In your before and after pictures, few patients show their face. Why is that? If I could afford a hair transplant and had a great result, I would show my face and feel proud of it.

First, with regard to costs, the costs have dropped significantly over the past decade because of better techniques and more competition. Second, cost is a relative term. What may seem “expensive” to one person may be “priceless” to another. In absolute terms hair transplants can typically cost under $10,000 and it depends on the number of grafts you need.

With respect to patients showing their face, this is a private matter for each individual. Some patients have no issue with letting the world know of their transformation. Some rather remain anonymous. We respect the wishes of each individual. In fact most patients rather not have photos published (even when it does not show the face). Some of our best work at New Hair Institute will never be published and go unnoticed to the public. There were a few of our patients on stage and in the audience during the recent Oscars for the world to see but their results will never be published on our site. Each patient has to sign a written consent form giving us permission to publish any photos (even if it doesn’t show their face).

Before hair transplant

After 2400 grafts


Some people just want to keep their hair short. Some realize the comb over is not fooling anyone. They think about a hair transplant procedure but they realize they may not end up with a full head of hair with just one surgery (especially when they want to keep their hair short and they are completely bald Norwood 6). This corporate businessman in his late 30’s didn’t want to look like he was in his 50’s. He chose SMP.

NHI Scalp MicroPigmentation Before After

NHI Scalp MicroPigmentation Before After


I have been taking finasteride for 15 years, and though I still have most of my hair, I have fairly brittle hair, at least on the hairline. Today, my friend began celebrating like a madman and, without warning, aggressively rubbed the top of my vertex/crown area with his palm. Could this have permanently damaged some of the follicles in that area?

I then went to the gym, took a shower, and dried off in the sauna for about a minute. Someone must’ve turned the heat in the sauna way up because I dried off all over within the seconds and started to feel like I was on hot coals. Even my hair went from being soaked to being damp. Could the heat have damaged my follicles?


Was your friend’s name George?

Seriously, rubbing one’s scalp should not damage your hair follicles in that one incident. Even if the rubbing pulled out hair, that hair would return. No matter what type of hair you have, it is rather very difficult to permanently damage a hair follicle. I always discuss that people who are balding, should be gentle with their hair brushing as those hairs which are miniaturized, can be pulled out with repeated rough brushing.

For that matter, taking a shower or going in to a sauna should not damage hair follicles either. The most common cause of hair loss in men is androgenic alopecia which is genetic and genetically impacted hair often become miniaturized before they die off. If you were already going bald (fact you are taking finasteride) and there was vigorous rubbing or trauma enough to bring you to a hospital, maybe (far fetched maybe) you can have hair loss akin to shock hair loss which sometimes happens after a hair transplant surgery. (Shock hair loss usually impacts miniaturized hair and when it happens, it is often permanent.)

Tags: miniaturization, brushing hair, rubbing hair, hair loss

Can I have a Scalp Micropigmentation (SMP) and later a hair transplant surgery? What if I want to grow out my hair as well? I don’t want to always keep my hair shaved.

You ask a great question! We have been combining SMP with hair transplant surgeries using FUE or Strip FUT. After all we are a medical practice that specialize in all aspect of hair restoration!

This patient came to us with a old hair transplant surgery scar. He had a strip FUT surgery which didn’t really give him a full head of hair and he just gave up with the idea of having a full head of hair. But he had the strip scar which he couldn’t hide when he decided to cut his hair short. So he went to local doctor for FUE to the strip scar. As we tell all our patients, FUE to the strip scar doesn’t really give perfect results when you are looking to shave your head. So he ended up with MORE SCAR, many ‘punctate scars’ from the FUE surgery. Needless to say he was angry and was very skeptical when he came to see us. We didn’t blame him. He didn’t trust any doctors at this point. Although Dr. Pak thought he would be a great candidate for the SMP procedure, he actually turned him down because the patient’s expectations seemed unrealistic with a bad attitude.

Eventually, the patient came back for another consultation and even saw other SMP patients in person at our monthly Open House Seminars (where prospective patients can meet with former patients and see an actual SMP or Hair Transplant surgery taking place).

This patient eventually had SMP to the entire scalp and covered his FUE scar and strip scar with great results. In the process he came to know and befriend Dr. Pak to trust his work. So after about a year he came back to Dr. Pak for a FUE procedure (about 1500 graft) to add density to the top and soften (corrective surgery) his front hair line from the old transplant work.

While the FUE transplant didn’t give him the full density, the SMP provided a cosmetic benefit to provide a look of fullness. Now he has the option to shave or grow his hair out long.

Old FUE and FUT Strip Scar addressed with SMP Scalp Micropigmenation

Old FUE and FUT Strip Scar addressed with SMP Scalp Micropigmenation

SMP Scalp Micropigment for a shaved look

SMP Scalp Micropigment for a shaved look

SMP Scalp Micropigment with FUE Hair Transplant for Fullness for Long Hair

SMP Scalp Micropigment with FUE Hair Transplant for Fullness for Long Hair

Most consumers and patients take for granted that “board certification” implies some level of expertise and qualification of a doctor. What does it ultimately mean to you? Why do we even bother with it? Is it to advertise achievement reflecting doctors’ credentials?

In the United States there are 24 approved medical specialty boards that are overseen by The American Board of Medical Specialties (ABMS), a not-for-profit organization. Certification by an ABMS Member Board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training with adequate supervised activities a medical institution AFTER earning their medical degree. After this training, they must successfully pass a level of competence through written and oral examinations.

Hair transplant surgery is not a part of the ABMS so there really is not a board certified hair transplant surgeon in the traditional sense the public thinks of. This is mainly because there is no formal supervised training or credentialing in hair transplant surgery. There is no curriculum and no oversight. There is no place to formally learn to become a hair transplant surgeon. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a doctor in the private practice of hair transplantation. We know of doctors who never performed a hair transplant surgery but only attended a seminar and within a week set up shop proclaiming that they were experts at Follicular Unit Transplants. If there was truly a board or some sort of governing body, the physicians who learn the field through an overnight effort would have been discredited and alienated from his/her peers. But this is not what happens because hair transplant surgery is not considered mainstream surgery and anyone with a medical degree (even straight out of medical school with no training) can legally perform it. Unfortunately, a license to practice any or all specialties of medicine comes after 4 years of medical school and an internship and with that completed, a doctor could proclaim themselves even a neurosurgeon; however, no hospital would allow this overnight sensation to practice neurosurgery.

Recognizing the need to become part of the mainstream, in the mid 1990’s the American Board of Hair Restoration Surgery was formed to independently certify hair transplant surgeons. The Board requires recommendations for other doctors and 100 hair transplant surgeries to qualify to take the Board’s examination. But the board can not certify adequate supervised training, as there is none. It is also powerless in its structure to monitor any doctor’s training or enforce any form of discipline. Why? Because there is no place for a physician to train to become a hair transplant surgeon. There is no education/training center. There is no residency. There is no fellowship in the traditional sense. Thus, the term “board certified” hair transplant surgeon is NOT the same nor does it hold the same value as “board certified” in the common sense that we think of a board certified plastic surgeon or neurosurgeon. In fact, states like California forbid doctors to use the term ‘certification’ unless it reflects the American Board of Medical Specialties’ endorsement, which is not the case today, nor should it be. The reality of this training process is that this is a one surgery field. Today, I know personally of doctors who started doing FUE after only attending one ISHRS meeting. When I spoke to the doctors about their results from the FUE they were doing in the first 6 months and they admitted to me privately, that they had very significant failures in their initial treated patient population.

This is why many hair transplant surgeons are not board certified in hair transplant surgery. Drs. Rassman, Pak, and Kim are not board certified in hair transplant surgery mainly because they felt that it had little significance to their practice or credibility. Since Dr. Rassman is widely regarded as one of the pioneers of modern day follicular unit transplantation (from the early 1990s) and even the innovator who started the FUE technique in 2002, his reputation stands on its own without a certification. When Dr. Rassman started performing hair transplant surgeries in 1991, the standard was ‘plugs’. He visited doctors who had great reputations in the hair transplant field and watched what they did. He figured out that the techniques that were used did not meet his standards and he refused to adopt that technique. He learned the details of how it was done by others over a period of a year and then he pioneered (a risky move) what eventually became the standard for hair transplantation across the world.

