Donor Recharging — Using Body Hair to Fill Out the Scalp Hairs Used in FUE

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

Doc,
I have slowly come to rely and trust this site on a day to day basis, so thank you.

I am considering an FUE surgery and have been reading a lot about “donor recharging”, where body hair is placed into FUE sites to help the donor region out. Ive unfortunately been around the block with this whole field and now feel the only way FUE should be done is by adding body hair as you remove a follicle from the donor.

My Question… Why aren’t more FUE specialists offering this technique? Won’t an FUE surgery be detrimental as the area will thin to the point of very shallow density in anyone with a norwood 3 and beyond.

I was hoping that the A Cell treatments would make this more viable but no one seems to be talking about it. Hence my question and my wishes for a great day for you and your staff!

“Donor recharging” is an interesting term I have not heard before. I do not buy into recharging the donor area from the scalp with hair from the body. I am just not convinced that the quality of the body hair will make for a good substitute for the donor hair that has been transplanted earlier.

It is easy for a doctor to do this to make more money, but unless there is proven value, I do not want to get on that bandwagon.

Tags: body hair, bht, donor recharging, hair loss, hairloss, hair transplant, fue

Hair Transplant Company Claiming “100% Natural Results”

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

I’ve just come across the DHI Direct Hair Implantation approach. DHI claims that it is better than FUE and Strip Surgery for reasons that include the following: (*) it leads to a 100% natural result, and (*) it involves no scars or holes. I do find it difficult to believe anyone claiming to have achieved 100% at anything. I also find the “no holes” idea self contradictory. However DHI seems to be rather convincing, except for the fact that no single Doctor’s career seems to be at stake. I have several questions, which I’ll limit to the following:

* Are you in a position to shed some light on the quality of the technique’s results? Perhaps in relation with FUE and strip surgery performed by average (and top notch) doctors?
* Are you aware of which method is used for the extraction of follicles? I couldn’t find this information on the company’s website.
* Is it possible for anyone to claim 100% natural results?

Finally, I’d like to disclose my personal situation and perhaps gain your opinion. I am 27 years old and have experienced gradual hairline recession. I’ve been on propecia for 1.5 years now. I’d like a lower hairline, but am in a position to wait at the expense of some self esteem issues. Should I go for a non-invasive technique such as DHI’s, or should I await the development of hair cloning techniques? Or might it be worth going for FUE or Strip?

Sorry for the difficult questions. I’m just confused, and I’m a PhD candidate researching informed consent!

If there is a cut on the skin, then you will certainly have a scar. All follicular unit extraction (FUE) procedures done, regardless of how small the instrument used, will produce some scar and from what I know about DHI, they are doing FUE. The point is that the small scars (dots or scar tissue) would not be as noticeable to the casual observer as a linear scar from strip surgery — especially when there is hair growing around it. If you sent a series of good pictures, I can offer you a telephone consultation.

As you have stated, you should always be cautious when someone (or some company) claims 100% of something. Sounds like marketing. With respect to certain medical groups, it is not my place here on BaldingBlog to endorse or discredit anyone. If you are interested in a particular doctor or clinic, you need to see the doctor, and meet some of their patients (in person). See if the claims stand up to your scrutiny. Anyone can have a convincing internet presence. Now you have to do the hard work of finding out the real truth.

You can wait for cloning, but it’s still in the early development stage and there’s no guarantees. It depends on how long you are willing to wait.

Tags: hairloss, hair loss, fue, dhi, claims, hair transplant

Removing a Cowlick and Replacing it With Transplantation

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

Hi,

A friend of my fathers has recently had a hair transplant to cure his baldness and it got me thinking of a possible solution to a problem I have. I have a cowlick at the front of my hairline and I was wondering if it would be possible for me to have this removed by laser treatment and then replaced by hair transplant. Is this a viable option?

Yes, this is a viable option. Many people with these ‘licks’ complain about them to me. Of course, I only see those people who are not happy with them. I happen to like the look, as one of my sons has a cowlick and I think it makes him look handsome.

