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The Size of the Harvested Donor Area Is Critically Important

This patient had an FUE megassession surgery. When harvesting the FUE grafts, the surgeon must recognize the size of the donor area and limit the FUE extraction to the permanent zone as outlined in this FUE patient photo. The doctor who did the surgery on the patient in the photo did not understand the limits of the donor area.

The permanent donor area for a hair transplant begins at the bottom of the skull bone, known as the Occipital Notch, and extends upward two and half inches. This is the case for patients who will bald to a Class 7 pattern and sometimes to an advanced Class 6 pattern. This two and a half inch zone extends horizontally to just in front of the ear level. Hair was harvested for FUE from above and below this zone of permanent hair which in the long term will fall out by not standing the test of time. The hair below the permanent zone is neck hair and not scalp hair and this hair does not last.

QUESTION:

Why do doctors harvest hair beyond the permanent donor area as shown in the photo?

ANSWER:

(1) Because the patient wants a high number of grafts.

(2) Because the doctor makes more money by charging more for the larger FUE session.

(3) Everyone thinks it is safe and the hair will last a lifetime – Dead Wrong!

A word a of caution: some doctors will push the number of grafts within the permanent zone so much that the permanent donor area becomes a new bald area.

Buyer beware: it is your responsibility to keep the doctor honest and to make sure the doctor does what is in your best interest. This is why I shared this information with you. Good luck.

bad donor

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Good Short Term Photos of Microneedling Benefits (from Reddit)

This man has shared some amazing photos of his 6 month course treating his hair loss. I suspect that if he keeps up on this the hair may all regrow. I believe that the microneedling was critical to the benefits he has seen here. He has used:

  • microneedling 1x week @ 1.5mm
  • .5mm fin (1x daily)
  • minox (2x daily)
  • peppermint oil (2x daily)
  • keto shampoo 2x/week
  • dht organic shampoo every other day or so.

The long term question that we don’t know is if the hair does all growS out, how long will it last? The experience is minimal for follow-up of this treatment in men, but I would guess, based upon human skin transplanted in mice with dormant human hair and microneedling, that the hair will last one anagen cycle and then fall out (an anagen cycle in a young man is about 2-3 years on average). At that point the treatment would have to start again, or alternatively a hair transplant may become an option if a restart of the treatment doesn’t work.


2020-06-25 20:40:06Good Short Term Photos of Microneedling Benefits (from Reddit)

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There Are Bald People Throughout History, So Why Are We Obsessed with Hair?

Is going bald even such a big deal. I know that many men could really care less about the way they look, the only reasons we keep our appearances up is for the ladies and for our professions. But there have been bald people throughout history, some of the sexiest men alive were bald. Do you think we are just becoming too vain and obsessed with our image?

Aging is a part of life and should be accepted. Today we here about older people taking anti aging creams, special diets, “get those 6 pack abs”, and so on. I think this is hurting us a lot and we many of us are losing our self esteem which is terrible. We should feel comfortable with ourselves.

Am i right? You Dr.Rassman are 67yrs old and look damn good for your age, there is nothing artificial to your image.

Why are we so self centered these days?

There are many reasons for this. History has shown that when men got sick (tuberculosis over the course of human history) they lost hair and died early, so when selecting a mate, women picked men who had good hair, because in the search for a husband they could not have a man would would die on them (not good for long term futures and babies). This had a great deal to do with prejudice against balding men. Men when they are in their 20s don’t yet have enough confidence in their manhood, so losing hair seems to exacerbate the balding problem. I’m not a psychologist or sociologist, but I am a surgeon that helps men improve their image… so maybe I’m the wrong person to ask a question like that.

Would it be safe to assume that you, the author of the above question, has no hair loss and no sensitivity to balding as a male problem? Do you think that George Clooney would look sexy as a bald man? If so, I have not seen him shave his head as an alternative style. I had someone on my staff do a quick Photoshop of what Mr. Clooney might look like bald and put it side-by-side with a typical look for the actor. Which do you prefer?

George Clooney


2009-03-24 16:42:05There Are Bald People Throughout History, So Why Are We Obsessed with Hair?

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Number of Grafts In My Donor Area?

Thanks to everyone for the great emails. Keep them coming in! Here’s one I received on Tuesday, but didn’t get a chance to answer until today…

Dear Dr. Rassman,
I have a slightly below average donor density and I am wondering if a hair transplant would be sutable for me. I am 33 years old and last year started receding agressively. I think I am NW 5 heading to 6. How many graft can you take from my donor for me to have a full coverage? In other words: How many total grafts does my donor have?
Thank you for your attention.

