Why Would You Be Concerned About Transplanting a 22 Year Old Patient?

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

Dr Rassman,

I was reading some of the past blogs and came across an entry in which you mentioned you were disturbed by the patient having a procedure at age 22. What concerned you about having a procedure at this age? I’ve also had a procedure at age 22 and was happy with it however, my hairline has continued to recede over the past few years and I’ve contemplated a 2nd procedure. Would you recommend this?

I generally do not recommend hair transplant surgery on men in their early twenties, because of the following reasons:

  1. They risk accelerating their hair loss due to shock loss.
  2. One does not know how much balding they have in front of them.
  3. The patterns of hair loss may be difficult to identify, which makes building a Master Plan (for long term planning) difficult or impossible.

Of course, if you are already bald (a well defined Norwood Class 3 pattern, for example) this would not be much of a concern. So it is not an absolute rule and every man should be evaluated based upon their maturity, their realistic expectations, and their balding pattern. Your very question supplies part of the answer, as you have had surgery and now notice that you are thinning or receding. Get a good doctor to build that Master Plan I mentioned above, so the best and worst cases of what might happen to you will be clearly defined for your benefit.

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

Scalp Pimples Weeks After Hair Transplants

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

I had 2200 grafts in the front. About 6 weeks later, I noticed pimples breaking out on my head. I went back to my doctor and he put me on an antibiotic which helped for a week and then when I went off the antibiotic, the pimples came back. What is happening to me? Will this kill off the transplants?

After a hair transplant, spicules of hair are left behind after the grafts have shed. These spicules of hair can be like a foreign body and cause cystic reactions. This process is usually self-limiting and with warm soaks, will disappear over the next month or so. I believe that every person has these spicules in the recipient area, but only a limited number of patients have these type of reactions. The differential diagnosis is important here, namely distinguishing it from folliculitis, which can endanger the growth of the grafts.

You may have heard about MRSA (Methicillin-resistant Staphylococcus aureus), and if this should occur, a culture of these pimples are important to determine the correct treatment modality. There can be iatrogenic (doctor induced) causes where during the placing process the staff ‘piggyback’ one graft on top of another. This is often due to poor quality control processes and if the doctor sees this often, then the doctor may have a problem with his office staff. In less experienced hands, this is an iatrogenic problem so a good solid surgical team with good quality control systems in place will guarantee that this will not happen to you.

If properly treated, these sores will not cause hair loss. Sometimes local drainage with a needle is needed, but usually they will spontaneously drain on their own with frequent warm compresses.

Another Hair Transplant Clinic Called NHI

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

Hello NHI team,
I was wondering if you have heard of another NHI hair transplant clinic in greece and how they can use the same name. They use the choi implanter. Their representative is a man called Malcolm Mendelsohn. Heres their web site www.nhihairclinics.co.uk

I try to refrain from commenting on other clinics unless specifically asked. One can only assume that the NHI name was taken by this man for his clinic, because he wanted to claim some affiliation with us (or give the illusion of such). There is no connection between this clinic and the New Hair Institute. The name has also been copied by others in various parts of the world for hair transplant clinics (from Australia to the UK to even here in the US) with the same nefarious reasons, I suspect.

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

Age and Hair Transplants

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

At what age will a transplant not work?

I have done hair transplants on children with bad scars and men as young as 89 years old. They really work regardless of age. I perform it with the same basic anesthesia routine, but in children, I often use less systemic drugs if one of the parents comes into the operating room and holds the child’s hand. There is nothing more soothing to a child than the touch of a parent’s warm hand.

Tags: hairtransplant, hair transplant, age, parent, young

Why Didn’t You Transplant 5000-6000 Grafts For a Norwood Class 6?

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

In the piece dated October 19 “Goodbye Combover, Hello Hair!”, I am critical of your choice to limit the graft numbers. You should have performed 5000-6000 grafts in a Class 6 patient. Why didn’t you?

Here’s the post you’re referencing.

The number of grafts that were transplanted on this patient was the maximum safe amount that could be harvested, reflecting the density of this man’s hair in the donor area. If the grafts were cut down to single hair grafts, the number would have been more, but the amount of hair would have been the same. Some doctors would have cut the follicular units down to single hair grafts to make some more money out of the patient (since they charge by the graft). Not only will that not produce more hair, but it would be unethical to milk this patient’s pockets for more money. Cutting the grafts down would have yielded less hair in the long term, as all of the cut grafts may not grow as well.

With his fine hair character, this patient needs 5000-7000 grafts to get excellent coverage. On the day the initial blog post was published, I repeated the procedure and only got out 1706 more grafts — again, because that was what was safe (there are no results photos yet, as the procedure was just over a month ago). Each person is different, and while some people have enough scalp laxity to allow for a larger strip (with more hair), some people will only have enough for a smaller strip.

The photo on the left is before; the photo on the right is after one procedure of 2590 grafts. You should note that the transplants were artistically weighted to the frontal area to produce the best frame for his face and distributed to the back with a much lower density to reflect the limited number of grafts. Click the photos to enlarge.

 

More photos of this patient can be see at the original post —Goodbye Combover, Hello Hair!

Tags: hairtransplant, hair transplant, hairloss, hair loss, patient, photo, combover, comb over

Auto-Cloning Technique for Facial Hair?

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

I have heard of a technique called auto-cloning performed by Dr. Gary Hitzig in New York, New York. He tweezes beard hair under the chin which leaves part of the root to regrow and part of the hairs root stays with the tweezed hair to grow in the transplanted area. I would be very interested in having this procedure performed to thicken my mustache both because of my limited donor hair and for having the thickness and texture of beard hair. Facial hair and body hair transplants are becoming increasingly common why is this technique not more popular as it solves many problems for people who have limited donor hair? Is there a problem with this technique?

My medical group had tried to repeat the work after we heard about it from the doctor who said that he invented the technique. We did it just as he said it was to be done, and as was expected, the results were essentially a complete failure to grow hair. As far as I am aware, nobody has proven this technique or published the method in a peer reviewed journal for confirmation, which says a great deal about credibility. If it worked, I am sure that the technique would be available everywhere, because it infers that you get two hairs for one (hair replication)… something that has not been done by any other.

I also look to the credibility of the ‘inventor’ and via Google, I turned up with the following links:

Tags: auto-cloning, facial, hairloss, hair loss, gary hitzig, new york, hitzig, hairtransplant, hair transplant, replication, cloning, hair cloning

I Had 3 Procedures and Now I Want to Shave My Head

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

I have had 3 procedures over the past 9 years. My total transplant count was in the range of 5000 grafts. I have had very poor results in terms of density.

I am ready to shave my head and have seen photos showing what I should look like with ashaved head. I am happy with the look. I know that my donar scar will be visbible but I am ok with that. My question is regarding the liklihood that my recipient area will be detectable as having had grafts when shaved bald. I have no visible scarring there that I can see but am still concerned about this. Can you or anyone else offer some guidance/comfort so that I can proceed. This has been an enormous daily battle for me for many years. I have considered going to a hair transplant specialist and asking for some type of magnified examination of my recipient area, but other than than Im not sure how to know. I have hair up there but its too thin too really work with. Any feedback would be greatly appreciated.
Thanks

I really cannot give you much assurance, since I haven’t seen your hair transplant or your scars. Some hair transplants may leave some degree of scarring in the recipient area that may be detectable when you shave your head. To be honest, the only way to tell is to go for it — but before you do this, you should sit down for a face-to-face with a doctor who is experienced in this type of problem and examine your options in detail, one on one. I would be pleased to do this with you and it is may even be worthwhile for you to come to Los Angeles where I will personally evaluate your situation. Considering all of the money you paid for what you describe as poor results, the cost of such a trip is nominal.

Tags: los angeles, hairtransplant, hair transplant, scar, hairloss, hair loss

Results of Transplanting Firefighter’s Hairline (with Photos)

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

In my experience, performing hair transplants on firefighters, police officers, and soldiers can be a problem, not because they are different from you and I, but simply because they tend to get more good-natured teasing from their colleagues when issues of vanity come up. Although I haven’t seen any formal studies about it, I’ve found that society looks at the man in uniform as a “macho” guy, and vanity + macho don’t exactly go hand-in-hand. This is why I’ve found that these men can be more sensitive than the average male about having a hair transplant, as they are extremely worried about having a detectable procedure.

This patient had two hair transplant procedures totaling 2431 grafts to the frontal hairline, extending back about 1 1/2 inches. His skin is light and his hair is jet black, but he told me that no one ever teased him about undergoing the surgeries and nobody noticed anything unusual.

The photo on the left is before; the photo on the right is after two procedures. Please forgive me for the quality of the before photo, as it was taken with a different camera under different lighting, but his hair loss is clearly evident. Click the photos to enlarge.

 

Tags: hair transplant, hairtransplant, hairloss, hair loss, patient, photo, police, firefighter, soldier, uniform

Traveling to the United States to See Dr Rassman

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

Hello Dr. Rassman, I’m a 22 years old living in Brazil and I have been balding since I was 15 (right now norwood class 3). I’m thinking about going to a hair doctor to start taking propecia and maybe even do some kind of hair transplant, but I would like to go to a doctor as good as you. Do you usually do transplants in people around my age? I would love to see some photos.

I was also thinking about travelling to the US next year and have a consultation with you. How should foreigners proceed?

Thank you very much!

TravelTo start, you can send me photographs to the email address on the Contact page. Since there is the obvious distance between Brazil and my office in Los Angeles, the internet will be the easiest communication tool (specifically, email) so that it can be determined if you’re even a candidate. We can also setup a phone consultation, if you’d like to go that route.

I do not have any hard rule on what age I will consider a hair transplant, but generally I like my patients to be at least 25 years old. I have, however, transplanted men of your age when the hair loss pattern is fully defined and maturity is there.

Tags: rassman, hairtransplant, hair transplant, age, brazil, travel

I Don’t Have Hair Loss, But My Hairline Is Not Straight

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

I do not have a hair loss problem, but I do have a hair line that is not even close to being straight. I was courious to know if there is anything that can be done about this?

Hair transplants can be done on the frontal hairline to address this problem in non-balding men and women. If you come to one of our free open house events, you can meet patients and look closely at the hairlines we’ve created to determine if what you see meets your standards. Hair transplants in people who wish to balance their hairlines or fill in the natural hairlines they are born with, constitute a small percentage of my practice and by its nature is a cosmetic procedure, rather than a restorative one.

Tags: hairline, hair transplant, hairtransplant

I Have a Low Donor Density — But I Have a Large Head

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

Doc,

You talk of “donor densities”, but how about of donor areas? When you saw me a month ago, you told me I have a below average donor density of 1.8 hairs/mm squared and a fine hair shaft and a loose scalp. However, I have a fairly large back of head that can easily fill my Norwood 3A pattern. Will my large head help out the fact that I have a low 1.8 density compared to my caucasian brethren? This is just a curious question since I am not yet a candidate for a hair transplant and have been on 1 mg finasteride since our visit.

Thank you in advance

This is always a demand and supply issue for donor hair. Large heads have more donor hair than smaller heads, but lower Norwood balding patterns (Class 3) means that if you control your hair loss with drugs like Propecia, then your lower than average density may never be an issue for your need for donor hair. Large heads have larger Class 3 patterned areas than smaller heads.

Tags: hairloss, hair loss, donor, supply, head, hairtransplant, hair transplant

A Week After Transplant, I See Small Hairs Falling Out With the Scabs

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

Hi, I had 500 grafts to the temples 12 days ago. I have been washing the recipient area almost every day, and gently dabbing the shampoo on and off but some scabs still formed. I began very gently running my fingers over them when dry (but certainly not pulling them) by about day 7 and noticed some easliy fell out but with small hairs attached. Is this my grafts coming out?

We all worry about losing hair grafts after the surgery and that is the basis of your question. It is an important question; so important that NHI did a major study on the subject and the best answer to this question is for you to read our article on this subject — Graft Anchoring in Hair Transplantation (PDF file).

Tags: scab, hairtransplant, hair transplant, graft, anchor, hairloss, hair loss

My Hair Is Very Fine — I Had 2 Procedures, Should I Try Laser or DermMatch?

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

Dr. Rassman, I have completed 2 NHI transplant procedures. However, because of my very fine hair, my scalp is visible, especially under bright overhead lighting. I am considering a third procedure, but would like to first try the X5 HairLaser or DermMatch. Any thoughts? Thanks

A hair transplant procedure has limitations, in that it simply can not restore all the hair that was lost, since there is a limited supply and usually a relatively large area to cover. Individuals with very fine hair often have see-through coverage, even with normal (birth) densities. As hair transplants rarely produce over 50% of the original density in one or two procedures, I am never surprised when there is a see-through look and I tell my fine haired patients that this is what they must expect. There has to be realistic expectations and if the desire is to increase the fullness and let less light through (making it less see-through), then more grafts are necessary if the supply of good donor hair lasts and the use fits into a good Master Plan.

If you had surgery with NHI, please give my office a call (800-NEW-HAIR) and I will review your file and would be happy to discuss your situation. We offer free in-office laser treatments for all of our patients, but I can not tell if it works yet. Before any lasers or other alternative treatments, I would strongly recommend finasteride (Propecia / Proscar) as an option if you are not using it already.

While products such as DermMatch and Toppik are great cosmetic adjuncts to disguising thinning, it should be noted that these products do not grow hair.

Tags: dermmatch, toppik, hairtransplant, hair transplant, finasteride, propecia, proscar, laser

How Can I Expect a Natural Transplant Result when Donald Trump and Other Rich People Can’t?

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

Hi Dr.

I’ve been looking at your page for some time now and it is loaded with great information. I also consider myself to be fairly well educated regarding the various options available to balding men such as myself since I’ve spent years keeping up on these developments. I am 39 years old and my hairline began to recede when I was about 20. For the longest time, the rest of my hair was so thick that no one really noticed since I wore my hair long. Over the past few years, the top has thinned substantially and I no longer bother to try to style it. I just wear it very short. I’ve never wanted to be one of those guys who look like he’s trying to hide something. The problem is that I’m also not one of those guys who looks good bald. I wish I were, but I’m not. About 15 years ago I had consultations at two different hair replacement doctors and both, to their credit, told me I was not a candidate at that time and to come back in the future when my hair loss was more advanced. I’m sure that time is now. However, I’m not sure I want to commit to a transplant procedure. The biggest question I have is this. Is there really a chance for someone of moderate means such as myself to achieve a natural and attractive result from a hair transplant when people with unlimited resources like Donald Trump, David Lee Roth or the myriad other balding rich people can’t seem to do it? I would say that I’m probably somewhere around a 3 on the Norwood chart.

TrumpI laughed when I read your question; I’ve been wondering the same thing. A good hair transplant today is the norm, but in the days when Donald Trump did it (allegedly *cough, cough*), it was not a procedure that produced undetectable results. Mr. Trump, I believe, had scalp reductions (the bald spot was cut out) and hair transplants of the older vintage. The issue for people like him should be to repair the process, but he can not wipe the slate clean and go back in time prior to having the surgery. We wrote and published in peer-reviewed medical journals; most of the original articles were on the art of repair. I have no hesitation in discussing the repair process, but first, please read some of the articles we wrote on the subject:

For a person having his first hair transplant, you need to find a competent doctor (when you are ready) who is artistic and has a great reputation. I stress the importance of viewing patients (one-on-one) as a doctor who proudly shows off his/her results by giving you the opportunity to meet many of his/her patients. This will give you a very good idea of what you would look like after a hair transplant. I always say that what you see in the patients you meet will be a reflection of the surgical results you will get. Always ask for “before” pictures when you meet these patients yourself! Not to be alarmist, but I know of one immoral doctor who used a photo in a newspaper ad of a man with no balding to promote his practice — he was legally able to call this man a hair transplant patient because he had a few grafts placed behind his thick, normal hairline.

Tags: roth, trump, hair loss, hair loss, hair transplant, hair transplant, repair, plugs, scalp reduction