Cheap & Discounted Hair Transplants

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

When you buy a cheap airline ticket and you are flying American Airlines, neither the airline nor the seat is shoddy. But when you buy a cheap hair transplant, you may not be getting a ‘legacy carrier’ doctor. Cheap hair transplants means that it is highly possible that you will get the pluggy doll’s hair look, inexperienced surgeons, poorly trained teams of people working on you, and an absence of quality control. I know of one of my former technicians who did a hair transplant on a friend on his dining room table. The procedure was done outside the United States and his friend would have bled to death had he not gone to a hospital to stop the bleeding. On a more local level, I have seen many patients over the years who were enticed by a new doctor who wanted to build his experience by offering discount prices. Sadly, they now needed an experienced and ethical doctor to undo the damage. Fundamentally, I can recommend if you are committed to going to the cheapest place for a hair transplant, that you do your homework. Make sure that you extensively research their medical licenses, how they were trained in hair restoration, how long they been performing hair transplants, what techniques do they use, their board certifications and in what field, are they active members of recognized hair medical societies (like ISHRS), and what do their results look like – because you will usually get what you pay for.

I’ve touched on this before in a previous blog entry, Bargain Hair Transplantation.

Propecia vs Proscar

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

Can doctors legally give someone a prescription for proscar when they just need propecia?

Yes, doctors can prescribe whatever is in the best interest of their patients. With regard to Proscar versus Propecia, they are both exactly the same medication, but Proscar is a 5mg dose of finasteride while Propecia is a 1mg dose. The two are exactly equivalent if you can cut the Proscar 5 mg pill into fifths. That is a problem for some patients, because the cutting process is not easy.

Stress Induced Hair Loss

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

I am a 57 year old male. Recently I have been under a lot of stress. Have been taking a topical testosterone ointment off and on, HGH injected of and on. Have noticed a great increase in hair loss lately. Have been taking Saw Palmetto as a DHT Blocker. Would I benefit from beginnning Propecia or am I too old to benefit from it. I am going to get a Hair transplant with NHI in the future but now just want to stop the hair loss. Thank you.

It appears that you have many reasons for hair loss (stress, testosterone, HGH injections). Clearly a good DHT blocker like Propecia will be far more valuable than Saw Palmetto which is very weak, if effective at all. Still, the combination of contributing factors may not be enough to stop the hair loss. Visit me and let’s talk.

Body Hair Transplants

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

Is it not possible to transplant hair from other body parts to the head. I do realize the texture etc is different, but it might be usefull as filler to make the transplant of people with finer hair like myself have a fuller look. I have had 2 procedures with you with over 3000 grafts but i still really am not 100% happy with the density. And i do not think i have enough hair in my donor area to do another procedure. So i thought it would be great if other hair could be used in order to give my already transplanted area a fuller look. What do you think?

Body hair is being transplanted by a few doctors, but there has not been any real follow-up on the results. The few that I have seen did not meet my standards on density or quality so I have not jumped on board to do body hair transplants. FUE is possible from your remaining donor area, however I would need to assess your supply to judge what kind of density and coverage you could expect. Generally most people have well over 3000 grafts in the donor area, so I would suggest that you make a re-check appointment at my office. While I do keep an open mind on new and creative solutions, I would need to be convinced that body hair transplants will give good results before recommending them over standard solutions.

Women’s Opinion of Balding Men

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

Do women really care if a man is bald?

According to a survey that appears in the July/August issue of Cargo on newsstands June 14, “almost half of U.S. women do not mind if a man is losing his hair, but 99 percent are against comb-overs.”

Forty-eight percent of the women in the online poll for Cargo magazine say men shouldn’t even worry about hair loss, while 32 percent recommend going with the flow and cutting all hair off. Only 1 percent suggest hiding a balding head under a cap or a comb-over.

Propecia Dosage

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

In your opinion is there ever any reason to up the dosage of propecia? Do you know of any side effects from doing this? If you were to raise up your dosage would a smaller dosage then become ineffectual as your body gets used to the larger amount?

The dose of Propecia has been tested from as high as 20mgs to as low as .25mg. The researchers did a good job testing the value of higher doses. They determined that higher doses were no more effective than the recommended 1mg dose, much to their surprise. If you were to take a higher dose, you might start to see sexual side effects which start to show up as the dose increases.

Propecia Results – Crown Photos

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

I am 30 and I have had a good results from Propecia on my crown, but not good enough. Can I have my crown transplanted? What will the results be like?

You have had an excellent result from Propecia. The readers of this should first put themselves into your place and ask themselves if they would be satisfied with this result. If not, yes you can have transplants, but transplanting the crown without knowing what will happen to the front has risks. You need to know what is your worst case balding scenario. Whatever grafts you use in the crown now, will not be available for the front later if you start frontal balding. However, if your donor supply is very high, or if you don’t have a family history of extensive balding, or if you have no significant amount of miniaturization in the donor area, then saving grafts for future balding may not be a concern.

You and your doctor must lay out the long term goals and the plan that you will follow. Only you will be in a position to make the final decision.

The photo on the left was taken about 18 months ago (before taking Propecia) and is scanned from a Polariod, so please excuse the quality. The photo on the right was taken this month and shows the results of this patient’s crown after taking Propecia.



How Bald Will I Get?

