Author: Dr. William Rassman

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So, What Should I Look for In a Doctor? – Hair Loss Information – Balding Blog

Hello, I am a 27 year old male who is seriously considering a hair transplant in the begining of next summer. My concern is to make sure I find a good surgeon. Do you have any other surgeons that would reccomend. Maybe, its just yourself and whoever works with you.

What should somone look for?
Are there any new technological breakthroughs to look for?
What can I do to make sure my scar is not very bad? I always wanted to get a fade again. Maybe Im just dreaming but in getting a fade, the side of the head is shaved and the scar would be present.

I have thinning along the middle of my head and a clear receding hair line. I now shave my head to conceal it.

My last question, is how long does it take for it to look and feel normal after and a transplant. Also, how long should my hair be when I go for a consultation?

Thanks for your time

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I wrote a book on these very subjects (with Dr. Robert Bernstein), so rewriting it for this blog would just be too time consuming. You can request a copy of the book and I will send it to you or to any of my readers that want a copy. Or, even easier, the text of the book can be downloaded in PDF format here. Also, I posted a blog entry just a couple weeks ago that may be of interest to you — How to Tell if You’ve Found the Right Hair Transplant Doctor.

With regard to your other questions, thinning along the middle is an unusual presentation of genetic balding, but I have seen it. You need to get your hair mapped out for miniaturization to determine if there is genetic balding or not.

A person who has a hair transplant will feel normal (no pain in the back of the head at all) usually within 2 weeks or less. I generally like people to keep their hair long for the consultation, because I want to understand the impact of balding in a styled hairline. Sometimes thinning hair looks full when it is styled or longer.

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Is My Barber Possibly Pulling Hair Out? – Hair Loss Information – Balding Blog

BarberHello i think this website is great. I had one question…im experiencing some thinning in my bi-tempural areas. I get my hair shaved (not bald) every two weeks. I notice that my barber is a little rough with the clippers/shaver…could this be pulling my hair out??? Would this cause further miniaturization??

Does rubbing your scalp really work at reviving thinning hair??? thanks

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If your barber is pulling out your hair, he is not furthering his business. Being rough with hair brushing will not accelerate miniaturization, but it can loosen hair that is on the way out to produce premature thinning.

Rubbing the scalp feels good, but you have to be careful that the rubbing does not pull out the weak hairs that are miniaturizing.

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Electrolysis to Make Transplanted Hairs Finer? – Hair Loss Information – Balding Blog

Couldn’t electrolysis be used to make transplanted hairs finer? I have mostly folicular transplants however I noticed that they are still courser and darker than my native hairs. Couldn’t electrolysis be use to make them lighter in texture and finer in contrast? Thanks for your response.

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In theory, if the electrolysis damages but does not kill the hair, it would become finer. I would think that this would be a difficult or near impossible thing to achieve.

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Minoxidil on the Chest – Hair Loss Information – Balding Blog

You said that minoxidil might work on the chest in one of your answers to a question but the container says not to apply to anywhere but the scalp. Can I get sick from putting minoxidil on my chest?

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The larger the area you apply it, the more of the drug your body will absorb. Minoxidil does drop blood pressure, so if you put it all over your chest and back (for example) you could possibly overdose and get a stroke or heart attack (in theory at least).

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Taking Proscar 4 Days On, 1 Day Off – Hair Loss Information – Balding Blog

Hi Dr Rassman, i have a question regarding the use of finasteride. I am a 26y.o. male with a history of gynecomastia and moderate acne. Last year my family doctor prescribed proscar for my hair loss. He has instructed me to cut the pill into 4 pieces, take 1/4 of proscar each day and have an off day after every four days. At the beginning of this year i’ve noticed that my frontal and termporal areas have been thinning out tremendously. The thinning has been progressing really fast ever since. My question is, should i start taking 1/4 of proscar everyday from now on(instead of having an off day after every 4 days) or should i take propecia everyday instead? Thanks.

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You should address these concerns to your doctor who prescribed you the medication. Finasteride is well known to address the top and crown areas of the scalp for male pattern balding. It is less effective on the front and the temporal areas and maybe the genetic hair loss is accelerating on its own. We go through phases where the rapidity of the hair loss goes active in spirts. You should at the least have your hair mapped for miniaturization by a doctor to document the progression and the degree of hair loss, rather than just subjectively noting the thinning. With good measurements in hand, you may be able to judge the effect of changes like what you are proposing.

Anyway, to answer your question — in my personal opinion, taking Proscar 1/4 pill (1.25mg finasteride) four days on and one day off is not as good as taking it once a day.

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Hair Loss InformationHair Transplant for Severe Alopecia Areata Sufferer? – Hair Loss Information – Balding Blog

I am 52 years old, male, and since about 18 months ago I have severe alopecia areata but only in the top of my head, not on the hair line, sides or back. My dermatologist says a hair transplant will not work in my case, that it will fall shortly, etc.What is your opinion?Isn´t there any hope for me on any kind of transplant?

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Alopecia areata can be transplanted if the disease has been inactive for 3 years and shows a negative biopsy for active disease during that period. For those who I have transplanted who met that criteria (very few people), the disease had not returned, but this is a real risk even when the disease is inactive for 3 years.

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Shampoo and Hair Transplants – Hair Loss Information – Balding Blog

I seem to have this “sebum” buildup which creates dried residuals on my scalp since the transplant was done. Does that imply that I need a stronger shampoo rather? I was told that it was good to use a very mild shampoo because it did not remove the surface oils, but I would think sebum is surface oil? Thus, perhaps a “Head and Shoulders” might be better? Can ANY shampoo hurt the transplants and/or contribute to natural hair loss?

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Any shampoo will work. The transplants are no different today than your original hair was, just less density than you originally had. Switch to another shampoo, be adventurous and experiment until you find something that works better for you.

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Hair Loss InformationAnyone Taking Propecia for a Decade? (with Photos) – Hair Loss Information – Balding Blog

Hi, I just want to know: do you have many patients who have been on propecia for 8-10 years and yet still have a healthy head of hair on their heads?

Alternatively, do you have many patients who have taken propecia for a long period of time and have gone bald?

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I have a number of patients who went to Mexico to get Propecia (finasteride) before it was sold in the United States (maybe 10 years or so ago). One in particular (24 years old at the time), who was balding in the crown, reversed quite nicely on Propecia and maintained that reversal without any progressive miniaturization over the 10 years. Because he was young, the drug worked beautifully. His crown was never transplanted but he did receipve alightly over 6000 grafts in the frontal area. He now has a crew cut.

I have not seen anyone who stayed on Propecia go bald, but I have seen many, many men who were taking it and decided to stop, who then went either very bald or very thin.

Before Propecia on left; After Propecia on right:



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Hair Loss Information22 Year Old Male Taking Avodart – Hair Loss Information – Balding Blog

hi ive been reading your forum all morning, and im really impressed by the site, if you replied to me it would be greatly appreciated. im a male 22 yrs old. and have been takin avodart for 4 months,my hairline is slightly receiding on the side but the front of my hair is at the right height my problem is my hair seems to grow longer, but continurs to thin. on the top. will avodart cause my hair to shed then grow back thicker? or will once its fallen out will it never grow back?? thanx 4 any response.

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It is my general opinion that you should not be taking Avodart (dutasteride). It is a powerful medication with a very long half life in the order of weeks/months (half life is the time it takes for a drug to be out of your blood stream). It is not approved or indicated for male pattern hair loss and more importantly, it has not been studied on young men who may potentially (intentionally or unintentionally) be fathers.

If a doctor prescribed you Avodart, you should discuss these matters with him/her.

With respect to growth and shedding, there is no way to tell or predict your rate of hair loss or the contributions of shedding as a cause of it (I suspect shedding is rare). At the least you may want a baseline study, so I would suggest that you map your scalp for density and miniaturization to objectively record the hair loss/gain.

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Hair Loss InformationHair Loss on Top of Head, Hairline is Fine – Hair Loss Information – Balding Blog

PorcupineI am 29, male. Recently I got my hair cut rather short, and it has kind of spiked up, somewhat resembling a porcupine, i guess you could say. I notice when looking at my head from above that my hair seems thinner, like there are some areas not as full as others. Is this a sign of hair loss? My hair line is not receding, and my hair is fine at the crown/point at back of head, where you usually see bald spots in people going bald. Do you have any idea what I am seeing in the mirror? Is there a pattern of baldness where you start to lose hair on the top or in the middle of your head? Thanks in advance for your comments.

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Some people will develop thinning behind the hairline, leaving a normal hairline. We also see thinning in the crown with no problem in the frontal area as well. The first 3/4 inch from the highest crease or the wrinkled brow is the juvenile component of the frontal look. Behind this first 3/4 inch starts what I call the mature hairline.

The shorter you cut your hair, the more you will see of any thinning that is present. To find out what this means, map out your hair and scalp for miniaturization so that you can know if this is a genetic pattern for you. If it is genetic, Propecia works well in the crown.