Megasession Results (with Photos)

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

What does a 3000 graft operation look like in a person with a Class 6 Norwood balding pattern, fine hair and moderate contrast between hair and skin color?

The below patient is in his late 60s and had one hair transplant procedure of 3,164 grafts. The grafts were placed to cover the entire balding area. In helping you understand the issues related to fullness, the area covered placed about 6000 hairs (in 3,164 grafts) in an area that originally had 50,000 hairs. That means that what you are looking at about 12% of his original hair density (before he went bald). Clearly, the math points out that a return to his original fullness is not possible. Many times people ask me how many grafts one needs to get a full head of hair. The answer to that question depends upon the thickness of the hair shaft, the character of the hair (straight or wavy), the color contrast between hair and skin color (the lower the contrast the better) and the size of the bald area being treated. I have placed 3000 grafts into an area 1/4 the size of this man’s bald area and the results were a much fuller appearance.

There is a general misconception in the hair restoration community that one can tackle a man with this degree of balding and replace the fullness to his original look in one session with as few as 1500 grafts. Many unethical doctors make that representation and I find it difficult to ‘compete’ with a doctor who promises a full head of hair with half the number of grafts I showed here (probably at half the price because of fewer numbers and salesmen that promote such misconceptions). I try to show how important it is for today’s buyer to understand just what he is buying and what he can expect. Be careful when a doctor shows you just a single view of a result, places the photo in a shadow, and does not really cover the entire transplanted area. That is the reason we have open house events monthly and have been doing them for 14 years. Visitors can see and interview patients, examining just what they are going to get without tricks of photography or slick salesmen to tell you what you might want to hear, true or not. With that said, the man shown below felt transformed in just the one procedure. He wanted a second session to increase the fullness further and after these pictures were taken, a second procedure of 3000 more grafts were done with a similar distribution, though it is far too early to show the results of that procedure. Please click each photo to enlarge.

The 1st set (below) are the before photos.




 

The 2nd set (below), are the after photos, taken 10 months after one procedure.




Itch and Dandruff from Propecia?

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

Hi Doc,
I recently came in for an open house at NHI and it was very helpful. Unfortunately, I forgot to ask one question. I’ve been on propecia for about a month, hoping that it reverses some of my miniaturization (you said about 50% in the crown and 40% in the mid scalp from what I remember). Almost immediately after starting propecia a month ago, my scalp started itching and I’ve noticed slight dandruff. I’ve seen other posts on propecia as a cause for this annoyance, but never any scientific evidence (I believe there is evidence that Rogaine causes thes same effects).

I’m not sure if this is expected or can cause further loss due to irritation of the scalp; any inputs? I’ve starting using Novarel 1% dandruff shampoo to hopefully manage the itching/slight dandruff.
Thanks!

Treat your dandruff as you are doing, as there is no evidence that Propecia causes dandruff. Wait out the 8 months. Hopefully with good dandruff treatment and shampoos, the problem will abate. Glad to hear that you came to an NHI Open House and I hope that others reading this blog will do the same. Our next open house is on Thursday, January 12, from 4-7pm.

Using FUE to Touch-Up Straight Hairline

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

Hi Dr. Rassman…
First of all, I want to thank you so much for creating balding blog, it gives us very valuable information from one of the top and best surgeon in the world. About five months ago, I had a 3000 graft transplant with Dr. XXXX in toronto to restore my hairline and part of my midscalp. growth is coming in good so far but I really dont like the hairline design. it is densly packed however the grafts follow and curve almost on a straight line letting everyone know its a transplant. I like the more jagged style where the hairline is kind distruped to give a more natural look like I have seen in some of NHI pictures. so I was wondering if you can probably FUE some areas on my hairline to give a more natural look, maybe 50-100 grafts depending on what you think is best just enough to distrupt the line pattern. Is there a minumum number of grafts needed for FUE procedures?? also is it okay to perform this procedure after six months of my initial transplant as I want to get this done ASAP. Thanks again Dr. Rassman

The problem with straight lines is that they are too orderly, like Count Dracula’s appearance in the movies of the 1930’s. They accentuate a hairline when the hairline should be a zone of transition from a bald forehead to a thick head of hair. I fix these types of hairlines all of the time. Depending upon the color of your hair, it usually takes between 200-600 grafts in the frontal hairline to build a good transition zone. I wasn’t 100% sure by your email if you’d already had an FUE procedure or just wanted to use FUE for some “touch-up” work. If you have already had a strip procedure, it would be less expensive to do it with another strip procedure. An FUE procedure will work as well, but at twice the cost.

