Hair Transplant Before Face Lift?

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

I have a question about possible future hairloss. I have a list of procedures I want to have done and thought I knew the best ordering of them. I plan on having a hair transplant first, this so my hair has time to regrow. About 6 to 7 months later I would have a SMAS Facelift. However, I have been reading about the hairloss common to post face lifting and now I am perplexed. Bear in mind, my eyebrows are to be lifted with a method that doesn’t go near my hairline on top, however, it is the sides of my hairline, the temple region that has me stressed. A facelift will deal in that area and quite truthfully, I can’t afford to lose hair there. It is already thinned out considerably as it is. But, I need to have the facelift. So, is it possible to have a “temple” hair transplant? I don’t see any way around this. Help me by imparting your knowledge so I make an educated choice. I think I can proceed with the transplant on top, to be scheduled in early december, but what about the temples and future facelift?

Thanks so much for taking the time to answer my question and solve this.

Generally, I like to do hair transplants after face lifts, because if there are any problems to the hair caused by the face lift or brow lift, they can be addressed at the time of the hair transplant. A good deal of my practice is this type of surgery. Clearly, the newer face lift procedures spare some, but not all of the problems. You can follow your facelift with a hair transplant after a few weeks to a few months. If there are hair problems following the facelift, they will be evident by month three.

Different Hair Characteristics in Transplanted Region

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

I had my transplant at NHI 9 montys (2000 grafts to the front). My hair is growing very fast, and looks awesome, except that it is curly, and the rest of my hair is absolutely bone straight. I am growing my new “full” head of hair long and “surfery” looking, but it looks so different with a curly, puffy front, and then the rest is long, flowing and stick straight. Will the front ever be straight? What can be done? I use a hot flat iron every day to try and straighten it.. I know totally why people with curly hair hate humidity and rain…instant frizz. Help.

Hair transplants rarely radically change the character of the hair, but it can happen. In about half of the people when this change occurs, the hair will straighten a bit after going through a hair cycle. I remember one person who had a very radical curly change to his hair after the first surgery. I personally did not like it at all, but he loved it. When he came in for his second transplant, the same thing happened again. It remained very curly and he could not have been happier. Much to my surprise, it lasted through a hair cycle, possibly a bit less curly.

Some people who get changes in hair characteristics, go to a slightly more wavy hair and this change is appreciated in almost every person because it produces ‘body’ for styling that they never had when their hair was very straight. This often reverses in a hair cycle (about 2-6 years), so these benefits may not last.

With regard to your situation, you need to see me personally so that I can review your change in hair character. In addition, unfortunately, you will have to learn to control the hair with relaxers that will allow you to gain better better control of styling. Blow drying and conditioners may help a great deal so that you may not have to use an iron. We should discuss this together. Call my office at 800-NEW-HAIR to schedule a visit.

How Does Dr. Rassman Manage His Hair Loss?

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

hi doc, what do you use for your hairloss???? what is your regime??? do you take propecia or proscar and how long you been on it??? and has it stop your hairloss??????? please be specific on what you use… details please!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I take Propecia, and that is all I do. Propecia may have stopped the hair loss or it may have stopped by itself (I am 63 years old, so it is not uncommon in a man of my age). I had 3 scalp reductions in 1992 (big mistake) and then 2 hair transplants in 1994 and 1999. I was lucky that the first hair transplant fixed the scarring problem and the second one added bulk to the crown.

Do Transplanted Hairs Fall Out When Washing?

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

Hello Dr. Rassman

You are really doing a great job in this informative blog, thanks a million for that. Have had a recent HT procedure for about 1500 grafts by strip excision method that were implanted along my temples in addition to the frontal hairline. So far everything seems to be going fine as i approach my 8th week post-op except for one slight problem. Just like any other HT, the grafted hairs begun to shed within the first 4 weeks & i was left with only about (20-30)% of the total amount, now i started seeing new hair growth of very fine hairs but the problem that these little stubbles-like hairs are easily fallen as i wash/shampoo my scalp, are the implanted follicles intact? will new firm hairs grow later?

With Regards

Thank you for your kind words.

Now that you are in your 8th week post-procedure, I would not worry about losing the transplanted follicles, as they will regrow over the subsequent 2-5 months. In general, a small percentage of all normal hair comes out when you shower, when you walk along a windy path, or when you comb or brush your hair. The same number of hairs start into anogen (growth) so that the total population stays the same (about 100,000 hairs). When your transplants grow, they will behave as your normal hair does and cycle the same way, some falling out while an equal amount will regrow. In the normal, full haired adult, about 100 hairs per day come out that way. If you have hair loss for any reason, be gentle with brushing and washing, as vigorous handling will negatively impact genetically ‘fragile’ hair.

Thinning in Temples

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

My hair has been thinning for some time now, right in the temple areas, but especially on my right side. I do, however have some fine hair in these areas but it will not grow long, and also in these areas some spots are just simply bald, clean, bare skin.

Will hair every grow their again, and how can I get the short hair that is there to grow long again?

Hair transplants work well for this problem, but first a diagnosis must be in hand. Assuming that you do not have an autoimmune cause of the hair loss or some problem that will cause a hair transplant to fail, then the transplant option is a good one. Some examples of temple hair transplants can be seen in the NHI ‘other’ photo gallery, which contains before and after photos of crown, temple, sideburns, eyebrows, and female transplants.

The Medical Science of Hair Loss

/by William Rassman, M.D./12 /, ,

What constitutes a good way to follow genetic balding? So far it seems to be a vague art that varies between doctors, and not something that will give an intelligent person an understanding of what is happening to them.

Miniaturization occurs in men and women who are balding. Miniaturization is the process where a normal thickness hair shaft becomes thinner and thinner over time due to the genetically determined effects of aging and/or androgenic hormones on the terminal (normal) hair follicle. The process of miniaturization is a slow process in genetic balding. Hair shafts may lose 10% of their diameter, then 20%, then 30% and so on. Each degree of increased miniaturization reflects further progression of the genetic balding process. The instruments that measure miniaturization were invented (and patented) by me in the early 1990s and they are in wide spread use today. Socially detectable hair loss is not evident until more than 60% of the hair has been lost and as a result, many men do not seek out expert help until they see some evidence of balding (which they too often deny).

When a doctor views the scalp hair with high magnification, the degree of miniaturization and the location of the miniaturization are both critical to establishing (1) the diagnosis and (2) the rate of the process, which progresses over time. Because miniaturization is a relative measurement at any one time (comparing finer hair to the thickest hair), it takes substantial experience before this measurement can be useful to the individual clinician. In our experience, from examining and following thousands of patients with the Hair Densitometer, we have found that assessing the degree of miniaturization has useful predictive value when evaluating the risks of hair loss and in establishing hair loss patterns. The amount of miniaturization in each section of the scalp tells the physician just how far the balding is progressing or has progressed. In men who show more and more areas of miniaturization over time, the genetic balding can be considered active.

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Transplanting African Hair

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

HI I understand that hair transplant is not favorable for black man. it causes spots pimples and scarces!
do you know of a procedure that would work! I am located in montreal Canada

Simply stated, you are incorrect. Black people do great with hair transplants, often better than white people because the color contrast between hair and skin is low, and the hair has a very curly character which is a far better characteristic than the straight hair of an Asian, for example. Also, scars and pimples are rarely a problem. Sometimes, surgeons do not want to perform hair transplants on people with African hair because it is a more difficult job for the surgical team and requires a high degree of skill, more than on Asians and Caucasians.

I Have “Landing Strips” on My Head

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

I am 23 years old and would like to achieve even density on head. I dont mind my hair being short, but i would like to fill in the two landing strips that are forming and extending to the back of my head. The front has a hole in the middle the size of a walnut. I started taking propecia 4 months ago and I figure that will take care of the crown area. How many grafts do you think I need, and what is the charge per graft.

You need a Master Plan. Since you are under 25 and are taking Propecia, I would wait a full 8 months to see the impact of Propecia. If the ‘landing strips’ return with hair then you may not have to do anything more. If there is some gain but not a complete reversal, then this will reduce the number of grafts required from a transplant but I do believe that without having this knowledge, you will be vulnerable to more hair loss, possibly more than you can gain with a transplant, particularly if the hair loss does not respond to Propecia.

For your own welfare and wallet control, please do not rush to transplant before these other steps are taken. If you were over 25 and had no response to Propecia, yet still agreed to stay on Propecia, I would consider transplanting as many as can be safely moved in one session (2500+ with normal donor density, normal laxity and healthy donor hair), weighting it front to back. The hairline (walnut area) is more eroded than the rest, indicating that the frontal hair loss is significantly progressing.

Too Young For Transplant at 23?

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

Hello Dr. William Rassman,
I’m 23 and i have been seeing thinning of hair well in the past two years. i have been on propecia for two years, which did stop my hair loss to a certain level but lately im noticing more hair loss even on propecia. i had an appointment at a hair transplant doctor in the past week to go see if i can get a hair transplant. I saw a counselor, not a doctor who told me that no surgeon will perform a hair transplant on me because of my age. Me being too young, he said i have to wait till i go all bald. Can you help me or suggest me of any products, any new advances medications?

It is generally true that young men under 24 should not get a hair transplant, but it is a crazy thing to be told that you have to first go bald. Generally, I judge everyone differently, make few rules other than protect my patients from me, themselves and poor decisions. Because I am not a salesman, I make judgments all of the time about the maturity of the person I am talking with, their ability to understand what a Master Plan for their balding is going to be, and their response to drugs like Propecia. I find immature 50 year olds, and very mature 20 year olds. As I get to know the person, I would not say that someone of your age can not get a hair transplant. Medicine and surgery are a combination of art, science and compasion. You need all of the benefits of this with a caring doctor while making your Master Plan. Then and only then, can your candidacy be determined.

