Author: Dr. William Rassman

I am a 30 years old male, I have found that my falling hair have different textures. I notice this when I shower. Some of the hairs are much finer and lighter in color while some hairs are thick and dark. By the way, the falling fine hairs in the bath are generally shorter than the falling thick hair in length. I do not understand this situation, I guess those fine hairs are the ones still in process of growing out? Or those fine hair are actually from shrunken follicles? Cheers.

The falling fine hairs are likely miniaturized hairs that may be at the end of their life cycle. They sometimes become lighter losing their dark color, almost blonde or gray in a black haired male.

Hi Doc. I was just reading your recent article “Hair Transplants with Scalp Micro-Pigmentation (with Photos)” and was wondering whether or not the patient would be in the same position now if you knew the hair transplant techniques back then, that you know now.

Is it possible that with ultra refined techniques the transplanted hairs would have been transplanted more evenly around the head meaning that Scalp Micro-Pigmentation would not have been necessary.

Best

The simple answer to your question is: Yes! Many people with advanced balding patterns just don’t have enough donor hair to cover the entire balding pattern, so SMP (scalpmicropigmentation) solves this problem.

I hear ultra refined technique used sometimes but it is more of a term described in forums such as Hair Transplant Network. That terminology is just semantics. The GOLD STANDARD in hair transplant surgery is transplanting one follicular unit at a time. It doesn’t matter what you call it. AT NHI we have being doing this since we opened in the early 1990’s and have pioneered and published on this technique (HERE).

To be clear, no matter how perfect the technique (you can use ultra refined technique if you would like), you have a LIMITED and FINITE supply of donor hair. So no matter how refined, you can never have the fullness of someone who is not bald. Hair transplant is great at providing a non balding look and creating a solid non-receding frame to your face. But hair transplant is in essence moving hairs around from one place to another.

Scalp Micropigmentation (SMP) is not perfect since it is not hair. However, (like Toppik and DermMatch and other concealers) it reduces the contrast between hair and scalp providing the look of fullness that a hair transplant may not provide. It also provides an EVEN appearance when you shave your scalp. More importantly, SMP provides any hair transplant patient an option to SHAVE their scalp and disguise the donor scar. Even for people with FUE surgery, there is a scar in the form of DOTS. SMP can also blend in these FUE dots.

SMP is a great adjunct to hair transplant.

I have a question regarding traveling with finasteride. Can any problems be caused at customs when you take international flights etc. Is the drug illegal in any country to your knowledge? I read rumors online that apparently it is banned from pharmacies in Russia and the middle east? is this true? and can issues be caused at customs if you have a large supply (2-3 months when going to another country)?

You can always check with the laws of countries you are traveling to, but I have not heard of Propecia (finasteride) being banned in countries. Having a few month supply is different than having multiple unopened bottles that look like you are bringing it in to sell the drug.

The British Journal of Dermatology (2014 May 16. doi: 10.1111/bjd.13114.) The authors were Fischer TW1, Herczeg-Lisztes E, Funk W, Zillikens D, Bíró T, Paus R..

The study suggested that caffeine promoted hair growth. Human male and female hair shafts were cultured in the presence of testosterone. Many factors were studied. “Caffeine enhanced hair shaft elongation, prolonged anagen duration and stimulated hair matrix keratinocyte proliferation”. Females were more sensitive to caffeine than males. From the abstract I read, it was not clear that drinking caffeine in your coffee or tea worked as the study was on human hair shafts out of the body.

Dr. Jerry Cooley (not a researcher in this study but a practicing hair transplant surgeon) reported the use of topical caffeine products such as “shampoos like Hair Surge or topical leave ins like Nioxin Diamax, which has been rebranded as Pantene Age Defy and Head &Shoulders Advanced Thickening Tonic;” however, I have no experience with these for promoting hair growth. What is needed is a real human clinical trial before drawing conclusions that there is some value in caffeine in some form.

About two years ago I noticed thinning at the front of my scalp and corners, now I still have thin hair at the front but what really bothers me is that there are two dime sized patches of hair that is not completely bald but much much thinner. will this progress? and should I expect more thinning in the future?

I often get these questions emailed to me. Actually I get these questions asked alot! I just want to make it clear that I am not a fortune teller nor can I diagnosis hair loss over the Internet. If your hair loss bothers you, see a doctor. You can always search the Internet but you’ll end up with mixed messages or information. I can tell you in general the most common cause of men’s hair loss is genetic and it is known as male pattern balding (MPB). If you have MPB and would like to do something about it, there are medications (Rogaine or Propecia) and hair transplant surgery. There is also Scalp Micropigmentation (see scalpmicropigment.com). When people describe circular dime sized or quarter sized bald patches, it makes me think of alopecia areata (AA), an autoimmune disease that requires a doctor to make the diagnosis. There is no cure for AA, it has a different cause than male pattern balding and if hair is transplanted in to these ‘dime sized areas’ it will not grow unlike male pattern balding where good results from a transplant can be expected.

