Is Buying Cheap Hair Transplants Really in Your Best Interests?

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

Cheap ain't goodI’m sure you’ve heard the saying, “You get what you pay for.” With offerings in the dollar store, are you getting real value? Those who purchased cheap toothpaste at bargain stores a few years back obviously didn’t know that it was toxic with lead or antifreeze, or those that bought imported pet food filled with chemicals to make plastics had no idea they could potentially be killing their pet… but fortunately the FDA came to our rescue. For those that buy cheap hair transplants, there is no FDA, medical board, or attorney general to tell you if you are getting what you are going to pay for. Even if the doctors had a better than 90% failure of the transplants, what is your recourse? You can ask for your money back, but it’s doubtful you’ll get it. I just read a recent post on a hair forum from one poor fellow that had an almost complete failure of the transplants and was refused any money back.

Recently I met with two men. One had 2000 grafts done about 8 months ago by a Los Angeles doctor with a survival rate of the grafts at about 20% (my estimate). That means that his $2/graft pricing really was $10/graft based upon survival of the grafts. Not only did the grafts that survived cost more, but there was significant damage to the donor area with 1600 graft with at least 3000 hair equivalents lost from his donor bank. What was the negative value of that loss? Incalculable in my humble opinion, as these hairs are gone forever.

The second man was an old hair transplant patient of mine from about 13 years ago. He had terrific results and loved his transplanted hair, which lasted to the present time. A friend of his wanted a procedure done and found a doctor willing to do it for $2.50/graft. My patient referred his friend to me, but wanted to know if I would match this price point. It just so happened that the doctor offering this cheap rate was the same doctor that had the 20% survival on the other patient! [note – It’s our policy to not speak unfavorably about doctors by name on this site, so please do not ask me to reveal his name (do your research and you can probably figure it out though)]

I told him to look over our Selecting a Hair Transplant Doctor guide, and invited him to our next open house event. We had 6 of our former patients come to that event to show off quality results. That other doctor never showed off the quality of work he does. Does that mean that he has no patients worth showing? The only way you can really get an idea of what is going to happen to you is to see results first-hand. We wrote the how-to guide on selecting a doctor, because we want you to become smarter shoppers. This is surgery on your scalp! I fail to understand why someone would risk having this procedure look completely fake or risk the loss of valuable donor hair. Ask yourself, do you really want a discount store hair transplant?

Tags: hair transplant, hairloss, hair loss, surgery, risks, discount, bargain

Hair Transplant Post-Operative Risks and Complications

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

Can you please tell me about the post-operative course I can expect after a strip and FUE surgery?

If you wash your hair twice a day starting the next day after surgery, most of the scabs and redness should be gone and you should be left with a 1/4 inch stubble of hair on the front after 2 weeks. I suppose if you are really looking at it you may be able to tell something was done. Cosmetically it should not be an issue. For those with transplants to the hairline or frontal area, if your exiting hair is long and you comb it forward to cover it, then it should not be noticeable.

Some patients with fair skin may get persistent redness for weeks after surgery. The redness will look like you have a slight sun burn. Most patients do not. Risk is higher in fair skinned individuals. As a rough rule of thumb test, to see if you may get the redness after surgery by scratching your forehead with your fingernail. Wait a few minutes to see if your scratch mark is bright red. If that happens, then your risk of redness after the transplant is higher than most people.

Some patients get forehead swelling on the 3rd day after surgery and it may last a couple of days, up to a week. For your social needs, 14 days should be no issue. Risk of swelling is about 1 in 30 and it is completely random. Once in a while some people get swelling so bad it may shut your eyes and cause bags under your eyes. We give corticosteroid to minimize the risk, but the risk is still there (although very small).
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I Took Steroids, So Would I Benefit From a Transplant?

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

dear doctor.
I am 29 yrs old, I took steroids about 10 years back because I was heavily into bodybuilding and competing. I noticed I started to lose hair so I stopped and went on finasteride which my doctor gave me. I have been on the drug for about 10 years with moderate success, other people cannot see the balding but I can. As I was going bald I would take pictures of my scalp when my head was shaved and I noticed I was thinning in the classic horse shoe pattern with sort of like a thick bridge of hair in the middle of my scalp going from ear to ear but minor thinning in the crown and front part. Since I know my pattern already from taking steroids, would I benefit from a transplant or since I know my final pattern at my age its not worth it?

Thank you, I do hope to hear from you, please.

As you are now off the steroids and have been for some time, you will be treated as any other balding patient. Of course, you took some steps backward with hair loss that may never return, but that does not mean it is hopeless.

A visit to a doctor’s office who cares about you and has the requisite skills in the hair restoration filed would be your best option. What you need is a good Master Plan for short and long term hair loss management.

