My Chin & Goatee Transplants are Red

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

Dear Dr. Rassman,
First of all please let me thank you upon your excellent work (as i overheard from sources). Am 25 year old and had a HT procedure of about 1600 grafts by strip method 4-5 weeks ago for increasing my facial hair density around the chin and goatee region and due to the fact that i live in the middle east i didn’t have the chance to perform it with you,otherwise things would have been different. Without any exaggeration am now having cruel restless nights with lots of suffering. I have two major problems or should i call them concerns, first is that the recipient areas are exhibiting significant redness (even after more than 4 weeks post-op). Add to this a long battle with infections, second is that after going through many forums, i’ve found that infinitely many people are depressed about their donor area linear scars as the scars tend to stretch and looks ugly which restrict them from having their heads shaved or get a simple buzzcut. Is there anything i can do about the redness of the transplanted areas? Sorry for elaboration but you are saving a man’s life Dr. Rassman

I am assuming that you had only the chin and goatee region hair transplanted. With that assumption, 1600 grafts seems a bit high. If larger than one hair grafts were used, I can imagine a great deal of reaction to them. including skin changes like puckering of the skin. If you look at typical beard hair, these hairs rarely are more than one hair per grouping so if you had more, then there are wound issues in healing which might point to problems. Without seeing you myself or knowing what you had, I can not be certain. Infections are rare indeed, but if you are having them they are most likely the results of cysts at this early stage where sebaceous glands from the transplanted hair are producing sebum below the skin and becoming reactive cysts. There are usually best treated with soaks at least twice daily and meticulous hygiene. Antibiotics may have value but good cultures should be done prior to starting antibiotics in the event that you have a bad organism causing the infections.

We have spent a great deal of time discussing scars in previous blogs.

How Long Until Hair Regrowth with Medications

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

Hi DR,
i have been through all the entires in the blog and find it quiet useful… here is my problem/question…

I am almost 26 yr old male and experiencing considerable thining. This probably started 7 months ago although it was not that noticeable and there was considerable self denial on my part. My frontal hair are thinning althogh my hairline is maintanied and now even the crown area is thinning considerably. It a very emotional rollercoaster for me and i’m feeling depressed. today I started on propecia and saw palmetto and maybe i ll use nizoral shampoo too. I want to know how long will it take to see a complete stoppage of hairloss and regrowth of new hair ? I may be a BIT late in starting but the thinning started occuring 6 months back and considering that I had a head of full thick hair until october last year… I was in total self denial that my hair was thinnnig. My dermatologist confirned its a case of MPB since my dad started losing his hair in his very late 20s. I am not even married and its very emotionally distressing :(. What are my hopes ?? Also will a sinus surgery(with local IV sedation) cause any further hairloss on me or contibute ?

Please write back. Thanks

With a 7 month history of hair loss, there is sill a possibility of controlled loss or reversal of some or all of the hair loss within the first two years you are on this medication. You must wait this out. I would recommend against taking Saw Palmetto with it, as there may be competition for the DHT enzyme sites between the two medications making the Propecia less effective. Any added stress can impact the rate of hair loss, and sinus surgery is no exception. Still, if you need the sinus surgery, do it and continue to take the Propecia regularly.

Good luck.

Scotland Doctor Recommendation?

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

i am a 26 year old female from scotland, and i would like to know if you could recommend a clinic in the UK who do the hairline lowering procedure. Please say there is one!

I don’t have any personal Scotland-based recommendations, but I would check the International Society for Hair Restoration Surgeons (ISHRS) site at ISHRS.org. Use the physician search section to look up doctors in the UK. You can then call and get a direct referral from someone within the United Kingdom.

European Office? BHT? FUE?

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

Do you do Body Hair Transplants (BHT), FUE, and do you have an office in Europe?

New Hair Institute has offices in Northern and Southern California. Sorry, we do not have a location in Europe.

We do perform Follicular Unit Extraction (FUE), and in fact, we invented it. See our site for information about FUE.

Body Hair Transplants (BHT) are still experimental. I do not do them because I want 100% predictability and I am not sure that this will be achieved with BHT. Some past BHT posts include:

How Bald Should I Be Before a Transplant?

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

I am a 25 year old male, and I am probably a Norwood III Vertex. Most of the balding is at the crown, but now the front is getting thin as well. My father is completely bald, Norwood 6 I guess.

I have a feeling I’ll end up like him or close to it. I have been on Rogaine and Propecia since I was 19, and 21, respectively. They may be slowing down the balding process, but it is still gradually worsening.

Do you recommend waiting until I’m totally bald like my father, before considering a procedure? What is your best advice for me? Thank you.

At the age of 25, it is not unreasonable to consider hair transplantation to restore the corners of your hairline. The key is to develop a good Master Plan with a doctor who will know how far to push it and not to be too radical. Any crown loss that is transplanted in someone of your age with your pattern, may not be a good medical decision. It sounds like you have done well with the Propecia, so it is not unreasonable to put the corners back and expect that Propecia will allow you the enjoyment of hair for much of your youth. Your worst case, of course, is your father’s hair loss pattern, but provided that you stick to transplanting the front only and that your hair is healthy and of adequate densities, you will never look abnormal and should join the choirs of men your age who want to maintain their youthful look. Generally, I do not recommend hair transplants in men under 25, but there are always exceptions to that general rule.

HairGenesis

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

Dear Dr. Rassman,
I’ve been taking propecia since I first noticed my hairloss, at age 20. Now I’m almost 24, and while I’ve retained some hair in the vertex, there’s been substantially more loss in the front/temple areas. Transplants are probably not a financially plausible option for me presently, so I’ve weighed other solutions (mostly vitamin/herbal supplements), bearing in mind the advice published in your blog. The website for “hairgenesis” touts an FDA-regulated published study supporting it’s claims: Is this information credible, or is it merely a marketing ploy? What other information should I look for when considering treatments other than propecia and surgery?

Thank you in advance for considering my question.

I do not like the Hair Genesis site, because it is very heavy on claims that appear unsubstantiated. As I have no experience with it, I can not tell you what I do not know or have not learned, but when there are so many claims and reflections on FDA ‘endorsements’, I would doubt their credibility. The field of homeopathic and herbal medications is generally unregulated, but it is not proper or ethical to claim FDA ‘endorsements’ like this company seems to have done. To my knowlege, only minoxidil and Propecia have been FDA approved for safe and effective hair loss treatment and there is good scientific evidence that minoxidil and Propecia works. When it comes to natural and herbal medications, there are many harmful natural and herbal medications. Arsenic, of example, is a natural medication that has been used in historical medicine for the treatment of syphilis, but I would not use it for prevention of syphilis nor for any human use as it is a well known poison, so ‘natural’ does not imply safety. The message here is BUYER BEWARE, and remember that just because claims are posted on a website, it does not imply true safety or effectiveness.

More Questions for Clarification

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

I read your blog from beginning to end and found it very resourceful- thank you. There are a few questions on which I would like clarification.

  1. I have read briefly about itchy scalp which requires use of Nizoral. Is this a very common side effect which I should expect if I decide to take Propecia, or does this only happen to a small number of patients you have seen? I had to stop using generic Minoxidil after three days because it gave my hair a greasey feel. Will Nizoral cause a similar problem or other side effects?
  2. I have read somewhere that you might expect to see accelerated loss for the first four months as the follicle’s “cycle” adjusts. What percentage, if any, of your patients would you estimate see this accelerated loss?
  3. I take various supplements for body building purposes, such as creatine, glucosamine, and whey protein. Since hair loss is related to testosterone/DHT, are there certain substances which I should be avoiding in order to prevent extra testosterone generation in the body?
  4. What is your real world experience with the Laser Comb? With all the various internet sites which sell this type of gadgetry, is there a reputable company or site which you would trust?

  1. Itchy scalp does not require any particular treatment, but some people feel strongly about their medications and post their opinions on the internet. This is particularly true for those who sell the medications. In my experience, not one patient complained about itchy scalp after being placed on Propecia, but they do complain of this from the use of minoxidil. Many people find that styling hair is made difficult with minoxidil. If you want the non-greasy minoxidil, try the minoxidil for women, as it is alcohol based and is not greasy.
  2. I have personally not seen any patients complain about a period of hair loss when they start Propecia, but I have heard reports by some of my colleagues. I must therefore assume that it is a rare occurance.
  3. Anything that builds up testosterone production will raise DHT levels and accelerate the course of male pattern balding. Check with the claims on the bottles and check out each component of the nutritional substance you are taking.
  4. I have no personal experience with the Laser Comb. The story is still out on all laser hair treatments, but I remain very hopeful. See Low Laser Light Therapy for Hair Loss for more details.

How Long Until Transplants Grow?

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

How long does it take for the transplants to grow?

I generally tell my patients to wait a full 8 months to have 80-90% of the impact of growth on stylable hair. Hair grows about 1/2 inch per month and as transplants often do not start until 3-5 months after the surgery, growth can be calculated from that point. For those hairs that start to grow at 5 months, they will be 1 1/2 inches at 8 months, while those that started at 3 months will be 2 1/2 inches long. Usually a person has a combination of the two. On less frequent occasions, about one in twenty people have instant growth of all of their transplants.

In good hands, however, growth will always occur. I hope that answers your questions.

Southwest Florida Doctor Recommendation?

