Had a Hair Transplant 3 Months Ago, 80% of Transplanted Hairs Haven’t Fallen Out – Hair Loss Information by Dr. William Rassman

hello
i had the strip procedure done about 3 months ago with 1500 grafts. within the first two weeks many shafts fell out as is normal, however about 80% of them have not. i am unsure if this is normal and if these grafts will eventually begin to grow.

thank you for your help and this wonderfully informative website.

If the hair is still there but not growing, it just means that the shedding has not taken place. These hairs are dead, but new ones will arise in the next few months. Those dead hairs will eventually shed.

Balding Forum - Hair Loss Discussion

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Body Hair Transplant for Alopecia Sufferers? – Hair Loss Information by Dr. William Rassman

Hello Dr. Rasman
I have Norwood class 7 diffuse ‘patterened’ alopecia. I am 26. You have seen my scalp and said I am definitely not a candidate for hair transplant because my donor density is poor and I have ’see through scalp.’ I have been on propecia since then for almost one year. My question is: what is the current success rate of using non-scalp hair for a donor region, such as chest. Do you do these procedures for people with poor donor density? Last question: When will hair cloning become available w/Aderans?
Thank you very much.

Body hair is not the solution you are looking for. I do not expect to see hair cloning for at least 5 years or more. For the moment, if I saw you only once, then you should have a yearly visit with me to follow what is happening to you. There is not much to offer other than Propecia and possibly Avodart (something that I might consider using in your case).

A Good Hair Transplant Made Great (with Photos) – Hair Loss Information – Balding Blog

Once you have a follicular unit transplant (FUT), if the procedure was done with care, there is no question that the results can’t be detected in any casual encounter, or even on close inspection in most circumstances. Yet with that said, there is still a difference between patient results that go beyond the characteristics of (1) hair shaft thickness, (2) hair character, and (3) hair color.

Let’s take a look at a patient who had two hair transplant procedures. The patient is Dr. Jon Perlman, the well-known Beverly Hills plastic surgeon that has been featured on ABC’s television show, Extreme Makeover. After his first session, he had good results that nicely framed his face when his hair was groomed. But on close examination, his hair was somewhat see-through. Dr. Perlman has very fine hair, so the bulk of each hair shaft was lower than average. By undergoing a second procedure, the bulk was doubled and the results shown in the pictures below say a great deal about the change he experienced. He was more-than-satisfied after the first procedure and thrilled after the second one. A good transplant became a great transplant.

Sometimes patients will tell me something like, “I don’t want it too thick and I am afraid if I put too much hair there, it will look unnaturally thick.” In all of the years of doing this surgery, I have never, ever had a patient who told me that I had made the hair too thick in a single session. We have seen many of our patients (initially satisfied, but wanting more hair) receive another transplant and become transformed back in time to their youthful look. By performing NHI’s pioneering dense packing procedure, we can increase the density of hair in a single procedure, often reducing the number of procedures needed to obtain results like the one shown here, but when the hair is super fine (like the example below) then two sessions may be needed. For many people, hair is like money — the more you have, the better it is.

Click the photos to enlarge.

Before and After 2 procedures (2890 grafts total):

 

For more photos, click “read more” —

Before (left) and immediately after surgery (right):

 

After 1st procedure (1529 grafts):

 

After 2nd procedure (1361 grafts):

 

Hair Loss InformationHair Diameter Thicker Near Middle, Rather than Near the Bulb – Hair Loss Information – Balding Blog

I have read that hair diameter is thickest near the bulb and thinnest as it reaches the tip. Recently I have seen some fallen hairs with the diameter thickest at the center and thinner as it reaches the bulb and tip. Is this indicative of hair loss?

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The hair shaft should be uniform in its thickness through its entire length when the hair is shed during the normal growth phase that all hairs go through. If there is active miniaturization that radically sets in, then that could explain what you see in some of the hairs that you observed. In the miniaturized hair, the hair probably grows slower than in the normal state, so a hair that you are looking at (lets say one inch long) might have taken some time to find its way out (more than the normal 1/2 inch of growth per month). The best indication of hair loss is to assess the degree of miniaturization that is present throughout the scalp, particularly the areas that are thinning. I hope that this helps.

Skin Cancer on the Scalp – Hair Loss Information by Dr. William Rassman

In an earlier post, you commented that Toppik can cause skin cancer. Did I read that wrong?

