Not Enough Donor Hair for Transplant

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

I do not have donor hair (enough) for a trnsplant what would be my next option. currently, I am using a hair system with HMW. I find it to be quite expensive and there times when you still feel uncomfortable when it needs to be replaced. I would like to find a new alternative which would make me comfortable and make me feel connected to my hair:-)!!! What is the next best thing to a transplant. Why cant’t human hair be sewn into my scalp, just looking for solutions that I can still treat wash hopefully will grow like human hair.

First, have you had your head mapped out for miniaturization? What is the donor density? What is the laxity of your scalp? Do you have Diffuse Unpatterned Alopecia (DUPA)?

These are the questions that I would want to know to determine if you have enough donor hair for a transplant. Even the baldest of men (Norwood Class 7) can get great results from proper distribution if there is adequate supplies (see Patient ZU).

Alternatives may mean that you get less than a full head of hair. A thinner look can work for many people. Better coverage in the front at the expense of the crown can also work for the very bald person without enough donor hair. You should come to one of our Open House events to see some patiens with these alternative approaches. At these events we have some patients who choose to be thin either because of donor supply limitations, very fine hair or just limited budgets. Some choose to transplant the front and spare the crown. At these open house events we try to give our guests the opportunity to see a wide sampling of what hair transplants do and how normal people deal the the decisions involved in the process. It is important to think of the hair transplant doctor as a partner working with you to maximize your the value of what he/she can do for you.

Tags: hairloss, hair loss, dupa, donor

HIV Positive and Hair Transplants

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

I have been diagnosed with HIV which is now under reasonable control. For a period of time I was very sick, but now with the proper balance of medications, I am healthy and active. The problem is that I lost a great deal of hair from the time I got sick 2 years ago to the present. I am 54 years young and I do not like looking 80 whic is what I feel I look like when I saw a recent picture of myself. Can I have hair transplants or does the my HIV status impact either my candidacy for surgery or the results of hair transplants? Will the doctors turn me down for surgery because I am HIV positive?

A healthy person who is HIV positive may be a good a candidate as an HIV negative person. Your sickness probably caused the ‘expression’ of your genetic balding process on an accelerated timeline. At your age, I would be surprised if it continued to progress, but after mapping out your hair for miniaturization, I would go on Propecia to protect you hair from further loss and then be evaluated for a hair transplant if you want to change your look.

Under most state laws, doctors can not discriminate against someone who is HIV positive. Some doctors fudge on this and do what I call ‘closet’ discrimination where there are convenient reasons to turn down patients, but not only is this against the law, it is against the oath we as doctors are supposed to adhere to. If you are healthy, you can expect that you should be a reasonable candidate, certainly one worth evaluating. I perform hair transplants on many such patients each year.

Plugs to Bald (with Photos)

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

I hate my look. I answered an ad in the newspaper when I was in my early 20s and very depressed about losing my hair. It was not bad then, just starting to thin in the front. The doctor’s sales guy came in and did a job on me, telling me that it was on special and that he would give me 50 free grafts on top of the reduced price and I would never have to deal with the balding again. I scheduled for surgery done the next morning. This was 8 years ago and have hated myself ever since. I did not see how bad they looked until the hair fell out in the front, all within a few months of the surgery. Now I just want to become bald. Can I do it?

My astute readers will notice that this is the 3rd blog entry I’ve made in the past week relating to this very issue (see also: Alas, Bald Again and Years After Transplant, I Want To Shave My Head ), but it is very important to drive home the fact that hair transplants are forever. I know that these deforming surgeries are what most people think that a hair transplant is, but based upon what I see in these pictures, I would expect that you had this 15 or more years ago, not 8. This is malpractice today and I believe even so 8 years ago. The way the doctor unleashed the salesman on you was downright immoral and I would report that doctor, at the least, to the medical board of the state. In California, the medical board takes responsibility to protect consumers against such behavior.

I think that going backwards and becoming bald may not be your best choice, because even if each of these plugs were removed, the scalp skin would then show the individual scars from each excision and the reflection of any light in the room would show the deformity. I suspect that the situation can be improved as shown in these articles and this patient example (see Dean’s Story link below).

You need a good doctor working with you one-on-one who has the experience to address YOUR needs. This requires both a very experienced hair transplant surgeon, one with good communication skills, compassion, and understanding. Then the two of you can work out what your real options are. For those readers who are seeing this scary picture, don’t think that this is the standard of care (take a look at what is the standard of care today in our Photo Gallery).

Note: This work was NOT performed by New Hair Institute. Click the photos to enlarge.




I Want Even More Hair (with Photos)

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

I have wonderful results from the transplants you have given me, but now I want more hair in the crown. Can I do it one more time?

This is not an uncommon question. I have shown his before and after pictures here, with permission. He has received 3,218 grafts in three procedures. The first procedure was a limited FUE surgery placed into the corners with 484 grafts. This gave him a nice result, but he wanted more fullness so another procedure was performed in the front to finish out the hairline reconstruction. Had he elected to allow me to dense pack the frontal hairline and use a more traditional approach (strip harvesting), I would have done the entire procedure in the front (1391 grafts) in a single procedure, but the FUE limited the harvesting in the early days (2001) when this was considered a large FUE procedure for me. He elected to come back a third time now to address the top and back of his head. His third procedure had 1,827 grafts and it achieved wonderful, natural results. Now he wants a tighter swirl in the crown and a second procedure into the crown (a 4th procedure overall) will finish the job.

A good Master Plan might have reduced his entire process to two procedures (front and back), but sometimes it takes a slower approach to make the patient feel comfortable with the process. He now has 3,218 grafts total and will receive another 1000 in the crown in the very near future.

Before (click photos to enlarge):


After:


Why Can’t Hair Be Transplanted Person-To-Person?

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

Can hair be transplanted from another person? Is this even remotely possible or in the possible future at all? We transplant skin, organs, etc from other donars. Why not hair?

Medical science has made it possible to transplant human organs such as heart, kidney, liver, or other critical organs from one person to another. However, the recipients of these organs have to be on life-long immune suppressing medications, which make them prone to life threatening infections. Otherwise, the transplanted organs would be rejected by the recipient’s immune system. Even the face transplant that hit the news recently required these dangerous medications to prevent the rejection of the face on that particular patients.

Hair, being an organ, can be transplanted from one person to another; however, to stop your body from rejecting the hair, dangerous drugs would have to be taken. As balding is not life threatening, taking these dangerous drugs may produce life threatening infections and this risk makes person to person hair transplants not acceptable by medical standards.

Doctors Disagree About Whether I Am A Transplant Candidate

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

Hello Dr. Rassman,

I made a trip down to Los Angeles last summer to visit some relatives, and I had the opportunity to have a consultation with a prominent LA based hair restoration surgeon (I was unaware of you or NHI at the time). He told me that I was not a candidate to have a procedure; however, later on that summer I went to a very reputable HR practice in Vancouver and the physician stated that I was a candidate. Right now, at the age of 25 I’m thoroughly confused as to what to do. Any help as to where I can go from here? I have no idea who to listen to. Thank you.

Without knowing your hair loss pattern or the degree of hair loss or miniaturization of your hair, it is impossible to comment on your dilemma. Your age may have also played a factor in the different advice you received, as you may be at a relatively early stage of your potential hair loss process. If your miniaturization is early, it is possible that for each hair that your transplant, you might lose a hair, leaving you no better off and just a bit poorer. It is important to have a good rapport with your doctor and to have a Master Plan for possible hair loss in the future. It seems you need a tie breaker. If you find your way to Los Angeles or San Jose (my offices), I would like to add my vote. Send me some good photographs and we could, at the least, connect by phone (800-NEW-HAIR).

