Scalp Tattooing that Looks Like Hair?

/by William Rassman, M.D./6 /

Hi Dr Rassman,
Since I like the close cropped look and I am probably a Norwood 4 leaning towards 5, I am considering getting cosmetic hair tattoos to the scalp. What do you think about this place? The results look great in the photos, but I’ll ask to see some patients in person of course (thanks for putting that in my head!). Here’s the place. They are in the UK, but I’ve got family there and have been wanting to visit anyway.

HIS Hair Clinic

TattooI would definitely want to see some real patients up close before deciding on tattoos like this. As I’ve written before, I have seen scalp tattoos that try to mimic hair, but what I’ve seen has been unimpressive and some even seem to have a greenish tint as well (maybe it is the ink or the artist — I have no idea, as I am not a tattoo expert). I understand tattoo technology has evolved, but drawing what looks like hair on the scalp can be tricky.

The photos presented by the clinic you linked to are quite nice, I will admit. I’m sure these results look fine from a distance, but I wonder if you’re sitting across from someone at dinner would it look like someone drew on their scalp with a pen? If the light hits your head wouldn’t it still shine like a bald head? Over time, tattoos with fine lines will blur… so how will that change on the scalp? I know there’s at least one scalp tattoo place that posts comments on this site from time to time, so perhaps they can post below to inform us about that.

I do recall one patient who did draw (non-permanent) individual hairs on his bald head to mimic a close shaved look, but it took many hours, special artistry, and skill. He eventually went on the have a hair transplant procedure.

Tags: hair loss, hairloss, tattoo, scalp tattoo

Thickness of Hairs

/by William Rassman, M.D./0 /, ,

First off i just want to congratulate you on your blog. You’re doing a splendid job. It helped me tons in these two years of my battle with MPB.

My question relates to thickness of the hairs. You had mentioned previously in several posts that the thickness of hairs is standard for each hair in the non balding areas (the horse shoe pattern hair remaining that will probably outlive us). However i did a test and plucked some of these hairs in this region and not all of them have the same thickness. I didn’t use a microscope or anything but it it is quite clear to the naked eye. I am also sure that i am not thinning in these areas because my MPB is very very early and just in the corners of the hairline and none of my family members went past NW 3-4.

So to sum it up is it possible that some hairs on the head might be thinner than others? Is this normal? thank you

Yes, you are correct! Hair thickness varies all over the head as each hair is going through its cycle of growth/rest/fall (anagen/catagen/telogen). For non-balding men and women, you should have about 90% of hairs in a growth phase with relatively thicker hair and about 10% should be in a relatively thinner state. Then there are vellus hairs which are found in the follicular units. These vellus hairs are always thin and that is normal. So it is perfectly natural to have thinner hair in the back of the scalp (permanent, non-balding zone). If you are balding, this ratio will be dramatically different. Keep in mind this is a relative comparison with respect to your own hair at different areas of your scalp. This is in essence the miniaturization study that we have been advocating.

When technology catches up to us, we will have an instrument to accurately map all the hairs and its states on our scalp. As an aside, you should know that this horseshoe rim of hair is often impacted in women and in men who develop DUPA (diffuse unpatterned alopecia).

Tags: hairloss, hair loss, hair thickness, growth cycle

Does Propecia Work for the Vast Majority of Men Under 30?

/by William Rassman, M.D./0 /,

Dr. Rassman,

Do you agree with the following statement: At least 50 percent of men in their 20’s today who have little or no hair on their head should not be bald.

Propecia doesn’t last forever, some can’t afford it, others will choose not to take it, and it won’t work effectively on some group of men. But for the vast majority of men, it works and it seems like most men under 30 who are visibly bald missed the chance to buy themselves a few important years by not taking Propecia.

Agreed?

The statistics indicate that men over 50 years old have a frequency of some degree of balding in half of the Caucasian male population. That does not mean than the same statistic will be found in men under 30, as some men start balding in ages beyond 30. The full value of Propecia for those that see benefits changes over time (opinion backed up by the Merck study). The choices are always yours.

The other side of the coin is that Propecia works best when hair loss is earlier. If you start hair loss at 22 years old, then you are a better candidate for value (slowing, stopping, or reversing hair loss) than if you were 32 and had hair loss for the preceding 10 years. Also, if you start balding at 35 and start taking Propecia at 36, you will have a better value in its use than if you were balding since you were 22 (14 years of balding) in that same situation.

Tags: propecia, finasteride, hairloss, hair loss

Looking at Family Hairlines to Determine MPB?

/by William Rassman, M.D./0 /

Hello,

I have a question regarding hairlines. Does the similarity of hairlines bewteen family members serve as a tool in determing the possiblity of MPB? Or does hairline similarity have nothing to do with MPB? Thanks.

Since the balding gene can come from either side of the family, you couldn’t make a determination about hair loss just by looking at hairlines. It’s not that simple, but if you have started to bald at 25 years old and someone in your family says, “Wow, your hair looks like mine at 25 years old!“, then it would be safe to assume that your pattern might follow his pattern both in scope and in timing. So, ask around and speak to the men in your family.

Tags: hairloss, hair loss, hairline, family, genetics

My Newly Transplanted Hairs are Falling Out!

/by William Rassman, M.D./0 /,

Three months ago I got a hair transplant and over that time the hairs that were put in fell out. Is this transplant going to fail?

Normally the hairs that are transplanted do fall out in the first few months and then they get replaced by your body at about 3-5 months with new hair. If the transplant is a success, you should see 80-90% of the results in 8 months. Patience is your friend at this point!

Tags: hair transplant, hairloss, hair loss

Hair Loss from SSRIs

/by William Rassman, M.D./5 /

Hi, I would like to request clarification on something. I saw a post where you mentioned Sertraline causes hair loss as well as Zoloft. I also saw on some posts where SSRI’s are said to cause hair loss. The questions is how common is this? I have seen different sources use different percentages to represent how rare or often this can occur. I ask this because online it appears as a significant amount of people have voiced their concerns about Sertraline or Zoloft possibly contributing to their hair loss. However, there have to be many people who simply will never come to these forums because they are not affected. Also, how long does the hair loss take? Some posts mentioned period from 2-8 days, while some people blame the meds after they have used them for 4-6 years.

I have been told by several physicians that hair loss with SSRI’s is simply an alergic reaction which is rare. Do you agree with that? Thank you for your help.

PillsHair loss from SSRI (selective serotonin reuptake inhibitor) drugs are relatively uncommon, but they can occur. First and foremost you need to find out if there is a pattern to your hair loss. Is the hair loss everywhere or just confined to the front/top (in a pattern)? If the hair loss is happening in a pattern like those shown here, then it is most likely not from the drug. Hair loss from drugs will often impact the donor area, which is what we generally refer to as “permanent” hair not susceptible to genetic factors.

Most doctors (and even the doctors that treat hair loss, such as myself) do not know the exact mechanism of why some people lose hair from certain medications. We must believe the patient when they say that they are noticing some correlation with the timing of starting these medications and the hair thinning, but these things are often very difficult to narrow down. It is just not that simple, as the patient may also have underlying genetic hair loss as well. Remember that more than 50% of the population have some form of genetic balding which has nothing to do with SSRIs or other medications! I do not think hair loss from SSRIs (or other medication in general) is an allergic reaction, but more of a rare side effect. If hair loss is caused by a medication, I do not think it would happen in the time frame of a few days, but more likely several weeks to months.

Finally keep in mind of the big picture, rather than focusing only on hair. You are taking a certain medication for a reason, such as the SSRI to treat depression. What you are experiencing with respect to hair loss may or may not be related, but the reason of WHY you are taking the SSRI or other medication is real and the pros and cons (risks/benefits) need to be discussed with your physician before taking any action.

Tags: ssri, anti-depressant, depression, hair loss, hairloss, zoloft, sertraline, medication

New Hair Loss Gene Finding, APCDD1

/by William Rassman, M.D./1 /

I’ve received quite a few emails in the past day or so about the news of a hair loss gene finding that was announced. Thanks to all the readers that sent in links.

Here’s a snippet from one of the articles:

Researchers have found a gene mutation which leads to thinning hair and which can even start taking effect in childhood. The gene, APCDD1, causes hair follicles to shrink, leading to thinner hair. Now the team at Columbia university hope the findings could help discover new ways to treat the condition.

The condition leading to thinning hair is known as hereditary hypotrichosis simplex and the researchers believe they have pinpointed the gene behind it. However the scientists the cause of the more common male pattern baldness, which affects most men at some point in their lives, remains elusive.

DNARead the rest of this article at Telegraph UK. And here’s a couple other news links about this — CNN and WebMD.

I wasn’t involved in the research so there’s not much I can add beyond what these articles have already mentioned. It is an interesting finding and I am pleased that there is ongoing scientific research into the cause and the genes for hair loss. Unfortunately, as Dr Angela Christiano (lead author of the research) notes, “The gene we discovered for hereditary hypotrichosis does not explain the complex process of male pattern baldness.”

One thing I am particularly happy to read about is that they discuss the miniaturization of the hair follicle, which is a process that needs to be quantified as a miniaturization study when diagnosing balding patterns (as we have stressed here on this site for many years).

Tags: hair loss, hairloss, genetics, gene, hypotrichosis simplex, hypotrichosis, apcdd1

Eye Irritation from Rogaine for Women

/by William Rassman, M.D./0 /,

(female)
I tried using Rogaine a couple of years ago but stopped after 3 months because my eyes became very red and sore. I am considering starting to use the foam for men, 5%. Is there a known problem with the female version causing sore eyes?

Is it possiblle the foam will not have this effect – if it were indeed side effect of the Rogaine?

Rogaine FoamThat could be an allergy to an added ingredient in the minoxidil liquid or it could even be the minoxidil itself. The liquid is known to cause eye irritation in the 5% solution. The female version that you used is likely the 2% formula… so if you had the problem with your eyes with 2%, I’d expect you would see it from the 5%.

That being said, it might be worth giving the Rogaine Foam a try since it is a different way to apply the medication.

Tags: rogaine, minoxidil, female hair loss, hair loss, hairloss, eye irritation

Using Toppik to Cover a Transplant Scar?

/by William Rassman, M.D./0 /, ,

Hey dr. How are you on this fine day ?

i was just wondering on your opinion on using toppik to camouflage a transplant scar so buzzing hair down to a number 1 would be an option with the addition of the use of a trichophytic closure. would this be a viable route for someone who appreciates short hair?

ToppikI am fine. Thank you for asking.

Some people use Toppik, DermMatch, black marker, or even permanent tattooing with reasonable results. I am not sure if you already have a linear scar or are thinking of having a hair transplant and worried about a scar, but really, successfully camouflaging a scar on the scalp all depends on the scar itself. If the scar is wide (despite a trichophytic closure) a number 1 clipper haircut may still show it somewhat.

Tags: toppik, dermmatch, hair transplant, scarring, scar, hairloss, hair loss

Dry Scalp Contributing to Hair Loss?

/by William Rassman, M.D./0 /,

I notice my hair has been thinning quite quickly the past few months and my scalp has been awfully dry which I’m sure is a contributing factor. When my hair falls out I can usually see the “roots or follicles” at the end. I have taken notice of your responses regarding alcohol and hair loss. While I usually over indulge on the weekends, I wouldn’t call myself an alcoholic.

My main question is, I am taking Milk Thistle supplements to try and maintain healthy liver function, but if I were to start taking Zinc and Gingko Biloba supplements, do you have any knowledge of these helping? Thank you much!

If you have a zinc deficiency then taking zinc supplements might be helpful. Otherwise, zinc and ginkgo biloba are used in some hair products to promote healthier hair, but they won’t stop genetic hair loss if that is what you are experiencing. Also, a dry scalp will not likely accelerate your hair loss.

Tags: dry scalp, hairloss, hair loss, zinc, ginkgo biloba, supplements

I’ve Been Losing My Hair Since 14 Years Old!

/by William Rassman, M.D./0 /, ,

Dear Dr.Rassman,
I am so scared about my hairloss because it is so severe. I started to have a receding hairline around 14 in which I had a NW3 hairline. Now at 17 (almost 18) it’s safe to say may hairline is fortunately still an NW3 however i am starting to lose a little bit of hair in the front of my head and at the crown. I cannot stop thinking about it and I don’t want to be bald by the time I’m 20. Am I too young for a hair transplant? If so am I old enough to use propecia? If not is there anything I can do to stop or at least slow down my hair loss? Please help me out!

First and foremost, do not let fear interfere with your choices. Empower yourself with education to learn about hair loss. Unfortunately, 50% of men will have some type of hair loss in their lifetime. When it is genetic it usually starts above the age of 18, though there are cases that I’ve seen start around the same age you saw your loss start. I can empathize that you are frightened and afraid of going bald, but if that is in your genes, it is something you are going to have to accept. Fortunately, taking Propecia may solve the problem if you have the correct diagnosis. Get a doctor to map out your scalp for miniaturization and with that metric in hand, if you have miniaturization present, then the drug Propecia is the right way to go. Propecia was studied in men as young as 18, and as you’re nearing that age you should be fine.

Just know that you have choices and there are treatment options and plans, but you need to first start by seeing a physician that will address your concerns and come up with a life-long Master Plan. Propecia can certainly help if you have male pattern baldness, but you need a diagnosis first. Something else to note — Propecia has limitations and it will not completely stop or reverse hair loss. Hair transplantation may also be an option later on, but it is very important that your physician address that master plan to determine a worst case scenario of how bald you may be not just one year from now, but 30 years from now. Right now, you are too young for surgery.

Tags: hairloss, hair loss, age, propecia, finasteride, hair transplant

Richest Man in the World Has a Bad Hair Transplant?

/by William Rassman, M.D./0 /

Hey doctors! Love the site. Have you seen this article about how the richest man in the world Carlos Slim has a weird hair transplant? Thought you might enjoy it.

Bad hair transplants, number 3: Carlos Slim, richest man in the world

For those that haven’t heard of Carlos Slim, he is the world’s richest man and owns many telecommunications companies throughout Mexico. You can learn all about him here. As for the article about his hair, well, we have all seen bad hair transplants… but this doesn’t appear to be one. Why? Well, because I don’t believe it is a hair transplant at all. Take a look at the hairline close-up:

Carlos Slim hairline

Although the author of the article quoted an unnamed “expert” trichologist to give some added weight to his story, I think he’s wrong. What Carlos Slim is showing here looks like a natural pattern of hair loss, though if there was a transplant I certainly haven’t seen enough to make that claim.

Tags: carlos slim, mexico, billionaire, hairloss, hair loss, hair transplant

I’ve Got More Questions Since My Consult at NHI!

/by William Rassman, M.D./0 /, ,

Dr. Rassman,

I wanted to ask you a question about hairlines but first, I wanted to personally thank the staff at NHI, Dr. Pak and you for the wonderful visit I had at NHI this past Friday. This is a bit long winded but please bear with me.

I am a 25 year old caucasian male with light brown hair and am in good health. I started noticing a little thinning at my temples over the last year. To be honest, I was very nervous. I then went from nervous to hysterical. I could not stop thinking about it. Nothing can be more vicious than your own imagination and mine was painting all kinds of horrible scenarios.

In lieu of this, I made several appointments to see various hair transplant doctors here in Southern California. Of course, I never ACTUALLY meet with a doctor. Instead, I ended up talking to a consultant. To be perfectly honest, I did not gain a great deal of insight from these visits. I wanted something empirical to measure my hair loss, a metric I could use to stay informed and make an intelligent decision about my hair loss. None of these visit’s gave me that information.

The balding blog has been a part of my daily routine for a little while now and I decided to do what you suggest in so many of your posts and get my hair mapped for miniaturization and start my master plan. I was looking forward to my visit but also fearing it a little as well. So many things over the last few months have convinced me that I was going to bald to a Norwood class 4, 5 or 6. Pictures I had taken in the last few months, the look of my hair when it is wet or under bright lights. Except for my temples, I looked normal but I felt awful.

