Your hair loss questions, answered daily.

 

I was doing some research on your company and your service and was intrigued to see a number of actual patient photos and their results. I was very impressed, but I did not see any photos of patients with blonde hair. I am 26 years old and have incredibly blonde, fine hair and I am interested to see if I can get similar results as your other patients and how natural it will look given my complexion.

Do you have any photos of light blonde patients? If so, could you forward them to me or send me a link if you have them posted online. Thank you for your time.

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Blonde hair is my ideal patient because of the low contrast between hair and skin color. In our video, there is a fellow with VERY fine platinum blonde hair who had a relatively low number of transplants in an advanced balding pattern. You can see that his results are better in proportion to the balding pattern and other hair colored people. You can get a free copy of our video (now on DVD) by calling 800-NEW-HAIR or visiting newhair.com.

Also, take a look at Patient VS on the NHI site. This young man had excellent results with blonde hair. Unfortunately, the photo made the hair appear much more sandy colored than the pictures suggests. Blondes are my best patients and those blondes with ‘reflective’ blonde hair do even better. We do have a lot of patients online, but I don’t believe there are any that truly represents a platinum blonde hair color. We’re continuously adding new patients, so please do keep checking back for updates.

 

I am a 23 year old male with an extensive family history of balding. I am well on the way to follow my father and grandfather’s pattern. What can I do?

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I just had a patient of the same age and with the same problem in my office, so I thought it might be worthwhile to read what I wrote to him. I send comprehensive letters like this to all of my prospective patients out of respect. It is always an honor to be able to play such an important role in the life of a patient.

Here’s the letter:

You have an unusual problem found in less than 1% of balding men. Your donor hair density in the rim of ‘permanent’ hair around the side and back of your head is higher than average (300 hairs/cm2 while the average is 200 hairs/cm2) but 1/3rd of these hair show miniaturization. This is the same process that goes on in the balding area on the top of your head and it should not occur on the side and back. When it does, it reflects a condition we have defined in the medical literature which we call Diffuse Unpatterned Alopecia. In essence, you have a process going on throughout the hair on your head, even the ‘permanent’ zone. Now with that said, your effective donor density of 200 hairs/cm2 (which reflect the sum of your hair count less the miniaturized hairs) is from a practical point of view, normal. But the fact that you have this process going on in the permanent zone means that the future of your permanent hair is uncertain. In my fairly wide experience, people who have had Diffuse Unpatterned Alopecia, have not experienced progressive extensive balding in the ‘permanent’ zone, but there is not certainty in your future. In determining your predicament, I would like to call your attention to some of the other elements of the examination I performed on you. Your hair is more coarse than most people, which means that the value of each hair is much higher than a normal person. There is a slight wave to your hair which means that it grooms and covers well with its strong character. Your hair is black and your olive colored skin provides moderate contrast between your hair and skin color, and although your olive skin offsets the dark hair a bit, it still calls attention to a lighter background which might require more coverage to get a full look.

Your biggest problem is the extent of your balding, which appears well on the way to becoming a Class 7 balding pattern (the most advanced pattern) and one that runs in your family. At the age of 23, you have a typical early appearance of this advanced balding process, but that balding process although mild in the top and crown of your head at this time, may respond well to the drug Propecia. You indicated your objection to using this medication to slow down or arrest the hair loss in the top and crown area. Your objections are over the side effects of the drug (rare and unusual). Considering your age, you have a good chance to get some reversal of the balding process in the top and crown area. With the diagnosis of Diffuse Unpatterned Alopecia that we found our your examination, I see even more reason to use the drug. I have seen fully half of the men who take Propecia see some reversal of the diffuse hair loss process in the ‘permanent’ zone, giving you two reasons to reconsider your position against taking this drug.

When dealing with a young man, I tend to be conservative, leaning on the drug treatment to slow down the balding process and for the maturity of the patient to line up with the extent of the problem. By saying this, I do not mean to be offensive, but young men are driven for now answers and often do not see themselves through the entire balding process which may take years. Transplantation, although a wonderful solution when appropriate, is the wrong answer for those who have not worked out a Master Plan with a good doctor that accounts for the worst case scenario of the balding process as modified by a transplant program. That is the dilemma before you and I at this time. You have to convince me that you understand what I know about your hair loss and what can be and can not be done about it. I must understand your maturity in dealing with a transplant program that will be with you the rest of your life. A good doctor/patient relationship is what I am talking about, something that is not easy to obtain in an hour visit to my office.

