About two years ago I noticed thinning at the front of my scalp and corners, now I still have thin hair at the front but what really bothers me is that there are two dime sized patches of hair that is not completely bald but much much thinner. will this progress? and should I expect more thinning in the future?

I often get these questions emailed to me. Actually I get these questions asked alot! I just want to make it clear that I am not a fortune teller nor can I diagnosis hair loss over the Internet. If your hair loss bothers you, see a doctor. You can always search the Internet but you’ll end up with mixed messages or information. I can tell you in general the most common cause of men’s hair loss is genetic and it is known as male pattern balding (MPB). If you have MPB and would like to do something about it, there are medications (Rogaine or Propecia) and hair transplant surgery. There is also Scalp Micropigmentation (see scalpmicropigmentation.com). When people describe circular dime sized or quarter sized bald patches, it makes me think of alopecia areata (AA), an autoimmune disease that requires a doctor to make the diagnosis. There is no cure for AA, it has a different cause than male pattern balding and if hair is transplanted in to these ‘dime sized areas’ it will not grow unlike male pattern balding where good results from a transplant can be expected.

I have just turned 27 and I am concerned about my hairline . I have never really given it much thought but then someone commented on it and I noticed it is a triangle shape. I am concerned that I am going bald but have heard of the term mature hairline. I have drawn in a line to show my highest wrinkle. I am thinking about getting a hair transplant as the hairline looks rather odd. My crown is fine I think ! I have attached photos which may be of use. There are no bald people on either side of my family which is why I find it strange that I could be.

Any help or guidance would be much appreciated.

If you are concerned about your hair line and considering a hair transplant, you should see a hair transplant surgeon. I don’t mean to sound obvious but there is not much I can say here. Balding occurs in the 20s for most men. From your picture there are two things happening: (1) your forelock comes down to the highest crease which indicates it is located where it was when you were 5 years old, and (2) you hairline on the corners is certainly receding upwards giving you a bizarre shape to the hairline that that makes it look pointed. If you transplant the frontal corners, you can move to a different hairline that better fits with your look. You are in your 20’s and that is when such frontal recession appears.

I started receding when I was about 18 but it stabilized and never went past what I now understand to be a “Norwood 2.”

However, now that I’m in my early 40s, and particularly over the last year, I’ve noticed a substantial thinning on top (still no bald batch in the back). I can clearly see scalp.

Could this be a medical issue (hormone changes with age) or is there something I should be tested for to correct the situation?

My grandfather (mother’s side) was bald; my father had his hair, as did his father. My uncle (on mother’s side) lost most of his hair in his 40s-50s. I have two older brothers and both are receding but nothing dramatic.

This is called getting old. Maybe you always had some thinning but as you get old it is showing more. Maybe you were genetically programmed to be a Norwood 2V/ 3V. I do not know.

The best test to find out if you are balding, is to get a hair Bulk Analysis or a Miniaturization Test in a doctor’s office. We do these routinely. Just yesterday, a 27 year old male came in with hair loss in the frontal hairline, but when I did the hair bulk analyses, I found that he was losing hair in the top and crown where he could not see it. There really is no blood test other than establishing a diagnosis by a competent doctor in the office setting. I realize there are genetic blood test for androgenic alopecia but the results will not give you a clear cut yes or no with regard to whether you are balding or not. Even if the answer to the genetic test is that you do or do ot have genetic balding genes, you still have the hair loss issue that is something that only a doctor can tell you once he examines you for hair bulk around your entire scalp.

In the end if you want to do something about it, you are left with (1) drugs (Propecia or Rogaine) (2) hair transplant surgery if you can see the hair loss (3) scalp micropgimentation (4) different hair style. Finally it is rare for men to have other medical issues that would cause a “pattern” balding. The “pattern” you are describing may be Male “Pattern” Balding. See a doctor if you want to do something about it.

I have noticed that I’ve been losing my hair since I was about 18 years old. For the past few years , I’ve been using finasteride, nizoral, and minoxidil. It worked for a couple years but now I’m noticing that my hair has been falling at a very fast rate. I currently live in Seoul, South Korea, and I have been thinking about having a hair transplant but I’m afraid of having one at a young age.
Do you have any advice?

There are things you need to be clear of:
1) Losing hair is not fun but it may be something you may have to face. More than 50% of men face some degree of genetic hair loss. If you are worried, find a doctor who can give you a diagnosis and a Master Plan for how to possibly address the hair loss.
2) You don’t have to have a hair transplant. Losing hair does not automatically mean you need to have surgery. There may be other options such as medication or scalp micropigmentation.
3) As you live ins Seoul Korea, you can always visit my colleague Dr. Jino Kim of New Hair Institute in Seoul Korea.

How many hours does it take for each SMP sessions and how many sessions will it take? I understand it is permanent ink and was wondering if it fades after time and would need additional touchups? What happens when my hair turns gray? Will I need additional touch ups at that time? How many additional treatments after graying would be recommended?

Yes, there are between 2-4 procedures over a time span of a few weeks (you work that schedule with us). A full head SMP takes between 20-30 hours and we like to see some spacing between the procedures so that if it is going to fade, we can adjust for the fading on the subsequent session. The cost is $7,000 for an entire head SMP and we generally cover it until you are happy with the results. If it fades more than most people, we will do extra work at no charge. Touch-up may occur after a year or so at a cost of $500/tough-up. Most of our patients have not come back for touch-ups. We use a variation of gray/black or gray/brown in the inks and if you turn gray, worst case years down the road (and the inks did not fade enough for you) you might want to color your hair. You can expect that the pigment will fade over long periods of time. The absolutely best way to know the answer to your questions about graying over time, is to come to our Open House and we usually have a patient with gray hair so that you can see the answer for yourself. I hope that this answers your questions.

Bad Concealer (Too Much)

No Concealer , No SMP

With SMP

This patient was 87 year old with SMP who had Toppik plastered on his head and he looked ghoulish. We just washed the hair and then did an SMP on his whole head (see attachment). A different man who is now dating again. Age does not mattern.

Merck states that “Contact with the semen from a man being treated with PROPECIA is not a risk to the unborn child of a pregnant woman“. My question is: can the same rule be applied to those taking DUTASTERIDE, considering this is a higher potent DHT inhibitor? I take 0.5mg daily for the treatment of hair loss.

Probably not, but we don’t know. Dutasteride can also have fertility issues in the men who take this drug, but the proof is not available at this time. This is probably one of the many reasons that dutasteride is not approved for the treatment of hair loss by the FDA.

Can You Use Leg or Body Hair for Eyebrow Transplants? I understand that if you use head hair for eyebrow transplants, the hair will keep growing longer than the other hairs on the eyebrow and I don’t like cutting my eyebrows.

Leg hair has a different hair cycle than head hair. Some body hair has 70% of its life cycle in telogen (sleep) and does not appear on the recipient area transplanted therefore but 30% of the time. So a successful eyebrow transplant with body hair, will keep to its growth cycle. It will disappoint the recipient as only about 70% of the hair will grow at any one time, even if it was successfully transplanted. There is no way to stop head hair moved into the eyebrow from growing. I generally joke to my patients that they can grow a pony tail from an eyebrow transplant. So basically, you will have to cut these hairs twice a week or so, and when you cut them, they must be cut on an angle making the tip look sharp.