We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on July 1, 2009.)

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Each and every day, I receive emails from readers asking about individual doctors’ and their reputations or even wondering if the doctor they just met with is a good doctor. Most doctors care about you and are competent and ethical, but there are a few who really don’t give a damn about you and look at you as a way to simply make more money. The unethical doctors often push men who are too early to have a transplant (like most 20 year olds) into getting one when they don’t need it, or they expand the number of grafts in a transplant procedure into areas that do not have hair loss under the guise of performing preventive hair transplants which happen to push their fees higher. Unfortunately, there are too many unethical doctors doing hair transplants and while I’m always willing to help when I can, I’m disappointed when I hear how some doctors take advantage of people in an attempt to line their pockets with your money.

In the years I’ve been posting on BaldingBlog, I’ve accumulated a lot of content about avoiding doctors that don’t put patient welfare as priority #1. I’m outspoken when it comes to patient advocacy, so I’ve also written much about how to select your hair transplant doctor. Most of my comments have been put on the daily responses I write to questions posed to me, but I’ve never put all the information in one easy-to-find place and organized it in a way that makes the job easier for the reader. So with that being said, I now present you a new “How To” type of series. These are MUST READ articles for those interested in having hair restoration surgery.

	Selecting a Hair Transplant Doctor
	How to Avoid Dishonest Doctors

I also write about why it’s important to shop around for the best doctor before committing to a hair transplant. Don’t be afraid to have to travel to get a surgery that is PERMANENT and on your head! Don’t settle for someone you’re not comfortable with just because it is convenient. At NHI, we offer travel discounts, so factoring travel and hotel costs into your surgery should not be a concern.

Why Should You Visit Us?

We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on November 20, 2009.)

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This is a patient who I just performed a corrective procedure on. There were many mistakes made here in the past with his other doctors and I wanted to share those problems with you. Knowledge is power, and I hope this will teach you what to look out for so you can prevent them from happening to you. So let’s jump right in…

The Problem

First, let’s take a look at the “Before” photos (click to enlarge):

1. The patient had received around 3000 grafts total in three surgeries on the frontal hairline at another clinic.
2. The hairline is harsh, without single hair grafts in front of the larger grafts. Plus, these were not follicular units, but the old type of minigrafts of 3-5 hairs each.
3. The hairline was placed too low and too straight, creating an abnormal edge which made the transplants obvious to the patient.
4. The surgeon made incisions in the scalp that were not kept in the same place, so the patient had two scars rather than one (see arrows in photo above). The second and third surgeries should have been performed at the same location as the first surgery. The location of the upper scar was too high as well, so transplanting into the upper scar made sense to me.

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We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on March 2, 2006.)

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I saw Bruce Willis on the David Letterman show the other day and he told everyone that he was bald and happy. That could put you out of business so don’t buy your new Mercedes yet doc. What do you think of the balding trend? Is bald beautiful?

I have followed Bruce Willis’ hair loss over the years from his thinning during the TV series Moonlighting, to the present day shaved head look he sports. A while back, I did notice what I thought were hair transplants placed in the front of his head, showing a less than artistic straight line of hair (suggesting a poor hair transplant), but if my initial guess was correct, there would be some signs of it on the front (recipient area) and in the back of the head (donor area). Judging by photos I’ve seen, I can not stand by my original assumption. I do not think Bruce Willis ever had transplant work done. It is interesting that my daughter met him at a party in the mid-90s and engaged him on the balding issue and my transplant services. He commented that he would remember the connection when the time came, so with that knowledge, I have followed his balding over the years waiting for him to come to my office and join others in that line of work that have come my way.

It must be clear to anyone considering hair transplants that the option to shave the head as Bruce Willis does may be lost if you have the procedure, as some scarring may be present at the donor site (even with the FUE technique). I have seen many patients that had a small-session transplant, which was inadequate to cover the bald area, because less hair is moved to produce the fullness that a reasonable person might expect. Small, delicate follicular units will mimic the normal hair and to get that, the doctors performing the surgery must be adhering to the standards of Follicular Unit Transplantation. Anyone with even a good hair transplant that uses strip harvesting would have a noticable scar if the head was shaved, even if it were 1mm in size. For the unfortunate person who had unsightly or poorly planned hair transplants, they may have no choice other than to live under a hat or a hair piece most of the time.

