Desperate for Hair that Looks Real

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

I’ve been losing my hair since i was 19 and now i’m 23. I’m pretty much at a strong norwood 3. I tried alot of things, but nothing has helped. My mom’s dad was bald and the rest of his family too. Basically don’t know what to do. I’ve read that i’m too young to get a transplant and have not made a move on it. Im also afraid to get one cause of the scars. I really don’t know what to do. It has pretty much ruined my life. I use to have girlfriends all the time now have not had one since 20. Pretty much so desperate i would sell my mustang just to pay for a transplant but i don’t know if i should if results don’t look real and if there is scars involved.

First, be careful with statements like “I would sell my mustang just to pay for a transplant,” because many unscrupulous people will take your money and sell you hair. Realistic expectations, reasonable predictions based upon a good solid examination of your hair and hair loss distribution with good microscopic examination of the scalp, a good doctor with great integrity and lots of good experience, and some comparative shopping will tell you much about what you can do. Read my book, available online in PDF format here, or get one sent to you free. Visit my offices if you are in California. Natural results with a hair transplant are not difficult to obtain, but first you must know where you stand and what your long term ‘Master Plan’ should be before you jump to a hair transplant.

I know that if you do not feel good about yourself, if you do not have the self-esteem you want, then having a normal life becomes more difficult. A hair transplant may or may not solve these problems. The main reason we generally discourage men of your age in getting a hair transplant is that (1) you may not be able to determine when the hair loss will stop, (2) you may not be mature enough to understand both the financial and social remifications of the transplant process, and (3) you may not be able to get the realistic expectations that fit with your hair metrics (hair density, contrast in colors, character of the hair, laxity of the scalp, etc..). In effect, will you have enough hair supply to follow your hair loss to meet your expectations? Get a good doctor and develop a Master Plan with him/her. Then and only then, can you deal with the decision of “Should I or shouldn’t I?”

The Woods Technique

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

Is the Woods technique a viable option to consider for hair transplantation?

This technique is undocumented and has never been explained. This doctor has kept his process secret, including the yield and growth rate of the transplants. Woods has chosen to do his technique without any peer review and not publish it in recognized journals. By making his technique secret, he has succeeded in creating a mystique (a cult) that he has promoted on the internet to create hype.

I have had the opportunity to see a couple of his patients and the recipient sites are not as clean or as natural as ours (I believe he creates larger recipient site wounds). In addition, the scarring in the donor area is evident on his videos and on his patients. Doctors in Australia tell me of significant failures in his hands based upon patients that have come to them. Although bashing doctors is at times fashionable for competing doctors to try to gain a competitive edge, Woods has failed to fulfill his basic responsibilities with the Oath that doctors take when they are given their diploma to practice medicine and surgery. That failed responsibility (to share knowledge and educate patients and colleagues to improve the quality of medical care) increases my skepticism about his work. Creating secrecy does little more than to make a sect that confuses the public and people who may get sucked into marketing hype and then ask obvious questions, wanting to know facts. I have tried to find out what he does, if only for curiosity. For now, however, Woods chooses to do his thing under the cover of secrecy.

For more info on the New Hair Institute’s published FUE technique:

Transplanting Hair to Face

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

Hello,
Can hair be transplanted to the the chin and sideburn areas of the face to fill in where facial hair does not currently grow? Have you done any of these types of procedures? I’m 30 year old white male with very little facial hair.
Best regards

We do transplant scalp hair to the face. Often with face lifts, repairs are made to the pulled back hairline and to lost sideburns. We also repair beard and mustache defects (the mustache defect is common in cleft lips). I have also had some Asians patients who had sparse facial hair and wanted it filled out more.

I often tell my patients that the good news about hair transplants from scalp hair is that if you put a hair graft on the end of your nose, it will grow to pony tail length. That is often used as an illustration of the reality that hair transplants do grow, almost anywhere you put them.

Transplants in the Baldest Men

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

I am very, very bald and 60 years old. I am having a hard time believing that you can really help me. Please let me know why I should believe that this enormous bald area on my head can really be covered with hair.

Some people with advanced balding, low hair densities and high contrast (black hair and white skin), can not get great coverage with a hair transplant. On the other hand, if you have lower contrast between your hair and skin color, higher densities, good character hair, and a loose scalp, you might be surprised at what you could achieve by the artful distribution of hair in the hands of a good hair transplant surgeon (see below for an example). There is real art in making less hair look like more hair and that is just one of the reasons why you need to shop around. Come to one of our open house events and you will be able to examine these patients yourself and make your own judgments. If you have a wife, female relative or friend whose judgment you trust, bring them too, as women have more discriminating views on what they see than men.

This patient 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.



More photos of the above patient on the NHI site: Patient ZU

Hair Transplant Growth Success Rate

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

What is the growth success in 100 grafts that are transplanted?

This is a good question. We really do not know exactly. I suspect that the growth rate success in our hands is over 90%, but it is almost impossible to count the transplanted hairs and compare their numbers to what was moved.

