First, I would advise you to go back to your doctor and ask him/her the very same question you asked here. A good doctor will either give you your money back or redo it, that is, if you trust your previous surgeon to do it right the second time at no charge to you. Eyebrow transplants using scalp hair requires a special skill in identifying the ‘bend’; that is natural in each transplanted hair. So when put in by the surgical team, the natural curve of the hair must be placed to take advantage of it as it is placed. It must also be placed laying flat, consistent with your natural eyebrow hairs. Too many surgeons without considerable experience can’t seem to get either of these techniques right, and if they don’t, the eyebrow hairs stick out rather than lay flat as they should.
I Am 50 Years Old and I Look over 60. What Can I Do?
I am 50 years old and balding. My neck droops, my joules show, by face is the opposite of tight and I have bags under my eyes. Can facial surgery and hair transplants fix these problems. Will these congeries cause scars that everyone can see?
If you feel you are looking older because of Jowls or a turkey neck or creases on your face and bags under your eyes that make you look old, you could be a candidate for a face lift and surgery on the bags under your eyes. Good hair on the sides is important to cover up face lift incisions where scars might form scars. The symptoms you listed can be addressed by working with a good hair transplant surgeon (for a hair restoration) and a good plastic surgeon. Hair covers incision scars from a face lift, even short hair provided that there is hair in front of and behind the ear where the incisions are made for the face lift. The bags under your eyes can also be treated with a good plastic surgeon and these surgeries usually do not scar. Good planning with your plastic surgeon is important.
Most men tell me that the hair transplant makes them look 10 years younger. Add to that the work on your face and your eyes, and you might be looking 30 again. If course, you did not comment on your ‘got’ and I am assuming that you are not heavy or looking for a liposuction.
2014-09-17 06:44:472014-09-15 12:53:36I Am 50 Years Old and I Look over 60. What Can I Do?
Testicle Pressure from Finasteride
I have been taking Fincar (generic finasteride) for a little over a week. I noticed two things…a slight pressure feeling on both of my testicles, and a sudden shedding that happened today (there were like 20 hairs at once on my hand when I shampooed.) I’m kind of thinking about stopping, and I wanted to know what I should expect. I’ve read that once people stop, you can have a massive shed. Did taking the drug for 10 days even do anything? Am I going to have another shed on top of the one I just had?
Finasteride is a great drug for treating genetically induced hair loss, but if you were on it for just one week and stopped, there is no risk of loss. Twenty hairs is not a big deal (for example, you could’ve had some product in your hair that kept hairs from falling out through the day — totally normal) and you are probably overreacting.
Testicular symptoms do occur in a very small number of patients, and you should see your doctor if you’re experiencing pressure in your groin.
Not- Hair Loss News – Physician Suicide
Medscape November 17, 2014
The fact is that each year we lose over 400 doctors to suicide—that’s like an entire medical school gone. I lost both men I dated in med school to suicide. In my town, in just over a year, we lost three doctors to suicide. One doc in town lost seven colleagues to suicide! In what other profession can you lose seven colleagues to suicide?!
This is an interesting quote from a female doctor about a problem that is not uncommon. My son, a practicing surgeon, lost a colleague to suicide this year and that was not the first suicide at his hospital. Everyone was shocked. The suicidal doctor clearly did not communicate what must have been depression. Doctors are just like everyone else. They carry their baggage, their disappointments, their problems (both emotional and financial) with what they feel can’t be communicated to others, possibly some defect in themselves. They may not reach out for help, like so many ordinary people. In a conversation with my surgeon son, he said that all too often, the doctors who commit suicide, just don’t reach out and that some system needs to be created to address their somewhat unique status.
Thank You for Meeting Me at the Open House
Hi Dr. Rassman,
I was the 22 year old with the early balding. We met at the open house on April 9.
I just wanted to say thank you for all of the information and the prescription for finasteride that you provided. Although I don’t know how I will respond to the drug, you may have saved my fairly full head of hair in the process.