Tags: hairloss, hair loss, steroids, hair transplant

Blood Flow to Grafts After Multiple Hair Transplants?

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

Is there any research that shows that blood flow to the grafts could be compromised or growth delayed with multiple procedures as compared to the first procedure? Is it possible that multiple procedures can outstrip the blood supply necessary to insure maximum growth and thus limit graft survival?

Does every patient with multiple procedures always see a stubble of erupting hair coming in between their hairs after 3-6 mos.?

The reason I ask is that I don’t recall seeing any stubble on my 2nd procedure and am concerned as whether I will see any for my 3rd. It was easy to see on my first procedure.

The blood supply on the third procedure should be as good as the first procedure.

The presence of any immediate stubble reflects retention of the hair shafts after a hair transplant, not growth. Growth should come in at about 4-5 months and the stubble that you detected after the first hair transplant, if it did not fall out by the time the hair grew, will be forced out by the growing hair. I don’t know anything about your procedures, but it’s possible that it was easy to see growth after the first transplant simply because you had less hair in the area.

Tags: hair transplant, hairloss, hair loss, blood supply

Is There Research Into Manipulating Body Hair Growth Cycles?

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

Hey good sir I hope your day and your new year are treating you well. I recently read on your blog that you were in Antartica. Just out of curiosity how was your trip? Would you recommend visiting there? I am just curious because I never hear of anyone going down to Antarctica electively.

Also I had a hair related question. Instead of trying to create completely new hairs from an existing scalp hair, why dont researchers work on manipulating the growth cycles of body hair and other sources of donor hair extraneous from scalp hair? I understand that this hair maybe contextually different but would it not offer the patient some sort of cosmetic value?

My trip to Antarctica was interesting, to say the least. Lots of penguins of all sizes and colors, a few seals and whales, and some very nice scenery. There were long periods at sea, so I sat down with a good set of books on my Kindle and filled the days well.

As for body hair transplantation, some doctors have been doing hair transplants to the scalp using body hair and the results are less than ideal. Leg hair, for example, has a 60% telogen cycle… which means that these hairs stay “sleeping” most of the time. While they are sleeping, they are not visible above the skin. To the point of your question — I don’t know who, if any, research groups are working on changing the hair cycle in body hair.

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

What Would You Do if Propecia Was Hypothetically Pulled from the Market?

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

Always great to see this site up and running. Thank goodness you did not pull a “Merck.” Let me segue then into the question: Let’s say that you were practicing HT’s ten years from now and it turned out data showed that finesteride’s long term effects were more detrimental to libido, erectile issues, etc. than previously reported, and the drug was pulled from the market as a hair loss fighter. All things being equal to today’s other hair loss products, would this alter your approach to certain patients?

There was no Propecia on the market in the early 90s, so young men would get hair transplants anyway and many would suffer from shock loss (especially those under 25 years old). Then the doctors chased the hair loss as the eventual pattern of each patient emerged. I guess the same would happen in 10 years or hair transplants would become a dying industry. Knowing some of the less honorable doctors, denial of the accelerated hair loss might be a pattern to keep up payments on big houses and expensive cars, but for the most part, I suspect that the demand for many repeat procedures will become the trend in the long term.

As long as we’re playing with hypotheticals, I’d hope that in the next decade there would be advances in treating balding that might make medication unnecessary.

Tags: propecia, finasteride, hairloss, hair loss

Hair Transplant Now, Shaved Head in the Future

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

I don’t mind shaving my head in future when hair loss develops, but not now. What I want to have is a hairline to frame my face even if I shave my head.

Is there any technique performed by any surgeon which does not leaves VISIBLE scarring on the back of your head? If I want my head shaved in future, what do you advice me?

I’ve thought of FUE + (ScalpMicroPigmentation on the tiny dots) when I finally shave my head. What do you think about it?

Not everyone will have very visible scarring, but any wound to the scalp will leave a scar to some degree. Just to what degree you will scar, I have no way to know.

The combination of follicular unit extraction (FUE) and Scalp Micropigmentation (SMP) does work… but with that said, you need to be evaluated by a real expert to know where you stand.

Tags: smp, fue, follicular unit extraction, pigment, hairloss, hair loss, hair transplant

Sex After a Hair Transplant?

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

Hello,

I recently received a transplant of 2500 graphs. The day after the transplant I had sex and was wondering if the increase in blood pressure to the head may have dislodged any of my graphs.

There was no unusual bleeding nor was my transplant area touched.

As with all your first time hair transplantation-ees, I am concerned that I may have adversely impacted the recover process.

Comments?

I doubt that any problems were produced. I generally tell my patients if they must undergo sex right after a hair transplant, try to be a bit more passive in the process. Full active sex is safe after about 3 days.

Tags: sex, hair transplant, surgery, hairloss, hair loss

Is Scarring Common at the Recipient Sites?

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

Thank you for the time and effort you put into answering all of our questions. My question regards scarring. I have heard some people say that scar tissue forms where the hairs are implanted during a transplant, and that this can result in bumps or raised spots on the hairline. Is this true? If so, is it common? If not, why don’t scars form where the hairs are implanted? After all, a wound of sorts must be made to implant the hair, so how would do you prevent hundreds or thousands of scars from forming after a hair transplant?

With the technique we pioneered, we do two things that minimize recipient site scarring —

  1. We make very small wounds in the skin, essentially slits that approximate the size of the grafts. These heal very fast.
  2. When preparing the grafts for implantation, we cut off the skin disk at the skin level. To minimize the skin disk, we remove the top layer of the graft skin from the surface of the graft. This prevents the skin from surviving the transplant which could, in some individuals, produce the bump seen in recipient areas. The same process is done with grafts taken from strip surgery.

When doctors use grafts that have a larger surface area than what I described above, the bumps you referenced get more prominent. We have seen from the old days when plugs were done and the graft sizes ranged from 3-5 mm across, the skin always was deformed. Clearly the more skin that survives at the top of the graft, the more detectable will be the existence of the transplanted graft.

Tags: hairloss, hair loss, hair transplant, scarring

Actor Joe Rogan’s Hair Transplant?

/by William Rassman, M.D./4 /

Joe RoganI was listening to the Joe Rogan podcast and was really surprised when he mentioned that he won’t shave his head because he had a transplant a few years ago and has a scar. I always wondered why he DIDN’T have a transplant when I would see him on TV but was kind of surprised that he says he had one. Do you think he was misinformed as to what his eventual loss would be?

Your guess is as good as mine. I do not know the circumstance of actor/comedian/host Joe Rogan’s hair loss or the treatment he had. It’s possible that he had the surgery many years ago and had continued hair loss, but I really don’t know.

Someone might mention to him that we can treat his scar with either a scar revision or Scalp MicroPigmentation (SMP).

Tags: joe rogan, fear factor, hollywood, hairloss, hair loss, hair transplant

With Shock Loss a Possibility, Is the Best Transplant Candidate Mostly Bald?

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

IDOC.. let me see if I have this correct. Having a transplant in an area where there is still a fair amount of hair increases the odds of shock loss? if i want to get a head start and restore my hairline as its thinning but still have hair, the trauma from the surgery will most likely cause shock loss to the existing hair in that area. Is that right? So the best candidate is one who has little hair in the area to be transplanted?

Is anyone still testing A Cell therapy for hair restoration?

Thanks

Broken recordThose who are at the highest risk for shock loss include:

  1. Patients with noticeable hair loss that is active at the time of surgery
  2. Patients that are younger than 30 years old
  3. Patients that have significant miniaturization of hairs in the balding pattern.

When such patients are on finasteride, the risk for shock loss is reduced.

I know I sound like a broken record at times, but everyone is different and every individual case is unique. There is no universal answer to this question. Some wait until they are bald before they have hair transplant surgery. Some have surgery as they are balding (to maintain their existing look). Shock hair loss is always an issue, but not an overriding one after all the factors are considered… as long as you and your doctor are realistic about shock hair loss. Some overreact or misinterpret what shock hair loss really is, and make it out to be an overbearing issue. But this is a generalization. Please read this recent post on shock hair loss. We do take it seriously, but we also take it on a one-on-one basis. That is why we have a real doctor- patient examination and consultation before any surgery.

With respect to ACell, we have conducted the one year study for hair restoration, but it was a failure. As far as I know, no doctor has been able to reproduce the results claimed by Dr. Hitzig or Cooley on hair multiplication. That is probably why you are not reading about it in scientific journals or in the mainstream media as the next great breakthrough. I don’t know which doctors are still experimenting with it, though.

Tags: shock loss, hairloss, hair loss, acell

Electrolysis of Hair Transplant Results

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

Can I use hair removal if I decide my transplants just aren’t looking right? I am just trying to figure out what my options are to undo the surgery.

I met with a patient a couple years ago who had frontal hair transplants at a clinic with results that did not meet his expectations. He responded by going through electrolysis and removing the grafts. He came to my office to figure out what to do with the linear scar.

The results of the tedious electrolysis was very good, but in our experience, electrolysis is very dependent upon the skill of the person doing it. The means the results from this process can vary considerably. The use of hair removal lasers also can be a problem particularly if the grafts are large since they leave an abnormal “foot print” in the skin once the hair is gone.

