Another Procedure to Thicken the Hairline

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

Hi. I have a few questions for you that I hope you can help with.

First off, I have had multiple transplants so I would ask you not to insult me by sending me advertisement-type answers. I found you by Google searching so I don’t know much about you.

As I stated I have had multiple transplants. Dr. X and then Dr. Y were the two physicians I met with. Dr. Y’s scars from the donor area are rather large, Dr. X’s less so. But I did have a problem with one large graft falling out that essentially left a small ‘holish’ scar on my bald spot in the back of my head. Something I am not happy about but it is not that bad.

My hair is thin. It always has been. I am 39 years old now. I do not think I have much hair left to give from my donor areas without the back of my head starting to look bald too. I am right at the brink of what is acceptable re-distribution of the hair from the back of my head to the front of it.

It seems like you are strictly a hair transplant outfit but I thought I would ask for your opinion anyway. I do not think of myself with a full head of hair, I just want enough up front and even on the bald spot to have a stronger looking hairline overall. What would you recommend? Thank you for your time.

To address your question, you need to be evaluated directly. As you are local to Los Angeles, I ask you to please visit our open house on January 12 to meet some of the repair patients we have done. We have an open house event every month in our office if you can’t make this one. Read our repair articles published in respected medical journals, and get a private consultation to walk away educated with your options clearly defined. I will not insult you with propaganda and if you look at our website you will see that we are quite professional in the way we manage the medical hair restoration practice.

For more information about repairs, please read these articles:

Revising a Scalp Reduction

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

I had a scalp reduction and two hair transplants. I would like to see some before and after photos of a revised donor scar.

Scalp reduction repairs vary widely because of the types of incisions that was used, the number of surgical procedures that you had (I am assuming only one by the question you asked), and the damage to the underlying scalp. When a person has had many scalp reduction procedures, they often develop a deformity called a ‘Slot Deformity’ (see this article by Dr. Patrick Frechet) where the hair from the sides grow away from the scar and when this meets the hair in the back that point downward to the floor, a slot is created that looks most unnatural. You need to be evaluated in person. If you come to my Los Angeles office, I can lead you through the many types of repairs you need to know about. Alternatively, if you are not near either one of our California offices, let me know where you are, or send good photos to me (via mail or email) and I can try to address the question more appropriately over the distance.

Tissue Expansion

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

Hello Dr. Rassman,

I have read in a few your blog responses about a procedure called Tissue Expansion involving the insertion and inflation of a balloon into the scalp to create new tissue allowing for a effective scar reduction. Are you familiar w/ patients w/ HT scars that have used TE and if so have they been successful?

I’m interested in learning more about this procedure and it’s viability. I live in LA – would it be possible for you to refer a Dr. who perfroms TE?

Thank you for your insight.

I would be happy to see you myself, where I would first assess your scarring problem. One must command the problem before recommending a proper treatment. I have been involved with tissue expansion for the past few years, but it is not the solution for everyone. If I can not manage the process, my ego would not get in the way; I would then refer you to an appopriate expert, that is, if you needed another opinion. First, let’s start with a visit to my Los Angeles office. Please call 800-NEW-HAIR to setup a free consultation.

Using FUE to Touch-Up Straight Hairline

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

Hi Dr. Rassman…
First of all, I want to thank you so much for creating balding blog, it gives us very valuable information from one of the top and best surgeon in the world. About five months ago, I had a 3000 graft transplant with Dr. XXXX in toronto to restore my hairline and part of my midscalp. growth is coming in good so far but I really dont like the hairline design. it is densly packed however the grafts follow and curve almost on a straight line letting everyone know its a transplant. I like the more jagged style where the hairline is kind distruped to give a more natural look like I have seen in some of NHI pictures. so I was wondering if you can probably FUE some areas on my hairline to give a more natural look, maybe 50-100 grafts depending on what you think is best just enough to distrupt the line pattern. Is there a minumum number of grafts needed for FUE procedures?? also is it okay to perform this procedure after six months of my initial transplant as I want to get this done ASAP. Thanks again Dr. Rassman

The problem with straight lines is that they are too orderly, like Count Dracula’s appearance in the movies of the 1930’s. They accentuate a hairline when the hairline should be a zone of transition from a bald forehead to a thick head of hair. I fix these types of hairlines all of the time. Depending upon the color of your hair, it usually takes between 200-600 grafts in the frontal hairline to build a good transition zone. I wasn’t 100% sure by your email if you’d already had an FUE procedure or just wanted to use FUE for some “touch-up” work. If you have already had a strip procedure, it would be less expensive to do it with another strip procedure. An FUE procedure will work as well, but at twice the cost.

