Author: Dr. William Rassman

Posted on

Hair Loss Information – Balding Blog

Hi Doctor,

A lot of questions on here about initial shedding after a transplant, but my question is regarding transplanted hairs shedding years later, due to the natural hair growth process.

I noticed my transplanted areas have become thinner over the past couple of months. It has been almost 4 years since my surgery. It is well known that the hair growth cycle for hair is between 3-4 years, then they shed to make room for new hair. I was wondering since all transplanted hairs are relatively growing at the same rate or time period, should we expect periods of thinness every 3-4 years when these hairs are ready to shed again? In other words going through a shed similar to your first initial shed before the hairs started growing again. I hope my question makes sense.

Transplanted hair is permanent for most people. In the recipient area, the surrounding non-transplanted hairs may not be permanent and you will continue to lose those hairs. Years after a hair transplant you may be noticing the non-transplanted hairs falling. This is assuming there was non-transplanted hairs mixed in with the transplanted hairs.

If your hairs were transplanted on a completely bald area of your scalp and you are noticing shedding, this is not considered normal. It may regrow if you are experiencing telogen effluvium, which is a temporary hair loss that can occur at any time… or you could be one of those rare people who lose transplanted hair. I always look at the permanent zone when someone asks me about hair loss in the recipient area, in case they are losing donor area hair. Whatever happens to the donor area will happen to the recipient area. For example — in elderly folks, there is a condition called senile alopecia which reflects thinning of the hair throughout the head, including the donor area.

In a very rare instance, you may actually be experiencing permanent transplanted hair loss which I have seen possibly a dozen times in my 20+ years in practice. I don’t remember a cause of this to ever have been pinpointed in most of those patients and I wonder if I should be biopsying them when I see that problem, looking for diseases like diffuse alopecia areata.


Posted on

1 year after 3000 FUE graft surgery and I am unhappy (photo)

There are many comments I could make here. There are teams of technicians working on a case of your size and if any of them had less skills than others, the grafts placed by the less skilled technicians could have caused this problem. There are many technical nuances in a hair transplant and any of them could have caused this problem, so speaking with your doctor is a good idea, at the least to get the feedback you need.


2017-11-19 15:44:301 year after 3000 FUE graft surgery and I am unhappy (photo)

Posted on

Am I Experiencing New Hair Growth on the Crown?

Dr Rassman,

thanks for all your blog has done, its really a great resource and place for answers. Its been a great help for me.

I am turning 25 soon, and for the past year have been driving myself crazy because my hair has thinned. I did catch it very early, its far from noticable to the naked eye, and ive been on propecia for almost 10 months.

Heres my question, I recently noticed what feels like short spikey hairs on my scalp, my hair is long so i cant see them, only feel them.

would this be considered new hair growth? I know all about miniaturization (thanks to this blog) but these hairs feel very hard and spikey. And im sure they werent there a few months ago. The spikey hairs are only on the crown and other areas my hair has thinned.

any comments you have to help answer my question are greatly appreciated

You could be experiencing new hair growth. Follow it over the next few months and get some good photographs if you can ASAP and then more later on to compare.


2007-02-14 14:53:02Am I Experiencing New Hair Growth on the Crown?

Posted on

Am I Regrowing Hair from Cialis?

Does anyone know why I’ve also started to grow hair? I’ve started taking Cialis about 2 months ago with the once a week pills, it was giving me a major headache so i broke the pill into thirds and I’m talking a third every week or like every 4 days or so (headache is gone) and its great stuff, but my hair is starting to slightly grow back. Anyone know or is it a fluke?

Cialis (tadalafil) is generally taken for growth in the other head.

No, I am not familiar with any verified reports of hair growth from Cialis. We have had reports of hair loss from this drug, however, nothing is clear with regard to this. Have you talked to your doctor about your findings?

Posted on

Am I balding (photos)

Yes, you have a very early recession developing with miniaturization of the hairs in the frontal hairline. This could be reversed with minoxidil, finasteride and possibly microneedling.


2020-09-01 09:42:41Am I balding (photos)

Posted on

Am I receding?

A good photo to show your recession should be a frontal view with your hair pulled back and your eyebrows lifted high so that the creases on the forehead show up. This will show the anatomical landmarks to measure where your hairline belongs and more about what the shape should be. A normal hairline is one finger breadth above the highest crease of the furrowed brow. Anything higher is recession. I can only guess that this man doesn’t have recession because the frontal hairline is flat, which is an evolutionary step towards a mature hairline, but if he supplied me the photos as I outlined above, I could be more definitive.

 

Posted on

Am I really balding?

Did my dermatologist prescribe Finasteride too liberally ? Context : 27 y/o. Father and his 4 brothers have full heads of hair. Mother’s side : 3 out of 4 bald uncles. They were bald in their early twenties. I went to the derm two weeks ago. He didn’t look closely at me or do a hair count. He was like “yep, looks like MPB alright” and gave me a prescription for Fin (1mg). First pic is Aug 2017. Rest of the pics are from the last 2-3 months.

I would have performed a HAIRCHECK and a miniaturization study before committing you to a lifetime of finasteride. Too many men go on the drug not knowing for sure if they are balding. I like to make the diagnosis with instruments first, then use these instruments to establish a ‘metric’ which I can follow yearly to see the effectiveness of the finasteride yearly. That is the value I believe doctors should add to this treatment process.

question balding