Would Getting a Hair Transplant Give Me Cloning Priority at NHI?

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

Dr. Rassman I have an odd question for you. I plan to have a hair transplant with you in the near future. Playing devils advocate here, let’s say that hair cloning is a viable option in five years and the demand would be great.

Would having a prior surgery with you give me an advantage of getting this procedure done sooner? (i.e. cutting in line)

Thank you for your time.

First and foremost, having posted over 8000 questions on this site and answering some real doozies, I don’t think yours is all that odd.

Hair cloning just means there will be more hairs available for transplantation and you will not be limited to the donor hair. With respect to priority, our surgeries are scheduled on a first-come, first-served basis… but when it comes to procedures done with hair cloning, it’s all hypothetical at this point. I’d like to hope that in 5 years from now we’ll be transplanting with cloned hair, but that remains to be seen.

We look forward to seeing you!

Tags: hair cloning, hair transplant, hairloss, hair loss

Transplanting from My Hairy Neck

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

I have quite a lot of hair in my neckline. The hair is thick and straight, which makes me wonder whether it could be transplanted to my head. I have already had 1000 grafts via FUE, and I see the diffuse pattern from the FUE transplant whenever I trim my hair very close to the scalp. Using neck hair seems like a way to augment the donor pool, but I don’t know how receptive the scalp is to that type of hair and whether FUE performed on the neck would leave visible scarring. What do you think?

Neck hairNeck hair is not considered “permanent” like the hair on the back of your scalp. There is a chance that as you get older your neck hair will fall out, so if neck hairs were used for a hair transplant it would also fall out. This is what makes neck hair not ideal for transplantation.

In addition, as you clearly have found out, follicular unit extraction (FUE) still produces small round punctate scars. So if you have a FUE procedure to the hairs on your neck you will definitely see the same type of scarring, which would be more difficult to hide.

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

Using Body Hair With Scalp Hair for Transplanting?

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

Hi
I have read about Body Hair Transplants and I do see that it is not recommended. I was wondering though, would it be a feasible thing to have it used in conjunction with scalp transplants, kind of a topping it up for density?

As you’re familiar with my issues with body hair transplants (BHT) due to differences in growth cycle, length, and character, I won’t get into it again here. For those unfamiliar with my stance, you can read about it here, here, and here.

It is technically possible to do what you’re asking, but whether it adds real value is another story. For the patient who had a depleted donor supply in their scalp from many hair transplant procedures, body hair may have value.

First, you need to be evaluated by a GOOD doctor who cares about you and your results, not just the money he would make. I realize finding a “good” doctor is easier said than done, but do your due diligence. Research this procedure and the surgeons who perform it to form a short list of doctors you want to meet with to hopefully find someone you trust with the patient results you’re looking for. Then get an assessment of your need, and your donor supply will be matched to your goals by that doctor. Only after you have a good education on the matter, should you make decisions like what you are asking me here.

You might detect that I am neutral on the value of body hair transplants when mixed with donor hair, but I would be open to do them if I felt that it had value to you and you were well informed.

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

My Hair Was Transplanted with Micrografts Lower than My Juvenile Hairline!

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

Hello Dr. Rassman,

I had a couple of HT procedures in the late 90’s that placed several hundred “micrografts” and “minigrafts” into my hairline. While the result is not as bad as some of the super-pluggy transplants I’ve seen, I now know that an FUE procedure could produce much better results. The issue is that the surgeon placed my hairline too low – it was lower than my juvenile hairline, but still along the forehead muscle. Due to this, I have no room to have a “transition zone” transplanted in front of it.

Would it be possible to have my hairline taken back a centimeter or so over a few sessions by individual graft excision and then have some refinement with FUE? I have spoken to one doctor who wants to bring my hairline down further, but I am completely opposed to this (I would like it to be a little higher at the end of any repairs).

Without examining you, I wouldn’t be able to define your options (particularly based on your unique case, which might be very difficult to correct). Generally, a brow lift may essentially bring the hairline up to a level that can be worked with, but it’s really not a sure thing. There will always be some risk of scarring when you take out old grafts in the front, but with a brow lift and a surgery to bring up the hairline you might be able to have follicular unit extraction (FUE) to thin it out some. People have entertained using laser hair removal which may expose the micrograft scarring (I personally have not seen a successful one yet) and even with FUE there are issues of scarring and a risk of an unnatural appearance.

You need to find a surgeon that will work with you, and assess the risks and benefits. You have limited options, but you need an expert to analyze your problem.

Tags: hairloss, hair loss, hair transplant, hairline, hair restoration, repair

Hair Loss from Combat Stress, Heavy Equipment, and Wearing a Helmet for 5 Years?

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

Dear Doc Rassman

How are you doing doc rassman? i have an interesting question for you. and from reading your bio im sure you already have seen and know the answer for this. im 23 years old and have been in the army 5 years as an airborne infantryman, deployed to baghdad iraq for 15 months and am current back in iraq. been here a year. ive always had great hair, my buddies nicknamed me Jewfro hah. its thick, and slighty wavy. i did notice tho during my last deployment the hair on my temples was going, quick.

i was injured, put in combat stress and have worn heavy equipment and a helmet for 5 years straight, it seemed like when i came home the areas regrew. now that im back its happening again, worse, almost into a widows peak. again i am under constant combat fatigue and stress. its got me worried. im young, about to be a civilian and in college and id like to…well not look like an old beat up war horse. ive wondered if this was common or am i just balding? i know my current situation is almost more stress inducing and extreme than others who are and im sure its got alot to do with it.. just wanted to double tap. and see what i have to look forward to.. hoping to have a full head of healthy hair in my near future

Thank you

HelmetAny stress could potentially cause hair loss (called telogen effluvium), and certainly the emotional and physical toll of war is among those stressors. I couldn’t say with any degree of certainty that your hair will regrow again, but if you saw regrowth the last time you were home, I’d hope you’d see the same regrowth the next time you’re home.

When you get back to the US, you should see someone who specializes in hair loss and can judge what has happened to you. In the examination will be a process I call mapping the degree of miniaturization of the hair in different parts of the scalp (learn more about that here). This will show if the hair loss is in a pattern consistent with genetic hair loss or not. If you have miniaturization present, the use of finasteride (Propecia) may be warranted. Helmets should not cause hair loss unless the helmet is tugging on the hair, creating traction alopecia.

Tags: combat, stress, war, hairloss, hair loss, army, military

I’ve Taken Propecia for Years, But Now I’m Afraid

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

I have been on propecia for 4 years prior to a procedure. The medication was working very well and I was holding on to most of my miniaturized hair until the procedure shocked all of it out and basically voided any benefit and progress that the medication provided me.

Since my terrible experience with this surgery, I have been doing so much research and have come across horrible side effects of propecia that I previously was not aware of…ED, breast enlargement, etc…. This has scared me so bad and is adding to my stress level which I am trying to control. I have not experienced ED up to this point, but not sure about the other…..have you seen these side effects in others and how often?

My question is that do you think (in your general experience) since most of my hair has been lost because of surgery that the propecia is not really necessary now? I just want to get off it and not take any more risks….

PropeciaSo you took Propecia for years (including follow-up visits and prescription renewals) and somehow were never informed of any side effect potential, nor did you even read the insert that comes with the medication? If you have not had any side effects after 4 years, it would be unlikely that you will experience them now or at any time. I believe erectile dysfunction risks are about 1%, libido decrease 1%, breast enlargement much less than 1%. You should be in discussion with your prescribing doctor, not me over the internet.

