Will Hairline Lowering Look Better than Hair Transplants?

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

Hi Dr Rassman, i have spoken to you before and cannot decide between scalp advancement or hair transplants. I spoke to beverly hills institute and they told me dr mayer and dr fleming are the ones who started scalp advancement and having hair transplants will not look as good and that i will only be disappointed…i am now confused because i thought dr kabaker initiated this procedure. Also the doctor i went and saw suggested 2000 grafts however he seems to think a scalp advancement may be a better option….why is this so it seems so extreme as i have a young family i am scared …thanks for listening

You have every right to question the things that are unknown to you. It is a surgery on YOUR body that you will carry for the rest of your life. Different doctors will have their own opinions, as doctors are human and they tend to ‘sell’ what they do best. My point is that there is no clear and definite answer to your question. You need to do your due diligence and research and speak with former patients. You need to try to see the before and after results (not just pictures) of the doctors and procedures you’re researching. This may be easier said than done, but not for our hair transplant practice, as we do this all of the time. We do this in our monthly Open House events where my prospective patients have an opportunity to meet my past patients who have had the surgery, so they can see the results for themselves.

To clarify some facts: Dr. Kabaker is well known to perform hairline lowering procedures. He is not the only one that does this, as many plastic surgeons who do browlifts can easily do hairline lowering procedures. Dr Fleming is well known for his scalp reductions and flap procedures, not for hair transplants and therefore they will sell what they do best. Scalp reduction is different than hairline lowering.

If you have a hairline lowering procedure you may need a small hair transplant procedure to hide the inevitable scar at the frontal edge, but the procedure is literally instantaneous while you must wait for 6+ months for the hair transplants to grow out. If you have a hair transplant procedure you many need a second hair transplant procedure to meet the density goal that you desire no matter what anyone tells you. Just remember that if it sounds too good to be true… well, you know the rest.

Tags: hairloss, hair loss, hair transplant, hairline lowering

Transplanting Neck Hair to My Mustache?

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

I had a question regarding a moustache transplant. I have a sparse moustache and thin hair on my head. I’m concerned that my head hair would not be thick enough for facial hair. I was wondering if it is possible to transplant my much thicker coarser beard hair on my neck to thicken my moustache without too much scarring. My beard goes all the way down to my chest and I hate shaving it anyways. Thanks

MustacheHair from anywhere on the body can be transplanted to another location. Follicular unit extraction (FUE) is a good way to do a limited number of hair transplants into a mustache. This is something that you and your doctor should discuss.

Remember, however, that hair from different areas on the body have different hair cycles, which means that if the telogen (resting) cycle is long and the anagen (growing) cycle is short, then less of the hairs will be working for you at any one time. You can learn more about hair growth cycles here.

Tags: bht, hair transplant, neck hair, moustache, mustache, facial hair

Can a Hair Transplant Cure Migraines?

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

Does Hair Transplant cure Migraine too?

NYTimes.com – Plastic Surgery May Also Ease Migraines

Personal experience — after HT, forehead lines decreased considerably. Perhaps because of increased skin tension after a part of skin is removed?

MigraineFrom the article:

The double-blind study, published in the journal Plastic and Reconstructive Surgery, found that more than 80 percent of patients who underwent surgery in one of three “trigger sites” significantly reduced their number of headaches compared with more than 55 percent of the group who had sham surgery. More than half of the patients with the real surgery reported a “complete elimination” of headaches compared with about 4 percent of the placebo group.

No, a hair transplant would not cure migraines. Maybe it causes less headaches as you are not so preoccupied with balding, but a hair transplant wouldn’t be among the trigger sites the article refers to. Plus, this is all very experimental. Lots of work remains to be done, but thank you for bringing this to my attention.

Tags: headache, migraine, hairloss, hair loss, hair transplant, surgery, study

Dr. Rassman, What Do You Need to Finally Accept PRP?

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

Dr. Rassman,

I understand your skepticism and reluctance to accept or recommend PRP on the scalp. I was wondering though, what would it take to establish a definitive verdict in regard to effectiveness (or lack thereof) of PRP? There have been some very promising sounding testimonials and pictures that some doctors have produced. But nothing that I guess would qualify as a comprehensive medical study.

I would need a well-controlled scientific study and if it proved to have value, I would likely become a convert. I generally keep an open mind about new techniques and love to see things progress as long as they’re safe and effective. The last thing I want to do is give false hope and waste anyone’s time or money.

Tags: prp, study, protein rich plasma, platelet rich plasma, surgery

Could Hairline Lowering Cause Hair Loss in Men?

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

What are the chances of some sort of balding from the hairline lowering procedure on men??? Im 27 years old and have not have any balding whatsoever yet and have no history of balding in my family. I am also Brazilian.

Any surgery like you describe (since it is stressful) could kick-start hair loss in men. With that being said, I generally recommend that the hairline lowering procedure (where a piece of forehead is removed and the hairline is brought down) is not a procedure for men. On the remote possibility that there is late onset balding in your case, you will be left with an obvious scar as the hairline recedes. If, on the other hand, you elect to lower the hairline with hair transplants, then there will be no loss of the leading edge of the hairline, as hair transplants are permanent.

The worst case scenario of having hair transplantation to restore or lower the hairline is that the hair behind it might recede, leaving a gap between the transplanted hairline and the hair behind it. In that worst case scenario, you can transplant the hair and fill in the gaps.

Tags: hairline lowering, hair transplant, hairline, hair loss, hairloss

In the News – Hair Transplants for Other Parts of the Body

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

Snippet from the article at MSNBC:

Thanks to advances in technology, hair-transplant procedures are sprouting up all over the country and the human body. While the majority of transplants still involve the scalp (and that remains the primary donor area), doctors are now able to harvest and replant hair follicles into eyebrows, eyelashes, beards, mustaches, sideburns, chests and beyond, allowing a growing number of people to become members of what you might call the “movable hair club.”

Nearly 99,000 surgical hair restoration procedures were performed in the United States in 2008, according to the International Society of Hair Restoration Surgery, a non-profit medical association. Of that number, approximately 93,000 procedures were scalp transplants (hair transplants to fill in bald or thinning areas), followed by 3,484 eyebrows, 1,369 mustache/beard procedures and eyelashes with 531 procedures.

Read the full text — Hair here, then there: Odd transplants take root

I guess it is still news that hair from the scalp can be transplanted to any part of the body, but we’ve been doing this for many years. There are some examples of transplanted eyebrows and sideburns here (scroll towards the bottom of the page).

Tags: hair transplant, hair loss, hairloss, msnbc, body hair, bht, eyebrow, pubic, sideburns, facial hair

Young Daughter Lost Hair After Radiation to Brain Tumor

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

I’m hoping you can help us. When my daughter was 20 months old, she was diagnosed with a brain tumor. After numerous brain surgeries and chemo, we decided to have a bone marrow transplant just before her fourth birthday. Thankfully, this saved her life. She also had focal radiation to the tumor site – on the right side of her head – and unfortunately most of the hair on that quarter of her head did not grow back.

She has worn hair pieces since she has been five years old. We’ve talked to people about hair transplants in the past, but were told there was too much area to cover and also, that hair transplants do not work on the side of the head.

I’m wondering if this still holds true for this procedure. I could send you some photos so you could see the extent of the hair loss if you think that would help. Please let me know your thoughts.

Thank you

Most people with large defects are treated with balloon expanders, which stretch the normal scalp to cover the defective areas. There are a few doctors who are very skilled in this specialized technique and although I have assisted in this type of surgery, I would not consider myself at the lever of expertise needed. I have seen these expanders done in children, but every person and every situation is different. I would suggest that you send me photographs and I will forward them on to such a specialist. I have seen some miraculous results from this type of reconstructive surgery.

Usually, at the end of the expansion surgery, hair transplants are done to refine the work and cover remaining scars.

Tags: brain tumor, child, hair loss, hairloss, radiation, hair transplant, reconstructive surgery

Platelet-Rich Plasma (PRP) Safety is Really a Concern?

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

This is in response to Since When Does Platelet-Rich Plasma Need FDA Approval? —

This tone is alarmist and feels competitive. I appreciate the scientific method you’re supporting, but do you really think there are SAFETY issues with putting your own blood back into your body (or parts thereof)?

This may be a new trend that will catch on more over time. I have not used the technique yet, but at the ISHRS meeting next month, this will be a subject that is going to be discussed. I will form opinions when I meet with those who are using PRP.

The following article is a good overview that shows the “simple” side of the PRP story — nwoms.com.

Tags: platelet rich plasma, prp, hair transplant, fda

Since When Does Platelet-Rich Plasma Need FDA Approval?

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

I read your last post about PRP but now several well establish hair transplant doctors are now offering the procedure with positive results. In addition, this doesn’t need to be FDA approved because it’s from your body to your body. I actually had this done yesterday. Let’s hope this turns out to be a good thing for hair loss.

PRPThere have been various reviews by different doctors on the use of platelet-rich plasma (PRP) and few of those that used it are convinced that they have seen benefit. This technology has been used for bone grafts, especially by dentists. It drives up the costs of the procedure and proof of safety and effectiveness with regard to hair transplantation is not at hand. Any claims of safety or effectiveness do fall under the purview of the FDA, although the FDA is too busy managing its other problems to become involved in what individual doctors offer and claim with regard to this process. It is a complex process with many variables depending upon the doctor’s style. A patient’s blood must be harvested, separated from the cell portion (red and white cells) and then used in some manner to get it to the transplant.

Some doctors inject it into the scalp, some soak the graft in the PRP before implantation into the body, and the process must be carried out with impeccable sterile techniques (managing this process is not something normally found in a hair transplant practice as these procedures are not done with true sterile technique, but rather clean techniques). Can you imagine an infection that arises in a patient who underwent such a treatment? I know that my malpractice carrier would not approve as they may look at it as human experimentation (falling outside my policy coverage).

Tags: platelet rich plasma, prp, fda, hairloss, hair loss, hair transplant, experimentation

Could I Have Body Hair Transplants with a Strip Method?

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

Dear Doc,

I have heard of body hair transplants and read that they are not a reliable form of surgery due to the body hairs being weakened during extraction. However, because the body hairs are being removed with a hole punch type of instrument that may damage them, could significantly better results be attained if the body hair grafts were removed via a strip method? Let’s say the patient did not mind have a scar on their thigh as long as the strip provided enough grafts for his needs. In my case, I am thinning in the crown and anticipate that I will require far more grafts than my donor supply. Thanks

Body hair transplantation is not a gold standard method to transplant hair to the scalp, because body hair looks and behaves different than scalp hair. Damage isn’t the problem — hair growth cycles are. Only about 50% of the body hair is in growth stage at any one time, so the hair-for-hair yield is 50% rather than 90% plus as with the scalp donor hair. In other words, you won’t see most of the hair at the same time… and the hair that you do see will look different from actual scalp hair. Body hair does not grow long and has a different texture than scalp hair. To directly answer your question, yes you may find a doctor willing to do it, but the above material is presented to try to get you to think through that decision.

Tags: bht, body hair transplant, hairloss, hair loss, body hair

Moving Neck Hair to the Beard or to the Scalp?

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

Dear Dr. Rassman,
I have two questions. Before that just few words about me. I am one of the hairiest people, period. Yet and a bad luck has it, I lack hair on my head (thinning) and on some spots on my beard.

1) I see people doing beard implants (recipient is beard). I might be interested in that. In fact I would be very interested in relocating the hairs under my beard line (which in my case there is not even a beard line) and above it to the beard itself. People say that there are no scars left. Is this true? I actually started electrolysis (1 session) to get rid of my facial and neck hair, but it seems leaving some marks. Is it possible that extracting the whole follicle will leave less marks (while having the advantage of using the follicle for implant !).

2) second question is about the quality of strong beard and neck hair on the head.

MANY THANKS

Neck hair is not permanent hair in many people so it should not be used for donor transplant hairs. Filling in a beard with holes of absent hair works very well. Moving hair from one place to another can be done, but I would rather meet you and make some determinations of goals, hair quality, donor scalp density, etc… to understand your goals on a one on one basis.

Tags: neck hair, bht, hairloss, hair loss, hair transplant

I Want to Transplant Hairs from My Toe to Eyebrow

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

Do you do eye brow transplants?

I have toe hair, and I would like to either remove it or have laser done to get rid of the hairs. I don’t like my eyebrows, because they are thick. The color matches between my eyebrow and my toe hairs and they seem to have the same texture.

I think I would be a good candidate if you did.

Mark TwainYes, we do eyebrow transplants! Body hair transplants (from the back, chest or leg) have been attempted in the past with minimal success because the telogen cycle is long, at times longer than the growth cycle. Although scalp hair transplant to the eyebrow is routinely done, it does not always produce soft eyebrows that women want if the scalp hair is anything but fine. Keep in mind that scalp hair is generally more coarse than eyebrow hair. Thus, eyebrow transplants for men with coarser hair produce a more aesthetically pleasing result (as men generally want bushy, coarse eyebrows like Einstein or Mark Twain — well, maybe not that far). That being said, many of my patients (who are women) were very satisfied with their eyebrow results. The key point is that everybody is different and each patient needs to have realistic expectations and goals and know the limitations of such surgery with regard to the thickness of the hair being transplanted. This goes for any type of surgery.

I would not object to toe hair transplanted to the eyebrow, but it would be purely experimental and the growth rate may be less optimal because the sleep cycle (telogen) is relatively long, possibly longer than the growth cycle. The reason I suspect that this is the case is that I have rarely seen very long hairs growing from the top of the toe. I would want to know more about what the patient expects and what other hair may be available as an alternative.

Tags: eyebrow, hair transplant, toe hair, hairloss, hair loss, bht

Total Crown Renewal, Follow-Up

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

Dr. Mark DiStefano commented on my Total Crown Renewal post, and I’m highlighting it here:

It is truly regretful that Dr. Rassman was so scarred, both physically and emotionally by scalp reductions performed on him nearly two decades ago. I have known Dr. Rassman since I entered this field from Emergency Surgery almost 15 years ago. He has been a leader, entrepreneur, academician and teacher in the field of hair restoration.

When I entered the specialty of hair transplant surgery, Dr. Rassman had already established his practice and was experimenting with new hair transplant techniques.

With his help, the (then) modern use of the FUE (follicular unit extraction) procedure changed how we view the use of “plugs” or punches. Most hair transplant surgeons stopped using the punch 10 or more years ago . But with his invention of the FOXâ„¢ Megasession technique, he helped to lead the rest of us to today’s FUE method. When he started with this technique, many physicians were skeptical and discredited the “punch technique. But now, after continued development and refinement of technique, this has opened up an incredible area for donor hair and seemingly scarless (lack of linear scar in the donor area) surgery.

This, too, can be said for the Total Crown Renewal®. Although it may appear this procedure is based on the “old” scalp reduction, the Total Crown Renewal® utilizes different techniques to make dramatic final results.

With the old scalp reduction, the area of balding was pulled closed with from 1 or more scalp reductions. The problem with the “old” scalp reduction, was that it used mechanical stretch, (brute force), to stretch the hair bearing scalp together. This usually resulted in “stretch back, phenomena that resulted in production of excessive scar tissue in the area. Also when the number of scalp reductions was done to complete the process, there was a slot formed in the midline of the scalp and the hair was now going in the wrong direction.

[See Dr. DiStefano’s full comments here]

I thank Dr. DiStefano for his comments. The number of surgeons capable of performing the correction surgery for the deformity created by scalp reductions are very limited I have seen many doctors attempts at this corrective procedure and it was botched. For our readership, most surgeons are cocky about their abilities to see a single surgery and then with a book in hand, do it themselves. This corrective procedure is a rare example of the failed logic of this premise.

But basic to my problems with this surgery is the logic of the scalp reduction surgery itself. When the scalp is stretched (even with the well designed Frechet Extender discussed above), the hair that comes from the sides of the head is diluted so much that the density of the donor area is significantly depleted. This means that the available hair to treat the front and top of the head is reduced substantially (robbing Peter to pay Paul). Unless a person has an unusually high donor density and a reasonably loose scalp, there may not be enough hair to properly treat frontal balding. My second problem with Dr. DiStefano’s approach is that the procedure always produces a deformity when it is successful (the famous “slot deformity”) and the only way to manage this problem is with the Triple Flap Procedure that Dr. Frechet has personally defined. That would leave me asking, “Why would anyone want to have a Total Crown Renewal and get a deformity that still needs another surgery to correct?”. Certainly not me!

Tags: total crown renewal, frechet, distefano, hairloss, hair loss, flap, hair restoration

Total Crown Renewal

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

Hi Dr. Rassman, thanks for your great contribution to hair loss sufferers, and the art of hair transplantation.

I have a question concerning a practice said to completely eliminate balding in the crown area called “total crown renewal” done by a doctor in the U.S., or it’s original counterpart, the triple flap with tissue gain/scalp extension done by it’s inventor in Europe. This practice is not promoted as a “repair” procedure, but is promoted to completely eliminate crown area baldness for “normal HT candidates”. I saw pictures on their site and the result “seems” great, but I am wondering if it causes a new “head shape” by stretching and pulling the sides of the scalp to such extent.

  • Would the face and profile look different by such a procedure?
  • Would the crown hair, while completely full, look peculiar to some extent? (Most pictures I saw were from the back, not face or side…)
  • My last question: I already had 2 strip procedures for a total of 5000 grafts (one scar). Would this procedure be a risk to my existent scar? (stretching)

I am puzzled because I was about to go for a last strip for the crown, while maybe I could save all these grafts for other areas “if” needed in the future (I’m a 38 y.o. and good responder to propecia and minoxidil), and solve the crown problem with this total crown renewal procedure. What would you recommend?

Thanks very much in advance for your help!

The procedure you referenced is an old procedure called scalp reduction using a Frechet Extender (named for the doctor that created it). For a reasonable Norwood Class 6 patient it would take between 3-5 scalp reduction procedures, ending up with what is called a Triple Flap procedure. The scalp reduction procedure has been discredited as a deforming procedure thanks in part to me being so outspoken about it. I am a personal victim having had three of them in 1992. I was furious at the deformities that it created on my scalp and let the world know about it though publications in the Hair Transplant Forum (industry newsletter) and debates before medical physician audiences. Now, people doing this procedure could be open to malpractice actions if things went wrong and I have personally testified as an expert on such cases in the past.

Call it anything you want but as Shakespeare wrote, “A rose by any other name would smell as sweet” — in other words, however you change the name, it is what it is and in my opinion the scalp reductions should not be back on the market because they are deforming procedures.

Tags: flap, scalp reduction, hair transplant, surgery, hairloss, hair loss, frechet

I Had 5 Hair Transplants and 5 Scalp Reductions…

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

Hi, (classification: Norwood 6)

I need some advice on scalp reductions please!!!

I started to lose my hair at the age of 17-18 and it had a profound impact on me. I went to a dermatologist who recommended a very good hair transplant doctor and at the age of 19, I had my first hair transplant which really helped my confidence. As the years progressed, I started to lose hair in the crown area and it was suggested to have a scalp reduction.

Well, i’m 33 years old and i’ve had 5 transplants and 5 scalp reductions. Along with some cover up, my hair looks pretty good! But i’m still losing hair in the crown area! My question is: Do scalp reductions really work? What about stretch back? I still wonder back to the days when I was 17, and wonder if I had just shaved my head bald!!

Your thoughts and opinions are appreciated, thanks.

Scalp reductions do not work well and have caused misery for many patients, including myself (having had three of them and ended up more bald in the crown then before I started). I went on a campaign to discredit that surgery and I believe that my opinion is now shared by most competent doctors. That is why scalp reductions are not the standard of care for balding men today.

You probably should not have had a hair transplant in your late teen years — and as you can see now, you’re probably out of donor hair and options. As you wonder back to your days, I agree with you. Sometimes bald is beautiful!

Tags: scalp reduction, hairloss, hair loss, hair transplant