Surgical Camouflage of Pluggy Hair Transplants (with Photos)

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

This patient had 1414 grafts almost 12 years ago to camouflage the obvious grafts in his frontal hairline and in the process, bring down his hairline into its normal position. His old transplants were placed too high and looked too pluggy. This is a nice result and a good demonstration of the value of camouflage when used properly. The photo on the left is before I performed any transplants on him (note the plugs there on the close-up), and the photo on the right is over a decade later. The key to the camouflage was to create a feathering zone of one hair grafts irregularly placed and spaced apart in front of the plugs, then with two hair grafts placed closer together, the transition to the old plugs was so gentle that the plugs were hidden from view. The patient was thrilled with the results.

When we wrote the original articles on repairs for the medical journals, it was taken from experiences like this man had. Today, we can harvest hair from the big plugs (not shown in these photos) as well as use camouflage as we did here. When this repair was done in 1995, the unfortunate standard of care at the time was still the ‘plugs’ that produced the corn row deformities. Surgeons were trying to repair the rough work by putting even more large grafts in between the larger grafts, which only compounded the problem. Fortunately today, few of these pluggy procedures are done and much of what we published has become today’s standard of care for repairs. To see the original work we did on the subject and the publications, look at: NewHair.com – Repair (search).

Click the photos to enlarge.

Tags: hairloss, hair loss, hairtransplant, hair transplant, photos, repair, plugs

Female Hair Transplant and Shock Loss

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

I am a female planning to get a hair tranpslant and have heard that the trauma of the surgery can cause other hair to fall out. I was wondering if being on Propecia would help keep the hairs from shedding. And if so, do you need to be on Propecia for a certain number of months before it works (i.e. keeps hair from falling out)? Thanks!

Propecia (finasteride) is contraindicated in women who may become pregnant and inefficient in post-menopausal women. It probably will have no impact on pre-menopausal women. Although studies have shown significant reduction in the rate of shock loss in men who are on Propecia, it has not been studied for in women for that purpose and in theory should not work. Hair loss shock is not common in women after transplantation.

Tags: shockloss, shock loss, hairloss, hair loss, women, woman, female, hairtransplant, hair transplant

10 Days After Hair Transplant (with Photos)

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

This patient had 1461 grafts just 10 days before these photos were taken. There is only a small beard and no real problem hiding that he had hair transplants as I comb my hair foward. In this way there is a canopy covering the frontal hairline. As with any surgical procedure, there is some visible redness (the degree of which varies per person), but this will subside more in the coming days. So many men expect that the post-operative patient will show deforming holes in the head. Note that there are no wounds evident, just a beard.

Click the photos to enlarge.

Tags: hairloss, hair loss, hairtransplant, hair transplant, photos, after, post-procedure, post

Typical Donor Wound Scar (with Photo)

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

Can you show me a typical donor wound scar?

Here’s a photo of a typical donor wound scar after a single surgery in a person who heals normally. The scar measures 1mm (in the ruler, each line is 1/2mm). He came in for a second surgery this week and I am hoping that the scar from this week’s procedure will turn out as well today as it did before. The risk of significant scarring (greater than 3mm) is 5% for the first surgery, 10% for the second surgery, and higher still for a third surgery. Usually the combed hair in the back will cover most scars.

I apologize that the photo isn’t perfectly focused, but the scar still shows well here. Click to enlarge.

Tags: hairtransplant, hair transplant, donor, scar, wound, hairloss, hair loss, photo

Are There Factors in Determining Why A Transplant Might Not Grow?

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

Hi Dr. Rassman, I have seen postings on discussion boards from patients who have had transplants that did not grow. What are the factors in determing if transplanted hair will grow and is there any way of pretermining probability of growth?

A hair transplant will grow almost 100% of the time. When they do no,t the failure to grow can be segmented into:

  1. Patient causes: These are diseases like the various forms of autoimmune and scarring alopecias such as alopecia areata. These take many forms.
  2. Infection: If a person gets a bad infection in the recipient area, the grafts may not grow out.
  3. Technical issues at the surgical team level: This is a common point of failure in the inexperienced teams that try to do hair transplants and have not worked out the many nuances in the process. The grafts can be killed off simply by keeping them exposed to air, which causes drying. Poor graft handling therefore is the #1 cause. I have heard of doctors who accidentally used sterile water to keep the grafts wet instead of saline or Ringer’s solution that will kill of 100% of the grafts, but this is a freak occurrence.

What most people do not understand is that this is a team process and like any team process, the surgery is only as good as its weakest member. In training a good team, the surgeon must have a tight quality control process in place to be assured of consistency.

Tags: hairtransplant, hair transplant, hairloss, hair loss

I Have Less Hair Now Than Before My Hair Transplant 14 Months Ago

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

I had a Hair Transplant 14 months ago. There is no noticable growth. Infact, there is less hair than befpre the 2000+ grafts… all done at one time. Is there still a chance of it growing or is it over?

I would first wonder if your lost your native hair and suffered shock loss. That would be my first guess. If your doctor was sophisticated and experienced, there should be good growth evident in about 8 months. If there is really no growth, this is a set of questions you need to ask the doctor. A second opinion would have value.

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

Regulation for Wig / Hair Transplant Facilities

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

WigFrom Shakopee Valley News in Shakopee, Minnesota

“YOU’LL FLIP YOUR WIG: Rep. Frank Hornstein (D-Minneapolis) wants to create a new state bureaucracy to regulate “hair transplant facilities.” One of the purposes of investigating hair-weave artists is top make sure there is no “conduct which is likely to deceive, defraud, or harm the public.” (House File 1069) Maybe it’s time to bring back Ron Popeil’s spray-on baldness remover.”

I think what the author is trying to say, is that there are facilities/clinics/wig salesmen who pray on unsuspecting men. This is a consumer protection issue. These facilities may have deceived the public, which can result in a fraud that might harm them. The regulation of wig-makers may be at the root of the problem and although some hair transplant doctors may be also a focus of such legislation, I would like to believe that doctors would not be included in this group. There are laws that regulate what the doctor can and can not do. These laws exist in every state and these laws require the doctor to fully inform patients as to what can be done and what can’t be done with any particular treatment as well as alternatives to any suggested treatment (it is called ‘informed consent’).

I have been told horror stories by young men who respond to an ad in the newspaper (or TV) promising hair. Desperate for a solution to balding, the young, unsuspecting man goes into a wig facility and is sold some solution to his balding problem which is poorly defined. Before he knows it, he finds that the hair in the front of his hairline has been shaved off. The salesman says: “Don’t worry” and a wig is placed over the shaved area. There is no obligation to purchase a ‘system’, of course, but if the young man does not buy it, he must leave with a partly shaved head. The sale is easily made under such duress. This wig ‘system’ is attached with glue and it pulls out the hair the longer a person uses it. In effect such ‘systems’ accelerate the balding process and many wig salesmen understand that and make their money from the recurrent revenue produced by monthly adjustments to the systems and replacement systems. Sales are commission driven, so the sale is all important. The costs for the wig is a big business with wigs that sell for thousands of dollars. Everyone needs two wigs — one to use while one is being washed or repaired. I have been told that the cost for such hair systems run well over $10,000 over a five year period.

Could that be what this legislation is about?

Tags: wig, hairpiece, hairsystem, hair system, toupee, hairtransplant, hair transplant, law, legal, hairloss, hair loss

Should I Discontinue Using An Herbal Product On My Hair After Transplantation?

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

Hello Dr. I had a hair transplant in first week of december 06. Its about 3 months now and haven’t seen any growth. This is my second procedure (2200 grafts). My first one gave moderate results (1500 grafts).

I gave up on rogaine as it did more harm than good and I am currently using a herbal product to keep my preexisting hair and it works well.

Should I be concerned about using it on a transplanted area? I started using this after all my scabs were gone(15 days after surgery). I hope this would not interefere with growth of transplanted hair as I see only beneficial results out of it. My doc said it cannot possibly cause any harm as the transplanted hair bears the same identity as the ones in the back of my head.

Your response will be highly appreciated and thanks for your time.

I do not know what is in the herbal substance you are using, but I would generally agree with your doctor that it will not probably make a difference. It is my belief that most herbals do not impact hair growth. At 3 months, most people are just entering into the growth phase which will become evident over the 4-5th month. See Patient’s Guide — How Many Grafts Will I Need? for more.

Tags: hairtransplant, hair transplant, herbal, hairloss, hair loss, rogaine, minoxidil

Staph Dermatitis Infection After Hair Transplant

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

I am a 56 year old female who had a hair transplant 7 weeks ago. I developed a staph dermatitis infection and am on my 3rd round of antibiotics. Is it normal to feel a crawling sensation in the recipient area or is this related to the infection? I sprout new pimples on my scalp and have them drained by the dr. Are the pimples normal or is it related to the infection or something else? Is staph dermatitis hard to cure?

