What is the Choi Implanter?

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

I am reading your site with great interest. I have also looked into the Choi procedure, and one well-known Choi advocate in the UK (where I also live) offers what seems to be a reasonable package, in Athens Greece. I was wondering if you could tell me more about the Choi procedure and does it yield the BEST results, with regards to density with least scarring as it is claimed? Why do some people say that FUE is not so effective? Is an “needle implanter” better than the conventional method? What about the use of Choi around the world? For instance USA, Japan, Australia? Any advice you can provide would be greatly appreciated!

The Choi implanter is just a surgical tool. It makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills with the more traditional transplant tools used throughout the world. An instrument is only as good as the person using it, so I can not package the tool with the technique. The Choi generally requires ‘skinny’ grafts, which tend to dry out more easily, therefore, this instrument requires special skills, different than those that do not have to make the grafts skinny. Some people believe that skinny grafts do not grow as well. I believe that in the right hands, with the years of experience, skinny grafts should grow as well a chubby grafts. The grafts we make are half way between skinny and chubby, just my preference.

The Choi implanter did not develop a following in the United States. In Asia and other parts of the world, it is very popular. I do not believe that it is any better than anything else that the surgeons have perfected in their native countries.

To answer your questions about FUE, I would suggest that you look at the FUE category of this blog.

If I’m Completely Bald, Do I Still Have Follicles?

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

Im completely bald! I have heard that Curis can stimulate the transition of hair follicles from the resting to the growth stage of the hair cycle.
(line picked up from a proper source). Does this mean it can help grow hair on my bald scalp too?

My question may be silly, but if im completely bald….do i have follicles on my head?

I’ve written briefly about Curis previously.

There are many steps that initiate hair growth in a hair cycle. I have heard that some people believe that there are 200 separate steps. If any one step is impacted by some disease or genetic balding process, the hair may not grow. This suggests that the elements of the hair are present even in the very bald person and there is much research going on to identify each step in the hair growing process and the critical proteins or genes that are needed to fix the process when it goes wrong.

Simply put, the answer to your question is a probable yes. How to get the hair to grow is another process completely. The good news is that there are many people and research groups working on the problem, but at this time there is no answer to each and every defect that has been identified, even in the experimental mouse trials that are being most used.

Microscope for Follicular Unit Transplantation

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

What is so great about using a microscope for hair transplantation? I read some ads in the Los Angeles Times which stated: “Dr. X set new standards in hair restoration through the use of the ‘X’ Scope [Doctor’s name removed], an advanced microscope that allows more healthy hairs to be transplanted than ever before”.

At the same time, a second ad appeared which said: “Dr. Y’s new Mantis Microscope allows for greater single-hair dissection accuracy, significantly less donor hair for wastage, high hair growth success and better, denser and more natural results.”

Are you keeping up with Dr. X and Dr. Y?

Dr. X and Dr. Y somehow just came into the modern era in hair transplantation. Please look at the many articles I authored on the use of microscopes for hair transplantation which address the use of the microscope and its value. Most of what Dr. X and Y said is true. The industry standard was set by us in an article written in 1998 which conclusively showed the value at minimizing damage in harvesting grafts by the use of the microscope. What we reported was that the hair yield produced without the microscope was 25% less than the yield with a microscope. These numbers were even more dramatic in individuals with white or gray hair, where the advantages of the microscope showed hair yields from harvested strips were 40% higher than those without the microscope. The lost hairs in the count have almost certainly been tossed into the discarded tissue and were lost value to the patient. In a common idiomatic expression, ‘The baby was tossed out with the bath water’.

The focus for Dr. X and Y in claiming a breakthrough is one of ‘grandstanding’, bringing something to the forefront of importance and trying to take credit for discoveries where none is due. Microscopic dissection has been around since the 1980s’ (first introduced by Dr. Bobby Limmer). We applied the microscope to the follicular units which we defined and published in 1995 to define the standard which is now universally accepted as the golden standard for hair transplantation in everyone’s hands. The ads are largely correct, the use of the microscope is critical for significantly less donor hair wastage, high hair growth success and better, denser and more natural results. This is just what we have been doing for the past 10 years, so there is nothing new here.