Tags: electrolysis, hair removal, hair transplant, hairloss, hair loss

The Dangers of Medical Tourism: What It Is and How It Can Impact You

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

The following post is by UK-based physician Dr. Bessam Farjo:


Written by:
Dr Bessam Farjo, United Kingdom
Dr Bessam Farjo
United Kingdom

I recently came across a poll on newbeauty.com, which reveals that one in four Americans would consider having surgery if it wasn’t so costly. With this in mind, it’s not surprising that people seek a lower cost option and consequently consider having surgery in a country where it’s cheaper. While the discounted price tag may be very appealing, there are some important things to bear in mind when it comes to having surgery abroad.

The same website outlines some of the dangers associated with medical tourism. It describes how it can be difficult to check if a foreign physician’s credentials are genuine, suggesting that the International Society for Aesthetic Plastic Surgery is a good place to start. It also flags up that you may not be covered by your travel insurance if something goes wrong in another country. Another issue concerns recovery, which can sometimes take longer than expected after surgery and there can also be a danger of clotting if travelling by plane.

Similar considerations apply to our own field of hair transplant surgery. The website of the International Society of Hair Restoration Surgery provides a list of members as a reference not necessarily recommending anyone in particular. It is down to the individual patient to do their due diligence whether online or in person.

There are clinics that try to take advantage of potential patients who consider surgery at home too. We’ve seen a growing number of men come to us after opting for surgery via an offer on a discount website such as Groupon or KGB deals. These ‘deals’ are usually limited to 1,000 grafts which is only around 2,000 – 2,500 hairs. To anyone with a significant amount of hair loss this would be nowhere near enough to provide a suitable result.

The small print in these offers often dictates that only one discount is available per person, meaning that anyone requiring further treatment would have to pay the full cost or more likely, above the odds.

There certainly are some serious dangers involved with having surgery both abroad and at home and I would strongly recommend considering these should patients be tempted by low-cost surgery options. As always, I must stress the importance of thorough planning and research when contemplating any type of surgery, make your decisions based on what’s right for you, not on the price it costs.

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Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

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Dr. William Rassman’s Comments:

    I can speak to having surgery in the United States, Canada or Europe. The issue of recourse comes up. What recourse do you have if the doctor misrepresented himself (or herself)? Or if there is medical malpractice involved in the delivery of the surgery? Or if the “doctor” really isn’t a doctor?

    I know the laws in California are made to protect the patient at all times, and California lawyers are waiting enthusiastically to represent those who are harmed. The legal recourse in many foreign countries may not be there, which means that if you become a victim of the surgeon, there is little you can do about it. This, to me, is a good reason to have the surgeries in the United States, Canada or European countries that have strict laws that control doctors’ licenses and the way they use their licenses.

Tags: hairloss, hair loss, hair transplant, travel, surgery, farjo

In the News – Transplants Using Leg Hair

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

Snippet from the article:

A new report highlights a novel way for doctors to replace thinning hairlines: transplanting leg hair.

The report, a study of two cases published in The Archives of Dermatology, describes a new procedure in which receding hairlines were restored by taking hair follicles from patients’ legs and grafting them to the head. Men’s leg hair had successfully been transplanted before to the back of the head, but these are believed to be the first documented cases of leg hair being used to restore the hairline.

Leg hairRead the rest at the NY Times — A New Approach to Treating Hair Loss

The article is about Dr. Sanusi Umar’s amazing work as a pioneer in body hair transplants (BHT). He has privately reported procedures of 10,000 grafts in one sitting using body hair. These procedures are done through very long sessions at times, reported to run in the wee hours of the morning.

Body hair is not the same quality of head hair for use in hair transplants, so I don’t think that this technique will catch on. Although body hair seems to change and grow longer when placed into the head, its value is not equal to donor hair taken from the back and sides of the scalp.

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

Why Can’t I See the Tiny Recipient Holes After My 3rd Transplant?

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

I am 1 month post-op on my 3rd transplant. Just curious why I can’t see the tiny holes where the grafts were placed as compared to the first transplant. I recall this from my 2nd also. The scabs have healed. I look for the incisions but can’t see them. Is it because existing hairs make it hard to see or because the incisions have healed and the grafts are beneath the skin?

I can only guess. Maybe the surgeon used a smaller instrument making smaller holes, or maybe the holes are not there because there were no hairs transplanted on the area you are looking at. Could the holes have healed so that you can’t see them? That will depend on how long it has been since your surgery.

You should at least see some scabs, unless they were there and it have fallen out. It usually takes one to two weeks for scabs to heal and fall out. Then it takes another few weeks for the hairs to fall out, unless the transplanted hairs were shaved. The main point here is that I have no way to know for sure via email, and it is all a guessing game. The best person to ask is your surgeon.

Tags: hair transplant, scarring, hair grafts, hairloss, hair loss