Author: Dr. William Rassman

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Best age to do FUE?

I’m 31 years old. Last year people really started to notice my hair loss… I recently discovered FUE. I expect my hairline to further recede as I age. What age should I wait to – if I should wait – to start to seriously consider FUE (or similar measures)?

Hair transplants come in two flavors (1) FUE where the surgeon uses a punch like instrument to remove single follicular units ‘one at a time’ ( https://baldingblog.com/class-23-patient-just-5-days-after-fue-procedure-with-photos/ ), this is the surgery I pioneered worldwide, and (2) the strip surgery (often called FUT) where the surgeon removes a strip of scalp and they sews it closed. Both cause scarring, the FUE causes very small punctate scars and the strip surgery causes linear scars (usually just a fine line but sometimes these will stretch). You should ask yuour surgeon to allow you to meet some of their patients (we hold open house events monthly where former patients come in to discuss their experience and show off their work). At 31, you can do either type of hair transplant, just find a good surgeon. We offer Reddit readers 5% off plus we offer travel reimbursement programs for out-of-town patients.


2020-12-17 07:51:03Best age to do FUE?

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Best treatment for dormant hairs? (from Reddit)

What would you say is the most effective growth agonist? I’ve heard people say oral minoxidil, but is topical estrogen also capable of reviving follicles after they’ve dormant for a few years?

Reviving dormant follicles is not something that may always happen. The places were we see revival is usually when the loss is less than a year, two at most. Those who have had long term balding may not be able to revive those hairs. The traditional approaches all have value including Microneedling, minoxidil (oral or topical) and finasteride. Estrogens in the face of high testosterone may have more limited value.


2020-12-08 06:38:06Best treatment for dormant hairs? (from Reddit)

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Best Dermastamp to buy?

Derma-rollers are something I’ve overlooked but seeing as how they’re so popular here I think I’ll give it a try. Thing is, I’m not quite sure how to tell if one is good or not. I did read that 0.5mm is the ideal starting size, used once a week, but other than that is there anything else I should know about? I’ve heard the titanium ones are better than stainless steel. Also, are the rollers better or worse than the derma stamps? I have large diffuse thinning, not just a local spot.

And does the brand matter? Any brand or model recommendations?

Microneedling is best done with a reciprocating needle device like the Dr. pen device, which has 36 needles and a depth of 1.25mm. Using once a week is the best way to go. You can hold it in a single area for a defined period, like 10 seconds, which delivers a known injury. This injury starts a healing cascade that brings in or activates the stem cells found in the upper part of the hair follicles or in the upper part of the dermis at a depth of about 1 mm.

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Best Diet with Finasteride and Minoxidil to Maintain Hair?

Hello Doctor,

I want to thank you for a great blog that I visit nearly daily. I visited your offices around 5 months ago and had a consultation with Dr. Pak, who was very informative and understanding. Since then, I’ve been on a daily regimen of Finasteride 1.25 mg/day but am going to wait until the follow up appointment before I make any judgments (superstition does that to you).

I have two questions. I already know that Finasteride does not completely stop hair loss. It just provides its patients an outlet for growing old gracefully (under my impression). Have you seen or heard of any patients who took Finasteride while also including Minoxidil in their regimen to maintain for longer than 10 years with good results?

My second question is how big a part does diet factor into the MPB process? I’m already exercising 6 days out of the week even before MPB hit me but diet (what kind of foods to eat) has always escaped me. I would like to know if there is any information a professional such as yourself can provide pertaining to what kind of diets would promote hair growth and what kind of diets work best in conjunction with Finasteride and Minoxidil to maintain hair.

I apologize for the long message and sincerely appreciate all the help you have given.

Best regards!

I believe that for some people, the use of both Propecia and minoxidil has value when used in combination, but that may depend upon a variety of factors including age, appropriate use of the medication, where the minoxidil is applied, and where on the head the balding is that you are treating. The crown generally does better with combined treatment compared to the frontal hairline. I have seen patients using both medications with good results after a decade of use.

I do not believe that any particular diet works better than another, provided that the diet is well balanced.


2010-04-22 12:30:52Best Diet with Finasteride and Minoxidil to Maintain Hair?

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Best Hair Product Combo to Use?

Can I for instance use:
Propecia pills
Hairmax
Organic shampoo

All at once? What is the best combo? Your advice is appreciated. Thanks!

There is no “best combo”. I do not endorse any products. I only prescribe medication such as Propecia (finasteride 1mg), because it works. All others are “buyer beware” as far as I’m concerned. With respect to the Hairmax laser, I have written extensively on that topic (here).


2007-05-23 12:33:52Best Hair Product Combo to Use?

