Author: Dr. William Rassman

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Diffuse Patterned Alopecia

Hi Dr Rassman!

I’ve been said I have male pattern baldness by a doctor. I’m currently 21 years old I lose my hair since I was 14. From reading articles over the internet, I think I have DPA (Diffuse Patterned Alopecia). My hair is thinning on the top, but remains thick on the sides. I have loss at the temples and crown in a diffuse way, but not restricted to these places (also thinning all the top). I currently take Propecia since I was 18. I don’t know if it’s helping, but I take in case it would be worse without it.

I’d like to know what causes DPA. Is it really androgenetic? Can it be from poor diet and life style? Is it reversible? What are the best options for treatments? Thank you for your attention and this excellent website!

Diffuse patterned alopecia (DPA) in men is mostly genetic in origin and Propecia (finasteride 1mg) is a good way to treat it. Have you had your hair mapped out for miniaturization to be sure? What is the result of your hair pull test? This test may point to a diffuse telogen effluvium. I can not really diagnose you via this site without examining you first.

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Should Diffuse Thinning Be Treated with Hair Transplantation? (from Reddit)

Although some hair transplant doctors offer hair transplants for diffuse thinning, I consider this an issue of malpractice because, if it is really diffuse thinning, there is little value of a hair transplant to correct this. Sometimes, a hair transplant for thinning in the frontal area can work in women. For men, it takes a good honorable surgeon who is not in a rush to take your money. So, be careful about hair transplantation to solve this problem. Patterned thinning is often a precursor to balding. If you are a male, have a doctor evaluate you for this then build a Master Plan for your future balding which almost always happens.

Hair transplant for diffuse hair loss from tressless

 


2018-09-14 09:06:55Should Diffuse Thinning Be Treated with Hair Transplantation? (from Reddit)

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Diffuse patterned or unpatterned thinning?

Is it the occurrence of shedding all over the top of the scalp? From what I understand there are two major camps of hair loss suffers, the diffusers and the miniaturizers… and sometimes both. But anyways what exactly is diffuse thinning? I get mixed answers all over the place

Thinning comes in two types (1) Diffuse Patterned thinning that fits into confined areas and it is often related to genetic balding and the thinning is a precursor to it, and (2) Diffuse Unpatterned Alopecia (thinning or DUPA) which occurs throughout the entire scalp, even in the back of the head which is usually immune to genetic hair loss. Some women get DUPA when they pass menopause. There is a new term just pioneered by Myself and Dr. Robert Bernstein which is Age Related Thinning (this occurs when the entire population of terminal hairs become uniformly thinner.
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Diffuse Hairloss and Sebum Plugs

I’ve have consistent diffuse hairloss universally around my head for about a year and a half, to the point where I believe I’ve lost about 60-70% of my hair. Many of the hairs that fall have large white plugs attached to them (see pictures), which I believe may be sebum.

Is this in fact sebum? Can these plugs cause diffuse hairloss? Any idea what may cause them or what might treat them? So far, I’ve tried zinc, ketoconazole, salicylic acid, coal tar, and other “sebum reducing” shampoos. I have also been on propecia for 6 months, but with no noticeable reduction in the pace of my loss.

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Sebum is a waxy substance from the production of oil from your sebaceous glands. It can be seen on ends of hair follicles that fall out but this does not mean you have a hair loss condition or disease process (because of the sebum). There are products that claim better control of sebum and Internet posts that claim the sebum is the cause of hair loss. It generally makes for great marketing campaign to sell a product to those who are looking for a hair loss cure. Sebum does not cause hair loss, if it did, the many men and women on skid-row would be balding as they often do not shampoo their hair and reduce their sebum buildup. If you are experiencing diffuse hair loss, I doubt sebum is the root cause (no pun intended). You need to see a doctor for your hair loss condition to establish a good diagnosis.

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Direction of Graft Growth

Hi Dr,

Can you explain how accurately a surgeon such as yourself can transplant grafts so that hairs grow in the same direction?

I have seen quite a few celebrity transplants where the hair still appears thin and the hair once grown out always looks messy because the direction of the grafts is not quite right.

How are you able to ensure that this doesn’t happen?

As someone with naturally fine and very straight hair then i imagine it would be essential that any transplant i had done should be performed by a top surgeon who is able to make sure that the angle of the transplanted graft is accurate. If i had thicker and naturally curly hair then i suppose this wouldn’t matter so much and is probably a part of the reason why those with curly make better candidates?

Thanks

Doctors have direct control of how the transplanted hair grows and how the transplanted hairs are distributed to give the most natural look. This is a very important point that most prospective patients do not take into account when searching for the right medical group for a hair transplant procedure.

