Month: January 2023

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Hair Stands Straight Up After Transplant

I had a procedure of 3000 grafts placed in the front and now 8 months later, the hair that grew out stands straight up like toothpicks coming out perpendicular to the scalp. Can this be fixed?

The direction that hair grows after a transplant is determined by the transplant surgeon. Some doctors place the hair straight upward reaching for the sky like you reported, while others place them in a radial direction so that the hair looks like the spokes of a bicycle wheel. Some hair restoration procedures (like those of flaps), have hair that grows 90 degrees off pointing to the side. In all of these situations, the transplants or flaps permanently point the direction of the hair.

These are tricky repairs and most of the time the repairs are not able to correct the entire directional issue. I would advise setting up a consultation with me or a good hair transplant doctor in your area with lots of experience (I’m not sure where you’re located) to ascertain what, if anything, can be done to correct the problem.

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Hair Spray and Hair Loss

Can hairspray damage hair follicles and lead to hair loss?

If you brush or comb through your hair after the hair spray dries, you may pull out hair. In men and women with varying forms of alopecia, the use of hair sprays can be dangerous with rough combing of the hair. Best to wash it out rather than brush it out. Rough brushing can be a cause of hair loss made worse with hair sprays. Otherwise, hair spray by itself doesn’t equal hair loss.


2008-10-01 11:50:15Hair Spray and Hair Loss

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Hair Salesman

I went to a hair transplant facility the other day and had a consultation. Most of the time I was there was spent with a salesman. Is this usual? Do they generally get a commission of I sign up.

Your question is a good one. Unfortunately, many doctors in this field do use salesmen as communicators for their patient interactions. Although I have never done this, I do understand the huge costs involved in patient education and communication. The salesmen do perform that role well, but in the ending part of the question, you raised the most important issue, the one which defines whose interests are being weighed during the consultation process. The laws of all states generally forbid the payment of commissions to ‘communicators’, but I have no doubt that most salesmen have incentives to sell the hair transplant process. The doctor, on the other hand, is sworn by oath to put your needs ahead of his financial interests. There is clearly a conflict between selling you the transplant and watching out for your needs. You might judge the doctor by how much of his time you are worth.


2005-05-02 09:38:20Hair Salesman

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Hair Sales Questions

I loved the question about the salesman and the consultation [see: Hair Salesman]. I am a professional salesman selling high end cars, and I fully understand this issue. When one is selling a car or a service, the businessman asks: how many people does one have to go through to get a sale? Now with that said, How many prospective candidates do you go through to make a sale?

We call this conversion rates. Taking 100 people coming through, how many will sooner or later (within 2 years) make the decision to have a surgery. I have found that the number for my practice is between 33-40% and for other doctors working for me it is about 25-30%. My ‘conversions’ are higher because most of the people who come to see me know about my reputation in advance and often have made up their mind in advance of the visit. I am often the last doctor that they will visit. Still, my conversion numbers are low because I turn down most women (they often can not be helped), young men (who are too young and therefore too early in the process), people with unrealistic expectation, etc.. A salesman would view that the right conversion rate should be the majority of people coming through the door-whether they truly needed the surgery or not. When I had worked for another medical group who had employed a full time sales force, the conversation rates ranged between 50-95%! They would have fired me for my low conversion rate if I was one of their salesmen. That tells me that those doctors who employ salesmen, insulate themselves from the patient. These doctors build more a money focused practice than a people focused practice. My style is to use the medical forums and meeting, my website, the internet and activities like this BaldingBlog to communicate and educate, then have the prospective patient come to see me after they are informed. I have built a boutique practice where I have Hollywood stars and heads of state or CEOs of large companies as often as blue collar workers.

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Hair Restoration Society Credentialing

I read on a doctor’s resume that he is a member of the International Society of Follicular Unit Extraction Surgery. Can you shed light on the value of this society on the doctor’s resume?

In the past, to develop expertise that is unearned, a doctor would create a society and possibly become its only member. That could make him/her the founder of the society, president of it, director or it, or whatever he/she chooses to be. For the less than knowledgeable buyer, the name of the society implies, as is here, some international expertise, some special training and certification, some special recognition by peers in the industry (like an Academy Award Society). The International Society of Hair Restoration Surgery (with hundreds of member physicians) has looked at creative societies with disdain and so should the buyer. There is a suggestion of a ‘slight of hand’ when one invents expertise for themselves or a group of like physicians. As the inventor of the follicular unit extraction technology and the doctor who published the authoritative article in the field, I was never invited to join that society, speak before it, or review contributions by its members in the field. I would find that strange if it were a legitimate society.

