On NBC in Philadelphia

I just got word that the news item about the FOX™ Procedure that aired this past Monday on NBC in Los Angeles is now going to air tonight (April 13) on the 11pm news on NBC 10 in Philadelphia.

For those outside of the Philadelphia area, if you missed the airing in LA, or you just want to see it again — the video is posted on my earlier blog entry, found here.

More information on the FOX Procedure:

Update: Found the article on the NBC 10 website

Why I Am A Hair Restoration Surgeon

Received this email yesterday…

Why would someone who has been in Cardiac, Orthopedic and General Surgery be doing Hair Transplants? Did you fail at these other fields?

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I would start off saying that I was very successful in every field I have been in. Part of the reason that I moved around a great deal was general boredom or lack of stimulus. In the hair restoration field, I have had the opportunity to become intimate with my patients. I have had similar intimacy with my patients when I treated their cancer, but the involvement with them was make the best out of a bad situation. If they survived the cancer, they wanted to forget it and I was more part of that period of their life (where forgetfulness is part of the denial process).

In hair restoration, the entire process up-scales as it progresses. The further down the path you take it, the more the intimacy and the pure pleasure you get with each milestone the patient achieves. First, getting to establish rapport is a challenge. Two people getting together, one with a problem and the other with a potential solution. The prospective client wants to determine: “Can I trust this doctor to do what it is he says he can do?” Once the relationship is cemented in place, you plan together what you are going to do. You share his/her intimate thoughts and fears and guide him/her though the plan like an architect experiences when he/she shows the plans for a new house to a home buyer/builder. This is a wonderful experience that for me only gets better as I deliver what it is I promise to deliver. While waiting out the growing stage, like a find lawn and garden, it takes time for the brown dirt to turn green and for the flowers to bud and bloom. But when the hair comes in, wow, what a HIGH it is for the doctor and patient to share.

I have been in the unique position of having done some of the most difficult surgeries on the human body. Early in my career, being able to perform them competently was my goal. The intimacy part of the process in the world of difficult surgery does not have the same significance with it as in the hair restoration business. The general surgery focused for me on issues of technical competence in the first half dozen years. Once I had proved to myself that I could perform almost all of the difficult surgery before me and treat the sickest of patients, the process becomes a matter or routine. Every sick patient in Intensive Care is so sick that they are as far from their normal selves as they could be. Aortic Aneurisms are the same. The ones that are acutely life saving (like those that are rupturing) brings up the adrenaline in the surgeon. Like a ride on a roller coaster, the feeling is frightening and wonderful, both at the same time. But the anxiety of holding a human life in your hands, no matter how exciting, still produces bad outcomes and brings heart break to surgeon and families. Half of all ruptured aortic aneurism patients die within a day of the event, even in the hands of the greatest surgeons. Hair, on the other hand, is almost a complete opposite experience for the surgeon. The results almost always come out the way a good surgeons predicts that they should. The key to success, like aortic aneurism surgery, is skill and in building a good surgical team. The hair restoration business is no different on this technical end where skill and team building is critical, but the patient is always awake and he/she is coming to see the doctor because he/she wants to be there (not has to be there like a ruptured aneurism). My days in the office make me feel that I have great value to people and because of the trust that is built, I have looked at many of my patients as friends for life.

Is Repairing Possible?

I’ve had surgery 14 times on my hair (5 scalp reductions and 9 hair transplant procedures) since I started the process 20 years ago at the age of 19. I don’t look normal and that is hard to say, even in an email. I went to a number of doctors over the past 20 years and each one told me confidently that they could make me normal. I want to believe that I can be made normal, but I am not sure if I can trust anymore. Do you have any advice for me?

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This is a question that I could write a book to adequately address. It involves many things including (1) ethics and earlier surgical solutions that were sub-standard solutions for hair loss, (2) what was/is informed consent for the surgical process of hair loss, (3) After 14 surgeries, what can he expect from the more modern procedures available today, if anything, (4) how does anyone get faith back, when they have experienced hopelessness, etc..

