SMP First, Followed by a Hair Transplant (Photos)

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

The idea I had is, that I want to implant hair into my frontal micropigmentated area, but since I am young(only 23-Norwood 3 almost 4),I know that I will keep on losing my hair and the donor area is limited, so I am interested in speaking with my HT doctor, and convincing him to transplant me a smaller amount of hair only enough to give the impression of hair which will be accentuated by the micropigmentation. I think this could be a good idea, as I am ok with having a short haircut, like in the photos.

My problem is that I do not know if it would work for my frontal balding area, as most people who have combined SMP and HT seem to have had it done in their crown area.So I am really curious if any of you guys could give me any advice or opinion, as I am sure most of you know how depressed this whole ordeal this can make someone feel ,and any response would be greatly appreciated. I will try posting some photos down bellow of me and the length of hair of hair I’m interested in keeping and the bald/micropigmented area.

If you do Scalp Micropigmentation on the areas you showed, you must shave your head or it will not look good. I would advise against a hair transplant at this time.  If you have a hair transplant later on, you can do this on top of your SMP. I just did someone this week who took this route. Having had SMP a few years ago, he decided recently to transplant the hair he needed above it so he could let his hair grow out.

Young women want lower hairlines (photo)

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

Many women are now coming in to get their hairlines reshaped or lowered. The face needs a good balance and proportions of facial features include the framing of the face with (1) a well positioned hairline and (2) good eyebrows to highlight the eyes.  We have been doing both hairline lowering hair transplants and eyebrow hair transplants with great success. Women are happy when they look in the mirror and see the person they want to look like, as shown below immediately after the surgery.


You can view more female Hairline Lowering results here.

“Something I hate about the hair market” from Reddit

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

Every once in a while, once a month, I simply search “hairloss treatments” to see if anything new happened, or maybe a new treatment, but all I get is recent articles like “does ___ cause hairloss?” “can vitamins help with hairloss?” “can saw palmetto halt hairloss?” Bull**** articles like these make me pissed off, not because of the articles themselves, but because they are repetitive articles that i see every month when I search this shit. What happened to Breezula? WAY-1001? Guess we’ll never have a good safe, non-fearing treatment. Guess everything comes with a price.

Back in the 1980s, there was a ‘product’ called the Helsinki Hair Growth Forumlae that may have been the first modern product claimed for the hair growth pitch to hit the US market for magic hair growth cures. As the first, it sold like ‘hotcakes’ and it took more than 10 years for it to lose its unique market position because the FDA dinged them for claims that could not be proven. I look them up, and they are still selling hair products, just no magic claims.
If you look at newspaper in the late 1800s and early 1900s, you will see a lot of products selling cures for hair loss like magnetic hats that you wear at home. People never liked the idea of being bald so they easily reached out to anything that was offered. Today, with the internet, we have the ability to discern the difference between fact and fiction, but many people have realities that they want to believe and will often buy into anything that sounds ‘reasonable’ with low risk and possibly low cost solutions for hair loss.
There are now many doctors who have become the salesmen for sometimes shady cures, but because they wear a white coat, or have the MD after their name, they become believable. I have to be careful how much I say about the doctors who are making promises that they can’t deliver on but I can tell you, the readership, ‘Let the Buyer Beware’ as there is no fast, cheap fix for hair loss that I know of.

Stopping finasteride after 5 years

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

I’ve been taking generic finasteride for around 5 years (since I was 25) and I’ve maintained the hair that I had when I started taking it. I also only had a minor side effect (orgasms seem to be a bit weaker, not too much but enough to notice) but the plus of keeping my hair outweighed this negative.

I read a scientific paper yesterday about the long term effects of neurosteroids and 5a alpha reductase inhibitors and it got me a little worried. Then I went down the rabbit hole of posts on places like Medium and Vice about how the drug ruined their lives and it was difficult for me to get some sleep last night and I was seriously considering just going cold turkey but even there you get people saying that stopping finasteride could give you PFS symptoms as well.

Not really sure what to do now, as much as I like having my hair I don’t want to screw up my brain and body over the long term.

Currently, I’m thinking of dropping down from 1mg to 0.25mg a day as I saw a graph showing that DHT inhibition only goes from 68% to 62% but what do you think?

Almost all of my patients who were on finasteride for years and who have stopped the drug for man y reasons, have often seen significant hair loss and regretted stopping the drug.

How Do Fue Scars Look on a Shaved Head After Years?

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

FUE scars can show on a shaved head, especially if you had (1) many FUEs and (2) a large punch used to create the FUEs. If you shave your head you will see the areas where the follicular units were removed.  Longer hair can always grow out to cover it. For people who have significant scarring in their donor area, we often do Scalp Micropgimentation (https://scalpmicropigmentation.com/). The people with most detectable scars, when the surgery was performed with small punches, are those people who may have had a lower donor density so that the missing follicular units are more detectable. In people who have higher donor densities, there is enough hair not to notice the missing follicular units.

Ashton Kutcher talks about dutasteride

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

As some of you may know, Ashton Kutcher revealed during a talk with Conan O’Brien that he’s taking Avodart, which basically is Dutasteride.

If you now compare his hair situation with the one of his un-identical twin brother, Michael Kutcher, it may be an indicator of Dutasteride working.

Of course they don’t have the exact same DNA but in my opinion this is none the less an okay reference. Also because we know he hasn’t done any hair transplant.

Conan: https://m.youtube.com/watch?v=Wv9gu1zJdRo

Michael Kutcher: https://marriedbiography.com/wp-content/uploads/2019/11/Michael-Kutcher.jpg

Of course, in the right person and the right time both finasteride or dutasteride may work for reversing hair loss.

