Why Might a Patient with 6000 Grafts Have a Thinner Appearance Than a Patient with 3000 Grafts?

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

Dear Dr.,
First of all thank you very much for the help you have given on this forum. I have had two HT operation 1000 FUE(1.5 years ago, worked very well) and 2000 FUT (3 months ago). My question is has to do with HT results and I would appreciate if you could answer;

  1. I saw pictures of more than 5K-6K grafts but has poor coverage/appearance compared to some 3K graft transplantation? Even, the pictures are from the same clinic. What are the reasons of this inconsistency?
  2. Most of the pictures show hairlines and first half of the top. How about the crown? Is it a common practice to leave crown bald? Is it because the budget or a bald person does not have enough donor for front and crown so has to select one?
  3. Does hair loss stop or decrease rate with the age? My lost started at age 26-27 with diffuse pattern now I am 31. A diffuse pattern goes till NW-7 or NW-6 or NW-6 with some diffuse hair still on top and crown?

Thank you very much.

Regards

Three months after a hair transplant should not produce enough hair to show any significant results. Wait a full 8 months to see the results of the second surgery.

  1. There could be a variety of reasons for that. Patient A and Patient B could have different hair color, skin color, hair characteristics, degree of balding, etc. Or it could be different techniques used (many clinics have damage problems with FUE grafts, for example). There’s just a lot of variables that could be the reason.
  2. The transplantation of hair in the crown does depend upon many factors, again including donor density, scalp laxity, thickness of the hair shafts, and the degree of balding. It may not be possible to transplant an entire head with a Norwood class 7 pattern of balding, but I have done it in patients with great hair qualities (see Patient ZU here, for example).
  3. Only about 7% of men go as far as a class 7 pattern, about 20% a class 6/7 pattern… and most of these men with the class 7 pattern have clear signs of it before the age of 30. You need to be evaluated by a doctor like myself or Dr. Pak that specializes in this field if your doctor does not answer this question for you.
Tags: hair transplant, hairtransplant, fue, hairloss, hair loss, crown

Educate Yourself to Avoid a Hair Transplant Doctor’s Scam

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

I met with a patient last week who had a spectacular head of hair. On examination of the scalp there was absolutely no miniaturization anywhere, indicating that he had no genetic balding.

He was an obsessive young man who wanted to be sure that he was not going to go bald, as some of his male family members had. Because he needed the advise of a doctor to determine if he was losing his hair and what his future might be, he went to a hair transplant surgeon who determined that he might go bald and needed to do something about it. The young patient showed some maturing of his hairline only in the corners and even that assessment (by me) may be overstated, but because of the power of the doctor’s magnetic personality, the young man was convinced that he needed a transplant and got 800 grafts into the corners of his frontal hairline. The transplant clearly did damage, so he lost hair around the transplant area and many of the grafts did not grow.

Too many young men are receiving hair transplants when they are not indicated, even showing no balding. I would suggest that everyone considering a hair transplant to map out their own hair for miniaturization and if there is none, you can then confidently say that you are not balding and not fall for traps like what this young man fell for. It is unfortunate that many people are preyed upon by surgeons looking to pad their wallets, but you need to be smart about what you’re getting yourself into. Educate yourself and use the tools available online to be able to better understand things. The patient story I described above ended up leaving this young man worse off than before he ever went to see that surgeon. This site is free for anyone to use and learn from, and I am an outspoken member of my community simply because I don’t like to see people taken advantage of. I routinely turn patients down for surgery if I can see they are not candidates or a simple daily pill could be the solution they are looking for.

Tags: scam, hair transplant, hairtransplant, patients, patient, surgery, hairloss, hair loss

Where’s the Scar? Hair Transplant of 1807 Grafts (with Photos)

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

I saw this patient last week for a follow-up and he had a wonderful result from a single session of 1807 grafts in the frontal area. When I looked for the scar to see how well it had healed, I could not find it. The scar was closed with an upper and lower trichophytic closure and the results of doing this make strip surgery more than competitive to follicular unit extraction (FUE). This type of closure allows hair around the wound to grow through the scar, making it extremely difficult to see once it heals. To learn more about this, see Techniques to Minimize Donor Area Scarring. I have been routinely getting this type of healing from trichophytic closures.

