Hi Doctor thanks for the great website. I’m currently still trying to pinpoint where the mature hairline exists.

Would you say the ex president George W. Bush, actor Matthew Mcconaughey (post wig/ transplant) and actor Jim Carrey have mature hairlines, this is of course without a personal examination by you. I’m sorry to ask you about celebrities but they are the only people I can really compare my hairline to without being creepy and staring at strangers hair.

I have seen in photos of Matthew Mcconaughey which showed a frontal balding pattern. Whatever he did, it reflects something that is difficult to analyze. Hollywood can create wonderful hairlines in movies and on TV that can completely obscure the absence of a hairline. Another possibility is a really bad photo that is not the most flattering. I actually met Matthew Mcconaughey in person and I can tell you he has not had a hair transplant. While I’ve never met the former president or Jim Cary, I would guess that neither of them had a hair transplant. Jim Cary has a Class 3 pattern on the Norwood scale.

Ronald Regan and Bill Clinton both had juvenile hair lines.

You can search my BaldingBlog (see upper right) for “juvenile hair line” to read about the numerous posts I’ve written. You can also look at this POST. Generally, it is easiest to see the highest crease on the forehead to determine if the hairline is mature or receding. That requires the cooperation of the person being photographed or can be seen if the person being photographed was excited enough to lift his eyebrows up.

I am 55 years old and started working out for the first time in my life a couple of years ago. I want to be healthier and found that my testosterone levels were in the low normal range. I had a full head of hair before I started to think healthy. I take supplements for working out to stay healthy, but I have been losing my hair for the past couple of years. If I am healthier, why would I be losing my hair?

We lose hair for a series of reasons. If you were mal-nourished or rapidly losing weight, you might precipitate your genetic balding pattern which could have been silent before you started working out. Good nutrition is important, but if your supplements contain any synthetic steroids (I do not know if they do), that would induce acceleration of your genetic hair loss pattern. Hair loss in men is fundamentally genetic and although some men do not ‘express’ their balding pattern (express is a genetic term), taking any form of steroids could be enough to bring on your genetic balding pattern.

I would like to clearly state that exercising does not cause hair loss. Natural over the counter supplements should not cause hair loss. The steroid factor from taking natural supplement is hypothetical. You could be just expressing your genetic pattern for your age (a bit late for a 55 year old).

Bloomberg News (8/13, French, Basak) reports that according to the National Institute of Mental Health, symptoms of depression “vary and can include feelings of hopelessness, extreme anxiety, appetite changes, insomnia or excessive sleeping, and suicide risk.” Sadly, “just half of Americans diagnosed with major depression are treated and only 20 percent are cared for according to practice guidelines, according to the National Institutes of Health.” ….. It “affects rich people, it affects poor people, it affects people across the spectrum.”

We see a very high suicide rate in the military and in teenagers, young people who have stress that they can’t handle. Most people know of someone or some family member where suicide occurred, a sad statement on how we recognize and manage this problem. In my 20+ years as a hair restoration surgeon, I’ve seen patients with depression who look to cosmetic surgery for the wrong reasons (to cure their depression). I can remember one patient who was scheduled for a hair transplant and I cancelled his surgery (on the morning he was to have surgery) and referred him to see a psychiatrist that same day! It was the right choice for him and he was treated. (He never ended up with a hair transplant surgery as it would have been the wrong choice.)

I also remember two patients who committed suicide because of depression where balding was the tip of the iceberg. I recognized one of these two individuals as severely depressed, and tried to get involved in his life by recommending appropriate treatment, constant follow-up and I had discussions with his family about the problem. This second patient was from the mid-west so meeting with him regularly was out of the questions and my many phone conversations just showed caring. After he committed suicide, his mother called me to thank me for my support, but clearly not enough was done for him. It was a very sad experience for me, a frustrating one, as I felt helpless.

I just met with a Asian man with very low density, even for an Asian. He was considering the different harvesting techniques FUE vs strip surgery. He met with other doctors who represented that they could transplant 4000-5000 grafts in a single strip session and 3000 FUEs in a single FUE session. This poor man was confused when I suggested that his yield would be less than 2000 grafts with a strip surgery.

There is a great deal of hype on the Internet that people need to have a single large session of 6,000 grafts to get coverage and that is preferable to 3000 grafts in each of two sessions. I would agree if I did not know better. First let me state my qualifications for what I am about to say. I was the first doctor in the world to do 2000 grafts, then 3000 grafts than 4000 grafts in a single session back in 1992-4 and I have been doing larger sessions longer than anyone in the world starting back in 1992. I was using follicular units in large sessions before most of the doctors heard of the follicular unit, let alone the megasession. That would make me an expert on the subject of large sessions hair transplants and I doubt that anyone would challenge my expertise (see references below from prior to 1995). Add to that the fact that I practically invented the large session of small grafts. You may not know my training in surgery, but I am a board certified general surgeon who did everything from war surgery (in the Vietnam war) to extensive trauma, vascular and cancer surgery. That would make me more than qualified to perform a large session harvesting technique for modern hair transplantation.

Of course, if I could harvest 6000 grafts in a single session safely, I would do it more often. I have always had the supportive staff to carry out this type of surgery. But as safety is my guide in all circumstances, my judgments tell me often that taking out a strip which would yield 12,000 hairs (6,000 grafts) is often dangerous and would put the patient at risk to develop some complication. Please note that I clarified that a 6,000 graft harvest should yield about 12,000 hairs, so if a 6,000 graft harvest yielded substantially less than 12,000 hairs, then I might start thinking that smaller grafts were produced by sub-dividing follicular units which is a sin in my ‘ethical’ book. What makes it a sin is that as the fees are directly related to graft counts, sub-dividing follicular units as a routine accomplish two things (1) it raises the surgeon’s fee, and (2) they damage follicular units which tends to produce decreased hair survival.

A hair is not a hair. Fine hair has low bulk and when someone states that they can completely cover a bald man’s head with 6,000 fine hair grafts referencing a ‘gorilla’ result, they are just plain lying. Dr. Feelgood may market his god-like qualities, but Dr. Feelgood just ‘ain’t’ god.

I get rattled when someone tells me through the various internet forums that I should have given someone 6,000 grafts to manage his bald head and that if it was done by Dr. Feelgood, everyone knows that Dr. Feelgood always achieves high graft counts (no mention of the hair count of course). I would ask two questions, (1) what are the hair counts in such large sessions as a matter of routine, and (2) what do the donor wounds look like as a matter of routine. I know more than most what is possible and what is safe, and I know what is not. I use my judgment to ascertain safety and I really don’t believe for one minute that Dr. Feelgood would get 6,000 grafts (12,000 hairs) when I could only get 3,000 grafts (6,000 hairs), never, never, never. If a graft count in the 5000-6000 range is possible, I do them with the agreement of my patient.

The forum chat ‘folks’ who are not knowledgeable about the subtleties of a safe strip harvest and who believe in the marketing hype of some of the internet doctors can talk from their ‘armchair’ all they want. Either my patients are not typical and have tighter scalps and lower densities than Dr. Feelgood’s patients, or some of the doctors who claim these high numbers routinely are either lying to push up the numbers and claim a ‘mighty’ superman deed rewarded (of course) by making more money, or I am a monkey’s uncle.

Published References from prior to 1995 when almost every hair transplant doctor in the field was doing small sessions of large plugs:
# Rassman, W.R.; Bernstein, R.M. One of our greatest problems – lowballing! Hair Transplant Forum. 2(6); 1992.
# Rassman, W.R.; Pomerantz, M.A. The Art and Science of Minigrafting. International Journal of Aesthetic and Restorative Surgery. 1(1): 27-36; 1993.
# Rassman, W.R. A buyers guide to hair transplantation. Los Angeles, CA: NHI; 1993.
# Rassman, W.R. The minigrafts’ revolution, can we keep up ethically? Publication Journal of Cosmetic Surgery.
# Rassman, W.R. Everything you wanted to know about hair transplantation but were afraid to ask. Los Angeles, CA: NHI; 1993.
# Rassman, W.R. The fast track option: a common sense approach to hair transplantation. Los Angeles, CA: NHI; 1994.
# Rassman, W.R. Megasessions: Dense Packing. Hair Transplant Forum 4(3); 1994
# Rassman, W.R Concern about quality. Hair Transplant Forum 4(4); 1994
# Bernstein, R.M.; Rassman, W.R.; Szaniawski, W.; Halperin, A. Follicular transplantation. International Journal of Aesthetic and Restorative Surgery. 3:119-32; 1995.
# Rassman, W.R.; Carson, S. Micrografting in extensive quantities, the ideal hair restoration procedure. Publication to Journal of Dermatology, Surgery and Oncology, 1995
# Rassman, W.R. Follicular Unit Transplantation Megassessions, Hair Transplant Forum Intl. 5(5); 1995

This patient was a victim of a bad surgery and old plug scars. He didn’t have enough hairs to cover the plugs or enough transplanted hairs to cover the top. He was out of options other than wearing hats or a hair piece. SMP helped him with creating a hair line and hiding most of his scars. The photos were taken a few minutes after the SMP so it still looks a bit red.
Hair line and temples are very important part of creating a natural looking hair line. There is no standard “template” you can use. Everyone’s hair line and individual goals are different. Dr. Pak’s artistic background helped create a new hair line. Dr. Pak actually does most of his hair lines free hand much like his portrait sketches. This prevents the all too common helmet head or lego head.

SMP to scar plugs by New Hair Institute: Note soft natural hair line and temple. The redness will go away in 2 days.

SMP to scar plugs by New Hair Institute. He needs one more SMP session to even out the back with the crown area. Top still looks “thin”.

SMP to scar plugs by New Hair Institute. Soft hair line. Redness will go away in 2 days.

Dear Doctor –
Is there any chance that a long-ish regimen of antibiotics could interfere with the efficacy of ongoing finasteride treatment?

More broadly, is there any contraindication of commonly used antibiotic scrips and finasteride? Is there any connection of antibiotic Tx to hairloss, in general?

Thanks.

There is no association that I know of with hair loss and chronic antibiotic use with or without finasteride.

Time February 1917, just prior to the Russian Revolution. Vladimir Lenin was living in Zurich. He was depressed. “Nothing he tried seemed to succeed. The pamphlets he wrote drew little response while the hair oil which he bought in quantity and rubbed assiduously into his skull failed to stimulate even the slightest growth of hair(*).” This is an interesting footnote in history as we all know that Lenin was bald and his balding seemed to add to the depressing circumstances around him. (taken from Nicholas and Alexandra, by Robert K. Massie).

Hair has always impacted the emotional state of mind of men, especially during stressful periods. Famous celebrities, emperors and presidents stress out all of the time and some of them lose their hair from the stress and their genetics.