Dear Sirs,

Do all people follow the same pattern of hair loss, meaning they start from the temples and progress in a specific way as Norwood classification describes or there are unique variation for each person? People from the Balkans as Greeks, Bulgarians, Romanians are considered Caucasian or for them there are different hair loss patterns as Norwood describes?

Thank you in advance

Every male, from anywhere in the world, can have a balding pattern that has been defined by Norwood. The Norwood patterns are not showing a progression of balding that one goes through, but they show the end stage of a process as Dr. Norwood described it.

For example, to develop a Norwood class 6 pattern, you will not start with a 2, then go to a 3, then a 4, and then a 5 pattern. Most men with a Norwood class 6 pattern start losing their hair with thinning in that pattern that precedes the end stage of the balding (the hair begins to thin all over in that pattern).

Norwood chart
Tags: norwood, hairloss, hair loss

Hi Dr. Rassman,

I’m 20 years old with a receded hairline (my derm. diagnosed me as a NW2). No one in my family is bald, with the exception of one distant relative. My hairline receded 2 years ago but then didn’t budge. However, over the past few months, I’ve noticed it rapidly thin about a 1/4 inch into the hair line all around. My derm. said this could be the result of a final surge of hormones as I finish growing/developing. Is this common?

I’ve been on Propecia for one week now and will that be able to help me return to where I was only a few months ago? Any help would be greatly appreciated and keep up the great work with this blog!

A “final surge of hormones” sounds nutty to me. Young men always have hormones that surge. What you’re describing could just be your genetics, not some hormonal surge.

Starting on Propecia when you have early hair loss is the best course of action, so stick with it and lets hope that it reverses or halts the progression as it does in many 20 year olds. I can’t say for sure what benefits you’ll see, but you’ll know in the coming months if you’re experiencing less loss or regrowth.

Tags: hairloss, hair loss, propecia, finasteride

If you have no donor supply left would it be possible to use body hair to help with density. I understand your positions on BHT having read your posts on the topic, however is that something you would ever consider?

There are few indications for body hair transplants (BHT). From what I have seen, the results are quite variable. It might be a waste of your money doing it, especially if it did not meet your objectives. I occasionally refer patients who are committed to body hair, but I do not do them myself.

Tags: body hair transplant, bht, body hair, hairloss, hair loss, hair transplant

If a younger patient (late 20s) wanted to ‘touch up’ their hairline to make it more symmetrical with a small transplant e.g 10cm surface area…approximately what density should this be at if you were to consider that the patient has fine hair and wants to be cautious with regard to future loss?

I’ve seen some surgeons using ‘dense packing’ produce great looking results, but i know these can be risky as future loss can leave a bad result…but would it be ok to transplant at a lower density in this case? And do you ever perform ‘touch ups’ to the hairline of a younger patient if they’re not on medication?

Also, are lower densities (i assume 25-30 per square cm?) going to give a very poor looking result for someone with fine hair?


Each case is different, so you will need a diagnosis first to see if you are balding. Some young men get freaked out about a mature hairline (which is not balding), so it’s very important that you get a diagnosis before you can plan for surgery to address any cosmetic issues to the frontal hairline.

If someone wants a very full hairline (original non-balding density), for most people that would likely require more than one surgery, regardless of how densely packed the hair can get. If your hair was medium-coarse or thicker, you might get a reasonably full look in one session.

If it sounds too good to be true, it usually is. You should want to create a Master Plan with your surgeon to account for any future loss that might occur. Remember, you’re talking about a surgery to your scalp (particularly at the hairline, right in front of everyone that you interact with in person). You should want to make sure that if you do have hair loss progression, the results from any earlier surgery will remain natural in appearance.

Tags: hair transplant, hairline, hair restoration

Hi, first of all, I’d like to thank you for taking some of your time to answer our questions. Losing hair is not something easy to deal with and having a knowledgeable voice is really helpful.

My question is about the efficacy of Propecia if you restart it after a long break. To make a long story short, I went to a dermatologue about 7 years ago for my slight hair loss and he didn’t want to prescribe me Propecia as he felt I wasn’t receding enough. But as I didn’t want to take any chances, I went to a generalist whom I persuaded to give me the stuff (incredibly, he didn’t even knew what it was). But after about a year, noticing that my twin brother wasn’t losing hair either, I kind of believed I simply had a mature hairline and stopped using it. But now, I’m pretty sure I have MPB, nothing to dramatic but enough to make me want to be proactive and start Propecia again.

My question is, will it be as helpful to me as to someone who never took it or will my body had developed some kind of resistance to it ? Thanks a lot.

You do not develop a resistance to Propecia. It is always better to take it earlier on in the hair loss process, but it is never too late. I can’t say for sure how helpful Propecia will be, but hopefully you’ll see some benefits if you stick with the medication this time.

As you are aware, Propecia is available by doctor’s prescription… so talk with your doctor about whether it is right for you.

Tags: propecia, finasteride, hairloss, hair loss

Snippet from the interview with Carl Djerassi, “father” of the The Pill:

Djerassi himself was snipped in his early fifties; his daughter was sterilised at 25, convinced the world didn’t need more babies and she’d adopt if necessary. But will there be a male Pill?

“Never. This has nothing to do with science; we know exactly how to develop them. But there’s not a single pharmaceutical company that will touch this, for economic and socio-political rather than scientific reasons. Their focus is on diseases of a geriatric population: diabetes, obesity, cardiovascular, Alzheimer’s. Male contraception is nothing compared with an anti-obesity drug. Plus, men are preoccupied with the side-effects. Men who start taking it at 18 will ask, ‘Will I still be able to have a child 30 years later?’ How do you answer? To prove that is monstrously difficult and expensive. No one would spend that amount of money.”

Read the rest — Carl Djerassi: ‘We know exactly how to develop the male pill, but there’s not a single pharmaceutical company that will touch it’

Tags: contraceptive pill, djerassi

In a caucasian male with brown, straight, fine hair…what sorts of transplant density would start to appear ‘full’? Is it possible to get a thickness so that the hairs can stand up or will they always ‘fall down’ because of the lack of surrounding hair?

There is no magic number for density. Hair transplantation is about using a limited number of hairs to make your overall scalp hair appear fuller. The density varies from location to location to achieve this look.

For example, if we put a density of 10 hairs per square centimeter all over the entire bald area on a Norwood 6 patient, it will look very sparse with no significant cosmetic improvement. If you put 100 hairs in a square centimeter on the same patient you will quickly run out of hairs and will only be able to cover a small / partial area on the bald head. But if you vary the density from 50 hairs to 10 hairs and focus with the higher density in the front AND combine it with hair styling, you can achieve a full appearance.

Thus, the overall result of a hair transplant is not only about the density. It involves hair texture (thicker and curlier is better), hair color contrast against the skin (low contrast such as black hair on dark skin is better), and hair styling (longer hair, wavier hair is better than a straight buzz cut).

Tags: hair transplant, density, hair grafts, hair restoration


I have read quite a few times individual people have said finasteride thickened their hair up but they did not actually grow new hairs. How can the hair thicken up without new hair growth. Does this mean the hair root expanded and got thicker making the hair on our head appear thicker or fatter?

Thank you.

Propecia (finasteride) generally thickens the miniaturized hairs, as well as grow new ones. For men that see thicker hair but no growth, there is probably some new growth that just isn’t being noticed.

Seeing results could also have to do with the age of the patient and the degree of hair loss they have. In general, the older you are, the less effective the drug will be. If you have early hair loss, the medication helps to reverse miniaturization (thus thickening the hair).

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

I met with one of my earliest transplant patients who had surgery in 1992 when I was just in practice for about 6 months. We performed 400 grafts on this patient and he reminded me of the troubles I had in using the glue to hold the grafts in place. At first I had to think about what he was talking about… and then I remembered the painful process of placing a large number of grafts close together.

In those early days, just 80 grafts was considered a big session. 400 grafts was a huge surgery and putting grafts close together caused them to pop out, so I came up with the use of a medical quality methyl methacrylate (a form of super glue) to hold the grafts in place. The problems I encountered was that the glue was stringy and I had to be able to limit the glue to one corner of the graft, holding it to the skin. I had to put the methyl methacrylate into an insulin syringe and then express it through a very tiny needle to produce a micro-drop.

I had to work out just how to do many grafts at one time to stop the popping before this “glue” bonded into the insulin syringe. The glue problem was never solved to my satisfaction, but eventually I developed a very sensitive touch so that when I placed the grafts and kept a steady hand, I did not disturb the adjacent grafts. Eventually I mastered this technique and taught it to my staff. Now the world does it that way.

The patient compared the procedure we did recently to the one I did to him in 1992 and we both has a good laugh. This most recent procedure was his third and the grafts that I placed in 1992 worked very well for him over the past 22 years.

Tags: hair transplant, history, surgery

Snippet from the article:

They promised her a full head of hair, but it was a bald-faced lie, a $15 million lawsuit says. A real estate exec says she shelled out over $250,000 to a clinic that promised to “restore her hair and confidence” — and wound up leaving her permanently bald.

Deborah Betesh’s lawyer, Bruce Baron, said what happened to his client at the Microdot Technique was “an egregious case of fraud, misrepresentation and deceptive business practices.” “The defendants preyed on someone who was hoping to remedy something that was truly a burden and they’ve now destroyed her life,” he said.

Betesh, 56, first went to the E. 58th St. clinic in 2012 because she was worried about her thinning hair. She says techs at the clinic told her they could give her “the hair of her dreams.” They also told her it was “a safe and effective alternative to having hair transplant surgery,” and that just two to four hours after the procedure, “her short hair would become long, and that her thinning hair would become full again,” the Manhattan Supreme Court suit says.

Read the rest — Salon that promised to give woman ‘hair of her dreams’ caused her to go permanently bald: suit

Wow, that’s quite a bit of money and seemingly little research done. She’s claiming there was artificial hair surgically implanted, while the defendants are adamant about performing no such procedure. Without knowing more about this case specifically, the Microdot process sounds like it is just another type of hair weave to me.

Tags: hair loss, hairloss, lawsuit, microdot

Snippet from the article:

Popeye, Garfield, My Little Pony and Snoopy: some of the world’s most famous cartoon characters are getting a very special makeover in an effort to help kids cope with losing their hair to cancer.

Knowing that hair loss brought on by chemotherapy can make children feel different from others, Brazilian cancer advocacy group GRAACC created a unique campaign called “Bald Cartoons.”

According to the Bald Cartoons website, “Famous cartoons from all over the world have gone bald, sending out the message that a child with cancer deserves to be seen just like any other child.”

Read the rest — “Bald Cartoons” Help Sick Kids Cope With Hair Loss

I really love this campaign. Emotional pain from hair loss sometimes gets the best of many young men, and children may be especially affected. These cartoons help show kids that losing their hair due to chemotherapy isn’t something they should be embarrassed of.

Tags: bald cartoons, hairloss, hair loss, chemo, chemotherapy, cancer, children

I am female and decided to have an FUE transplant of 1200 grafts just to fill the front centre. I have some existing native hairs there but it was just getting very thin and more and more difficult to conceal.

I am now due to start the minoxidil foam 2%. I was advised i should use the foam once a day in the evening for at least 6 months. I do not wish to use minoxidil for life and would stop after the 6 months. My question is whether i should use it at all if i plan to stop..? is it necessary to use after surgery? Will it cause more hair loss if I stop after 6 months?

Many thanks

You must use minoxidil for life to maintain any benefits you may see from it. If you do not plan to stick with a minoxidil treatment beyond just 6 months, I don’t really see a point in starting it. If you do start and then stop after 6 months, you will lose any hair that regrew from the medication… though it’s not likely you would’ve seen much regrowth after only 6 months anyway.

Follicular unit extraction (FUE) to the middle of the head for increased density may have a negligible impact. A reasonable alternative to your surgical plan might be Scalp MicroPigmentation (SMP), as it is less expensive and the results are instantaneous. See an example female patient here — Bride-to-Be Received SMP Before Her Wedding to Cover Her Thinning Scalp.

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

Can you show me the difference between the temple peaks that are strong and weak. I need clarification on what they are.


Here’s a few celebrities with different temple peaks. Will Ferrell (left) has virtually no temple peak; Tom Cruise (center) has a weakening temple peak; Mario Lopez (right) has a very prominent temple peak.

Temple peaks
Tags: temple peaks, hairloss, hair loss, celebrities, hollywood, actors

Snippet from the article:

Prince WilliamThe Duchess of Cambridge passed a royal milestone today by cracking a joke at her husband’s expense while on public duty for the first time. She suggested the perfect solution for Prince William’s growing bald patch – a toupee made from alpaca wool. “You need it more then me,” she said, pointing to his head.

William, who has teased her mercilessly about her clothes, telling her she looked like a banana in a yellow dress and complaining that a dazzling green outfit was too bright, laughed and took it in his stride.

Read the rest — Kate teases William over thinning hair at Sydney Royal Easter Show

Over the years, many patients have come to our office to have hair transplants because of such teasing by family. This is not uncommon.

Tags: prince william, kate middleton, duchess, hairloss, hair loss

I’ve seen you mention many times that bulk analysis is a good way to determine if someone is balding and that density should be the same everywhere for a non balding patient.

But I’m not convinced by this – I recently saw a well known hair transplant surgeon and he said that people typically have less density around the crown and temple areas anyway. He didn’t believe in bulk analysis for analysing hair loss.

Today I saw a male child who must have been around 8 years old. His hair was shaved short and sure enough, his temple/corner areas were noticeably less dense than the rest of his hair and this went quite a way back (I suppose to the point where someone might have suggested he was between a NW2 and NW3 on a balding scale if he was an adult).

HaircheckYou may not be convinced of the value in measuring hair bulk, but I am not going to try to convince you.

In a non-balding man, the bulk analysis shows that the hair in the 4 areas we measure (down the midline: front, top, crown and donor area) are all within 10% of the measurement of each other. I do not measure the hair at the sides of the head, because that is not where the balding will be. I would therefore possibly agree with you that the side densities are not as high as the midline densities.

Out of curiosity, I will measure a non-balding man’s sides and see if we are both correct.

Tags: hairloss, hair loss, hair bulk, analysis