Just because you had the surgery doesn’t mean Propecia is unnecessary. I don’t know where your surgery was on your scalp, but let’s assume it was done in the hairline and Propecia has kept the crown. Stopping the Propecia would just create a need for further procedures, as the hair that Propecia kept would soon be gone. Obviously this is just an example as I have no idea about your case or history, but if you stop the medication all the benefits disappear within a year.

With regard to the shock loss you experienced following your procedure, this is highly unusual in patients that are taking Propecia. I would have to know more about you, examine you, and understand just what happened and when.

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

In the News – Other Doctors Starting to Warn About NeoGraft

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

Snippet from the article:


Hair transplant experts are excited about a new technology called NeoGraft that restores lost hair.

But they warn that a never-ending series of bad hair days could be the outcome for patients who turn to NeoGraft clinics run by poorly trained doctors and technicians.

NeograftRead the full text — Bad hair forever? Experts: It’s possible

A little over 3 months ago, I posted my concerns about the NeoGraft hair transplantation tool and the fact that it was being marketed to surgeons that had no experience doing hair transplants. Well, now it seems others are finally speaking out.

I have personally tried to get to the company to observe the system in action, but my requests have been ignored by them. Considering that I hold many patents in this field and am a real expert on automation, their disinterest tells me that they don’t want to be observed in action. I would, of course, remain objective and if it is all that it is hyped to be, I would probably want to buy one… but that does not seem to be happening any time soon.

Tags: neograft, fue, hair transplant, hairloss, hair loss, warning

Small Bumps on Scalp After Hair Transplant?

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

Dear Dr.,
I had a HT about a year ago utilizing the strip to micro graft method and I noticed that I have small bumps resembling chicken skin from where the hair is anchored. When this occurs from the old hair plug method it’s referred to as cobble-stones and surgery and/or camoflouging tends to help but what about when the hairs are single grafts? Do these bumps go away over time? Is laser surgery or some other cosmetic method suitable? I like the hair I have just not the rough scalp.

I have heard complaints about bumps around the grafts after a hair transplant surgery, but frankly I have not seen them in my practice. The classic cobblestone appearance of the large, older “hair plugs” did form many skin abnormalities, and even the types of transplants done today could produce bumps if the instrument used is too large.

Bumps like you describe likely can not be repaired, but they can be camouflaged with a good hair transplant around them. Have you talked to your surgeon to find out why your result came with these bumps?

Tags: hair transplant, scalp bumps, hairloss, hair loss, hair restoration

When Can Hair Transplant Stitches Be Removed?

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

Dear Dr. Rassman:
I’ve read that following a hair transplant stitches are routinely removed in 10 to 12 days. However, I was told by a physician that he could remove them in as little as 6 days, because at that point the skin has already healed. Is it safe to do this within 6 days, and can this cause harm to any grafts?

Thank you

I would go by what your doctor/surgeon recommends.

I personally do not use sutures that need to be removed. I either use self-dissolving sutures or staples that are routinely removed in 10 to 14 days. Wounds can be sealed and stay closed with stitches removed at 6 days, but there is no strength in the wound at 6 days. If you do not pull on the edges, 6 days will probably work for many people. Removing sutures (or staples) has to do with how well your donor wound healed. In my opinion, 6 days is a bit too early… but the ultimate decision is with the surgeon who performed the procedure and their comfort level.

Tags: hair transplant, hairloss, hair loss, surgery, stitches, staples, healing

Hairs Never Fell Out Months After My Transplant

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

Dr. Rassman:
Thank you for your service to this country when you served in the US Army. I am a 26 year old male who recently had a hair transplant procedure in late March which involved about 1,500 follicles (FUE). Immediately after the surgery I noticed tiny hairs throughout my frontal area where I have been experiencing thinning for the past few years. I was told by my doctor that these tiny hairs were normal and that they would likely fall out in 2-4 weeks. It has now been about 2.5 months since the procedure and I believe I still maintain about 80% of these tiny hairs. Is this a bad sign for future growth? Will these hairs retard growth? Please let me know. Thanks.

I’d ignore these hairs. If they are the same length as the day they were put in, they will eventually fall out and new hair will grow from the transplants. Some people keep these beard-like hairs for months after a hair transplant and there is nothing to read into this observation. They aren’t a sign of future growth in a positive or negative sense.

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

Asian Hair Transplants

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

Dr. Rassman, I noticed few before/after photos of Asian males. I am an Asian male that has typical Asian hair which sticks straight out. Is this not an ideal hair type for hair transplants? I would assume it would be hard to cover a scar. thanks!

On rare occasions, some Asians with coarse straight hair may have hair that points upward. This is not common, but when it happens, the hair from strip surgery may have to be longer if a scar greater than 3mm is created (~5% risk). Alternative for this, of course, is follicular unit extraction (FUE), where there is no linear scar present.

Most (better than 95%) Asians have results as shown in the referenced posts below and we perform a great number of such surgeries as a matter of routine. It is worth noting that we only post the patients that have signed photo releases, so if there are few Asian patients posted it is because they simply don’t wish to have their photos made public.

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

Juvenile Norwood 3 Hairline?

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

Dear Docs,

Please look at the pictures in this thread at BaldingForum. I’d like to get a hair transplant shortly.

How often do you come across a juvenile Norwood 3 hairline? How soon can you schedule a procedure and i’m interested to consult on proposed hairlines.

I was born with a weak hairline and in my 30’s, i’d like something I NEVER had in my teens and twenties; A hairline that won’t be the butt of jokes. Luckily my hair is coarse and wavy with thickness.

I originally met Dr. Bernstein in 2000 at a seminar in Boston. For background information, my grandfathers’ on both sides had hair. My father and his brother are both bald. My older brother 3 years older has a full and thick head of hair with zero recession.

The photos you showed go from being a baby to being in your 20s, and its common for a baby’s hair to be sparse and grow in, so that photo doesn’t really tell me anything. I need to see photos of your hairline before puberty, because if you’re telling me that you had a Norwood 3 at 12 years old… well, I have never seen a 12 year old with a hairline like that (Norwood 3 for a juvenile hairline).

As far as scheduling procedures, I’d want to meet with you or at the very least have a telephone consultation prior to setting up a surgery. If you’d like to setup a consultation, please call my office at 800-NEW-HAIR (or 310-553-9113) and have someone on my staff fill you in on available times/dates.

Tags: hairloss, hair loss, hair transplant, hairline

Severe Histamine Reaction to Hair Transplant

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

Dear Dr. Rassman,

I was reading through your blog with regards to histamine positive scalp. (Which I have). My question has to do with autoimmune response and hair transplants. I have a very over-active auto-immune response to some things, especially poison ivy/oak.

Several years ago (2006, age 50 at the time) I had a transplant done. Top-flight hair transplant surgeon! My hair was relatively dense, with receding hairline. The histamine reaction to the transplant was severe, with a tender and red scalp for over 8 months. Today, I have lost over 50% of my 2006 density, my hair has turned nearly white (was salt and pepper), and miniturization is everywhere (when there was none prior to transplant in 2006). A prolonged histamine response can cause antibodies to attack the body (or follicles). I am convinced this is what happened. Any thoughts from the information I have given you?

Well, if you are convinced that is what has happened, what more can I say?

I do not know of histamine response connected with hair loss. Maybe you need an allergist or a good diagnosis of what is going on with your hair. Maybe you have diffuse unpatterned alopecia (DUPA), which is causing more thinning everywhere. I really do not know without examining you.

I realize you are trying to establish a cause and effect relationship between histamine and hair loss, but I do not know how it is relating. When I talk about histamine reaction of the on the scalp it is the redness that a person sees when you scratch the skin/scalp. Your body releases histamine and makes the skin turn red temporarily. This is not an autoimmune response you are referring to. This is not the histamine reaction from poison ivy/oak. Moreover, histamine is used by your body in many other ways (other than auto-immune related). So you see, biochemistry and our human body is very complicated.

Tags: hair transplant, hairloss, hair loss, histamine

My Surgeon is Reluctant to Do a 2nd Hair Transplant!

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

Dear Dr Rassman,

Great blog with an incredible depth of information. I had a hair transplant 12 month ago with a reputable European surgeon. I am very pleased with the result; I had 1500 grafts placed at the front, restoring my hairline as i have quite thick hair. However, I was considering having further surgery to further thicken the frontal areas and also increase the density around the temples.

My question is two fold:

  1. Would you recommend such as course of action? My surgeon is reluctant to do so in case there is future recession behind the grafted hairline, thus causing a splitting effect. I am currently on propecia and have not noticed any further recession but am aware this may happen.
  2. How many hair transplants can you reasonably have and what is the optimum amount of hair you can transplant? I ask this because I am slightly conscious that if i do have further surgery to thicken up the front then i might not have enough supply if i do further recede.

  1. I have no recommendation. How can I? I have never seen you, examined you, or even have any idea of what your balding pattern and level of thinning or your donor hair density, etc. Before any surgery, you must have specific goals and a Master Plan, which is a plan for your future balanced with your donor hair reserve (this is very important).
  2. The number of surgeries or the optimum number of hairs you can transplant is highly variable on each individual. It depends on your hair density, scalp laxity, the number of grafts you attempt for each surgery etc etc. These are very basic questions that your surgeon can easily answer. I want to help you but you need to first start by talking to your doctor and asking these same questions to him. Maybe you can write your questions down on a piece of paper and ask those questions one by one to your surgeon. I am not trying to be facetious but I do realize that maybe when confronted face to face with a doctor your mind may go blank.

For your general knowledge, the donor area is between 25-35% of your total scalp area. That means that the average person with 100,000 hairs on their head have around 30,000 donor hairs. Keeping half and transplanting half means that this person with average sustained laxity can move up to 15,000 hairs or 7,500 grafts in his lifetime. Those with higher densities can move more, those with lower densities can move less.

The Asian man with 80,000 hairs or the African man with 60,000 scalp hairs still must maintain 15,000 hairs (approximately) in the donor area. That means that the number of transplantable hairs in the lifetime of a person with low density will be less (you can do the math). With these numbers, your having 1500 grafts means that you probably had 3000 hairs transplanted (assuming that you have an average hair density) leaving you with lots of reserve hair for future hair loss. This is a general rule, and your doctor will modify it based upon his examination and your vital statistics. If your scalp became tight after one strip harvest procedure, then you may not be a good candidate for another surgery, but possibly follicular unit extraction (FUE) would be a good alternative.

Further reading on this topic:

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

Before Selecting a Hair Transplant Doctor, Do Your Homework!

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

Dear Dr. Rassman,

I wanted to share my thoughts with your readers concerning the selection of a HT doctor. I had several transplant sessions in the mid-1990’s. After many years, I find myself in need of a hair tune-up and will be scheduling surgery with Dr. Rassman this Fall.

I cannot stress enough that people do their homework when selecting a doctor. You only have so much donor area. When it is gone, it is gone. No amount of money can bring it back.

Through my research concerning HT doctors I have come to two conclusions. First, see a doctor that has been awarded the Golden Follicle award. This is voted on by their peers. Secondly, see a doctor whose primary specialty is hair transplantation. There are even winners of the Golden Follicle that practice other forms of cosmetic surgery. My reasoning is that I believe that HT is both surgery and art. The more a doctor performs quality HT, the better your results![/bq]

This is good advise. And you are correct in that hair transplantation is as much an art as it is a surgical procedure. This is a cosmetic procedure, afterall!

For more tips on choosing your surgeon, we put together a checklist of sorts that I encourage people to check out — Selecting a Hair Transplant Doctor.

Tags: hair transplant, doctor, hairloss, hair loss, surgeon, surgery