The after photos were taken about 22 months post-op. Click the photos below to enlarge.

Before on the left; After 1807 grafts on the right:

 

Donor area – After. Can you find the scar?

 

Tags: hairloss, hair loss, hair transplant, hairtransplant, photos, miracle, trichophytic, scar, healing

Aspirin and Hair Transplantation

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

I take baby aspirin daily as a preventive for heart and stroke, I have no history of either condition but believe it is prudent to take aspiriin daily. I am considering a hair transplant and wonder how long before a procedure should I stop the baby aspirin or is it necessary to stop taking it all? Thanks

Most doctors believe 7-10 days off of the aspirin would be adequate to have any surgery.

Tags: hair transplant, surgery, aspirin, hairtransplant

Maximum Amount of Grafts That Can Safely Be Transplanted in a Single Session

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

My question is if this,if a person had unlimited donor hair and you had all the assistance you could use at your side.How many grafts would you be comfortable transplanting in one session without fear of the grafts not surviving?

I ask this question looking into the future,if hair cloning becomes available.Would it be possible to transplant 5,000 – 10,000 – 15,000 grafts in one session? Thanks for your time.

Flying carMy personal record at New Hair Institute has been close to 6000 grafts in a day on one patient. The patient had a very high hair density and a very lax scalp. He did not need more grafts, but I was confident that if he had the recipient area to take more grafts, his donor area could have yielded another 2000. Keep in mind the most important factor is the skill of the entire staff of the medical group. This would not be possible without a fantastic staff.

As for what the possibilities are with hair cloning — it’s all very much speculation still. Perhaps we’ll be able to hop in a flying car or maybe even teleport to the clinic where you’ll get your cloned hair implanted, then rub magic lotion on it all to get everything to grow wonderfully overnight. It’s fun to speculate on the future.

Tags: hair transplant, hairtransplant, hair loss, hairloss

How Does a Patient Look When Leaving Your Office After a Transplant?

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

Hi there,

I saw screenshots of Jon from Jon & Kate Plus 8 and had some questions:

When a patient leaves the office after the operation, does he just walk out of the office looking like Jon did (in the 3 Immediatley After photos)- without a covering/hat, redness in the forhead, and hair messy?

I just wonder for people that fly into your L.A office for a procedure then fly out straight from surgery- and having concerns about being self concious as they stand in line for the flight back.

It all depends on how bald you are or how much hair you had before the surgery. If you are completely bald, it is hard to not notice some stubble and a few patients may have considerable redness that lasts a few days on the bald scalp, but we provide a hat to cover that easily. In Jon’s case, he was able to cover the transplants by combing his natural hair forward and wearing a hat and also the ‘cover up’ may be dependent upon how you can style your hair. Quite a few patients are undetectable immediately after the surgery.

Tags: hair transplant, post-operative, hairloss, hair loss, surgery

Is Age More Important than Donor Density in Hair Transplant Patients?

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

Hello Dr. Rassman and staff,

Doc thank you for your time, you speak your true feelings and I appreciate it. Ok, I started losing my hair around 19, which wasn’t very fun. Within a few months, I did start taking Propecia. I’m 21 years old right now, Propecia has been working for me but the damage was done early enough. I would say I’m a Class 3 on the Norwood Scale and would someday hope to change that. Personally I would love to have all of my hair back right now but it doesn’t look like that will happen too soon, but I’ll live. The hair loss process actually hasn’t been all bad; it actually has been a good humbling experience for me, although, in the end I plan on winning the battle.

I’m not really looking for a hair transplant in the near future, from what I have read on your website almost every 21 year old isn’t a good candidate. Although, is age always so relevant? I would think the biggest factor would be the donor density. Lets say you have two men who both have the same amount of hair loss (Norwood 4), one in his early twenties and the other in his mid thirties to forties. Wouldn’t a healthy 22 to 24 year old with a high density be a much better candidate than a person who is 35, 40 with an average density?? What’s your opinion on this, also where would someone go and get their hair density tested, would a dermatologist typical offer some type of test?