Repairing a Flap

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

First of all I would like to commend you on your website. It is the first I have seen not trying to sell anything, but trying to help. To help people like me.

I apoligize for not giving my full name, but given the sensitivity of my query I wanted to establish a rapport and trust with you prior to identifying myself on the world wide web, I hope you understand. I really hope you can help. I feel that you can identify with my plight as having been a recipient of scalp reductions as you have mentioned in your replies.

About 10 years ago I had a scalp reduction in Beverly Hills. Looking back, I was certainly of low self esteem, and uninformed for what I was about to do. The plan was to eventually get a flap surgey done, after several scalp reductions. They advertised the fullest head of hair I had ever seen in various magazines, and had an office in tinsletown, they must be good I thought. Well I went through with the reduction and have regretted since. To my credit, I had not returned to have any more work done, and have certainly come to terms with my alopecia. I see pictures and read the horror stories, and thank God I didn’t continue on, as it seems a never ending pursuit to cover up the damage most recently caused.

Ten years later, and my hair slowly getting thinner, and the scar is becoming more and more visible. I have come to terms that I will never have the scar completely removed, or at least until some revolutionary technology is availible. But I would like to minimize the appearance if it is safe, and very probable (I am soooo very leery of making matters worse!!!!!. I will not succomb to sales pitches and insecurity, and may have actually learned a valuable lesson from this about the inner beauty of people (to look at the bright side). I have about a six inch scar starting from the back of my head over the crown, and about three inches thereafter. The scar on the back is very fine-at least he did that right. However on the top it seems to have stretched somewhat, and still a little pinkish, slightly elevated and still sometimes sore. This is the part that is most visible, and concerning.

I will send you pictures if you respond to my email address to help you with helping me. I read that you suggested a scar revision from a Dr. Nordstrom in Helsinki with a new type of suture. To be honest, surgery scares the hell out of me given the result of my last one, and would like to try anything else that may be less risky and effective in reducing this scars appearance. Can you recommend a dermatologist that you think can help? A minimal risk dermatology procedure? Maybe a product? I have read about several silicone based products that claim to help.
Would you recommend daily massage to lessen the pain?

I would like to take advantage of only the latest most effective remedies, and am in the information collecting phase, and would like to be thoroughly informed . Of all the hours and hours I have spent on the internet, your blog has made an impression on me the most, and I hope you can offer some suggestions-if only some creams that may reduce the colour and slightly elevated skin until some new better technology is availible.

Of course if they ever master hair cloning-I want hair like Bon Jovi in the 90’s! Anyways, I sincerely appreciate your time, and keep up the good work, you offer some realistic hope to people like me.

Best Regards

I appreciate that you are very sensitive about your scar. Repairing scars is an art form, because every scar and every person is a variable and the differences between people and their scars make the repair of choice a difficult selection. I encourage you to send your photos, and even when you do, I can tell you that the number one best thing you can do for your “information collecting phase” is to be evaluated in person.

Scars are all different. They may respond differently to different treatments depending on the person, skin type, the direction of the scar (in your case a particularly important point) and the only way to know what the treatment options are is to have someone trustworthy and experienced to give you a hands-on evaluation and an opinion based upon experience with the problem. In my practice, I get doctors and patients sending me people for scar repairs almost every day, so a good deal of my practice profile deals with scars and/or difficult cases.

Hair transplants into scars may help and can be done with minimal invasiveness (see FUE/FOX procedures) and may apply to you. There are scalp coverings like Dermatch that when applied to the scalp make it match the hair color. Daily massage is something I recommend wholeheartedly for everyone regardless of scarring – and you are correct in that it has been shown to decrease pain in some cases and loosening up the scar from the surrounding tissues.

