Author: Dr. William Rassman

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Can I See a Trichologist to Diagnose Hair Loss?

Would trichologists be a good place to go to diagnose genetic hair loss. Consultation with examination is a bit expensive so I’d like your opinion on it. I’m seeing one in 2 days and what he plans to do is take some of my hair and examine it under the microscope. Would you have any idea on the effectiveness for diagnosis with this method vs the scalp mapping for miniaturization? I’m 26 asian male with a full head of hair (although not as thick or a lot compared to in HS)Is it still a good idea to see these specialist anyways even though Im not exhibiting any clear observational signs of balding (my diabetic father thinned and had bad hair loss at 46 and his younger brother balded in his teens…grandfather on both sides have hair although diabetic mother on father’s side has extremely thin hair pretty much balding)

I can not tell you what the trichologist will see or what he/she is looking for. Without miniaturization studies I do not believe that hair loss patterns for genetic hair loss can be anticipated. The miniaturization study is a microscopic examination of your scalp. If your trichologist is doing this, and knows what to look for, then you’re a step in the right direction.

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Can I Really Trust My Surgeon?

I recently had a hair transplant and I can tell that the grafted skin is clearly visible in only one particular area (I keep the hair extremely short). All other grafted areas are perfect. The difference is night and day. Can the surgeon tell if there will be a mark in one spot by inspecting the grafted areas during surgery? What causes one grafted area of skin to be visible and not all others? Could it be that the incision wasn’t deep enough…making the grafts not go in far enough and stand out a bit resulting in bumpy grafts? I hope you can answer because I am concerned about returning. I need to know if I can really trust the surgeon. Maybe I made him angry?

It is difficult to understand why you would have surgery without being able to trust him/her. Afterall, they are cutting you open. You really do need that trust. Furthermore, I cannot stress the importance that the relationship between a doctor and yourself should be a partnership and one of mutual respect. Your surgeon should be able to address any and all of your concerns before and after surgery without any reservations. I understand that it may not be a perfect world, but I would recommend that you speak with your surgeon first.

With respect to your particular situation, it is virtually impossible to know what was done and what the plan in your surgery was without examining you or asking your surgeon/and yourself the pre-operative plans and expectations. The ability to see the transplanted skin in the graft could be caused by many factors, including the deployment of minigrafts rather than follicular units, placing the grafts too deep or too superficial, angular placement that is inconsistent, inadequate trimming of the grafts when they were harvested, etc…

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Can I Shave My Head Bald After FUE?

Well I am black male and currently shave bald. I want to continue to shave bald. I am thinking of FUE to give me some hair in a thinning area. I have few questions: What does the donor area look like when you shave bald after FUE, does it show scarring? I mean razor bald like MJ. Is it worth doing?

I’m confused as to why you’d want a hair transplant only to shave your head bald. All wounds to the scalp will cause some scarring. With FUE, the scars are tiny dots, instead of a straight line scar like that of the strip transplant and they may have a white color to it that would show up after healing an FUE donor area. With dark skin, that might be a problem and one way to tell that is to have a test FUE session done of just 2-4 grafts and assess the healing at 3 months. These tiny scars allow you to keep your hair very short without noticeable scarring if the whitish scar does not appear, but that being said, completely shaving your head may make these scars visible. Again, a test is worth a try.


2008-11-05 12:45:37Can I Shave My Head Bald After FUE?

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Can I Restart Using Rogaine to Regain Lost Hairs?

Hello, I’m a 21 year old male who started using Rogaine at the age of 19. I was worried I was losing my hair because it is very prevalent in my mom’s family. After using Rogaine for over two years I decided to stop because of the irritation it was causing on my scalp. I stopped late last January and for the first three months I did not notice my hair count change at all, but in about the past three weeks my hair has been falling out by the handfulls. If this continues much longer I may be left with no hair at all. I have been using Rogaine again now for about a week and will continue, but do you think I will be able to get back in the large amount of hair I lost that was apparently dependent on Rogaine? Will reintroducing Rogaine to the follicles bring my hair back to what it was? thank you!

The only two FDA approved products approved for male pattern hair loss are topical minoxidil (Rogaine) and oral finasteride (Propecia). They both have limitations and work primarily by slowing hair loss than growing new hair. Only a small minority of men with genetic hair loss will experience great amounts of hair regrowth with minoxidil, while Propecia will show more predictable results in someone of your age. In your case, your genetic destiny may be catching up to you. It is doubtful that restarting Rogaine will regrow your hair, but Propecia, on the other hand, may reverse recent hair loss. Both drugs may slow the process of hair loss, but if you are genetically balding, Propecia attacks the cause of the hair loss and therefore is far superior. Get your diagnosis by mapping out your hair for miniaturization and with good measurement, you will be smarter about what is causing your hair loss and what benefits you may or may not get from doing whatever you choose to do.


2006-05-22 09:47:57Can I Restart Using Rogaine to Regain Lost Hairs?

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Can I Stop Being Bald Like My Father?

I am 24 years old and now have advanced my balding to include the front and the crown. I don’t want to be bald like my dad who is probably has a Class 6 pattern of balding. He said he got most of it when by the time he was 35. What if I started taking Propecia when I was 18, would that have preserved my hair?

That is a great question. Most advanced balding pattern patients have their pattern established in their 20s. Despite that almost 20 years that Propecia has been on the market, we really do not know if the progression could have been stopped had you taken the drug when you were 18. There would have had to be controlled clinical trials where one group who had advanced balding in their families were put on Propecia and the other group not. In that situation, we would know the answer to your question, but no such study has ever been done.

