Did I Actually Get All the Grafts I Paid For? (with Photos)

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

Dear Dr: can you help me estimate the number of grafts and hairs I receive based on the following photos? feel free to download and use them.

The doctor said, in a very random manner, he did 2900 grafts. Then plus post-op meds, this number exactly matches what I have paid before the surgery and we do not owe each other a penny. I won’t argue about it if there’s only a little discrepancy.

Thanks for sending the photos and allowing me to post them. I’ve chosen one photo to post that will give readers an idea of what you had done. Click to enlarge:

 

I have actually counted the grafts on patients that have doubts like you expressed in your question. If peace of mind is what you want, then a visit to a doctor who is willing to count the grafts is probably a good idea. On a few of the patients where I counted the grafts, wide discrepancies have been found, confirming their suspicions.

But counting the grafts in the photographs or counting them after the third day of the surgery will not get you what you want. You should have written to me right after the surgery and then I could’ve given you an accurate count within 1% of what you got.

Tags: hair transplant, post-operative, graft counting, hairloss, hair loss

Hair Stuck in Scabs After Hair Transplant

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

Hello,

I wanted to ask a question about scabs. I am 33 year old African American male and I had surgery done for 1000 grafts about 15 days ago. After the surgery, I was told not to wash them until the next day. I was told I was “poppy” which mean, I bled alot when the surgery was being performed. These forms little round beads of blood when I left, but I could see my hair transplants nicely.

When I washed my head, I was careful not to move them, so I just dabbed them and rinsed. Over the next week, these turned into scabs.

Now, my scabs are falling off when I take a shower, or when I lightly move them, with no bleeding. However, what I am noticing is there is hair stuck on them. I am so afraid that they are taking with them the hair follicles.

Is there a way I can find out instead of waiting 3 months. I still have some scabs remaining and it is exactly 2 weeks since I had surgery.

How can I be sure that my anchors are still in place.

Any ideas, thoughts appreciated.
Thank you

Everyone experiences hair in the scabs when they come off. The key to good management is to get the scabs off immediately after the surgery. Now you should wait until the scabs come off with gentle shampooing of your hair. The hair you see in the scabs should not be the grafts, unless the grafts were not seated correctly on the time of the surgery. Talk to your surgeon about proper aftercare.

Tags: hair transplant, hairloss, hair loss, scabs

What is FOX Negative?

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

What does FOX negative mean?

Thanks.

We coined the term “FOX” at New Hair Institute back in 2002 for FOllicular unit eXtraction. We thought FOX sounded better than FUE. We also published a paper on follicular unit extraction, describing how some patients are good FOX/FUE candidates and some are not.

I realize FUE is performed at many clinics without any pre-testing on all patients who want to have the surgery, however at NHI we pre-qualify potential patients with a FOX/FUE test to see if they are good candidates. A very small percentage of patients will have high transection rates with FUE and these are the FOX negative patients we are talking about.

We generally do not recommend FOX/FUE surgery if the transection rate is approaching 20% or more. If the patient is FOX negative, it is an inherent problem to the patient (not the doctor or clinic or machine). As we wrote about our experience with NeoGraft a week ago, the machine could not successfully harvest a known FOX negative patient.

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

Have You Tried NeoGraft Yet?

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

Hi Dr. Rassman,

I read where your colleague, Dr. Bernstein, recently decided to add the NeoGraft Unit to his office’s hair restoration offering – see his blog for more information. I was wondering if you have had an opportunity to try the NeoGraft and whether or not they have managed to overcome trauma to the grafts from “drying” and mechanical effects (during extraction and implanting)? I have read your blog concerning your (and Dr. Pak) device (hydro) and was really hoping that they might take a page from your book on this technique.

I did try NeoGraft on one of our known FOX negative patients and the results were not good, but comparable to what we would have gotten using our own techniques in such a patient. A quick aside, the FOX test means that we ran a small FUE test to see if they are candidates for a full FUE procedure… and FOX negative means we do not recommend the FUE procedure for them.

The NeoGraft system did what we would have expected it to do. I believe (without direct experience) that the ARTAS robot would have also produced damage with this FOX negative patient, but as most patients are not FOX negative, the test of the NeoGraft on this patient was not a fair representation of what it should do.

I have asked for a loan of a NeoGraft system to help me find a place in my practice for it. I know that Dr. Bernstein is getting an ARTAS system and I am sure that when he has a FOX negative patient, I will find out what his experience is with such a patient.

Tags: neograft, fue, hair transplant, follicular unit extraction

Do Doctors Track Transection Rates in Hair Transplant Surgery?