So maybe the answer to your questions is: Dr. X and Dr. Y have now finally understood the standard of care and are moving into using it. It’s about time.

FYI: I changed the names of the doctors to Dr. X and Y. Buyer Beware remains the quote for the day.

What Type of Dermatologist Should I See?

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

Hi,

First, thank you for your wonderfully informative blog.

1) I’d like to see a dermatologist about my scalp. Would any dermatologist be okay or should I make sure it is a dermatologist specializing in hair loss? (I’m currently between III and IV on the Norwood chart. Also, I my skin seems unnaturally dry in those areas, and there are two tiny red sores that I discovered about the same time my hair loss began three years ago which have never gone away; so I think there may be a correlation.)

2) I’m in San Diego. Do you (or your associates) or anyone you can recommend in my area accept Blue Cross/Blue Shield health insurance?

Thank you very much for your time.

Insurance for medical work-ups for hair loss is covered by many insurance companies, but you will have to investigate your benefits from your present carrier. Hair transplants, on the other hand, have not been covered by insurance companies unless there is a burn or accident associated, and again, the benefits are defined as ‘covering’ those injuries for cosmetic surgeries.

If you are a male or female with hair loss, then your doctor should be able to make miniaturization mapping of your scalp. Some dermatologists do this, so you should ask their staff before you set up a visit. People who call themselves hair experts can be found in the physician search on ISHRS.org in your local area. My closest office is 120 miles from you, in Los Angeles.

Moser Clinic

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

Hello!

Here in Austria we have a hair restoration clinic named Moser Clinic. This is a quote from their website:

“Unlike scientists in America Karl Moser and Dr. Krugluger integrated the experience and know-how of organ transplantation into their research. They found out that the time when the hair is removed from the donor area until it gets placed into the recipient area is the most critical and the major reason for reduced hair growth after the transplantation. During this time the FUs need a perfect, humid environment.

While other clinics still use a saline solution for intermediate storage, the Moser Medical Group developed its own solution to stop hair loss after transplantations. After the FUs have been dissected, they are stored in this solution where they are treated against disturbance of growth, until they get implanted. ”

Well they claim they know how to make the hair not fall out after a hair transplant. Could such things be true or is it simply a hoax?

The Moser Clinic is a highly respected organization and the work of Karl Moser and Dr. Krugluger has been presented to the ISHRS (International Society of Hair Restoration Surgery), where I was in the audience. They are credible scientists. Their solution appears to reduce the hair loss shedding immediately after the surgery. I would be interested in trying it, but I am prohibited from using it for many reasons including:

  1. It is not FDA approved in the United States
  2. The technique appears to have many nuances and I would want to master them before trying it on people
  3. I do not perform human experimentation

I spoke to them about the FDA and offered to cooperate with them and help them get it through the FDA process when we met this summer in Sydney, Australia.

Miniaturization?

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

I have gone to a number of doctors and asked, as you have advised, to map my scalp for Miniaturization. They do not know what I am talking about? What should I do? Are you the only one who does this? How important is it?

There are a series of hair metrics (measurements) that any good doctor must do for a proper analysis of your scalp. First, if the doctor waves his/her hand over your head and says that you have a fine hair density, run for the hills. Good metrics require scientific measurement and the science of densitometry as I have defined it in scientific publications (such as this article from 1993 which discusses densitometry) .

If you step back for a moment, you will see that if you do not know just how much hair you have and the value of each hair, then you do not know much about the way your hair (or lack thereof) will meet your needs as you replace it. Metaphorically, think about a house, where half of the house has been eaten by termites and you need to replace the wood that is not any good. Then you want to add a room on at the same time. It would be crazy to try to do this job without assessing just how much wood is rotten (miniaturized hairs), how much wood is available from the lumber yard (assuming that you have a limited amount of wood/hair from the donor area), and how much area you intend to build up from scratch (the balding area which needs to be restored). If you can not measure any of these factors, you can not determine your needs, which must be matched against supply. It is not very complicated when you know what you are doing.

