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Can I have a Scalp Micropigmentation (SMP) and later a hair transplant surgery? What if I want to grow out my hair as well? I don’t want to always keep my hair shaved.

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You ask a great question! We have been combining SMP with hair transplant surgeries using FUE or Strip FUT. After all we are a medical practice that specialize in all aspect of hair restoration!

This patient came to us with a old hair transplant surgery scar. He had a strip FUT surgery which didn’t really give him a full head of hair and he just gave up with the idea of having a full head of hair. But he had the strip scar which he couldn’t hide when he decided to cut his hair short. So he went to local doctor for FUE to the strip scar. As we tell all our patients, FUE to the strip scar doesn’t really give perfect results when you are looking to shave your head. So he ended up with MORE SCAR, many ‘punctate scars’ from the FUE surgery. Needless to say he was angry and was very skeptical when he came to see us. We didn’t blame him. He didn’t trust any doctors at this point. Although Dr. Pak thought he would be a great candidate for the SMP procedure, he actually turned him down because the patient’s expectations seemed unrealistic with a bad attitude.

Eventually, the patient came back for another consultation and even saw other SMP patients in person at our monthly Open House Seminars (where prospective patients can meet with former patients and see an actual SMP or Hair Transplant surgery taking place).

This patient eventually had SMP to the entire scalp and covered his FUE scar and strip scar with great results. In the process he came to know and befriend Dr. Pak to trust his work. So after about a year he came back to Dr. Pak for a FUE procedure (about 1500 graft) to add density to the top and soften (corrective surgery) his front hair line from the old transplant work.

While the FUE transplant didn’t give him the full density, the SMP provided a cosmetic benefit to provide a look of fullness. Now he has the option to shave or grow his hair out long.

Old FUE and FUT Strip Scar addressed with SMP Scalp Micropigmenation

Old FUE and FUT Strip Scar addressed with SMP Scalp Micropigmenation

SMP Scalp Micropigment for a shaved look

SMP Scalp Micropigment for a shaved look

SMP Scalp Micropigment with FUE Hair Transplant for Fullness for Long Hair

SMP Scalp Micropigment with FUE Hair Transplant for Fullness for Long Hair


I had been experiencing hair loss the last year and now my hairline has started receding.

I am now 24 and i was in denial but now that it’s visible i started propecia although i didn’t want to because of the horror stories i read. After i started i had testicular pain and i felt a lot of anxiety and stress so i decided to stop. It’s been a week since i stopped the 1 mg per day. How long do the effects of it need until they are gone?

From a study i read the byproduct ([3H]dihydrofinasteride) has a half life of 1 month and the intermediate adduct of it (NADP-dihydrofinasteride) still effects DHT production. Will i need that long to be sure that it doesn’t creates me the stress i feel? The fact that finasteride is an irreversible 5AR2 inhibitor means that i will have to wait for new 5AR2 enzyme to be reproduced, and can this be downregulated in any way? Is my anxiety caused by the the inhibition of allopregnanolone maybe?

Thanks for your time, your input and knowledge based on your experience will be very helpful.

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For all practical purposes, the half life of Propecia (finasteride 1mg) in your blood stream is about 4-6 hours. This means the drug should be out of your blood stream in one day. This is why you need to take the medication everyday. Some believe there is a component of tissue fixation where some residual drug linger on for about one week. This is why we often write that if you experience a side effect you should see it reverse in about one week.

It is quite a remarkable coincidence that as someone who was apprehensive about taking Propecia from reading the “horror” stories of on the Internet also happen to get the rare side effects. Testicular pain and anxiety as a side effect in it of itself individually is probably less than one percent but having BOTH would be even rare. Also note that these symptoms are not even reported in the actual drug insert. Please note that I am not trying to ignore what you are experiencing but rather you should also speak to your doctor as testicular pain is a very serious medical issue that may not be related to the medication itself.

