We have known for years that there is a connection between crown (vertex) balding and heart disease but this article seems to extend the relationship with all forms of balding, worse in men with crown balding.


Clearly, whoever did this surgery, they did not know that the hairline should have single hairs and not be in a pattern. This is relatively easy to repair by creating a transition zone in front of this hairline.

bad HL turkey

This disease, more common in women than men, is responsible for considerable hair loss in women.  Too often, hair transplant surgeons who don’t understand the diagnosis will transplant such patients and when the do, the transplant always fails.  An experienced hair transplant surgeon is critical because he/she detects this disease which can be devastating.  It is easy to see why surgeons get excited about transplanting this type of patient (see photo of female below) but careful examination would show that this patient is missing vellus hairs and has skin abnormalities that are not reflective of genetic balding.  This article shows a treatment which has proven successful in 78% of patients:


Screen Shot 2019-02-01 at 7.21.14 AM

This patient had too many FUEs performed too close and possibly with instruments that were too large for the process. Necrosis (skin death) is a complication seen in the inexperienced, over ambitious hands of inexperienced doctors or technicians who should not be doing FUE.  I expect this complication to be more and more common in the coming years and more and more providers enter the FUE business without adequate training. The only tre)atment for this is Scalp Micropigmentation, which will work well provided that the patient keeps his hair very short (see: https://scalpmicropigmentation.com/scar-covering/

scarring from necrosis

This is a funny piece!

Larry David on Being Bald and Min and Fin from tressless

I just turned 20 and recently started taking propecia as my doctor told me I have lost about 40 percent of my crown hair using haircheck (None of this is visible). Even I was surprised to learn that I was actually balding. There is baldness in my genes but it’s not really aggressive or noticeable until older age (40+). Additionally, my fraternal twin hasn’t gotten his hair check but I am assuming he has not lost any hair yet. I am currently on finasteride and planning to take it as long as possible if the side effects aren’t severe. Do you think it’s possible for me to keep a full head of hair (or the appearance of one) through at least my 30s? Thanks

 The difference between frarternal twins may be related to stress but the genetics of one does not impact the genetics of the other. Did you have more stress in your life than your twin brother. Did you go on any radical weight loss diet?. These can be causes of bringing out the genetic in you and not your brother but maybe your brother did not inherit the balding. Taking finasteride might work for years, if you are one of the lucky ones.

The main reason to get a hair transplant lowering procedures are (1) there is no limit to how far to lower it as it does not require a loose scalp (2) the hair transplant lowering will address the sides of the hairline (the temple areas) which can be built up to create a rounded look which can not be accomplished with a hairline advancement surgery, (3) there is no risk of frontal scarring with the hairline lowering transplant approach as with a hairline advancement surgery and lastly, (4) if a general anesthetic is used for a hairline advancement surgery, the risks of general anesthesia are greater than the risks of a local as with a hair transplant lowering procedure.

Before you start, get a baseline if you can with a HAIRCHECK test (https://baldingblog.com/haircheck-test-how-it-is-done-and-what-its-value/) to see how you are doing over time. If you start off seeing a doctor who can build a Master Plan for you, you will be miles ahead in the years to come. Taking dutasteride to start makes no sense to me if you don’t know where you are starting from and this drug has lots of side effects, including sterility in some men (unable to have children).

20yo starting the journey on the big 2.5 from tressless

The real issue is that hair loss is a progressive process in men. You need to find out what your eventual balding pattern is now and what it might be, how fast your hair loss is moving to more balding and then build a Master Plan with a doctor like me, who cares about you (not your money) and is willing to invest the time to follow you as your situation progresses, maybe to a hair transplant eventually. I turn down a lot of young men, because they are not ready yet (pattern not right or they are too young) and just work with them. That is why I am successful and have such a great relationship with my patients. I believe that I defined first class hair transplants as far back as 1991. You did not state your age, but if you are 21, then you may be in trouble because you could be chasing the hair loss every year with more and more hair transplants, not good

i love my transplant


You do a HAIRCHECK test and repeat it every year. The first test will define the baseline, and depending upon your treatment or the progression of the hair loss, changes in the HAIRCHECK test will answer these questions. See here for an example: https://baldingblog.com/19-year-old-parent-told-not-balding-according-haircheck/

The way this should be approached, is to analyse your hair with respect to its hair thickness (fine, medium or coarse, the coarser being better than fine hair), and the donor density.  The number of grafts that can be safely moved in a Class 6 pattern of balding depends upon the donor density. The higher the donor density, the more grafts you have to move.  A typical Caucasian male has ~110,000 hairs on their head with 50,000 Follicular units, or 2.2 hairs per cm square. There is a difference between FUE and Strip surgery maximum numbers as you can see in this chart: https://newhair.com/resources/#tab-id-4 so your doctor should measure your original donor density so that a plan for both the first transplant and the potential to cover the entire balding area with an additional transplant can be determined.  A typical Caucasian with an average weight hair (thickness) can get reasonable coverage of a Class 6 balding pattern. Body hair is never as good, because the growth cycles are short and the length and thickness never matches the donor hair from the scalp in quality and length. If you don’t have enough hair, then Scalp Micropigmentation can make up the difference very nicely as shown in this article I wrote last year: https://newhair.com/wp-content/uploads/2018/11/Combining_Follicular_Unit_Extraction_and_Scalp.98621.pdf



The use of general anesthesia for a hair transplant is not a good idea because a hair transplant takes many hours and general anesthesia risks go up the longer you are under it, plus the costs would be very, very high.  The use of local anesthesia like you dentist uses, is the only way to do this.  Pain should not be a problem as most people feel nothing once the local anesthetic has been administered.

This poor man went to someone who did Scalp Micropigmentation and had neither the art, nor the pigments, nor an understanding of what the hair should look like. With a little bit of luck, this will all come off with a proper laser. Once it is off, he should get it redone by someone who knows what they are doing!  See here for examples of good SMP https://scalpmicropigmentation.com/gallery/

bad smp2 bad smp

This is a great article which shows what an earlier study showed on the value of finasteride in reducing the risks of prostate cancer. See  New England Journal of Medicine(www.nejm.org) article.