Do Doctors Charge Per Graft or Per Hair?

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

I’ve been doing a bit of research and noticed when people get a hair transplant there are usually 2 numbers that come into play. folicular Unit grafts and the total hair transplanted. Do surgeons charge per graft or per hair? I think how it works is say a patient had 400 grafts done (per/unit graft) and a total of 1800 hairs. Each grafts varies whether there’d be 1 hair-5 hairs in the bundle. Correct me if i’m wrong.

thanks

MoneyYou are correct. The fees actually vary by:

  1. Charges per session (small, medium, and large)
  2. Charges per graft (most common practice)
  3. Charges per the hair

The best quality graft is a follicular unit graft and the number of hairs you get varies from 1-4. When some clinics charge per hair, it makes the price to the patient higher, and if grafts contain a larger number of hairs that are naturally found on the patient’s scalp, they may look pluggy. That is why the follicular unit graft is superior to all other types of grafts. Follicular unit grafts can be obtained with a strip method of harvesting, as well as through follicular unit extraction (FUE).

Tags: grafts, hairloss, hair loss, hair transplant

Thinning in the Middle of My Hairline Started In My Mid 40s

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

I am a 48 year old male. About 3 years ago I started noticing significant amounts of hair in the shower after showering. I didn’t think much about about it because my very full head of hair didn’t look any different. About a month ago I noticed that I have thinning in the middle of my hairline. The thinning goes back about 1 cm and is about an inch wide. There is no thinning at the temples or the top of my head at all.

Could this be an unusual presentation of MPB or could it be something else? Note that I am vegan and at one time I did have a zinc deficiency. Also my thyroid was borderline low at my last physical. Please advise.

Thanks in advance

Unfortunately, I cannot really guess at what you have just based on an email, unless it seems specific and obvious. In other words, you’d need an examination. Keep in mind we have about 100,000 hairs on a non-balding scalp. You can lose 50,000 hairs and still look normal. If you have male pattern baldness, then it should occur in a pattern. Perhaps your hair loss is too early to see a pattern and it is just starting in the front? Maybe a miniaturization mapping to see the state of your hairs at a microscopic level may be helpful. You should see a doctor for this.

I am not sure how a zinc deficiency or being vegetarian has anything to do with what you describe.

Tags: hairloss, hair loss, zinc, hairline

How Long Until I Can Have SMP Done After Having FUE Into My Strip Scar?

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

I recently had a FUE procedure to place hairs into my wide strip scar. How long do I need to wait before having SMP done to blend the scar?

Generally speaking, you should wait at minimum 2 to 3 months until the area has healed. Scalp MicroPigmentation (SMP) would not affect hair growth or hair loss.

Tags: smp, scarring, hair transplant, hairloss, hair loss, pigment

I Definitely Noticed a Body Hair Reduction from Propecia

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

I’m a 49 year old caucasian male who stopped using propecia because i can say with 99 percent certainty that it reduced the amount of hair on my legs and stomach. I had been off propecia for about six months and can already see hair returning to my stomach and legs. I also believe, though am less certain, that taking propecia contributed to a brief bout of alopecia on my face. Again, the hair in my beard is coming back now that i’m off propecia, though it’s growing back gray (i’m 49).

In short, I think the makers of this drug should DEFINITELY be required to list loss of body hair as a known side effect. And doesn’t it make sense that surpressing DHT would slow the loss of hair on the head while also increasing the loss of body hair in some people?

Feel free to use what i believe is an informed opinion of someone who will never go back to propecia after using it for about 8 years. Best regard

I’ve heard reports of body hair reduction in a few cases with Propecia use. It may deserve to be in the official side effect list, but I haven’t seen any good study about the effect on body hair, and it doesn’t seem to be very common.

Tags: propecia, finasteride, body hair, hairloss, hair loss

My Hair Loss Isn’t Gradual and It’s Diffuse

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

Hi, great blog filled with lots of good tips and reassuring words of encouragement.

I’ve been suffering from diffuse shedding for a year and a half now, losing upwards to 100 strands per day. I’ve been diagnosed with male pattern baldness since my dermatologists were unable to find any other cause. I have my doubts as I’ve been lead to believe that male patter baldness is a gradual thing of the hair whereas I’m shedding hair all over.

I’ve had countless blood work done (all normal) and a scalp biopsy that showed the majority of my hair in the anagen phase.

what could be causing my loss? please please help!

Your issue and statements are confusing and contradictory. I will outline some simple facts that may help.

It is normal to lose 100 – 150 hairs a day. In its place, more hairs are/will grow at other areas to compensate (for those who are not balding). So seeing or counting 100 hairs lost each day is not necessarily diagnostic, since non balding people can have 100-150 hairs lost in a day.

Diffuse shedding as you describe it may not be diffuse shedding in objective terms if you were diagnosed with male pattern baldness. If you have male pattern baldness it would not be diffuse. It would show a pattern. Generally for men hair loss is genetic and there is no specific blood test or biopsies to diagnose male pattern baldness (also known as androgenic alopecia). Male pattern hair loss is a diagnosis mostly made by a physical exam. Good bulk measurements can help establish a diagnosis, as well as a through microscopic examination of the scalp looking for signs of miniaturization. This is offered by many hair transplant doctors and if not, find one that does offer this service.

There is help, but you need to see a doctor for that. If you indeed have MPB, there are medications (Rogaine or Propecia) and surgeries as options.

Tags: diffuse, hairloss, hair loss, male pattern baldness

How Long Does Catch-Up Loss Take If I Take Propecia for Years and Then Stop?

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

Hi,

Thanks in advance. Couple questions –
1) How long does it take the hairline to recede…can it take 10 plus years?

2) If you take Propecia for years then quit, and if it was working, how long does it typically take to revert to the state as if you never took the medication? Is it possible that the loss can be worse in the 2nd year off the medecine?

As a general rule, catch-up hair loss happens in the first 6 months after stopping Propecia. It occurs over several months, and usually brings you back to wherever you were in the hair loss process when you started the drug. The degree of hair loss or how much your hair will recede is based on YOUR genetics. Everyone is different.

If you stopped Propecia 2 years ago and are noticing hair loss now, it is not catch-up hair loss. It is likely natural genetic hair loss taking its natural course.

Tags: propecia, finasteride, hairloss, hair loss

Salesman Tried to Push a Bunch of Hair Care Products and Lies

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

Hi

I went to see a few trichologists in London. The first was a free consultation by [name removed] at The Westminster Practice. He told me I was losing my hair and it would get worse and I should pay £2200 upfront for a year treatment of Vitastim and Biostim and hair care products.

I saw 2 other trichologists who couldn’t see a problem with me except I have naturally fine hair. They had never heard of the products and I have since researched both those and [name removed] (who is not a registered trichologist) and found every single mention of these products online was written by [name removed]. I also found on the ITN website he was on a program called ‘Salesmen from Hell’ and he was recorded trying to push expensive products and was fired from his position for fraud.

I was very very close to handing over the money a few months ago until I took a second opinion and need to share my experience with others. However, he instilled a seed in my head that the products he mentioned could thicken my hair and give me a “curtain of hair better than I had before” and I am unable to put this seed out of my mind. Are these products available anywhere else under a different brand name?

Many thanks

I blanked this person’s name because it is our policy not to slander anyone. I am free, however, to reference publications like newspapers or official news releases if they are in the public domain. You did the right thing to research the person who was selling you a line. Don’t believe people when the promises made are outlandish and not realistic. £2200 (around $3500 US) is a lot of money to gamble on a sales pitch.

There’s no magic product that will give you better, fuller hair than you had before you started losing it… particularly for women, since they have more limited treatment options.

Tags: hairloss, hair loss, female hair loss, scam

Sexy Bald Women in Sci-Fi

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

Hi guys –

I wanted to share an article about sexy bald women in sci-fi that you might be interested in: the 4 and a half sexiest bald women in sci-fi.

Here’s the link: Hairlossgeeks.com

Personally, I thought it was a bit of positive fun about a pretty serious topic for your readers. Hope you guys enjoy it!

Thanks!

There are absolutely bald women with sex appeal… but the blue skin would turn some heads.

Tags: female hair loss, sci-fi

Best Country for a Hair Transplant?

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

Hi, what countries are the best for hair transplant? Trying to debate whether to find HT center in india or go abroad. Cant seem to find one here and its not easy getting centers to let us interract with patients as most patients want their confidentiality.

Also, in your website you mention it may take about 6000 hairs for a class 6 to get coverage. Does this mean full dense coverage?

I would be biased to say the best hair transplant surgeons are in the United States as a whole, but I am sure there are great doctors spread out all over the world. Look at the patient results and meet patients. Most patients do want confidentiality, but we have open house events every month where past patients come in to meet with and talk to prospective patients… so it’s not impossible to find live examples if the patient is really pleased with the work. With an ‘open door’ policy, that means that anyone can come in, even if there were patients who may not be pleased with their results. In 20 years of doing open house events, there has never been an unhappy patient showing up at our ‘open house’ events.

As for the second question — you will never get a completely full dense coverage with ANY hair transplant. It is mathematically impossible! Hair transplant surgery is basically moving your existing hairs around, so the density will never be full as it once was. For a Norwood 6 patient to get good coverage, about 6000 grafts is what is typically needed. Sometimes more, sometimes less. It also depends on many variables such as your hair texture (fine, medium, coarse), hair character (straight, curly, wavy), length (long, short), color contrast (between hair and skin color). These subtle factors all contribute to the results of a hair transplant. So while we strive to create the illusion of full density, it simply can’t be as full as it once was because those hairs are gone.

Tags: hair transplant, hairloss, hair loss, density, hair restoration

Am I Too Old to Try Propecia Again?

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

Hi Doc,

I’m 39 and have a Class VI balding pattern. Tried propecia a couple years ago for a few months but stopped due to side effects. Am I too old to try it again or should I give it another shot? Would I need to take it before a HT (to avoid shockloss) and for how long before?

