My Transplanted Areas Have Gotten Very Thin

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

i am a 32 year old male who has had 2 transplant surgeries that have been very successful. i have recently noticed the tranplanted areas have thinned quite a bit all within about a weeks time. could this be due to stress? i thought transplanted hair always remained. is it possible for the new growth to be affected by dht?
thank you

Something is wrong here. Transplanted hair does not usually fall out, even with stress. If you still have native hair in the area where you are reporting the loss and the hair was taken from the true donor rim (not above or below it), you most probably are losing the hair around the transplants. If that is the case, see a good doctor, get your hair mapped out for miniaturization and then you will know for sure what is happening to you. Propecia may stop the loss. The only reasonable explanation if you are really losing your transplanted hair is that the donor hair will be reacting the same way and this diagnosis will be very evident from mapping out your hair for miniaturization in the donor area (from where the hair was originally taken). If you’d like to see me in my Los Angeles office, please call 800-NEW-HAIR to setup a free consultation (and please reference this post when calling).

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

Do Transplant Yields Vary Per Physician?

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

Dr. Rassman:
I’m a 32 y/o physician and have had a high temporal hairline for as long as I can remember. Unfortunately, over the course of the last few years it has gotten higher. I’m thinking about doing something about it but have concerns about transplantation. My concenrs include the durability of transplantation and the potential need for more and more procedures as time goes on. I also wonder about the variability in outcomes from physician to physician, even in your group. Do you keep track of graft yield/take statistics within your group, do you know who the best is as far as the above is concerned, and do you share this information? After deciding on proceeding with transplantation, can one ask that you specifically be the one to do it and, if so, do you charge more? Thanks.

Wow, that would require a long dissertation to answer it all. Yes, there are differences between medical groups in the survival of grafts and the yield of hair as it relates to different procedures. As you may know, there are many techniques being used today. The golden standard is Follicular Unit Transplantation, a process which we pioneered. See Follicular Transplantation: Patient Evaluation and Surgical Planning? and The Aesthetics of Follicular Transplantation for more.

Hair transplants, once grown out, are quite durable and they should last your lifetime. The issue you should be concerned about is the progressive nature of hair loss in the balding man. Propecia (finasteride 1mg) is a good way to address this problem and in most men with a good Master Plan, they (in conjunction with a good doctor) should be able to define what will happen to your hair situation over time. Good miniaturization studies are critical to the development of a Master Plan for hair loss and treatment.

The average clinical doctor does not keep records on graft survival, but the different doctors have learned over time that they must have graft survival if they are to survive in the competitive marketplace. So what they have done is modify what they can do effectively. Some doctors do not do Follicular Unit Transplants (FUT) and instead have developed modifications of this technique so that their survival will be high. But, in my opinion, the FUT standard is the Golden Standard and has been so since the day we first published the article on it 9 years ago. The reason that it is the golden standard is simply, it produces the best and most natural results possible.

Pricing does vary between medical groups and even within my medical group by doctor (my price being higher than the other doctor because of availability issues). I suspect that the quality of work in any one medical group should be consistent with doctors in that medical group. Dr. Pak, for example, does as fine work as I do as he uses the same staff and the exact same techniques. As you should realize, the crux of the quality of the work you get is tied to the staff as much as the medical group, something we proudly show off at our monthly open house events, where our patients come to meet with prospective patients.

For further reading, here are some past blog posts that I’d recommend:

Tags: hairloss, hair loss, hairtransplant, hair transplant, doctor, yield

Slow Progress After Hair Transplant 6 Months Ago

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

Dear Doc

Thanks alot for this blog site. I had a transplanting surgery of about 600 to 700 gratfs towards the end of April this year.

Now I am a bit worried, I must say that I started seeing new hair growing, but its not as dense as I supposed it would be. I still feel itching tendencies almost daily and sometimes I even get pimples. I have noticed also that some of my hair that was there before the op had fallen gradually, is that normal? I am really getting worried, as against my expectations of getting better, the progress is slow.

