Curious About The Hairline My Transplant Doctor Gave Me

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

I recently had a hair transplant done and I was curious about the way my doctor had done it. I naturally have had a widow’s peak but it has receded some. The way the doctor put the graphs in was sort of also in a M shaped form just out to the sides. Will this restore my natural hairline?

I cannot answer your question without seeing a current photo and comparing it to what you looked like before you lost your hair. More importantly, you should have addressed this before the surgery to make sure that your doctor understood your goals and expectations.

The standard practice at NHI is for the physician to draw a hairline with an erasable marker prior to surgery and have the patient look at the general shape and position so that he/she can approve or modify what the doctor planned. Generally this take a few minutes as the patient has specific concerns and requests (such as adding a widow’s peak). In the end, both patient and doctor are on the same page in agreement before the surgery starts and we take good pictures to document what we had agreed to. After the hairs grow in, we can then go back to the drawing on the head and see if the hairline we had tried to produce, was actually produced.

Tags: hairtransplant, hair transplant, hair loss, hair loss, hairline

False Statements About FUE Published on Doctor’s Website

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

Found this info on Sword site in reference to regenix regarding the FUE…any truth to this, especially in my case?

“The Follicular Unit Extraction Technique: The concept makes sense, and it sounds great! Instead of making an incision in the back of the head, simply remove each individual follicular unit with a punch blade then relocate it to the areas of thinning and loss… all in one step. The problem is, it isn’t quite that simple.

Hair follicles don’t grow straight up and down beneath the skin. They grow at angles, and each follicle can be at a dramatically different angle than the follicle next to it. It’s virtually impossible to know for sure. Clinical studies have shown that 25% to 40% of all follicular units being extracted during follicular unit extraction are destroyed. They are simply cut in half. And since we have a limited supply of donor hairs, we can’t afford to destroy even one unnecessarily. Additionally, the punch blade will leave multiple scars throughout the donor area. When follicular units are simply extracted from areas of the skin, the result is an overall thinning to the remaining hair. Follicular unit extraction procedures last, on average, 30% longer, cost more, result in less density and compromise the donor area.

Every surgeon has this procedure option at their disposal; the vast majority sees that it just isn’t in the patient’s best interest to utilize it.”

Partial truths can be dangerous. In the right hands, under the right conditions, he is wrong about FUE. He is right that 50% or more of the follicular units can be destroyed if the doctor doing it does not know when to do the procedure and how to get out yields in the 90% range. I suspect that either the doctor who wrote this does not want to learn how to do it right, has not been trained in the procedure properly, is ignorant, or he is just incapable of doing it and does not want to admit it. I do not fault a doctor who does not want to perform FUE, but I would expect that doctor to learn what he is talking about and admit he does not know enough.

Tags: fue, follicular unit extraction, physician, doctor, hairloss, hair loss, hairtransplant, hair transplant

Do Propecia and a Hair Transplant Compliment Each Other?

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

I really never believed in hair growth products. But after you mentioned Propecia I tried it. It took a while but I eventually saw a great difference in the thickness of my hair! Then, when I stopped using it, the hair went back as it was before using Propecia. I knew this would happen but I wanted to know if I was just imagining the change.

Hence, my question: You advised using Propecia prior to having the HT procedure. Its seems I must use it before the HT and also before the full effects kick in or how will we know how much density is normal and how much is density is due to Propecia?

If I had a choice I guess I would rather have the great results of a HT without the added cost of meds. But if they compliment each other, well, it may be worth the prescription price. Thanks

I believe that every young man should be on Propecia/finasteride if they have genetic balding. This drug will also offer some protection against shock loss that would be common with a hair transplant, and you should be on the drug at least a couple of weeks prior to having a hair transplant. If your thinning is early, then Propecia may be enough (just as you described), but if you lost hair in the front, it would be unlikely that the drug will return it. So these two modalities (transplant and drug) work nicely together and yet they do compliment each other.

Tags: propecia, finasteride, hairtransplant, hair transplant, shock loss, shockloss, hairloss, hair loss, balding

Understanding When a Hair Transplant is Appropriate

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

Hello,

I am a 21 year old male and for the last year or so I have began to notice that my hairline is receding. In an attempt to control my hair loss I have purchased Procerin and minoxidil 5% and I am considering going to my doctor to ask for his opinion on using Propecia. I have also been reading up on the subject of hair transplants but have came to understand that I am too young to consider this sort of option. However, this brings me to my questions:

  1. If I add Propecia to my current regime (Minox, Procerin) will my doctor or dermatologist still be able to map my hair loss and estimate when it would be wise to consider a hair transplant?
  2. Or will I have to stop my regime, for a period of time, to allow the regrown (if there is any) hair to fall out, thus allowing my doctor to see the natural recession of my hair line?
  3. Or would I have to stay on a course of Propecia forever, so to stop any hair loss behind the hair transplant?

I am answering your questions in the order you asked:

  1. The available FDA approved medications for hair loss can help slowing down or in some occasions stopping the process of hair loss. Early 20s is the period that most physicians don’t want to rush into performing a hair transplant, because it is hard to predict the progress of the hair loss and final hair loss pattern at this age. Considering the family history of baldness, hair loss medication use and degree of miniaturization can help establish a Master Plan for a young patient like you. So, you need to find a good doctor for a thorough evaluation and only after considering all above factors should atime table be tailored for your hair transplants.
  2. The effect of these medications on your hair growth is gradual and I don’t recommend stopping them to find out your natural degree of hair loss. You will end up losing more hair unnecessarily by doing that. I have no information about Porcerin, but Propecia is the most appropriate medication to control progression of genetic hair loss in young men.
  3. I recommend that you develop a Master Plan for the treatment and stick to it, being monitored with yearly miniaturization studies to follow the progression of the hair loss. Most of the patients need to continue their treatment for the rest of their lives, so it is wise to do your research before starting such treatments.
Tags: propecia, finasteride, hairloss, hair loss, fda

I Don’t See Results After My 2nd Procedure 8 Months Ago

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

i have my 2nd procedure and it hasn’t worked for some reason. its 8 months out now and i didnt see any result. even my original hair i had, i lost because of the procedure. it can take more then 8 months or is something wrong? i try to use the low level laser therapy but it didnt work for me? please advice me what to do. thanks

I would need more information about you. What hair have you lost? Are you on Propecia? What did your hair transplant surgeon say? Look carefully at the pictures that he took and be sure that the transplants failed. If they failed, did you surgeon agree with you? Consider getting a second opinion if your doctor is not direct with your questions.

Tags: hairtransplant, hair transplant, fail, failure, hairloss, hair loss, surgery

Tissue Expansion to Repair Alopecia After Ringworm Resulted in Infection

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

My 13 year old son underwent tissue expansion in 2003 for an area of alopecia following an attack of ringworm. He developed an infection an underwent scalp reconstruction. The scar stretched and he underwent scar reconstruction again. Yet again the scar stretched. He has refused any further expansion. The scar is very wide 1inch wide running from ear to ear across his head. Please can u help

I have seen similar patients who have had scalp reconstruction and were left with bad scars. It is not really possible for me to assess what was done from you brief narrative, but when scars become stable, hair transplantation works well to cover many of these scars. Bad scarring occurs in accident, in neurosurgery cases, and associated with different types of scalp surgery. We are presently writing a paper on the treatment of such scars.

As much as you would like to help your son, your son is also the main participant in the matter. While I sympathize with your need to address your son’s scar, it seems your son does not want any more intervention. Nevertheless if you are exploring all the options, you should seek second opinions on flap surgery and see doctors that are also experts in hair transplantation. A next step might be to send your son’s picture or make an appointment to see me if you would like your son to have a formal consultation. Remember, he is 13 years old, and at 13 he has other priorities which may interfere with sound logic.

Tags: tissue expansion, alopecia, ringworm, infection, scarring, scar, hairloss, hair loss, reconstruction

Extracellular Matrix?

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

Hi Dr. Rassman & Dr. Pak,

I saw an interesting item in one of the hair loss forums about a company called ACell, which makes “extracellular matrix” (ECM) products from pig bladders for veterinary use. They are apparently in the process of getting FDA approval for use of some of their products in humans. According to the company’s website, ECM “serves as an inductive template around which around which mammalian tissues grow and differentiate.” There are pictures on this site that are pretty amazing — gaping wounds in animals with insufficient tissue for closure that heal nearly completely, including new hair growth, after application of the scaffolding material. This seems like a pretty exciting development, with obvious potential applications in the HT field. What do you think of this?

Plastic surgeons use this similar type of technology to address open wounds and reconstruct tissue. With respect to the hair transplant field, it may have certain applications in troublesome wound areas (severe scalp injuries) where the tension on the skin makes it almost impossible to close the wound. These wounds can close, but they will not develop hair on the skin and I doubt that the pig model will apply here.

Tags: extracellular, matrix, injury, plastic surgery, hairtransplant, hair transplant, ecm

Norwood Class 6 Patient Results (with Photos)

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

This is a Norwood class 6 patient with very fine, salt and pepper colored hair. He had a total of 5431 grafts placed in two procedures. His results are fantastic and he excitedly agreed to let me post his results. The after photos were taken just under a year after his 2nd hair transplant procedure. Click the photos to enlarge.

Before:

 

After:

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

Physical Activity Immediately Before a Hair Transplant Procedure

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

Hi Dr. Rassman:

I’m having a 3000-3500 graft strip procedure next Monday. I am an avid runner and long distance walker. I understand I should wait until the staples are removed to resume these activities. Is there any issue with running or walking for exercise in the days immediately before surgery?

Thanks

MarathonI don’t believe you can hurt anything by strenuous activities prior to your hair transplant surgery. After the procedure however, you should take it easy for at least a few days. You should completely avoid any activities that can increase the tension on the skin edges for several weeks after your hair transplant surgery. Running does not impact donor wounds, so I generally tell my patients that they can run a marathon after a week if they want. I gave that advice to a man last week and he told me that if his hair transplant allowed him to run a marathon, that was better than he could do prior to getting it. He was not a runner. Ha!

Better check with your doctor, because he/she might not agree with me.

Tags: marathon, runner, hairloss, hair loss, hair transplant, hair transplant, activity

Long-Term Stubble After Hair Transplant

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

Hello and thanks again for this most helpful website.

I am a female who is just over one year post-op. For months now (no exaggeration), there has been a 1″ to 2″ band of stubble on the top\front of my scalp that DOES NOT GROW. It remains stubble.

I went to my HT surgeon for a follow-up and he said it’s just “slow growth” and we should wait another 8-9 months for another follow-up. The rest of my HT seems to have grown in fine, albeit I wish I had more grafts. How is it possible that this stubble has just stopped growing?

With many thanks and blessings.

Transplanted hair should usually start growing in 3-5 months. They should be all growing in six months and by month 12 they should be a few inches long, as thick as the original hair and long enough to comb. Some variation is seen in the growth rate among people, but no growth in one year is unusual and its causes should be explored further by your hair transplant doctor.

I have on rare occasions seen the presence of persistent stubble in the transplanted area (rarely longer than 1cm). What the stubble (after 6 months at least) should reflect is the old left-over hairs from the transplant. You can confirm this by pulling out a few of these and you should see no bulb at the ends of the hairs (from deep in the skin). If that is what you are seeing, pay no attention and these should eventually come out in a hair wash. You might get a second opinion.

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

Telogen Effluvium of Donor Area

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

I had loss of hair below the donor strip. Will that be permanent.

TE, when it occurs after the donor strip was removed, almost always returns (most of the lost hair), because this donor hair is not miniaturized unless the patient has DUPA (Diffuse Unpatterned Alopecia) or there is vascular compromise of the skin around the wound.

Tags: telogen effluvium, hairloss, hair loss, donor

When Transplanting, Do You Plan for Future Hair Loss?

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

Dear docter, great work on the website

I have a question concerning the long term results of a hair transplant patient and how you look at the long term when you transplant them.

Do you take in account how much balder the patient will be, in other words, if you continue balding after a transplant will it still look like a natural balding progression? Or will it not matter because if the patient is unhappy ten+ years later you know they’ll be coming back for another transplant.

thank you

You asked a very important question. If you have been following this site you would know the importance of the Master Plan when planning for hair transplant surgery. While it is difficult to predict how much hair you will lose, proper examination such as a miniaturization study and careful medical history will clue the doctor into the patient’s possible future hair loss. With that information, the surgeon can plan the surgery accordingly, which includes eventually transplanting into where the hair is miniaturized (planning for the inevitable hair loss) when balding occurs in that area. The patient may choose or need surgery in the future, but these are the things the doctor and the patient must review before the surgery.

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

Chance of Infections from Hair Transplant Clinics

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

Dr. Rassman,

Given that most of the hair transplants typically do not take place in strictly-regulated facilities / hospitals, and that the invasive procedure takes hours to complete — what is the chance of suffering an infection (HIV, Hepatitis, other blood-related ones) from a transplant?

I asked same questions to my dentist and according to him HIV virus cannot sustain for more than 15 minutes outside human body, but there is a very low risk of Hepatitis infection if the dental facility does not follow the strictest standards.

Do hair surgeons follow some minimal set of established operating guidelines to prevent infections et al?

Thanks

All medical facilities should follow established operating guidelines, but there are no guarantees. The HIV virus dies almost immediately when the virus is outside of the body and exposed to air. Hepatitis is more robust and some forms of the virus can move more easily between people. One of the reassurances may be to ask to see medical facility licenses and check if the hair transplant clinic is certified as an outpatient surgicenter, as ours is. Hair transplants are done under ‘clean’, not sterile conditions, but all equipment should be autoclaved or disposable to avoid infections. In our hands, infections are very, very rarely seen. I can not comment on other facilities or other doctor’s track records. With our certification process, our infection rate is compared to hospitals or other outpatient certified facilities and we do better than most. For most hair transplant facilities which are not certified, there is no review process from ‘outside the clinic’ so it would be impossible to answer your question. I suspect that infections are relatively rare in most clinics.

Tags: hairtransplant, hair transplant, clinic, infection, hepatitis, hiv

Immunoprivileged Follicle

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

I saw the previous comment about obtaining hair follicles from a donor (another person than yourself) transplanted to the patient. I’ve looked on the internet and did a search for “immunoprivileged follicle” and found dozens of articles that suggest that the follicle of the hair seems to fall in the category.

They’d even claim that it is also trans-gender: www.nature.com/nature/journal/v402/n6757/full/402033a0.html
and the Journal of Investigative Dermatology Symposium: www.nature.com/jidsp/journal/v8/n2/full/5640115a.html

Does this mean that it is possible,after all, to obtain hair follicles from a donor? Thanks!

It may be possible, but for all practicality, not probable. Even with the best case scenario, where would you get the donor hair? Could this give a new meaning to selling your hair for money?

Generally hair transplantation from one person to another carries the same risk as organ (liver, heart, kidney) transplants. There is a risk of rejection and failure and life long anti-rejection medication. You may accept the risk of rejection when faced with threatening situations such as heart/ liver/ kidney failure, but most people spending thousands of dollars for a cosmetic (hair transplant) procedure may not accept the failure risk. One might think that hair from a newborn baby might be immunoprivileged (it seems to work for a heart transplant), but again, who would endorse such a donor?

Tags: hairtransplant, hair transplant, immunoprivileged, hairloss, hair loss, organ

Using Minoxidil On Newly Transplanted Hair?

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

Hello-

What is your recommendation regarding the use of Minoxidil post-op on the newly transplanted hair?

Does Minoxidil really do anything to speed the growth of the new transplanted hair?

It seems like half of the guys use this and half do not.

Thank you.

You can use minoxidil after a hair transplant surgery, but there is no conclusive proof that it will speed the growth of the newly transplanted hair. In the end, if your hair transplant was a success your hair will grow with or without minoxidil.

Tags: minoxidil, rogaine, hairtransplant, hair transplant