Neck Hair and DHT

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

Dr. Rassman,
I was told by my hair transplant surgeon that FUE can be performed effectively from extracting the hairs near my neck since he finds it unusually dense compared to other areas on my scalp.Are you in agreement of this=based on the fact that these hairs can in fact be effected by DHT?

In other words if the hairs are in fact efected by DHT why would I go through this expense/discomfort if they will eventually fall out? please advise

Neck hair is not scalp hair and as such it is NOT considered permanent hair. I have seen plenty of patients who had lost their neck hair as they age. If you transplant neck hair it may NOT be permanent. In your particular case, you mention hairs “near” your neck — and I simply don’t know precisely the area you’re talking about.

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

4 Months After Hair Transplant, Seeing Dead Skin and Hair Coming Out

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

Hi,
Im 4 months post op and noticed some dead skin peeling off fro the recepient area while combing my hair after shower.

There was no blood behind. Just Dead skin with some attached hair to it. is there anything to worry about? Will the hair grow again in place of the dead skin?

thanks

This is probably crusting that you haven’t washed off. I have seen this on people who were too gentle with their post operative washing. See your hair transplant doctor to ask about your post-op care.

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

Thanks, My Stylist Doesn’t Believe That I Had a Hair Transplant!

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

I had two transplants at NHI over the past 5 years (last one was 3 years ago) and the results are fantastic. Whenever I get a haircut I will tell the stylist that I had the transplant procedure done just so they are aware of the line scar in the back and don’t cut my hair too short back there. I find that as long as I tell them before they get started, its no big deal and the scar is never visible, even with a $15 Supercuts haircut that I get. BUT, I usually end up spending the 10 minutes I’m getting my haircut explaining to them that yes, this is a hair transplant and no, I’m not just joking around. Nobody believes me! Outside of getting a haircut, I never mention it anyway… but the one time I tell someone, they don’t believe it. So that just goes to show that you did a damn fine job. Really incredible work and as you can probably tell I am thrilled with the end result. I’ve included a couple photos that you can use for your blog.

Thanks, doc. I’m very, very, very pleased.

I’m glad to hear that nobody believes you — that means we were successful! In all seriousness, this is how any good hair transplant should be. We never want patients to be easily spotted as having had a hair transplant. The end result should always look natural.

This patient had 1,737 grafts transplanted over two procedures.

Update Dec 2008: [Photos removed by request]

Tags: hairtransplant, hair transplant, haircut, supercuts, hair style, photos, hairloss, hair loss

After 4 Years, I Still Feel Pain in the Donor Area

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

After almost four years, I feel pain around the donor area. I doubt the doctor has cut too deep and damage my nerve or muscle. What is the way to identify the source of the pain?

Thanks!

Possible nerve damage or irritation is a potential risk of hair transplant surgery as well as other surgeries which involve a deep cut in to the skin. Rarely, I have seen cases where a patient may experience pain in focused areas around the donor scar. With time this should resolve. However, after four years you may want to go back to your surgeon and discuss what this source of pain may be. Without a direct examination, I do not believe I can advise you on a possible source of your pain. An examination of your scalp will show if the major nerves are intact, and if you have a trigger point from which the pain can be elicited. This should be part of a doctor’s examination of you, something I would do if I were your doctor.

Tags: donor, hairtransplant, hair transplant, pain, nerve, hair loss, hair loss

Transplanting Hair While Still In the Early Hair Loss Stages

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

Hi,

Why do you say it is such a bad idea to thicken up an area that you may lose in the future? Say if you had hair that was 50% of it’s original density and thinning continually, could you not get 50% of the original transplanted into the thinning so that as the remainder eventually thins out and has gone your still left with what was transplanted earlier?

Thanks!

Shocked!If your hair loss is in its early stage and a hair transplant procedure was in that early stage there are problems with that approach. I have little doubt that in the young man with early hair transplants, the hair that is destined to fall out, may fall out at a faster rate than they would have had a transplant not been done. I am not talking about hair transplant shock alone (which is short term by months), but rather mid and long term by years from a time frame point of view.

Even though Propecia (finasteride 1mg) works in most men to prevent hair transplant shock, there is no better treatment for hair transplant shock than not having a transplant into areas of early thinning. So if you transplant hair that causes native hair in the vicinity to fall out, you could possibly wind up just replacing miniaturized hairs with a lesser number of transplanted hairs. The net effect may be zero and the preventive hair transplant would have been unnecessary and wasteful. Hair transplantation is a permanent process and it must fit the Master Plan of your hair loss process.

I do not believe surgery is in their best interest for younger men thinking about getting hair transplantation when the hair loss is just starting. All hair taken from the donor site is ‘finite’ which means that transplanting donor hair depletes the donor supply. If a person had 6000 grafts in his lifetime and he uses 2000 of them in an attempt to anticipate what might happen, the reserves for treating what will happen will be less than had the person had no surgery. The young patient can always delay the decision to have a hair transplant. Perhaps meeting again 8-12 months after your initial consultation will allow your physician to reassess the Master Plan to see where your hair loss is going.

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

Harvesting Hair for Transplantation From Other Areas with FUE?

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


Hello Dr Rassman
Is FUE able to harvest in regions that were considered unaccessible with strips? I think about the temple areas and also the region called the “pigtail”, which in my case seems very dense.

Thanks

Yes, harvesting the areas you are talking about can work. It is very difficult to do and the yield will probably be less, because hair densities tend to drop on the sides of the head.

Tags: hairtransplant, hair transplant, fue, follicular unit extraction

Norwood Class 3A Patient — 10 Days After Surgery (with Photos)

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

This Norwood Class 3A patient came in for a check-up 10 days after his hair transplant procedure of 2,000 grafts. The scabs are gone and the recipient area is very clean with no visible redness. I wanted to show this patient because I’m constantly asked, “What will I look like after surgery?” — and with proper washing techniques, this is a typical result. Please click the photos to enlarge.

10 days after hair transplant surgery:

 

Before:

 

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

Transplanting Younger Men — You Do It Too, Dr Rassman!

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

Dear Dr:

I visit your website everyday and find it really informative and reassuring….in some instances.

My question is, I see a lot of young people (between the age of 25-30) getting hair transplants. Now, I remember one time you had posted a message saying that people under the age of 35 should not be getting hair transplants because it is hard to tell the “final pattern” of a person’s baldness. So, why do you as well as other doctors elect to do transplants on young patients (even as young as 22 who have minor thinning but will go bald later on in life) when you know in the future the hair behind the transplants will fall out. It doesn’t make sense?

I’m sorry if I targeting you personally, I don’t mean to do that.

MagicYour question is a good one, but firstly, I’ve never used the age of 35 as a minimum requirement. I will readily transplant any man if:

  1. They have a hair loss pattern that is clear and bald. For example, a 22 year old Norwood Class 3 pattern patient who has lost his corners or his hairline has risen significantly above the mature male hairline (see Maturation of a Hairline — Moving From Juvenile to Mature). I will consider doing a hair transplant even on a younger man once I get to know them well and see the support of their family in the process.
  2. They are mentally mature, understand that the hair loss process is progressive, and have the financial ability to stay the course.
  3. They are on the drug finasteride for at least a month before surgery (to prevent potential shock loss) and agree to continue it for years (to halt the progressive nature of hair loss).
  4. They have donor densities which are adequate for harvesting as well as enough reserves to follow the hair loss to mid-scalp. In this way if they became a Class 6 or Class 7 pattern and were willing to accept a bald crown (the worst case) then they would always be normal looking.
  5. They are healthy and have no contraindications for surgery, such as bleeding disorders, etc.

Once the pattern is clear, the scalp is mapped for miniaturization, and the patient is on Propecia (finasteride 1mg), I don’t see how you could say that I’d “know” the native hair behind the transplants will fall out. That is not necessarily true, and is precisely why it is important to seek out a physician that will microscopically examine your hair rather than just waving their hands around the head like a magician and tell you what you want to hear.

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

Using Apple Cider Vinegar After a Hair Transplant

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

Is it safe to use Apple Cider Vinegar on the scalp after Hair transplant. I had hair trasplant two months ago, and I love to use it because it makes my hair soft and eassy to manage. Does it damage my new hair follicles that were implanted? Hope to hear from you soon. Thanks

Apple Cider Vinegar
I tell patients that after a week or so following a hair transplant procedure, you can do whatever you like with your hair and your transplants. For those that are curious, apple cider vinegar is apparently used as a holistic “cure” for a wide variety of ailments, including allergies, acne, high cholesterol, flu, arthritis, and acid reflux.

It likely won’t benefit your hair transplants, but I doubt it will hurt them either. I certainly don’t subscribe to the idea that vinegar will cure all of your troubles, but you can read more about it here.

Tags: vinegar, apple cider, apple cider vinegar, hairtransplant, hair transplant

Has Hair Transplantation Technology Plateaued?

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

Dr. Rassman,
Thank you for taking your time to read this. I know that hair transplantation has improved greatly in the past decade. Do you think that the improvments have plateaued or can we expect even better results in the hair transplant community in the future.
Thank you for all you do.

I am hoping that the follicular unit extraction (FUE) technology will be improved from an instrument point of view. I personally believe that this technology has great room for improvement. With regard to strip harvesting, I think that we have only improved in our overall efficiency, not in a better technique. We are all waiting for breakthroughs in hair cloning, hair replication or stem cell work for creating new hair.

Tags: hairtransplant, hair transplant, cloning, future, tools, instrument, fue

Doctor Warned Me Not to Pop Scalp Pimples After Hair Transplant

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

hello doctor

i’m three months post a hair transplant operation, i started to note a scalp pimples appeared stating from the second month after the operation, i had told by the doctor who did the operation to me don’t burst these pimples as this could lead to follicular death!, but sometimes i got to burst the white head of the pimples spontaneously. is it true what he told me about damaging the FUE???? this could happen when combing or whatever i do actions to my scalp by mistake.

also i read on the internet that this is normal and a very good sign to hair regrowth underneath the scalp.

another question please, now and after the third month hair density is very thin, is it normal ? and what is going to happen in the next 3 months, can i really got 5 or 6 times the hairs which i got now ? or it depends on something i don’t know it ?

thank you so much

Many of your questions should be asked of your surgeon. I do not know enough about your case to address most of your questions. Some people do develop cysts after surgery and they tend to ‘pop’ by themselves with warm compress soaks. If you develop folliculitis, then you could lose a graft under the skin, but folliculitis needs to be treated, again by your doctor, not me over the internet.

Tags: hairtransplant, hair transplant, pimple, cyst, hairloss, hair loss, aftercare

I Want a Hair Transplant to the Crown and Front

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

I am considering a hair transplant. My crown is nearly bald and my front is thinning to the point you can see scalp. I’ve been on Propecia for 4 months and hair is still coming out. THe loss doesn’t seem as rapid, but I’m still seeing hair in my hand after shampooing. What’s your opinion on getting a transplant to cover the crown and thicken the front. Thanks

I would want to know your age, see your photos, determine your density and laxity, and map out your hair for miniaturization so I can understand where your hair loss is going. I would want to know what your expectations are and be sure that they are realistic — and most important, I want to know more about you, as a person. With all of that behind us, then a discussion of a hair transplant may be appropriate.

Tags: hairtransplant, hair transplant, crown, hairline

9 Months Since Hair Transplant — Not Impressed with Results

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

dear doctor rassman.

i am in a bit of a confusing state. i had a transplant with a reputable doctor in canada 9 months ago to restore the hairline and provide some coveredge on the top and not the crown (i was a norwood 5).

i had roughly 3600 grafts, mainly focusing on the hairline. 9 months have past and i can say honestly that im not impressed. whilst i see an improvement on the top of the scalp, the main area which is the hairline is unexceptional. from temple to temple, it still looks like a receded hairline and the surprising thing is, its just the hairline area which is from temple to temple and approximately half an inch in lenght i.e. hairline lenght (temple to temple) x half inch which has shown no improvement. its extremely thin and whilst i can feel some stubble in various regions there, i honestly think that for 9 months, it is unexceptional. my head is visible through my hairline and anyone can say that i am balding.

i have been imforming my doctor on regular basis and he says i should wait a full 12 months before coming to a conclusion. i have not been satisfied with my hairline for the past 9 months, is there any hope that the next 3 months could make a difference?

At about 9 months you should have 90% of your results in. You might get a second opinion if your doctor is not being responsive. Some rare people have slow growth, but usually by 9 months, much if not most of the hair should be growing. An expert doctor will tell you how many grafts are growing. 3600 grafts is a lot of hair moved — you must have been fairly bald.

If you email me some before and after photos and point out the areas that were transplanted, I might be able to help you over the internet. Be sure they are good quality digital pictures (various angles will help) and please reference this post when sending.

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

Hair Transplant Failure (with Photos)

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

This young man had a hair transplant by a doctor who had done very few transplants on his own. He might have actually been this doctor’s first hair transplant patient. The procedure, which occurred around 5 years ago, failed after the doctor attempted transplanting around 1200 grafts. The patient was lucky (in a way) that the balding area was well covered by his existing comb-forward hair stying. His photos are below (click to enlarge) —

 

Doing modern hair transplants requires experienced doctors and experienced teams of people. Always check on the experience of your doctor. For more information about finding a good doctor and knowing what to look out for, please see:

Tags: hairloss, hair loss, hairtransplant, hair transplant, failure, photos

Can Rogaine On Healthy Hair Cause it to Fall Out?

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

Thanks so much for this resource! I am 3 weeks post op from a HT of 4200 units. I was on propecia for 30 days prior to HT and began Rogaine / Minoxidil 2 weeks post op. I had temple work and work at the front of my hairline. I want to get the best result and minimize shock loss. I have heard Rogaine can cause shedding. Am I at risk for shedding in healthy hair zones if I apply Rogaine in it’s correct dosage to the entire top of my head, temples and along the donor scar?

Rogaine (minoxidil) on healthy hair most likely will not cause shedding, but I would strongly suggest that it only should be applied to areas of concern and not the rest of the head for two key reasons:

  1. Cost
  2. Side effects (or potential thereof) will occur as the area of treated skin increases

It is also worth noting that minoxidil will not influence the hair transplants to grow any better or any faster.

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