With respect to all the biochemistry questions of the breakdown of Propecia, I do not believe it has anything to do with your issues. I am also not a biochemistry expert to state all the importance and functions of the enzymes or hormones you are trying to correlate with your issues. I have said many times before, our body and its function/dysfunction is not so simple to define with single biochemistry pathways.

With all due respect your “anxiety” may just be more of a psychological issue rather than these enzymes and by products of Propecia. Because if you really want to really get in to all the biochemical process behind your “anxiety”, you must think of all the other medications you may be taking (for example: anti-depressant drugs can cause sexual dysfunction, anxiety, suicidal feelings, etc), recreational drugs you may be using or have used (for example: effects of marijuana, cocaine etc can cause long lasting mood related side effects), your social life (for example: dating in your 20’s while losing hair in it of it self can be filled with anxiety), the sun exposure you have (for example: not having enough sun light can cause psychological effects), your childhood experiences (for example: you can fill in the blank and blame x y z from your childhood), the friends you have, etc etc etc. This list is endless and Bladingblog and a short paragraph cannot begin to understand the big picture nor solve your issues. I will say again, biochemistry alone does not explain your mood.

My final point: TALK WITH YOUR DOCTOR for your anxiety issues and your testicular pain.


How Do You Know if Your Hair Transplant Doctor Has a Good Track Record or Review?

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That is the big question and you should know how to manage the hair transplant doctor selection process.

These are the things you should do before selecting a hair transplant doctor. There is uncertainty in the field as some doctors do not get the results that they should and you don’t want to be on the receiving side of that statement so research the doctors and the medical group you should be interviewing.

Our medical group (the New Hair Institute) has pioneered most of the new technologies of the past 20 years. These technologies included (a) The use of small grafts in large quantities instead of the large grafts which gave the appearance of ‘dolls’ hair in 1992, (b) follicular unit transplant first introduced in 1995 which used the natural growing units of 1-4 hairs each found in the human scalp (follicular units), published 1995, (c) Follicular Unit Extraction pioneered between 1996-201 and first published by use in a peer reviewed medical journal in 2001, (d) Scalp Micropigmentation introduced by us in 2010 and published in various medical journals and text books since. What we do to help you, the buyer, is we hold Open House Events every month where patients can come and (a) meet with the doctor, (b) meet with other patients who had their work completed, (c) see a procedure as it is being done. We believe that seeing is believing and that a good buyer will know if they are being ‘led down the garden path’ to disaster or if it what we represent is real. Our patients have been coming to these open house events for over 20 years and what you will see here is what you will be getting with the results that are shown.

There are ‘for profit’ networks or forums that promote doctors under the “guide” that their list of doctors are the good doctors inferring that if the doctor is not on their list, they may be ‘bad’ doctors. Unfortunately, these “networks” or “organizations” or “forums” or “coalitions” have their own issues and flaws. For starters, these organizations are there to make money! To put it bluntly, the doctors have to pay for being on these lists and the fees amount to thousands of dollars per year. It’s actually a clever way for these forums (networks) to make millions of dollars as they endorse a doctor and post the doctor in the recommended list of doctors. The doctors’ results are never evaluated, but feedback from dissatisfied patients get posted to alert prospective patients that there may be problems with those doctors posted by unhappy patients. They create an image of being an “independent” source for endorsements. It is a Faustian bargain for the doctors.

I generally advise prospective patients to go to the internet and look up the doctor on the official licensing agency. In California is is the California Medical Board. If the doctor has been charged for any reason and found guilty of any infraction, they will be listed on this website.

The buyer has the burden to check out the doctors in their area by asking a lot of questions, researching the internet, Yelp and other such sites, the Chamber of Commerce in the area and go to the Board of Medicine which controls the license for doctor (for California it is the California Medical Board). These boards will make public, complaints about the doctor and disciplinary actions taken against the doctor, a worthy effort in your due diligence process.

The International Society of Hair Restoration Surgery (ISHRS) is a non-profit medical association of over 750 physicians specializing in hair loss with defined skills in the hair transplant and hair restoration field. To be a member you need a medical degree and the annual dues. You do NOT need special training in hair transplant surgery. The ISHRS is the most well known and respected organization for physicians with the most members and its focus is on medical education and we participate every year in their educational programs. There is no discipline or authority to oversee the practices of its members. To the consumer (patient) the doctor’s membership to the ISHRS just means the doctor is paying his dues annually and keeping abreast with the science of hair loss and therapies to treat hair loss. At the annual and regional meetings, the ISHRS enables doctors to keep up to date with the rest of the specialists in the field. Despite the lack of accreditation or oversight, the ISHRS is considered “the” main organization for hair transplant surgery.

The ISHRS has no disciplinary powers as it depends upon its members to promote medical education. It has the most membership of hair transplant surgeons in practice. It’s an outlet for sharing and presenting new information and research among surgeons with its yearly meetings..

There is a group called the American Board of Hair Restoration Surgery (ABHRS). There were 154 members as of 2010. To become certified by this society, there is a $400 application fee and $1900 testing fee. The doctors in this group must present two reference letters, have 100 cases logged and pass the written examination. The ABMS does not recognize ABHRS.

Tags: hair transplant, surgery, surgeon, board certified


Most consumers and patients take for granted that “board certification” implies some level of expertise and qualification of a doctor. What does it ultimately mean to you? Why do we even bother with it? Is it to advertise achievement reflecting doctors’ credentials?

In the United States there are 24 approved medical specialty boards that are overseen by The American Board of Medical Specialties (ABMS), a not-for-profit organization. Certification by an ABMS Member Board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training with adequate supervised activities a medical institution AFTER earning their medical degree. After this training, they must successfully pass a level of competence through written and oral examinations.

Hair transplant surgery is not a part of the ABMS so there really is not a board certified hair transplant surgeon in the traditional sense the public thinks of. This is mainly because there is no formal supervised training or credentialing in hair transplant surgery. There is no curriculum and no oversight. There is no place to formally learn to become a hair transplant surgeon. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a doctor in the private practice of hair transplantation. We know of doctors who never performed a hair transplant surgery but only attended a seminar and within a week set up shop proclaiming that they were experts at Follicular Unit Transplants. If there was truly a board or some sort of governing body, the physicians who learn the field through an overnight effort would have been discredited and alienated from his/her peers. But this is not what happens because hair transplant surgery is not considered mainstream surgery and anyone with a medical degree (even straight out of medical school with no training) can legally perform it. Unfortunately, a license to practice any or all specialties of medicine comes after 4 years of medical school and an internship and with that completed, a doctor could proclaim themselves even a neurosurgeon; however, no hospital would allow this overnight sensation to practice neurosurgery.

Recognizing the need to become part of the mainstream, in the mid 1990’s the American Board of Hair Restoration Surgery was formed to independently certify hair transplant surgeons. The Board requires recommendations for other doctors and 100 hair transplant surgeries to qualify to take the Board’s examination. But the board can not certify adequate supervised training, as there is none. It is also powerless in its structure to monitor any doctor’s training or enforce any form of discipline. Why? Because there is no place for a physician to train to become a hair transplant surgeon. There is no education/training center. There is no residency. There is no fellowship in the traditional sense. Thus, the term “board certified” hair transplant surgeon is NOT the same nor does it hold the same value as “board certified” in the common sense that we think of a board certified plastic surgeon or neurosurgeon. In fact, states like California forbid doctors to use the term ‘certification’ unless it reflects the American Board of Medical Specialties’ endorsement, which is not the case today, nor should it be. The reality of this training process is that this is a one surgery field. Today, I know personally of doctors who started doing FUE after only attending one ISHRS meeting. When I spoke to the doctors about their results from the FUE they were doing in the first 6 months and they admitted to me privately, that they had very significant failures in their initial treated patient population.

This is why many hair transplant surgeons are not board certified in hair transplant surgery. Drs. Rassman, Pak, and Kim are not board certified in hair transplant surgery mainly because they felt that it had little significance to their practice or credibility. Since Dr. Rassman is widely regarded as one of the pioneers of modern day follicular unit transplantation (from the early 1990s) and even the innovator who started the FUE technique in 2002, his reputation stands on its own without a certification. When Dr. Rassman started performing hair transplant surgeries in 1991, the standard was ‘plugs’. He visited doctors who had great reputations in the hair transplant field and watched what they did. He figured out that the techniques that were used did not meet his standards and he refused to adopt that technique. He learned the details of how it was done by others over a period of a year and then he pioneered (a risky move) what eventually became the standard for hair transplantation across the world.

Dr. Pak was part of the original research team (working as an engineer) that developed FUE instrumentation from the mid-90’s (that eventually ended up in a U.S. Pat. No. 6,572,625 licensed to Restoration Robotics for the Artas® Robot) and has been trained exclusively by Dr. Rassman as a hair transplant surgeon. Dr Pak’s hair transplant surgery education was in the traditional sense of a fellowship or apprenticeship by working one on one with a mentor, Dr. Rassman, for more than a year. For that matter many well respected physicians have gotten their start from Dr. Rassman in the 1990’s and 2000’s. To this day, Dr. Rassman receives several emails a month from physicians requesting private fellowship training. In fact, we even found on multiple occasion, doctors from a foreign country that display photos of Dr. Rassman standing next to themselves to advertise to their patients that they were trained under him. These pictures were taken at conferences.

Misrepresentation in this industry are common. A series of website or “forums” or ‘Networks’ exist that define the best doctors in the world for its viewers. To get such endorsements, doctors must join that organization and pay a monthly fee in excess of over $1000/month. The implication is that if the doctor is not endorsed by that particular ‘forum’ that they are not amongst the “elite” and highly respected doctors in the world. The ‘forums’ or ‘networks’ collect these prospective patients and dole them out to the doctor so that the doctor might get there money back through professional fees. It becomes an interesting way to advertise through third party ‘endorsements’. To be as blunt as possible, these ‘forums’ or ‘networks’ are not neutral patient advocate sites but a subtle way for doctors to advertise by paying a membership fee. As I know most of the really great hair transplant surgeons world-wide, I know who is good, who is very good and who is not so good. The good and the bad surgeons may inevitably be endorsed by the website as long as the payment is made. I do not know them all. So you, the consumer, must be really careful if you accept the endorsements of these organizations without doing your research.

In the end the consumers (patients) are left not knowing what to believe. Board certification does not mean much if no one can enforce a certain standard of care or even oversee the training of surgeons. The Forum that endorse doctors do it for their profit, so they should not be trusted without really doing your own research. Sadly many great hair transplant surgeons are intermingled with the sleazy opportunistic ones and the entire profession is dragged through the mud as a whole but the consumer who do not get what they paid for, what they expected and end up blaming the ‘sourcing’ for their doctors.

Tags: hair transplant, surgery, surgeon, board certified


I am a 23 Female, I have been losing hair for 2 years now. My dermatologist prescribed minoxidil 2%, but after 4 months i didn’t see any results. Is it safe to use both 2% and 5% (2% in the morning and 5% at night) to make it more effective?


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In general we advise our female patients to use minoxidil 5% twice a day, although the official recommended dose is 2%. We take the blood pressure of the patient prior to prescribing this medication. Although this medication can be purchased directly from any pharmacy or grocery store, there are side effects that you must read about prior to starting the medication.

Tags: minoxidil, dose


“It is well known that a person’s lifestyle affects the risk of cancer. Swiss scientists have now shown that this is at least partially the result of effects of lifestyle factors on the genome. While aging is slowed down with regular aspirin use, smoking increases it. The study was published in the “Journal of the National Cancer Institute”. ”

The Journal further reported “that regular aspirin use and smoking led to changes of gene markers – however, with opposite effects: while smoking accelerated the effects, aspirin slowed them down. Genes that are associated with the development of cancer are particularly affected by this, said lead author Faiza Noreen. “

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If there is a wonder drug, it seems to be aspirin. I have taken it for years. There seems to be beneficial effects on aging (see above), heart and vascular disease and cancer prevention. What else could you ask for?

Tags: aspirin, aging, cancer


According to the indictment below, a named doctor has been using the Internet to sell non-approved doses of Minoxidil with claims that are not proper. Read the document below for details

SALT LAKE CITY ‹ Four men, including two Utah’s, face federal charges for allegedly selling hair replacement drugs over the Internet without U.S. Food and Drug Administration approval. Dr. Richard Lee, 72, and James Dorius, 69, both of Whittier, Calif., owned Regrowth, LLC, a business that made and sold hair treatment drugs online. Alexander Ahn, 32, and Min Kim, 32, both of Provo, ran a Utah company called Minoxidil Solutions that sold the drugs after Regrowth had agreed with the FDA to pull them from the market, according to the indictment.

The indictment alleges that the FDA discovered that Regrowth was selling drugs Lee made using his own formulas and recipes dating back to 1996. Some of the products contained active pharmaceutical ingredients. The company was not registered with the FDA and did not seek or obtain approval to sell its hair growth drugs, according to the indictment. As apart of an agreement with the FDA in February 2011, Lee stopped selling the products and sent customers an ³urgent drug recall² notice informing them of potential health hazards. Two months later, Lee and Dorius delivered Regrowth¹s remaining drug
>ingredients and manufacturing equipment to Kim and Ahn in Utah. According to the indictment, Kim agreed to pay Lee and Dorius half of what Minoxidil Solutions earned on the sale of hair growth drugs made using Lee¹s ingredients and formulas. “These kinds of cases are important because in many instances individuals are advised by FDA that they cannot lawfully manufacture and sell unapproved and misbranded drugs, yet even after warning, they continue to manufacture and sell these prohibited drugs,” said Patrick J. Holland, special agent in charge of the FDA criminal investigations office in Kansas City. Lee, Dorius, Ahn and Kim are charged with conspiracy to introduce misbranded drugs into interstate commerce, which carries a penalty of five years in prison and a $250,000 fine. All four men are scheduled for an initial appearance in U.S. District Court on Oct. 23.

Tags: inappropriate claims, hair growth


Ever since I became a doctor, friends and family have asked me to prescribe antibiotics for them as a favor when they don’t feel quite right and think that they are coming down with something. They don’t want to go to a doctor’s office when they have the flu-like or upper respiratory complaints such as a cough, a runny nose, sinus pain, and many other such miladies. When I have refused to prescribe the requested antibiotic, my routine, they make me feel as if I have betrayed them, after all, it is so simple for me to do it.

“The Centers for Disease Control and Prevention (CDC) reports that each year in the United States, at least 2 million people become infected with bacteria resistant to antibiotics, and at least 23,000 people die as a direct result of antibiotic-resistant infections.

Tom Frieden, MD, MPH, CDC Director, points out, “It’s clear that we’re approaching a cliff with antibiotic resistance. But it’s not too late. Clinicians and healthcare systems need to improve prescribing practices. And patients need to recognize that there are both risks and benefits to antibiotics — more medicine isn’t best; the right medicine at the right time is best.”

The above quote was taken from Medscape General Surgery website July 7, 2014 and after reading it, I felt better about turning down my friends and family when they don’t feel well and ask me to prescribe an antibiotic for them. There clearly is some misconception in our society that antibiotics cures the common cold, flu, coughs and sinusitis. FYI, none of my family or friends died or became hospitalized as a result of my turning them down for their requests.

Tags: antibiotic


Are native Americans immune to DUPA like they are Male Pattern

seeing as full native Americans are immune to typical male pattern
baldness would this also apply to the other hair loss type ‘DUPA’ and
if so/not could this help us narrow down the list of possible causes
at the genetic level?

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Not all Native Americans are immune to male pattern balding. Only a certain minority tribes, those whose ancestors came to North America over the Alaskan Bridge, appear not to have male pattern balding. Many Native Americans came to North America from the south and these men do have genetic balding. DUPA – Diffuse Un-Pattern Alopecia is not related to Male Pattern Balding (MPB) so I do not know how that would fit in to the Native American traits on balding. I think you are trying to find a common denominator but the cause and relationship of two separate type of balding does not fit.

The cause of male pattern balding is genetic.

Tags: male pattern balding, native americans, balding, DUPA


One of my favorite BaldingBlog contributors (who shall remain nameless) sent in some great insights about FDA advisory committees. We’ve previously posted his thoughts on the LaserComb, clinical trials, and FDA trials. This post will be used in the future as a point of reference:

    Dr Rassman,
    Given the many questions related to consideration of FDA expansion of the finasteride label for prevention of prostate cancer, your readers may wish to access the data themselves and better understand the process (which becomes more transparent and less “conspiratorial”).

    The recent finasteride and dutasteride opinions noted in the Dec 3 Balding Blog posting are not from the FDA, but are from an independent group termed the Oncologic Drugs Advisory Committee. The committee is composed of 18 voting members (and several non-voting members) – mainly oncologists, with some statisticians, epidemiologists, and a patient representative, the former mainly from academic institutions.

    The FDA eventually considers the committees opinion in approval or withdrawal of drugs (or “expansion” of a drug label for a new indication). The FDA usually follows the recommendations of advisory committees, as the committees’ recommendations are presumably “data-driven” and the FDA typically comes to similar conclusions. However, as in the case of many decisions that are split or where significant differences in interpretation of risk-benefit exist, the FDA has occasionally approved or rejected a drug against the recommendation of an advisory panel. Examples of split Advisory decisions (where a majority vote did occur) are the opinions this year related to several weight loss drugs.

    The Oncologic Drugs Advisory Committee voted 17-0 against expanding the label for finasteride to include prevention of prostate cancer. A unanimous vote by FDA Advisory Committees is rare. I have no special knowledge of the meeting. This decision was based in part on data from the 19,000 patient Prostate Cancer Prevention Trial and the belief that the data did not support the risk benefit profile (i.e. possibility of increased aggressiveness of tumor did not outweigh reduced risk of low-grade tumors). As with all such committee meetings, which are open to the public (including listening via live webcasts), the transcript will be published and available within a few weeks at the FDA’s web site.

    However, interested readers can go to the FDA web site now and access the Briefing Document and presentations given to Committee members from the drug company seeking approval. This information is public and typically posted several days before the meeting. The meeting was held on Dec 1, but the date of posting was Nov 26 (see under Oncologic Drugs Advisory Committee). The info can be found at the following links [note – all are PDF files]:

  1. Draft Agenda for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
  2. Briefing Information for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
  3. Draft Questions for the November 30, 2010 Meeting of the Pediatric Oncology Subcommittee of the Oncologic Drugs Advisory Committee
  4. Merck Briefing Information for the December 01, 2010 Meeting of the Oncologic Drugs Advisory Committee
  5. FDA Briefing Information for the December 01, 2010 Meeting of the Oncologic Drugs Advisory Committee
  6. GlaxoSmithKline Briefing Information for the December 01, 2010 Meeting of the Oncologic Drugs Advisory Committee
  7. Draft Questions for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
  8. Draft Meeting Roster for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
  9. Webcast Information for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
Tags: fda, dutasteride, finasteride, proscar, avodart, merck, glaxosmithkline, prostate, cancer


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