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

I am 43 years of age and have been classified as Norwood 4. I started slowly losing hair in my mid thirties or so. Both my grandparents had a full head of hair, but my uncles on my Mothers side are Norwood 6’s. So, is it a high probability that I will progess to class 5 or 6 + in my later years?


Norwood Class 4
Norwood Class 6

With treatment using the drug Propecia, I suspect that you can arrest your hair loss so that you do not become the Class 6 pattern of your mother’s side. If that is all you want, then no transplants are needed. If you want to reverse the hair loss, then hair transplants are the only real option.

Hair Loss in the African American Man

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

I am 33 years old African American and am very concerned about my hairloss. I am probably between a Type 3 Vertex and Type 4 hair loss pattern. My crown is very thin and my hairline is getting thinner by the day. I tried Propecia for 10 months and did not see any substantial differences. I stopped using Propecia because of the uncertanity of future complications.

My hair on the sides and back are very strong, but I am concerned about how a transplant would look. I have seen some guys that have that pluggy look, which looks bad. Can you give me some advise on what the best step would be.

A man of your age who is still at a Class 3 Vertex or Class 4 pattern, is usually not going to get very bald. In the African American, this is more typically the case, but it would be best to get a complete history of your family to be sure that your ancestors did not have advanced cases of hair loss. My concern would be that Class 4 patterns sometimes do lead to Class 5 or even to a Class 6 pattern. That is why I like trying to prevent progressive hair loss with a DHT blocker like Propecia which will probably stop or slow the progression. Stopping the progression is as important as fixing your problem correctly.

African Americans’ are the best candidates for transplant. The characteristics of very curly hair make the frontal work look awesome and the hair just covers better. It is always a pleasure to show off the results. Here are some examples from our website, newhair.com:

Menopausal Female Hair Loss

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

I am a 47 year old female, who has had thick, coarse hair all of my life. Last year, I had a few hot flashes, my gyn gave me some estradiol to take……..I felt better, discontinued it. *this was in April…I took it for a few months. I had a surgery in August…general anesthestic. In December my friend mentioned my hair looked thin. I got some Rogaine…..used for one month until my hair was falling out by the tons and I had noticable thinning in my temples/hairline. Hair looked much, much worse. Stopped using it Jan 21. Gyn gave me estradiol Feb 21st.,,after I saw him complaining of hair loss….he said I was periomenapausal. My hair shed slowed until two weeks ago and is now shedding again. I still have very thin hair in the bang area/temples….you can see my scalp in the sun or bright light. Blood work showed normal levels in all tests. I do have lots of new hair that can be seen over the back of my head…but I don’t see anything in my bang area. I am suffering anxiety and worrying constantly…which I know doesn’t help. How long does it take for hair to get back to normal if it is going to? Am I expecting results too soon? Have you ever heard of Rogaine making the problem worse and does it make it permanently worse?
I would like to consider a hair transplant if it can give me some density back. I am taking vitamins/EFA supplements….don’t smoke, ….also interestingly my once coarse hair is now soft/finer feeling which seems wierd.
thanks for any insight, help.

Your email sounds desperate and you need to be sure that there is no underlying medical condition causing your problem. Assuming that you fully check out (see female hair loss Q&A), then it sounds like much of your process is reversing. The reversal time should be less than a year. You should be evaluated by a doctor like me, who can determine your base line today, the full extent of your miniaturization and then follow your progress. A transplant can solve the ‘bang’ problem, but first let’s clear you of a medical problem.

Eyebrow Transplants

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

Can you transplant an eyebrow?

Yes, eyebrow transplants work nicely. There are a series of problems that hair taken from the back of the head causes when it is moved to the eyebrow:

  1. It will grow long, so it must be cut on an angle a few times a week.
  2. It may take on the thickness of the hair behind the head. If the eyebrow has finer hair, than this might be a problem.
  3. There is always a risk of a change in character of the hair itself (unusual).

I love doing eyebrows on men, as most men want bushy or wider eyebrows. For women, we must be selective and sensitive to hair type. The photos below are of one of our male eyebrow patients who just came back a little over a year after his transplant. On the left is the “before” photo, on the right is the “after” photo.



What If I Stop Using Propecia?

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

I stopped using Propecia and over the next 3-5 months, the bald spot on my crown became large. This was 2 years ago. I have been sick about this and afraid to go back to my doctor and tell him what I did as I felt stupid. If I go back on the drug, will I get my hair back? Should I go to a different doctor?

There are a number of issues here. First, stopping the drug and having lost the benefits with a return of balding is a common problem. Men frequently stop the medication after they have tried it for months or years and after seeing no benefit, they feel less committed to the drug. When they stop it, there is a period of what I call ‘catch-up hair loss’ where you will lose all of the hair that you would have lost without the drug in a short time period. That is what happened to the questioner. Some people may have progressed too far between stopping the drug and restarting it. Some people may have had slow progressive loss. Each will respond differently. All I can say is that restarting is better than doing nothing. You already know what nothing did and you are now sick over doing nothing.

As far as selecting a doctor for the second round, ask the basic question that I always like to ask – Is this a man that is caring, competent and ethical? If the answer is yet to all three, swallow your pride and take your lumps. Laugh when you tell him how foolish you were. If he is a cool dude, he will laugh with you.

Temple Hair Loss

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

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.

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 bernsteinmedical.com.

Daily Hair Loss – What is Normal?

/by William Rassman, M.D./9 /

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

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.

Alopecia Conditions

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

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?

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.