My Blood Pressure Went Up After My Hair Transplant — Are My Grafts Going to Suffer?

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

I’ve never had blood pressure before, but about 4 weeks after my mega-session it shot up (mostly 144/90 range) along with a light elevation in blood sugar (110 avg.). This all coincided with a family move to the other coast and switching jobs. This went on for about a month before things died down again. Do you think I injured my grafts? Also, would it be deterimental to take just a few (5 or less) Inederol/Propanal to help with calming down during this period?

I do not believe high blood pressure should impact hair growth or a hair transplant. Please follow up with your doctor and get your blood pressure under control.

Tags: blood pressure, hair transplant, hbp

Transplanting an Eroding Hairline

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

Hello Dr. Rassman

In one of your latest replies you suggested that transplanting grafts just to thicken the regions close to hair line is not advisable as it can damage existing original hairs. Also you said you have applied this to some actors. Didn’t their existing hairs get damaged as you said? Could you supply us some further information?

There are judgments that are made based upon experience. If a hairline is eroded or eroding and the person is on finasteride (Propecia), I would treat the hairline that has hair present in it, provided that the patient understands the nature of progressive hair loss. In the young man, the erosion of the hairline is just the beginning of the balding process, so keeping a fuller hairline with transplants and following the loss as it goes back is not unreasonable.

What I avoid is someone who has miniaturization in and behind the hairline, but the hairline is still normal. Getting to know the patient has a lot to do with what I do and I tend to be more conservative than most doctors are protecting the patient from unnecessary surgery.

From time to time, I see a person with a Norwood Class 2 pattern that received 3000+ grafts in the frontal hairline. As a Class 2 patient, unless the hairline is eroded I do not usually transplant these patients… but if I do, just a few hundred grafts usually work. To give these patient 3000+ grafts means that the doctor is money hungry, pushing aside ethics to get as much of the patient’s cash as possible.

Tags: hairline, hair loss, hairloss, hair transplant

I’ve Had 8 Transplants Over 20 Years and Can Still See My Scalp Under Harsh Light

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

Hello there,
I hope you can help me please? I am 51 yrs old and over the last 20 years have had about 8 hair transplants, the last one being a FUE procedure in London approx one year ago. I have an average height hairline which had around 1400 grafts to thicken the frontal area.

Under normal light my hair (which is quite short and brushed back) does not appear thin, but under sunlight and house lights I can see through virtually the whole top. I have a good crown and temple peaks which have not receded at all.

My Q’s are – could the hair be taken from my temple peaks and from the front hairline to move it approx one half inch back on my head then place all these hairs on the top to thicken that area further?

Also, could a small area, say half a centimetre be taken from around the bottom rear of my hairline extending over my ears, with a view to putting these hairs on the top of my head too ?

Thankyou for any reply you send me. Regards

That seems like awfully too many hair transplant surgeries. Added to that, if you are still considering having more surgeries it sends a huge red flag. I read your requests and it seems a bit too drastic, but also note that I do not know your history or even know your ultimate expectations (as 8 surgeries in the past did not fulfill them), so I am just speaking in generalities based on your one email.

Perhaps you are trying to set a goal you will never achieve or had surgeons that never developed a Master Plan for you? Again, this is a generalization and I really cannot answer your question in detail without a private consultation. You may have many options once you are evaluated, such as Scalp MicroPigmentation to increase the appearance of fullness (see example) if you are running out of donor hair to harvest.

We do not harvest hair from 1/2 centimeter around the bottom of the ear and hairlines.

Tags: hair transplant, hairloss, hair loss

Bumps in Donor Area After FUE

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

I had a FUE operation of 3650 grafts exactly six weeks ago to my frontal hairline NW2. I recently, last 5 days, have about ten bumps like pimples in the DONOR area? what is going on?

Norwood 2If you were really only with a Norwood Class 2 pattern balding, why would you have 3650 grafts transplanted? This just does not make any sense to me.

Two things come to mind that could explain the bumps you’re seeing — 1) When transected hairs in a graft are placed, they can act as a foreign body. 2) There may also be folliculitis at the recipient sites.

If there is a folliculitis, the treatment should be incision and drainage of the bumps, a culture of what comes out of the wound and the use of antibiotics. Once the culture has grown out, the organisms will be identified and tested against the medication that the doctor will give you. That will tell him if his guess is the correct diagnosis.

For transected hairs, there may be a different course. As much as I would like to help you, I think that you will be best served to go back to your doctor.

Tags: hair transplant, fue, surgery, pimples

16 Months After My 3rd Transplant, I Only See Baby Fine Hair

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

Hello Doctor,
I have had three hair transplants totaling to about 5,400 grafts. I am about 16 months into my third transplant that i had in March 2010. I have observed that i still see baby like fine hair, as they seem when transplanted hair start to grow, still in some of my transplanted areas of the scalp. And i don’t think these are my miniaturized native hair as alot of them are grafts of two, three or single.

I am not sure if this is happening because i have had that many surgeries and there is lack of blood circulation for the hair to grow properly or the grafts were not transplanted properly by my doctor. I tried talk to my doctor about it, but he kept saying that they are probably my native hair. I am not sure what i can do to confirm this.

I generally want to see the patient 8 months after the procedure to get an idea what it looks like. By that time, I usually see 80+% of the growth that was transplanted. I wouldn’t expect to see blood supply problems.

Since you’re already 16 months in and not fully satisfied, then you should get another opinion from a doctor (in person exam). Hopefully you have detailed before photos to compare to your hair now.

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

Wolff-Parkinson White Syndrome and Hair Transplants

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

Hi, thank you for providing your blog as a source of information. I’m a 40 y.o. male and recently had an appointment for a transplant to correct some mild thinning in the frontal and temple area… approximately 800 grafts. I was literally minutes from the procedure when the doctor learned that I was diagnosed with Wolf Parkinson White syndrome as a teen and informed me that he would not continue with the transplant. From a providers perspective, is this the consensus of the industry as a whole or are there still transplant options available to me? Thanks in advance

There is no contraindication to an outpatient surgery (such as a hair transplant procedure) for patients with WPW. Moreover, if you were diagnosed with WPW in your teenage years, I would assume you have had it treated with ablation. If you were not treated with ablation, I would think you should be followed by a cardiologist.

Tags: wpw, wolff parkinson white, heart, cardiac, hair transplant, surgery

Transplanting a Tight Scalp?

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

For somebody with a tight scalp is a FUE procedure really the only hair transplant option?

If you have a tight scalp, you can “work” your scalp with an exercise program for 30 minutes per day for 3 months. Most people will succeed in getting more laxity with these exercises. We made a video of this here.

Tags: laxity, scalp, scalp exercise, hair transplant

I Can’t Believe One of The Results on Your Site is Real

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

I’m sorry, but I can’t believe that the following picture on your website is true. There’s no way a class 7 can have so much donor hair and have results like this.

Patient ZU

It’s absolutely true. This was a patient model of ours for many years, coming to every open house event in my office each month to show off his wonderful result in person for anyone that wanted to take a look. He had above average donor density that allowed for the amount of grafts we were able to get. So yes, there is a way… because this patient is for real. We don’t play tricks with photos of patient results.

His sons followed in dad’s footsteps and they are transplant patients as well. We showed one of the sons here.

Tags: hair transplant, patient results

A Month After a Hair Transplant, I Had Major Stress

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

About four weeks after getting a large hair transplant I had a bit of a major shock to my business which caused a good deal of panic. A lot of adrenalin rushes, flight/fright, etc., off and on for a few weeks. Pretty constant. The worst has passed, but I am wondering if these adrenalin surges hurt my new implanted grafts’ growth chances. I know it is a vasoconstrictor, but assume that the grafts were secure and alive after 10 days or so.