Dr. Pak was part of the original research team (working as an engineer) that developed FUE instrumentation from the mid-90’s (that eventually ended up in a U.S. Pat. No. 6,572,625 licensed to Restoration Robotics for the Artas® Robot) and has been trained exclusively by Dr. Rassman as a hair transplant surgeon. Dr Pak’s hair transplant surgery education was in the traditional sense of a fellowship or apprenticeship by working one on one with a mentor, Dr. Rassman, for more than a year. For that matter many well respected physicians have gotten their start from Dr. Rassman in the 1990’s and 2000’s. To this day, Dr. Rassman receives several emails a month from physicians requesting private fellowship training. In fact, we even found on multiple occasion, doctors from a foreign country that display photos of Dr. Rassman standing next to themselves to advertise to their patients that they were trained under him. These pictures were taken at conferences.

Misrepresentation in this industry are common. A series of website or “forums” or ‘Networks’ exist that define the best doctors in the world for its viewers. To get such endorsements, doctors must join that organization and pay a monthly fee in excess of over $1000/month. The implication is that if the doctor is not endorsed by that particular ‘forum’ that they are not amongst the “elite” and highly respected doctors in the world. The ‘forums’ or ‘networks’ collect these prospective patients and dole them out to the doctor so that the doctor might get there money back through professional fees. It becomes an interesting way to advertise through third party ‘endorsements’. To be as blunt as possible, these ‘forums’ or ‘networks’ are not neutral patient advocate sites but a subtle way for doctors to advertise by paying a membership fee. As I know most of the really great hair transplant surgeons world-wide, I know who is good, who is very good and who is not so good. The good and the bad surgeons may inevitably be endorsed by the website as long as the payment is made. I do not know them all. So you, the consumer, must be really careful if you accept the endorsements of these organizations without doing your research.

In the end the consumers (patients) are left not knowing what to believe. Board certification does not mean much if no one can enforce a certain standard of care or even oversee the training of surgeons. The Forum that endorse doctors do it for their profit, so they should not be trusted without really doing your own research. Sadly many great hair transplant surgeons are intermingled with the sleazy opportunistic ones and the entire profession is dragged through the mud as a whole but the consumer who do not get what they paid for, what they expected and end up blaming the ‘sourcing’ for their doctors.

Tags: hair transplant, surgery, surgeon, board certified

Ever since I became a doctor, friends and family have asked me to prescribe antibiotics for them as a favor when they don’t feel quite right and think that they are coming down with something. They don’t want to go to a doctor’s office when they have the flu-like or upper respiratory complaints such as a cough, a runny nose, sinus pain, and many other such miladies. When I have refused to prescribe the requested antibiotic, my routine, they make me feel as if I have betrayed them, after all, it is so simple for me to do it.

“The Centers for Disease Control and Prevention (CDC) reports that each year in the United States, at least 2 million people become infected with bacteria resistant to antibiotics, and at least 23,000 people die as a direct result of antibiotic-resistant infections.

Tom Frieden, MD, MPH, CDC Director, points out, “It’s clear that we’re approaching a cliff with antibiotic resistance. But it’s not too late. Clinicians and healthcare systems need to improve prescribing practices. And patients need to recognize that there are both risks and benefits to antibiotics — more medicine isn’t best; the right medicine at the right time is best.”

The above quote was taken from Medscape General Surgery website July 7, 2014 and after reading it, I felt better about turning down my friends and family when they don’t feel well and ask me to prescribe an antibiotic for them. There clearly is some misconception in our society that antibiotics cures the common cold, flu, coughs and sinusitis. FYI, none of my family or friends died or became hospitalized as a result of my turning them down for their requests.

Tags: antibiotic


I took Norlevo (morning after pill) 15 days ago and now I have noticed that my hair is falling out. How long will this last? Is there anyway to stop it?

Thank you.