  1. Ethics and the Earlier Solutions for Hair Loss: There was a time when surgeons and patients alike were naive and thought that they solved the hair loss problem with creative surgical solutions. Patients want to believe that doctor could produce miracles, and doctors want to view themselves as miracle workers. No field was more fertile that the balding young man who desperately felt that solving his hair loss was more important than almost anything ‘on his plate’. Unfortunately, desperation mixed with over exuberant doctors (some of whom had the ethics of a viper) was drawn together with an inferior surgical procedure that was (unfortunately) the only procedures available at that time. As more and more men came in ‘hordes’ to the doctors doing the surgery, doctors convinced themselves that what they were doing must be the right thing, for why would the patients come in droves if they were not pleased. For the pluggy or deformed patients that were produced, denial was a quality that played tricks on the mind, like the Emperor’s New Clothes, everyone saw what they wanted to see rather than what was there, or did they?

    In the 70s and 80s, many celebrities were drawn into the stampede. When Frank Sinatra had hair transplants, everyone found out about it. Even the doctor who did it promoted the Sinatra name as if it was an endorsement for either his services or the procedures themselves. A patient of mine and friend of Sinatra (1993) told me how angry Sinatra was when he discussed his hair transplant experience. The rumors of despair and depression that followed Elton John’s transplant experience are legendary and echo the questions posed by this 39 year old’s questions to me. If the rich and famous were sucked into a substandard standard, how could the ordinary working class man avoid the trap? The answers here are many. There were ethical doctors around in the 1970s, 80s and 90s, so the axiom buyer beware still prevailed then as the ultimate fail-safe control for our welfare in our capitalistic society. Even today, finding an ethical doctor is as important as finding a competent one, for the vipers are still out there and buyer beware paradigm is still an important guide in selecting a doctor. Unfortunately, in the 1970s and 80s, the procedures that were available were still (in my opinion) substandard which is the dilemma that our questioner implied from his early experience and it unfortunately still goes without an adequate answer.

  2. Continue reading “Is Repairing Possible?”

African-American Female Hair Loss

Here’s an email I just received today…

Dear Dr. Rassman,

I am an African- American female, aged 62, with pattern baldness around my hairline. I would like to know if the “new hair” will grow and how will any chemicals, ie. straightners, dyes, etc. might affect the transplanted hair. I would also like to know where and how I can schedule an appointment for consultation ASAP. I have been using Rogaine but I am still compelled to wear wigs to look my best…HELP! I am VERY interested in getting this procedure and I have the blessing of my husband of 40 years!

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I have done work on many African American females. As you may know, frontal balding is common amongst African American females largely because of the combined effect of pigtails that were used for styling in their youthful days as well as the abuses with chemicals, ie. straightners and dyes. First, a good examination needs to be done to separate the effects of chemicals and pigtail styling (if appropriate) to the female genetic hair loss. Then, a complete examination needs to be done to make sure that other medical conditions are not the cause of the hair loss such as thyroid disease, hormone imbalances, anemia, etc. There are a series of blood tests that can rule this out.

My recommendation is to make an appointment first (if you wish to see me, ask for me by calling 800-NEW-HAIR). The consultation is free.

Thanks for the good question.

Hair Transplant Doctor Training

What type of training does a hair transplant doctor need?

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This is a difficult question to answer properly, so as I have lots of room and time to consider the question thoroughly, I will answer it in great detail. Read as much as you wish.

The Hair Restoration industry has a society called the ISHRS (International Society of Hair Restoration Surgeons) and they are trying to provide both the public and the doctors who ‘specialize’ in hair restoration a way to define this, both for those who call themselves specialists and those doctors who want to enter the field and learn how to become a hair restoration surgeon. As you may notice the way I started answering this question, I have divided the answer into two categories: The existing doctors who call themselves specialists (like myself) and the new doctors wanting to get into the field.

Existing Restoration Doctors: The existing group of hair restoration surgeons come from a wide diversity of specialties. Dermatology was the field that produced the original hair transplant process in the late 1950s, so this specialty has officially hosted the field ever since. The text books are largely written by Dermatologists and the leading medical journals in Dermatology have articles about advancements in the field with great frequency. In fact, most of the articles written by New Hair Institute doctors have been published in Dermatologic medical publications.

Continue reading “Hair Transplant Doctor Training”

April 11 on NBC in Los Angeles

I just got word that the local NBC affiliate in Los Angeles are going to air a piece about the FOX™ Procedure tonight (April 11) on the Channel 4 News at 11pm. Readers from the LA area should try to watch (or set your TiVo).

Update (April 13, 2005):
Found an article on Los Angeles NBC News

Update (April 12, 2005):
Here’s the video from NBC News in LA.

Continue reading “April 11 on NBC in Los Angeles”

Multiple Sessions

A recent post I made about large sessions has lead to another good question:

What about multiple smaller transplant sessions… are they better?

