Month: January 2023

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Is the Hair Transplant Industry Getting Oversaturated?

Hello Dr. Rassman,

I’m a pre-medical student, applying to medical school next year, and ever since discovering sites like ‘hair transplant network’ and doing independent research, I’ve decided I have a great interest in entering the hair transplant field. However, I recently read an abstract you published in 2003 regarding the status of the transplant market for both the consumer and the physician, and it lead me to believe that by the time I get out of medical school and residency, hair transplants may be an over saturated commodity? I may have interpreted the results of your work a tad harshly, but I was wondering if you had any advice for someone in my situation? Do you think there will still be potential for a successful, innovative private practice, or would it be akin to opening a laser clinic on Rodeo in 2009 -aka you’ve missed the cusp of the wave and it’s too late to break in now? I realize that you can’t predict the future, but I’d appreciate any advice or insight you can give me. Thank you very much.

I think that the issue is classic capitalism (supply and demand). With today’s economics, hair transplantation is not a necessity so there are clearly more providers than patients, but who knows 10 years down the road. The miracles I see daily in my practice will be better understood by the balding population and will, almost certainly, cause an upswing in patients seeking this service, but who know if the physicians skilled in the art will multiply faster than the demand for services. Ask our economists, who seem to know the answers to everything in our present economic climate.

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Is the Flap a “Cure for Baldness”?

There is a post out of the UK that says there is a cure for Baldness called the Fleming-Mayer Flap. Please see the link and give me back your comments. See “An end to baldness – for those who can stomach it“

The original procedure was actually ‘invented’ by Dr. Jose Juri in South America. It was widely performed around the world with, at times, terrible consequences. Dr. Juri has been quoted by doctors I know as believing that this invention was a terrible mistake and I believe he apologized for the damage his procedure did to the many victims that the radical surgery produced.

As there is no cure for baldness, certainly a radical scalp moving procedure has many opportunities for problems. Worse, it can not cover all of the balding area, for that would take God’s hands, and not this technique.

  • A banana-shaped piece of hair-bearing skin is marked out on the side of the head
  • Incisions are made and the flap is loosened, always remaining attached to the head in order to maintain the blood supply
  • The bald area is cut out of the patient’s scalp and removed
  • The flap is twisted, flipped over the top of the head and sewn into place where the bald patch was. Surrounding skin is stretched lower down to compensate

I would not recommend this procedure for many people with ordinary male pattern balding. Even if their balding pattern does not look too bad at the time they have the procedure, as they get older, the flap will make them look freakish and I have treated many patients for deformities resulting from this type of surgery as they continued with an advancing balding pattern. The article you sent is very misleading; the flap is not a cure for baldness.

For more information about the flap procedure, please visit:

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Is the Donor Hair Really Permanent?

My grandfather’s has what you call a Class 7 pattern and the hair around the back and sides is very thin. I asked him if his hair was always that thin and he replied that when he was my age, his rim hair was much thicker. He became bald in his later 20s. Is the donor hair really permanent?

The donor hair around the sides and the back of the head in some men is not permanent.

I have seen men like your grandfather in my office and their donor density is very low, but as they are usually coming for a hair transplant assessment, I, of course, turn them down. There is some miniaturization in the donor hair in these men and I suspect that the miniaturization process that impacted their original frontal hair extends to the donor region. These men are clearly not surgical candidates.

On very rare occasions (about once every few years) I see someone who lost hair bulk in the transplanted hair. These men have a drop in donor density as well, so I must assume that these men are losing this sacred donor hair. This introduces two more risk for patients who have transplants: (a) the loss of some of the transplants over time as the donor hair dies off, or (b) the hair becomes finer with age (a common finding). The few who I have seen that reported transplanted hair loss to me, fortunately did not lose all of their transplanted hair, but it is a risk. I have only been doing hair transplants for 20 years, a relatively short period of time in the life of my patients.

Amongst those men I have transplanted above the age of 70, they never showed miniaturization in the donor area and they behaved like the young men I transplanted. One of my most unusual patients who came to my office frequently during our Open House events, was a Class 7 patient who received 9900 grafts over 9 years and he maintained his donor density through the entire process without miniaturization. He was 74 years old.

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Is the Alcohol in Rogaine Causing My Irritation?

Dear Mr. Rassman,

Thank you for all the help you are providing the public. I am 23 years old and suffering from thinning hair. Unfortunately, we have limited options in Dubai. We have only one product of minoxidil 5% which is regaine, however, I develop scalp irritation from using it. A dermatologist asked me to try ordering rogaine foam from the US. He believes that the irritation was caused because regaine 5% is an alcoholic solution.