Then I came to NHI this Friday and that all changed in about 5 minutes.

I can’t tell you how much better I feel after visiting your office. I made an appointment to see Dr. Pak and he was very informative and understanding. He magnified my donor area for me to show me what non-miniaturized hairs look like. He then moved the scope to various parts of my head. This is the part where I held my breath. However, when he zoomed in on my crown, he saw no miniaturization. The same was true for my vertex and other parts of my head. In fact, the only area that showed any miniaturization was my temples, something my paranoid imagination would not let me believe.

Words can not describe how relieved I was. Dr. Pak was very helpful and he answered all of my questions. However, on my drive home I though of one more question I wished I had asked him and it is this: If none of my hairs, other than my temples, displayed miniaturization then where does my fight against balding go from here?

In your Hair Loss for Dummies Book (page 12) you say the following; “If you’ve inherited this pattern (Class 7), it is usually evident by the time you are 30“. In my examination, Dr. Pak said that my fears about progression to a class 7, 6 or 5 were unwarranted. In fact, he didn’t assign a class at all. He said my hair was healthy all over and my density (2.0) was normal (only miniaturization at the temples).

Am I simply developing a mature hairline? In this post from your blog you say that the mature hairline develops from ages 17-29. I guess what I am trying to understand is the correlation between someone’s age and their degree of miniaturization. At 25, is it too early or difficult to diagnose what class I may (if ever) progress to? Could a Norwood 7 be a lot easier to spot at my age that say, a norwood 3 or 4? I only ask because if I don’t progress any further in the next 5 to 10 years, would some moderate temple restoration be out of line with FUE?

I am 25, but I am not so naive as to think that the battle is over. I do not intend to let anyone else touch my hair except NHI now that I have visited your office. Dr. Pak put me on finasteride and I fully intend to visit your office on an annual basis to check on my hair. Like you say, tenacity and diligence.

Sorry again for the long winded question and many, many thanks to Dr. Pak and you for keeping me informed about my hair loss and educating me before I gave into my fears and did something drastic and foolish.

Sincerely and respectfully

If at any point in the future you want to address only the front corner areas, you can always do so with a small hair transplant procedure using FUE.

You may have a maturing hairline… perhaps in combination with slight recession in the corners. It remains to be seen as you age, but take comfort that Dr. Pak did not see miniaturization beyond the front corners. Stick with the medication and we’ll see you again for your follow-up appointment.

Finally, thank you for the kind email and allowing us to publish it.

Tags: hairloss, hair loss, hair transplant, propecia, finasteride, consultation, nhi

Will Beard Hair Grow Back After Pulling It Out?

/by William Rassman, M.D./0 /

If you pulled out beard hair some times it will grow back? When you say doctor you have to pull too long, that hair generally not to grow back, this means years or just a few times. Thanks in advance

Plucked out beard hair will grow back. I have plucked a few of my beard hairs (the stray ones I don’t like) many times in the past for many years… and at least in my case, they still grow back! I suppose if you keep pulling the same ones they may eventually not come back. There’s no exact amount of pulls before it becomes permanent, though.

Tags: facial hair, beard hair, hairloss, hair loss, plucked hair

Hair Loss After Radiation Treatment

/by William Rassman, M.D./0 /,

I lost a lot of hair due to radiation treatment last June. I had a benign tumor removed and my doctors wanted to be sure they effectively treated me after surgery. They pretty much covered the top of my head with the treatments. It all fell out but only some of it grew back. And it’s obvious. I had a full, thick head of hair before this and now it looks like I have male-pattern baldness (and a large scar on top of my head from the surgery is visible). Would finasteride be at all helpful in this case? I can’t seem to find any information that speaks to this particular problem.

Finasteride will not reverse hair loss caused by radiation, as it only works for men with genetic hair loss. The good news is that hair loss from radiation may grow back, though it can take up to one year.

Tags: radiation, finasteride, propecia, tumor, hairloss, hair loss