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Dear Dr Rassman

I am a 31 year old male and around 5 years ago I realised that I had some hairline recession at the corners. I spent 2-3 years obsessing about this and worrying about whether I would be bald before I was 30 and I also worried about my crown too which looks a bit thinner than the centre of my scalp but remains covered with hair.

As I was so obsessed with this at the time, I tracked my hairloss pattern pretty closely and can safely say that it has not progressed much, if at all since then. The hairline is exactly the same (as is the crown). Maybe the corner areas which were thinning are a bit thinner but the actual area has not expanded. I do not take propecia and would prefer never to take it, for medical reasons.

Recently, for some reason, my hairline has started bothering me again, and feel like I would be more confident if I had it restored slightly so that I could spike my hair a bit rather than have the forelock fall flat over the receded areas. Actually what bothers me is not so much how it looks in the daytime, but first thing in the morning when I wake up. I guess the area which I would need transplanting is around 10-11cm squared in total…maybe 6 on one side and 4-5 on the other. This wouldn’t bring me to a straight juvenile hairline (which I don’t want anyway) but would be enough that I don’t look like I have a receded hairline.

My hair characteristics I am guessing are not great for a hair transplant. I have pretty good density in all other areas but my hair is brown and very fine. People are often surprised by how soft it is when they touch it – to give you an idea of how fine it is.

My question is, would having a small transplant (FUE) in these areas be a bad idea? Is it ever possible to perhaps transplant to these areas at a lowish density, just so that I look like I have a hairline rather than a forelock and so that if/when I lose hair elsewhere then I won’t be left with really dense temples and bald areas elsewhere. I would be happy with quite a conservative transplant which just gave the appearance of some hair in these areas, maybe just enough to style. I also think that one day, if I do lose a lot of hair elsewhere, I would shave my head down to a grade 3-4, but if I did this I would still want the appearance of a hairline to frame my face. With this in mind, maybe it wouldn’t be a terrible idea to get the corners transplanted? If it is not, roughly how many grafts might a 10-11cm squared area need?

Please let me know your thoughts. I have seen some very good FUE hair line transplant results online but I am guessing that a lot of these are very dense/’packed’ transplants.

 

There is a very simple answer to your question. If you are obsessed with your hair line then you need to make an appointment to see a doctor.

4 dermatologist and 1 urologist. All of them said the same thing; It is safe. They said that side effect risks are very low and most of the people who get sides are in nocebo group. Because of that, my urologist recommended me to stop reading about finasteride in web and forget about side effects before I start the medication. They are not believing in post finasteride syndrom they said it’s a coinsidence and different body, hormon issues lying behind it. So in their opinion if you get sides and quit the drug, everything should be back to normal after 30-90 days. Also they suggest three times a week 0.5mg to me (20 years old, diffuse thinning on top).

I agree with their opinions; however, I would start at half the dose of 0.5mg/day or 1mg every other day (which is 80% as effective as the full dose) The dose that they recommended may at bit too low to get the impact you need.

If i remove testicles do i gain my hair back and where do they do such operations? Knowing that hair transplant is expensive , with average results and success rate i am trying to know my options

This was done back in the 1920s when identical twins we compared by a psychiatrist. One was a patient in the hospital who had his testicles removed and a full head of hair, the other was his identical twin brother who visited and was bald. When the psychiatrist saw the bald twin on a visit to see his brother, he gave his full headed identical twin a single shot of testosterone and the bald twin lost all of his hair. That should answer your question. Removing your testicles is not a good option and will not restore your hair.

 

For men with genetic balding, stress-induced hair loss often does not return.

balding caused by stress, will hair return? from tressless

This appears to be a disease called Alopecia Areata or a scarring alopecia, both autoimmune diseases of the scalp. See a dermatologist to get it biopsied and treated.

This is a publication from the Kaiser Wellness Journal written by my son Sean Rassman, an orthopedic surgeon moved by a motivational speaker

Woe is me vs. Wow is me – what’s your take?
Published July 9, 2015
By Sean O. Rassman, MD
Department of Orthopedic Surgery, Fontana

Of all the physician off-sites and speeches I have attended in the last nine years, the personal life story told by my colleague, Dr. Kent Miyamoto, had the greatest impact on me. I am sure each physician who heard him speak that day took away something different. What touched me most about his story was not what one may think — the precariousness of life — but what he felt as a patient. He said that he had tried to thank his doctor for saving his life and his gratitude was met with, “I was just doing my job.” He indicated that he actually felt a bit dismissed and cheated by the response.

This made me rethink all of my patient interactions. What we do is more than just a job to the people we treat. I may see up to 40 or more patients on a clinic day, each scheduled for 15 minutes. In reality, I may have even less time than this, due to my seemingly always overbooked schedule. Many days I go through clinic stressed. I work straight through every lunch and often stay an hour or more after my clinic to finish up and then respond to patient messages. I will admit that I have felt frustration and even anger towards patients who try to extend their 15-minute appointment into 20, 30, or sometimes 45 to 60 minutes. I have thought too many times, “Don’t they know how busy I am and how many other patients are on my schedule?”

There was something about Kent’s story that made me realize, although we may only spend 15 minutes with a patient, that 15 minutes is amplified in so many ways.
Often, patients wait weeks or months to see me and may drive for an hour or more in each direction. They may give up several hours of a day for a 15-minute appointment with me. It is likely that all of their family, friends, and perhaps even coworkers have heard about that upcoming appointment. Many patients have likely spent hours thinking about it, discussing it, trying to anticipate what the doctor will say, and, after the appointment, may spend additional hours trying to make sense and summarize that 15 minutes with all of those in their lives.

I realized I had the choice to see these appointments as something that I needed to get through or 30 to 40 opportunities to make a tremendous impact in people’s lives and the hundreds of friends and family who are impacted by that illness. This is both an honor and a weighty burden.

I asked myself, what would happen if I tried to use the 15 minutes not just to “satisfy” or placate patients, but what if I could use that time to wow or amaze them with by showing them that I not only understand their problems, but that I care about them?

Switching to this attitude resulted in a mental shift and I began to look forward to my clinics more as opportunities to make daily, meaningful impacts and perhaps even amaze a few people.

This mindset is something to which I must frequently rededicate myself, particularly when dealing with difficult patients. Whether they are abusive or manipulative, they can contribute significant stress and one or two difficult patients can ruin a physician’s entire day.

I will probably remember little of our motivational speaker from that meeting last year, aside from the fact he liked to climb mountains, but I will always remember Kent’s story and the impact it had on me.

In the past, I was often guilty of brushing off the compliments of grateful patients, because I knew I had a chance to reduce their 15-minute appointments and use extra minutes on difficult patients.

I used to focus on trying to get out by 5 p.m., but came to realize, if I focus on providing not only excellent orthopedic care, but also emotional and psychological care, even if it means I finish 30 or 60 minutes later, I would leave happier and more satisfied.


Now, I make it a point to try and own the difficult patient, even though I have to accept that I will not be able to positively affect each one. Coming up with ideas for dealing with the difficult patient are the things I struggle with most. Here are some that work for me:

1. Attempt to empathize. It may change your own perspective and reactions.
2. Make sure the patient knows that you are truly listening. Sometimes that is all you can do.
3. Make sure the patient does not feel brushed off; something the patient believes other providers have done.
4. Accept that you may need more time with that patient; that you may leave late and try to somehow see this as a positive challenge.

Sometimes, the angry, difficult patients can become the most grateful and sometimes the challenge and joy can be flipping them from angry to amazed.

I was wondering, I looked at a post on newhair.com about two post operative examples where they had minimal to no scabbing/crusts. After my hair transplant I was instructed to wait 24 hours before washing, I washed gently by pouring baby shampoo mixed with water over my head. I did this daily. Now at 8 days post-op, I have quiet a bit of scabs still. The scabs that fell off also shed hairs. I was reading on Wikipedia an article about hair transplant and it stated “Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.” This has me concerned, as I have bald spots throughout the hair transplant and was shedding scabs as early as day 4. I read through your posts and you had mentioned that you try to reduce scabs as much as possible. Will my prolonged scabbing at day 8 effect my outcome? I washed my hair 3 times today and let it soak but the scabs are still not falling off yet. And as I mentioned, there are bald patches where the scabs came off with the hair.

The key is to wash it the very next day and use a surgical sponge filled with shampoo, rolling the sponge over the recipient area over and over again until all of the crusts are off. Pouring soapy water alone will not work. The Wikipedia report came from a medical article I wrote which you can read here: https://newhair.com/wp-content/uploads/2018/11/mp-2006-graft-anchoring.pdf

Below is an example of what a post operative patient should look like one day after surgery (2150 grafts) with good washing techniques as discussed above. If he keeps washing his graft area, the terrible crusting seen without washing will never develop.