Hello doctor

I see a lot of HT photos, a lot of the patients seem to have their hair up and raised back like they’ve been in the wind. Is that just the way they style it? If I was to have a HT I’d want my hair down towards my eyebrows..

Is every patient different?


Hair normally grows forward in the front (parallel to the ground when standing upright). As one moves back from the frontal edge, the angle starts to change with hair pointing a few degrees upward until it reaches the front of the crown, where the frontal pointing hairs are about 35 degrees to the ground. So you see, the hair when placed by the surgeon is never placed perpendicular to the horizon. At the crown, the hair changes direction in a circular pattern (swirl) and as you look further back, eventually the hair points down and away from the front.

What you see in our patient photos reflect each patient’s styling (or lack of it), not something we do. I always put the hair back in the direction it would have been had they never lost hair and depending where I am working on the scalp, the rules I discussed above are followed with every hair placed by me. Patients generally like to play games with their hair and although a few comb it forward, most do not. Some comb it to the side with a part on one side, others comb it back with some product that they apply to the hair. Some just let it stray, taking on the character of the hair itself. If the hair is curly, then the natural state will look less groomed than if it is straight or has a nice wave to it. If you want to comb it down to cover your forehead and point to your eyebrows, you can do that also.

Every patient is different and the results we get depend upon texture of the hair, density at the area we are looking at, thickness of the hair shafts, the degree of curliness (or lack of it with very straight hair). But the hair transplant you get will be your hair, and it will bring all of its characteristics that are present in the back of the head where the hair grafts are taken.

Tags: hair transplant, hair loss, hairloss, hair style

i have always have had a full beard- past year i am losing facial hair- i am getting bald patches and lines of missing hair on my cheeks and chin-what is this? is there anything to cure this? i would appreciate any suggestions.–thank you

You need to see a good dermatologist, as such bald patches may reflect conditions such as alopecia areata. It’s possible this could be stress related, or an allergy, or something else altogether.

I can not say much more without seeing you myself… but even if you saw me in my Los Angeles office, I would still want the opinion of a dermatologist.

Tags: beard, facial hair, hair loss, hairloss, bald spots

Dear Doctors,

2 years ago i went to bed with a clean dry head and awoke to a greasy, wet head. My daughter also awoke to a greasy head. She had had a friend sleep over that night, and now after 2 years and 3/4 of my hair gone on the top of my head, and my daughter’s hair thinning greatly, all i can think of is that her friend mixed something caustic with oil and dumped it on our heads while we were sleeping. We are both losing the hair only on the crowns of our heads and not in the back. Is there something she could have put on our heads to do this to us?

Also, if by doing this she killed the hair follicles does that mean there is no chance of getting hair transplants…i know you are very busy but i would greatly appreciate it if one of you could take the time to answer my question. i am pretty desperate….thank you so much, sincerely

Your story is highly unusual. This sounds like a crime scene which may require some probing, interviews with the potential offender, etc. Yes, a hair transplant can probably solve the problem, but I would be very curious to know exactly what occurred first.

Tags: hair loss, hairloss

Doctor Rassman, I am sure you get this questioned asked alot, but in your opinion as a hair restoration expert, do you think by adding 0.5 mg avodart once a week to a every 1 mg propecia regimen can make a difference in loss of hair or even gain?

There was a study of a an individual who took one avodart pill once a week to a propecia everyday regimen and he saw substantial growth. The study was only on one person, but its not a conicidence that it happened when he added the low dose of avodart once a week? or do you think avodart and finasteride at the end of the day still produce the same outcome? I know at the 2.5mg it produces the best results, put more of a high side affect profile, and very expensive.

Both Avodart (dutasteride) and Propecia (finasteride) work in a similar mechanism by blocking the formation of DHT, but I have often stated that treating androgenic alopecia is not only about blocking DHT. I do not believe if you block DHT 100% you will stop or reverse the balding process.

I’m not sure which study you’re referring to, but if it was an anecdotal report on ONE patient, it isn’t something I would put a lot of stock into. Please note that just because there is study results available, it doesn’t necessarily make it the golden truth. Now with that said, many doctors believe Avodart is a better medication for stopping hair loss than Propecia, but I am concerned about sexual side effects and the few reports of sterility that came from Avodart.

A few patients that I treated with Avodart did get a response after Propecia stopped working as well for them. That is as much as I know. I couldn’t tell you if adding a single Avodart dose per week will make a difference, though.

Tags: avodart, propecia, dutasteride, finasteride, hair loss, hairloss

I am 53 yr old, African American female with lupus, it is not internally only scalp. I have seen many dermatologists and finally after 2yrs of testing, they stated it was Lupus. I have been told that my scalp is scarred. From the top of my head to near my ears, I am bald. Is there any physician in my area that can grow the hair back or is this just permanent. My scalp literally looks like Bozo the clown. Is there any help for me? I have tried cortisone injections and no help…

Please Help me what can I do? Thanks for taking time to read my story, may God continue to Bless you for the help you have given many.

Usually, people with lupus who lose their hair as a result of this autoimmune disease will not be candidates for a hair transplant. The Lupus Foundation of America has an article about hair loss that can result from the disease or the treatment, which you may find helpful (see here).

There is possibly a solution with Scalp Micropigmentation (SMP) if you have some patchy hair, but I would need to view many good photos of your scalp and hair loss to see if you would be a candidate for this approach.

Tags: lupus, hairloss, hair loss, female hair loss

I am 52 and very athletic. I started taking Androgel about 3 or 4 years ago and usually stay on a low dose (2 to 3 pumps/day) except when training hard for a marathon or triathlon (a couple a year) and I go up to 8 pumps/day. I noticed I have lost a significant amount of hair around my crown so I’m now wanting to quit Androgel for good IF there is evidence that the hair will grow back over time. Is there any evidence that this happens or have I lost that hair for good. My hair is otherwise plentiful and my hereditary traits are for thinning hair but not baldness like I am getting so I feel sure the Androgel is causing it.

Usually, hormone induced hair loss in men is permanent. You might try minoxidil in the crown, which might grow back some of the hair. Finasteride (Propecia) may stop the progressive nature of the hair loss while you are on Androgel.

Tags: androgel, hairloss, hair loss

Snippet from the article:

The group aimed to see how energy drinks affect heart health, given that these drinks, along with dietary supplements, are not regulated as stringently as new drugs that must meet Food and Drug Administration (FDA) safety requirements, Shah said.

In a literature search, they identified seven observational and interventional trials that evaluated the impact of energy drinks on QT interval, blood pressure, and heart rate.

Three studies with a pooled sample of 93 subjects had QT/QTc data. Six studies with a pooled sample of 132 subjects had blood-pressure data, and seven studies investigated heart rate.

The patients, who were all young (aged 18 to 45) and healthy, underwent ECG and blood-pressure testing before and just after drinking one to three cans of energy drink—most commonly Red Bull, but also others such as Full Throttle and Meltdown RTD. An 8.4-oz can of Red Bull contains 80 mg of caffeine, compared with 35 mg of caffeine in a 12-oz Coke or about 100 mg of caffeine in an average cup of coffee, Shah said.

Read the rest — Energy drinks may prolong QT interval, raise BP

It’s not hair loss related, but it’s worth a post…

This is a study by Dr Sachin Shah, presented at the American Heart Association Nutrition, Physical Activity and Metabolism / Cardiovascular Disease Epidemiology and Prevention (AHA EPI-NPAM) 2013 Scientific Sessions.

According to the report, the increase buzz may be the result of caffeine alone, but the changes in the EKG has not been explained and the relevance of it is not clear.

Tags: energy drinks, health, blood pressure

What is your view on using SMP for someone with a fair bit of hair, fairly stable with propecia/minox for over 10years with a bit of thinning? Wanted to fill in the crown a bit to minimize the contrast of light brown hair and the scalp of a caucasian 42 yar old male? Is this a good solution and could it negatively impact a hair transplant in the future if need be?

Yes, it could have value if you already have some hair in the crown. Think long term –if you lose all of your crown hair, then the SMP will not work so well, but a hair transplant could solve that if and when that occurs. SMP works reasonably well in thinning hair.

If you would like a formal consult you can send your photos to hairdoc@newhair.com (it will be confidential) and I will reply with more clarity.

Tags: smp, scalp micropigmentation, pigment, hairloss, hair loss

I was wondering if you have any thoughts on the new Invati Treatment for Thinning Hair (shampoo, conditioner, and scalp revitalizer) from Aveda. Supposedly it won’t regrow hair, but it will stop hair loss (at least that’s what they said in the store.) Sounds too good to be true. It also seems to be mainly targeted towards women, though they claimed it would work just as well for men.


I found the product’s page and have seen the commercials on TV. The site says it stops hair loss from breakage, meaning it does nothing for actual genetic hair loss, but rather, it may strengthen hair. I think you answered your own question about it sounding too good to be true. Having said that, if you want to try it, it is your prerogative.

Tags: aveda, invati, shampoo, hairloss, hair loss

Hello, I’m 26 years old and was curious if I have a juvenile or mature hairline in my photo. My hairline has been the same since I was 16 or so by looking at past photos and I’ve had no hair loss or recession in other areas. The current length of it is 1/2in.

You have my permission to use for the site.

Thanks for your permission to post this. Click to enlarge:


This is a great picture because you wrinkled your brow, as I always ask my patients to include in their photo, is touching the highest wrinkle. If you follow the highest crease, that is where your hairline was when you were 7-9 years old. The corners are rising very slightly, but this is still in the Norwood class 1 category and I would consider this a juvenile hairline still.

There is a wide range between when your hairline hugged the highest crease to a fully mature hairline. What is noteworthy about your present hairline is that the mid-line ‘kisses’ the upper crease, which is clearly the same hairline you had in the middle when you were between 7-9 years old.

Tags: hairline, mature hairline, hairloss, hair loss

Dear Dr

There has been a lot of interest in the UK about intermittent fasting where an individual eats normally for 5 days a week and then fasts for two (not on consecutive days). There was a BBC horizon programme where it was shown to reduce IGH-1 (growth hormone) and improve insulin sensitivity. It is claimed that when a body goes into fasting mode the body starts to repair itself better by repairing cells rather than producing more cells. It was suggested that this may be beneficial to age related diseases, cancer etc.

Do you think this would slow down the pace of hairloss if insulin sensitivity improved and/or IGH-1 was reduced? Has research been done on this approach? Your thoughts would be appreciated

Genetic hair loss is not a disease. Balding is a genetic trait, like your height, body build, hair color, the way you look, etc. Even if this ‘fasting’ has value (which I would doubt), it will not change your genetics. Significant fasting can actually accelerate hair loss. You are what you are and although your patterned balding can be modified with drugs or transplants, your balding pattern is fixed in your genetics.

Tags: hairloss, hair loss, genetics, fasting

Hello Dr

Are there or have you heard of any new potential treatments for hair loss that we might likely see in the next 5 years or so? There doesn’t really seem to be anything new since the discovery of propecia and that was some time ago. In your opinion will it be hair cloning or some form of drug if there is anything on the horizon

There is a lot of activity with clinical trials going on, but we are not privy to them. We, like you, wait to see which treatments rise to the top. I couldn’t say whether cloning or a new drug will be first to rise, though. It all depends on the ongoing research and development.

Tags: hairloss, hair loss, treatment, cloning

My question is about the link between DHT, testosterone, aging and hair loss.

If DHT levels are related to testosterone levels, and testosterone peaks at about age 18-22, how do we explain a hairline that does not even begin to recede until age 40? Does DHT increase with age? Do follicles become more sensitive to DHT with age? Is hair loss that begins at an older age caused by something other than DHT?

I will be turning 40. Up until about 1.5 years ago, my hair was very full – no signs of loss at all. Since then, it has gradually receded above the temples and it feels a little thinner on top. I’m not interested in Rogaine or Propecia, but I would like to understand what’s happening.

If you are losing hair (in a pattern), you probably have genetic balding. It generally happens in the early 20’s to the 30’s, but there are always exceptions to the rule (and it can happen in your 40’s and 50’s). In my opinion, it does not have to correlate with the levels of DHT, because it is programmed in your genes… and your genes will express your balding pattern as it was programmed to do. You can have very high levels of DHT and never go bald if you do not have the genes. Or you can have very low levels of DHT and still go bald because you do have the genes.

In the end, the best treatment for genetic balding in men is finasteride tablets daily to slow or stop the loss as long as possible (for those men with the genes for balding, so that DHT can be minimized). If you are not interested in the medical option (Rogaine/Propecia), then the surgical option would be hair transplants to address the corner recession.

Tags: hairloss, hair loss, age, genetics

Hello Dr,

First I would like to thank you for writing this blog which has been very helpful to me. I was wondering what exactly you are referring to when you mention the “leading edge” of the hairline? Is that the center of the hairline just above the furrowed brow or does it include the whole “edge” of the hairline? Also I was wondering if it is possible that the hair thinning at my temples is just a sign of a developing mature hairline? Thank you!

If you believe you are losing hair on your temple area, you may have a component of genetic balding. I am not sure that dicing out the semantics of descriptive terms will help in diagnosing a condition. Leading edge just means the frontal edge of your hairline.

Send us pictures and with your eyebrows lifted enough that you crease the forehead and we (as well as the readers) can comments on your hairline location and appearance. Your question and pictures would probably be more suited for BaldingForum.com.

Tags: hairline, leading edge, hairloss, hair loss

I have been recently diagnosed with alopecia areata (one spot) and have had several HT session in the past. Recently been under a lot of work related stress. and my hair has been thinning all over event in the safe zone (I am 48 Years old). And the back of my scalp has a see thru appearance. So I am wondering if this is diffuse alopecia areata that could evolve to alopecia totalis or DUPA since my donor area is very thin?

Anything is possible, but not probable. Alopecia areata without any treatment often will resolve over time (which can take up to one year).

Tags: alopecia areata, hairloss, hair loss