Very Bald Patient Megasession Results (with Photos)

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

Norwood Class 6Here’s a before and after picture set that I wanted to show. Though you can’t see it in the photos because I can’t show his face, the smile he showed me really says something about the value of one session of 3539 grafts just one year earlier. The patient’s crown still needs more coverage and he is expecting to do one more session in the upcoming month. Very bald people take a large number of grafts and this man will require between 6000-7000 grafts total, which should complete the entire restoration process. It is important to take note of the high number of grafts required to fill in a Class 6/7 balding pattern patient. Some doctors say it can be done with 500-2000 grafts, but that type of lowballing is not the reality, as shown here. This man has a very fine, gray, slightly wavy hair. His wife says that she has a new man at home, and she shares his smile, as well as the credit for supporting him the way she did.



Hair Shedding for Past 2 Months — Should I Get Transplants?

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

I’m 33 and my hairline has been slowly receding over the last 10 years. By slowly, I mean very slowly. I never even gave it much thought until about a year ago. Within the last 2 months, my hair started shedding without any real reason. I went to my doctor to make sure there wasn’t any serious issue causing the hair loss and all my tests came out negative.

I don’t want to lose my hair and am now considering hair transplants. My question is: when should I get them? Do I need to wait until I’m bald?

First, I would ask if you have been losing hair for a long time and just noticed it. That would be evident if you already have one of the balding patterns (see Norwood Classes). If you are considering hair transplants because of one of these patterns, you should set an appointment with a hair transplant doctor for a formal consultation to map your hair loss for a href=”https://baldingblog.com/2006/02/07/hair-mapping-for-miniaturization/”>miniaturization to find out if you have male pattern balding. There may be other options that your doctor may recommend, such as taking a medication called Propecia (finasteride). You do not need to wait until you are bald to start this medication and if you have early hair loss, then this drug may reverse it. Not using Propecia would be similar to waiting for a heart attack before you start doing something about coronary artery disease. Perhaps not as drastic, but you get the idea. Then again, I am often surprised that hair loss can sometimes be a life and death matter to some people.

A hair transplant should not be your first option. Get a diagnosis first, determine if the hair loss is reversible with a drug like Propecia and then if the hair loss is cosmetically a problem and does not respond to Propecia or if the hair loss has gone too far, then and only then should a transplant be considered.

FUE After Strip Procedure

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

You mentioned, “If you have already had a strip procedure, it would be less expensive to do it with another strip procedure. An FUE procedure will work as well, but at twice the cost.”

Does this mean that once you’ve already had one strip procedure there’s no compelling logical reason to move to FUE since you’ve already got a scar from the first procedure? Or is there a chance that having a second strip procedure could make the first scar more noticeable or do more damage to the donor area?

Thanks

The beauty of the FUE / FOX Procedure is the fact that there is no linear scarring or the stigmata of a hair transplant scar (the linear scar in the back of the head). The scar that occurs after a traditional strip surgery rarely exceeds 2-4 mm in height, and such a scar is easily covered by the hair in the donor area.

You are correct, that the downfall of the FUE/ FOX Procedure is that it costs twice that of a traditional strip procedure, and the number of hairs transplanted in one session is usually much less . The FUE procedure has time and labor constraints involved. Thus, if there are no compelling contraindications to not have the same procedure, the advice was do the same procedure for your next hair transplant procedure.

FUE is not necessarily better just because it is new. It has its indications and specific benefits. Scarring risks do rise with additional surgeries, but very minimally. If a scar is present, then it can be addressed easily for most people.

Wearing a Hair System While New Transplants Are Growing

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

I have been wearing a hair system for almost 10 years and want to transition to a transplant, my concern is really with the transition..how to do this without letting the world know that I am infact wearing a system..or was wearing a system and am gettiong transplants.

Is there a way where I can keep wearing teh system, get transplants and as they start growing just crop the hair as short as aesthetically okay,a nd then just toss the system?

Please let me know I am a level 6 or so, have fairly realstic expectations about what hair transplant can do for me, but am simply confused about the transition period and thus have nto taken any steps.

Yes, many people in your situation continue to use the hair system. The systems must be switched to clips and great care needs to be taken not to allow the piece to irritate and rub the new hair. I generally recommend using a hat when you are not needing the hair system and taking off the system at night (easy to do with clips). Keeping your hair and scalp clean is important. I ask that you hold off using the hair system for the first week after the transplant, and recommend that if you really want to keep it covered, use a hat during this time.

Transplanting Hair Into Scars

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

Hi again Doc! First off, I want to say that I really appreciate your site and plethora of knowledge of this very “thin” topic. My question today concerns whether or not it is possible to transplant hair successfully onto a site where a scar exists? I have had several sebaceous cysts removed over the years, and two of them left very noticeable scars. That coupled with my thinning hair, has made me very self conscious. Your thoughts are greatly appreciated.

By the way, I have begun using that “horse” conditioner, Eqyss Megatek as well as applying some emu oil on my scalp at night. After about 3 weeks or so I do find that my hair appears to be responding well to this combo. I notice less fallout and I have to say am surprised to find quite a few little sprouts along my entire frontal hair line. I am not saying I stumbled upon the cure, however as far as I’m concerned, I’ll keep trying this regimine.

Keep up the great work

Transplanting hair into the scarred area can be done with good success. Generally it may take more than one session to get the thickness you want/need. Thanks for the feedback on Eqyss Megatek and emu oil.

How Are Grafts Removed From Strip?

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

My brother had a hair transplant with you last summer and I’m seriously considering it myself. I’m still on the fence, but I know that my hair isn’t just going to magically regrow in the front and my brother’s hair is coming in quite nicely. That’s a very positive thing. Anyways I’ve been reading a TON of stuff online (thank you so much for this blog) but I have not read anything about how you cut the hairs out of the donor strip. So I’m just curious to know what is involved with removing the hairs from the strip once the strip is cut from the donor area? Thanks

It is natural to be curious and even nervous if you are considering a hair transplant procedure. The best thing is to come to one of our monthly Open House events to see a live surgery take place (on closed circuit TV with the patient’s blessing) and meet NHI patients in person to see the quality of our work.

If the saying goes, “A picture is worth a thousand words”, then I wonder what a video is worth?

Another great option is to watch this quick, informal video filmed during a hair transplant procedure, shot earlier this week at the New Hair Institute’s Los Angeles office. The video, found below, shows a quick scan of the surgical room, followed by a technician dissecting the grafts from the strip under a microscope. The video is narrated by Dr. Rassman — you can try to count the words, but hopefully, this video speaks more than just a “thousand words”.

Note: This video is of surgical nature and may be too graphic for some viewers.

There’s also more videos available on the NHI Videos page.

Using Arm or Armpit Hair As Donor?

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

I have an unusual hair replacement question. I suffered from alopecia and my entire hairline fell out along with some of the fron of my browline. I have been using organic products with great success and finally after a year, My hair line is returning, but the space between my brows has not filled in and now my features are greatly imbalalnced. i was wondering if it is possible to have a browline restoration procedure on a very small area, about 5/8inch on front of right brow and 1/4 or 2/8inch on left brow? As technology has advanced so much with the advent of hair restoration, I think this would be great for me, but would it be very expensive as it is such a small area of hair to be replaced/enhanced? ANd would armhair or armpit hair be eligible as donor hair as it more closely resembles the bushy brow area hair. I am AA by the way.

The technology is available to transplant hair from one part of the body to another. However, the catch is that the hair transplanted from one part of the body, such as your armpit, will retain the same characteristics from the donor site (in this case being the armpit area). So hair moved to your eyebrows will still look like armpit hair. I generally like to use scalp hair as the donor because it most often reflects normal eyebrows. Bushy eyebrows are easy to create if needed, the art is in making it fine and less bushy from any donor site.

Accutane Caused My Hair Loss — Will a Transplant Fix This?

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

First, let me tell you how wonderful and informational your website is. Never have I seen such an informative site that so clearly tells a customer what they might be getting themselves into if they undergo such a surgery. You should be commended!

Here is my situation…

When I was 22 years old (I’m 31 now), I took the Acne drug Accutane to clear up a moderate problem with Acne. My little brother took it and had no permanent side effects, so I figured it was safe enough. One of the rare side effects listed on the container of the drug is hair loss. Well, as you can imagine, I experienced this side effect. Within 3 weeks of taking the drug, the hair on front part of my head, the “juvenile” hairline, started to rapidly fallout to the point where it was clogging the shower everday. I didn’t realize how bad it was and kept taking the drug for a couple more weeks. After it became apparent that the hair was falling out and not growing back, I stopped taking the drug. The hairloss stopped within a couple of days of stopping the medication. I went to several dermatologists complaining of this because the hair never grew back! They all told me I was crazy and that I had plenty of hair and that they saw nothing wrong. Basically, they were defending their drug!