What is the Megasession?

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

I found this story in my local news [from November 2005], Patients Thrilled with Hair Transplants. In referring to Dr xxx, it says “He’s pioneered a painstaking process using one-to-two-thousand grafts at a time.” I thought you pioneered this with the megasession. I’m just curious if the ABC news was wrong or this doctor is doing something unique.

There is certainly some misrepresentation or failure to do adequate research here. I published information about the megasession in in early 1990s, and discussed the 1000, 1500, 2000, 3000 and 4000 graft sessions over a period of two years before anyone was doing this type of large session. In 1995, I presented 23 completed hair restoration patients at a medical convention in Las Vegas who had megasessions when most doctors were just starting to consider doing them. Why is this important, you may ask?

  1. If the doctor was the source of this mininformation, then his integrity is reflected in the statement. My publications on this subject in the various journals in the industry (see: Follicular Unit Transplantation Megasessions from 1995 as an example)
  2. The ability to do them reflects the focus that I pushed early in the development of this technology, which is to try to get the patient finished with as few surgeries as possible. I had coined the term ‘FastTrack’ for the ability to accelerate the time-line for a hair transplants into as few as one or two surgical sessions. That means that there was much to innovate as the technology that was available at the time I started this process was ackward for getting many grafts done at once. Take a look at the NHI Timeline, which will show when we announced what we did and when we did it. I would challenge others to produce such documentation, because it just is not there.

In the case of the article you are referring to, I am going to just assume that it was poor wording / research by the article’s writer. Be sure to be a perceptive shopper, always keeping in mind the “let the buyer beware” adage in your buying process.

Post-Transplant Shampoo Recommendation?

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

I had my HT one month ago and have been searching for a good shampoo and conditioner. On the blog I’vee seen entries talking about Regenix and Nioxin, which you seem to think have had anecdotal evidence of working. Would you recommend one over the other, or do you think its a waste of money. I just feel like I spent a lot of money and want to protect my investment as well as possible.
Thanks.

Use whatever shampoo you like, as none will be better than the rest in getting you to where you finally want to be after a hair transplant. What is most important is to get the ‘scabs’ off with good washing and then keep clean. Do not scratch your recipient area.

Treating Alopecia with Acupuncture

/by William Rassman, M.D./4 /, ,

hi dr. rassman! i came across your website and i found it to be very helpful. im a 14 year old girl and about a month ago i was made aware of a bald patch at the crown of my head about the size of a 10p.a few days ago,i noticed that it had grown to about 2inches by half an inch. this is the only patch that i am aware of. im only 14 and i am sooo soo depressed about it and am constantly crying about my hairloss. ive been to see several doctors and i know there is no cure accounted for. today i went to a chinese health practice and went for a consultation with a chinese doctor, i was asked many questions about my diet and health and then acupuncture was suggested to me. i was very shocked and scared but went ahead with the acupuncture session there and then. and i was given a selection of herbal remedies to help with the alopecia also. what i would like to know is, how effective is acupuncture for the treatment of alopecia as i am extremely confused and scared as whether or not go ahead with regular acupunture. i am absolutely terrified of needles and i know i will be crying the whole way through, but if there is that possibility of my hair growing back again, i would definitly go ahead with the treatment. please please give me any advice you can im very scared that i will lose more hair and im confused as to what to do about it! please help im desperate

Acupunture should not help hair loss. Patches of hair loss are often caused by alopecia areata and this should be one of the diagnoses to consider. It sounds like you need a competent medical doctor to examine your case. It is impossible for me to make the diagnosis without seeing you, but if you send me digital photos to the address on the Contact page, I might be able to make a suggestion in the differential diagnosis.

Scalp Aches After Laser Therapy

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

I am a 23 yr old male, suffering from thinning hair. I went to a Dr, and he gave minoxydil as part of the treatment, and laser therapy as the other. He uses a laser pen like device, and runs it through my scalp for about 15 min. Well my question is that: everytime he does the laser therapy, my scalp aches a bit. I told him about it, and he says that it is normal, but i need more reassurance.
Thank you

I am unfamiliar with this “laser pen” he is using, but if you think that the aching follows the use of the laser pen, then I would believe that the laser pen is the cause. Perhaps it would be helpful to read my past blog entries regarding the use of lasers in hair therapy, and more specifically, this blog entry about Low Laser Light Therapy. I’m sorry I couldn’t be more helpful, but if you could get me the actual name of the device, I might be able to research it further.