The morning after pill is a hormone similar to what you find in a birth control pill. Birth control pills could possibly cause hair loss in rare instances. I can not tell you if that if your hair loss is related to the pill (Norlevo). It may be due to stress in general as well. You need to follow up with your doctor for an exam.

Tags: norlevo, morning after, gene, hairloss

Hi there. I recently pulled my hair, in the front part of my scalp, just to see how bald I am going and noticed that the hair I pulled didn’t have a bulb at the end. Does this mean that I have permanently lost this hair?

You probably pulled a hair that was about to be shed, like the hairs you see in the shower. We lose 100-150 hairs per day. If you want to know if you are balding, see a specialist.

When I was an intern with the cardiac service of CW Lillehei at the University of Minnesota. Dr Lillehei had just performed a surgery on a 16 year old girl with a Tetralogy of Fallot (a congenital heart defect). Being 16, Maria was unusually old for this type of surgery as most children with this condition who are left untreated typically would die from the disease before reaching adolescence.

Maria had severe heart failure when she came to us for treatment. It was a very risky surgery for her, which at 16 and extremely ill, had very low chances of survival. I was the intern on the case and followed her into the coronary care unit after the surgery. She suffered 260 cardiac arrests over the first week (I believe a record). For this reason, I stayed with her day and night, addressing each and every cardiac arrest episode as quickly and as efficiently as possible. She was fearful if I ever left her room, even for a bathroom break. I ate my meals beside her and slept in the adjacent bed next to her if it was not occupied, or on the floor, or in a chair.

After the multiple cardiac arrests, her chest wound incision (the mediastinum incision from the base of her neck to the bottom of her breast bone), could not tolerate the repeated cardiac compression episodes and electric shocks for defibrillation, and the chest wound eventually opened up, exposing her heart. When she would sit up, her heart came out of her chest. Eventually, the heart became infected and I was assigned the job of washing out the chest cavity, putting my gloved hand into the chest and breaking up pockets of pus that formed around the heart and great vessels. The process of clearing up the infection went on for many months and eventually another intern took over that responsibility.

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BagelsBear with me here while I delve into a story…

It is always good to see past patients. I’ve met them in airports, at shopping malls, or just around Los Angeles. For as big as a city it is, sometimes L.A. can feel really small. I’ve had so many patients over the years that I’m not surprised to run into them at various places around town. Most patients are discreet, but just last week I ran into a past surgical patient in a local bagel shop. He immediately told me his name (I am terrible about remembering names, but better with faces) and we talked generally about the economic recession and its impact on both of our businesses. Pleasant morning chit chat, really.

Then, right in the middle of the bagel shop, he bent down to have me look at his head and asked me what I thought about his hair. I didn’t remember where I had transplanted him and from the quick look I had of his scalp right there amongst the cases of baked goods, I honestly couldn’t tell his transplanted hair from his original remaining hair. I wasn’t going to break out a camera to start snapping photos right there, but he told me that so many people mentioned how good he looked and I’d have to agree with that. It was a nice start for my day.

Tags: hair loss, hair transplant, patient

One of my favorite BaldingBlog contributors (who shall remain nameless) sent in some great insights about FDA advisory committees. We’ve previously posted his thoughts on the LaserComb, clinical trials, and FDA trials. This post will be used in the future as a point of reference:

    Dr Rassman,
    Given the many questions related to consideration of FDA expansion of the finasteride label for prevention of prostate cancer, your readers may wish to access the data themselves and better understand the process (which becomes more transparent and less “conspiratorial”).

    The recent finasteride and dutasteride opinions noted in the Dec 3 Balding Blog posting are not from the FDA, but are from an independent group termed the Oncologic Drugs Advisory Committee. The committee is composed of 18 voting members (and several non-voting members) – mainly oncologists, with some statisticians, epidemiologists, and a patient representative, the former mainly from academic institutions.

