Hair Transplant Surgery Looks Painful!

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

i need to know the hair transplant surgery pain and its procdure. i saw on youtube it was looking very painfull inserting many needles in your head please tell me about it.
thanks

The application of the anesthesia can be painful for a few moments, but inserting the grafts during the hair transplant itself is pain free. The numb scalp and skull have no feelings under local anesthesia (like the dentist uses when he numbs your gums).

I’ve written about what you can expect here — Pain with a Hair Transplant.

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

Is FUE or Strip Better for Asians?

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

Hi Dr. Rassman,

I’m considering getting a hair transplant and I need your opinion. I am asian and was wondering which suits better for asians FUE or the strip harvesting method? I am hearing mixed comments. FUE less scaring for asians. strip harvesting higher chance. from your experience which is better for asians?

Thanks!

Both the FUE technique and the strip technique have their own pros and cons, and there is no correlation with Asian hair. The type of surgery is based on each and every individual. FUE is best to use with smaller areas and when the density of the hair is good. The strip can be used almost on any good transplant candidate. FUE is not the latest and greatest that some clinics claim it to be and for those individuals with extensive hair loss, it is clearly not the procedure of choice. That is why patients like you are confused about these choices.

As an example, many Asian patients have surgery with Dr. Pak and most of them have the traditional strip surgery with great results. One of the more public examples of such a patient was Jon Gosselin (he had the strip surgery).

Tags: asian, fue, hair transplant, hairloss, hair loss

FUE’s Impact on Donor Density

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

Hello dr rassman,
I did 1000 grafts FUE hair transplant one year ago, which was my biggest mistake in my life from 1000 grafts half of them didnt grow back , my donor area damaged considerably, my density in donor area was 85 grafts in 1cmm before surgery now its gone to 55 grafts in 1cmm , i calculated approximate 2500 grafts been damaged. dont you think FUE is a basic method and must be banned?

Swiss cheeseI’m sure the donor impact of follicular unit extraction (FUE) is rarely a subject discussed by many of the doctors doing this procedure. When the donor area has a below average density, the impact on the donor area is very significant and it may appear to look like Swiss cheese. When the density is high, this is not a problem.

Some doctors and patients seem to think that FUE is the answer to the ideal method of harvesting, but your example shows that it is not. Of course, it is possible that in getting out 1000 grafts, 2000 punch holes were made, but as I was not there, this is only speculation about a doctor that has perhaps not mastered the process. Damage to the donor area does occur with FUE, the question is just how much damage occurs in the hands of a skilled FUE surgeon.

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

Good Surgical Candidate Vs Bad Surgical Candidate

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

Dr. Rassman,

Thank you for your very informative blog, it’s a daily read for me.

My question for you is simple. I’ve heard Dr. Bernstein say that one of the reasons why he has not undergone a surgery is because he is not a good candidate.

First, what makes him a bad candidate, and second, at what age would it have become apparent that he would become a bad candidate? I’m only 29, and although I’ve been told that I’m a good candidate for surgery now, I worry that down the road I’ll turn into a bad candidate because of future loss or donor thinning.

There are many things that make someone a good/bad candidate for hair transplants. A key problem for any candidate is a low donor density and a large balding area, which may mean the donor supply is insufficient to address the needs of the recipient area. I have had many patients that ran out of donor hair before they completed the transplant procedures they could’ve used. That is why I always stress a Master Plan for anyone undergoing a hair transplant.

Someone like Dr. Bernstein, with low density and a very large bald area, needs a great deal of hair to achieve any degree of fullness. The most he could have accomplished is to transplant the frontal area and leave the crown bald, so maybe he felt that the benefit was just not there. Dr. Bernstein is happily married and is not motivated to change his look. He looks handsome with his short hair style and is satisfied with that.

For you, at 29 years old, with the early use of Propecia you may slow down or stop the process and if your hair loss is confined to the front and top, then transplants may offer you a good option later if needed. Too many doctors want to push patients towards hair transplants because that is what they do for a living. The not-so-good doctors just do transplants without a Master Plan communicated to the patient. Many patients want hair, will pay for hair, want a bargain for the graft cost, and really have no concept of a plan.

