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    Questions about SSRI’s

    Apr 28, 2023/by William Rassman, M.D./0 /Hair Loss Causes
    1. Can SSRI cause a receding hairline?

    2. Does Telogen affluvium work with male pattern baldness? Because I had a really bad shed if I got out of the shower and 3. I have male baldness what kind of shed is that?.

    3. Does finasteride respond to telogen affluvium?

    1- SSRIs can kick in genetic balding from stress alone, as well as a drug response
    2- Telogen effluvium can impact any man or women undergoing stress
    3- Finasteride does not impact telogen effluvium

    Interesting balding without a Norwood Pattern

    Apr 28, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Because these balding photos do not follow the Norwood scale photos of balding, I doubt that they are genetic.  The diagnosis could likely be made with a hand microscope (trichoscope).  These are the things that the physician should look for with a trichoscope. High on my list of diagnosis, is Alopecia Areata.  Trichotillomania usually doesn’t show such a diffuse pattern but would show blunt amputated hairs. Alopecia Aerata will show exclamation mark hairs.  Lichen planopilaris (an autoimmune disease) includes the absence of follicular openings, perifollicular scaling and white cicatricial areas that point heavily to this diagnosis.  This man’s doctor should certainly biopsy his scalp and send off the tissue scalp samples to an expert dermatopathologist.  That is absolutely the necessary next step after a trichoscopic examination. This man should NOT BE TRANSPLANTED.

    What is the best depth for microneedling?

    Apr 27, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    The purpose of microneedling is to create a wound in the area of the hair stem cells that trigger the hair growth cycle. Those are found at around 0.8-2 mm below the scalp surface. The needle must get to the stem cells to get the best results.

    Microneedling and Ehlers Danlos Syndrome

    Apr 27, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Is microneedling safe for people who have hyper mobility Ehlers Danlos Syndrome?

    I have never been asked that question before. I don’t see a reason that a 1mm needle couldn’t be used

    Chest hair as a source for hair transplant hair

    Apr 26, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    How many chest hair grafts does the average male have that can be obtained from their chest and what is the survival rate?

    Chest hair can be used for hair transplant as a donor source; however, it is not the best hair because (1) it has a short anagen cycle and a long telogen cycle, which means that only about half of the hairs will be growing at any one time, (2) the hair is finer than scalp hair most of the time, (3) chest hair grows as single hairs so a graft requires two or three grafts put together for a reasonable graft value. If the surgeon charges per graft extracted, that makes chest hair three times the cost of scalp or beard hair.  The hair usually falls out within days or weeks after the start of the telogen cycle.

    4 months on finasteride and minoxidil (photos)

    Apr 26, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Again, hair that is very sensitive to finasteride and/or minoxidil with terrific early results.

    7 months on finasteride

    Apr 25, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Amazing results in young man that shows a Class 7 balding pattern in the crown. Note that the entire lower half of the crown has miniaturized hairs suggesting that the loss is recent and reversible. 

     

    Topical minoxidil once or twice a day?

    Apr 25, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Most of my patients use it once a day. I recommend doing it at night after a hot shower when your scalp is more receptive to it.

    Should I trransplant my crown?

    Apr 24, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    I’m 25 and medications reversed my frontal hair loss, but now I am thinking about getting a hair transplant for the crown which did not reverse with medications.

    The size of your crown balding is minimal. If you start transplanting it now, maybe it will get worse and then you would have to do it again. The crown is a “Sinkhole” for using up your donor area.

    Can you stop recession 100%?

    Apr 24, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Can people still recede despite being on finasteride and using a dermaroller and loniten ?

    Recession is not 100% preventable. Treatment works in some men, the younger they are, the more effective these treatments are

    2700 grafts in early 20s male

    Apr 24, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    The transplant looks good; however, I am concerned about your Master Plan for long term management of your overall look. If you are in your early 20s, then I generally don’t believe it should be done. Let’s take a objective look. 2700 grafts in the first 2 inches with a high probability that you will eventually develop a Class 6 of worst case Class 7 pattern of balding. I would have calculated your total donor supply. Assuming that you are an average Caucasian, 2700 grafts reflects possibly 33-40% of your total donor supply. How are you going to manage the rest of the balding? Beard hair becomes an option when you run out of scalp hair. Other body hair is not an practical option. You can reach out to me at williamrassman33@gmail.com and I would be happy to show you how to calculate your remaining donor supply.

    Mature hairline with widow’s peak

    Apr 21, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Is this a mature hairline or am I receding?

    You didn’t lift your eyebrows to show the creases in the forehead as I always suggest; nevertheless, because you have a defined widow’s peak, this shows a mature hairline with the widows peak showing as a remnant of your juvenile hairline. This affirms that you have a mature hairline after seeing it here and seeing the hairline in reference to the widow’s peak.

    Minoxidil and finasteride 2.5 years

    Apr 21, 2023/by William Rassman, M.D./0 /Hair Loss Causes
    Persistence is the plan that gets results in those people with sensitivity to these drugs. These drugs work nicely when you want to thicken up the thinning frontal area which indicates that the hairs that have miniaturized are probably still there and just need the boost.  This is a better result than a transplant can give you at much less cost. The main difference is that when it is medications that give you these benefits, you MUST stick to the medications or risk losing it all. A hair transplant doesn’t require any medications to keep it.

    Beard hair vs Scalp Hair

    Apr 20, 2023/by William Rassman, M.D./0 /Hair Loss Causes
    I have a question about using beard-to-scalp transplants for additional coverage/density in people who have advanced balding and are out of head donor hair. I know that for beard hair grafts, there’s usually only one follicle per graft whereas for scalp hair grafts there’s usually two or more follicles per graft. On the other hand, however, beard hair is much thicker than scalp hair. So does that mean that if you are using beard hair to provide density/volume, you would need twice as many beard hair grafts to provide the same density as you would get if you were using scalp grafts? Or does the beard hair thickness offset that?

    Alopecia Areata

    Apr 20, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    The arrows show the irregular nature of the balding.  It is as if these areas are cut out of his scalp, devoid of hair.  This can be treated with appropriate medications in the hands of a skilled medical professional.  Too many young men who have such conditions, first try all of the medications offered on the internet through various forums. For me, it was an easy diagnosis and a diagnosis I would drill down by first performing a trichoscopic examination, then probably a biopsy to confirm what the trichoscopic examination showed me (signs of alopecia areata, of course)

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