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If an unlimited supply of donor hair were available, could transplant surgeons give a patient the 200 hairs per cm squared that the average human head has or would a new tool smaller than the .5mm tool im aware need to be created to achieve this look?

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I suppose you can achieve 200+ hairs per cm squared (which is about the average for a non balding Caucasian male), but I find most people who are obsessive with hair per square centimeter don’t understand the full story and are mislead by all the discussion groups on the Internet.

You can have 100 hair per cm squared and still look like someone with 200 hairs per cm squared, as this is not a numbers game. Furthermore, hair transplant is NOT about the numbers and density. It is about the art of creating a natural looking hairline with minimal number of hairs you harvest.

With respect to graft survival, there may be some issues of the grafts surviving such close packing in ONE surgery. Now 200 hairs in a square centimeter is possible with multiple surgeries to the same area… but again, numbers do not translate to how it looks overall.

Tags: donor supply, hairloss, hair loss, hair transplant, dense packing



I seem to recall reading a message of yours where in a reply to a reader you mentioned that you personally discontinued your usage of finasteride. You felt it had stabilized your hair loss.

What confused me is that you seemed to imply finasteride stabilized your hair loss and you could thusly stop treatment. (or at least chose to and wasn’t any worse for it). It was my understanding that hair-loss will always resume once treatment is discontinued. Is this not true? Or did I misunderstand your message?


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SeniorYou’re right that once you discontinue Propecia (finasteride 1mg) treatment, your hair loss resumes. For me though, since I originally had crown loss, I tried finasteride to see if I could increase the hair in the crown. At that point, my crown was clearly stable and I did not gain anything from the finasteride.

Considering that I was about 60 years old when I started taking the drug, I probably had as much hair loss as I could expect for my age. There are advantages of being a senior besides discounts in the movie theaters and on public buses. I hope that clears up any confusion!

Tags: rassman, hairloss, hair loss, finasteride, propecia


I am a 38 year old male who has always had full head of hair. I also have been on the drugs Dilantin and Neurontin for many years.

After issues with Dilantin caused bone loss, I was tapered off that drug and now only take Neurontin. Since, ending Dilantin I have had numerous side effects, including hormone issues (increased Prolactin levels, lower end bioavailable testosterone, etc) and increased hair loss.

My hair still covers my head but it feels thinner and I notice alot of it in the drain of the shower. Over the past year off of Dilantin, the Prolactin levels have dropped back into the normal range. However, I still notice the hair loss.

Is it possible that these hormonal issues have caused my hair loss, or could it be the Neurontin acting on its own ?(my Neuro says I am having other effects from the Neurontin that may have been masked when I was taking it with Dilantin, so I wondered if hair loss could be included with that.)

As I haven’t had a seizure in many years, I am going to get off Neurontin too if all goes well, but I wanted an opinion on this hair loss before I go bald. By the way, my dermatologist doesn’t seem to have much of an opinion, is there another type of specialist I should look for who might help?


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You need to speak with your doctor and read the label material that comes with the drugs, which will have comments about hair loss if it is a known side effect. I’d expect your prescribing doctor, who you should always talk to before changing your medication, would be the best person to ask. That being said, here are some past posts that may be of interest to you —

  1. Dilantin and Hair Loss
  2. Dilantin and Male Hair Loss
  3. Neurontin (Gabapentin) and Hair Loss
  4. Neurontin and Hair Loss
Tags: dilantin, phenytoin, neurontin, gabapentin, hairloss, hair loss


Dr. Rassman,

Below is a study that links alcohol and testosterone levels- Does an increase in testosterone levels necessarily accelerate hair loss in men who are predisposed to lose their hair? Thank you-

Study abstract: Alcohol Clin Exp Res. 2003 Apr;27(4):682-5. Testosterone increases in men after a low dose of alcohol.

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We have known for some time that alcohol is metabolized by the liver, as is testosterone. I can not connect the dots between the casual drinker and the hair loss victim.

Tags: alcohol, testosterone, hairloss, hair loss


Hi Dr. Rassman. You’ve talked about the FDA cracking down on “false advertising” in the past, specifically on labels. I was wondering why Head and Shoulders can put on the front of their bottle “Improves Hair and Scalp Health Guaranteed”. This is a loosely based statement lacking specifics; i.e. how it improves my hair or scalp health. I can understand it clearing up dandruff, hence improved scalp health, but hair?

People may associate improved hair health with thicker, stronger hair which I believe no magic shampoo has been factually proven to do so.

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I asked FDA consultant Norman F. Estrin, PhD, Managing Partner at Estrin Consulting Group LLC, to answer this one. The following response was what he sent me —

FDAImproves Hair and Scalp Health” is a claim that the FDA would call “puffery”. Puffery is allowed for cosmetic claims. You correctly pointed out that it is a loosely based statement lacking in specifics”. This is characteristic of puffery. It just as easily could have said “livens up your hair” even though we all know hair outside the body is not alive.

Head and Shoulders is an OTC drug because it treats dandruff. It is also a cosmetic as well and its cosmetic claims are regulated by the FDA Office of Cosmetics and Color Additives, while the drug claims are regulated by the Center for Drug Evaluation and Research (CDER). The Federal Trade Commissions also monitors fraudulent claims, especially in advertising. Here are some other examples of puffery:

  • Best shampoo ever!
  • Energizes your hair
  • Eye awakening
  • The skin you want
  • Safeguards your beauty
  • Age Control
  • Helps restore youthful zones
  • New life for your hair

Since these claims are qualitative descriptions rather than hard facts, the FDA cannot regulate such claims because they are so hard to define. If, however, a cosmetic company claimed “Proven to increase collagen synthesis”, the cosmetic company would be in trouble because any product that does so would meet the FDA definition of a drug:

(A) articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease
(B) articles (other than food) intended to affect the structure or any function of the body of man or other animals

In this example, increasing collagen synthesis in the body would be an effect on the “structure or any function of the body of man”.

