Your hair loss questions, answered daily.


If the hair grafts are taken exclusively from the donor area (permanent zone), they will ?have hair that is resistant to males hormones. The wreath of hair around the side and back of the head, is permanent on 99+% of men no matter what they have inherited from the ancestors, these hair will last their lifetime. Although this is the written rule, occasionally we see some patients that may lose their transplanted hair and if they do it may result from: (1) miniaturized hairs in the donor area (often called DUPA or Unpatterned Alopecia), aging of the donor area (seen in men over 50-70 years old a condition that unfortunately bares the name ‘senile’ alopecia, in many women whose hair around the side and back of the head is susceptible to female genetic balding and for other unknown causes we doctors call the ‘X’ face, which means we don’t know.

When strip surgery is performed and it strip incision is placed in the lower border of this permanent zone, these hairs will be lifetime hairs. If however, a doctor pushes the number of harvested grafts and extends outside of the permanent zone to push up revenue as they charge per grafts which are worth more to the doctor, these hairs may not be permanent.


African American’s fall into two categories of hair types, somewhat related to where their ancestors came from. Those from East African (Ethiopia for example) have curly hair but not kinky hair while many from the Western part of African have a kinky hair. Kinky hair has the ‘kink’ extending below the skin so that unlike Asians and Caucasian hair which is straight below the skin. some of the African people with very kinky hair, when transplanted, create a challenge for the surgical team. For strip surgeries, when the follicles are dissected under a microscope, it is easy in skilled hands, to navigate the ‘cork screw’ appearance of the heavily kinky hair below the skin as the grafts are prepared under a high powered microscope; however, when FUE is performed, the procedure is somewhat of a blind procedure where the dissection occurs while the hair is in the scalp. As drills are most often the instrument of choice and as always they are very sharp, a ‘cork screw’ hair follicular group may get transected (cut) as attempts to core it out is done with a sharp drill. Some surgeons use special types of punches that do not use a sharp ‘drill’. We use, for example, a serrated punch without rotation as it is hand help. We FEEL the punch as we navigate the coring process. Others use dull rotating punches of different varieties that can often, but not always, manage successful coring without damaging the hair follicles while it is in the scalp. The ARTAS robot uses two punches, a sharp rotating drill for penetrating the skin and a dull rotating punch for the deeper dissection limiting the depth to avoid cutting the ends off of the hairs.


I have heard this from some patients that they feel that the generic drugs are not working as the original brand drugs worked. Generic finasteride drugs (Propecia or Proscar) are regulated by the FDA. Dr. Ready Pharmaceuticals, for example, is a major suppler of generic finasteride and I have check that the drugs that they produced are manufactured according to the FDAs Good Manufacturing Procedures. As a buyer, you can always use the more expensive brand name if this does not work for you. I am not equipped to tell what is the difference between two samples of finasteride. I know that there are, unfortunately, many counterfeit drugs on the market purchased through the internet without FDA overview.


You have to deal with your mother and possibly bring her to a consultation with a doctor who has experience with this drug to discuss the difference of opinion between yourself and your mother. If I were your doctor, I would encourage her to join us in a consultation. Maybe she knows more about you that is relevant to her concern, maybe she does not understand the real risks. Only a one=on-one meeting between your doctor and your mother with you present, is the way to manage this problem.


We are the doctors who first wrote about DUPA. About half of the men who have gone on either finasteride or dustasteride have had benefit of their DUPA (Diffuse Unpatterned Alopecia) so don’t give up and find a doctor willing to follow you with this routine.

William Rassman, M.D.


Depending upon your bone maturation, it may not be unreasonable to use the drug finasteride, but first where you are on YOUR growth curve (e.g. bony maturation) plus other factors relating to your hair loss are critical to understand. I belong to a group of 60 doctors who share a common email and the subject of young boys 15 and up and the use of finasteride has come up. With proper doctoring, this can be an option. The HAIRCHECK test is a critical first step in evaluating the degree of hair loss that you have. Many doctors may not want to use this drug on you so it is a careful discussion with you, your parents and your doctors that is critical in making such decision.

William Rassman, M.D.


I would suggest that you stay on the drug finasteride. If you stop it you will lose all that you gained and it may NEVER come back. Many of my patients who did just that, regretted it. You are one of the fortunate people who reversed on finasteride.


The use of JAK inhibitor drugs have been shown to be effective in the treatment of Alopecia Areata. Janus Kinase Inhibitors (JAK) are drugs which supress the functions of the JAK enzyme, a critical en\This is an inherited ‘autoimmune’ disease that causes the body to reject regional areas of hair in various parts of the body. It is usually found in the scalp, but face and other body parts can show this problem. Two drug have been tested effectively, they are (1) ruxolitinib, a medication used in the treatment of certain malignancies such as bone marrow cancers and (2) tofacitinib, a drug used in the treatment of Rheumatoid Arthritis. This is an early report from the Journal of Investimationo/Insights 2016.


This is a 33 year old male who I have been following for a year. His concern is that he is losing hair and he will consider a hair transplant once the hair loss is substantial enough. He is lucky because his hair is wavy, has salt and pepper color and it has a good weight. Because of these characteristics, the eye nor the camera shows the thinning that is certainly happening in his hair. From his HAIRCHECK measurements today, he has lost 50% of his hair in the front behind the hairline, 72% of the hair in the top of his head (imagine a line between the ears) and 50% of the hair in the crown. This is worse than it was a year ago. His frontal hairline shows some see-through as shown in the photos below.



The second patient is 18 years old, noticed that he was losing his hair when he was 16 but failed to see a doctor until today. HAIRCHECK measurements of his hair bulk show that he lost 78% of his frontal hair behind the hairline and 40% of his crown hair. Despite the huge amount of hair loss that was measured, the balding is barely detectable because of his sandy blonde hair which has a low contrast between his hair and skin color. Because he is 18, he has an excellent chance of reversing this hair loss (some or all of it) by using the drug finasteride. See his pictures below:



The University of Pennsylvania has been on the cutting edge of both (1) stem cell development for hair growth and (2) fat cell use in the treatment of acute scars producing reprogramming of cells in a wound. This is going to become a huge field with almost incalculable value. We have known for a long time that fat has stem cells has significant value when used in the treatment of various skin and scar problems. For example, the yellow fat next to the hair follicles seen in a hair transplant, has strong supportive characteristics that are important anatomical elements contributing to a successful hair transplant.

Various presentations on the use of such fat cells have been presented at medical meetings and in various medical publications. One in particular stands out was the use of hair grafts for the treatment of huge ulcers on the leg resulting from vascular disease. When these ulcers are transplanted with hair grafts that contain significant amounts of fat around them, these non-healing ulcers fully heal. As my background included the treatment of such non-healing ulcers, I was amazed to see the value of such grafts in such dire circumstances.

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