I have a Class 3 balding pattern (just corner loss) and I went to a hair transplant doctor who offered to perform 2000 grafts in the front to address the balding area.  It seemed to me that I was thinning outside of my frontal balding area. The doctor who offered me the surgery never looked at my hair under a microscope. I am a 24 year old male and I purchased a hand microscope as you suggested on Amazon. When I looked at my donor area, this is what I saw in different parts of the donor area.  How would you interpret the hand microscope pictures I have attached here?

This is clearly Diffuse Unpatterned Alpopecia (DUPA) which I originally wrote about in 1997 (see here: https://baldingblog.com/wp-content/uploads/pdf/mp-1997-evaluation.pdf). The view of your donor area shows very significant miniaturization of the donor area which means you are not a candidate for a hair transplant because it will fail. The hairs that get transplanted will look like these hairs and not have much bulk to them. The doctor who recommended 2000 grafts just wanted your money and probably never read about DUPA.  You seem too smart for that doctor. The drug finasteride sometimes helps.

This is what my donor area looks like

I had a hair transplant 4 months ago and found out that my testosterone levels were low, so I went on Testosterone. My doctor prescribed Dutasteride to protect my native hair.  What do you think?

With hormone supplements or testosterone, you run the risk of losing more native hair, not from the donor area or the transplanted hair, but from the native hair.  Taking Dutasteride, which has a sterility side effect, is not in the best interest of my patients so I rarely prescribe it.

You have a condition called Cobblestonning that is produced by the graft skin edge, located above the surface of your normal scalp, resulting in these “bumps”. There is little you can do about this other than get another hair transplant to overwhelm these graft sites, putting possibly more hair in front of them so that they can not be seen. Of course, your surgeon must be made aware of the problem to ensure that he places the grafts flat against the surrounding skin at the time of the next surgery.


I understand the reason people say you must go on fin, is to stop their hairloss. But I really want to keep my libido. Lets say I get a transplant and don’t go on finasteride. I probably could have a nice hairline for a few years, then I will start to look weird. But I’m pretty much content with shaving it short once I’m older. I don’t care if I have good hair from mid 30s and forward. I feel like its OK to be bald then. I just want the rest of my youth with good hair. What is your thoughts on this? Also my main problem is receding sides. And its been that way a very long time. 

Hair transplants should wait until you are at least 25, in some unusual circumstances this timeline can be moved forward. At 25, with a good HAIRCHECK instrument check, I can predict your eventual balding pattern with some degree of accuracy. With this information, I create a MASTER PLAN for your hair loss management and if that management includes surgery, then the plan will address a ‘what if’ you should continue to bald.

Unless you are going to have a very advanced hair loss pattern, the constant hair transplants every two years is not probable and if you are going to develop a very advanced pattern of balding, a totally new discussion must be undertaken with your doctor. The concept of a MASTER PLAN is like everything in life. An architect can’t build a building without a Master Plan, nor can an army wage a war without it.  The doctor who builds your MASTER PLAN will be making a commitment with you and that should assuage your fears.

I have been doing such planning with patients for 27 years in this business and I can’t tell you how many of my patients are grateful for the openness and honesty that comes with selecting the right doctor. The good news is that there are many such doctors out in the world who care about people like you.  Do your homework and explore the process. I offer monthly open house events where people like you can meet people like you who have been where you are and you can see what has transpired since they made the decisions that are before you now.

Of course my answer would always be to go back to see your doctor. These red spots are suggestive of some type of inflammatory process or infection.

red spots 3 months out


Chicken Pox at 4 months after a hair transplant? After your hair transplant, having Chicken Pox is no worse than not having a hair transplant. There is nothing you can do about it, just don’t scratch it. The grafts will grow out normally and should not be affected by the virus.

A failure of a hair transplant is most often a reflection of the techniques used. If I had a failure, I would perform the next surgery at no charge. Yes, by all means, go back to your doctor and ask about why it failed. Assuming that you do not have some dermatologic disease that caused the failure, your doctor should make things right with you financially.  Ask how he/she will make sure it does not happen again. Ask yourself if you trust that the doctor will get it right the second time.

You are correct to wait until you are older to be sure where your balding pattern will show up so you will know what you are in store for. Your family history might indicate where your balding may be going. Look at your brothers, uncles, father and grandparents on both sides of the family to see what they hair loss pattern is/was, Usually by the age of 25, you will know and you can then build a Master Plan with your doctor.

