Transplanted hairline densities with high graft numbers in Turkey

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

What you should know about the hair density of a transplanted hairline. The results of the end product depend upon the following:

  1. The appearance of thickness comparable to where they were before they became bald.
  2. The color contrast between your hair and scalp color. The closer the match, the better the transplant looks.
  3. Many transplants from Turkey appear to push graft numbers high. Where I might put 1500-2000 grafts in the first 2 inches of the hairline, many Turkish clinics (with or without a doctor on staff) have technicians or inexperienced doctors deciding graft numbers.  They tend to over-shoot the numbers without being able to mechanically place the grafts close enough to get anywhere near their original hairline density without getting necrosis as a complication of the surgery. Good doctors shoot for appearance and fullness; by doing so, they don’t waste the donor hair supply in the first surgery.  In my hands, fewer grafts for comparable balding areas than most of the Turkish clinics produce the same appearance of fullness for the area transplanted. 
Always remember that Hair Loss is progressive, even after a hair transplant. If you waste your donor hair on the first 2 inches of your hairline with, let’s say 4000 grafts, you have used up more than half of your donor hair supply for the rest of your life.

Designing a female hairline

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

A classic female hairline is curved, and in the middle, it touches the crease of the furrowed brow. This woman’s hairline receded to the male position and the corners also moved up. This newly drawn hairline will address all of her concerns.  Note that the normal female hairline does not have temple peaks present as they are buried inside their concave hairline. 

Finasteride and hair growth overtime with graphic

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

I have seen a similar curve running for 10 years. It shows a similar spread between men who stay on finasteride and those who do not use it. The non-users develop a more advanced pattern of balding. I try to tell every man that is balding that this is a progressive process over the patient’s life, so a hair transplant doesn’t stop the balding in the non-transplanted areas.  Today’s young men who head to Turkey or get less reputable surgeons seem to be getting high graft numbers, so the reserves for future balding will not be there. 

 

 

 

 

 

Click to enlarge

Necrosis and lack of random placement of grafts

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

This is not an uncommon problem in the hands of less knowledgeable surgeons, assuming, of course, that this was done by a surgeon and not a technician.  The Necrosis outlined in the photo by a circle, is probably the effect of improper use of adrenaline (epinephrine) to minimize the bleeding at the time of implantation.  In addition, note that all of the grafts are placed in rows. The grafts line up like soldiers.  In men with straight hair, these rows will be detectable when and if the hair grows out.  

Possible Triangular Alopecia

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

This young man sent these photos to me asking about this area of extreme thinning, which appears in the same place, even on the other side of his head. He said he had this same thin area when he was younger and it is also on the other side of the head, just less prominent.  This is often an inherited balding area called triangular alopecia, which is always found in this area. A simple hair transplant can permanently fix it if it is triangular alopecia. It could be alopecia areata, which is rarely in the same place on both sides of your head.

Lot’s of things wrong with this transplant

/by William Rassman, M.D./0 /
I saw this photo posted and decided to comment on it. There are many things wrong with this surgery, and as I don’t know the age of the patient nor the number of grafts he received, it is hard to complete my assessment; nevertheless, it is important for those of you who are considering a hair transplant to understand the difference between good and bad hair transplant techniques.
The transplant donor area was unusually focused above the donor area, and that hair may be lost if this man develops an advanced balding pattern with age. The surgeon did not confine his surgery to the permanent zone (a 3-inch high area around the side and back of the head). The surgeon created a picket fence to the leading edge of the hairline, which will show up if the hairline finally grows in.  The patient needed to be instructed in proper washing techniques, as residual crusting increases the risk of infection. ‘Cleanliness is close to godliness‘, so proper early washing is critical (see here for my golden standard: https://baldingblog.com/one-day-post-op-2150-grafts-photos/).   If this man was under 25, he shouldn’t have done this because the amount of hair transplanted may have been disproportionally high when compared to his donor supply.

Beard growth on young man

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

I see questions about if a beard will grow with finasteride on here, and for me it doesn’t seem to affect my beard! I’ve seen improvements and have used minox for my beard, even before my hairline started going. I was aware of the results from minox research I’d done for my beard, so thank god I knew of treatment when my hair started to go, because it went quickly..

I use a simple routine of fin oral 1mg and minox foam on my beard and hairline once per day before bed and that’s it. Tried oral minox for a bit and actually lost ground, so swapped back to topical foam and got the hairs back. For me, topical is more superior than oral even at once per day.

Your beard response is dramatic. I would not rush stopping the minoxidil on the beard, as these hairs may be dependent on minoxidil until your genetic kick in.  The big question for you is that at some point, your beard should grow independent of minoxidil, so ask yourself, when do you stop the beard minoxidil? Possibly when you are in your later 20s, to be sure that your genetics are controlling the beard. 

Genetics vs situation?

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

The man on the left uses great shampoos and conditioners, has a great diet, and takes hair loss medication, while the man on the right is Homeless.  It’s all in the genetics!  (Taken from a Facebook post). Hair loss is in your genes!

1.5 years minoxidil, finasteride and microneedling

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

I started minoxidil at 18, then added finasteride and then added microneedling. I got my hair back.  What should I do now?

You can cut back on the microneedling to once a month. Keep up the other medication. It is likely that at 18, when you started this routine, you might have had good results from finasteride alone. 18-year-old men are generally very responsive to finasteride in the frontal hairline.