Author: Dr. William Rassman

I did my FUE in Turkey. After opertion I noticed some part of my recipient area seems more dark than rest of the part.After 1st week after wash the head is getting clean but those area,where still seems to be wet and little red.Today is 12th day,I am getting worried about the progress.As I am quite far from Turkey to consult my surgeon so please give me a guideline about the possibilities or likelyhoods.

You really need to contact your surgeons back in Turkey for a follow up (even by phone). What I see is not normal.

We actually wrote about hair transplant in Turkey as a medical tourism destination last week FUE in Turkey.

I work in a school and recently met an 8th grade student, so 13 or 14 years old, who had very advanced male pattern baldness. It had clearly progressed in the male pattern, and he was somewhere around a Norwood 5 or 5A. There was a large bald circle on the crown, and what remained of the forelock was very thin. My question is: Is it possible for MPB to occur that early without the presence of a disorder, or does balding at such a young age reflect some underlying problem beyond the simple genetic predisposition for male pattern baldness?

Androgenic alopecia (AGA) or Male Pattern Balding (MPB) starts with puberty when the hormones change in the young man. In general most MPB starts around late high school/ early college years. I suppose a 14 year old going through puberty can have signs of MPB. I have seen 16 to 18 year old boys with complete Norwood 5/6 balding.

Hello Dr! First of all, english is not my native language so please bear with me.

My question is about the genetics regarding male pattern baldness and if it’s only a “guessing game” to determine the future outcome of my hair situation.

I need some advice on my hair situation. I’m a 30 year old male who has been “struggling” with high temples since about high school. I’ve been obsessing about my hair since about january (never even thought about it before then). Probably a nw 2,5-3.

My family history is making me so confused over the outcome of my, probable, upcoming hair loss. Making a list for an easy read;

Moms side;
Granddad, full head of har until his 60s then a diffuse thinner. (Always had “fine hair”)

Grandmom, curly hair, little temple recession.
Uncle 1, fine hair. Receding hair line and vertex thinning in his 50s (maybe later)

Uncle 2, full head of hair, curly. Mom, thin fine hair.

Dads side;
Granddad, bald. Probably started in his late 20s. Uncle, bald. Noticeable when he was about 25. Dad, straght hair, high temples (like me). Full head of hair.

Brothers;
3 year older, diffuse thinner. Noticeable at vertex in his early 20s. 6 years younger, high temples, a little bit diffuse thinner.

Question:
Is it possible to pick up my grandfathers balding pattern later, for example, he started too notice thinning at the age of 28.. Can i follow hes pattern but 5 years later?

We don’t generally go into this much detail into family history or give a diagnosis or a prediction based on family history. In general male pattern balding is genetic but it does not always follow a family line. The best way to diagnose MPB is through an exam (in person).

If you have a Norwood 3 hair loss pattern then that is what you have.
If you think you are going to have a Norwood 5 hair loss pattern, then the best way to find out is through a detailed exam. Looking at your hair under a microscope (MINIATURIZATION STUDY) or testing the bulk of your hair over a period of time (BULK STUDY) is the best way to diagnose the balding pattern.

Dear Dr.i would Like to ask about finasteride,while taking finasteride can i have oral sex or not,my wife is feeding mother now for the past 3 months i am taking generic finasteride in my query is can i oral sex or not is it safe or unsafe please advise me my,during the medication period oral sex is safe or not pls advise still we are continuing the same.

Always follow up with your doctor and address the issues that concerns you. The Internet is not the source for medical assurance or self treatment. Taking finasteride from my knowledge should not be an issue when you have oral sex with your partner even if she is pregnant. If you are still worried, you can always abstain. We’ve written about this subject in the past. Search your query on the upper right corner.

Cell. 2015 Apr 9;161(2):277-90. doi: 10.1016/j.cell.2015.02.016.
Organ-level quorum sensing directs regeneration in hair stem cell populations.
Chen CC1, Wang L2, Plikus MV3, Jiang TX4, Murray PJ5, Ramos R3, Guerrero-Juarez CF3, Hughes MW6, Lee OK7, Shi S8, Widelitz RB4, Lander AD9, Chuong CM10.
Author information
Abstract

Coordinated organ behavior is crucial for an effective response to environmental stimuli. By studying regeneration of hair follicles in response to patterned hair plucking, we demonstrate that organ-level quorum sensing allows coordinated responses to skin injury. Plucking hair at different densities leads to a regeneration of up to five times more neighboring, unplucked resting hairs, indicating activation of a collective decision-making process. Through data modeling, the range of the quorum signal was estimated to be on the order of 1 mm, greater than expected for a diffusible molecular cue. Molecular and genetic analysis uncovered a two-step mechanism, where release of CCL2 from injured hairs leads to recruitment of TNF-?-secreting macrophages, which accumulate and signal to both plucked and unplucked follicles. By coupling immune response with regeneration, this mechanism allows skin to respond predictably to distress, disregarding mild injury, while meeting stronger injury with full-scale cooperative activation of stem cells.