In reality, they get no bargain and will pay for that ignorance in the future when their hair loss gets out-of-control and they find themselves out of hair and money. I see people every day in this situation and somehow I can not get the message out there that everyone needs to plan ahead for their worst case hair loss, because they will continue to lose hair for the rest of their lives. The question that should be addressed, as you so nicely pointed out, is about what you will look like 5, 10, 20, 30, and 40 years later.

Tags: surgical candidate, hair loss, hairloss, hair transplant, hair restoration

Using Chest and Back Hair When Scalp Density is Low?

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

I am Norwood 6/7. I had a nice transplant to the front 1/3 of my head, which frames my face well. Unfortunately, the density of my donor area is on the low side. I have VERY heavy body hair on my chest and back.

Would this be an acceptable situation to transplant body hair to crown area?

Body hair is a difficult call for me. I have tried using it and have not done well with it. Aside from the physical characteristics of the body hair, the growth cycles are different from that of scalp hair.

There are a few doctors who claim to specialize in using body hair for scalp transplanting, but I am skeptical that the results are as good as claimed. The patients I’ve seen in my office with body hair transplanted to the scalp at other clinics have been less than impressive. If you’re considering body hair transplants, just be sure to meet with patients that have had it done by the doctor you’re considering so that you can see the results for yourself in person.

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

My Donor Hair Got Weaker After My Hair Transplants!

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

I’m a year post-op on my 2nd HT procedure, 6300 grafts total including my 1st round.

While my results are dramatic and I am quite pleased for the most part, the crown area is still somewhat sparse, and upon my recent 1-year follow-up, I am told there is the issue of some donor hairs that have, according to my doc, become thinner in diameter or possibly even miniaturized due to genetic programming that came with those grafts (in other words, at the time the grafts were transplanted, they were of even diameter and size, but some weakened and shrunk according to him). He took some extreme closeups and showed me the photos on a computer.

I had always believed from my research, that miniaturization is halted or cannot occur in transplanted hairs. Is this not true, and what do you recommend to protect my investment other than finasteride and/or minoxidil?

It’s difficult to provide an accurate answer to your question, because I do not know what you have…

Donor hairs do not normally miniaturize for men with male pattern baldness (MPB), so I must assume there is something more going on or there’s something that wasn’t diagnosed. I would ask your doctor about the cause of your problem and what you can do to for it (in other words, you need a diagnosis). If you do not receive a satisfactory answer, get a second opinion from another physician!

For example, I have seen a few patients over the years who had hair transplants by other doctors, but didn’t know that they had diffuse unpatterned alopecia (DUPA). Their donor hair had significant miniaturization and the transplanted hairs eventually were also miniaturized. I am not implying that you have DUPA, but this gives you an idea of how things are not so simple when undergoing a hair transplant.

Tags: donor hair, hair transplant, hairloss, hair loss

Hair Loss from Coronal Brow Lift Scar

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

I had a coronal brow lift in Feb. 2009. I had a wider than desired scar. I also had a spot the size of a quarter of permanent hair loss. The plastic surgeon who performed the brow lift has tried to do a scar revision by excising the scar. But I am 3 weeks post revision and I see where all along the new revision scar I have hair loss. The line where he cut is pencil thin, but I have hair loss in front of the scar.

Is this going to be permanent like before? I thought that maybe the staples I had in initial surgery were the problem. But he used sutures to do revision and I still had hair loss. Why is it that every time my scalp gets cut I have hair loss in front of the scar? And what can be done to fix this?

Thank you

This is a real problem. You must wait out the course (about 4-6 months) and then you will know if the surgery succeeded. I suspect that you will see that the scar is the same or worse and the hair loss may not go away. I see many female patients with this problem and end up transplanting most of them with good results.

