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I am 22 years old. I underwent 3 treatments of laser hair removal and believe that I have made the biggest mistake of my life. It was after my third treatment that I realized that the results I had in mind were not feasible at all. I have since stopped the treatments and am now trying to determine how much permanent damage was done to myself. My last treatment was in September of 2004. For many months there were lots of spots that were bare, but in the last couple of months I’ve noticed lots of hairs growing in. It seems as though it is filling in almost as thick as how it was before I started treatments. Although none of the hairs are growing in white, some of them are growing in light with hardly any pigment at all. Is this permanent or will the pigment fill in with time? Basically this question is leading into my next one which is the most important to me. Have I damaged the melanocytes in my hair or my in skin?

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In response to your multiple questions, I can simply say that lasers do cause damage to the pigment cells both in the skin and in the hair. Hair has an amazing ability to come back, so maybe the changes in color that you noticed, may return after the hair goes through another cycle. There is nothing to do here other than wait it out. Be patient.


I was told by my doctor that I need 3000-4000 grafts, but it would take at least 3 surgeries. He said that their maximum per day is 1000-1200 grafts. He said that limiting the number of grafts is better for graft growth and for patient comfort, since each surgery will take 7 or 8 hours. What do you think?

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In your doctor’s hand, if his comfortable number is 1000-1200 grafts, than that is what he should do. Seven hours of surgery is a lot, so the number he is quoting is reasonable for him. In our practice, we often perform 3000-4000 grafts in a single session and it takes usually about 5 hours or so. The reason we can do this is because:

  1. We have been doing megasessions for 13 years, originating the technique back in 1992.
  2. We have very experienced team members who do this every day. Many of our staff have been with us for up to 10 years.
  3. Our staff is very efficient. Having enough efficient staff allow us to do more work in less time than most medical groups.
  4. Better growth reflects the issues of quality control and the time it takes to get the grafts into their recipient site. Keeping them out of solution for more than a few seconds, damages the grafts during the placement process.

In conclusion, three sessions of 1200 grafts moves the same amount of hair as one session of 3600 grafts, but it would not be in your best interest to push your doctor’s estimate of what he will transplant in one session for it will, almost certainly, reduce graft growth in his hands.


I have a couple stretch marks in my back donor area performed years ago from older methods of harvesting graphs.

My new HT doctor has revised these stretch marks by suturing into the subQutaneous. What is your opinion on this?


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I am having difficulty understanding your question. I think you are saying that there are ‘rail road tracks’ where you were stitched years ago. If widely spaced sutures are placed a bit of a distance back from the wound, they tend to produce ‘hash marks’. Today’s suturing with very fine sutures close to the edge of the wound does not produce ‘hash marks’. Is this what your doctor is suggesting?


Another Propecia question, this time from Thomas…

I have been on propecia now 9 months and have receded more and gotten thinner on top. Propecia either accelerated my mpb or did nothing for it. I am worse off now then when i started. I never used to have hair in the shower, on my hands, or in the sink..Ever since the 3rd month on propecia, it has not stopped. My head even itches now sometimes when it NEVER used to before. My question is can Dutasteride help me or because i had no response to Propecia, is it a waste of time?

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I do not know your age or family history, when you started balding, or what pattern you are heading to. This information is critical. Already you know that Propecia has not helped you (slowed or stopped the hair loss) so this is already atypical. It is possible that you have other than a genetic cause for hair loss. Thyroid disease and some other medical conditions can produce hair loss that will not respond to Propecia.

With regard to Dutasteride, there is no doubt in my mind that it is a better DHT blocker than Propecia, but it has not been proven to be by appropriately controlled studies. A few doctors who I respect have used it for genetic hair loss and they tell me there is significant benefit in some patients that do not respond to Propecia.

First and foremost, you need to have a competent doctor make the assessment. If it proves to be genetic hair loss, then using a non-FDA approved medication (called off label use) has implications for both you and your doctor. If you are in the California area, I would be happy to see you personally and make that assessment.


I am almost 30 years old and just started propecia. My general practitioner advised against taking it due to the risk of prostate cancer. I’ve tried to research this and have not really found any evidence to support this other than the increased risk at the 5mg level.

I’ve been told by a few doctors that I should take propecia and not necessarily have a hair transplant at this time given that my hair is only beginning to thin; and that propecia should help.

Additionally, I’ve heard recently that I should not be surprised if “hair cloning” becomes available in the next few years. Would appreciate any comments.

Best Regards

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Propecia, according to a recent article in the New England Journal of Medicine, reduces the risk of Prostate cancer by 25% in the men who were studied. I personally believe that it is a good medicine for this. There is some general argument on those who may develop cancer while on the drug, that the drug may have made the tumors look more aggressive. I think that the evidence amongst most knowledgeable people points to safety and Propecia is not a carcinogen. Your doctor is misinformed.