There are five characteristics that vary with each person, that determine the value of the hair for a hair restoration procedure. They are:

  • Density of the hair. Yours is lower than average, but that in itself does not necessarily mean that you are not a good candidate
  • Hair shaft thickness. The coarser the hair, the better it supplies bulk. Hair bulk is a critical element in producing fullness and coverage.
  • The size of the balding area. The more bald you are, the more hair you might need. Sometimes, the goals may be changes to adjust to limited supply or a demand that is too high. That is something you must work through with your doctor.
  • The characteristics of your hair. African hair is the best because it wants to cover, good wavy hair is the next best because it wants to flow together. The Italians and French had the best wavy hair. Straight is the most challenging, as found in many Asians.
  • Color/contrast between hair and skin color. This is critically important. A Class 6 pattern blonde person could reduce his hair population to 85% of its original density and still look full as the blonde hair and blonde skin have low contrast. The same applies to black hair and black skin, brown hair and brown hair, sandy hair and sandy skin and any skin color with white hair. Salt and pepper hair works very well and I have produced some amazing results in very bald men with very little hair.

The amount of hair needed to transplant depends upon many things. Look at our website and see the hundreds of patients there, many who show balding patterns similar to your. The number of grafts are clearly defined for you to see.

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Great results from finasteride in a year then I stopped it

I’m a 26 year old male, 157 lean, healthy diet, active lifestyle.

Many users may not want to hear this, but your lack of side effects may well be your ignorance of them. Finasteride affects your hormones, no argument—that is its entire purpose.

I used it for a year, and it 100% worked! Hairline strengthened, had a full head of hair, and even all grew faster. Body hair reduced as well for an added bonus. I was monitoring any immediate changes in mood/cognitive function/libido but sensed nothing different over the 12 months. This is only because they were so gradual.

I stopped taking it two weeks ago, I feel like I used to in college. It feels like I’ve always had a cup of coffee compared to needing to “wake myself up” before doing anything requiring thought or strength. I’m not sore as long after lifting, and I’ve already gained about 5 pounds of lean mass, as if my body was holding out on me all year. I’m sleeping completely through the night compared to waking up multiple times. I also am constantly horny again.

All these gradual changes I went through, I never noticed or completely rejected because I so badly wanted them to not exist. It worked, but just know you could be a better version of yourself (with less hair) if you hopped off fin.

Ignorance is bliss, however, and beauty is pain. I may start taking it again in the future, but I’m enjoying the DHT right now—it clearly serves a purpose in your body.

When you stop finasteride after getting good results from it, all of the benefits will be lost over a few months and if there was potential progression of the hair loss, you will see that too.

 


2021-03-02 08:36:54Great results from finasteride in a year then I stopped it

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Thinning hair and going crazy about it

Ever since my hair started thinning it literally took over my life it’s all I think about I’m only 22 and I also overthink and worry about what people would say I’d they noticed it and I’m living in fear, I’m also scared how I’m gonna find a wife if I actually lose all my hair. I also can’t open up to my family about it cuz they’ll make fun of me or clown me it’s just the worse feeling in the world, I’m on oral min 2.5 for 4 months now I’m getting regrowth but I was little far back so it’s gonna take a while I also think that if might not regrow back. What’s crazy is I don’t even have mpb I have seb derm hair loss when I was 16 I never took care of my hair I wouldn’t wash it for weeks and it caused my hair to thin. If I do get my hair back one day I would not complain about anything and I’d be the happiest man alive

Not washing your hair when you were younger, did not cause hair loss. You are not equipped to manage this process, that is clear. You need to see a good doctor who can manage the process for you to make you “the happiest man alive.”

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Gynecomastia from Finasteride, lumps removed. Will it come back?

I was taking finasteride and developed breast lumps. I met with a surgeon who recommend that I remove them and then followed through and had them removed. My question is: If I continue to take finasteride, will I get breast lumps back again?

Usually the surgery solves the targeted breast area so it is unusual to have it a second time. Most people who have had the surgery for such complications, stop the drug for fear of it returning so my experience is limited based upon patient choices.


2020-12-04 11:55:22Gynecomastia from Finasteride, lumps removed. Will it come back?

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Hair Assessment in Early Balding

Hi Doctor,

I am a 26 yr old male started thinning about 11 months ago sometime in december last year. My hair was really thick before so obviously I didnt realise I was thinning when it kicked in during the early stages.