Tags: brow lift, browlift, coronal brow lift, scarring, hair loss, hairloss

Graft Counting, Large Session Discounts

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

Hello Doctor,

How are ya? I’m 26 year old Male and have been using the Finasteride (5mg cut into 5 pieces) over past 2 years. I’m very happy with the results so far. Although the side effects are very mild, I wish it could reach absolute Zero. I had miniaturization of 65% in frontal region two years ago, I use to see my scalp under normal sun light and it was very awful. Now i believe my miniaturization is less than 65% (not sure as i have not consulted NHI) and follicles are more thicker and stronger, However i can see my scalp under certain circumstances (when its Wet/Windy/bright light)

I’ll be get getting married in 2 years and i’m considering hair transplant for thicker, natural looking hair. I wanna consult you or Dr.Jae Pak so that i can get better idea (i stay in TX and have to plan my travel, i’ll be SF from 9/30 – 10/4 but will be missing the open house event on 10/7, I couldnt get an appointment within that time).

My question to you is, Would it possible to reduce frontal hair line, as i have M shaped hairline? Also would it be possible to do a transplant in between existing hair follicles? (i have a thin frontal region) Also if i do continue using Finasteride would it be possible to reduce the shock loss to 0%?

I have another question about the fees for the hair transplant. The website says Dr.Jae Pak charges $6.00/graft for the first 2500 grafts and $2.50/graft over 2500. Simple math its gonna cost me $6000 for 1000 grafts and $6250 for 2500 grafts. what if dont require 2500 grafts to cover my bald region? choosing 2500 grafts is good value for money. Also during the transplant how do you count exactly 2500 grafts? to put an another way how can i make sure you transplant 2500 grafts.

Thanks in Advance.

You got the math wrong. It would be $6/graft up to 2500 grafts. On graft #2501, 2502, 2503, and any beyond the 2500th graft, it would be $2.50 per graft. It’s a discount for larger surgeries after you reach a certain graft number, but it doesn’t make all the grafts cheaper once you reach a threshold. So if you schedule surgery with Dr. Pak for 2500 grafts at $6 each, it would be $15,000; for 2502 grafts, it would be $15,005. If your schedule is flexible, NHI also has Standby pricing at $5/graft (plus the large session discount of $2.50/graft for those grafts above 2500).

I’m sure we can lower the hairline, but without seeing you first I can’t make any suggestions on where your hairline should be. Shock loss can be reduced with finasteride use before surgery, but I don’t know that it can make sure that every single existing hair stays in. Your hair normally cycles anyway.

As for graft counting and making sure you get what you paid for, see here: Hair Transplant Doctors That Charge By the Session vs By the Graft.

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

If the Average Person Has 10k Grafts Available, Why Are Most Patients Given Less?

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

I’ve read time and time again the average person has 7000-10,000 grafts available to transplant. If this is true why isnt there anyone on your website (Newhair.com) who is even up tp 7000 grafts?? Obviously some of the patients dont need anymore grafts but i’ve found a few pictures of your patients that have had 2000 to 3000 grafts transplanted that still have somewhat of a see through look. Why don’t these patients get more grafts transplanted? Would you say a lot of these patients are content with what they have?

I also have a random question. After the grafts are extracted from the back of the head and ready to return to the top of the head. How many grafts do you think two technicians put in on average per half an hr? A couple hundred per Technician???

Even if what you area reading is true about 7,000 to 10,000 grafts being available, it is up to the patient to want to have a hair transplant and use those grafts wisely. The Master Plan may include saving the remaining hairs for possible further hair loss. It may be a see-through look for you, but have you considered that the patient with 3000 grafts is happy with their results?

That being said, here’s a patient that has been presented on this site multiple times and had close to 10,000 grafts transplanted. He wasn’t going to be losing more hair, as his pattern was quite advanced already.

Patient ZU’s before and after (click to enlarge):

 

The speed of transplanting hair varies with each technician, along with the instruments and techniques used in the surgery. In other words, all clinics and doctors vary in technique (despite what they advertise). An average surgery of 2000 grafts can take 5 to 6 hours, so you can do the math backwards if you wish.

Tags: hair transplant, hairloss, hair loss, surgery

Exposing a Recent Hair Transplant to Sunlight

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

I have undergone hair transplantation recently, can i wash my recepient hair with shampoo as i use to wash before transplantation, can i expose to sunlight after 3 month?

