Should I Lower My Hairline with Transplants or Just Bulk Up the Existing?

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

Hi Dr Rassman,

I recently visited a very reputable hair transplant surgeon. I am a 33 year old with Norwood 2 recession. My hairline has receded at the sides of the hairline and slightly at the temples. The surgeon recommended that instead of straightening off the hairline and transplanting hair to the temple that due to chances of further recession it would be more beneficial to bulk out the line of the current hairline, totalling 800 grafts/20cm. He was adamant that this would produce the most natural looking results, whereas bringing the hairline further forward would leave open the danger of having a gap between transplanted hair and any hair that further receded (both in the hairline and temple regions; i thought that he was using the danger of further recession as an unnecessary reason. Am i best to follow his advice or go with the look i would like?

In essence he is recommending this type of procedure: link

when i would he more inclined to go with this: link

I am generally not inclined to perform preventive hair transplantation and given the borderline nature of your desires, I would have to evaluate you to determine if your goals are reasonable or not. You must remember that once you start the process, you are committed for life to following back the balding if and when it should progress.

I’d need to see photos of your head at the very least before getting any kind of idea of the best way to go about creating a hairline for you. Unfortunately, I can not answer your question from the photo examples you supplied.

Tags: hair transplant, hairline, hairloss, hair loss

A Patient that Followed Hair Transplant Aftercare Instructions

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

Dear Dr. Rassman:

Thank you for a very comfortable and professional session yesterday. You and your competent staff made my day enjoyable; quite different from my prior experience in the early 1990’s.

I experienced no pain last night before bed at 9 pm and took no medication, until I became a slight bit uncomfortable around 1:30am. I took one Vicodin and one Valium, and slept until 5:30am. This morning I took the Prednisone.

I used one half cup of hydrogen peroxide and one half of cup of water for 5 minutes, as directed. I washed my hair; the donor and recipient areas as directed, and experienced very minimal bleeding in the donor area, a couple of drops in one location in the frontal area, and none in the crown area. There was minimal crusting in the donor area, and it was cleaned with a cue tip. This will be done again tonight. My wife also applied the anti bacteria ointment, as directed. I have not taken any Vicodin today, and am not experiencing any pain at all.

I will wash my hair again before bed as directed.

Best regards

I don’t usually post testimonial style emails like this, but I just received this note from a patient who had 2159 grafts earlier this week. I wanted to show how a patient is following my post-operative instructions for washing and medicating, and isn’t experiencing any pain or heavy scabbing.

The lesson here is for anyone interested in getting a hair transplant — follow your doctor’s aftercare instructions!

Tags: hair transplant, hairtransplant, hair restoration, aftercare, instruction, hair loss, hairloss, surgery

Case of 5000+ Grafts Immediately After Surgery (with Photo)

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

There have been concerns expressed that people that have had a hair transplant look like a bloody mess right after the surgery. When I recently posted a photo of a typical post-op case to another website, some forum members there expressed surprise and disbelief that a patient could not have blood on their scalp as they left our office immediately after the surgery.

To handle any concerns over whether it is actually possible to leave an operating room without having your scalp dotted with blood, I am presenting a case done just last week where the patient received 5,019 grafts in a single session. These photos are not retouched and are typical of 90+% of our patients at the time they leave our office after surgery. The technique that produces this result reflects the instrument we use for site creation. The recipient sites that are made will tighten around the graft to create a mechanical seal around the site and minimizes any post operative bleeding. With good daily washing, the wounds usually do not form any crusts (scabs). If there is any hair present, the patient can often walk around without a hat and be virtually undetectable with regard to the hair transplant visibility.

Immediately after one session of 5019 grafts. Click to enlarge:

 

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

Hair Loss In Scabbed Area

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

About 3 weeks back i had got a bandage wrapped tightly around my head after a surgery i underwent. Since the bandage was tight, initially it hurt a bit for about 2-3 days, after which the pain subsided. The bandage eventually came off about 4 days later(it was on for 1 week in total). a week after it came off i noticed that area (about 1/2cm in diameter) had formed a kind of scab. A week after that the scab became hard and looked ready to fall off. So a few days back while gently scratching that portion of my head, the scab came off in my hand, and along with it a bunch of hairs growing through it. My worry is that, will this hair grow back? The area where the scab was now looks healed. This happened on the front crown portion of my head, just above my forehead. Will the new growth take long? Thanks.

I don’t really understand the anatomy as you described it. Wrapping the head for a week… well, I have never heard of that excepting in World War I when soldiers had head injuries or Hollywood wanted to get audience sympathy. What I do is put a ‘tennis’ type band around the head (like a sweat band) to keep pressure on the donor wound and take it off next morning just before the hair is washed.

Generally, if the grafts have not been pulled out by the head bandage, they should start to grow in 2-5 months after the surgery and then continue at a rate of about 1/2 inch per month.

Tags: hair transplant, hairloss, hair loss, scabs, aftercare, bandage

I Still Had Scabs for Weeks After My Hair Transplant — Is That Bad?

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

hi doctor,
i just had a FUE procedure last month and fine crusts had been forming on the transplanted hair since 1 week after the procedure and it had remained there and even multiply till now! The doctor’s explaination is that i didnt wash my hair properly even though i wash my hair daily. He even said that the crusts will hinder the growth of the transplanted hair which makes me worried! Can i know what is the consequences if the crusts still remain there even after 6th,7th week? Will it really affect the growth of my new hair? Thanks!

It sounds like your washing is poor and the existence of crusts at 7 weeks reflects poor hair hygiene. I agree with your doctor on a better washing approach, but I do not agree that the crusts will stop the growth when the time comes to grow.

Tags: scabs, scabbing, washing, cleaning, crust, hair transplant, hair loss, hairloss, aftercare

I Don’t Want Multiple Linear Scars from Multiple Hair Transplants

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

Hello Dr.Rassman,

Is it true that during the second transplant, the physician can cover the first scar that was caused by the first transplant? I would like to do a second procedure but do not want to have multiple scars as well as one BIG scar. Also, is it true that a scar from the transplant will be visible as the person ages and the hair in the back of the head gets thinner? One last question, can shock loss (loss of hair due to transplant) occur for already transplanted hair when a person undergoes a second transplant.

Thank You for your time

The state of the art today is to limit transplanted scars to just one, even with multiple surgeries. If, for any reason, the scar gets wider (5-10% of people) then a single scar can often be corrected in a special surgery that addresses the need for a scar revision. Some surgeons go into untouched areas of scalp and intentionally produce a ‘step ladder’ set of scars which accomplishes two things: (1) a higher yield of hair, and (2) more dollars for the doctor’s pocket. I generally believe that step ladder scars produce a more unsightly look and can not be fixed easily while a single scar is easier to manage in the long term.

I personally had two hair transplant surgeries 16 years ago and you can barely see my scar and it has not changed (as typical) since the last surgery that had been done.

Your last question addressed shock loss in previously transplanted hair. It is very, very rare and if it should occur (less than .01% of cases) it always returns.

Tags: scars, scarring, hair transplant, hairtransplant, hair loss, hairloss, shock loss

Eating a Marijuana Brownie After a Hair Transplant?

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

Doctor,

I asked you this question in a very log winded fashion the other day without a response, pls let me be more brief….as I am sure you are quite busy and I do realize you have answered somewhat similar but certianly not the same questions. If you are uncompfortable answering these questions I understand so pls let me know and I will not bother you, but i LOVE the blog!!!!

Would you think I would impact my hair transplant yield or donor scar if I eat marijuana(this is all legal) in a brownie or take it in a “marinol” pill via prescription a few times a week? Or have 1 TINY 5 second inhale of smoke daily? Pls let me know, I would love to have my hair and enjoy my life as well.

FYI I am 31 and in pretty good shape.

Thanks

I have no experience with this situation, but I would guess that there will be no impact from the marijuana (legal or otherwise *cough*) on a hair transplant growth rate.

For the record, brief emails do help (as long as the pertinent facts are there), but I wasn’t avoiding your email because it was lengthy. I just get a lot of messages and can’t get to all of them.

Tags: marijuana, pot, hair transplant, hairloss, hair loss, brownie

Hair Transplants for Really Short Hair Style?

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

Hello Dr.

I have a short but interesting question for you.

Is there a way to get a hair transplant which caters to a shaved head? what I mean is, since it’s less important to have such a packed in and natural look when you shave your head; is it easier or cheaper to get some sort of thinner coverage on your head which still looks natural when you shave it really short?

I really don’t know what your expectations are, but I think that the answer is a hair transplant will not add value to your bald areas in the front, top, or crown in very low densities and wide distributions. If you want the easiest and cheapest way to have a shaved head look, use a razor and just take off whatever hair you have left.

Otherwise, the follicular unit extraction (FUE) technique doesn’t leave any linear scar in the back of the head, but there are tiny pinhole size scars that could be visible upon close examination. I’m not sure how short “really short” is for hairstyles.

Tags: hair transplant, fue, hairloss, hair loss

How Long Should I Wait Between Hair Transplants?

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

Hi Dr. Rassman,
I recently had a hair transplant in February and have a few questions:

  1. How long do you recommened waiting before having another procedure? I’m thinking a year (to see results), but would any sooner hurt the transplanted hair?
  2. If you have additional procedures, can the newly transplanted hair be affected by shock loss?
  3. How often do your patients stop using Finasteride after having hair transplants?

  1. I generally recommend waiting between 8-12 months between hair transplants as 80% of the hair will be at styling length by the 8th month.
  2. Shock loss is rare in a second hair transplant within 2 years of the first.
  3. I generally think of Propecia/finasteride as a lifetime decision, because stopping it would allow the progressive nature of hair loss to show and evolve. So I don’t recommend stopping Propecia once it is started. I don’t have statistics on how many patients stop using the medication after a transplant, though.
Tags: shock loss, hair transplant, hairloss, hair loss, propecia, finasteride

Hair Transplant at Early Stage of Hair Loss?

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

hi doctor,
in your earlier blog you said that best time to do a hair transplant is when the hair loss becomes unbearable and you(doctor) has something to work upon.however in your recent blog you said that it is better to have hair transplant in early stage. what exactly in your view is the better option?

For starters, you need a Master Plan to understand what is going to happen to you.

Hair transplants work well early in some men if there is obvious balding, but just having miniaturized hair and some thinning may be better treated with medications like Propecia (finasteride) before considering a surgical approach. Frontal areas, as they bald, work well with hair transplants, while crown areas may take huge amounts of hair that will not meet your needs in the supply/demand ratios of your hair density and scalp laxity.

Tags: hair transplant, hairtransplant, hairloss, hair loss, age, early hair loss

Direct Hair Transplantation?

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

Dear Dr Rassman,

What is direct hair transplanation. Is it different from FUE or strip transplants?

thanks

It appears that this is a marketing term applied by some medical groups for follicular unit extraction (also known as FUE, the procedure I first published and pioneered). Whatever you call it, it is FUE.

Tags: fue, follicular unit extraction, direct hair transplantation, hair transplant, hairloss, hair loss

Does an Area of Scalp Need to Be Completely Bald Before It Can Be Transplanted?

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

I’m curious – in your response you state “Transplants should never, ever be used to build up what you may lose in the future.” Why is this?

Also, does this mean that an area that’s thinning but not totally hairless (in my case, the frontal scalp, or “forelock”) can’t be thickened up until it’s gone completely bald, or nearly bald? I’m confused.

Just to clarify for readers, the above email was received in response to My Crown Is Starting to Thin and I Want to Thicken It Up With a Hair Transplant. Now that we’re all on the same page, I may not have been clear in that posting so I’ll attempt to fix that now.

Some unethical doctors use hair transplants in areas which are not balding and show no miniaturization on the anticipation that it may happen. I do not approve of that practice, nor do I approve of transplanting an area that has minimal cosmetic balding without first using a course of Propecia (finasteride 1mg).

Assuming that you have lost 50% or more of the frontal hair and are obviously thinning, transplants can be done. In this case, Propecia is good to prevent shock loss to the existing hairs. You do not have to go bald before having a hair transplant.

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

When Can the Grafts Come out?

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

Hi there Doctor Rassman, I’ve got a question for you about graft safety/anchoring. It has been roughly 13 days (12 days, 14 hours) since my procedure – I had a temporal/hairline restoration of about 2200 grafts.

