Category: Hair Loss Causes

I am a 26 year old man with some minor receding at the hairline which I take Propecia (Proscar cut into 4 pieces) for. However, independent of this I have always had a very profound cowlick on the back of my head. This has always been there and is not a result of any MPB I may be experiencing. I was wondering if you could correct this cowlick and how much scaring would be involved in something like this. Also I would like to add that your website is an excellent source of information.

Yes, here is a result of a hair transplant to the crown. This is most probably Male Patterned Hair Loss that you see in this patient. This patient also had some frontal loss, a classic Norwood Class 3V pattern (crown and frontal loss in combination).

Time February 1917, just prior to the Russian Revolution. Vladimir Lenin was living in Zurich. He was depressed. “Nothing he tried seemed to succeed. The pamphlets he wrote drew little response while the hair oil which he bought in quantity and rubbed assiduously into his skull failed to stimulate even the slightest growth of hair(*).” This is an interesting footnote in history as we all know that Lenin was bald and his balding seemed to add to the depressing circumstances around him. (taken from Nicholas and Alexandra, by Robert K. Massie).

Hair has always impacted the emotional state of mind of men, especially during stressful periods. Famous celebrities, emperors and presidents stress out all of the time and some of them lose their hair from the stress and their genetics.

Dr is it possible to experience an acceleration of genetic hairloss from eating meat? I have heard meats are pumped with steroids and hormones can that have a negative impact on someone with genetic hairloss?

I would doubt it as the US Department of Agriculture tests meat products for things like steroids and antibiotics. If you are concerned, switch to grain fed beef that is Organic.

I read on a website:
“July 11, 2014 – White & Blue Lion, Inc. in the City of Industry, CA is recalling all lots of tattoo inks and tattoo needles due to pathogenic bacterial contamination. Use of these products may cause bacterial infection and can lead to sepsis, a potentially life-threatening complication of an infection. The recall includes all tattoo inks, tattoo needles, and tattoo kits distributed by White & Blue Lion, Inc.”
Do you use these inks or any of these products?

Tattoo products and inks are definitely a public health risk. Scalp MicroPigmentation falls in this category. You must check who is doing the SMP and if the establishment has a valid license and safety clearance. I have heard stories of SMP being offered in hotel rooms, in private residences, and even out of a car. As simple or harmless as it may seem, tattoo and SMP involves a needle piercing your skin with a foreign substance left inside. The pigments are not regulated or inspected by the FDA or any specific government agency other than the overworked State Health Department. There are numerous things that can go wrong in the wrong hands. HIV, Hepatitis B and C, skin infection, and allergic reaction are among a few that can have disastrous consequences.

We treat the SMP process very seriously as it is performed in a controlled medical environment. While it is not a medical procedure, contamination of needles and pigments are controlled by us. We use only disposable needles and sterilized pigments. We use the exact sterile techniques that we use when we do a hair transplant. We culture the inks and pigment for possible bacteria from our suppliers on all new batches we get and then we sterilize them in our own offices. We throw away all bottles, once opened. We have not seen any issues of bacteria present in the pigments from our testing, but if we did, we would know it. We use ultra-clean techniques for our SMP procedures as if we were going to do a hair transplant surgery to be assured of the least risk of infections as possible. We have not had an infection in the hair transplant procedures for more than a decade (including our SMP experience since we started doing them).

Older patients with very low levels of vitamin D have about a 122% increased risk for dementia compared with those with higher levels, according to a large, prospective, population-based study.
Pauline Anderson
August 06, 2014

The study provides “robust evidence” of the link between vitamin D and cognition and adds important new information to the association, said study author David J. Llewellyn, PhD, senior research fellow in clinical epidemiology, University of Exeter, United Kingdom. “

For those of you who have elderly parents, this is an important piece of information for you. Testing for Vitamin D levels in your blood is easily done in most doctor’s office and taking vitamin D is even easier.