Tags: cowlick, hair removal

Do Eyebrow Transplants Look Normal?

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

Hello Dr. Rassman,
I was considering eyebrow transplant surgery after many years of overplucking and abuse to my once bushy brows. I have read that as a side effect the hairs may be “raised” or grow in awkward directions. I was wondering in your experience how often does this occur? Say in 150-200 grafts how many may grow this way? And can they be “trained” over time to grow correctly? Thanks

EinsteinEyebrow transplantation is a delicate art and even for skilled medical groups it is never perfect. As you correctly state, the eyebrows can grow slightly raised and grow in slightly different directions, regardless of how precisely you pay attention to detail. And since the focus is right above your eye, the eyebrow transplant subtleties are not as forgiving as with hairs transplanted on the scalp.

I can’t give you a generalization of what to expect, as each and every person is different. It depends on hair texture, curl, shaft diameter, follicle length, orientation around its central axis, how it lays down, etc. I can say that male eyebrow transplants are more forgiving, as men have bushier eyebrows. My eyebrows seem to be admired by many men who request eyebrow transplants, as mine are the spitting image of Albert Einstein (see right).

I can also say that if you don’t like a certain eyebrow hair in the mix, just pluck it out! Often times patients usually have at least two eyebrow transplants to get it just right.

Tags: eyebrow transplant, hair transplant, eyebrows, overplucking

Why Do People Risk Getting a Bargain Hair Transplant?

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

PennyI’m going to rant for a moment, even though I know I’m running the risk of repeating myself. I’m disheartened by the amount of emails I get from people that are upset about the “bargain” hair transplant they got at various clinics around the globe. Of course, we realize that usually it’s the negative results that are the subject of such communications and we do not often hear from those patients with great results, but I felt I needed to post this as a reminder to the regular readers and hopefully something fresh for new visitors.

I believe that finding a good hair transplant doctor is like locating a good heart surgeon. Yes, heart surgery is more important than a cosmetic surgery… but I’m referring to the process of selecting a doctor. There are many qualified surgeons, but only a handful are capable of producing consistent, high quality results. In the heart field (I started out as a cardiac surgeon), you simply die when you select the wrong surgeon or get the wrong surgical team.

I’m sure I’ve mentioned it before on this site, but I remember a patient who came to see me (with his two kids) for a consultation. He then selected another doctor just a couple of miles from my office to have a transplant at the low, low price of $1.75/graft. When costs are too cheap, the quality of care tends to be low and corners are cut. That patient died during the transplant. It was the only death from a hair transplant that I’ve heard of. Granted, this was an extreme case of a hair transplant gone wrong. The usual result from a hair transplant that does not go perfectly will be with you for the rest of your life, and if the process is done without a focus on details and the art of the transplant, you will end up advertising your poor decision to everyone you meet. So please, please read this easy how-to guide on selecting your transplant doctor — here.

Some of the public is misinformed when it comes to doctors who offer hair transplantation. Just because a doctor is offering it, it doesn’t mean he can actually do what he’s selling you. The results from a hair transplant takes 6-8 months to grow, so by the time the results are evident, the patient’s check has cleared the doctor’s bank account and as many patients find out, there is little recourse to getting their money back from a failed hair transplant. Or worse, the results are clearly unnatural and detectable. Remember to research, meet patients, and be a smart shopper. I know the economy isn’t great for a lot of people right now, but don’t forget that this surgery is forever.

Further reading on this topic can be found here:

Tags: hair transplant, hairloss, hair loss

Dense Packing of the Hairline (with Photos)

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

What is the average distance between each hair at the hairline and about a half inch behind it on a non balding adult male? And what is the smallest distance between each graft you can safely transplant at the hairline? When you normally transplant grafts at the hairline is the distance between the grafts always larger than the native hair of the person. I know only single grafts make up the first few rows of the hairline to give a natural looking transition but if they are not packed closely enough the hairline looks almost “see through” or whispy looking. I have noticed this on alot of transplant photos. Is there anyway to avoid this and give a very dense looking hairline transition even using single grafts?

I am a male with minor female pattern balding with very little temple recession but my hairline transition has become thin and whispy and looks similar to the hairlines created with a hair transplant in a totally bald area? My goal would be to thicken up the transition area so it looks thicker and dense similar to the hairline of Brad Pitt or Tom Cruise since I am in their age bracket. Is that even possible?

First off, I’d like to think I am a good surgeon, but I highly doubt I can make you look like Brad Pitt or Tom Cruise.

Second, a hair transplant cannot give you back the same hair density as you once had. Think about the simple fact that the surgeon has to get your OWN hair from the back of your head and move it to the front. In other words, the surgeon isn’t creating any new hair, just moving hairs around. If you move too much hair from the back you will be bald in the back (so to speak). Thus, the main goal for a hair transplant surgery is to give you a non-balding hairline and good enough coverage. But a hair transplant cannot give you back the fullness of Brad or Tom. Maybe another way to understand this point is to know that an average non-balding head has over 1250 hairs in a square inch (or 625 follicular units in a square inch).

The only exception to this is if you do not have too much hair loss (like Norwood 2 or 3) and understand you will not achieve the FULL look with one surgery alone. You need multiple surgeries to fill in the ‘gaps’ to achieve the fullness. You must also consider conserving the remaining donor hair available in case you continue to lose hair at the top and crown. This is what we refer to as the Master Plan.

There are several patients that come to mind who requested precisely what you are asking for. The patient below is one such example of a Norwood class 3 pattern patient that had two surgeries with me in a very small area. Click to enlarge.

2 years after two hair transplants totaling 3182 grafts:

 

Before:

 

Tags: hair transplant, hairloss, hair loss, hairline

Shock Loss from Eyebrow Transplant?

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

(female)
Hello Dr,
I was wondering if shock loss occurs in cases of eyebrow transplantation? Also, are there any other side effects that could potentially occur? Thank you for your time.

Shock loss can also occur with eyebrow transplantation. The main side effect (if it can be called a side effect) is lifelong trimming of your eyebrow, as it will continue to grow like your scalp hair. For the original viable eyebrows that falls out from what I will call hair transplant shock, these may not grow back and it can result from damage induced at the time of the surgery. Original eyebrows seem to be sensitive to trauma more so than head hair.

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

TV Chef Gordon Ramsay’s Hair Transplant

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

Check this out:Keep it under your hat but Gordon Ramsay’s had a £30,000 hair transplant

They mention that chef / TV personality Gordon Ramsay had a hair transplant using a “radical new treatment” called follicular unit extraction that “leaves no scars”. The press is so uninformed about things they report on sometimes. Hasn’t FUE been around for like a decade? What’s radical about it now?

Gordon RamsayOf course, you know that I pioneered follicular unit extraction (FUE) and published the first article in the medical literature on the technique in 2002. As for why the press is misreporting information, I don’t know why it happens. Perhaps it’s just laziness on their part.

FUE is far from a radical technique and it is incorrect to state that it leaves no scars, as anytime the human body is cut upon, there is ALWAYS a scar to some degree. The difference here between traditional hair transplants with strip harvesting (which leaves a linear scar) is that FUE leaves punctate scars that can be seen through the hairs in the donor area if the scalp is shaved very close there. Most people who have longer hair do not have visible scars, but that does not mean that it “leaves no scars”.

Good luck to Gordon Ramsay for the courage to address his hair loss concerns.

Tags: gordon ramsay, chef, celebrity, kitchen nightmares, hair transplant, hairloss, hair loss, fue

Patients with DPA Can’t Get a Transplant?

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

In response to: Is Taking Propecia to Prevent Shock Loss an Indefinite Necessity?

I’m confused by Dr. Rassman’s response to this question. For the longest time you have written that sufferers of DPA have a stable permanent zone and they can usually can receive a transplant at the appropriate time. You’ve written that it’s suffers of DUPA that aren’t appropriate candidates for transplantation. Has something changed?