At 3 months, you can wash your hair properly as you have always done. Sunlight exposure should be in moderation and progressed to more and more sun over time. The use of a sun blocker is always a good idea unless there is so much hair that you have shade from that hair.

Tags: hair transplant, sunlight, hairloss, hair loss

I Have Frizzy Hair and Think I’d Be a Good Candidate for Surgery

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

Male, 32. My hair has been thinning quite a bit in the front temple region and frontal area in general. Back region is fine. When I look at before and after pictures of hair transplants some I think…wow that is great….others I think I can’t believe he paid thousands of dollars for that. I have frizzy wavy hair and it doesn’t take much for it to look full with its color and texture.

My question is would it be possible for a surgeon to look and comb through my hair(which is pretty thin) now and see whether he thinks he may be able could duplicate this? I am happy with it now but much worse and I might consider HT. Its very thin but I’m happy with it now. I think I would have really good hair for a transplant because of the texture of my hair. Obviously there are other factors though.

Results do vary between patients (hair character, color, density) and surgeons (experience, technical staff), but if you have frizzy hair I’d believe you could have some full looking results. It’s not really possible at this stage to tell since I haven’t even seen you. Meet with a hair transplant doc and see what he/she thinks about your candidacy. Generally speaking though, people with wavy or curly hair will be able to achieve thicker looking results than a patient with fine hair.

Are you treating your hair loss right now? Propecia or even Rogaine could help to maintain the hair you’ve got now if you’re happy with that.

Tags: frizzy, hair character, hair loss, hairloss, propecia, finasteride, minoxidil, rogaine

I Want a Hair Transplant Now So I Can Start College with Hair!

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

Hi Dr. Rassman and staff. I am 19 years old and Just graduated high school and am all of a sudden noticing all my hair is turning baby fine. People are noticing that my hair is thinning on top but I still have quite a bit of hair. Hair loss runs in my family so I am probably going to be bald eventually but I didn’t think it would start this early! This is devastating to my self esteem and I just want to go to college with hair!

Some people say that my hair has always been this thin but I know it hasn’t. It can’t be normal to see scalp on the top of my head vertex area. Is it too early to get a hair transplant at my age before I go bald so no one will notice and I can get my hair thick again?

BelushiIf you’ve got early hair loss, that is when medication like Propecia (finasteride 1mg) works best. You might be able to take a pill each day and see better results than you could from a hair transplant surgery. The medication can stop the loss from progressing and possibly regrow hair. Besides, no surgeon should perform a transplant on a teenager with early hair loss like you describe. If you find a doctor that wants to rush you into cosmetic surgery at 19 years old with early hair loss, he’s just looking at you as a revenue source, not as a patient.

Hair loss is progressive, so if you had surgery today (hypothetically) you could end up continuing to lose hair around the transplants. You’d be doing yourself no favors in that case, because it would be a very short-term solution to a long-term problem.

Talk to a doctor about getting on Propecia (it is a prescription medication). That should be your first step… not surgery.

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

My Friend Had Surgery and I Love the Results

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

Hi. I’m 30. My hair has been thinning. I recently met with Bosley after a friend of mine said he’d been there and was very happy with his results. His hair looks great. But I’m a little freaked out cos there is a lot of bad press on Bosley on the internet. I dont want to wind up in a position where it looks awful and I have to keep going back. I really don’t know what to do.

Thank you

SurgeonIt really comes down to the surgeon and technicians staffed. As with any clinic, look at the doctor’s work in person. Don’t just rely on photos that may only show what the doctor wants you to see. Ask to meet patients that were done by the surgeon you will be getting and see what they say about the experience and the results. I’ve created a checklist for selecting your doctor that should be helpful. In your case, you’ve got a friend with results you can see in person… and if you’re satisfied with your friend’s results, that should say much.

It also doesn’t hurt to get a second opinion. Since you’re on the east coast, Dr. Robert Bernstein is in Manhattan and is a fantastic surgeon. Or if you happen to be visiting the Los Angeles area, you could always see me.

Tags: hair transplant, hairloss, hair loss, bernstein, bosley

Does Any DHT Reduction Shrink the Prostate?