Yes, you read it wrong. Toppik can hide a skin cancer, because it is like a make-up that covers what it is put on. If the scalp is tan, then a tan Toppik would be used to cover the scalp, thereby hiding a skin abnormality like the skin cancer seen here:

I actually picked up this cancer by giving this man a hair wash in the office so I would get off the Toppik and get a good examination of this scalp. He had noticed this spot when his comb got caught on it. It often bleed, but he did not think much about it because he assumed it was from his comb. Wounds that do not heal like this must be examined by an expert to rule out a skin cancer. I found this tumor and was concerned that it was a malignant melanoma (see below), but after excision biopsy was done, it turned out (fortunately) to be a Basal Cell type. The excision alone should cure this particular cancer.

Skin cancers come in three varieties:

  1. Basal cell cancers are the most common and they frequently ‘crater’ and elevate. These tumors are most often the result of direct sun damage and they rarely metastasize and they are slow growing. They will, however, locally invade the surrounding structures.
  2. Squamous cell cancers are the second most frequent cancer and they will invade beyond the confines of the tumor, even spreading to other parts of the body. They can kill.
  3. Malignant melanomas are skin cancers most dreaded by everyone. They often have a black, elevated surface with a spreading out of the tumor like an octopus or an amoeba. Once they invade below the very superficial surface component and break through into the lower structures of the skin (about 1-2 mm below the surface), they can and often spread through the body and they can be deadly.

Patches of Hair Loss from Medication? – Hair Loss Information by Dr. William Rassman

I am 31 years old, and I have noticed patches of my hair have been falling out in certain areas. Friends have noticed as well, especially right at the front of my forehead. I have been on birth control for several years ortho novum 777, and recently changed to a new pill this month called (low estrogen), due to medicine I am taking for seizures(Topamax) What can I take to help this? I don’t want my hair falling out. Please help me

Some of the medications you are taking can cause hair loss, but patches of hair loss on one side of your head indicate either an infection problem (like ringworm) or a condition called alopecia areata. You need to see a specialist for this. It is not for me (over the internet) to diagnose your problem, but it does need a competent medical expert.

Balding Forum - Hair Loss Discussion

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Is Weight a Contributing Factor to Female Hair Loss? – Hair Loss Information by Dr. William Rassman

hello! i’m a 21 year old female student that has been experiencing hair loss for a couple years now. my stress levels varies, but i doubt that is the reason why i’m shedding. my mom believes that i’m lacking the correct amount of vitamins and what nots. i eat regularly, but i’m 5′4” and only 102 lbs. do you think my weight is a contributing factor? also, what kind of supplements should i consider? rogaine would be my very last resort, so any advice is greatly apprecaited. thank you.

If you are malnourished, then this is a cause of hair loss along with a variety of medical conditions that require a good doctor to exclude in a diagnostic workup. Diseases like thyroid disease can cause weight loss and hair loss. Focusing upon dietary supplements is the wrong focus. You need to know if you are healthy first, and if you are malnourished second. Taking some natural supplements will delay what you need to do. The best students are those who understand and learn about their body. It is a temple, so treat it with respect.

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Any Way to Tell How Many Transplant Hairs Actually Will Yield Growing Hair? – Hair Loss Information by Dr. William Rassman

IS there a correlation between how well transplanted hairs “took” at first, and the eventual yield?

The reason I ask is, I’m about 4+ months out from a 1,200 FUE session and I have seen little/no evidence of growth yet. But, I remember in the first couple weeks after my procedure, I felt and saw a whole lot of hairs as nubs, and they grew a little before falling out. If the hairs held at first, and even grew, can that be an assurance (or at least almost an assurance) that everything was done properly and they’re going to come back and grow for real? or is it still possible to end up with poor yield even if the hair looked real good at first?

At 4 months, I would not have expected much hair to be there. Between the 4-5 month, you should see hair growth and by the 7-8th month you should be in the combable hair stage. By the 12th month, expect over 95% of the grafts to have grown.

It is rare to have no graft growth if your surgery was performed by a doctor with an experienced team. A complete failure of the transplant in the hands of such a team is very rare. Those hairs that appear to grow in the first 2-3 weeks after the surgery (those short hairs that feel like a beard) are really just being shed and contrary to what you see, they are not growing. These hairs sometimes remain in the head and are not shed in the first month, but most times they do not grow either. Any residual hairs that look beard-like will almost all shed by the time the actual transplanted hair grows.