Nothing has changed. We always look to the health of the permanent zone when considering if someone is a candidate for a hair transplant. We weigh the balance between the supply of hair from this permanent zone and the demand of hair from the balding or thinning area.

Tags: dpa, diffuse patterned alopecia, hair transplant, hairloss, hair loss

Australia Hair Transplant Recommendation?

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

Hi, im from Australia. Unfortunately i can’t come visit you for a consultation due to the distance and all, so i was wondering, if you could suggest any hair restoration clinics here in australia, or doctors? I heard Dr. Richard C. Shiell is good? any suggestions?

thanks in advance

I rarely give specific endorsements of doctors. I would suggest you see as many doctors as possible, find a fit with your personality, and ask the doctor to see their patients results in person. Before/after photos may be a good starting point, but nothing compares to seeing results in person and speaking with unbiased past patients.

Also, I believe that Dr. Richard Shiell has retired from surgery, but there are physicians at his clinic that he trained. You shouldn’t consider this a personal recommendation, but it might be worth researching it further — Shiell-Knudsen Clinic. Or you can find other doctors in your area by using the physician search at ISHRS.org.

Tags: australia, hair transplant, recommendation

Scalp Laxity and Hair Transplants

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

Wonderful blog you have up here, Dr. Rassman. I just wanted to know how scalp laxity affects a person who is willing to get a hair transplant. If i have a very loose scalp, how will it benefit me when i am getting a hair transplant procedure done?

Increased scalp laxity will allow the surgeon to harvest more hair in one surgery. It is like pinching a part of your skin. The more you can pinch your scalp (skin), the more hair comes with it.

Tags: laxity, hair transplant, surgery

Is Taking Propecia to Prevent Shock Loss an Indefinite Necessity?

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

Hi Dr Rassman,

Fantastic site, and I’m really enjoying your cautious matter-of-fact coverage of the new A-Cell technology!

I’m a 28 year old male, slowly but surely experiencing diffused patterned alopecia. So far it’s not visible except when wet, but miniaturisation mapping shows I’m probably headed for a NW7.

I’m interested in whether you think it’s possible in theory for a surgeon to insert A-Cell treated hairs into the balding areas, thus gradually replacing the DHT-affected hair with permanent hair, and ensuring coverage “continuity”. Obviously this will depend on whether the A-Cell hair is in fact permanent.

Also, I believe you indicated in a previous post that finasteride is recommended to prevent shock loss. Do you believe this will be an ongoing necessity? i.e. assuming the new hairs take root and are unaffected by DHT, would a patient need to remain on finasteride indefinitely or only for the months following surgery?

Perhaps you need a good diagnosis of what you have. Do you have diffuse patterned alopecia (DPA) or androgenic alopecia (AGA)? I suppose you can have both, but that would be rare. It’s important to determine the proper diagnosis, because diffuse patterned or unpatterned alopecia is generally a contra-indication to a hair transplant surgery. The donor hair area is questionable in its permanence in those cases.

Thus, even ACell technology would fall into the same uncertainty. In other words, the hairs transplanted with ACell may not be permanent if the donor hair is not permanent. The technology is so new that I do not have an answer for you.

Finally, Propecia (finasteride 1mg) is recommended for men with androgenic alopecia (AGA). Patients who take Propecia need to take it indefinitely if they wish to slow down or keep the hairs that are at risk from falling out. Many doctors (including us) recommend Propecia to decrease the risk of shock loss. For practical reasons, patients who do not want to be taking Propecia indefinitely (but wish to decrease the risk of shock loss), usually take the medication for about one year. Once they stop taking the Propecia they risk the same ‘catch-up’ hair loss phenomenon. The main thing one needs to understand is that Propecia is an OPTIONAL medication and the only thing that we (doctors) can do is to recommend it.

