Month: January 2023

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Why Didn’t My Surgeon Just Make My Hair Dense in 1 Surgery — Now I Need Another Procedure?

I had a hair transplant 15 months ago using the strip method procedure. I only had the temple areas done for my receding hairline. I am happy with the procedure, however i would of liked slightly more density. I told this to my surgeon who said he could preform another transplant but i was confused to why he couldn’t of transplanted such two small areas in one session. My worry is that my scar although really well concealed and unnoticeable it is very long. Im worried i dont have enough donor hair now incase i developed into a norwood 7 (completely bald). I know unless you seen me face to face and analyzed my head you couldn’t tell however here is my question. If my transplant surgeon has used alot of donor supply another strip procedure would obviously not be a good idea.

Here is my thinking and i might be wrong so please explain if i am. If i have already had a strip procedure and i wanted another transplant i think FUE would be a better second procedure as you have ability to choose hairs from different areas from the donor area thus being able to use more hairs than you could from a strip procedure. The reason for this is that a strip procedure can only can only be extracted in one long strip which is wasting useable hairs, however with FUE i feel that if someone has had a strip procedure which has used a large amount of surface area obviously another strip procedure would be difficult as theres not enough space for another slit and but with FUE you could extract hairs from all over the donor area. Am i thinking correctly. The doctor told me he transplanted 1464 hairs. is that too much for a receding hair which goes back 2 inches, which means he mustn’t of transplanted that many? Please reply. Thank you NHI team.

I really don’t have a clue as to the size of your recipient area for those 1464 hairs. Assuming that it was 1464 hairs (not grafts), that means that the strip taken should not have been very large (in surface area, that is). The normal person has 1250 hairs (or 625 two-hair grafts) per square inch. At a transplant, you can calculate just what you received by figuring out the square area of the recipient area. Let’s say, for example, that you had 4 square inches of hair transplants in an area that was originally bald. That means that if you had normal hair without balding, the area we are talking about would have had 5000 hairs (or 2500 grafts) in it. If your surgeon put in 183 grafts per square inch, that reflects about 29% of the original density into that recipient area for an average Caucasian density. That is a reasonable number of grafts from a density point of view, but fullness reflects many other factors, including thickness of the hair shafts (coarser produces much more bulk than fine hair), color contrast between hair and skin color (the lower the contrast the better), the degree of wave or natural curl (straight hair is not as good as wavy hair), and the hair styling you use (short requires more density, but long does not unless the hair is fine).

The average donor supply for a typical male is about 20,000 hairs (or 10,000 grafts) and this is dependent upon the laxity (looseness) of the scalp. Based upon the number of grafts you receive as discussed above, you should have a great deal of donor hair left. The scar should be managed by your doctor and removed with the next surgery and a trichophytic closure should be done to manage the scar. Be sure that your laxity is good and do the exercises before the next surgery (see video). There is much controversy to the issue of just how dense one has to make it. I generally shoot for 25% or the original density, but in the very front of the hairline I might go a bit higher (35-40%) if the hair is fine. Transplanting hair into a bald area has mechanical limits that may reflect growth, graft damage and other factors unique to the surgical team and your unique circumstances.

FUE as a unique procedure is not very efficient in most surgeon’s hands. I believe that you are incorrect about FUE vs strip surgery. The strip method may be more efficient in the long term. Once you had a strip, it may be better to remain with it. With regard to your scar, some people just form wider scars than others. The use of special closures like trichophytic will automatically force hair to grow through a wound, but it does not sound like that is the type of closure the doctor used on you.

Progressive balding is something that occurs in every person with genetic hair loss, but fortunately only about 7% of the male population will end up with the Norwood Class 7 pattern. All good surgeons should have a Master Plan for your worse case scenario for balding, so if you should be unfortunate in developing a Class 7 pattern (even with good drug therapy) you should still have a normal appearance. I have been doing this for 18 years, and I admit that did not have the same type of common sense in my first year in practice as I do have now. There is no real substitute for that type of experience, particularly in determining the rate and degree of balding progression.

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Why Did My Body Hair Thin Before on Propecia, But Not This Time?

Hello Dr., I took Propecia a few years ago for a period of 8 months and had good results, but also had significant thinning of body hair (legs, arms, chest, & back). I quit taking it because of financial reasons, but 6 months ago I got back on generic finasteride (1.25mg) and now have no perceptible body hair loss, maybe slight thinning on my back. How could I have such a different response this time? Should I assume that the generic finasteride is not working? (I got it from my local CVS pharmacy.) Thanks

I have heard on rare occasions that for some men that take Propecia (finasteride 1mg) their body hair thins out. This isn’t a usual side effect, though. I am not denying that you have noticed a relationship between Propecia and body hair loss, but that does not mean the drug is or isn’t working. If you are splitting the finasteride 5mg into quarter sections to make it 1.25mg, that is nearly equivalent to Propecia (finasteride 1mg), and there shouldn’t be a significant difference.

I have no way to explain the side effects (or lack thereof) that you’re seeing. The presence or absence of side effects do not indicate if the drug is effective.

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Why Did I Start Balding at Age 15?

Dear Dr. Rassman,
I am a twenty-seven year old man, and I began to lose my hair at age 15. I went to several doctors when I was younger but they all told me the hair loss was male pattern baldness and not the result of any health problem. I am already as bald as my father, who is thirty years older than me.
When someone begins to lose hair at the age I began to lose mine, will the baldness progress until all of my hair is gone? Will I ever be able to use a hair transplant system? And what the heck would cause my male pattern baldnes to start so early anyway?
Thanks.

Androgenic hair loss or male pattern hair loss starts as males enter puberty, as their testosterone levels increase, bringing on voice changes and pubic hair and other male sex characteristics. Although it is usuual to start the genetic process at 15, the DHT is clearly working on young men of that age. There is an issue of ‘gene expression’, which means that the trigger for the gene may have started early on you. Unfortunately, some men have the gene that causes male pattern hair loss to trigger earlier, while others do not see this until later in life. For example, Don Ameche, a popular old-time movie star in the 1930s and 40s known for his perfect hairline and good looks, started to bald after the age of 50 (late onset trigger for gene expression) and was almost completely bald when he was in his mid 70s (and starred in the movie Cocoon in 1985).


2006-04-12 08:56:24Why Did I Start Balding at Age 15?

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Why Did I Lose Hair After Bumping My Head?

I bumped the back of my head about two months ago. Since then I still have a bump and a bald spot the size of a band aid where the bump is. What could cause this?

You could have put that hair into its sleep phase and if that is the case, it will come back in 6 months from the time the injury occurred. If you cut the scalp, a scar could form that may not have hair in it. You should see a dermatologist if the bump is persistent, as 2 months seems awfully long for a mild head bump. Usually swelling will go away within days or even as long as a couple weeks… but months?

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Why Did I Create This Blog?

I was wondering why you are running this baldingblog.com site rather than participating in one or more of the many chat groups on the internet?

The chat groups have a scattered agenda. Many are using it as a magnet for doctor advertising, charging doctors a fee for participation and favoring those that participate. Some of these sites have a combination of content focused on hair loss and chat activities. These sites are frequented by many of the same people who dominate the chat agenda, so it is less focused upon subject content and more focused upon selling something. With the anonimity of the internet, you can not always be sure which of the posters are honestly trying to help and which are trying to line their own pockets. Some of these sites thrive on things that go wrong. In our practice, things rarely go wrong, so a site that focused on the exceptions rather than the rule, gives a false impression of the process to the new inquirer who wants to learn about the reality of today’s modern hair transplant process. I have always liked to have free forums where new people can get answers without intimidation or salesmen hawking their every move. In my office, I started having open house events and hotel seminars 13 years ago with patient participation long before a hair transplant recipient ever came ‘out of the closet’ where he hid his hair transplants. We never used a salesmen anywhere in our business model. In those days, the ‘standard of care’ was the pluggy graft, so showing off a patient without plugs made our seminars and open house events very successful. Those who came, expected to see pluggy patients and what they saw were normal looking people where the hair transplant could not be seen. At these events, I always held an open forum, allowing interruptions as the audience fell into the tempo of the subject material and conversations. It was the audience that ran the ‘show’ not me. The BaldingBlog.com site allows the type of freedom that I have in our seminars and it put the agenda into the hands of the questioner. I am more a responsive participant as a content expert. I have had many emails that I do not put on the BaldingBlog because I am frequently responding to a follow-up question that may not have a public interest.

I have in the past experimented with participating in these chats, but many of the aggressive participants love to go after a doctor who is not paying his ‘right of way’ for immunity in the for-profit sites. Some of the comments have been tasteless. Hearsay comments dominate. If I go down in the mud with those that are hair obsessed or angry, I generally get frustrated. Arguing with an irrational person is akin to a Jerry Springer milieu rather than an educational and informative framework. The worst part of anonymous free speech is that some of these chat groups don’t care if any statement can’t be proved to be true. One can say that Dr. X is a murderer, a heartless transplant mutilator, a mercenary who is driven by the almighty dollar, and if there is no recourse to identify the person who sends out such comments, then you can not necessarily believe anything you read. I have seen people say that they have personally seen patients of Dr. X …. Or that they are a patient of Dr. X and certifies to the crime personally. Defending oneself from baseless attacks are pointless and a wasteful use of time. I would doubt that any of this audience would want to read the JerrySpringerBaldingBlog.

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Why Did Dr. Rassman Become Interested in Hair Loss?

What inspired DR.Rassman to become interested in hair loss related issues and how to tackle them?

