Hair Transplants, Shock Loss, and Propecia for Women?

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

(female) I heard of the possibility of shock and its harm to cause loss of existing hair from hair transplantaion. How frequentlly does this happen and does is the risk lower with follicular unit extracton?

Many women can not get real benefits from a hair transplant, so that is why I want to see pictures. There is no substitute for a direct examination of your hair with miniaturization studies to determine just where your hair loss is and how good your donor area is. Most women with genetic hair loss have a poor donor supply because of the thinning and the high degree of miniaturization in the donor area so they do not qualify for a hair transplant. Too many doctors will still perform surgery on these women when there will be no benefit just for the money. You need to find a good, honest doctor who keeps your interests central to your evaluation (not your purse). I am not convinced that Propecia would work for woman’s hair loss and in fact, it is not FDA approved for treating female hair loss because there is no proven benefit of it for women.

When a transplant is done, shock loss may occur in the recipient area so the method of extracting the donor hair is what is important. The best way to reduce the risks for shock loss is the use of Propecia (for men only) to be taken orally prior to the surgery and for the subsequent 6-8 months. For women, hair loss from shock loss usually reverses if it occurs (less than 10% risk in women) and it is possible the Minoxidil may help prevent it.

Tags: propecia, finasteride, shock loss, hairloss, hair loss, hairtransplant, hair transplant, female, women, woman

Wondering If I Should’ve Had an FUE Procedure Instead of Strip

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

I am 26, type V norwood, 5 months ago I had 3500 grafts HT. Just found out about FUE and am very interested as I have a large scar – hair has grown thru as is tryco closure – but still visible on my No 3 cut due to pinkness and 2-3m width (will this improve?). I am happy with results overall but now wonder if I should have had a FUE? Im told I have 3000 left to harvest which I will need for future loss.. should I open up my original scar when needed or opt for FUE? Can i extract more than than the 3000 if I use FUE? Thanks for help!

The Follicular Unit Extraction (FUE) procedure is ideal for patients who cut their hair very short, those who have a relatively small requirement for transplants (less than 1500 grafts), and for patients who absolutely do not want any visible scar on the back of their scalp. Patients who have already had a strip procedure will always have a linear scar, so an FUE procedure would not be of much benefit unless they want to have hair transplanted into the existing scar. While this is possible and routinely done, you must also consider that you will still have a visible scar if you shave your head or cut it too short (with a #1 or 2 cut setting for example).

Tags: fue, follicular unit extraction, hairtransplant, hair transplant, hairloss, hair loss, scar, strip

Minimum Fees for Transplanting Hair Into a Small Facial Scar

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

Dear Dr.,
I recently emailed you about adding hair to a scar on my cheek. On your fee’s page I see that there is a minimum 3000$ fee. If I needed a lesser amount of grafts for this smaller procedure, would I still have to pay that 3k minimum?
Thanks

Yes. There is a $3000 minimum per procedure because other factors such as anesthesia, medication, post op medication, nursing staff, operating room, follow-up, and administrative costs must all be factored in. In other words, even if you have a 100 graft surgery or a 1000 graft surgery the set up and logistics and the orchestration of a surgery is still the same. On occasion, a modification of our minimum fee rule is made.

Tags: hairtransplant, hair transplant, fee, cost, price

I’m Advancing Toward a Norwood Class 6 or 7

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

I have been balding since the age of 18 and am now 29. I have been taking propecia and then dutasteride for 5 years and although the process is still continuing I’m sure I would be completely bald by now if I hadn’t gone on the medication. I can see I am am advancing to a 6-7 norwood. I have thick blonde hair which sticks up and has lots of body, when i had a full head of hair as a child the barbers all commented on how thick it was and it was a nightmare to style. I would say presently i have about 20-30 hairs per square cm, less at the front and the coverage still looks ok. could i achieve good coverage from transplant procedures with a naturally looking but thin hairline?

Look at the previous blog post titled, Difference Between Norwood Class 7 Patients. In that post, you will see a man (Patient BF) that became a Class 7 patient over 10 years. He started getting transplants in the front initially and then progressed to a Class 7 after the transplants were done. So yes, you can get a transplant and continue to maintain your look.

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

Wearing Sunblock and a Hat Weeks After Hair Transplant

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

I just had a transpant operation 2 weeks ago and am going to the beach in 2 weeks. My doctor told me it is okay as long as I wear sunblock and a hat, for longer times. I really don’t want to mess up the follicles or the entire transplanted area or the donor area for that matter. What’s your advice?

My advice would be the same as your doctor.

Tags: sunblock, hairtransplant, hair transplant, hairloss, hair loss, sun block, sunscreen

Donor Scarring, Suture vs Staples, and Other Hair Transplant Questions

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

Hi, Dr. Rassman.
Some more issues:

  1. Your book says the Monocryl suture can produce a fine surgical scar superior to metal staples and is less painful and more convenient to remove (since it doesn’t have to be removed…) If this is the case, why would stapling even still be used? Is it a matter of closing the wound as fast as possible?
  2. Regarding scarring of the donor site, if scalp laxity can be measured before hand, why do people even end up with donor sites that cannot be completely closed?
  3. Do you always remove a 1 x 15cm strip, and use all the FU’s, however much that turns out to be? Somewhere it is written that if I leave the session open-ended, more hair can be harvested. But don’t you close the donor site before proceeding with the transplants?
  4. Tell me some more about the risks and the rates of complications. What percentage of the grafts transplanted at NHI typically grow? How much variability is there?

I am, as you would say, “doing my homework…”

Good questions!

  1. I have changed my mind on the use of staples. The Monocryl did produce some reaction in some patients which may have increased scarring. With regard to laxity measurements, there is presently no instrument available that will measure it (other than one we are presently testing) and laxity is often a judgment call by the experienced surgeon.
  2. The size of the donor strip depends upon the number of grafts you need and this is a math calculation based upon the density of the hair (see Patient’s Guide — How Many Grafts Will I Need?).
  3. I tell people to keep it open ended if possible so that a more generous strip may yield more grafts and then we can place higher densities.
  4. With regard to the risks of any transplant surgeon, I wrote a book on this and can not replicate that book here. Our informed consent document defines those risks for our surgery patients in enough detail to manage what MIGHT happen, not what probably will happen. Most, if not all, of the grafts should grow after a transplant with a good surgeon and experienced transplant team.
Tags: hairtransplant, hair transplant, suture, staples, donor strip, surgeon, surgery, hairloss, hair loss

One Session of 4085 Grafts 8 Months Ago (with Photos)

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

This Norwood Class 6 patient had one procedure of 4085 grafts just over 8 months ago. He went through the following routine immediately after surgery:

  1. For the first few weeks, he let his beard grow out to a good length.
  2. Then he shaved off his beard and left a longer mustache, which he maintained for a few more weeks.
  3. Nobody noticed his hair transplant, but they did comment on his new facial look. The laughing ended when he finally shaved off his mustache.
  4. Then he was his normal bald self, but slowly over the next months, the hair came in. It was so subtle that no one ever noticed it.

Before photo on the left; After photo on the right. Click the photos to enlarge.

 

Tags: hairtransplant, hair transplant, hairloss, hair loss, patient, photo

Are Doctors Promising More Grafts Than Can Possibly Be Delivered?

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

Dr. Rassman, I’m surprised no one else has raised this issue with you given the activity on various hair transplant discussion boards during the last few months. My question concerns the quantity of grafts in the donor reserve.

On these boards, I see a new trend of very young men wanting high density transplants to restore their juvenile hairlines and being transplanted under the assumption that they have, *on average*, 10K-15K grafts available via both strip and FUE. When the blarney of the clinic(s) making these graft count claims is questioned by more critical posters, the young men in question usually get very defensive and end up expressing their confidence in their doctor(s), and say that even if such estimates are exaggerated, surely some new drug, or hair maintenance, will come along to help them by the time their balding progresses to the point of making their transplants looks unnatural.

Since you believe in documenting scientific findings and have published the pathbreaking papers in this field, do you feel that these young men are being sold a false bill of goods? Can any clinic in good conscience be promising to be able to harvest twice as many grafts as we previously believed available? Has there been some breakthrough in graft harvesting capabilities that the laymen has yet to hear about? And should hope about the availability of future technology being able to benefit patients ever be part of a Master Plan?

You raise a very good point and concern. A typical hair transplant procedure of an average male with good scalp laxity will yield 3000 to 3500 grafts in Caucasians (who often have higher densities than Asians). The most that we were able to yield in one single surgery was about 5800 grafts from a patient with a very high donor hair density and good scalp laxity. This was the exception to the rule, of course. Some doctors split the ‘follicular units’ into smaller units and then charge the value of the ‘split’ number. So if a doctor got 3000 grafts, by dividing the grafts into smaller units, he/she may be able to charge for 5000 grafts and give the patient a feeling that he got more than he really did.

Thus, I very highly doubt that any clinic can yield 10,000 to 15,000 grafts in one procedure. They may be cutting all these grafts (which contain one, two, three, or four hairs) into single hair grafts. See my recent post titled How Do I Know I Am Getting the Number of Grafts I Am Paying For?. I feel strongly that splitting grafts to make money from patients is highly unethical and desperate patients are ultimately paying a price -– not only in financial terms, but in a lifetime of potential disfigurement from a depleted donor supply.

Tags: doctor, hairtransplant, hair transplant, grafts

Wait Time In Between Hair Transplant Surgeries?

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

Hi Dr. Rassman:

I had a 4085 graft strip procedure in the front 2/3 or so of my scalp about a month ago. I want to have another procedure in the back third. I have some hair there but I want to thicken it. I was thinking of having a 500-1000 graft FUE procedure. How long after the first surgery do I have to wait?

Thanks

I don’t understand why you want to do an FUE if you already had a strip harvest. The scalp recovers in 2-3 months and then another surgery may be done if you are going to have it put into a completely separate area. I generally like to wait 6+ months between surgeries, because then you will be in a better position to determine where you want the new grafts and to find out if the goals of the earlier procedure were adequate to meet your needs.

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

Hair Transplants Aren’t Growing 5 Months After Procedure!

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

Hi

I did HT surgery for about 5000 grafts in Feb. 2006. My surgeon is very well known. It is now more than 5 months and I do not see any regrowth at all. i am very disappointed. Does it mean that my HT was a failure? May the high number of transplanted grafts be the reason for no growth?

I never worry about growth at only 5 months. You should be seeing growth any day now. Wait out a full 8 months and then you can make a proper assessment. Always consult with your doctor for the type of reassurance you need.

Tags: hairtransplant, hair transplant, hair growth

Do I Have to Shave My Dreadlocks For a Hair Transplant?

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

I am an african american male that has a receding hairline that I would like to correct. It makes my large forehead appear even more pronounced. The problem is a have long beautiful dreadlocks that I have been growing for the past 8 years. I am worried that if i have a hair transplant I will have to shave an area from the back of my head in order to harvest hairs and then shave another area on the front of my head where i want to have the hairline filled in. My question is, can this be done without having to lose my locks? Has this type of procedure been performed on anyone with my situation? I want to get back my hairline but i don’t want to start my dreadlocks all over again.

I just had a patient with dreadlocks stop by to show his results. He did not have his dreads shaved for surgery and he had great results!

Tags: dreadlocks, dreads, hairtransplant, hair transplant

Transplanting the Crown In a Young Man

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

My crown is balding, but my frontal hair has a solid hairline. I am a 26 year old actor and a bald beany does not fit the type of actor I want to be. How can I play the role of a seducer of women, a handsome male icon who tries to get those romantic leading man roles, when the crown shines with a beacon that draws the eye like the Luxor hotel lights up the Las Vegas skyline. Many doctors frankly refused to do my balding crown. Don’t I get a say here? What do you think?

There is a general reluctance to transplant the crown of a young man by competent hair transplant surgeons who tend to think long term on the progressive nature of hair loss. I think that transplanting the crown is not a problem provided that:

  1. You are on finasteride (my strong preference) and you give it enough time to see if the drug alone reverses the hair loss in the crown.
  2. You are aware of the long term supply and demand issues to manage your hair loss if it becomes extensive. I would require that you work out a Master Plan with me on what you would do if your Hair loss/Hair supply issues would be a problem in the long term.

People who are body dysmorphic can be treated with transplantation if there is enough education, maturity, and money available in following the course of the progression of the hair loss. With luck, you might just be a pure vertex balder (like me, who had just a crown hair loss and crown transplants) or have great success with finasteride with reversal of the hair loss. Behind every balding head is a balding ‘human being’ whose vote is important in determining what trade-offs the person is willing to accept in his future. Knowing who you are is important to me, so our relationship then becomes a mutual decision (a partnership) and although I agree that for many patients transplanting just the crown of a young man is not a good idea, I would put the doctor/patient relationship to the center of this discussion. Although I understand the general reluctance for good, honorable, and competent doctors to transplant a crown in a young man, rules are just rules and they do not dictate every decision before me.

Tags: hairtransplant, hair transplant, hairloss, hair loss, vertex, crown, young

How Many FUE Sessions Can Be Done Into a Scar?

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

i recently have had some fue into a scar in my hairline. It has been 6 months and approximately 60 % of the hair has grown back. I plan on doing another fue procedure in 6 months from now. My question is how many transplants can be done into a scar? I am not sure if the density of hair in the scar will ever match the density of my surrounding hair but i will try.

There is no specific limit to an FUE (follicular unit extraction) session, other than the supply of hair you have left (and the skills of the doctor / surgical staff). As long as there is enough supply and an area (such as your scar) that require more hair, you can have the FUE procedure. As a rule of thumb after only 6 months out, you may not have all the transplanted hairs grown out (some may still be dormant). I would wait at least 10 months before having another procedure in the same area.

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

My Genetics Suck — I Am Losing Scalp Hair and Can’t Grow a Beard!

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

Dear Dr. Rassman.

I am 24 years of age and have been losing my hair since I was 17. However it has been a very slow process and I am now a NW II moving to a III but with no frontal receeding. However I can not for the life of me grow a full beard or moustache, infact my cheeks except by my jawline are pretty much bare of facial hair with a couple odd ones here and there. ( I have black hair and many of my facial hairs are red and transparent). I thought DHT was responsible for facial hair growth and thus if I was losing my hair, I would at least be able to grow a beard. I feel totally ripped off by my genetics. I can’t keep all my hair AND I can’t even grow a beard to frame my face a bit better as I deal with my rounded out hairline. What gives?

If you have scalp hair loss with good donor hair in the back of your head, you might be a good candidate for hair transplantation (which can work on the beard as well). Look on the bright side — having less facial hair may not be such a bad thing. Personally, I would trade with you and give you my beard if I could. I’m tired of shaving every day. Ha!

Tags: hairtransplant, hair transplant, genetic, genes

Keeping Up with Hair Transplants Once Finasteride Loses Effectiveness

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

Doc,

It appears that most of the hair transplant examples I’ve seen have tended to be transplants around the hairline (and hair combed back in most cases too) versus crown transplants. If one suffering from MPB were to undergo a hairline transplant and be on Propecia (for the crown) indefinitely, there will inevitably come a time (5+ years) when even the finasteride will wear out in terms of its effectiveness in keeping the crown hair. Does that mean that a series of hair transplants are required to “keep up” with the rate of hair loss overtime?

To give this question the respect it deserves, one needs to understand the natural progression of genetic male patterned balding. This is a progressive process that will eventually lead to a final pattern consistent with your genetically predetermined pattern. Look at the Norwood classification chart for hair loss and you will see a series of patterns. These can be the ‘end stage’ of the hair loss or they may be intermediate stages leading to a more advanced stage along the progression indicated in the Norwood scale. The problem is that you really do not know (for sure) where you will end up, but there are many ways to estimate where you might be by looking at:

  1. Your miniaturization map of your scalp. The final pattern may very well show some degree of miniaturization, even if you are not frankly balding yet.
  2. Your family pattern and see if you can identify (a) the worst case in the family or (b) the person whose pattern you believe you are following. Then you might be able to ascertain your final pattern (an educated guess).

If your final pattern is not the more advanced patterns (demand for hair) and if your hair density is adequate (supply), then you might be able to keep up with the progression of your balding as it is happening. If, however, the final pattern will be a Class 5, 6 or 7 pattern, you might not be able to keep up with the balding process with additional transplants because you may run out of donor hair (supply). The one clear point I wish to make is that you need to have a Master Plan to take in your worst case scenario and you must have a doctor who you can trust to work with you on that plan. The Master Plan has one objective and that is that no matter what happens, your hair restoration surgeries should always leave you with a natural appearance. Too many patients and doctors think in the short term, and think that the hair transplant will solve the problems of balding. That may not be realistic, so the relationship between the patient and the doctor is all important.

If you are having your first surgery when you are 24 years old and you are supposed to become a class 6 or 7 in the future, even though you are only a class 3 now, it is likely to assume that you need more than one surgery. On the other hand, if you are 35 and have almost reached the end of your hair loss process, you may be done with just one procedure and may never need another surgery. You have to understand that Propecia is not a permanent solution, but it does slow down the loss process in most men. Sooner or later, your hair loss will catch up until that final hair loss pattern is reached. Taking Propecia (Finasteride) may prolong the outcome, but the final pattern is probably inevitable.

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