Category: Uncategorized

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Transplanting a Mohawk into a Norwood 7?

hi, i want to ask, hypothetically could a NW7 get an FUE but instead of getting a natural hairline get his grafts redistributed to a Mohawk so he would have no hair growing out of the sides but instead have all his hair concentrated to a 1 inch thick line going from the front to back and if that could be done, how many grafts would that be?

Mr. T's mohawkI’ve never had that request before, but yes, it is distinctly possible. What I tell all my patients is that the good and bad news about hair transplants is that they are absolutely permanent. As a young man, a mohawk may be a great idea for your particular look, but at 60 years old, will it still be great? Depending upon how thick you want it, it might take between 2500-6000 grafts.

Note: The image to the right is of the iconic Mr. T — and as far as I know, he didn’t transplant the mohawk to his scalp. I’m just using the photo as an example of the hair style.


2009-10-29 08:48:15Transplanting a Mohawk into a Norwood 7?

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Hair Loss from Hair Twirling?

Does twirling the hair at the front of the head cause extra hairloss? I am 37 and have had male pattern baldness.

Only if you pull on it while you are twirling it. If you have not seen hair loss in the area you are ‘working’ I would not worry much about it.


2007-06-08 09:35:37Hair Loss from Hair Twirling?

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Transplanting Hair Into a Cranial Morcellation Scar

I have a scar that is about the width of my pinky finger that goes from ear to ear on my head. This is a result of a surgery I had done when i was younger from cranial morcellation of my skull. I was wondering if there is anyway to get hair put into this scar.

There are ways to address such scars, including hair transplantation (in some people) or scalp surgery by those who are experts in the field. From what you described, I can not tell you which way to go, but scar repairs from brain surgery is one of the areas where what I do works very well. I need to see some good digital photos of the scarring and possibly would need to meet you to examine your head before giving any real options. Tentatively though, it does seem like you have some options.

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Hair Loss from Tuberculosis?

My 17 years old daughter was diagnosed with inactive tuberculosis about 8 months ago and has been taking INH. However, about 18 months ago she started losing her hair. Could this be caused by the tuberculosis alone?

I have written on this medication with tuberculosis before (see Tuberculosis Drug and Hair Loss). The disease itself is a wasting disorder which is known to produce hair loss, as with other wasting disorders. The same recommendations I made before apply: good diet and appropriate vitamin therapy. A full work-up for female hair loss is in order here as there are many diseases that cause hair loss in women (see Female Hair Loss category). Read these pages carefully and seek out a good doctor to follow through with a thorough examination of your daughter. Also, you might want her to see a hair specialist who will study her for female genetic hair loss and assess the miniaturization of her hair to see if the pattern is typical of female genetic hair loss.


2006-01-05 10:24:30Hair Loss from Tuberculosis?

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Transplanting to the Hairline Corners Without Risk of It Looking Bad with Future Loss?

Hi Dr Rassman,

I am 30 years old and for the past four to five years have had some recession/thinning at the corners of my hairline. It is uneven (on the left side around a 6cm triangle shape in area) and on the right side around half that area. For years I’ve monitored the area (even went to see Dr Farjo two years ago who confirmed i had mild recession – not a mature hairline) and in terms of area of recession it has got no worse – maybe a little thinner in those areas but it has not spread.

The fact that I have a receded hairline REALLY bothers me because i have very dense hair in the middle and on top but it is thin on the sides making my hair very messy when i wake up etc. I would love to have it filled in slightly with a hair transplant to frame my face better and so I wouldn’t have to worry about styling it as soon as I wake. It consumes too much of my time/thoughts and I’d like to not have to worry about it so much. So here are my questions…

1) If my hair loss has been fairly stable for over three years is it likely that I won’t lose so much hair in future or does it not work like this? Dr farjo didn’t seem to think that I would not lose a great deal of hair in future but my dad is NW6 bald, My maternal grandfather was more NW3-4v in his later years with hair combed over.

2) If as I suspect it is just not possible to predict that I wont lose too much more hair in future, is there any way that I can have a hair transplant to the hairline corners without risking looking stupid in future if I do lose lots of hair behind it and can’t afford a future hair transplant or don’t have enough grafts left to cover it all (I have very fine hair by the way). What I mean is, is there any way for a HT surgeon to do a lower density transplant at the corners to stop it looking like the patient is looking like they have thick horns of hair left in future as they go more bald? By the way – I have ruled out the option of ever taking propecia as for me i can’t afford messing with my hormones (other health issues) and minoxidil never worked for me in this area (I sometimes wonder if it did more damage than good as it is when i used it years ago that the thinning progressed).

3. Finally… For someone with fine hair…what would be the density per square centimeter needed for a transplant at the hairline corners. I’d like to get an idea of how many grafts i might need if it is possible.

Thanks in advance for your help.

p.s. I realise my questions are quite specific and will of course go back to see a surgeon for an opinion but just can’t afford to at this moment hence my questions.

Dr. Farjo will give you good advice on these issues. If he thinks your hair loss won’t progress to your father’s pattern, I would plan for that. Ask you dad when he started to lose hair. I suspect he started earlier than you and accelerated more quickly.

That said, since we never know with 100% certainty what is going to happen to the hair loss over time, you need to make plans for now and then be able to maneuver to another step if the hair loss progresses. You should have a Master Plan created with Dr. Farjo if you have not done that yet.

Concerning a transplant to your hairline corners and having very fine hair, if you do opt for surgery, be sure to have it done right. Creating a thinning or balding look with this hair is not in your best long term interest.

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Treating Hair Loss with Rejuvenating Oil (Includes Olive, Sesame, and Peanut Oils)

Hello Dr.
I am 21 years old and i have been using Rogain and Propecia for a long time( about a year). Unfortunately I have not had a positive result from these medicines. I lost hair since I was 15. I am norwood 1 or 2. I have heard about an oil called Rejuvenating Oil including oils from plants such as:

Olea Europaea (Olive) Fruit Oil, Sesamum Indicum (Sesame) Seed Oil, Arachis Hypogaea (Peanut) Oil, Prunus Amygdalus Dulcis (Sweet Almond) Oil, Simmondsia Chinensis (Jojoba) Seed Oil, Juglans Regia (Walnut) Seed Oil, BHT, Cananga Odorata Flower Oil, Lavandula Angustifolia (Lavender) Oil, Gardenia Florida Oil, Geranium Maculatum Oil, and also chemicals such as: Chlorphenesin, Amyl Cinnamal, Benzyl Alcohol, Benzyl Benzoate, Benzyl Salicylate, Citral, Citronellol, Coumarin, Eugenol, Farnesol, Geraniol, Hydroxycitronellal, Isoeugenol, Limonene, Linalool

Are these oils really helpful ?

Olive oilNo, the oils probably do not help with your hair loss. Of course, you’re welcome to try the product out for yourself, but I don’t see anything in that list that will cause your hair to regrow.

My question to you is why did you use Rogaine (minoxidil) and Propecia (finasteride) when you classify yourself as a Norwood 1? Plus, I’m not sure what you’re looking for as far as results that have lead you to believe there was no positive result. Are you expecting complete regrowth, or do you know that just seeing the hair loss halt is also considered a positive benefit? As you can see, after reading your email I’m left with more questions than answers. There is something wrong with your logic, and unfortunately without an exam and better medical history, there isn’t much I can offer you.

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Hair loss on sides and back of the head after a hair transplant (photo)

I belieeve that you are addressing the hair loss on the sides and in the back that are shown in the photo shown by the arrows. I have never seen this type of loss outside of the transplanted area and in areas (particularly the side) where the hair is usually permanent. Time will tell (6 months) if this is the result of the anesthetic or not. .A biopsy, at some point in time, may be a reasonable thing to do by a good dermatologist? who should be managing the problem


2017-11-19 13:27:06Hair loss on sides and back of the head after a hair transplant (photo)

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Trichotillomania

I have been picking my hair for years. I would like to think that I stopped, but I know that I keep picking at it. I now have a series of bald areas where the picking has taken out some hair. Is this permanent? Will it come back if I stop picking at it? Can it be transplanted if it does not grow back?

The medical condition is called trichotillomania. Children or adults sometimes twist or pull their hair, brows, or lashes until they come out. This hair pulling is sometimes a coping response to unpleasant stress and occasionally is a sign of a serious problem of an obsessive disorder. If the picking stops early enough, then the traction alopecia that results will reverse. However, this is not what usually happens as most of the people with this disorder continue to pick on the hair until it eventually becomes lost permanently. The best way to determine permanence is to look at the area with a high-powered microscope. Active areas of trichotillomania show blunted, short hairs which are signs of recent regrowth of plucked hair. When these short hairs do not show up under microscopic examination, the traction alopecia is probably permanent.

Yes, hair transplants can put the hair back in the area of alopecia produced by trichotillomania, but the problem with doing it is that the person will just pluck out the same hair again and again and produce the bald spot. What is the point of transplanting the area of alopecia only to have it returned? The key is to address the trichotillomania from a medical/psychiatric medication or therapy approach and solve the underlying problem. Once the patient knows that the cause of the trichotillomania has been fully addressed, then the reward can be a hair transplant to put their hair back.

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Hair Mapping for Miniaturization

Dr.Rassman, What is hair mapping? I have a derm doctor. He did a biopsy that showed AGA. I am 59, female. I started taking Prempro again, with hope of keeping what hair I have. Who do you think I should see in the Orland Park IL. area? I have lost more than half of my beautiful hair! I am at the moment using steroid gel on the bald spots every day, I really value your opinion.Where do I go from here? I will travel any where…

P.S. My doctor loves your site/ He said he would follow your instructions!

Hair mapping means that a physician is using a densitometer or video magnifying camera to look for miniaturized hairs at multiple sites on your head. The percentage of miniaturized hairs and the thickness change in those miniaturized hairs will determine:

  1. if a balding process is going on
  2. the pattern of the balding process
  3. over time and advancement or regression of the balding process

Based upon the many different published patterns of hair loss, the doctor can determine:

  1. what pattern of hair loss you are demonstrating or probably evolving into
  2. a look into your future hair loss based upon his/her experience with that particular pattern of hair loss as it conforms to the published patterns (e.g. Norwood Chart)
  3. the overall health of the hair in different parts of the scalp

For example, if a man has extensive miniaturization of hair in the Norwood Class 6 pattern (under microscopic examination), he may advance to a fully bald Class 6 pattern (even if it is not evident to the naked eye). Miniaturization is looked at in two ways; first, the total number of normal vs miniaturized (narrow shafted) hair, and second, the degree of overall miniaturization on a per hair basis (e.g. 80% of the hairs are miniaturized with an average hair loss 50% of its original diameter). If, over time, the percentage of miniaturized hairs stay the same, but the diameter of the hair shafts increase to, let’s say, 80% of their original diameter with a person on Propecia, the change can be documented as benefiting from the Propecia, or reduced to 20% of its original diameter, indicating a progression of the miniaturization and a failure to respond to the Propecia.

For women with genetic hair loss, miniaturized hair follows very different patterns than for most men. For the transplant surgeon, it is critical to know the miniaturization that is going on in the proposed ‘donor area’, for if the hair in that area shows significant miniaturization (diameter reductions and the percentage of hair involved in the process), then most of the hair that is used for donor hair will fail to survive a transplant, because the miniaturized hair will not have value in the new location. As an example, if a woman needs hair in the frontal hairline but has 80% miniaturized hair in the sides and back of the head, then one would assume that 80% of the hairs that are transplanted will fail when moved from this donor area.

For the male patient who is going on Propecia, getting baseline measurements will tell something about the changes in the hair after a reasonable treatment period. An example of this would be: a young man who had 90% miniaturized hairs in the hair population from a balding area measuring a 3 inch circle in the back of the head. Let’s say he was started on Propecia and then 8 months later, the miniaturization came down to 50% of the hair in the circle. That means the drug is working nicely and some reversal of the impact of genetic balding on the 3 inch circle in the back of the head had responded to treatment.

So you can see that the value of measurements here are both for diagnosis (what is causing the hair loss and how bad it is) and prognosis (predicting the future with and without treatment). If measurements are not made, then there is no sense of control for the doctor or the patient and the cause of the hair loss can not be followed intelligently. Measurements are the foundation for clinical science. A patient with compromised kidney function gets a blood test to see the progress of the disease and the value of any treatments given. The electrocardiogram (ECG) measures the damage of the heart after a heart attack or predicts a pending heart attack. I can go on and on here, but basically, hair should not be treated any differently than other sick organ systems. There must be an end of the days when a doctor runs his fingers through your thin hair and says (somewhat magically) that he knows what is wrong and how to fix it, he knows that the density is good or you are not going bald.

Blood work will help rule out other causes of hair loss such as hypothyroidism, anemia, hormone imbalance, and malnutrition.


2008-01-18 13:45:27Hair Mapping for Miniaturization