It would be absurd for a doctor to tell you that measurements are not important in determining early balding (miniaturization). It would be as if he/she is saying that the pending termite damage is irrelevant, and to just wait until the house caves in. Crazy? If you do not know if your wood supply is in 2×2’s, or 4×4’s then you do not really know the value of the essential replacement resources you have. If you have miniaturized hairs in the donor area, then you might have a disease which will contradict a hair transplant, but without measurements you can not say. If the termites have invaded the wood supply (miniaturized hairs in the donor area which is a disease in men and a common finding in women with genetic hair loss), then you can not build a house (trusses and all) with 2×2 studs alone (damaged or otherwise inadequate in quantity), you need wood beams and 18 on center 4×4 studs to support a wall properly. Likewise, you can not put in single hairs or damaged hairs into the transplant to do what god’s follicular units are doing for you now like when you were young.

So, to conclude, a doctor adds very little value to your Master Plan to help you determine what you must do over time, when the doctor does not use measurements to determine:

  1. what the status of your scalp is at the time he starts Propecia with regard to miniaturization and in predicting your final hair loss pattern
  2. what you are losing
  3. what you have for supply to replace what you are losing or lost

This is not about the doctor making money doing hair transplants to all balding men, but rather using a full arsenal of treatments available to you, determining the value of those treatments over time and using his/her skills to your overall benefit. You have must a real clinical scientist / caring physician on your team who puts your benefit and goals above all else.

The Value of Hair Transplant Experience

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

Is hair transplantation an art form? Does one doctor really get better results than another? If it is only technicians putting grafts into holes in a head, how is it worth the money that you doctors charge?

Hair transplantation is a discipline that includes a sense of artistic balance, a sense of meticulous organizational skills, good judgments, and lots of experience. I know this because I see too many hair transplants that reflect failures of these elements. For example:

  1. Artistry: I can tell that a person had a hair transplant just by the location of the hairline. There is a range of normal locations, yet many doctors tend to place the hairline too high, in order to conserve hair, when the location is clearly not ‘right’. The eye catches something is not normal, and even when, on close inspection, the grafts meet the follicular unit golden standard for today, you know that something is wrong.
  2. Teamwork: Poor growth may reflect poor organizational skills and less than experienced staff. Many doctors use itinerant staff, brought in and paid by the hour. They were trained in different offices with different standards and learned habits and techniques that may not conform with the same standards as other team members. Many of the technicians who were terminated from NHI, now work as itinerant technicians who move from office to office. They bring with them the same bad habits that caused them to lose their job with me. Unless a doctor’s team has been working with that doctor for years and are self disciplined with a common focus using strict quality control processes, the team’s work will often reflect the weakest person working on the case. It is critical to recognize that today’s modern hair transplant standards are a team effort, not the output of a single individual, doctor or nurse.
  3. Judgment: The problem with balding people is that hair loss is a moving target, progressive over time. For the hair transplant surgeon it is also a matter of balancing supply of donor hair and the ‘moving’ demand of balding. A surgeon must work in the present time using what hair is reasonable to move today, while preserving hair for future hair loss so that the patients always looks normal. I have seen people who have had grafts placed in a 2 inch bald spot in the crown, which then advances to a 5 inch bald spot in the crown. They had an island of hair like an oasis in a bald desert. The same is true for frontal balding in the young man who has corner recession and gets them transplanted only to find that the corner recession advanced to full frontal balding. He comes to my office with ‘wings’ protruding out at the corners and a bald area around it. Both of these men looked freakish, so that any short term benefit they received was offset as their balding progressed. The unfortunate fact is that too many young men do not recognize that their bodies (and balding patterns) will change over time.
  4. Experience: I can not say that experience is king here, but I can say that experience means that mistakes should be minimized and #1, 2 and 3 above, have been incorporated into the routine of the transplant surgeon. I am fortunate to have become the doctor’s doctor in the Beverly Hills plastic surgeon community. These surgeons have had their transplants done by me or they have sent their patients to me and have seen the results we get. I have focused much of my professional career to publish the lessons I have learned over the years in the most prestigious medical journals and text books. Often I have had patients come to me saying that Dr. X told them that he invented ‘blah, blah and blah.’ I always tell the patient to have the doctor prove that they are the inventor and most of the time what they can’t get the information they are asking for. Falsely claiming authority or inventor status should not be taken lightly, as it is a measure of the fabric of the surgeon. Look up his/her credentials and experience and only believe what you can verify.

I can go on an on here, but to see what I am talking about, visit my website. There are over 200 patients with before and after photographs on the site and copies of much of what I have written and published is in the medical literature. Yes, hair transplantation is expensive, but would you want people to immediately say, “Nice hair transplant”? No one should even know.

Hair Doctor? Hair Specialist? Hair Consultant?

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

I understand that miniaturization is the first step for most people to begin understanding hair problems. But this procedure seems very exclusive as I have not often seen this on the internet for searches in my area.

I live in montreal Canada and I don’t even know who to look for to consult: Hair Doctor? Hair Specialist? Hair Consultant? I do not know the name of the profession so finding someone to help me is difficult.

What am I looking for exactly? And do you know if this procedure is availible for my area?

Visualizing instruments that magnify the detailed microscopic view of hair follicles, allow the viewer to estimate the miniaturization of all of the hair as compared to the healthy hairs in the field of view. The term ‘miniaturized hairs’ have been around for decades and they are the hallmark of genetic balding. I (Rassman) invented a practical instrument which I called the “Densitometer’ and patented it in the early 1990s so that every doctor could do the analysis. The tool was eventually sold by Radio Shack as a hand microscope for about $12/U.S. There are hair transplant surgeons in Canada, several good ones actually, and you should look for just that, a “hair transplant surgeon” who looks for the health of the hair and makes projection of the long term hair loss pattern with this hand held instrument. If the donor area has significant miniaturization, then the patient may have a poor outcome from a transplant. Now, my $12 hand held instrument is hooked up to video monitors and computerized for about $6,000. Still, although I use the video versions of it that are commercial (I paid about $5000 for mine), I still use the $12 hand version for measurement.

Choose a doctor who does hair transplantation exclusively (not on the side) and who has a good reputation among their patients. Often these people will call themselves a “hair doctor” but it is okay to question someone about their practice if you are unsure. “Hair Specialist” or “Hair Consultant” is likely to be a non-medical professional (in North America), usually knowledgeable about the procedure but not medically trained. I suggest you check their website, visit the doctor’s office and ask to meet many of his/her patients. At our offices in Los Angeles and San Jose, we hold open house events every month, which allow prospective patients to meet actual completed transplant patients, for we always say, what you see is what you are going to get. I personally like photographs, but photographs have the limitation of showing you what the photographer wants you to see. When you actually meet patients you can trust your eyes. Our upcoming Open House event schedule is available on our site. Also, go to the ISHRS site to find a listing of doctors who focus in this specialty and in your area.

Ranking Doctors

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

I am considering a hair transplant procedure. would you rank the following doctors based on the quality of their work (detectable transplant and actual results):

Five names were suggested by the sender but omitted by me:

Thank you.

I feel that it would be wrong of me to pass judgments on doctors in this forum. I would rather ask you to look to my blog posting, The Truth About Cheap Hair Transplants. Although the article appears on the surface to be about cheap hair transplants, it actually is a piece about the very subject you asked about. I took a great deal of time to focus upon physician integrity and the quality of the transplants that are delivered, linking ethics and results of what is done, to the doctor and the medical practice. Essentially I provided the basis of a buyer’s guide to selecting a hair restoration surgeon. I also wrote a book, which you can get by download or mail. Our newhair.com site extensively makes points on how to educate yourself on becoming a smart buyer. I always suggest that you ask any doctor to attend something like our open house events so that you can determine first hand what the doctor is actually doing and what his patients think of him. The hidden benefit of such events is that most of the attendees, like yourself, have shopped around a great deal and they share stories about their experiences, so the shopping process becomes like a consumer report with first hand reports obtained from sources you could never get otherwise.

The “Sean Connery” of Hair Restoration?

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

Hello, doctor. I do not mean any disrespect in my question, but I do believe it is an important one. I am considering surgical hair transplantation, and I’ve heard that you are one of the better surgeons in Los Angeles. My concern… my question is, how old are you? I ask this for two reasons. (1) Have you passed your surgical peak? (2) Will you be there in a couple of years when I may conisder another procedure?

Thank you. Again, no disrespect intended, but I am looking for a relationship with a physician who is not only qualified but who will be there when I need them.