Is this common? Thanks

I always tell my patients that you have to wait out a full 8 months before judging the results of a hair transplant. You are now approaching 6 months and should soon be starting to see the effects of the hair transplant. The hair which may have broken through the skin may not have any length to it at 6 months, so do not panic.

Take a look at Steve Hartman’s photos and see his results from month to month. His results at 8 months are wonderful, but at 5 months he only had fuzz in the recipient area.

View the video below to see one man’s example of hair growth that was taken and narrated by him.

Tags: hartman, hairtransplant, hair transplant, results, progress, growth, video

How Can I Convince My Transplant Doctor to Refund My Money?

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

Hi

I had a hair transpland done in May of this year and i am very unhappy and dissapinted in it, since i had it done all i do is suffer becase the docotor that did it made it to high and is very rude when i tryed to tell him the problem
Im 22 years olds and came into the clinic with NW 2 hairloss, my hair stated to fall out and stoped when it became a ugly widows peek. I had over 800 grafts done and paid over $7.000 with little or no change in my hairline, the only difference is my hair is a little thicker behind my hairline. I tried to call the docter and tell him about it but he would not listen he was very rude and told me he is a doctor and he knows whats better for me. thats all got from him. I dont know what to do, this has made my life very bad, all i do is think about my hair and look at people with normals hairlines that did not have a hairtransplant and compare it to mine and it hurts to see that i spent over $7.000 with bad results.

Please tell me what i can do to convince the doctor to repaid the hair line. r to refund my money s i can find another doctor. If your intrested to help me i can send you the pictures if my hairline when you email me back.

thanks

If your surgery was done in May, your results will just be appearing at this point, so you really do not know what you have achieved in terms of yield. From what you are describing, I am appalled at this doctor’s attitude and behavior. Disrespect and rudeness is intolerable, especially from your doctor. Understanding and compassion is what you should expect from him and his staff — nothing less.

First, please send me pictures, preferably at the 7-8th month (and please reference this post when sending). Then, armed with a candid opinion from me, you can decide what you should do. A doctor is not legally required to respect his patients, nor to treat them with dignity, but that does not excuse bad manners. Having hair transplants at 22 years old is a bit young and if the balding was very, very early, he may not have met the ‘Standard of Care’ in making the decision to offer you surgery. Did you try to treat your ‘hair loss’ with Propecia before you elected to have a transplant? Are you on Propecia now (as you should be)? You need to work out and fully document just what is going on here. Yes, you can ask for your money back, but there is no obligation for the doctor to refund it. You can write a letter to the medical board of your state and file a complaint with them, but it is better to get that message to the doctor first. If you are not comfortable to speaking with him, then you can set up an appointment and be accompanied by someone older and wiser who can speak with this doctor with an authoritative personality. If you get an opinion from me, and I agree with you that you were not treated with the ‘Standard of Care’, then I might even place a simple phone call to him on your behalf, but for that, I would need to be your doctor and we would need to meet somehow. Let’s start off with a picture at the 8th month post surgery and then go from there.

You will never see me run from being a patient advocate and my heart goes out to you. Doctors have the legal responsibility to produce a full ‘informed’ consent for your surgery. That means that it is his obligation to be sure that you understood what you were agreeing to and what he was going to do for you. If you did not communicate with him adequately, it is his responsibility (legally) to close the information gap. Assuming that his behavior is as you described, I would think that you have every right to confront him, but you might need some help. I am hoping that you will be surprised and find that your doctor is not the ‘bad’ person you believe and he will surprise you with compasion and caring. Let me hear from you.

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

Surgery Error — Hey, We’re All Human

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

Here’s a quick story I felt was important to share…

Eight months ago, I performed a surgery of about 2500 grafts. The day following the surgery, I noted that the hairline was not in balance (the right side was 1/4 inch higher than the left side). I mentioned it to the patient and suggested that we could modify the surgery and balance the hairline better. He was surprised when I told him of my error, because he did not see the imbalance. What we agreed to do was to wait until all of the hair grew in and then address the imbalance.

