FUE Donor Exchange?

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

Dear Dr.

This is the scenario, I am 28 male, balding on the front 1/3 of my head, I am currently using Proscar and Rogaine. I am most likely going to lose the rest of my hair and be a worst case hair situation one day if I don’t act on it now. So here are my questions:

1. Would you recommend I do FUT or FUE hair transplant as I want to reserve the right to shave my head of use the clippers on 0 blade if things don’t work out with the way I want it to look?
2. If you said FUE, would you do donor exchange which DR. [name removed] recommends in order to not deplete the donor hair and less visable scarring?
3. In the FUE scenario, how do you find a doctor who is going to give you the best price and the best job? Is it ok if a doctor is in 3 surgeries per day or would you reommend a doctor who is just working on 1 patient?

I will answer your questions in the order you asked them:

  1. FUE will give you what you want if you eventually want to shave your head.
  2. In my opinion, replacing hair from the body into the FUE donor sites in the back of the scalp (“donor exchange”) is crazy and I doubt that there is much proof that this technique results in anything worthwhile. Why would you consider being a guinea pig and paying for that privilege?
  3. This is a Buyer Beware market. Too many unsubstantiated claims are made and the search I performed on the internet to research your question. I found a site which had a blend of famous, credible doctors mixed in with the scum of this business. One of the ‘doctors’ on the site I just referred to, is not even a doctor (I previously looked into his credentials). FUE can be done in one surgery (our group did as many as 2600 in a single patient in a single session) or it can be done multiple day surgeries. Just because a doctor does these procedures, this does not mean that the FUE will produce viable hair. You won’t know the results for 8 months and by that time, the money you paid will clear the doctor’s bank account.

Sounds like human experimentation, metaphorically similar to something Dr. Josef Mengele did. This is an ethical and medical licensing issue for the doctor if you were to have this procedure and were not fully informed about the ‘experimental’ nature of this process. Even with adequate informed consent, the legality of performing such ‘experimental’ surgery without proper institutional review and approval, is ingrained in our legal system.

Tags: donor exchange, donor, hairloss, hair loss, hairtransplant, hair transplant, fue, follicularunitextraction, follicular unit extraction

How Can I Convince My Transplant Doctor to Refund My Money?, Part 2

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

This is a follow-up to a post from a month ago, How Can I Convince My Transplant Doctor to Refund My Money?

Hi i wrote to you in October about my bad hair transplant and i would like more advise from you because everyday i suffer from it. its making me hate my life ever since i had the procedure done. Here is the message that i wrote to you and you responded.

[note: see link above for full message and reply]

I would like to also add that when i tried to speak to the doctor he did not let me finish what i was saying. it was like he already knew what was on my heart and on purpose shut me up. Im not a cruel person so i did not argue back i just listened to all his rude remarks and hung up when he was done making me feel stupid. Every day i look at my hairline and it just hurts me deeply. I have spent over $7.000 and when i look at before and after pictures i still look the same. When i lift my hair up i can see that my left side looks like it has plugs and the right side is noticibly higher then the left. It has been 7 months and i still look like NW class 2 hairloss. im just tired of feeling depressed and feeling stupid. I dont know what to do anymore. im so frustrated with this. Im tired of waking up and falling asleep with the same though on my head. Im tired of seeing all the people in my college class with much better natural hairlines and feeling stupid that even after spending over $7000 i look worse then them. If theres anything you can do please help me

Now that you have waited the 7 months I suggested the last time you wrote to me, I would suggest that you get another opinion. If you can see me in Los Angeles or San Jose California, I will be able to render you an opinion and even offer to help you once I know what the problem is (in medical terms at the least so that I can frame the process). This does not seem like a comfortable problem you have, not just because of the lost money, but your perception of poor work. Call my office and let’s start off with a conversation. You can reach me at 800-NEW-HAIR (or 310-553-9113) and ask to speak with me (Dr. Rassman). Please reference this blog posting when you call. My heart goes out to you and I would like to see if I can help.

Tags: doctor, refund, hairtransplant, hair transplant, opinion, hairloss, hair loss

Transplanting Asian Hair (with Photos)

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

I am Asian. I lost all of the hair in the front. I understand that black hair and white skin (my situation) is more difficult to get good results. True or false?

