The Value of the Sweat Glands in the Hair Grafts

Dr. Paco Jimenez identified the eccrine gland in the upper part of the hair follicle. We discussed that when the surgeon creates chubby grafts in a hair transplant, the eccrine gland is included in the grafts, but when the grafts are very skinny, or stripped of their capsule as with some FUE grafts, this gland probably is not included in the graft. We have seen that chubby grafts produce the best long-term results, and skinny grafts may possibly be responsible for grafts that don’t continue to grow through many growth cycles. This is all speculation at this time, but Dr. Jimenez believes that he will hone down further on the value of the eccrine gland in the near future.

I have always believed that chubby grafts are better than skinny grafts and my results of seeing long-term growth has been very good. I also believe that chubby grafts reduce the risk of dehydration of the grafts during the hair transplant process. Dehydration of the grafts is the major cause of graft loss during a hair transplant surgery.

Value of Styling Can be Everything

Here is picture of a woman who has probably lost 80% of all of her hair in a uniform manner. You could see through the hair and see bald scalp; however, this women learned that by using creative styling, she could actually look like she has almost no hair loss. It is wonderful to know that the old cliche applies here ‘where there is a will there is a way’


2020-05-04 15:19:29Value of Styling Can be Everything

Value of microneedling alone

I’ve seen a lot of talk around dermarolling and topical minoxidil application. My question is if I am already on 1mg fin and 5mg oral minoxidil a day, is there a benefit to dermarolling without topical application?
Is there an argument to supplement oral minoxidil w/ topical minoxidil regularly? What about right after dermarolling say once a week?
The use of microneedling has value beyond the medications you are taking. Creating controlled wounding (10 seconds on each location, something that requires a microneedling device, not a dermaroller) will induce a healing cascade that stimulates the stem cells near the sebaceous gland of the hair follicle. This is what causes new growth, and it is independent of the drugs that you are taking.

What is the value of limiting the dose of Finasteride?

Hey, so if i take just one pill of Finasteride 1mg, my body will need at least a month to get back my DHT to normal? So taking 1mg Finasteride like twice a week is good enough to maintain a low DHT (I only have very, very slow MPB, no shedding) ?

Yes, you are possibly correct. This dosage is less than the therapeutic dose as recommended by the drug company and will be less effective than the full dose but maybe enough to get you what you want.

Value of HAIRCHECK bulk measurements in two patients seen by me today

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:

What is the value of a conditioner in a person with hair loss?

I heard shampooing everyday isn’t good so I am trying to space it out more and do twice a week or so. However, on the off days, I plan to use conditioner but not sure which one. Does conditioner help with hair loss? I never proactively used it in the past so I am not sure. Also how long do you guys keep the shampoo and conditioner in for?

One of the problems that make hair loss of fragile hair worse, it combing and brushing hair that pulls out miniaturized or weak hairs early. The use of good conditioners, solves the pulling problem because the comb and the brush glide through the hairs with less pulling.


2019-02-01 15:10:57What is the value of a conditioner in a person with hair loss?

Using Toppik for Norwood 6 or 7 Patients That Can’t Have Full Coverage from a Transplant

Dr. Rassman,

What is your opinion on using products such as Toppik to enhance a hair transplant on a Norwood 6 or 7 patient who cannot achieve full coverage? Obviously the need to use a product like Toppik long-term may not be ideal, but for a man whose hair loss is too extensive to achieve full coverage from donor hair, a keratin hair-binding product combined with a hair transplant may be the most effective and natural looking solution for a lot of men with extensive balding.

A bald Norwood class 6 or 7 patient does not do well with a concealer like Toppik, which works better with some hair. Many men who use this product without hair in the bald area will actually show the Toppik itself, which is often irregular in the way it is put down. If used to enhance a hair transplant that is not thick enough, it might work if it can be applied so that the Toppik can not be detected. The keratin hair granular product has significant disadvantages, as it can come off on your clothes, your sheets and pillows, and when someone runs their fingers through your hair.

There is another treatment which is a permanent concealer that can thicken up a hair transplant look — Scalp MicroPigmentation (SMP). If you look at the SMP site, you will see examples of this type of concealer and most of these patients (who have hair that is just not thick enough) can avoid another hair transplant with the SMP alone. We have successfully used this SMP technique to address individuals whose balding patterns are too large and the transplants too few to get the coverage they want.

As everyone is different, I would suggest that you request a virtual consultation with me and send photographs in good lighting so that I can understand your problem as you see it. Also, please include a phone number.

Using the Sides of the Head as Donor Hair?

Greetings,
Solid good data base you have built on this blog Dr. rassman. Thank you

My question is: Can you transplant hair from the upper sides of the head “left and right” about 3 inches above the ears, or is it only possible as a donor area to be from the lower back above the nick ? Reason I’m asking this question is because I have what i want to define as “Global hair loss/damage”. Meaning even in the donor area it’s clearly visible that i do not have a normal hair distribution/density “there is holes among the donor area” but, in my sides “just below the flat crown of my head” the hair is extremely healthy/dense/thick and can grow for long time with out being damaged.

Your time and answers are greatly appreciated

NW7First I though you were describing diffuse unpatterned alopecia (DUPA), but if there are clearly areas of your scalp that are full and lush, and they are about 3 inches above the ear, I would rule out DUPA on first glance. I would have to examine you to understand what you are telling me.

As a rule, however, the donor fringe is only 2 1/2 inches high on the back of your head and about 3 inches high on the side above the ear. Donor hair implies that the hair is permanent when full balding (up to a Class 7) occurs. Note the diagram at right of a Class 7 figure and you will see the 3 inches high fringe above the ear. Donor hair taken above the 3 inch level will not be permanent hair for the advanced balding patient.