Thinning of Transplanted Hair

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

How big of a problem is the gradual thinning of transplanted hair — have you seen cases where a transplant looks decent but then some years later looks crummy because it thinned out too much?

In about 30% of the male population, men will lose some of the hair we call permanent hair from the sides and back of the head. If that would have been you, then you might lose hair in the transplanted area. There are other causes of hair loss, so seeing a good doctor should help you with the diagnosis. I would want to look at your donor hair and see if there is significant miniaturization in that area. With loss of donor hair, we should see some miniaturization in the donor area.

Frontal Hair Loss

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

I have a receding hair line, similar to my fathers’. As of right now if i were to lift my bangs up, the two ends of my forehead are pretty far back(much like the shape of an M from a top p.o.v.)How can i grow this hair back before it’s too late? And will i ever loose the thin hair that is slightly covering this hairline?

Assuming that you are older than 24/25 and you have genetic balding, then it would be reasonable to assume that you will probably not get your frontal hair back with anything short of a hair transplant. Take a look at this celebrity with a similar sounding problem to yours. We performed a hair transplant on Steve Hartman, a CBS sports correspondent with his own radio sport show every day in Southern California. He had a single hair transplant session of 1,895 grafts to accomplish his goal of restoring the hairline (see Steve Hartman feature for photos and details). You should also be on Propecia, a drug that can stop, slow down, and on rare occasions can regrow hair.

I’ve written previously about Steve Hartman on this blog. For more info, please see: Where Are the Celebrity Transplant Photos?

Gap in Moustache

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

i used to pluck my moustache when i sit to watch tv and now there is a big gap left. Will it grow back or do i have do something else. Please advise and mail me.

It sounds like you have developed traction alopecia from the plucking of your moustache hair. People who pluck out the hair have a type of OCD (Obsessive Compusive Disorder) with a condition we call trichotelomania. Hair transplants work well for solving the ‘gap’ you are referring to, assuming that you have stopped plucking out your hair. Many people do grow out of the plucking problem as they get older.

Transplanting Pubic Hair to Head

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

So since there are already tests that determine the pubic hair a possibility for transplantation to the scalp, are there any doctors currently performing this procedure now? If so, how much would it roughly cost?

I remember a picture and article in the parody tabloid Weekly World News from many years ago, of a person with a pubic hair to head transplant. The pictures looked exactly as described — like curly pubic hair transplanted onto a head. Obviously, being parody, we can’t take this at face value, but it serves as an example. If your head hair is like your pubic hair, then this may work fine for you, but I would want to know why you want to use your pubic hair for the donor supply rather than using your other head hair? Personally, I would not want my transplants to look like pubic hair if the other hair was different in character. It would be like transplanting hair from a french poodle to a bulldog. To answer your question, I can’t recommend anyone that may be doing this procedure.

Where Are the Celebrity Transplant Photos?

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

I want to see a one time result, best if you can show it in a celebrity who had a hair transplants. Come on Dr. Rassman, if you really have celebrity patients, why won’t you share them with us?

Privacy is critical to my business and to the entire issue of medical ethics. All patients are entitled to their privacy. Also, California law states that a doctor can lose his license if he breaches the confidentiality of his patient’s identify or shows his/her pictures without consent. Now with that said, CBS sports reporter and XTRA Sports Radio host Steve Hartman does come to mind. Steve had one surgery of 1,895 grafts with us almost 12 months ago. As he has allowed the use of his identity and his pictures, here are the before and after photos. The photo on the left was taken just minutes after his procedure was completed, and the photo on the right was taken 11 months after. Click each image below to see the full size photo.



The entire growth cycle from start to finish are shown in the Steve Hartman Feature.

Face, Beard Hair, and Sideburn Transplants

/by William Rassman, M.D./3 /

Hi, I am 50 years old. I am unable to grow sideburns. I am sure it is inherited because I can grow a great mustache and facial hair on my chin, and from there, down my neck, but no sideburns which I have always wished I could. So, I see you folks may be able to help me. I have the usual questions, cost, and will the results look natural? Thanks!

Unless you have a disease like alopecia areata, you should be able to get hair transplants to place into the face and chin to create a beard, mustache, or sideburns. We do these kind of procedures all of the time and they look completely natural. The use of a fine needle to create the sites in the facial beard area is important to minimize any puckering of the skin. Most doctors charge by the graft, but some charge a flat fee. Your costs can be estimated by sending me photos to the email address on my Contact page. To help get an understanding of where you want the transplants, I would suggest marking up your face, beard area, and chin with a China Marker, which will easily wash off. You can get a China Marker from a local stationary store.

Here are some examples of sideburn transplants we have done at NHI: