What’s the Average Hair Transplant Patient Age?

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

hey doc, i’m considering a hair transplant down the road. whats the average age of transplant patients ? I am in my early 50’s and have been a nw 6 since my thirties. I am trying to decide if there is any point in getting a hair transplant at my age. I would just be doing it for myself and not to impress anyone

22 years oldThe average age by my estimate is in the 40-50 year old range, but many young and older men will have hair transplants. I have done transplants on men as young as 22 (see photo of 22 year old patient at right) or old as 89 (see late 60s year old patient ZU). In the end you need to have a Master Plan for your hair loss. Most men decide on having a transplant not as a vanity issue or to impress others. It is mostly a personal issue about how it makes them feel and addressing something that has been bothersome to them for many years. I often hear regret from patients that they should have done it earlier than later on in life. It takes courage for a man to admit to themselves that they are vain, and to have a surgery to do something about it. There is a great deal of justified fear based upon the number of sleazy doctors in the field, but you need to do your research, for there are many good doctors as well.

Tags: hairtransplant, hair transplant, hairloss, hair loss, age

Realistic Expectations of a Transplanted Hairline

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

I am trying to find great hairline work. The pictures on your site can’t get me excited. What can I do to get to a realistic expectation and become comfortable?

For the readers that are not familiar, the photos that are being referenced are located here — New Hair Institute – Patient Photo Galleries.

You are looking for a perfect hairline. I would love to know what your problems are with the posted photos. If it is that the density is not what it originally was, it is possible that we did not try to get to the original density (most patients require more area to be transplanted so achieving the original density is not in the cards). Some patients have their own mind made up as to what they want and I almost always do what they want, not what I think is best. I am not super selective on the patients I show on the site, for if I were, I would not show so many patients and only show those who had their original densities restored. All of the posted patients were happy with their hairlines and they allowed us to show off their photos (even for those that do not allow their face to show). I try not to pick out just the best of the best — I want to be honest and give a clear idea of what is possible. If the patients were not happy, they wouldn’t sign the photo release to allow us to show off their hair.

The posted photos may give you an idea of how a natural hairline looks after hair transplant, but the pictures lose the impact of the difference in hair textures that people have. There are a subset of patients who I would challenge anyone to detect anything but a natural appearing, non-transplanted hairline (even to the experienced eye), and some of these patients routinely show up at our open house events. They come to challenge even the most discriminating prospective patients who attend. If it is feasible for you, you can attend one of our monthly open house events at our Los Angeles office. This will give you the chance to meet with some of our previous patients and will allow you to examine our results very closely. I strongly suggest you do this, because pictures just don’t tell the whole story. It is not unusual for us to have 10+ patients show up to demonstrate their results in our Los Angeles open house.

If you have any other questions I will be glad to answer them by email or in person. I look forward to meeting you soon.

Tags: hairtransplant, hair transplant, hairline, nhi, open house, event

Transplanting Hair Where Mole Was Removed?

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

Hi Dr. Rassman,

I have a mole that has been revealed as my hairline has receded and I am thinking about getting it removed. However, I may transplant hair into the area in a few years. Will hair be able to be transplanted into the area where the mole was removed?

Yes, you can transplant hair into the area where the mole was removed. You should monitor that area to see if there is a recurrence of a mole or any skin changes.

Tags: mole, hairtransplant, hair transplant

Hair Transplants in a Class 7 Blonde Patient (with Photos)

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

This is a patient who was transplanted in two sessions totaling 4500 grafts over a decade ago. He stopped by my office to say hello and show off his great results so many years later. His before pictures (I apologize for the quality, as they were before we used digital cameras) are shown as well as the pictures taken today. Essentially, all of the original hair is now gone (Propecia was not available at the time he had his original surgery) and 100% of the coverage you are seeing in the recent photos are the results of his hair transplant. The only hair that exists now apart from the transplants is the 3 inch high ridge of hair around the side and back of his head. In many ways, this is a worst case scenario because his donor supply was limited but even with that, he has coverage for the front (going back about 4-5 inches) and his hair naturally parts down the middle. He is active in life, surfing regularly.

He is 57 years old and he now has the look of a 35 year old from the front. He told me that this was the best thing he ever did, that is, before he got married to his beautiful wife 18 months ago. Note that the crown bald area is wider than it was 10 years ago, but because of his comb-back, the view from the front (the fellow he sees in the mirror every day) is a hairy fellow.

Click the photos to enlarge.

Before:

 

After (a decade later):

 

Tags: hairtransplant, hair transplant, blonde, blond, hairloss, hair loss, photo

I Had a Hair Transplant 4 Months Ago and See Nothing

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

i had my hair transplant done 4 months ago and I do not see any results.

how long before i see my new hair. do you think i’ll see a big diffrents by next month?

thanks doc

It can takes 4-7 months for the hair to grow after a hair transplant. You have to be patient. Most people will see results by the 6th month or so.

I wonder why you thought I would be a better source for this information than your doctor? It is important that you take full advantage of your doctor/patient relationship to answer these questions. If you don’t have a good relationship, then get another doctor, one who is free to talk and answer your questions.

Tags: hairtransplant, hair transplant, hairloss, hair loss

My Old Plugs Are Going to Be Visible Soon!

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

I’m 47 years old and had several “plug” transplant sessions and a few single hair sessions. My first session was in 1990. I was on Lexapro for 4 months (Feb 06 – May 06) and I lost a lot of hair. That hair has not grown back and I’m losing additional hair (sides and back)! Soon my “plugs” will be very noticeable and I’m very upset! I’m currently using Nizoral, Avodart, laser comb and 2% Rogaine for the last 6 months.

Will the hair I lost from the Lexapro grow back?

There is no way to tell if the hair will grow back. I suspect you have a component of genetic male pattern hair loss and at your age, you will lose more hair despite all your preventative measures. You many need further hair transplant surgery to disguise the plugs (granted that you enough donor supply left), or you can have an FUE procedure to core out and thin the plugs. You need a real expert to give you an opinion. For more information on repairing old hair plugs, please see:

Tags: hairtransplant, hair transplant, fue, plugs, hair plugs, avodart, rogaine, lexapro

Size of Incisions Contribute to Hair Transplant Failure?

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

Dr. Rassman,

For people with very fine native hair, is it important that the incisions for the recipient site be made very small to minimize shock fallout. I had a procedure about 1 year ago and lost much native hair due to shock fallout even though I was on Propecia for several years beforehand. Obviously I am very disappointed with my results (less hair now than prior to surgery) and am wondering if the size of the incisions caused this unfortunate outcome. Thanks for any insight you can provide.

I cannot tell you why your hair transplant failed, but the size of the incisions should not have a significant impact on hair growth. The size of the incision is related to the size of the grafts (not the size of the hair). Just because your hair is fine does not necessarily mean that the size the graft will be small (needing a smaller incision). Get a second opinion. Hair transplantation works.

Tags: hairtransplant, hair transplant, incision, surgery, procedure

More Important to Your Doctor — Patient’s Welfare or Patient’s Money?

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

This is a follow-up of the blog entry from the other day, What Happens When a Doctor’s Car and Mansion Payment Is More Important Than You?

First, lets get to the photos. The photo on the left was taken this week in my office. The photo on the right was taken 18 months ago, also in my office (forgive the quality — it is scanned from a Polaroid). Click the photos to enlarge.

 

The above photos are of a man in his mid-50s. Note that the progression of his hair loss has been very significant. Some of the medications he uses may be promoting hair loss rather than saving his hair. He tried Propecia (finasteride), but he had wiped out his sexual drive from it. He went to another doctor for a second opinion and then came to see me with that second opinion. He was a good note taker and is fastidious about medical records. His father had prostate cancer. The doctor who offered him the second opinion suggested that he have 3000 graft placed all over this head. He would then have a “full head of hair”. Even though he saw a doctor, it was the salesman inside the doctor who was talking. That has to be the worst recommendation he can get, because shock hair loss is almost a certainty and this patient would be like the fellow I showed you the other day. To make matters worse, his donor supply was low so that the probability of getting 3000 grafts would have failed.

This patient did the right thing — he got a second opinion. In this case, he checked up on me. Transplanting the corners and making a hairline is an option, but he should stay away from transplanting into the thinning area. Because of the steroids he is taking, I advised him to stop some of the medications and try to take a smaller dose of Propecia, for if he undergoes a hair transplant (or even if he does not) and would want to see his hair loss stop first. Propecia may be the only good option for him and worth a try again at half of the dose. With the family history of prostate problems, Propecia is a good medication to reduce this risk. The other doctor only talked about selling him 3000 grafts and the benefits of such a procedure for him. Why am I alarmed? Simply, this man is losing hair in ‘gangbusters’ and as he is in his mid-50s — that is not supposed to happen. He is clearly an exception to the rule that men over 50 don’t usually go through accelerated balding. With low densities, any doctor who put hair into his crown will deplete his donor supply. He is also losing frontal hair now, so what is the Master Plan when he runs out of donor supply and money?

I showed him photos of his hair, and explained how the miniaturization of the hair was throughout the top and crown and if this area was transplanted, the hair he would lose would be more than any benefits he would have if he was transplanted. I am personally appalled at the desire of a doctor to try to push him into getting thousands of grafts and to make matters worse, he was never told that he may accelerate his crown loss with a transplant. Patients have every right to know such potential side effects and the probability of that happening. Doctors are legally obliged to inform patients of such risks. My only place to vent this frustration is on this site. I don’t mean to scare you and I don’t want you to think that every doctor out there is trying to screw you. There are many good and honorable doctors that do hair transplants, but again and again, I tell patients, Let the Buyer Beware.

Tags: hairloss, hair loss, finasteride, propecia, cancer, prostate, photo, steroid, steroids

Numbness in Non-Transplanted Area 4 Months Post-Op

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

Hello,

Im 24 years old and have been taking Propecia 6 months prior to my surgery and have been doing so ever since. In which now I am 4 months post op. I had 1500 grafts done, 500 in each temple and 500 in the crown.

I still have some mild numbness since the surgery directly on the top of my head in the non recipient sites. This area was very dense and now is very thin and I believe it is due to the numbness. Can you tell me generally when the numbness starts to subside. As well will that density come back or is it safe to say my hair will continue to be this thin?

Thank you.

It sounds like you have two different things happening. At 24 years old, if you thinned after surgery, you probably experienced ‘shock loss’. Do you know if the hair you lost was miniaturized? Miniaturized hairs are the ones at risk for shock loss. Propecia has wiped out most of the hair loss caused by the surgery that we experienced prior to Propecia’s availability on the market, but there is (of course) no guarantee that it will wipe out all of the risks of shock loss.

As for the numbing you’re feeling — all numbness should be gone by now. You need to go back to your doctor and ask these questions or get a second opinion if your doctor does not give you satisfactory answers.

Tags: numb, numbness, hairtransplant, hair transplant, hairloss, hair loss, shock loss, shockloss, propecia, finasteride

Death Rate of Grafts Kept Out of the Body for Too Long

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

I was recently told that if the grafts from a hair transplant were out of the body for more than 4 hours, they died. Is that true?

This was studied in the past. Dr. Bob Limmer did this study and kept one group of grafts out of the body for up to 8 hours (studied them each hour for growth), and then studied the graft survival after 8 hours on another group, then 24 hours, then 48 hours, and finally 72 hours later. There was no difference in graft survival in the first 8 hours, but after that, the death rate came out at about 1% per hour for grafts out of the body above 8 hours. I hope that this answers your question.

Tags: hairtransplant, hair transplant, graft, death, hairloss, hair loss

Hair Transplant in Crown a Year Ago — I Don’t See Anything New

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

I am 37 and had a transplant done to try and fill in a thinning area on my crown. It does not seem to have done anything and it was about a year ago. Have you heard of this? Is there anything I can do?

You should certainly speak with the doctor who did it and ask that doctor this very question you posed to me. The crown generally takes a great deal of hair grafting to see significant benefits. If you did not lose your original native hair with the transplant and had a significant number of grafts, then maybe the transplants failed (quite unusual in the hands of a good doctor).

Tags: hairtransplant, hair transplant, crown, failure, hairloss, hair loss

How Long For a New Hair to Emerge Through the Scalp?

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

Under normal circumstances once a hair has been through the resting stage and fallen out, how long does it take for a new hair to emerge through the scalp. Thanks

You should be aware of the various hair cycles, as follows:

  1. Growth phase (Anagen phase) — lasts anywhere from 2-6 years. This is the phase where your hair is actively growing at approximately 10cm per year. 85% of hair is at this phase at any given time.
  2. Transitional phase (Catagen phase) — lasts about 2 weeks. This is the phase where the hair follicle shrinks and prepares to enter the resting phase.
  3. Resting phase (Telogen phase) — lasts about 1-6 months. This is the phase where hair does not grow but stays attached to the follicle. Some hairs are shed at this phase, but at the end the hair follicle re-enters the growth phase to start the cycle over again. 10-15% of hairs are at this phase at any given time.

Freshly transplanted hair will emerge from the scalp anytime within 6 months of the time that it is transplanted. In about 5% of patients, hair growth is immediate, but largely the hair takes about 3-5 months to start growing at about 1/2 inch per month.

Tags: hair cycle, hairloss, hair loss, hair growth, anagen, catagen, telogen, hairtransplant, hair transplant

Transplanting Hair in the Correct Direction

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

doctor my question to u is regarding direction.while transplanting grafts into the balding areas of the scalp how do u determine the direction in which it will grow, the depth or angle? the hair is trimmed so short before a surgery is there a sureshot way to determine the direction of hair will grow after a transplant??

The direction the hair will grow in is determined by the surgeon as he/she puts in the recipient sites. The direction and angle of the instrument in making the ‘hole’ is the direction that the hair will grow in. Almost 100% of the hairs between the parts point forward. At the part, the hair changes angle and the surgeon’s skills here are most important. I have seen far too many patients have a ‘radial’ direction to the hair where the hair is directed more like the spokes of a bicycle wheel. For those patients with straight hair, any faulty placement of the hair direction will be magnified.

Take a look at an article I co-authored back in 2002, The Art of Repair in Surgical Hair Restoration. In the images shown in this article, you can see some of the wrong directions and how to do the work correctly. Particularly, take a look at figure 3 from the article which shows the wrong direction (below for convenience) and the right direction in a schematic form:

Tags: hairtransplant, hair transplant, direction, hairloss, hair loss

The Beard After a Hair Transplant

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

Hey Dr.,

I’m coming in for about 1000 grafts next month. I do have a slight concern, however. I’ve seen pictures of this “beard” effect, in which you can noticably tell there is a dark area where there has been transplants. How long is the beard usually visible? Would it be as drastic with just about 1000 grafts in the front?

Thanks.

The beard effect you talk about is from the short transplanted hairs that are visible immediately after the hair transplant. It usually lasts one to four weeks before it sheds. It is not readily detectable if you have other hair to cover it, but if you are a class 6 (completely bald) obviously you cannot hide it. I would then suggest that you clip it short or let your facial hair grow out as this will detract from your head viewing. If you already have facial hair (a beard or mustache) shave it off for the shock value and it’ll draw less attention to the top of the head. This works very well.

Tags: hairtransplant, hair transplant, hairloss, hair loss, beard

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