Am I Losing My Hair or Am I Going Crazy?

/by William Rassman, M.D./4 /

This 28 year old man came to see me, because his family said he was crazy when he mentioned that he thought he was losing his hair. He came in convinced that he is following his father’s pattern and feels that the hair in the front, top, and crown have all lost volume over the years. This is a great challenge and using the HairCheck tool showed that he has lost 40% of his hair in the front, and 47% of his hair in the crown when compared with his permanent zone at the back of his head.

Armed with this information, he was happy that he isn’t going crazy, but I don’t know that any patient has left my office truly “happy” after being told they’re losing hair. I actually thought when I first saw him that he would have no balding present at all. My eyes told me what everyone in his family told him — that he had no hair loss problem. The measurements proved otherwise. His hair is coarse (black with light skin), but because of his hair character he would have to lose over 60-70% of his hair bulk to see the impact of the loss that I measured above.

Click photo to enlarge.

 

Tags: hairloss, hair loss, thinning hair

Female Corner Hairline Loss – An Interesting and Unique Situation (with Photos)

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

This patient had corner hair loss on one side of the hairline following a brow lift that she had done in 2003. We transplanted that weaker corner with 509 grafts in 2010. This is a unique case since we rarely just do the one corner, but the patient wanted to transplant just the left since the right corner did not show the same severe hair loss. We also treated the scar from the brow lift itself.

The corners of the female hairline often have slower growth than the middle of the hairline, so when one corner is transplanted with donor hair it will likely grow longer, thicker, and faster than the original corner hair. Why? Well, because her native hair in the hairline probably has a hair cycle measured in months rather than years. Now the hair that was transplanted at the left corner will most likely have to get cut frequently to maintain symmetry with the other side. We’re now planning another procedure to balance the sides out.

Anyway, this is a unique case and wanted to share. Click the photos below to enlarge.

AFTER – 9 months post-operation (509 grafts):

 

BEFORE:

 

Tags: hairline, female hair loss, brow lift, hair transplant, hair loss, hairloss

Hiding Old Plugs So Nobody Can See Them (with Photos)

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

This patient came to see us in March 2007 for 1004 grafts and then for a follow-up procedure in May 2009 of another 1045 grafts. All of these grafts were placed into the hairline to cover up old plugs. On his recent visit to the office, I couldn’t even find the old plugs… and when I told him that, he smiled ear to ear. Click the photos to enlarge.

AFTER (2049 GRAFTS TOTAL):

 

BEFORE:

 

Tags: hair transplant, hair restoration, repair, hairloss, hair loss, hairline

Some People Prefer the Stubble Look with Real Hair (with Photos)

/by William Rassman, M.D./1 /, , ,

I believe Dr. Rassman I can shed some light on a recent post. You have answered the question many times in regards to BHT and short cut hair. I agree that it does seem somewhat pointless to shave ones head after recieving a hair transpant however I do understand the logic behind it. With a short cropped haircut (even a #1 clipper shave) you can still see a visible hair line that defines the face much like the tattooing service you are now offering. With a completely shaved head it is not visible.

Many people such as myself would prefer real hair on their head rather than ink although I must admit that the results do look pretty good. None the less body hair is different than scalp but cut short can offer a more realistic illusion of stubble that in this day and age appears acceptable if not attractive. Counter argument it is very expensive for just stubble. Agree?

Why would you bother with body hair transplants (BHT) when you can use your scalp hair? Body hair tends to be texturally different. If you truly want a stubble look with real hair, using Scalp MicroPigmentation (SMP) with scalp hair extracted with FUE is a good way to accomplish this. On the flip side, patients who’ve had a hair transplant and want the closely cropped look would already have stubble, so SMP is a great option to add the appearance of fullness.

Here’s an FUE patient who had very little restoration work done — under 600 grafts to the front corners — and later decided to shave his head. On the top of his head, the hair is miniaturized so it appears thin and lighter in the picture. The following result shown is immediately after the first SMP session. This will fade slightly as the color sets and the client will return in 3 to 4 days for a touch-up. (Note that because the photo was taken immediately after the SMP session, you can still see some initial redness.)

Before SMP on left; After SMP on right. Click photos to enlarge:

 

Tags: smp, scalp micro-pigmentation, pigment, tattoo, bht, body hair, fue, hairloss, hair loss, hair transplant

Using SMP to Create More Fullness in Transplanted Patient (with Photos)

/by William Rassman, M.D./8 /, ,

This patient received 1260 grafts in 1998, but over the years he continued to thin in the front and top of his head. He came in last month for Scalp MicroPigmentation (SMP) in hopes of adding fullness to the area immediately behind the frontal hairline. The results are spectacular and he avoided another surgery as a result.