Observations :
1. I notice about 18 -25 hair every morning on my pillow. Most of these hair are very fine and shorter than usual. Some of them have a white bulb at the end.
2. Even at work I notice about 4-5 hair falling on my desk/ keyboard everyday even when I gently rub my fingers on my scalp.
3. During a shower when I apply shampoo on my hair I get about 10 – 12 hair sticking on my hands/fingers even though I shampoo very gently. I wash my hair with shampoo and conditioner ( Clairol Herbal Essences/ Nizoral; was using Garnier Fructis earlier) about 5 times a week usually after a workout.
4. My Hair is thinning all over my scalp. Even on the back although since there is a higher density of hair so No scalp is visible.
5. Some of the common symptoms I have experienced in the past 8-9 months are itching, flaking/daindruff, A kind of burning sensation as if there is some heat generated from my body which is burning the hair roots on my scalp, and obvoiusly my hair is a lot thinner than a year back.
6. I do not see any receding of my hairline( thank god for that)but the area right behind my hairline/top has some noticeable bald spots where it seems like the hair thinned a lot and i have lost some hair.
7. Been on propecia for almost a month and do experience some pain in my balls of late (after ejaculation) however I dont think its reduced my sex drive or erections but I am determined to ride it out.
8. Overall When I examine my scalp minutely,I notice my hair still grows fast however the quality of hair is much more thinner than a year ago annd as a result a lot of scalp is noticeable. I probably have some hairloss too.
8. The worst part is I am not able to comb my hair like before and if I make it puff from the top/front My scalp is very visible from the front. I really woe the fact that I should have taken corrective measures early (when visible hair loss/thinning started about 10 months back but like most people I was in a denial mode and just would not digest the fact that I was loosing/thinning for good.

I have spent many sleepless nights on this issue in the past month and literally think bout it every 30 minutes.
I am a vegetarian and take about 100 grams of whey protein (courtesy GNC) per day for supplementation. I would say My professional life isnt that stressfull at all. The pics in the album were taken with a Kodak 4.0 MP digital camera under bright light.

1. I am applying Minoxidil twice a day but I am thinking bout changing it to once a day at night. I apply it mostly at the top and some on the vertex. Also its too flakey and makes it look like I have daindruff on my hair. Do you think this is a good move and is once a day 5% effective ?
2. From my pictures can you tell me whats my norwood scale ? I am thinning considerably from the top. The hair on the top of my scalp are very thin compared to last year. As a result They tend to clump together when I make them wet or when I apply hair gel. Sometimes in the morning when I gently rub a wet hand on to my scalp I get about 6-8 hair sticking into my hand. Will Propecia or Minoxidil make them thicker again ?
4. From the pictures how bad is my vertex ?
5. Realistically what are the chances I will retain my “Hair Glory” I had in Sept 2004 ? Or is it all downhill from now ?
6. Is there any way i can get the thickness measures with a densitometer in the North California area ?

Photo Album at [link removed for privacy]

Most of the pics in the first album were taken immediately out of the shower. these days I just stand under the shower and let the water wash the shampoo itself with out rinsing it off after applying. No towel dryng too. Notice how the thin hair clumps together from the force of the shower and my scalp is exposed. Or Am I balding on those areas ? looking at my current situation do you think I should continue using minoxidil 5% I started it 2 weeks back in panic I use it twice a day for now. Should I cut it back to once a day or totally eliminate it ?

I would appreciate your assessment of my situatiocn.
Best regards

Your photographs are consistent with genetic hair loss, but there is no substitute for a good examination as I have said many times in this blog. You should not be your own doctor. The miniaturization mapped on your head will allow the doctor to determine the pattern of the hair loss. The Propecia you are taking will probably stop much of what you are seeing, but you do need to have the examination for miniaturization, or you will not ever truly know if you are actually benefiting from the drug, or if the problem was just temporary and drugs were not necessary. You discussed your hair glory, wanting to go back. I can not (nor can anyone else) predict your response to Propecia, although I have seen some men return to their ‘hair glory’. Responses depend upon the time you have been losing hair, the genetics of each patient and the timing with regard to starting the Propecia with regard to when you actually started losing your hair. The quicker a young man starts Propecia, the greater the overall effect I generally see. As to your question about using Minoxidil while also using Propecia, I’ve talked about this a few times before: here, here, and here. I am in Southern and Northern California, and would be happy to perform such an examination on your free of charge. I can not make a doctor recommendation in the North Carolina area, but you could take a look at the physician search on ISHRS.org. Be sure to do your research before chosing a doctor.