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Hi, I am interested in possibly obtaining your services. In particular, I am interested in the FOX procedure. My problem areas are in the temple region. I live in MD so I have included some attatchments of the temple region. The ones that look like I have less hair is what I kind of look like in the morning. The ones that look like I have more hair is after I have brushed my hair. As my hair grows longer the hair around the temple region doesnt look as thick as the rest of my hair. I am currently taking propecia which seems to have stop the hair loss but I believe I started it a little to late to help my temple region. So my primary go is to thicken the areas of the temporal region. I may also be interested in some small things such as thickening some of my facial hair. If more pictures are needed I would be happy to get them to you. I am not sure what the next step is so I’ll be looking forward to hearing back from you. Thanks.

P.S. I am 27 years old.

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Nice to talk to you today. You reported that you have been on Propecia for 9 months. In addition, you saw a doctor from another clinic who suggested that you visit me and get an FUE (FOX) procedure into the temples.

I have reviewed your pictures. At 27 years old, I am generally very cautious. Before I would even consider adding hair density to the temple region, I would want to assess your overall future balding possibilities, looking for miniaturization throughout the head. I would also want to see what your temple densities are. As you are on the East Coast, I would recommend that you visit Dr. Robert Bernstein in New York where he can make such an assessment. He is an excellent doctor whose opinion should have great value. No one wants you to take unnecessary risks, particularly me, so a good opinion from Dr. Bernstein will determine the best approach. His website is


I heard from somebody that the average person loses 100 hairs a day. This seemed really high to me, is it true?

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Yes, this is true. It is believed that the average person has about 100,000 hairs on their head and the life cycle for a hair (before going into its cycle shut down and regrowth) is 3 years. Wtih that said, that means 35,000 hairs lost per year or about 100 (rounded) hairs per day for 3 years will equal the total number of hairs on the head of an average Caucasian Male.


Barring any sort of glaring injury like a burn, how easy is it for a dermatologist to tell if someone has scarring alopecia and their hair follicles have been permanently damaged?

I’m a female in my twenties and have had scalp dermatitis for several years. I tend to scratch it pretty badly in my sleep, resulting in small open spots that then scab over. Just within the last five months or so, I have developed bald patches as well as diffuse hair loss. There are other things it could be, but is scarring alopecia a possibility? Also, could the hair loss be from the dermatitis itself?

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The best way to determine which alopecia condition you have, is to get a dermatologist with considerable experience in diagnosing the various alopecias to give you an opinion. You may then need to get a biopsy of the area of alopecia and get a dermatopathologist to read the biopsy if there is any doubt on cause. Most good dermatologists do this in tandem, although your history seems to suggest that your constant scratching has produced traction alopecia with possibly some scarring. Sometimes, the alopecia will reverse (Alopecia Areata for example) if you completely stop scratching it.

Clearly, the picking of your hair at night can produce trichotelomania, which is a condition where constant picking or scratching causes hair loss. The diagnosis is always clear on microscopic examination of the scalp. If it only happens in your sleep, put on mittens and sleep with them on. Get a good doctor to examine you before you startsleeping with the mittens and after a few months. If the mittens works, then the changes that we can see under magnification will demonstrate that you are on the right path. Ordinary dermatitis without picking or scratching should not cause hair loss, unless is is associated with the genetic forms of hair loss.


I am a 33 year old female who visited a dermatologist that specializes in hair loss because of a receding hair line, (frontal hairline thinning). Very much the same why men start receding in the front. I was diagnosed with female patterned baldness and told to take Rogaine. In the past I was told the 2% was not very effective to use the 5% but the nurse has informed me to use the 2% and it will take up to 12 months to see any results. I have used the 5% in the past and have not had any side affects though I am not completely happy with the results. Is there any other medications or options I can take other then the Rogaine? I am feeling a tightness in my chest and shortness of breath which I think is from using Rogaine, but I am not 100% sure. I have had blood work done and everything has come up normal. I take no medications other then the Rogaine. It is just so frustrating to be told to use Rogaine when there has been so many medical advancements for men.

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Bells go off for me when I hear about tightness in the chest. Women with heart disease is far more common than most people realize. You must remember that Rogaine is a hypotensive medication and could induce (under certain conditions) a drop in blood pressure and chest pain from Angina. Please, see a good doctor. If you want an opinion on what to do about hair loss, please take a read through the many Female Hair Loss posts on this blog. If you are on the west coast, please come and see us.


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.


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