True. Asian hair, which is often straight and black, is contrasted with a light skin color making the hair transplant less forgiving if it is done improperly. So while it is more difficult to get great results, it is not impossible. We have transplanted hair for many Asian patients over the years.

Here’s an example of one Vietnamese patient that has a Norwood class 6 pattern of hair loss. The photo on the left is before hair transplantation, the photo on the right is after 1 procedure of 1,852 grafts. Please click to enlarge.



Tags: hairloss, hair loss, hairtransplant, hair transplant, asian, asian, vietnamese, vietnam

Which is Better — FUE or Strip Harvesting of Follicular Units?

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

Does follicular unit extraction (individual follicles are removed from the back of the head creating a tiny round punctate scar) and FUT (follicular unit Transplant – where by a strip of hair is removed creating a line scar) produce better grafts? In your experience, what procedure out of these two causes the least amount of damage and would better serve the interest of the patient at the end of the procedure?

Both techniques should give you real follicular units, but often the FUE in many doctor’s hands do not give real follicular units because they are transplanted as they are taken out (complete follicular units, more than one follicular unit, or parts of a follicular unit). Strip harvesting is better in most people, simply because the strip is highly efficient and very controlled in most doctors’ hands to prevent damage. FUE grafts are not always of the same quality as strip follicular units. The reason for that depends upon the particular patient and the particular method used for the extraction. In many patients, the grafts are extracted and devoid of fat and supporting infrastructure (very skinny grafts), which makes them more vulnerable to the environment and more easily damaged when transplanted.

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

When Is a Good Time for a Hair Transplant?

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

I was just wondering when you can get a hair transplant. I’m 20 years old, male. My hair is falling and I’ve already started the propecia. I know that the propecia isn’t going to get me to where I am before so I just want to get a transplant. I don’t want to stick with where I’m at. There are no bald spots….just the scalp is visible all over when my hair is wet. My question is this…..can I get a hair transplant already or do i have to have a bald spot? Thanks a whole bunch.

You should be on Propecia (finasteride 1mg) for at least a year. You need to get your hair mapped out for miniaturization and follow the benefits or lack of benefits of the drug. Either you will:

  1. Get better with less miniaturization after a year
  2. Slow or stop the hair loss
  3. Get worse

Based upon the response to the miniaturization mapping, you need to develop a Master Plan with your doctor which will define the various paths open to you, including the timing of things you can do. Some men of your age will slow, stop, or reverse the hair loss on Propecia, while others may continue to bald at their own accelerated rate indicative of strong genetic and hormonal influences. There is no magic about hair transplants and if you are going to get really bald, then great care in how transplants are used is critical to being sure that you will always look normal, never trading short term benefits for your long term appearance. The Master Plan will lay out the transplant option and put it into perspective with projections on your hair loss which might be easy for a doctor with a great deal of experience in doing such predictions. 20 year old men are often less objective and less able to stand back and look at the long term hair loss process when they have short term needs (girls, self confidence), but some doctors see the money in it and may be willing to take your money to allow you to focus on short term agenda issues. That is in no man’s best interest. If you are unfortunate and have a very rapid hair loss process going on that is not benefited from Propecia, hair transplants could be the worst thing you could do right now. Please remember the following philosophy: A Good Decision Today is a Good Decision Tomorrow. Get a caring doctor who works with you on that Master Plan I discussed. I have done a few hair transplants in very young men (early 20s) but I am careful that I know what is happening to them and I learn a great deal about them as fellow human being before embarking on such a path.

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

I Have Very Patchy Facial Hair (with Photo)

/by William Rassman, M.D./7 /, ,

I’ve got some horrific facial hair coverage. From the jawline up it’s just atrocious, very thin coverage of hair, and it’s very patchy. however from the jawline down, I’ve always thought I had really nice thick coverage. Not that I’m really thrilled about it, I’m not too fond of the “amish beard” look. Is there any way to fix patchyness in facial hair? And what would cause this to happen? I didn’t have any injuries to this area as a child (no scarring or burns or anything that i remember that might prevent hair from growing there). I have attached a photo which you may use on your site. I’m 25 years old. Thanks

Some people have uneven facial hair distribution and others are delayed in their beard growth, which may develop well into their 30s with more uniformity. You should wait and see what grows out as your beard matures.

