Do Hair Transplant Surgeons Take Shock Loss Into Account?

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

I wanted to comment and say you have a really informative website and I enjoy reading the blogs on here and your advice to people. I try to come here as much as I can and get advice with my hair loss situation.

My question is regarding thinning hair and transplants. When a surgeon places grafts into a thinning area, does he take into consideration there might be shock loss present and places more grafts into that area to fill it in, even though the patient is on propecia and lets say he’s 30 yrs of age? Or, does he expect the patient to come back for future surgeries to fill in the thinning area due to shock loss?

My other question is regarding working out and losing hair. I mostly run to stay in shape and stay away from the heavy lifting. I have read on this website, that working out with either weights or running doesn’t increase hair loss. However, I have read some comments from posters also on here that it has made them lose hair, and I have heard from other people at the gym where I live that they noticed hair loss while working out, without steroids of course, or while taking creatine (supplement). So, Which is the truth?

Thank you for helping me.

When transplanting hair into a young man (under 30 years old), shock hair loss should be at the top of the discussion points, particularly if the young man does not take finasteride. Of course, the same is true for patients older than 30. Where the cut off is for risk of shock hair loss without finasteride on board, I am not quite sure… but I know it happens even to a 40 year old and an occasional 50 year old. Being on finasteride, having a small number of grafts (no mega sessions), and not having any accelerated thinning definitely is a good indicator. In the end it is really about each patient on a case by case basis. There is no set rule. Thus relationship with a doctor is very important.

Transplanting into thinning hair follows the same rules as above, but there is not the introduction of mechanical shock into thinning, miniaturized hair, which is more susceptible for hair loss than normal hair that is not miniaturized.

As for exercise and heavy lifting, as long as you stay away from anabolic steroids, I do not believe there is risk with protein concoctions. Hair loss has been reported in rare cases while taking creatine, but I can’t say for sure if there is truth to it.

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

I Have Obvious Hair Plugs and Now I Just Want to Be Naturally Bald

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

Dear Dr. Rassman:

I am a 45 year old male with obvious hair plugs. I had two sessions done back in 1993. In considering all of my repair options, I would like to just be naturally bald. I wonder the hair transplanted can be removed. I am not interested in additional grafting. I like to be bald. Thank you.

Shaving your head will probably bring out the pitting in the recipient area that often accompanies the old style of hair plugs. We have developed a process call Scalp MicroPigmentation (SMP), which works well when the hair is clipped very short to make you look like a normal fellow with a shaved head. The pitting I mentioned is often hidden by this process, but I would have to see you to tell you what can be done.

Here’s an example of a patient that had SMP done to hide his plug scars in the donor area. The photo was taken immediately after one session.

SMP

 

If you are not in California, send some good photos with multiple angles to the email address on the Contact page and I will try to give you an opinion over the phone.

Tags: repair, scarring, hair plugs, smp

I Had Multiple Hair Transplants and the Hair Fell Out After 5 Years

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

Had my first transplant (flap rotation) at age 19 in 1985 (big mistake). Continued to bald behind flap and put up with stares from strangers until 2005 when had 3000 fue put in front and behind flap. Grew out well, no stares, felt pretty normal, life was great.

Problem April 2010, nearly all 3000 fue fell out after 5 years of growing, all in about a 6 month period. Back to being stared at. September 2010 had another 3000 fue (2000 scalp 1000 beard) put in front and behind flap by same reputable FUE surgeon. Grew out well again, but now starting to fall out and started getting stared at again.

Had blood work done but all clear for thyroid, lupus, iron etc. Have used 2.5mg Proscar for many years and not changed regime. Not on any medications known to cause hair loss. Getting very desperate as no donor left for more transplants. Any ideas on what could be going on ? Any advice much appreciated. Thanks.

There is clearly something going on and you need to address your issues with your surgeon.

