We are constantly bombarded with news releases that bring the modern techniques in medical and surgical treatments for hair loss to the forefront. Here is another such release, important for its review of today’s standard of care.
I am considering having my hairline lowered by Dr. Sheldon Kabaker in Oakland, California. What do you know about this doctor’s work in this area?
Thank you!!
I generally do not comment on a doctor’s ability on this website, because if I do not know or I think negatively about him/her, I do not want to put myself in dangerous territory. I will make an exception in this case. Dr. Kabaker is a master of the hairline lowering procedure and taught it to me.
Dear Dr. Rassman.
Sorry if I’m bombarding you with a lot of questions recently.
I recently met with a hair restoration surgeon here in my city. Let me tell you quickly about how my meeting went, and my impressions:
- Uses FUT.
- Doesn’t use the Norwood scale. (uh-oh)
- Just ran hands on back of my head and said I had good healthy hair. (First red flag. Even I can do that.)
- Recommended 2500 grafts. (Second red flag.)
- Scalp mapping= Useless.
- Got me to speak with a consultant.
- Not much regard for developing a master plan. (Third and final red flag.)
In regards to recession, I’m a class 2. If all my thinning hair were to fall off, I’d be a class 3 or 3A. My grandfather on mother’s side was a 5/6. One uncle is a mild 3, other is a 5. My dad barely had a mature hairline. He died with lots of hair. No loss on any of my uncles on his side.
Taking all of this into consideration, I have decided to make a trip to California and meet you or one of your specialists. I don’t want to blow my money and my donor hair lowering my hairline to what it was four years ago, if 10 years down the road I’m going to have the top and crown all bare.
I’ll be calling you soon to see if I can send you some pics of my current condition. 2500 grafts seems excessive to me, after seeing what you do with only 1500-1800 on types 4 or 5. (Or your type 3 patient who only had 860 grafts and looks like a 17-year old now)
Please post this on your blog, Doctor, so others may be aware of the danger of making a bad decision based on impulse. Bad hair transplants, just as the good ones, will stay with you forever.
Thanks for your time, and hope to visit your office soon.
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Mapping out your scalp for miniaturization is critical for someone like you. Based on what you’ve described, you may be a Class 2 on the Norwood pattern scale on your way to a thinning, more advanced pattern that will reflect long term hair loss (thinning in the Class 6 pattern, possibly leading to balding in that same pattern). The thinning pattern can often be treated with Propecia, preventing further balding and avoiding any hair transplants.
Please send me photographs and then we will talk prior to planning a trip to California to see me. Once I view the photos and talk to you, possibly coming to Los Angeles will get us to the bottom of your diagnosis and Master Plan.
(female) Every now and then I get bumps on my scalp that are tender, itchy. Awhile after I lightly scratch my head,some of the bumps have oozed and dried. I also notice my scalp is oilier than normal and I lose hair. Sometimes one of these bumps appear at my hairline and have a white head on it. What is this and what causes it?
Thank you.
Sounds like you get outbreaks of folliculitis for which you should see a good dermatologist to learn prevention techniques. Folliculitis reflects infections around the hair follicles, most often involving the sebaceous gland. The bacteria that cause these infections reside on the skin. Folliculitis can be caused by scratching of the skin, breaking the skin surface making it vulnerable to infection, or glands that are very oily with the openings of the hair follicle blocked with sebum. Good washing and hygene techniques usually work well to prevent the process.
I had my eyebrow tattoed twice. It created a “bump” after. It looks ugly.Could you please recommend what to buy in order to restore the hair growth for my eyebrow. I would appreciate any input please. I am frustrated everyday looking at my face on the mirror daily. On top of that, brown spots started to grow on my forehead. I tried every skin bleaching cream & sun block with high SPF, but did not clear it.
Please help.
Tattoos are permanent and they tend to change color with time, many turning a green hue. Restoring hair growth may not be possible. Most women that lose eyebrow hair get the loss from plucking the eyebrow and producing traction alopecia. Eyebrows are more sensitive to permanent loss from plucking than head hair. However, hair transplants work nicely in the eyebrow to restore them. We have an office in San Jose, which is where I believe you reside (that’s the location you provided, anyway).