I am not firm against a transplant solution for your balding but because of the Diffuse Unpatterned element of your Alopecia, I need some comfort that whatever we plan is going to be the right plan for you. I want to speak with you again about the Propecia option and dive more into depth on the various subjects we discussed. We spent a great deal of time discussing the safety issues with Propecia, hopefully giving you more comfort in considering this drug as part of the long term treatment of your progressive hair loss problem.

 

Dr. Rassman,
What are your thoughts on Dutasteride (Avodart) in comparison to Propecia. I have been using Dutasteride for hair loss for about three months and seem to notice a positive response. i.e. there is very little new hair loss and there seems to be new growth on the vertex.

I just wanted your opinion as it relates to safety and efficacy of Dutasteride vs. Propecia.

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Dutasteride has great promise as a drug, but I have several problems with it as follows:

  1. Dutasteride is not FDA approved for safety or efficacy at this time. That leaves me a bit uncomfortable at recommending the drug.
  2. Propecia has a half life of 5 hours. That means that in five hours, half of the medication is gone from the blood stream and five hours more, 75% is gone, and five hours more 87.5% is gone and so on…. Dutasteride has a half life of 3-8 months depending upon who you believe. That means that once you take one pill, it hangs around for a long time. Any side effect therefore, does not go away fast like with Propecia.
  3. Dutasteride has been reported better or more effective than Propecia, but these are unofficial reports and at this time there is not absolute evidence that is scientific which will hold water on the comparison.
  4. Doctors who prescribe Dutasteride may not be protected by State Laws that govern use of non-approved medications.
  5. Most important of all, if people get a good response to Propecia, why switch?

 

In the interest of keeping things as private as possible, I have removed the Doctor’s name from this email I received…

Hi Dr. Rassman,
I read your recent comment about young guys under 30 years old who get an HT and are not on Propecia. I fit into that profile. I recently had a HT with [another doctor] and its 4 months post -op now. had a lot of shockloss of original hair post op and am really concerned now that I read your comment online [see: Hair Loss After Transplants]. Since I had sexual side effects when on Propecia, I had to quit it and cannot tolerate being on it.

I received a total of 3366 grafts in total. Am attaching Before Hair transplant pictures with this email and 6 weeks post op pictures. According to [my hair transplant doctor], he feels that the shockloss will mostly come back and eventually I will have good results. He recently asked me to take Saw Palmetto and see if I can tolerate being on it. Started taking 320 mg of Saw Palmetto twice a day recently.

Please advice what I can expect from the procedure. Do you think that I will permenantly lose a lot of original hair that has fallen due to shockloss for good? Or will it mostly come back?

I’m seeing growth in the 4th month but not sure if the shockloss hair is coming back or it is the new grafts that are growing in. To highlight my case, I mostly had diffuse thinning in frontal 1/4 of my scalp. The hair that was there was strong and had a thick shaft, there might be other miniaturized hairs, but looking at my pre-op pictures you will get an idea of the state of the existing hair follicle.

Thanks a lot for your time and effort.

My current regimen includes : minoxidil 5%, topical Spironolactone 5% cream from Lee’s, 3000 Mg of MSM, 2% Nizoral trice a week, Recently added : betnovate topical lotion, 320 mg Saw palmetto twice a day, Folligen lotion.

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I have had an opportunity to review your questions and photographs. For our general audience who are reading this, I will summarize the salient points.

You appeared to have a large surgical session with dense packing based upon the number of grafts reported by you. The frontal area appears to have been shaved for the procedure and the growth of the hair does not reflect the normal growth that one would expect in 3 months. This is a case of hair loss transplant shock in a young man, just as my previous responsive email reported to another young man. There is a possibility that the hair that you lost may come back. Most likely though, it will not return. Other medications have not been shown to be effective (like Propecia). In people like you, I generally try to cover the short term transplant period with half of the Propecia dose, even if it causes some drop in sexual performance just to protect the hair.

The good news however is that the new grafts that you had done should (hopefully) more than offset any loss you may have. You will know reasonably well at about the 7-8th month by comparing the two sides. The left side that seemed to suffer more of the reactive hair loss needs to be compared to the right side. If the hair loss was reversed, the densities of the two sides will be the same. Please drop me a line or send me photographs at the 7-8th month and I would be happy to give you further insights. Good luck.

 

Rick asked…

Unlike the 62 year old man, I’ll soon be 48 & my loss started about the age of 25, gradually. Now, I am about a VI hair loss on this website’s Norwood Scale & will this new minimal hair transplant I saw on Ch. 4, Bruce Hensel, work for me ? I think the root cause(no pun intended !) is primarily stress. Many thanks in advance.

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Stress is one of the four causes of hair loss in the genetically prone individual. Yes, the minimally invasive surgery, the FOX™ Procedure (Follicular Unit Extraction) can work, but before embarking upon that route, plan on a visit to a competent doctor’s office. If you are in California or the New York area, we have easy access. I assume that since you referenced NBC Channel 4 News, you are local to the Los Angeles area. If you would like more information from me directed at you and your condition, please call for a free consultation or at the very least, send me a photo of your hair loss from a series of views. A good digital camera will work, or call my office at 800-NEW-HAIR or fill out the form on my website and we will send you a disposable camera.

 

Essie writes…

I have discord lupus and the scarring on my face I know can not be repaired. I also have hair loss in the very front top of my head and where there was hair, there is now scarred scalp. I just want to know if it is possible for even a little encouragement for this head of mine.

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If your disease is not active, then it is possible to use hair transplants to address the balding area. If the disease is active, it will attack the transplanted hair as it had the original hair. Sooner or later, the disease will burn out and then a transplant might become a good option for you.

 

I had a session of about 1600 graphs about 4 years ago. I have thin hair, and it had receded to about a grade 5 baldness. Because my hair is thin, and maybe because I didn’t get enough graphs, I’ve never really gotten the thickness or coverage that I was hoping for, and I am now considering having the transplants removed entirely. Have you had much success with laser removal of transplants? How much scarring is typically visible? I am concerned about having a bald head with little holes all over it.

Thanks

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Your question comes right after I met a fellow in my office today who asked about the same subject, removing his transplants completely and going back to his normal balding state. You are correct to worry about the deforming issues if the grafts were anything but today’s modern follicular unit grafts with skin trimmed down when they were transplants. There are many things that an examination will show a good doctor and they include (1) the presence of cobblestonning of the skin along with other surgical scars in the recipient and donor area, (2) the number of grafts we are talking about removing and what type of grafts that was transplanted, (3) The distribution of the grafts, etc…. With that information, it would be easier to discuss this approach, but generally removing the grafts involve removing both the hair and the skin, each producing its challenges. The patient I just saw was more specific in his questions, so I am going to reference my letter to him reflecting the visit he and I had. This particular patient did not want another hair transplant, even though it is the only good option for him to become normal looking.

(more…)

 

Dr. Rassman,
I am considering hair transplant but have a question that I cannot find the answer to on any website. What are the long term cosmetic issues associated with a younger person (I am 26) who has hair transplant surgery?

In other words, my hair has begun to recede to an NW 3 (approx.). If I was to have transplants, and several years later my hair line continued to recede, wouldn’t that make an unnatural and strange looking hairline? I.e. there would be transplanted hair at the very front, then further up the scalp there would be a zone with thin or non-existent hair, then there would by my natural hairline.

I hope I have adequately explained myself. Any info you could provide would be great.

Thanks,
JX

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This is a great subject, one that is important to everyone who undergoes a hair transplant. In essence, JX is asking, “How does the hair transplant fit into the changes that keep producing more hair loss?” Much of this material is covered in a book I wrote, The Patient’s Guide to Hair Restoration. You can get a free copy of it by calling my office at 800-NEW-HAIR, or visting our website.

Everyone will lose hair to whatever their genetic pattern will eventually be. Those with advanced balding, usually develop indications of their pattern by the mid-twenties. Most will have their pattern evident by the time they reach 30. It is rare that people will start with hair loss beyond their 30th birthday so a good examination by a competent doctor will show the signs of ‘miniaturization’ on microscopic examination of the hair throughout the head. JX reports a Class 3 pattern hair loss at 26 years of age. Assuming that the pattern will not progress much further (that there is no ‘miniaturization’ of the hair in the mid head or crown), it would be safe to assume that he will not develop an advanced hair loss pattern and that a hair transplant program will never make him abnormal as he progresses slightly from this pattern. If he wishes to get the hair transplanted in the front to return his hair to its normal mature position, he can do this easily. If he uses the drug Propecia, his ability to slow down or stop the hair loss is good. There is now 8 years of good data on Propecia’s ability to slow the hair loss down, but only time will tell us if the medication can continue to be effective in the long term.

