Wouldn’t Delaying the Final Balding Pattern by Taking Finasteride Cause a Delay in Having a Transplant?

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

Dear doctors, love the website. I come here as much as i can and its helpful in learning and coping with hair loss, which is the worst thing a man can go thru.

I understand that a lot of transplant doctors tell their patients its better to wait to get a final hair loss pattern rather than going for a hair transplant when the hair is still falling out. So wouldn’t finasteride be a bad thing to take then because if it merely slows down the hair fall out rate and doesn’t stop it, then a patient wouldn’t really reach his final pattern at a proper age where he can have a full HT?

The drug would just keep on delaying the patient from reaching the final balding pattern but he would still be losing hairs, albeit not as many as he would have if he were not on the drug, but he would still be losing hairs and can not get a hair transplant.

NW2Delaying the need for surgery is sort of the point.

The goal for finasteride in many patients is just what you said. Why rush into surgery that may not be necessary? If you are lucky, the drug may delay the final pattern for many decades. Surgery is more of a last step unless the pattern impacts your appearance and you want it restored.

Many young men find themselves in the situation you are talking about and may never develop a pattern beyond a Norwood class 2 and could keep the hair throughout the scalp.

Tags: hairloss, hair loss, finasteride, propecia, hair transplant

2 Weeks After My 2800+ Graft Surgery, I Had Massive Shock Loss

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

hi, two weeks after a surgery with dr. rahal of 2846 grafts (888 1 hair, 1526 2-hairs, 429 3-hairs, and 3 4-hairs), i experienced a massive shock loss. it has been one month post surgery and i am very worried about even going to my original look, which at this point i would be happy with. i only take minoxidil, because of the side effects of finasteride.

do you see a lot of this shock loss from the pics as being temporary, because although i am thinning, i am not an entirely diffuse thinner, but lost everything. at this point would total of the 5239 hairs even be enough to fill in what i have lost? i should also note that the hairs that are remaining are ones from a previous surgery with ziering that was supposed to be around 2300 grafts, but i am not even entirely sure about his work.

thank you so much for your help and suggestions, greatly appreciated!

Click the photos to enlarge:

 

It is difficult to make many comments about your exact situation, because the before picture and the change in your hair length are confusing your situation. I will assume that you are young (under 30 years old). Were you afraid of possible side effects from finasteride, or did you actually experience them? Shock loss is common in young men after a hair transplant, unless the young man is protected with Propecia (finasteride). Prior to the appearance of this drug on the market, shock loss was a common problem for hair transplant surgeons. Since the use of finasteride, this type of report is relatively uncommon.

Shock loss usually appears in the first three months after a surgery, when it happens. I do not believe that the size (# of grafts) is related to the shock loss, as a hair transplant of any size can do it. Shock loss reflects your genetic timelines and often accelerates the timelines 1-3 years.

Tags: shock loss, hair loss, hairloss, hair transplant

Can I Have a Hair Transplant Into a Scalp Scar I’ve Had Since I Was a Kid?

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

I have a large scar from a head surgery from when I was young. Hair does not grow there, and it looks very bad with my hairstyles.

I am currently 18. Would I be a good candidate for hair transplantation onto the scar, especially as regards to shock loss?

Maybe, but I can’t really say without an exam. You should see a hair transplant doctor for a better idea.

At NHI, we routinely perform surgeries to cover scalp scars as long as realistic expectations are understood. In other words, each case is different.

Tags: scar, hair transplant, scalp scar

Class 7 Patient with One Surgery of 3072 Grafts 10 Years Ago (with Photos)

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

This is a Norwood class 7 patient with very fine hair. who loves the hair he had transplanted a decade ago in a single procedure of 3072 grafts. He is using a comb-back styling technique.

After seeing him again, we decided to do one more 3000 graft surgery to fill in the crown. His entire bald area is huge, so even the next surgery will not give him a full head of hair. The solution we came up with is that we’ll follow-up after the next procedure with Scalp Micropigmentation to thicken its appearance. That will make a huge difference and this patient is thrilled with the idea. I will post some updated photos in about 12 months from now to show the transition.

Click the photos to enlarge (and apologies for the blurriness of the top view Before photo — I can’t go back in time to take a better one).

After:

 

Before:

 

Tags: hair transplant, results, hairloss, hair loss

Cutting Multi-Hair Grafts Into Singles for Eyebrow Transplantation

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

My goal is to do the eyebrow transplant. I did some research and it said that it is difficult to separate the single hair from the multiple hair graft if your hair root is thick. So probably means big roots will be risky and causes the root to die and not grow in future.

My question is do i have to be concerned about the separating process of single hair or not because my hair root is quite big.

It has not been a problem in our hands. Careful microscopic dissection is critical to make sure that the area of the sebaceous glands are accurately dissected.

For those that aren’t familiar, follicular unit grafts used in transplantation contain 1, 2, 3, or 4 hairs each. With eyebrow transplants, these multi-hair grafts are split into single hairs. I generally like to find and use 1-hair grafts for the eyebrows.

Tags: eyebrow transplant, eyebrows

Taking Ibuprofen After My Hair Transplant

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

Hello there Doctor Rassman!

My compliments on a great blog here. I’ve just had a FUE done for my hairline today. I have 2 simple Q’s –

1. Is Ibuprofen recommended after surgery? My surgeon has prescribed it twice a day for 5 days, but I read on the internet that it promotes bleeding?

2. On reaching home, I have been spraying the recipient area with saline solution every 30 mins as prescribed. I am seeing some drops of blood oozing out of the recipient area. Is this normal? I couldn’t spot any hairs in the blood so just concerned that none of the hair roots have fallen out due to this bleeding.

Thanks for your time and help

1. Ibuprofen in general can cause bleeding, but you need to understand and takes things into context. Believe what your doctor (a real live person you trusted to perform your surgery) over what you read on the Internet.

2. A little bit of bleeding should be normal since you just had your procedure done. It was surgery, after all. Many doctors have different post operative instructions, so if you are concerned you should contact your surgeon.

Tags: hair transplant, bleeding, ibuprofen

My Scalp is Red Years After My Hair Transplants

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

Hi Doc. I’ve had 2 hair transplants. Both over 2 years ago. One in Australia and one in North Carolina.

Today my new girlfriend mentioned to me that “where my hair is it looks red and sore”…. this is very disturbing as I have often thought the skin around my recipient area had a sort of raised redness about it. But I never thought anybody else would notice.

Before you say “see my doctor” I just want to know if you’re aware of this happening and whether or not there are any skin creams that might help my skin go back to normal. If not skin creams… is there anything you can do?

Redness can be an issue for some patients even years after surgery. I’ve seen this on occasion from old (bad) hair transplant days, but I rarely see this anymore. Maybe you have a skin problem, though it’s all a guessing game without an examination.

Tags: surgery, hair transplant, redness

Losing Grafts After a Hair Transplant?

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

Hi Dr,

Thank you so much for this wonderful blog. I just recently got an HT with a very reputable clinic. My question concerns shedding of the grafts. I notice shedding began around the 9 day mark. Is this considered normal? Also, i had crusts on my head for approximately 9 days, and i noticed there were a couple of crusts that fell off with a hair in it. My question is, is it possible i lost a graft in one of these crusts. Or would there be some noticeable bleeding from the graft from being dislodged?

Thanks

At 9 days, I would expect that the grafts will grow out nicely. In a published article where we tried to identify when the grafts would be stable to grow out normally, we determined that stability occurs usually in a week or so. When the grafts fall out with the hairs in it after a week, they leave behind the stem cells in the recipient site. Don’t worry, it sounds like you will be fine.

Tags: hair transplant, hair growth, hairloss, hair loss

Can I Use Baby Shampoo On a New Hair Transplant?

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

Doctor,

Is Johnsons baby shampoo ok to use on newly transplanted hair?

Thank you

Always check with the doctor who performed your surgery. Basic information such as this should have been explained to you when you had surgery! I sometimes wonder who is doing these surgeries and why some patients kill blindly trust doctors with their medical care.

In general, baby shampoos should be fine on a new hair transplant. But as I don’t know anything about your surgery, you should always check with your surgeon.

Tags: hair transplant, shampoo

Is There Any Hope for Norwood 6 Patients?

/by William Rassman, M.D./10 /

Hi Dr Rassman,

Had a question about hair transplantation. In your professional experience in treating thousands of patients, would you say there is any hope for norwood 6’s?? I mean I know the limitations of supply and that everyones characteristics are different, but can a norwood 6 get any kind of decent coverage to get rid of the bald look. I ask because I fear thats where I am headed.

Have many norwood 6’s on my father side and have been loosing hair. At the moment I have arrested it with the help of finasteride (stopping around a norwood 3 and have not progressed in over a year), but as you keep stating, eventually your genes win, so I was just wondering what advice you give to people high up on the norwood scale, and if transplantation can do anything for them. thanks

We have transplanted many Norwood 6 pattern balding people. Some have excellent results, such as the one shown here (click the photos to enlarge):

 

You can read more about this patient here and here, but in case you don’t want to click, he had a single procedure of 2781 grafts. The results shown are after 9 months.

These type of results occur in people with average or above average hair density, and medium or coarser hair thickness. Don’t lose hope.

Tags: hair transplant, norwood 6, hairloss, hair loss

Styling After a Hair Transplant

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

Hello doctor

I see a lot of HT photos, a lot of the patients seem to have their hair up and raised back like they’ve been in the wind. Is that just the way they style it? If I was to have a HT I’d want my hair down towards my eyebrows..

Is every patient different?

Regards

Hair normally grows forward in the front (parallel to the ground when standing upright). As one moves back from the frontal edge, the angle starts to change with hair pointing a few degrees upward until it reaches the front of the crown, where the frontal pointing hairs are about 35 degrees to the ground. So you see, the hair when placed by the surgeon is never placed perpendicular to the horizon. At the crown, the hair changes direction in a circular pattern (swirl) and as you look further back, eventually the hair points down and away from the front.

What you see in our patient photos reflect each patient’s styling (or lack of it), not something we do. I always put the hair back in the direction it would have been had they never lost hair and depending where I am working on the scalp, the rules I discussed above are followed with every hair placed by me. Patients generally like to play games with their hair and although a few comb it forward, most do not. Some comb it to the side with a part on one side, others comb it back with some product that they apply to the hair. Some just let it stray, taking on the character of the hair itself. If the hair is curly, then the natural state will look less groomed than if it is straight or has a nice wave to it. If you want to comb it down to cover your forehead and point to your eyebrows, you can do that also.

Every patient is different and the results we get depend upon texture of the hair, density at the area we are looking at, thickness of the hair shafts, the degree of curliness (or lack of it with very straight hair). But the hair transplant you get will be your hair, and it will bring all of its characteristics that are present in the back of the head where the hair grafts are taken.

Tags: hair transplant, hair loss, hairloss, hair style

Smoking Weed Before a Hair Transplant

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

Hi Dr. Rassman,

Does smoking weed before a hair transplant affect the hair transplant in any way? When i say before, I’m referring to like a day or two before the procedure.

Thanks

I don’t have a clue. If you plan on being the test subject, you should discuss your plans with your surgeon.

Tags: marijuana, weed, hair transplant, surgery

Would You Try The 0.3mm FUE Punch?

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


Hey doc. I’m just wondering something. Since you’re willing to trial the laser hat technology would you also be willing to try out Dr Gho’s smaller 0.3m FUE punch.

I don’t really care about the supposed hair multiplication stuff that he claims but I am really interested in the size of his punch. And I am interested in the size of his punch because cosmetically speaking its really hard to see any white dot scaring on any of his patients.

Lots of people on various forums are showing really good photographic evidence of what I would simply call really really really refined FUE. The proof does seem to be out there and since I know for a fact you fight for the balding brothers would you be willing to try that out on willing patients? in the name of science and progressing FUE technology.

Cheers!!

I assume you mean a 0.3mm punch, not 0.3m.

I am open to any innovation, but I am also a realist. Have you actually gotten out your microcaliper and measured what a 0.3mm diameter punch really looks like? It is smaller than a hair follicle, and smaller than a hypodermic 30 Gauge needle (OD). See the needle gauge comparison list here.

Tags: fue, punch, surgery, hair transplant

Which Association Site is Best for Finding a Hair Transplant Doctor?

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

I am looking into finding a doctor to discuss my plan of attack for hair loss, and i was wondering what is the ISHRS International society of Hair Restoration Surgery? Is finding a doctor off of that website reliable as finding one from the American hair loss association website?

The International Society of Hair Restoration Surgery (ISHRS) website lists doctors who are members of a learning society. The American Hair Loss Association (AHLA) is a similar site. You must understand that any doctor can be a member of these associations and societies as long as they pay a yearly membership fee. These societies do not have the power to enforce or regulate a doctor’s practice and skills, and the hair restoration/hair transplant field does not fall under the American Board of Medical Specialties (ABMS).

In the United States, there are 24 approved medical specialty boards that are overseen by ABMS, a not-for-profit organization. Certification by an ABMS member board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training at a medical institution after earning their medical degree, and has successfully passed a level of competence via written or practical or oral examinations.

Since hair transplant surgery is not a part of the ABMS, there can not be any physician that is board certified as a hair transplant surgeon. This is mainly because there is no formal training or credentialing in hair transplant surgery. You read that correctly — there is no board certification in hair transplant surgery! There is no standard curriculum. There is no oversight or direct review of the quality of the work being done. Unfortunately, there is no ABMS sanctioned facility to enroll and learn hair transplant surgery. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a private practice hair transplant surgeon. Even ABMS board certified plastic surgeons do not receive training in hair transplant surgery as part of their formal training.
Read more

Does Closing a Strip Scar Cause the Crown to Be More Visible?

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

Does the crown stretch when closing a FUT scar?

Hi there – First off I would just like to thank you for providing this excellent resource. I just have two short questions related to FUT scars:

1) Firstly, I know you have answered this in the past with hairlines, however since the crown is within inches of the incision site above the prominent bone, does it slightly move/stretch downwards towards the incision site once the scar is closed?. For example… I have some thinning in my crown but im lucky in the fact that it doesnt dip low at the back so its not very visible unless looking from above my head. If I had a strip procedure would this thinning crown be more visible from the back because the skin has been pulled down to close the strip wound?

2) Secondly, I believe avoiding strenuous exercise is recommended for about a month after the procedure to avoid scar widening, but is general head tilting and looking downwards in the weeks after surgery ok in terms of putting stress on the scar?

I would be most grateful for any response you have for the above questions. Kind regards.

Strip scars placed in the true donor area in the back of the head should not impact the location or the size of the crown area. Strip surgery takes up laxity that is there at the time of the surgery. Bending your head should also not impact the crown area.

I have never been sure why we tell the patients not to lift heavy weights. If there is a pull from the muscles, it comes from the trapezius muscle, which inserts below the scar at the base of the skull. I still tell the patients not to lift heavy objects, but I am not certain there is any value to the advice.

Tags: hair transplant, scarring, scar, hairloss, hair loss