As Seen on


Double click on this photo after you read this. When I met this person I assumed that he had a bad frontal hair transplant that did not take, but he informed me that he had lost his hair naturally and never had a hair transplant.

So what are we looking at? The hairs that are left in the front have full normal, coarse diameters to them. That is why I thought that they were hair transplants. This is not the normal balding mechanism. Normally, the hairs become thinner and thinner and then fade away, yet this did not happen to the hairs that remain after balding. Many prospective patients tell me that they can always tell a transplanted hair line from a normal non-transplanted hair line. I always tell people that 90% of the time I can not tell a transplanted hair line. In this person (picture above) it is exactly the other way. A normal balding hair line is shown and it looks like a transplant (which it is not).

This is just an unusual case that I thought would be of interest to the readers of this blog.


I just started loose my hair from the front side.Male pattern(Type 1). I am 28 years old and i started to use propecia 3 months ago. There is no proof that propecia stops balding on the front of the scalp. I feel like it is not helping. My father and my uncle they had lost their hair untill they are 45 and now they have type 3 male pattern baldness, no baldness at the top. We all have very thick hair. I just want to know,if their is anyway to stop hair loose. I am not worry about bring them back.At least for now.

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Propecia has been proven to stop or slow hair loss down, provided it is started early enough in the balding process. The term ‘early enough’ varies with the genetics of the individual. Based upon the ‘Class 1’ pattern, you may just be migrating your frontal hairline to the mature position. If your father and uncle had a Class 3 pattern, the slowing of your hair loss is highly probable, but three months is just not enough time.

Many men do not notice their frontal hair loss until hair miniaturation is almost complete, and by that time Propecia will not be effective in the front. Since balding in the crown is generally slower, starting Propecia when it is too late for the frontal area, may still be early enough to work for balding in the crown.

As you have only been on Propecia for three months, you may want to give it some more time- it can take nine to twelve months of staying on Propecia before you will see the difference. I also suggest that you take a photo of your frontal balding now with your brow lifted high so that the creases show up well. Once a month photographs with comparasons over time will show subtle changes we might not see on close daily inspection.


Hello Doctor. Recently I had a hair transplant in NJ with a very respectable Dr., someone you have worked with, lets leave it at that. I was scheduled to have 1500 grafts, but after taking the string, the doctor came back in and said I have to cut another piece because we could not get 1500, so in total at the end of the operation I recieve 1800. I was alittle upset, because I had no choice of paying the additional 300, they gave me 100 free grafts for free, so I only paid for 200. Not only did this happend, but my original scar probably grew by another 2 to 3 inches. But anyway. It has only been 2 1/2 months and to be honest, I have less hair than I originally did. My original hair was evenly spaced, now, after the surgery it looks like I hae patches of hair. It looks so weird. To be honest, I have not seen such great results, I know that 2 1/2 months is nothing but so far I am displeased with the results. My question is, when you have results such as mine, and if you are displeased, should I contact the doctor, and if I should, why should I explain that I am not pleased with the results so far?

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Sometimes an initial estimate of a patient’s density is quite different from what is actually obtained during the hair transplant procedure and this affects the amount of hair that is harvested. When this happens, the surgeon may take more tissue to obtain additional grafts to more closely achieve the patient’s desired results. Additional grafts can be obtained by going back over the same area or extending the initial incision to one side. The surgeon makes that judgment based on factors noted during the surgery, such as scalp laxity.

Hair doesn’t generally begin to grow after a hair transplant for two to three months and when growth starts it is characteristically uneven. Although it is way too early post-op to have a sense of what the transplant will look like, it is still best to contact the doctor that performed the surgery with any questions you may have, as he would best be able to answer these questions and explain the reasons why specific things were done. I would encourage you to do this.


To round out the collection of Minoxidil questions I’ve received in the past few days —

Hi Dr. Rassman,
I have recently decided to move to the Re-Mox III 15% minoxidil lotion for my frontal hair loss. Is there a danger to using such a high concentration of Minox? if not, why can’t one find this concentration in rogaine or other branded minox in the stores? Do you know of any side effects? Thanks!

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You must remember that Minoxidil is a known anti-hypertensive and can cause low blood pressure and other reported side effects. Any medication that you get at the normally prescribed concentration will be worse in side effects at the higher dose. 15% Minoxidil must be formulated -I do not know where to get it. A pharmacist must prepare it if it is to be legally obtained.


When on a topical such as Rogaine does the “new” hair initally fill in as a finer thiner hair that thickens up over time —-or should the “new” hair start out as a thick terminal hair ? Thank you

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I believe that it starts off finer as a rule, then it may or may not thicken. Please see the below blog entry for more on Rogaine / Minoxidil.


I am 27 and currently experiencing baldness in the crown and the vertex region. I also have a receding hairline. I am currently using minoxidil 5%. It has shown some results but I am not sure if it will be effective for the receding hair line. There is general thinning of hair too. I want to know the options that I have and whether I should go for propercia or surgical procedure.

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Minoxidil is not as effective as Propecia generally speaking. It is also not very effective in the frontal area. Generally growth with Minoxidil is in the 3-15% range for noticeable clinical growth. Propecia works best in young men of your age with benefits in excess of 50% and better results in the crown, but sometimes surprising results in the frontal area in a small percentage of men. Please meet with a competent doctor- that is always the best way to start the analysis. Don’t rush off to surgery until you know the impact of Propecia.


This writer indicated that he was based in Dallas, TX, but was currently in Iraq…

I guess I started losing my hair about 4-5 years ago. I am 29 years old now and it shows now in the crown area. My hair is pretty thick everywhere else except for that spot where it seems that the hairs that I do have aren’t growing as fast and feel weird to the touch. If I were elegable for FOX and got the procedure done is it my decision how many graphs I would need or want if I wanted it extra thick like it used to be? Also, what are the chances that the hair would just fall out in another few years after the procedure and is there something that can be done to ensure that that doesn’t happen? I will be home in September for a month,..can I get information on cost and location closest to me? Thank you

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I am a former Vietnam vet, so I appreciate your Iraq experience and feel it deep in my core. First off, thank you for writing. The number of grafts is something that needs to be discussed during the consult. I would need to examine the balding area, and based on the density needed to give you the look that you want, I can determine the approximate number of grafts need. If you are a candidate for the FOX procedure, we can discuss the fee at the time of your consult. The grafts used come from the permanent zone of your scalp. These grafts are genetically programmed not to fall out, unlike the hairs in your balding area.

Our closest office to Dallas, is in Los Angeles — I’ll bet that you would enjoy a vacation in Southern California after being in Iraq. If you would like to schedule a consult appointment for September call 1-800-639-4247, or if you would like to email photos, send them to the address on my Contact page and I can email you back with my recommendations. Be sure to provide enough views (front, top and sides) including frontal views with your eyebrows lifted as high as you can lift them on your own. I need such views to determine the normal location for your hairline. As an Iraq vet, I will give you special pricing if surgery is appropriate and you elect to have surgery.


I was looking at the NHI site and thought it might be helpful to identify medication that has been significantly associate with hair loss. Eq lithium for bipolar illness.

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When you read the insert on most drug information packages, hair loss is mentioned in almost every one. I tried to do some internet searches, but alas, the number of drugs appear substantial. If you are looking up lithium, in particular, just go to Google. Hair loss is a known side effect of lithium.


I recently had 2000 FUT’s by a well respected doctor in the field (and planning to get more, but this time, FUE’s). But I notice though that my donor scar location is about an inch above the occipital protuberance (I believe that is what that small bump in the back of the head is called), that is, one inch above the ears. He evaluated my hair and also I had a small previous scar from a prior HT done with laser (600 grafts) that he cut out with the new donor location. I am 43 years of age and I believe that I am a class 4 (or maybe close to 5).
My questions are: Is my donor scar too high? Are the chances high at my age that I will progress to a class 5 or 6 pattern?
I am fearful of future hair loss progressing down to my donor location. My Father and grandfather (both from my mother’s and father’s side) had full hair and of course normal thinning hair as they reached their 70’s. Except my uncles on my mothers side are classes 5’s and 6’s.
Thank you so much for your time

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One can not predict hair loss with any certainty. It is clear that you do not follow the family pattern you identified in the body of your question. Scars that are placed in the wrong position may be impacted by the hair loss pattern, but without examining you, I can not make such judgments. An FUE procedure will not address the scar adequately in one surgery and as you have already had two strip surgeries, I generally tell patients that it is too costly to go the FUE route once you had strip surgeries. Maybe with good pictures and anatomical markers on them to show the notch at the back of your head and the location of the scar relative to the ears, I can get enough information to give you further insights. If you do wish to send photos, my address is on the Contact page.


Hi I’m a 23 year old male who has lost the corners and the top is also beginning to thin. I had a consult at a local clinic and received a prescription for propecia and a rough estimate of 1800 to 2000 grafts. I still have a lot of hair but it looks miniaturized on the top giving a see through look, especially when spiked. My question is I have been on procepia for a month now and of course it is too early to be able to see anything but I can feel many very short thicker hairs in the area where i am thinning on top. I don’t want to read too much into this since it’s so early but i’m curious of any signs of propecia working? Will the finer hair be shed and replaced by hair that is thicker or will the hair thicken in mid growth cycle? I’ve pretty much ruled out a transplant for about a year just to see if I can get any hair back from this. Thanks, this website is one of the best on the internet lots of good information.

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You are very wise that you should wait at least 8-12 months for a visual effect from the Propecia. I also try to always tell my patients not to watch too closely. Watching the hair grow is like watching a child grow or the graft grow. If you watch too closely, you will not be doing yourself a service. As hard as it is, try not to look at it much for 6 months. To be more specific, I would think that in a 23 year old with good response to the drug Propecia, both reversal of hair loss and reversal of miniaturization is possible.


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