Sterile Spray on Scalp After a Hair Transplant?

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

Hello Doctor

What is the use of the sterile solution that one is supposed to spray his head with for three days after a HT? Is it just to hydrate the skalp or is it vital to transplanted graft surviving ? What happens if someone , for some reason , doesnt spray his head for several hours ? And how many hours could jeopardise the survival of the grafts ?

thanks for your time

I’ve never recommend sterile spray for patients after a hair transplant, so if you miss your spray, I would doubt it will cause you any harm. I wouldn’t even know what the spray contains. Ask your doctor about it, as he/she seems to believe in it.

Tags: hairtransplant, hair transplant, spray

Hair Transplants in the Frontal Hairline, Hair System Up Top

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

I have used a hair system for a few years. Some seem to be better than others,but I am looking for the most undetectable result. I thought of having partial hair transplants done in the front- this is the area most detectable as fake. Have you any ideas of the best possible solution for me?

What I can tell you is that the combination of hair transplants in the front and a hair system behind it works for many people. You are correct in that the hair systems are generally easy to detect in front, so if you have a good hair transplant in front of the hair system, you will have considerably more freedom in styling your hair.

Tags: hairtransplant, hair transplant, hairloss, hair loss, hair system, wig, hairpiece

Lost Hair From Previous Transplant Due to Shock!

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

I had four sessions done between 12 and 15 years ago. My hair looked great. About a year and a half ago I noticed that my transplanted hair started thinning out in the front making my hairline look rigid. I recently had another session (same doctor) and I experienced a shock factor – which I didn’t experience before. It has been six months since the last session and the results are not promising – the hair that I lost due to shock has not returned and I believe many of the new grafts have not started to grow.

Do you know why –
1)My transplanted hair started to thin out in the first place
2) Why the hair I lost to shock (transplanted area) has not returned and why the new hair is not as prominent as I thought and
3) Do I have hope? Help.

First, you must wait another 2-3 months for long telogen cycles to reverse. I have never seen a previous hair transplant lose hair and then not grow back. I have seen about a dozen men who have lost previously transplanted hair, and it always came back. If the new grafts did not grow, then I would worry if that ran in parallel with your previous lost grafts. Ask your hair transplant doctor and get his/her advice after another 3 months, then write again to let me know the status (reference this post when sending).

Tags: hairtransplant, hair transplant, shock loss, shock

Is Thinning on the Sides Ever Normal?

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

Dr. Rassman,

my hair appears thinner on the sides of my head, I do not mean the temples, but the area above the ears and side burns. is this a normal part of aging or MPB? does everyones hair thin a little on the sides? or does this mean I am heading toward an extremely advances form of hairloss?

I am on proscar and I have already had a transplant (to the frontal region) with a reputable surgeon in Ontario, Canada

thank you for you input

Some men will thin out their donor area. You should be your hair mapped out for miniaturization to see if you are developing a problem in the permanent zone. One should quantify the thinning. Without a good examination of you, I really can not tell you what is going on.

Tags: hairloss, hair loss

I Think I’m Too Young for a Hair Transplant, So I Want to Use a Hairpiece Until I’m Old Enough

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

Hello NHI physicians,

I’m thinking about getting a hair transplant in the future, but at the moment I think I’m a bit too young for one (under 25). I have diffuse MPB on the crown (it’s quite severe), and am thinking about shaving the top off and using a hair piece/hair system until I reach the age when the MPB is more stable.

My question is, would the glue or bonding method from using a hair piece damage my scalp in any way that would prevent me from getting a hair transplant in the future?

I appreciate all the information you all have provided on this site.

ToupeeGlues, tapes, and even clips are methods used to hold down the hairpiece to the scalp, which can cause even more hair loss. These will likely not prevent you from getting a hair transplant in the future, but you’re running a huge risk of causing yourself more trouble with hair loss. Weaves also cause traction alopecia. There is really no way around this. The decision to go with a hairpiece is a more common decision than those that want hair transplants, possibly because of the perceived cost difference and/or the fear of a surgical procedure. The choice may be a very expensive one, however, as the 5 year cost for a hair system can run well over $15,000. See My Hair System Cost Me Over $16,000 In 5 Years! for a breakdown, as sent in by a patient.

If you are losing your hair from MPB, be sure to also consider finasteride. This is a prescription medication and requires you to meet with a doctor.

Tags: hairpiece, hair system, wig, toupee, hairloss, hair loss, glue, tape

Plucking Out My Old Hair Plugs

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

I had one procedure done around 10 years ago. I was young, and like many, I jumped without doing too much research. I’m glad that I stopped at the one procedure. Now I’m looking for a way to reverse the whole thing. The scar is hard enough to keep hidden, but the hair plugs are even harder to deal with. Is there any way to get rid of the transplanted hair besides shaving it or tweazing it? Tweazing the 600 grafts takes too long, and like a beard, they grow back a few hours later after shaving them. I thought about lazer hair removal, but I’m worried that it will permanantely damage the dormant follicles, and with just my luck, they’ll find a cure a week later!

I really do not know your specific problem and the extent of the “pluggy” appearance to give you a personalized opinion. However, it may be almost impossible to completely undo old (or new) hair transplants, because a hair transplant is permanent. It goes to stress the importance of good research and being able to see the results of patients from the doctor as well as the medical group you are having the surgery with. Even 10 years ago, the pluggy transplants were not standard care.

You can try laser hair removal, but you may be left with scarring if the old grafts were the large plugs. Large plugs often leave a cobblestoned skin and depigmentation where the plugs were. Sometimes, these can be cored out, but an experienced hair surgeon needs to evaluate you for this option. Otherwise you can attempt another hair transplant to disguise the old plugs.

For more information on repairing old hair plugs, please see:

Tags: hairtransplant, hair transplant, fue, plugs, hair plugs, repair

Math Problem — Making a Class 7 Look Like He Has No Hair Loss

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

This is a follow-up to last week’s How Many Grafts to Give Dick Vitale Hair Like Brad Pitt?

Doctor by saying you would need 40000 hairs to give mr Vitale the coverage mr Pitt has, do you mean that 40000 hair could produce the coverage but not the density? Cause otherwise the numbers don’t add up. A head like mr Pitt’s has at least 100.000 hairs right? Now, assuming that Vitale has kept about 10.000 hair at the back of his head : 40.000 + 10000 = 50000

What am i calculating wrong?

Brad PittWe at NHI have produced wonderful, full-looking heads of hair with a total of 50% of the original density. If Brad Pitt would allow me to pull out every other hair behind his hairline, I don’t believe that you would be able to tell that he lost 50% of his density. One doctor actually did this on a human volunteer and found (using good photography) that in this white male with black hair, observers and photographs could not tell the difference. The contrast of the black hair against white skin is what makes this most interesting.

This is an important observation, because if 50% is the amount of the original density a white male with black hair needs to appear full, then a white male with light brown hair may only need 20-30% of his original density, and a white male with blond hair may only need 10-20% of his original density to look full. The color contrast also extends to dark skinned people who have matching hair colors and they may behave just like the blond hair white skinned man I discussed above.

Tags: math, hairloss, hair loss, hairtransplant, hair transplant, vitale, pitt

Numbness Months After Hair Transplant

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

I am still feeling numbness over the area of my surgery 2 months after the procedure. Is that normal?

I assume you mean numbness in the donor area (back of the head). Your doctor should check for numbness over the distribution of the major occipital nerves if the numbness is very wide. Most people who feel some numbness are experiencing the cut cutaneous nerves just above the incision. These should not extend more than an inch and they should return in time. Best to check with the doctor who performed your surgery.

Tags: numb, nerves, numbness, surgery, hairtransplant, hair transplant

Reader Says He Discovered the Hair Transplant Miracle-Gro!

/by William Rassman, M.D./4 /,

Miracle-GroHello! I’m a 55-yr-old guy who’s had several HT procedures over the past 20 years. My last two were performed by different surgeons (both well-respected in this field), and both times I was surprised and delighted to note astounding growth of newly-grafted hair which I believe resulted from my coincidental use of a unique nutritional supplement. At six weeks following surgeries, I already had a solid half-inch crop of thick, colored new hairs which continued to grow like crazy. My current HT doc is starting a small trial with this supplement next week. Would you be interested in hearing about this? I think I accidentally discovered HT Miracle-Grow!

Sure, please keep me in the loop. I try to keep an open mind.

Update:
The person that sent me this email has told me that he’ll send me updates when he can, so I’ll post more information as it becomes available. In the meantime, take the above for what you will. Anyone want to wager a guess as to what this supplement could be?

Tags: hairtransplant, hair transplant, miracle gro

Neck Hair and DHT, Follow-Up

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

This is a follow-up to Neck Hair and DHT

To further elaborate about my earlier question about neck hair being prone to DHT. When I say neck hair I mean the normal hair that grows from the base of the scalp toward the neck. Not body hair. You know where the hair ends on a guy when he gets his hair trimmed. I have a very thick density from which the surgeon says would be a great alternative donor supply for FUE.

Will that be a good choice to gleen hair from and not worry about DHT? I hope the question is clearer. thanks

Sorry, but that still doesn’t help me. Neck hair starts at the notch at the base of the skull. The hair at and above the notch is scalp hair. Where exactly is the hair you are talking about? When you touch your chin to your chest, does the hair in the area of your focus tighten? If so, it is probably neck hair.

If you’re in California, why not visit me and I can tell you in less than a minute? If you can’t visit me, send me a good set of digital photos (reference this post) and mark where the notch on the midline of your skull is in the back of your head.

Tags: dht, neck hair, neck, hairloss, hair loss, hairtransplant, hair transplant

Does FUE Produce Higher Hair Counts?

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

Getting confused here.

I read that the average hair per FU for strip is 2.0. On the other hand I read that average hair per graft for FUE is 2.3 or higher. Is it correct that FUE produces higher hair counts, and if so how come ?

With follicular unit extraction (FUE) you can select how many hairs per graft you want, while with strip harvesting what you get is the average density in the strip. That means that if you want a higher hair count per graft, in theory FUE will give it to you if they are present in the donor area in adequate quantities.

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

Had 3 Transplants 20 Years Ago, Now I Am Losing Temple Hair

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

Dr. Rassman,

Great website. I am a 50 year old man who had 3 sessions of transplantation in my early 30s. I now am in need of another procedure as my lateral hairlines have become bare, ie temple areas. I still have a good deal of donor supply in back but am not looking to use Propecia, in the past it did cause sexual side effects I was not willing to put up with. What are my chances of success and how common is it to need an additional procedure or 2 as we age? Thanks

I can not tell you how much hair you have left to transplant in the areas that are thinning, as I do not know the following about your case:

  • what procedures you had done in the past
  • how much area of donor supply was moved
  • what your donor density is
  • what your scalp laxity is
  • what your Norwood classification is
  • what your residual donor supply looks like

It sounds like you had your surgeries prior to the advent of the megasession and follicular unit transplantation. It is not unreasonable to have more surgeries as one ages and one continues to progress in the balding process provided that you have a Master Plan which deals with change and hair loss over time. The supply of donor hair is critical in the formulae. If you want to send me some photos I would be glad to look at them and give you better advice (please reference this post when sending).

Tags: hairtransplant, hair transplant, megasession, fut

Folliculitus Decalvans and Hair Transplantation

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

Doc,

I have something between reoccurring folliculitus or folliculitus decalvans, depending on which doctor (i’ve been to a few) you ask. I have had a biopsy. The problem is located on the crown of my head. Subsequently, there is bald spot on the vertex of my scalp (about the size of a dime). Assuming I can get the infection to go away, is this something that can be cosmetically repaired?

Thanks for your input

If you have folliculitis decalvans and you can get the infection under control, any type of repair work in this area (i.e. follicular unit transplantation) could set off the disease process again and you have the potential of losing the transplanted hair and having to deal with the disease process all over again. This is your worst case scenario. I have had 3 such cases over my years in practice. Two ended up with reasonable hair growth, the third one is presently being diagnosed and treated. Good luck.

Tags: folliculitis decalvans, folliculitis, hairloss, hair loss, hairtransplant, hair transplant

How Many Grafts to Give Dick Vitale Hair Like Brad Pitt?

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

Hi Doc, cool blog.

I was just wondering if hair multiplication became a reality, would it be possible to give a guy like Dick Vitale hair like Brad Pitt? If so, how many grafts woud it take, and what approach would you use? I’m sure if any surgeon could duplicate nature, it’s probably you. Thank you.

Dick Vitale and Brad Pitt

 

I am going to assume ESPN’s Dick Vitale is a Norwood Class VII, and he has an average hair density of 2. This equals about 1250 hairs per square inch, or 625 follicular units (FU) per square inch, assuming an average of 2 hairs per FU. The front and top part of the scalp on average cover about 16 square inches, the crown another 16 square inches, for a total area of coverage of 32 square inches. If we had unlimited source of hair (cloning, multiplication, etc) we would need about 20,000 FU or 40,000 hairs to give him coverage with a density of 2 in the transplanted area (for the head of hair that Brad Pitt has). However, as the gold standard is follicular unit transplantation, this would be the method I would use, even in the make-believe world we just described.

Tags: dick vitale, espn, brad pitt, actor, celebrity, broadcaster, hairloss, hair loss, hairtransplant, hair transplant

Retin-A and Minoxidil After Hair Transplant

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

I am a 25 year old male. I had a HT procedure about 2.5 months ago. What is the risk to the transplanted follicles from using a minoxidil + 0.025% retin-a formula? I use 5% rogaine foam and 1/4 proscar religiously, but I was wondering if the added retin-a might help. Any advice is much appreciated.

Retin-A is an acid and is sometimes used for the treatment of acne. It causes skin irritation that some believe will help with minoxidil absorption. There is no proof this works in helping with hair growth. It is a buyer beware market. I would speak with your doctor about this use after a hair transplant, but I do not recommend that my patients take it.

Tags: hairtransplant, hair transplant, retin-a, minoxidil