As Seen on newhair.com

 

Dear Doctor Rassman,
I am 20 years old. I want to know something more about triangular alopecia. My temples are receded about 1.5 inch. I have also genetic hair loss in bitemporal area and also in vertex (or at least it is what the doctors said). My father has lost also all of his temple hair including the hairline and the top, but nobody else in my family lost his temples hair, even though everybody has genetic hair loss. In addition I want to say that my temple hair is changed. Above the ear it is thicker than before but with less hair count, curly (it was not) and with a slower growth. Can it be part of genetic hair loss or it is genetic and something else in the same time? I have tried many doctors in Vienna, but I was not satisfied. When I ask about Propecia thay said: “It is not for you, it is for old men”. There is a clinic, Moser Medical, with some doctor of ISHRS but from the emails that I sent to them, they seemed more commercial than helpful. Can you tell me something about my condition? Thank you for your time and for this website.

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Triangular alopecia is a condition of hair loss which impacts the anterior temple area on either or on both sides. It may not be a complete loss of the temple hair, at times showing an atypica or asymetrical pattern, even to the point where a little residual tuft may be present on one side and no problem on the other side. It can affect either men or women and it is not necessarily part of the genetic balding process we commonly see, which produces balding in other parts of the scalp. It is probably another inherited process and hair transplantation is the best approach to treating it.

 

I have been taking Propecia for about 8 years. My wife and I are anxious to have another child. I completely stopped taking Propecia for about 5 months when my wife and I started trying to have our first child two years ago as I was afraid of side affects. He is perfectly healthy. Was that necessary or advisable? Should I stop taking it while we try to conceive again? Thank you.

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There are many answers to this question depending upon the doctor and his interest in practicing and giving advice on what could be sensitive medical legal issues which are at time at odds with what is in your best interests. Very little, if any, Propecia comes from the sperm into the woman’s womb. Merck (the manufacturer of Propecia) does not warn men wishing to have children to stop taking the medications for your situation. That, in itself, tells much of the answer to your question. Some doctors, however, tell their patients if they are worried to do the following:

  1. stop taking the Propecia during the one week that fertility is present or stop it through the entire period from conception to the delivery of the baby
  2. use a condom when your wife is pregnant
  3. stop the drug completely during the entire pregnancy

I feel that the first part of #1 may be wise if you do not trust the drug company disclosures and to adopt #2 if you are really worried. These two steps are extreme, while #3 is almost crazy because you will abandon all of the benefits of the drug and get progressive hair loss during the 9 month pregnancy period, based upon no evidence that this is a problem. See my previous answer to this question here: Taking Propecia While Starting A Family.

 

I want to see a one time result, best if you can show it in a celebrity who had a hair transplants. Come on Dr. Rassman, if you really have celebrity patients, why won’t you share them with us?

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Privacy is critical to my business and to the entire issue of medical ethics. All patients are entitled to their privacy. Also, California law states that a doctor can lose his license if he breaches the confidentiality of his patient’s identify or shows his/her pictures without consent. Now with that said, CBS sports reporter and XTRA Sports Radio host Steve Hartman does come to mind. Steve had one surgery of 1,895 grafts with us almost 12 months ago. As he has allowed the use of his identity and his pictures, here are the before and after photos. The photo on the left was taken just minutes after his procedure was completed, and the photo on the right was taken 11 months after. Click each image below to see the full size photo.



The entire growth cycle from start to finish are shown in the Steve Hartman Feature.

 

Hi, I am 50 years old. I am unable to grow sideburns. I am sure it is inherited because I can grow a great mustache and facial hair on my chin, and from there, down my neck, but no sideburns which I have always wished I could. So, I see you folks may be able to help me. I have the usual questions, cost, and will the results look natural? Thanks!

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Unless you have a disease like alopecia areata, you should be able to get hair transplants to place into the face and chin to create a beard, mustache, or sideburns. We do these kind of procedures all of the time and they look completely natural. The use of a fine needle to create the sites in the facial beard area is important to minimize any puckering of the skin. Most doctors charge by the graft, but some charge a flat fee. Your costs can be estimated by sending me photos to the email address on my Contact page. To help get an understanding of where you want the transplants, I would suggest marking up your face, beard area, and chin with a China Marker, which will easily wash off. You can get a China Marker from a local stationary store.

Here are some examples of sideburn transplants we have done at NHI:

 

i am 36 and have been losing my hair over a span of about 12 years. it started after my pregnancy, but over the last 2-3 years it has gotten VERY, VERY worse. I’m getting a lot facial hair, and acne. I NEVER had an acne problem until having a baby. I’m afraid i’m going to wake up bald . any answers will be appreciated. Thank You, Michelle

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There are a series of masculinizing disorders that should be checked out by your gynecologist. Rather than play doctor here or set you into an alarming process, just pay your doctor a visit and have him/her perform an examination and do the appropriate testing for these disorders.

 

I have been using Lisinopril for high blood pressure for more than a year now and I have noticed that my hair is falling out. I don’t know if the Lisinopril is the cause because I am also under a lot of stress, but is hair loss a side effect of this medication? If it is, will my hair grow back if I stop using this medication? Is there another high blood pressure medication I can use? Please let me know. I don’t need this added stress.