A trip to Los Angeles may be your best investment with the discounts now available on the various airlines.

Wishing you the best in the New Year! (and PS – I want hair cloning to be perfected, too!). Dr. Rassman has extensive experience in dealing with these problems, but before you come, please do send pictures from many good angles.

Laser Hair Removal on Scalp

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

Dr Rassman-
I am seeking your advice regarding laser hair removal on scalp hair. How safe is the procedure and what is the success? I know that this sounds counter productive for a hair transplant BLOG but here is my dilema…
I have had procedures done and the transplants were put about 1/2-3/4 inch behind my widows peak. The problem I have currently is that my widows peak does not now line up with the hairs behind it making my widows peak not lined up with my new hairline. Should I have transplants put farther down to round out my hairline (still having a very pronounced widows peak) or can I have the small cluster of hairs that make up my widows peak lasered off and use the transplants that would be necessary to round my hairline for other areas? It seems to lower my already low hairline 1/2-3/4″ would be a waste of transplants. Thank you for your response.

For your type of problem, lasers are not the best approach as they have a generally poor response (30% after one treatment) and unknown long term results.

Please send me photos of your situation from front, sides, and top view with hair dry and then another set of photos with your hair wet. Include one or two frontal views that have you lifting your eyebrows as high as you can to show the wrinkles in the brow. I will get back to you with a recommendation.

Revising Donor Scar

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

I had a strip hair transplant done a couple of years ago, was unhappy with the results, and now shave my head. The scar on the back of my head is 5-6″ long. What are my best bets for revision?

Many thanks

A scar, which is present in 100% of all patients who have strip harvesting, is usually under 3mm in width and although noticable with a shaved scalp, they can be well covered with any reasonable hair length. With that said, if your scar width exceeds 3 mm, then you should consider seeing an expert to have the scar removed and the incision closed with a ‘fascial’ closure and without another hair transplant, minimizing the tension on the wound. If the scar is 3 mm or less, than an FUE procedure would be a good technique to use for your scar revision, which would transplant hair directly into the scar from the surrounding areas. The FUE technique, which has been defined by us, will eventually cover the scar, but it might take a few small procedures to get there.

Deformed Hair Plugs — I Just Want to Be Bald

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

I have been mutilated by your hair transplant community and I am angry as hell about it. It has forced me to modify my life to address the deformities of my hair, so I do not and can not have a normal life. I have lived in hats and closets for years, and now I just want to go bald and look bald. How do I do that? I have scars on the back of my head that is wide and long (5 of them), holes in the back of my head from the first surgeon who drilled them out before the second surgeon cut them out, I have pits in my head in the front and top and my hair line looks like a Frankenstein movie part that am auditioning for.

I was told about FUE-extraction but I know that it will lead to more scars. Another doctor told me to do a second step would be to do a scar revision as well, but with than number of scars, I really can not imagine that this can be done. I want to shave my head every day and want my head to be smooth. I have very little money and that makes the problem worse.

There are many things you could do to come out of the ‘closet’ that you are forced to live in. Technology and your decisions processes of ‘old’ (many years ago I suspect) meant that you made decisions at the time that were not wise in hindsight. You can and should get out of your situation and with today’s technology, you probably can.

I am sorry to say, but your plan may just get you in a worse situation than you have now. Scar revisions can be done but you will need to camouflage the new scars (which you will have) with longer hair. There are lots of tricks to make the scars better, like a trychophytic incision which allows hair to grow up from the scar from the edges, but no single solution short of FUE (at the proper time) can address the tendency for scars to widen. Dr. Nordstrom in Helsinki has developed a special suture to address these scars and he is a reputable surgeon, but you have many scars, so that this approach is not a good one unless you get it down to a single scar. Balloon expansion of your scalp, where you will look very bizarre for up to 3 months as your head is expanded to the size of a soccer ball, can deal with the multiple scars, reducing them into a single scar with reasonably assurance of success hopefully achieving only a single small scar is a reasonable approach for multiple scars in the donor area. With the pitting you describe, the scars and the progressive hair loss, adding dermabrasion will be a disaster producing still another set of problems, more than you need.

