African American Female Hairline Lowering in NY?

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

Hi Dr. Rassman

I am an African American female with a congenital high hair line. I have always hated the vastness of my forehead and am limited to hairstyles with bangs. I would like to have have my hairline lowered. Because of keloid risks I would probably opt for transplants instead of surgery.

My questions are; do you know of any good or great surgeons in NYC or surrounding area who have experience in this type of surgery? Everything I see is in Beverly Hills or Oakland Ca. And also, if I choose to have implants do I have to go to a surgeon who does implants or can I go to a hair restoration institute? Thanks for your time.

I can’t say for sure either way about the keloids or whether you’re a candidate for surgery, but I do know that Dr. Robert Bernstein in Manhattan would be the person to see in New York. I have worked with him for more than 10 years and we co-authored Hair Loss and Replacement for Dummies.

Tags: hairline lowering, nyc, ny, new york, bernstein, hairline, hairloss, hair loss

I Want Scar Revision and Then FUE to Eliminate My Scar Completely

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

Hi,

First of all I want to thank you for this informative blog. I have searched this wonderful blog and have found numerous postings relating scars and hair transplant. Here’s my case: I have what “they” call a coronal scar that runs from ear to ear. What I want is to completely cover the scar through a FUE procedure, but I want my scalp to be like how it first was, normal. My research has been conclusive and I first want to have a scar revision surgery to reduce the width of the scar, once that is done i want to follow some type of scar treatment to make the scar less obvious in color (seems like the scar gets pink/red after a scar revision surgery). Afterward get the FUE procedure and go from there. Is there any treatments that you would suggest?

I want the scar to be inconspicuous to the point to be able to cut the hair in the military/short hair style, because ultimatley i want to join the military as an officer.

Best Regards

Your plan is good, but it may not be realistic to have the scar completely hidden. Even if the hair in the scar is brought up to near normal density (which may take a few FUE procedures), there is often a color difference in the remaining scar, though of course it will be hidden with FUE grafts.

As you are local to my Los Angeles office, please arrange to see me so that I can ascertain a plan that matches yours. Any preparatory treatments can be assessed and recommended when you see me. You can call 800-NEW-HAIR (or 310-553-9113) to schedule a free consultation with myself or Dr Pak.

Tags: fue, scarring, scar, repair, hair transplant, hairloss, hair loss

FUE Affordability and Restoration Robotics

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

Hi Dr. Rassman. I’m 25 and have been following your site for a few years now since my hair started thinning at 22. I’ve been taking finasteride though and it’s kept it at bay…

I have a couple of questions for you if you please:

1) Any chance that FUE can become more affordable soon? Am I right in thinking that a FUE procedure of 2000 grafts would cost over $15,000 nowadays? Any chance it could drop to $10,000 soon?

2) This question is sort of related to the one above – Do you have any updates on the Restoration Robotics FUE procedures? All I know is that there are trials being carried out here. You mentioned before you had granted them use of your license… Have you enquired as to whether they’re seeing any success? Any chance the robotic technique will result in cheaper FUE procedures?

That’s all. I really hope you can answer these questions which have been on my mind (and many others I’m sure) for a while now.

Best Regards

RobotCosts for follicular unit extraction (FUE) will follow a supply/demand formula. Although many physicians perform FUE procedures, the failure rate is very high, so buying 2000 FUE grafts may mean that you purchase the delivery of these grafts, but survival may not follow the delivery because of damage done at the time of extraction. There are many groups working on mechanisms to deliver quality FUE grafts that will not be damaged so that they grow. Many groups have devised better tools and have announced them at the various ISHRS conferences and elsewhere (Drs. Feller, Harris, Boudjema, Cole, and myself).

Restoration Robotics will require FDA clearance before their product can be released for commercial application. The other devices are what the FDA calls Class 1 devices, which do not require FDA approval. I’m not sure of their progress at the present time, nor do I know of any costs, though doctors will still likely set their own pricing. My guess (and I am not privy to any info, so this is entirely speculative) is that the equipment start-up costs will be substantial and like any other product or service, costs will come down at some point in the future when it becomes available to a wider market. How near of a future, I couldn’t tell you. One step at a time.

Note: The image is of a violin-playing robot developed by Toyota. It won’t do hair transplants, but it might play you a song.

Tags: robot, restoration robotics, fda, fue, hair transplant, hairloss, hair loss

What Happens to Surrounding Skin After the Strip is Removed?