Tags: propecia, finasteride, acell, dpa, alopecia, hairloss, hair loss, shock loss

Removing Brain Surgery Scars?

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

Hey. I’ve had brain surgery back in 2000 and an additional one in 2004. I have a scar on the front of my scalp going from my right side of my head to the top of my forehead. Its not from left to right but almost there. And I have some kind of missing spot on the back of my head. I dont know where that came from. But I was wondering if u had any suggestions on getting hair to grow inside my scars so I have no noticible scars?

We (NHI) have been treating scars of all types on the scalp with hair transplants (especially brains surgery / craniotomy scars). The process is as simple as a hair transplant on the scar itself.

The entire process may take more than one procedure to fill in the scar, as hairs are transplanted directly on the scar and may not fully grow. Whether or not the scarring remains noticeable will remain to be seen. I wouldn’t want to make any wild promises without seeing you.

Tags: brain surgery, scarring, hair transplant

Dr Gho’s Recently Published Partial Follicular Unit Extraction Study

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

What are your thoughts on Dr. Gho’s partial extraction stuff? There’s a new study in the Journal of Dermatological Treatment:

Link: Donor hair follicle preservation by partial follicular unit extraction.

We are aware of this and I believe I’ve commented on partial unit extraction before. Similar work has been done by others with very different results, so I am a little skeptical. First of all, only five individuals were used in the study and between 100-150 grafts were harvested. The results look very promising, but I do not understand how you can achieve a success rate over 100% (104.1%) like is mentioned in the results.

It is also difficult to understand how one could keep track of where the 100 to 150 grafts were harvested from to see if they regrew hair. Think about this. Unless you make a clear mark (like a circular tattoo) around where you harvested the grafts, how can you say the hairs grew back? In the end, with all due respect to Dr Gho, I remain a bit of a skeptic.

Tags: gho, partial unit extraction, hair transplant

Hair Transplant Pricing, Wigs and Hairlines, Time Between Surgeries

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

I am sorry to ask so many questions and I did try and search for the ones I have. If they are redundant, I apologize. Also, if you could keep my info as anonymous, I would appreciate it.

  1. For pricing is the $6 for 2,500 and $2.50 per session or per patient. As in: If you do 2,800 one session and 2,900 another. Would I still be paying $6 for 5,000 over 2 sessions or is it $6 for the first 2,500 and $2.50 for the rest, no matter how many grafts or session I have after?

    2.  

  2. Second, I know you can’t technically answer this without a master plan. But I am going to be 23 in a couple months and my hairline is shot/receding pretty bad. I’m quickly starting to realize I may become a Norwood 3 to a 6. I’m still not sure yet. Anyways, no matter the Norwood I still want to start building a strong hairline. I’m impressed with the wig technology now, except for one thing…the hairline. If I would get an amazing hairline back and then wear a piece to hide the rest until something logical comes by, I think that would be the best option right now. If I saw you and you said I was a good candidate for this would you say this is a decent plan?

    3.  

  3. Theoretically speaking, if I got one surgery with 2,800. Do I have to wait for the 2,800 to completely grow in the 12 to 18 month span to get another or could I schedule another session closer to the other a couple months later.

TaxiI believe there is confusion with respect to the NHI surgical fees. That pricing applies to traditional strip surgeries performed by us in our Los Angeles office. The standard fee is $6 per graft up to 2500 grafts. Anything beyond 2500 grafts would be charged at $2.50 starting with the 2501st graft. So graft #1-2500 are one price, #2501+ are lower. Like a taxi ride, the meter starts all over again on the next trip.

Some men (who are completely bald) choose to have hair transplants in the frontal hairline so that they can wear a wig on the top and still keep a natural looking hairline. It could be a decent plan for you.

Generally, patients need to wait about one full year before they can have another hair transplant surgery. This is because we need to assess how the new transplanted hair has grown and also to make sure the donor scalp has returned back to its flexible/elastic state. Some people can accelerate that timeline to 8 months.

Tags: hair transplant, pricing, fees, wigs