Cheap Hair Transplants Are Not Such a Good Deal After All?

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

MoneyI’ve been thinking about the case I wrote about last week — “How Many FUE Grafts Actually Grew?” — about how a patient (we’ll call him Mr. Smith) came to NHI after feeling royally screwed over by another clinic he went to for his follicular unit extraction (FUE) procedure. It’s quite an interesting case of being scammed by a doctor that advertised super low prices, so I really suggest you read it if you have the time. Even so, I want to talk a little about value in surgery…

If you run the numbers, you will see that the actual growth of hair was only 25% of what he got transplanted. There were two consequences of this:

  1. Of great importance is the loss of your finite (limited) supply of donor hair. In the case of Mr. Smith, his surgeon killed 3 out of 4 hairs that were transplanted. These hairs are forever lost to the patient. I also believe that there was damage produced to the donor area, evident by a thin see-through appearance. His donor supply is significantly worse off following his FUE procedure than if a scar formed from a strip surgery, which could have been easily hidden by surrounding hairs. FUE is not always the answer to harvesting hair without post-surgical consequences, as seen in Mr Smith’s case.
  2. Of lesser importance, the cost per graft was multiple times higher than what the patient thought. Let’s assume that Mr. Smith paid $5/graft. When measured against growth, his actual costs were $15/graft for the work that was done. The rate he paid had nothing to do with the value he actually received (in his end result), as he really was paying more for less. That’s quite a bit of money out of his pocket.

The lesson here is that experience in a hair transplant surgeon and his team is directly related to the actual costs when measured by the yield of what actually grew from the hair transplant. My advice to prospective patients is to change the way you look at value! In our practice, we allow prospective patients to meet our patients to see what type of results they got. As these Open House events are open to all patients (or future patients), anyone with results like shown in Mr. Smith’s example will be as evident as the nose on your face. This will help you in the education and selection process. This type of surgery is forever, and unfortunately some patients have to learn the hard way when they try to pinch pennies by going to a surgeon that has no business messing with your hair.

Tags: hair transplant, fue, value, price, fees, hairloss, hair loss

How Many FUE Grafts Actually Grew? (with Photos)

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

A man came to see me last week with a problem following his hair transplant at another clinic over a year ago. The surgeon told him that 6600 grafts were transplanted (in three sessions) using the follicular unit extraction (FUE) technique, which he guaranteed has a yield of over 90%. The patient wanted to know if his surgery actually reflected 6600 grafts, so at the patient’s request, we counted the actual grafts that grew. We divided up his head into 1cm square units and then counted the individual grafts inside those squares. The count yielded 2092 grafts of which approximately 50% had only one-hair and 50% had two-hairs, totaling approximately 3100 individual hairs. The hairs did not look very healthy, but the patient had fine hair in his donor area, so I suspect that the fullness reflected the low volume of each hair that survived.

I actually had the opportunity to measure his density before he decided to have his surgery with another doctor. His initial preoperative donor density measured 2.4 hairs per mm square. In my experience this type of donor density usually yielded about 15% one-hair grafts, 65% two-hair grafts, and the rest would be three-hair grafts. Estimating the hair count from the 6600 grafts he expected to grow, he should have had hair growth that would reflect (1) approximately 3960 hairs from three-hair grafts (20% of the 6600 grafts), (2) 8580 hairs from two-hair grafts (65% of the 6600 grafts) and (3) 990 single hairs (reflecting 15% from one-hair grafts)… for a total of 13,530 hairs that would have grown from a 100% successful harvest. Estimating an FUE yield of 90% (a reasonable estimate for FUE and his surgeon’s guarantee of that amount) from a projected successful hair count from the 6600 grafts, I would reduce that count to 12,204 hairs (90% of the 13,500 hairs estimated above). He should compare the actual hair count we obtained in the counting process of approximately 3100 hairs which reflects a loss of 9104 hairs. The hair count therefore reflected a substantial reduction in the hair yield of those grafts that grew when compared to what should have grown. When one would count the grafts that did not grow, the death rate of the hairs was almost three times what did grow.