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Best Solutions for Balding

What is the best product for thinning hair and small spot on the top of my hair. Thanks

If there are many small spots of balding, then a visit with a doctor is critical because you may have a medical problem that requires expert insights. If you are a man, I am assuming that you are talking about male pattern ‘genetic’ balding. Both Propecia and Minoxidil may work. Minoxidil, applied to the balding area like a lotion, can be purchased over the counter in many stores. Propecia, a daily pill, requires a doctor’s prescription. Propecia, made only for use by men, can stop and even reverse the hair loss in some of the younger men.

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Beta Blockers, Shampoo and Female Hair Loss

(female) Hi my question relates to the previous question you received regarding hair loss and the use of head and shoulders shampoo. I have used this product for about 10 years now and have over the last month or so noticed my hair thinning. I have switched to the Loreal Elvive Anti Dandruff shampoo now but the volume i once had to my hair does not seem to be returning. My hair used to be very thick and wavy now it is limp and lacks volume. I also am currently taking the medication beta blockers, would these be contributing to what is happening, rather than the shampoo?

I clearly can not tell you what, if anything, will help you. Too many changes at the same time confuses the issues. Go back to do what you were originally doing and then after some months, make one change at a time to see if there is an effect and note what that effect is.

Be sure that you have a medical work-up for the diseases that impact women (first choice) before jumping to conclusions that this is a simple matter just involving shampoos. Hair loss in women can sometimes be caused by underlying medical conditions, so it is important for you to be evaluated by your own physician. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. It is also important to review the use of medications that can cause hair loss, such as oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone. The following laboratory tests are often useful if underlying problems are suspected: Estradiol, FSH, LH, SHBG, Prolactin, T4, TSH, ANA, Iron, TIBC, Ferritin, Free and Total Testosterone. It might help to print this page out and show this to your family physician.

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Best Hair Characteristics for a Fuller Looking Hair Transplant?

Hair characteristics plays a big role in the final appears of a hair transplant, but does any characteristics have more of an advantage than the other? If there were two men who had the same amount of grafts transplanted; one with relatively fine blond hair (that closely matches his skin shade) and another man with relatively course dark hair (that drastically contrasts his skin shade),who do think would have a fuller appears?

There are general rules I use to determine what a person will look like so I can help set expectations with my patients. Amongst the rules are:

  1. People with blonde hair and white skin, people with brown hair and brown skin, and people with dark skin and dark hair do well — in other words, less contrast between skin and hair color.
  2. Coarse hair works better than fine hair on a per hair basis, because coarse hair has more bulk to it
  3. Curly hair is better than straight hair as it wants to cover the scalp. With the African hair type, the hair that ‘mats’ covers bests
  4. The density of the hair will tell me much about how much hair can be moved. The more hair in the smallest area is obviously better
  5. The size of the balding or thinning area when compared with the donor supply tells me much about supply and demand

To assess the various elements, a very complex multivariate analysis would have to be done to really answer your question above, but the general answer is that in my hands (for example) it is experience and my artistic abilities that allows me to help you set expectations. Ask you doctor about your characteristics.


2010-09-03 10:11:09Best Hair Characteristics for a Fuller Looking Hair Transplant?

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Best hair transplant surgeon in the world

The International Society for Hair Restoration Surgeons gives out an award for the best hair transplant clinician every year. For its 27 years history, there are 27 winners (I am one of the award winners given the Golden Follicle Award) so look to ISHRS.org and find one that suits you in your country of origin. They are voted in by an entire society of over 1000 doctors world-wide.


2020-06-05 10:14:37Best hair transplant surgeon in the world

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Best Surgeons for FUE in the US?

Hello,

I apologise if this question has been asked and answered previously, but who would you recommend as the more accomplished surgeons performing FUE in the US. Kind regards

There are a handful of hair transplant surgeons who claim expertise in follicular unit extraction (FUE) in the U.S. You should visit the International Society of Hair Restoration Surgery (ISHRS) for a listing of qualified surgeons and there is a sub-group from this list that do this procedure. Some good hair transplant doctors do not do this procedure, by choice. At NHI, we created the FUE technique and published it in medical journals. There are a few doctors with publication credentials, but many claim expertise. Unfortunately, I have heard about many failures by some of the doctors who claim expertise so you need to do the research yourself and meet with the surgeons on your list (who claim FUE expertise). Ask to meet some of their patients so that you know what the surgeon is capable of doing. I realize this may not be the answer you are looking for, but there is some work required on your part to assure yourself of a good result. Even for me, sorting out the doctors who can perform successful FUE procedures is very difficult as there are so many who claim such expertise and just can’t cut it.

For more, please see:


2007-11-23 09:23:09Best Surgeons for FUE in the US?