Transplanting Chest, Leg, and Thigh Hair

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

I have read some doctors preaching the use of chest and leg hair for hair transplants. I have also read your comments and general lack of enthusiasm for this. What is behind your strong opinions against this?

Scalp hair is better understood and tested for over 50 years. Although the art form has only been reasonable for the past decade or so, the facts concerning hair growth from a scalp source as donor hair are well understood. It is always important for me to inform patients about their risks, expected growth rate, and reasonable results that they should target. We have no body of evidence that hair taken from body or leg parts will work to any reasonable degree, but there seems to be (as P.T. Barnum said) a sucker born every minute. I do not want to be part of such a process, at least until it is clarified as something real.

In the book by Elise A. Olsen, Disorders of Hair Growth, the rest cycles of hair are stated. Although I can not attest for the science of these figures, let’s take them at face value for a moment and see what it means if correct. All hair cycles go through various growth phases, so the length of these growth phases are critically important to understand. For head hair, growth cycles range from 2-7 years, with a sleep period of 3-6 months. Generally it is believed that head/scalp hair is in its resting phase for about 10% of the hair population, which means that of all hairs growing on the head, another 10% is lying dorment awaiting its growth phase.

  • Leg hair has a cycle between 7-12 months, but between 62-88% of these hairs are in their dormant phase.
  • Thigh hair has a cycle of 3-5 months, but between 64-83% of these hairs are in their dormant phase.
  • Arm hair have a cycle of 3-7 months, but between 72-86% of these hairs are in their dormant phase.

With chest, arm, and body hair, the above numbers suggest that there is a large number of sleeping follicles at any one time. If this is true, then there will be questionable value from a hair transplant using these body parts from fullness or coverage point of view. Add to that the pain of hundreds or thousands of small wounds created all over your body might produce. I wonder about the doctors who are routinely performing this type of surgery and ask about their motives. I have concluded that any doctor who offers this must let his patient know that this is not a tested procedure, falling in the experimental rather than the clinical hair transplant offerings. I’d also hope they reveal the figures related to sleep cycle of the hairs from the various body parts as discussed above so that their patients are well informed.

Wrinkles, Shock Loss

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

Did you say that scalp excercises and massages actually CAUSE wrinkles in your forehead?

Also, Im not sure if you answered my question regarding hair follicles, but if you have a hair transplant and hairs fall out due to shock loss and dont grow back….does that mean that the follicle is actually destroyed or is it still intact, but just not producing hair anymore.

Thanks for your help

Sleeping BeautyMassages do not cause wrinkles in the forehead, nor will exercising the forehead muscles make that happen. You may be thinking about what I said when a person is trying to find out where their hairline was when they were youths. Wrinkling the forehead will produce a line at the top of the forehead muscles (frontalis muscle) and that line marks where a child’s hairline or a woman’s hairline starts.

‘Shock loss’ from a hair transplant may grow back if the hair is permanent hair (most women) or hair that is not at the end of its life cycle (such as an accident with a scalp wound in a non-balding man). When the balding process is at the end of the cycle for those hairs that fall out from shock loss, these hairs may not grow back. Miniaturized hairs which result from genetic balding are ‘weak’ hairs that will not live through a major stressful event.

When it does grow back in balding men, it is because the hairs that were lost are usually not at the end of their natural life cycle. If they grow back, then clearly there is life still left in them. Hair that does not return after shock loss in the male is for all practical purposes hair at the end of its ‘life’. With that said, I do not really believe that the hair is ‘dead’, but rather impacted by whatever the defect that causes male patterned genetic hair loss. Some day, hopefully in my lifetime, a medication will be produced that will take up all of the ‘seeds of hair’ that I believe are still in the scalp, closing the defect so that the hair will start to grow… in a way much like the classic tale of Sleeping Beauty, I suppose.

Sometimes ‘shock loss’ can be minimized by being on Propecia prior to having the hair transplant. Shock loss does not happen to all patients who undergo hair transplants, just some of them. Most people are quick to forget the robust nature of permanent hair which comes with the hair transplant process. Shock loss should be something that is explained to you before you get hair transplants. It is a part of the informed consent process and you need to know all of the risks involved when you undergo a hair transplant (or any surgical procedure).

Avoiding Hair Salesmen

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

SalesmanI just saw a 23 year old man come back to see me after he had a hair transplant with another medical group known for ‘overselling’ hair transplants using pressure tactics with an aggressive sales force. He had seen me just a few months earlier and I told him that I felt that he was not a good candidate for a hair transplant at this time, because he was too early in the hair loss process. I further told him that if he had a surgery without a course of Propecia, he might accelerate the hair loss. I thought we had agreed that he would go on Propecia in an attempt to slow down the hair loss he was experiencing and then return in 8 months for further evaluation.

He went to another doctor for another opinion and then, under pressure by their salesman, he had a hair transplant. On his visit with me yesterday, it is now 5 months after his surgery and he looked fairly bald now, with a reactive hair loss. Prior to his surgery he was a Class 3 pattern balding and now he showed a full Norwood Class 6 pattern. The 1000 grafts he received at the surgery were insignificant in view of the hair loss he had. The patient never took the Propecia (which might have protected him from the loss he experienced).

Some clinics still exist today who ‘sell’ hair transplants like a used car. This young man is now hooked on the hair transplant process, like it or not. Will he ever be normal? Will his supply of donor hair meet the demands of his progressive balding? Will he have enough money to follow the course he is now on? Did he ever really have Informed Consent offered to him? What are his options?

I am not going to answer these questions, because by posing them I have in a way brought the purpose of this blog entry to your attention. For those shopping for a hair transplant today, it is still appropriate to warn: Let the buyer beware!

Itchy Scalp After Transplants

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

I am a 53 year old male who was blessed, until November 2004, with a mostly full, but fine head of hair. At Halloween, I put hair coloring in my hair for a costume, did not wash it out until the following Monday morning (the color came out when I slept and I did think about the chemicals still being there – when I read the can later, it said not to use on fine hair – I was extremely mad at myself). Anyway, I had six weeks of an itchy scalp and some hair loss with it.

This past summer, I had another 8 week bout with itchiness and even more hair loss- I started using tea tree oil shampoo and creme rinse, and Jason’s thin-to-thick shampoo and rinse, as well as putting jojoba oil with tea tree oil into my scalp at night. I visited two Chicago area doctors who told me itchiness was part of the active balding time and nothing was wrong with my scalp. I visited them after this bout ended, with loss that I now wanted to do something about. I decided to go to female doctor at the end of October 2005. Everything went fine until a couple of months ago, four months after the transplants. I started to notice hair coming in, but then the itchiness/sensitivity started. I thought that was just irritation from the new hairs, but then I started to worry that maybe this was not the case. Anyway, the hairs placed deeper in the middle front and the majority of the right side transplants came in, but the front middle (new V) and the front left side mostly did not. I am very unhappy about this, and I just hate this feeling of itchiness /sensitivity that is only on the left side this time. (two months and running-getting better) I was / am taking propecia three times a week, as I had a lowered libido with daily use. (Dr. told me to go to 3x a week) I was not using Rogaine until a week ago, where I started to use Scalpmed, another minoxidal product.

Do I possibly have some stress loss of new hairs? Should I go back to using Propecia more often? I can accept the more frequent use until the hairs come in, if they still can. I was told by an assistant than it will take 18 months for the complete result.

I am in great need of some guidance. Thank you

If you have a good doctor, you should be discussing these things with that doctor. You asked about itchiness and was told that it is caused by male pattern balding. That is not the case as there is no evidence that the two are connected directly unless it is the result of sunburns or other things that dry your scalp skin. You had transplants about 7 months ago. I generally tell patients that 80% of the results will be in by the 8th month and 95% should be in within a year. If one side grows slower than the other, that is ok, but if one side does not grow and the other side grows out well, then the technical people placing (different technicians placing the grafts into the different sides of the transplanted area) may have caused a problem that killed off hair. Less skilled technicians may damage the grafts when moving them around or take longer to place them and in the process of placing the grafts, they just dry them out (just 10-15 seconds exposure of these grafts to the air can kill them). Wait out the full 8 months first before thinking of the worst.

Taking Propecia three times a week makes no sense to me, because it is completely out of your body in a day. Taking 1/2 tablet of Propecia each day has about 80% of the benefits of taking a full tablet if you have a libido problem. Rogaine (which is minoxidil, also contained in ScalpMed) can dry the skin and make it itch and that is not commenting on the other additives in each of the commercial products containing minoxidil. Propecia will have no effect on the new hairs, nor will the minoxidil impact the hairs from the donor area. I think that you need to sit down with your doctor and get answers from your doctor, real answers and not be talking to his technicians. This is what a doctor/patient relationship is about.

My Father Had Awful Transplants from a Dermatologist

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

I have been on finasteride for 7 years. I have pretty much maintained my same density over this period. A little more thinning in the front. I am now 36. My father had many transplants from a doctor who is a dermatologist. Not from a doctor that specializes in transplants. His transplants are awful. What should my expectations be if I wanted to get off the drug and try transplants? I am fair-skinned with wavy auburn hair, and my individual follicles are thick, but not dense.

First, the old plugs can easily be fixed today. Look at the following links for articles and examples of good repair work which can and should be offered to your father:

The second part is that taking the drug Propecia is a different decision to having transplants. They can be complementary (see: Hair Transplant and Propecia Combination Results). As for expectations about transplants for yourself, meet with your doctor and have him/her develop a Master Plan with you, so that you have your needs addressed before the procedure.

A Transplant Doctor Told Me I Need Multiple Procedures

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

I am not bald and have a thick head of hair. My only problem is my naturally deep temples which I want to fill in so that my hair line looks straight.

I was recently told by a hair doctor that only a certain number of grafts can be performed on the temples of my head in 1 session since the number of hair follicles in my hair which is very dense. He states it is impossible to graft too many or the follicles will compete for blood supply and the instrument’s pressure will cause adjacent grafts to pop out. The area I want to fix is rather small. However, he says I will probably need two transplants.

Is this true or is it just a way for him to make more money?

Without knowing the size of the area, the number of grafts, or the thickness of your hair it is hard for me to answer this question. Generally you can safely put 40-50 follicular units into a square cm (normal densities are 100 follicular units per square cm), but that depends upon various mechanical factors. The average person does not need to achieve normal densities to get adequate fullness. With a small balding area I would assume that your blood supply should be very good. Dense packing of the grafts was pioneered by me in 1993. I believe that there are situations where one doctor can put too many grafts too close so that growth might be impacted. Some doctors have extensive experience in dense packing and can do it safely, others have not built the skills and would prefer not to dense pack the grafts. Whatever the doctor is comfortable with is what is probably best in that particular situation. Never push the doctor to do more than his comfort level is. Plus, you always have the option to visit with a different doctor.

Hair Coloring and Scar Visibility After Transplantation?

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

Hi-
Over the past 3+ years, I’ve had 3 transplant surgeries and I’m tremendously happy with the results. Some years ago, I used to occasionally double process my hair blond (it’s dark brown naturally) and I liked the results. Is this still a possibiliy or is it to risky for my hair. Will it make the scars more visible? Needless to say, I wouldn’t want to damage my transplants in any way. Many thanks

Colored HairYour hair is your hair and a hair transplant, once done correctly, means you can dye it, cut it, perm it, spike it, etc. The beauty of a good hair transplant is that it is just like you never had lost your hair. As for the scars, I couldn’t tell you for sure, as there are a number of factors such as width/length of your scars (I am assuming you had strip procedures) and the length of your hair. However, I do not think the scar visibility will be an issue with processing your hair blonde, but the only way to know for sure is to try it once. Generally, the only time the scar has a chance of being seen is when the hair is cut way too short (like crew-cut length).

I Don’t Like Having a Mature Hairline

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

I am 23 and notice I have a mature hairline. its a 2 on the scale. I dont like my hairline though and would like to get the hair around my temples back. Is there any procedure that can fix this? If so please tell me

I have transplanted the juvenile hairline back in some men, but I do so only under certain conditions:

  1. There is no evidence of advanced balding either on examination or in the family line.
  2. I want to get to know the patient and he must be mature and able to understand the ‘worst case’ scenario that could happen (in your age the worst case thing is advanced balding).
  3. I look at the value of the various elements of hair quality, skin color, hair density, and overall donor supply characteristics and connect it with potential demand considerations.

I have clearly done this more than once, but in my present memory the only ones I have done under 25 years old were professional actors, television soap opera sexy men, or models whose livelihood depends upon that ‘youthful’ look.

Hair Transplant and Propecia Combination Results (with Photos)

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

This patient had a hair transplant a few years back with me, which filled in the front and top. He has been taking Propecia for the crown. The combination is awesome. In just ONE surgical session of 2,626 grafts, he now has a strong frame to his face and filled in much of the frontal hair. The back of his head gained just enough hairfrom the Propecia to take away the heavily see through look and all of his sensitivity to being the balding man we see in his before pictures. Photographs were taken from eyebrows up only. Click the photos to enlarge.

Before:



After:



Another Patient Returns (with Photos)

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

I met with a patient who had one procedure of 1,541 grafts a little over a year ago. We sat down and reviewed his pictures together and he completely forgot that the man from a year ago ever existed. I share with you his wonderful results and I thank him for allowing me to show his face and post these photos. Click the photos to enlarge.

Before:



After:



Hair Transplants or Propecia

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

I have been on Propecia for 6 years now and have decided to get off of it due to potential unknown long term side effects and even short term side effects that I seem to notice more as I age(Libido, minor Gyno, etc). My question is how long do you recommend I go before I consult for a potential hair transplant since it is difficult to say what my potential future loss will be right now since Propecia did have a positive effect on my loss and I would have almost certainly lost more. Im currently 30 years old and have probably a Norwood 3V and more of a Norwood 2ish in the Temporal/frontal region which hasnt changed to much since I started Propecia. Ideally I would love to get a transplant now to basically keep my existing hairline(which im ok with even though its receded a fair amount) and fill in some of my vertex while I can still conceal it with exising hair but Im worried about not being able to plan correctly since I wont be taking Propecia. Any advice will be most helpful.

Thanks

You need to be evaulated. If you density is good and there is miminal miniaturization in the top (area between front and crown), then you may be a good candidate for hair transplants. At 30, your pattern should be evident when your scalp and hair gets mapped out for miniaturization. From that a Master Plan needs to be developed which will take into account your worst case hair loss scenario and then the supply/demand for hair transplants becomes a measurement to base a safe decision in the long term planning for any transplant process that you undergo. Stopping the Propecia is something that you should think carefully about, a lengthy discussion with your doctor to see how this decision may alter that long term plan I am talking about.

HIV and Hair Transplants

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

I just had a patient who, in our routine testing, had a lab test that was HIV positive (he was very surprised). He is over 50, recently married and his wife of three years was tested for HIV prior to her marriage, but he was not. He and she came into the office quite calm. They had just returned from getting the news from their family doctor who wanted to repeat the test considering the patient’s history would not support a high risk status. When he came in, we spoke calmly about it and we ran tests from our lab on both the patient and his wife. Within 2 days, the tests from my office came back negative, as did his family doctor’s repeat test. What a hell he must have gone through!

I have dealt with many men who were HIV positive and who wanted a hair transplant. They knew that they were positive to the test, were already under treatments, and had good control of the disease. I took them on as patients just as I would anybody else. I routinely screen for HIV, although I am not hard on this rule. I have had 5 patients with positive tests when these men did not suspect that they were positive to the virus. The shock of my interviews with these patients is memorable and I spent a great deal of time working with them, arranging a repeat test, being sure that the tests are not false positives and advising them as any good, concerned human being would do. This was the first time (1 out of 6) that the test came back negative on re-running the tests. Four of the six patients eventually had hair transplants with me including the patient who tested a false positive this week.

I remember one patient who had advanced HIV, not controlled by medications very well. He was healthy enough to have a hair transplant and did after I worked through this decision with his doctor. I remember him well for two reasons: (1) He felt that he was going to die and wanted to meet his maker looking good with a full head of hair, (2) I accidentally cut my hand with the scalpel that I used on him. Yes, accidents can happen, and this was certainly one that I’ll never forget. Over the next six months, I tested myself for HIV monthly and have done so yearly, every time being negative (that was 10 years ago). I learned that the risk to a person who cuts his hand with a surgical knife that was previously exposed to HIV blood is less than 1% in contracting the disease, but had it been a needle with a drop of blood in it, the story would have been different. In fact, most healthcare workers who got HIV from a hospital accident got it through a needle that originally contained blood. About a year after the incident, this patient’s mother came by my office to inform me that her son had passed away. She smiled as she told me, ” He was happy in the last days of his life, and when he looked in the mirror, he liked the new look he got from the transplant.” She went on to tell me that her son wanted to lie in an open casket at his funeral and he wanted to have his own natural hair at that time. He wanted his friends to remember him that way. I realize that this story may seem a little morbid to some readers, but I wanted to share this very humbling experience where I helped someone achieve one of their final goals in life, even it the goals were outside the goals I normally see.

Hair Growth After Transplant

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

It’s been just over 8 weeks since you performed my 3000+ grafts hair transplant. I’m noticing some of the little guys are still falling out. There are no scabs, only small hairs that continue to tumble to their death into my bathroom sink. Am I not being aggresive enough when I shampoo, or do each of these little guys tumble to the ground on their own schedule?

I noticed a few grafts growing immediately from day 1, and these guys are actually pretty long already! Others, though, fell out early and are now pushing their way toward the light. I imagine the ones still shedding will subsequently start their growth later, and that’s probably why the 8-month total wait, huh?

Just wondering.

You are on schedule for your hairs to be doing what they are doing. It is not unusual to lose grafted hair as the old transplanted hairs shed. Sometimes the stubble of the transplanted hairs stay around for a few months, then they sooner or later fall out to their “death” (not really an appropriate statement, as they have been dead since a week after the transplant). The hairs from the transplant that did not grow immediately and fell out, do not reflect the hair growth center cells which are alive and getting prepared to start their anagen cycle. FYI, at the end of the cycle, a hair “bud” situated at the base of the “rest” root (phase 2) develops and will push out the hair in the involution to become a new hair as it ‘grows up’.

At this stage of your recovery, I would not worry much about aggressive shampooing, just do what you generally do and that should be fine. You must wait out the 8 month period to see 80-90% of your growth.

Does Transplanted Hair Grow Like “Real” Hair?

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

Hi, I was wondering if the hair you add on is real hair, does it grow normally just like normal hair does? How long will the surgery take? How expensive is it? Accroding to your pictures, I’m at stage two of baldness, I’m currently using procerin, but the hair still falls, not as much though, I know the problem will continue and eventually I’ll go bald. I want to add on about an inch of hair down to my forehead all the way to the corners. I want to know what’s the cost of the surgery, your response will be greatly appreciated.

A hair transplant takes hair from the back of your head and moves it to where you need it (hairline, top, or crown). So yes, it grows just like normal hair, because it is normal hair. Pricing varies per doctor, and procedure length is measured in hours (depends on how many grafts you need transplanted). Our pricing can be found here — NHI – Fees and Financing.

Your brief description of hair loss is alarming because you state you have a Norwood class 2 hair pattern. What you may perceive as a hair loss problem may be that you are transitioning to a mature hairline, which is not a sign of balding.

Tags: hairtranspant, hair transplant, procerin, cost, fees, hairline, hairloss, hair loss

Lose 10% of My Hair From Shock Loss After Hairline Lowering?

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

Hi, I would like your opinion on lowering my hairline (I’m female).Dr. ‘X’ in Australia stated that i may lose 10% of my hair from the shock loss due to the new implanted hairs? Why do some say there won’t be any shock loss and others say there will be? It is the only reason delaying me to proceed with the procedure. Dr do you travel to Sydney etc or could give any recommendations? Also would you suggest i get the fox procedure rather then the traditional way? Is there any benefits of this procedure over the conventional way? Thank you. Kindest Regards.

The answer is, “It depends.” If you have genetic female hair loss (which actually usually maintains the frontal hairline in women) shock loss is possible and when it occurs in women, it is rarely permanent. If you are trying to lower your hairline because you have had a forehead/brow/face lift then hair transplants work very well (see Female Hairline Restoration After Brow Lift). If you don’t like how your face is framed, because you were genetically programmed to have a high hairline and have no other underlying medical conditions, then a hairline lowering procedure is a good surgery to fix this. Shock loss is rarely a problem in this type of surgery.

As for the other, FOX/FUE may or may not be a better option for you, again just depending on your reasons for getting it done in the first place. These FOX/FUE procedures are fairly expensive. I would suggest that you send me photographs and tell me something about yourself so I can give you direct advice that fits your agenda.