What crystal ball does anyone of us have? Do you know when you cross the street that you will make it to the other side and not get hit by a car?

I am 63 years young. I have performed surgery on a couple of billionaires this past year and a number of top celebrities, one head of state, many CEOs of large companies, four patients from the TV show Extreme Makeover, construction workers, a bus driver, a grandmother and a mother of 7 kids, and many others who asked similar questions. My health is good, my maternal grandmother lived to 114, my maternal grandfather died at work when he was 102, my father’s grandmother lived to 99, and many uncles and aunts lived into their 80-90s. Like Sean Connery, I like to think that I get better with age. Mr. Connery turned 75 a few months ago, so he’s got many years on me yet.

I received the hair restoration industry’s equivalent to the Acadamy Award for Best Actor, called the Golden Follicle Award in 2004 at age 62, published the FUE technique when I was 59, and am probably one of the few doctors world-wide who does it well today. The FUE technique has to be the most taxing surgery in hair restoration that there is. I wrote chapters in text books and published scientific and other papers in the past 18 months numbering about a half dozen. I can not run the marathon (nor could I when I was 23), bench press some 500 pounds (also not able to do it when I was 23), or sprint the 100 yard dash (no comment is needed here but for that I am clearly out of shape). However, I ski regularly, scuba yearly to depths of 100 feet, ride my bike about 16 miles a day when I am not over-working and can play the piano for hours (my fingers, at least, hold up well). I can work longer hours than any of my staff and can get along on 3 hours of sleep per night if I must. If you get a younger doctor, ask to see patients of his/her which were done this year. I can show off many of my patients (which we do monthly) at our open house events and have done it for 14 years consistently. I tend to take my responsibility seriously, and have often helped my patients through many personal health crisis that were unrelated to their hair transplant. One patient of mine stands out (age 44) when he discovered that he had John Ritter‘s vascular diagnosis (actor known best for his role in “Three’s Company”). Mr. Ritter died just a few days from his 55th birthday from a rupture of his ascending aortic, so I became involved in the diagnoses and open heart surgery decisions that saved my patient’s life from Ritter’s fate. There is no doubt that had this patient not had a hair transplant, his diagnosis would probably have not been made and as his cardiac surgeon told him, he probably would have died in a year or so. If you would like, I can ask this patient for a reference that would back up this claim.

When you get to my age, you appreciate people for their value, hopefully gain wisdom, and with wisdom should come temperament that allows an artist to perform finer work, perfect his art, and refine and hone judgments that generally take years to define (just like Sean Connery has done for acting). I believe that what I bring is judgment and wisdom to my patient’s problem and potential surgery, and provided that my vision holds out and my hands remain as steady as they have for the past 35 years of doing surgery (from war torn Vietnam, to orthopedic, vascular, and general surgery), I fully expect to be doing hair transplants for some time, at least, on a selective basis.

Come meet with me and judge for yourself:

  1. if you like me
  2. if you respect me
  3. if you trust me
  4. if you think that I will be around for the duration of your needs

Your call, of course. When and if you come, please refer to this blog answer as I would love to connect with you, see the smile on your face and understand your motivation for writing this question to me. At the least, I enjoyed writing this answer, and at the most, maybe we will have things in common. I have made many friends amongst my patients, including many who did not ask traditional questions when they met with me.

Hair Restoration Societies and Accreditations

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

I am researching the hair transplant doctors to find someone I want to tie my hitch to. On your New Hair site I noticed that you had four links at the bottom of the left column. Why do you link to them and what is the significance? Some doctors have similar links on their sites, but I haven’t seen the AAAHC triangle logo before.