I don’t have a definitive answer, but I would guess that your emotional stress would have no significant impact on your hair transplants particularly since it occurred a month after your surgery. It’s going to be a case of wait and see.

Tags: hair transplant, stress, surgery

Transplanting a Non-Balding Person’s Hairline?

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

Have you ever transplanted grafts along a non balding person’s hairline not to lower, but to thicken the hairline so that they could grow a fuller fringe if they had fairly fine hair?

In dealing with hairlines, transplanting a normal hairline just to thicken it is not advisable, as the transplant could damage the existing hair. I have fixed defective looking hairlines on male actors and models who need perfect frontal hairlines for their careers, so I have worked to keep their juvenile hairline intact.

For women who have normally high, non-balding hairlines, these can also be addressed with either frontal hair transplants to bring the hairline down or hairline lowering surgery. Many women have these procedures done.

Tags: hair transplant, hairline, mature hairline, juvenile hairline

Could a Hair Transplant Cause Tinnitus?

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

Hi Doc,

I suffer from tinnitus due to tension in my neck. I am unable to figure out anything about it besides that when I am nervous or I am slouching for a long time, it comes.

My question is – Is there any swelling in the neck area or behind the ears or in the sinuses from a hair transplant? If so, would there be anyway to avoid it? Have you heard of a transplant causing tinnitus? I’d like to get a transplant but the thought of it worsening my tinnitus makes me nervous!

I’ve never heard of a hair transplant causing tinnitus. Tinnitus generally has to do with the inner ear problems or even certain brain pathology. I would follow up with a specialist.

With hair transplant surgery, you may have swelling of the neck and ear area. I would follow up and raise these concerns with your doctor before having any surgery.

Tags: hearing, tinnitus, hair transplant, hair loss, hairloss

2011 ISHRS Meeting Review, Part 7 – FUE Robot

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

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 7. More to come…

***

 
Robot assisted hair transplantation was introduced for sale at the meeting.

    It had been approved by the FDA earlier this year. There was considerable excitement generated by doctors, however, the high price tag ($200,000 plus $1/graft) certainly dampened the enthusiasm. This meeting was a come out party for Restoration Robotics’ hair restoration robot, a very impressive modern technology. The company believes that hair transplants will follow other minimally invasive and more precise surgeries such at the robot assisted surgery for the prostate, the heart, the uterus, the lung, and on and on. The hair transplant robot is called Artas® system, and will clearly standardize the quality of FUE grafts and minimize the damage when used by surgeons who are not as skilled in the manual techniques as some of the more experienced surgeons; however, all three of the first surgeons to buy the robot are experienced in the field of FUE. Restoration Robotics wants only the best surgeons to purchase and use the system.

    One experienced hair surgeon, Dr. James Harris, has been testing the robot for some time for the company. Dr. Harris invented and marketed the most popular FUE harvesting tool (The SAFE System), which has been installed in over 200 hair transplant practices around the world. Although the two technique are comparable, Dr. Harris felt that the robot will minimize the tedium of doing the procedure for the doctor. I totally agree with him and I firmly believe that the new technologies like the robot will become the way of the future as FUE gains market share. The only question yet to be answered is “Who will pay for the higher costs of this procedure?“. As many of today’s hair transplant surgeons do not offer FUE, this opens the appeal for doctors to buy into the FUE technology to expand their service offerings. The unit is expensive, but should pay for itself easily in 4-7 years.

    The Artas® system will generate more interest in FUE and many newcomers in the field will start to offer manual FUE at discounted prices to kick-start their business. All FUE techniques and surgeons are not equal and new doctors without extensive experience are bound to create significant transection of FUE harvested grafts causing more than their fair share of hair transplant failures. Unfortunately, the average prospective patient who does not do their research may fall trap into the pricing competition. The results will be (1) high transection rates with graft kill, (2) failure or the hair transplant to grow in significant quantities, and (3) large scale destruction of the donor area hair (something that is never reversible). This, as I have said before, is a buyer beware business for the potential FUE candidates looking for a bargain.

