How many grafts will I need? I have LLP!

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

Plan on getting a HT I have an autoimmune disorder called LPP & the top of my head started thinning really bad about a year ago hair falling out in clumps flaky I’ve tried meds and everything there’s not much they can really do . It’s killed my confidence but I’m looking at getting a hair transplant to correct my hairline how many grafts would I need? Its just the top of my head thats needs to be filled in I have a really good donor area and I’ve been thinking about a HT for awhile now if anyone could give advice thanks

Having LLP (Lichen planopilaris) is generally a contraindication for a hair transplant, as the odds are that the disease will kill the grafts.

Beard vs Scalp hair for transplant

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

I start to get bald from top of my head. The other areas are staying strong so far. Although the front headline go up a bir, it is not at a level it concerns me much. On the other hand, I have a very thick beard. It is actually more than I like at this point. I want to use this beard to close the balding spot. I don’t really care if the beard will be a bit curly since I don’t plan to have a very long hair. Do you think this would work? What is your experience after a year or more if you had a similar operation? I would like to know what are the results of people who have similar experiences with me.

Scalp hair is the ideal hair for a hair transplant. Beard hair is only used if you run out of scalp hair from overharvesting. Overharvesting reflects poor planning on your doctor’s part. Beard hair, when used, is never used in the leading edge of the hairline because it looks like beard kinky hair.

Sleeping after crown hair transplant

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

 i had a HT on my crown area. Last night i rolled much in my sleep and i saw i lost a lot of hair in my crown because of the rubbing against the pillow. Can you still damage the grafts at day 20th?

Use an airline pillow and put a pillow on both sides of you so you sleep on your back. Take a good dose of medication to put yourself to sleep. Keep this up for a week.  If this happened at day 20, then there is nothing to worry about as the grafts are fully secure by this time.

How many grafts do I need? (Photo)

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

I am unsure if you have a Class 6 or 7 pattern balding pattern from the photo you supplied to me. Still, in any event, to set realistic expectations, you need to know the following: (1) donor density, (2) donor hair mass, (3) the capabilities of your surgical team, (4) what your Master Plan is for going forward after the hair transplant (may be more than a single hair transplant). There are many limitations for men with fine hair and low donor densities. YOU need to understand these elements, or you might be disappointed with the results.

How many grafts do I need (photo)?

/by William Rassman, M.D./0 /
You need to know the following: (1) donor density, (2) donor hair mass, and (3) what your Master Plan is for going forward after the hair transplant, as you may lose more hair. There are many limitations for men with fine hair and low donor densities. Blonde men generally require fewer grafts to create more fullness. YOU need to understand these elements, or you might be disappointed with the results. Assuming that you have medium-weight hair, I would imagine that 2000 grafts would likely give you a great result. Because you are 22 years old, your balding pattern is not stable, and that means that the hair transplant could accelerate a more advanced pattern if you jump the gun and do the hair transplant at 22. I would wait until you are 25 or 26.  

Day 65, is this a live graft I lost?

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

This is not a problem at day 65 as this graft is a dead remnant of the transplanted graft. You will be shedding many of these starting two weeks after the surgery, and shedding remnants of the grafts is normal until all of the new hair grows in. The hair graft is held in the upper left corner.  

Inheritance from my family?

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

If you maternal grandfather is “dome” bald and your maternal uncle has the same appearance, but his maternal grandfather is not bald: does that mean such gene was inherited through the Y chromosome? Therefore, will my mother carry that on her X chromosome to me?

There is a 50/50 percent chance that you will get the genes from your mother’s or father’s side of the family. By the age of 26, you might know who you take after. Look through a lot of photos of uncles and grandparents and see if you can identify yourself. 

How many grafts will I need (photo)?

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

I would be greatly concerned if you went to Turkey for most of the ordinary clinics there. They may fill up your crown with most of your donor hair, so when you lose the frontal hair you presently have (a considerable amount), you may not have hair left to transplant. This is primarily a concern if you are under 25 years of age. See a good doctor and find out what your donor supply is, what your hair thickness is, and what hair loss pattern you may likely develop. Would you go to Turkey for a brain surgery?

Also, many young men can reverse this with medications alone.  Finasteride is usually very effective in this type of thinning.  Add microneedling, and you might find that you avoided a hair transplant altogether. 

Minoxidil itching

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

I was using topical minoxidil before but my scalp was itching very much so I switched to oral minoxidil but now my body has started to itch.

Itching is a sign of allergy to the drug or the carrier.  If you have it with the oral, it is likely an allergy to minoxidil. 

Proactive about hair loss?

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

I’m 17 and I’ve been lurking on various blogs and forums due to hair loss paranoia. Saw a post about shedding short hairs indicating AGA, freaked out, and saw a dermatologist. They said no significant thinning (other than a few vellus hairs on the left side of the hairline, which is normal )after looking at my hair under a microscope. Any advice on proactive hair loss detection since early intervention is the key…thanks

Forget about it for a year, and if you want, follow up with the dermatologist in a year or so, that might be a good idea. Hair loss from AGA is a slow process; there will be no surprises here.

Finasteride frequently reverses crown loss

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

In my experience, when I put a man on finasteride, it is not uncommon to reverse this process if they have crown thinning.  I have seen this happen as men in their 50-80s, who were put on Proscar (finasteride 5mgs) for their prostate, and they were considering a hair transplant only to come in and show me the of the reversal of their crown thinning from the prostate drug that they were given.

Shock loss from another hair transplant

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

After experiencing shock loss so dramatically from my first hair transplant, would another hair transplant in the next two years cause more shock loss to happen of my current native hairs too?

Usually not.  The shock loss knocked out the miniaturized hairs that were the cause of the shock loss.

Dosing finasteride and dutasteride

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

I have been seeing the charts going around that a .3 or.25 topical finasteride reduces scalp DHT more than 1mg oral fin. I am asking this because I am losing density on 1mg finasteride. Before I try DUT or anything else I was wondering if you believe that this will help me. Please let me know!

The ideal dose of finasteride is 1mg. Higher doses usually are not better than then 1mg dose. Losing hair while on finasteride means that your hair loss is moving more than the finasteride is helping. The 1mg dose is ideal. I question your thinking that finasteride at higher doses than the 0.3mg you are taking, is worse for you.  Adding Dutasteride may add a 15% benefit at the expense of a long half-life of 5-6 weeks, and possibly it would hang around your body for many months if you decide to stop it.