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

I was curious if you know if any doctors track the survivability of the grafts? I know that there is quite a bit of information on transection rates for different surgeons but was wondering if anyone monitors this metric? If they do – how might the survivability be determined outside of just counting the grafts in the recipient area a few weeks/months after the surgery? Thanks

This is a great question. We track transection rates when we perform FUE surgeries. The transection can vary from 5% to 50%. I believe 5 to 10% is an acceptable number. If there is a high transection rate then we will abort or never recommend surgery. This is the reason why at NHI we always pre-test all potential FUE patients, but I realize other clinics and doctors may not do this.

The data for other clinics and doctors is not available or well published in studies. I believe mainly it is directly linked to business. No one would publish poor results or high transection rates, as it is not good for business. As unfortunate as it may be, the consumers and patients are left to do their own due diligence and trust their doctor, probably by contacting patients who had it done by that doctor. One way around this would be for patients to ask about seeing actual patients in person or seeing their own surgical records of how the grafts were tracked (if it is done at all). In theory, the transection rate should be documented on the day of surgery, but I realize not all doctors will keep this record (as it is not mandatory) and some may refuse to show it to their patients. I can say this because I have heard these issues come up in consultations with some patients that have had procedures done elsewhere previously.

I know of one doctor who promotes and reports 96% good FUE grafts (4% or less transection), yet I have see many of his patients and found a high degree of failures in those of his patients who came to me for a second opinion. This is a buyer beware business. Sometimes you can expose poor practices through reports by the chamber of commerce or the courts in the areas where the doctors practice. I’ve also been asked to post the names of doctors to be weary of, but if I were to speak up and identify those who may not be honest in their representation, I would become a target for slander. I have better things to do than take up residence in the court system.

Tags: transection, hair transplant, surgery, hairloss, hair loss, fue

Is Robot FUE Actually Cheaper?

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

This article says the FUE surgery using the Artas® robot is actually cheaper, which goes against what you said about higher costs. Thoughts?

LA Times: Robot-assisted hair restoration?

The cost of the ARTAS robot is $200,000 and the doctor must pay a fee of $1/graft for its use. That cost must be factored into the doctor’s overhead for the procedure (rent and surgical supplies). The robot will not lessen the cost of a highly skilled staff, so I am not sure if the overall cost will be lower financially or not. I see in the article from the LA Times that a discount for follicular extraction (FUE) pricing will be offered for the substitution of Dr. Harris’s time, but as many of the other costs remain fixed, the discount may be relatively smaller (in the range of $1-2/graft). This is the opinion of one doctor and one doctor only.

In the past, I have said that the robot might actually increase the costs, especially in its early phases (today’s form) where it can only core the graft (FUE style), not remove them or place them into the scalp. When the robot is capable of doing the entire process — including the graft placement, which is still years away — I am relatively confident that the overall cost to the patient will be less. I hesitate to comment on Dr. Harris’s pricing formulae and I am not sure that he will be able to maintain lower prices with the robot without some history of working with the robot occurring.

Besides the financial aspect, the real cost for the patient in FUE procedures is graft damage during extraction which causes less graft growth, a common problem for FUE in all but a few highly skilled doctors. I see patients in our office quite frequently who have had FUE procedures with significant failures of the grafts to grow, so the robot will assure the patient that (at the least) the grafts will not be damaged during the extraction phase. Damage of the grafts can also occur when the grafts are exposed to air for more than 10-15 seconds, if they are mishandled during placement, or if they are killed off during storage while awaiting placement (now a manual, not a robotic technique).

So to answer your question, the charge for the present technology may or may not really be significantly lower, but for the less-than-very skilled surgeons who do not have a great deal of FUE experience, the cost to the patient in successful extractions will be leveraged with better results. From a quality point of view, the robot levels the playing field for FUE, making the inexperienced FUE surgeon possibly as good as the skilled FUE surgeon. It will absolutely level the playing field once the robot can perform the entire mechanical process from extraction to placement of the grafts in one smooth process. That functionality is not at hand now or anytime soon.

After discussions with the president of Restoration Robotics (the makers of the robot) last week, I was told that the full functionality of the robot with FDA approval will not be available for 4-6 years. Pricing something that is worked into our daily process will take time.

Tags: fue, artas®, restoration robotics, hair transplant, follicular unit extraction

I’m 23 Years Old and Want a Hair Transplant — Will I Regret It in 10 Years?

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

Hi,
I am a 23 year old male seriously considering a hair transplant. I am a norwood class 2 w/a naturally high hair line and diffuse thinning in the temples about an inch back and slight thinning in the front (minor). I have been on finasteride for 2 years and rogaine foam (on the hairline) for 2 years. I have a few uncles on my mom’s side who are norwood 5’s and some uncles on my dad’s side who are norwood 2’s and 3’s. My dad is a norwood 2a.

I have been to two hair transplant surgeons who both said I was a good canidiate because I have good donor hair and I’ve halted/slowed my hair loss with finasteride. The surgery would be a conservative approach to establish a mature hairline. I’m not trying to get my adolescent hairline back. They each recommended btw 800 and 1000 grafts via the strip technique.

I know I am young but what do you think? Will I regret this in 10-20 years? Is shock loss a major concern in my case?

Thanks.

You need to find a great doctor that is known to be honest — not one that wants your money instead of giving you what you need. A good relationship with a doctor you trust will be critical to the decision making process. I cannot say the recommendation you got was good or bad, as I haven’t seen you. Some 23 year olds are excellent candidates, some are not. If you do go through the surgery, hopefully the Propecia will limit or prevent shock loss, but there’s no guarantee.

It seems you are having doubts and that raises a red flag for me. Unfortunately I cannot give you a diagnosis, recommendation, or prognosis here.

Tags: hair transplant, age, hairloss, hair loss

After Taking Propecia Daily for Years After My Transplant, I Think I’m Losing Hair Again

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

I have had two procedures in the past at Dr. Rassman’s NHI facility. The first about 8 years ago, the second about 6 years ago. I have used Propecia, or Finasteride as a substitute, religiously since before the first procedure.

About a year ago I started to notice substantial thinning in the areas that had become filled in from the procedures. I have assumed this to be loss of original hair. Is it common for Propecia/Finasteride to stop working at some point? Does substituting Finasteride have a negative effect?

Last, I have read that Propecia (Finasteride) dosage can be reduced from 1 mg a day to .2 mg per day with no negative effect, and that it may be possible to take the med every other day. True?

Hair transplants are permanent and lifelong, but those remaining hairs you had in the balding areas (not the transplanted grafts) will continue to fall out. When you have surgery, we transplant the hairs in between any existing hair to blend it in so that if the existing hairs fall out years down the line, you will still have the transplanted hairs to keep things looking natural without an abrupt demarcation.

Propecia is just a brand name for the finasteride (in 1mg dose). There should be no difference between generic and brand name other than possibly the strength in dose of the active ingredient. It’s possible that there are different fillers. Propecia/finasteride does help hold on to the existing thinning hair as long as possible, but eventually your genetic predisposition catches up with you. This does not mean it just stopped working, but rather, you are getting older and your predestined hair loss fate is winning the battle.

The medication is about 70 to 80 percent as effective at half the dose of the recommended 1mg daily, so you can theoretically cut the pill in half (0.5mg) and still see some benefits. There have been some patients who have seen side effects, and cutting the dose in half has allowed them to experience good results without the side effects.

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

Hair Transplant Results of Man with 2415 Grafts (with Photos)

/by William Rassman, M.D./7 /,

This is a college professor who saw a new man in the mirror with this single hair transplant procedure of 2415 grafts. He has fine hair, which often takes more than one session for a completely full look. He told me that no one ever noticed the transition in his appearance, because the change was so slow.

Approximately 2/3rds of the transplants were placed in the first 6 inches of the hairline, which was moved forward, and some grafts were placed in the frontal part of the crown area.

Click photos to enlarge.

After (2415 grafts):

 

Before:

 

Tags: hair plugs, hair transplant repair, hair transplant

Declining Propecia Benefits and Shock Loss

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

If you have been taking propecia for a number of years and you are seeing the benefits slowly decline, but you opt to get a hair transplant done anyways, wouldn’t that still kill the native hair beside the transplanted hair because of shock loss? because the benefits of propecia are declining.

Maybe, but that is were your doctor’s expertise comes in. Your scenario is the worst case outcome, but our experience has shown that finasteride can reduce the risks of shock loss after a hair transplant. Shock loss would be a “worst case” if you do have surgery.

You will have to weigh the “risks versus the benefit” and the inevitability of where your pattern will end up. You will arrive at a point where the surgery will make a difference despite the worst case shock hair loss.

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

My Transplanted Hair Grows Faster Than My Native Hair

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

I have had two transplants (1800 total grafts) over the past 2 1/2 years in the vertex (400 grafts) and front (1400). I have noticed that the transplanted hair grows significantly faster than the native hair (mostly in the crown/middle scalp). This increased rate of growth is probably 50% or more. I suppose this indicates that the grafts are growing well and are healthy, but has this effect been noticed in other patients?

Thank you.

I have a hard time understanding how you can distinguish transplanted hair growth from non-transplanted hair growth, as 50% faster growth seems drastic. I have not had patients mention this type of phenomenon, as all hairs (transplanted and non-transplanted) should grow at the same rate if they are the same scalp hairs. If you had body hairs transplanted to your scalp it will grow at a different rate.