Golpour, M. Rabbani. Comparing the effectiveness of local solution of minoxidil and caffeine 2.5% with local solution of minoxidil 2.5% in treatment of androgenetic alopecia. Journal of Mazandaran University of Medical Sciences. 2013;23:29-36.
Abstract: Background and purpose: Androgentic alopecia (AGA) is physiological hair loss induced by androgens in genetically predisposed persons. Different medications have been suggested to treat AGA until now but there is no certain treatment. This study aimed to compare the effect of caffeine + minoxidil topical solution 2.5% and minoxidil topical solution 2.5% in AGA treatment. Materials and methods: In this double-blind randomized clinical trial study 60 patients were enrolled. The sampling method was simple classification and patients were divided to 2 equal groups. The first group received minoxidil topical solution 2.5% and the second group received caffeine + minoxidil topical solution 2.5%. Method of treatment was the same in both groups (one milliliter of solution was applied twice a day) and follow-up was by computation of hair numbers on alopecia area in scalp. Both groups were followed in 7 stages: at the beginning of study and the days 7, 30, 60, 90, 120, and 150. Results: Caffeine + minoxidil topical solution 2.5% was more effective than minoxidil topical solution 2.5%. There was a significant statistical difference between the groups. Conclusion: This study overtly showed that the effect of caffeine + minoxidil topical solution 2.5% to treat AGA was better than minoxidil topical solution 2.5%. We suggest more studies with greater sample size and longer period of follow-up

This study, as stated in the abstract, uses only a small population. Also, it is not clear that the increase in the number of hairs with Minoxidil and Caffeine 2.5%, produces enough hair to be visibly improved. We have seen benefits of Minoxidil, but only 15% of subjects have significant visible benefits. Clearly, more investigation is needed before the FDA will allow such a treatment on the market.

The risks of having a complication or dying from a surgical procedure is small in some cases but clearly not insignificant. I found the following article which not only outlines the problems concerning the long-term risks of any major surgery, but also the article had some suggestions for doctors on how to go about assessing the risks. There is no easy solution.

Introduction of article: “Owing to increases in life expectancy, the patients presenting for surgery are older, and have more co-morbidities. Worldwide, 3–4% of patients die within 2 months of major surgery, with increased mortality and morbidity in high-risk surgical candidates, including the elderly and medically unwell.[1,2] In Australia and New Zealand, older patients having non-cardiac surgery have a 20% risk of serious complication and a 5% risk of dying within 30 days of surgery.[3] The cost to patients and the community is enormous. In a cohort of 806 534 Medicare beneficiaries having surgery in America, 51.5% of patients discharged after a surgical procedure had either died or been readmitted to hospital within a year, and 70.5% of re-admissions were for a medical problem.”
(*) Above quote was taken from the British Journal of Anaesthesia, 2014;112(6):955-957., “Not Fit for a Haircut … How Should We Assess Fitness and Stratify Risk for Surgery?” by M. A. Shulman, B. R. Thompson

As part of the informed consent for any surgical procedure, even a hair transplant, patients must fully understand the risks to life that confront them. I am aware of two deaths from hair transplant surgery, probably the result of doctors inexperienced with the use of medications such a Xylocaine (Lidocaine). One of those cases involved a non physician involved with surgery. That person is still out there offering discount hair transplants last time I checked. How he is still allowed to conduct business is beyond my understanding.

Many years ago, I was the guest speaker at a major medical meeting where the audience numbered about 300. At the end of my speech, a doctor came to the microphone from the audience and ask the following question (from the best of my memory) “I am seeing some of my patients complaining of numbness of their fingers and lips. Have you seen that complaint?” I asked him to see me after the meeting and found out that as his number of grafts were increasing with each surgery, he was increasing his dose of Xylocaine. Numbness of the lips is a sign of Xylocaine overdose and it may be followed by seizures and/or a drop in blood pressure. When I told him, he was shocked and relieved. He asked me why I did not get that side effect. I told him that more anesthesia was unnecessary with large hair transplant sessions. He thanked me.