I have not personally seen such responses, but I will reach out to my colleagues and ask for their opinions. I already had a response from Dr. Bernstein in New York when asked about pucking, said: “No… I’ve been plucking for years – and look where it got me.” Dr. Bernstain has a Class 6 balding pattern as you can see on his informative hair restoration site here: http://www.bernsteinmedical.com/

I have been following your blog avidly and I see that you are very doubtful about LLLT therapy.

I have two questions. First, somewhat recently two double-blind randomized control trials for LLLT have been published (http://www.ncbi.nlm.nih.gov/pubmed/24474647, http://www.ncbi.nlm.nih.gov/pubmed/25124964) and they provide some evidence that the treatment seems to work. These are company sponsored trials but they are published in (reputable?) journals. Have these articles in any way changed your opinion about LLLT efficacy?

Second, if someone is already on Propecia and Rogaine, do you think LLLT has sufficient evidence in favor of it that it might be worth their while as opposed to seeking no further treatment?

If you want to try LLLT, it is your prerogative and my opinions should not really matter. If you are trying to change my opinion on the LLLT, then I would really need to see the results first hand or read a well done study.

I have written about the studies you mention above in the past HERE, and HERE.

Propecia and Rogaine work in different ways. If someone wants to add LLLT to their treatment regimen, then it is up to them.

Dear Dr. Rassman: Yesterday, the first of 3 session for Scalp Micropigmentation at the New Hair Institute was pretty remarkable. Under the guidance of Dr. Rassman and Dr. Pak, the technicians, Christine and Leonard, delivered tens of thousands of precise ink dots that in the end look like stubble.

Along with multiple hair transplant that you, Dr. Rassman delivered 22 years ago, hopefully I’ll end up with a head of hair that has the appearance of rich, full density.

Today’s 7 hour session was like being on a mini-vacation in a comfortable lounge chair, music in the background, and light, easy chatter with the technicians. I felt embraced and well take care of.

Thanks again.

Hair transplants breed a new type of tourist in Turkey

In Turkey, revenue from popular procedures adds to country’s $7B medical tourism industry

By Nil Köksal, CBC News

“There is a new way to spot tourists in Turkey or in Iran, and it doesn’t rely on catching a glimpse of selfie sticks, maps or cameras slung around their necks.

Instead, look for the black terry cloth headbands and a telltale triangle of red spots on their scalps.” (hair transplant)

Doctors in Europe are feeling the pinch from competition from doctors in Istanbul Turkey and Iran who have set up hair transplant mills. This is similar to what the Russians did in the 1990s when setting up Cataract Mills for eye surgery. These are all FUE procedures and I doubt the ladies performing the FUE are all licensed doctors. It seems they are offering travel packages that cover air fare, hotel and the surgery for a 3 day stay. Of course, there is no guarantee of quality and there is no recourse if something goes wrong when these people return home after the surgery. Infections, if you get one, will have to be treated by a local doctor and if the procedure was not done right, the patient will not know for 8 months, which is the time that it takes for the hair to grow after a hair transplant. I suspect that the quality of the work ranges from good to poor, depending upon the clinic that is chosen. It is a bit of a gamble. Stay away from politics in either country or your stay may be longer than you planned.

Hi doctor, weird question. Have you ever taken a strip from the arm pit region? One would think there would be great elasticity in that area. If not, would you ever consider it?
Thanks again!

We have had these requests in the past. There has to be a good reason (such as depleted donor scalp hair) and a realistic understanding of its limitations (such as a difference in hair quality). It does work and we have done them.

I am 23 years old. I would like to know if the shedding phase associated with Propecia is a real thing. I was on Propecia for 2 months when a shed began. I was losing about 3 times as much hair as usual. I read on some online forums that Propecia can have a “shedding phase” where you lose a bunch of hair but it then stops and grows back. So I stayed on Propecia for an additional 2 and half months after the shed began. During this time the shed never relinquished so I stopped Propecia. My hair loss returned to its baseline rate within a few days. When I talked to my dermatologist he had never had a patient experience this “shed.” Also, on the forums it appears that for many people the shed never actually stops. For these people it just continues to fall out. This led me to believe that maybe the Propecia is causing a chronic telogen effluvium that does not cease until the drug is discontinued, as can occur with other medicine. I was considering trying Propecia again. So my question is, have you ever actually seen someone go through this shedding phase and then it stopped and they experienced no more hairloss? I would like to know if I should have stayed on the drug longer or if I just simply did not respond to it appropriately.

There is no shedding of hair associated with Propecia. There is however, natural genetic hair loss that still persist even while taking Propecia. In other words, Propecia does not completely stop hair loss. Propecia does not cause more hair loss. Internet forums are a collection of opinions from its members. It does not necessarily mean it is a definitive source or the correct source of information. If you are seeking a personal medical information, please see a doctor.