Double Follicular Unit Grafts (DFU)

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

Why don’t you offer double follicular unit grafts (DFU)?

Double follicular units (DFUs) are 3-4 haired grafts that have a slight gap containing skin between the hair follicular units (the natural growing anatomical units). Some people claim that if they use them, they can get more density per square cm and that the advantage is that more density can be created with fewer incisions… which means less grafts/cost to the patient.

DFUs are essentially the old type of minigrafts and the problem with them is not only a slightly pluggy look (for those people with dark hair and white skin), but also that there is skin transplanted with the follicles. This skin becomes depigmented and forms a whitish plaque on the scalp on close inspection, particularly noticed if you have a tan or olive skin. So while it is true that this can provide more density at less financial cost, the price is in a lesser quality transplant. The older large plugs had the highest densities, so if one takes the logic that DFUs are less expensive than follicular units and are the way to go, you can also look like you have doll’s hair for about a tenth of the cost of a fdu. You get what you pay for; do not lose sight of the fact that this is a surgical procedure on your head.

So to answer your question about why we don’t offer DFU, to be blunt, it’s because we don’t offer grafts that can be detected as a hair transplant, even on close inspection. The question should be, would I do it if someone specifically asked me to do it, to which my answer would be that I would consider it if there was complete informed consent present at the time the decision was made.

Tags: dfu, double follicular unit, follicle, hairtransplant, hair transplant, hairloss, hair loss, plugs

My Crown Is Starting to Thin and I Want to Thicken It Up With a Hair Transplant

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

i know from reading your other entries that proscar doesn’t “cure” balding but i’m noticing some serious hairloss lately and i read something in the blog about a guy that “doubled” his dose to a half pill a day…. do meds work that way? will it help? could it help?

also i am thinking about getting a hair transplant. couple things i’d like to know

– i’m not really bald but my crown is thin, is it possible to just thicken it up and kind of blend it into my hairline. in otherwords anticipate the loss most likely to come.
– i keep the top of my hair longer but shave the sides to about 1/4 inch. would the scar be visible provided the job is done well.
– approximately how many graphs would i need to fill in a thin crown? I know it’s hard without seeing a pic, but just an idea..

Thanks a million your site is amazing!

Firstly, Proscar is 5mg of finasteride, Propecia is 1mg of finasteride. The recommended dosage for treating hair loss is 1mg. I would seriously consider not taking more than the 1mg dosage… 1.25mg at most. And I only say 1.25mg because some people will buy the 5mg pill and cut it into 4 parts (easier than cutting it into 5 equal pieces) to take 1.25mg daily. Taking two 5mg Proscar will likely produce substantial side effects and have no more value than the 1mg dose.

You don’t want to have hair transplant surgery without determining where your hair loss is likely to go. You have a limited donor area to harvest hair from and if you use it all up early on and continue to bald in more visible areas (such as the frontal region) then you’ll be out of luck. Miniaturization mapping over time will give a likely path to where your hair loss is at and where it is going to end up. Age plays a role as well.

If you had a FUE (follicular unit extraction) transplant, there would be small dot scars on the back of the head and keeping the hair short would not show any significant scarring. If you had a FUT (follicular unit transplant) strip procedure, you may see a linear scar in the back of the head if your hair was very short, but to what degree really depends on how you heal, skill of the surgeon, etc. Without seeing the area, I couldn’t estimate the amount of grafts; I’d need to know your hair color, hair characteristics (wavy, straight, fine, etc), and whether you’re even a candidate for hair transplantation.

Transplants should never, ever be used to build up what you may lose in the future. Plus, I need to point out that finasteride works quite well in early hair loss, particularly in the crown. It is very possible that you can avoid surgery and just take a daily pill — you will know in about 8 months if it is working. I would look into this by seeing a doctor. Propecia (finasteride 1mg) is available by prescription only.

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

Resuming Activities After FUE

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

Good site…I had a strip procedure(5080) Feb./06…Pretty good results…I recently went back for a Fue procedure(1050) to touch up the middle, temple and on a part of the scar from the previous strip…

  1. How long should I wait before working out and running?
  2. How long does it take for the newly implanted grafts to settle in their new home?

Thanks and keep up the great work in helping others..

Thank you for the compliment. Where is your doctor? He/she should’ve supplied the answers to your questions as a matter of routine. These are the most basic of questions that should have been explained to you before your surgery.

To answer your questions:

  1. You can generally resume exercise after one week and you can run a marathon without difficulty (not to say that hair transplants will help you run better, but you get the idea). I always restrict heavy lifting, weights (under 40 lbs with proper lifting techniques), sit-ups, and pull-ups.
  2. Most grafts are relatively secure after a day or two.
Tags: fue, hairloss, hair loss, hairtransplant, hair transplant, activity, running, exercise

I’m Numb Above My Surgical Donor Site

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

please take a moment to reply? i would very much appreciate it! i had a ht and it is 3 weeks later and the area above the donor area is still devoid of ANY feeling for about 6 inches wide and 2 to 3 inches upward! i am worried that the surgeon cut too deeply or incorrectly and has damaged nerves. i can’t find anything about this on the internet which tells me i am dealing with something unusual. have you heard of this? and if so, how long before i regain feeling back there? thank you so much for your reply!..

I would think that you either have some nerve swelling or some nerve damage. Nerve swelling usually resolves in weeks and on occasion within months. Upon examination, the doctor may not be able to tell the difference, but several examinations are probably indicated. Definitely ask your operating doctor about this.

Tags: hairloss, hair loss, hair transplant, hairtransplant, donor, nerve damage, nerve swelling

In the News – Eyebrow Transplants

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

There’s a new article about transplanting eyebrows, and features quotes from myself and my colleague Dr Bernstein, and contains before and after photos of an eyebrow patient of mine. Here’s a snippet from the story:

Throughout the country, follically-challenged and over-tweezed women (and some men) are discovering a new solution to their eyebrow woes that does not involve tattoos or makeup pencils.

Eyebrow transplants accounted for just 3 percent of all hair transplants in 2006, according to the International Society of Hair Restoration Surgery, but they grew by 35 percent over the previous two years and appear to be gaining momentum

Read the rest of the article here — Transplant perks up fading eyebrows

Tags: eyebrow, eyebrows, hairtransplant, hair transplant, eyebrow transplant, rassman, bernstein, hairloss, hair loss

Reshaping the Temples with Hair Transplants

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

Dr. Rassman, thank you and your team for always having a very informative blog and website.

My question is about transplant to the temples… is it a good idea to reshape the triangle part of the temples? Or is it better to use the grafts for the hairline, etc? Do you have pictures of patients you’ve done temples to that you can share with us?

Thank you very much for your help.

Yes, we can reshape the temples! In fact, my surgery case today was reshaping a patient’s temples and sideburns. Here is an example of a patient with temple transplants. He had about 1100 grafts placed into his front hairline and 150-200 grafts placed into each temple.

The before photo is on the left, after on the right. Click the photos to enlarge.

 

To see more of this patient (including other angles), check out his profile in the NHI Patient Photo Gallery. Even more temple hair transplant patients can be seen here.

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

Shouldn’t I See Significant Growth at 5 Months Post-Op?

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

I got a hair transplant myself almost 5 months ago- on October 10,2007. The hair on the front of my top scalp is still pretty thin,.I can’t tell if I lost more hair than before I had the transplant or if there is little growth from the transplants. AT 5 months, shouldn’t I be able to see significant growth- and if there isn;t should I ask my doctor at 11 months do consider doing it over again?- because they will probably say they did everything right despite the results being poor???

At just 5 months post-surgery, you can not tell how successful a hair transplant was. You shouldn’t be in such a rush to expect failure. Usually the growth just starts at 4-5 months, so I would expect that by the 6-8th month you should see 80+ percent of the hair grown.

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

About a Year Ago, I Met with a Doctor That Was Still Doing Minigrafts!

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

First of all I want to thank you for this great site.

In Dec. of 2006 I went to a T.P. doctor, mainly to get a prescription for propecia and to hear what he had to say about how good of a candidate I would be for a hair transplant. I found out at that time that he still used the mini & micro minigraft procedure, with magnification and backlighting.(no steroscopic microscope). In Dec. 2007 I was looking at his web site,and to his credit, is now doing follicular unit grafting using stereoscopic microscopes.

My question is this,how difficult is it for his staff to learn to use microscopes and to be cutting in follicular units instead of minigrafts? I guess what I really want to know is how much time should I give them, to learn the “new” procedure before I go back for another consultation?

Do you have any photos that show the difference between minigrafting and folicular unit graphing on the scalp?

Thanks again.

P.S. How much does a stereoscopic microscope cost? This doctor has been doing hair transplants for 14 years and is now just getting some.They must cost alot!

Cost for hair transplant at New Hair Institute… as low as $5 per graft.
Cost of microscope at a local scientific store… around $500.
Cost of a well done follicular unit hair transplant… priceless.

The difference between minigraft and follicular unit transplantation is small, but can be significant when you look closely at the growing hair. Minigrafts and micrografts transplant skin between the hair follicles and this skin can produce changes in the scalp at the point the hair exits the skin. There may be cobblestoning from the transplanted skin. Follicular unit transplantation only transplants the natural occurring units of hair as they exit the scalp and most of the skin edge is removed so that the point of exit of the hair is normal.

More importantly, the difference when using a microscope for dissection is that you do not waste good follicular units since you can see minute details (under the microscope).

For more details, read our published articles on the subject:

Tags: minigraft, micrograft, follicular unit transplant, fut, hairloss, hair loss, hair transplant, hairtransplant, microscope

Plucking Transplanted Hairs

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

If I were to pluck some of my surgically implanted hair in order to achieve a balanced look, would they eventually grow back over time? So if I then decided to get another transplant to balance things out, I wouldn’t regret doing it?

If you pluck out transplanted hair it should grow back just as if you pluck out normal (non-transplanted) hair. However, if you keep plucking out the same hair, eventually it may never grow back, which is what happens with trichotillomania.

Tags: hairtransplant, hair transplant, pluck, trichtillomania, trich, pulling, hairloss, hair loss

I’m Wondering If My Strip Scar Is Bigger Than Most

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

Hi Doc,
Have a question on my strip scar. I can shave the sides with a #8 guard and can still see my scar, do you think its a little bigger than most. I also have light hair. Had my procedure done at [name removed].

Everyone has a linear scar after a strip hair transplant, but some tend to have wider scars than others. Normal scarring in 95% of first time hair transplant patients is under 2-3 mm. Scars are produced by a combination of:

  1. surgical technique
  2. healing properties of the patient
  3. tension on the wound

Don’t be too hard on the doctor, for as you can see from the above list, you are more likely the cause of the scar from healing properties. The medical group you used does good work. I am sure their surgeons are all well qualified and fully capable of performing the strip excision.

Tags: scar, strip, hairtransplant, hair transplant, scarring, healing, tension, wound, donor area, hairloss, hair loss

How Do You Measure Scalp Laxity?

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

Hello dr Rassman

How exactly do you figure out the laxity of the scalp and the residual donor area capacities if somebody went through strip procedures in the past? Is there a “measurement” possible or is it only by touching and feeling?

Thanks

There are two tools that I use on occasion, one in the office and the other in the operating room. We call it a Laxometer which we invented and just submitted for publication in the Hair Transplant Forum. Experienced surgeons know how to test and quantify scalp laxity at examination and good surgeons develop a ‘feel’ for it. You can see the video on scalp exercises and estimate the up and down movement. One half inch is average, more is better, less is tight.

Tags: scalp, laxity, exercise, hairloss, hair loss, hairtransplant, hair transplant

Hair Implanter Carousel (with Videos)

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

I have heard alot about the Implanter Carousel which i find very interesting and a great method of preserving the hairs and keeping them moist in the ‘carousel’ unlike the choi implanter were the hairs are left on a tray open to drying with warm air until they are put into the implanter. If you dont mind me asking, was the choi implanter an influence with its design and was the carousel, put simply, designed to better the disadvantages of the choi implanter. As they are an automated method of implanting the hair would that not take remove the artistry of a manual job. You once said on a answer to a blog on the subject of ‘The choi implanter’, ‘The Choi implanter is just a surgical tool. It makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills with the more traditional transplant tools used throughout the world. An instrument is only as good as the person using it, so I can not package the tool with the technique. The Choi generally requires ‘skinny’ grafts, which tend to dry out more easily, therefore, this instrument requires special skills, different than those that do not have to make the grafts skinny’. My question is how is the carousel different in the sense that an automated implanter such as the choi implanter makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills. Thank you, for all your advise.

It sounds like you know all the technical difficulties associated with follicular unit transplantation — are you a hair transplant surgeon?

As you mentioned, I wrote about the Choi Implanter before — What is the Choi Implanter?. There’s nothing else I can really add to that. The Hair Implanter Carousel was patented back in the 1990s and it works distinctly different from the Choi Implanter. It was designed to take advantage of a ‘machine gun’ approach to loading the grafts for implantation and percutaneous use and keeping them moist (as you wrote). I’ve used both and found the Carousel to be much easier than the Choi. The drying of the grafts was not a problem for the Carousel as it was for the Choi. Unfortunately, the instrument manufacturer was unable to produce a consistently high quality product and we ended up in court trying to get my money back for the build out of the Carousel, rather than getting the tool into the transplant surgeons’ hands.

A paper about the Carousel was published in 1998 and three videos of the instrument can be seen below:

Part 1:

 

Read more

Sylvester Stallone’s Hair Restoration

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

Dr Rassman,

As part of your occasional series discussing the hair jobs of celebrities, could you take a look at this (rather unflattering) article on Sylvester Stallone in London’s Daily Mail?

Link: Daily Mail

In short, he does look very good for his age — until you check out the closeup of his hairline. In your opinion, what technique is responsible for that restoration job?

Thanks for your time

StalloneYikes! What I see in the link you sent appears to be a harsh hairline. Even with the limitations of the photos, I think I am able to see some of the older type of work, some large grafts mixed with smaller grafts — so in my opinion he looks transplanted. I have no firsthand knowledge and am basing this on Mr. Stallone’s appearance in this photo. The older (and larger) grafts are relatively easy to detect and reflects more than one surgery, one of which may have been done years ago, prior to the advent of the modern Follicular Unit Transplant technique that we defined in 1997 in the published literature (see links below).

Tags: stallone, sylvester, rambo, rocky, hairloss, hair loss, hairtransplant, hair transplant, celebrity, actor

I’m Male to Female Transgender and Was Told a Hair Transplant Is Not an Option

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

I am transgender male to female, and have male pattern thinning. I have been on hrt and antiandrogens for 2 years and Proscar and Minoxodil for 8 months. I consulted a hair transplant surgeon about transplants on the crown and top of my head, and after a video microscope evaluation he said that he cannot do transplants as there is no room for grafts. He stated that I have not really lost any hair and have great density, just that the calibre of the hair had diminished. Do you think given more time on hrt, antiandrogens, proscar, and minoxodil, that the miniaturized follicles may recover to terminal thickness and if not what other options do I have?

If your hair is miniaturizing, then the hormones and complex medications you are taking may be the cause of your problem. Hair transplants, where there are normal densities of hair, may not help solve your problem. I couldn’t tell you if more time will for sure help your hair.

Tags: transgender, male, female, hairloss, hair loss, hair transplant, hairtransplant, hormones, lgbt

I Want My Head to Always Have a 5 O’Clock Shadow of Hair

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

Heres one for you: I wouldnt mind a shaved head if the shadow of existing thick hair wasnt so obvious around the donor areas. It’s like the top is your normal face color, and the donor areas white with potential hair. The shadow where hair grows is just so noticeable. My question is: is there a procedure where you can have implanted just tiny hairs as in a shadow over your balding? So it looks like you only shave your head?

5 O'Clock ShadowI suppose you can tattoo your bald area, but that’s not the recommended route. I have seen it done in a few patients with reasonable results, but they have done this because of some deforming surgery they had from older hair transplant techniques many years earlier. Alternatively, you can air spray the balding area to develop a subtle shadow. If you’re looking to transplant a “5 o’clock shadow” look to your head (like the facial hair style that became popular in the 1980s), it’s really not going to be possible without having visible scarring to some degree (even if minor from FUE) in the donor area.

In other words, to answer your question — no.

Tags: shadow, hairloss, hair loss, hairtransplant, hair transplant, shaved