Alternatively, you may consider transplanting hair from your head to the beard area, assuming the caliber of the hair is similar (it must be close to the same texture). If it is not, then you might have two types of hair which may be obvious and another type of problem. Even though beard to beard transplants would work, I would not recommend this approach, because it would thin out the beard you have in other areas (where you are happy with it) — unless you take the hair from below the chin where it is not easy to see. This may be a bit extreme and costly, but it would work beautifully. Although the transplantation may be an option, I actually think that this may be overkill and would ask you to wait until you fully grow out your beard. If it continues into your 30s and you still want to do it, then go for it. I will take you on as a patient.

Here’s the photo that the email included (with permission to post it here):


Tags: facial hair, hairloss, hair loss, bald spot, baldspot, beard, neck

16 Days Post-Procedure, I Still Have Scabs

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

Hello,
I am a 34 year old male and it’s been 16 days since my Hair Transplant of 1200 grafts. I still have scabs. I have been very gentle with washing, but am currently allowing the full pressure of the shower head. I have not scrubbed my scalp the way I normally would prior to surgery. Today, I lightly rubbed and picked a scab with the hair attached. It came off pretty easily. Was this the graft? Did I lose the future hair?

Can I start scrubbing my scalp at this point? My doctor recommended waiting 1 more week (3 weeks total) before washing and combing my hair as I did prior to surgery. What is your recommendation? And did I lose my hair graft? I am eager to get back to normal life. Thank you for any help.

Patients may generate scabs after surgery. It is best to wash them off before they get ‘rooted’. When they are not washed off immediately, they may last for days. I have even seen patients who do not wash well and have their scabs last for weeks. Pulling off scabs during washing and styling is one of the most common causes of losing a graft after transplant, although I would doubt that it would occur 16 days out. We did a careful study to determine when the vulnerability of graft loss ends and we found out that the existence of scabs parallels that risk. Study shows that pulling grafts can remove the whole graft any time during the first 10 days, at which time the scabs usually fall off with reasonably vigorous washing.

When fully healed, the follicle becomes part of the recipient skin and will keep its ability to generate new hair. You are well beyond day 10 and it is unlikely that you will lose your graft at this point in time. Let shampoo stay on your wet hair for 10 minutes or so, then rub the scabs gently with your fingers and the scabs will fall off.

Tags: scab, hairtransplant, hair transplant, aftercare

60+ Year Old Female — Hair Transplant Possibility?

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

I’m a 66 year old female taking thyroid and blood pressure pills for an underactive thyroid and high blood pressure. Would having hair transplantation be successful at this age? How much would it cost? My hair has become thin and brittle, as well sparse. Please let me know what is the possibility of a successful transplant without complications.

To answer the question, I would want to understand the quality of your donor area and the degree of miniaturization you have in the hair of that permanent zone. Then I would want to know the extent of the hair loss and the size of the area that you want to treat. I would want to map out your scalp for miniaturization as I would need to know that information in order to ascertain if you will be helped or hurt by a hair transplant. Evaluating women for hair transplants is a real art combined with science. I met a doctor at the recent annual International Society of Hair Restoration Surgeons meeting that told me that their medical group did surgery on better than 95% of women who came to them. I would suspect that the doctor has terrible results and many unhappy patients. Get a good doctor who knows about this and get yourself evaluated properly.

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

Cyst Removal on Head Causing Female Hair Loss?

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

i have been on the depo shot for about a year now and have noticed that my hair on the top of my head is thinning. now i didnt notice this until about august i think it was after i had a cyst removed from my head. it is by the area where it was removed but all they did to remove it was make an incision and it was tough coming out so they had to pull and dig a little. my question is could that removal of that cyst have caused this and in either case, will it grow back?