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In the hands of experienced doctors who understand large session hair transplant surgery and the nuances in performing them, the larger sessions are better than multiple smaller sessions. Each and every time the donor area is harvested, scarring to the deep structures are the inevitable result. I am not talking about visible scarring at the skin level, but deep invisible scarring below the skin. This scarring increases with each subsequent procedure. Fewer procedures produce less deep scarring.

Simply, I will answer your question with another question: Why have two surgeries if you can do it just once?

Hair Loss in the Mature Man

Reader Tom asks…

My hairline has been receding for a number of years, I am now 62 and recently had a heart attack. It seems to me that the hair loss has accelerated since that trauma. My hair now has sort of a trough down the middle that was not there before, but it was thinning. My question is, Can a heart attack cause acceleration of hair loss and can hair replacement techniques be employed to reverse it? Thank You

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Hi Tom, thanks for writing.

There are generally four causes of hair loss in men. Genetic inheritance and male hormones are the two most important. Time and stress are the other two. Typically, genetic hair loss occurs well before 35 years of age, and in most people it slows down with time. There are some older men who start showing the hair loss over the age of 45, although this is more the exception to the rule. Don Ameche, a popular film actor in the 1930s and 40s, was a hairy sex idol even at the age of 50, but was bald at the age of 75 when he had a prominent role in the movie Cocoon. So, he had an ‘expression’ of his genetic balding late in life. Your heart attack certainly brought on ‘STRESS’ and with a delayed genetic expression, probably precipitated your hair loss. I have seen this in illness or even divorce, both of which are heavy stress induced initiators for hair loss in the genetically prone man.

As your hair loss is recent, I would probably recommend that you go on the drug Propecia, because continued hair loss is possible. This drug may slow or stop the progression of the hair loss and it might even reverse it. If it does not do the trick, then a hair transplant works wonderfully.

Hope this answers your question.

FUE – Follicular Unit Extraction

Can a Hair Transplant be done without a cut in the back of the head? I really do not want to be cut upon!

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In an article I wrote in the August Issue of the Journal of Dermatologic Surgery (2002), a new Procedure for hair transplantation was introduced which can be performed without a traditional surgical incision. The healing time is clearly reduced and the risks of surgical scarring are practically eliminated. This type of surgery is particularly useful in patients who have limited donor hair, a small balding area, a tight scalp, or the need to keep the option of wearing their hair closely cropped (crew cut style).

We called the technique the FOX™ technique, (short for FOllicular unit eXtraction). The FOX procedure involves the direct extraction of the follicular units from a patient’s donor area using a small instrument called a trephine. Healing is quick, scarring is virtually nonexistent, and discomfort in the donor area has been practically eliminated. I was quoted by the LA Times to say: “The FOX procedure gives yet another option for those patients who were hesitant or were unable to undergo traditional surgery.”

The article in the August 2002 issue of “Dermatologic Surgery” discusses our research, methodology, and detailed results. This new procedure is currently available at NHI’s offices.

In various surgical specialties, minimally invasive surgery has shortened recovery time and lessened the risk of complications in fields ranging from orthopedic joint surgery to open heart surgery. Now, minimally invasive surgery has arrived to hair transplantation. The technique has become a standard offering in the field, but only a few surgeons have mastered it as the technique takes years to perfect and a lot of practice. Our website has good videos of the procedure and a shaved head after the procedure wounds have healed so you can see what you would look like if you shaved your head.

Large Sessions

Here’s a question I get quite a bit from people that just start doing their research…

Hi Dr Rassman,
I have been reading a little about hair transplantation but I am still very new to this stuff. I was wondering why all hair doctors can’t transplant a high number of grafts in a single procedure?

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Not all physician teams are equal. In our medical group, we (NHI) pioneered the large graft session transplanting as many as 4400 grafts in 1994. So performing a large hair transplant session is a function of experience and the skill of the surgeon and his team. If a doctor routinely performs sessions in the 3000+ graft size, then it would be safe to assume that this doctor has mastered the skills required for large session. Unfortunately, not all doctors have either the teams or the skills to accomplish the feat on a routine basis. For us, we have been doing sessions of over 3000 grafts for almost a dozen years and are performing sessions of this size almost every day. If a doctor must limit the size of the session to under 2000 grafts, it may take more surgical sessions to accomplish the same goal as when twice the number is transplanted.