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

Dr. Rassman,

I know that this question is probably answered in many FAQs, but I’ve been watching your blog for two years straight and do not recall seeing it:

What happens to the surrounding skin when you cut out the donor area? I’m particularly concerned with knowing exactly which areas of skin are going to get “stretched” to make up for the missing skin. For example, does my face get tighter? Does my neck feel tighter? Does the skin regenerate to compensate? Can this lead to minor sagging/stretch marks in areas behind the head? More importantly, can it shift parts of your face slightly out of line?

Face stretchThis is a great question, one that I am asked when I do consultations. Your face doesn’t get tight, your neck isn’t stiff. You don’t even get tighter buns. The stretch that occurs is so uniform that most of the time there’s nothing that can be detected. Some people who have good laxity will notice a slight decrease in the looseness of their scalp.

I only wished that my own strip excision would’ve produced even a small face lift, but the answer is that there is really no shift of anything. I dream of doing a hair transplant and giving a person a facelift, which would allow me to increase my fees and offer more value, but alas this does not happen.

Tags: hair transplant, surgery, tightness, laxity, facelift, hairloss, hair loss

I Had a Hair Transplant 7 Months Ago and It Still Doesn’t Grow Right

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

I had a hair transplant about seven months ago. It was performed April 5 2009. I had been cutting my hair all this time because I am in the military. but started to grow it out the last two weeks. but it still looks funny. What I mean by that is when it grows it doesn’t match the rest of the hair. the back hair is more full, and the front looks like stitches. Is this normal after seven months? How long do I have to let it grow to make it match the rest of my hair?

I do not know about your hair transplants or how the procedure was performed. I do not know what your expectations were or if you were given realistic expectations. So I really cannot comment on what you are experiencing. Keep in mind that not all hair transplant procedures are the same. The doctor and the team you chose can either produce great results or substandard results, depending upon their experience and skills. It is not like shopping for a car.

The best advice is to follow up with your doctor. Sometimes it can take a full year for 95% of the growth to be evident. At 7 months, I would expect 60-80% growth.

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

What Hair Can Shock Loss Effect? — and the Cost of Hair Transplant Surgery

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

I can only afford to have my bald patches of my hairline transplanted (FUE) so no other areas of hair will be near. Will the shock loss only affect the donor follicles? or does all of your head hair fall out?

QuiltWhile price/cost is a factor for any cosmetic surgery, it should not dictate the surgery itself. Having cosmetic surgery is not like shopping for the cheapest loaf of bread, laundry detergent, or shoes.

When shock loss occurs, it may be the result of the anesthesia given to numb the head for the transplant and may cover a large area of the scalp, not just the area where the grafts are placed. The mechanical impact of the transplant may not be the cause of shock hair loss. You also have to look at the big picture. We call this the Master Plan. Surgery must be placed along your hair loss timeline and it will be progressive. In other words, you can’t just transplant hair to the small bald patches and expect that to solve your problem, as the balding process is regional. What if you lose more hair around the transplant and behind it as your balding continues? A good doctor should give you insight on your worst case scenario and plan for such consequences. After all, you don’t want to have small patches of transplanted hair scattered around your bald scalp in the years down the line “IF” you were to go bald.

To answer your question in further detail, shock loss is a concern… and while it may not happen, it is a risk. I have addressed your question with the assumption that you have genetic male pattern baldness and not just a patch of bald scalp (which is very rare in genetic balding). Either way, you need a Master Plan created with a doctor (not just me on the Internet) who is willing to look at your hair loss problem as a long term process.

For the follicular unit extraction (FUE), you need to understand it does not work to fill in the scalp balding areas like a patchwork quilt. Do not let the cost of FUE be the primary reason in your decision making process as to what to do and where to put the hair. It is better to be bald than be disfigured with a half-ass surgery.

Tags: hairloss, hair loss, fue, hair transplant, surgery, shock loss

Besides Propecia, What Else Can I Do to Prevent Shock Loss?

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

Hello Dr. Rassman,

What precautionary steps can a younger man take in order to help prevent and/or lessen the effects of shockloss? I know it’s important to be have been on Propecia for several months, but what else can contribute? Will having the recipient area shaved help? I’m likely to have some hairline touch-up work. Would having a less-dense prodcedure (decent amount of native hair remains) impact less trauma on the recipient zone, thereby reducing potential shockloss, or does the point become moot regardless of the density placed? Thanks.

Shock loss can occur regardless of density, and there is really not much you can do. Taking Propecia is the best option to try to prevent shock loss, though I guess another option would be not to have surgery at all. You have to weigh the risk vs the reward. If you have more to lose than gain, then I would be very cautious.

Surgery is not always the answer… and it is not reversible, which is why I’ve often said that the good news and the bad news about hair transplants is the permanence. Be sure to pick a good doctor you trust and have seen his/her work on previous patients (in person is best) before you get a hair transplant, and do not be driven by the best price you can find.

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

Transplanting Neck Hair to My Mustache?

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

I had a question regarding a moustache transplant. I have a sparse moustache and thin hair on my head. I’m concerned that my head hair would not be thick enough for facial hair. I was wondering if it is possible to transplant my much thicker coarser beard hair on my neck to thicken my moustache without too much scarring. My beard goes all the way down to my chest and I hate shaving it anyways. Thanks

MustacheHair from anywhere on the body can be transplanted to another location. Follicular unit extraction (FUE) is a good way to do a limited number of hair transplants into a mustache. This is something that you and your doctor should discuss.

Remember, however, that hair from different areas on the body have different hair cycles, which means that if the telogen (resting) cycle is long and the anagen (growing) cycle is short, then less of the hairs will be working for you at any one time. You can learn more about hair growth cycles here.

Tags: bht, hair transplant, neck hair, moustache, mustache, facial hair

Using Botox to Reduce Scar Widening After a Hair Transplant?

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

I read that some doctors have suggested that Botox can help in the reduction of scar widening following a hair transplant. If this is true, why don’t doctors use this routinely?

BotoxBotox (Botulinum Toxin Type A) works by paralyzing muscles. If the widened scar was the result of muscle pull, then the idea would make sense. Let’s take a look at the anatomy:

In the area below where the donor area is taken out lies a muscle that is called the occipitalis muscle. It has the unique character of not attaching to any tendons or bones, and is a vestigial muscle that has no real function in humans. It does not connect to the scar, so paralyzing this muscle will have no benefit. The only other muscle in the vicinity of the donor area is the occipital head of the trapezius muscle, which inserts on the occipital bone on the skull and its purpose is to allow you to lift your head and hold it upright. Paralyzing this muscle might just give you a head drop, which would not be a good idea. I am not sure what else might be paralyzed to help heal the donor wounds.

In conclusion, it does not makes sense to use Botox for scar stretching prevention.

Tags: botulinum toxin, botox, hair transplant, scar, hair restoration, muscles, hairloss, hair loss, surgery

Using Rogaine on Transplanted Hair Area

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

Hello Doc,

Nice to know of this site. I appreciate your help in answering queries for hair loss victims. I am 27 yr old male and I had a hair transplant on my crown earlier this year and to date its more than 7 months. The transplanted hair looks good but its not covering my full scalp. I think I need an another procedure. I am on generic finerstride and minidoxil 5%. I wanted to check with you regarding the usage of rogaine. if I use the rogaine on my transplanted hair area, is there any chance if at all it is there to grow new hair in those gaps.

If there is a chance Rogaine (minoxidil) will grow hair between your hair transplants, it is a very small one… and if it does grow hair, it will not likely cover your bald area. Isn’t that why you had a hair transplant in the first place? Unless I’m misunderstanding you, why didn’t you try the medications before your first hair transplant to see if they might help?

Tags: rogaine, minoxidil, hairloss, hair loss, hair transplant

Density of Hair Transplants

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

Hello, I just had a wonderful procedure. Their offices were clean, procedures were excellent, and the staff was very accommodating. In 2002 I had 800 grafts done by another group in San Francisco and then again I just did 3500 grafts. The follicles were transplanted throughout my scalp approximately 25 FU/CM2. I have a very nice NW2 hairline. Also, I had a very high number of 4-hair grafts. Over 400 of them! They excised a strip of 3500 grafts and got 3703!!!

Do most of your patients get about 25FU/cm2 and are happy with it? I think it will be ok but just need reassurance.

A normal person will have 1250 hairs or 600 two-hair follicular units. When converted to cm/square, that would extrapolate to 100 follicular units per square cm. If you received 25 follicular units in 1 cm, that would suggest that in one procedure, the doctor returned 25% of your normal density on the transplanted area. This is often not really the case, as some areas will have higher densities put in and other areas lower densities. For a person with average weight hair, olive skin, and brown hair, 50% densities overall should be more than enough to produce a full appearance. If you had a high number of four-hair grafts, then that might mean that your overall densities are higher than average. I generally target 25% density return on the first session, but at times I will go higher or lower depending upon other factors.

Tags: hair transplant, density, surgery, follicular unit, hair restoration

What Percentage of People Are Happy with Hair Transplants?

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

Thanks for the forum Dr. Rassmun, it has been very informative. I do a lot of research on the internet and it seems that people are all for hair translplants or they are all against them with many failure and nightmare stories. I saw something you wrote saying hair grows for 99% of translpants, but gaging from other sites it seems like 50,50. I was wondering if you could give me a ballpark number in your experience of people who are happy with their transplant to people who are not.

Anyways I am 24 and have pretty accelerated hair loss, but the back and sides of my hair is pretty strong and thick. Does the regrowth of transplanted hair in the mid 20s have a better look than transplanted hair later in life? Its seems the pictures Ive seen have led me to believe this, thank you for your time and keep up the good work.

Generally, delaying hair transplants just increases the suffering time for those individuals who are bothered by the balding process. Why delay a hair transplant when the young man needs and wants the youthful impact of a full head of hair? If you wait until you are 60 years old, then you will look older until the day you decide to be transplanted. A 25 year old may look 40, a 40 year old may look 50 or 60, and a balding 60 year old may look 80. A hairy 25 year old will look 25 and that is what most 25 year old people want. I have transplanted many 40, 50, and 60 year old men who look 10-20 years younger with hair.

Satisfaction rates in my practice are very high, not just because we are good surgeons and know what we are doing, but because we set expectations correctly, do not employ salesmen who get a commission for selling you what you may not really want or afford, and we give all of our patients access to previously transplant patients at our monthly open house events. Patient education is at the foundation of satisfied patients.

Tags: hair transplant, hair loss, hairloss, satisfaction

Hair Transplant Using Single Blade or Multi-Blade?

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

I went to a local doctor for a consult and he mentioned that he uses a 2-3 bladed knife with the Haber spreader to insure that no transection occurs. He said that there is less transection with that than with the single bladed knife, when used properly. According to him, with the single blade, you must go down 2-3 times as deep to cut past the follicles, and if you are not right on target there will be some transection. Does this sound correct – does using a Haber spreader with a 2-3 bladed knife sound right?

Thanks…

BladeMore than 2 blades with depth may cause hair transection. The use of spreading instruments such as the Haber spreader or a Kelly clamp will also work to minimize transection. If a two-bladed knife is used, it should have a built-in angle to minimize transection. A three (or greater)-bladed knife causes more transection and loss of hair from the donor area.

One vs two blades (with built-in knife angles for the 2-bladed instrument) are about equal to minimize hair loss from the harvest. I use a specially designed (by me) two-bladed knife that has a 30 degree angle built into the holder to minimize transection. Two-bladed knives like the one I use precisely control the width of the strip, so I prefer that to a single-bladed knife.

Tags: surgery, blades, blade, knife, knives, scalpel, hair transplant, hair restoration, hairloss, hair loss

I Want to Take Propecia Temporarily Before Surgery

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

Dear Dr. Rassman

you mentioned before “Some of my patients do not take Propecia (finasteride 1mg) by their personal choice. It is your choice as well. The risk is that you may have increased shock hair loss without taking Propecia before surgery. Shock hair loss is common in men under 30 years old or those who are losing their hair actively when they have a hair transplant. Propecia will prevent this complication in most men” …

Well i used propecia before for 9 months and had great results. but by the 8th and 9th months it killed my libido and impotence although i was 26 years old only.. but as you said shock hair loss is really scary. so if i wanted to use finasteride just to avoid the hair shock loss post surgery, how many months you advice me to take it temporary, definitely im not willing to go on with it…

thanks doc…

Stopping the finasteride after a hair transplant has been done with a few of my patients with success. The risk of shock loss is mostly in the first 4-6 months, and those that stopped it after the transplanted hair grew out did not have a problem with shock loss. Of course, they had the benefit of hair transplants to cover any new loss of the original hair, so they may have lost some hair without knowing. This may be a better route than not taking the drug at all, but you will still face the natural evolution of your hair loss over time without the drug on board.

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

I’m 22 Years Old and Showing Norwood Class 4 Already!

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

hi dr. william rassman.

i am a 22 year man suffering from male baldness pattern near to stage 4. at this young age i have lost most of my front hair and from front i am almost completely bald. i want to have hair transplant surgery within next a year or two. what is your suggestion? thanks and waiting for your reply soon.

Norwood 4Without an examination, I can’t tell you whether you are a candidate for transplantation or not. You should have your scalp mapped for miniaturization, which will help determine how advanced your hair loss pattern will get. For example, you wouldn’t want to rush into a surgery at 22 years old only to lose more hair as the years pass, leaving you with an unnatural looking pattern. At your age with class 4 hair loss, your pattern may continue to recede further. You should meet with a doctor that can help you form a Master Plan (an outline of your surgical requirements and plans for the future). The use of Propecia (finasteride) should be an absolute in slowing or stopping the hair loss in its tracks. Don’t get me wrong, even at 22 years old you still might be a candidate for a hair transplant, but you need to have a good doctor focus on building your Master Plan that will protect you for years to come.

Tags: hair loss, hairloss, hair transplant, norwood