Does thinning hair lead to balding?

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

Do the thinning areas in whatever balding pattern you have always end up totally losing all the hair in those areas? Or can those areas just thin to a certain percentage of it’s original density and then stabilize remain that way

Miniaturized hairs, if left untreated, will become balding areas. I have to follow the same people for more than one visit, and many balding patterns start with miniaturization (seen as thinning) and then advance to complete balding if untreated.  The only patients I follow are those I am treating with finasteride, which is likely slowing the process and preventing balding. When discussing thinning, we discuss miniaturization in the front, top, or crown of the head, not the donor area. Donor area thinning reflects a condition called Diffuse Unpattterned Alopecia (DUOA)

[If you have any questions, you can reach me at williamrassman33@gmail.com] 

4 months on finasteride (photo)

/by William Rassman, M.D./0 /
The crown is very sensitive to finasteride in many men, regardless of age.  This is unlike the frontal hairline, where finasteride sometimes reverses hair loss in young men under 25 but rarely over 40.  The rest of the male population falls between 25-40, with variable results on the frontal hairline. Generally, the older you get, the less finasteride reverses the frontal hairline.

16 years old with great response to topical minoxidil (photo)

/by William Rassman, M.D./0 /
When you started on minoxidil for a year at 15, your hair loss reversal was remarkable. At your age (now 16), early genetic hair loss will reverse with either minoxidil or finasteride.  You must accept that you will be using one of these drugs for most of your life to keep your hair if you have inherited significant balding in your family line.
[If you have any questions, you can reach me at williamrassman33@gmail.com] 

Am I a candidate for a hair transplant? (photo)

/by William Rassman, M.D./0 /
How do I go about finding out if I am a candidate?
You will likely develop into a full Class 7 pattern of balding which I see is almost there now. These sides will become lower, either quickly after the hair transplant or sometime in the near future. Finasteride may slow that process down. Good doctors routinely perform trichoscopy to rule out diseases in the donor area and establish the metrics that I am about to discuss. It would be best to have your lifetime donor supply of grafts ascertained, including (1) donor density and (2) hair shaft thickness of the donor hairs. This will tell the surgeon what you will look like after the hair transplant, which should be shared with you. Not all grafts are equal; for example, coarse hair has 10 times the value of very fine hair (cosmetic-wise). Hair transplant science is well-established today. See the following patients: https://baldingblog.com/difference-between-norwood-class-7-patients-with-photos/
[If you have any questions, you can reach me at williamrassman33@gmail.com] 

Shock loss was severe

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

I’m 22. I recently went to turkey to complete a FUE hair transplant, where basically it was just to fix my hairline and make it more straight and filled out a bit more and not a full scalp job. I also got my beard filled out as there was little area of no growth, everything was going fine and my transplanted hairs have fell out and i can see some hairs pushing through(please note i wasnt using any medication but have went back on topical minoxidil and started prp treatments). I am currently at the 10 weeks stage but as time has went on through the transplant process at around the 6-8 weeks stage i started to notice extreme hair shedding of my natural hair i had before, big clumps of aleastt 5 hairs each time a brush my hands through my hair, please not my hair is quite fine as it is so its started to really impact my density. My question is will all these hairs grow back when they want to, i went to my local clinic back home and had a hair check where they put a camera into my scalp but there was no baby hairs pushing through for my original shedded hair, will they start to push through later in the cycle? Or is this permanent shedding? Its really stressing me out as my hair density is probs around 70% of what i had originally and its still falling, this is really starting to effect my life and i just want to know that everything will be alright. 

Men who are 22 and actively balding will have miniaturized hairs well beyond the visible area to the naked eye. If your doctor had used a hand microscope, he/she would have probably seen significant miniaturization of the hair behind your frontal balding area in your case. These miniaturized hairs will get shocked out from the hair transplant, unless you were put on finasteride.  In my experience, shocked-out hairs rarely return.  This could have been prevented had someone evaluated you properly and detected these miniaturized hairs.  Finasteride can prevent shock loss in most men, but at 22, you are unusually vulnerable to shock loss.  I hope that your estimate that 70% of your native hairs remain because that number may sustain your look.  You may have another problem if the Turkish clinic has taken out too many grafts (often the case in Turkey).  The average Caucasian only has about 6-8000 grafts for hair transplantation in their lifetime. Still, that number depends upon various factors, including (1) remaining hair in the donor area, (2) your final hair loss pattern that should appear by the time you are 30 or less.  You have tp get a detailed Master Plan for your future balding (inevitable).  Did someone measure your donor supply and give you an estimate as to your total usable donor supply and what your future looks like? Do you know your final hair loss pattern? When you finish your shedding and are growing out your transplants, write to me, and I can discuss this over the phone. My email address is Williamrassman33@gmail.com

Do all transplanted grafts shed after the surgery?

