Unfortunately, Some Hair Transplant Doctors Are Crooks

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

Last week, I met with two patients who came to me with thinning hair. One was 19 and the other was 22. The 19 year old had very early miniaturization, evident by the measurements that were taken of his scalp, and I built a Master Plan for him and advised him to go on Propecia. The 22 year old had clear thinning in the frontal 2 inches of his hairline with 40-50% miniaturization and a thin type hair shaft. The thin hair shaft made his miniaturization look worse than if his hair had been more coarse.

Both of these young men went to these doctors before they came to see me (and no, I won’t name names). In my opinion, both patients should not have hair transplants at this time; certainly the 19 year old is not a candidate at all and probably will not be for years, and the 22 year old may become a candidate if the Propecia does not stop or reverse his hair loss to meet his goals. However, the 22 year old might be able to avoid a hair transplant if the Propecia works well for him. The lack of ethics of the two doctors who viewed both men and gave them both recommendations of 3000 grafts each reflect the ‘scum’ of the hair transplant industry. I know I’ve written on this topic a few times before, but it truly outrages me and demands this repetition. Performing surgery when it could be avoided with a simple daily medication shows that the doctors were chasing their patient’s pocketbooks, not pursuing their patients best interests. Fortunately, both patients liked my advice and will see me for a follow-up in a year or so. I am sure that they will get calls from these two doctors and/or their sales staffs and I strongly advised them to resist sales pressures to sell them what they do not need.

To make matters worse, in my normal examination I measured the hair density of the donor hair on these patients and found them both to be lower than average. That means that they might be limited as to what they can expect from a hair transplant when and if they balded. Both of the doctors that they met with just ran their hands over the patients’ scalp in the back of their heads and magically reported that they were unusually blessed with “lots of donor hair”. Neither of these doctors made a measurement of the donor density on either of these patients and as if by magic — *poof* — they had enough hair to meet the doctor’s income requirement. These scams are unfortunately common in this industry and I always warn patients that if the doctor does not precisely measure the donor density, they should run for the hills when told that their donor supply is good. Worst of all is the fact that if these men had undergone hair transplantation, their donor hair (which was limited in the first place) would be depleted, wasted, and worse yet, put in the wrong place. Over and over again I warn patients to do their diligence on the doctors they see and choose. This again, is a Buyer Beware market.

Tags: hairtransplant, hair transplant, hairloss, hair loss, doctor, physician, propecia, finasteride

What’s the Highest Density Possible from a Hair Transplant?

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

Doctor,

Quick question: what is the most density one can achieve after a hair transplant? I’m a little more than 6.5 months after my first hair transplant (temple and front), and wondering if I’ll
ever be able to slick my hair back like I used to. I’m seeing growth, but the density surely isn’t near what I’ll need in order to reach my goal (at least right now it isn’t).

The issue is fullness, not density. At 6 months, I would not expect much fullness, but each successive month I would expect to see more and more. At 8 months you should see about 80% of what will eventually be there. The fullness may not directly relate to the density, as there are many variables (hair shaft thickness, hair character, hair and skin color, degree of baldness), so any absolute number without taking these other attributes into consideration does not mean much.

Tags: density, fullness, hairtransplant, hair transplant, hairloss, hair loss

Why Can Some Doctors Create the Illusion of Greater Density?

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

Dear Dr Rassman

I am inquiring why some transplant surgeons can achieve significantly greater density than other surgeons on patients with similar hair loss and hair characteristics using the same number of grafts. is this due to the way the hairs are implanted to create the illusion of higher density?

There are many factors that distinguish one hair transplant from another with the same number of grafts. They include:

  1. The artistic skill of the surgeon and the way the grafts are distributed (as well as the direction of the hair shafts)
  2. Hair thickness
  3. Hair character (curly or straight)
  4. Color and contrast between hair and skin color
  5. The number of hairs per follicular unit (relates to the way the harvesting is done and the density of the original hair)
  6. Styling (layering works better on some people, particularly those with straight or slightly wavy hair
Tags: hairtransplant, hair transplant, hairloss, hair loss, density

Does The Balding Process Ever Stop?

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

Dear doctor, good work on the site, it is very helpful.

I have a few questions about hair transplant procedures.

  1. Is a short haircut such as a buzzcut or crew cut probable with a transplant, or would the hair look too thin on top?
  2. Does the balding process ever stop?, does the donor area ever bald?
  3. How many grafts can someone actually have?

Thank you for the help

  1. When you have a hair transplant, the density of your transplant rarely will exceed 35% in one session, so if you cut it short, the reduced density will show a thinner look. Repeat sessions can solve the problem, but these are only a good idea on people who are not very bald.
  2. Balding is a progressive process over a man’s lifetime if he is genetically prone to balding. It generally slows down in men over 40.
  3. The total number of grafts available for a hair transplant depends upon the donor density (higher densities can provide more grafts), and the scalp laxity (looser scalps are easier to harvest). In patients with very high donor densities, there could be easily 15,000 grafts. In Asians with generally lower normal densities, the number of available grafts could be in the 5,000-6,000 graft range.
Tags: hairloss, hair loss, hairtransplant, hair transplant, balding, grafts, density

Dense Packing of Grafts

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

Hi Dr…. is it really possible to pack 70 to 120 cm2 in a hair transplant???? Please let me know because a doc told me he can do this….

Some people can do the impossible. Putting that density together is crazy. The normal density is 100 follicular units per square cm, so why put in a number that is greater than normal? The real issue here is not if it can be done, but whether or not they will actually grow. What you are hearing/reading are stupid comments by an ignorant doctor.

Tags: hairtransplant, hair transplant, dense packing, density, hairloss, hair loss

Shouldn’t Losing 100 Hairs a Day for Asians Be Considered Thinning?

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

(female) I am aware that dropping a 100 hairs a day is normal. However, when I met a trichologist about 2 years ago, she told me that for Asians, a 100 hairs is considered a sign of hair thinning. This is because that most tests are done on Caucasians and they have apparently more hair on their scalp. The ideal would be 50 hairs per day for Asians. What are your views on this?

Assuming that you have a typical density for an Asian (1.6 hairs per square mm on average) then I would expect your daily loss of hair would be about 80 hairs.

Tags: asian, hairloss, hair loss

FUE vs Strip Harvesting for Transplants

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

I am considering doing an FUE, and later on need I recognize that I may want another transplant, won’t the FUE cause my donor availablity to be less as compared to having the strip transplant?

I think that you must put the various surgeries that you may want into a Master Plan for your hair loss. If you are not going to be very bald, then an FUE solution is not an unreasonable one. The long term yields for an FUE may have to do with donor density, but for strip harvesting, I have exceeded 10,000 grafts over more than one surgery. With regard to your query, I do not believe that anyone really knows whether FUE will cause your donor availability to be less than that of the strip procedure, but I would personally doubt that FUE will yield more hair for transplantation than strip harvesting. There may be a role for combined FUE and strip at the end of the process.

Tags: hairtransplant, hair transplant, fue, strip, harvest

Just Started Losing Hair a Year After Pregnancy

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

I am a 31 year old female with a 17 month old son. At about the time he turned one, I started to notice hair loss. It’s all over my head, and has caused my hair to thin a lot. It is still happening. I have been to the doctor and was tested for thyroid. It was negative. What I am wondering is, could this hair loss still be related to my pregnancy? It has also been an extremely stressful time – but could this long period of hairloss be related to stress? Will my hair grow back? And can continued stress mean continued hair loss?

Hair loss in women can sometimes be caused by underlying medical conditions, so it is important for you to be evaluated by your own physician. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. It is also important to review the use of medications that can cause hair loss, such as oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone. The following laboratory tests are often useful if underlying problems are suspected: Estradiol, FSH, LH, SHBG, Prolactin, T4, TSH, ANA, Iron, TIBC, Ferritin, Free and Total Testosterone. Your scalp should also be mapped out for miniaturization to define patterns in genetic hair loss that are typical for women. Pregnancy can activate genetic hair loss in some women.

Tags: hairloss, hair loss, female, women, woman, pregnancy, pregnant

Hair Diameter Thicker Near Middle, Rather than Near the Bulb

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

I have read that hair diameter is thickest near the bulb and thinnest as it reaches the tip. Recently I have seen some fallen hairs with the diameter thickest at the center and thinner as it reaches the bulb and tip. Is this indicative of hair loss?

The hair shaft should be uniform in its thickness through its entire length when the hair is shed during the normal growth phase that all hairs go through. If there is active miniaturization that radically sets in, then that could explain what you see in some of the hairs that you observed. In the miniaturized hair, the hair probably grows slower than in the normal state, so a hair that you are looking at (lets say one inch long) might have taken some time to find its way out (more than the normal 1/2 inch of growth per month). The best indication of hair loss is to assess the degree of miniaturization that is present throughout the scalp, particularly the areas that are thinning. I hope that this helps.

Tags: hairloss, hair loss, diameter, density, miniaturization

Trichoscan for Measuring Density?

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

Dear Dr. I am 29 year old Indian. I want to measure my hair density before undergoing hair transplantation. My doctor has trichoscan with him. I want to know if it is as accurate as your densitometer. Please reply.

Probably yes, assuming that he can see the individual hairs. Ask him to show you the miniaturization so you will know as much as your doctor knows.

Tags: trichoscan, density, hairloss, hair loss, miniaturization

Injecting Saline Into Scalp To Transplant Higher Density?

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

Dear Dr. Rassman,

A couple of years ago I remember reading an article about a hair transplant doctor at UCLA (I believe) that was able to transplant a higher amount of hair into a site by first having the scalp injected with a solution (possibly saline) to actually swell or enlarge the scalp area so more hair could be transplanted into the area. Later when the swelling receded the results would yield a higher density.

Can you comment on this. Is this something that you would recommend? Why or why not?
Thanks!

Many hair transplant surgeons will inject saline into the scalp to accomplish just what you are talking about. The important thing to focus upon is graft survival. Are the grafts packed so closely that the blood supply may be compromised? It is possible. I recently saw a patient done by another doctor who had the skin in the recipient area develop gangrene from a decision to put too many grafts too close together in skin that could not tolerate dense packing of grafts. The details of what the surgeon does is not a simple one thing vs another thing. A good hair transplant is the result of a complex series of decisions and takes into account not only the size of the grafts and the nature of the skin, but many other judgments. I have heard doctors focus on one thing that makes them unique, but ask yourself, “Am I being pitched a sales line here?”

Tags: hairloss, hair loss, hair transplant, scalp, saline, density

Is Hair Always Uniform Over the Head of a Non-Balding Person?

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

I’m a 24 year old male, and I have a family history of balding. I have close-cropped hair, and I noticed that I can see a bit more scalp in the “runways” along the sides of my head and around the crown than I can see on the top of my head. The individual hairs in the thinner areas do not actually seem to be miniaturized compared to the hairs in the thicker areas, which is what confuses me. It looks like there are just fewer overall hair follicles in the thinner areas. It may have always looked like this and I never noticed, since I never thought to check until my brother started balding. My front hairline is not receding at all. Could this be a normal (non-balding) hair pattern, or is hair always completely uniform over the entire head on a non-balding person?

There are two independent measurements that will point to what is going on. There is the actual hair counts by area and miniaturization by area. Both of these metrics can be obtained when you map out your hair for miniaturization. I do not always do hair counts in all of the areas I map, but in your case, this might be worthwhile.

Genetic hair loss causes both miniaturization (thought to be a precursor of balding, but not always) and direct reduction of hair counts without going through the miniaturization process. What you are viewing should have numbers put to it so that the diagnosis is in hand answering the basic question: Do you have genetic balding going on?