Any procedure in the scalp may trigger hair loss at the surgical site. Two main factors may cause this local hair loss:

  1. Shock loss: If you are predisposed to balding, you may have already had miniaturization to some degree and the surgery on the scalp may have only facilitated the process of hair loss. This phenomenon is called shock loss, and it may or may not be reversible. It varies per person.
  2. Undermining the edges of incision: In order to remove a mass or cyst from the scalp or sometimes to reduce the tension of the skin edges, the surgeon may cut some of the hair follicles. Dissection of hair usually results in permanent baldness in the affected area. This baldness in a scarred area is similar to the hair loss that patients get after a craniotomy or scalp trauma.

My suggestion is to wait it out for 6 months. If the bald area doesn’t grow hair during this period, the baldness may be permanent. At that point, if the location of the scar is noticeable, you may want to see a hair transplant surgeon. The treatment options for this condition will be either to primarily remove it if the scar is small enough, or to use hair transplant to fill the bald area if it is too large.

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

Can the Triple-Flap Procedure Give Me a Full Head of Hair?

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

Hi Dr. Rassman,

Can someone who is completely bald (everywhere, except the very back and sides) have a full head of hair like that of a teenager by the triple-flap procedure?

Is there any procedure or combined procedures to give a completely bald person that final result?

Best regards

There was an article in the news last week about this very procedure, which I am assuming is what prompted your inquiry.

The triple-flap is a corrective procedure, generally used to repair patients where slot deformities were created by scalp reduction scars (surgeries that tried to remove the bald spot). This article seems to be misleading, because it does seem to make clear enough that the triple-flap procedure should only be used to repair deformities of the scalp. If there are defects in the scalp that are not the results of multiple scalp reduction surgeries (like a burn), then many of these people need balloon expanders to shift large areas of the scalp. In any event, this is a very specialized field and something that I can not comment without examining you. Please send me photos (you may cover your face) and I will evaluate what you are talking about.

Tags: hairloss, hair loss, flap, triple-flap, triple flap, tripleflap, corrective, hairtransplant, hair transplant

Will Propecia Only Prevent Shock Loss in Younger Men?

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

Dr. Rassman,

You frequently mention the safeguard of taking Propecia to prevent shock loss. You also mention how shock loss is more frequent in younger men and so I’m left with the impression that Propecia will only help young men prevent shock loss. I’m 36. I seem to have stabilized my hair loss with propecia. If I’m a NW 3 and have been on propecia for 15 months, what are my chances of shock loss? Also, if I’m going for a mature hairline, how many grafts are needed for a typical NW3?

Thank you

I believe that Propecia can and does prevent shock loss in anyone having a hair transplant at any age (although nothing is 100%). The young man is most vulnerable to this complication. At your age, your chances of developing shock loss are slim.

Tags: shock loss, shockloss, hairtransplant, hair transplant, propecia, finasteride

Hair Transplant Did Not Grow After a Year!

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

Dear sir,
I underwent hair restoration surgery last year in the month of Octobar. All the transplanted hair fell and i didn’t get them back.what could be wrong? doctor not skilled enough to do it or what,Is it possible to redo surgery?

When the entire transplant fails, then it is possible that something major went wrong at the time of the surgery. This could be a disastrous mistake that killed the grafts or even an unskilled surgical team. Was the team skilled? Did you check out the doctors first? Did you see patients of theirs? If you decide to redo it, be sure that you have these questions answered… or do some more research and find a different doctor.

For more on what could go wrong during a hair transplant procedure, please see Things That Can Go Wrong in Hair Transplant Surgery.

Tags: hairtransplant, hair transplant, problem, failure

Growing a Handlebar Moustache

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

I have a decent moustache. A little on the thin side but decent. I have been letting it grow out for 5 years and I wax it. I love handlebar moustaches and I want a nice thick one instead. I have been trying to do research online but don’t see lots of information out there. I don’t know if anyone really near me does it or not. The phone pages only list baldness help. My hair on my head is thin but I keep it buzz cut anyway. Remember the movie Tombstone? I want a ‘stache more like Kurt Russells and mine is really alot like Val Kilmers. Any suggestions? I guess I don’t know anything about this so I’m unsure of who to go to for the procedure and I don’t want to chance losing anything that I have.

Thank you.

