Your hair loss questions, answered daily.


I still have enlarged breasts and I am 18. I am also conscious about it, never going out without a shirt on. I never had it treated as my doctor thought I could live with it. My doctor told me that I would have to go through a surgery to fix the problem. My question is this:  If I take finasteride (Propecia) will this problem get worse?

Answer: Although the drug finasteride (Propecia) is know on rare occasions to cause gynecomastia or breast lumps that are painful, your risk for this is the same as anyone without the condition (over 1:1000 men run this risk). You will have to weigh out the value of holding onto your hair with this drug vs the very remote risk on increasing your breast mass or developing painful breast lumps.



Diffuse thinning impacts the hair around the side and back of the head in males in a condition of diffuse thinning we call DUPA (Diffuse Unpatterned Alopecia) which impacts all of the hair on the head even the area normally spared by the genetic balding process.  Women have this condition most commonly, but it is not common in men. About 50% of men respond to the drug finasteride to reverse this condition.  I almost always examine the back hair on men in my office with a hand microscope looking for this diagnosis because men who have this condition should never consider a hair transplant because the transplanted hairs will thin just like they do in the donor area.


Below are four patients (two of them are ours, two of them are not). The first reflects our transplant technique where we have focused heavily on what a patient would look like after they leave the office. This patient is just a few minutes after her surgery was performed. We wash the recipient site when she left the office as well as the day after so that no crusting or scabs form. Most of our patient have an undetectable hair transplant from the moment they leave the office. They can go back to work in a few days, sometimes even the next day without calling attention to their private decision to have a hair transplant. A hair transplant is no ones business but the patient.

This obsession with undetectable hair transplants by us is not always shared by other doctors who ignore the abnormalities shown in this picture where the grafts were left partly out of each recipient wound so that even a fastidious hair wash can not erase the visual reality that this patient had a hair transplant done for everyone to see (not our patient). The third picture shows a patient one week from his hair transplant with heavy crusting on his recipient area (again, not our patient). He should have washed off these crusts while they were forming so that he would look like the patient on the bottom of the screen (no crusting at 5 days). Now for this patient, he has problems with the remaining crusts which if pulled or picked will pull out the grafts. He must try to apply shampoo twice a day, leaving it on his head for 10 or so minutes each time he washes. Eventually these crusts will shed, accelerated by more aggressive washing but it is not as good as doing it the right way in the first place.

female corner hair line transplant

female with corners transplanted, shown minutes after the hair transplant was performed

Lego Transplantcrusted hair transplant

Just after  transplant with grafts showing                               The above patient is one week after a hair transplant


5 Days after hair transplant by NHI                                                      Same patient 5 days after FUE


There are a series of articles about Donald Trump’s hair. Here are two of them

The Huffington post came up with the answer here:

Donald Trump’s Ivana Rape Allegations Turn Uglier As New Details Emerge About The 1989 Incident


“Hi Bill! I really feel remiss for not checking in with you sooner after my last procedure, but somehow during the 6 month period that followed there was not much to say other than that the recovery period was pretty much text book and as you described it, would be; and I didn’t want to bore you with minor stuff. During that first period, the growth of some new hair was there, but not that much, so there was nothing exciting to talk about. However, around the first of December 2016 (approx. 7 ½ months. after the procedure) my wife and I went to South America and returned at the end of the year. Between the time we left for South America and now, my hair growth has been remarkable. It looks almost as good as when I was 18 years old, quite unbelievable! The really unbelievable part is how you can do this and make it look so natural. Thanks again for your great work and the special care you gave to make this situation turn out so well.

If you have the time in the near future, I’d like to come by the office to let you see the results.”

I have always felt gratified in taking care of people and helping them with their problems. Hair is just one of them as is shown above comments from one of my patients, but the scope of satisfaction goes well beyond my role as a hair restoration surgeon. I remember many of my patients going back to the 1970s. One, I remember clearly, came from Vermont (where I was a surgeon) just to visit me, at my home in Hawaii. He was 95 and she 96 (I treated him for colon cancer and her for breast cancer 10 years earlier). The surgery is not the challenge once you master technical aspects of performing it, but the people that I have taken care of and the unique relationships I have developed with each of them, has made me a better man and it gave me the feeling that my life as a physician has and continues to be fulfilled. My patients know that they can call me about anything that bothers them, anytime and every one of my patients have my cell phone to reach me. I have responded to a myriad of health and social problems brought to me by my patients. I have modeled by career after my family doctor whose office was in his home and it was his wife, who enhanced the link between he and I.


The Huffington post came up with the answer here:



This is one of the most amazing videos I have ever seen posted anywhere that shows a normal juvenile hairline evolving into a genetic pattern of hair loss. I can’t help but wonder what it would look like if this young man went on the drug finasteride.

See here:


This young man saw me one year ago and I put him on the drug finasteride to slow down and possibly reverse the hair loss he had then. Usually, the drug often reverses hair loss in 18 year olds, but the degree of balding that he has now and the degree of balding he had one year ago suggested that his genetic balding is very aggressive. Today, one year later, he had lost more hair and continues to do so at the present time. I examined him and found that he has a coarse hair, a very low donor density (30% under average) and early signs of DUPA (Diffulse Unpatterned Alopecia). He will eventually develop a Class 6 balding pattern (shown below) possibly in the next few years.

I suggested that he have Scalp Micropigmentation ( and mimic many of the men on this website. I told him that all is not bleak. Scalp Micropigmentation is a great solution and it allows him to forget about his hair for his entire future and go on living his life not thinking about his hair loss.

Here is a picture of his situation as well as a schematic of what he will eventually look like in the next few years.


Norwood Class 6 pattern


We have become aware from the hair transplant community that the use of a specially designed tape, when placed at the mid-forehead, prevent swelling from going below the tape and given enough time, for those who wear the tape, to absorb the edema from the surgery through the scalp directly. Note the swelling above the tape which will not drop down below the tape. When combined with our traditional steroid use, we now can prevent swelling of the eyes and face as shown in the photo below who is two days following his surgery with much of the redness already gone.

To get a clean wound, we always wash the recipient area on the day of surgery and the following morning in our office, a perk for many of our patients. Many of our celebrities love the hair washes after the surgery so much, that they come in every day, something we are always happy to do for them.



Emu Oil comes from the flightless bird in Australia which the native aborigines killed and use the fat of the bird for all sorts of medicinal purposes. The oil is a mixture of monounsaturated and saturated and polyunsaturated fatty acids, some of which is used, when consumed by these natives, to protect them against heart disease. Although one might believe that there is some connection between what we eat on the fatty side and heart disease, the stretch to the treatment of hair loss is a myth that might have been propagated to sell Emu Oil. Buy it and try it if you like. I suspect it is not inexpensive considering where it comes from and how it is derived. Maybe a good business for me if I had a larcenous streak.


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