Author: Dr. William Rassman

I’m 18 and I’ve had diffuse thinning for the past 3 years. Yes it sucks but it’s slow and still have decent amount of hair. I’ve noticed for the past 3 years that when ever I get a hair cut, my hair is easy to pull out. Same with sides and my back. Is this DUPA? I’m really worried because I hope it isn’t. I took pictures with the flash and it’s still thick. Also when my sides grow out, I try pulling on it and it doesn’t come our. WTF.

I am the doctor who defined DUPA and it is rare. You need to have a microscopic examination of your donor area if you want DUPA eliminated as a diagnostic possibility. Most hair transplanted doctors offer this.

Hello fellow baldies. I’ve finally decided to take the leap and go get a hair transplant. I’ve been quoted on the price and scheduled an appointment in Istanbul. The clinic is Esteliv if anyone’s wondering or if anyone has underwent a procedure there I’d love to hear how it went. About the procedure: *Extraction of follicles with micro motor using stemcell technique and Sapphire FUE. They will be extracting between 3000 and 4000 grafts. Hopefully this’ll be game changing for me. Wish me luck!

Do you need 3000-4000 grafts? You have a donor bank that only has withdrawals and the typical Caucasian has between 6000-7000 grafts, only half of which can be safely harvested from the donor area without getting over-harvesting. If you are Asian, Middle Eastern, or family from Southern Asia (India, Thailand or Vietnam) then usually limits are substantially less than Caucasians. Do you actually believe this Stemcell and Sapphire FUE stuff? You should realize it is all promotional stuff.

The photos show a lot of miniaturized hairs behind the hair transplant. I would expect to see hair loss behind the hair transplant unless you had been prescribed finasteride. Even with that, your hair transplant probably didn’t extend far enough back to cover the area of what appears to be advanced thinning. Hair loss here will not come back.

Dear Dr Rassman

I am a 31 year old male and around 5 years ago I realised that I had some hairline recession at the corners. I spent 2-3 years obsessing about this and worrying about whether I would be bald before I was 30 and I also worried about my crown too which looks a bit thinner than the centre of my scalp but remains covered with hair.

As I was so obsessed with this at the time, I tracked my hairloss pattern pretty closely and can safely say that it has not progressed much, if at all since then. The hairline is exactly the same (as is the crown). Maybe the corner areas which were thinning are a bit thinner but the actual area has not expanded. I do not take propecia and would prefer never to take it, for medical reasons.

Recently, for some reason, my hairline has started bothering me again, and feel like I would be more confident if I had it restored slightly so that I could spike my hair a bit rather than have the forelock fall flat over the receded areas. Actually what bothers me is not so much how it looks in the daytime, but first thing in the morning when I wake up. I guess the area which I would need transplanting is around 10-11cm squared in total…maybe 6 on one side and 4-5 on the other. This wouldn’t bring me to a straight juvenile hairline (which I don’t want anyway) but would be enough that I don’t look like I have a receded hairline.

My hair characteristics I am guessing are not great for a hair transplant. I have pretty good density in all other areas but my hair is brown and very fine. People are often surprised by how soft it is when they touch it – to give you an idea of how fine it is.

My question is, would having a small transplant (FUE) in these areas be a bad idea? Is it ever possible to perhaps transplant to these areas at a lowish density, just so that I look like I have a hairline rather than a forelock and so that if/when I lose hair elsewhere then I won’t be left with really dense temples and bald areas elsewhere. I would be happy with quite a conservative transplant which just gave the appearance of some hair in these areas, maybe just enough to style. I also think that one day, if I do lose a lot of hair elsewhere, I would shave my head down to a grade 3-4, but if I did this I would still want the appearance of a hairline to frame my face. With this in mind, maybe it wouldn’t be a terrible idea to get the corners transplanted? If it is not, roughly how many grafts might a 10-11cm squared area need?

Please let me know your thoughts. I have seen some very good FUE hair line transplant results online but I am guessing that a lot of these are very dense/’packed’ transplants.

 

There is a very simple answer to your question. If you are obsessed with your hair line then you need to make an appointment to see a doctor.

Yes, it does look like you have pushed your donor area and now have ‘donor site depletion’. I would have to examine you and measure your residual donor density. I see many such patients both in my office and over the internet. Scalpmicropigmentaiton is the best way to treat this and make it look good (https://scalpmicropigmentation.com/). If you are planning on doing more FUE grafts, make sure that you and your doctor discuss the risks of balding of the donor area.

 

I am just 15 and i am male. About 3 years ago i got nits and bought some conditioner for it. My scalp reacted with it and i got dandruff. My peers teased me about my dandruff and i started frantically rubbing my hair to get rid of it. When i was 14 it turned into pulling hair from the very centre of my scalp. i didnt want to pull my hair and get bald but i had an urge and got satisfaction out of pulling. i have now got a small circle of baldness on my scalp and have managed to stop pulling from there but now im pulling from the back of my neck and behind my ears and it is thinning out there. I require help and advice and want to know:if i leave it will it grow back to normal?

This condition is called trichotillomania, which is an impulse disorder characterized by the urge of pulling out hair from scalp, eyelashes, eyebrows, beard, nose, pubic area, or any other area in the body. It is most often related to obsessive-compulsive disorders. Surgical treatments for hair restoration are usually not indicated, and the best treatment would be through psychotherapy and behavioral treatment. You should be seen and treated by a psychiatrist. If you can stop pulling hair, it will usually grow back in a few months with no further treatments, but if you have stopped pulling out your hair and the hair does not return, then transplants are a relatively fool proof way of handing it provided that you do not go back to pucking out the hair again and again.

Dr. Richard Shiell wrote the following about this disease: “By far the most common of patients with this disease are children of both sexes and as trichotillomania is an OCD, where stress seems to play a role, most of the kids just “grow out of it” with no lasting problems. Success rate very high (probably over 90 %)

Some do not grow out of it however and a small percentage of the females go on to be chronic pluckers. They associate the plucking with episodes of stress but I do not know if this has been verified scientifically. Most of the cases I see fall into this category and have plucked each hair so many times that the follicles in the patch cease to grow somewhere along the line. In other cases, not so long standing, the hair is short , vellus-like and snowy white in the plucked area. It is this group of women who acknowledge the plucking (past or present) and who are seeking help that you will have some success after transplantation. I cannot give you a figure for success as I have lost contact with all of these patients over the years. Psychologists tell me that medication will assist those members of this group who find it difficult to refrain from plucking.”

The cowlick is a remnant from your juvenile hairline and many women think it is sexy. Consider yourself sexy and lucky

You have something called ‘donor site depletion’ or you could have shock loss which means that the FUE grafts were taken too close and possibly too many for your donor area to support it. Maybe some of the hairs have been shocked out and may return, but if this continues through the 8th month, then you have a problem, the only solution is Scalpmicropigmentation which can hide the effects of the missing hair very well.

I started receding when I was about 18 but it stabilized and never went past what I now understand to be a “Norwood 2.”

However, now that I’m in my early 40s, and particularly over the last year, I’ve noticed a substantial thinning on top (still no bald batch in the back). I can clearly see scalp.

Could this be a medical issue (hormone changes with age) or is there something I should be tested for to correct the situation?

My grandfather (mother’s side) was bald; my father had his hair, as did his father. My uncle (on mother’s side) lost most of his hair in his 40s-50s. I have two older brothers and both are receding but nothing dramatic.

This is called getting old. Maybe you always had some thinning but as you get old it is showing more. Maybe you were genetically programmed to be a Norwood 2V/ 3V. I do not know.

The best test to find out if you are balding, is to get a hair Bulk Analysis or a Miniaturization Test in a doctor’s office. We do these routinely. Just yesterday, a 27 year old male came in with hair loss in the frontal hairline, but when I did the hair bulk analyses, I found that he was losing hair in the top and crown where he could not see it. There really is no blood test other than establishing a diagnosis by a competent doctor in the office setting. I realize there are genetic blood test for androgenic alopecia but the results will not give you a clear cut yes or no with regard to whether you are balding or not. Even if the answer to the genetic test is that you do or do ot have genetic balding genes, you still have the hair loss issue that is something that only a doctor can tell you once he examines you for hair bulk around your entire scalp.

In the end if you want to do something about it, you are left with (1) drugs (Propecia or Rogaine) (2) hair transplant surgery if you can see the hair loss (3) scalp micropgimentation (4) different hair style. Finally it is rare for men to have other medical issues that would cause a “pattern” balding. The “pattern” you are describing may be Male “Pattern” Balding. See a doctor if you want to do something about it.

Although the front looks good, the back does not look as good as I expected. What do you recommend?

What you got now is about what you will get and no more. Usually all of the grafts have grown out in a year? If you want more density, you will probably have to meet with your surgeon again and ask for a second surgery for the crown or consider Scalp Micropigmentation (https://scalpmicropigmentation.com/gallery/thinning-hair/#!https://scalpmicropigmentation.com/wp-content/uploads/2016/04/scalp_micropigmentation-new_hair_institute-042-thinning_hair.jpg).