Where did those missing hairs go? I suspect that they were killed at the time of the FUE either through drying of the grafts during placement, trauma from the technicians placing the grafts, or transection of the grafts (a common problem in those surgeons who really do not have mastery of the FUE technique).

Read more

Concerns About NeoGraft

/by William Rassman, M.D./3 /,

NeoGraftJust after I published a post about the NeoGraft tool, a phenomenon began occurring in the community. I’ve been seeing an increasing number of press releases that get brought to my attention from readers and from Google Alerts, announcing that some doctor with no experience in the art of hair restoration is now the first in his area to offer hair transplant surgery using this new NeoGraft tool. It could just be due to the marketing efforts of the makers of NeoGraft or it could be doctors following other doctors in issuing these press releases (and also the machine being shown on the Rachael Ray show)… but some of these physicians often have no real training, and this machine offers them another source of revenue with the ability to do what we have been doing manually.

Michael Oakes, president of NeoGraft Resource Group (makers of NeoGraft), even brags about the ability to sell the tool to doctors that have no prior experience performing hair transplants. In his Plaxo.com public profile, Oakes writes that the NeoGraft machine “opens up opportunity for non transplant physicains [sic] to add to there [sic] exsisting [sic] practice.” This is quite alarming to me!

I am writing this as a warning for those who are considering a NeoGraft transplant. Some additional comments that Dr. Robert Bernstein made on his site about the risks of the NeoGraft tool suggest real problems that will, almost certainly, produce failures of the transplant. I have seen one such failure recently from an experienced surgeon who used it. If you’re still considering having surgery with this tool, just be sure to check out the technology and the doctor who is performing it. Ask about the physician’s training and also ask to meet some patients who have had successful hair transplants with this tool. The proof is in the pudding.

Tags: neograft, concern, risk, hairloss, hair loss, fue, hair transplant, hair restoration

Transplanting Body Hair Into Strip Scar from Previous Surgery

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

Hi! Been reading your blog for quite a while now. I know that you are against body hair transplants onto the scalp, BUT — I don’t want to have body hair transplanted anywhere but into my strip scar. The reasons I saw you give in the past for avoiding body hair transplants were because body hair doesn’t grow out very long, so it would be bad for styling. Well, I would like it transplanted into my scar so I can cut my hair much shorter than I currently can without it being noticeable.

I have looked at my chest hair, and they’re not curly. I plucked out a few and compared them to my scalp hair. They’re quite similar. Is this still a terrible idea? I honestly don’t want to FUE scalp hairs because in case this simply doesn’t work and I end up deciding to just say “Screw it…I’m shaving my head and i’ll live with a visible strip scar,” I would then also have to live with little white dots all over the back of my head. I know, they’re not supposed to be very visible, but I don’t want to add to more scarring on the back of my head. I really don’t.

It’s actually not a terrible idea. I am not against using body hair to repair a scar on the scalp, provided that you realize that the telogen (resting) phase is very long… which means only about 50% of the hairs will be growing at any point in time. I would want to evaluate you first if you want me to do this.

Tags: bht, body hair, hair transplant, scarring, scar, hair loss, hairloss, hair restoration, fue

NeoGraft, a New FUE Instrument

/by William Rassman, M.D./3 /,

Can you tell me about the Neograft technology. Is it better that what is out there?

NeoGraftAutomation of the hair transplant process has been a goal of doctors from the earliest part of their career because of the tedious manual processes used today. In particular, with the large sessions, fatigue becomes a problem and the skill sets required of the staff take years to acquire proficiency.

I have been a pioneer of many of these devices, receiving patents on some of them. Included was the Carousel, and a series of follicular unit extraction (FUE) techniques devised for faster extraction. The NeoGraft machine is just one of the newer devices, but unfortunately it has its problems.

NeoGraft uses a vacuum system to assist in the removal of grafts that are first partially dissected with a sharp punch. The grafts that are “sucked” out of the scalp are collected in a chamber. The grafts are then removed from the chamber and drawn up, again by suction, into a needle and then injected into pre-made recipient sites using air pressure. The NeoGraft seems to eliminate some of the risks of mechanical injury to grafts in traditional FUE by not requiring forceps to remove grafts from the donor site or insert the grafts into the recipient area and, in theory, may save time by eliminating the need to extract grafts manually. A concern expressed by those who have seen the system in action is that the suction removal has a tendency to strip the surrounding tissue from the lower portion of the grafts or pull out just the upper part of the graft. Because the grafts are exposed to a great deal of air movement, the continuous flow of the vacuum adds to the risk of graft drying, a problem well known to be a major cause of poor graft survival. To our knowledge no independent studies have been performed to show that grafts are not harmed by this vacuum technique and it is our concern that the drying action of the air on the exposed grafts may limit their growth. As many of the grafts are stripped from their fat, the risks to the grafts are theoretically significant.

Restoration Robotics (RR) has a better way to do this with a robot, but it is not yet on the market and it will most probably be very expensive. RR have been successful at doing FUE, although slowly, but they have yet to demonstrate an ability to place grafts mechanically.

There is no substitute to learning and mastering the manual skills that are used in the best hair transplant clinics around the world. So without a good automation instrument, many of the doctors who use an unproven method for hair transplantation just makes the risks to the hair transplant procedure greater and the work by the doctors who use them possibly second class. Would you buy grafts from a second class surgical team and pay the consequences of poor growth?

Tags: neograft, fue, hair transplant, tool, hairloss, hair loss

Scarring Amongst Different Races?

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

I am a 40 year old asian male with slowly thinning hair. I’ve been using minoxidil for 4 years and propecia for 2 years now. They seem to help maintain what I have. Eventually I would like to consider surgery, but I am not bald enough according to the doctor I have seen. My question is:

1. is it better to wait until I am more bald, and, if so, why?
2. Is it true that FUT generally causes more scar in asian men? While I prefer FUE, I was told that the result is much better with FUT than FUE.

I would much appreciate your professional opinion. Thank you.

Without seeing you, I can not address your concerns about when the best time is for your hair transplant. I generally tell patients that when it bothers them a lot, the surgery may be appropriate provided that the doctor agrees that you are a good candidate for it.

FUT (strip) and FUE are both good harvesting mechanisms. There may be better growth with FUT, but in good hands the FUE should be a fine alternative provided that you have a biopsy and are what we call “FOX positive” (see this article for more about the FOX Test). Scarring is not a racial thing except in keloid formation, which is more common in dark skinned people. If you have a scar on your body and it did not heal well, discuss this with your doctor.

Tags: race, scarring, hair transplant, hair loss, hairloss, scars

Wearing a Hat After FUE Surgery

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

Hi there,
I am wanting to go for the FUE procedure in Thailand to have 1500 grafts in my crown and two temples. I only have one week of work and have 5 or 6 days to recover before returning to work. I don’t want anyone to notice so i would like to wear a hat or beanie and for health and safety i must wear a safety hat at work. Will this effect the result of the outcome of the procedure or how long must i wait until i can wear a hat. Thank you.

Hard hatYou should ask this question to the doctor who is going to do the surgery. Don’t be afraid to ask questions to the person that will be performing a permanent cosmetic procedure on your scalp. Have an open dialog!

Generally, after the transplants have passed the 3-14 day period and there is no scabbing, then wearing a hat should not be a problem provided that it does not rub on the recipient area.

Tags: hard hat, fue, hair transplant, hairloss, hair loss

What If I Want to Practice Hair Transplantation Surgery on Myself?

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

If I was crazy enough and with a high pain toleration, could I buy the equipment need to do a “Home FUE” on my body hair? I guess I would need a punching tool and an implanter.

I have very dense and thick leg hair, so as a project I could collect all my leg hair in a strip on one leg to see what kind of coverage I could get for a future strip-transplant if needed, I’m not bald yet. But if I go bald,and there is no histogen or other cloning breakthroughs. I would think, using all my scalp donor to cover the front, and top + all my leg hair to cover the rest, and keep it buzzed down, I would still be quite happy.

I know you don’t like bodyhair on scalp,but if it was a single strip of dense hair on my leg it would be different, right?) + I like my hair buzz cut.