I sound like I’m a broken record, but body hair / beard hair does not follow the same growth cycle as scalp hair and it is not considered the standard in hair transplant surgery. I have seen many failures of body hair transplant patients performed by doctors all over the world.

Some surgeons use grafts from outside of the donor area, and FUE grafts taken from the non-permanent areas can fall out, as this may be genetically triggered and accelerated. For clarity, the permanent zone is 2 1/2 inches high and can be measured above the notch on the back of the skull and around the sides of the head.

Tags: hair transplant, fue, failure, hairloss, hair loss

My Hair Transplant Looked Great at 5 Months, Not As Great at 8 Months Post-Operative

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

My question is regarding post operative transplant shedding. For a little background, I’m a 26 year old male on Propecia for 2 years and exactly 8 months out of a 2000 graft hair transplant all in the frontal part of the scalp. At 5 months, my results were excellent, a very dense, even result with a natural looking appearance and texture. Since that time, however, I have noticed an increased thinning in my hairline; leaving a more see-through appearance. This has been coupled with a more “pluggy” texture. Furthermore, at 6 months, I noticed an increase in shedding but it has slowed down in the last 6 weeks.

My 8 month result is still great but there’s a visible difference in the last three months. Is this merely a part of the natural process for some patients and can’t be judge too quickly in my first year growth? Any help would be greatly appreciated! Also, let me know if you need extra information to answer my question.

Why don’t you follow up with your doctor with these issues? A pluggy texture is not good. Thinning may be related to continued (normal) genetic hair loss that may have happened without surgery. Shock loss is generally seen in the first month or two after the surgery.

In general, results of a hair transplant surgery can be seen in as early as the 2nd month all the way up to 12 months. Most see results in about 6-8 months. I couldn’t tell you why your results looked better at 5 months than they do at 8 months, though.

Tags: hair transplant, post-operative, hairloss, hair loss

Patients That Opt for a Transplant That Still Shows Hairline Recession?

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

Hey doc, I noticed your blog here presents us with numerous demonstrations of surgeries, where a receding hair line is being restored to a full-blown NW1. However, the impact of surgery on donor area (whether FUT or FUE) has drawn me to weigh the benefits of smaller improvements.

But I don’t remember seeing here any pictures of patients who could easily (graft-wise) afford a Norwood 1 transformation, but have chosen a minimalistic path (for example, going from a Norwood 3 to a 2 or simply increasing the width of the forelock a bit to eliminate the steepness of its shape). Such visual representations will surely educate us about our options with surgery.

I’m sure we’ve posted examples of patients that didn’t want a fully restored hairline on this site in the past, and I know there have been plenty of men who have had surgery for a “minimalistic” path. A patient must give us permission before publishing their pictures, so we’re only able to post those that have given their consent. Not every patient wants their photos shown to others.

There are comprehensive before / after pictures in our NHI photo galleries that will show various examples of hairline restoration.

Tags: hair transplant, hairloss, hair loss, photos

FUE: More Automation and Physician Integrity (Part 4 of 4)

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

This is the last part in the series about follicular unit extraction (FUE). Here are the previous posts in this series — part 1, part 2, and part 3.

—

Neograft:

We have heard a great deal about the Neograft automated system. This system has two components to it:

  1. A sharp drill that provides controlled torque. It is a manual system requiring a very skilled operator.
  2. An implanter is part of the Neograft system and it uses an implanter invented by Rassman (patent #8062322) that works nicely.

The advantage of the Neograft system is that an implanter is offered, which is not present in the ARTAS system. Traditional implantation with forceps requires specialized skills and the greatest cause for failure or death of the grafts occurs during the implantation process. The neograft implanter, can be used effectively by an inexperienced person, therefore it is relatively easier to learn when compared against the use of forceps. The inexperienced surgeon or technician will probably get better graft survival with the implanter. When compared with a skilled experienced technician’s competence with forceps, I suspect that the two techniques will be comparable.

