As Seen on


The interest last week on our piece addressing hair cloning was very high. I would like to call your attention to a recent breakthrough that has just been reported on gene therapy. Scientists hope that by getting at the genetic roots of hair loss, they will eventually spawn better baldness treatments or a cure. This is a distinctly different approach than cloning a hair and more in line to the approach being used to cure cancer, Alzheimer’s disease and the like. The focus of such work is to identify the defect that causes the problem we wish to fix and then to develop a drug, enzyme blocker, or another approach to address the problem. There are many baby steps taking us to that cure and Dr. Markus M Nothen of the University of Bonn in Germany identified an androgen receptor gene on the ‘X’ Chromosome which is contributed by the mother in setting a person up for balding. The androgen receptor gene helps govern the workings of male sex hormones (androgens), such as testosterone.

Though these hormones promote the growth of body and facial hair, on the scalp excess androgens may cause hair loss. Dr. Nothen believes that this is only one of possibly many genes that trigger the balding process.



I am 50 with early gray coming on the sides and black hair in the front. I have had 10 hair transplant procedures over the past 8 years [not at NHI]. I go from happy about them (when I had bald areas and then they went away) to unhappy (now). I am bothered about my left frontal hairline in particular. It is obvious to me that it is transplanted. I am not an expert, but I know it is not right, yet it is not the pluggy look like your book shows in the back section. I comb my hair forward to cover the hairline which I should be showing off, not hiding. What is wrong with it and can it be fixed with 100% certainty?

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It is clear that you are a perfectionist, for only a perfectionist would notice your problem. The problems are that the grafts in the frontal line are two hairs each, the hair seems to point outwardly, rather than forward and the frontal grafts are a straight line that line up like soldiers. These two problems are not uncommon when a transition zone of single hairs is not created at the leading edge of the hair line. The concept of a hair line should not be taken literally, for there is no ‘line’ in a natural hair line. You were created with a zone of single hairs that transition from a bald forehead to a full frontal hairline presentation. A good hair transplant doctor must create the same transition zone to accomplish the natural look. With your black hair, these changes are more noticeable than if your hair color was lighter, making it easier to detect a transplant. As the gray hair moves forward, the problem will become less noticeable, but I suspect that you do not want to wait a decade or more for that to happen.

The second problem is outward directional growth of the transplanted hair. Judging from your photos, that problem is the result of a radial placement of some of the recipient sites when the procedure was first done. The direction of the hair growth is totally controlled by the surgeon who made the recepient sites. Additional grafts placed in a better position and direction might influence the hair that is growing outwardly. Using the concept of ‘following the crowd’, the normal direction of the new hair can be transplanted to influence how the existing hair will lay.

The third problem is the ‘line-up’ of the hairs in a straight line that is easily detected. The frontal hairs should be irregularly placed so that no line is evident.

The last point of your question talks about certainty in outcomes. Any surgical procedure has risks of failure, so certainty in medicine is more an act of God than an act of a doctor. In my experience, the success rate for building a good transition zone is very, very high. The hope would be to complete the transition zone in one session with 500-600 single hairs in the front. Sometimes more is needed, particularly if your hair is coarse, black and straight. What you need is comfort and that is established with a visit to the doctor’s office. As a perfectionist, you will interview your potential new doctor with an open mind, but keeping some skepticism and doubt, so the doctor will have an uphill battle for your confidence. Ask the doctor to show you people he has done with black hair, you can look at the transition zone and see if you see a ‘line’ in the hairline. I always say, what you see is what you are ‘gonna’ get.


I am considering a hair transplant procedure, but I am nervous about doing the surgery. What kinds of things can go wrong?

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Hair transplantation is indeed a surgical procedure, and there are risks associated with any type of surgical procedure. The degree of risk, however, is more tied to the type of anesthesia than the surgery itself. With the anesthesia being limited to local and sedation, rather than a general anesthesia, the risk is about the same as a visit to the dentist’s office, statistically a risk of death estimated at less that one in a million people.