Donor density and where you are on the balding process are two different variables. Maturity of the balding pattern is also important for that 21 year old you referenced. There are no absolute rules with regard to having a hair transplant, but a bond between doctor and patient is critical in understand the meaning of all of the variables (age, donor density, hair characteristics, donor laxity, etc…) including the maturity and financial stability of the patient considering a hair transplant.

Tags: hair transplant, density, hairloss, hair loss, age, maturity

Eyebrow Hair Stopped Growing After Waxing!

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

(female)
Hello! i use to go and get my eyebrows waxed. The last time i did was about 7 months ago and every since then they haven’t grown back, they are very thin (it looks like i dont have any eyebrows) and there are a few bald spots.. What could of caused that? and is there anyway i can get them to grown back?

If you pluck out your eyebrows all the time, eventually some hairs may never grow back. Think of it as causing small trauma to the hair follicle over and over and eventually the hair follicle will stop producing hair. Wait it out for a full year. If it does not return, you can have a hair transplant to put them back, using hair from your scalp.

Tags: eyebrow, hairloss, hair loss, hair transplant

FUE Scarring?

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

Hi Doctor,

If one were to get a FUE or FUE2, and in the future decide to shave it all, will there be left over dotted scars in the back from the donoring?

What kind of scarring can one expect from FUE or FUE2?

Thanks

PencilYes, any incision made to the scalp will result in a scar of some kind. It is not an entirely scarless procedure and any doctor that tells you there are no scars is feeding you a load of bull. Scarring for FUE will be a small pinhole… like a pencil mark. If your density is low, scarring can be a problem with the follicular unit extraction (FUE) procedure, because the amount of hair to cover the donor excisions will be less. If the density is high, it hides well. Shaving your head like your facial hair, will leave ‘dots’ of white circles measuring between 0.7 – 1mm wide, or if your surgeon used a wider instrument, it will be even wider.

I just saw a patient who had 3300 grafts with a FUE technique by another doctor and the back of the head looked like he was shot with 3300 holes from a pellet gun; few of the grafts grew after a year. Your skin and other factors will determine how visible these scars are with your head completely shaved to skin level — but why would you bother getting a transplant if you’re just going to shave your head anyway?

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

Any Restoration Robotics Update?

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

Hi,

Have you heard any recent news on the robotic hair transplant procedure from Restoration Robotics? I had read a while ago they were conduction clinical trials at the end of this year, but haven’t heard anything since.

Do you know if they are accepting volunteers for the clinical trials? If so I’d be interested in participating.

Thanks

The last I heard was that they were moving forward with clinical trials on a limited basis, and a Google search reveals that they were hiring for a clinical trials manager just a few months ago (see job listing). There’s info about the trials in a posting at HairSite, although it is from about 6 months ago. Unfortunately, Restoration Robotics doesn’t have a website, so it’s difficult to find a central location for their current news.

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

The Story of a 3,000 Graft FUE Procedure Failure

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

Story time! Although I can’t provide photos (by patient request), I’ll do my best to paint the picture…

A man in his early 20’s flew to Los Angeles from Alaska to see me last month. He already had two hair transplant procedures using the follicular unit extraction (FUE) technique — one surgery of 1,000 grafts, and another of 3,000 grafts — by two different doctors (that I won’t name) who each claim expertise in this process. The 1,000 FUE case by the patient’s estimate was about 50% successful, while the 3,000 FUE case had, according to the patient, no growth after a year. The donor area was heavily scarred from the FUE extractions and were easily seen by lifting up the hair. A strip procedure would have produced less scarring than this patient showed now. To compound the problem, those hairs that did grow from the first surgery were placed in a radial direction (like the spokes of a bicycle wheel) and the hair pointed to the sides, not the normal frontal position. So not only was he dealing with a huge failure of growth, but now he had to deal with poor placement for those grafts that did grow! Imagine a person with hair growing out of his head like the spokes of a bike?

This patient most certainly had a low donor density to start. I recommended a strip surgery to harvest the most grafts he can get and with the reduced donor density, I recommended about 1,300 grafts, which is possibly the most I can harvest. Fortunately, his hair loss was only in the first 1 1/2 inches of the hairline and by taking Propecia he might hold the rest of his hair in place, although there is miniaturization behind the frontal 2 inches, suggesting that he might bald further over time. He wanted to look normal, but I could only suggest that I would try to make him look better.

