Hi Doctor,
Does swimming in the sea(since summer is hot here) can affect the 7 months transplants? Thank you
You can go into the sea anytime after 3 weeks safely (possibly earlier). I tend to play everything on the conservative side.
Dear Dr Rassman,
thanks for creating such an informative website. I was wondering, how profitable is the hair transplant industry? What is the difference between the actual cost of the hair transplant and the price surgeons charge (i know price varies from surgeon to surgeon but an approximate would be useful).
thanks
The hair replacement industry is a multi-billion dollar industry. The difference in results between medical groups is highly variable because the surgery is NOT standardized. As such, the consumers (patients) are mostly left with the burden of researching through a massive number of ads and advertorials on late night TV, though these days there are many web forums that allow consumer input. The difference in cost is highly variable. I have seen and heard of surgeries that range from $1000 to $100,000!!! A few months ago I saw a patient who came to me for a second opinion after spending $152,000 on a hair transplant surgery and was angry that he did not get good results.
On the average, I believe the cost of the surgery as we do it at New Hair Institute should be between $3,000 to $15,000 depending on the number of hair grafts a patient needs. The cosmetic industry has hit hard times lately, so gross revenues are down, bringing down profits to marginal levels. When the surgeon uses experienced teams, the cost of labor is high (our practice) as we pay good wages and expect long term people to stay with us.
Hello doctor Rassman. I know you have answered similar questions like this one before however I would still appreciate some information. I was thinking about getting a hair transplant about two years ago so I went to Bosely but decided not to go through with it on account of the sales people and how I did not believe they cared about my best interest. I have done a lot of research on the many different surgeons and techniques available in the field of hair transplantation. I have come to the conclusion that if in fact I was to opt for a hair transplant, follicular unit extraction will be my best option and only if performed by a highly qualified surgeon such as yourself and a few other qualified surgeons (all members of ishrs). I am currently a norwood 6 receding hairline, loss in crown, and diffuse thinning (typical mpb)and more than likely will advance to a norwood 7 as I age. I have been shaving/buzzing my hair for the last two years and am ok with it. I have begun shaving it recently due to more loss in the frontal region.
I have real specific goals for my hair loss and am a little unsure whether or not my goals are realistic. I wish to add hair along my receded hairline (not lower it) so that it may be more defined but still mature, and go back to buzzing my hair to a #2 or #1. Eventually I know my hair loss will progress so I still wish to have the option of shaving my head but still have a vague hairline. Basically what I want is to have a noticeable hairline buzzed and/or shaved. My main concerns of course are future hair loss and scarring. As long as it looks natural as I age and cannot be detected, I am fine even with limited coverage. I understand that fue is not completely scarless however since I am looking for coverage rather than density, my hope is that less grafts can be used sparsely to create a sort of illusion of stubble on the front and frontal mid portions of the scalp without risking over scarring. I hate to throw this in there but I heard that one may to minimize scarring is to add body hair to the donor area at the same time the grafts are dissected. Although it yields a lesser success rate than that of head hair, it may be a good idea in this particular situation as a filler as I am all for more coverage if possible.
I realize that the only true way to answer this question will be to examine me and do the fox test to see if this can even be accomplished, but lets say hypothetically that I am a good candidate for fue. Can this be accomplished? I would definitely prefer some hair on the top of my head than none even if shaved. Thank you for your time Dr. Rassman. I will be sending this message to two other ishrs surgeon members for their opinions.
P.S.-If you need some pictures to get an idea of where I am ,that is my hair loss, feel free to ask. I will be taken some soon.
It’s really hard to tell if what you’re asking for is even possible for you. So yes, please send extensive pictures (and reference this post). If you have adequate density and are becoming a Norwood Class 7, you will need a careful analysis of the various Master Plans with a transplant. This is far too complex to cover here and elements of this have already been discussed by me on other posts. After sending me your photos, arrange a free telephone consultation with me (310-553-9113) and I will then cover as much as I can without seeing you, since I assume you are not near either of my California offices. If you can make it to California, that would even be better for an in-person examination.
I recently met a prospective patient (Asian male) with a very low hair density who kept his hair very short. He wanted a follicular unit extraction (FUE) procedure and I strongly advised against it as in his particular case, the tiny white punctuate scars he would get from FUE might become detectable. His skin was a dark olive color. He did consult with another doctor by phone who told him after seeing his photos that he could easily get 4000 FUE grafts in the first session followed by 3000 in a second session and that he would have a reasonably full head of hair.
We then discussed a strip procedure and I told him that in a single session he might get approximately 1500 grafts, yet still another doctor told him that he easily could get 3500 grafts from a strip session. The prospective patient asked me why these other doctors were so enthusiastic about the surgery they recommended and why I was so low with my estimates on the strip procedure. I told him that I was an ordinary, mortal doctor with human limitations and he needs to understand that this is more than a number difference because the doctors may be talking about different things. I always talk about follicular units which is the graft count that I obtain at surgery. In other words, I’m not going to recommend something to this patient that will ultimately not be in his best interest and I am not one who victimizes patients for what they have in their wallet by charging for something that is not a follicular unit.
There is math and economics in these various estimates. For example, this patient’s graft count could be pushed higher if the grafts were divided so that each graft would have less hair. What one doctor calls a graft (1-3 hairs each) another doctor can cut down into grafts that contain less hair each (shifting to mainly 1 hair grafts) and get the illusion that there is more ‘value’ because the number of grafts is higher. If the amount of hair is say 5000 hairs, one can produce grafts ranging from 1500 to 5000 grafts from this hair count. So first, one has to define what the doctor means by a graft, does he cut them down into small units to get higher number of grafts? Economically for the doctor, it is better to cut these follicular units down (in the number of hairs each) because the fee is based upon the number of grafts. So more grafts means more money for the doctor (and higher fees for the patient). What matters is not just the graft count, but the total amount of hair that is removed in the procedure. Then add to that the way it is divided into small hair units (ideally it should be true anatomical follicular units). In the case of a strip procedure, the value would reflect the ‘area’ of excised scalp. Grafts should reflect the normal anatomy of the follicular unit that G-d created, not one that the surgeon invented (a subset of the follicular unit devised to push up his income).
We are not all equal with regard to the amount of hair that can be moved in a single session because the hair density between people can vary significantly (some people have more than twice the hair density of others). Also the looseness of the scalp may mean than in one patient twice as much scalp can be moved than in another patient. Merging these two measurements, when comparing two people, the maximum safe capacity for moving hair can reflect differences of 4-5 fold. I believe what is ethical from a fee point of view, should reflect the amount of work that the surgeon and his team invest in performing in the surgery. That is why, if true follicular units are what is counted, then the ‘apple for apple’ comparison is appropriate in the calculations for value. A patient should demand knowing that he is receiving follicular units, and not a number reflecting a subset of the follicular units for the purpose of pushing up fees.
We spent some time talking about what he could and could not expect. Expectations really reflect the amount and distribution of hair used in the transplant. The issue of value discussed above, should reflect the number of actual ‘true’ follicular units removed. It is wrong for not educating the patient. A doctor who did not take the time to review what he was going to do, how he was basing his graft count, what constitutes a graft and how he determined the charges for each graft is not doing his job. If you know this information, then you have done the proper research and you have a better chance of getting what you are paying for.
For further reading, plenty of similar links to past blog posts can be found here.
Dear Dr. Rassman,
In one of your previous posts, you said that a scar from a strip surgery will be at about 80% of healing after 6 weeks. From that logic, I wonder if keeping the staples longer after a strip surgery (for 6-8 weeks, rather than the usual 14 days for instance) would help in getting a better scar…
I know that for practical and cosmetic reasons, keeping the staples longer can be problematic for many people, but in special cases where there is more tightness due to past surgeries (or a history of enlarged strip scar) wouldn’t this be a good solution to help getting a finer scar?
Or, would this in return create other problems such as:
1-skin growth around the staples?
2-Train marks?
3-Shock loss around the scar?Thanks for your help
Scar formation and wound healing is not that simple. Aside from the technical aspect, everyone heals differently and scars differently. Leaving staples in for about 10 to 14 days is what we generally do. We leave the staples in for up to 21 days in some patients. Sometimes leaving staples in longer will cause the familiar Frankenstein or train track marks (as you state).
In the end there is no universal solution to closing a tight scalp. One solution does not fit all patients and it is up to the physician to address it on his/her individual basis. I know this may not be what you are looking for, but it points to the fact that sometimes there is just no specific answer. Leaving the staples in for 6-8 weeks will cause undo pain in most patients.
I am someone who currently is probably not the best candidate for a hair transplant but may be interested in the future if my pattern of loss continues. While the FUE procedure looks like a desirable option it is expensive for someone on my salary/budget. I’m curious about how much the cost of hair transplantation has gone down or up in the past and what that could mean for the affordability of hair transplants in the future. Also, I understand that the costs of hair transplants vary based upon the quality as well as other factors but Im wondering more from the perspective of the hair transplant industry as a whole. Any thoughts would be appreciated. Thanks!
Hair transplant pricing follow the rules of supply and demand. There are discounters who sell it for less and many of these discounters will not provide the same quality. Quality is defined by the percentage of grafts that really grow and the art of the distribution of the hair. Price ranges from follicular unit transplants range between $15 and $2/graft depending on where you live. FUE (follicular unit extraction), on the other hand, seem to have a slightly higher rate ranging from $20/graft to $7/graft. Because of the recession, prices have dropped. We have dropped our FUT (strip method) pricing by 20% to reflect the hard financial times in the economy. See our fees here.
I had a transplant in August, 2007. Needless to say it has been over a year and a half, and to my sadness and distress, I have yet to see ANY results. I had a full head of hair going into the surgery, and I went to Mexico with the doctors of a medical institute there, maybe that was my first mistake.. I was 21, and I am a female, and now I find I might not even have been a good candidate to begin with. The doctor just looked at me and told me that I was a good candidate. My hair had a diffuse thinning, but still there was quite a bit of hair stil left, something I wish I would have appreciated before. After the surgery, my hair fell out. I was patient, thinking it was shock loss and it would be temporary, but it has been more than a YEAR and the hair never came back. Fortunately I can use powders like Topikk all over my head to fake a full head of hair, something not necessary before, and my hair is much thinner than before. Does this seem like shock loss and is it permanent? I am upset over this and stressed out, but I would like to know what the future holds for me. Any help given would be greatly appreciated. Thank you.
This is quite unfortunate. Hair transplantation on a 21 year old woman is usually performed by doctors who want the money and do not care about the patient’s welfare. Indeed, about 80% of women with hair loss are not candidates for hair transplants and may suffer the same outcome that you did. You should have had a full medical work-up to include many blood tests for medical conditions that could cause female hair loss. There is even a genetic test for the inherited form of genetic hair loss. This remains a buyer beware market.
It might be worthwhile visiting me in my Los Angeles office. I could then confirm for you what may be going on and possibly give you some insights into what may happen to you in the future. I may even be able to suggest treatments for your hair loss. As your surgery was over 20 months ago, you should’ve seen some growth by now if the surgery was successful.
Firstly, I would like to thank you for your input on the website; I’m a daily reader. I have read your previous posts regarding preventative transplants. I am in my late 20’s and essentially had a first transplant done 1.5 years ago in what was pretty much a preventative measure. The transplant definitely had the impact of which you speak, namely causing native hairs to fall out, replacing miniaturized hairs with a lesser number of transplanted hairs. My transplant was only done in the front portion of the scalp, not touching the crown. I was not taking Propecia before the surgery, although there is doubt as to whether or not that would have prevented the shedding. Either way, I now am being told the following from my doctor, whom I trust and with whom I’ve developed a very good relationship:
- The procedure was not wasteful as if we had waited 1-2 years, there would have been less hair to camouflage the procedure.
- You did lose some pre-existing miniaturized hairs, but gained permanent, terminal hairs that give much more of a cosmetic fullness than miniaturized hairs.
- It is disappointing that you did not get the full potential cosmetic fullness because of miniaturized hair loss so the relative change wasn’t as great as you had hoped. But if you had waited there would have been less hair to camouflage what we were doing, and you would have been perceived as having more hair loss going into the procedures.
- For now you can go on Propecia for 6 months to help maintain hair and perhaps beef it up somewhat. Then you may have a 2nd and 3rd procedure at some point for the frontal half of the scalp to get the density you can get with transplants. You can also do a second procedure at any time, and I know you will feel that much better when that second session is in and growing.
My questions at this point are the following: Should I do another transplant now or should I wait longer? I’m told that 70% of the hair in that area now is transplanted hair and that I wouldn’t really get much if any shock loss from the next one as there are very few miniaturized hairs between the transplanted hair. Should I take Propecia before going to another transplant and if so for how long or does it not matter because there will not be anymore shock loss?
Thank you for your answer. I have had a great experience with my doctor so far and trust him to the fullest. I simply post as an educational measure for myself and for all other readers as I think this is a topic of great interest to younger men in the initial stages of hair loss.
I am a bit critical of your doctor for not using Propecia prior to your first surgery, as this probably would have prevented much of the hair loss you experienced. Propecia (finasteride) is very important in young men having transplants to protect against shock loss. Anytime after 8 months you can follow up with another procedure. Best this time to be on Propecia before hand.
I recently underwent a 1700 FUT procedure in the temples with a very respected surgeon. I followed all post-op instructions. A day after the surgery I noticed that the incisions on the left side temple looked closer than the right and I could see more hair coming from them. It is now 13 days post op and all scabs are gone. It seems that the hairs are more dense on the left side of my head than right.
My question is if the density of the hair I see that was transplanted is indicative of the final density I will see? If the right side looked less dense a day after surgery and looks less dense 13 days after surgery does that mean it will likely be less dense in the final result or can small hairs be transplanted below the skin hence not being seen until they grow out?
What you see is what you will probably get. Ask you doctor about it — maybe he did it intentionally as part of a plan he had for you.
I heard many excellent reviews about your work on Hair/eyebrow transplant, I wish to ask you a few question regarding a procedure. do you do eyebrow restoration? how often do you perform this procedure?. how much would it cost? I enclosed several photograph regarding the area, the scar is about 6cm long and 1/3 cm wide.
I done a procedure with another company back in June 27th, but they only put in 30 (as supposed to 100-150 recommended by most doctors). It’s almost 3 months since [my transplant], I already begin to see 10 follicle grow out. when do you think I can do a 2nd procedure? beside Rogain, is there any medication I can do to speed up the growth? I heard follicile transplanted to eyebrow usually grow faster then those transplanted to scalp? What’s the reason beside the difference?
Since scalp hair is different than eyebrow hair, what do you usually do to make the result look more natural? Thanks for your info!!
It sounds like you were given far too few grafts. Generally it takes 300-400 grafts to complete an eyebrow transplant. We charge about $3000 for eyebrows, but if I do it, it will be $4000 as my fee is higher. Dr. Pak is my associate and he is terrific and his work is impeccable. I would consider another transplant after 6-8 months. By that time all of the eyebrow hair will have grown in. Eyebrow transplants are with scalp hair and grow at about the same time as if it were transplanted into the scalp. In other words, it does not grow faster than when it is put into your hairline.
Dr Rassman,
You may or may not have seen this post on the online forums that you visit. Dr Shapiro was the only Dr to answer these questions and as a reader of the forums i wanted to see if you would answer them about NHI?Do all NHI’s surgical technicians have valid, unrevoked, or unsuspended certificates/licences? Do they place the grafts in the receptor sites during HT surgery? And if they do, Is The surgeon in the room all the time with his HT patient,supervising that process of grafts transplant?
At the New Hair Institute, our technicians were all internally trained by me. They are not certified by any state agency. If you check with Dr. Shapiro, you will find that I was the doctor who trained him in FUT. Our technicians do both cutting and placing of the grafts and the surgeon is either in the room or close by checking on the progress of the technicians frequently. As these technicians have been trained by me, I know what is happening at all times. I am supervising everything that goes on before and during the surgery. Either Dr. Pak or I usually see the patient the next day when we wash the hair and make sure that the scalp is clean of all crusts (mostly done on the day of surgery).
The quality of the technicians determine the results you will get after 8+ months have passed. I recently met with a patient who had over 4000 grafts from an experienced doctor (at another clinic) with what I suspect was a very weak and inexperienced team. When I viewed his results 1 year after his procedure, it was evident that there was easily a 90% failure of the grafts to grow. If the surgeon does not have absolute control over the technical process minute by minute and the technicians and nurses are not very experienced, these large sessions often fail. Here I am just questioning the quality of the technician work in this particular patient. Many doctors have difficulty in hiring experienced people, particularly if they attempt these large sessions and hire inexperienced people. The sloppy work by many itinerant technicians reflects poor training and the patient becomes a victim, never aware of what is happening to him. Even the technicians are victimized by the heavy workload of a very large surgical case and few can manage the tedious work for hour upon hour (e.g. often 7-9 hours for a 4000 graft case with a highly experienced and competent team).
The tragedy here is not just the wasted money (for many people their life savings) but the depletion of the donor hair supply (an invaluable and non-replaceable resource). I warn patients all of the time that as they do their diligence, they should command the ‘team’ nature of this surgery and not go for the least expensive bargain available. This patient paid $2/graft and lost a considerable amount of his donor supply. To say he got what he paid for would be insensitive on my part.
I’ve been losing hair for years and heard that nothing really works unless you get a hair transplant or use rogaine.Transplants look horrible and are quite expensive, and they say Rogaine does not work for african american hair.There are a lot of topical solutions out there.I’ve been told that products like carol’s daughter,doo gro, and a product by a company called hairobics do some good. Can you give some advice.
thanks
Judging by your email, you haven’t looked into hair restoration (medical or surgical) in the past 15 or so years. Hair transplants done with old pluggy technology 20 years ago might look horrible, but transplants done today look very natural. Cost can be up there depending on your hair needs, but it’s a surgical cosmetic procedure that lasts forever.
I don’t know who “they” are that says Rogaine doesn’t work for African American hair, but that’s not true. Rogaine (minoxidil) and Propecia (finasteride) are the only FDA approved hair loss medications and are proven to work. I’ve seen fantastic results with Propecia, in particular. You can try any product you want (those that you mentioned look to be herbal supplements and shampoos), but I personally like to go with the stuff that is actually proven to do what it says, with actual peer-reviewed medical studies to back it up. I think your first step should be to see a dermatologist to find out more about your options.
Hello Dr. Rassman and Staff
I am norwood 3 pushing 4. I recently had a FUHT with a very respected surgeon. I was transplanted 1500 grafts and ended up having a few hundred grafts left over after all of the desired areas were filled in. The left over grafts were placed behind the newly placed ones in the healthier hair. These grafts ended up being preventative grafts. This minor mistake was done by accident but if you know your likely to lose the hair why isn’t it a common practice to transplant more grafts for major preventative measures? (Initially we even planned for some preventative grafts but it ended up being more than what was planned.)
I have objected to preventive hair transplants for many years, because they line the doctor’s pocket with money and do not offer much for the patient. Preventive hair transplantation is quite common and many times they induce further hair loss.
On the other hand, extra grafts are not uncommon… and when I have them, I increase the density in the transplanted area. A well planned surgery should have predicted the ‘overage’ of grafts. When I see doctors performing preventive hair transplantation, I add them to my personal “bad doctor list” (which I never share with anyone).
I have very little hair. I have very little hair anywhere on my entire body (except my eyebrows and chin hair). What little hair I actually do have is very thin and very fine. For my entire life, I have never had much hair. I am a female and tired of not having enough hair.
I cannot believe you cannot easily take some hair off a dead person (their not going to need it anyway) and use it for hair plugs. The body will actually reject hair plugs from another (dead) person? I thought hair transplants were superficial and not “deep” implants? I could not take the hair from my back or side of my head (or anywhere else other than eyebrows & chin) I simply do not have enough hair anywhere. I’m not losing hair, I simply never had enough.
Is it possible to get donated hair plugs from a son? My middle son has tons of beautiful thick hair (like my husband) and has offered to donate some? I’m tired of wearing wigs. DNA wise, I took after my father, hardly any hair. Got a very raw deal for a woman not having enough hair in this society sucks.
I’m tired of not having enough hair to be considered “average” looking. I’m tired of wigs. I’m really tired of hearing other women say “oh I have too much hair, it’s such a pain”. At which point I am tempted to rip some of their “too much hair’ right out of their head.
Nature plays dirty tricks on us (genetically). But if you use the hair of a dead person or even your son, it will be rejected just like any organ transplant (kidney, heart). The medications to stop rejection are dangerous, and as hair transplantation is not a life-saving procedure, the risks wouldn’t be worth it. I discussed this before here.
I recently had a hair transplant. I started shedding my newly transplanted hair on day 9 and lost most all of it shortly after. I started noticing new growth around day 24. Is my growth ahead of the average patient? Will my hair growth be suffice before the 8th month? ( I’m also very young and very healthy.)
About 5% of patients get growth within the first month, but most do not. Consider yourself lucky if it continues.