Here’s a little on each external link you’re referring to, as found on the New Hair Institute homepage:

  1. The Accreditation Association for Ambulatory Health Care (AAAHC) is one of two national accreditation agencies for surgical centers. The “accreditation from this organization is a voluntary process through which an organization is able to measure the quality of its services and performance against nationally recognized standards. The accreditation process involves self-assessment by the organization, as well as a thorough review by the Accreditation Association’s expert surveyors, who themselves have extensive experience in the ambulatory health care environment. The accreditation certificate is a symbol that an organization is committed to providing high-quality health care and that it has demonstrated that commitment by measuring up to the Accreditation Association’s high standards.” I believe that our clinic is the only fully accredited HAIR TRANSPLANT facility in the United States (other than those that have plastic surgical accreditation) that has taken the effort to obtain such recognition. The reviewers have always rated our service as meeting or exceeding the best standards in the country.
  2. The International Alliance of Hair Restoration Surgeons (IAHRS) is an organization of physicians who have banded together setting a standard for the industry’s standard of care, the Follicular Unit Transplant.
  3. The American Hair Loss Association (AHLA) is an organization focused on consumer education.
  4. The International Society of Hair Restoration Surgery (ISHRS) is a non-profit medical association of over 700 physicians specializing in alopecia and hair loss. The ISHRS provides continuing education to physicians specializing in hair transplant and restoration surgery and gives the public the latest information on medical hair restoration and non-surgical treatment for hair loss.

I believe in excellence, whatever the cost. There are no shortcuts to delivering a quality product. I have a terrific staff and pay them well so that they have a quality life at home and can focus upon my patients when they come to work. For this reason, I retain 100% of those that I want to retain and many have been with me for more than a decade. The AAAHC (a completely voluntary effort that is a very costly process for us and equates to the rigorous standards imposed upon hospitals today) is a way that I guarantee to myself that our standard matches the best standards in the world. To comply with these standards, I calculated that my annual cost exceeds $100,000/year and both of our offices are certified by the AAAHC. Our focus upon supporting national and international hair restoration / hair loss societies (like IAHRS, ISHRS, and AHLA) are reflective of our patient and physician educational efforts, which should be supported by those in this industry. Our involvement with them is consistent with the massive efforts we have made over the years to innovate (leading the standards that are accepted and adopted by everyone of value in the industry) and force an improving hair restoration environment along with others who share this objective. See the History of NHI and the NHI Timeline for more.

My Hair Loss Pattern is Not on the Norwood Chart

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

Dear Sir,
My hair loss does not resemble any of the stages in NORWOOD SCALE! I mean i am using hair on the entire SCALP (Not back and sides), but im using it uniformly on the scalp. Theres no such condition in norwood scale. this makes me wonder if i have MPB….though my dematologist says i do have MPB. Also, can there be any tests, which can be done so that i can figure out if Propecia will have side effects on me or not?

You need to have your hair mapped out for miniaturization, which will show patterns that the eye does not see. Early balding may be diffuse in a pattern or non-patterned. The mapping will show just what it is.

Is Bosley the Best Hair Transplant Place?

/by William Rassman, M.D./5 /, ,

Hey doc, I have just found your website and have enjoyed it tremendously. I am 23 and have noticed my hair thinning since I entered college at 18. I tried Propecia but grew impatient. I wish I would have stuck with it but I chose to stop. I have lost enough hair now that I am fairly thin on top and towards the front. I was curious if you would recommend a transplant for someone so young. I am on the bubble about this, but I think that for my mental well being and career that really it is my only option. I am constantly unhappy with my looks and miss dating a lot. Truly the only real thing holding my back is the price, I would do it tomorrow but I just truly do not have enough saved. I think I would need extensive graphs to restore what I have lost. I have only looked into Bosley because it is the most popular and respected name. Would you recommend them or should I look elsewhere? I am very afraid of a poor surgery where I come out looking like a fool for the rest of my life because of some doctors weak job on my head. Thank you so much for your time.

You must be careful that you are not body dysmorphic. Dating and hair loss relate with regard to self-confidence certainly, but losing your hair should not be an excuse to stop living. Your points about career, mental well being, dating, happiness, (I can go on and on) are good reasons many people try to either hold on to their hair, or if they can not or have lost it, they can get it back with good medications or hair restoration surgery. Now with that said, you need to first get a diagnosis established, your scalp mapped out for miniaturization and the pattern of hair loss that you may develop. Many good medical hair restoration practices, such as Bosley or NHI, can supply a good working diagnosis for you. It is important that you find a hair restoration clinic that you feel comfortable with, and that you feel will give you the results you are looking for. I would not go somewhere based solely on marketing. Do your research.