I am not sure what the bump is that you are talking about, nor do I understand the brown spots that are growing on your forehead. Without seeing you, there is little I can offer. May I suggest that you see a dermatologist?
hi dr rassman,
Have you heard about GENETIC GRAFTING? This clinic in Philadelphia claims to do that: https://www.ferrarihair.com/grafting.htmWhat are your thoughts about it?
I would be more than suspicious about what “genetic grafting†really means. The site suggests scam or deceptive advertising all over it. There are no doctors or credentialed folks listed on that site. It seems every other website or clinic claim they are the “world leaderâ€. Who are they leading?
Hi Doctor. Thank you for this blog and your honest responses. The fee that you charge to perform a procedure yourself is nearly double the fee to have one of your other doctors perform the procedure. I am sure that you are in high demand and as the laws of supply and demand go you are able to command double. What I really want to know is if the QUALITY of the results of a procedure performed by you would be noticibly better than that of a procedure performed by one of your doctors? I also see that there is only one other doctor and if I’m correct he is new to your practice. Bottom line is that when it comes to something such as a hair transplant, Quality and not Price would be a deciding factor as to who I went with. To use a baseball analogy, If you and John were baseball players would you both be batting .350 or would you be batting .400 and John .250 :)
Thanks again!
Great question! Like any good baseball team, you need to have the team work together to get a winning result. What I have consistently said is that a great hair transplant doctor can not produce great work without a great team. In 1991, the quality of the work performed by the hair transplant industry was not acceptable to me, so I had to redesign the surgical techniques to make them acceptable. I have published a massive amount of work defining the standards in hair transplantation techniques (see: Medical Publications).
If you took me out of the team today and moved me to a 2nd class team, I might produce 2nd class work if I would allow myself to do just that. Back in the late 1980s and early 1990s, the quality of the work done by all hair transplant doctors was poor because the techniques were crude. The pluggy ‘dolls’ head appearance was the standard of care. So, on the first day I started to do hair transplants, I changed the technique I offered to one that allowed for delicacy of the transplants with a larger and larger number of smaller grafts, but this took manual techniques that had yet to be invented and lots of labor to produce and place these smaller grafts. Since I have never allowed myself to produce 2nd class work in anything I do, I had to build a 1st class team that understood all of the nuances that made for great hair transplants so that I could increase the number of small grafts in a single session so my patients would not have to have a surgery many times to get their hair back. You can not imagine the number of things that are controlled by the processes we developed and implemented at NHI. If I had to start all over again, I am one of the few physicians worldwide capable of doing every single part of the transplant process and I have been teaching process and techniques (one on one) to dozens of doctors and many, many medical assistants over the years. I have personally trained and retained the best people with me over the years. I pay them well and create a festive and positive work environment for the team and they return to me a diligent focus on quality and an attitude that most patients feel is imparted to them when they experience a hair transplant from this team. When I have ‘terminated’ a staff member, they always find work with other hair transplant doctors (many doctors want a medical assistant trained by me), but as I would never ‘fire’ someone great, these doctors get medical assistants that could not meet or sustain my first class standards.
In my practice, there is no such thing as a batting average of less than 1000 (400 just does not cut it, because it means that the doctor and team get great results only 40% of the time). Barry Bonds does not bat 1000 when he is at the plate, but I can bat consistently at 1000 with the NHI team and a batting average in a hair transplant reflects great results consistently. Without the team, particularly in these larger session transplants, I doubt that I would bat 1000, unless I reduced the size of the sessions to meet what I could do alone in a single day, as I did in 1992 as I evolved the megasession.
Simply put, my fees are higher because of supply and demand issues competing for my time (as you discussed).
Hello Dr. Rassman… I am now 4 weeks post op and I seem to be on track, thanks to you and your team. My question is about losing or gaining weight in relation to density/fullness of one’s hair on their head. When a person loses a significant amount of weight this weight lost is evident through out the whole body even the person’s head. With significant weight lost would hair on the head appear more dense or full? And vice-a-versa, would significant weight gain cause hair on the head to appear less dense or full? This question may sound rather odd and funny but I got the idea from a ballon with prints on it. When the ballon with prints was semi-blowned-up it appeared all covered up with prints but when it was blown-up to a nice size ballon it appeared less covered and gaps between the prints were very evident. The reason why I’m asking this question is of course I need to lose a significant amount of weight for health reasons and to get your professional opinion to satisfy my master plan of hair restoration.
I believe that your blog is of great service to many people. Keep up the good work and God bless!!!
I am glad your surgery at NHI went well and that you are pleased.
With respect to weight loss and hair density and your analogy to a balloon, it is an interesting question. However, your head is not a balloon and I suspect when you lose weight your head won’t shrink and it would not have any significant impact on the density of your hair.
I hope to see you on your 8th month follow-up a few pounds lighter and thousands of hairs fuller. Thank you for writing.
Dear Dr Rassman,
I have read with huge interest your blog/articles and links. I have a hair-loss problem and live in the UK. I am convinced that your clinic and FUE techniques are the best solution to my problem. I believe I would score as a type 6 pattern and accordingly may need more than one session. Being based in UK and having to travel to California several times would make it cost-prohibitive for me, I believe even with your 5% travel discounts.
Most of the UK surgeons in this field seem to me to be much less experienced and professional with only a few of them offering FUE.
Do you have colleagues on the East Coast of the US and/or clinics you could recommend in eg. Florida where inexpensive flights from UK are frequent these days.
Kind regards
You may want to consult with Dr. Robert Bernstein in New York.
I have noticing balding since I was 13 years old, but no one seemed to believe me for many years of it. At age 15, I saw a dermitologist who told me that I was not balding. At age 18, I finally convinced my mother to take me to a better dermitologist who confirmed that I indeed was balding, and prescribed me Propecia. Honestly, it’s to a point which I can no longer walk around like a normal human being. I am in such deep depression and will be unless the situation gets much better. Keeping the hair I have isn’t enough and a hair transplant isn’t afforadable. Am I in the position to sue my old dermitologist (and win)?
I understand losing hair in your teenage years can be devastating, but if you were dealt a genetics card of male pattern hair loss, there is not much you can do. Of course there are medications such as topical minoxidil and oral finasteride, but they are not generally prescribed for men under the age of 18 because few doctors recognize that teens can experience genetic balding just like young men can. With a parent’s cooperation and understanding what is going on inside and outside the head, I would consider prescribing Propecia for someone much younger than 18. There are also hair transplants available but at the age of 18 you can not possibly know that your final hair loss pattern might be so that a hair transplants done without a good solid prediction of your future as it fits into a personalized Master Plan for you, would not be a good idea. Add to these problems, that teens often do not have the maturity level or the finances to follow through with a surgical solution, and hair transplants make for possibly a worse situation than doing nothing.
You need a good diagnosis, confirmed with objective measurements to know that is going on. If you are indeed in “such a deep depression†because of your hair loss, perhaps you may consider seeing a psychiatrist over a dermatologist, but at the least a doctor who is caring who you can bond with. Depression is a real problem for anyone fixed upon some body deformity, real or imaginary and it should be cared for by a professional.
Eyebrows in some men grow long. The one reported here measured 3 1/2 inches in length. My eyebrows grow long and I do trim them. After reading this article, I wondered what my eyebrow length would be if I did not trim them…
So congratulations to Leonard Traenkenschuh for your world-record eyebrow hair. May we all be so lucky…
I have a few questions actually
I have heard that transsexuals who take certain hormones to become female have stopped their hair loss and even regrown some. I was wondering if someone didn’t mind becoming totally androgynous if that could be a solution to hair loss.
Now for my actual issue. My hair is thinning quite a bit in the front but is still full and thick most everywhere else. I have long hair so I have noticed it falling out quite a bit recently. I haven’t started Propecia as I am only 19 and I have heard it is a life long engagement costing upwards of $100 a month.(I am currently on accutane and since starting have noticed a dramatic change in the amount of hair I loose daily, and the costs work out the same, so I might just switch one for the other) I was wondering if I did start treatment with the medication and I were to have the hair on the top of my scalp thickened and my hairline returned with hair transplants, if I might be able to beat the risk of Shock-loss? I was also wondering what the risk factors for it are.
