Lateral Slits

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

Thank you for answering all our questions. This site is a great help!
Can you address the below paragraph pulled of Hasson & Wong’s (Canada) website?

“Hasson & Wong have pioneered the revolutionary Lateral Slit Technique. This technique of creating recipient site incisions allows for far more accurate control of hair graft angulation and direction. In addition, the coverage of bald scalp is increased on average by two hundred percent…Hair transplant surgery utilizing the Hasson & Wong Lateral Slit Technique is the only technique that is able to duplicate the alignment and distribution of hair as it occurs in nature. The result of this amazing technique is the complete absence of plugginess seen in other techniques including standard follicular unit transplantation.”

Hasson and Wong do very nice work. I have nothing but admiration for them both. With regard to lateral slits, I have been doing them on all my cases for three years, but I have never been convinced that they are superior to vertical slits. The written studies done by different doctors throughout the world have not proven that lateral slits are any better. Patients who have had lateral slits on one side and vertical slits on the other side, are split on which side is better. So while there may not be any scientific proof that lateral slits are superior or inferior, it becomes a matter of physician preference, and my choice is to use lateral slits.

An Answer to a Patient’s Questions

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

Dear Dr. Rassman,
Thanks for taking the time the other day to visit with me and also for the very informative follow-up letter and your recommended plan for my hair transplantation. Over the last two months I have been seriously looking into the hair restoration field and have read three credible books and studied every web site of every accredited hair doctor. I also consulted with doctors that I felt were very respected in hair restoration. My conclusion is that I need to stay on Propecia consistently to preserve the hair I have right now and use the follicular unit transplantation (FUT) technique exclusively, to replace the lost hair.

But I am confused by the number of grafts recommended. So far, I have heard various numbers ranging from 1,000 to 3,000. After visiting with you and hearing your recommendation of 2500 grafts, I wrote back to a very reputable doctor who had recommended a session of 1,500 grafts and told him that another clinic had recommended 2,500 grafts. He then told me that 1) each person has very limited donor supply and one must plan a session based on future hair loss, and 2) the survival rate of transplanted grafts deteriorates as the number of them placed close to each other is increased, as is done in megasessions. He told me that other clinics have no guarantee or refund policy if the hair follicles don’t grow back, so they just transplant as many as possible, even if not safe for the patient.

So my questions are:

  1. What does ‘limited donor supply’ mean in my case? You saw my hair, how many good donor grafts in total do you think I have for now and the future? What would it be if Propecia did not work and I continued to lose hair?
  2. Have you seen any side effects with larger sessions such as more noticeable scar in the donor area, loss of transplanted grafts, excessive swelling of the forehead or longer recovery periods?
  3. Do you or can you guarantee a certain survival rate for the transplanted grafts?

I appreciate the time you have taken to help me with my hair loss problem. I guess I can’t help it, I am a natural engineer, and this being the most important decision I probably ever make I have just been researching the hell out of it! I am confident, however, that I am talking to the best source there is out there.

Part of what is important about being a doctor is the concept of mutual respect. The person who wrote the email to me on this blog, is analytical and clearly fully aware of the subject material. Good communication produces respect so a doctor should spend an appropriate amount of time and focused attention to address your concerns at the interview and in followup to that interview. I would welcome a call from you to elaborate on this blog answer.

  1. Some people do not have the donor supply and when that will be an issue, I tell them. The amount of donor hair is a calculation of density in the donor area plus laxity of the skin. Finally, the size of the bald area and the final worst case pattern must be taken into account. As measurement is critical to this process, one must make direct measurements of the density in the donor area. I was the first to publish on the measurement of the donor supply and the instrument I invented to do this is now used by every competent doctor in this industry. There are no other instruments that are used for hair measurements that do not fall under my U.S. Patent. The average patient has about 6,000-12,000 grafts to move but the wide spread reflects the many variables discussed above.
  2. If you come to our free open house events, you will meet people who had thousands of grafts and see for yourself what happens. The key to understand the safety of large sessions is to meet directly with many people who had them. I would not be doing large sessions if they were not as good or better than multiple smaller sessions. With good decision making by the doctor, large sessions should not scar more than multiple smaller sessions but there may be a cost for aggressive decisions in large session transplantation if the doctor is not experienced in such procedures.
  3. This type of complaint usually reflects the act of denial which most people exercise when they forget what they looked like ‘before’ the started the hair restoration process. Sometimes, people continue to loose hair and think that the new hair loss reflects a transplant failure when it really reflects the unpleasant idea that balding continues. To address the growth of the transplanted hair, wWe guarantee our work. Anything that does not grow, we will replace at no charge. This almost never happens, so I rarely discuss it unless asked.

MFG, MUG, and FUT

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

I have been reading about Multiunit Family Groups (MFGs) and Multi Unit Groups (MUGs) which are felt by those who do them to be as good as Follicular Unit Transplants. These claims are very confusing. I met with a doctor last week who does MUGs and he stated that they are essentially the same as Follicular Unit Transplants. Is that true?

The reason that many people use MUGs or MFGs is that they can not or will not put the effort in learning or mastering the Follicular Unit Grafting techniques which are clearly more difficult and more expensive to deliver. There is a great movement to show equality between MUGs and MFGs and the golden standard Follicular Unit Transplants, which is absolutely not the case. At the ISHRS convention these past few years, some doctors showed off patients with MUGs and MFGs. They were at the same session as patients with final results from Follicular Unit Transplants and they are clearly not as good on close inspection. Like the “Emperor’s New Clothes’ , the MUGs and MFGs proponents want to believe that it is something that it is not.

Clearly, the use of MUGs and MFGs are better, much better than the old large plugs of yesterday. But they are just smaller plugs made up of groups of Follicular Units which when placed into MUGs and MFGs, tend to become compressed and look ‘stalky’. Real Follicular Unit Transplants are more difficult to do, but the quality on close inspection with Follicular Unit Transplantation can not be told from God’s work in the best of hands, most of the time.

William Shakespeare said, “A rose by any other name would smell as sweet“, but the MUGs and MFGs doctors might modify this famous quote by declaring that a synthetic paper rose with perfume on it is exactly the same as a real rose for all practical purposes because it may (from a distance) look like a rose.

I think that Shakespeare was talking only about real roses and I am talking only about what God had designed in his original plan for us. We are naturally put together with Follicular Units, not MUGs and MFGs. Sorry if I offended anybody here.

Funny Patient (with Photos)

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

The photos below are of a patient who came to my office yesterday, now 11 months after his transplant of 2403 grafts. When he saw his before pictures, he asked me to cremate them because that man no longer existed. We had a great laugh together as he shared his own amazement of the transformation which he had not fully appreciated until he viewed those old photographs. The humor took another step as he put on the Groucho Marx mask that we bought to give to his grandson. It was one of those joyous experiences that I see day after day. For me, it’s the impact on peoples’ lives that really makes my day.





This patient is a Norwood Class 6 with salt & pepper, medium fine hair. “Before” on the left; “After” in the middle and on the right.