    The FDA eventually considers the committees opinion in approval or withdrawal of drugs (or “expansion” of a drug label for a new indication). The FDA usually follows the recommendations of advisory committees, as the committees’ recommendations are presumably “data-driven” and the FDA typically comes to similar conclusions. However, as in the case of many decisions that are split or where significant differences in interpretation of risk-benefit exist, the FDA has occasionally approved or rejected a drug against the recommendation of an advisory panel. Examples of split Advisory decisions (where a majority vote did occur) are the opinions this year related to several weight loss drugs.

    The Oncologic Drugs Advisory Committee voted 17-0 against expanding the label for finasteride to include prevention of prostate cancer. A unanimous vote by FDA Advisory Committees is rare. I have no special knowledge of the meeting. This decision was based in part on data from the 19,000 patient Prostate Cancer Prevention Trial and the belief that the data did not support the risk benefit profile (i.e. possibility of increased aggressiveness of tumor did not outweigh reduced risk of low-grade tumors). As with all such committee meetings, which are open to the public (including listening via live webcasts), the transcript will be published and available within a few weeks at the FDA’s web site.

    However, interested readers can go to the FDA web site now and access the Briefing Document and presentations given to Committee members from the drug company seeking approval. This information is public and typically posted several days before the meeting. The meeting was held on Dec 1, but the date of posting was Nov 26 (see under Oncologic Drugs Advisory Committee). The info can be found at the following links [note – all are PDF files]:

  1. Draft Agenda for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
  2. Briefing Information for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
  3. Draft Questions for the November 30, 2010 Meeting of the Pediatric Oncology Subcommittee of the Oncologic Drugs Advisory Committee
  4. Merck Briefing Information for the December 01, 2010 Meeting of the Oncologic Drugs Advisory Committee
  5. FDA Briefing Information for the December 01, 2010 Meeting of the Oncologic Drugs Advisory Committee
  6. GlaxoSmithKline Briefing Information for the December 01, 2010 Meeting of the Oncologic Drugs Advisory Committee
  7. Draft Questions for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
  8. Draft Meeting Roster for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
  9. Webcast Information for the December 1, 2010 Meeting of the Oncologic Drugs Advisory Committee
Tags: fda, dutasteride, finasteride, proscar, avodart, merck, glaxosmithkline, prostate, cancer

A couple months ago I was invited to speak before the Anderson School of Business at UCLA about entrepreneurship, and I was able to talk about the diversity experienced in the multiple careers I’ve held since receiving my Doctor of Medicine degree from the Medical College of Virginia. So from time to time I’ll share some of these personal tidbits that I spoke to the Anderson School about so you can learn more about me.

I was encouraged by the feedback I received after posting about my short-lived farming career, so I’ll continue to post these as long as there’s an interest. For those of you who do not know much about my background or Dr. Pak’s background in various fields, you can find those here. So without further ado…

HeartThe Intra-Aortic Balloon Pump:

In medical school, I was fortunate to find a number of faculty who stimulated the inquisitive mind. I developed an interest while I took a job on the inhalation therapy team and the university hospital. I worked nights and was usually the first person to be called when a patient went into extremis or had a cardiac arrest. I quickly became an expert on cardiac resuscitation. I wondered why some of the patients survived and some did not, so I set up experiments, first in the VA hospital (under Dr. Yale Zimberg) where I started to develop cardiac pumps and then eventually in the research lab of the cardiac surgeon, Dr. Richard Lower. The dean of the school of medicine eventually funded my projects. That got me to eventually work at the University of Minnesota under the famous surgeon Dr. C.W. Lillehei, the father of open-heart surgery. Funds for my ideas eventually came from an endowment fund under Dr. Lillehei’s trust and when I moved from Minnesota to Cornell Medical Center, I eventually came up with the first commercial bedside assist pump, the Intra-Aortic Balloon Pump (see: demo video). The medical cardiology community initially opposed the application of the technology, so the only patients I had a chance to work on were those patients who would not come off of the heart lung machine after cardiac surgery. Dr. Lillehei was clearly my sponsor and not only paid for this work, but encouraged me in developing further improvements. I believe that cardiologists were intimidated by the technology, particularly because some minor surgery was required in the leg to insert the balloon, something that in those days cardiologists were averse to.

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FarmingMy bother-in-law is one of the most brilliant men I have ever known. I do not mean the Einstein type, but rather, he’s incredibly practical, creative, and clever. He ran a dairy farm passed down from his father in Ireland’s lush countryside, and gave me the opportunity to experience farming firsthand. Enthralled with his inventiveness with solutions to his daily problems on the farm, I realized the creative opportunities in farming. So in 1976, while running one of the busiest surgical practices in Vermont, I decided to enter the farming business. I really knew nothing about farming, but felt deep in my heart that this was a venture I would prosper in and enjoy the rewards of manual labor, something that the surgical practice did not offer. So… I bought a farm. With the agreement of my surgical partner, I took off enough time to set up the farm I purchased, which already had almost 100 dairy stock cows. My wife grew up in Ireland and as a child had to milk 7 cows each day by hand before going to school, so I figured that the difference between milking 7 cows by hand and 100 cows by a set of milking machines could be made up by just hiring a few farmhands. I purchased the farm in May and almost immediately had to plant my corn to feed the herd, so I was off and running right from the start.

It was a marvelous experience and I really fell in love with being a farmer. I felt invigorated after a day’s work and I put on muscles I did not know I had. I even bought a horse and broke it, and she only threw me once before we became bonded and I felt like a true horseman. I was really living the life, but things weren’t always so rosy. There were lots of problem with the farm, economics being the first one I never sensed I would have. Like any company, one needs a business plan that would anticipate the potential problems, but in the autumn of that first year, 40 cows developed pneumonia. I went to the hospital, got lots of IV solutions, and created an intensive care unit in the barn. I asked the drug reps for antibiotics, which they freely gave me, and used the hospital lab to help me treat the cow’s infections. So I now had two medical activities: my busy surgical practice and a fill-in veterinary practice. All of the sick cows never recovered their milk production and this failure almost lead me into bankruptcy. I learned that the pneumonia was caused by not allowing free circulation of air in the barn, so when I tried to regulate barn temperature I then created a situation where the cows easily became overheated. That was a costly lesson. I had to repurchase an entire herd.

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Dr William RassmanThis isn’t a hair transplant related post, but it is a trip down memory lane for me. Allow me to indulge myself…

I was recently talking with a friend, and I was asked to think back on a case where I had a patient that I simply did not like. While I do get along well with all of my patients today, I thought for a few moments and remembered an experience I had in my first year in surgical practice (before my life as a hair transplant doctor). The chairman of the hospital board of trustees, a very fat, nasty, and ugly man, was an obstructionist to everything that the doctors, nurses, and local politicians wanted to improve, not only the physical facility, but he was also against changing policies that would make the hospital a more patient-friendly place. He was a political person with strong prejudices and he was despised by most of the doctors as he exercised power over them by vetoing everything they asked for. I remember wondering how I’d react if he came into the emergency room bleeding to death from some type of accident and I was be the surgeon on duty. Then one day, that wonder became reality as he was rolled into the emergency room with internal bleeding from a really bad car wreck.

There was no question how I was going to behave, how I must behave — that I would do my best to save this man’s life. This was no ordinary effort, as he had major bleeding from his liver and a ruptured spleen. By the time I got him to the operating room, his blood pressure was barely detectable. We pumped many units of blood into him, got his blood pressure up a bit, opened his abdomen, removed his spleen, and sewed up his liver. I got him out of the operating room barely alive. If he had died, his injury would have justified it… but not for me. I thought that my subconscious might have tried to work against him. I remember staying at the hospital for 2 days and nights, barely sleeping. I stayed at his bedside and did not go home for over 50 hours. Slowly, he got out of shock, remaining very sick for some days until eventually he recovered. When he came back to his chairman duties months later, he was changed. Anything I would say would become his cause célèbre, so when I endorsed various hospital agenda issues like any improvements in hospital policies, in the hospital’s physical plant, etc… he became an advocate.

This experience was unique for me. I knew if he died, I somehow might be responsible for his death. I did not give him any better care than I would give any of my patients, but my prejudices towards him made me so aware of how vital and important it was for me to be impartial.

Tags: healthcare, doctor, patient, medical, surgical