My question is simple, at 12-13 days post-op is there any single circumstance that can dislodge a graft? My crusts started flaking off about 9 days post-op. I have been washing using the fingertips to gently massage and soak the crusts, and they seem to be flaking off no problem. Sometimes throughout the day, i will gently massage the scabs with my fingertips (without washing my hair, just dry) and the crusts will continue to flake off. I am noticing hairs in many of the scabs, but I know this is normal.

However, I noticed a few particularly persistent scabs. I did not peel or pull on the scab, but rubbed it much more vigorously with my finger tips until it came off, however, I noticed a slight bit of bleeding in the area where the scab was.

I have two questions.
1) If you do not see any bleeding, but see a hair/bulb in your crusts as they flake off, is it 100% certain that the growth center has not been dislodged?
2) If you DO see bleeding, is that generally a guarantee that the growth center has been dislodged with the scab?

There are no 100% guarantees, but it is probable if there is no crusting and you did not pull out the graft (and it shed on its own), a hair with a bulb after 12 days will leave behind the growth center. See the medical paper I co-authored, Graft Anchoring in Hair Transplantation (PDF file).

Bleeding should not change what I said above, but why are you bleeding 12 days after a surgery?

Tags: hair transplant, hairloss, hair loss, graft anchoring

Will Miniaturization Mapping Show If I’ll Bald Like My Father?

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

I am 24 y.o. male and i’ve been losing hair since i was 19/20. My father (52 y.o.) and uncle (46 y.o.) are NW 4A and i think i am balding the same pattern. I’ve seen many results where people with NW 4A achieved almost complete coverage with 4000 grafts. Is miniaturization going to show if i will be in my 50’s like my father so that i can start thinking for a HT? I think I’m too young to go for a HT and end NW6.

Mapping out the scalp for miniaturization can be used to forecast balding patterns, particularly if your eye is telling you that you are losing hair. For a Norwood Class 4A pattern, 2500-4000 grafts can do a good job depending upon the thickness of your hair. Finer hair takes more grafts than coarser hair.

Tags: hairloss, hair loss, hair transplant

I’ve Been on Propecia for a Year and I Got Shock Loss After a Small FUE Procedure

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

Dr. Rassman,

I have used the search function and read all about telogen effluvium and shock loss post-transplant. I just had a very minor FUE procedure of 400 grafts performed a few days ago.

I have been on Propecia (1 mg) for over a year and have diffuse alopecia. However, I am now experiencing hair loss all over my head (including what I believe to be the donor area). Is this telogen effluvium from the shock of surgery or just ordinary shock loss? The doctor said it was probably just some shock loss. What the are long-term effects of something like this?

I notice the hair loss by doing a gentle (very gentle) pull test in all areas. Thanks for your help.

I honestly do not know. I am not trying to brush you off, but every case and every patient is different. What is your age? What did your hair look like under miniaturization mapping prior to your follicular unit extraction (FUE) procedure? Did you have diffuse unpatterned alopecia (DUPA)? If you had done a proper pull test, you might have developed a telogen effluvium (TE). Differentiating TE and shock loss may be difficult at this time. If you had DUPA, you could be at the forefront of disaster. If it is TE, then the hair may return, but if you are under 30 years old, I would want to know, because shock loss is often permanent in the very young men. For shock loss, it does not matter if you had a small surgery or a big surgery, as just the anesthesia can precipitate the process (even without the surgery).

This question points out a series of problems for me when trying to answer some questions here. I sometimes get minimal information and am asked about diagnosis and prognosis. What I do when I see a patient is get a complete medical history, including significant discussions on the hair loss history. Then I perform a very thorough examination, which includes mapping the scalp for miniaturization. I put it all together at that point. As you can see from the above email I received, when little information is available to me it is difficult to really help.

Consider a visit to my office for an appointment and then maybe I can help you more extensively. The cost of a trip to Los Angeles has to be minimal when compared to a large amount of hair loss, which is priceless. Or please speak with your doctor regarding this matter. In your case only time will tell and following it with your doctor may give you some comfort in what is happening to you.

Tags: hairloss, hair loss, telogen effluvium, shock loss, fue, hair transplant, propecia