Protruding Donor Area?

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

Dear Doctor Rassman, Thanks for your all your help in helping people with their baldness issues.

I have two questions. The part of where the top of my skull meets the bottom part, it protrudes a little more then usual and it feels like a bump. That protrusion is in the same area the donor area would be. If I were to have a strip surgery would that protrusion prevent me from having strip surgery. Second question, I have noticed that transplant surgeries in other parts of the world other then North America, are much more cheaper. The quality and techniques are the same and so is the results are amazing, so how come transplant surgeries are so expensive in North America?

The protruding part on the back of the scalp around at the ear level is called the occipital protuberance. This may be more pronounced in some individuals. It is the same area where donor hair is harvested and should not affect the surgery.

With respect to cost of the surgery around the world, I understand it varies, but cosmetic surgeries and its fees are not commodities like an object (automobiles, electronics, etc). So the quality and techniques are not the same all over the world. In theory, it should be, but it is not. One example may be your taste of food in different restaurants all over the world. You can eat a $1 hamburger or a $20 hamburger, but it is not the same. In addition, some parts of the world use different instrument and techniques. The results may be the similar, but not the same.

Tags: hair transplant, occipital bone, hairloss, hair loss

Permanent Hair Destroyed By Accutane

/by William Rassman, M.D./8 /,

Hi doc
I want to know if there is medication that can cause hair transplants to fall out. I know you’ve said that transplanted hair is permenent but is there any cases where medication can result in that not being the case?

I recently performed a hair transplant procedure on a patient that I had initially transplanted 17 years ago. He had good results at that time, but slowly over the years, the 2500 grafts he had transplanted in 1995 had died off. When hair transplant surgeons say that transplanted hair never falls out, one is reminded of the old saying, “Never say never”.

The permanent hair I transplanted for him 17 years ago was slowly destroyed by the drug Accutane (isotretinoin), which he has been using for years. Of interest, his donor area is also damaged with much less density than I measured 17 years ago and the Accutane clearly impacted those hairs as well. I suspect that the transplant will be possibly more successful this time around, as the hairs that he had in the donor area survived against the Accutane attack.

So while it is true that in most cases the grafts taken from the donor area for transplantation aren’t susceptible to hair loss, it’s possible that some medications could cause continued loss. It’s not very common though, and in the majority of cases the transplanted hair is permanent.

Tags: hair transplant, accutane, hairloss, hair loss

Shaved My Head After a Transplant and I’ve Got Pits at the Recipient Area

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

Ive shaved my head, have scar from hair transplant, that’s ok but how can I conceal the pits on top of my head, I can’t explain away that besides saying fell into cactus

The pits you are seeing, assuming that you had true follicular unit transplants, are probably the result of too much skin left at the surface of the graft. I make a point to cut off as much of the skin as possible without damaging the hair grafts at the time of surgery. When follicular unit extraction (FUE) is done, most surgeons do not trim the skin edge, leaving more skin present in the graft. These bits of skin in the graft can cause the type of pitting you are referring to.

Unfortunately, it can not reasonably be fixed. Some doctors suggest dermabrasion (filling down the skin with a rasp), but this just produces other types of deformities, often worse than the pitting you are referring to.

Tags: hair transplant, pitting, scarring

Any Treatment Suggestions Now That I’ve Stopped Pulling My Hair Out?

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

Thanks for taking my question. I am a 23 year-old who had the OCD scalp-picking issue you mentioned in a previous post. I managed to completely quit the behavior approximately a year ago after doing it for about 2 years at varying levels of severity. As a result of the disorder, I have hair pulling back on one side of my head much more aggressively than the other. I also have hair that is thinning all over, but the thinning is not yet visible when dry. I also have a very dry scalp, which I have read may cause hair to grow thinner. I wear my hair at a medium to medium-long length.

Could you please provide suggestions? Suggestions in all aspects of hair care are welcome. (Shampoo, hair regrowth treatment, etc.) Thank you very much for your time.

Best Regards

Many people who reported to me that they stopped pulling their hair out, were not being honest with themselves. The good news is that if I examine you, I can tell you if you have pulled hair out in the past 3 months. Minoxidil might help — try it for a full year before considering it a success or failure. There’s no shampoo that will regrow your hair. Even with medication in a best case scenario, you’re not going to get back to where you were before your picking or pulling began.

Hair transplants are a known and proven option, but this requires you to visit a specialist in this field as it can not be done by just anyone.

Tags: trichotillomania, dermatillomania, hair loss, hairloss, pulling

Will We Ever Be Able To Use Other Organ Donors for Hair Transplantation?

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

Immunosuppressive drugsI have been asked the question posed in the title of the post many times, and each and every time I answered it on this site, I was emphatic that this could not be done because of the problems that we see in kidneys, livers, and hearts when they are transplanted (i.e. they get rejected by the body). Now, the possibility that this may not be the case was raised by Dr. Sharon Keene after she read this article in the LA Times about a small pilot study which may lead to the elimination of taking anti-rejection medication for life following organ transplants — Study suggests breakthrough in organ transplants.

Japanese doctors tried homografts and allografts of scalp hair back in 1928 and again in 1938. They left detailed descriptions of the results. The growth rate was zero percent; however, we have learned much about transplanting organs since then and maybe we can apply what we learned to allow for a better outcome.

Of course, I am not saying that my answer has changed, but who knows for sure what could happen. Successful transplants have been done between different people, in baby hearts under a year of age and in face transplants where the anti-rejection medications can be far less and possibly stopped, but the experience is still very sketchy, as not many face transplants have been done to really know what it takes to sustain such a transplant without anti-rejection drugs.

There are also ethical considerations and medical-legal ones imposed on doctors who think that they could experiment on people without legal ramifications. When I was in medical school our most famous surgeon was Dr. David Hume, who made his reputation in Boston at the Brigham hospital doing a kidney transplant from one twin to another in the wee hours of the night without the permission or knowledge of the medical staff. It worked and he became a hero, but had it not worked, he would have become vilified and this act could have ended his career. With stem cell progress and some of the tricks outlined below, who knows what the future holds; however, I have long believed that the really important problems we, as doctors, will be allowed to treat, will not initially be for the vanity of perfectly healthy men who are balding.

Tags: organ transplant, hair transplant, surgery

7 Months After My Transplant, I Have Tiny Baby Hair Growing

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

Hello,

Thank you for wonderful blog. I had my hair transplant done in September last year. It has been 7 months now. After shedding I had new hair but they are all tiny baby hair and they are not growing at all. I can only feel them by touching my scalp and they are not visible. They are really really tiny. I was not prescribed any medication after transplant and had none complications as well. They new hair are of same tiny size as they were 2 months ago. I followed everything told by my surgeon religiously.

My Surgeon is not in this country and I have spoken to him over the phone. He told me it never happened to any of his other patients and I should see him on my next trip which is in October. Can you tell me what could be the problem?

By the 8th month, you should have 80% of the results of the transplant and approach 95% by the 10th month. Sounds like the transplant may have failed. I would be happy to see you and render a second opinion after the 10th month milestone has been reached.

Tags: hairloss, hair loss, hair transplant

What is Confusing About The Dr Gho Patient Diary on Hair Regeneration?

/by William Rassman, M.D./8 /, ,

Dear Dr. Rassman,

you stated in a previous post that the pictures of the Dr. Gho patient is “confusing”. Could you be more elaborate on this topic? Why do you say so? In your previous post concerning Dr. Gho you stated that a follow up video would be nice. Aren’t these photographs followup documentation. It clearly shows regrowth. I used photoshop to lay the before and after images over each other. It is definately the same hair region displaying how the follicles are regrowing from the extraction sites. Why do you still consider this deceptive?

Regards

For those that missed it, the original post is here.

Has anyone ever stopped and considered that maybe the regeneration you are seeing is just regular hairs (missed FUEs) growing back? I mean, what about the photos of the recipient site? Did anyone count the number or percentage of transplanted hairs that actually GREW?

If 1000 hairs were harvested, 700 of the transplanted hairs grew in the new location and 300 hairs regrew in the harvested donor area, would you consider this regrowth or hair multiplication or hair stem cell transplantation? Of course not! But you can take pictures of the donor area and show regrowth, and take pictures of the transplanted area and also show growth. The observer could think, “Wow! This is regeneration!” — but the observer would be mistaken. To show regeneration, duplication, cloning, stem cell transplant regeneration, or an outcome that showed splitting of the hairs, you must account for ALL the hairs that were taken out and ALL the hairs that grew back (not just a sample section). Otherwise, it is just hairs that grew back after being plucked.

Basic high school science teaches us about conservation of energy or mass in the universe. Many have tried to invent the perpetual engine or create gold from lead with no success. If Dr. Gho really figured out a way to clone hair, then he will be famous. If you would like to believe in it, that is your prerogative… but simply looking at someone’s diary or posts on the Internet is not a way to validate or document science.

The method and presentation of Dr. Gho’s study has serious issues and it does and (will) confuse many readers. A credible review by a third party should be something that Dr. Gho should want to do, if he is legitimate.

P.S. I understand that you’re very excited for my answer to your question, but sending a dozen emails and blog comments demanding that I answer right away is unnecessary.

Tags: hair multiplication, gho, stem cell, claims

Would My Slow Hair Loss Rate Prevent Me from Having a Transplant?

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

This may sound like a weird question and it might not really happen. If an individual is 29 years old and is on propecia losing hair at a slow rate initially, and then all of a sudden starts to lose it a rapid rate, and then goes back to losing it a slow rate what is the cut off age for you to perform surgery? I ask this questions because I am in a similar situation and I feel that my hair loss at a slower rate is preventing me from getting a surgery right now. I have minor thinning in the front which is noticeable in certain lighting, but still enough to cover it up for the time being.

I am afraid if I get surgery done right now, the shock loss will for sure kill those hairs I have in the front. And if I am losing hair at a slower rate it will be hard to determine when I will reach my final hair loss pattern, so by me getting a surgery will be pointless because I will always be losing hair, albeit it a slower rate. Please help!

If you want to have a hair transplant, taking Propecia (finasteride) in advance and through the process beyond 8 months, should reasonably be expected to prevent shock loss from the transplant. This has been my experience. Hair loss is progressive, and taking this medication should halt or slow your continued loss so that you’re not just chasing your loss with transplants.

As for your surgical candidacy, that is up to your doctor to determine. You’re not disqualified from surgery at 29 years old, though.

Tags: hairloss, hair loss, propecia, finasteride, hair transplant

SMP for Younger Patients?

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

I understand that younger patients may be denied hair transplants due to the fact they may lose more hair. If this patient gets scalp micro pigmentation as well and is happy with a shaved head if he loses too much hair, is there really a problem with running out of donor hair? I’ve actually seen results of men who get the procedure who still have somewhat of a hairline, and it looks much more realistic overall.

The desire to have Scalp MicroPigmentation (SMP) seems to be more common in younger men. The choice to do SMP reflects what may be a lifetime decision.

Let’s say, for example, that you have SMP done with your existing juvenile hairline at the age of 20 and then you progress to some hair loss pattern. You would then be stuck with your juvenile hairline even if you were to evolve into a Norwood class 6 or 7 pattern. You would not look normal, as you would have what appears to be a shaved frontal scalp and hair behind it… unless you shaved your entire head. Rarely can a class 7 patient be transplanted to cover the entire balding area (not enough donor hair), and in this scenario, if a 20 year old should let his hair grow out, the frontal leading edge (the SMP treated hairline) would not match the rest of the scalp unless he continued with a shaved look for his entire life.

So let’s say a young man decides to have SMP to address his frontal hair loss and is now stuck to shaving his entire head for the rest of his life. He then decides to do a hair transplant in the same area where the SMP was done, allowing him to then his hair grow out or shave it, and either way, he is covered (unless of course he loses more hair — let’s say in the class 4A pattern). Now the frontal area is covered with hair and pigment, and the back area may or may not be covered with pigment, but the problem now is that between the transplanted frontal area with SMP and the top/back of the head (in front of the leading edge of his natural hair in class 4A pattern), he would have developed a space which now almost certainly will be addressed with more hair transplants, or just SMP. With more hair transplants, he can let his hair grow out, but if he elects to fill the space with SMP alone, he is stuck once more needing to shave his entire scalp to remain looking normal.
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Would You Restore a Mature Hairline to a Juvenile One?

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

Greetings, Doctor. I’d like to ask a couple of questions if I may!

How unique can hairlines be, in your experience? Can the hairline position at a young age predict hair loss?

How do you feel about restoring a juvenile hairline, if the person that comes to you has a perfectly fine mature hairline?

I’m asking this because most of the pictures from the hair transplants I’d seen on your website and others have had people’s hairlines restored to a ‘mature hairline’ and not a juvenile one. Am I wrong?

Thank you very much for taking the time to answer!

ReaganMany men into their 30s have juvenile hairline. For example, Ronald Reagan had one for his entire life (see photo at right)… and he was well past 35 years old at the time he died.

If a man developed a mature hairline and had no signs of balding (with good measurements), I might restore the juvenile hairline if I thought the patient was mature and level-headed. I have rarely restored the juvenile hairline, but I have repaired some that have had erosion and an incomplete migration to the mature hairline.

Tags: hair transplant, mature hairline, juvenile hairline

In the News – Tissue Engineering and Follicle Regeneration

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

Snippet from the article:

A hair-raising trick may lead to better hair transplants. Engineered hair follicles patched into skin can be coaxed to connect to surrounding tissue and to grow hair in an organized way, a study in mice finds.

Unlike current hair transplant methods, which simply move existing hair follicles from one area of the scalp to another to cover a bald region, the approach would spur the creation of new hair follicles from existing cells.

Read the rest — Engineering better hair transplants

Progress moves slowly and consistent in the direction of solutions that will eventually allow doctors to produce the entire hair organ, essentially producing new hair. These articles are very exciting. To quote from the Nature Communications article: “Concepts in current regenerative therapy include stem cell transplantation and two-dimensional uniform cell sheet technologies, both of which have the potential to restore partially lost tissue or organ function” such as hair. The article demonstrates “fully functional orthotopic hair regeneration via the intracutaneous transplantation of bioengineered hair follicle germ” (i.e. stem cells).

In the discussion, the author Koh-ei Toyoshima et. al. states: “In this study, we successfully demonstrate fully functional bioengineered hair follicle regeneration that produces follicles that can repeat the hair cycle, connect properly with surrounding skin tissues and achieve piloerection. This regeneration occurs through the rearrangement of various follicular stem cells and their niches. These findings significantly advance the technological development of bioengineered hair follicle regenerative therapy.”

Tags: mice, mouse, hair transplant, nature communications, bioengineering

Am I Losing Grafts 4 Months After My Transplant?

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

Hello
i had a FUE transplant last december, everything seems ok, but sometimes i feel a little itchy spot and when i scratch it, a hair (seems like it is one of the transplanted ones) comes out of the scalp attached to a bit of something looking like hard sebum, almost looking like when cleaning a black head blemish or an ingrowing hair. Is that normal? is that the follicle coming out? if so does this mean that i’ve lost one of the transplanted hairs?

thanks

These are really questions for your doctor. If you pick (or vigorously scratch) at your hair, you run the risk of losing the hair. Picking causes hair loss, infection and associated skin problems. For hair transplant patients, they should always have their doctor check out what is going on with their head.

I would doubt that you’re losing grafts at four months after your surgery, but I couldn’t tell you what is causing the itch. Maybe it is an infection, but this is clearly not something for an Internet-based diagnosis. Please call your doctor for a follow-up exam.