The patient came in this week. I reminded him of the problem. We looked at it carefully and he said that he still did not notice the problem and was fine with it the way it was. I have always had a rule that if something goes wrong, I will always tell the patient when I realize the problem. No one is perfect and even under the most careful watch, things can go wrong. Honesty is always the best policy and I have found that my patients recognize the honesty as a good trait, one that builds confidence.

So while the problem may have gone unseen by the patient, it was my duty as his doctor to share my error with him, no matter how minor it may have been.

Tags: doctor, error, hair transplant, hairtransplant, hairline

How Do I Know I’m Getting the Amount of Grafts I Paid For?

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

Here’s a question I’m sure many prospective patients have asked before: How does a patient verify that he’s getting exactly the amount of grafts he’s paying for and that they aren’t being divided to artificially bump up the count and thus increase the cost of the procedure? Are we just going on blind trust or what?

Most important to ask, “Does the count of grafts correspond to what you are buying?”

  1. There should be an accounting system in place at the doctor’s office and you should have the opportunity to ask to see it. Any honest doctor will be proud to show their graft accounting system working in your situation. I just had a patient the other day who had surgery and wanted to know just what you asked. He came in to the surgery of another patient (with permission of course) and was shown how the accounting system worked to guarantee that what he was quoted was actually given. I also showed him his count sheets. Although he was shy to ask, he clearly felt better after seeing it.
  2. Is the number of grafts artificially inflated to make money for the doctor? Some doctors divide their grafts into sub-follicular units. For example, a 4-hair graft could be divided into two 2-hair grafts, and a 3-hair graft or a 2-hair graft could be divided into 1-hair grafts. In this situation the graft count would climb while the hair count would be the same. This is a problem in my industry, unfortunately. I have been quite outspoken about this problem in the past.

It all boils down to trust. If the doctor is open to questions posed by his/her patients, then this builds a trusting relationship. To be as completely blunt as possible, if you don’t think you can trust your doctor to not ‘screw you over‘ with the amount you’re paying for, you probably shouldn’t trust that doctor on almost all counts, let alone to give you the results you’re looking for. This is just another reason why doing research is very important in making your doctor selection. Also, see The Truth About Cheap Hair Transplants for more.

Tags: hairtransplant, hair transplant, hairloss, hair loss, procedure, count

Will You Give a Patient a Juvenile Hairline?

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

hi dr… will you give a pt a juvenile hairline if they want it and promise to stay on propecia and are 40 yrs old and do not have a lot of balding??? please let me know .. thanks

I have to be encouraged to produce juvenile hairlines in 40 year old men. Included in my criteria are:

  1. emotional maturity
  2. good, solid thinking
  3. a good reason for wanting it
  4. some assurance (by examination and from taking a careful family history) that the person does not have advanced genetic balding

The need for Propecia (finasteride) is only critical if there is balding present. I have done hairlines on actors whose youthful hairlines are critical to their professional careers. I have created these juvenile hairlines in other people too, but these men usually bond with me and develop a relationship with me that convinces me that it is the right thing for them to do. Sometimes, when older men want a lower hairline and their balding is stable, I will move it down to a lower position (lower than a mature hairline but possibly higher than the juvenile hairline).

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

Can I Get a Hair Transplant If I Have Fine Hair?

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

Hello Doctor,

I’m currently a 21 year old male with some signs of MPB. I would say that I currently am between a NW II and III and I do have a family history of MPB on my mother’s side.

My question is more for future reference as I know you advise against most people under the age of 25 to get hair transplants.

Now for the question, I’ve always had “fine” hair (much like my mother and her father). Would this affect my ability to get a hair transplant in the future since my donor area’s hair would be much finer and not cover as much as personal with “full” hair? Have you ever turned away a patient because of this?

Also, which technique of hair transplantation would you recommend for someone with “fine” hair? The FUE or the Strip procedures?

A transplant with fine hair will produce coverage that you have always had. The transplants bring you your hair, with all of its characteristics. Most people with fine hair have a see-through look when they at 12 years old, so a hair transplant will bring you back to the see-through appearance you had all of your life. Fine hair is not a contraindication for hair transplants. The harvesting mechanism should be up to you and your budget, the supply of the donor hair you have, and the size of the bald area you are transplanting. FUE is not a good surgery for extensive hair transplants in a very bald man, just because of the number of surgeries you have to go through to achieve the numbers of grafts.

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

Transplanting Transgender Patients

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

My younger brother (32 years old) is undergoing a sex change operation. He’s on the hormones and going to the doctors, and i’m not really sure what is involved but the family supports him. My question is relating to the genetic hair loss that runs deep in our family in almost all of the males (our dad, my cousin, me, my brother). He started to lose his hairline before he began his transition and i think it is quite rare for a woman to lose the hairline, right? Right now he wears a wig, and he’s going to have enough challenges with closed minded people that i don’t want him to have to deal with something like hair that he can probably take care of with a hair transplant. What do you recomend? Thank you for your time.

When men become women, they bring with them whatever male patterned hair loss they had. As such, looking like a female is not possible without either a wig or a transplant. The reverse is also the case if a woman becomes a man. Exposure to high doses of testosterone will precipitate a male pattened loss if the person has the genetics for genetic balding. In this situation, their balding genetics were protected when they did not have testosterone and were a woman, but that protection is lost when the sex is switched. Transgender patients may be candidates for hair transplants if their balding can be diagnosed as genetic hair loss.

Tags: transgender, hairloss, hair loss, hairtransplant, hair transplant, transsexual, sex change

What Will Take the Place of Hair Transplants?

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

What and when do you think will take the place of traditional hair transplantation?

Thank you for any comment or answer.

The theory, in answer to your question, may be some form of cloning, cell manipulation, genetic transfer or magic drug. Possibly we will identify some substance, stem cell, genetic alteration or the like that will be more acceptable than traditional hair transplants for the balding man.

When I started in the field of heart surgery (1966) we were just learning to replace heart valves in diseased adults and fix the broken hearts of children born with heart defects. It was a glamerous thing to fix the broken heart and for doing it, some doctors thought it would make them rich, so either for the glory or the money, many, many surgeons became heart surgeons and eventually most of the defective heart valves and hearts got fixed, leaving surgeons with nothing to do (possible bankruptcy or even to become a family doctor, whichever was better). Then we learned that we could re-vascularize the heart with veins taken from the leg and save lives, and the new bonanza happened again. The unemployed heart surgeons were feasting one more time until they caught up on the backlog of blocked heart blood vessels to repair. Then, a shift appeared (away from the heart surgeon) with the new ‘invasive’ cardiologist who became part of a new feast and the era of cardiac catheterization was born, shifting the work from the surgeons to the new bread of surgical ‘like’ cardiologist. Many heart surgeons found themselves unemployed again. One day, we will find an easier way around the cardiologist’s catheter and possibly this new break of cardiologist will learn to adapt or fall into the unemployment lines, just like the heart surgeons of yester-year.

When the day comes that hair transplants will be replaced with a needle injection into the scalp, doctors like me may be unemployed. One might think that any doctor can inject magic potions into the bald scalp of men for profit. As with Botox, they will. Personally, I do not believe that I will be unemployed for years yet as I do not believe that hair transplantation is going to go away anytime soon. If you are balding, ask yourself the following question: Am I willing to wait for years, possibly decades, for the best solution to hair loss and remain bald during my youth and most productive years just to avoid a simple surgery?

Tags: hairloss, hair loss, hairtransplant, hair transplant

Hair Robot Funded in UK for Hair Cloning

/by William Rassman, M.D./5 /, ,

The excitement continues on the possibilities of cloning hair from special cells located in the hair follicles of healthy hair.

The company says:

We take cells responsible for hair growth, multiply them and then inject them in the head. We tease out the cells responsible for growing a new hair… The hair is taken during a 30-minute operation under anaesthetic and replanted three weeks later after the cells have had time to grow.

The process for harvesting hair from the permanent zone is performed today using my Follicular Unit Extraction technique. If this is to be done on a larger scale, my patented instrumentation (of which, Dr. Jae Pak is co-inventor) will be employed (see USPTO.gov).

One license for this patented technology has been sold to a California robotic company which is presently attempting to automate the entire hair transplant procedure.

Update: Here’s another article about this — BBC News

Tags: hairloss, hair loss, hairtransplant, hair transplant, hair cloning, clone, cloning, robot, automate

22 Year Old Just Had a Hair Transplant

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

I am 22 years old male and i have nearly lost all my hair keeping in mind its genetic in my family but i think it happened too quick to me. I started experiencing hairloss at about 17. now i have had a hair transplant done (at age 22). what will be the best thing i can do to prevent losing anymore hair?

One more thing is my transplant Dr told me that my transplanted hair will fall in 1 2 months and then regrow again, but the transplanted hair have already fallen (14 days after the surgery) with the dried out skin. please advise me on this thanks

You should be relating to your hair transplant surgeon face to face, not to an internet source like this for your reasonable and unanswered questions. The fallout you experienced is normal. Hair from the transplants should grow in 3-5 months.

To prevent hair loss, any 22 year old should be on Propecia. If your doctor did not put you on that drug (generic name is finasteride) then I might consider that to be malpractice (in the United States), as hair loss in a young man is progressive and often rapid after a hair transplant in someone of your age. For the man in his 20s who has a hair transplant and are not on that drug, the hair loss will almost always accelerate as you suggested that you have already experienced.

I am concerned about hair transplants at the age of 22. Did you seek out second opinion? What is the Master Plan for the long term? You and your doctor need to lock that plan into place, or you may feel abandoned if your hair loss progresses. Peace of mind is in proper planning and good communication between you and your doctor is as important as good surgery. Please arrange to meet with your doctor and get a long term plan from him/her that you can use as you get older. Find out what he expects will happen to you. You need to know that information, for it is critical to your future.

Tags: hairtransplant, hair transplant, hairloss, hair loss

I Want to Have More Chest Hair

/by William Rassman, M.D./8 /

I’m a 48 year old man with a very fuzzy belly and sparse chest hair. I’d like to make the set a bit more balanced, especially between my pecs. Will minoxidil make the hair on my chest denser?

You can try minoxidil, but be careful not to overdose yourself, as it is a hypotensive agent and it will get absorbed into the body through the skin. Hair transplants work well for transplanting hair from the head to the chest — and it is medication free. With hair transplants on the chest, the hair should last your lifetime.

Tags: hairloss, hair loss, chest hair, hair transplant, hairtransplant, body hair, bodyhair, body

I Had a Temple Transplant, But Left Side Hasn’t Grown

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

i did a temple transplant a year ago, the left side hasn’t progressed at all. it is just light red, but no hairs. on the right side it has grew alot but it is still a bit red. how is it that i can’t see any progress at all on the left side?

You should speak with the doctor who did the surgery. At a year out, there should be full growth and no discoloration of the skin.

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

No Change After Taking Propecia for 11 Months — Should I Keep Taking It?

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

I am a 30 year old male and I have been taking Propecia for about 11 months now. I have not seemed to maintain or grow any hair in the front and back of the head. My father and uncle are a NW 6/7, my brother is current a nw 6/7 and he is 34 years old. My mother’s father was balding but never went completely bald. I know this is difficult without an examination, but I have had to change my hair styles twice in the past year to provide for more coverage. In some prevois posts you had mentioned giving Propecia up to 18 months. Do you feel that I should continue for another 6 months? Do you think that adding Minox would add any benifit? Any comments/thoughts would be greatly appreciated.

I believe that Propecia always has some benefit. In some people, however, the only benefit may be in slowing down the hair loss process. There is no easy way for you to be sure that this is working, but I am convinced that in young men this always happens. Sometimes you have to take it on faith just because the consequences for not doing so may be faster hair loss. Without stopping the medication you will never know, but stopping it is a bad way to find out if you can not recover what you lost when you stopped it. Maybe hair transplants are a reasonable option for you.

I have one of the most extensive hair restoration websites in the world at NewHair.com, and if you look at the patient photo galleries, you will find hundreds of patients with before and after photos, some of which may have “before” photos that look like your hair loss.

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