Photos – Page 16 – Balding Blog

January 8, 2008

Woman with Tingling Scalp Pain; Doctors Can’t Find Anything (with Photos) – Balding Blog

I am a 22 year old female, active, healthy diet. For a year I have slowly been experiencing some form of hairloss. It seems that with every hair that falls out there is nothing to take its place. I have been to the dermatologist 3 times, and had a skin biopsy that came back perfect. The Derm gave me tetracyclen to try but after 4months I found it wasn’t working. She then sent me to a rheumotologist who see’s no signs of lupus etc. But saw in my blood work that there could be something wrong with antibodies?, she has given me APO-Hydroxyquine 200mg to try for 4 months. With my hairloss I feel a lot of tingly, burning and pain which makes me feel that this would be a skin situation, apparently it isnt though because of my clear scalp biopsy! When i get these tingling sensations in my head I will also sometimes feel the same pain on my nose, back and shoulder. I have sent you a photo to help! I have been reading your blog and trust your word more than anyone else.

Thank you for the compliment and the trust, but I really am not your doctor and I do not have the luxury of examining you in person. I do not take your trust for granted and I do appreciate you sending me photos with permission to publish them here.

Moreover, it seems you have been evaluated by many doctors for your condition. I realize that you are frustrated and confused about your condition and lack of improvement despite various treatments. The best advice I can offer you is this — what doctors do is often referred to the “practice of medicine” and not a complete “science of medicine”. I realize this isn’t what you want to hear (or read, as the case may go), but this points to the fact that sometimes we (physicians) are just as confused as you (patients) and sometimes there are no good treatments to offer. If you want a medical opinion, you must establish a doctor/patient relationship and that is something that just can not be done over the internet.

January 4, 2008

My Hair Transplant Is Growing At an Unnatural Angle (with Photo) – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

Thank you so much for the service you provide the public with this site. It must be alot of extra uncompensated work for you, I appreciate it.

I got a 1300 hair graft about 9 months ago to the area that I roughly outlined in red (on both sides of my head of course, I am only showing one side). As you can see it is growing at nearly a 90 degree angle on my head whereas my natural hair falls forward. Even though I cut my hair at the same length, the transplanted area looks twice as long because it is growing directly ‘up’. My two questions are this: 1. Is this a lack of skill on the doctors part that it is growing at an unnatural angle? and 2) if I keep trying to comb it forward can you gradually adjust the natural angle of the hair so that it matches with the rest of my hair as to the angle that it grows (or will the transplanted area permanently be at odds with my natural hair growth angle)?

My doctor recommends a second procedure because as you can see the transplanted area looks quite thin. I am 26, do you see any concerns with having a second procedure done with this doctor, or do you sense a lack of skill and I should look elsewhere? I have minor thinning in the crown area as well, but I do not plan on transplanting anything to that area. I have been on propecia for 9 months, and while it has not totally regrown the crown area, I am hoping that it will prevent further loss in that area.

Many thanks, and feel free to post the picture.

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Thank you for permission to post your photo. Please click the photo to enlarge.

You are correct. It seems your hair was transplanted at different angle than your native hair. The surgeon planning for the correct angle and direction of hair is a very important factor in a hair transplant procedure. Unfortunately, this is very difficult to correct and relatively impossible to reverse. Your transplanted hair will always grow in that unnatural direction. One of your options is to have another transplant procedure and make sure that the new transplants are in the correct direction to “blend” in with your hair.

With respect to a second surgery with the same doctor, you need to be able to trust the doctor before having any procedure. Doctors are human beings and they can make mistakes or misjudge the many decisions that are before them in a treatment plan. If you and your doctor have a good trusting relationship, I am sure he/she will see the difference in angle and your concerns and will be more than happy to accommodate accordingly. The key here is to directly discuss this with your doctor first, and then make decisions on the value of the doctor/patient relationship.

January 2, 2008

Hair Loss Information17 Year Old Concerned About His Hairline (with Photos) – Hair Loss Information – Balding Blog

Dr. Rassman,

I am a 17 year old male concerned about hairloss. I have not noticed any receding or thinning or extreme shedding or any typical symptoms of hairloss. However, I have always had a very high hairline ever since I was 2. And from the front my hairline looks like a U shape when I pull my hair back. However, as you can see from the pictures my hairline lines up perfectly even with the side of my hair and does not go farther back like the diagram of the “receding” hairline does. I just want you to tell me if my hairline is a receding one or if it is the normal mature hairline that 95% of all caucasians get. What do you think? I have always and still do have a very thick head of hair, I just need to know if you think my hairline is abnormal or balding, or does there appear to be nothing to worry about. PLEASE Respond. YOU MAY USE MY PICTURES ON YOUR SITE!

Thank YOU SO Much!

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Thank you for your permission to post your photos.

A high hairline at your age is most likely genetic and not a sign of hair recession or balding, particularly since you’ve had it since childhood. If you look back at your family tree, you could probably find someone in the family (either side) with a similar hairline. If you are happy with your hairline and there is no sign of hair loss in the area immediately behind it you don’t need to do anything. If you are unhappy with having a high forehead or you think the appearance of recession make you look older, you can treat it with either a hairline lowering procedure or hair transplants — but these solutions are not for a 19 year old male who may bald as he matures. This restriction does not include women.

December 14, 2007

12 Days After Hair Transplant (with Photos) – Hair Loss Information – Balding Blog

I wanted to show some 12 day post-operative photos of a very early Norwood Class 5 patient after one procedure of 1588 grafts. I get a lot of emails from people ask me what they can look like with good post-operative washing, and this is a good example of one such patient that kept the recipient sites clean. While there is still some slightly visible redness, he is less than 2 weeks out of surgery and this should subside soon enough.

Click the photos to enlarge.

After

Before

December 5, 2007

A Case of Diffuse Unpatterned Alopecia (DUPA) – Hair Loss Information – Balding Blog

This 24 year old man presented to my office today with hair falling out. He has been on Propecia for 9 months. Upon examination I made the following observations:

His hair density was low all over the scalp.
He is losing substantial amount of neck hair disproportionally to other hair.
He has miniaturization in the donor area to about 30%.

I am concerned that this young man has Diffuse Unpatterned Alopecia (DUPA) and that he may lose some of his donor hair in the future. This condition is an absolute contraindication for hair transplants and at the age of 24, what is the rush? As you can see from the photo below, his hair looks full, but just thinner in the frontal area. I told him that he needs to be followed closely over the next few years and that his Propecia is the correct medication to try to hold his condition at bay. Many other doctors with less scruples might transplant him and if they did, he might accelerate his balding pattern in the recipient and the donor area and a see-through look could develop from the sides. The last doctor he visited never mapped out his hair for miniaturization and as such would have missed the diagnosis.

Click the photo to enlarge. Note that the miniaturized hair count is about 30% from the donor area.

December 4, 2007

Why Didn’t You Transplant 5000-6000 Grafts For a Norwood Class 6? – Balding Blog

In the piece dated October 19 “Goodbye Combover, Hello Hair!”, I am critical of your choice to limit the graft numbers. You should have performed 5000-6000 grafts in a Class 6 patient. Why didn’t you?

Here’s the post you’re referencing.

The number of grafts that were transplanted on this patient was the maximum safe amount that could be harvested, reflecting the density of this man’s hair in the donor area. If the grafts were cut down to single hair grafts, the number would have been more, but the amount of hair would have been the same. Some doctors would have cut the follicular units down to single hair grafts to make some more money out of the patient (since they charge by the graft). Not only will that not produce more hair, but it would be unethical to milk this patient’s pockets for more money. Cutting the grafts down would have yielded less hair in the long term, as all of the cut grafts may not grow as well.

With his fine hair character, this patient needs 5000-7000 grafts to get excellent coverage. On the day the initial blog post was published, I repeated the procedure and only got out 1706 more grafts — again, because that was what was safe (there are no results photos yet, as the procedure was just over a month ago). Each person is different, and while some people have enough scalp laxity to allow for a larger strip (with more hair), some people will only have enough for a smaller strip.

The photo on the left is before; the photo on the right is after one procedure of 2590 grafts. You should note that the transplants were artistically weighted to the frontal area to produce the best frame for his face and distributed to the back with a much lower density to reflect the limited number of grafts. Click the photos to enlarge.

More photos of this patient can be see at the original post –Goodbye Combover, Hello Hair!

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November 30, 2007

Hair Loss InformationResults of Transplanting Firefighter’s Hairline (with Photos) – Hair Loss Information – Balding Blog

In my experience, performing hair transplants on firefighters, police officers, and soldiers can be a problem, not because they are different from you and I, but simply because they tend to get more good-natured teasing from their colleagues when issues of vanity come up. Although I haven’t seen any formal studies about it, I’ve found that society looks at the man in uniform as a “macho” guy, and vanity + macho don’t exactly go hand-in-hand. This is why I’ve found that these men can be more sensitive than the average male about having a hair transplant, as they are extremely worried about having a detectable procedure.

This patient had two hair transplant procedures totaling 2431 grafts to the frontal hairline, extending back about 1 1/2 inches. His skin is light and his hair is jet black, but he told me that no one ever teased him about undergoing the surgeries and nobody noticed anything unusual.

The photo on the left is before; the photo on the right is after two procedures. Please forgive me for the quality of the before photo, as it was taken with a different camera under different lighting, but his hair loss is clearly evident. Click the photos to enlarge.

November 26, 2007

One Year of Propecia Use (with Photos) – Hair Loss Information – Balding Blog

This is not an atypical response to Propecia on a man in his mid-thirties with a great deal of miniaturization throughout the top and crown. Click and enlarge the photografts and you can easily see the change in miniaturization on a macroscopic view.

The photo on the left is before taking Propecia; the photo on the right is after 13 months of daily Propecia (finasteride 1mg) use. Click the photos to enlarge.

November 19, 2007

Hair Transplant Results After Just 1 Procedure (with Photos) – Balding Blog

This Norwood Class 5 patient had just one transplant of 3684 grafts about two years ago. He recently came in for a Propecia prescription renewal and allowed me to take updated photos and post his results. He had a wonderful, big smile for me and said everyone he meets knows he looks different, and so rather than explain these changes, he made a point to lose weight and show off his newly trim figure. No one suspects that he has had a hair transplant.

Click the photos to enlarge.

After

Before

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November 9, 2007

Are Minoxidil and Propecia Worth Using? (with Photos) – Hair Loss Information – Balding Blog

Whats up Doc!

I am considering getting on rogaine but am wondering whether or not the benefits of it would be worth the annoyance of its daily use. Is Propecia better? Have you seen any substantial results on Rogain along from any of your patients? I am currently just looking to reverse some thinning in miniaturizing hairs on my crown. Also, is the shed that it mentions is a possibility of any significance, i.e. can you visibly notice a shed from the minoxidil?

Thanks in advance!

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When there is a shedding from minoxidil or Propecia, the effects on fullness are rarely visible.

Here are photos forwarded to me (with permission to publish here) by Dr. William Parsley of a 40 year old male patient who had a great response to a combination of minoxidil and Propecia (finasteride 1mg). He had no hair transplants. These medications do work together and on some patients they can have a remarkable result. From his before pictures, there appears to be considerable miniaturization and I can not tell which medication was responsible for this outstanding response. When there are miniaturized hairs, they can often be stimulated so that the hair shafts will thicken and many studies show that when these medications work, the greatest response comes from these miniaturized hairs which become thicker. If you click on the photographs and compare the before and after pictures carefully, you can almost see the miniaturized hairs (without magnification in these pictures) showing the thickening in the ‘after’ picture. I have seen significant benefits from minoxidil by itself, though not as spectacular as these photos show. Please note that neither medication has proof that they work in the frontal area, yet seeing is believing here. Click the photos to enlarge.

Before

After (minoxidil and Propecia combination use for 7 months)