20 year old

The before pictures (above) and the after pictures (below) show the results of a women who requested to have her temple peaks restored which she started to lose 10 years earlier. She also wanted a slightly lower hairline that would not be perfectly balanced because she feared that a perfectly symmetrical hairline would look “man-made”. The hairline was drawn on the day of the surgery. The after picture below are shown nine months after the hairline was corrected.

The horizontal arrows show the temple peaks before and after the surgery.  The vertical arrows show the point to where the hairline was lowered. She had an unusual hairline for a female, as many of the women we see actually have thinning corners of the frontal hairline. This was not the case with this woman. A surgical hairline lowering procedure could not address the missing temple peaks which is what makes this hairline very feminine.

customized transplanted hairline

Hairline: customized transplanted with temple peaks (before and after photos)

These are signs of possible infection. The pustules should be drained by your surgeon, cultured to identify the bacteria and then you should be placed on appropriate antibiotics?


We’d both be 19 if he was still here. We were pretty alike. Both were studying together. Life bummed him out but not that much. Then hair loss hit. He started losing hair all over his head. Every doctor just said it was aggressive hair loss. His worries become amplified ten fold. Everything bummed him out, he wouldn’t leave his house. I wake up one day to my mum telling me that he hanged himself in his room when everyone was away. Nobody talks about how hair loss made everything worse. I understand depression plays a huge factor but it would have never happened if hair loss treatments were not complete bull shit. Guess what though? Now i’m going through the same thing. Rapidly losing my hair and people are noticing it. My own parents won’t even look at me the same way. Can the industry get its act together? I want to live. Why can’t people understand how balding screws up your mind at a young age.

Hair loss can be treated and today, with modern technology, almost every person can get the hair that they are losing back when in the hands of an experienced, ethical and skilled doctor. There is no hopelessness with balding, not at all.  Yes, our industry may not focus well on people like you and your friend.  I, for one, have had too many young men in your situation and I spend a lot of time with each of them. Most of the time I am successful in bonding in a positive way to impact their depression; however, depression needs professional help. I had one young man commit suicide after being mutilated by a hair transplant doctor with the old plugs and many scalp reduction surgeries. I knew about him because his mother and I bonded over his management, but he lived far away and a phone connection was not enough. When his mother called me and told me the terrible news, I felt that maybe I should have flown out to see him or send him the money to come to visit me in LA, Hindsight does’t help.  Hair loss just adds to the depression that already exists in such young men and I keep seeing young men voice their depression about hair loss and relate it to hopelessness.

The picture on the left shows a high degree of miniaturization (12 miniaturized hairs and 41 normal hairs) with a ratio of 29% miniaturized hairs. The magic number is that miniaturization is present if the number of hairs exceed 20% of the total. The picture on the left shows just that. Miniaturization means that the hair is in some stage of being lose, going through Apoptosis (cell death) that is certainly a problem for this patient.  The drug finasteride can reverse this on some patients.  You can purchase a video microscope on Amazon (https://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=video+microscope) for as low as $19.  You can become your own doctor making your own diagnosis just by counting hairs as I have done here.


miniaturization 2

At one year after a hair transplant, I would expect to see at least 95% of the growth to styling length on your head. Go back and meet with your doctor and see what your doctor has to say. If you were my patient, I would want to know for sure that you don’t have some autoimmune disease and if you don’t then your doctor should make it right financially for you

poor result

I was trying to get an understanding how long it takes till the new follicles and the implant area closes up completely and becomes as insensitive to external stimulus/irritation as normal hair, if it makes sense. For example, right now I am extra careful when going to gym and doing exercise lying my head on a bench, because I am afraid of rubbing the implanted area and potentially causing damage to the new hair. We don’t want to damage it if the surroundings are still not fully closed and healed.
At 3 weeks it is reasonably healed. Wound healing has been studied and 70% of the healing is complete at 3 weeks. Complete healing really takes about 3 months because the body continuously replaces the skin and the new collagen more heavily for the first 3 months, but for practical purposes 3 weeks is reasonable


He did 1500 grafts in just 40 minutes. I counted only 700 or so. What do you think?

The surgeon must make a surgical record of the actual graft count. Ask for that surgical record, as you are entitled to it. In 40 minutes for 1500 grafts, I would say that is ‘god’s speed’.  Was the surgeon some deity?  The wounds look larger than I would make them.  I would need more information about the surgery such as strip or FUE?  If it were a strip, the dissection would not have been very careful and in 40 minutes, I believe you may have been, as you said, ‘taken to the cleaners’.

1500 grafts in 40 minutes