I have just turned 27 and I am concerned about my hairline . I have never really given it much thought but then someone commented on it and I noticed it is a triangle shape. I am concerned that I am going bald but have heard of the term mature hairline. I have drawn in a line to show my highest wrinkle. I am thinking about getting a hair transplant as the hairline looks rather odd. My crown is fine I think ! I have attached photos which may be of use. There are no bald people on either side of my family which is why I find it strange that I could be.

Any help or guidance would be much appreciated.

If you are concerned about your hair line and considering a hair transplant, you should see a hair transplant surgeon. I don’t mean to sound obvious but there is not much I can say here. Balding occurs in the 20s for most men. From your picture there are two things happening: (1) your forelock comes down to the highest crease which indicates it is located where it was when you were 5 years old, and (2) you hairline on the corners is certainly receding upwards giving you a bizarre shape to the hairline that that makes it look pointed. If you transplant the frontal corners, you can move to a different hairline that better fits with your look. You are in your 20’s and that is when such frontal recession appears.

You mentioned in one of your posts that you generally use grey/black or grey/brown ink tones. I understand that they will fade over time but does the fading change the remaining pigment to a slight blue tone. This is the type of thing you see with tattoos that use black ink which generally fade to a blue tone over time. Or does the ink hold its colour integrity over time? Thanks

All pigments deposited under the skin will turn blue/ green over time. The time frame that this happens is within a week to a month (not years). And the blue I am referring to is nothing like the blue in this post, it is a black color with a tinge of blue to it.

Any claim that it does not is a marketing gimmick as the human body will react with the pigment as well as the layer of overlying skin will alter the perception of color. For example your red blood vessels will look green under your skin but the green you see is an absorption issue because these blood vessels contain red blood, yet these blood vessels don’t look red under the skin. There is actually a paper written on this topic HERE.

The green /blue that some may think of (or you may be referring to) are the old pigments or cheap brands that oxidize and actually change color dramatically. The green/ blue I’m referring to is generally not noticeable unless you have a keen sense of color. If the SMP pigment is high quality and the person applying them is experienced you should not have this issue. The best and ultimate test is to physically see a SMP patient up close in person. Don’t rely on advertisements or photos.

I started receding when I was about 18 but it stabilized and never went past what I now understand to be a “Norwood 2.”

However, now that I’m in my early 40s, and particularly over the last year, I’ve noticed a substantial thinning on top (still no bald batch in the back). I can clearly see scalp.

Could this be a medical issue (hormone changes with age) or is there something I should be tested for to correct the situation?

My grandfather (mother’s side) was bald; my father had his hair, as did his father. My uncle (on mother’s side) lost most of his hair in his 40s-50s. I have two older brothers and both are receding but nothing dramatic.

This is called getting old. Maybe you always had some thinning but as you get old it is showing more. Maybe you were genetically programmed to be a Norwood 2V/ 3V. I do not know.

The best test to find out if you are balding, is to get a hair Bulk Analysis or a Miniaturization Test in a doctor’s office. We do these routinely. Just yesterday, a 27 year old male came in with hair loss in the frontal hairline, but when I did the hair bulk analyses, I found that he was losing hair in the top and crown where he could not see it. There really is no blood test other than establishing a diagnosis by a competent doctor in the office setting. I realize there are genetic blood test for androgenic alopecia but the results will not give you a clear cut yes or no with regard to whether you are balding or not. Even if the answer to the genetic test is that you do or do ot have genetic balding genes, you still have the hair loss issue that is something that only a doctor can tell you once he examines you for hair bulk around your entire scalp.

In the end if you want to do something about it, you are left with (1) drugs (Propecia or Rogaine) (2) hair transplant surgery if you can see the hair loss (3) scalp micropgimentation (4) different hair style. Finally it is rare for men to have other medical issues that would cause a “pattern” balding. The “pattern” you are describing may be Male “Pattern” Balding. See a doctor if you want to do something about it.

Well from the last year i think my hairline has been receding. I am 20 years old and i just have a strange feeling that it has started receding from the sides.. Please help..

You should see a doctor who offers ‘bulk analysis’ with the instrument called Haircheck. This will tell you fairly definitively, if you are starting to lose your hair. Some doctors have not acquired the instrument, so as you check the doctors in your area, call them and ask their office in advance if they have the instrument. You can also have a doctor look at your under a microscope for a Minaturization test. This can give you some objective (measurable) perspective on your hair status. In general most common cause of hairline receding for a 20 year old is genetic male pattern balding (MPB).