I have had opportunities to transplant a limited number of hairs in a scar, or an area of the head that was easy to separate from the rest of the areas and when I counted them, they all grew. I do test grafting in people with Alopecia Areata when I believe that the disease is inactive. In those patients who have inactive disease, I put in about 20 grafts into various areas of a bald patch of scalp. If the disease is really inactive, all 20 grafts are counted after some 6 months. I do the same for some burn patients where the scars may not support the grafts. When the scars can support the grafts, all grafts are then counted and if one grows, they all grow. This experience does show what is probably the case in our typical hair transplant sessions.

What we stress is a quality control process to minimize those factors that can cause hair loss in the transplant process. For the natural hair that is still present, we use drugs like Propecia before surgery. Various technical systems are enforced which guarantee that the grafts do not dry out (the leading cause of graft death), gentle handling (the second most common cause of graft death) and very experienced technicians (we have no turnover of clinical staff). A good transplant with a high success rate depends upon good team work with employees that know how to work together. Just like a good football team, every player in every position must work at peak efficiency to win the game. Winning the game in hair transplantation is a combination of 100% growth and good esthetics. This is why we show off our patients after their procedures at our open house events and also have a live surgery so that you can see, first hand, what will happen to you both in surgery and then 8 months later.

Today’s Man – How Much is Enough Hair?

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

Part 1 of “How Much is Enough Hair?” showcased a patient in his mid-20s. The patient below in part 2 is in his mid-50s and achieved wonderful results.

The change in my appearance in just 8 months has been remarkable. From a balding man that I hated to look at in the mirror, to a younger man who looks like he has a full head of hair has changed my life. My friends can’t get over it and even though everyone knows that I have had a hair transplant, no one believes it when they look at me. The back of my head is still bald. Can I expect to fill that in as well?

I loved seeing you the other day. Every time I see one of our patients with the right hair and skin color and the right hair texture, I feel that the work we do in restoring hair is almost like God’s work. Another session will probably suffice to fill in the back and when done in combination with some styling effort, you will look like a man with a full head of hair. I recommend another 3000 or so grafts be placed into your crown. Thanks for allowing me to use you questions and picture for my blog.

When looking at these pictures, please note that the hair line is not a line but an irregular zone of hair. It does not have a start point and you can not connect the dots. Note that behind this zone, the hair is thick and you can not see through it, while in the zone, the hair is subtle in its appearance and does not hit you like a wall when you look at it. There is a smooth transition from the forehead (without hair) to the thick lush hair sitting back about 1/2 inch behind the transition zone. That means that you can not tell that it is a transplanted hair line, just like mine or other normal people that do not bald.

This first set below are his before photos (Norwood Class 5), taken in December, 2004.



The following are his after photos (one procedure of 2,773 grafts), taken in August, 2005.




Fair Skin, 2 Weeks After Hair Transplant Photos

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

I am planning to have a hair transplant, but I must return to work 2 weeks after. I am fair skinned, so I am very concerned about the appearance of my transplanted area. I do not want people coming up to me asking me what I did to my head, or in the alternative, looking intensely at my head like I was a freak.

Pictures are worth 1000+ words. These pictures were taken today at my office, of a fair-haired patient two weeks after surgery. You can see a blush of pink, or is it just a beard that accentuates a pink that normally one would not notice? He said that the only person who commented on this was a close friend, and the patient told him it was a sunburn. He said that no one looks at it and he is not self conscience about it at all. Click on the photos to enlarge.



How Much is Enough Hair?

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

This 26 year old man received 2200 grafts into the frontal hairline. He came into my office today asking me if he should do any more transplants. He trusts me and felt that I would give him the correct advice.

His results are remarkably good and he is very pleased with the results. Like most young men, he feels he might be happier with more hair, but he is not at all dissatisfied with the fullness he sees when looking in the mirror. I told him that considering his age and his overall satisfaction with the results, that additional hair transplants should be postponed, and we should watch for more hair loss over the next 5-10 years. If his balding does not progress and his present stage of fullness is maintained by continuing Propecia (he has been taking it for the last three years), then he can increase the fullness with more grafts into the frontal triangle. If, however, his balding pattern should progress to a more advanced pattern, the additional donor hair may be best placed elsewhere on his head, for the best results.

This is a call that could go either way. If he felt that a fuller forelock area was his focus, then I would have no hesitation to fill in the rest of this frontal triangle. Clearly, I am in no rush to take his money and he is in no rush to get more hair, so for the moment, we have decided to wait out the unfolding nature of his future.

Photo on the left is the “before”, from a few years ago. The photo on the right is the “after”, taken today.



Shock Hair Loss from Transplantation

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

I want to get a hair transplant during the summer while I am off from school but if I am going to lose hair, I won’t do it. Is there a guarantee that I will not lose hair?

I will assume that you are a student of college age (under 30) in answering this quesstion. If you are older, then shock hair loss is less of a risk. If you take Propecia, I have found that the likelihood of having reactive hair loss is significantly less likely. In the days before Propecia I used to see it all of the time in young men. For those who are on the drug before surgery, there appears to be a protective effect that stops the hair transplant shock loss that plagued the men prior to the introduction of the drug. There are few guarantees in medicine, but I do not remember any person in recent times that was on Propecia that had significant reactive hair loss.

Transplant Hairline, Drugs for Crown?

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

sorry to bother you again just one more question. the front of my hair is going quite fast so i was thinking if it was possible to put hair transplants just for the front because that would look so much better. and then i would just use the minoxidil for the back?
best regards

You need medical treatment first, before surgical treatment. Propecia should be tested for a period of 8 months. It may regrow your crown hair. Hold off on the transplant option, as you will have a lot of time to consider having surgery. A try with Avodart may be appropriate if Propecia does not control the balding within 8 months.

Dateline NBC on Hair Loss

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

There was a great story on NBC last night, where Dateline followed five men on different hair treatments for 12 months. It compared Propecia, the laser comb, Minoxidil, a European fish oil claimed to grow hair, and hair transplants.

Transplanting Identical Twins

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

I just saw pictures of identical twins, one transplanted with 3000 grafts and the other not. The twin who had transplants, also took Propecia at less than the recommended dose, while the non-transplanted twin did not take Propecia at all. The difference between the two was dramatic, of course.

I have seen many identical twins over the years. These two were done back in 1993, when one twin had 3300 grafts removed, and gave 800 of those grafts to his identical twin brother on that same day (on the house of course). The twin who had lost his hair had genetic MPB and wore a hair piece which pulled out most of his remaining hair and he became balder than the twin that had done nothing. Eventually, they both got transplants, and one more procedure was done where the recipient twin had to pay back the donor hair to his twin brother. The piece in the video is short, but you can see the dynamics between the two.

I also remember twins that had been done years apart. The first was done with the old plug technique elsewhere, and the second was done by me with FUT just 7 years ago. The one with the plugs does not like to talk about his hair transplant, while the patient who was done by me has been trying to get his brother to fix the old work. Unfortunately the “pluggy” twin has been gun-shy about surgery since he was plugged years ago and has not yet had repairs done.

From my experience, only a minority of twins go the transplant route. I wonder if it is because my focus is not to ‘sell’ hair transplants but to be a physician hair loss advisor and I do not exert pressure on my patients to go for the surgical solution.

Shaving the Recipient Area

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

I came into your office for a hair transplant in September of 2004. It was very successful and I now scheduled to come in for a second transplant to add density in a few weeks. When I came in for my first transplant I was surprised to hear that the doctor wanted to shave the recipient site of head to about 1/4″ in length. At the time it did not bother me, because I was able to wear a hat where I work. I am now coming in for a second session and things have changed. I need to be able to go back to work within four days of the surgery. I have spoken with several staff members at your office and they all have stated that there is no reason for the doctor to have to shave my head except in the donor area, but if my hair is long enough it will cover it up. I wanted to ask you personally if it is true that I don’t need to have the recipient site cut or shaved at all. My hair now is about 1 1/2″ long and I would like to leave it at that. If so I would also like to know why I had to do it the first time or was it just a personal preference of that doctor.

The recipient area does not have to be shaved for a hair transplant, but there are some doctors that prefer to make the recipient sites in a shaved area. When I am the physician I do not have the recipient area shaved.

Crown Thinning – What To Do?

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

I am a 39 year-old man whose hair is moderately thinning. I have taken Propecia for about 5 years with excellent results but now it seems to have little to know results on the crown. The past two months hair has been falling out consistently. It has finally started to stall but now there are two very noticeable areas on the crown. I never really found minoxidil too helpful. What can I do?

You need to have an examination to determine the extent of miniaturization in order to predict what will happen to you. You also need to quantify the donor supply, so that you will know if there is enough donor hair to meet your expected needs. Transplants work well, but before embarking on this path, you need to know what your future has in store for you.

Donated Hair for Transplantation?

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

why can’t someone use another person’s hair if the blood types match and he is willing to donate his or her hair for you

Good question. When you think about hair you think of that stuff that grows on top of your head. Hair on the top of your head is dead as it exits the skin. The frozen Eskimos and ancient Egyptians in the tombs still had hair after thousands of years. Of course, it is dead. Now when I think about hair, I think of an organ. Each follicular unit of hair has blood vessels, glands, nerves, skin, and fat. It takes all of this plus a growth center and the right genes and nutrition to make hair grow. Since by definition hair is an organ, transplanting the hair from someone else is like transplanting a heart, kidney, lung, etc. These organs are rejected by a person unless the recipient is given drugs to suppress rejection. If you had a twin, then hair from that twin with the exact same genetic blueprint would give you a successful transplant. We did that exact process on identical twins and it worked wonderfully. The usual problem is that when one twin has balding, so does the other.