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This is a 44 year old male who had a juvenile hairline in 2010 when he came in as the corners were eroding. He didn’t like that and although I rarely will transplant these corners, I did on him because he was 36 and still had his juvenile hairline. Today he came in with a complaint of some increasing hair loss on his right side just outside the area that was transplanted in 2010 which shows nicely on the first photo. The left side has held nicely since that 2010 surgery.

I performed a HAIRCHECK test on him which showed that his hair population is now 80% of what it was 8 years ago, so he is losing hair in the first 3 inches of his hairline (what I call the frontal area). He has been on Avodart since 2010 and this recent hairloss, has occurred while he was on this drug. He wants his juvenile hairline back with its tight look. I agreed to do this and also recommended that he address the 20% thinning in the frontal 3 inches with Scalp Micropigmentation. The pictures below show what was done on the day of the surgery.

Sometimes, i panic (over nothing really), and because of that, it gets difficult to breath and in some cases, i feel anxiety and get dizzy (because of the panic). Could that contribute to hair loss? I am a male diffusing on the scalp (not sides), shedding very much, and shedded stripes have a clear (big) white bulb at the end.

Yes, you can certainly lose hair from stress caused from your extreme anxiety. It could precipitate your genetic balding earlier than it would’ve, as is generally the case for men that have stress induced loss. It sounds like you need a good, caring doctor to get your anxiety under control.

I know you’re not supposed to brush wet hair after the shower, but I didn’t know that until today… After I’ve been doing it for years… Thankfully, currently, I have a pretty full head of pretty thick hair and I’m obviously prepared to stop brushing my wet hair indefinitely. However, I’m worried that I’ve done damage that can’t be undone that could eventually lead to severe hair loss in the future. Should I be concerned?

When people brush hair roughly, then they can pull out miniaturized hairs easily causing evident balding in those men or women with genetic hair loss and significant miniaturization. I tell people to use gentle brushing or a wide tooth brush or comb to minimize the pulling effect on these miniaturized hairs.

Thank you for the baldingblog. The answers you’ve give over the years are a very valuable resource for patients before, during and after hair transplants.

It’s now 9 weeks after my FUE. My recipient area is very red and incision marks are all visible. The color and texture of the recipient area improved until the 2 week mark, but since then it hasn’t changed in the last 7 weeks. I understand from your baldingblog that your patients have at most 6 to 8 weeks of redness (you wrote about it in separate posts in March and May, 2014). Unfortunately, my redness has lasted longer than that and shows no signs of improving any time soon. For what it’s worth, I’ve seen internet posts by guys who have had similar redness, so I imagine this is a topic of interest for quite a few men.

I’ve had no sun exposure, swelling, pus, warmth, fever, or health issues. I did thorough blood both tests before the operation as well as last week; all results were and still are good. There’s no hair growth yet obviously, but at 9 weeks, that’s normal. My HT surgeon said it’s the reddest he’s ever seen. He has no idea what’s going on. He said it doesn’t seem infected or to have any problems except that it’s still very, very red with incision marks still visible to the naked eye. He very honestly told me that he doesn’t know what to advise and suggested speaking to other doctors. I’ve consulted several doctors, both hair surgeons and dermatologists. They all have very different ideas for diagnosis and treatment, as well as reasons why the other proposed treatments aren’t good. I’m confused by the different ideas and would like to ask your opinion about them:

Treatment #1.
Diagnosis: small dilated blood vessels near the surface of the skin (“broken capillaries”), i.e. a form of telangiectasias caused by the trauma of surgery. If you push with finger on the redness and release, the skin becomes white for a second and then returns to red. That brief whiteness happens because of these dilated blood vessels. Treatment: pulsed dye laser (“V-beam”). Targets only the red wavelength of the capillaries, so the laser will reduce the redness but not hurt the (soon-to-arrive) growth of the transplanted follicles.

Counter-argument: The range of wavelengths of the V-beam laser cannot be made so narrow as to ONLY work on the blood vessels. The laser will probably hurt the hair follicles and harm my eventual transplant result.

Treatment #2.
Diagnosis: inflammation caused by the HT surgery. Treatment: 100 little PRP injections throughout the red area as an anti-inflammatory to stimulate angiogenesis. In addition to promoting healing of the redness, it will help the eventual hair growth.

Counter-argument: PRP won’t help much, while 100 injections into an already red area would just irritate the skin more and cause even more redness.

Treatment #3.
Diagnosis: inflammation similar to eczema. Treatment: a mid-level topical corticosteroid with potency around 100-150x hyrocortisone, perhaps mixed with an anti-bacterium. It’s anti-inflammatory, immunosuppressive, vasoconstrictive. Doesn’t affect the hair follicles. Try it 3-4 weeks. If it helps, great; if not, stop after a month and there’s no danger of harm or long-term damage.

Counter-argument: The vasco-constrictive properties of steroids is exactly what I don’t want while my body is trying to heal itself now. And steroids have lots of bad side affects: red skin syndrome from withdrawal, thinning of the skin, etc.

Treatment #4.
Diagnosis: That’s life. I’m blonde, light blue eyes, fair skin (stereotypical Scandinavian look). Redness can happen. Treatment: can’t do anything. Will take 6 months to 1 year to heal. Bad luck. Buy lots of hats.

Continue reading “Patient with persistent redness in the recipient area (with Photos)”

That is fascinating but it prompts a few thoughts. Why not use body hair for transplant processes? And why does the balding gene only impact on the top of the head and not the sides?

The sides of the hairline, as well as the 3 inch section at the bottom of the back of the head, is immune from genetic hair loss. Body hair can be used for hair transplants but it has a short growing cycle so if you transplant 100 body hairs, only half will be growing at any one time while the others are in the telogen (sleep) phase. This means that you generally only receive half the value when body hair is transplanted compared to scalp hair.

It is rounded and there are no temple peaks because they are incorporated into the rounded hairline. This is the same hairline that she had when she was a child at 5 year of age.

In an interesting article in the Hair Transplant Forum by Nicole Rogers, M.D., has a review of the association of the existence of androgens in men who were infected with severe cases of Covid-19 suggested a relationship between the two. “This protease has a 15 base pair androgen response element, and in humans, androgens are the only know transcription promoters for the TMPRSS2 gene. The ACE2 receptor, which is also a route of COVID entry, is also mediated by androgens.”

Men with balding may have had an increased risk to the Covid-19 virus and severe disease. Women, of course, don’t have the androgens and it is possible that their estrogen protects them against the virus. There is also a suggestion that men who take androgen blocking medications like finasteride, dutasteride, Spironolactone, Enzalutamide and even canabidoil might help mitigate the severity of the disease. This is all hypothetical as there is no direct evidence for this in studies that have been done to date. The date has probably been collected but not looked at with this in mind.

Post finasteride syndrome is reported between 0.1 – 1% and some reports are higher. In my practice and in the practice of a dozen other doctor who, combined, easily have written prescriptions for over 200,000 young men, have not seen PFS because when sexual side effects happen, we stop the medications. Look at this link: https://baldingblog.com/finasteride-what-are-the-real-sexual-side-effects/