Shedding with microneedling?

/by William Rassman, M.D./0 /

Ive had pretty lame results with minox only the past 8 months so I decided to add microneedling a month ago (.75m once a week with .3mm for topicals 2x a week). Ive been having a pretty big shed as a result and dont know if this is a sign to stay on. I did have an initial minox shed when i first got on min but there wasnt much regrowth after, so Im hoping this would be different.Thoughts?

You should understand that the scalp epidermis is 0.5mm thick, so if you go less than 0.5mm with microneedling, you are not reaching any hair stem cells; in fact, you are not reaching anything. With your 0.75mm length, you are barely going through the scalp’s epidermis. The stem cells that need to be reached are about 1.0- 1.7 mm below the surface of the scalp, so that is why I recommend a depth of 1.25mm to reach those stem cells that control hair growth cycling. The shed may have nothing to do with your microneedling.

Overharvesting in Turday (photo)

/by William Rassman, M.D./0 /

They gave me a little certificate upon completion of the transplant with a redo guarantee of the results are poor, I still have it. But I cannot just go back to turkey, the plane ticket there was more expensive than the procedure. I told them I wanted a refund but they gave me the run around for legit 2 months, I got tired of it and ripped into them real bad. After that, they declined to give me a refund and they keep telling me no

The value of seeing a doctor in your country is that you always have recourse, either to get your money back or take action against the clinic that did this to you.  A solution, if this is older than 6 months, which in your situation is so, then SMP is part of your solution, but don’t get ripped off doing this again, get a reputable group to do this for you, one that does both transplants and SMP.

How many grafts do I need? May go to Turkey (photo)

/by William Rassman, M.D./0 /

The donor hair thickness’s value will dictate the graft quality and quantity you need. Men with coarser hair require fewer grafts and get better results than men with fine hair who require more grafts; even with more grafts, the difference between the results is significantly different. In Turkey, most of the clinics (not physician-run nor driven by such factors that I mentioned above) do not do this analysis but deplete your donor area regardless of your needs.

Frontal hair placed in wrong direction

/by William Rassman, M.D./0 /

This is a widespread error for surgeons performing a hair transplant.  Hair is often placed like the spokes of a bicycle, circularly.  In this particular man, the mistake was for half of his right hairline; however, I often see the entire hairline created this way.  When a man has straight hair, such errors create a freaky look.  See where half of the right frontal hairline points in the wrong direction. I drew straight lines in the photo to show the error. 

Is doing 4000 grafts on a Class 3 pattern a good thing?

/by William Rassman, M.D./0 /

I’m 21 and I want to get a hair transplant. My Norwood class of balding is a Class 3.  I met with one doctor who wanted to do 4000 grafts on me. What do you think?

At 21, you should not do any hair transplants. Your balding pattern will not be clear, and the use of your donor supply by sloppy doctors may deplete your donor supply before knowing where your balding is going. Get a Personalized Master Plan from a good hair doctor, first and foremost. Too many Class 3 and 4 patients get megasessions and eat up their donor supply before they complete their balding process. Being deformed from bad planning for the rest of your life is not a good thing!

Am I a good transplant candidate at 21? (photos)

/by William Rassman, M.D./0 /

You appear to be a good candidate, assuming that you have already tried some of the other non-surgical treatments and that they have failed. Do you have miniaturization on your scalp beyond the hairline area? Ask your surgeon about your baseline donor density and hair mass (donor hair thickness). These two factors will allow you and your surgeon to predict how you will manage if you continue to lose more hair (likely). If your surgeon can’t answer these questions, could you find another surgeon who will? You must remember that the surgeon works for you, and as such, in a job interview (you being the interviewer), you need to ask the right questions and expect reasonable answers. If the surgeon gets upset with your questioning why he is offering you surgery, then get the hell out of there because you shouldn’t want to hire such a doctor.  If you only meet with a salesman or saleslady, then run for the hills. 

FYI: Juvenile hairlines are not uncommon. In Caucasians, they are less than 5% (e.g., Bill Clinton), while in India, they may reflect 25% of the male population. My Grandfather died at 102 with his 5-year-old hairline and black hair (no gray).

I need a hair transplant for my career (photo)

/by William Rassman, M.D./0 /

I am in the situation where I am quite good looking (sometimes get asked if i’m a model when wearing a hat), but genetically have a terrible hairline. My hairline has been like this as long as I can remember. It’s a problem that’s been bothering me greatly since I was 13 already, always wearing a “justin bieber hairstyle” to cover it up, being scared of wind, etc. Hair loss fairly minimal. Recently I decided to get a transplant and put down a deposit. Plan is to lower the hairline a bit, fill in temples, maybe temporal peaks (undecided). 2700 grafts planned for hairline and temporal peaks. However, I’m not totally sure if it’s worth it. The things I am worried about:

  • Lack of density in the transplanted hairline.