Any time one has surgery there is the risk of something rare and serious happening, such as an allergic reaction to medication, or a blood clot to the lung, or even cardiac arrest. The best surgical facilities in the United States are certified for surgery by one of two independent agencies. Our facility is the only hair facility in the United States that is certified by one of these two agencies, ours is certified by the Accreditation Association for Ambulatory Health Care.

The thing that you have to remember is that hair transplantation does not penetrate any body cavities. It is really analogous to taking off a big mole or wart. In 15 years and doing over 10,000 procedures, I have never seen any of the previously mentioned serious things happen. For a hair transplant the surgical risks can be defined well enough. The types of risks that should concern you include: infections, bleeding, swelling, wide scarring of the donor area, nerve damage and poor hair growth. I have never seen any serious infections as the scalp has a wonderful blood supply which prevents and protects against these infections. It is very common to have a few ingrown hairs with localized infections in the first few months as the new hairs grow in, but this is cared for by just keeping the scalp clean. Sometimes ‘popping’ these pimples yourself works, and when we do it we call it ‘draining’ the cyst. Sometimes these ingrown hairs produce a wider infectious problem which might require an antibiotic. Significant bleeding at the time of surgery should not occur in the hands of a competent surgeon, there may be some small drops of blood the first night after surgery but it is almost always handled with a little pressure directly to the bleeding area. If that doesn’t stop it, a suture might be needed, but that is exceedingly rare. Swelling after surgery is common. The swelling may work its way down to the eyes three or four days after the surgery, but the use of post-operative steroids may be helpful at reducing or eliminating swelling. Swelling always goes away after a few days.

Scarring always happens when the skin is cut, but newer techniques of wound closure usually prevent that from occurring at socially detectable levels. The more procedures one has, and the more grafts that are done with each successive procedure may make for a slightly wider scar. Rarely do these scars become cosmetically significant unless one shaved his head and in that case, all such scars will be seen no matter how perfect the healing is. Nerve damage should not occur, provided that you are using a well trained and competent surgeon. Poor hair growth is also something almost never seen, but occasionally happens. If your doctor and his assistants are experienced, and the techniques they use are modern state-of-the-art methods, only rarely is growth a problem.

Your question is important, for we often forget that everything in life has risks. Driving may be more risky than having a hair transplant surgery.


I am 26 years and experiencing hair loss. I haven’t done anything different. This has been going on since Aug 04. Then it was not so bad but i noticed a difference. In November I went to my doctor & told them that it’s getting worse. She had my thyroid checked & it came back normal. She recommended a dermatologist. The derm said there’s nothing wrong. It’s getting WORSE. I wear hair pieces now so it doesn’t show. I’m to the point now that in every stroke of a comb/brush through, a quarter to half of my hair is in the comb just from that one stroke. I know this is not normal for me, this has NEVER been a problem before. can you please suggest where I can go or what my next step should be?

Sincerely, Scared Hairless

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Your questions are very appropriate for hair loss in a young person. Now that we know you are healthy, then the most probable cause of the hair loss will be genetic balding if you are a male. The physical examination will determine if you have genetic balding as a female. This is a crisis for a 26 year old. Hair that is lost now from the genetic process (in men), will probably never return. For women, it will be a slow process over time with incomplete loss if the cause is genetic. The next step is for you to see a doctor who will consider putting you on Propecia as this is the only drug that can slow down, stop, or in some cases reverse hair loss in men. The use of a hair pieces/systems (wigs) will only make the problem worse as the glues, tapes and weaves will pull on the existing hair producing a condition we call traction alopecia. If you want to put the lost hair back, you should consider a hair transplant.


What should I look for in a doctor that does hair transplants?

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In real estate, the most important thing is location, location, location. In hair transplant doctors, the most important thing is experience, experience, experience. You should look for someone who has years of experience in performing surgical procedures, such as a general surgeon, a plastic surgeon, or a dermatologist who does surgery. On top of that, you would want someone with years of experience doing hair transplants, and preferably someone who does that exclusively. You would also want to know what type of technique he/she uses, and only go with someone who does state of the art follicular unit transplants. You would want to know about the medical assistants that work with the doctor, since they are critical to the operative results. Hair transplantation is such a labor intensive operation that no doctor can do it alone; he or she needs help, and the assistants must be as good in their part of the operation as the doctor is in his/her part. The other thing that is important is that you see doctors’ work, preferably at a open house situation where you can actually see surgery being performed and see actual patients that they have operated on, and look at the result in person, not just in pictures. You need to spend time with the doctor, have your questions answered fully and with candor. You must have full confidence in him or her, and be assured that they are not just someone who wants to sell you something.


i’m a 40 year old white male that is totally bald on top,with hair just on the sides. i have alot of baby hair or very small white hairs in the balding spot.i’ve been bald totally on top since i was around 25 to 30 yrs old. will transplants or drugs work for me………help

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The ‘baby hair’ you are reporting in the balding area is what we call ‘miniaturized hair’ which means that the hair shaft is reduced in diameter and takes on the fine baby hair appearance we had at birth. This is a process that precedes the final balding stage. If the miniaturization is caught early enough, there are medications (like Propecia) which may reverse the process. Near the end of the loss process, it would be unlikely that the hair can be brought back. As the process you are describing sounds like the end stage of the loss, then the only solution may be hair transplantation. This is well defined on, which has hundreds of photos of men who have had the hair moved into the balding area from other parts of the head.


I would like to get HT, but one question: how do you determine as to the donor site location? My friend had 2000 FUE’S and it seems like his donor cut was equal level with the eye brows, is this OK? He told me that he had a HT doen ten years ago and his FUE dr. told him that he would remove the old scar which was that high as well. What if he became so bald that his hair loss went lower than his current scar? Can HT doctors determine as to future loss?

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Thanks for the fine questions. Donor incisions, if placed in the middle of the permanent hair zone should be covered with the hair that is there for the life of the patient. FUE (Follicular Unit Extraction) is an alternative, but you must be sure that you will be a candidate for such a procedure. I would want to see you and test your hair to find out if you are a candidate. I suggest that you read up on FUE at It includes pictures and videos of the procedure as well as post-operative patient followups. Scars from traditional hair transplants can be fixed in many cases. Again, I would have to evaluate the person in order to judge repair possibilities. To answer your last question, yes doctors can determine what your most probable hair loss situation is, provided that you are over age 30.


I had a hair transplant 4 months ago and I lost hair in the months that followed. Is that unusual and will it return?

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Shedding is not common after surgery on a patient who had a previous hair transplant nor on patients who are taking Propecia. In the days before Propecia was available, hair loss (shedding) following the first hair transplant was common in the younger men and less common in the men over 40. When the hair loss happened in the younger men, it frequently reflected what I might have guessed would have come out by itself in the next year or two. I only remember a small hand full of patients who lost some of their older hair transplants after a new procedure, but all of them (less than 1% risk) had the hair return at between 4-6 months. If it is the transplanted hair from a previous hair transplant, I am confident that it will all return.


You mentioned that some vitamins may cause hair loss. Could you elaborate on that?

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Essentially, overdosing anything that may be good taken in low quantities, can cause hair loss when taken in high quantities. In my brief review of the subject, the data is not clearly defined. There is a worthwhile site for answers to your question, written by Dr. Michael Biamonte, found here.

Summarizing what he said: We know that toxic levels of minerals such as lead, cadmium, mercury, iron, aluminum and copper commonly cause hair loss. Copper also prevents zinc from its effectivness at preventing hair loss.

Zinc, iron, B vitamins, essential fatty acids, amino acids and other nutrients are responsible for hair growth. If deficiencies occur, for whatever reason, hair loss is likely. Poor diet or malnutrition also can contribute to hair loss as the body will shut down hair growth to save nutrients for other ‘more important’ functions.


i just want to know whether dandruff and frequent shampooing contributes much to hair fall and balding .

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Dandruff and/or frequent washing will not cause hair loss. However, hair that is already weak and falling out as a result of cyclical processes or as a result of genetic hair loss, may fall out sooner if you are rough with the washing.


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