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

Hi Dr. Rassman,

I regret to inform you that after recently undergoing a v. successful hair transplant I was prescribed 1.25 mg of finasteride every Mon, Wed and Fri. This is all good news but the bad news is that when I got to my laptop I got on the internet and started researching the drug and found the scaremonger sites about permanent side effects. Although I’m skeptical and like you believe more in scientific research plus I am impressed at your responses to people who ask about the drug, it has still planted a seed in my head. I’m going to make a decision on whether to take the ‘risk’ soon but first have some questions that I cant find the answers to.

1. Does ANY reduction of DHT i.e. any amount (1.25mg every other day-5mg daily) of a suppressant like finasteride result in a shrinkage of the prostate? Or is it possible to suppress the hormone enough to slow hair loss but not interfere with the prostate?

2. I took Avodart 0.5mg for a year and got slight ED. I was prescribed it for hair loss in the UK which I’m sure is not ethical. I stopped taking it but that was about 2 years ago, I’m 25 now and as finasteride is weaker is it logical to assume that the sides if I get them may not be as bad even though I’m older and my neuro endocrinal system and gonadal system (I think that’s right) could be at a different stage to when I was 22?

3. If you have looked at some of the YouTube videos and forums for the men who claim to have permanent side effects from the drug, although you haven’t seen their medical records or examined them and I know you are professional in that you don’t like to jump to conclusions, if you made an educated guess what would you assume has done this if it isn’t the drug?

I know that the decision is mine to take, but I am worried about the stuff I have read. I feel that your answers to these questions could help me make my decision. Thank you

I am curious about your research on the Internet. As you found your “scaremonger” sites on finasteride, have you researched the “scaremonger” sites on hair transplants? Because you will find many and it will be a double whammy for you since hair transplants are permanent (side effect from finasteride are not).

To answer your questions:

1. Finasteride in 5mg is used for certain prostate conditions. Finasteride in 1mg or 1.25mg should have little or no impact on prostate health, but the inferences are there.

2. Avodart (dutasteride is the generic name) works in a similar way as Propecia (finasteride is the generic name) by blocking DHT production. Side effects from dutasteride and finasteride are similar, but with dutasteride being a stronger medication, it’s difficult to suggest you wouldn’t experience any side effects from finasteride. No matter how similar they are still different.

3. I have seen some of the YouTube videos, but you highlighted what many of these videos tend to be with a single word: “scaremonger”. I can’t begin to hypothesize what those people are going through, but there is clearly an agenda. They do not like finasteride. That doesn’t mean finasteride is the cause of their problems, but some people simply aren’t willing to look past that to see if there is something else going on.

You decision should be made with your doctor (not me).

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

Do People Actually Care About a Man’s Hairline?

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

Before I begin, I want to thank you for taking the time to answer all these questions. You and your staff are tremendous!

My question is what is/are the best hair products (etc. gel, mousse) to use after receiving a hair transplant over a year ago?

I have a receding hair and have trouble styling my hair so I ALWAYS wear a hat. I have no confidence in myself and extremely self-conscious about what others think. In your opinion and stories that you might have heard, do people, peers, or women actually notice or care about a man’s hairline?

Thank You!

I believe that most of the readers would answer your question with a strong YES — people do notice. Today, I met with two men separately (20 and 25 years old). The 20 year old man still had his juvenile hairline, but there is evidence that one one side is moving to a mature hairline. The 25 year old has lost his juvenile hairline and now has the leading edge about 1/4 inch above where it belongs. One side is slightly worse than the other side. Both men had strong family histories of balding and both were very handsome. They felt strongly that the changes that had started to see had impacted their self image. Both look, from a distance, to have a great head of hair and neither man had any see-through appearance.

I also met with a 83 year old who recently lost his wife to breast cancer. He started dating again and was concerned that his receded frontal hairline made him look older than he thought he should look like.

So do people notice or care? Absolutely!

As for the best hair products to use following a hair transplant — really, styling aides are best evaluated by trial and error or by your local hair stylist.

Tags: hairline, hairloss, hair loss, hair product, hair transplant