Author: Dr. William Rassman

This patient came today at the age of 44. He start to lose hair just 3 years ago, an came because he wanted a hair transplant. His hair is black, medium weight and it has a good wave to it. He is of Italian heritage which gives him a terrific hair character. I measured his hair bulk with the HAIRCHECK instrument and found that he lost 66% of the hair in the front and 55% of his hair in the crown. Considering that is hair is black and his skin is light, he still have good coverage in the front of his head which shows something very important, that you really only need 33% of your hair when the quality is there to have a reasonably full look. This is the type of look to generally achieve in a single hair transplant in a bald man.

 

 

This is a common finding in some women, although it is more common as women get older. I have treated many of these women with a hair transplant to put back the rounded hairlines typical of the female hairline. You should be look at my an expert to make sure that you don’t have an autoimmune disease like Frontal Fibrosing Alopecia. a diagnosis that is easy to make when your doctor is skilled in the examination of a female hairline

You need to sit down with a good doctor and get an examination that might predict your hair loss pattern. If that can be predicted (I often do this with the HAIRCHECK test), then your course after a single hair transplant might be anticipated. There is never certainty as I use the tools I have to give people the best assessment of their course over time. At our Monthly Open House events we have patients who had one or two hair transplant sessions and did not need anything after. If you come to one of these events, you can meet these patients one-on-one. The older you are when you start, the more predictable the risks, but if you wait, then you will learn to live with balding while you are younger, something most men who see me don’t want to do.

Considering a hair transplant but thinking about long-term commitments post-op from tressless

It is very difficult to tell from this photo if you are receding or developing a maturing hairline. The best way to determine this is to lift your eyebrows so that your forehead wrinkles and the hairline should be no higher than one finger breath above the highest wrinkle. If this is the case, maybe your hairline is maturing.

This is a failure of the transplant unless your surgeon placed far less than the 2200 grafts you reported. I would go back to have a frank discussion with your surgeon as you paid good money to have this done. The most frequent reasons for hair transplant failure, is some technical glitch or lack of experience by the surgeon and/or his team!

I am 26 and I lost a lot of hair giving me a huge forehead. How many grafts will this take?

First, what I need is a frontal picture with your hair pulled back and your eyebrows lifted high so that your forehead creases. That shows me the anatomic point that allows me to determine the proper place of the hair line. Once I know this, I can give you a recommendation on the number of grafts you would need for a hair transplant. Keep in mind that fine hair takes more grafts than coarse hair. In addition to the picture, I would want to know the thickness of the hair in the back of your head.

My mother and aunt have a similar problem. What should I do?

Clearly you are very thin and have a see through appearance. If this is in the female side of your family, it is most likely genetic. First, you want to make sure that it is not caused by some medical condition.

Female hair loss is a difficult analysis and requires many tests, not just thyroid testing. I simply can not write a textbook on the subject on this site, but here’s a list of past posts that may help you understand what you’ve got going on:

1. Female Genetic Hair Loss Is Different From Male Genetic Hair Loss
2. Birth Control Pills and Hair Loss
3. Woman With Thinning Hair After Family Tragedy
4. Diseases Causing Women’s Hair Loss
5. Female Hair Loss

The first step in evaluating hair loss in women, after a detailed history and physical exam, is to rule out any underlying medical causes of hair loss which can be treated. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. Furthermore, over 50% of women going through change of life hormone fluctuations (menopause) experience significant hair loss. It is also important to review the use of medications that may cause hair loss, such as (but not limited to) oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin, and prednisone. The following laboratory tests have been recommended to rule out the aforementioned medical conditions:

Some common blood tests for female hair loss:

• Sex Hormone tests
• SHBG (Sex Hormone Binding Globulin) used to test status of male hormones
• Estradiol is a sex hormone
• FSH (Follicle Stimulating Hormone) *not hair follicle but follicle in the ovary*
• LH (Luteinizing Hormone) is a sex hormone
• Free Testosterone
• Total Testosterone
• ANA (Anti Nuclear Antibody) used to test for Lupus or other autoimmune diseases
• TSH (Thyroid Stimulating Hormone) used to test for hyper or hypo-thyroid disease
• Test Iron status
• TIBC (Total Iron Binding Capacity)
• Ferritin
• Iron

Assuming that you do not have a medical cause and it is genetic female hair loss as seen in your aunt and mother, then one of the better cosmetic treatments for this is Scalp Micropigmentation: https://scalpmicropigmentation.com/smp-for-women/

This is his answer to me: “Thanks for your reply. You bring up a very good point that if I continue to bald behind the transplant it will look strange, however, if that does occur, I do plan on chasing it with further HT’s in the future. I positioned myself in a career where I can financially do this and am very aware that this is not a “quick fix”. I see this initial transplant as the first step in a long process. Please continue to voice your thoughts and concerns.”

If you go forward with this plan, be sure to put together a good Master Plan for your future, and include an assessment of your depleting donor supply, which will occur as you do more and more hair transplants. You must make sure that you never get into a situation where you will run out of hair.