I know this is ridiculous, and something you wouldn’t recommend, put THAT aside, my question…. Do you need a license to buy this tools? Feel free to make a joke about this plan, I know it’s waaaay out there…..

I can joke about your plan, but there really is not much to say. I suppose you can do anything if you are really determined to do it. I am told you can even find instructions to build a nuclear bomb on the Internet. It is your body and if something goes wrong, you can have a life threatening skin infection and die. I will agree with you in that your idea is “ridiculous”, but unlike an atomic bomb, an explosion is not the problem.

I get calls from time to time from doctors wanting to purchase FUE tools, but I don’t have them for sale. You might be able to find a supplier on the web, but I’ve actually posted a similar request a couple years ago from someone wanting to be their own bathroom surgeon. I obviously can’t condone this.

Tags: fue, hair transplant, home surgery, hairloss, hair loss

Pain in Donor Area a Week After FUE

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

Hi Doctor,

I had a 1500 FUE session 7 days back. My donor and recipient sites has healed well. Everything looks normal. But since the 3rd day, I have been having a lot of pain in the donor area. Its a burning pain. For some reason it gets better at times and worse for no reason. The whole area, although well healed and looks normal from the outside, is sensitive to touch and a bit numb too. Is this normal? I talked to my doctor. He asked me to keep taking the pain killers and give it more time. Is this something to be worried about? Is it going to get better? How much time would it take? Can this be a nerve damage of some type? Is that a possibility? I would appreciate any info/help on this. I was told there is almost a zero chance of nerve damage in FUE.

Thanks.

Pain is subjective and it certainly is reasonable to have post-operative pain as many small nerve endings were traumatized. There is always some degree of nerve damage when you cut through the skin (that is why it hurts). The main issue could be major nerve damage that runs along the back side of your scalp. These are the greater occipital and lesser occipital nerves. My recommendation is to follow up with your doctor and have him/her examine you.

By the way, not all follicular unit extraction (FUE) is the same; each doctor can use a slightly different technique and different instruments. So I couldn’t say how slim your chances were of having a complication, because I don’t know how the procedure was done. You’re not alone though, as I had a similar question posed here.

Tags: fue, hair transplant, pain, nerve damage, nerves

Scratching Out FUE Grafts a Month After Surgery?

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

Hi Dr. Rassman,

I’ve had a hair transplant a month ago. Is it still possible for me to scratch my implanted FUE out?

Thank you

I would usually say no, but I have seen some strange results and methods of hair transplants over the years. Not all FUE (follicular unit extraction) is the same and not all hair transplants are the same. If you are able to pull out a graft one month after surgery, then it was never going to grow anyways. Under most circumstances though, the graft has already taken hold by then.

Tags: fue, hair transplant, hair loss, hairloss

My Boyfriend’s Hair Transplant Didn’t Grow Back After Shaving His Head!

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

Dear Dr. Rassman,
My boyfriend had a FUE operation using hair both from the back of his head and his chest (all together about 1200 follicular) to cover the toothbrush look of his previous punch graft operations on the frontal part of his head. After less than six months the result was so great that everybody was under the impression that with another operation or two on the crown part of his head he would have a 70 to 80 percent of his previous normal hair days look back.

Approximately eight months after the operation he completely shaved his head with a Gillette Fusion razor with the hope that his new and old hair may look thicker and more ready for the next operation, but to everybody’s surprise (not to mention his horror) only 40 to 50 percent of his newly transplanted hair has grown back (after two and half months now) and the look of his frontal head now can be described as balding with previous plugs being visible again. I would really appreciate your comment and/or advice on the matter.

RazorFUE is not a perfect technique and it has a higher failure rate than the standard strip surgery, as the follicular units are often stripped of fat at the bottom of the grafts. Also, body hair transplants do not work to my satisfaction, because body hair does not grow the way scalp hair does. Body hairs do not grow continuously like scalp hair, as it is in its resting phase much longer. That is why most doctors do not perform body hair transplants; it’s not because body hair transplant is difficult.