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

I’m 36, female, and have been losing hair for 8 years. My hair has always been fine and thin, and I inherited my father’s “receding” hairline. Now to be losing hair on top of this is awful. I’m new to the are and seriously considering transplants. I just saw a dermatologist who took a biopsy and said it’s female pattern hairloss, use Rogaine, there’s no other hope. I want to see a real professional who is caring, sympathetic, and willing to work with me to discover the best option of treatment. Can you recommend someone in southwest Florida please? Thanks

Ask your dermatologist to recommend a doctor in your area. A direct referral is always the best way to go. Dr. Bernard Nesbaum is a hair transplant doctor in Florida who has considerable experience with women and he is a dermatologist. You might want to check with him. You can get the doctors in Florida by looking at ISHRS.org.

Where Does the Hair Loss Gene Come From?

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

I am 23 years years old and have been losing hair since a litte before I turned 20, but only in the form of a receding hair line. Aside from my fairly quickly receding hair line, the rest of my head, including the crown, remains covered with thick hair. Would taking Propecia be a waste of time at this point since it supposedly does not help in the temple region? Should I just wait until I start losing hair on the top and crown of my head before I start taking it? Is there anything I can do to slow the progession of the receding hair line? Also does the hair loss gene come soley from one of your grandfathers, or is the state of your hair a result of a variety of genes from one side of your family? I ask this because one of my grandfathers died with a full of head hair in his late 70’s and one was completely bald in his thirties. Given that I am experiencing hair loss at such an early age it is obvious that I am taking after the side with the balding grandfather. Does this mean that I’m undoubtedly destined to suffer complete hair loss if I do not take action? Thank you.

If you are losing hair now, you should start Propecia now. The longer you wait, the worse the genetic toll will become if you are prone to it. You will not bald any further than your genetic pattern, but alas, no one knows the genetic pattern of anybody until you finish balding. A good doctor can do some estimating based upon the degree of small hair (miniaturized hair) in the areas that to your naked eye look normal. Many times what you see is not what is really there.

We can inherit it from anyone in either side of the family, male or female. The gene can skip generations, so sometimes people can not identify a balding person in their family. If you take after one of your family members in pattern and age of loss, it is more possible that you may be like him. There is no way to determine that final pattern, as I said above, but you can control it if you treat it with Propecia early and then get transplants to return what was lost. Between the two, people are often able to control what they look like.

Hair Loss, Lasers, Drugs and Transplants

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

I am undergoing a hair loss treatment. This treatment involves lasers, basically a helmet that shines light on my head to deter DHT. I am somewhat skeptical, but it was the only option that was within my price range at the moment. I am 20 years old; my hair loss is not substantial. I am thinning on the top of my head and the most severe areas are in my hairline and the back of my head. I took this treatment to prevent my hair from thinning anymore. The thinning is not very obvious but I can tell it is still progressing. I wanted to know if transplanting hair from my own head would leave an area in the back of my head that hair will not grow on anymore. I also wanted to know if there are ways of getting transplants from other donors. Lastly, I want to know how much these treatments would cost and how effective the treatment I’m receiving is.

There is anecdotal evidence in Europe that hair lasers (Low Level Light Therapy / LLLT) increases hair growth. I’ve written about LLLT previously, here. Thinning of the hair in young men often starts off insidiously and gets slowly worse. At the beginning, you might actually lose 50% or more of your hair before you notice it. If you are a platinum blonde, you could lose 85% of your hair before it becomes noticable. The key is to make the diagnosis early and get on the only good, FDA approved DHT blocker that is out there: Propecia. This drug is the best and possibly the only real hope at this point to slow down, stop or reverse the hair loss. In young men, I have seen some wonderful reversals of hair loss. Transplants in a 20 year old without noticable hair loss is NOT something you should pursue at this time. When the donor area is harvested for hair transplants (the back of the head) it does not produce a bald area as you suggested in your question.

Laser treatments can be obtained from those who sell those services. We have a laser in our Los Angeles office, but do not sell the service at this time. I am told that the company that provides the service charges about $3000/year for treatment. Propecia costs range from $55/month to as high as $120/month depending upon the pharmacy you purchase it from. We sell it in our office at $53/month (very close to our cost). Transplants are sold by the graft. These surgical procedure generally cost a few thousand dollars per surgery, but they do last your lifetime. The more transplanted grafts you buy, the higher the fee.

Doctor Recommendation in Turkey?

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

Hello doctor. I was wondering if you knew any good doctors in Turkey. I live in turkey and it would cost me alot to travel to the united states. I was wondering if you knew any doctors with a good clinic and staff..

It is important to read as much as you can about hair transplantation. Know the different types of techniques and know what the standard of care should be. Our website, www.newhair.com, has a tremendous amount of educational material for you to review. Then look up the list of doctors in Turkey on the International Society of Hair Restoration Surgery. I do not have any personal recommendations for Turkey, but ISHRS is a good place to check. See if any of the doctors have websites that detail the type of procedures they do. You’ll want to find a doctor that at the minimum does ‘state of the art, follicular unit transplantation’, and has their staff use microscopes for graft dissection. See if they post patient photos of their results or allow you to meet their patients to show examples of their work. After you have narrowed down your list, make consult appointments with the doctors, try and see their patient results in person, tour their facility, ask questions, and get as many recommendations that you can. Find a doctor that you feel comfortable with, and one that gives you the best plan for your hair loss treatment. If you have access to a digital camera and would like me to also give you a diagnosis, email them to me and I will review them.

Hair Transplantation in Filipino Man

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

I am a filipino male with brownish black hair that is semi thick in nature. My hairline is receeding and would like to have the FUT procedure done. but before this takes place, have you done this procedure on clients that fit my description, and if so, may i see pictures of them? may i also call them if possible. as far as medication goes, do i need to take propecia, rogaine or any other prescription? because i rather not. my next question is time off work. because i am self employed and serve clients face to face i can not afford to take more than 5 days off from work. is there way to discreetly hide my surgery as it heals? my last question is i enjoy having my hair cut very short, is possible to do that without showing that i have had hair transplant surgery? do you have pictures of your clients like this?

thank you

What you have is typical for our practice. Our website has many, many patient pictures of what you are talking about in our Before and After Photo Galleries. Our monthly open house events allow you to meet former patients and see the results for yourself. You do not have to rely solely on photographs when you get to meet the patients in person. In addition, an open house allows you to see a surgery, talk with the patient having the procedure, and see how he looks immediately after surgery. We also invite patients who have had surgery during the previous week to stop by, but I can not guarantee that they would have the same hair characteristics as you.

The use of medications relates to the natural hair that you are losing. Medications may be necessary to hold on to hair that is genetically not going to last, but medication is not needed for the hair that is transplanted. I strongly recommend that my patients use Propecia, to maintain their existing hair.

You can return to work fairly fast. I have performed FUT surgery on a number of celebrities who have appeared on television within days or even hours of their surgery. I have had a few people run a marathon within 5-7 days of the surgery. Going back to work is easy, but the question relates to just how bald you are and if you care if someone notices that you had a hair transplant. For the very bald man, this can be an issue, yet for those not very bald, they can be undetectable within a day or two. There can be a little redness in the recipient area for the first few days and if you allow your hair to grow a little longer than usual, it will hide the donor area nicely. If you do schedule a surgery, you may want to shoot for a Friday, taking the following week off, then you will have nine full days before your next work day. As far as wearing your hair short after the healing is completed, that will be up to you. FUT surgery will leave a thin scar in the donor area, the length of which is determined by the number of grafts you need, your hair density, and scalp laxity.

My advice is to visit us at an open house event and get comfortable with what we do. Review our website, where hundreds of patients are shown, and get the book I wrote, The Patient’s Guide to Hair Restoration, which is probably the most comprehensive book ever written in this field.

Losing Hair Grafts After Transplant

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

Hi, Dr. Rassman, I hope that this email finds you well. I had my surgery in June and have lost about 9 grafts (4 in the last 3 weeks or so). I didn’t lose this many last time. Should I be at all concerned?

Nice to hear from you. I would doubt that you lost any hair grafts. After 5-10 days, once the scab is off, most of the grafts actually can not come out even if pulled on. What you may have lost was the remnant of the graft and the hair shaft. The growth center will remain and will grow its hair in 4-5 months. If you are at all concerned, call my office at 800-NEW-HAIR and make an appointment to come in. I will be happy to take a look at your early results.

Graft Quality From Different Areas of Scalp

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

I am a 48 year old male who has had 3 procedures: 800,800, 2000. I was told that by the 1st doctor that the same donor area would be used over again for the 2nd procedure. For the 3rd procedure I went to another Doctor who told me that the quality of the grafts is better if they used another location. slightly higher than the first. I would like at least one more procedure and would like to know if I need another donor area or can one of the old areas work as well. Also is there any benifit to having a hair analysis done. Thank you for your time.

Some doctors take the hair from the high neck rather than the mid posterior scalp. This view is misguided because using the high neck has problems, including:

  1. it is not permanent hair
  2. it tends to scar
  3. it does not tolerate much taken from it without severe scarring that is difficult or impossible to cover up

I always take the donor area from the middle of the donor area (the 3 1/2 inch high band around the side and back of the head) as that is where the best hair is. I call this area the sweet spot, because it is highly productive for good quality hair. I continue to harvest the same area, at the same scar in subsequent surgeries, when they are needed. This gives me the ability to reduce any scarring, if it should occur. Since you are in my area, I would be pleased to give you another opinion, at no charge, and I will analyze your hair at the same time.