For those in the US — Happy Thanksgiving! For those elsewhere — hello!

We’re off for a long weekend, but we’ll be back first thing Monday, December 1st! Feel free to check out our new forum,, in the meantime (and don’t forget to create an account and post)!

How accurate is miniaturization analysis? My trichologist said unless you examine hair bulbs and shafts under microscope, you cannot determine the exact cause of hair loss. She also said that any thinning looks like male pattern baldness. What do you think of her opinion and the microscopic hair analysis?

A miniaturization mapping is just looking at the hair under a microscope and comparing it with normal hair that is often in the general area you are studying! I have never understood what the trichologist is looking at under the microscope. The accuracy of our mapping process is regional, based upon the changes that occur in miniaturization (often progressive) with genetic balding. More importantly we evaluate the pattern of miniaturization (under a microscope) at different areas of the scalp to determine how extensive it is in areas where future balding will occur, which will always miniaturize prior to becoming bald. Early in the process, the naked eye will often be unable to pick up the changes in thinning, so the mapping here has great value. And in case you missed it, I’ve provided tips on performing your own miniaturization mapping:

  1. Mapping Your Own Scalp for Miniaturization, Part 1
  2. Mapping Your Own Scalp for Miniaturization, Part 2
  3. Mapping Your Own Scalp for Miniaturization – VIDEO

To answer more specifically to what your trichologist said, you don’t need to examine the hair bulbs and shafts under a microscope to determine the exact cause of hair loss. The cause of hair loss is genetic balding in probably 99% of men. We use a miniaturization study to find out if there is early balding and then quantify it as well. We also use a miniaturization study to plan for treatment (medical or surgical) and follow the progress of such treatment plan. Drugs like Propecia may reverse miniaturization.

Finally, if you do not have male pattern baldness (women, for example) looking at hair or its bulb under a microscope wouldn’t tell much unless there is a telogen effluvium. Generally after taking a good medical history and examination, doctors do a scalp biopsy in women (as a last resort) to determine if there is a pathological process or order blood tests to see if there is an underlying medical issue.

Tags: miniaturization, study, mapping, hairloss, hair loss

My 12 y/o son had a ringworm in his head when he was an infant. The doctors prescribed medicine to be taken orally, and the ringworm went away, however his hair will not grow in that spot anymore. Is there anything you can recommend to promote hair growth in this area? This is affecting his self-esteem.

Ringworm is usually successfully treated with medication and does not generally cause hair loss. Maybe there is some deep scarring that had caused hair loss around the area of infection, as I have seen some cases where this has happened in childhood and then the patient comes to see me as a young adult with that history.

My best advice is to see a physician or a surgeon who specializes in hair transplants. Hair transplantation may be an answer, but your son definitely needs a good diagnosis first. A 12 year spread indicates that the hair will not return, but I would generally not treat it with transplants at that age unless it bothers him, though that may occur further into his teens.

Tags: ringworm, hair loss, hairloss, hair transplant, child, infant

Hello Dr. Rassman (and contributing doctors),
I have a question that I believe is something most of your readers might wonder:

For us hopeless (hair) romantics, what would you say is the best possible scenario for someone undergoing a HT procedure? Put another way, is it possible for someone with limited (or even moderate) balding to realistically expect to repair their hair loss to the point of zero detectability? …Hypothetically of course

Absolutely! Non-detection for a hair transplant is a reality on most patients who get them, provided that the densities are brought up to enough of a level to produce the fullness that normal densities will have. Without knowing more about your hair loss pattern, hair characteristics, color, skin, etc, it would be difficult to give you realistic expectations. If you visit me in my office in Los Angeles, I’ve got plenty of patients (and some on my staff) that have the type of transplant which is completely undetectable. I mean, who wants their hair to look transplanted? Nobody! As I always say, seeing is believing and our Open House events show this on many of the patient models who visit us from time to time.

Tags: hair transplant, hairtransplant, detectability, hairloss, hair loss

Dr. Rassman, I wanted to ask you about how quickly baldness can set in. I’m a 21 year old male and I’ve noticed that my hairline has been receding over the last few months. Originally, I was convinced that I was going bald, but then I figured maybe it was only my hairline maturing (as the hairline is hovering just around 1.5 inches above the highest forehead wrinkle at the temples), but now I think it may be balding again. It has receded almost half an inch at the temples in about a month, so I want to know if I should expect it to continue receding at this rate, assuming it is baldness and not simply a maturing hairline. Thank you.

If you are balding, then you will have miniaturization leading to the balding pattern. Look to map out your scalp for miniaturization, especially in the frontal corners. The difference between a maturing hairline and early frontal balding can be difficult to spot. The onset of a maturing hairline usually takes a few years, but I have seen it start up and move more quickly. There is no rule you can use.

Tags: hairloss, hair loss, hairline, mature hairline

I’m a 46 year old male and for the past five or so years, I have felt like I’m turning into a Chia Pet! I have hair growing all over my body and it grows fast. Is there anything that will stop the growth of hair? If I pull it out, it grows back within a week.

Chia PetShort of laser treatment to kill the hair area by area, you may be stuck with what nature and your ancestors gave you.

Laser hair removal is a fairly large industry today, and from what I understand, not too comfortable (and could take multiple treatments).

Tags: body hair, hair removal, hairloss, hair loss

Body HeatI am wondering if the areas on the head which lose hair first in Male Pattern Hair Loss are the areas of the head which naturally release the most body heat (e.g. the temples/crown). Is there more blood flow near the skin surface in these areas?

Great thought, but no. Your hair loss pattern is genetic and it really has nothing to do with blood flow. If you lost hair and became bald (let’s say in the crown) then any hair loss will probably occur in the hairy area where the blood supply is more robust.

Tags: hairloss, hair loss, heat, body heat, temperature

My mother and I both shed much more hair than the 200 hair maximum for normal hairloss. The odd thing is that my mother and I both show no signs of balding. What’s going on here?

You would need to be evaluated and examined. If you are really losing 200+ hairs per day, something other than genetic patterned balding is present.

Tags: hairloss, hair loss

I’m 22 and starting to bald. My stylist said it’s from High DHT levels. She gave me NIOXIN System 1 and told me not to worry that my scalp is still alive and NIOXIN will take care of it. It’s been a month and I’m still gradually thinning. There’s evidence of it all over my head. especially my sides receeding and my sideburns thinning. She said NIOXIN would help me keep most of my hair.

What should be my next step. Speak with my dermatologist? I don’t really know any hair experts. I have long hair, and it’s a big part of me. I really want to hold on to it. I’d hate to lose it before I’m 24. Is my baldness inevitable? Or is it really possible to catch it early and take care of it with the NIOXIN S1 treatment? I’d be thankful just to hold on to what I have now. Any help will be much appreciated.

Thanks for your time

Well, of course your scalp is alive. Unless you have gangrene all over your head, I think that would be a given. Your hair stylist isn’t necessarily going to be an expert in treating hair loss, but I’m sure she’s an expert in selling products that are available in the salon. The Nioxin won’t solve your hair loss problems, and I’ve found that medication such as Propecia and/or Rogaine are the best bets. You can discuss a Propecia prescription with your dermatologist, and Rogaine is available over the counter.

I don’t know if your balding is inevitable since I haven’t seen you. I’ve found much success in treating patients with Propecia, and even if you don’t see regrowth with that daily pill, it’ll at least hold onto the hair you have. If you want to try to make your own diagnosis, look to Mapping Your Own Scalp for Miniaturization.

Tags: hairloss, hair loss, stylist, nioxin, shampoo, propecia, finasteride, minoxidil, rogaine

well we finally got a name for my son’s hair loss problems! he is a white male 19 yrs old. first developed a “cyst” in 2005. it was drained, and a bald spot finally started to grow back.about 6months ago started having more. it would start with a bump,break open with nasty yellow drainage and hair loss around the area.after seeing several doctors, last month,we were told it was dissecting cellulitis of the scalp.he is taking solodyn 90 mg 1 x a day. a few hairs have started to grow in that spot. but now he has several more started, and several more bald spots. what can we do to help his hair not come out? and to stop these bumps? how did he develop this in the first place? is it an imbalance of something? could this turn out to be serious health problems?? he’s very embarrassed about all the bald spots. please share anything you know about this. thanks!

Dissecting cellulitis is a very virulent infection wherever it is found. This type of infection can be life threatening as the bacteria eats away on the tissues of the impacted area. In the days before penicillin, Streptococcus was the main cause of battlefield deaths through dissecting cellulitis, which invaded every organ of the body and eventually led to multi-organ failure. I saw a number of such cases in Vietnam, but with modern drugs, most of these cases were controlled. Usually a recurrent cellulitis has a history of how your body keeps it under control. I would hope that you and your son’s doctor have a good line of communication open. I would assume that you have already received a second opinion from an infectious disease specialist.

Tags: dissection cellulitis, cellulitis, hairloss, hair loss, infection, bacteria

Hi doc, much thanks in advance for taking your time to answer this question.

I’m a 22 yrs old healthy male. I’ve been taking Proscar daily (cut into quarter pieces) since January 2006. I wasn’t exactly losing hair when I started taking it. I initially shedded hair for the first 3 months and then the hair that I lost grew back thicker. Since then I’ve lost hair rapidly and while the medication helped me maintain hair , I’m beginning to believe it has stopped working. My hair had thinned overall and the crown area of my head constantly feels sore. I’ve recently noticed that the hairs that fall out from my crown area are much thinner than anywhere else.

Is it possible that after years of dht suppression, my body has grown immune to the medication and/or started producing more dht to compensate and this overproduction of dht is the reason why I’m losing hair? Since I don’t believe I was losing hair when I started the medication, should I discontinue using proscar to return my dht production level back to normal? If not, since proscar most definitely isn’t as effective on me as it once was, should I switch to Avodart? Thank you.

I don’t want to make this a lecture, so I’ll just say this: finasteride is a prescription drug for a reason. I can’t tell you to start or stop a medication because I’m not your doctor and I didn’t prescribe it to you in the first place. I do not believe that people get immune to finasteride, just that the genetic hair loss goes into a higher gear, of sorts. If you were to stop the drug, you will probably see considerable hair loss indicating that it is still working, although I would not recommend that as a way to find out if it is still working.

You need to get your hair mapped out for miniaturization and find out first if you have male pattern baldness — and second, the impact of the drug over time.

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

Snippet from the article:

MammothTufts of frozen woolly mammoth hair have yielded a rough draft of its genome. It’s the most successful attempt to sequence the DNA of an extinct ancient animal to date, and although we won’t see resurrected mammoths grazing the tundra anytime soon, it could give us a peek into the reasons for their extinction.

Sequencing extinct organisms is tricky since DNA strands quickly degrade after death into short fragments that are difficult to piece back together. In porous tissue like bone, these fragments can also become flooded by DNA from bacteria and fungi growing on the decomposing body, making it hard to pick out the genetic material of interest.

Read the full text at NewScientist — Frozen hair gives up first mammoth genome

This is very, very cool stuff. We can learn much about the genetics of an animal from the DNA of hair. Scientists now know that elephants and mammoths are closely related (more so than previously thought), and this is the best example of a near complete genome of an extinct animal, since they used an elephant as the blueprint.

Tags: mammoth, prehistoric, dna, hair, newscientist

Hello I am an 19 year old african american male that has small patches of missing hair on my scalp. When i was about seven years old I contracted a sever case of ring worm on my head, due to picking at it, when it healed i was left with small patches if missing hair. Since then, i have always had hair styles such as braids, afro, and now dreads mainly to cover the few small spots. I am now wanting to cut my hair and in some spots small patches still appear, how can i fix this?

As long as you are not still picking at the area (which is either trichotillomania or dermatillomania), you can consider a small hair transplant surgery to put hair back into the bald patches. If you are still picking these areas, any transplanted grafts will be lost from the picking.

Tags: scars, ringworm, trichotillomania, dermatillomania, hairloss, hair loss, picking

I use minoxidil and nizoral shampoo and am considering a hair transplant procedure in the future. Will it be necessary to suspend use of these products before or after hair surgery? If so how long before and how long after?

I just tell patients to continue on their treatments up until the day before surgery and then restart them about a week after surgery. Withdrawal effects from minoxidil will not occur in 1 week. Always discuss pre and post care with your surgeon, though.

Tags: minoxidil, nizoral, shampoo, hairloss, hair loss, hair transplant

How long for a full skin recovery after a plug removal? (punch size 1 mm)

A 1mm punch excision will usually fill in over a week’s period of time. Large punches will take longer unless they are sutured together.

Tags: hair plug, plugs, hair loss, hairloss, repair