Tags: product labels, fda, shampoo


Hello,I am a 31 years old female and a mother of one child. I am currently losing hair on the top of my head, you can actually see scalp. My hair has become very thin. I have always had fine hair but it is curly so I can cover it up very easily. I have been looking around for something to help me and came across Viviscal. Would you recommend this for a woman who has excessive body hair? If not what do you recomend? I thought of Rogaine but I hate the idea of having to take it forever.

Thank you

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ViviscalI don’t recommend Viviscal, as it hasn’t been proven to my satisfaction to treat hair loss. It also isn’t FDA approved, as it is just regarded as an over the counter supplement. The key ingredient appears to be a marine protein extract, so if you’ve got a fish allergy you should steer clear. Another key ingredient is vitamin C. While the product might help nourish your hair, I don’t know that it would treat hair loss, particularly if it is genetic in nature. Otherwise if you wish to use it, that is your choice to make.

For women, your options for treating hair loss are unfortunately rather limited. Have you seen a doctor to find out what the possible cause of your hair loss is? We compiled a partial list of female hair loss causes here.

Tags: hairloss, hair loss, viviscal, nourkrin, marine extract


I have plagiocephaly and feel very uncomfortable with my head ever since I started to bald. I feel that since it has bothered me more with my balding, is hair transplantation a good solution?

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Flatened headFor those that aren’t familiar with plagiocephaly, it is when the skull is misshapened and flat. This usually occurs when a baby spends too much time laying on his/her back in one position.

As you’re aware, this condition can be hidden by good hair styles… so a hair transplant is an excellent approach to your problem. Whether or not you’re a candidate, I couldn’t say without an examination. But generally speaking, transplantation should help you become more comfortable with your appearance.

Tags: plagiocephaly, hair transplant, hairloss, hair loss, misshapen skull, deformity



I think I may have an allergic response to many shampoos. I’m getting a lingering burning sensation for about 30mins after washing it out.

Are there any other alternatives for washing hair? Or should I just not worry?


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I’d see a dermatologist to try to figure out what you’re allergic to. There’s probably some common ingredient amongst the shampoos you tried, but I’d have no way to know what that could be.

Tags: allergy, shampoo, allergic


I am an african american woman with traction alopecia. I have about an inch to inch and a half of traction above my forehead and temples. No traction any where else. I have ample donor supply. My hair is very thick and coily. I recently saw a hair transplant surgeon in San Francisco, that told me i have the donor supply but may not have a successful transplant because of the texture of my hair. The surgeon has showed me pictures of his past work but I was not impressed.

They were pics of african amer men but i saw little improvement. I see pictures and comments on the web that it is possibly for women of my hair texture to have successful transplants. I am not prone to keloids, however, I experience ingrown hairs in my pelvic region. Is there a specialist our Dr or technique that can help me?

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Success of a hair transplant surgery is highly variable with each medical group. It’s not like going to a mechanic, where you can have a tire changed or your oil changed and the end result is pretty much the same. Unfortunately, I don’t have any specialist referral to provide.

Surgery in African American men and women is technically challenging, because each hair (underneath) the skin is curly. In other words, the grafts are curly. That means it is difficult for the technicians to cut and place the grafts. If threading a needle is hard enough, imagine threading a tightly coiled thread through a needle. Many doctors and medical groups for this reason shy away from performing surgery on African American hair or even curly hair. Add this to the fact African American men and women have a greater tendency to develop scarring and keloids. If you’re not prone to keloids, you’re lucky!

Another point to make is that hair transplantation surgery in women generally is not as straight forward as surgery in men, as the results may not be permanent. Men have a permanent donor area, whereas women’s hair loss is more diffuse. You should also know that to fix the balding from traction alopecia, the patient will often need more than one surgery, as the density of transplanted hair may not match the density of the natural hair behind it.

Alas, I am not your surgeon and I am not here to give you a personalize opinion. This information is generalized and you need to understand what is and is not possible. Weigh out the pros and cons of what you are trying to achieve and make an informed and educated decision.

Tags: african american, black, hair loss in women, female hair loss, hair transplant, hairloss, hair loss


I read the item about hair foliclle damage because of lactic acid secretions on the scalp. Well, I was told the same thing, and given a lotion to neutralize the acid. I can confirm this situation does occur when subject to unpresidented levels of stress. When i say stress, stress at such a level I was physically ill with it, for a long period of time. Halucinations etc

One day I notice that my incredibly thick hair was going fine and curly. Finasteride made no difference, and I was shown hairs from my head, that had no outer sheath on them. Also prior to seeking advice the affected area became hot, itchy and greasy- when i was stressed, and this is where the hair follicles have died.

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Lactic acid is not a cause of hair loss. Whatever you read about lactic acid secretions on the scalp causing hair loss is false. I found some message board that talked about it, but I don’t think it went beyond speculation. It wasn’t mentioned in any medical journal that I could find.

Without knowing what dose or how long you took finasteride, I don’t know that I could agree that it “made no difference”. I don’t know enough information to give you anything beyond generalities, but if you’re balding in a pattern, it’s not stress. Stress could be exacerbating the loss, but it’s ultimately your genetics. I wouldn’t expect a “hot, itchy, and greasy” scalp to be normal from stress, and it’s certainly not normal to have hallucinations, no matter how much the stress. You need to seriously see a doctor.

Tags: lactic acid, hairloss, hair loss, hallucinations, stress


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