Hair Transplants for 21 Year Old Male

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

I am 21years old and I am starting to look like my dad. According to your balding classification, my pattern is now like a a Class 4a pattern but my dad is a Class 6 or 7 pattern. I went to a hair transplant doctor and he said I was too young. I already have no hair halfway down my head, Would you transplant me?

First, you must recognize that this process is an important lesson in planning for both you and I. I believe that young men like you can receive surgery, but before that happens, you need to have a Master Plan that takes into account all of those elements that make a 20 year old different than a 26 year old or a 50 year old. These would be my criteria:

  1. Propecia: I would want you to be on Propecia. Would you be willing to stay on it? I would want to know if you had any side effects from the drug.
  2. Hair: I need to assess your donor hair supply and be sure that it meets your present and future need for donor hair over time. I would also need to know your overall hair and scalp characteristics as a hair transplant candidate.
  3. Health: I would need to have a complete medical and psychiatric profile on you.
  4. Maturity: I do not do surgery on anyone who does not do their research and understand what they are getting themselves into. I must be assured that you understand what is happening to you and what may happen to you as you continue to bald in the future. By the way, did you elicit the advice of others (parents, close friends, some older, wiser person)?
  5. Finances: Have you lined up the financial resources to follow the surgery to a reasonable stopping point? What if the balding progresses to a Class 7 pattern?
  6. Reasons: I need to know much about you — I’d need to know if your expectations are realistic and reasonable? What is the goal in terms of what you expect to obtain? I would want you to meet patients and understand just what you will look like if you had a hair transplant.

I must be sold on taking you on as a patient. I must have faith that you know enough about the process (over time) to appreciate the things I said above. Although I rarely do a hair transplant on someone under the age of 25 (I do some), the concept of your becoming a Class 7 balding man is the worst case for both of us. You do not have to become bald to get hair as that would be unreasonable on my part. Are you prepared to manage the worst case in a cooperative manner with me?

To state emphatically that you are not a candidate for a hair transplant is an unduly hard position. Each and every patient needs to be assessed individually, weighing all of the elements above (and everything else that is relevant) before any decisions are made. I try not make decisions about any of my patients on any one issue, including age. I want to get to know the person inside the head, well beyond what is evolving on top of the head.

Moustache Restoration?

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

Moustache

i would like information on moustache restoration as mine is thin

The use of hair transplants for the moustache is relatively easy to do technically, but may be more difficult from a planning point of view. The hair usually would come from the back of the head and you therefore must be reasonably sure that the character of your hair from the back of the head will look like your existing moustache. If you have a coarse, brown haired moustache and fine, blonde hair in the back of your head, a transplant using scalp hair might not be the right decision. To get around this, one could use pubic hair which is more coarse than a fine character scalp hair transplant. Get an expert to find out what is reasonable.

Hair Transplant for Pro Soccer Player

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

Hello Dr Rassman,
Your site is very helpfull and I appreciate what you are doing to help and support those who are suffering with hair loss.

I am a 22 yr ol male and I play professional soccer in the UK and am seriously considering coming over to you for a consultation in hope of having a hair transplant. I was wondering however if the surgery will affect in the long term my ability to head the ball and my sporting performance and also if taking propecia will affect my performance. I look forward to hearing from you.

SoccerFirst, be aware that Propecia is banned for many professional sports players, because it masks steroid use. A hair transplant will not stop you from engaging in full sports within a couple of weeks after the surgery. “Heading” the ball should not be a problem either. If you want to get to full sports in a few days after surgery, you might be a candidate for FUE as a harvesting approach.

Please send me pictures showing the degree of balding and I can be more informative. Your confidentiality is convered under laws that protect you when dealing with a doctor.

From Bowling Ball to Gorilla (with Photos)

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

Patient ZU is in his mid 60’s and he is what we call a Class 7 Norwood scale balding person (click name to see his before picture). He came to an open house last week and he has now filled out nicely. He told every person at the open house that he looked like a ‘bowling ball’ before his hair restoration, smiling as he made that reference. I talked about him before on this site (and posted some photos), but when last I spoke of this patient, I had said I’d post updated photos of results from his last procedure when I got the pictures. Well, now I have them. He had a total of 8,300 grafts. Would you believe that he still wants more hair? The crown area needs more fill and his comb-back styling is now working well for him, but he believes that with more hair it will work better. I guess when you have been deprived of hair for 40 years, you may over-react. Patients continuously tell me that when it come to hair, like money, more is better.




I Have An Egg-Shaped Head

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

Dr. Rassman,

First off, I’d like to thank you for the informative blog. I’ve been able to get an idea of what to expect and what to ask for. Always a good thing.

I’m a 22 year old male with a Pattern 3 hairline. I’ve always had a fairly high forehead, as well as an egg shaped head with temples pretty deep into the sides, so my current receding hairline doesn’t do me much good considering I work as a model. My father is in his late forties and starting to get to Pattern 3 Vertex, we have the same head shape and both started receding around the same time, our late teens. I’m considering getting my scalp mapped out when I return to Toronto [I travel a lot] and see what to expect. I should mention that I have very fine straight hair.

I’m wondering if you could let me know what options I have considering my head shape, as well as age and hair type and also if you have any doctors you can recommend that are in the Toronto area.

I look forward to your reply, thank you for your time.

The shape of the head is often more of an issue as hair is lost. A good head of hair hides the wide variations of shape that makes us each far more different than we think. Hair transplants do address head shape, because it allows men to go back and hide their peculiar shape under a mat of hair. Sounds like you will follow your father’s pattern. Toronto has some very good and some not-so-good doctors. I always tell patients that the axiom is Buyer Beware, so follow the guidelines I wrote about on how to pick a doctor (see: What To Look For In a Doctor). You can find a list of doctors in Toronto or for any other place by using the phsyician search at ISHRS.org.

Continued Balding After a Hair Transplant

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

What happens if you continue to bald after you have had a hair transplant?

There is no doubt that everyone that has had a hair transplant will continue to lose some hair. The question is not if, but when and by how much. It has to be put into perspective with your appearance over time. The correct answer to the question is that the first transplant must be done according to a Master Plan, one that anticipates further hair loss so that the look you evolve into will always look natural. If the look is not going to be natural, for whatever reason, then your doctor MUST tell you this at the time he/she performs the transplant. There is a logic to both the balding process and the transplant process and these two processes must be coordinated. I can not go into all of the possibilities of this on the blog, but I wrote a book on the subject which covers the process in great detail, titled The Patient’s Guide to Hair Restoration. Mapping out the scalp for miniaturization may tell you something about what the future has in store for you and you need to have as much anticipation of what may be as you can get.

Just the other day a young man came in to show me his progressive hair loss since his hair transplant at NHI nearly 5 years ago. Much of the remaining frontal hair (going back about 4 inches) is transplanted, but the non-bald areas are receding further back behind the transplanted frontal hair (he moved from a Norwood Class 4A pattern, more towards a Class 5A pattern). He had been told that this could happen and was put on Propecia to minimize either the possibility that this will happen or at the least, the speed by which it might happen. Unfortunately, he had stopped taking Propecia after the transplant was done, because he felt it was not helping grow more hair and since his transplant looked so good he had a false sense of security. Had he continued taking the drug, the progression may not have happened. I don’t know that for sure, though. He elected to now go on Propecia again to prevent further progression, but may be stuck having to undergo another transplant to fill in the areas he lost if the drug does not reverse it in the next 8 months or so.

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

Laser Comb and Transplants

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

Hi there. I am a 25 year old UK doctor (straight black hair/olive skin). I first noticed hair loss about 4 years ago. It has progressed at a slow rate. I have not receeded at all but am a diffuse thinner – the main areas are at the front-top of my head (about 1.5 cms behind my adequately thick frontal hairline) and also at the crown.

