Letter from a Patient

I received this letter from a patient that we did two procedures on, totalling 1584 grafts. It is the knowledge that we can change lives, that makes my day that much better.

Thank you very much for the work you did on me. It has completely changed my life. You guys are so professional and courteous. You go above and beyond to make people feel comfortable. Your work is flawless and undetectable. I have had two surgeries and people I work with (which is quite a few), have never noticed anything.

The beauty is in the illusion. If anyone reading this is contemplating surgery, just go ahead and book the appointment. I give you permission to look at my before and after pictures. Notice how much younger I look and how different my face is framed. It is the You, You’ve always wanted.

Best of luck and thanks again.

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The first two photos were before hair restoration at NHI, and the photo on the right (in black and white) is the final result. This patient is an actor, and the photo was scanned from his headshot. Click the photos to enlarge.




Unusual Natural Hairline – Photo


Double click on this photo after you read this. When I met this person I assumed that he had a bad frontal hair transplant that did not take, but he informed me that he had lost his hair naturally and never had a hair transplant.

So what are we looking at? The hairs that are left in the front have full normal, coarse diameters to them. That is why I thought that they were hair transplants. This is not the normal balding mechanism. Normally, the hairs become thinner and thinner and then fade away, yet this did not happen to the hairs that remain after balding. Many prospective patients tell me that they can always tell a transplanted hair line from a normal non-transplanted hair line. I always tell people that 90% of the time I can not tell a transplanted hair line. In this person (picture above) it is exactly the other way. A normal balding hair line is shown and it looks like a transplant (which it is not).

This is just an unusual case that I thought would be of interest to the readers of this blog.

A Perfectionist’s View of Transplants

I am 50 with early gray coming on the sides and black hair in the front. I have had 10 hair transplant procedures over the past 8 years [not at NHI]. I go from happy about them (when I had bald areas and then they went away) to unhappy (now). I am bothered about my left frontal hairline in particular. It is obvious to me that it is transplanted. I am not an expert, but I know it is not right, yet it is not the pluggy look like your book shows in the back section. I comb my hair forward to cover the hairline which I should be showing off, not hiding. What is wrong with it and can it be fixed with 100% certainty?

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It is clear that you are a perfectionist, for only a perfectionist would notice your problem. The problems are that the grafts in the frontal line are two hairs each, the hair seems to point outwardly, rather than forward and the frontal grafts are a straight line that line up like soldiers. These two problems are not uncommon when a transition zone of single hairs is not created at the leading edge of the hair line. The concept of a hair line should not be taken literally, for there is no ‘line’ in a natural hair line. You were created with a zone of single hairs that transition from a bald forehead to a full frontal hairline presentation. A good hair transplant doctor must create the same transition zone to accomplish the natural look. With your black hair, these changes are more noticeable than if your hair color was lighter, making it easier to detect a transplant. As the gray hair moves forward, the problem will become less noticeable, but I suspect that you do not want to wait a decade or more for that to happen.

The second problem is outward directional growth of the transplanted hair. Judging from your photos, that problem is the result of a radial placement of some of the recipient sites when the procedure was first done. The direction of the hair growth is totally controlled by the surgeon who made the recepient sites. Additional grafts placed in a better position and direction might influence the hair that is growing outwardly. Using the concept of ‘following the crowd’, the normal direction of the new hair can be transplanted to influence how the existing hair will lay.

The third problem is the ‘line-up’ of the hairs in a straight line that is easily detected. The frontal hairs should be irregularly placed so that no line is evident.

The last point of your question talks about certainty in outcomes. Any surgical procedure has risks of failure, so certainty in medicine is more an act of God than an act of a doctor. In my experience, the success rate for building a good transition zone is very, very high. The hope would be to complete the transition zone in one session with 500-600 single hairs in the front. Sometimes more is needed, particularly if your hair is coarse, black and straight. What you need is comfort and that is established with a visit to the doctor’s office. As a perfectionist, you will interview your potential new doctor with an open mind, but keeping some skepticism and doubt, so the doctor will have an uphill battle for your confidence. Ask the doctor to show you people he has done with black hair, you can look at the transition zone and see if you see a ‘line’ in the hairline. I always say, what you see is what you are ‘gonna’ get.

High Hairline in Teenage Male

Hi im 18 years old and i have had a high receded hairline all my life. Im thinking that a hair transplant might help lower it and fill in the gaps. Am i a good candidate?

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At 18 years old, that might be a problem because no one knows the status of your genetic balding. You would need to be evaluated by a hair loss specialist, to discuss your options. If you should bald as you age (a 50% chance in most men prior to the age of 45), then moving your hairline down today may be a problem for a long term normal look. Unless you make a living as a model or actor where a high hairline might compromise your earnings potential, I would suggest that you wait for 5-8 years before making a decision to have surgery.

A Day in the Life of Dr. William Rassman

This was a busy day. I started early this morning – today’s surgical patient (Patient A) had a Class 6 balding pattern. He had great donor and scalp laxity- we transplanted 5069 grafts in 7 hours! Patient A’s “before” photo is just below, on the left — his “after” photo was taken immediately post-op and is below, on the right.



My clinical staff is amazing; they are so efficient and focused on the needs of the patient. I hope Patient A enjoyed his shrimp cocktail, his Thai lunch, and the movies he watched.

I got to see the patients from earlier this week, when they came in for their hair washes. They are healing really well. I wonder if I could talk the staff into doing my hair every morning.

Starting mid-afternoon, I saw a series of consultations, some new patients and a few old patients coming in for follow-ups.

 

Patient B came in today. He has had 5870 grafts with us in three sessions many years ago. He told me an interesting story today. A friend of his came over to him, looked at his hair and said, “I know that you probably don’t follow this hair transplant stuff, but I have just seen a doctor about getting one. Do you think that I am foolish?” Patient B confided in his friend, “Well that is one funny question. Didn’t you know that my entire head is transplanted?” His friend had no idea. They both laughed.

Here is Patient B’s before (on left) and after (on right). He had a procedure in 1997, 1998, and 1999. Six years later, his hair is still looking great. Please note that the quality of the “before” photo is from a scanned photo, so it is not as clear as the “after” photo, taken with a digital camera.



 

Then I saw Patient C. He had a total of two surgeries with us, the first being only about 7 months ago to repair an old hair transplant. Many years ago he had the older technique of large plugs done by another clinic, and had been wearing a hair piece to help cover them. Every morning he had faced himself in the mirror and saw this:



I removed many of the big plugs, dissected them into follicular units and then relocated the hair. I replaced his frontal hairline zone with 1501 grafts of single hair units. The entire frontal presentation is what you see here:


After his first NHI surgery he tossed away the wig once the new grafts grew out. His second and last surgery was just a couple of months ago. The photos below were taken less than two weeks after this second procedure. I was able to place 992 grafts into his frontal hairline. The hair is still very short and beard like in length. I told him that I expect this last surgery will finish his reconstruction. He now sees a normal man in the mirror every morning and he is pleased. So am I.



I love it when my previous patients come in to see me and to show me their results. Prior to surgery they are often anxious, and frequently during surgery they are so relaxed that they sleep through some of the movies they selected. These follow-up visits really give me chance to bond with them and share in their ‘hair happiness high’.

 

This is Patient D. He had three procedures with us totalling 4391 grafts and he stopped by to say “hello”. The “before” photo is on the left, the “after” is on the right.



 

Also, four new patients were on the schedule and it is the adventure in meeting new people that is most fun. Today I was able to spend at least 45 minutes with each of them. In my career I have personally consulted with tens of thousands of hair loss patients and their families. They are each unique, but they share so many of the same concerns. It is a pleasure to discuss their options, to encourage them to research, to seek out the best!

At the end of my day, I got a call (on my cell phone at about 7pm) from a very successful LA area businessman who was 4 ½ months out from his surgery. He just wanted to tell me that now his favorite activity is shaving in the morning. He said “Each and every morning there is more and more hair. It is exactly the reverse of what I saw when I was losing my hair. Back then, my nightmare started in the morning when I looked in the mirror to shave- all I could see was me getting older and older. Now, the mornings are the bright spot in my day.” His thanks and appreciation was a nice way to end my long day.
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Youthful Hairlines

I am 34 and in the music business. Like the email from your model, I am in a position where I wish to look like I’m in my late 20 for a few more years–Its more business then vanity. My hair looks how it should for 34 (I am a type two), never the less, I wish to have the sides of the front filled in a bit (as well as the hariline reconstructed).

Everything I read implies that this is a bad idea, because my hairline will look too low when I am 45. If I brought my hairline back down to where it was 5 years ago, would it look stupid in 15 years?

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Clearly, you understand this subject, so I will not repeat much of what I have said in previous blog entries. First, Bill Clinton has the same hairline today that he had when he was 12 years old. His hairline does not look weird to me. It just reflects a small number of Caucasians who keep their juvenile hairlines into adulthood. IF you are not balding and you’re examined throughout each area of your scalp, looking for miniaturization and none is found, then it is not unreasonable to assume that you would be in the 55% of the population that does not bald at all. Putting back the frontal hairline will just make you look like Bill Clinton, Ronald Reagan, actor Andy Garcia, and many others like them. They looked good with their low hairlines. On the other hand, if you should start to bald, a discussion with your doctor needs to lay out a worst case scenario for you to consider along with the statistical possibility that this might happen.

Young Male Model’s Hairline

I’m 22, a model who has just recently hit it big. The clients seem to love my look, but I worry that my hairline is receding and my hair seems thinner, just like my older brother’s hair. It hasn’t been a problem yet on the job, but the competition is intense and I want to stay on the top as long as possible. My brother uses a scalp coloring agent which seems to cover the thinning, but I don’t think that will work for me under the lights. What are my realistic options? I have been extremely busy and don’t have much time between bookings. Are hair transplants an option ?

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As young men age, the normal hairline does rise about ½ inch in the front and about 1 – 1 ½ inches in the corners. I call this the mature male hairline. This is not what the advertisers want in their young male models. Like with male actors, low hairlines are a sign of virility and youth, and no one wants to get cast as an older man before their time. This patient’s hairline is a great example of the youthful look (Patient RA, after 7,147 grafts). I have had the wonderful opportunity to work with many daytime actors during their off-season hiatus, to put back their adolescent hairline and they, like you, were afraid of being replaced with a more youthful ‘would be’ competitor. The best thing for you to do is to use Propecia and possibly consider Rogaine as well if you are really balding. A good evaluation by a competent doctor is an important first step. I would strongly suggest that you make an appointment to see me in my Los Angeles office. Having worked with so many actors and others in the public eye, I understand the sense of urgency, since your earning capacity can be affected.