Topical minoxidil didn’t work

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

When I first started thinning around 21 I hopped on minox and would apply it gently to my scalp. I think I was afraid of the manual shedding that would be caused by really rubbing it in. After 6 months I stopped using it because I didn’t notice any improvement. I continued using keto and 1.5 mg fin for the next 8 years. With a very slow progression of thinning. About 6 months ago I decided to try minox again, and instead I rub the minox vigorously into my scalp for probably 20 seconds. While at first I did notice a lot of hair in my hand from the rubbing, over time less and less hair would fall during the rubbing.

I feel like now my hairloss has pretty much halted, and maybe even a little regrowth (it’s hard to tell because I’m a diffuse thinner).

If minoxidil didn’t work initially, then you might be in the 60% of men that will not respond to topical minoxidil but will respond to the oral form. Read this: https://baldingblog.com/sulfotransferases-and-minoxidil/

Can finasteride completely restore my hair?

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

 I was wondering if fin restores pre-thinning hair, if caught early. Will it give you the hair you had as a teenager, for example. Is this possible? I’m 21 years old.  

Sometimes, if you catch the hair loss early, finasteride can restore it to pre-loss levels.  This occurs only for the mature hairline, not your juvenile hairline. 

Too Many Grafts (thousands) (photos)

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

Please note the arrow which shows that there were soo many grafts that they didn’t get into the recipient sites with enough depth to grow in the long term.  The technicians that did this in Turkey, must have felt it was a badge of honor to put soo many grafts into the recipient site.  I doubt that this man needed this number, but more important, most of these probably will not grow.  In addition, his risk of necrosis of parts of the scalp from blood supply interruption is high.  Add to this a depleted donor supply, so that when the grafts don’t grow, there will be not enough hair for a good surgeon to fix his problem.  I cried to this man who just tried to deal with some level of balding and got sucked into some bargain salesmen who took advantage of him, took his money and probably damaged him for life.  This goes on all of the time, view this wonderful seminar on this black market for hair transplants in Turkey here: https://baldingblog.com/seminar-hair-transplant-black-market/

Hairline too low

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

This young man went to a clinic that clearly didn’t know what they were doing. His hairline is almost down to his eyebrows, less than 1 inch.  Every hair in the frontal hairline that is too low will have to be removed, hair by hair. He will probably be scarred as well.  This is a very costly repair. and it will take some time to see if he can get all of these hairs out.  As soon as I saw this, my mind wondered into the type of people who can do this type of mutilation to a young man that just wanted to look better.  Worse, they are probably doing this over and over again.  I blocked out his face to preserve his dignity. He posted this on Reddit. I wonder if this could be a photoshopped photo, exaggerating it to get comments.  

Question about Class 7 pattern of balding

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

I have read a few articles stating that for most norwood 7 men they would display that pattern by the time they reach 26. Would you have a reference picture of what that would look like? Im assuming they generally would not be fully bald by that age.

Two scenarios point to a Class 7 pattern of balding. 
1- The aggressive balding pattern fully appears by the age of 26-

2- The balding pattern is evident with thinning and miniaturization down to the rim of permanent hair around the top and back of your head which suggests that your pattern will eventually become a Class 7 pattern. 

You need a good doctor to manage your balding and if you want a hair transplant, to help you get realistic expectations for what you can achieve as determined by your donor density and your hair bulk.

Who does what in your hair transplant surgery?

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

I always like to ask, what roles do you play during the operation and what do you like to delegate to the technicians. There is a lot of variety in how this is approached. Who does the incisions, extractions, and graft placement?

For a hair transplant, this is who does what:
1- Design of the recipient site with the patient, hairline when appropriate with the patient. Come to a mutual understanding for what it would look like. SURGEON
2- Reviewing expectations SURGEON
3- Determine the extent of where the grafts will go, how many to grafts to remove, and how (FUE or Strip but this is usually determined in advance of the surgery day) SURGEON
4- Perform the anesthesia SURGEON
5- Make the recipient sites (incisions), determine where to place the highest densities and distribution. Control of hair direction is in the surgeon’s hands. SURGEON
6- Harvesting the grafts (FUE or Strip)  SURGEON
7- Sorting, reviewing the grafts and placing the grafts (SURGICAL ASSISTANTS)
8- Final review of the surgery SURGEON
9- Placing the first day dressing SURGEON
10-Discussing post operative care (SURGEON AND ASSISTANTS TOGETHER)
11-Being available day or night after the surgery is performed
I hope that this answers your questions

 

How many grafts will I need?

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

You are fortunate in that the balding just goes to the swirl. This means that the hair can be easily layered when styling it. The number of grafts is partly dictated by the thickness of your hair in the back of the head (fine, medium or coarse). The finer it is, the more grafts you will need. A quick guess that if you have fine hair, it might take 2500-4000 grafts, but if you had coarse hair, you might get away with 1600-2000 grafts.

 

I’m balding and may commit suicide

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

My dad is norwood 2 and there’s only one norwood 7 in the family. i’m destined to be bald. Can’t take finasteride or any meds due to financial reasons. I seriously want to commit suicide because of this.

Everyone in the US can afford finasteride which costs $28 for one year supply at the 1mg dose. If you elect to reduce the dose to half dose (80% as effective) that will last you two years. Suicide is not an option because finasteride at half a dose always works to slow, stop or reverse hair loss, especially in men under 25.

If you would want a free consultation with me, then reach out to me at my email address williamrassman33@gmail.com. To evaluate you properly, I need to see some photos to show your balding and one of them should be a frontal view with your hair pulled back and your eyebrows lifted high so that the creases on the forehead show up. This will show me anatomical landmarks to measure where your hairline belongs and more about what the shape should be. Tell me what you don’t like about your hairline and your overall hair situation. Please include your phone number and the best times to reach you. I usually get back to such emails within one – two business days.