The use of SMP for patients who were previously transplanted to create the illusion of fullness in areas where there is existing hair is nicely demonstrated with this patient. Click the photos to enlarge.

AFTER SMP:

 

BEFORE SMP:

 

Tags: scalp micro-pigmentation, smp, hair transplant, pigmentation, pigment

Scalp Micropigmentation (SMP) for Scar Camouflage (with Photos)

/by William Rassman, M.D./1 /, ,

This patient came into the office with a widened scar from a hair transplant we did over a year ago. The photo at the lower left is following his second transplant procedure (the first was with another doctor). The widened scar risk increases with each additional procedure. Only the central 2 1/2 inch portion of the wound stretched 1cm (as seen here), while the two 1/2 inch wounds on either side didn’t stretch. Donor scarring is a real risk of strip harvesting for FUT but usually the scar is under 3mm in width. After the second surgery, the scar may widen as in this man.

We suggested scalp micropigmentation (SMP) for camouflaging the scar and these photos below were taken 10 minutes after his SMP session was done. This is a typical scar treatment for SMP. Sometimes a second treatment is needed. Click the photos to enlarge.

BEFORE SMP (on left); IMMEDIATELY AFTER SMP (on right):

 

Tags: scalp micro-pigmentation, smp, hair transplant, scarring, pigmentation, pigment

Follow-Up: Hair Transplants with Scalp Micro-Pigmentation

/by William Rassman, M.D./2 /,

I received a few emails asking for more views of the Scalp Micro-Pigmentation (SMP) patient we featured last week. One specific request was to see what the scalp looked like immediately following a session. Here we go…

Going from left to right (click the photos to enlarge):

  1. First photo is his transplanted hair (before SMP). Keep in mind that he was a Norwood 6, so most of what you see there is transplanted (6900+ grafts). He wanted it to look even thicker and opted for SMP for this.
  2. Next photo is 2 weeks following the first SMP session.
  3. Last photo is immediately following his second SMP session. Patients are instructed to not wash their scalp for 3 days following a procedure. The pigment appears darker at this point than it will be once washed.

 

I’ll update this post in the next day or two with a photo of the patient after he’s washed his scalp.

Tags: smp, scalp micro-pigmentation, hair loss, hairloss, hair transplant

Hair Transplants with Scalp Micro-Pigmentation (with Photos)

/by William Rassman, M.D./7 /, ,

This is a hair transplant patient who wanted his hair thicker, but had depleted his donor supply so that more transplants would not be productive. Many doctors would try still another procedure, but this was not my approach. Instead, I put pigment into the areas where he wanted more thickness. He loved the results of his transplants for his Norwood class 6 pattern and over the years he received a total of 6,905 grafts for that pattern, but as with many patients who have advanced hair loss, the supply did not eventually sustain the demand for hair.

With the addition of scalp micro-pigmentation (SMP) to augment the fullness, he felt that the results were exceptional. After his first SMP session he used a hat, but slowly and cautiously he showed off his shorn scalp to his friends without creating much fanfare. In a social setting, his friends saw the new look and all he got was compliments on how good he looked with his new hairstyle.

The first photo (left) is of the patient’s hairline after all of his transplant work (last procedure was almost 4 years ago); The next photo (middle) is immediately after shaving his head; The last photo (right) is 2 weeks after his first SMP session. Click the photos to enlarge:

 

He came in for his second touch-up SMP procedure, but this time we went a little denser with the pigment. The key in the plan I put together was that the SMP would be placed in behind the leading frontal hairline that we created with transplants so that he could let his hair grow out whenever he wished. As the interval between the first and second procedure was 2 weeks, he let his hair grow out over that time to sense what it would look like when he let it grow out long. He could not have been more pleased with the result! I’ll post some photos of the results in the coming weeks.

Since my post from last week, I have come under fire on some forums and even on this site for changing my stance on scalp pigmentation (from being somewhat negative in past posts to my current enthusiasm). Really, the change in my view reflected a better command on the art, something that I hadn’t previously seen when I made my earlier comments about the tattoos that I saw in my office over the years. I realize now that I should’ve been more open-minded to possible advancements.

Nothing is perfect in this world. This patient would have rather gone the transplant route or have taken a magic pill that would get him his hair back, but it was not a reasonable option for him… so as a second best option, SMP more than met his goals. Now I must note that due to his nearly 7000 grafts that were transplanted, he does have a linear scar in the back of the head. We’re still working with him to cover it with SMP and will post resulting photos soon.

