Author: Dr. William Rassman

I have been on oral minoxidil and been microneedling for a year or so, then I added finasteride just 3 months ago. What do you think?

I suspect if you continue with this routine, you will get the results you are hoping for. Finasteride works well in the crown, more than the frontal areas. Your frontal areas have filled in nicely and I would expect the crown to follow. Keep it up.

I have a scar from hitting my head on the sidewalk 3 months ago. The gash on my scalp has healed very nicely(thin red line) but there’s a bald spot to one side of where the gash has healed. How long do I wait to find out if hair will grow back there and why is it not bald on both sides of the gash?

If the spot lasts more than 5-6 months, you can probably see someone about treating it. Sometimes a limited transplant can work nicely on scalp scars from accidents.

I recently moved to US (bay area) and have been noticing a lot of hair fall. Slightly pulling my hair causes them to come out. I have no serious illness etc. What could be causing the increased hair loss?

Thanks!

It could be a variety of things. Perhaps it is your genetics and the timing was coincidental to the move… or it could be stress-induced (moving can do that)… or it could be allergy… etc, etc. I really have no way to know based on your email with limited information. You should see a doctor if you’re concerned.

You should see a dermatologist! This could be alopecia areata.

My medical hair history: I entered the Hair Transplant business in my private practice forming New Hair Institute in late 1991. With a partner who had done thousands of hair transplants at Bosley, he and I worked together. My crown was balding and my wife told me that it was bad business to have a bald crown and then talk to patient about treating their bald crown areas while I had one. So my partner recommended Scalp Reduction Surgeries (I had three of them, one every 2 months completing the sequence of surgeries in 6 months). What happened was historic. By the last of the three surgeries, my bald crown came back and my scalp was scarred badly. As soon as I realized I was deformed, I picked up the phone and called the worlds expert in the field at that time (no name here because he is still alive) and told him about my problem, asking him how often he saw such problems (I was thinking it was rare). He said it was very, very common, in fact, most people had their bald areas return. I followed up with: “Why didn’t you publish these results and stop the surgeries from being done?“. He responded: “It would have been bad for business!” I felt sick and disgusted with him and his comments as now I was both a victim of this horrific surgery (the removal of the bald area in the crown) and a doctor who had already started doing them on my own patients (6 surgeries, one on my own first cousin and best friend). All 6 people had the same thing happen to them, so I tried to make amends with them by giving them hair transplants to solve their bald crown area. I also started a campaign to DEMYSTIFY this horrific surgery and expose it for what it was, a deforming surgery. I published against it and spoke before the largest hair meeting in the world telling the audience: “That I would volunteer my services for all victims of the Scalp Reduction surgery as an expert witness in any malpractice case brought against anyone performing this surgery with the resulting deformities that it produced” . I was blackballed for about a year by other doctors who made a good living doing this surgery, but what happened was almost immediately after my announcement, the doctors that performed the procedure stopped doing it. Now, it is rarely, if ever, performed. To fix my problem, I had three hair transplant surgeries of about 900 grafts each over 25 years. Still, my crown was not as thick as I wanted it to be, so today I took the last step and had Scalp Micropigmentation performed on my crown. My before (the first two photos) and after pictures (the last ones) are below. Now any thinning that has remained is gone! I practice what I preach! Comment: I don ‘t think I look balding in my crown now, the first time in years that the problem is solved. The last picture was taken 6 weeks later (I think I got more salty color in my hair over the past month or so).

AFTER

4000 grafts are likely 60% or more of your donor supply. Have you considered what you would do if your hair loss pattern evolved into a more advanced balding pattern? If you are under 26, this is a significant question; however, if you are over 35, the risk of developing a more advanced pattern may not be substantial unless some male in your family line developed a later pattern of advanced balding. Who do you take after in your family line? Do you have a worst-case plan? I think 4000 grafts for a balding Class 3 pattern male is mal-practice.

I’ve only just noticed I have bald spot after someone mentioned it, it is in an awkward place to see in the mirror. The bald spot is only at the crown area and I haven’t noticed any other hair loss anywhere else. However I do think my hair has thinned recently (last year or so). Do you have any suggestions as to what I should do next -see a GP, observe for a few months etc.?

I’m only 21 years old and I’m quite self conscious now that I’ve had comments about it.

Thanks in advance for any help.

You can consider a visit to our office in Los Angeles if you’re local or planning a trip out this way (the consultation is free). Otherwise see a good doctor, perhaps your family doctor, who will be able to determine what you have and what you can do about it.

If you think it is the beginning of male pattern baldness, you certainly want to see about starting treatment early… but I don’t know what is causing your bald spot at this point. I often mention the Master Plan when considering future hair loss. Educate yourself.

I began using fin (1mg) today and want to avoid sexual side effects. Do you recommend starting out by taking it only a few times a week then progressively taking it more often until it’s 1mg per day? I saw you’re comment saying that this is a reasonable strategy to avoid side effects

Generally, since the risk of sexual side effects is less than 4%, it is best start at a full dose. If you are the 1:25 people, then change to the routine I referenced in a previous post.

I just started Dutasteride. What’s this about the half-life allowing you to take it less often than fin?

The half life for dutasteride is 6 days (this is in the blood), but the tissue life (at the hair follicle itself) lasts much longer-possibly weeks or even a month. Less frequent dosing is ok, in my humble opinion.