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We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on March 2, 2007.)

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People always ask, “How many grafts will I actually need to have transplanted?” Time and time again, that graft number answer will vary by doctor. When a doctor recommends a certain number of hairs/grafts, the doctor’s experience and his/her artistic skills are used to estimate what it might take to fill in the balding area with enough fullness to meet the person’s needs. I have seen estimates that could be a four fold difference and when you are shopping for a hair transplant, the differences in the estimating abilities of the doctors can be very unsettling. Who do you believe? Clearly you want to believe the doctor who has the lowest estimate for hair moved (transplants are priced by the graft), but then you are locking yourself into what might become a never ending series of hair transplant surgeries with an unrealistic amount of hair transplanted that may not meet your goals.

Does your doctor have the necessary artistic ability, not just to estimate the number of hairs/grafts, but also to take advantage of the hair supply to create a distribution that maximizes the value of the transplants for the most fullness? We have put some factors together to address how a surgeon actually calculates the numbers of grafts. These factors may not apply equally to all people. No two people are the same. The various factors like the thickness of the individual hair shafts (coarse vs. fine hair), the character of the hair (curly vs. straight hair), the color of the hair and the skin (the closer the match, the more full appearance of the hair), and any special needs defined by the patient, make us very different.

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We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on September 14, 2006.)

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Once you have a follicular unit transplant (FUT), if the procedure was done with care, there is no question that the results can’t be detected in any casual encounter, or even on close inspection in most circumstances. Yet with that said, there is still a difference between patient results that go beyond the characteristics of (1) hair shaft thickness, (2) hair character, and (3) hair color.

Let’s take a look at a patient who had two hair transplant procedures. The patient is Dr. Jon Perlman, the well-known Beverly Hills plastic surgeon that has been featured on ABC’s television show, Extreme Makeover. After his first session, he had good results that nicely framed his face when his hair was groomed. But on close examination, his hair was somewhat see-through. Dr. Perlman has very fine hair, so the bulk of each hair shaft was lower than average. By undergoing a second procedure, the bulk was doubled and the results shown in the pictures below say a great deal about the change he experienced. He was more-than-satisfied after the first procedure and thrilled after the second one. A good transplant became a great transplant.

Sometimes patients will tell me something like, “I don’t want it too thick and I am afraid if I put too much hair there, it will look unnaturally thick.” In all of the years of doing this surgery, I have never, ever had a patient who told me that I had made the hair too thick in a single session. We have seen many of our patients (initially satisfied, but wanting more hair) receive another transplant and become transformed back in time to their youthful look. By performing NHI’s pioneering dense packing procedure, we can increase the density of hair in a single procedure, often reducing the number of procedures needed to obtain results like the one shown here, but when the hair is super fine (like the example below) then two sessions may be needed. For many people, hair is like money — the more you have, the better it is.

Click the photos to enlarge.

Before and After 2 procedures (2890 grafts total):

For more photos, click “read more” —

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We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on October 17, 2006.)

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Follicular Unit Extraction (FUE) has been in vogue with hair transplantation surgeons in recent years. It is an elegant approach where one follicular unit is taken from a patient’s donor area, one at a time. There are no scalpels or the traditional linear scar. An FUE procedure requires a special 0.7 to 1 mm diameter tool that is used to harvest each hair follicle. All incisions and cuts leave a scar, but an FUE scar is barely visible to the naked eye because each FUE scar shrinks to less than 0.5mm.

There are many variables that contribute to the success or failure of an FUE. As one can imagine, harvesting a single hair follicle one at a time can be extremely tedious and fatiguing to the surgeon if he/she had to do it several hundred times for each procedure. More importantly, negotiating a 0.7 to 1 mm diameter tool to perfectly encompass a hair follicle is technically challenging even under magnification and requires a very steady hand and much experience doing it. Of course, one might ask how a doctor gets that experience and what the cost is to the patients from which that experience comes from.

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We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on April 5, 2007.)

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I’ve put together a nice list of things to consider if you’re interested in having a hair transplant, particularly when comparing the Follicular Unit Extraction (FUE) technique and the Follicular Unit Transplant (FUT / strip) technique.