So to make a long story short, it never grew back but I still have plenty of hair left and have not lost any more hair since. So I do not have the typical male pattern baldness (at least not yet) but would like to fix the minor loss and restore it back to the way it was. I am concerned about the success of the procedure due to the fact that the Accutane changed my skin such that occassionally, the skin in the area where I experienced the Telogen Effluviam is dry. I am in Miami Beach now, so the humidity keeps it pretty healthy, but I am hoping that if I go through this procedure that there is not something else that might cause the newly transplanted hair to not grow there. For example, what if the Accutane changed the skin such that the blood flow is lessened there and hence, the transplanted hair would experience the same event?

I see this as the only risk for me right now and would like your comment on it. If I come in for an evaluation and it is determined that this should not be a problem, I will do the procedure without looking back.

Please advise.

Accutane may have had the side effect you describe. It is difficult to say that it only caused your frontal hair loss, as I would have expected a more diffuse hair loss pattern. It may have been just coincidence, but either way you should be evaluated by a good hair transplant surgeon to map out your hair loss pattern for miniaturization and then develop a Master Plan to ascertain what and when you can address this surgically with a hair transplant. At 22, the mapping I am talking about is critical, for if you do not know what you might look like when you are 30, 40, and 50, then starting before that evidence is in may not be in your best interest. Generally, I can see the pattern emerging on most men by the time that they are 25 with good mapping performed.

By Dr. Jae Pak

[Note: This blog entry has been answered by Dr. Jae Pak, who has been working with Dr. Rassman for the past 9 years developing new surgical instruments and hair transplant procedures.]

Single Session Hair Transplant (with Photos)

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

How good can I look with a single session hair transplant. I am willing to undergo one surgery, but I am afraid that I might not ever do it again. Will I look normal wiht one session?

Almost half of our patients stop at just one hair transplant surgery. Below, please find some representative examples of our Fast-Track technique of one surgery, where the grafts are densly packed and can stand alone. I have made a point here not to show the final results, as the after photos are only 8-10 months post-procedure. Every patient looks normal and better than they did prior to the transplant, but they may or may not look full. I always tell those interested to try to find someone with their hair characteristics and their balding pattern at one of our open house events or in our extensive patient photo gallery.

Here’s Patient TG, who is also one of the patients featured on the NHI site. The after photos (on the right) were taken around 10 months after his single transplant procedure of 2,716 grafts.





This is Patient SM (below), who had one procedure of 2,353 grafts and came into my office just this past month. The after photos (on the right) were taken around 8 months after his hair transplant procedure. Patient SM has very fine hair and his results are not the thick head of hair you can see with patient TG (above), but his results are just right for him. The value of hair that has a nice shine to it and reflects light well can be seen on his photographs. Some people with gray, white, blonde, or sandy hair with white skin fall into this group. Others, like TG, who have olive or darker skin tones can have results just as good. Add to the mix, a thicker hair shaft and some natural curl or wave to the hair, and another set of beneficial attributes are also present.





Cancer and Hair Transplants

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

Hi Doc,
I have written to you before. For a while I have been “shopping around” for the best techniques, as well as how cost effective the available procedures are. So far by comparison, NHI has the most natural looks I’ve seen. (in the mild or moderate cases, the more severe cases are less convinceing.) However, my question is this: If you have oily skin, is this a problem for surgery or healing. Also, I was close to have the transplant surgery. I postponed further pursuit of the surgery due to possible symptoms of cancer. (Tests were negative thank God). Now if that ever were the case, I am assumeing that if you had a transplant surgery, chemotheropy would cause all hair to fall out. In conclusion, Is scarring so severe, that being bald or even desireing a haircut style cut close (military style) would bring an alarming rate of attention? I thank you in advance for answering my concerns…

To begin, I am happy to hear that the recents test for cancer were negative. No, oily scalp is not a problem for a hair transplant.

If you drive your life in fear of cancer then you have a problem that needs professional help. Chemotherapy MAY cause hair loss anywhere in the body as chemo impacts rapidly growing cells in the body. Ask yourself what drives your life. When hair is lost with transplants, it almost always returns after the the course of chemotherapy is completed. You can live in fear of what may happen and play into those fears by creating a life around “what if”. Healthy people may have a worst case scenario, but live their lives for meaning, love, happiness, family, friends, and such.

As far as your concerns about scarring, I would suggest that you research the Follicular Unit Extraction (FUE) procedure. You can find more information about this here, here, and here.

Wigs vs Hair Transplants

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

WigWigs, when worn by men, can look great at times, but if you’ve ever spotted someone wearing a wig, you know that they also can stand out as pretty bad (the old rug on a head look). Good hair systems are costly (possibly thousands of dollars a year). They require constant maintenance and they do wear out. Everyone having them must have at least two of them, each often costing over $2,000 and those that are made for the ‘upper class wealthy people’ are significantly more, I am sure. The hair grows under the wig, so these wigs must be removed and repositioned with fresh glue after the scalp is shaved. Eventually, the glues used will produce traction hair loss so that all of the hair in the glued areas will be lost. As many as two or three maintenances per month are often required and that costs $$$ if you have your special stylist folks do it for you, pushing up the annual costs substantially. To avoid odor from developing, the wig and the scalp must be washed regularly. Can you imagine wearing a T-shirt day after day and what it might smell like after just a few days? This is a characteristic odor that reflect body oils in decay. The scalp is no different, as it sheds skin at a high rate which also undergoes decay, so it must be scrubbed off with frequent washings, taking off the hair system and replacing it regularly. Many men with hair systems are tense when in intimate situations, as they have a no touch zone around their head. Can you imagine a woman running her fingers through your hair and have the piece come off in her hand, or her finger nails catch on it. No way! So men with hair systems do not allow intimacy to go as far as to let a woman touch their hair.

Hair systems and hair transplants often run neck and neck with regard to costs for the first few years, but after a hair transplant has grown out, the costs end, while those people with hair systems continue to contribute to the profits of a ‘hair club’ type organization to the tune of about $15,000 every 5 years or so. The good rugs probably cost more and I suspect that celebrity costs might be equal to the annual salary of many of my readers. To the credit of many hair system wearers, these systems can look damn good; as good as any transplants I have done. Of course, my hair transplant patients can let their ladies run amuck in their hair. Add the smells and additional maintenance required for a hair system, and there is just no comparison to what a great hair transplant can accomplish.

Shock Loss?

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

I had my hair checked about 18 months ago as it was receding a bit in the frontal area. I am 52 years old and have no issues anywhere but the front. I started Propecia at that time and it worked. No real regrowth in the front, but no more loss and some thickening everywhere else. I was told by the Doctor that he didn’t think I was a good candidate for a transplant because I still had some frontal hair and that it would fall out if I had transplant and the overall gain would be the same as before. There was a name for this, but I can’t remember it. Have you heard of this?

Shock loss occurs when pre-existing hair is shed after hair transplant. This event occurs mostly in patients who are younger (often less than 30 years old) and a first time surgery patient. Although this event does occur with men who are on Propecia, it is more common for the young men not on the drug. With that said, those are two factors going for you which decreases the chance of shock loss following a hair transplant. Just being 52 years old, the chance for you makes shock loss is unlikely (less than about 2%). Using Propecia protects most people from experiencing the problem. It sounds to me like your doctor just does not know enough about today’s risks. Maybe we should educate him.

Densely Packed Hair Transplant?

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

I am a little concerned. I have had 2 consultations with 2 very prominent doctors in the field of H.T. Surgery. Both were very warm doctors, with the first doctor offering a much lengthier and thorough consultation. My concern is that the first doctor suggested about 650 grafts and the second doctor suggested almost three times that amount (for $2,000 more). My concerns are why the diffenence in suggested procedures? Should I consider the “dense packing” suggested by doctor #2?

Without seeing what your pattern is, I can not give you an answer to your question. Without knowing the doctor and his/her ability to perform dense packing, I also can not give you an answer. If you send me a photo, I might be able to tell you which one of the two doctors is closer to get you a good result, but then the actual delivery is the issue. We have hundreds of patients featured on our NHI photo galleries, complete with before and after photos, how many transplants they received, and what their balding pattern looked like. You should try to match what you look like to these pictures for a realistic assessment of what you may need. Also, I have written a book to help people like you through the decisions, called The Patient’s Guide to Hair Restoration.

Any Supplements to Take With Propecia?

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

I’m a 25 yr old man w/ receding at the temples & am deathly afraid of going bald. I’m on propecia right now. Are there any supplements that you would recommend I take as well? Also, can a transplant restore the temporal area & what is the avg amount of days a patient needs to take off from work for the surgery? Thanks.

Propecia alone should be adequate. You can elect to add minoxidil to it as well.

Transplanting the temples are not difficult for a good, experienced hair transplant surgeon. You should take off from work on the day of surgery, but you do not need to take any days off after that. It really depends on whether you mind if people see the initial redness in the transplanted area. You can see some examples of temple hair transplantation at the patient links below: