African-American Female Hair Loss

/by William Rassman, M.D./1 /, ,

Here’s an email I just received today…

Dear Dr. Rassman,

I am an African- American female, aged 62, with pattern baldness around my hairline. I would like to know if the “new hair” will grow and how will any chemicals, ie. straightners, dyes, etc. might affect the transplanted hair. I would also like to know where and how I can schedule an appointment for consultation ASAP. I have been using Rogaine but I am still compelled to wear wigs to look my best…HELP! I am VERY interested in getting this procedure and I have the blessing of my husband of 40 years!

I have done work on many African American females. As you may know, frontal balding is common amongst African American females largely because of the combined effect of pigtails that were used for styling in their youthful days as well as the abuses with chemicals, ie. straightners and dyes. First, a good examination needs to be done to separate the effects of chemicals and pigtail styling (if appropriate) to the female genetic hair loss. Then, a complete examination needs to be done to make sure that other medical conditions are not the cause of the hair loss such as thyroid disease, hormone imbalances, anemia, etc. There are a series of blood tests that can rule this out.

My recommendation is to make an appointment first (if you wish to see me, ask for me by calling 800-NEW-HAIR). The consultation is free.

Thanks for the good question.

Hair Transplant Doctor Training

/by William Rassman, M.D./6 /,

What type of training does a hair transplant doctor need?


This is a difficult question to answer properly, so as I have lots of room and time to consider the question thoroughly, I will answer it in great detail. Read as much as you wish.

The Hair Restoration industry has a society called the ISHRS (International Society of Hair Restoration Surgeons) and they are trying to provide both the public and the doctors who ‘specialize’ in hair restoration a way to define this, both for those who call themselves specialists and those doctors who want to enter the field and learn how to become a hair restoration surgeon. As you may notice the way I started answering this question, I have divided the answer into two categories: The existing doctors who call themselves specialists (like myself) and the new doctors wanting to get into the field.

Existing Restoration Doctors: The existing group of hair restoration surgeons come from a wide diversity of specialties. Dermatology was the field that produced the original hair transplant process in the late 1950s, so this specialty has officially hosted the field ever since. The text books are largely written by Dermatologists and the leading medical journals in Dermatology have articles about advancements in the field with great frequency. In fact, most of the articles written by New Hair Institute doctors have been published in Dermatologic medical publications.

Read more

Multiple Sessions

/by William Rassman, M.D./0 /,

A recent post I made about large sessions has lead to another good question:

What about multiple smaller transplant sessions… are they better?

In the hands of experienced doctors who understand large session hair transplant surgery and the nuances in performing them, the larger sessions are better than multiple smaller sessions. Each and every time the donor area is harvested, scarring to the deep structures are the inevitable result. I am not talking about visible scarring at the skin level, but deep invisible scarring below the skin. This scarring increases with each subsequent procedure. Fewer procedures produce less deep scarring.

Simply, I will answer your question with another question: Why have two surgeries if you can do it just once?

Hair Loss in the Mature Man

/by William Rassman, M.D./5 /,

Reader Tom asks…

My hairline has been receding for a number of years, I am now 62 and recently had a heart attack. It seems to me that the hair loss has accelerated since that trauma. My hair now has sort of a trough down the middle that was not there before, but it was thinning. My question is, Can a heart attack cause acceleration of hair loss and can hair replacement techniques be employed to reverse it? Thank You

Hi Tom, thanks for writing.

There are generally four causes of hair loss in men. Genetic inheritance and male hormones are the two most important. Time and stress are the other two. Typically, genetic hair loss occurs well before 35 years of age, and in most people it slows down with time. There are some older men who start showing the hair loss over the age of 45, although this is more the exception to the rule. Don Ameche, a popular film actor in the 1930s and 40s, was a hairy sex idol even at the age of 50, but was bald at the age of 75 when he had a prominent role in the movie Cocoon. So, he had an ‘expression’ of his genetic balding late in life. Your heart attack certainly brought on ‘STRESS’ and with a delayed genetic expression, probably precipitated your hair loss. I have seen this in illness or even divorce, both of which are heavy stress induced initiators for hair loss in the genetically prone man.

As your hair loss is recent, I would probably recommend that you go on the drug Propecia, because continued hair loss is possible. This drug may slow or stop the progression of the hair loss and it might even reverse it. If it does not do the trick, then a hair transplant works wonderfully.

Hope this answers your question.

FUE – Follicular Unit Extraction

/by William Rassman, M.D./2 /

Can a Hair Transplant be done without a cut in the back of the head? I really do not want to be cut upon!

In an article I wrote in the August Issue of the Journal of Dermatologic Surgery (2002), a new Procedure for hair transplantation was introduced which can be performed without a traditional surgical incision. The healing time is clearly reduced and the risks of surgical scarring are practically eliminated. This type of surgery is particularly useful in patients who have limited donor hair, a small balding area, a tight scalp, or the need to keep the option of wearing their hair closely cropped (crew cut style).

