Month: January 2023

As promised, I’ve uploaded a tutorial video for the miniaturization mapping. You can find the thread with the video at BaldingForum. I encourage you to sign up at the forum to post any questions you might have about the video or the process, as well as posting your miniaturization results if you’d like me to analyze them.

If you missed the first 2 parts, be sure to read up!

1. Mapping Your Own Scalp for Miniaturization, Part 1
2. Mapping Your Own Scalp for Miniaturization, Part 2

This is part 2 of a series. For the first part, see Mapping Your Own Scalp for Miniaturization.

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Interpreting the Results:

Is miniaturization present? Hair shaft thickness should be relatively comparable from one part of the head to another. There are exceptions to this rule in the first 1/4 inch of hairline, the temple prominences, and the hair of the neck where the shaft thickness may be less than that found throughout the scalp. In any one area of the scalp, the hair shaft thickness may be reduced significantly in 20% of the viewed hairs. These reflect vellus hairs, not mature normal ‘terminal’ hairs — so any measurement below 20% can be thought of as normal without miniaturization.

The area of the head may have different findings. For example, frontal hair in the balding Norwood Class 3A will show varying degrees of miniaturization eventually leading to complete balding, while crown views of the hair may show no miniaturization whatsoever. The balding patterns shown in the Norwood classification chart will parallel the distribution of miniaturization as the balding process develops.

All miniaturization is not equal. Some hairs in any one part of the scalp may show different degrees of thinning. That is because the impacted hairs are self-destructive and different times. Eventually, those miniaturized hairs at the beginning of the destructive process will progress with more and more miniaturization until they just fade away. In the various stages of miniaturization, the hair’s growth slows (no longer growing at 1/2 inch per month) and they will lose their pigment (become gray or transparent). These changes will be appreciated by those of you who become experts on your own miniaturization process.

Now What?

This week, I’ll be posting a tutorial video on BaldingForum.com to show how the process works using the sub-$100 Celestron handheld microscope I mentioned in part 1 of this series. First though, you’ll need to get the microscope. I provided the links in part 1, but to keep things convenient here they are again:

• Buy it at Amazon.com
• Buy it at JR.com

Assuming you have the microscope, the tutorial video (Below!) will be a big help. It’ll not only show you where to map on your scalp, but it’ll also show you how to create files of your historical record on your computer and compare the pictures you obtain over time may give you insights into your balding problems.

This is an example of a person who mapped out his scalp to determine the degree of miniaturization in the different areas. The key is not only to identify the areas where it comes from, but to see enough hairs roots so that I can count the degree of miniaturization. For DUPA, this is critically important as shown in this link for a DUPA patient: https://baldingblog.com/classic-case-of-dupa/

The recipient are requires daily washes as well to keep the recipient area free of crusts. I generally recommend the use of a sponge and supply my patient with a surgical sponge to fill with soapy water and press on the recipient area daily. By repeating this daily, all crusts can be washed off without any fear of losing grafts and you should be clean of crusts within a day. IF any crust are present, use a Q tip and dip it into soapy water, and roll it on the crusts and that will lift them off without dislodging them, but never rub them, just roll the Q tip on the recipient crust. I like to see no evidence of any crusting in the recipient area and the crusts from the donor area gone in 7-10 days with daily washing, You will have to leave the shampoo on for a good 15 minutes and gently rub the crusts with your fingers. Be sure not to pull them off, just let them shed with the shampoo and it will take a few days for this to happen. You can wash twice a day if you wish to accelerate the process.

Good for you. It is worth trying almost anything to keep your hair treatment going forward. I hope, now that you managed the worst of the side effects, that your hair responds as you hope with the drug Finasteride.

How I got rid of fin sides from tressless

There are treatments today that can freeze your hair loss and possibly reverse it. If you just standby, the loss you get while you are waiting for a cure, may be irreversible.

How many of you are in that stage where your hair loss isn’t noticeable to others yet and you’re holding off for a better treatment? from tressless

Clearly, there are two factors that are critical to determining the value of an FUE graft. (1) the thickness of the hair shaft itself is important as that reflects to weight of each hair shaft as it is viewed. A fine hair is less weight and less value than a coarse hair as shown in the patient’s magnified view of his donor area as he has coarse hair. I tell my patients that two fine hairs is equal to one medium weight hair and two medium weight hairs is equal to one coarse hair. (2) the numbers of hairs per graft is also critical. This is a racial thing, Caucasians average 2.2 hairs in each follicular unit, while all Asians average 1.6 hairs per follicular unit as do many people from the middle east. The patient’s donor area here measures about 1.6 hairs/follicular unit. He is of Arab decent so that makes him average. In this magnified photo, I tried to circle the number of hairs per follicular unit and put a number on many of them. This is what the surgeon sees when he is doing an FUE under magnification. An FUE removes the follicular unit and each FUE itself is created with a punch and has a wound associated with it.

If you ever read about the number of FUE grafts done in Turkey in the 5000 graft/session range, think about it and then look at the patient below. This patient has less hair density than a Caucasian and the number of grafts per FUE will have less hairs. That means that there will be more wounds created for the FUE with a less hair yield. In this man, if he had 5000 FUE grafts in the back of the head and did not develop necrosis of the wound, he would almost certainly develop a see through donor area (balding in the donor area) something that we are now fixing with Scalp Micropigmentation.

Thanks for the further performance pointers! Is (1) primarily avoided by trimming off as much of the skins as possible (without damaging the follicles) and (2) by inserting them so that the hairs grow out closer to perpendicular to the scalp (rather than tangential). I speculate there is a lot of room for automation during the “filtering” the grafts based on follicle counts. I’ve read that in some areas of visual-diagnostic medicine, computer models are able to classify images more accurately than medical professionals (on a nonmedical image classification task, a convolutional neural net I built was more accurate than me in a small labeled test sample). But perhaps even more important is that it can reduce the time needed for the procedure, and therefore, also reduce the costs (which allows more people to get a transplant).

WE have monthly open hose events where our former patients come in to talk about their experience. Most people like you who come are skeptical thinking that can tell who had a transplant and they are always pleasantly surprised that they can’t tell. Good transplants can’t be detected. Look at Elan Musk before and after his transplant, a good example of a good job with actor Joe Penny (https://baldingblog.com/actor-joe-penny-shows-off-his-repaired-hairline-with-photos/).

You have a Class 6 balding pattern with a persistent forelock. If the forelock holds up until you are 35+, then a general estimate of at least 2,500 grafts would be appropriate because the middle of the frontal hairline will not have to be transplanted on the first round. But if the forelock disappears after the transplant, then a hole may appear where the forelock was. This area will HAVE TO BE TRANSPLANTED because if it is not, then your hairline will have a visible hole in it. I always tell my patients that genetic balding is a progressive process, and this discussion is such an example. Even the hair in the existing balding pattern will eventually fall out, possibly requiring still another surgery. In some family lines, forelocks tend to last. If it lasts until you are 35, then you may fall into that category.