I rather like my long hair as it makes me look quite androgynous, so I don’t want to risk losing it all from shock-loss. I know that Procrecia doesn’t return a youthful hairline (which has receded 2cm) so I would like to know if I might be able to with the use of transplants without much risk.
Thanks for your time
Propecia will slow down and sometimes reverse hair loss. Shock loss from hair transplants can be diminished if you are taking Propecia.
Taking female hormones to become a woman may slow male pattern hair loss. Most of the patients I see who are taking female hormones and have male pattern balding, see me because of the male pattern balding. When and if they get their testicles removed, the hair loss stops but the hair that was lost prior to removing the testicles does not come back. I perform a number of hair transplants in people who have changed their gender.
Most importantly at the age of 19, you should seriously consider all your options and see a good doctor before considering any of the aforementioned topics. If you have a sexual identity issue, you should get professional guidance.
I’m curious (and nervous) about what it means when I comb out two scalp hairs that both stem from a single, hard substance that looks like a follicle. My hair is too short for this to be a split end. Is it a follicle these hairs are attached to? If so, why are there two hairs growing out of it?
Hair grows from a follicular unit in one, two, three, or four hair groups. It seems you pulled a follicular unit that had two hairs.
A recent article, titled “An update on chemoprevention strategies in prostate cancer for 2006”, published in the May 2006, Volume 16, Issue 3 issue of the Current Opinion in Urology medical journal discusses the ability to reduce prostate cancer with a variety of herbs, vitamins and drugs including the roles of: finasteride, selenium, lycopene, soy, green tea, anti-inflammatories and statins. It warns of the increased risks associated with excessive vitamin E and cyclooxygenase-2 inhibitor. We are learning much about prevention of Prostate cancer. Below is a review of the article:
PURPOSE OF REVIEW: An increasing volume of research has been directed at the prevention of prostate cancer. This review proposes to summarize the large trials, novel approaches and molecular mechanisms of effect published in 2004 and 2005.
RECENT FINDINGS: The impact of the Prostate Cancer Prevention Trial continues and subsequent articles have addressed the increase of high-grade prostate cancers detected in the finasteride arm of the trial, as well as the potential costs and benefits of extrapolating the findings to a public health campaign. Studies of risk have been published warning of excessive vitamin E and cyclooxygenase-2 inhibitor use in chemoprevention. Growing evidence supports the concept of chemopreventative agent combinations and further data on the roles of selenium, lycopene, soy, green tea, anti-inflammatories and statins in prostate-cancer prevention are presented.
SUMMARY: Level one evidence exists for the preventative effects of finasteride in prostate cancer. The evidence for other agents is less conclusive but a number of large-scale, appropriately designed trials will hopefully address some of the relevant issues in prostate-cancer prevention over the next decade.
Source: Curr Opin Urol. 2006 May;16(3):132-7, An update on chemoprevention strategies in prostate cancer for 2006, Neill MG, Fleshner NE. Division of UroOncology, University Health Network, Toronto, Canada.
I have been diagnosed with HIV which is now under reasonable control. For a period of time I was very sick, but now with the proper balance of medications, I am healthy and active. The problem is that I lost a great deal of hair from the time I got sick 2 years ago to the present. I am 54 years young and I do not like looking 80 whic is what I feel I look like when I saw a recent picture of myself. Can I have hair transplants or does the my HIV status impact either my candidacy for surgery or the results of hair transplants? Will the doctors turn me down for surgery because I am HIV positive?
A healthy person who is HIV positive may be a good a candidate as an HIV negative person. Your sickness probably caused the ‘expression’ of your genetic balding process on an accelerated timeline. At your age, I would be surprised if it continued to progress, but after mapping out your hair for miniaturization, I would go on Propecia to protect you hair from further loss and then be evaluated for a hair transplant if you want to change your look.
Under most state laws, doctors can not discriminate against someone who is HIV positive. Some doctors fudge on this and do what I call ‘closet’ discrimination where there are convenient reasons to turn down patients, but not only is this against the law, it is against the oath we as doctors are supposed to adhere to. If you are healthy, you can expect that you should be a reasonable candidate, certainly one worth evaluating. I perform hair transplants on many such patients each year.