Review of Microneedling (From Reddit)

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

The attachment goes through all of the definitions, common practice and a reasonably complete review of the industries experience with microneedling with minoxidil, PRP and mesotherapy. This is a must read for those of you who want to go through this treatment modality, how to do it and what you can realistically expect. The conclusion from the various references seems to show a uniform benefit from the microneedling.

A Scientific Perspective in Microneedling for Alopecia from tressless

Don’t fall into this trap and do unnecessary hair transplant (photo)

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

This man had a hair transplant and had holes punched into the front, top and crown of his head.  Some young men panic thinking that they are losing hair as their father may have lost it so they might not do their research and think that they need a hair transplant to keep their hair. This patient was probably such a man and I say this because there is hair on his head and it appears to be good quality hair. Maybe he tried to find an inexpensive hair transplant doctor and found a doctor or someone who claimed that they were a doctor who was able to persuade this man to have a hair transplant.

Using holes for recipient grafts (a technique that has been abandoned years ago), this man had a hair transplant and the person doing it was so proud of the work that these pictures were taken and given to the patient.  But what is worse than the terrible work, is that this man appears to have a reasonable hair density so it is clear to me that he had an unnecessary surgery. Maybe he felt he was losing hair and some doctor or some non-doctor who maybe acted like a doctor must have talked him into have an this hair transplant surgery.  Some young men are very impressionable and can be influenced especially if the person doing the ‘selling’ appears to be a doctor. Some day, this man may lose hair and what he will have left is plugs where all of these holes can now be seen.  He will look freaky.  Bad, Bad, Bad!!

Reddit comments on ‘After Hair Transplants, many doctors ignore patients’,

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

The Post: After Hair Transplants, many doctors ignore patients’ questions – why? was followed on Reddit where it was posted initially with the following responses. I think that my point was understood.

Comment 1: Yes I totally agree. I had a good transplant so I am ok and don’t had much to complain about (post here if interested), but indeed, the customer care service sucks. Went to Cinik (Istanbul), he is a pretty reliable surgeons nontheless. But the clinic went from super reactive to automated mails, not even translated in the language we used when scheduling the operation.

I think they have a shit tons of clients. They ask you right after the operation to leave comments here and there to boost their ranking. Which is not illegitimate, the hair business in Turkey is highly competitive, but you must be thoughful and update your comment when you can truly assess the success of your operation.

Another behavior I have witnessed through several testimonies is clinics’ tendecy to minimize / wrongly reassure the patients when their result is obv unsatisfactory. Like “It is normal”, “you have to wait 12 full months to assess the result” bla bla bla etc. If you have blank spots or below 40% of your hair grown back at the 5 or 6 month mark it is worrying. After 6 months the result will only get marginally better. All the hair should have popped out by then.

Comment 2: Good idea (i.e. ask to meet his patients one-on-one)  but how would you ever get access to patients contacts? Answer: To make the sale, put the burden on the doctor to supply you access to his/her patients. The doctor then will be motivated to do so.

Comment 3: Because they already got paid.

Comment 4: This is exactly my experience. The doctor was very kind and patient and buddy like prior to surgery. A few days after I started to get a spot that looked a bit dark. I came in and saw a “technician” who told me it was nothing to worry about, gave me some product to help the area and sent me home. That spot turned into an area that became a total nightmare with me concerned that my skin was dying (necrotic). I would send photos, they would bring me in to see this “technician” every week or so. Never did I see that doctor again.

Comment 5: This is exactly my case. My Turkish Dr. (Real Dr) is barely responsive since my surgery. I am exploring getting PRP to help regrowth and wanted to know his thoughts. Crickets.

Comment 6:  you are right about the fact that one should be evaluated by an expert who specializes in hair transplantation, and is honest and doesn’t do it just for the money he gets from you

Comment 7: I took a really long time to heal. Lots of bleeding and oozing and anxiety about going out in public for a long time.

Comment 8:  I am going to do a big write up at the 6 month point about my experience of going to Turkey. I wont deny it was the price point that pushed it into affordability but at the same time, and as of my experience right now, I would consider encouraging someone to spend the money to see a US Dr like Rassman even it it meant doing it sooner rather than later, and by assuming some debt.  That says quite a bit coming from a financial planner.

Comment 9:  Thank you so much. You just saved me some money. I’m completely serious about possibly visiting you next time I’m in LA. Perhaps even having you touch up whatever does not take with my Turkish hair procedure.  Thanks for what you do for the sub.

Comment 10. (12/15) I think it depends on your expectations, how carefully you selected the doctor, and how much you need to interact with the doctor after the surgery. I had FUT x 2 and did interact with the doctor afterwards and felt the interaction was just fine i.e. it was what I needed when I needed it.  After FUT #1 I had some questions and was able to reach the doctor by text (during the evening after the procedure) and later on by email, which was fine. The surgeon did call me on my cell the day after surgery to ask how I was feeling which was good as well.  After FUT #2 (same doctor) he again called me the day after surgery to see how I was doing. About 10 days after that surgery I had some issues and communicated with him by phone and email and got my issues resolved, so I was happy.  I have said in a few posts that you really, REALLY, REALLY need to choose your doctor carefully. If you are not 100% confident in your doctor and the procedure you should not do it.  (I AGREE)

 

 

FUE over-harvesting of the donor area (photo)

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

If you have completely healed, you can have Scalp Micropigmentation to address this problem, see here: https://scalpmicropigmentation.com/scar-covering/.  Your problem should be a warning to many men to have their FUE pushed high especially when non-trained people are doing it and don’t understand the math of supply and demand for donor hair nor the necessity to remove the FUE grafts uniformly.