I noticed that many of the photos show red head where the transplants are. Is that what I am going to look like and have to walk around with?

The pictures we show that are ‘bloody’ red or pink, reflect the time that they were taken (usually minutes after the surgery). Most are in the first 24 hours after the surgery when we have access to the patients. After that, the patients wash their own hair and the pinkness goes away faiirly quickly. What I mean by fairly quickly is that most people with dark, medium, or olive skin color rarely show any red color within 24-48 hours of the transplant. People with very fair, pale skin tend to show more pink or red in the wounds, but these people fall into two categories:

1. The first are the people who have what I am going to call ‘Histamine’ positive skin. These pale skinned people tend to develop redness in any scratch or trauma to the skin. They store higher amounts of the chemical Histamine at the ends of nerves which release to cause vaso-dilitation of the blood vessels. If you are one of these people, you can easily see it, just by taking your fingernail and scratching your arm. The people who are Histamine positive will develop a red-streak within a minute of the finger nail scratch. When we know that people are in this category, I treat them with two medications to minimize the redness and how long it lasts.
2. The second group of people are those who are not Histamine positive and they will respond like all other people with the redness or pinkness gone in just a day or two.

If you come to one of our open house events, we usually have someone there who had surgery earlier in the week. This allows you to see the post operative wound and the issue of social detectability, within a week of surgery.

A former patient came to my office last week complaining that the hair from the transplant last year did not grow. He wanted to discuss his options with me. When he came in, I pulled out his before pictures to be sure that both he and I would be talking about the presence or absence or change. As he looked at his before pictures, I asked him again to repeat the complaint. He repeated it despite looking at a before picture of himself — when he was a bald man. Then I gave him a mirror and asked him to look at the pictures from one year earlier, and then look back at the man in his mirror. I asked him if there was a difference.

He looked confused. When I probed his confusion, he told me that his wife was totally convinced that the hair did not grow. She reported to him that she had watched for his hair growth very closely and never saw the growth occur. He did admit that the man in the mirror was hairy and the man in the picture was bald. To help him through whatever problem he was having, I told him to think about planting grass seed or watching a child grow. The more closely you watch, the less change you see. Clearly, his wife had that problem and complained over the past year that the transplant was a waste of money. Then I suggested that he take home pictures of himself before the surgery to show to his wife, and see if her view changed. That seemed to solve the problem and he left very happy.

We see the same thing echoed by many men who are amazed that their hair transplant was never detected, even by them. In the workplace, the change occurs so slowly, that people who see you every day never notice any change. We quickly adjust to what we see before us, not the image we stored in our memories.

I always enjoy these return visits a year or so after the initial transplants were done, to be able to compare the image stored in the before photos to the ‘hairy’ person in front of me.

I am 44 and have just started to lose my hair. I have lost 70% of the first inch of my hairline and the back of my head started to thin as well. I started Propecia when I started to bald along with many other vitamins and minerals as well. Now I want to get all of my hair back. I visited a doctor who thought that the hairline I wanted was too low so he recommended that I put it higher. I don’t like what he said because the hairline he showed me was not me. My friends want to see me and I want to see me. Can I dictate where the hairline should be or must I listen to what the doctor wants.

Not having you in front of me is a problem, but I can make certain assumptions. At 44, with hair loss in the front and crown, you will probably not get very bald. However, since your hair loss started late in life, this assumption may not be an accurate reflection of your perception of the hairl loss you will see over time. What you must ask is the following question: “Given the worst case for hair loss in your future, can you live with the hairline that you have asked for?” If the answer is yes, then you must convince the doctor you will select to see it your way. I often argue with the patient but it is always a pro-patient argument challenging the patient to look at his new hairline many ways. Hair transplants are permanent, so that is both the good news and the bad news. In a consultation, you might say ‘black’ and I might respond with ‘white’, not because I believe ‘white’ but I want to make sure you understand all of the choices and consequences of selecting ‘black’ as the option. Clearly the relationship and trust you develop with your doctor will point you and your doctor to the correct decision. There are no absolute rules here, just judgments which we hope will be kind to us as we get older. Isn’t that what life is about?

