Transplanting Hair Between Identical Twins

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

Hello Dr!

I just had a quick question. I have a NW 3 vertex balding pattern, but so does my identical twin. Would you ever consider transplanting hair from one twin to another? Not against his will of course! I can see an ethical delimma on the future situation of the twin donor if he ever changes his mind, so I was curious what you would do in this situation.

TwinsYes, we have done this on one occasion. Twins have to be identical twins (exact same DNA) and not fraternal twins. If one wants to donate to another, it’s their choice and wishes. I would want to know both of the twins and understand the reason for transplanting from one to the other.

In a Norwood Class 3 pattern, there is really no need to take from one twin and move it to the other. The recipient area is easily covered with a single surgery in many patients and the use of finasteride will keep the hair loss from advancing in most cases. I understand, however, your desire to keep it in the family so set up an appointment with a good doctor to cover these issues in great detail.

Tags: twins, hairloss, hair loss, hair transplant, dna

Getting More Permanent Hair from the Scalp?

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

Hi Dr. Rassman,

Excellent blog. I read it every day and would love to add my question to the plethora of information available.

I have a question about donor supply. I of course understand that when it comes to strip harvesting, you can only cut out so much of the skin, and that only some of the hair at the back, below a certain line, is permanent. But I’d like to know why after using up all the available donor hair with reference to what you can get with the strip-cup method, you can’t go in and take more grafts via the FUE method. There is still plenty more permanent hair at the back and although it might be too low to cut into because of the nerves and muscles, using tiny punches to get it out I’m guess wouldn’t have negative affects.

Thinning out the sides too would I think also have the advantage of not only providing more donor hair, but it would also make the transplanted area not look as thin in comparison since you’re making this “thick” permanent zone thinner.

With doctors performing FUE where ever there is hair, even body hair, I’d like to know why you can’t just go after more permanent hair that you still have in the back of your head and on the sides.

Thanks!

Doing a strip harvest for the first hair transplant surgery and a follicular unit extraction (FUE) at a later time is generally not advisable, as you limit the donor density with the FUE. Essentially, you’re asking why doctors don’t try to thin the donor area as much as possible, but for many people having the sides and back of the head looking sparse would also be a problem. Then again, everyone is different and I would rather not make a rule without knowing your situation. If you start with strip harvesting, you should finish with strip harvesting if you go for another procedure.

Tags: hair transplant, hairloss, hair loss, density, laxity, fue

Density — FUE Versus FUT

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

One aspect puzzles me. In FUT a strip is removed and closed so a part of the scalp vanishes and is replaced by a thin scar. The areas adjoining the scar retain their hair density and very often with trichophytic closure hair grows out of the scar, again with no reduction in density.

In FUE follicular units are harvested individually. No large scar is generated but hundreds (thousands?) of tiny ones. However (and this is my main point), donor area density is reduced because the scalp from where the hair is removed does not vanish and is essentially now a tiny bald spot.

Does this mean FUE thins out the donor area in return for not creating a long FUT scar? Is that the trade-off?

Thanks for asking, as this can be a bit abstract.

When you remove a strip of hair (say 1/2 inch wide by 4 inches long) you are effectively removing skin and pulling the scalp from top and bottom. This in effect stretches the scalp/skin along with the hairs. So if you have a very, very precise measuring tool of hair density before and after the surgery, then you will definitely see a decrease in hair density after the surgery… but this reduction in density is very low and not perceptible to the naked eye.

When follicular unit extraction (FUE) is performed, many hundreds and thousands of hairs are taken out (and never grow back on that spot) so it is easy to see how this would also reduce the donor density.

Tags: density, fue, strip surgery, hair transplant, hairloss, hair loss

I Have to Take Medication That Causes Hair Loss

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

A bit complex. I am a 47 y/o male. In good shape. Been slowly balding on the top of my head for 8 years.

Had a kidney transplant 4 months ago. Not related to diabetes. Donor was Brother. Take Prograff 2mg 2x a day. Started Testosterone thereapy 2 months ago. Very low levels. started with Androgel 5 mg. daily. Stopped that…Now on Testosterone Cyp 200mg every 21 days. The Testosterone does make me feel much better. I would rather not stop taking it. And the Prograf, I cannot stop… Hair is falling out fast for the last 2 months!

A side effect of Prograf is hair loss. A side effect of Testosterone therapy is hair loss. Is there any way to combat this? Would a hair transplant work or would it just fall back out again from the medications that I take? Any help you may be able to offer is greatly appreciated.

