https://www.barrons.com/news/hair-transplant-fad-turns-deadly-in-inda-01669949408

Cleanliness is close to Godliness.  I can’t comment too much about this tragic report; however, the surgery was apparently performed by a non-physician team, possibly without respect for the cleanliness required of a surgical procedure.   These Hair Transplant Black Markets, have reduced prices to induce naïve men to think that they are getting a bargain but these non-physicians don’t know about the toxicity of the anesthetics we use or many other issues related to the human body’s reaction to the surgery or the medications. Death is a high price to pay for a bargain.

Why with eyebrows raised up? Is that how the rule of 3rds supposed to work? Distance from bottom of nose to eyebrows line should be the same as the distance from eyebrows line to hairline? But that should be properly done with eyebrows lifted high?

The hairline ends at the frontalis muscle when you are 5 years old. Ask a 5 year old to lift their eyebrows and you will see their upper middle hairline touch the highest crease of their furrowed brow. The juvenile hairline is always located there. and as a male matures his hairline without balding, it will go up one finger breadth above that highest crease and change its shape from concave to convex taking in a V-Shape.  That is why I I always ask my patients to raise their eyebrows, to determine the proper location of the hairline.

Have you seen any of patients who ended up getting COVID after their transplants. What was their results like ?

I have not seen anyone who developed Covid after a hair transplant but I would suspect that nothing would happen to the transplant, if that is your concern

 I’m considering switching to Dutasteride, as I’m still, slowly, losing hair, I’ve been on Fin for 8 years (currently on 1/3 of a 5mg proscar tablet daily) – Do you know of any issues regarding male fertility while on Dut? I read a medical paper a while back stating that it affects sperm, and since reading that I’m hesitant to make the switch, at least before having children.

Dutasteride is more potent than finasteride. There is no data addressing fertility on young men on dutasteride and that is one of many reasons I don’t prescribe it.

Hey Dr. Can microneedling cause scarring that prevents a successful hair transplant in the long term??

Hey Dr. Rassman,

I’m a 21 year old guy who’s concerned about balding in the future. The main reason for that is that I’ve got hair that falls to my hips, so losing my hair would really suck! I wanted to reach out to you to kinda see if there was any way for me to predict if I’ll go bald or not since I’m so nervous about it.

My dad is 55 and he has a full head of hair. All 5 of his male siblings still have a full head of hair and his dad had a full head of hair when he died, albeit with a little bit of thinning. On my mom’s side things are a bit weirder. None of my mom’s brothers nor her father lost hair in their 20s or 30s, but both of my mom’s brothers as well as her father began developing a bald spot on their crowns in their late 40s/early 50s.

I know it’s basically impossible to really predict balding but I just am scared of losing my hair in my 20s or 30s since it’s my crowning glory! I also know this is basically just a random lottery when it comes to whether or not you will lose your hair. At the moment my hairline looks fine and I don’t see any signs of balding. Do you think it would be worth it for me to start propecia/finasteride ASAP to preemptively counter potential genetic baldness?

At 21, the hair cycle often decreases in men, so if your hair grows to your hips that might mean that you have more than a 3 year cycle as hair grows 1/2 inch per month. Measure the length of your hair and if you don’t regularly cut it, then the length of the hair cycle will be easy to calculate. A two feet hair length, for example would suggest a 4-year cycle. If you were shortening your hair cycle, maybe the long hairs will be falling out and look like more hair loss. Seeing a doctor with a trichoscope, will define if you have miniaturization which would suggest genetic hair loss.  Before you commit a lifetime to drugs, be sure that you have genetic balding and that is why a good doctor examining you with the proper instruments, is the only way to go so that you get a proper diagnosis.

Have you seen 1.25mg effective for growth? Or do you like to go higher?

Yes, I have seen good growth at 1.25mg. Sometimes if there is little or no response I go up to 2.5mgs of oral minoxidil. Remember, only about half of people are minoxidil responders but that number reflects the topical dose.  Responders with the oral dose are in the neighborhood of 95%.