Yesterday I had a visitor from Saudi Arabia, a well known woman who is actively involved in the womens’ rights movement. She was sent to see me for thinning hair by a former patient I did some 10 years earlier. She came with a message for me, “Tell Dr. Rassman that for the past 10 years, I have been enjoying the hair that he gave me more than I would have ever expected”.

This message epitomizes what I experience every day, a sense of worth communicated by heartfelt patient appreciation.

My husband is considering a transplant operation as one way to address his waning male libido – and yes, he has thinned quite a bit since he turned 50. A friend told him that since he (the friend) had hair transplants he was feeling more confident in ALL areas of his life, including his sex drive. Is this true? Better than Viagra?

Libido is a complex characteristic of the human male or female and is not related to just one factor. Clearly, what men think of their manhood, their attractiveness, their self-esteem, the influence of the woman in their life, directly impacts their libido. One of the important determining elements for libido has to do with a man’s emotional state and sense of well being. The second, is a man’s reaction to his hormonal influences and brain regulators that drive libido. We know that Testosterone is the most potent hormone that in determining the sex drive in men (and in women). Third, is the physical ability of a man’s penis to react to his sexual wants and needs. Penile function is another complex process and the failure of a penis to become erect, even in the motivated sexually driven male, will perpetuate (or make worse) sexual dysfunction.

With regard to your comment on the increased confidence of men who have had a hair transplant, well, this is a very common message my patients pass on to me. For example: One well known, rich, successful and happily married businessman came to me with a Class 6 (fairly bald) pattern. He had two transplant sessions totaling about 5000 grafts. He was dynamic and was known for his charismatic style in public – but there was a piece of the inner, sexual man what was influenced by his hair loss. His wife came to me a couple of years after I had finished his hair restoration process. When he told her of his decision to have a hair transplant, she was outwardly supportive, but secretly did not feel it was necessary. She told me that after her husband had his hair back, the man she married came back and her confession brought tears to my eyes. She told me that her love had never diminished as he was balding, because he was still the same man she fell in love with and married. Now she wanted me to share her joy in the decision and to thank me for my role in his restoration two years earlier.

This story should shed light on the secret inner man which is in every man. The inner man does not like aging, Balding is a reminder of the aging process that men hate. The problem for most men, however, is that the transplant route is imbued with negative connotations and men tend to be averse to the idea that their vanity is a problem for them. Facing their vanity without the support of a loving and understanding wife, can be a difficult decision for a married man. For the recently divorced man, on the other hand, hair transplantation is a common process during the post divorce period and with the change in their image (even the possibilities of a potentially painful surgery), a hair transplant is often moved to the forefront. With a change in the physical appearance that comes with a normal looking head of hair, comes a confidence and a libido to match provided the plumbing is in good condition.

How soon after a transplant procedure can you resume using cover ups such as, Couvre or GLH, until your newly transplanted hair grows in?
Thank You!

The use of Couvre and other scalp coloring agents, which tend to be powdery, can be safely used after the scabbing is gone. Scabbing is gone as early as 1-2 days on the short side, and 5-9 days on the long side. The difference between the short and long side reflect two controllable variables and one non-controllable one. The controllable ones are (1) size of the wounds, the smaller the wounds the shorter the healing time, and (2) the washing technique used at the surgery, the end of the surgery and the next day or two after the surgery. Good aggressive washing gets rid of scabs (in many of our patients) in a day or two. We offer hair washes for all of our patients after the surgery and as often as they feel that they are helpful. Patients are rightfully afraid to be too aggressive with the wash, out of fear that the grafts will be washed out of their recipient site. The non-controllable variable is the patient’s individual and unique reaction to the surgery. Some patients tend to exude more ‘transudate’ from the wounds (the yellowish fluid that brings blood-coagulating elements will often form scabs) and some patients may have microscopic bleeding at the wound site after the surgery (forming clots). All of these scabs and clots can be washed off the next day with properly administered washing techniques.

After the scabs are gone, these powdery agents can be used until the new hair wipes out the need for them (usually 5-8 months after the surgery).