Interesting balding without a Norwood Pattern

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

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.

Chest hair as a source for hair transplant hair

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

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.

Should I trransplant my crown?

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

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.

2700 grafts in early 20s male

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

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

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

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

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

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

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

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)