Desperate at 23 — Is a Hair Transplant Worthwhile to Me?

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

Letter from a person in Europe:

I am 23 years old and i am suffering from hairloss male pattern with a receeding hairline. I am contemplating a procredure and I want you to tell if it it is worthwhile. They assert to be the best in the industry. Can i trust them?. Have you heard of them?

Going through such a horrible condition at such a young age, as you can imagine is truly stressful. My personal doctor says nothing can be done and i have seen dertmotologists who say nothing can be done either. So i am taking things to the extreme.

Thanks

I have reviewed your pictures today. You appear to be a Norwood Class 3V pattern. At the age of 23, I would rather that you start taking Propecia (finasteride) before you do anything. If you have a transplant without that drug, you will accelerate your hair loss and if you think you are miserable now, it will be worse if you became much balder immediately after a hair transplant. The issue always is: Where is your balding going and what is the Master Plan for what you will have to manage over the years in front of you? With the genetic balding that you are showing in the photos you sent to me, anybody that would recommend transplants without giving you at least 8 months of finasteride, would be in my opinion incompetent and immoral. There is no doubt that a transplant on you now will leave you more bald, not less so; PLEASE do not start transplants without 8 months of oral finasteride. Get your hair mapped out for miniaturization to anticipate your pattern of eventual hair loss and then get a competent doctor who will put a plan for your long term (you have years to live and I do not believe you want to live it as a bald man). I have seen too many unhappy men your age who go for a transplant out of desperation and then use up the valuable donor hair without any plan and no way to ever look normal again. Do you get what I am saying?

Tags: hairloss, hair loss, propecia, finasteride

Doctor Won’t Transplant Me Until I’ve Taken Propecia for a Year

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

I met with a doctor in Madison Wisconsin, Dr. Gencheff.

I am 21 years old, soon to be 22. He advised me to start taking Propecia first to “stabilize” because he said young men can have an “shock loss” if transplantation is performed without it. This was in December 2005. It’s been 6 months roughtly since I started the drug. I actually take “Finpecia” which is a generic finasteride. I think it is working to slow down the process, but I can’t tell the full results yet. I will continue to take it as long as i need. He mentioned that transplanting in the crown area is not a good idea. I am not exactly sure why, i think he said its because you don’t know how far its going to progress. All in all, he said I had good hair to transplant with, but he said he wouldnt operate on me until I had taken Finasteride for at least a year. Is it possible to transplant in the crown area? By the way, i think he diagnosed me as a future 5a. The mid scalp is thicker as well as the front hairline. Thank you for your help, I may be seeing you soon.

From your brief description, I agree with your doctor that you should be on Propecia for a reasonable amount of time before resorting to a hair transplant surgery — especially at the age of 21. Your doctor seems to be looking out more for your interest than his own bank account, which is definitely a good thing. I often write on BaldingBlog about the “Master Plan” of a life long goal of maintaining a desirable head of hair, rather than just achieving a quick fix. If you are indeed a future Norwood 5A (assuming you are a Norwood 3A now) then it would be wise to see how much Propecia can slow, stop, or even reverse the hair loss process. Maybe you will be lucky and reverse some of the process you are now experiencing. I look forward to seeing you in San Jose and would be happy to map out your scalp for miniaturization, trying to outline where you may be going with the balding process.

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

DHT and Transplanted Hair

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

I would like to know how a hair follicle falls off. I was told that as DHT accmulates at the bottom of hair follicles hair falls off. This DHT is produmed by male harmones. Is this true? If this is the case even after hair transplantation DHT will be accumulating and it will cause the transplanted follicle to fall off. Then how is hair transplantation a permanent solution?

DHT is created when your body metabolizes testosterone. It is mostly made by your liver. For people who have the gene for genetic balding, when the hair is at the point in time when it is susceptible to the effects of DHT, it usually starts to get thin (we call that miniaturized) and as it thins out more and more, eventually the hair will permanently fall out. Sometimes the hair just falls out rather than going the route of miniaturization.

Transplanted hair does not have the faulty genetic code, because hair from the sides and back of the head (for reasons not clearly understood) have normal genetic code. These hairs are not vulnerable to the effects of DHT. Look at the people who are genetically bald. They always have hair around the side and back of the head, always. I can not tell you why that is the case, but I know for certain that these hairs around the side and back of the head are programmed to grow for life, so when they are moved in a hair transplant (to a new home in the front), they keep growing as they did at their old ‘home’ in the side and back of the head.

Tags: hair transplant, hair loss, hairloss

Concerned 22 Year Old Getting a Hair Transplant

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

I am a 22 year old man who recently signed up for a hair transplant. While I really don’t have a spot on my head that is bald, I can tell that the day will be coming when they will be. My question is how noticable is the donor area damage directly following the procedure? If I return to work in a few days will people be able to tell? I am so nervous about the procedure. I have visions of the procedure going well and having a nice head of hair for several more years. I also have visions of being scarred and worse off than when I started. Please write back as soon as possible, I look forward to any advice and answers you may be able to give. Thank you for your time.

Please think this through. Are you on Propecia? If you aren’t on Propecia because your doctor did not put you on it, he is not a good doctor and you should run for the hills, not for a hair transplant. Assuming that you have no visual balding, then doing hair transplants on a non-balding 22 year old for prevention purposes is malpractice. You are in control of this. Send me some good quality photos and let’s talk this through.

Why the rush?

Tags: hair transplant, hairloss, hair loss, propecia

Coloring Hair Before Hair Transplant

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

I color my hair, would this be a problem if I wanted to get a hair tranplant down the road. Would it have any effect on the procedure?

Coloring or dying your hair should not have any significant impact on a hair transplant procedure. I generally tell those people who do color their hair, to have it done within a few days prior to the HT procedure.

Tags: hair transplant, color, dye, hairstyle

Newly Transplanted Hairline is Uneven

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

I’m a 49 yr old male. My transplant is a month old [editor’s note: not with NHI], and the only thing that bothers me is that the hairline is not even. It looks not receding enough on one side and too receding on the other. I’d rather have two receding sides. But that would mean removing some of the plugs? Is this possible and would the scars be very noticeable?

At a month, the hair transplants can not be removed. I would suggest that you wait out the period that it takes for full growth to occur. It will be easier to accept the lower hairline and move the higher one down to it, rather than the reverse.

Tags: hair transplant, hairline

How Long Should I Take Propecia Before Transplant to Prevent Shock Loss?

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

Dear Dr Rassman,
I have been reading your blog for quitesome time and have benefitted a lot from it. I have leant from you that propecia is helful in preventing shockloss. I’m planning on a HT session say like in a month. Would it help me in countering shock loss if I started using propecia today?…or should I be on propecia for a specific period of time say like 6 month, before I go for a Transplant.?

If you have been evaluated by a doctor and have a diagnosis of male pattern hair loss, Propecia may benefit and prevent or reverse the hair loss. Propecia may also prevent shock loss from a hair transplant and I generally recommend that it is best to take it one month in advance of the surgery if possible. Certainly, being on it as early as possible is best, but even the day of surgery will work better than none at all. The enzyme that makes DHT is at work all of the time and blood levels of Propecia are achieved in an hour or two, so hopefully some value should be there even if first taken the same day of the transplant surgery for the prevention of the transplant shock you asked about.

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

Rapid Growth in Frontal Area, Slow Growth in Crown After Transplant

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

I had a 1565 follicular unit transplant 3.5 months ago and I seem to be experiancing a more rapid pace of growth on my frontal hairline compared to that of the growth on my crown. I am curious to know weather of not this is common and if the number of hairs within each follicular unit impacts the rate of growth? The doctor who operated on me put 3 and 4 hair follicular units on the crown and 1 and 2 hair units in the frontal region.

Almost every patient will experience varied rates of growth by where in the scalp you are looking. I have seen the crown exceed the frontal growth rates and visa versa. You must have patience. Generally you can expect newly transplanted hair to grow within 8 months. You seem to have a relatively early growth and I suspect the transplanted crown area to catchup.

Tags: hair transplant, hair growth

Stinging Pain from Hair Transplant 3 Years Ago

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

Hello Dr. Rassman,

I am a 50 year old male and had a hair transplant 3 1/2 years ago. In retrospect any ethical surgeon would have sent me home. I don’t even know the number system that represent how much hair loss I had experienced but I’d give about anything to have not done this.

I thought I was getting 400 grafts using the latest follicular unit technology. What the doctor actually did is anybody’s guess. By two weeks after the surgery, to my complete surprise I had lost about half my hair. When the grafts began to grow a few months later I spent the next 18 months going to another dermatologist whom I understood to be a hair transplant surgeon (I later learned he had possibly never done a single procedure). Every week I would experience around 5 inflammed ingrown hairs, in which I would receive a cortisone injection. The surgeon who performed the procedure even put grafts all over the back of my scalp where I had absolutely no hair loss.

I developed a severe, debilitating pain problem in my scalp which started almost immediately after the procedure and has progessively gotten worse. The pain is a burning, stinging, scratchy sensation in the entire recipient area. A few months ago I started to experience a new wave of transplanted hairs all over my scalp and I have no idea why. The transplanted hairs have always been, and are, extremely stiff and course. They feel like thorns and are very painful.

I have been able to function by taking narcotics for the past few years but the resulting debilitating constipation recently got the best of me and I decided I needed to start making attempts to have the problem diagnosed correctly (and treated if possible)instead of treating the symptoms with no clear understanding of the problem. I had the pain before this last wave of grafts began to grow and I can’t really tell if the grafts are actally growing properly or not. I also don’t understand whether these “thorns” are causing this pain, or whether I have some kind of painful neuralgia. Sometimes I can feel every single graft just stinging.

I need help very badly. I have been to at least 25 doctors including hair transplant surgeons, dermatologists, neurologists, infectious disease, general practioners, pain management, psychological, etc. It seems that nobody has ever heard of this or just admittedly doesn’t know the first thing about hair transplantation, much less its possible complications like mine.

Any helpful advice you can provide would be greatly appreciated.

If you have been to 25 other doctors, I do not know how much I can help. Hair transplants should not hurt after a few days. Moreover it should never require dependancy on narcotics and “debilitating constipation”. It is my opinion your pain may be from other causes.

Tags: hair transplant, hairloss, hair loss

Why Would a Doctor Limit to 1000 Grafts Per Session?

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

hi Dr,
i am considering getiing FUT done in the near future. i am from Ireland and there are limited surgeons here. one surgeon, has an excellent reputation, and an impressive bio, but limits his sessions to 1000. I would need about 2500 to 3000. what would be the reason for the limitation, and do you know of Doctors that also limit their sessions?

The limitation on the number of follicular units transplanted may be due to the limitations of the doctor’s staff and time. For example at New Hair Institute, we are capable of transplanting 3000-5000+ grafts in a day. This is possible because of our experienced staff, mastery of the tools we use, and techniques we have refined over many, many years. We were the first medical group in the world performing sessions of 1000, 2000, 3000 and even 4000 grafts (in 1994). The key to doing these larger sessions must address reasonable limits based upon each patient’s dynamics, skin laxity and supply/demand considerations. Then, the doctor’s team should become a focus and one should never push a doctor or his team to do more than they can competently handle. The level of competence with these large sessions varies between doctors.

If you are referring to Follicular Unit Extraction (some doctors may use different terms) where individual hair follicles are harvested one at a time, 1000 may be a reasonable number because it is a very laborious process, but here too, as the originator of the FUE process, we have performed as many as 2200 grafts in a single session in appropriate candidates. It is all a matter of experienced teams of doctors and staff working together after years of training. If your doctor is unwilling to perform a larger session, either stick with him/her and do more surgeries with smaller numbers of grafts or find another surgical team able to perform larger sessions with lots of experience doing them.

Tags: hair transplant, experience, doctor, hairloss, hair loss

Injecting Saline Into Scalp To Transplant Higher Density?

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

Dear Dr. Rassman,

A couple of years ago I remember reading an article about a hair transplant doctor at UCLA (I believe) that was able to transplant a higher amount of hair into a site by first having the scalp injected with a solution (possibly saline) to actually swell or enlarge the scalp area so more hair could be transplanted into the area. Later when the swelling receded the results would yield a higher density.

Can you comment on this. Is this something that you would recommend? Why or why not?
Thanks!

Many hair transplant surgeons will inject saline into the scalp to accomplish just what you are talking about. The important thing to focus upon is graft survival. Are the grafts packed so closely that the blood supply may be compromised? It is possible. I recently saw a patient done by another doctor who had the skin in the recipient area develop gangrene from a decision to put too many grafts too close together in skin that could not tolerate dense packing of grafts. The details of what the surgeon does is not a simple one thing vs another thing. A good hair transplant is the result of a complex series of decisions and takes into account not only the size of the grafts and the nature of the skin, but many other judgments. I have heard doctors focus on one thing that makes them unique, but ask yourself, “Am I being pitched a sales line here?”

Tags: hairloss, hair loss, hair transplant, scalp, saline, density

Why Not Transplant Hair From the Arm to the Eyebrow?

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

Hello
I had a question about hair transplantation for eyebrows. Ive read through the blog and many articles about this kind of procedure. What am wondering about is, why take hair from the scalp when we know it will act like the hair from the scalp, growing 3 feet or so when using hair from the arm won`t grow any longer than an avergae eyebrow hair.

Would that be a possibility, to actally take hair from the arm insead of the scalp, and not needing to trim the eyebrows after the procedure?

Arm hair will grow like arm hair so you are correct that for delicate eyebrows in a coarse haired person, head hair may be too thick and arm hair in theory might be better. Now with that said, the problem with arm hair is that the telogen (sleep) cycle for the hair is longer than the growth cycle. If you place 10 arm hairs in the eyebrow, only 2-4 of them will be growing at any one time while the rest is in telogen. To address this problem, you would have to transplant at least twice the number of hairs to achieve the targeted densities. Great idea, just not the right hair sleep cycle.

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

Should I Try Medications Before Considering a Transplant?

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

Just turned 40 and starting to bald on top back “crown” of head, was using minoxidil 5% (~1yr), just started on Propecia (day 2) (from what I read here, I guess OK to use both). Should I try all these remedies first before considering a Hair Transplant, do hair transplant results look more natural and successful if started early? Where are you located (offices), would I have to travel from Houston to there for a consultation?

If you just starting to lose the hair in the crown (meaning that it is now noticeable), there is a good chance that Propecia will reverse some or all of it. Recent hair loss (2 years or less) is most susceptible to reversal. I would suggest not stopping the Minoxidil, as your hair is almost certainly dependent upon it. Wait 8 months and if there is not enough reversal, then a hair transplant may have great value.

Our offices are both in San Jose and Los Angeles, California. If you come from out of town and have a procedure, we will subsidize your costs of travel and put you up in a hotel for the night of surgery.

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

High Forehead and the Rule of Thirds

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

I had a question concerning hair transplant. I am 20 and do not have an issue with balding yet, but I do have a larger forhead than I would like. Is there a way for me to be able to get my forhead to the 1/3 proportion of my face? I’ve always dreamed of not having a high forhead….i hate when people mention it…they say I have Dawson’s forhead from Dawson’s creek. I was planning on visiting your area. Is there a way you can help me while also making it look natural?

thanks

DavidThe rule of thirds (1/3rd chin to nose, 1/3rd nose to gully between the eyes and 1/3rd the gully between the eyes to the hairline) does not apply to very many people. Although Michaelangelo made David according to the rule of thirds, I rarely have seen any man have those proportions. I measure these elements in every patient coming through my office so I am more than a casual authority on this matter. The normal proportion is equal distance of chin to nose tip and gully between the eyes to hairline. This is generally the normal male mature hairline, which is higher than the child hairline in most people (by 2/3rds inch). With that said, high hairlines which do not show this proportion can be treated and the hairlines can be lowered. What always worried me is that in young men like you who may have genetic balding (a 50% risk in most men), such a surgery may accelerate the genetic hair loss.

As you suggested, visit me at my office and let’s bond. Best way to deal with this problem is to command it and anticipate the future on a worst case scenario.

Tags: hairloss, hair loss, hairline, forehead

Having a Second Hair Transplant

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

Hi, I have good hair on the side and back and I think I would be a good candidate for the transplant. I also still have fine hair on the top of my head still. I wanted to know how thick will it grow out? How come you never see people on the hair websites that have really long hair? Does it not grow that long? Will the scar show when I go swimming after my hair gets wet? Does Biotin Vitamins work for thinning hair, does it grow hair? Is it possible to hair a second hair transplant if the remaining hair falls out on top? Do they cut the donor from the same area? Will hair grow out of the scar? How far off is hair cloning?

thanks

  1. We have many patients who grow their hair long — I wouldn’t say they are the majority, but there is certainly quite a few. As to why they aren’t shown on any websites, I guess because those patients with long hair didn’t sign photo releases to appear on the sites. I really wouldn’t know. But what I do know is that the transplanted hair grows just like the rest of your scalp hair.
  2. The scar should not show after swimming, but I can’t make any guarantees as the results of each patient could be different.
  3. Biotin vitamins do not work to make hair thicker or reverse the effects of thinning from genetic hair loss. Scars should not be a problem, but there is a 5% risk of some scarring in a single first session (scars greater than 3mm), slightly higher risk in subsequent sessions. Transplanted hair from the first transplant does not fall out in the second transplant, in fact, it is hidden well by the first one. Any second session is taken from the same place as the first donor strip is taken from, keeping the wounds in the same place. This best controls scarring risks. Scars can be created so that hair grows out of the scar (see trichophytic closure).
  4. Hair cloning may not appear on the scene in my working lifetime (10+ years). See the Hair Cloning category.
Tags: scar, hairloss, hair loss, hair transplant, vitamins, long hair