There are a lot of men who would consider you and all the other scientists regarding hair to be their knight’s in shining armor

Thank you. I am humbled. In all of the fields of medicine I have practiced — heart surgery, orthopedic surgery, gynecology, cancer, and vascular surgery — the field of hair is the happiest of all. The patients are helped, grateful, and at times their lives are transformed. I am an agent of that transformation and that makes me a very lucky doctor. In my former practices, I did it all and felt that I lacked the challenges of new things with the more traditional surgeries. The hair transplant industry was generally doing terrible work and I saw opportunity to change it, invent new technologies, push the envelope and create something that was never done before, so I began doing hair transplants to meet those personal needs after doing the appropriate research. If you look at my CV, you will see what I did and what I published in medical journals, radically changing the field.

90% of my practice is made up of male patients, and these men want their youthful look back. I carry out the steps to get them what they want. Men are delightful patients and the bonding I have with everyone is wonderful. For the 10% of women I work with, there is a special relationship, because most doctors don’t want to deal with their hair loss problems. It takes great patience and time to diagnose female hair loss and the time to educate them makes them happy for the experience with me. About 80% of the women I see are not surgical candidates, but I take the time to get to know each woman on a one-on-one basis.


2009-12-04 11:01:54Why Did Dr. Rassman Become Interested in Hair Loss?

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Why Did My Doctor Tell Me Not to Touch My Hair Grafts?

Your doctor is worried about the possibility of introducing an infection if you constantly touch your hair grafts. Some people constantly touch their grafts, even when their hands are dirty. This brings bacteria to the recipient area. In the first week, the grafts are sensitive to being exposed to bacteria which can cause folliculitis.


2018-09-14 09:18:00Why Did My Doctor Tell Me Not to Touch My Hair Grafts?

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Why Could I Be Losing Eyelashes?

I am 29 yr old female and I am losing some eyelashes on the middle part of my upper eyelid. Is it do to a lack of some kind of vitamin or could it be because I had an eyelash perm? But I was losing a couple before I had that done.What do you think?
Thanks for your time

Eyelash loss is often due to blepharitis, which is an inflammatory condition of the eyelids. Any mechanical manipulation may cause eyelash loss. It may happen with false eyelashes or eyelash perm. The other possible causes include hormonal problems, such as a thyroid problem (hypothyroid), and pulling eyelashes due to psychological conditions (trichotillomania). Your eyelash loss may be part of a condition called alopecia areata, which is an immunologic disorder that may cause patchy hair loss in different areas. I recommend that you see a dermatologist for this problem.


2006-11-20 09:39:32Why Could I Be Losing Eyelashes?

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Why Can’t You Name Those Unethical Physicians?

In response to Areas of Unethical Behavior Practiced Today:

“I ask you to consider your obligation under our oaths and our respective state medical board license agencies to report these doctors.”

Why not name the unethical physicians here then, so that would-be victims can be warned ? How else are patients supposed to find out, if not from web pages like this one ? I understand the fear of libel, but is that more important than the obligation under oath referred to above?

This isn’t the 1950s Hollywood blacklist and I can not go around identifying various surgeons without them bringing on legal actions against me. While you might think it is a noble thing to do, such actions could consume all of my finances and my time and I could live in the courts rather than do surgery. I have written to the Medical Board of California whenever I’ve identified a sleazy practice for California based physicians. The State of California is good at follow-through. If the sleazy doctor is located in another state, it may not be that simple. California will always create an investigation if they receive a complaint from either another doctor or a patient who has been wronged, but some of these sleazy doctors work outside of the United States and that produces even more problems for patients who have been victimized.

If you follow my instructions on how to pick a hair transplant surgeon, you can avoid the traps and not become a victim. You need to be an educated buyer in any medical treatment. Health care, like cosmetic surgery, is a buyer beware market!


2009-10-20 15:45:36Why Can’t You Name Those Unethical Physicians?

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Why can’t we clone hair?

Am I the only person questioning why there isn’t a big market for this? Scientists all around the world are cloning hearts, lungs, and other organs in a glass box without a body. Yet these scientists cant just clone your hair follicles and transplant them or something – and just “cure” baldness? Or is this once again just the trillion dollar hair corporations refusing to let this become a thing because they will lose millions on selling imaginary hairy growth products to the gullible masses?

Good questions. Cloning was done in the late 19802 when Jahoda cloned hair from he and his wife. They were only a few hairs and it has never been something can can be done commercially. In the 1990s, hair cloning was successfully done on mice, but the the hair which was cloned in a petri dish, when transplanted into mice, killed them because the hair grew wild in every direction causing massive infections. What most people don’t realize is that a hair is a complete organ system and each follicular unit, as an independent organ, has be be developed that it grows like a complete organ, in the correct position and direction. For this reason, most people have tried to work with stem cells to grow the organ from scratch, which would then have a direction and each stem cell might produce a hair organ (follicular unit). We have not gotten there despite now almost 30 years after the first hair was cloned.