Hair cloning, I believe, will not be addressed in the next decade.

CNN released the following news in 2003: In the study, which was funded by the National Cancer Institute and published in the online version of the New England Journal of Medicine, researchers at 221 sites nationwide followed nearly 19,000 men older than 55 for seven years. About half of them were assigned at random to take either finasteride, a drug that lowers male hormone levels, or a placebo. By the end of the trial, those taking the drug reduced their risk of prostate cancer by nearly 25 percent over those on placebos.

Also, give the following reference to your doctor: New England Journal of Medicine Volume 349:2387-2398, December 18, 2003, Number 25, The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia, John D. McConnell, M.D.,et. al.


I live in Brasil, I’m 41 year old and my grade of baldness is 6 / 7. I use a hairpiece for 18 year and i want to get free of this, but i have a problem, because when i started using , i was able to avoid peolple noticing that was a hair piece, as was very natural and my baldness was class 2/3 and as i used to travel a lot i didn4t see people so frequently. My case i believe is needed a scalp reduction for a start, but i’m afraid of procedures go wrong and i cannot remove the hairpiece to much in advance. Please help me . I can travel to NHI if necesary but I can forward photos to a better evaluation of my case

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Your story of how one starts with a hair piece and then gets caught in a cycle of more and more dependence as the hair loss advances, is a common story. Many of our patients have been where you are now. The problem for advanced hair loss patterned people is the availability of supply. The basic point is to find out if there is enough donor hair, when combined with good styling, to produce the type of coverage you want or need. That depends upon many factors, of which the number of hairs available for transplants is only one of these factors:

  1. A better match of hair and skin color will work to your advantage, wavy hair and coarser hair also will work to your advantage if that is what you have. What is your skin and hair color?
  2. How loose is the skin in the back and sides of your scalp. For those who have loose skin, the availability of donor hair is generally higher.
  3. Is your hair wavy or straight?
  4. Is your hair coarse or fine?

Sending me a good set of pictures is important for me to establish a good baseline. Please answer the questions above for me in your responsive email. You can use the form or my email address on the Contact page.

In answer to your other point, the idea of using scalp reductions, I will just say that this procedure has fallen into a bad reputation and most good surgeons do not do them anymore. The problems are that there is severe scarring on many patients and thinning of the donor hair to such a degree that there is not enough donor hair to restore the frontal area. Although there are some patients that may do well with them, there are far too many risks for the average patient. I know about these risks because I had three scalp reductions in the early 90s and was left with scars and a return of my entire balding area. I eventually got transplants and had enough donor hair to fill in the crown defect. Best of all for me was that I had no frontal hairloss. Had I been a Class 6-7 balding pattern, I would have been in trouble. So in conclusion, cutting out the bald spot is a risky surgery with many things that could go wrong. The key to a good hair restoration procedure is low risk and a normal, hairy outcome in a reasonable time-frame.


Does body hair work for hair transplantation?

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There are no survival reports or good data on the subject so there is little to report that is reliable. There is one published case with scant data from an unreliable source so I can not feel comfortable about recommending it.

This is an issue that particularly bothers me. Body hair generally grows one at a time, rarely are there two or three “body hair groups” as it is in donor from the head where groupings of one, two, three and even four hair is not uncommon. For those doctors who are offering it, I wonder if the offering is accompanied by “informed consent” documents that reflect the experimental nature of the process. It would seem to me that for those who are considering it, they should first be sure to consult a competent, ethical doctor capable of doing all of the types of follicular unit transplants including FUE / FOX techniques before going any further.


I was doing some research on your company and your service and was intrigued to see a number of actual patient photos and their results. I was very impressed, but I did not see any photos of patients with blonde hair. I am 26 years old and have incredibly blonde, fine hair and I am interested to see if I can get similar results as your other patients and how natural it will look given my complexion.

Do you have any photos of light blonde patients? If so, could you forward them to me or send me a link if you have them posted online. Thank you for your time.

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Blonde hair is my ideal patient because of the low contrast between hair and skin color. In our video, there is a fellow with VERY fine platinum blonde hair who had a relatively low number of transplants in an advanced balding pattern. You can see that his results are better in proportion to the balding pattern and other hair colored people. You can get a free copy of our video (now on DVD) by calling 800-NEW-HAIR or visiting

Also, take a look at Patient VS on the NHI site. This young man had excellent results with blonde hair. Unfortunately, the photo made the hair appear much more sandy colored than the pictures suggests. Blondes are my best patients and those blondes with ‘reflective’ blonde hair do even better. We do have a lot of patients online, but I don’t believe there are any that truly represents a platinum blonde hair color. We’re continuously adding new patients, so please do keep checking back for updates.


I am a 23 year old male with an extensive family history of balding. I am well on the way to follow my father and grandfather’s pattern. What can I do?

