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I would like to see more data than reported here. I do, however, believe this study, because I suspect that the wounds created with the microneedling technique will have increased the blood supply to the scalp that was damaged from the microneedling. What we don’t know is the downside of this type of treatment – complications such as infection, especially when done with less than very clean techniques. Do all patients shower and shampoo prior to microneedling or do they just do this when they come home from work and watch TV?


The problem I see in this patient is not only what appears to be excessive FUE depletion of the donor area, but that FUE extractions went well beyond the donor area into the crown and even the upper neck. Much of the hair extracted was too high in this man’s head or too low near the neck, which will not be permanent hair.

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Assuming that you are a Norwood Class 3 at this time and do not have a crown component, it is likely that you will not advance to a significant Norwood Class compared to most people your age. If you take the drug Finasteride, it will not advance the balding pattern. With these factors, it is possible to restore the balding area to a “full level,” provided that your donor area has at least average donor density (which could be a limiting factor). You are asking to restore your recipient site density to near normal in order to cut your hair very short; I think this is worth discussing with your hair transplant surgeon.


I would want to know more about you to give you more insights. If you are a female, then traction alopecia is a possible cause if you pulled your hair back tightly for many years.

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If the graft was placed upside down and it grew for months, it might have grown to full length inside your scalp at a rate of about 1/2 inch per month. I am sure that your doctor remove the hair that came from the cyst (and it most likely was created from an ingrown hair).


I also have a history of having Gynecomastia when I was 15, and it was surgically removed.  Will my risk be high if I start Finasteride?

Before staring the drug Finasteride, I always perform a HAIRCHECK, which accurately shows the amount of hair lost at the time the drug is started. If no hair is lost, I advise against the drug.

However, if hair is lost, then I remeasure the patient one year later to see what happened to the balding process and if the drug (1) was started, and (2) the value and the benefit, if any, of taking the drug. For young men with a history of Gynecomastia, the drug Finasteride is not any more of a risk in your situation compared to other men of your age.


A proper consultation include building a relationship between the doctor and the patient, not a salesperson. Unfortunately, too many doctors see $$$ when they see patients. I often see patients and tell them that they are not good candidates for a hair transplant or that the timing is too early. I always build a Master Plan with the patient, so the patient has both a short and long-term plan which may or many not include a hair transplant. My favorite part of what I do is meeting the patient. My practice may be unusual in that I have many celebrities and CEOs of big companies, but I also get truck drivers or students too young for hair transplants. I try to give them the materials that equips them to handle their “balding problems” and balance it with their lives.

FUE Hair transplant consultation results from tressless


I went to a surgeon for a consultation, and he said the following in an email to me afterwards: “Your Norwood classification is possibly Norwood 3. You may not look like this, but you are showing a similar pattern. Your Norwood classification is not meant to be seen as a progression of hair loss, but rather a genetic predisposition (like the color of your eyes).” Is this true? I thought this entire time that when you start going bald, you always end up going completely bald (at some point). This is an important question to have answered because it will determine if I end up getting transplants or not. Is it actually possible to lose hair up to, say, Norwood 3, and then the hair loss completely stops? Or is this bullshit?  I’m currently 26, and the surgeon said to me that, by the time you are in your late twenties, it is relatively easy to predict what classification you fall under by just using the microscope to identify currently thinning hairs, and that most men who ended up completely bald showed clear signs of hair thinning throughout the head in their late twenties.

Yes, many people with a Class 3 pattern of hair loss will retain a Class 3 pattern of hair loss for their entire life. The original classification system was to define the end stage of hair loss patterns, not necessarily transition stages of hair loss, although some people do get transitions from a Class 3 pattern to a more advanced pattern of hair loss.


I have been taking finasteride for 10 years now, and I have been slowly losing my hair since, though at a much slower rate. I was wondering, will I eventually become slick bald in a class six pattern if that’s what my genetic fate is, even if I continue to take the medication?  Does hair have to miniaturize to the point of completely not being visible anymore, or is it possible for the process to stop in an intermediate stage of miniaturization?

Look at the miniaturization pattern and try to predict your hair loss. Or, better yet, see a doctor like me with specialization in hair loss who might be able to answer your questions after a detailed examination of your scalp. Hair does not have to miniaturize for balding to occur, and most patterns can be predicted after a man is 26 years old.


Is hair thickness dependent on which phase it is in right now? The hair I shed is much different than the hair I can cut off. It is less pigmented, much thinner, and less robust. I mean MUCH thinner and not just some but all of them. Is this normal? Are hairs in telogen thinner than in the anagen phase?

When a hair miniaturizes, it becomes less thick, losing its mass. It also loses its pigment, becoming white, and it often stops growing. This hair may just hang there for a long time, not contributing to your overall hair mass.


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