Kidney transplamtAs a male, it is possible that the impact of testosterone may be offset by Propecia (finasteride). Propecia may also have some beneficial effects on the general genetic balding process, but you need to discuss this with your doctor before doing anything.

Hair transplants may help if you have patterns of distinct balding, as the transplanted hairs (which do not have the genetic components of balding) may be able to resist the hair loss caused by the anti-rejection medications taken for your kidney transplant.

Tags: hair transplant, liver transplant, prograf, hairloss, hair loss, medication, propecia

What If I’m Already Taking Anti-Rejection Medication for an Organ Transplant?

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

Dear Dr Rassman,

You’ve written before that hair transplant from another person or the dead are not possible because it’d mean the recipient needing to take anti-rejection meds and the risk being much greater than the benefit.

But what if a potential hair transplant patient has already had a previous heart/liver/lung etc transplant, and so is already committed to a lifetime of anti-rejection meds, would it then be possible (even if only theoretically) ? If so, has it ever happened, and is it something you yourself would be ethically comfortable with and technically confident of getting a natural looking result with ?

Thankfully, this is not a situation I’m in myself but presumably there must be some small percentage of your patients who this would apply to and it’d be interesting to know. Thanks!

What you are asking is theoretically possible. However, one of the many side effects of anti-rejection medication is hair loss.

In the last 15 to 20 years of my practice, I don’t recall seeing a heart/lung/kidney transplant patient nor have I met someone willing to donate their hair to someone else. I think people may be more willing to donate one of their kidneys than their hair… which says something about how important hair is to most people, eh?!

Tags: anti-rejection, organ transplant, hair transplant, hair donor, hairloss, hair loss

Why Don’t Transplanted Hairs Grow at the Same Time?

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

Dr Rassman

I have a query that has always interested me but I have never quite found the answer to. Why does newly transplanted hair grow at different timelines to each other (either scientific or theoretically). For instance I had a hair transplant nearly 6 months ago. Today I could see a couple of new hairs popping through, yet my first good initial growth that I could visibly see was just before the 3 month mark. I find it amazing that there can be such a time buffer between growths, yet all the transplanted hair was inserted in my head within a 4 or 5 hour timeframe!! Surely all the hair should grow back within that timeframe??

Thanking you for your time.

I do not have a good answer for you, but I can offer some speculation. Some hair follicles remain dormant longer than others, but it has nothing to do with the time it took to place the grafts in your scalp. All of the hairs on the head are growing at different and overlapping cycles. So naturally the transplanted hair would behave in a similar way. It may have something to do with the time in the cycle the hair was in when it was moved.

Tags: hair transplant, hair growth, hair cycle, dormant

Transplanting Hair to Cover a Scalp Keloid?

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

I am an African American male age 46 with a keloid on the back of my head which resulted from two surgeries to remove it. Now I have a keloid the size of a strawberry which leaves a bald patch in my hair. Can a hair transplant or hair patch be put in that area to cover it for good? If so will it cause more problems in the future or no?

I often see patients that wish to cover scars (and keloids), but hair growth on this tissue can be less than optimal and patients often require addition surgery to increase the density of hair. In the end, the scar and keloid is still there, but it might be covered with the new transplanted hairs.

Transplanting into keloids, however, also runs the additional risk of making them worse. If you’re known to form keloids on the scalp, then having more surgery (like a hair transplant) could result in more of the same. You already tried to surgically excise the keloid on your scalp and it caused it to grow larger? I don’t think its worth the risk, though without an examination I couldn’t make a definitive opinion.

Tags: keloid, hair transplant, hairloss, hair loss, hair restoration, scarring

Shedding Months After a Hair Transplant?

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

I had transplant 3 months back. After about 3 months I see 3-4 hairs coming out after shower while combing. Am I experiencing shock loss? How do we know if its a shock loss or normal shedding?

thank you

Losing a few hairs in the shower can be normal, hair transplant or otherwise. It’s just three hairs you’re talking about… and it’s normal to lose 100 a day.

Shock loss timing runs from 1-4 months after your hair transplant, so if you are concerned that you’re seeing shock loss I’d suggest you make an appointment with your surgeon for an exam. He’ll be able to compare your pre-operative photos with you to make that determination.

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

Using the Sides of the Head as Donor Hair?

