FUE Surgery in Turkey with Over-harvested Donor Area and no Master Plan (photos)

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

A colleague of mine was walking and saw this man. He asked for permission to take a photo of him and found out that he went to Turkey for his FUE. He had two FUE surgeries. What is impressive is (1) the now almost bald donor area and (2) the terrible growth and distribution that shows from the side view.  If the surgery was done by a competent surgeon, a Master Plan would have been done that would not cause a depleted donor area (he is out of hair now) and could have been artfully placed to cover his hair (his hair would have grown and not failed to grow).  Yes, didn’t pay much for the surgery, but was this really a bargain?  I tell people all of the time that they need a good surgeon who understands and respects the patient’s donor area so that the hair that is used is strategically used and can be used so that they patient gets a head of hair that reflects his situation and that enough hair is left behind not to make him bald in the back of the head as this man is.  I believe that this man didn’t know what he was buying, so UNFORTUNATE!

There is hope even for this man, as he could get Scalp Micropigmentation and look normal again as if he has a full head of hair, just shaved down to the skin. He is already shaving so just adding the SMP by a competent provider would be a good step for him (see here for many examples of this approach).

Joe Tillman shows his hair transplant results and discusses it in this informative video (from Reddit)

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

In the old days, the number of grafts per session were smaller so it often took more surgeries to accomplish these results. Today, it can be done in 2-3 surgeries and almost everyone can get these type of results. If their hair bank is poor, Scalp Micropigmentation added to the hair transplants can make up the difference. This is what an FUE surgery looks like when the surgeon is overly aggressive: https://baldingblog.com/wp-admin/post.php?post=20313&action=edit. This is the right way to go in two patients just like is shown in the Reddit video: https://baldingblog.com/difference-between-norwood-class-7-patients-with-photos/. I have known Joe Tillman (man in the video) and he is a tireless advocate for the hair transplant consumer.

Almost NW7 who had 9 hair transplants! nice results from tressless

The limits of hair graft calculators (from Reddit with comment by W. Rassman)

/by William Rassman, M.D./0 /
This is nice to see, however, it doesn’t take into account a few very important factors:

1- Your hair thickness (fine hair has 1/4 the value of coarse hair) so the calculations are different based upon hair thickness

2- Your hair density in the donor area: We are all different with different hair densities. The density reflects the donor bank so if you take out say 3000 grafts, and you only have 3000 to donate, then you have used up your reserve. A good doctor will tell you how much hair you have in your donor bank and as you use it, how much remains.

3- What can you expect in the future as hair loss is progressive. Today, for example, you have some frontal loss and you transplant it with 2000 grafts. In a few years maybe you have more frontal recession behind the area that was transplanted and you also develop some early crown loss. If you transplant these two areas, then maybe in time, the crown loss will become more and wider, what do you do then? Did you leave enough hair in the donor bank to manage future hair loss?

The hair transplant conundrum is not so simple as a graft calculator can easily solve. A good doctor who has experience, will address this for you and give you a realistic assessment of your short term and long term needs. I always tell my patients don’t think a year out, because balding is a lifetime problem.

HOW MANY GRAFTS Do You Need? Try this 30 Second GRAFT CALCULATOR! from tressless

I am in a panic as maybe I have DUPA?

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

I’m 18 and I’ve had diffuse thinning for the past 3 years. Yes it sucks but it’s slow and still have decent amount of hair. I’ve noticed for the past 3 years that when ever I get a hair cut, my hair is easy to pull out. Same with sides and my back. Is this DUPA? I’m really worried because I hope it isn’t. I took pictures with the flash and it’s still thick. Also when my sides grow out, I try pulling on it and it doesn’t come our. WTF.

I am the doctor who defined DUPA and it is rare. You need to have a microscopic examination of your donor area if you want DUPA eliminated as a diagnostic possibility. Most hair transplanted doctors offer this.

My dermatologist says combining finasteride and minoxidil doesn’t improve results

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

I just got my first box of finasteride 1 mg today.  I wanted to get minoxidil 5% as well, but I need a prescription for that where I live.  However, my dermatologist said the action of finasteride and minoxidil isn’t synergic, and that I won’t get better results by adding topical minoxidil to oral finasteride. That’s the opposite of everything I’ve heard so far. Men do combine oral finasteride and topical minoxidil 5% exactly to get better results, don’t they?

I don’t agree with your dermatologist. These two medications have different modes of action so taking them in combination, especially for the crown, is more effective.

How “reliable” is a hair transplant?

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

They say you can get a transplant once you’ve stabilized your hairloss with Fin – but how reliable is it actually? I’m not sure how accurate this is, but I often read that Fin doesn’t really halt your hairloss, it slowns it down a lot but your hairline is still receding. And who’s to say that you get you a transplant and, 3 years later, Fin starts losing effectiveness and you end up looking even worse before? Do you just have to gamble on this, or am I missing something? Or is the transplant a commitment in the sense that you’ll eventually need more to “recorrect” everything?

What are you realistically getting in the long term with a hair transplant?

I have been doing hair transplants for 28 years and started the trend with small follicular units used for the hair transplants. Many of my patients from 28 years ago, come and visit me and a few came back for more hair transplants as they continued to lose hair. In good hands, hair transplants work and in 99% of people, the results are permanent. That is good and bad because if it is done well, you will look good, but it is done poorly, you will always look freaky.

Three months on finasteride, minoxidil and microneedling (from Reddit)

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

Nice early results. It shows the impact of finasteride and minoxidil used in combination. The impact on the crown is clearly better than on the front, but both are better. It is unusual to see results in just 3 months but because he kept his hair short, the new hair impacted by the finasteride and the minoxidil showed better. If his hair was longer, then he may not have seen the value as quickly because only the hair close to the scalp was helped by the finasteride and the minoxidil.

Thinning of body hair on finasteride

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

I have been on Fin 1mg for last six months. I have started observing that my Hair, Armpit Hair, Pubic Hair and Facial Hair have started thinning and the density & growth has reduced. Could this be related to Fin ? I checked with my dermatologist. I was told that it was unlikely. Does anyone had a similar experiences ?

Some people do report a reduction of body hair when on finasteride. It is a known, but rare, side effect

Weird bald spot + possible androgenic alopecia. Help me identify this please.

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

I didn’t post this in the other thread mainly because I have a weird bald spot that I’m hoping someone will help me identify.

A few years ago I went to a hair salon to get my hair curled and somehow the hairdresser burned off some some strands of my hair (one in the front and one in the middle). I only noticed it weeks later when the one in the front was just standing out up in the air (it looked weird lol). Around the same time I realized I had a weird bald spot in my scalp. Until this day I’m not sure if it was caused by the blow dryer/curling iron the hairdresser used or if it happened naturally. I still have this bald spot. And I’m saying “the hairdresser used” because I don’t curl or flat iron or blow dryer my hair at all. That was a rare thing and I did it for an event. So now I don’t know if this is part of the alopecia or if somehow the hair root was burned and that’s why it’s not growing back. Does anyone recognize what this is?

Also I feel like my hairline is receding but I do notice some baby hairs growing at the same time. The middle part of my hair is significantly thinning over the past couple of years. Is this androgenic alopecia? And is the bald spot related to this? Should I start treatment and do I have keep doing it for the rest of my life (cue panic mode).

I attached pictures from different distances. Please excuse the dandruff and the frizz (trust me, I’m trying to get ride of it). Thank you so much for your help!

If this is new, you should see a dermatologist who will perform dermoscopy on your to find out if you have any disease in this area. You might have had a partial burn to the scalp that could cause it, but the loss is uniform

Finasteride shedding

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

Hey Doc- I had a quick question. Have you seen any patients have hair loss worsened by Fin? I took fin from roman for maybe a week and had such extreme shedding immediately that I stopped. Shedding continued for 8 weeks or so and stopped but I went from a NW2 to a NW4 in that time. Do you think this will grow back? I tried Min, but the sides were bad for me and made it extremely uncomfortable. Thanks! 

I have heard about shedding, but I haven’t seen it myself in my patient population so it must be rare. I gather that those who have it should stay on the medication as their is a delayed response but the response usually does happen in a couple of months.

Scalp micro pigmentation quality and recommendation

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

I can’t comment about Europe, but we are the best traditional Scalp Micropigmentation  in California here: https://scalpmicropigmentation.com/ . I just published an article about a Scalp Micropigmentation breakthrough with a new system which we just started using and are the first in North America to have it:

“We introduced a new needleless microjet injector that uses laser pulse energy to inject tattoo pigments for Scalp Micropigmentation (SMP) directly through the skin without a needle”. It also has the advantage of a one-pass use, which means that when the pigments are deposited, it is permanent and doesn’t have to be repeated.

It has the advantage of an almost painless experience, eliminating the need for anesthesia.that has no needles and does not require anesthesia. Right now, there is not much availability of this technology but I am sure it will change soon. We are offering it to a limited number of people.

I’m 20 and I don’t want to take endless medications, just get a hair transplant

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

My best alternative for my hair loss is to get a Hair Transplant. However I have read various news from the internet and I came down to these conclusions:

  1. It is permanent however you would need to get another hair transplant in the future if you want more density.

  2. My hair transplant doctor says you do not need to take any medications, treatments. For my case, and that is exactly what I want to do but alot of internet topics suggested to take minoxidil, rogain, finasteraide, proprecia, prp to keep the existing hair for the rest of your life if you do not want to lose anymore hair.

  3. I wear toppik and have 1 picture of my current hair.

  4. I would consider a hair transplant if all I had to do was 1, and no medications were required. Is it possible or are you in a endless cycle of multiple transplants and a lifetime supply of treatments.

You discussed endless cycles but at 20, the reality is that repeated hair transplants every year until your balding becomes stable is a awful endless cycle, see here: https://baldingblog.com/22-year-old-received-a-hair-transplant-of-2800-grafts-from-reddit/