TombstoneA hair transplant is an ideal procedure for scars on the moustache area, but in your case, you already have a moustache and just want to make it thicker. If the problem with your moustache is the density of hair, more hair could be added with hair transplantation, but it would be scalp hair. We can not create thicker hair shafts, but if you have thin mustache hair that is about the same diameter as your scalp hair, then this might work for you. Hair densities on the scalp are probably at least twice the density of moustache or beard hair. A hair transplant simply moves hair from one area to another and as such, it should be relatively easy to double the density of your mustache hair. The anatomy and alignment of hair of the moustache is different than that of a traditional scalp hair transplant. If you decided to do this, you need to be seen by an experienced hair transplant surgeon and only then you will know if you are a good candidate for this procedure.

Tags: moustache, mustache, handlebar, hairtransplant, hair transplant

Hair Transplant Surgery by a Non-Licensed Physician

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

I just saw a person that had a hair transplant by a man claiming to be a doctor (who actually wasn’t). This fake doc opened up a practice for doing hair transplants, and I decided to write a brief note here to hopefully serve as an important reminder about verifying your doctor’s credentials.

So what does one do to verify if the person who claims to be a doctor is really a doctor? It may sound ridiculous, but you could ask to see his/her state identification (like a driver’s license, for example) to get the correct spelling of the first/last name and then look the physician up at the state medical board database. For California, check here — for other states in the US, I found this Medical Board Directory, and if you can’t find what you’re looking for in there, I’m sure a Google search will turn up results by state/country/region. Try using the keywords “medical board” followed by your state/country/etc. Granted, fake state identification might be relatively easy to get, so maybe then you need to get his/her licenses to practice medicine and their narcotic number, both of which are harder to falsify.

The particular phony doctor that prompted this blog entry had rented another doctor’s office to give himself some credibility and had a line-up of patients for surgery. I won’t get into how wrong it was for the doctor to have rented him the office, but what was particularly significant to me is knowing what would have happened if something went wrong with a surgery. One of the most common complications I see is a fainting spell brought on when the Vagus nerve is stimulated from the excitement of the procedure, slowing the heart down to possible unsafe levels. When the heart slows, there is often a temporary drop in blood pressure, but if this very simple process is not addressed quickly and the patient had atherosclerosis of blood vessels to the brain or heart, a simple drop in blood pressure can lead to or cause a stroke or a heart attack. This complication is easily prevented by lying the patient back with the head down and the feet elevated. In a few minutes of careful observation with the patient in this position, the heart rate usually goes back to normal on its own. If this is not done, what may have been simply practicing medicine without a license might turn into some murder prosecution if the patient died.

Tags: doctor, training, hairloss, hair loss, hairtransplant, hair transplant, physician, surgery, procedure

Eyelash Transplants in the News

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

Dr. Rassman, It was great seeing you at the ISHRS conference. In Los Angeles last week, I demonstrated my ‘follicle-pairing’ technique for eyelash transplantation for an international group of physicians and journalists. As such, you might be receiving some questions regarding this ‘hot topic.’ Here are some of the relevant links to cosmetic and reconstructive eyelash transplantation procedures:

ABC News – Video

Reuters – Eyelash transplants set to sweep nip tuck world

Before and After photos of eyelash transplants can be found at https://www.eyelash-transplant.com

There has been great interest from recovered trichotillomania patients as well as those seeking the procedure for cosmetic enhancement. Please let me know if you would like me to provide any additional information on the procedure for your readers.

Talk to you soon,
Alan

Alan J. Bauman, MD

Eyelash transplants have risks associated with them and that has kept me from doing them without clear medical documentation of those risks. Hair direction and rotation are difficult to control with 100% precision in an eyelash transplant. My concerns are that the hair may ingrow and folliculitis of these grafts could cause various eye problems. I have seen a number of eyelash transplants and had one doctor try to build a practice doing them in my office (an ophthalmologist using my staff and facilities). I was less than impressed with the limited results I viewed, although I did supervise the actual placement of the grafts into their respective recipient sites. I would be interested in following Dr. Bauman’s results. I am sure he will keep me in the loop as time goes by. I will certainly followup any patient that has an eyelash transplant. The field is exciting and just emerging, so I am always cautious as I follow such new applications.

Tags: eyelash transplant, eyelash, hairtransplant, hair transplant, hairloss, hair loss, bauman