Doctors must command every medication they use and the complications of that medication. Even hair transplant surgery has its risks. People have hair transplants even with known heart disease, kidney disease or liver disease. These diseases could impact the results of a hair transplant surgery and I am sure you would want to know that you doctor is prepared for all such eventualities. Both Dr. Pak and I are routinely certified for Advanced Cardiac Life Support every two years as part of our preparedness. Fortunately, in the 24 years of performing hair transplant surgery at NHI, even thought we have done hair transplants on many men over 80, some with known cardiac disease we have never had a complications from a hair transplant procedure that required our advanced (non hair transplant related) training.

From Medscape by Terrence Keaney, MD, FAAD: “An allergic sensitivity to tattoo pigments is a common adverse reaction. Individuals may manifest sensitivity to a particular pigment in several ways, including contact dermatitis or photoallergic dermatitis. This image shows a bullous (or blistering) eczema allergic reaction to a henna tattoo.

Image courtesy of the NIH.”

Tattoo and pigments under the skin can cause infection and reactions. We have not seen issues with infection associated with SMP at New Hair Institute. It probably helps that we are a medical facility and our physicians oversee and perform SMP. We are careful not to go overboard and are generally conservative in our decision making process. We give patients the option for a steroid injection to minimize any reaction. We perform a patch test before the SMP procedure to determine allergies to metals and any topical allergies to the tattoo pigments we use.

The regulations for business offering tattoo or permanent pigment (such as SMP) varies by state and city. It does require a license and registration with local authorities if you are not a licensed medical doctor.

Here is a link for Los Angeles Public Health

For the Haircheck device what is considered a normal percentage for non-balding male 5-8% or more? what percentage would normal for a non balding male from the donor hair to
the hair on front,top and the crown?if some of hairs diameters look different when I take a picture up close with my iPhone is that normal for a non balding male my dermatologist said you really can’t do that unless you have digital handheld microscope.Can you tell miniaturization by just taking a picture of your hair? My dermatologist said I had no thinning or signs of male pattern baldness and I have thick hair. Thank you again and look forward to hearing back from you! Have a great day!

Bulk measurements measures an area of hair that is gathered in a particular area of the scalp. We take several measurement on different areas of the scalp. We compare the bulk measurement from area to area. The back of the head is our baseline as this area always shows what a normal bulk will be for each person. When we compare area to area, we can tell if the bulk in one area is less than the bulk measurement from the back of the head and by how much. For example, the top of the head may have a bulk measurement equal to 50% of the back of the head and this would indicate that the person lost half of his hair volume on the top of the head. We also look at the measurements taken over a period of time (about one year) to see if there have been changes. For example, maybe last year the top of the head showed a bulk measurement of 50% of the back of the head, but today it might show a bulk measurement of 25% of the bulk measurement from the back of the head (such a finding would show progression of hair loss over the past year). This way we can put a number or a metric to the hair loss or gain. This will help the patient in developing a long term plan. It’s better than a photo.

There is a margin of error of up to 10%. You can probably measure the same location at the same location within a minute and get a small variation in the measurement. Every doctor may be different in how they go about using the bulk measurements. The number values are not important if there is no one to give you the analysis or a meaning to the numbers so that you understand the big picture.

Finally, you can’t look at miniaturization with an iPhone or a photo. We look at miniaturization with a microscope that has a 50x zoom lens. Miniaturization is also looking at comparisons between one location of the scalp to another location and seeing if there is a pattern of very thin hairs to normal thickness hairs. This suggests some early balding if the number of fine hairs is significantly larger than the number of normal hairs; however, this is hard to replicate and as it measurement only an area the size of a pea, it is far less accurate than the bulk measurement made with the Hair Check instrument.

Hi there I have scar in the back of my head very wide and I like to know if theres anything to make invisible when I shave bold I can see the big strip there, please let me know thanks!

Yes. The scar in the after picture here is still there. Can you see it? This is a typical result of our work with Scalp Micropigmentation?

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