Author: Dr. William Rassman

What I would want to know is your hair character, its thickness and your donor density, all three are determined at an examination. Once I have that, I can determine what it would take to perform a hair transplant in terms of using up your donor supply which is limited. Your pattern of hair loss is a ‘high’ Class 6 pattern which means to me that the sides may come down as you age. It would be all part of my Master Plan to be able to work with you for the years to come as hair loss is progressive and you might not have yet seen where your hair loss will take you. i tell most men that they should not do a hair transplant until they are at least 25 years old and clearly you are older than that so that your present hair loss pattern is now evident? The key here is to set realiztic expectations with your surgeon.

If you have thinning and possibly PCOS, treatments like Scalp Micropigmentation works very well to make your hair look fuller: https://scalpmicropigmentation.com/gallery/smp-for-women/

Yes, at age 27 with a Class 3A pattern of balding, you are an excellent candidate for a hair transplant. I would think that it would take about 2000+ grafts (less if it your hair is coarse, more if it was fine hair).

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/

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.

I have been to 4 different doctors about my hair loss and none of them gave me a diagnosis or treatment recommendation other than Rogaine. I am not happy with the results of the Rogaine and I want a solution to find out what is wrong with me and what can I do about it. Any suggestions you might offer will be helpful.

You most likely have some component of female genetic hair loss. I look at you and would ask: How can I help you if you came to see me. Assuming that your blood tests and medical history was clear of causes for hair loss, I would do the following:

1- Perform a hair transplant in the frontal 1 1/2 inches where there is clear balding

2- Perform Scalp Micropigmentation for the rest of your scalp where your hair is thinning as hair transplants don’t do well with thinning hair in women (see here: https://scalpmicropigmentation.com/smp-for-women/)

See if you can find a doctor who can do both of these processes. If not, consider coming to Los Angeles, as we do offer travel subsidies.

I can now see through to the scalp in the back of my head, which looks like it is balding now. Will the hair grow back in the donor area?

After an FUE, the hair that was removed is gone forever and will never regrow. In African hair, the donor supply is numerically lower than both Asians and Caucasians by as much as 10% to 40% respectively. As a result, the limits for FUE are much more restricted in people of African decent. If you are a typical African American, then the limit for FUE should have been 1,400 grafts (see this link which explains this: https://newhair.com/donor-area/). You have what we call donor site depletion. Since you now have donor area depletion, the only thing that you can do, which works very effectively, is Scalp MicroPigmentation (see here: https://scalpmicropigmentation.com/scar-covering/).

I have a few questions about getting a hair transplant as a 26 year old. Before I get the “just go bald” comments, I’m not gonna do that, so save your breathe. Call me vain or whatever.

Anyway, I’m currently on finasteride, but I started after my temples had already receded and my hairline is just….a mess. I really, really want to get a transplant on my temples/hairline right now, while my looks actually matter to me. I know waiting till I’m in my 30’s makes more sense, since the balding will likely have completed by then and I can repair it all at once, but my looks are important to me now more than ever. It really hurts my self-esteem…

I guess what I’m wondering is, will it be okay to get a transplant on my hairline now and then just get another one when I’m older/in my 30’s to fix the rest once the balding has completed? The finasteride should keep the rest from falling out until then, right? (It’s been working for me thus far)

By this age, you can transplant the frontal hairline. What you need is a Personalized Master Plan for this process. I would do a HAIRCHECK test (https://baldingblog.com/haircheck-test-how-it-is-done-video/ ) to determine your present balding pattern and try to predict your future hair loss pattern. Then I would quantify your donor supply to know just how many grafts you have in your lifetime so that good planning can start now. With this information, you can be intelligent about how many grafts that doctor is going to use up now, and how many grafts your doctor will leave behind. There is an interesting problem that most men don’t recognize. Too many doctors push graft numbers high because they charge by the graft so they profit from more grafts at the time of the surgery. I have seen many patients that had twice the number expended for a frontal hairline and then down the road they might run out of hair. Get a doctor who understands this process and cares more about his/her patient than their pocketbooks. If you stay on finastetride, you will prevent shock loss and hold on to your native hair.

The hair loss behind what is still a strong hairline. In some Indian men, these strong hairlines can persist for many years even if the hair behind it goes. His pattern from other photos not shown here, is almost certainly going to develop into a Class 6 pattern so I told him to postpone surgery at this time. He should try the drug Finpecia (available in India) as this drug might reverse the hair loss especially when used in conjunction with minoxidil.

Too many young men want to rush hair transplants and too many doctors are happy to take their money and do it; however, hair transplants done too early, may leave the man with a balding pattern that the doctor and the patient never planned for (and that would be bad for the patient but the doctor has already pocked the money and I am sure it cleared his bank account)