Most people will have some variations of densities by the part of the scalp, and these differences do have some consistency in the population. Hair along the sides is often less dense than hair in the very back of the head, for example. Yesterday however, I met a man who had just the reverse — a higher density on the sides, less in the very back. Good baselines are critical to understanding your hair loss, and good measurements in the hands of a good doctor will reveal that information for you.

Tags: density, hairloss, hair loss

I’ve Had 7 Strip Surgeries

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

ive had about 6 or 7 full strip procedures over the past seven years and have developed a scar that runs almost ear to ear and is an inch wide!

My surgeon has tried twice unsuccessfully to cut out the scar. There feels like very little excess tissue when i try and pinch. Im a dentist and am sure the tension from looking downwards post surgery was a factor although my surgeon says no. He is now talking about FUE from my chest. Would i be better suited seeing a plastic surgeon. He doesnt think anyone could achieve a better scar result. Ive had 2 colleagues get similar scars from the same doctor. Any advice would be greatly appreciated.

You must be careful here. Do you want to continue on a never ending process from surgery to surgery? There are creative options including:

  1. FUE — but not from the body, rather from the scalp where hair is active 85% of the time, rather than 20% of the time as with body hair
  2. Balloon expanders which can reduce scars very nicely if there is reasonable donor hair

Send me pictures (which I will keep confidential) and then I can offer you general advice about what is possible and what is not. You might consider coming to California after I get your photos for a one-on-one consultation if the photos lead me to believe that there may be a good solution for you.

Tags: density, hair transplant, surgery, fue

Transplanting Grafts Into 1 Square Centimeter

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

can you fit 100 grafts in a 1sq2 cm without damaging existing hair ?

Yes, the density or 100 grafts per square cm can be achieved in some people. Generally it would take fine hair and supple skin with good elasticity to do it. The issue of a successful transplant is a more important issue. By crowding the grafts at 100 per square cm, the blood supply may be compromised. Some very crude studies of this have been done and presented at the past few ISHRS meetings (the largest society in the industry), which have shown that as more than 40 grafts are put into a square cm, the successful growth of these grafts starts to fall off significantly. If there is hair already present in the transplanted recipient area, there is great likelihood that it would damage the existing hair as well as obtaining poor growth.

I have seen this issue become one where doctor’s ego is pushed at the expense of patient welfare. Just because a doctor says he can do this, does not mean that this type of density has value and will grow out. I did the first dense-packing ever reported at about 100 grafts per square cm in 1993, but the growth was less than that number, so I toned down these numbers and developed judgments that allowed me to know just how far I could push densities at the time of transplants. Everything is strategy and judgments in the field of surgey. So I smile when I hear doctors talk about the high densities that they can achieve, realizing that they may be less patient outcome focused, and more in love with their own image in the morning mirror.

Tags: density, hair transplant, hairloss, hair loss

I Was Told I Don’t Have Good Density for Transplant

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

I had my second consultation with Dr. Bernstein in Fort Lee recently, and He told me that with a 1.3 rear hair density, I was not a great candidate for a transplant. I already have atleast a Norwood 4a and I don’t see what I have to lose (pardon the pun) by what I think would significantly improve my appearance if for a while. What is your opinion on this?

Telling me your donor density in one area does not tell me enough about your donor hair quality or your hair health. Asians often have donor densities of 1.6 and Africans have donor densities of 1.3. Do you have Diffuse Unpatterned Alopecia? What is your age? These two questions are very important. For an African or Asian man under 25, a donor density of 1.3 without Diffuse Unpatterned Alopecia may make a good candidate with high quality hair, while a Caucasian with Diffuse Unpatterned Alopecia present and an effective density of 1.3 might make a very bad candidate for a hair transplant for many reasons. I am sure that Dr. Bernstein knows the answer to these questions and you should speak with him about it. I need more information to give you more help here.

Tags: density, hair transplant, hair loss, hairloss