There is much in this blog about how to shop for hair transplants (my lengthy post from earlier today, The Truth About Cheap Hair Transplants, is a good start), because budget minded people need to understand the entire shopping experience. With a diagnosis in hand, you may find out that you can reverse it (if you have it) with something as simple as Propecia (one pill a day), which works well for many young men. Be careful of the sale pressures to make you buy a hair transplant before you do your comparative shopping and before you know what is wrong with your hair. Knowledge is power, and you as a buyer are very powerful in determining your fate and the status of your hair for much of your life.

Multi-Bladed Knives and Dilators

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

I just visited a doctor who took me into a surgery and showed me nails in the head of a patient. He said that these kept the wounds open and makes the graft placement easier and produced less damage to the skin and hair. He also told me that he used a multibladed knife to harvest the grafts. I thought I read somewhere that these instruments cause damage. Can you explain what I am being told?

These nails that you are describing are something that was invented by Dr. Manny Marritt in the mid-eighties to make the placement of smaller grafts easier. Within a year, he abandoned the use of these dilators as his staff built the skills to not need them anymore. He concluded that these dilators did not have great value to anyone other than the novice. I did try them early on in my practice, but I quickly abandoned their use within a month. For more information on dilators, including a photo of what they look like, please see this dilators page.

After I designed the 2 bladed knife with the offset of 30 degrees, I built a multi-bladed knife with variable settings to it. I eventually found that when I used the final design on the first 9 patients, the results were decent (I estimated the loss at about 15%). Then on the 10th patient, I had a follicular holocaust with a loss factor of 70%. Fortunately, on these first 10 patients, I only used it on a limited area, but the high transection rate on this 10th patient said to me that inconsistency was going to be the problem. If I could do it 9 times right and then 1 time wrong, the technique was flawed.

This clinical research was done by me in 1992-1993 when cutting was a manpower problem that I eventually solved with a larger and better trained staff. The multi-bladed knife was the wrong answer to this problem and that is my final opinion on the subject. With multi-bladed knives, the labor that the doctor saves does not offset the hair that is killed off. I believe anyone who uses such instruments today are subject to the same type of variables.

The Truth About Cheap Hair Transplants

/by William Rassman, M.D./4 /, ,

Note: My answer to this question is very extensive and detailed, almost like a consumer guide for shoppers needing hair transplants. Please take your time in reading it and try to read between the lines, for there is much I did not say. The answer took me over a week to write, because the question was so pointed and so appropriate to what I am asked almost daily.

I am very confused about prices that are charged in your field and the associated estimates in what you guys want to do for me. I believe in capitalism so the wide range of prices does not bother me as much as the wide range of recommendations I get when I see a hair transplant doctor. This clearly impacts costs. My Norwood Classification is a Class 6. I have had recommendations as low as 1000 grafts in one or two sessions. That doctor told me that more than 1000 grafts in a single session could not be supported by the blood supply of the balding area. I have also been told by you earlier this year, that I could have as high as 4000 grafts in one or two separate sessions. No matter what the prices are, the difference between one session of 1000 grafts and two sessions of 4000 grafts is a huge cost differential. On one hand, I want to believe that 1000 grafts will work for me as it is easy to afford (the doctor charges $5/graft, or $5,000) but on the other hand, your estimate of between 4000-8000 grafts is so out of line with the lower estimate, I am a bit put off about having hair transplants at all. I have also seen other doctors and the wide range of estimates continue to amaze me. I want to be a good buyer so I want to compare apples and apples. Who should I believe?

Hair transplant costs are one thing and ethical practices by the physician are another. You must know what you are buying to value a hair transplant’s real cost to you. Add to that, the expectations you have and the probability of meeting them. Bottom line, a meeting of the mind between you and your doctor addressing your goals is what matters and only in the final results will you really know what you purchased.

In your particular case, the more of a perfectionist you are, the more hair you will want. If I projected 4000 to 8,000 grafts, I would have anticipated your desire for fullness is far greater than the average person. Then there is still another factor, your donor supply. If your donor density is high, then you can get more hair moved and more hair placed in the balding pattern you describe, but if it is not very high, then you will be hair limited and 4000 grafts might be out of the question for you. Some doctors will tell you exactly what they think you want to hear (rather than what is really best for you) – to make sure that you will proceed with the surgery.

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