The key here is to establish reasonable goals with a good surgeon who has lots of experience dealing with people in your situation. I think that your goal should not be to shave your head or to restore you to a hairy man, but to restore you to a normal looking balding male without a freaky, man-made look. With a frame built to your face that is normal looking, and the plugs removed, camouflaged, and properly dealt with, you can achieve this goal. Trying to go bald with what you tell me you look like, will make the scars obvious. A hair system (wig) could be considered as well, though I generally recommend to stay away from those for a variety of reasons.

Be careful not to step off another cliff. You have a bad problem, but if you look at our war stories (see Dean’s Story link below), you might realize that others have been there and fixed that under my care. Get a good doctor first, bond with him/her and then develop a plan that you can afford and live with. Then stick to it.

For more repair information:

Waxing Transplanted Hair

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

HI,
I am about a #7 on the baldness scale and I have about 200 (2-3 hair) plugs on the front hairline. I now want to go bald and was considering waxing (although painful) in the plug area. (There is nothing really wrong with my transplant, I just like the bald look better on me). My question: Will waxing do any damage to this area or the plugs themselves? Your advise is greatly appreciated.

Waxing may eventually produce traction alopecia and as such, it may in the longer term cause these ‘waxed’ hairs to fall out. If the plugs are really plugs in the old doll’s head view, there are better options including excision, FUE extraction, and laser hair removal. The problem with the doll’s head plugs is that there is often skin changes associated with them, such as cobblestoning and depigmentation, which may stand out if you go bald. Take a look at our newhair.com site and search for “plug” to see and learn much from the many pages of information on this subject.

Repairing Plugs From 25 Years Ago

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

I have 25 yr old plugs in frontal and crown area. Interested in repair work. Can repair work be done unilaterally so one side can be used to cover (comb over) the treated side, wait 6-12 months, then do the other side using the first treated side as a comb over to cover the second treated side? Do not want to walk around with scabs/scars and don’t want to wear hairpiece to conceal surgery while healing. Second question: How do I request the surgeon at NHI who has done the most repair work and who is the most talented at doing repair work. I’m not interested in any special pricing. Thank you.

I am one of the most experienced surgeons for hair work, along with Dr. Robert Bernstein in New York. Read our articles on the NHI website and make an appointment to work out the details of what you need to do, along a timeline that makes sense to you. My offices are in Los Angeles and San Jose, and are reachable by phone at 800-NEW-HAIR. Some good places to start for repair information:

Removing a Hair Transplant

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

hi, i’ve had two hair transplant procedures in the past. over the last couple of years i have just been shaving my head. i feel very uncomfortable going anywhere without a hat because of my scars. i would just like to be able to shave my head without the scars being so obvious. they are mostly right at my front hairline. can i go to a physician to have the transplants removed? and if they are removed will my scalp where the transpants are taken out heal so those little puncture holes are not as noticible? or could a procedure such a dermabrasion or laser help to smooth out the area? thank you

Without seeing you it would be difficult to make an assessment. Please send photos to the email address on the Contact page.

Generally, it is difficult to put you back in time to the days before you had your hair transplanted. With that said, we can reverse it in many ways, and sometimes it might be brought back to the “before” status. I like to tell my patients that I have good news and bad news about hair transplants: they are permanent, so get it done right the first time. If you are amongst the unfortunate that did not time your procedure correctly with current technology, then the good news is that there is a great deal of experience now in removing or hiding the ugly plugs of the older types of hair transplants.

Fixing Plugs with Electrolysis

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

On your site, you write that removing grafts via electrolysis does only work on bigger grafts – what does this mean? How big are bigger grafts? I think my grafts have maximum 5 very thin hairs in it, many have 3 hairs or less. Would it be possible for you to treat 5-hair- grafts via electrolysis?

