Hello doctor, I have a 2 part question:

I am confused about the location of temples. I’ve been reading many of the previous posts here and I’ve heard you say a few times that people get the temples/corners mixed up and that the temples are above the ear. What I would like to know is: where exactly are the temples/temporal hair? I am having trouble understanding this.  Also, I know what vellus hairs are but I see some hairs that are longer than 2 mm (what you said were the max length for vellus hairs) that are sort of whitish near the part of my head I assume to be the temples (right near the corners).

The leading edge of a hairline often has small vellus hairs that never grow very long. Behind this there are soft one hair follicular units and behind those are two and three hair groups. It is the two and three hair groups that make our hair look full. For purposes of definition, I have put a picture of a patient where we transplanted everything in the front of his head. Notice a soft hairline that is not a line but a zone that is irregular and reaches back to fuller, more dense hair. Many of our patients tell us in emails that they are losing their temples, but what they are saying without knowing, is that they are losing their hairline as this man did.

 

I am seeing more and more patients with depleted donor areas and thinning/balding in the back of the head where the hair formerly looked normal. This can be avoided in FUE by controlling the number  of FUE grafts excised. It can only be treated with Scalp Micropigmentation which we do routinely in our office.

“About 40% of US adults will develop diabetes, primarily type 2, in their lifetime, and over 50% of some ethnic minorities will be affected” according to the Centers for Disease Control and Prevention (CDC) and Emory University, Atlanta, Georgia, published online in Lancet Diabetes & Endocrinology.”

Obesity is the major cause of adult onset diabetes as people have great difficulty in managing sugar. If you are worried about this, get your doctor to perform a basic blood test called ‘Hemoglobin A1C’ which will tell you if you run a high blood sugar at times. I am a big fan of finding out risks and addressing them in time before problems set in. The good news is that once you know your Hemoglobin A1C level, you can take appropriate actions with the help of your doctor if needed. We know that diabetes accelerates heart disease and many other conditions including stroke, so the theme of this post is ‘find out and then take action’.

I am a 20 year old boy, I have been noticing hair fall eveyday.  I have read on the website progesterone cream for hair fall. Is this safe? What about PRP?

While progesterone is generally considered a natural female hormone, biochemically it is a precursor to testosterone much like testosterone is a a precursor to DHT. (Men produce progesterone naturally  just like women produce testosterone in their body)

Without going into detailed biochemical / medical logic, there may be an academic reasoning behind the use of progesterone but it is not a standard treatment for male pattern balding.

Keep in mind, male pattern balding is a genetic condition for which there is no definite cure.  Drugs such as Propecia and Rogaine can help but over the long run the genetic predisposition will manifest.  The only FDA approved medication for the treatment of male pattern balding is Propecia and Rogaine.

Many doctors and Internet sites will promote treatments such as progesterone, PRP, low level laser light therapy but it is my opinion that the consumer take a “buyer beware” approach for every treatment as you are the only one to protect yourself.  For every success story behind these treatments, there are many disappointed consumers who have spent thousands of dollars with no benefit. Try to make sure you are not one of them.

Doctors, I’m confused as to what Haircheck is and how it’s different from the miniaturization mapping. Can I get some more info please?

I’m going to try to clarify the usefulness of this tool as best I can. I saw a patient (we’ll call him John) that came to see me after I started him on Propecia a year ago. At the time I prescribed Propecia, I noticed he had miniaturization to 50% in the top of his head. I measured this when I used the video microscope, but there was no see-through appearance as his hair had a good weight to it so with the naked eye and I did not see miniaturization, nevertheless, the hair looked normal but with the microscope. It was clear that he had early balding when measured by the HAIRCHECK instrument. The HAIRCHECK instrument measures hair bulk and puts an actual number to it. From a visual appearance, there was no sign of balding on John (just like a year ago). The main reason for taking the test at the office on this visit (as with the last one) was that John saw hair on the pillow case indicating that he was losing hair. The HAIRCHECK device confirmed his concern that he was losing hair.

The measurement of hair in the mid-head (between the ears) at, 17 cm just above the glabella (just above the nose), was measured for hair bulk and compared with hair from the donor area, just above the occipital notch, in the back of the head. The measurements of the hair on the back of his head should reflect his normal hair bulk. If the area between the ears had the same bulk as the back of his head, I would tell him he did not need Propecia and was not balding. But last year we saw a reduction in hair bulk determined with the HAIRCHECK instrument in the top of his head indicating that he was balding. One year ago, John has a measurement showing that he had lost 45% of the hair on the top of his head. On today’s visit John had a bulk measurement of the hair at the exact same location (in the middle of his head) and a bulk measurement indicated that on this visit, John had a hair loss now of 55% of the hair on the top of his hea (between the ears), a clear sign of more hair loss and a progressive process.

When he comes back in a year, if his number may drop further because hair loss is progressive. Fortunately, many men stop their hair loss with the drug finasteride (Propecia). Let’s assume that in 1 year it drops to 35% of the bulk, and in three years it drops to 25% of his hair bulk when compared with the back of his head. If this becomes his case, then the idea of the Master Plan that I have been pushing for many years is just what should he needs, as this plan will define a path for him to take. At some point, his hair loss will become obvious to him.  My job is to follow the progression of his hair loss and build a plan for him on what to do. There are many options, but I will not write a book on it for this blog post.

I hope that this blog post gets the message across that everyone needs a Master Plan for his hair loss and it must be with a good doctor, one that can be trusted to always act in the best interests of the patients.