I generally tell my patients to create a Worst Case Master Plan which assumes that progressive hair loss will occur. With that Master Plan, you can estimate what might happen and plan for it both economically and socially. The one evident thing to point out is that once a hair transplant process is started, it should be followed with more transplants until the loss stabilizes or it takes you to another hair loss pattern that is found normally in nature. Frontal hair loss only commits the patient to frontal work, not to crown work. Worst, worst case is that with transplants in the front, the balding in the back will reflect what many men have naturally: a full-haired frontal look and a balding or thinning crown. This last scenario is JX’s worst case. If he wishes to see his worst case, he can visit me and look at my before pictures. I had a normal full front of thick hair (naturally) and a bald crown (which I elected to transplant but could have left it alone as an alternative option).

 

I have heard that people who have transplants get more loss because transplants produces hair loss of normal hair. Is this true?

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First let’s answer this question in the typical young man, for the answer differs slightly than the older men. If a man (under the age of 30) has a transplant and does not take the drug Propecia, the normal course of hair loss that he could expect without the transplant could occur in a shorter period of time (e.g. two years of hair loss in as short as 6 months of time). To understand this lets focus on the causes of hair loss for a brief moment. The four causes are (1) hormones, (2) genes, (3) time and (4) stress. The stress of a surgery in a genetically impaired patient who is undergoing active hair loss (most young men under 30) are being attacked by hormones actively. In guys over the age of 30 when time has already taken its toll and the hair that was going to die, did die, the sensitivity to hair loss is less. In the days before the drug Propecia was released, these men under 30 lost enough hair from a transplant that they had to play ‘catch up’ (which meant that some hair was lost earlier than they expected and this required more transplants to treat). The drug Propecia has almost completely stopped this from happening and we use it on most men to prevent it from happening today.

In men who are older, the risks of reactive hair loss go down, as the hormone attack on the susceptible hair follicles have already done their damage. I have seen far less reactive hair loss on men over 30 and the older the man gets, the less risk there is to reactive hair loss.

In women, the problem differs. Some women, whose hair is easily stressed, could experience a temporary hair loss from a transplant (a minority) but in my many years in the field, I do not recall any female that had permanent hair loss from a transplant.

Previous hair transplanted grafts almost never suffer from reactive hair loss (far less than 1% of transplanted patients).

 

Thanks to everyone for the great emails. Keep them coming in! Here’s one I received on Tuesday, but didn’t get a chance to answer until today…

Dear Dr. Rassman,
I have a slightly below average donor density and I am wondering if a hair transplant would be sutable for me. I am 33 years old and last year started receding agressively. I think I am NW 5 heading to 6. How many graft can you take from my donor for me to have a full coverage? In other words: How many total grafts does my donor have?
Thank you for your attention.

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There are five characteristics that vary with each person, that determine the value of the hair for a hair restoration procedure. They are:

  • Density of the hair. Yours is lower than average, but that in itself does not necessarily mean that you are not a good candidate
  • Hair shaft thickness. The coarser the hair, the better it supplies bulk. Hair bulk is a critical element in producing fullness and coverage.
  • The size of the balding area. The more bald you are, the more hair you might need. Sometimes, the goals may be changes to adjust to limited supply or a demand that is too high. That is something you must work through with your doctor.
  • The characteristics of your hair. African hair is the best because it wants to cover, good wavy hair is the next best because it wants to flow together. The Italians and French had the best wavy hair. Straight is the most challenging, as found in many Asians.
  • Color/contrast between hair and skin color. This is critically important. A Class 6 pattern blonde person could reduce his hair population to 85% of its original density and still look full as the blonde hair and blonde skin have low contrast. The same applies to black hair and black skin, brown hair and brown hair, sandy hair and sandy skin and any skin color with white hair. Salt and pepper hair works very well and I have produced some amazing results in very bald men with very little hair.

The amount of hair needed to transplant depends upon many things. Look at our website and see the hundreds of patients there, many who show balding patterns similar to your. The number of grafts are clearly defined for you to see.

 

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