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

I know that theres a small chance that your grafts don’t shed at all, but thats not what I am talking about. I had my surgery done 2 months ago, most of my transplanted grafts shed until the 1 month mark, since then i have kept around 30-40% of the others and they grew like my other hair. Is this normal that not all shed, or should i expect them to also fall out in the next weeks?

It is common to lose all or some of the transplanted grafts between weeks 2-5.  Many of the grafts that stick around will grow, similar to your native hair.  I transplanted my cousin, and in just 4 months, he had a full head of hair.  He told me that he never shed any grafts.  Then I did another transplant on him to thicken up the previous transplant because his hair was “fine”. He didn’t shed grafts the second time either.  I find that one in 30-50 patients, will not shed their grafts. 

Am I a candidate? (photo)

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

I am 39 years old.  I have not taken any medication for my hair loss.  

I have written about this before on Reddit. Medical treatment is important, but at 39, it is unlikely that you will get a good response to it. It is worth trying anyway. I am concerned about the pattern of balding you are showing. I want to ascertain that this is genetic, not a form of autoimmune disease, as your pattern is not classic for genetic balding. Good doctors routinely perform trichoscopy to rule out diseases of the recipient and donor areas. I would look at the nature of the hair and the skin in and around the balding area. If I am concerned, then I would biopsy the areas of concern because autoimmune diseases of the scalp kill hair transplants. Assuming you have no autoimmune scalp disease, I would establish your lifetime donor supply of grafts, including (1) donor density and (2) hair shaft thickness of the donor’s hairs. This will tell the surgeon what you will look like after the hair transplant, which should be shared with you. Not all grafts are equal; for example, coarse hair has 10 times the value of very fine hair (cosmetic-wise). Hair transplant science is well-established today.

[If you have any questions, you can reach me at williamrassman33@gmail.com]

26 months using minoxidil, finasteride and microneedling

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

This is a wonderful result and shows the power of microneeding at maximizing the results of medication and cause such good growth.  A microneedling maintenance program should be continued at least once a month and if you see hair loss, then increase the frequency of the microneedling. Stay on the finasteride and the minoxidil. 

[If you have any questions, you can reach me at williamrassman33@gmail.com]

What do I do about my balding?

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

From this single photo, I don’t think that you are balding. Your hairline is a V-shape, typical of a mature male hairline. The fact that you have a widow’s peak indicates the location of your juvenile hairline at the tip of the widow’s peak. What you have drawn is a female-shaped hairline.  Get an expert to do the hairline for you.  If you are planning a hair transplant, then you will have to live with this hairline for the rest of your life.  Really want to do this?

[If you have any questions, you can reach me at williamrassman33@gmail.com]

Age 22, and worried about balding

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

I know it isn’t a super bad case of MPB yet but I really don’t like these temporal recessions. They make me look old and I want them to go away. I’ve traced where my hairline used to be and I’m wondering: can it be restored with just fin + min or will I need to buy a hair transplant at some point?

I am not 100% sure that this is balding. To be sure, I need to see a frontal view with your eyebrows lifted high so that you forehead creases. That will tell me exactly where your hairline belongs, if it is receded, and by how much.

This may be an early Class 3 pattern of balding. If you are under 22, it will likely respond to minoxidil and finasteride. If you are over 26, if it doesn’t respond to the above medications, then try microneedling for 6 months, which should regrow your hair. If not, you can get a hair transplant if you have tried it all and are over 25, which will work well if this is balding. The design of your hairline you sent to me is clearly feminine. You need a good doctor to design it properly if you get a hair transplant, and it should be a mature MALE hairline.