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

Greetings,
Solid good data base you have built on this blog Dr. rassman. Thank you

My question is: Can you transplant hair from the upper sides of the head “left and right” about 3 inches above the ears, or is it only possible as a donor area to be from the lower back above the nick ? Reason I’m asking this question is because I have what i want to define as “Global hair loss/damage”. Meaning even in the donor area it’s clearly visible that i do not have a normal hair distribution/density “there is holes among the donor area” but, in my sides “just below the flat crown of my head” the hair is extremely healthy/dense/thick and can grow for long time with out being damaged.

Your time and answers are greatly appreciated

NW7First I though you were describing diffuse unpatterned alopecia (DUPA), but if there are clearly areas of your scalp that are full and lush, and they are about 3 inches above the ear, I would rule out DUPA on first glance. I would have to examine you to understand what you are telling me.

As a rule, however, the donor fringe is only 2 1/2 inches high on the back of your head and about 3 inches high on the side above the ear. Donor hair implies that the hair is permanent when full balding (up to a Class 7) occurs. Note the diagram at right of a Class 7 figure and you will see the 3 inches high fringe above the ear. Donor hair taken above the 3 inch level will not be permanent hair for the advanced balding patient.

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

Can’t I Have Body Hair Transplanted to Scalp If I Don’t Intend My Hair to Be Long?

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

Hi am 30 years old with a norwood 6 level of baldness. I currently shave my hair with a razor. As i have an extremely large amount of body hair and i guess limited donour hair on my head, is body to head transplant possible? Would it be possible for the transplant to cover the crown as well as the front of the head? What is meant by resting phase for hair and how does that vary from the head and the body? I dont intend on growing my hair long and i would like to keep it at a buzz cut so it would not matter if the transplanted hair was to go frizzy or curly. But i am concerned if there will be a noticeable difference between my current head hair and the transplanted hair. Would i still be able to razor my head after i had a hair transplant? would the be any scars or signs of a hair transplant?

ClippersI don’t know why you’d want to just guess about the availability of your scalp donor hair. Have you been examined by a doctor? Body hair transplants (BHT) are technically possible, but they are not something I’d recommend for multiple reasons that I’ll try to explain simply. Body hair is not the same as scalp hair — it looks different, it feels different, it grows different. Even if the procedure is a technical success, it’s not going to give you natural looking results like you can achieve by using hair from the back of your head. Plus, I don’t know enough about your hair loss (donor, density, etc) to really be able to know if you’re even a candidate for any kind of hair transplant surgery.

As you seem to be aware, body hair does not grow at the same rate as scalp hair and about half of transplanted body hair is in a dormant state (see more on that here). Scarring in the recipient area depends on the skills of the surgeon and staff… but if you’re going to shave your head in the future why would you even want a hair transplant? Wouldn’t that be like getting a nose job right before you decide to take up boxing as a sport?

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

Shaving the Recipient Area to Prevent Shock Loss?

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

Hi Doc,

I have read places that shaving the recipient area before surgery prevents shock loss and has a higher graft success rate. Do you know if this is true or do doctors who require you to shave your head just want to make the surgery time shorter? Thanks!

It’s probably not true… and you probably learned it from a clinic where the doctor insists on shaving the head. At NHI, we only shave the area that we remove in the donor. The best way to prevent shock loss is to take finasteride before the hair transplant and stay on it for at least one year (better, lifetime). For an experienced doctor and staff, shaving the head is more of the doctor’s preference and doesn’t have much to do with growth / success rate.

Tags: shaving, hairloss, hair loss, hair transplant, shave

Cheap Hair Transplants Are Not Such a Good Deal After All?

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

MoneyI’ve been thinking about the case I wrote about last week — “How Many FUE Grafts Actually Grew?” — about how a patient (we’ll call him Mr. Smith) came to NHI after feeling royally screwed over by another clinic he went to for his follicular unit extraction (FUE) procedure. It’s quite an interesting case of being scammed by a doctor that advertised super low prices, so I really suggest you read it if you have the time. Even so, I want to talk a little about value in surgery…

If you run the numbers, you will see that the actual growth of hair was only 25% of what he got transplanted. There were two consequences of this:

  1. Of great importance is the loss of your finite (limited) supply of donor hair. In the case of Mr. Smith, his surgeon killed 3 out of 4 hairs that were transplanted. These hairs are forever lost to the patient. I also believe that there was damage produced to the donor area, evident by a thin see-through appearance. His donor supply is significantly worse off following his FUE procedure than if a scar formed from a strip surgery, which could have been easily hidden by surrounding hairs. FUE is not always the answer to harvesting hair without post-surgical consequences, as seen in Mr Smith’s case.
  2. Of lesser importance, the cost per graft was multiple times higher than what the patient thought. Let’s assume that Mr. Smith paid $5/graft. When measured against growth, his actual costs were $15/graft for the work that was done. The rate he paid had nothing to do with the value he actually received (in his end result), as he really was paying more for less. That’s quite a bit of money out of his pocket.

The lesson here is that experience in a hair transplant surgeon and his team is directly related to the actual costs when measured by the yield of what actually grew from the hair transplant. My advice to prospective patients is to change the way you look at value! In our practice, we allow prospective patients to meet our patients to see what type of results they got. As these Open House events are open to all patients (or future patients), anyone with results like shown in Mr. Smith’s example will be as evident as the nose on your face. This will help you in the education and selection process. This type of surgery is forever, and unfortunately some patients have to learn the hard way when they try to pinch pennies by going to a surgeon that has no business messing with your hair.

Tags: hair transplant, fue, value, price, fees, hairloss, hair loss

Why Aren’t There Photos of Donor Scars?

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

Sir,

I’ve always wondered why photos of hair transplant procedures never include a section of the donor area (elapsed over healing period)? I considered the transplant option years ago but I became very uneasy about scarring at the donor area. I have not seen one photo regarding this part of the procedure at any of the more reputable transplant provider sites. Why? Thank you for your insight.

It’s true that we do not routinely take scar photos, but we have posted photos of scars in the past:

Typically, donor scar will vary in each individual. It can be fine as a pencil-line or thick like the width of your picky finger (rare). Most scars are about 2 to 3mm in width. If you ever had a cut that needed stitches, you can use that as a baseline comparison. Some people are bad healers, some doctors use scar-minimizing closure techniques… so there are factors that can make scarring more or less severe.

Tags: hair transplant, scarring, donor scar, hairloss, hair loss, photos

I Had a Transplant and Take Propecia — Is It Too Late for Miniaturization Mapping?

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

Hi Dr. Rassman. You’ve written that after miniaturization mapping you can do a good job predicting what balding pattern a person will likely develop. If I’ve already had a hair transplant a few years ago and have been on Propecia, and mapping wasn’t done beforehand, is there no way for me to predict where I’m headed? Thanks.

I believe a miniaturization study is a good measurement of your hair status at one given point in time. It’s like taking your blood pressure or pulse when you go see your doctor. Even if you had a hair transplant, this should not matter. So to answer your question — no, it’s not too late.

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

Hair Transplant and ITP

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

I am considering having a hair transplant. I am have a bold spot of the right top side of my head and a similar one is gradually developing on the left. My biggest problem is that I have ITP. I had been scheduled to do a transplant a few days ago and had gone for ITP treatment- I was given IVIG but it had no impact; infact it seems the platelets dropped. So I had to put off my surgery. The problem is it is difficult to schedule an appointment for surgery without knowing for sure that I’ll have the right platelet count on the day of surgery. Do you know of any hair transplant centre whether they can handle both the haematological and transplant aspects?

For those unfamiliar with idiopathic thrombocytopenic purpura (ITP), I’ll turn to Google Health for a good description — “a bleeding disorder in which the immune system destroys platelets, which are necessary for normal blood clotting. Persons with the disease have too few platelets in the blood.” Idiopathic is just a fancy way for doctors say we really don’t know what is going on. There are some treatments as you know, but sometimes it can be difficult to treat.

Having surgery when your platelets are low can be dangerous, because your blood will not clot and any bleeding may not stop. I understand you want to have a surgery, but any surgeon in their right mind would not knowingly perform surgery on a patient with ongoing ITP with low platelets. The key point is that you need to have your ITP treated and wait until your platelets return to normal levels. Until then, I would worry more of your health than your hair.

My final thought is that you mention a bald spot on a part of your head. While I really cannot diagnose you with a description, are you sure you have male pattern baldness? Something about the way you described your hair loss makes me think you have alopecia areata (which is also a condition where your immune system attacks your hair follicle, the way it destroys your platelets in ITP). Just a hunch. Please follow up with your physician and I wish you well.

Tags: hair transplant, itp, platelet, blood clot, hairloss, hair loss