Balding Blog

Hi there,

I live in Canada, and unfortunately no one here provides miniaturization tests or hair bulk analysis. I understand Dr Rassman has offices in California and NY? Would it be possible to have these done if I came to one of his offices? Also, how much would I be looking at in terms of charge to have this done? I really have been trying any way I can to get a professional opinion with my hair, if I am over reacting or if there is something more going on. I would just like to know for sure, so I can determine my best plan of action, or if I need to be concerned at all. Any help would be much appreciated.

Thanks for your time.

We do this as part of a free consultation in appropriate young men. Our office is in Los Angeles, California. If you’d like to travel from Canada to see me or Dr. Pak, you can request a consultation via our website here. You might wish to send photos in advance of making any travel plans so that we can have an idea of what your loss is prior to your appointment.

If you decide to go to someone more local, just make sure that any doctor you see has the HairCheck instrument to measure your hair bulk.

Both sides have identical recession as shown here.

Assuming that you just want to fill in the corners and create a normal mature hairline, and assuming that your hair is at least medium in thickness in the back of your head, it would take about 1500-1700 grafts, depending upon where you and your surgeon place the exact location and shape of the hairline. A coarse, hair will drop the numbers while fine hair will increase the numbers. I have been doing hair transplants for 32 years and adjust the graft numbers to the donor supply, the balding pattern, the donor density the donor hair thickness and getting to know the patient and his expectations, so even the above estimate may change.

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.

I was wondering if balding is common, or am I just singled out to be bald while most men are not?

The incidence of balding varies with age, according to an article published by Dr. O’Tar Norwood in his 1975 male pattern baldness article in the Southern Medical Journal. This is reflected in the below diagram (and quoted text), borrowed from the textbook titled Hair Transplantation, by Dr. Walter Unger.

“(A) Incidence of different degrees of male pattern baldness compared by age. (B) Differences in incidence of male pattern baldness between Hamilton’s and Norwood’s studies, with Hamilton’s findings being consistently 20% to 30% higher.”

The frequency of balding is dependent upon age. Dr. Norwood reported it at about 35% in the 50 year old male, Dr. James Hamilton reported it at about 55% in the 50 year old male. As age goes up, the frequency of balding is higher, peaking in both authors studies at about 65 years old (55% and 85% incidence of balding in Norwood and Hamilton, respectively). It should be noted that Dr. Hamilton introduced his hair loss classification scale in the early 1950s, and Dr. Norwood revised this some 20 years later.

You have a Class 4A balding pattern and I would think that depending upon your hair thickness (fine, medium or coarse) you might take between 2,000-3,000 grafts (more grafts with finer hair).

You have a pattern of balding that indicates that you will probably lose all of the hair on the top of your head, maybe the frontal forelock will remain, maybe not. Based upon your skin color, I suspect that you may have an Indian heritage which means to me that your donor supply will be lower than the donor supply of the typical Caucasian. Your doctor needs to build a Master Plan with you, measure your donor hair density and donor supply for the long term. This will determine not only what you need now but what you will need in the future as well. I suspect the first surgery will take at least 2,000 grafts and further surgeries in the next few years may be required as you lose the rest of the hair on your head. I also suggest that you consider taking the drug Finasteride to protect the hair that you have left for both the short and long term.

The number of grafts depends upon (1) the thickness of your hair (fine, medium or coarse), (2) the donor density which tells the doctor how many hairs are present per follicular unit and (3) where the center hairline belongs (I don’t see the highest crease of the furrowed brow to measure the appropriate distances). Based upon these three factors and assuming that the center hairline is now in its final position, I would guess that the number of grafts (assuming that the grafts average 2.2 hairs/graft), that it would take 1700-2700 grafts (more if the hair is fine and less if the hair is coarse).