The manual drill requires expertise, and with the unit as designed the grafts have a tendency to dry out, possibly killing them before they get implanted as they are held in a chamber that has a high hair movement in it. As discussed before, air kills grafts as they dry and this killing process may take only seconds when there is substantial air flow in graft held in a chamber. Neograft associates with a private group of technicians that perform much of the procedure for the unskilled doctor, creating the illusion that the doctor is skilled in the process. If these technicians drill out the follicular unit, they will violate the laws in most states. Most doctors who use the Neograft system depend upon the technician teams to do the actual transplant procedure.

Other drills are supplied by a variety of device manufacturers. Dr. Harris employs a dull drill and his device is amongst the most popular of the devices that are manually driven with great success. He offers training for doctors who purchase his system. Drills with sharp edges are many and they differ only marginally from each other. Extraction speed varies with each surgeon and each instrument. There is no substitute for skill, and the skills for all instruments on the market (other than the ARTAS system) requires possibly years to perfect. Speed of extraction depends upon the surgeon’s skills and it varies between 200-1200/grafts per hour on average. The damage to the grafts varies with the surgeon, so speed tells you little about the skills of the doctor as some doctors kill more than 50% of the grafts in the extraction process.
Read more

FUE: Surgical Skills and Robots (Part 3 of 4)

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

So far, we’ve looked at the history of FUE in part 1 and graft quality/survival in part 2…

—

FUE Today:

The FUE market may reflect as much as 40% of the total hair transplant market today. I believe that 20% of the doctors offering FUE, are skilled in the process; however, a majority of the doctors who offer FUE today are not skilled in the process. With such a large gap between skilled and unskilled doctors doing FUE, one would ask what the doctors are doing about it, because no doctor wants to be second class. The doctor must get the expertise that they need… somehow.

Some doctors try one of the various instruments that promise great success with the FUE process. Some instrument entrepreneurs try to convince the doctors that if they purchase a particular instrument, great success will befall them and every new doctor purchasing these system, want to believe it. I admire Dr. Jim Harris, who pioneered a special instrument because he offers training on human volunteers to physicians who want to master his unique approach. I have participated in his course and own one of his instruments. There are instruments that:

    (a) drill out the follicular unit with a slow variable drill
    (b) that vibrate and/or rotate when they drill the hair graft
    (c) have variable depth control to minimize damage to the deep portions of the graft
    (d) claim that their punches are sharper than all other drills or punches on the market
    (e) are made dull intentionally to minimize transection, etc..

Drilling is the most popular way of performing the FUE and most doctors seem to favor the drill. Prices for these drills (the doctor’s costs) run as low as $1200 to as high as $220,000 plus $1/graft. Each vendor claims some advantage over the other.

With the discrepancy between $1200 and $220,000, let’s see what value comes with each package.

Read more

If I Want to Have a Very Short Hair Style Forever, Can I Use BHT?

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

Happy New Yr Mr. Rassman.

Currently, I shave my sides with a trimmer to 0.25 number and keep the little existing hair on my scalp shaved at 0.5 number. This is because I dont have hair to show off anyways, so might as well give it a shaved look. Even though I have some donor area, I am sure it wont be enough for hair transplant to give it a long full hair appearance.

As an alternative, I would like to have a shaved look but without SMP / using chemicals. I would like to achieve this with BHT but I do see from your previous posts that you are not a big fan of BHT because of the different texture and the growth rate of hair.

So my idea is to use the body hair on the the top of the scalp. It may not grow in the same pace / texture with the rest of the existing hair but what if I want to keep shaving it (or trimming to 0.5 number). Will it help? My logic says if I am shaving it / trimming it, it would probably.

My concern is:
1) ARE THERE ever SCARS in the recipient area? This question is relevant here because I will be shaving / keeping my scalp hair very short (0.25 or 0.5 number on the trimmer)

2) In your experience, while transplanting hair (whether hair from back of the head or body hair) into the recipient area, can existing hair get damaged?

Thanks for all your good work, may the force be with you.

I will be direct to your questions.

1) Visible recipient site scars are rare if the instrument is very small and a slit is used. But with any surgery, there is a small (rare) risk of keloid and scarring.

2) Existing hair is rarely damaged, unless perhaps there is shock loss, which is typical of young men under the age of 30 who do not take the drug finasteride. (This is not an absolute rule as some men decline to take finasteride. It is a case by case basis.) In general, the younger they are, the greater the risk of shock loss.

Tags: body hair, bht, fue, scarring

How Long Until I Can Use a Sauna After a Hair Transplant?

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

Hi doctors,
How long after a hair transplant until I can use a steam room / sauna? And how about a tanning salon? Thanks

You should address any post operative questions with your doctor, as each doctor has their own recommendations. In general, most patients can resume normal activities in two to three weeks after a hair transplant surgery — including a sauna.

Tanning salons are not generally recommended for health benefits and high dose UV rays can potentially discolor skin during the healing process, which can take up to 6 months. This does not mean you have to keep out of the sun, just use a sun blocker.

Tags: tanning, sauna, steam, hair transplant, surgery, tan

Legitimacy of Body Hair Transplantation?

/by William Rassman, M.D./9 /,

Hey Dr Rassman, I noticed that Dr. Umar was considered for recommendation on the Hair Transplant Network. The site also featured patient examples of his FUE procedures which combined body hair harvested from numerous locations and scalp hair. The results look pretty impressive.

Has your stance changed at all in regards to the legitimacy of body hair in transplantation?

There are obviously differences of opinion here, but to be endorsed by a website that is supported by and paid for by the physician (the doctors pay a monthly fee to be on that site) does not make it a new standard.

Plain and simple — today, body hair transplantation (BHT) is not a Gold Standard in treatment for hair loss. Other doctors still have a right (as licensed physicians) to offer this. I do not believe in using body hair transplants for most cases, because I have seen many cases where after it is transplanted, the body hair still looks like body hair sitting on the scalp. The shaft thickness of body hair is thinner than scalp hair in most people, so on a value comparison between scalp and body hair, you are miles ahead with scalp hair transplants. BHT is best used when you are out of donor hair and the body hair can be placed as a fill-in to traditional transplanted areas.

Remember, the body hair has long telogen cycles and depending on which body part, the telogen cycle is often longer than the anagen cycle. That means the hair will not grow in these telogen cycles. Also, body hair does not usually grow long like scalp hair.

Tags: bht, body hair transplant, hairloss, hair loss

If a Transplant Was Successful, Could Some Grafts Be Rejected Years Later?

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

Dr Rassman

Assume one has a successful transplant. Is it possible for some of the yielded grafts to die or be rejected some time (even years) after the operation? I am not talking about hair loss, nor about grafts that are genetically doomed. I am talking about healthy grafts, from a safe zone, that are transplanted and bloom normally but after some time die. If it is possible what would the chances be and why would it happen?

If the transplanted hair grafts have successfully taken and have grown hair, they should last as long as the hairs from the donor area. Over many years some donor hairs may eventually fall out and die (senile alopecia) or experience a temporary hair loss (telogen effluvium/ stress related hair loss). If something like that would occur, then the transplanted hair will experience this same fate.

With respect to graft rejection, it is highly unlikely to happen since the transplanted hairs are your own (autologous graft). Your body will not reject the material from your own body in normal circumstances. Over the past 22 years, I have seen a few patients that reported loss of donor hair at about 5 years post transplant. I have no explanation for this, but the incidence is far less than 1% in my estimate.

Tags: hair transplant, hairloss, hair loss

Taking Aspirin Before a Hair Transplant?

