Day: January 1, 2023

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I was asked this week if I was really a doctor

I addressed the question by suggesting that they check me out in the medical board offices of the States of California, New York and Florida where I am licensed. I thought I would share some of my recent awards with you in case you have any doubt. These include Best Doctor in the United State for hair transplantation by Castle Connolly (see here:https://www.castleconnolly.com/about/NomProcess.cfm ) for 10+ consecutive years, the Golden Follicle Award (see here: https://newhair.com/wp-content/uploads/2018/11/nhi-newsletter-2005.pdf), Two Life Time Achievement Awards presented in 2019 (by South American and European Societies).

I guess the answer to the question is that I must be licensed to practice medicine or I am a hell of an impostor.

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I Was a Heavy Drinker for Years and Now My Hair is Thinning at 22 Years Old!

Hi,

I just graduated college (22) and was a heavy drinker for four years (drunken stuper 3-4 nights a week, and heavy smoke the last year, as well as some drug use (vynase, oxycodone). Often times i’d be hungover for 12 hours, probably didn’t eat right.

I graduated and stopped, but was wondering if hair loss/thinning is temporary or not. My entire scalp is thin, with some receding.

Dad’s entire family has/had thick hair, one uncle on mom’s side went bald at 16, and so did his son.

DrunkWhile it’s obvious that you made some poor decisions re: drinking and drug use, I couldn’t tell you if they contributed to your hair loss. Nutritional problems can lead to hair loss, but you do have some family history of hair loss. The most likely culprit is genetics. I don’t know how long your hair loss has been going on or if you’ve done anything to treat it.

I would see a doctor for an examination of your scalp, and if you can find a doctor that will do microscopic miniaturization mapping, that’s even better. If you do have early genetic hair loss, Propecia would be a good way to slow the loss down. Talk to your doctor about that, as it is a prescription medication.

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I wanted to share a consultation I did this morning with you

Your examination showed that your hair is fine (measuring 40 micron thickness), has a salt and pepper color, is straight from what I can see, and your scalp laxity (the looseness of your scalp) is very good. I spent some time explaining that the area of balding you have now, was originally covered by 75,000 hairs. With the hair remaining around the back and sides of your head, only about half of it can be moved to cover this large bald area. I can move possibly between 10,000-15,000 hairs in two surgeries to cover an area that originally was covered by 75,000 hairs, so that the new density will be 1/5th or the original at best. As your hair is fine, the value of each hair is less than if it would have been coarser and does not cover very well without a substantial numbers which you will not get from the two surgeries I am recommending for you. I showed you many pictures today including someone with fine hair who had front and top coverage and expected that this is what you would look like, and you told me you would be satisfied with this look. I also discussed that when the hair is fine, longer hair gives you better coverage so when it starts to grow in after the hair transplant, you will make determinations at that time as to what length looks best.
I recommended at least two surgical sessions with as many grafts as possible and as are safe. The first session will get out between 2500-3000 grafts and the second session will be another 2500-3000 grafts (each graft contains about 2 hairs). If after the second surgery has grown in (about 6-8 months after), then we will make a decision about how full it is, if it meets your goals and if you want it to appear fuller, either a third hair transplant or Scalp Micropgimentation (http://www.scalpmicropigmentation.com) to color in the background), would be the next and possibly last step in the process.
I told him that I was confident that we would achieve the goals he and I defined if he followed the plan I outlined for him.
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I want two FUE and one FUT

If a patient gets two FUE’s and then later wants to do an FUT, will there be a risk that the two FUE’s will deplete the donor hairs for FUT regions in the future? I am thinking of getting two FUE’s in Turkey and then later when I can afford it get a big FUT in America with maybe Dr. Lindsey in Richmond because I can stay with family near there

Suppose the patient is like a NW2 with a very large / dense donor supply.

In an ideal world, if you are going to do both FUE and FUT in separate surgeries, you are better starting with FUT because the reduction on donor density is less and the FUE will be more successful in harvesting more grafts. The reason for this is that the entire back of the head stretches, reducing the impact on the 3 inch high donor area with the first a large FUT session.

I generally like to put together a Personalized Master Plan for each patient balancing donor supply with the present and potential balding. You may be over-doing the grafting without such a plan. Be careful not to jump on the bandwagon with too many grafts harvested from the donor area and get a balding donor area.


2021-05-17 12:26:32I want two FUE and one FUT

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I Want to Use Cream to Remove My Scalp Hair, But Not Permanently

Hello Dr. Rassman,

I’m a young man experiencing MPB, and I’ve decided I want to embrace it. I’d rather not shave my head since I find razors irritate my skin. My question is this: Do you know of any hair removal creams that are safe for use on the scalp? I’ve read varying reports that indicate Nair can damage the scalp. Furthermore, if I later choose to have a transplant or other hair restoration procedure done, would the earlier use of hair removal cream alter my hair’s regrowth in any way once I cease using the product?

Thanks for your informative site and the time you devote to answering all our questions!

There seems to be many warnings on using depilatories such as Nair. The warnings suggest chemical burns and damage may result from their use on the scalp. It appears that your options are limited to shaving. Try different razors or shaving creams to see if that helps reduce irritation.

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I Want to Transplant Hairs from My Toe to Eyebrow

Do you do eye brow transplants?

I have toe hair, and I would like to either remove it or have laser done to get rid of the hairs. I don’t like my eyebrows, because they are thick. The color matches between my eyebrow and my toe hairs and they seem to have the same texture.

I think I would be a good candidate if you did.