You are correct in stating the fine straight hairs need careful attention to detail when undergoing a hair transplant procedure, but careful attention to detail is also a must for coarse hair, because each hair can have many times the bulk of a fine hair. A coarse hair put in the wrong direction will be more easily detected than a fine hair put in the wrong direction. Some surgeons, when placing the hairline, place the frontal hairs radially (like bicycle spokes). Is it possible that surgeons who do this do not understand the normal direction of the hair growth, just are ignorant of the facts? Sometimes I think so.

To be sure that these poor placement doesn’t happen to you, you have to do your own research and due diligence. There are many good doctors with great artistic skills. The best way to determine who these doctors are is to ask to meet some of their patients. My patients love showing off their results in the privacy of our office, so we set up circumstances once a month to allow this to happen. To me, this is just plain good medical education. This is why we have our monthly Open House events where anyone can come and see our former patients (up close) and speak with them face to face.


2012-09-05 10:30:14Direction of Graft Growth

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Diffuse thinning and not getting better

hi doctor, i’d like to apologize’ first because i dont have good progress pics to post but i’d still like to get some advice

i’m a diffuse thinner and i’ve been using minox for 9 months and finasteride for about 7 month. was losing 100+ strands of hair daily when i shower but since last month the hair loss has gone down to around 50+ strands, should be a good thing right? but the problem is that my hair density and volume are way below baseline and it worries me a lot

what should i do, are there any other options? keep it up and just wait and see how it goes? i’m worried that my hair loss didn’t actually “improve” and i’m losing fewer hairs simply because i dont have as much hair to lose now compared to before, if you get what i mean.

There are thickening agents you can buy which will make your hair look much better. These medications will hold the hair you have and not regrow new hair. You need to see a doctor and get a Personalized Master Plan for your hair both short term and long term, knowing where you are going will be helpful for your future planning.


2020-12-15 07:07:33Diffuse thinning and not getting better

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Disappearing Neck Hair (photo)

Note that in this photo, the neck hair in this man has already started to disappear. This is a genetic trait that is different from general Male Patterned Genetic Balding. For this reason, I never transplant the neck hair into the recipient area because this hair, in some men, is not permanent hair. Note the transition between the neck hair and the scalp hair at are about the occipital notch (base of the skull).


2019-07-30 09:28:40Disappearing Neck Hair (photo)

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Disappointed with My Hair Transplant from 8 Months Ago

Hello. I had an FUT procedure done at [name removed] about 8 months ago. I see visible, what look like holes on my recipient area from overhead lighting, almost like scarring. Obviously, I wasn’t expecting this as I had heard that new techniques show no visible recipient scarring or mini holes. Will this EVER heal in time, because now i am freaking out about it. If so, how long does this take to go away?

In addition, my hair is darker on the sides than the top so the recipient hair does not match in color. Will this change in time? My doctor tells me the sun will change it and it will eventually grow in lighter at the roots but I don’t know if I trust anything they say anymore.

I wish I had never done this and don’t know where to go from here. Any answers and direction would be very helpful because I am freaked out now.

Generally by 8 to 12 months most of your hair transplants should have grown and you should not have the visible holes or scarring that you are describing. As you do, then this is probably permanent. Sometimes certain patients are more prone to scarring than others, but that is not what you seem to be describing and it is very, very, very rare in the recipient area. With respect to hair color, your hair color should generally match the hair on the back and sides of your head.

Obviously it is very difficult and practically impossible to give personalized advice this way. If I viewed the recipient site ‘holes’ you are talking about, what you call ‘holes’, I may call something else. If you like to have a formal consult, I would be happy to review your case. Please call my office at 800-NEW-HAIR to arrange this or send photos to the address on the contact page (reference this posting, please). You pictures and your correspondence with us will be maintained confidential (it is also the law that protects privacy).

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Diffuse Unpatterned Alopecia-DUPA

I have a Class 3 balding pattern (just corner loss) and I went to a hair transplant doctor who offered to perform 2000 grafts in the front to address the balding area. It seemed to me that I was thinning outside of my frontal balding area. The doctor who offered me the surgery never looked at my hair under a microscope. I am a 24 year old male and I purchased a hand microscope as you suggested on Amazon. When I looked at my donor area, this is what I saw in different parts of the donor area. How would you interpret the hand microscope pictures I have attached here?

This is clearly Diffuse Unpatterned Alpopecia (DUPA) which I originally wrote about in 1997 (see here: https://baldingblog.com/wp-content/uploads/pdf/mp-1997-evaluation.pdf). The view of your donor area shows very significant miniaturization of the donor area which means you are not a candidate for a hair transplant because it will fail. The hairs that get transplanted will look like these hairs and not have much bulk to them. The doctor who recommended 2000 grafts just wanted your money and probably never read about DUPA. You seem too smart for that doctor. The drug finasteride sometimes helps.

This is what my donor area looks like