Aside from these generalizations, I would only be guessing as to what caused the hair to not regrow after shaving it. And providing a guess would not be fair to you, your boyfriend, and even the surgeon. He needs to go back to his surgeon and follow up with this issue.

Tags: fue, body hair, bht, hair transplant, hairloss, hair loss

I Have a Surgery Phobia, but I Want FUE

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

Hi Dr.
I have a general phobia of surgeries. I am very scared of the whole idea of my skin being cut so when I have my hair transplant I will probably go for FUE. Is this procedure painful?
Thanks.

All anesthesia hurts a bit (like the dentist who prepares your teeth). While the surgery is going on, you feel no pain and after the surgery the pain has been reported as minimal by most people who have had it. Everyone has different thresholds though, so I wouldn’t make bold, sweeping statements like “guaranteed pain free” or similar. Make no mistake — this is a surgery and you need to know what that means for you by meeting with a good, caring doctor who will take the time to go over the process for you.

Tags: surgery, fue, phobia, hairloss, hair loss

FUE and Scalp Laxity After 3 Strip Procedures

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

How many more grafts can you gain if you add FUE. Say i had three strips for 6000 grafts and i’m stripped out. how many on average more grafts can a person get with FUE? One doctor said between 1000 and 2000. Does this sound accurate? thank you

Your laxity might be good after three strip surgeries, but some patients might find the donor area to be tight. The higher the density at the time of the follicular unit extraction (FUE) harvest, the greater the yield will be. For an FUE, the remaining density will reflect your depletion of 6000 grafts from the original permanent zone. For those men with a high original density, there could be many more grafts available… and for those with an average or below average density, the different yield could be significant. If I examined you, I might be able to give you an educated guess, but there is no general answer to your question. A graft estimate of between 1000-2000 grafts is possible, but an examination is critical to the estimating process.

Tags: laxity, fue, hair loss, hairloss, hair transplant

Hair Transplant Without Scars?

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

I read a doctor’s web-site and he said his hair transplants did not produce scars in the donor area. Is that possible?

The FUE technique is often called a “scar-less” surgery, but that is misleading. Instead of the linear scar with conventional strip harvesting, FUE produces punctate scarring (pin-point scars about 1mm or less in size). If a doctor would state either in an advertisement or on his/her website that they perform scar-less surgery, any doctor that did this in California, for example, would violate truth in advertising rules and could be disciplined for use of such language by the Medical Board of California. Every time the skin is cut, no matter how small the cut it, it will produce a scar. FUE scars can be seen easily when the scalp is shaved or clipped closely and doctors use many ‘punch’ sizes which will impact the size of these punctate scars.

Tags: scars, fue, hair transplant, hairtransplant, hairloss, hair loss

FUE for Early Stages of Hair Loss?

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

Dear Dr.,

I really appreciate your taking the time with this web site and the questions I have sent in that you have answered. I am 29, about to turn 30, and have been on Propecia for about 6 months now, which I started when I saw noticable thinning in the crown/Vertex area. I’ve had good results thus far, some thickening and reversal in the crown area. I have a strong juvenile hairline and in some lighting look like I have a full head of hair – under very bright electric or sunlight my crown looks a bit patchy and there’s a line of thinning/scalp on the top. As I stated in an earlier post, I was turned away from the Aderan’s trial because they said I have too much hair.

My Question is, after I turn 30, what kind of restoration results could I get from an FUE procedure? I’m a bit confused, since you state that extensively bald people should have limited expectations, but that you are reluctant to transplant someone with thinning who wants fill-in work. There is also all the advice I read on the web saying to wait for better treatments down the line if you’re in the early stages of hairloss.

Thank you very much

I don’t know how much or what type of hair you have, so I couldn’t begin to give you any kind of remote guess as to what you can expect from a FUE procedure. You’re getting ahead of yourself.

Every rule has exceptions and to determine what you should do, first get examined by an honest doctor who cares more about you than his wallet, and if he says go for surgery… come to me for a second opinion (you indicated that you’re not too far from my San Jose office).

Tags: fue, hairloss, hair loss, hair transplant