FUE pros

• There will not be a detectable scar in donor area. Of course the scar will be present after every skin incision, but since scars are very small and scattered in a larger area, they are not detectable even on a head with a close crew cut.
• There are no sutures or staples to be removed. The small pointy wounds on the back of the head will be left to be closed on their own with no sutures or bandages.
• There is minimal or no pain in donor area after the removing the grafts.

FUE cons

• Not everyone is a good candidate for this procedure. We always test our patients before doing the actual procedure with several biopsies with different methods and view the grafts under microscope to see whether we can harvest them without damaging the hair follicles. If we see a lot of transected (damaged) follicles, we can not proceed with this procedure.
• It is more expensive (almost double the cost compared to the strip procedure). Follicular Unit Extraction is very tedious and every graft should be individually extracted by the surgeon as opposed to the strip method where skin is removed first and grafts are harvested under a microscope.
• It takes more time, sometimes up to twice the time when compared to a strip procedure for the same number of grafts. A procedure to harvest one thousand grafts may take six to eight hours.
• A large area of the scalp needs to be shaved or clipped very short. This is not acceptable for many patients.

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We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on January 28, 2008.)

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I am concerned about the loss of sex drive from taking propecia. I took propecia for about 6 months and my sex drive was non existant. I stopped taking it over a year ago and it has returned, some what, but not nearly where it was before. Is there a product that will help it return, or anything that can be done? I would rather be bald with a strong sex drive, than a head full of hair without one.

You need to go see your doctor for a physical examination and possible testing. While Propecia can cause a decreased sex drive (in 1 to 2% of men), it is temporary since the drug only lasts in your blood stream for about one day. After one year, I hardy doubt your sexual problem is due to Propecia. You need to see a doctor for further evaluation. In fact, erectile dysfunction may be one of the first signs of an underlying medical problem.

Here are a few facts about sex drive / erectile dysfunction / impotence that I found at Minnesota Men’s Health Center:

• One in 10 men (10%) in the world have erectile dysfunction.
• 30 million men in the United States have erectile dysfunction.
• 50% of men with diabetes have erectile dysfunction, frequently within 10 years of diagnosis.
• The likelihood of erectile dysfunction increases with age: 39% at age 40, 65% over the age of 65.
• Smokers have a higher likelihood of erectile dysfunction.
• Men who smoke more than 1 pack per day have a 50% higher chance of impotency than nonsmokers the same age.

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We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on September 7, 2007.)

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I received this email from a patient of mine and I have reposted it below with his permission (removing any identifying information, of course). This was not solicited, and it serves as an example of those men out there that are looking into hair systems (otherwise known as wigs or toupees). The price chart at the end of this post could be a wake-up call to many that think hair systems are cheaper than hair transplants.

In the end, transplanted hair is YOUR hair and the only maintenance you might need to do for it is to use shampoo and perhaps even use a comb. Oh, and visit a barber from time to time, if you’d like. You know, the things you did when you had hair the first time.

And now, the patient email…

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We’re taking a week off from posting new content — our first break in almost 6 years — so we’re using this opportunity to repost some older articles that didn’t get the attention they deserved the first time around.

(Originally published on October 3, 2008.)

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I wanted to call your attention to yesterday’s announcement relating to follicular unit extraction (FUE). As the ‘inventors’ of the procedure, publishing the first authoritative article in the Journal of Dermatologic Surgery in 2002, I have taken a keen interest in the way this procedure is delivered throughout the world. Much of what I have been observing has been disturbing. Too many doctors with little experience, and skills that have not been refined, have entered the field with heavy marketing programs offering FUE. My experience, however, has shown that some patients are not good candidates for this procedure and damage to the harvested grafts can be substantial in most surgeon’s hands. The key here is graft yield and unfortunately, this is an assessment made either after the procedure is performed with careful surgical monitoring and record keeping (by recording hair damage within each graft), or 8 months after the procedure when the patient can judge the success or failure of the results on his or her head.

I realize there is a delicate balance between what we want and what we buy. Our progress in reinventing the FUE process is discussed here — new FUE breakthrough. I really hope everyone considering having an FUE surgery (or anyone just curious about how it works) will read our new guide to evaluating Follicular Unit Extraction Techniques.

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