  • Botched/failed transplant (surgeon is quite reputable but you never know).

  • FUE scars on my head.

  • Transplanted hairs falling out /not growing properly.

  • Transplanted hairs falling out after 5+ years,

I have previous experience doing a rhinoplasty to straighten my broken nose from boxing and I’m not very happy with the result (although its not terrible). I know that reality and what people write on the internet can be very different from my own case, and I really regret doing that procedure. Is it actually possible that I will do the surgery and end up with a result I’m satisfied with, a lower hairline with nicely dense looking hair I can style in any way? Or is it more likely I’ll end up with an inferior result and be sprinkling toppik into my fake hairline

I would REALLY appreciate some answers as I’m quite on the fence. In case there’s a decent chance transplants are overhyped and likely end up semi-botched, I’d rather just stick with the hats than worry about covering up my transplant for the rest of my life. But in the case that I could simply do it and have a great result and go out with a normal hairstyle, that would be life-changing. So it’s a difficult decision for me. Thank you so much.

Are you balding? Is this a hairline recession? You can alleviate these concerns by getting a good, honest, competent surgeon to evaluate you. The questions you ask here should be asking of the surgeon. A good surgeon will measure your donor supply, donor density, and hair mass to set up your expectations. You need to know more about what your balding pattern might evolve into, assuming that you are in some stage of the balding process. A good examination by a surgeon will help guide you here. This is what I do and have done for 33 years, and I have done it on some of the wealthiest people in the world and many, many celebrities from Hollywood.

Finasteride shedding

/by William Rassman, M.D./0 /

My shedding from starting finasteride is still happening 6 months since I started the drug. What should I do?

Drug-induced shedding usually stops in a month, rarely 2 months. See your doctor and find out what the cause of your shedding is as it may not be the drug but some acceleration of your hair loss.

When does finasteride start working?

/by William Rassman, M.D./0 /

When did you see results after using oral dutasteride and/or oral minoxidil

These drugs start working almost immediately. Remember that hairs that are miniaturized and benefit from these drugs have to grow from their base, a process that takes up to a month or so before they emerge from the scalp. If you plucked one of these hairs at, say, four months, you would see a wider shaft at the bottom (the new growth) and a smaller shaft on the upper part (the miniaturized component of the hair).  Sometimes it takes up to 18 months to see the value from finasteride. 

Editorial on Oral vs Topical minoxidil 5% in females

/by William Rassman, M.D./0 /

Editorial comment from American Journal of Dermatology: Scalp pruritus affected 19% of participants in the topical minoxidil group. Pretibial edema occurred in 4% of participants in the oral minoxidil group. Hypertrichosis was more common with oral minoxidil (27% oral vs 4% topical), although this side effect was mild and well tolerated; 3 participants did not take any action to remove the excess hair, and 5 managed it with waxing. There was no difference between the groups regarding the variation of mean blood pressure over time. The mean heart rate at rest increased 6.5% in the oral minoxidil group without tachycardia; there was no change in the topical minoxidil group. No hypotension-related events occurred. No adverse events in oral minoxidil group required cessation of medication.  Our results reveal that low-dose oral minoxidil provides improvement of FPHL that does  not differ Table I. Main clinical and demographic data from participants Category Oral minoxidil 1 mg Topical minoxidil 5%……. Research Letters from topical minoxidil 5% solution, with a safe profile and well-tolerated adverse effects. The performance of oral minoxidil in regard to the Sinclair hair shedding score was superior to that of topical minoxidil, reinforcing the favorable results reported with telogen effluvium. The increase in total hair density lay within the topical minoxidil 95% CI; however, if the outcomes are taken together, they suggest a trend toward a greater improvement in the oral minoxidil group. Confirmation of this would require larger and longer studies. In conclusion, oral minoxidil can be considered an option for FPHL patients with poor compliance or who cannot tolerate topical minoxidil.

Finasteride and miniaturization

/by William Rassman, M.D./0 /

Doc, how many months would you say if I went on finasteride? Is it needed for a very miniaturized hair to return to its original thick shaft diameter? Thank you.

That varies between people and the aggressiveness of the balding process. In some men, I have seen plucked hairs indicate that the new growth occurred within a month