We called the technique the FOX™ technique, (short for FOllicular unit eXtraction). The FOX procedure involves the direct extraction of the follicular units from a patient’s donor area using a small instrument called a trephine. Healing is quick, scarring is virtually nonexistent, and discomfort in the donor area has been practically eliminated. I was quoted by the LA Times to say: “The FOX procedure gives yet another option for those patients who were hesitant or were unable to undergo traditional surgery.”

The article in the August 2002 issue of “Dermatologic Surgery” discusses our research, methodology, and detailed results. This new procedure is currently available at NHI’s offices.

In various surgical specialties, minimally invasive surgery has shortened recovery time and lessened the risk of complications in fields ranging from orthopedic joint surgery to open heart surgery. Now, minimally invasive surgery has arrived to hair transplantation. The technique has become a standard offering in the field, but only a few surgeons have mastered it as the technique takes years to perfect and a lot of practice. Our website has good videos of the procedure and a shaved head after the procedure wounds have healed so you can see what you would look like if you shaved your head.

Large Sessions

/by William Rassman, M.D./3 /

Here’s a question I get quite a bit from people that just start doing their research…

Hi Dr Rassman,
I have been reading a little about hair transplantation but I am still very new to this stuff. I was wondering why all hair doctors can’t transplant a high number of grafts in a single procedure?

Not all physician teams are equal. In our medical group, we (NHI) pioneered the large graft session transplanting as many as 4400 grafts in 1994. So performing a large hair transplant session is a function of experience and the skill of the surgeon and his team. If a doctor routinely performs sessions in the 3000+ graft size, then it would be safe to assume that this doctor has mastered the skills required for large session. Unfortunately, not all doctors have either the teams or the skills to accomplish the feat on a routine basis. For us, we have been doing sessions of over 3000 grafts for almost a dozen years and are performing sessions of this size almost every day. If a doctor must limit the size of the session to under 2000 grafts, it may take more surgical sessions to accomplish the same goal as when twice the number is transplanted.

Scarring Advances

/by William Rassman, M.D./2 /

Have there been many advances to the visible scarring problem that is talked so much about?

This is an interesting question, most appropriately directed to me. A small number of patients do develop noticeable scars (less than 5% of first time patients). This is more intrinsic to the healing properties of the patient themselves, but the techniques used by the surgeon have not generally been able to address the unique needs of the small number of patients with a scarring problem. Now there is a new closure process that allows the surgeon to better address the scarring risk in this 5% of patients that have a scar widening tendency. We are using this new technique in virtually all patients. We have actively solicited patients who have widened scars as a new business activity and have been repairing scars from patients who come from around the world.

Density Limits

/by William Rassman, M.D./0 /

What is the limit for transplant densities?

Hair can be transplanted at a density that approaches 35% of the original density in many people. The ability to place such densities depends upon many factors which include: hair thickness, skin characteristics, the size of the instruments for making sites, the skill of the surgical team at placing grafts tightly together and the processes that reflect the quality management of the surgical team. Not all doctors can place, for example, two hair grafts into a 0.9mm recipient site. Even in the hands of a good surgical team, not all hair grafts can be placed into a 0.9mm recipient site. So there is a balance between what can be done and what should be done. A surgeon with considerable experience in hair transplantation dense packing is best able to make the judgments required for maximizing hair densities. I pioneered Dense Packing with the first published mention in a 1993 article in the Hair Transplant Forum and have been using this technique ever since. More recently, we have moved to combining Dense Packing and Large Session surgeries to maximize yield and reduce the number of surgeries required to get a person to his goal faster.

Visible Scarring

/by William Rassman, M.D./1 /

Do most people have visible scars from a traditional hair transplant?

The answer is that every person that receives a cut to the skin gets a visible scar. The more appropriate question should be: How often are scars large enough to be seen in social conditions? Most people who have donor hair taken with a traditional incision get a scar that is about 1-2 mm wide. A scar of this width can only been seen by combing back the hair and closely observing the scar with good lighting. Fully 95% of patients fall into this category. These scars should never be detected when the hair is at least 1/4 inch in length (this may not apply to a coarse, straight haired individual). If a person shaves his head, a pencil line scar will be evident in virtually everyone.

Keloid Question

/by William Rassman, M.D./1 /,

An African American woman writes…

I am interested in the restoration process to my temples. Having black skin I am concerned with forming keloid scars in the visible frontal and back area. Does this happen? I noticed pictures of African Americans however they may be some of the lucky ones who don’t form big scars. Can you give me some more information on this?

There also didn’t seem to be any info on other possible pitfalls to take into consideration?

Thank you for your email. If you are a known keloid former, then a test of the scalp may be the safest way to determine if you would form a keloid. Such a test might be performed with a very small incision in the area where the hair would come from and a few needle ‘pokes’ in the area where the transplants were to be placed. If you have no history of Keloids, and have had scars in the past that did not produce Keloids, then it would be reasonable to assume that you would not form a Keloid in a hair transplant area.

As a black woman interested in hair transplants, please make sure that you are evaluated by a good, ethical and competent doctor. With regard to Keloids of the scalp in association with a hair transplant, they are very, very rare even in black skinned people.