Risks and Pain in Transplanting a 50 Year Old

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

I am considering a hair transplant of 2200 grafts and am 50 years old. I am in good health and I have plenty of donor hair. I feel that this would make a tremendous difference in my hairline and appearance. What are the risks and pain involved for a man my age and with that amount of micrografts? How long would it take to heal? thank you

2200 grafts is a moderate-sized surgery that would likely take about a week to heal in the donor area. The risks for someone of your age if you are in good health are roughly the same as those for most other ages – to be more precise, there are surprisingly few. As with any surgery you risk the possibility of scar formation, infection, and possible adverse reaction to anesthesia or other drugs are very, very rare. These are the big ones we worry about and incidences are very uncommon in a proper surgery center and with a trained and experienced doctor and team. There is also no excuse for this elective surgery to be any more painful than a mild dental visit. Good pain medicines and effective techniques are available, well known, and should be used.

To be completely honest, your biggest risk is in the choice of your surgeon and the team they use. Choose a surgeon with a good reputation whose hairlines you like, and make sure they are willing to let you meet their patients and evaluate their results for yourself. Check the facility and ask the surgeon who is on the surgery team. An experienced staff makes all the difference in the world both in your experience that day and in your final result because of the way the staff members treat the grafts. Lastly, choose someone with whom you feel comfortable. Many of my patients who come in for corrective work had a less than good feeling when they went to their doc or they chose them solely on price. Remember, you are the one who gets to live with the permanent results after all, so be a little picky.

Cowlicks, Widow’s Peaks, and Hair Transplants

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

I have a question. The hair on the left side of my head, from the hairline to about 1 to 1.5 inches behind it moves in a fully forward direction instead of backwards and down. This cowlick creates a very messy look and contrasts with the normal direction of hair on my right side.

Is there any procedure that can be done to just change the angle of direction of those hairs? If so, who performs this?
Thanks very much

Cowlicks are hairs that grow in a different direction than adjacent hairs. They can be very sexy or they can be annoying, much like your complaint about them. Grooming can be a problem if you are a perfectionist, your hair character is strong, and the direction abnormality is in an obvious place, like the very frontal hair line. This is most often seen in the central area of the frontal hair line, frequently in association with a ‘widow’s peak’ or as in your case, it can be off center. There is little to do about them without damaging the frontal hair line. When we transplant near them and they are strong, there are many artistic judgments that the surgeon must make on how to deal with them. I love and hate them, depending upon what I am asked to do with them and the patient’s opinion of what he wants and what he can reasonably achieve.

My suggestion is for you to accept the cowlick, learn to style around it and not to aggressively go after it unless it is very limited to a small area, in which case, FUE might be possible. You need an expert to evaluate this in person and to protect your interests.

Advice for Balding Actor

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

Dear Dr Rassman,
I’ve got to a point now where i need to address my Hair loss!! I started losing my hair in my early 20’s but it was never that noticeable -this was probably due to the fact that it was a gradual thing and that my hair was densly thick! I’m now 29 and my hair seems to be falling out rapidly and it’s becoming harder and harder to cover it up. I’ve started using Propecia with the hope that it will stop the Hair loss. I’m an actor and am worried that my eventual lack of hair will effect my work! Any advice?
Yours Faithfully

I understand the need to maintain your appearance as an actor. Some character actors can establish a balding persona, so you can accept a balding fate and still make it in the movies or theater. As actors reflect the male population, half of all men will be balding by the time they are 45 years old.

Now that does not mean that I am advocating balding. If your desire is to maintain your hairy appearance and Propecia does not hold it, then hair transplantation is a reasonable option that can produce wonderful, normal, and undetectable results. First, get your hair loss pattern established with a map of your miniaturization. Then, work out your supply versus demand possibilities for hair over time based upon the mapping I just outlined. With that in hand, you can establish a Master Plan, from which you can then make plans. Hair restoration surgery does not mean that you must go bald to get hair back. It means that you plan out everything that is happening to you, short and long term, with the best tools and doctors available today. We are there, just look for us.

Hair Transplant Without Surgery?

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

Are any of the topical ointments being sold on TV effective? I have heard (in Jacksonville, FL) of a new transplanting system without surgery – any such thing??

Effective? That depends on what you want them to do. I’m not even sure what hair regrowth products are being marketed on TV these days.

There is nothing new on the face of this earth that can give you a hair transplant without surgery. Someone is dishonest or plainly a crook. Maybe you misunderstood, so giving the benefit of the doubt, please send me a phone number, website, or at least the name of this procedure the next time you hear about it, and I will check it out for you.

Lateral Slit Method

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

What exactly is the “lateral slit method”? Do you use it? How does it improve results?

The lateral slit method for placing grafts in a hair transplant recipient area constitutes the use of slits which are oriented from ear to ear, rather than slits that are oriented front to back. Proper slit making is best done with very small slits, measuring between 0.8-1.1 mm in length. Clearly for people with coarse hair the wider hair shaft may require the longer slits, while those people with fine hair will require smaller slits.

The skills in placing lateral slits is different than the more conventional slits oriented front to back. It is slightly more difficult for those not accustomed to the technical issues involved in the process. The claimed advantage of lateral slits are many, including:

  1. As the grafts heal, there is a fence like orientation of the hairs within the grafts which may increase a sense of fullness from a frontal view.
  2. There is a possibility that the hairs may angle forward from the point where they exit the skin. This may accentuate the layering effect from the transplant and some people believe that this will create more fullness.

The problem with these ideas is that there is no proof. But despite the absence of proof, I perform lateral slits in almost all of our transplants because there is no down side to doing it this way. I wrote about the lateral slit method earlier this month: Lateral Slits and Transplanted Hair Direction.

9 Months After Hair Transplant (with Photos)

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

This patient is a Norwood Class 6 and had one hair transplant procedure of 3,206 grafts just 9 months ago at the New Hair Institute.

This is what he had to say…

No one ever knew that I had a hair transplant or that it was even me until I told them! I had to let the secret out of the bag, because people couldn’t recognize me.



Even after only one procedure, the change in his appearance is so remarkable, that I wanted to show off his results (with permission, of course). The photo on the left was taken just before hair transplantation, and the photo on the right was taken 9 months after. Click each image to see the full size photo. Forgive the quality of the “After” photo — there was a problem with the camera that wasn’t noticed right away.

Matthew McConaughey and Hair Transplants

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

Dr. Rassman, I am concerned that your post about Matthew McConaughey is misleading. Do you honestly believe he had transplants? Here are two reasons why I think it is unreasonable to think so. First, he had a full head of hair in movies before and directly after the picture (showing hairloss) was taken. The only way he could have had transplants is if his hairloss was sudden and his regrowth was extremely quick. Second, the results are be too good to be transplants even if used in conjuction with drugs or anything topical. I’m sure transplants can make make a big difference, but not that big of one. If he did have transplants then the pictures of your work appear to pale in comparison to the kind of work that can be done. I don’t think your work is substandard to anyone. I think he uses a hairpiece. Are you worried at all that passing his improvement off as a transplant will give people unrealistic expectations as to what hair transplants can do and perhaps unduly persuade people to get hair transplants. Also, do you think hair transplant doctors may be attributing Matthew’s results to hair tranplants in fear of losing people to the hairpiece business?
Sincerely,
Concerned

Just to be clear for the readers of this blog, your question is in reference to the post I made back in May regarding Regenix and the role it may have played in the hairline restoration of this actor.

I have no first hand knowledge of Matthew McConaughey. From photos I have seen of him, there is obviously a big change in his hairline between the older pictures and his current presentation. If the change reflected a hair system, then it is a good one. In the movies, this is done quite often for balding actors, and there are people primping and grooming the hair piece just before they are on film to achieve the best possible look. If the change reflected a hair transplant, then he had a good hair transplant surgeon. Photographs show us what the photographer wants us to see. A hair piece (a wig) would be instantaneous, while a hair transplant would take 8 months to grow out.

As far as expectations, look at the change a hair transplant made in broadcaster Steve Hartman, as featured on the NHI website. The results were at least as good as a great wig, but since it is his real hair growing from his head, he doesn’t have to worry about the costly maintenance or smell issues associated with hair pieces.

I’ve posted links to these photos before, but they are worth reposting to show the dramatic change in Mr. McConaughey’s hairline.

Shaving the Head Before Transplantation

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

I had 1600 grafts transplanted at the hairline area about 4 months ago. When the procedure was done the doctor shaved that part of my head. My hair loss up until that point was somewhat concealable when the hair that I had was grown out and some of the hair further back was combed forward. After the procedure I had to cut the rest of my hair to make it look even with the area that had been shaved. This made my hair loss much more noticeable. I was not aware until seconds before the shaving that this would be happening and I was told that this was necessary to gauge the proper growth direction of the follicle. Was this necessary? Had I known it would take about 3 months of growth just to get my hair back to a place where I wasn’t obviously balding I may have reconsidered. At 4 months my hair looks very similar to my pre-operation density and I do not notice any significant new growth. Should I be concerned?

Sounds like some failure of communication occurred. You should have been told that your head would be shaved. I know that many doctors do this, but I do not recommend it. I tend to just work around the problem of long hair. I take the view that everything should be as natural as it was prior to the surgery. At 4 months, I would expect that the hair should be starting to grow out. Look for 80% of the benefits by the 7th month. Good luck.

Redness, Hair Growth, and Differences Between Doctors

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

My boy friend is considering hair transplant surgery. How long will the redness last? How long does it take for hair to re-grow? Are there different procedures use by different doctors?

If there is redness at all, it will be gone in 19 out of 20 patients within a week. It generally starts to regrow (like seeds of grass that get placed and take time to grow) in 2-5 months. I tell most people that they can see the impact of the hair nicely by the 7th month, where 80% of the hair will grow to styling length. In one out of 20 patients, the growth will be immediate. Most patients experience some early growth, but I generally tell them to wait patiently for the hair to grow.

There are many different procedures that doctors do. To get a complete scoop, you can call 800-NEW-HAIR or fill out the form on the Request Additional Info page and I will send you a free copy of The Patient’s Guide to Hair Restoration, the book I wrote with Dr. Robert Bernstein that defines the differences. As price is also an issue for the cost conscious buyer, please also take a look at the past blog entry, The Truth About Cheap Hair Transplants.

Would I Hate Myself If I Had a Transplant at Age 26?

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

I’m a 25 yr. old guy. I visited [a well known doctor] and he told me that if I had a hair transplant procedure, I’d “hate myself for the rest of my life.” Pretty harsh. I appreciate his honesty, but am disappointed that this is not an option for me. I’m confused! I would be more than pleased with the results that I have seen on various good physician web-sites. I’ll be 26 shortly, and am wondering what my options really are if the best results are so bad that I’d hate myself for the rest of my life.

You can always get a second opinion. If the doctor is well respected, there are a number of questions I first would want to know about you, so seeing a photo/meeting with you and speaking with you would be invaluable. Things that may make the doctor have hesitatations with transplanting a man of your age would be:

  1. Unrealistic expectations (which is why we don’t do computer imaging)
  2. Body Dysmorphic Disorder (see BBC News: Health)
  3. Poor donor supply (possibly from DUPA)
  4. Too early
  5. Unable to face the consequences of progressive balding
  6. Psychiatric problems
  7. Financial problems

Many times when I want to point a patient to a psychiatrist, they resist. After all, I am a hair transplant doctor and not a ‘shrink’, so it is not often that I give a special speech on this subject, and certainly not like the one the doctor you discussed gave to you. If you do not communicate with your chosen doctor, that would be one way for him to get your attention. Remember, you do have options, and if you are not comfortable with what you were told by one doctor, you are free to see another.

Hair and Love

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

Will my wife love me the same after a hair transplant?

On first blush, this could be conceived as a funny question, but I thought hard about it and looked back on my experience with hair restoration and relationships. There is clearly a connection best exemplified by one patient story, which says it all…

A 50 year old successful, powerful bald man (Class 6 pattern with a runway on his head) had two hair transplants, each time accompanied by his caring and loving wife. I got to know them personally and his personality was the type that would stand out in a room with 100 other men. He had a dynamic character with a warm side to his powerful presence. After two transplants with me of around 5,000 grafts, he finished his restoration and appeared happy. A year after I last saw him as a patient, his wife came to my office when she was on a business trip to Los Angeles. She said, “I owe you an apology”. I could not understand the statement and probed her for clarification. “I do not know if you realized that I was against the hair transplant from the onset, but I would never challenge him in public so I kept this a secret between he and I. I loved him without hair as much as I did when I married him with hair years ago. Now that he has his hair back, I realized that the bald man I was married to had changed over the years, but with his hair back he became more like the man I married. I realized that this hair transplant was about him, his vision of himself and not about me at all. I was selfishly looking at the inside man I love, but his pain was created by the outside man he saw in the mirror. The man I married came back with the hair transplant and it made our relationship far better than I could remember in years. I never realized the pain that his balding caused, and that is why I am apologizing to you.”

This story has always stuck in my head, because it reflected the reason men have their hair transplanted in the first place. A woman who loves her man, cares about what is important to him. To conclude with an answer to your question, she will love you more if you love yourself more and are more self-confident. Men who are free to love and who are not burdened with an image of themselves that interferes with who they are, make better lovers than men with an image problem of themselves, no matter how small. Loving these men with their freedom is easier than watching them be less than they can be.

Transplanting Eyebrows

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

After using SELECIA 10m (homeopathy overdose), I lost all hair on body, eyebrows and scalp (also had scanty hair anyways…probably due to MPB). I developed thyroid problems after that. Now i am on altroxin 150mg per day. NOW, can i transplant some hair for EYEBROWS???? I have NO EYEBROWS and NO BODY HAIR… just some scanty beard growing…

If you lost hair everywhere, you might have a genetic condition called alopecia universalis. That would impact eyebrows, pubic and underarm hair as well. Whatever the problem, with the complexity you outline above, you need to see an expert in this field. Do not be an amateur treating yourself. The product you are referring to is a known medication that will cause hair loss. I even found a site recommending it to remove hair permanently. Does sound suspicious, yes?

Eyebrow hair transplants work well, but not in a person who might have an autoimmune problem. Please check yourself out for the various conditions that only a good doctor will identify.

Does Hair Transplantation Hurt?

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

Hair transplanting looks like it hurts! Does it hurt is my question? I saw the video and almost threw up. So please respond to my question! Does it hurt? Especially with at least a couple of thousand grafts! Please respond! Thank you for your time.

Yes, part of the process is painful. The first part (with anesthesia) hurts for about 1 minute. This part can be subsidized with appropriate medications to reduce the pain and possibly eliminate it if you choose this option. The more medications, the slightly more risk you may experience with side effects. Pain is also present after the surgery. If you elect to have an FUE procedure, the pain is very minimal and rarely takes any medications after surgery. If you have a strip harvesting procedure, then there is pain in the donor area, particularly more on the first night, which is easily treated with strong medications that are supplied by us. Some doctors do not like to use the word ‘pain’ because its meaning might frighten patients away, so the word discomfort is used instead. Discomfort = Pain!

On the other hand. there is also the pain of hair loss. This pain is often described by our patients as far worse than anything that they experienced in the surgery. As the old saying goes, “No Pain, No Gain” which essentially means that you need to weigh what you are willing to experience against what you are not willing to experience. A 2,000 graft procedure does not really hurt more than a 500 graft procedure. I prefer the larger procedures, because the patient has to invest less time and have less surgeries to get the final end product of their hair restoration desires.

Transplanting Very Bald Patients

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

how much “coverage and density” can a norwood 6 patient actually achieve? All your photos of men with 6 or 7 norwood, all have “comb over” type hair styles? How come u never show any pics of the back of the finished product(or crown)?

A person with a Norwood Class 6 pattern will have lost 50-60% of his natural hair. A person with a Class 7 pattern will have lost between 70-80% of his natural hair. If you move half of the permanent zone of an average man, the most you can yield would be about 15,000-20,000 hairs (or 7,500/10,000 grafts in a series of about 3-4 surgeries). That would mean the coverage mathematics, of let’s say 60% of the total area of originally hairy scalp, can only receive maximally 20,000 hairs in an area that originally had 60,000. This is at best 1/3rd of the original density. In actuality, one rarely ge’s out that much and more likely 12,000-15,000 hairs is maximal. In the person with a Class 7 pattern and 80% hair loss by count, the maximum overall density in the recipient area is 80/12 or 15% of the total original density. We usually weight it to the front so that there is a comb-back effect, moving more density to the place where the greatest impact will occur. We could weight it to the front and sides, with a good comb-over produced (front to back or side to side). Either approach works. The crown is often sacrificed with the lowest densities placed there favoring the front or the sides, as the case may be. So you are correct, the densities in the less favored areas are ‘covered’ with some type of comb-over.

I posted these photos a few months ago here, but it is worth displaying them again to show that the results of weighting the frontal hairline can be very good, even though the crown is not as dense. Patient ZU is in his mid 60’s and had multiple procedures totalling 6,036 follicular unit grafts transplanted. “Before” is on the left, “after” is on the right. Click the photos to enlarge.



You can see more of his before and after photos on the NHI site: Patient ZU

Transplanted Hair Characteristics

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

Hi Dr Rassman,
Does hair from the neck change structure when it gets on the top of the head? And how long will that take if it does ? I mean does hair fit in properly with your original hair in the front of your head or is there a permanent difference ? The micro “scars” you will get in recipient area will they ever heal 100 % ? If you later in life choose to shave your head can one notice something on the skin in recipient area ? Best regards

Scars are scars and they always show. Depending upon what type of scars and where they are placed, the scars may be less obvious. Scars in the neck always widen and are always visible. The neck hairs used for transplants are often lost with time as these hairs are not permanent like the hair above, in the back and sides of the head. Transplanted hairs usually follow what they looked like from where they were taken. On rare occasions, the hair becomes wavy or curly. I remember one case where a patient’s transplanted hair became kinky, and he loved it. It was what he wanted and that made me happy because I always want to please the patient (but I personally did not like the look). Clearly, the grown characteristics are not in the control of the doctor when a hair transplant is done. The good news is that changes beyond what the original characteristics of the hair are rare.