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

Hi,
I am having a hair transplant surgery by the FUE method and I am aware that I should not take aspirin 7 days prior to my transplant, but I completely forgot the 7 day rule and by the time my surgery comes up it will be only 5 days since stopping my baby (low dose) aspirin use. Is this going to affect the outcome of my surgery or during surgery due to bleeding? Is 5 days time for stopping my aspirin use enough time to have my surgery without worrying about it? I am a little concerned and blame myself for not stopping it a little sooner.

Please let me know if OK. Thank you kindly.

Excessive bleeding is always a risk in surgery when the patient is on a medication that can cause major bleeding (such as aspirin). Your surgeon should be made aware and you should discuss your risks with him/her.

Tags: hair transplant, surgery, aspirin, fue, bleeding

You Say Norwood 2 is Just a Mature Hairline, But Can It Be Treated Surgically?

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

Hi Docs, thanks for the great site, it really helped me figure out my options. I finally got a check on what I thought was a receding hairline after seeing my brothers lose their hair and after a couple of checks with a hair specialist in the UK I was told I have a matured hairline but no apparent signs of real balding, recession or minituarisation. I was told that there was no apparent need for me to use Propecia or Minoxidil. I am aged 32 now and my hairline looked to have matured by around 21 and hasn’t moved noticeably since then.

My question is that you tend to mention on this blog that a Norwood 2 is approximately a mature hairline and you don’t consider this male pattern balding from a surgical standpoint – but on your New Hair Institute site you show Norwood Class II patients and count that as hairloss that could be treated surgically? Would this be strictly for a cosmetic adjustment of the hairline? (I realise it’s all cosmetic surgery but as in there’s no balding to cover, just a hairline change). Although I’m happy with my hair more or less, I’d still prefer a slightly straighter (closer to juvenile) hairline as I have quite a high, thin forehead and I’d be interested in surgery simply as a cosmetic adjustment.

Thanks for any clarification.

Norwood 2Hair loss is not a medical illness. Hair transplant surgery is considered cosmetic surgery. If you want to enhance your appearance, it is your choice. So for those with a Norwood class 2 or a mature hairline which is more like an early Class 3 pattern, we can certainly treat it.

The point I generally make in my medical practice and here on BaldingBlog is to have open communication between the patient and doctor. We give our opinions on what may be too low of a hairline and how it may not be age appropriate, but in the end each and every patient has a right to choose their own “look” and hairline.

There is nothing wrong with, as you put it, a cosmetic adjustment.

Tags: hairline, hair loss, hairloss, hair transplant, surgery

Great Hairline, Thin Top and Crown, Low on Donor Hair (with Photos)

/by William Rassman, M.D./9 /, , ,

This patient had 4608 grafts. As you can see from his photos below, the frontal area is great, but the top and crown are lightly covered. He lost much of the original hair in the top and crown from the balding process and as the transplant process was going on over a 10 year period in three sessions.

I am posting these photos to show that frontal hair can go a long way to making a balding man look fuller. We will still do one more surgery on him to fill in areas that need more density and then offer him Scalp Micropigmentation (SMP) to finish the creation of the fullness he wants.

Click the photos to enlarge:

 

Tags: hair transplant, thinning hair, donor area, hairloss, hair loss, photos

I Don’t Know If My Doctor Knew How to Transplant African Hair Type

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

I am a 30 year old African American male. I had hair transplant surgery a year ago. Mainly to fix my hair line fixed. It’s been a year and barely any improvement, there’s barely any new hair. I don’t if the doctor knew how to do an african american hair. Should i have it done again by another doctor? what should i do? thank you!

African hair requires considerable experience and few doctors have mastered the process. We have had no problem with this type of transplant of African-American hairs that are kinky.

After a year, the results from your transplant should be noticeable by now. I hope you didn’t have a transplant failure, but an exam would be able to tell that. As you are in Los Angeles, please consider making a free appointment with me in my LA office.

Tags: hair transplant, african american, hairloss, hair loss, failure