FUE is not a panacea for scars. As I have said here before, the follicular holocaust that is seen in FUE is substantial, even in the hands of those who claim success. This is a buyer beware market. You should always ask to see a number of patients who had the procedure and look carefully at the donor area. Another FUE procedure on this patient will be disastrous (even in my hands), as scarring is clearly a problem.

Tags: fue, hairloss, hair loss, hair transplant, propecia, finasteride, failure, surgery

I Want a Hair Transplant, But I Love Cocaine

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

Hi

I’m thinking of having a hair transplant done but I have a question before I bother to consult with you.

I attend college and with college come wild parties. I spend most of my time studying but I do go to atleast one part per month. I usually like to do cocaine at the party. I do this recreationally and it’s only one time per month at most.

I don’t think I would be able to give up my one party per month for a hair transplant. Is it safe to get a hair transplant if you know you are going to be doing a gram of cocaine every month for the post operative period?

CocaineOh boy. So as a physician, did you expect that I’d be fine with telling you its alright to use cocaine at any point, let alone during your post-op period after a hair transplant procedure?! Come on, now. The obvious answer is to stop using illicit drugs, even if it’s just once a month. Cocaine is not only illegal, but it can also kill you.

I’m not your doctor, but I expect any doctor you talk to will have the same reaction to your question. Now that I’ve given my mini-lecture, here’s a link to another site where another physician has his take.

Tags: cocaine, drugs, illegal drug, hair transplant, surgery

I Still Have Redness After My Hair Transplant Years Ago!

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

I had my first transplant almost four years ago and my second one last October. I STILL have redness on my right side from the FIRST transplant. It is almost as if I got sunburned and that area stayed burned. It is not really bad, but it is bad enough that the transplant area still looks “outlined” making it look a little unnatural. The other aspects of the surgeries are spectacular, just have this one issue. Is there anything I can do about it? Thanks!

This is the type of question you should be asking your surgeon. Redness can be helped with the judicious use of topical steroid, but this is not a good idea without medical supervision as the body can absorb the steroids if you use too much of it. Also, the redness should not last that long — certainly not years, as you describe. Please discuss this with your surgeon.

Tags: hair transplant, hairtransplant, redness, healing

I Make Minimum Wage and Want to Make Monthly Payments on a Hair Transplant

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

i was wondering if it would be possible to start hair transplant as early as 19, ive been losing since i was 17 and am currently taking propecia, propica has stopped most to all thinning around the tops of my head but my hair line is really embarrassing, i barley want to leave my house because of it, and when i do i wear a hat, i have long hair so this is really a stress

also i was wondering if you new of any hair transplant clinics that accepted monthly payments instead of one big down payment, i work a minimum wage job and really have been wanting to get this.

First you’ll need to get an assessment by a doctor to see if you’re a candidate for surgery. Rarely will a teenager be accepted for a hair transplant. We have loans in our office for those people who do not have enough money to pay for the procedure, but that requires good credit.

Tags: hair transplant, hairtransplant, surgery, payment, layaway, propecia

Large FUE Case?

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

Dr. Rassman

What is the largest number of grafts you recommend to be transplanted in one session using FUE? What is the maximum number you guys at NHI have done in one shot using this technique?

Thank you and Happy Holidays to you and your staff.

The largest case we did was 2,800 grafts. The large follicular unit extraction (FUE) cases require high densities of the hair in the donor area. Those individuals who have lower densities generally have from 20-40% less hairs per square inch, so one could expect that yields may be as low as 700 – 1,000 grafts for most — and that is generally people from Asia (like Indians), many from the middle east, and those with African hair. In a Caucasian with an average density, we have done 1300-1500 FUE grafts.

I think that many of you have seen comments made by me — comments of disbelief about the number of FUE grafts claimed to be performed by some dishonest doctors. I’d like to see some more honesty in the industry, but the almighty dollar is more important to some.

Tags: fue, hair transplant, hairtransplant, hairloss, hair loss