A staph infection can be very dangerous to the newly transplanted grafts. Your doctor probably had cultures done and knows the organism that is growing. Your doctor should also know what antibiotics will be effective for it. Speak with your doctor and ask him/her these questions. Pimples of pus are common in an infection, but with proper antibiotic treatment it should go away. Sometimes these pimples need to be opened and drained. Wet soaks will accomplish drainage in most patients as the skin softens from wet, warm compresses.

Tags: staph, infection, dermatitis, hairtransplant, hair transplant, hairloss, hair loss

Why Didn’t My Transplanted Grafts Take Root?

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


Originally I had the old plug type transplant, yrs later I got afollicular one to soften the look. I originally got 400 singles in front of it but because of my fine hair that wasnt thick enough. All of those grafts grew. I got a second batch of 400 and almost none of them took root. Can you explain how or why that may have happened? Now my hair line looks worse than ever because it looks like a stripe at my hair line. My doctor did not have an explanation.

Hair grafts grow! If they did not for some strange reason, your doctor should be able to give you an intelligent answer. Get a second opinion if your doctor does not level with you.

Tags: hairtransplant, hair transplant, hairloss, hair loss

I Want Amazing Transplant Results in One Session

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

Is it possible for me to receive a hair transplantation of approximately 3,300 follicles in only one session and finally getting the amazing result like patient LG in the photo section (hair line) of NHI website ? I am a class 4A Norwood.

Patient LGAn amazing result in one session is doable in some patients. There are many factors that lead to such results, including the hair texture and thickness of the hair shaft. Remember that “supply and demand” is important and your scalp must be flexible enough to handle these higher graft numbers. If your scalp has good laxity and you have a good hair density, you are a good candidate to get high numbers, which is needed to cover a large area. Hair characters including diameter, color, and waviness also play an important role in the final results. The best way to predict this is by visiting a hair doctor. If you’re in California, I’d suggest making an appointment with us and to come to an Open House event where you can see the results of such surgeries on many people and get a thorough evaluation.

Tags: hairtransplant, hair transplant, hairloss, hair loss

Aldactone and Shock Loss in Women

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

Hello. I am a 30 year old female and have been suffering from hair loss since my early teens. I FINALLY found a compassionate dermatologist who did a scalp biopsy and I was diagnosed with female patterned baldness. I have had a consultation at (name with-held) and I am concerned with Shock Loss. I am currently on Aldactone (prescribed by my dermatologist) and would like to know if this helps prevent shock loss as Propecia does and also what are the chances of shock loss in women.

We don’t know the answer to that, because the medication has never been studied for this purpose, to my knowledge. Hair transplants in women with female genetic hair loss have limited application if the hair around the sides and back of the head is diffusely involved in the process of miniaturization. Be sure that the goals are well defined and that the donor hair that is being used is healthy for if it is not, there may not be value in the surgery.

Tags: aldactone, hairtransplant, hair transplant, shock loss, shockloss, hairloss, hair loss, female, women, woman

Anaesthesia and Hair Transplantation

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

Hi Dr. Rassman. Which hair transplant surgeries can I have with local anaesthesia? I don’t want general asaestesia. Can I have hair transplantation without being knocked out? Thanks.

Yes, that is the only way I do it. It is done with local anesthesia (like a dentist does with your teeth). I can use some sedative or narcotic to make the day more pleasant. Most people find that the entire process is very easy. I had it done and it was a snap.

Tags: hairtransplant, hair transplant, anaesthesia

The “Baby” Hairs — 5 Months After Hair Transplant (with Photos)

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

Take a look at the very early growth in the first photo below, which reflects the first wave of growth following a hair transplant procedure of 2730 grafts. The new short hairs are easily covered by the hair from behind. When combed forward, the new hair blends with the old hair nicely. I’ve also included the before photo and a photo from 2 weeks after his procedure, just to be complete and so that you can get the full scope of what was done. Some of the short newly transplanted hairs have already fallen out and others that appear to be pointing the wrong way are actually about to fall out. Click the photos to enlarge.

5 months after procedure:

 

2 weeks after procedure:

 

Before procedure:

 

For an example of a past patient with similar results (but further along), please see radio host Steve Hartman‘s results. I’ve posted 3 photos of Steve below — the first photo is before the procedure, the middle photo is at the 5 month mark after his procedure, and the photo on the right is at around 14 months post procedure. I apologize that the angles are slightly different, but they illustrate the point that the above patient still is in the early stage and has a lot to look forward to. Click the photos to enlarge.

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