Category: Uncategorized

I had a hair transplant surgery since one month and week before (on the 20th of June), my hair is full of white crusts as shown in the photos, they exist everywhere in my hair. They are itchy and annoying. They increase with time. I wash my hair every day with a shampoo but don’t dry it to avoid hurting the grafts. I don’t know if this because of the residual of the shampoo or what. How to get rid of these white crusts please? They are very very annoying. I am afraid they affect the transplanted hair. I need your help please. I tried to contact the doctor did the surgery and didn’t reply. I am sorry for your disturbance.

This is residual crusting and requires a more vigorous hair washing with your fingers and a good shampoo. At this time you can’t harm the grafts so be aggressive.

What concerns me is the potential for change and any lack of planning for an outcome like this: https://baldingblog.com/need-master-plan-think-hair-transplants-photos/

I see such patients at all ages who developed balding that they didn’t expect. I always keep my eye on the donor supply, knowing that one should never use it up before the balding pattern completes, which may take many years. Young men in the early 20s don’t worry about getting older (like 30-50), but I see many 50 year old men who had hair transplants years before, and used up their donor supply yet continued to bald. Fortunately with tests like the HAIRCHECK test, I can often predict the long-term balding pattern when a man reaches 25 (not always) but I can always predict what their donor supply can provide for them for their lifetime. There are many things today that we couldn’t do years ago like Scalp Micropigmentation which can substitute for hair in certain circumstances (see: https://newhair.com/wp-content/uploads/2018/11/Combining_Follicular_Unit_Extraction_and_Scalp.98621.pdf). For these reasons, I focus on a Strategic Personalized Master Plan for each of my patients because even if they don’t worry about progressive balding, I am planning for it on their behalf.

How old are you? What have you done so for to treat your hair loss? The idea that you can get an estimate of how many grafts if you (1) are too young, (2) haven’t tried treatment without surgery, and (3) go forward without a Master Plan by a good doctor is crazy!

Like a question you answered from another emailer, I’ve also self-prescribed finasteride for the past few months. I went to a doctor a year ago, and he took a 30 second look at my hair and told me that I should consider Propecia. I’m 20 years old and hair loss is worrying me so much. I think I’m losing hair and want to be safe rather than sorry but I know I should get a professional opinion. Can I get a little more information about what would a doctor be able to evaluate me for?

When you visit us, we evaluate you as follows:

1. Analysis of your hair bulk with a special measuring instrument will focus on the top and crown of your head to determine if there is any early, sub-clinical balding present. One part of your scalp will be compared to other parts of the scalp (the donor area) to determine if you lost any meaningful amount of hair bulk or are in the process of losing hair. This test is highly accurate for determining the degree of hair loss you have to date.
2. Evaluation of hair for miniaturization is an important test, because hair loss in its earliest period will show decreased hair shaft thicknesses. This can be done throughout the scalp and is a good predictor for where you hair loss will stop, even though photos may indicate you’re at the end of your balding process.
3. Hair density evaluation is critical, because you must know the supply of good hair and establish a good baseline. Hair transplantation is a supply/demand process and you most know what you can expect over the years in front of you. You would not want to run out of donor hair or start too early, as you may continue to bald, leaving you freaky looking, as so many patients have found themselves in this situation when planning was not done properly. We are all different and are born with different hair densities. Add to that the ethnic hair densities found in different people (Caucasians are born with an average 100,000 hairs, Asians with an average 80,000 hairs and Africans with an average 60,000 hairs). Within each ethnic group, variations in the number of birth hairs vary considerably, so these measurements will give you guidance as to what can be accomplished and more important, what can not be accomplished. As an example, for an African who has a very advanced balding process, he would run out of hair before he could fill in the bald area so he needs to know this right up front, not find out about it after he starts the transplant process. The same issues reflect all ethnic variances.
4. Build a Master Plan for the present and the future, because hair loss is a progressive process. You must have a plan as to what you are going to do as you age and in the next 10-20 years, the progressive process should have slowed down substantially. The drug Propecia (finasteride) is generally safe and side effect free in 98% of people who take it. If you are really balding, there is no alternative way to hold on to your hair. Frankly, all of the other remedies out in the marketplace will not work as well as this drug, if they work at all.

They say you can get a transplant once you’ve stabilized your hairloss with Fin – but how reliable is it actually? I’m not sure how accurate this is, but I often read that Fin doesn’t really halt your hairloss, it slowns it down a lot but your hairline is still receding. And who’s to say that you get you a transplant and, 3 years later, Fin starts losing effectiveness and you end up looking even worse before? Do you just have to gamble on this, or am I missing something? Or is the transplant a commitment in the sense that you’ll eventually need more to “recorrect” everything?

What are you realistically getting in the long term with a hair transplant?

I have been doing hair transplants for 28 years and started the trend with small follicular units used for the hair transplants. Many of my patients from 28 years ago, come and visit me and a few came back for more hair transplants as they continued to lose hair. In good hands, hair transplants work and in 99% of people, the results are permanent. That is good and bad because if it is done well, you will look good, but it is done poorly, you will always look freaky.

Here is a picture of the donor area of a man who asked me: How much donor hair do I have? He asks: You have talked about the Donor Bank in your writings, so I would like to know how many grafts are in my Donor Bank and what will be my lifetime supply of grafts for hair transplants in case I should become very bald?

First let’s see where the permanent zone of hair can be found. It is called the permanent zone because even the baldest of men, never lose hair in this zone (see photo below). The zone measured from 2.5-3 inches in height and extends around the entire head from temple prominence on the right side to temple prominence on the left side. We generally assume (safely so) that this hair will always remain (regardless of the balding pattern a man develops). Back in the late 1950, a doctor ‘Orentriech’ discovered that if this hair is moved anywhere on the body, even into a bald area of the scalp, it would grow as it would have grown in its home location in this permanent zone. That is why it is called the permanent zone of hair.

There are two important numbers to determine from the hair in this zone (1) the hair count per follicular unit (these are the groups of hairs that contain one or more hairs each in them) and the thickness of the hair shafts of this permanent hair (never look at the hair you are losing as normal hair as it often gets thinner and thinner). I quantify the thickness of each hair shaft in the permanent zone by feel (experience helps here) or with a micrometer as Fine (~40 microns or less in thickness), Average (~60 microns in thickness) or Coarse (70+ microns in thickness).

I generally take a picture of the donor area with the hairs cut short enough that I can count the number of follicular groups in the field of view and how many hairs are in each group (see below). This field of view of the donor area of one of my patients was taken with a purchased lens as an attachment for my cell phone (https://www.amazon.com/gp/product/B07S5YPPQX?pf_rd_p=ab873d20-a0ca-439b-ac45-cd78f07a84d8&pf_rd_r=CCSSMZGDS79G6AG31TT9) at a cost of $16, something you should consider purchasing.

First let’s do some simple math: There are 34 individual hair groups (in the area shown in the photo) which contain from one to 6 hairs each (each are counted and labeled for you). The total hair count in this field is 85 hairs. If we divide the number of hairs by the number of groups 85/34= 2.5 hairs per Follicular unit (a Follicular Unit is essentially what we call a Graft in a hair transplant surgery). The average Caucasian has 2.2 hairs per Follicular Group so the man shown here has a hair count that is 13% higher than average. I can tell from this number that this man has 125,000 birth hairs on his head regardless of how much hair he has already lost. I felt his hair for thickness and measured it. It measured 60 microns which is essentially an average weight hair.

Now let’s look at more detail at this picture. There is a single hair shown that I labeled ‘m’ for a miniaturized hair. So this man had approximately 1% miniaturized hairs. The number of miniaturized hairs can be as high as 20% and the donor area is still considered healthy. As we get older (into your 50-90s) these hair groups may drop hairs so that the count could be slightly lower and the hairs that we often drop will often be miniaturized before they fall out. Everyone experiences hair changes with age, as donor area hairs may get ‘finer’ so that they contain less hair bulk per hair shaft. If these hairs are used for a hair transplant, whatever happens in this permanent zone, will happen in the hair transplanted hairs as well.

The calculations of his total donor bank supply is a bit more complicated. Each person has a fixed number of Follicular units (about 50,000 for an average sized head). Generously assuming that the size of the donor area is between 20-25% of the total hair baring scalp (let’s use 25% as a number for calculations here), this patient has 31,250 hair in his permanent zone or 12,500 follicular units (grafts) of which he can transplant theoretically no more than 60% of these hairs (follicular units or grafts). The 60% number is based upon an average hair count, but because this man has 13% more hair, he can actually move 13% more grafts bringing his total available lifetime hair to 7,500 * 1.13 = 8,475 grafts available during his lifetime.

Experienced surgeons like me who have been measuring hair densities since I first entered the practice and defined it in the literature, have learned when they can increase even this number safely. This is where surgical judgment comes in. I would like you to try to make this important assessment of your Donor Bank so that you will be able to (1) test the doctor’s knowledge of what he says about your donor supply, (2) be confident that your donor quality and quantity is adequate to meet your short and long term hair transplant needs.