Author: Dr. William Rassman

Hi Mr. Rassman! Many off us now that chronic stress is bad for the overall health, one of the potential effects of stressors is an increased hairloss, maybe not such a big problem if you dont have androgenetic alopecia but if you do this temporary increased hairloss can potentially do more damage to the already weakening follicles! So my questions is:

1. In the connection to stress what is exactly happening chemically in the hair follicles that is leading to increased hairloss/premature entering of the anagen follicles to telogen?

2. And finally, hairloss that is connected to severe stress follows a diffuse pattern or am i wrong?

I do not have the answer to your question. Extreme stress (both emotional or physical) can cause hair loss and for men with genetic hair loss, it will follow a pattern of loss (not become diffuse). In women, this is often not the case as they are more likely to develop a diffuse form of thinning (without a specific pattern). I do not know the exact biochemical science behind hair loss caused by stress. As it is often said, medicine is mostly a descriptive science. Many times, we don’t know exact mechanisms.

Is hair transplant useless if finasteride doesn’t work on your normal hair?

Hair transplants are taken from the back and sides of the head. These hairs (we call in the donor zone) are permanent hairs that never fall out, so when they are moved to the balding area they take their genes with them. Finasteride has no effect on these permanent hairs.

If you are considering putting hair back where you lost it by having a hair transplant, the big decision is to take the step of finding a caring, competent doctor working with an experienced team, followed by scheduling a hair transplant. For most men, scheduling a hair transplant is the greatest step, in other words, to fix a problem with a surgical solution.

Fortunately, the hair transplant procedure has been made absolutely undetectable today, contrary to the 1990s, when everyone could see a hair transplanted patient and know it was not normal. Today, normalcy is the rule in the hands of an excellent hair transplant surgeon who has developed an excellent surgical team that has been fine-tuned over many years.

Most cosmetic surgeries only require the skills of a single surgeon, but all hair transplant surgeries require the skills of a great surgeon who built a great team to work with. A great surgeon with a poor team will produce poor results. A bad surgeon with a great team will also produce poor results. Why am I saying this when everyone thinks that the surgeon is the key to a good hair transplant? It is because a good hair transplant requires a skilled surgical team that understands quality control systems, similar to great manufacturing operations. When the team produces 2,000 grafts, it is a team effort that works under strict quality systems rules.

Once you take the plunge in deciding if you should go for a hair transplant, the next step is to find the best doctor with the best team that knows how to work together. Then, you need to decide if you should want a strip surgery (FUT) or FUE.

The FUT procedure (Follicular Unit Transplant) harvests a batch of hair by cutting a strip from the back of the head. The strip of hair is then dissected into their natural family groups with a large team of technicians working with high powered microscopes. Both I and my wife and daughter-in-law had strip surgeries, and we have undetectable scars.

On the other hand, the FUE procedure (Follicular Unit Excision) is a hair transplant procedure that harvests the hair follicles in singular hair groupings. FUE is a great procedure that I pioneered. But contrary to most young men’s belief that FUE is better than a strip procedure (FUT) because it does not scar, this is not the case. Many doctors would like you to believe that FUE is a scarless surgery, but take a look at the type of scars a large FUE session can create. Scars are a complication when FUE is performed on a person with low donor density and is unable to support a large number of FUE grafts. Many patients found out the hard way by getting 3,000-6,000 FUE grafts without having an assessment of their donor density performed prior to their surgery. As a result, over-harvesting has become far more common than you might expect. I love doing FUE and half of all of the surgeries we do today are FUE hair transplants, but for those of you who are reading this post, please note that anything done well in moderation may be good/ . Likewise, FUE done in moderations is a great surgical hair transplant procedure. However, when done in excess, the patient pays the price with ugly scarring that may never have been anticipated. Certainly, the unfortunate man in the photo below had no idea that his FUE was a massively scar-producing surgery because his doctor over-harvested grafts.

If the hair loss is stress induced and you have the genes for hair loss, then the answer may be no, it may not be reversible.

Australian Times:

Jack was 16 when he first noticed that his hairline was receding, as he checked photos his surfing friends had posted on Instagram.

“I’d look at pictures of me when I was 14 or 15, see the hairline and then look at pictures from a year later and say, ‘Oh, that’s changed’,” says Jack, a bashful but athletic high-school student.

Last week Jack, still just 17, underwent hair-transplant surgery to move 3,000 hair follicles from the back of his head to the front to re-create the hairline.

His parents, worried about the impact on his self-confidence, paid dollars 22,000 (pounds 14,000) for the surgery.

Jack is one of thousands of American teenagers turning to surgery for a follicular fix.

“We live in a world where you are judged by the pictures that you take – particularly by the opposite sex,” he said.

“In our age group, most of what you do is going towards appealing to the opposite sex. We’re just fixing something that, by genetics, we just didn’t luck out (on).”

Dr Keith Durante, who is treating Jack, claims that a growing proportion of the 200 hair-transplant procedures he performs in a year in West Islip, New York, are for men in their early twenties or late teens.

Thanks to the barrage of high-resolution pictures on social media, young men are spotting their retreating hairlines and thinning crowns at a much younger age.

Many of the patients Durante treats are diagnosed with clinical depression and are beginning to isolate themselves socially as a result of paranoia about their baldness, he claims.

“You will spend more money on psychiatry bills and medications than you would if you just gave these kids some hair and let them enjoy it for 5 to 10 years,” Durante said. “If they need (the treatment) done again, we can do it.”

Hair-transplant surgeons have been reluctant to treat men until their balding has plateaued, fearing treated hair could end up as an island of fluff if the balding continues. Durante says he can offset the hair-loss process with a mix of treatments.

Nonetheless, some rival surgeons believe it is irresponsible to begin treatment at a young age.

“You’re not creating new hair – you are just moving hair,” said Dr Spencer Kobren, a hair-loss expert.

“You have a finite amount of hair you can utilise. Most experts in the field would say that not only is that medically inappropriate, but it’s unethical.”