Grafts came out within 4 days, what do I do?

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

There is too much crusting present making it easy to lose grafts.  I make it a point to get all of the crusts off on the day of the surgery as well as the day after the surgery to avoid this problem. Our article shows when grafts can be lost safely: https://newhair.com/wp-content/uploads/2018/11/mp-2006-graft-anchoring.pdf. Here is a video that shows how to wash your hair:  https://baldingblog.com/what-is-the-washing-technique-that-you-use-for-after-a-hair-transplant/

Read this article and then you will understand what is happening to you and the timing issue.  You should go back and see your surgeon.

How can HAIRCHECK tell the difference between aging hair and balding?

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

How would a haircheck distinguish between balding, and simply aging. Won’t the hair check just confirm that there is a loss of hair or density either way?

If all of the hairs on the head are thinning as a result of aging, the HAIRCHECK test will show no differences between one area of the scalp and another. In a balding person, there will be distinct differences in the various parts of the scalp that show reduced hair bulk. See here: https://baldingblog.com/haircheck-test-how-it-is-done-video/

Minoxidil put dark circles under my eyes

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

Hi doctor I am a 26 yo French guy who has been taking minoxidil & dutasteride for 6 years now. I am a special case because I have an identical twin who is not taking the minoxidil . I have developed hypertrichosis and dark circle from minoxidil . Does someone who develop hypertrichosis should get scalp result from the minoxidil? the dark circle and hypertrichosis under eye are 100% from the minoxidil because my twin doesn’t have those. Will it last if I keep taking the drugs? thanks a lot doctor

Stop the drug and the side effects should go away in time.

I need another hair transplant but look at my donor area

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

I want to keep my hair short right now from side and back but the scarring from the first fue is still noticeable. Do you think scalp micropigmentation will help with this? Second FUE would make this even worse potentially.  This is what it looks like right now. First FUE was years ago.

It looks like you are over-harvested. The instrument the doctor used appears to have been relatively larger than what I would expect. Scalp micropigmentation will hide the abnormal look in the back of your head. Send me photos of your entire head to info@newhair.com so I can give you a sort-of a Master Plan for what to do going forward. It would have been good to have a metric for the original donor area density.

Want to take a break from finasteride

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

I’m 18 and I’ve been secretly taking fin for 1.5 years (23m, losing hair since 18m mostly temples), I mainly kept what I had and regrew a bit.. Now I want to take a break for a few months, thoughts?

Taking a 2 months break will cause you to get “Catch-up Hair Loss” which means not only will you lose the benefits but you will also lose the hair you might have lost that the drug stopped from falling out. Think twice about it!

Daily hair loss normal at 100 hairs/day

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

A local doctor told me that it’s normal to shed 80-100 hair a day, but hairloss starts to occur when these shed hair are not replaced.,  Is this right?

We all shed about 100 hairs per day and replace that same number. IF you calculate that we have approximately 100,000 hairs on the head (typical Caucasian) and with a 3 year hair cycle between anagen and telogen, the growth cycle in a typical male is about 3- 3 1/2 years.

Getting a minor transplant for minor hair loss

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

I noticed that something like this takes only 800 grafts and my hair is not even close to as bad as this persons so reasonably speaking is 500 grafts not a reasonable guess and there is a lot of hair present, so these drugs are the best option. That area would take more like 1500-2000 grafts depending upon the thickness (fine, medium or coarse) of the hair

There is a lot of hair present, so drugs are the best option. If you are compelled to do something, then get Scalp Micropigmentation (SMP) rather than a hair transplant and you will not have a visible balding crown. Our website shows the results we get from SMP: https://scalpmicropigmentation.com/gallery/thinning-hair/

4600 grafts for Frontal Triangle only (photo)

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

Wonderful results. You have possibly used up half of your donor supply or more depending upon your original donor density. From the photos, it looks like you have a Norwood Class 4A pattern and the A patterns are great because it is likely that even if you lost all of the hair in that pattern (a Norwood Class 5A pattern), you would still have enough hair to cover the new balding areas; however, for others who are not so lucky and don’t have a Norwood A pattern of balding, so many grafts placed in the frontal triangle would leave them devastated with not enough donor hair to fill up a Class 5, 6 or 7 pattern. Keep in mind that a Personalized Master Plan is needed to not only treat the present balding pattern with a hair transplant as you have done, but the worst pattern that you might develop so that you will always look normal and hairy.

Wondering if bodily resistance to fin/dut is possible

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

Does this “tug of war” refer to the idea that your body responds to fin by increasing 5AR enzymes and therefore DHT in response to finasteride? Or does this refer to the idea that even if you inhibit 70% DHT with fin, or 90% with dut, it simply may not be enough to stop genetic balding?

The later. Also it assumes that you can stop the Apoptosis (programmed cell death) that hit hair follicles after they go through a specific number of hair cycles that are programmed in our genetics. Generally, finasteride prolongs the growth cycle and reverses the miniaturization of those hairs that are miniaturized. Given time, if the genes are strongly influencing the hair follicles, these drugs may fail over time.

I got 2800 hairs and found the experience bad

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

just got a hair transplant in the UK. Met the doctors on the day due to distance to clinic. i was informed my crown couldn’t be transplanted to which was difference to our email correspondence. After a short chat the dr., he drew what would be my new hair line in pen on my forehead. I asked for it to be lower in the temples to give the youthful look and they assured me they would transplant hairs to the very bottom of the drawn line which would achieve this. I took their advice after being assured it would be to the bottom of the line and went ahead with the procedure, it was straight forward and they were very professional – lasted around 4 1/2 hours. After the procedure i wasn’t shown the results by the team but had to check myself in the bathroom on the way out. My head was rather bloody and slightly swollen so it was hard to judge at this point. it has now been 4 days and things have settled but I am worried that the hairline doesn’t come down far enough at the temples and that it is noticeably squint from the front.

I also took short video during the procedure and have since noted that the hairline drawn for me before the procedure is not the same as the one used during the procedure which is slightly above the former. I have contacted the clinic on two separate occasions to ask for photos taken which they responded to but have ignored both my questions about the number of hairs/grafts actually used on the day. They have informed me it was roughly 2800 hairs, can anyone guess if this looks right from the photo provided. not sure how to add more than one for the changing hairline drawn.

Any thoughts would be appreciated.

This doesn’t sound like a good experience. we make it a point to make the experience fantastic confirmed by all of our patients comment on Yelp and Realself. We treat every patient like royalty and complete dedication to the patient’s needs.  Communication is key, of course.  Your complaints are reflective of poor communications on the physician side, but the transplant looks ok. 2800 hairs, maybe, but most doctors don’t count hairs but grafts. I would imagine that you had 1400 grafts. The hairline looks ok also. After it has grown out, if you don’t like the hairline you are given or anything is wrong, it can be improved to meet your needs.  Good luck.