—

Update Mar 8, 2011: More photos here!

Tags: smp, scalp micro-pigmentation, hair loss, hairloss, hair transplant

1 Year Propecia Results in a 45 Year Old Man (with Photos)

/by William Rassman, M.D./3 /, ,

This patient is in his mid 40s and is thrilled with his results from taking Propecia daily for a little over a year. The corners of his hairline appear to be a little bit stronger and certainly there is noticeable regrowth in the crown area.

No surgery was performed on this patient, and I must note that the lines you see drawn in the before photos were where a hairline might’ve been placed if he elected to have surgery. Click the photos to enlarge.

AFTER PROPECIA (no surgery):

 

BEFORE PROPECIA:

 

Tags: propecia, hairline, hairloss, hair loss, photos

Male Eyebrow Transplants (with Photos)

/by William Rassman, M.D./2 /, , ,

Hello Doctors
I am a 39 year old man and had a problem with my eyebrows since I was probably in my 20s. My eyebrows aren’t very thick. I never plucked them and do not know why they appear thin around the edges or when it exactly happened ,but I wanted to talk to you about what a transplant looks like in that area for men. My hair is otherwise great on the scalp and I have a strong hairline. Have you done any man eyebrow transplants? Thanks

Here’s a male patient we haven’t shown before, with some beautiful eyebrow transplant results. I placed 189 grafts into his eyebrows with almost all single hair grafts taken from the scalp using follicular unit extraction (FUE).

In general, eyebrows are difficult to get control of the direction of the hair as it exits the skin, but these results turned out great! The after photo was taken about 7 months following his hair transplant.

Before photo on left // After photo on right. Click to enlarge.

 

Tags: eyebrow transplant, hair transplant, fue, eyebrows, thinning eyebrows

Dense Packing of the Hairline (with Photos)

/by William Rassman, M.D./1 /,

What is the average distance between each hair at the hairline and about a half inch behind it on a non balding adult male? And what is the smallest distance between each graft you can safely transplant at the hairline? When you normally transplant grafts at the hairline is the distance between the grafts always larger than the native hair of the person. I know only single grafts make up the first few rows of the hairline to give a natural looking transition but if they are not packed closely enough the hairline looks almost “see through” or whispy looking. I have noticed this on alot of transplant photos. Is there anyway to avoid this and give a very dense looking hairline transition even using single grafts?

I am a male with minor female pattern balding with very little temple recession but my hairline transition has become thin and whispy and looks similar to the hairlines created with a hair transplant in a totally bald area? My goal would be to thicken up the transition area so it looks thicker and dense similar to the hairline of Brad Pitt or Tom Cruise since I am in their age bracket. Is that even possible?

First off, I’d like to think I am a good surgeon, but I highly doubt I can make you look like Brad Pitt or Tom Cruise.

Second, a hair transplant cannot give you back the same hair density as you once had. Think about the simple fact that the surgeon has to get your OWN hair from the back of your head and move it to the front. In other words, the surgeon isn’t creating any new hair, just moving hairs around. If you move too much hair from the back you will be bald in the back (so to speak). Thus, the main goal for a hair transplant surgery is to give you a non-balding hairline and good enough coverage. But a hair transplant cannot give you back the fullness of Brad or Tom. Maybe another way to understand this point is to know that an average non-balding head has over 1250 hairs in a square inch (or 625 follicular units in a square inch).

The only exception to this is if you do not have too much hair loss (like Norwood 2 or 3) and understand you will not achieve the FULL look with one surgery alone. You need multiple surgeries to fill in the ‘gaps’ to achieve the fullness. You must also consider conserving the remaining donor hair available in case you continue to lose hair at the top and crown. This is what we refer to as the Master Plan.

There are several patients that come to mind who requested precisely what you are asking for. The patient below is one such example of a Norwood class 3 pattern patient that had two surgeries with me in a very small area. Click to enlarge.

2 years after two hair transplants totaling 3182 grafts:

 

Before:

 

Tags: hair transplant, hairloss, hair loss, hairline

Family Genetics, Measuring the Mature Hairline

/by William Rassman, M.D./2 /,


Hello,

Thank you for taking the time to write this blog. I have two questions. First, how much truth is there in the genetics for hair loss comes from your mother’s father? If not completely, what role do your father’s genetics play?

