effect (my balding wasnt progressing this fast before I went on it), or maybe even consider hair transplants to fill in what I’ve lost.

It seems you are very proactive about your hair loss. As such, you need to start with seeing a good, qualified doctor for your hair loss options.

Saw palmetto is associated with improving prostate health and as such the natural supplement community now seems to link it to hair growth, because finasteride (Propecia / Propecia) is associated with prostate health. However, there is no ‘metric’ on the value of saw palmetto that would say just what does blocks DHT.

You need a miniaturization study before you start any medication so that you have a baseline measurement prior to taking any medical treatments. Photographs and general assessments may seem good enough, but you do not know what is going on at a microscopic level without a miniaturization study.

Avodart (dutasteride) is not FDA approved for treating androgenic alopecia (AGA). Just because it is said to be a stronger blocker of DHT does not mean it will be better than Propecia (finasteride). I always point out that the drug dosage is not documented, so every doctor that prescribes Avodart to treat hair loss should be wondering the correct dosage to prescribe. If/when it is finally FDA approved for treating hair loss, the decision to start this medication should not be frivolous.

Finally, hair transplantation in a 19 year old with Norwood Class 3 balding is not recommended. Give it at least a few more years to see where your hair loss pattern is evolving to before considering surgical options.

Tags: hairtransplant, hair transplant, avodart, dutasteride, finasteride, propecia, hairloss, hair loss, rogaine, minoxidil, saw palmetto

Four months back i had thick and shiny hair, then it started off falling very severly. I then went to a dermatologist. He advised me SeboWash, but there are many side effects with its usage, so now i am in dilema whether to use it or not. Is it safe to use?

As your dermatologist prescribed Sebowash (fluocinolone acetonide), I suggest you see that doctor ASAP to address your concerns.

Here’s info I found about SeboWash at CiplaDoc.com

  1. Sebowash is to be used as directed by the physician. It is for external use only. Avoid contact with the eyes. In case of contact, wash eyes liberally with water.
  2. This medication should not be used for any disorder other than that for which it was prescribed.
  3. The treated scalp area should not be bandaged or otherwise covered or wrapped so as to be occlusive unless directed by the physician.
  4. Patients should report to their physician any signs of local adverse reactions.
  5. Discard contents after three (3) months.

And here’s a little more from Wikipedia

Fluocinolone acetonide is a corticosteroid primarily used in dermatology to reduce skin inflammation and relieve itching. It is a synthetic hydrocortisone derivative. The fluorine substitution at position 9 in the steroid nucleus greatly enhances its activity. A typical dosage strength used in dermatology is 0.01–0.025%. One such cream is sold under the brand name Flucort-N and includes the antibiotic neomycin.

Tags: sebowash, fluocinolone acetonide, hairloss, hair loss, dermatitis, cipla

Dear DOC, what do you think of LASER FRAXEL SR1500 resurfacing of scalp scarring?

Any resurfacing of the scalp will damage the pigment cells and cause the color of the skin to lighten. It may also change the character of the skin surface and this may be more true when used for the treatment of a scar, which will require a deeper burn to get below the scar. I am not excited about resurfacing the scalp skin. I am not an expert on this though, so do ask your doctor for what his/her goals are — and specifically if the potential problems I discussed here are reasonable concerns.

Tags: laser, fraxel, scalp, pigment, scarring, scar

Hello Dr Rassman,
Lately my hairline has changed at at very fast pace. I´m 28 years old European male from Barcelona Spain and have noticed hands full of hair after washing it. I do however swim in the open sea once a week, and never wear a hat in the sun.

My hair type is wavey, drys easily and gets very light in the sun. Let me know your thougths and if it is something to be worried about? It is receding, however my father had most of his hair till his mid 40´s. Best regards

As regular readers of this site will know, I always tell my patients to have their hair mapped out for miniaturization to determine if this is genetic hair loss. You need to have a diagnosis first. If this is an accelerated genetic process going on, the mapping will show it. Treatments vary with the diagnosis, but Propecia (finasteride 1mg) is a great medication for treating the genetic hair loss diagnosis.

Tags: hairloss, hair loss, rapid, fast, propecia, finasteride

I went to the doctor yesterday to address the on-going issue with my hair loss ( i am 29 and have been experiencing this on and off of the last 12 years) and he recommended rogaine but the 5% foam. even though its not for women. I called rogaine and they pretty much said that if the doctor said i should use it then i should.

Im just concerned because i havent read of alot of women using it. I go in for blood work in two weeks to rule out anything serious ( ie iron deficiency, thyroid issues etc). But im just a bit concern as to why women can’t use the foam.


The 5% solution of minoxidil for women or men are just the same. The women’s version has an alcohol base (easier to style), while the men’s has an oil base (harder to style). I generally recommend 5% minoxidil for all my patients (both men and women). The foam is better for effectiveness and styling. Women can use the Rogaine Foam.

Tags: rogaine foam, rogaine, minoxidil, female, women, woman, hairloss, hair loss

I’m looking for help in the opposite direction. In my early 20’s, I started losing my hair and I decided to just shave it off. Eight years later, I have only grown my hair back twice (for maybe 1 month each time). My question for you is, is there permanent hair removal for the scalp? I get tired of shaving both my face and scalp each morning and when someone joked with me about laser removal of scalp hair. Any information you could provide me would be grealy appreciated. Thank you.

There is no joke. You can remove hair with laser hair removal. It will take many sessions to remove everything. More info on the process can be found at Wikipedia.

Tags: laser hair removal, laser, hairloss, hair loss

I am 29 years old man. I am suffering from frontal hair loss. I have come across a product called regen hair revitaliser (claiming to have bio active nutrients)from Raylon industries. Should I go for the same. I am not sure.There is one more product from Marico, Parachute hair therapie.Which one is advisable.

I found the product here, but if you are asking for a medical opinion, the only two products that are proven to work for the treatment of hair loss are topical minoxidil and oral finasteride (Propecia). I know of many thousands of products out there that claim hair growth, but the results are suspect. If it really works better than minoxidil or finasteride, I would think it would be a huge success. It is a buyer beware market.

Tags: hairloss, hair loss, vitalizer, regen, hair, raylon

RassmanI just had a patient (a 26 year old with very early class 6 thinning) who really does not look bald at all. I wish I could show you his photos, but I respect his wishes to not have his images published at this time. Anyway, he went to another hair transplant clinic (one of the chain operations) and was told that he needed 1,500 grafts. He had minimal thinning and looked good to me. I discussed it with him and he wanted to know if it would be a bad decision if he decided to just do nothing. I told him that his miniaturization was in the 30-40% range and that with his hair color and texture and considering that it really did not bother him, that just Propecia (finasteride 1mg) alone could be adequate until such a time that his situation changed. I recommended no surgery at all. He was happy to get that advice and was a bit frightened at the urgency created for a surgical procedure at the other clinic. As my consultations are free, my only satisfaction was that I saved him from unnecessary surgery or even accelerated hair loss due to shock loss after a surgery.

The reason I wrote this brief post was to point out that as a doctor, my priority is whatever is in the patient’s best interest. I’m not trying to line my pockets. I’m not trying to sell unnecessary procedures. I don’t split grafts to charge the patient more money. Unfortunately, not every physician follows this same line of thinking.

Yes folks, honesty is absolutely the best policy. Please remember this when choosing your hair transplant doctor. If you feel pressured, take a step back and remember that you aren’t buying a car, you’re having a consultation about cosmetic surgery.

Tags: propecia, finasteride, hairtransplant, hair transplant, surgery