Yes, we do eyebrow transplants! Body hair transplants (from the back, chest or leg) have been attempted in the past with minimal success because the telogen cycle is long, at times longer than the growth cycle. Although scalp hair transplant to the eyebrow is routinely done, it does not always produce soft eyebrows that women want if the scalp hair is anything but fine. Keep in mind that scalp hair is generally more coarse than eyebrow hair. Thus, eyebrow transplants for men with coarser hair produce a more aesthetically pleasing result (as men generally want bushy, coarse eyebrows like Einstein or Mark Twain — well, maybe not that far). That being said, many of my patients (who are women) were very satisfied with their eyebrow results. The key point is that everybody is different and each patient needs to have realistic expectations and goals and know the limitations of such surgery with regard to the thickness of the hair being transplanted. This goes for any type of surgery.

I would not object to toe hair transplanted to the eyebrow, but it would be purely experimental and the growth rate may be less optimal because the sleep cycle (telogen) is relatively long, possibly longer than the growth cycle. The reason I suspect that this is the case is that I have rarely seen very long hairs growing from the top of the toe. I would want to know more about what the patient expects and what other hair may be available as an alternative.


2009-04-17 16:12:29I Want to Transplant Hairs from My Toe to Eyebrow

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I Want to Transplant a Slight Widow’s Peak to Frame My Face

I am 29 with a stable NW 2 after taking Propecia for a year now. I’ve always had a high forehead and have always wondered if it is possible to have a small hair transplant to create a slight V in the middle of my hairline like Keanu Reeves, Leonardo Dicaprio or Johnny Depp. I feel like if you took that part of their hairline away, their hair wouldn’t frame their face right and I feel like if I had that bit of hair there, it would frame my face better.

The slight V you’re talking about is a widow’s peak.

Beauty is in the eye of the beholder, as the expression goes. If someone wants a different hairline, that is what we do. This is cosmetic surgery, after all. Meet with a hair transplant surgeon to go over your options.

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I Want to Take Propecia Temporarily Before Surgery

Dear Dr. Rassman

you mentioned before “Some of my patients do not take Propecia (finasteride 1mg) by their personal choice. It is your choice as well. The risk is that you may have increased shock hair loss without taking Propecia before surgery. Shock hair loss is common in men under 30 years old or those who are losing their hair actively when they have a hair transplant. Propecia will prevent this complication in most men” …

Well i used propecia before for 9 months and had great results. but by the 8th and 9th months it killed my libido and impotence although i was 26 years old only.. but as you said shock hair loss is really scary. so if i wanted to use finasteride just to avoid the hair shock loss post surgery, how many months you advice me to take it temporary, definitely im not willing to go on with it…

thanks doc…

Stopping the finasteride after a hair transplant has been done with a few of my patients with success. The risk of shock loss is mostly in the first 4-6 months, and those that stopped it after the transplanted hair grew out did not have a problem with shock loss. Of course, they had the benefit of hair transplants to cover any new loss of the original hair, so they may have lost some hair without knowing. This may be a better route than not taking the drug at all, but you will still face the natural evolution of your hair loss over time without the drug on board.

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I Want to Sue The Place I Got My Laser Hair Treatments

Dear doctor,

please help!

In [name removed], I payed dear money for laser hair treatment which included laser, serenoa products and minoxidil. Now I’m taking the hair studio to small claims tribunal for refund, because they told me the success comes in 85% cases and that I had great chances…

I’m immigrant in this country but like to invest in myself, so I can’t say goodbye to this money.

Unfortunately, now that I investigated it a little bit, I found the figures are different, but how do I present material on tribunal? Where do I find a person, an expert who can say what is realistic success rate with minoxidil, with laser (if it can be taken into account at all…)?

Please advise me where to seek for expert opinion and facts that can be used at court? Do you have any experience? Please help us protect ourselves from these marketing sharks.

Best regards and thanks in advance

Best go to the consumer protection agency in your government, which often protects people from false advertising, as that is their job. In California, this agency is active, but they generally do not like to take on the quest of individuals unless you can prove false advertising/promotion. I do not know where you could find an expert in your region, however.

Minoxidil does work in some people and the 2% solution can regrow some hair in about 30% of male patients with genetic hair loss (see health-cares.net for more).


2007-02-07 10:51:30I Want to Sue The Place I Got My Laser Hair Treatments

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I Want to Sue My Hair Transplant Doctor!

Dr. Rassman,

Hi doctor. I wish I could be writing to you under different circumstances, but I’ve got a major problem that I need some advice on. I had a hair transplant with a doctor here in Canada about 10 months ago and I really, really hate the results. This doctor completely ruined my appearance. I’m considering legal action due to what I feel are unethical practices. A couple thousand dense-packed grafts were placed in the hairline (some of them were placed at the wrong angles), and many 2-hair grafts were also placed there. My hair is dark and coarse, so it just does not look right! I’m considering electrolysis to try to undo this and maybe start over elsewhere. I need help!

Electrolysis

It is quite hard to remove hair by electrolysis and lasers without creating hypopigmentation (loss of skin color) in the area where the grafts are taken out. Surgically removing the hairline could work, but it would require real expertise in doing this. Hairs transplanted in the wrong direction / angle should be a real concern and some of the solutions can be as difficult to achieve as the actual problem you are trying to solve.

I always tell the patients I see to talk with their doctor. Most doctors care about the results you got and the doctor should be able to address your problem in detail. I always tell patients that the good news and the bad news about a hair transplant is that it is permanent. It is very hard to undo them if they are not done properly. I couldn’t tell you if legal action is the way to go — what I can do is try to help get you back to normal looking. You do have a very real problem, but I would have to see you in-person to determine what can be done to help your particular case. Whatever happens, you must know and set realistic expectations on what can be achieved with any ‘repair’ that you undergo.