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I just had a patient of the same age and with the same problem in my office, so I thought it might be worthwhile to read what I wrote to him. I send comprehensive letters like this to all of my prospective patients out of respect. It is always an honor to be able to play such an important role in the life of a patient.

Here’s the letter:

You have an unusual problem found in less than 1% of balding men. Your donor hair density in the rim of ‘permanent’ hair around the side and back of your head is higher than average (300 hairs/cm2 while the average is 200 hairs/cm2) but 1/3rd of these hair show miniaturization. This is the same process that goes on in the balding area on the top of your head and it should not occur on the side and back. When it does, it reflects a condition we have defined in the medical literature which we call Diffuse Unpatterned Alopecia. In essence, you have a process going on throughout the hair on your head, even the ‘permanent’ zone. Now with that said, your effective donor density of 200 hairs/cm2 (which reflect the sum of your hair count less the miniaturized hairs) is from a practical point of view, normal. But the fact that you have this process going on in the permanent zone means that the future of your permanent hair is uncertain. In my fairly wide experience, people who have had Diffuse Unpatterned Alopecia, have not experienced progressive extensive balding in the ‘permanent’ zone, but there is not certainty in your future. In determining your predicament, I would like to call your attention to some of the other elements of the examination I performed on you. Your hair is more coarse than most people, which means that the value of each hair is much higher than a normal person. There is a slight wave to your hair which means that it grooms and covers well with its strong character. Your hair is black and your olive colored skin provides moderate contrast between your hair and skin color, and although your olive skin offsets the dark hair a bit, it still calls attention to a lighter background which might require more coverage to get a full look.

Your biggest problem is the extent of your balding, which appears well on the way to becoming a Class 7 balding pattern (the most advanced pattern) and one that runs in your family. At the age of 23, you have a typical early appearance of this advanced balding process, but that balding process although mild in the top and crown of your head at this time, may respond well to the drug Propecia. You indicated your objection to using this medication to slow down or arrest the hair loss in the top and crown area. Your objections are over the side effects of the drug (rare and unusual). Considering your age, you have a good chance to get some reversal of the balding process in the top and crown area. With the diagnosis of Diffuse Unpatterned Alopecia that we found our your examination, I see even more reason to use the drug. I have seen fully half of the men who take Propecia see some reversal of the diffuse hair loss process in the ‘permanent’ zone, giving you two reasons to reconsider your position against taking this drug.

When dealing with a young man, I tend to be conservative, leaning on the drug treatment to slow down the balding process and for the maturity of the patient to line up with the extent of the problem. By saying this, I do not mean to be offensive, but young men are driven for now answers and often do not see themselves through the entire balding process which may take years. Transplantation, although a wonderful solution when appropriate, is the wrong answer for those who have not worked out a Master Plan with a good doctor that accounts for the worst case scenario of the balding process as modified by a transplant program. That is the dilemma before you and I at this time. You have to convince me that you understand what I know about your hair loss and what can be and can not be done about it. I must understand your maturity in dealing with a transplant program that will be with you the rest of your life. A good doctor/patient relationship is what I am talking about, something that is not easy to obtain in an hour visit to my office.

I am not firm against a transplant solution for your balding but because of the Diffuse Unpatterned element of your Alopecia, I need some comfort that whatever we plan is going to be the right plan for you. I want to speak with you again about the Propecia option and dive more into depth on the various subjects we discussed. We spent a great deal of time discussing the safety issues with Propecia, hopefully giving you more comfort in considering this drug as part of the long term treatment of your progressive hair loss problem.


Dr. Rassman,
What are your thoughts on Dutasteride (Avodart) in comparison to Propecia. I have been using Dutasteride for hair loss for about three months and seem to notice a positive response. i.e. there is very little new hair loss and there seems to be new growth on the vertex.

I just wanted your opinion as it relates to safety and efficacy of Dutasteride vs. Propecia.

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Dutasteride has great promise as a drug, but I have several problems with it as follows:

  1. Dutasteride is not FDA approved for safety or efficacy at this time. That leaves me a bit uncomfortable at recommending the drug.
  2. Propecia has a half life of 5 hours. That means that in five hours, half of the medication is gone from the blood stream and five hours more, 75% is gone, and five hours more 87.5% is gone and so on…. Dutasteride has a half life of 3-8 months depending upon who you believe. That means that once you take one pill, it hangs around for a long time. Any side effect therefore, does not go away fast like with Propecia.
  3. Dutasteride has been reported better or more effective than Propecia, but these are unofficial reports and at this time there is not absolute evidence that is scientific which will hold water on the comparison.
  4. Doctors who prescribe Dutasteride may not be protected by State Laws that govern use of non-approved medications.
  5. Most important of all, if people get a good response to Propecia, why switch?


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