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Yes, Lisinopril can cause hair loss. There are many antihypertensive medications, but I would not want to recommend which one you should try, as that is your doctor’s job. Ask your doctor to recommend another medication if you feel that the hair loss and Lisinopril are more than a coincidence.

 

Hi Dr. Rassman,
I was hoping you could help me with some suggestions or information on what is going on. I recently began losing a lot of hair suddenly. However, the really weird thing is that a lot of my hair (maybe 50 to 70%) of it has a white hard mucus type of substance that can be scraped off from the end of the hair(maybe its the actual skin from the scalp or the hair follicle or something?) Is this normal because i really feel like its not?!?!?! I’m freaking out here because im so young (21 years old) and it came on so sudden and i dont know if every hair that falls out with that stuff means that it will never grow back again, and maybe there is something i can do to stop it???? I’m really scared here, if you guys could help with any suggestion or what you think it is, i would forever be in debt to you. Thank you so much.

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You are panicking and that is not a good way to evaluate something as serious as your hair loss seems to be. Clearly, a good doctor knowing hair and scalp problems will be able to diagnose your problem. I can only guess without having you in front of me and that would not be doing your any service. My suggestion is to see a good dermatologist in your area.

 

I’m 36, female, and have been losing hair for 8 years. My hair has always been fine and thin, and I inherited my father’s “receding” hairline. Now to be losing hair on top of this is awful. I’m new to the are and seriously considering transplants. I just saw a dermatologist who took a biopsy and said it’s female pattern hairloss, use Rogaine, there’s no other hope. I want to see a real professional who is caring, sympathetic, and willing to work with me to discover the best option of treatment. Can you recommend someone in southwest Florida please? Thanks

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Ask your dermatologist to recommend a doctor in your area. A direct referral is always the best way to go. Dr. Bernard Nesbaum is a hair transplant doctor in Florida who has considerable experience with women and he is a dermatologist. You might want to check with him. You can get the doctors in Florida by looking at ISHRS.org.

 

Because this site was mentioned in the “Matthew McConaughey’s Miracle Hair” article in New York Magazine this week (see my blog entry from yesterday for details), I have been inundated with questions about celebrities and their hair transplants. One notable magazine asked for us to give access to some famous celebrities to talk about hair loss and the treatment for hair loss, like transplants.

It obviously would be improper for us to respond with names of celebrities who may or may not have had hair transplants. The point that I want to make here is that today’s modern hair transplant can be completely undetectable. Please take a look at Patient NU for a wonderful, closely cropped hairline. His hairline was lowered about 2 inches, including restoring the widow’s peak and temples. After you look at this patient’s photos, I challenge you to detect the difference between a completed hair transplant and the hair on a non-balding person.

Here’s the large “after” photos of Patient NU. Click these thumbnails to view the full-size images. To compare these to the “before” photos, please visit Patient NU’s profile. Also, this patient had temple transplants many years ago, and his results are available here and here.




There are many funny stories about celebrities and their not-so-unique sensitivity to their hair loss. For most men, there is some loss of maleness, like a lion without his mane. Men feel that if they lose hair that they will lose their sex appeal. There is some truth about that statement. The stars who are our sex idols (like Brad Pitt, Johnny Depp, George Clooney, and Mel Gibson) all have normal non-transplanted heads of hair, as far as I know. The patient in the pictures above wanted a pointed hairline like actor Andy Garcia. If Andy Garcia cut his hair short, this is most likely what it would look like. You would be completely surprised with the names of some of the men who I did transplants on, from heads of state, to movie stars who absolutely never, ever were detected as having had a hair transplant. The good news is that today’s hair transplants, done in the right hands, are completely undetectable, even by their hair dressers.

I treat all of my patients as celebrities; they are entitled to their privacy and to the best surgical techniques available. I am not just the hair transplant surgeon who defined the modern techniques of hair transplants, but I have also been a patient, and know how important our public image is to our personal well being.

 

I know you recently stated that you were reviewing the progress on transplants using body hair. Have you done any case studies? Do you believe this will be a viable alternative to those prone to scarring with donor hair taken traditionally from the scalp. Since many like me have a chest full of hair with, I’m assuming limited donor hair due to previous surgeries.

I have had three previous surgeries, none within the last six or seven years. My last surgery having been performed by Dr. Bernstein. I have had considerable hairloss since my last surgery. I am thinning to about a 5A. I have two linear keloid scars in the back of my scalp. Not to mention some cobblestoning in the front of the hairline, that is very difficult to hide with the increased balding. I would really like to have surgery soon, but I am worried about further scarring, and receiving transplants producing little or no real hair growth for my money and time. By the way, I am African American.

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I would suggest that you consider another visit with Dr. Bernstein. With that said, body hair transplants are still unproven and are experimental procedures only, at this time. In African Americans, the risk of keloid scarring is higher than in Caucasians, and you have a higher risk of keloid scarring on the body than on the scalp. In addition, the recipient site will almost certainly develop white scars. In an African American, these scars may become very noticable, far more than in Caucasions. Read the past blog entries for my previous posts about body hair transplantation here, here, and here.

 

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