Tags: hairloss, hair loss, hair transplant, hair growth

Should I Worry About Shock Loss?

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

I want to have a hair transplant, but i read about the “Shock Loss” I read that i will have to wait 10 days post-op to be able to have a normal shower/to clean my hair normally. That 10 days it takes to the grafts to be held to the scalp. So in the first normal post-op if I have native hair besides to transplanted hair i will have shock loss because the native hair will not be normal clean, because the needles, because the perforations in the scalp.

My question is if i have a shock loss in normal hair, it will grow back again???? Do I have to be worry???

Shock loss is unusual in men that are taking finasteride (Propecia) prior to the hair transplant, as it minimizes the risk. If you lose your normal hair, it may grow back, but likely it will be miniaturized.. A good doctor can ascertain this on an examination of your scalp.

I’ve written much about shock loss before, and some links to past posts can be found here, here, and here.

Tags: shock loss, hair transplant, hairloss, hair loss

Transplanting Beard Hair to the Scalp?

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

Hello doctor

What do you think about transplanting beard hair to the scalp ?

a ) Does it worth the cost ? Is it a measure of last resort or a reasonable addition to achieve better coverage and thickness ?
b ) How many hair can you get from a beard to transplant ?
c )Is there a significant risk of little dot scars to the face ?
d ) Is it true that although beard grafts are mostly single haired , those hairs are 3 – 4 times thicker than scalp hair ?

Appreciate your time

At NHI, we do not perform beard hair transplants to the scalp unless the donor supply is depleted. We therefore do not endorse this treatment. Another way to put it is, we do not recommend surgery that we would not want done on ourselves. I realize there are other doctors and clinics that advertise and transplant beard hair to the scalp, but results we have seen have been mixed (some good, some bad).

You must remember beard hair texture and growth is completely different than scalp hair, so there is a potential for mismatch. There is also a chance of some sort of scarring to the face. ALL surgery or cut on the skin will produce some form of a scar. Even the best FUE will produce a scar if you look close enough. Most people will never see the FUE scars, because they’re in the back of the scalp, but FUE to the face and beard area will stand out if you shave.

The cost of the surgery and its benefits are something only you can assess based on your expectations. The number of hairs and the quality of beard hair is dependent on your beard hair characteristics. Everyone is different and there is no universal answer.

Tags: beard hair, bht, body hair transplant, facial hair, hair transplant, hairloss, hair loss, fue

Repairing Old Plugs Placed Too Low at the Hairline (with Photos)

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

To many people that aren’t familiar with the advances made in hair restoration, “hair plugs” are still the norm. There’s nothing pluggy looking about today’s hair transplant procedures, but those bulky hair plugs of yesteryear were easy to point out and looked incredibly unnatural. I saw a patient that had an unusual placement of these old plugs and was looking to correct it.

This patient first came in about a year and a half ago with a large bald area and old-style transplant plugs that were placed far too low on the right side of his hairline. I suggested that he fill in the frontal area, and he also wanted additional grafts placed into his balding crown. A total of 1919 grafts were transplanted.

You’ll notice that the achieved result shown below is an uneven, but fuller looking hairline (we were limited to what could be done because of the placement of his old plugs). He recently came in to see me again lower the frontal hairline and I agreed to lower the left side a little to balance it out. I remembered how much he hated the plugs on his right side when we first met, and now we succeeded in managing the plugs with styling and camouflage. While that 2nd procedure hasn’t happened yet to even out the hairline, I’m glad he was so happy with the results thus far from the repair and he’s allowed me to share the photos here.

Before photo on left / After photo on right. Click to enlarge.

 

Tags: hair plugs, hair transplant repair, hair transplant

I Don’t Have a Stable Donor Area — So is Beard Hair a Possibility for Transplantation?

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

Dear Dr. Rassman,

Thank you for your informative blog.
I was wondering I have seen many posts in which you recommend against using body hair for transplants but a few months back a reader asked about using beard hair as donor hair, and I got the impression that you thought this was a reasonable option. I have been told by a doctor that i don’t have a stable donor area would beard hair be a possible alternative? maybe in combination with S.M.P. ?

Also how would this work? Would the patient need to keep a beard forever to cover the scar? Anyway thanks for your time.

We do not generally recommend beard hair as a donor supply for transplanting to the scalp unless the donor supply in the back of the head is badly depleted. I realize there are doctors who specialize or advertise in these type of procedures, but it is something we do not recommend. What is making your donor area unstable? Do you have alopecia areata?

SMP is also a procedure that is very uniquely specialized to an individual, and I couldn’t say one way or another if it would be right for you without an exam. Or are you suggesting to use SMP on your face? I’m confused…

Tags: donor area, bht, body hair, beard hair, hair transplant