This young man (Joe) believed that he was starting the balding process that his dad had (a Class 7 pattern of balding). His father was with him today and he told me that he started balding when he was in his very late 30s. That was unusual for a man with a Class 7 pattern of balding (just a rim of hair around the head) as most men achieved that pattern in their 20s. Joe had early recession in the corners of his hairline.

This is what I told him and what I did: “You were concerned about the balding in the family with your father developing his advanced balding pattern in his late 30s (unusual). We performed bulk measurements on your hair today and much to my surprise, the balding you are experiencing is very mild and early with less than 9% hair loss behind the frontal hairline and in the top of your head. At the age of 24, you might be able to hold on to your hair for years if you use the drug finasteride. We discussed the potential side effects of this drug and I told you to call me if you should develop any of these.”

This shows the value of the HAIRCHECK test for hair bulk measurements. Although he thought that shaving his head was a good option and receiving Scalp Micropigmentation rather than face his fading hairline every year, month by month, I felt that he had a good chance to keep his hair and postpone any more thinking about his balding. This is very important for any young man. At his age, thinking too much about his hair replaces the real important things in life. Hair may not be important for him to worry about for years to come.

In medicine we call everything by its Latin name and it is on both of his knees. This is what it is called: Bilateral Hairy Kneevus

Merck’s controversial hair loss drug Propecia (generic: finasteride) has been linked to penile fibrosis, a serious sexual disorder which is also known as Peyronie’s disease. This condition can cause severe genital malformation, as well as persistent urological problems. Signs and symptoms of Propecia-induced penile fibrosis may include excessive curvature of the penis, pain during intercourse, erectile dysfunction, indentations in the penis, and genital shrinkage.

In the tens of thousands of prescriptions I have written, no one has ever presented with this condition to me, which to me means that this is a very rare side effect. The incidence of this problem in the general population is reported to be as common as 13%. I do not examine men with an erection so unless they reported this problem to me, I would not know if they had developed it on the drug. I mention this because it is my responsibility to post any such possibility that links the drugs I prescribe to conditions that it may produce.

Follicular Unit Extraction (FUE) is promoted by many doctors as a scar-less surgery. This is never true. All FUE surgeries produce punctate (small) scars which appear at every site where a grafts is removed and can be seen only when the scalp is shaved very closely. Although many patients never see these scars, some of those who shave their donor area hair come to see us to address these problems with Scalp Micropigmentation (SMP). In some patients who have large FUE sessions (sessions between 2500-6000 FUE grafts), large scars may appear. Examples of such large scars as shown in the photos here and are the result of a combination of factors including (1) possibly too many FUE grafts in the surgery, (2) repeat FUE surgeries which may have produced vascular problems, (3) surgical techniques, (4) the anesthetics used, (35) the size of the punches used) and many other factors too numerous to mention. Some patients have come to see us with necrosis of the donor area (gangrene) and unlike the scars that appear in the photos which usually reverse, those with necrosis have permanent scars that do not go away. The good news is that we treat most of these people who come to us with bad scarring, punctate scars that bother them, donor site depletion of hair that produces a see-through donor area, and those with necrosis with scalp micropigmentation (see: https://scalpmicropigmentation.com/scar-covering/).

A number of patients (many under 30 years old) are coming in to our office and telling us that they only want one session of FUE transplants and don’t want more in the future, and it is because they see these advertisements on the internet that say that this is possible. Many of the doctors who do such promotions, do large numbers of FUE grafts, going into areas that they should know that these hairs will be lost over time, even though the hair is strong at the current time. Both FUE and FUT docs are involved and it shows the greed of many doctors, to get as much money from these impressionable young men who can delay the purchase of a car for hair. We try to tell these young men that what they are reading is unrealistic; however, I guess they go to the one-session docs anyway because of significant sales tactics. I am personally disgusted at this type of physician behavior and wish that at least some of these young men get the message that they are becoming victims of doctor greed. I just had an internet link to a patient who had 5000 FUE grafts from such a doctor. When reviewing his before pictures, it was obvious he was sold something that was not in his best interest. His results were very disappointing and to make matters worse, the surgery accelerated his hair loss making him worse off and significantly poorer for doing the surgery.