Balding Forum - Hair Loss Discussion

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Hair Loss InformationHow to Tell if You’ve Found the Right Hair Transplant Doctor – Hair Loss Information – Balding Blog

What is the difference between doctors and the various medical groups performing hair transplants. There appears to be a great deal of competition and as I go between groups, I get confused and overwhelmed.

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If you were looking for a good family doctor or plastic surgeon, you would most likely use certain criteria for selecting one over the other. Fundamentally, you would look for a well credentialed, caring, competent doctor who you like and feel comfortable with. Be sure that the doctor values you as a patient by spending time with you and discussing your agenda freely. Ask yourself if the doctor listened to what you were saying or lectured you about his/her ideas. That doctor must be trustworthy to take on your welfare or your family’s welfare, and not only must you believe in his/her skills, but you should also like him/her as a person. Although the various family doctors and plastic surgeons use physician’s assistants or nurse practitioners to help them manage patient’s needs, the doctor is always ultimately the person in charge, the one whose skills you will eventually depend upon. As most doctors practice in groups, you should feel comfortable with the doctors who work with your doctor in the group that you selected, as sometimes your doctor may be on vacation or off-call when you need him/her the most.

You should expect that physician extenders should be educated as physician extenders (nurses or certified physician assistants, not salesmen). Hair transplantation differs from standard family practice and cosmetic surgery procedures in that there is a team approach to performing surgery. Doing refined follicular unit transplantation takes a team of 3-6 people working together for hours, so the doctor’s team is as important as the doctor is. An old cliché says that a chain is only as strong as its weakest link, so the skills of the doctor as one link of that chain can easily be offset by inexperienced technicians in the surgical team or sloppy processes that are not put together carefully and not focused on the many detailed nuances that produce quality hair transplants. You should feel confidence in the doctor and the team and you should feel ‘integrity’ and trust in soul of that doctor.

In my hair restoration practice, I add many elements to build confidence and establish trust. I have an open practice, where new, potential patients can meet completed hair transplanted patients one-on-one. This offers the opportunity for new patients to probe the process and see up front what they will be getting if we perform the surgery. I focus heavily on patient education, not only by providing copies of some of the important medical articles I have written, but also in spending time with each potential patient (doctor and patient in a private room without a salesman). Then after the visit, I provide a detailed letter summarizing what I learned about the patient’s objectives, and a written Master Plan for what I think will happen to that patient. Fees are openly discussed by the doctor and quotes for surgical fees are put into writing. By far, most of our patients do not have surgery and can be spared surgery with appropriate medications.

NHI is unique in that we have a fully accredited surgical center where all of our surgeries are performed, ensuring safety for patients to the highest national standard. Our surgical center is audited regularly for following hospital quality processes and procedure. Very few (if any) hair transplant facilities adhere to such rigorous standards. Why is that important? Well, it is the patient’s assurance that our sense of quality is judged against the best healthcare facilities in the nation. When you select a medical group for your hair transplant procedure, you should not only know the facility, the staff competence, and longevity of that staff, but also the history of the doctor. Has the doctor been disciplined before the medical board for infractions in any form of conduct? What does the public and his colleagues think about the doctor (available through internet sources)? What is the doctor’s malpractice record? Have you met or spoken to his/her former patients, and if so, what do they tell you about their research prior to taking on this doctor as their doctor-of-choice?

I always tell my patients (and have written on this blog many times before) that there is good news and bad news for the hair transplant patient — simply put, hair transplants are absolutely permanent. Getting it done right the first time is far easier that trying to fix what might not be fixable if it is done wrong. By following this selection process, finding a good doctor should not be difficult. There are many good doctors out there, just be careful not to end up in the wrong place.

I’ve Worn a Hair System for 14 Years – Hair Loss Information – Balding Blog

I am a 55 year old, white male with normal crown baldness. I have been wearing a hair system for the last 14 years. Could hair transplantation work for me and what would be the estimated cost?

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See Patient ZU for a good example of a man that wore a hair system for 30 years. He was transplanted and has a wonderful result. The costs depends upon how bald you are. Send me photographs and I will give you some starting points and an estimate.

For more photos of Patient ZU, please click here.