Tags: hair loss, hairloss, ishrs, alaska, fue, hair transplant

2011 ISHRS Meeting Review, Part 4 – Surgical Techniques

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

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 4. More to come…

***

 
Which is better: FUE or FUT (strip)?

    I (Dr. Rassman) moderated a panel of 6 doctors to debate the merits of follicular unit extraction (FUE) over the more traditional strip harvesting transplant procedure (FUT). I started the sessions showing a case of what I called “follicular holocaust”. It was a case of 6840 FUE grafts performed over two sessions. I showed that the failure was not only on the growth of the grafts, but also on the destruction of the donor area. In all recipient sites and donor sites, there was a loss of 26,000 hairs and a massive failure of the FUE procedure.

    The debate followed this foreboding case study with the following insights:

  1. FUE is gaining popularity and seems to be demanded more and more by prospective patients. The graphs showed that the number of FUE procedures will surpass the number of FUT procedures in the next few years.
  2. FUE is safe in the hands of good doctors. The group all agreed on this because they were amongst the best doctors offering FUE. My only comment is that I can’t imagine any doctor putting themselves in the “bad doctor” category as shown in my presentation of “follicular holocaust”.
  3. FUE graft damage is being reduced with building experience resulting in better growth.
  4. Dr. Bradley Wolf demonstrated a patient who had 1000 grafts on each side of his head (total 2000 grafts) after 7 months of growth. The two sides seemed to be about equal. The patient reported no significant pain with either procedure (done one day apart) and the scars in both sides healed with minimal scarring.
  5. Dr. Suddleson argued that FUT supplied as many grafts as are needed, while FUE was more limiting in a single session. He argued that many of the advocates of FUE routinely offered FUT to their patients and that the FUT was the gold standard by which FUE would be compared. He generated a laugh when he pointed out that at least one doctor promoting FUE on the panel had reported his excellent results on the FUT strip based procedures.

Read more

2011 ISHRS Meeting Review, Part 2 – Female Hair Loss

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

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 2. More to come…

***

 
What is the role of immunity in the development of androgenic alopecia in women?

    In men and women, it was suggested that there is an immune response in genetic hair loss that could either trigger the process or be an early sign that hair loss is about to start. Dr. Neil Sadick of New York has been following female hair loss for years. He showed his results from scalp biopsies of the scalp in women with hair loss. What he saw were findings that were similar to the conditions found in diseases like lupus (an autoimmune disease). He believes that female pattern hair loss is attributable to immune driven inflammation and he believes that this interferes with hair stem cell activity as they enter into the growth phase of the hair cycle.

    The earliest symptoms of many women and some men start with pain and itching of the scalp, a set of symptoms that reflect the inflammatory response that he believes is always present, but often ignored. He raises the issue that if the connection is correct, the scalp may respond to the use of steroids in the earliest phases of the hair loss process.

Read more

Large Donor Area?

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

Recently, when at the barbers, I was told that the hairline at the back of my head was very low. Like most guys, I’d never put ‘hairline’ and ‘back of head’ together. Now that I have, i’m wondering: does having a low hairline at the back of my head mean I have a larger donor area, and the potential for more grafts if needed?

Thanks

Are you referring to hair at the nape of the neck? I’m a little confused as to what you mean by a low hairline at the back of the head. Neck hair may appear thick in some men, possibly even as thick as the hair in the true “donor area”. For people who have the narrow band of hair seen on Norwood 7 patients, there may be a limitation of your donor hair. However, you may have a very high density of hair, or your scalp may be very elastic, or your neck hair is very thick.

Neck hair is not considered permanent, as a substantial number of men will lose their neck hairs with age… so no matter how good your neck hair is, this should not be considered part of your donor area.

So there is no universal answer to your question without an actual examination by a physician. In matters of surgical recommendations, I would trust a doctor over a barber.

Tags: donor area, hair transplant, hairline, neck hair