I do not have the point of reference, but what I may have been referring to is that electrolysis of the hair has a 50% failure rate per hair. So when a larger graft is treated with electrolysis, the hairs are still present after one or two treatments. For large grafts, when the hair count in the graft is reduced, any skin cobblestonning (characteristic of the older grafts) may become more obvious. The modern approach could be to excise the entire frontal hairline since grafts in that location are most noticeable and bothersome. With fine hair and grafts that only have 4-5 hairs each (rather than the large plugs which may contain over 10 hairs), maybe less can be removed or treated with electrolysis. You can remove the hairs within the grafts with the FUE technique as well, with more certainty than electrolysis. I would need to see pictures to determine what is best. You can send pictures to the email address listed on the Contact page.

How Does Dr. Rassman Manage His Hair Loss?

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

hi doc, what do you use for your hairloss???? what is your regime??? do you take propecia or proscar and how long you been on it??? and has it stop your hairloss??????? please be specific on what you use… details please!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I take Propecia, and that is all I do. Propecia may have stopped the hair loss or it may have stopped by itself (I am 63 years old, so it is not uncommon in a man of my age). I had 3 scalp reductions in 1992 (big mistake) and then 2 hair transplants in 1994 and 1999. I was lucky that the first hair transplant fixed the scarring problem and the second one added bulk to the crown.

Scalp Reduction Slot Deformity

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

I had scalp reductions many years ago, about 7 such surgeries. I have this long narrow straight defect in my head that looks crazy from the back. Many people think that I had brain surgery and ask me about my brain operation. Can this be fixed?

Thousands of men have had the bald spots of the scalp removed in a procedure called a scalp reduction. There was a naïve view by many doctors that bald areas could simply be excised surgically. When this was attempted, the surgeon might be able to remove about 1 inch per procedure and therefore some patients would have many procedures done to tackle extensive balding of the ‘Top and Crown’ that might be as much as 7 inches wide. What the patient found out, however, was that after 7 surgical procedures, they might have only reduced the bald area by 3 inches or so. The match did not add up.

That meant that the bald areas came back by stretching (“stretch-back” was the term used), and the patient was subjected to a never ending battle to remove all of the bald spot. Rarely was this ever successful for any large bald spot, but what was successful was the appearance of a slot in the back of the excision area which joined the two sides of hair that normally was on the side of the head, growing towards the ears. It was like a aprt in the middle of the head with a bald slot in the center of this slot that often measured 1/2 inch wide or so. This abnormal hair direction moved to the top of the head accentuating the slot deformity that appeared.

There have been many attempts to get this fixed, but only one surgery really works well. It is a triple flap procedure where scalp is moved around on the two sides of the slot. The hair direction is changed. The scalp reductions themselves are well exemplified in this article by Dr. Patrick Frechet, where the slot deformity as well as Dr. Frechet’s newer methods to remove the bald areas are shown.

You might want to go to France and consider having him do the surgery, as he is one of the few doctors world-wide that can achieve consistent results from this surgery with minimal risk of scalp necrosis (a common problem in inexperienced hands).

For more information, please see:

Donor Area Repair

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

I would like to know if it is possible to repair the donor area. I had transplants done over 20 years ago, but they never formed well. I was able to survive on a comb over, but about ten years ago got a good hairpiece. I am satisfied with the piece and have no desire whatsoever to do a HT again (it is still painful in the back today).

The problem I have is that they took way too much hair on the back/left of my donor area. It has always been a problem and I had even resorted to using “Top Coverage” to fill it in so it wouldn’t be noticeable. If my hair gets wet or if I am laying on a pillow watching TV, when I get up, it is noticeable – VERY noticeable.

Ideally, I would love to remove the transplants form the top of my head and put them back on the side. Or, at least, reduces the thinning area in back.

Any ideas? Thank you

Today, we can relocate transplanted hair by removing them from within the old plugs thereby thinning them. When they are taken out, we can then move these follicles into areas of need. The areas of need could be the scars from the old transplants or to fix some abnormalities that make your ‘look’ less than what you may wnat to look like. Look at the links below and see some of the wonderful ‘fixes’ we have done. Send photos of yourself (confidential of course) and then give me a call and I would be happy to evaluate you and your problem.

For more information on repairs, please check out: