As Seen on


This patient ‘Tom’ started to lose hair 23 years ago. He was followed by me over the past 25 years and kept up with his hair loss as it occurred.  His father had a Class 7 pattern of hair loss and like this patient, had a high quality of hair with a very high donor density (I transplanted his father’s Class 7 pattern with 10,500 grafts and he looked like he never lost a hair on his head). He didn’t start with a Class 7 pattern

norwood class 7 patternbut evolved into it over the 25 years I worked with him.  Because of his high donor density and the excellent quality of his hair, it allowed him to get the end result shown in these photos here.  Tom had 4 strip surgeries and insisted on looking full haired from the moment he came to see me.  When the FUE was invented by me, he has a series of smaller FUE sessions to follow the last of his hair loss. He had considerable donor area scarring which was successfully treated with Scalp Micropigmentation as you can see from these photos. He is a perfectionist and that made us a good team, surgeon and patient, both perfectionists.  Like a teenager, he now shaves the back of his head because he can. It is important to note that this patient’s hairline was the initial target of the first transplant and we maintained his frontal look through the 25 years that I took managed his hair loss. As hairs were lost, they were replaced by me. Because he had a very high donor density, he was in the unusual position to have an ‘almost never ending supply‘ of donor hair.  Even today, he can do more transplants as the residual donor density is still adequate and can support more FUE transplants.

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I am a cosmetologist and have been so for over 25 years. I’ve been doing extensive research on hair loss for several years. Recently I’ve been experiencing hair loss myself. I have rosacea, the kind that results in acne like bumps. It creeps into my scalp also. After finding out that I have an inflammatory condition found in my lungs, it’s all starting to make sense. My pulmonologist is drawing lines connecting imflamation in my skin and scalp to this. Many people who have acne or other inflammatory conditions also experience hair loss. This is believed to stem from inflammation brought in by either infection, autoimmune disease or allergic response. I have rosacea and hairloss. I’ve not taken any oral antibiotic for this although it has been prescribed (minocyline) . This drug is used to treat inflammation, not so much as an antibiotic. I’ve used metrocream on my face with no great results. My dermatologist switched me to soolantra andnit and is working wonders on my breakouts and redness. She says this cream works to fight against the allergic response to skin mites. So interesting that the inflammation is due to an allergy. It’s probably also in my scalp too. If you have an inflammatory skin condition you most likely also have the same in your scalp. Because the cycle of the hair growth and shedding, you might be experiencing the loss a while after the inflammation began at least 6 months or so. I’m curious how many of you have experienced other inflammatory problems like IBD, joint pain, high blood pressure.

Thank you for writing. There has been microscopic evidence that some inflammatory process is present in female hair loss. We also have seen many autoimmune conditions such as FFA, LLP, Alopecia aerata, etc. that are known inflammatory autoimmune diseases that attack the hair.  I would not be surprised that the presence of other inflammatory conditions could overlap to the hair follicles. Unfortunately, our clinical science is not there yet.


I need your advice regarding reflex hyperandrogenicity.  I went on Propecia in March of this year. The doctor who prescribed me the drug told me to come back in 6 months for an evaluation. Within probably two weeks I started to experience what I thought was the usual shedding. I was obviously concerned and turned to discussion boards where I found countless responses indicating that the shedding, regardless of the severity, was just part of the process.

I wanted to believe that that was the case so I carried on. I was (and still am) experiencing hundreds of lost hairs every day, increased (though admittedly not drastically) acne, increased sebum production, increased sexual function for about two and a half months. Finally, I went to see the original doctor who prescribed it and another doctor. They both confirmed that this is not anything close to normal. Actually the second doctor (not the prescriber) told me that he had prescribed Propecia to thousands of patients over the years and he had seen maybe a dozen patients who responded like this.

Obviously, I am distraught. I don’t know what to do. I am one week off  Propecia and still shedding like crazy. I have lost maybe 60% of my hair. The loss is all over my head but it’s worse on the crown and the sides (I NEVER experienced loss on the sides before Propecia). Both doctors told me cautiously that some of it may grow back eventually. The sad thing is that my male pattern baldness wasn’t even that bad. I was losing my hair for sure. But I turn 40 next month and I probably would not have got to this point for a good number of years.

Most of the hairs I’m losing are thick dark hairs and most have NO bulb on them.

So my questions are:

(i) Given your experience, do you believe that some of my hair may grow back?

(ii) Is there anything I can do, any product I can use, to increase my chances of getting my hair back?

Shedding is not an unusual report for the first few months after starting finasteride, but it almost always stops and most patients find less hair loss after a few months. One family member of mine, did have an increase sex drive after starting the Finasteride. I have never seen a report that Finasteride kicked off massive hair loss as you are reporting. I would expect that, considering your age, stopping the drug might work in your favor and reverse the shed, but frankly, I am not sure. You should see a doctor who has the HAIRCHECK instrument to measure your hair bulk and then follow you over a year to report what is actually measured with regard to your hair loss.


There are clear risks here, one technician moves to another patient because the team needs help, instruments are crossed between patients, there is clearly not surgeons for each of these patients.  All of this can cause life threatening infections transferred from one patient to another.  There is a real question of quality control, who does it.  Are all technicians equal (some report that the technicians are hired and join the surgical teams that same week).

This would be outlawed in the US or most major Western countries.

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There is not much to say other than sit back and enjoy this

Hair System Malfunction! I attempt to stick the hair system on all by myself and lose half of my forehead! from tressless


I have collected a series of photos from the internet of victims from overly aggressive surgeons who don’t understand the limits of performing FUE and have depleted the donor area on this patients ( These men may have addressed their balding on the front, top and crown of their head, but they traded it off for balding in the back of their head. Balding in the back of the head can only come from an overly aggressive surgery so anyone that looks at them knows that they had a hair transplant because balding in the back of the head is not anything found in nature. It is man-made.

donor shock of over-harvesting donor area overharvested 58B9C929-B2E9-4BAE-A50C-677397794B02

depleted donor 13 depleted donor 15 depleted donor 12 depleted donor area 31 depleted donor 11 depleted donor 18 depleted donor 52


At the bottom of this posting, there are two examples of views of the donor area under a hand microscope (these can be purchased on The microscopic view on the picture above averages about 2 hairs per follicular unit.  This number is close to the average Caucasian’s density with a total hair count reflecting 100,000 hairs on the head.  The picture below shows follicular units that contain far more than 2 hairs each (a very high donor density). Without calculating it but eyeballing it, it appear that the number of hairs exceed 3 hairs for each follicular group or more than 150,000 hairs on the head. Let’s assume that there are 3 hairs per follicular unit for the simplicity of the calculations that follow.

The average human has 50,000 follicular units on his hair baring scalp, averaging 2 hairs each which calculates to 100,000 hairs on the head.  If you look at the Class 7 balding pattern patient, the remaining hair is the only hair that we can legitimately call permanent hair. This reflects 20% of the hair baring surface on the scalp (excluding neck hair) i.e. in a typical Caucasian male,Screen Shot 2018-12-14 at 12.39.18 PM 20% of the 100,000 hairs are permanent hairs for transplantation, which is 20,000 hairs or 10,000 permanent Follicular Units (grafts). 
That means that if 10,000 grafts were taken out of the Class 7 patterned area, the area would be completely bald.  Therefore the obvious question is how many grafts of these 10,000 permanent hair Folliclar Units (grafts) can we move.  The answer depends on a series of factors, but let’s say safely that 60% can be moved safely, or 6,000 grafts with the FUE technique. If your hair has an average thickness or is more coarse, then number of harvestable grafts can be higher so that the remaining follicular units (grafts) will be enough to make the donor area look normal. If the hair is fine, however, the number of extractions that are safe will drop below the 6,000 Follicular Units (grafts) that can be safely harvested. When you or your surgeon push these numbers higher, you take a risk of donor area depletion which produces a see-through donor area (i.e. balding in the donor area). This is the reason I am writing this post, to give you, the reader, the power to understand the logic in the decisions on how to estimate the maximum number of grafts that you can move before risking a see-through donor area.

One reality is that most people don’t bald to a Class 7 pattern (only 7% of the male population), but might stop at a Class 6 pattern of balding, so if your surgeon and you decide that you are willing to extend the donor area to the Class 6 pattern of balding, then the number of permanent Screen Shot 2018-12-14 at 12.17.48 PMhairs will increase to 30,000 hairs and the number of harvestable grafts will be much higher with harvestable grafts possibly at 9,000 Follicular Units (or grafts) leaving 6,000 remaining follicular units to cover the donor area (the size of the Class 6 pattern of remaining hair).  The decision to increase the projected size of the donor area has its risks because no one will know for sure that they will never develop a Class 7 pattern.  The consequences of this decision is (1) the extra 3,000 transplanted grafts will not live and will die where ever they were placed if you develop a Class 7 pattern of balding, and (2) the harvested area will show with FUE area as white scars above the remaining donor area and these scars will be visible to everyone. So this decision should not be taken lightly and it must be discussed with your doctor at the time of the FUE, or you may regret the decision sometime in your future.

In the microscopic view of the patient on the right who has a very high donor density, the harvestable hairs in the Class 7 area may have doubled because the look of the donor area reflects not the number of hairs that were removed, but rather the number of hairs (or follicular groups or grafts) left behind. To calculate the safe harvestable number of grafts, the key is to leave behind approximately 4000 Follicular units.  With an average Follicular Unit density of 3, the donor area contains 30,000 hairs or 15,000 Follicular Units (grafts) so that to leave behind 6000 grafts, this patient can safely harvest 9000 Follicular Units (15,000 – 9,000 = 6,000).

The use of strip surgery, on the other hand, always keeps the excised donor hair at the lower side of the Class 7 permanent zone, so that if your surgeon and you decide to take more grafts, other than a possible scar that may occur from the strip surgery, the risk of placing non-permanent hairs with the surgery is very low and the risk of seeing an area of harvested grafts with no hair will not occur.  Of course, the risk here is potential scarring.  The use of “Scalp Micropigmentation” solves the problem for either a see-through donor area or a scar. Here are examples of what can go wrong if things are not done right:


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Stephen Miller used too much Toppik in the front so that the back and sides of his head are a different color.  He should have Scalp Micropigmentation ( done so that the effect would be uniform and not stand out (you can see it in the video below). The key to undetectable concealers is that the leading edge can not be sharply thick. A normal hairline has a transition zone between the forehead and the thicker hair behind it. Hair is very important to all men and the use of concealers show that the men who use them are take charge guys, wanting to look how they feel.  I am not faulting Steven Miller at all by posting these Reddit photos and posts, just sharing my thoughts with my readers.

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Don’t go on (HD) TV show with spray-on hair! from tressless



 I tell men never to get a hair transplant prior to the age or 25 or 26 because they must know what their hair loss pattern is and until this age, the pattern is not clear. If you get transplanted earlier, you may chase your pattern with repeat hair transplants every year. Men in their thirties are idea, because most of the hair loss has happened in their twenties.

Hair transplant from tressless


This is a classic case of Triangular Alopecia, which is an inherited condition.  The only good treatment is a hair transplant into the area.

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