I also would like to stress to other young men my age: if your hair is important to you and you sense that something isn’t right up there, get yourself examined immediately. It is a lot easier to maintain than to regain. Up until a year ago, I thought I would have nothing to worry about until later in life (general family genes start balding in 40+). I was unlucky enough to start early.
Again, I cannot thank you enough. Although it wasn’t what I wanted to hear, the bad news is more valuable to me now that I know I can at least do something about it in the early stages.
You’re very welcome. Thank you for stopping by!
Our events are open to anyone that would like to meet patients and see what we have to offer. Our list of upcoming free monthly open house events in Los Angeles and San Jose, California can be found here.
I Had A Hair Transplant 11 Months Ago And Still Look Thin
I’m 28 years old. I got a hair transplant done in November 2013. After the transplant, I lost some hair and seemed to be more hair loss in the first three months. Now that i’m approaching my one year period soon, why is it that the amount of hair that was planted has not grown? I was expected a least twice of what i see. When i comb myself i still look like someone who is losing is hair, and i hate it, especially when i go under a light or out in the sun. What is your suggestion to my situation.
Setting expectations is as much the ‘art’ of what I do as doing the surgery. That is why I have open house events every month, so that people who are going to have surgery can see and meet someone with a similar balding pattern and hair color and ask them about their experience. It is possible that you lost a considerable amount of hair from the hair transplant surgery and the transplants actually grew but because of your shock hair loss, the net gains was zero (worst case). If you were on the drug Propecia (finasteride) it may have helped but that is hard to tell.
If the hair did not grow, then the question should be ‘what went wrong?’. Maybe it did grow but your expectation was unrealistic and the communication between you and your doctor may have been an issue. You can always get a second opinion, but first, ask the doctor who did it and find out if your doctor’s expectations were met and ask him/her to examine you for the results of the hair transplant.
The Dermaroller and Minoxidil seem to work nicely together – 4 months apart (photo)
Patient Story After FUE Surgery Cracked Me Up!
A patient who had a surgery yesterday, told me about his experience as he was walking the two blocks to his hotel. His surgery was finished at about 4:00 pm and he was wearing a surgical cap (to cover his FUE and hair transplant surgery) and a doctor’s scrub top (given to all of our patients for surgery). He was approached by two beautiful women who seem to be tourist with Russian accents. They flirted with him and struck up a conversation eventually asking him what type of doctor he was. While he loved the attention and as a single eligible man on the dating scene, he just had a hair transplant procedure and it was not the time to flirt back. He thought “what would be the chance of meeting women like that after his hair grew out wearing a surgical garb?”. We both had a real good laugh.
The Medical Science of Hair Loss
What constitutes a good way to follow genetic balding? So far it seems to be a vague art that varies between doctors, and not something that will give an intelligent person an understanding of what is happening to them.
Miniaturization occurs in men and women who are balding. Miniaturization is the process where a normal thickness hair shaft becomes thinner and thinner over time due to the genetically determined effects of aging and/or androgenic hormones on the terminal (normal) hair follicle. The process of miniaturization is a slow process in genetic balding. Hair shafts may lose 10% of their diameter, then 20%, then 30% and so on. Each degree of increased miniaturization reflects further progression of the genetic balding process. The instruments that measure miniaturization were invented (and patented) by me in the early 1990s and they are in wide spread use today. Socially detectable hair loss is not evident until more than 60% of the hair has been lost and as a result, many men do not seek out expert help until they see some evidence of balding (which they too often deny).
When a doctor views the scalp hair with high magnification, the degree of miniaturization and the location of the miniaturization are both critical to establishing (1) the diagnosis and (2) the rate of the process, which progresses over time. Because miniaturization is a relative measurement at any one time (comparing finer hair to the thickest hair), it takes substantial experience before this measurement can be useful to the individual clinician. In our experience, from examining and following thousands of patients with the Hair Densitometer, we have found that assessing the degree of miniaturization has useful predictive value when evaluating the risks of hair loss and in establishing hair loss patterns. The amount of miniaturization in each section of the scalp tells the physician just how far the balding is progressing or has progressed. In men who show more and more areas of miniaturization over time, the genetic balding can be considered active.
A high degree of miniaturization in the upper portion of the fringe area in a Norwood Class 6 pattern (see below in red) suggests that the donor fringe will lower over time so a person who may be a Class 6 pattern balding pattern may become a Class 7 pattern, reducing the fring around the sides and back to a 3 1/3 inch band. A high degree of miniaturization throughout the donor area indicates that all of the patient’s hair may be unstable for hair transplantation and that he may be at risk to have diffuse unpatterned alopecia with extensive balding, even on the sides and in the back of the head (an area normally not affected by any balding or miniaturization in most men). The unpatterned alopecia is characteristic of women’s genetic balding pattern which is often found all over the head including the back and sides.
Miniaturization in the recipient area (front, top and crown) can often delineate which areas of the scalp are most likely to bald and which are stable, anticipating the patient’s future Norwood hair loss classification. If a man has 90% miniaturization in the crown (back of the head) and only 30% in the mid scalp, the physician may assume that the crown is at a higher risk of earlier hair loss than the mid-scalp, giving him an eventual Class 4 or 5 balding pattern.
We feel that in predicting the short-term loss, the extent of miniaturization in the recipient area, as well as the rapidity of the loss, is critical in establishing the guidelines for treatment, whether it is a hair transplant or drug intervention. In the very early stages of hair loss (the many in his early-mid twenties), increased miniaturization can anticipate future balding even before any loss can be seen to the naked eye. Often the reason a person seeks a consultation for hair restoration expert is that there is some change in the “rate” of his hair loss (often more hair seen on the pillow or in the shower). A patient who is very gradually losing his hair is less likely to seek help than a patient who suddenly has acceleration in the rate that he is losing hair. Usually large numbers of hairs undergo miniaturization before any are actually lost and the time the drugs are most effective is in this early phase. In men, DHT is the hormone responsible for these changes.
For the most reliable prediction of the final hair loss pattern, the patient should be over the age of 25 (above 30 is better) and have some visual evidence that the process has started. A base measurement and subsequent follow up measurements are essential to the proper management of hair loss by any doctor considered to be an expert in the field. By understanding these measurements over time, the doctor will understand just what this all means and better yet, the patient now has a way to follow what is happening to him/her. Many young men worry about following their father’s or mother’s male family balding history and come to the office to find out what their future has in store for them. The microscopic assessment for miniaturization is the best way to determine this.
With successful medical (drug) treatments like Propecia in men, the miniaturization may be reversed (partly or completely). The responsiveness of each patient is different, so each patient must be diligent in follow up measurements of the degree of miniaturization and the location of the miniaturization by scalp location. The same diagnostic criteria should and must be followed in women. Without good measurements for miniaturization, there is no clinical science in the treatment of hair loss, just hocus-pocus and blustering, a problem that is far too frequent today.
Where Are the Temples (with photos)?
Hello doctor, I have a 2 part question:
I am confused about the location of temples. I’ve been reading many of the previous posts here and I’ve heard you say a few times that people get the temples/corners mixed up and that the temples are above the ear. What I would like to know is: where exactly are the temples/temporal hair? I am having trouble understanding this. Also, I know what vellus hairs are but I see some hairs that are longer than 2 mm (what you said were the max length for vellus hairs) that are sort of whitish near the part of my head I assume to be the temples (right near the corners).
The leading edge of a hairline often has small vellus hairs that never grow very long. Behind this there are soft one hair follicular units and behind those are two and three hair groups. It is the two and three hair groups that make our hair look full. For purposes of definition, I have put a picture of a patient where we transplanted everything in the front of his head. Notice a soft hairline that is not a line but a zone that is irregular and reaches back to fuller, more dense hair. Many of our patients tell us in emails that they are losing their temples, but what they are saying without knowing, is that they are losing their hairline as this man did.