Secondly, not to be too literal in what you’ve stated regarding measuring the mature hairline, but when you say it should rise about 1.5 to 2 times higher, does that mean from a center point used in measuring the midpoint of the hairline? I’ve included pics (feel free to publish), including one where I’m holding a ruler to show how I’ve been measuring my corners. My hairline is about 5/8″ from the midpoint and about 1 1/8″. What is that, about a Norwood 2?

Thank you for all the work you do.

 

Thanks for allowing us to post your photos. Click them to enlarge.

Hair loss genes may be passed on from mother, father, or both. I realize many people believe it follows more from the mother’s side, but that is not an absolute fact. I’d say if anything, it favors the maternal side only 52% of the time, compared to the paternal side in 48% of cases. Statistically it is insignificant.

Your frontal pattern shows early erosion and a movement in the direction of a mature hairline, as the leading edge is thinning and the corners are a good one inch from the frontalis muscle in the corners. I would assume that you are under 29 years old. Everyone’s hairline is different and there is no absolute math or measurement to say precisely where your hairline should be, but for a mature hairline the picture here shows its location well.

And yeah, Norwood class 2 sounds about right. Unless you’re seeing loss on other areas of the scalp, I wouldn’t be concerned about your hair loss at this point.

Tags: hairloss, hair loss, hairline, genetics

There’s a Single Bald Spot at the Back of My Head! (with Photo)

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

hey there,
i have just been told that i had a bald spot on the back of my head. people said that they never noticed it before and it just started showing. im sending a picture as well. im 29, i have not noticed any change in my lifestyle, except for the fact that i started back into a workout program.

 

Thank you for permission to post your photo. Click it to enlarge.

There is no real way to tell exactly what’s going on with just the photo alone. I would see your doctor for an exam and diagnosis. I can go out on a limb and say it looks like alopecia areata, but it can also be an infectious process, or repetitive trauma. I’ve also seen stress hair loss similar to this. Please see a doctor.

Tags: bald spot, hairloss, hair loss, alopecia areata, stress

Update: Reversing Frontal Hair Loss with Propecia (with Photos)

/by William Rassman, M.D./7 /,

We originally profiled this patient last year to show his remarkable frontal hair regrowth from Propecia… and now that another year has passed, the results are even more impressive!

This patient had no hair restoration surgery. The results you see are from taking Propecia (finasteride 1mg) daily, and although the amount of regrowth he has should be considered rare, it is exciting for the patient and I wanted to share his photos below. Click to enlarge.

After 3 years on Propecia (no surgery):

 

Before:

 

Tags: propecia, finasteride, hairline, hairloss, hair loss, photos

I Think I’m Destined to Be a Norwood 7

/by William Rassman, M.D./1 /,

Dr Rassman,

After reading through your blog posts I noticed something you mentioned a few times, about young men in their 20’s who show signs of an early Norwood 7, and how Finasteride may not help them.

This has alarmed me somewhat as I am approaching 23 and have been noticing my hair loss for 2 years now. For the majority of that time my crown area was unaffected, however I now have thinning there which extends down the back of my head, seemingly to the point where a Norwood 7 donor area would be at it’s highest.

I realise this is hard to envision so I have included a picture which I’m happy for you to publish. Aside from this area of my head, my hairline has moved back (it would look similar to that of a Norwood 2 hairline) and is thin, although not disastrously so.

Given that it seems (at least to me) that I am set to be a Norwood 7, am I wasting my time on finasteride, or any treatment for that matter?

Also if you could shed (pun not intended) some light on the thinning I seem to be experiencing at the nape of my neck (which is accompanied by thinning in the sideburn/ear area) I’d be appreciative.

Thank you.

 

First things first, thanks for allowing us to post your photo! Click it to enlarge.

I’m pretty sure we’ve never said finasteride wouldn’t help a young man with early signs of Norwood class 7. In fact, we strongly advocate finasteride over surgery for early thinning in young men.

You’re 22 years old with what sounds like a mature hairline, but with respect to your photo, I have a hard time seeing that you will become a Norwood 7. Did a doctor tell you this or is this just what you’re assuming based on what you’ve read? Did you get your scalp and hair mapped for miniaturization? If not, you should have it done and it should be repeated every 6-12 months to see what is happening to you.

Finasteride should be part of your treatment if you’re losing hair, but it’s most important to find a good, caring doctor to manage your hair loss. You should also want that doctor to be able to create your Master Plan, which will help you make the right decisions and help understand what is happening to you.

At this point though, I’m going to have to take your word on it that you see hair loss, because just based on the photo you sent, I’m not seeing what you’re seeing.

Tags: hairloss, hair loss, crown, thinning