Oh, by the way, why are most HT docs balding?! You would think that if the procedure is so good, they would get it done first! I mean, just look at Dr. Farjo!!!

There is no specific age limit to when you should or should not take Propecia. Your doctor can give you a better assessment based on YOUR specific goals and issues. You do not need to take the medication in order to have a hair transplant, but it is often recommended. You could take it temporarily if you have shock loss concerns.

As for why some hair transplant doctors are bald, we’ve answered this before here. Some doctors, such as my good friend Dr. Bernstein (who is a great hair transplant surgeon), are bald. For some it may be a personal preference, for others it could be that they simply weren’t candidates for surgery.

Tags: balding, hairloss, hair loss, shock loss, propecia

My Left Temple Thinned and Now I Have Scars After Using Head & Shoulders

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

Im 20 yrs old guy and 2 weeks ago I saw the hair in my left temple looked fine. It’s thinning out really fast and I dont know what’s wrong. My hair in the left temple is thinning fast.I noticed this after getting head and shoulders. I used a comb to scrub my head with H&S (I tried to clean something out of my head) Could this be the cause? My temple thinned in a 2 week span. Also I notice I have about 2 scars in my left temple now.

Shampoo isn’t going to cause scars on your head. It’s possible that you had the scars, but they were covered by surrounding hairs and not noticeable.

If by “temples” you mean the corners of the hairline, the loss you’re describing sounds like a maturing hairline (particularly at 20 years old). Many people call the hairline corners the “temples”, even though the temple peaks are actually the points between your hairline and your ears.

Tags: temples, shampoo, hairloss, hair loss

How Much Exercise is Recommended if You Have Hair Loss Concerns?

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

Hi Dr. Rassman,

I understand that exercising may increase the amount of Testerone and possibly DHT. For someone concerned about hairloss what level of exercise is recommended? Personally I am on propecia, and I dry to drop a couple of pounds.

Normal exercise has nothing to do with hair loss or DHT that causes hair loss. If you wish (or do not wish) to exercise, do not correlate it with hair loss.

Tags: exercise, hairloss, hair loss, weight loss

Any Requirements for a First Consultation?

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

Dr.Rassman/Dr.Pak,
Is it possible for you to provide a step-by-step guide describing the procedure a patient would undergo during a first consultation at NHI, please – are there particular requirements a patient should consider in preparation for such a consultation (e.g. hair length, washing instructions, medical records, etc.)?
Thank you.

During a consultation, we get to know the patient, understand their personal issues about hair loss, and recommend possible treatments. That is it!

It’s not all that complicated, if you think about it. You come to see us because you are losing hair. We examine the hair, measure the hair density, look for any microscopic patterns which may not be obvious (miniaturization study). If your hair is long enough we can do bulk measurements. But most of the time (for men) the balding is obvious and thus the reason for the visit. So we mostly talk about options and educate the patient. We actually spend a good 30 to 45 minutes on the first consult on most patients. Some more, some less. And while we often think about charging a fee for the amount of time we spend with the patient, we decided the first consult will remain free for a while, at least.

As a final note, at NHI you see the physician (Dr. Rassman or Dr. Pak). You will never see or be screened by a sales man or an associate or any other version of a middle man. Getting a doctor’s opinion always reflects your best interest and because there is no sales personnel involved in the process, there is no motivation for commissions that will be earned for a successful sale. We encourage prospective patients to come to our Open House events which are held monthly. In this way, you will know that what you see is what you are going to get. Nothing is hidden.

Tags: hairloss, hair loss, hair transplant, consultation

I’m Concerned About How My Hair Parts

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

Hey Doc,

Hope you’ve had a good new year! After my last question to you, I was pretty convinced I had nothing to worry about with my hair… however, there’s this part that concerns me.

I’ve been told that this is a natural parting, so I would just like confirmation that it is?
Link: Photo 1

This is my hair wet, which doesn’t show this ‘parting’ or whatever.
Link: Photo 2

When my hair is dry you can see a slight parting towards the top of my hair, in front of my crown.
Link: Photo 3

Does that look like a parting to you? Feel free to post any pictures again, if this question does get published.

Thanks.

I appreciate you allowing us to publish the photos.

If you are worried about hair loss (possibly seen in the first picture with your hair standing up), then you should come and see a doctor who can measure your hair bulk to determine if you are losing your hair. I can’t confirm if it’s just the way your hair parts, but I do notice a well combed hairstyle that does much to cover the suggestion of thinning in at least one of the pictures.

Tags: hairstyle, hair parting, hairloss, hair loss

Doctor Wants to Do 3 Scalp Reductions On My Crown

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

whats the thoughts on scalp reduction? is it a good option a doctor wants to do 3 reductions on my crown area. is this now common practice ?

As the famous movie quote goes: “Run, Forrest, Run!!!”

Scalp reductions for treating androgenic alopecia (AGA) or male pattern baldness (MPB) is in my opinion horrible and NOT a common practice in modern medicine. I try to be neutral most of the time, but on this point I would strongly believe a scalp reduction is a bad idea… and three of them would be three times as bad.

Tags: scalp reduction, hairloss, hair loss, surgery