Testosterone Replacement Therapy and Hair Loss

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

Hello Dr. Rassman,
I am 40 years old, male. I have been on presription testosterone replacement therapy for about 1.5 years, due to chronically low levels of total and free testoserone. My doses are physiological (about 100mg/week). I have always had a very thick head of hair — and no MPB or baldness of any kind on either side of my family as far back as any generation can remember. I never experienced any hair loss or thinning until about 1 month ago, when I started noticing my hair suddenly started falling out in the shower and when I combed it, at the hairline, top of the head. It has become very visibly thinner in the past month. I have had every test my doctor could think of (blood, glands, brain scan, etc.), and he has ruled out pretty much everything he can think of. He started me on .5mg daily of Avodart (yes, I know – off label use, but he has seen great results with it over the last 3 years with his patients), but I have been on it for only a month. My doctor says that as long as I am on Avodart, even if the testosterone is causing the rapid hair thinning and loss, then this will stop it. He suggested that I do not stop TRT. My questions are:

  1. Do you think that these testosterone injections can cause hair loss to suddenly occur after almost 2 years with no previous problems; and
  2. Do you think that, assuming it is the testosterone that is causing the hair thinning/loss, that I can continue on TRT without further hair loss, provided I stay on Avodart?

Thanks you for your help on this one!

Yes, testosterone replacement therapy can cause hair loss. Some people have the gene for hair loss that has not been expressed for a few generations. Testosterone can precipitate the gene’s expression. Some people believe that testosterone itself can cause you to lose hair.

With regard to your second question, Avodart will help block the effect on DHT receptors, but there is clearly a direct effect of testosterone on the gene as well, particularly if higher levels are achieved. Time will tell you.

I would get immediate mapping of your scalp hair for miniaturization to put some measurement to the process that you are observing. There is no substitute for good measurements to find out what is actually going on.

Minoxidil Sexual Side Effects?

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

Can minidoxyl loss of sexual urges….i have noticed that since past few weeks i get erection only in morning…but thru out the day …i dont get turned on seeing hot men (im 24-gay)

Minoxidil does not seem to have sexual side effects. Maybe you are just getting older, as men your age usually do not get erections during the daytime unless sexually stimulated.

See Through Hair and ‘Towheads’

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

Hello Doctor. I am a 20 years old and I had suffered from thin hair all my life. Since I was young, it was noticiable that I didn’t have a full set of hair, and as I grew older, my hair just mantained the same volume. There is no actual hairloss, but there is just not enough hair. Something maybe like half of the density it should have. I’ve been taking Propecia for 2 years now, and although the hair seems to be thicker, there is no hair regrowth at all. I’ve always wonder is this is something different from baldness, given that I dont lose hair; i just never had enough hair to look normal. If so, what are my options.
Thank You so much

I believe that your see through thin hair is just your genetics. Now that you are getting into the dating scene, you are more sensitive to your see through hair than you were before. We used to call people like you “towheads”, which implied see through hair. When I was young, people would always rub my hair for luck because it was thick, gorilla like and non-see through.

First, you need to have baselines made with good measurements for miniaturization, as I have talked about in many previous blog answers. It is critical to know if you are actually losing hair or just have thin hair and a changing view of your hair situation. This will give you comfort, at least, for knowing. If by chance that I have guessed right and you are a “tow head” and have no balding, then this is a situation that can be adequately address with hair thickening agents, of which there are many on the market today.

And yes, “towhead” is a real word. Here’s a link to towhead in the dictionary.

Alopecia and Pregnancy

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

Hello,
I got alopecia and I am 4 months pregnant. I have started using fluort lotion as it helped me 5 years back, but I worry if it will have side effects because I am pregnant now. Will it effect my baby’s growth? I am very worried. Please help me out.

I would be hesitent to use things that can be absorbed into your body (transepidermal absorption) as they may harm your baby. Hair loss in pregnancy is not uncommon, most of the time it will reverse after the baby is born (give it up to a year post partum). On occasion, pregnancy may precipitate the onset of female genetic balding, but until a year has passed after the baby is born, do not focus too much on that possibility. Good nutrition is critical both to the baby’s welfare and health, as well as your hair health.

Hair Loss After Chemically Straightening Hair

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

Hi,
Im a male, 23, with no family trends of hair loss at all. About 2.5 months ago i had my hair chemicaly straightened, by a professional, im sorry im not sure of the exact chemical name. For a week or so after i had a sore scalp, and a couple of small burns/scabs on my scalp. A couple of days after i had the treatment i noticed hair loss. I noticed at my desk and on my pillow, everytime i run my hands through my hair gently i lose several strands of hair. I also lose alot during washing. I do also heat straighten my hair, but am trying to limit this too, could this also cause it? I dont wear my hair in a style thats induces traction. As the hair comes out i can see a little follicle on the end, so i guess its not breaking but is coming out at the root. To this day it appears to be getting no better, and my scalp often feels tingly and itchy, although the sores have long since healed.

Im worried that im going to go bald, the hair is still falling out and i was basicaly wondering what i could do to help it, could this be related to the chemical treatment? And how long could it take for the hair loss to stop….or could it be perminent. I am now using Alphosyl 2 in 1 medicated shampoo as recommended by my doctor, but it doesnt seem to help, and my doctor doesnt seem to be of much help. Sorry for the lengthy email, i really appreciate any advice you can give me. Thanks in advance

Although there may be no obvious genetic patterned hair loss in the family, it sometimes can skip generations, so evaluation for miniaturization is always a good approach to put metrics to the problem (good clinical science). There is no doubt that you have precipitated a problem with your straightening and chemicals, but if you stop with these abuses, then the dry scalp and short term hair loss should reverse, provided that you do not have genetic hair loss.

Repairing a Flap

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

First of all I would like to commend you on your website. It is the first I have seen not trying to sell anything, but trying to help. To help people like me.

I apoligize for not giving my full name, but given the sensitivity of my query I wanted to establish a rapport and trust with you prior to identifying myself on the world wide web, I hope you understand. I really hope you can help. I feel that you can identify with my plight as having been a recipient of scalp reductions as you have mentioned in your replies.

About 10 years ago I had a scalp reduction in Beverly Hills. Looking back, I was certainly of low self esteem, and uninformed for what I was about to do. The plan was to eventually get a flap surgey done, after several scalp reductions. They advertised the fullest head of hair I had ever seen in various magazines, and had an office in tinsletown, they must be good I thought. Well I went through with the reduction and have regretted since. To my credit, I had not returned to have any more work done, and have certainly come to terms with my alopecia. I see pictures and read the horror stories, and thank God I didn’t continue on, as it seems a never ending pursuit to cover up the damage most recently caused.

Ten years later, and my hair slowly getting thinner, and the scar is becoming more and more visible. I have come to terms that I will never have the scar completely removed, or at least until some revolutionary technology is availible. But I would like to minimize the appearance if it is safe, and very probable (I am soooo very leery of making matters worse!!!!!. I will not succomb to sales pitches and insecurity, and may have actually learned a valuable lesson from this about the inner beauty of people (to look at the bright side). I have about a six inch scar starting from the back of my head over the crown, and about three inches thereafter. The scar on the back is very fine-at least he did that right. However on the top it seems to have stretched somewhat, and still a little pinkish, slightly elevated and still sometimes sore. This is the part that is most visible, and concerning.

I will send you pictures if you respond to my email address to help you with helping me. I read that you suggested a scar revision from a Dr. Nordstrom in Helsinki with a new type of suture. To be honest, surgery scares the hell out of me given the result of my last one, and would like to try anything else that may be less risky and effective in reducing this scars appearance. Can you recommend a dermatologist that you think can help? A minimal risk dermatology procedure? Maybe a product? I have read about several silicone based products that claim to help.
Would you recommend daily massage to lessen the pain?

I would like to take advantage of only the latest most effective remedies, and am in the information collecting phase, and would like to be thoroughly informed . Of all the hours and hours I have spent on the internet, your blog has made an impression on me the most, and I hope you can offer some suggestions-if only some creams that may reduce the colour and slightly elevated skin until some new better technology is availible.

Of course if they ever master hair cloning-I want hair like Bon Jovi in the 90’s! Anyways, I sincerely appreciate your time, and keep up the good work, you offer some realistic hope to people like me.

Best Regards

I appreciate that you are very sensitive about your scar. Repairing scars is an art form, because every scar and every person is a variable and the differences between people and their scars make the repair of choice a difficult selection. I encourage you to send your photos, and even when you do, I can tell you that the number one best thing you can do for your “information collecting phase” is to be evaluated in person.

Scars are all different. They may respond differently to different treatments depending on the person, skin type, the direction of the scar (in your case a particularly important point) and the only way to know what the treatment options are is to have someone trustworthy and experienced to give you a hands-on evaluation and an opinion based upon experience with the problem. In my practice, I get doctors and patients sending me people for scar repairs almost every day, so a good deal of my practice profile deals with scars and/or difficult cases.

Hair transplants into scars may help and can be done with minimal invasiveness (see FUE/FOX procedures) and may apply to you. There are scalp coverings like Dermatch that when applied to the scalp make it match the hair color. Daily massage is something I recommend wholeheartedly for everyone regardless of scarring – and you are correct in that it has been shown to decrease pain in some cases and loosening up the scar from the surrounding tissues.

A trip to Los Angeles may be your best investment with the discounts now available on the various airlines.

Wishing you the best in the New Year! (and PS – I want hair cloning to be perfected, too!). Dr. Rassman has extensive experience in dealing with these problems, but before you come, please do send pictures from many good angles.

Going Gray and Losing Hair at 14

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

Hi,
I’m only 16 years old and i’ve noticed I’m losing alot of hair, more then the 100 hairs a day that is “normal”, probably about 400+ a day. My hair has been going gray since I was 14 years old and I’ve died it a few times using the same product each time so I don’t think thats the problem. Since it started (or maybe a day before?) it was VERY itchy, and has been since. Is there anyone you can recommend going to see? or anything I can do myself? As its obviously far from normal losing hair/graying at 14-16yrs old.

You have an interesting problem which is not common and so your first step (based on your symptoms) should be to go to a dermatologist. You should expect that they will want to get some blood tests and possibly do a scalp biopsy. The dermatologist will likely advise you to stop using the hair dye at least until a diagnosis is established since dye in itself can cause itching and hair loss in some cases.

Before you go, there is one thing you can do – perform a hair count. Here is how you do it:

  1. Clean your brush and shower drain of all hair and change your pillowcase.
  2. For one week, collect all the hair that falls out and place it into an individual baggy marked with the day of the week.
  3. At the end of the week, sit down and count EACH hair in EACH baggy — keep a tally.

If your hair loss is less than 100 hairs per day (and some experts say 150 hairs), this is considered a normal amount of loss. When you go to a doctor for this problem, this will also be useful information for them so you might consider making a copy of the tally or bringing the hairs in so that they can be examined under a microscope. Whatever you collect, the actual hair loss will be higher because hair falls out everyplace you go, so if you count 100 hairs/day, it is possible the actual loss might be double that number. You will want your scalp mapped out for miniaturization to determine if you have premature genetic balding.

Hope all goes well!

Hair Miniaturized on One Side — Should I Get a Transplant?

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

First of all, thank you for the time you put into answering questions and posting them on your blog. I have found it a truly unique resource in the often troubling search for useful information on MPB and Hair Transplants. I am 27 years old and have been very slowly losing my hair since I was 20. All the loss has been in the form of a receding hairline and I am now probabaly only a norwood class 2 – 2.5. I have kept most of my hair most likely due to my use of propecia off and on for the past 5 years (2 years on and then 1 year off (like an idiot) and now 2 years back on). The outline of my hairline is now a normal mature hairline but it has slowly gotten thinner and thinner especially on one side while the other side has stayed relatively full. My question is two parts: Is it common to see significantly more miniaturization on one side of the hairline? Are there down sides to doing a hair transplant among those thin hairs to add density? Some might call me crazy for even considering such an option but the hair has gotten very thin and I would like to enjoy a full head of hair and not have to worry about covering up a balding area. I dont mind where my hairline stands but would really like to fill in the thinning area if there are not significant negative repercussions. My two biggest concerns are shock loss and what my hair might look like years down the road (will I have a small patch of transplanted hairs while everything else has thinned out or fallen out?). Thanks again for your time and this blog in general.

I am glad that you find my blog helpful. Thank you for your kind words.

It is not unusual for a person to show more hair loss on one side than the other. The reality is that the other side will catch up to the worse side eventually.

Transplantation may be an option, assuming that your hair loss extends beyond the class 2 pattern. If the miniaturization goes well into the existing hair, then a transplant AFTER you are on a course of Propecia, may be a reasonable option. Shock loss is rare if you are taking Propecia. Good planning with a good doctor will assure your best outcome concerning your final appearance and should prevent you from having islands of hair. This requires a master plan for your short and long term hair loss, because hair loss is a progressive process. Since you are in Los Angeles, you should call my office at 800-NEW-HAIR or visit the Request Additional Info page to setup a free consultation in our LA office, or better yet, come to one of our Open House events where you can see a patient surgery, meet many patients who had the transplants done by me and meet other patients who had surgery done by others so you can compare apples to apples.