My hair looks quite thin in these areas when wet (with very visible scalp) but if I blow dry my hair and wear it choppy/spiky/drawn towards the middle, it still looks good and my friends/family don’t think I look bald. I started propecia (with full compliance) 2 years ago with a good result – pretty much halted hair loss and possibly even grew back a little hair in the thinning areas.

However, over the last couple of months I have started to thin a bit further in these areas. I am considering buying a laser comb. (Not keen for topicals).

My questions to you are:
1. I know the laser comb currently has no FDA approval for hair loss but does have good(ish) reviews – do you think it is the most logical next step or should I go for minoxidil?

2. Transplants – (which I realise would be a bad decision at my current level of hair loss): It sounds like for a successful transplant I will have to endure a period of going almost entirely bald first in order to assess what needs filling in and to avoid just losing original hair around the transplants over the following years – is this true or can you transplant around thinning hair?

Thanks

From your writing, it appears to me that you are experiencing male genetic hair loss which has responded to Propecia. I am glad to hear that you have been compliant on Propecia for 2 years, but as you know, Propecia may not solve the problem completely. The science is out on the various laser treatments including the laser comb/brush. As for the minoxidil, you can try it, but I would not recommended stopping the Propecia.

In terms of the hair transplant, there is a delicate balance of timing here. People do not have to go bald to get hair transplants, but preventive hair transplants are not indicated unless the thinning has moved past a particular point (something that a good, honest doctor who specializes in this field should be able to tell you). Patience is a virtue, but failure to make a timely decision is a liability. Quite a balancing act! You need to have your scalp hair mapped out to find out how far back the miniaturization is going, so that you can develop a Master Plan before attempting any surgery.

Difference Between FUT and FUE

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

Hi Dr. Rassman,
Thank you for the very informative blog. My question: what is the difference between FUE and the strip surgery? What are the advantages and disadvantages to each? And do you perform both procedures?

Briefly, FUE is more expensive and time consuming and will yield less hair grafts due to the longer procedure time and technical complexities. FUE, however, does not leave a linear scar seen in the “strip” surgery. The traditional “strip” surgery is more suited for large hair transplant sessions. It does produce a linear scar, but with new scar reducing techniques such as the trichophytic closure, it is a great surgery for patients who want the most hair in one session.

Finally, our surgeons at NHI are very proficient and well trained in the FUE and the “strip” procedure. In fact we wrote the pioneering medical article on Follicular Unit Extraction (FUE). And way back in 1998, Dr. Jae Pak (with his engineering background) and I had developed an automated video FUE technique, which was awarded a U.S. Patent.

I Can’t Take Propecia, I Don’t Want to Bald

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

Dr. Rassman, what approach do you take with young men who are not able to take Propecia. Do you never do transplants in them? Do you sometimes do transplants? I am a norwood 2 going on a norwood 3. I am considering getting small transplants to keep up with my hairloss starting in about a year when I will be 23 years old. Is is a bad idea? Going bald is not an option for me, so its either transplants or a system.

I hope you read the blog entry from last week where a patient whom I did not recommend getting a hair transplant was not happy with my recommendation and got a hair transplant from another doctor. Now he is worse off and more bald because he lost more hair due to shock loss.

I would not normally recommend a hair transplant to a Norwood class 2/3, but every patient is different and it would be impossible for me to give you personal medical advice without a person to person consult. You may be a Norwood 2/3 now but without a good exam and a good medical history, there is no way of knowing what Norwood class you would be at the age of 50 (this is where the Master Plan comes in). If you have miniaturization in the areas behind the frontal corners (like the top and crown of your head), then it would be suggestive that you are in for a lot of balding in your future and fixing a Class 2 pattern may not be good timing just now. Alternatively, if there is no miniaturization in the rest of your head and your family history does not show advanced balding, then maybe with the right doctor / patient relationship, a hair transplant could be considered. I am not excited about the idea of doing a hair transplant on someone with such a pattern and at your age, because the pattern of your future hair loss is not going to show up for another few years.

I would also question why you are not able to take Propecia.