I suspect, however, that had you taken the medication when you were 18, you would have slowed down the progression of the balding and most of such young men in the 18 year old bracket, would not develop their final balding pattern for many years. i doubt that the final pattern would have been thwarted, but for such men, delaying into their 30s could give them the benefits for possibly another decade of so. We will probably never really know the answer, but for many men who I placed on finasteride (Propecia) I have seen the process slow, stop or occasionally reverse. Better to do it than not to take the drug if you are one of these 18 year old men. At 24, it can’t hurt and probably will help.

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Can I Have SMP in the Crown to Minimize the Contrast Between Skin and Hair?

What is your view on using SMP for someone with a fair bit of hair, fairly stable with propecia/minox for over 10years with a bit of thinning? Wanted to fill in the crown a bit to minimize the contrast of light brown hair and the scalp of a caucasian 42 yar old male? Is this a good solution and could it negatively impact a hair transplant in the future if need be?

Yes, it could have value if you already have some hair in the crown. Think long term -if you lose all of your crown hair, then the SMP will not work so well, but a hair transplant could solve that if and when that occurs. SMP works reasonably well in thinning hair.

If you would like a formal consult you can send your photos to hairdoc@newhair.com (it will be confidential) and I will reply with more clarity.

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Can I reverse my bad hair transplant?

I had a 1500 follicle FUE transplant about 8 years ago by a surgeon on Harley Street. I regret having it done now. I get the feeling that others can see the gap between the transplanted hair and behind it where my hair is thinning. Also the transplanted hair stands straight up which accentuates the difference between it and the rest of my hair. I don’t want to have another transplant as I feel that I will always be chasing the receding hair!

I went to see the surgery a couple of years ago about a reversal and they advised against it. However, I wondered if anyone had experience/knowledge of whether it was possible to have the transplanted hair removed?

I would want to see your hairline and get some good pictures of what you are looking like before rendering an opinion. I have fixed well over 1000 hairline patients. I find that the best way to fix it is to create camouflage that will take advantage of the poor grafts and fill it in with follicular units around and in front of the existing grafts (see here: https://baldingblog.com/actor-joe-penny-shows-off-his-repaired-hairline-with-photos/ ).

For those who need more, I add Scalp Micropigmentation (see here: https://scalpmicropigmentation.com/gallery/#!https://scalpmicropigmentation.com/wp-content/uploads/2016/04/new_hair_institute-scalp_micropigmentation-patient_photo-066b-smp-wm.jp here: https://baldingblog.com/repair-of-hairline-transplants-photos/. Also here is another fix: https://baldingblog.com/repair-of-hairline-transplants-photos/


2020-12-04 11:32:17Can I reverse my bad hair transplant?

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Can I Take a Half Dose of Propecia if I See Side Effects?

Hi, Doctor Rassman,
Im a 27 year old male,my hair has been thinning since I was 23.I still got hair on top and at the front but is thinning on the crown. After tried herbal remedies like Provillus (waste of time and money, honestly) and tried different topical lotions like Revivogen( the same as Provillus,waste of time and money.) Please guys don’t even think about this kind of products,they don’t work!!!

I just decided to try Propecia after a year of research,Im still bit scared about the side effects but I think I’m going to give it a go and see if it works for me. My question is: is possible to take a dose of 0.5 daily in case I get any of the side effects? Is this safe an effective?

Thanks

You should take 1mg of Propecia (per your doctor’s prescription) and if you develop side effects, you can cut the dose… but going the other way makes no sense. 99% of people do not get sexual side effects addressing sexual performance. Why would you assume you are in the 1% group of the population?


2009-05-14 15:04:09Can I Take a Half Dose of Propecia if I See Side Effects?

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Can I Stop Taking Propecia?

I have been taking Propecia since my early 20’s and I am now 39. My crown was thinning back in the day and that’s what inspired me to start the drug. My brother is totally bald but my frontal hairline seems to be in near perfect shape all these years later. I am considering stopping taking it because I’m worried about the long term effects and I think as I age my hormones may change and I’ll develop issues from it. In your humble opinion at this point do you believe propecia is keeping my hairline intact? I’ve read that propecia rarely works on hairlines and I’ve heard you say it’s a tug of war between genetics and propecia. I just think I wouldn’t experienced some form of loss by now. The crown is ok but not what it was 6-7 years ago. You thoughts?

catch up

Please speak with your doctor for these issues. In general if you stop Propecia you can ‘have catch up hair loss’ where the hairs you kept or regrew over the time you took Propecia, may fall out on stopping the medication. Long term use of Propecia from studies show no adverse effects. There was a study that show high dose (finasteride 5mg) can even lower the risk of prostate cancer and many doctors believe that this benefit extends to the 1mg dose, but this particular point was not studied and is just conjecture.

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Can I Still Use Rogaine While Trying to Have a Baby?

Hi there,
I have been using 2% Rogaine for over 10 years with great success. I know I can’t use while pregnant- but what if it takes 8-9+ months TO get pregnant? Can I really not use while just trying if I intend to stop immediately once pregnant?
Thanks

This comes from Drugs.com: “Minoxidil topical has been assigned to pregnancy category C by the FDA. Animal studies using oral minoxidil have failed to reveal evidence of teratogenicity, but reduced conception rates and an increased incidence of fetal absorption have been observed in rabbits given 5 times the usual human oral dose. Minoxidil topical should not be administered to pregnant women.”

The key point in the above paragraph that relates to your question is about the rabbits given abnormally high doses of minoxidil. While it is probably not a problem for you to continue using Rogaine while conceiving, I would talk with your obstetrician.