Tags: hair transplant, hairloss, hair loss

My Donor Area is Thin, So Can I Have My Entire Beard Transplanted to the Scalp?

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

Hello,

I’m a 25-year-old male and I’ve been thinning since the age of 20, and I believe I might have stabilized the hair loss process as I’m taking medication and substances to stop the hair loss.

I’d like however to undergo a hair transplant, especially at the front of the scalp. The bad news in my case though is that my donor area is also thinning out, which means that perhaps 1500 grafts can be harvested.

My question to you is if it’s possible to harvest grafts from other parts of the body, say like the beard, arm pit hair and pubic hair, also the hair between the buttocks? Let’s throw in arm, chest and leg hair while we’re at it. Is it possible to transplant hairs from these areas to the scalp?

I wouldn’t mind if my ENTIRE beard was to be transplanted, because I have sebhorroeic dermatitis and my beard is just aggravating that condition. Is it possible to transplant the ENTIRE beard?

Grateful for a reply

I really can not answer your question properly. First, I have not examined you so I can not confirm what you are reporting.

Second, if you are losing your donor hair, then you probably have some condition that is not genetic patterned balding. Do you have diffuse unpatterned alopecia (DUPA)? It’s not usual to have the entire scalp thinning like you described.

Third, a hodgepodge of hair transplants from different parts of the body may give you a freaky, unnatural look and therefore, I wouldn’t be interested in doing a surgery like that. The hair from the beard is different than the underarms, the chest, the leg and so on. Body hair in general is different from scalp hair, as I’ve written about before (see here). Hypothetically speaking, transplanting the entire beard would leave facial scarring that wouldn’t be in your best interest.

Anything is possible and any hair can be moved from one area to another, but how it will look in the end is another entirely different matter.

Tags: body hair transplant, bht, hairloss, hair loss, hair transplant

My Transplanted Hair Is Darker and Curlier Than My Native Hair

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

Hello Doctor

Last year I underwent a hair transplant. Seven months have passed and I am very happy with results, the regrowth is quite fast. I have noticed one thing I’d like to ask about, though. The color and the texture of the transplanted hair differs from my native hair. The transplanted hair grows darker and it’s somewhat kink and curly.

Is a texture change something that happens in the early phase of regrowth after transplant? When should my hair return to its normal state? Is this something I should worry about?

Thank you

Changes in hair texture are somewhat common, though kinky hair occurs less frequently. Usually patients that experience a characteristic change see their straight hair get more of a wave in the transplanted hair. It’s possible that you’ll need to wait out a full hair cycle (2-4 years for the average male) to see if the kinky change disappears.

The transplanted hair should replicate the native hair in the donor area and most changes in color reported reflect a comparison with miniaturized hairs in the recipient area when compared to the transplanted hair in the recipient area. I do not believe that transplants themselves influence changes in hair color, other than maybe accelerated aging issues like early graying.

One patient from 2006 showed changes from blonde to brown which is a process of color change that many blond people go through as they age. My three sons (born with blonde hair) saw their hair change from blonde to brown by the time they got into their late teens. So what you’re describing is unusual unless it is in the aging genetics that you have triggered ahead of schedule.

Tags: hair transplant, hair color, hair texture, hairloss, hair loss

Use of PRP and ACell in the Hair Transplant Process?

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

Im inquiring if dr rassman is treating people with thinning hair with acell and prp as a standalone treatment? (and if so can you give me some more info). Im intrested in this procedure before undergoing any surgery, i didnt see anything on the website but his name popped up on a web forum saying he does this?

Thanks kind regards

I do not use platelet rich plasma (PRP) or ACell prior to a hair transplant. There is no evidence that either of these produces value for the patient having a hair transplant. I’ve written about some doctors offering PRP, and we did try ACell for hair multiplication to no avail.

What gives value is a very high growth rate, which is produced by experienced surgeons with experienced, well-seasoned teams working under strict quality control conditions.

Tags: prp, platelet rich plasma, acell, hairloss, hair loss, hair transplant