First of all I want to thank you for this great site.

In Dec. of 2006 I went to a T.P. doctor, mainly to get a prescription for propecia and to hear what he had to say about how good of a candidate I would be for a hair transplant. I found out at that time that he still used the mini & micro minigraft procedure, with magnification and backlighting.(no steroscopic microscope). In Dec. 2007 I was looking at his web site,and to his credit, is now doing follicular unit grafting using stereoscopic microscopes.

My question is this,how difficult is it for his staff to learn to use microscopes and to be cutting in follicular units instead of minigrafts? I guess what I really want to know is how much time should I give them, to learn the “new” procedure before I go back for another consultation?

Do you have any photos that show the difference between minigrafting and folicular unit graphing on the scalp?

Thanks again.

P.S. How much does a stereoscopic microscope cost? This doctor has been doing hair transplants for 14 years and is now just getting some.They must cost alot!

Cost for hair transplant at New Hair Institute… as low as $5 per graft.
Cost of microscope at a local scientific store… around $500.
Cost of a well done follicular unit hair transplant… priceless.

The difference between minigraft and follicular unit transplantation is small, but can be significant when you look closely at the growing hair. Minigrafts and micrografts transplant skin between the hair follicles and this skin can produce changes in the scalp at the point the hair exits the skin. There may be cobblestoning from the transplanted skin. Follicular unit transplantation only transplants the natural occurring units of hair as they exit the scalp and most of the skin edge is removed so that the point of exit of the hair is normal.

More importantly, the difference when using a microscope for dissection is that you do not waste good follicular units since you can see minute details (under the microscope).

For more details, read our published articles on the subject:

Tags: minigraft, micrograft, follicular unit transplant, fut, hairloss, hair loss, hair transplant, hairtransplant, microscope

Dr. Rassman,

My main concern is being able to start using Propecia as soon as possible in order to slow down any further miniaturization and slow the progression of any further receding. The other concern I have is regarding the miniaturization study. I live in Minnesota and since your only offices are in California, the distance factor will create cost issues for me.

What options would I have with such a long distance and cost factors?

ProScopeYou can use a video microscope and look at your own hair. These run about $200-400 or so and are often sold online (price varies per vendor and tool used). I like the ProScope (the USB version for computers is more costly than the version that connects directly to the TV) and have them in my offices along with specialized software we developed for keeping records of the patient’s mapped scalp. You need to estimate the number of small hair shafts as compared with the larger, normal size hair shafts. It is often difficult to tell the difference between vellus hair and miniaturized hair, so I use an estimate of 20% as the normal level of miniaturized/vellus hairs. Any number in excess of this in different parts of the scalp is thinning/balding.

Alternatively, of course, try to find a doctor who will manage your entire hair loss process by developing a Master Plan, which should be the bible for your hair loss management.

Tags: miniaturization, mapping, microscope, microscopic, hairloss, hair loss, vellus, proscope

Bruce Willis and Halle BerryI have a dispute with my friend that Bruce Willis in the movie Perfect Stranger is using “movie hair”.

Is that his real hair or not?

Honestly, your guess is as good as mine.

I don’t have access to the make-up artists and stylists that were on the set during filming of that movie (see photo above), and I haven’t had the opportunity to examine Bruce Willis’ scalp. It appears like he has a Norwood Class 4 pattern of hair loss from the above picture (no crown is showing), but I can’t tell for sure since he usually shaves his head completely in most of the pictures and movies I have seen him in. I would guess that the frontal hair shown in the above photo may be real. My reason for such thinking is this — why would Hollywood put hair on Willis’ head with a frontal balding pattern, when they could just as easily put it back to a pattern reflecting a period earlier in his life? I haven’t seen the movie, so I couldn’t really tell you if it was a purposeful choice.

Tags: bruce willis, willis, halle berry, perfect stranger, movie, celebrity, actor, hairloss, hair loss, bald, pattern

I have ulcerative colitis and have experienced Telogen effluvium a couple of times. I recently had a very small flare up and my Dr. put me on mesamaline enemas. I have been on them for about a month and noticed that my hair is falling out….this can’t be because of extreme blood loss or anything because I haven’t had that with the UC. Does mesamaline enemas cause hair loss. Secondly, with TE, the hair loss happens for about 5 months, when a med causes hair loss will the hair loss stop immediately when i quit the drug? Thank you

There is a remote connection between mesalamine and hair loss. “Slight hair loss” is listed as a rare side effect from this medication. See the full list of possible side effects here. Looking at the potency of this medication in impacting rapidly growing cells, I am not surprised to expect such a relationship. Your ulcerative colitis in itself will cause hair loss when it is active in the form of telogen effluvium.

Tags: Mesalazine, mesalamine, hairloss, hair loss, ulcerative colitis, uc, telogen effluvium

Dr Rassman,
I have been reading your blog and I generally know your feeling about ‘natural cures’ for hairloss, and the claims the sellers make. I have been on Minox/Fin for a few months and I have seen very good results, so I intend to continue. My question is, do you have any recommendations for nutritional supplements or multi-vitamins that help promote healthy hair growth? I’m not looking for a natural ‘cure’; just some information on vitamins that would promote healthy hair growth.


I do not have specific recommendations for diet or nutritional pills. It may be a different story if I was selling any of these products myself, which for me, would be a conflict of interest. Point being, a lot of the recommendations various sites make about vitamins or other pills will also include a link to buy those same products direct from their online store. Just be cautious that you don’t get duped.

Tags: vitamins, pills, nutrition, diet, hair growth, hairloss, hair loss

After using rogaine and the quitting i discovered a mix between thick and thin hairs. Have I created DUPA because my hair is worse now then before. Also the colour of those hairs are gone..same thing happening to my pubic area and facial hair. Do you think rogaine has created DUPA on me. I used it for a month and haven’t used it for two months now

Having thick and thin hair does not mean you have diffuse unpatterned alopecia (DUPA). You need to be evaluated by a good dermatologist or a hair transplant surgeon to find out if your diagnosis is DUPA. The changes in hair color in different parts of your body indicate that you are undergoing some preprogrammed change, probably not related to Rogaine (minoxidil).

Tags: minoxidil, rogaine, dupa, diffuse unpatterned alopecia, alopecia, hairloss, hair loss

(female) I have been looking through your webpage and have a question for you, that I can not seem to get a good answer to. I do have a doc’s appt for later this week though.

On the right hand side of my head, kind of directly above the ear, i have noticed a bead like bump. Its firm…is a little sore, is form..and I have had it for a while. I keep thinking it may have been caused by a hair being pulled while I was styling my hair…but think that if it was an infection, would it not be majorly sore and all? I am completely freaked out…is there anything you could suggest until I see the doctor?

Based on what you’re telling me, it doesn’t sound serious. Cysts can be caused by hair getting pulled, and it sounds unlikely that if someone pulled your hair out that you would not know when it happened. Hair pulled out once will not cause a problem and it would regrow. See your family doctor and I am sure he/she will address it.

Tags: hairloss, hair loss, bump, infection, cyst

Hi Doc!

In several posts you state that breast enlargement (gynecomastia) caused by finasteride (propecia) is reversible after stopping this medication.

Well, I developed a slight breast enlargement (“puffy nipples”) after a year of taking propecia so I stopped immediately when noticing this condition. However, the puffy nipples are still present even though I have been off the propecia for about 7 months now (I have no other medical condition).

I have heard that the only way of getting rid of this “gynecomastia” condition is an operation, so how do you know that it should be reversible upon stopping propecia?

You need to speak with your prescribing doctor, as Propecia does cause gynecomastia in a very small proportion of men. This condition should reverse on its own when you stop taking Propecia and if it did not, then you need to see your doctor for other potential causes.

Something else to consider is that according to one study for those men (not taking Propecia) over the age of 44, the prevalence of gynecomastia was 57% (possibly the effect of being overweight in some men and this therefore may not be breast tissue, but fat buildup). This data indicate that palpable gynecomastia may be more common in normal adult men. See Journal of Clinical Endocrinology & Metabolism – Gynecomastia as a physical finding in normal men

You need a good medical evaluation by a doctor, in person. I wish I could offer more, but I’m limited by the Internet in that regard.

Tags: propecia, finasteride, hair loss, hairloss, gynecomastia, breast, nipple

I have been using rogaine foam for one month now and my hair has fallen out and is thinner then before I started…this getting scary! I do not understand the concept behind the shedding.How long is it suppose to last and could some people be allergic to the product? And what about the high alcohol content is that bad for the scalp? Dr Rassman do you believe it is worth trying for a longer period of time ?

Rogaine FoamSome people are sensitive or allergic to the non-active ingredient in Rogaine. I do not believe that a small alcohol content is bad for the scalp, but it can cause drying in some people and the minoxidil itself could be an irritant in others (or you could be one of the “lucky” ones and experience drying and irritation).

The shedding of hair while starting minoxidil may be due to the fact that the hairs undergo a “reset” cycle, as old hairs fall out to start a new growth cycle. This has not been medically proven, but is a generalized concept to explain why some men experience shedding when they first start using the medication for the first couple of months.

Tags: rogaine, foam, minoxidil, alcohol, hairloss, hair loss, allergy, allergic, irritation, drying, dry

Please help me – I’ve been suffering from hair shedding since Aug 2007. I was on the pill for 12 years and came off in august just after my wedding to conceive. I concieved straight away and am now 7 months pregnant. In Dec 2006, I was in hospital for a day with an infection which caused a hemorrhage. The shedding does seem to have slowed down now so losing about 25 after washes and I feel spiky bits all over my head. This has lasted about 7 months now and just wanted to know how long it usually last for and if it will stop? Will I ever get the thickness back in my hair?

I’m so depressed about this and would be grateful if you could help me. Thanks

You have many potential causes for hair loss, including:

  • Pregnancy, which can cause hair loss that should reverse after about a year
  • Changes in your hormones from the withdrawal of birth control pills
  • Illness from the infection that put you into the hospital

It is likely that this process will reverse. You are not alone and the experience of others with this problem have been far from hopeless.

Tags: pregnancy, pregnant, hormones, illness, hairloss, hair loss, female, women, woman

ProvillusI would really like to know if its a bad idea to take propecia and another hair loss treatment Provillus at the same time. I’ve been doing it for a month now and hair loss has only increased. Provillus has saw palmetto in it, a DHT inhibitor, could all this be too much and making things worse. I’m using rogain as well.

I have reviewed the ingredients in Provillus and there is nothing in it that should react with Propecia (finasteride) or Rogaine (minoxidil) adversely from that I can see.

The claims by the company are hard to believe, because they lack scientific study. The FDA may gripe over the claims of DHT blocking, but I am not a government agency.

Tags: provillus, propecia, finasteride, hairloss, hair loss, dht, saw palmetto

Dear Sir,
This is with reference to comment titled “Periodic Shedding from Finasteride?” in which you had mentioned that Finateride do NOT help to control genetic hair loss. I was impression that Finasteride helps to control the genetic hair loss by handling the DHT accumulation. If Finasteride do not help to control the genetic fall off, what exactly this drug is intended for? Request your advise to understand this better.

This is part of what I said in that post that you’re referring to:

It is important to realize the the genetic hair loss has its own course, independent of the effects of the drug. What you think is shedding from finasteride, is probably more genetic hair loss. Hair loss goes in waves and cycles of loss (shedding) most likely due to your genetics, not the finasteride. You should discuss this with your prescribing doctor.

To clarify, finasteride is not a magic pill that stops genetic hair loss. It decreases DHT production at the hair level to combat the DHT that facilities genetic hair loss. As a result, most men on the drug will have some hair growth or slowing of the hair loss. The main point here is that the genetic predisposition will continue and finasteride will carry you only so far.

Tags: finasteride, propecia, proscar, hairloss, hair loss, dht

If I were to pluck some of my surgically implanted hair in order to achieve a balanced look, would they eventually grow back over time? So if I then decided to get another transplant to balance things out, I wouldn’t regret doing it?

If you pluck out transplanted hair it should grow back just as if you pluck out normal (non-transplanted) hair. However, if you keep plucking out the same hair, eventually it may never grow back, which is what happens with trichotillomania.

Tags: hairtransplant, hair transplant, pluck, trichtillomania, trich, pulling, hairloss, hair loss

(female) I was put on 40 milligrams of prednisone after I got out of the hospital from a major infection… ulcerative colitis. I was on predisone for a month. Well, a month later after I stopped it, I starting losing my hair. Could this be caused by the prednisone? (I was also on Asacol too.)

The entire stressful experience may have precipitated a telogen effluvium. Hopefully it will reverse on its own in 4-8 months. Both medications and the illness you had could have caused the hair loss.

Tags: stress, prednisone, asacol, hairloss, hair loss, women, woman, female

This Japanese study (not the UPenn paper) shows that .2mg of finasteride is almost as effective as 1mg.

Finasteride in the treatment of Japanese men with male pattern hair loss.

PropeciaThis is interesting and I thank you for sending this. The problem I have is that there were prior studies that showed that 1/2 dose of Propecia (0.5mg finasteride) is about 70% as effective as a full dose.

In our hair restoration medical practice, I recommend 1mg finasteride for the treatment of male pattern baldness. For those who have unwanted side effects with Propecia, this study may show some promise. The study says that after 48 weeks, 58% of men on 1mg finasteride showed improvement, while 54% of men on 0.2mg finasteride also showed improvement. It doesn’t state to what degree of improvement was seen, so it is still possible that the 1mg worked better for that higher percentage of men. The study does say “All efficacy endpoints were numerically superior for the 1 mg dose over the 0.2 mg dose at 48 weeks.”

Nonetheless, if this study is true, perhaps more the pill cutting will begin. Who wants to be the first to try?

Tags: finasteride, propecia, proscar, hairloss, hair loss, japanese, japan, dosage