Dear Dr. Rassman,

Excellent blog. It’s great to be able to find straight forward information on hair loss which isn’t over hyped (like much hair info on the web) and isn’t afraid to point out pitfalls.

I’ve consulted with a Clinic who offer a technique which appears to be an advancement of FUE . They suggested I need one session and have 2,000 follicles transplanted on the day.

From looking at the photo of me today, aged 31, does it look like I need 2,000 transplanted? (I know a photo isn’t sufficient for you to diagnose and you could easily guess 15% too high or too low from looking at it) Also, how am I to know that I wasn’t charged for 2,000 while 1,500 are transplanted?

As I’ve found your blog useful I’m sure others have too and I’m more than happy for you to publish the photos attached.

Thanks in advance

Firstly, thanks for sending and allowing me to publish your photos. Even if I know the clinic you mention, it would be unprofessional of me to give a comment. The graft recommendation of 2000 grafts appears reasonable based upon the photos you sent and projecting the building of a mature hair line which is lower than the high exposed forelock the photo shows. Viewing the hairline proposed by the doctor would give me a better way to determine the appropriateness of the estimate.

In the end, it is still a “buyer beware” market. You really need to do your research, meet with the doctor, and meet with patients from the clinic to judge the results — don’t just settle for seeing photos of results. Most important, you need to be comfortable with your ultimate decision to trust the doctor performing your surgery. Yes… its a hard process. Speaking with patients who have had the work done there before you came on the scene, will tell you much about the doctor. Speaking with the patient that has had the work done by that clinic should get you the inside scoop. I remember a clinic that offered potential clients a list of over 1,000 satisfied customers, but when I personally called the first 20 on the list, 100% of them told me of horror stories about their experiences with that clinic. The trust issue sometime is relatively easy to flush out from former patients.

If you trust the doctor, you shouldn’t have to worry if you indeed got the grafts you were promised. And yes, there are clinics that can deceive you on the number of grafts you received. We developed count sheets and for FUE we even recorded the amount of damage to the hairs in the follicular units, but damage from the FUE technique is now virtually eliminated with our new breakthrough (but we still keep a written track record of what we do every time, even with FUE². Ask the clinic you ultimately decide to have surgery with, to show you their count sheet paperwork, not only for your own surgery (as this is something you should have in your possession when you leave the surgery), but also in other patients (with the name blanked out so you can verify they actually even make count sheets and record their damaged grafts). If the clinic will not give it to you, or they do not exist, then I would probe the situation more.

Hi Doc,
I’m a 32 year old male of Korean (dad) and French (mom) descent and have been obsessed with my hair loss for years. I got my dad’s hair, including his balding. It looks like I’m a Norwood category III or IV. I have light skin and dark straight hair so I think that would be difficult to make a successful transplant and haven’t seen many photos of Asians with hair transplants. Anything you can provide? Thanks so much.

Well timed! I just had a Japanese patient in my office this week that stopped by for a follow-up, so I’m glad I could promptly oblige your request quickly. He had a Norwood Class 4 hair loss pattern and we transplanted 1836 grafts in a single procedure about 3 1/2 years ago.

Click the photos to enlarge.

Before:

After:

For the record, it’s not that we avoid posting results photos of patients from certain ethnicities, but I can only show the results of patients that sign a photo release, and not everyone wants to do that (which is completely within their right, of course). I always appreciate when patients allow me to show their results, though!

Update — June 16, 2008: More photos added from the top view.

I have heard many people say that Norwood 7s are not good hair transplant candidates. However, two of the most successful hair transplants (Bobman and Jotronic) from another medical group were both Norwood 6’s heading towards level 7. What stops them from progressing further after their transplants? If you get a transplant as a 6, is it really that noticeable if you slowly progress to a 7? Is there something I’m missing altogether?

I have many Class 6 and 7 patients with great results from a hair transplant, so yes, it can be done well, but this is an issue of supply and demand with regard to donor hair. In other words, is there enough supply in the back of the head to meet the demands of the bald top? Take a look at Patient ZU from a past blog post (photos below) — now he has 9900 grafts and yet still has plenty of donor hair for more transplant procedures (which he does not need now) and that is because of two reasons:

1. His scalp had a great laxity to it.
2. He had a donor density which reflected an original hair population of 175,000 hairs on his head (normal is about 100,000 hairs).

Not everyone is a candidate and the issues that the doctor and the patient must face are one of realistic expectations and an excellent doctor/patient relationship.

Patient ZU – Before:

Patient ZU – After:

Update: More photos! Click to enlarge.