1) Do you think rogaine foam does not have alcohol? If yes, can you recommend any other product that contains minoxidil 5% but is not an alcoholic solution. Minoxidil is my only option and it is very important for me to find a way to avoid irritation.

2) I used the total daily dosage of regaine 5% at once a day, not twice as recommended. Do you think that is the reason for irritation?

3) I want to study whether regaine is effective with a microscope and taking pictures. How can I be sure that I am comparing the same spot with the same amount of zoom. For example, I zoomed a little and found 10 hairs in area A in the first month. I am worried that I might zoom less and find 12 hair counts after six months. Moreover, I might take a snap of another spot (beside the original one) in area A.

Thank you very much in advance.

1. Rogaine Foam does contain alcohol, but it is the propylene glycol that is generally what causes skin irritation in some people. Rogaine Foam doesn’t contain propylene glycol. If it is the alcohol that’s causing your irritation, unfortunately I’m not aware of any particular minoxidil currently sold with zero alcohol content. I have no way to know exactly what is causing your skin irritation, though.

2. Using it only once a day might just not be as effective as the recommended twice daily application, but I doubt the lesser dosage is what is causing your irritation. The irritation is probably from the propylene glycol in the Rogaine liquid, or perhaps an allergy to one of the other ingredients.

3. I suppose you could have a permanent dot the size of a pen mark tattooed on your scalp to be sure you have the exact spot monitored each time, but I think that’s a little overkill. The better way to go about this is to have a professional check the overall hair bulk using the HairCheck instrument, then recheck it again in a year to see if the numbers changed (increased bulk means you’re having more hair growth).


2014-03-11 13:06:09Is the Alcohol in Rogaine Causing My Irritation?

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Is the Alcohol Content in Rogaine Foam Bad for the Scalp?

I have been using rogaine foam for one month now and my hair has fallen out and is thinner then before I started…this getting scary! I do not understand the concept behind the shedding.How long is it suppose to last and could some people be allergic to the product? And what about the high alcohol content is that bad for the scalp? Dr Rassman do you believe it is worth trying for a longer period of time ?

Rogaine FoamSome people are sensitive or allergic to the non-active ingredient in Rogaine. I do not believe that a small alcohol content is bad for the scalp, but it can cause drying in some people and the minoxidil itself could be an irritant in others (or you could be one of the “lucky” ones and experience drying and irritation).

The shedding of hair while starting minoxidil may be due to the fact that the hairs undergo a “reset” cycle, as old hairs fall out to start a new growth cycle. This has not been medically proven, but is a generalized concept to explain why some men experience shedding when they first start using the medication for the first couple of months.

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Is Telogen Phase the Same Length for Balding and Non-Balding Men?

Dear DR, hi,

I found your blog by searching about duration of telogen phase on Men with male pattern baldness. I’ve a pretty simple question: is the telogen phase the same for Baldness suffering peoples and “normal” peoples?

I’m asking you that because ive checked your blog, and i saw tons of guys complaining about masturbation/working out incidence on MPB. Alot said they saw some changes in the daily shedding (in good or worse) after 3-5 days only… How is that possible? I though a “dead” hair fell 100 days after the beginning of the telogen cycle. So how can they check the result of abstinence OR over masturbation only after a couple of days? Do i misunderstood something? As nobody never corrected them about this point, do that means the telogen phase for MPB men is equal to less than 2 weeks and not 2-3 months like for others men?

In advance, thank you. Regards.

The duration of the telogen phase varies in everyone. The cycle can be longer when there is miniaturization present . If a hair dies (apoptosis), it can die within a follicular unit or miniaturize within a follicular unit. The telogen cycle, I believe, is significantly longer than 2 weeks. So, for example, if you have a high density and many three-hair follicular units, one hair may go into miniaturization and at some point in the follicular unit’s cycle, that hair can die off.

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Is Taking the Drug Topomax Connected to Hair Loss?

One question. I was surprised you mentioned beta blockers as a possible cause. Could you point me where I can see if my dose daily for migraine prevention may be why?

Also do you know the best source for which meds may or do cause it even if they aren’t readily listed as a side effect like for say Topomax? (Took they for two years for ptsd treatment. Stopped September of last year.)

Read the insert that is included in each of the drugs that you get when a prescription is filled. This is easily found on the internet on google. See here: https://www.epilepsy.com/connect/forums/women-epilepsy/topamax-and-losing-hair


2019-12-05 15:59:59Is Taking the Drug Topomax Connected to Hair Loss?

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Is Taking Propecia to Prevent Shock Loss an Indefinite Necessity?

Hi Dr Rassman,

Fantastic site, and I’m really enjoying your cautious matter-of-fact coverage of the new A-Cell technology!

I’m a 28 year old male, slowly but surely experiencing diffused patterned alopecia. So far it’s not visible except when wet, but miniaturisation mapping shows I’m probably headed for a NW7.

I’m interested in whether you think it’s possible in theory for a surgeon to insert A-Cell treated hairs into the balding areas, thus gradually replacing the DHT-affected hair with permanent hair, and ensuring coverage “continuity”. Obviously this will depend on whether the A-Cell hair is in fact permanent.

Also, I believe you indicated in a previous post that finasteride is recommended to prevent shock loss. Do you believe this will be an ongoing necessity? i.e. assuming the new hairs take root and are unaffected by DHT, would a patient need to remain on finasteride indefinitely or only for the months following surgery?

Perhaps you need a good diagnosis of what you have. Do you have diffuse patterned alopecia (DPA) or androgenic alopecia (AGA)? I suppose you can have both, but that would be rare. It’s important to determine the proper diagnosis, because diffuse patterned or unpatterned alopecia is generally a contra-indication to a hair transplant surgery. The donor hair area is questionable in its permanence in those cases.

Thus, even ACell technology would fall into the same uncertainty. In other words, the hairs transplanted with ACell may not be permanent if the donor hair is not permanent. The technology is so new that I do not have an answer for you.

Finally, Propecia (finasteride 1mg) is recommended for men with androgenic alopecia (AGA). Patients who take Propecia need to take it indefinitely if they wish to slow down or keep the hairs that are at risk from falling out. Many doctors (including us) recommend Propecia to decrease the risk of shock loss. For practical reasons, patients who do not want to be taking Propecia indefinitely (but wish to decrease the risk of shock loss), usually take the medication for about one year. Once they stop taking the Propecia they risk the same ‘catch-up’ hair loss phenomenon. The main thing one needs to understand is that Propecia is an OPTIONAL medication and the only thing that we (doctors) can do is to recommend it.

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Is Success is More Important Than Hair? (from Reddit 6/12/19))

Wanted to share some insight with you, in light of all the Incel BS that has been going on in this sub. I will try to make it quick. DISCLAIMER: I know that hair is important and balding sucks and I’m not saying don’t worry about your hair at all, but you need to know one thing. I live in Manhattan, I’m 27. When I first moved to NYC I signed to a modeling agency and did some modeling part time to make some extra money. This is not to brag and I’m by no means even a successful model (I don’t even do it anymore). During my time modeling in NYC, I’ve been fortunate enough to be around some of the most beautiful women in the world, and even been able to date some models here and there.

I want to make one thing very clear. The majority of the models I have met (especially ones in the 24- 30+ range care WAY more about success, confidence and personality, than they do looks. Sure, for a hook up here and there, they may go for the hottest guy, but the overwhelming majority of these girls end up In actual relationships with: entrepreneurs, bankers, business owners, Managing directors I.E confident successful men, most of whom are very average looking and a lot of them with bad hair (I’ve seen this over and over again with my own eyes) Actual beautiful women who can get any guy they want, care way more about their future with a guy than their looks.

The take away here is, if you’re going to put all your time and energy into something, put it into bettering yourself and trying to be super successful and don’t let MPB be the end-all be of your life. I know a lot of you already know this, but a lot of you also really need to hear it.

I believe that a good woman will care more about what is in your head than what is on top of your head. I totally agree with this post but the problem many men have, is that because of their hair loss, they lose confidence in themselves. I remember a young actor on one of the morning daily soap TV shows, a long running show in which he played the young man that the married women wanted to seduce. He came to me at the age of 20 telling me because he was losing his juvenile hairline and was developing a maturing hairline, that he was going to be terminated the next season. So he asked me to reinforce his juvenile hairline so he could keep his job as a ‘sex icon’. After the hair grew in, they renewed his contact which was for over $1 million/year. Another actor, came to me for hair loss in the frontal area and I put hair there. In just one surgery he radically changed his look. He landed the big leading man roles. He told me that it was not just his hair, but his self-confidence that changed and the combination of the two is what made his career. Everyone knows him today and he is a well known leading man in some great films. Self-confidence is hard to come by when you are losing your hair and you are early in a career without accomplishments, so the boost of some hair make the world of difference for some men.