Expertise should be earned. Inventiveness is something that should be published or proven. Put the doctor and his society to that test and you will see if it meets this criteria.

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Hair Regrowth vs Thickening

hello, I’m a little confused about what hair regrowth is and what hair thickening is. is regrowth when hair grows where it isn’t or is it when a small hair thickens?

Regrowth is when hair grows where it once was. It’s all a matter of semantics. One can thicken the appearance of a head of hair by increasing the number of hairs in the head (regrowing new hair), moving the hair around (transplant), using camouflage (pigments), or increasing the thickness of existing hair (products). This is done by:

  1. Reducing the degree of miniaturization with drugs like Propecia (finasteride) so that each miniaturized hair will become less fine and more coarse (closer to your normal hair in the donor area).
  2. Increasing the thickness of the individual hair shafts with thickening agents that are applied to the hair which cause them to take on more water, or coat the hairs with some product that makes them appear thicker (this is done by applying a product to the hair that will usually wash off when shampooed).
  3. Increasing the thickness of an area can be done through hair transplantation. This is a relatively permanent solution until you lose more hair (it’s progressive).
  4. By playing with color, someone can bring their hair color closer to their scalp color with chemical dyes or the use of scalp micropigmentation (a medical tattoo). The use of agents such as Toppik (adds fibers to the hair and scalp) or DermMatch (a crayon type application to bring color to the scalp.

So you see, there are many ways to get a fuller look that may not be the results of a full head of hair, but if it fools the eye, then many people will be satisfied using these approaches.

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Hair Regrowth Cycles

Dear Dr. Rassman,

I am a 43 year old lady with increased hairloss usually between 150-200 hairs a day at the moment.

3 years ago I had two lots of traumas which caused my initial hairloss. After eventually seeing a trichologist and starting estradex lotion (containing minidoxil and phyto hormones)my hairloss reduced this took 3-4 months to see benefit. Initial the estradex made more hair come out which trichologist said normal as the estradex gets rid of the bad hair making room for better quality hair. I was also put on a antidepressant dotheipin 75mg. 12 months ago I stopped estradex, hairloss returned, not that it totally stopped but hair did look thicker. I have started back on estradex about 3 months on side of head but the partening looking slighlty wider on one side so started using estradex along this area for last 6 weeks. Still taking dothiepin 50mg – 75 mg alt days. I have recently started vitamins saw palmetto and pygeum and stinging nettle root. Sure my telogen as increased within a day of taking this vitamin could it be related. Taking high doses off this up to 2000mg. Or do you think its the estradex getting into my system (which contains 5% minidoxil)?

When I woke up yesterday, the birds were chirping and the air was crisp and I had a great day. Today when I woke up the dog was barking and the air was smoggy and I had a bad day. Do you think I had a good day because the birds where chirping or the air was crisp? Do you think I had a bad day because the dog was barking and the air was smoggy?

Your guess is as good as mine.

There’s too many variables and no direct proven relationships in the information you provided. It is normal to lose 100+ hairs a day. For most normal people, the regrowing hair will start at about the same time as the hair is lost so that the total hair count of hairs growing on the head stays constant. If you do the math, 100 hairs lost per day is about 109,500 hairs in three years (36,500/year) and that is the normal adult hair population. The hair cycling we have discussed before on this web site, is responsible for the fall out and the regrowth that is every person’s normal. The average growth cycle is 3 years for most people, so that means that in three years, most people replace 100% of the hairs on the head with new hair, one day at a time.


2006-08-18 09:34:13Hair Regrowth Cycles

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Hair Regrowth After Waxing Scalp

I recently had a minor accident with hair removal wax. Well to make a long story short, it ended up in my hair on my scalp. It has been five weeks and the regrowth has been pretty sparse and not at all in some areas. I was wondering what the chances are that it will still grow back, and if not what I can do about it. thanks

Wax only removes the hair shaft, not the entire root. Thus, your hair should grow back. It may take up to a few months for hair regrowth unless there is more to the story which I am not understanding.

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Hair Regrowth After Waxing Scalp, Part 2

Hi i recently sent you a question about waxing. [see Hair Regrowth After Waxing Scalp]

For some reason the waxed area appears worse. I am worried that I may have developed folliculitis on my scalp as a result. My entire scalp itches. It would be helpful if you could give me some information about folliculitis as well as the differences if any between folliculitis and folliculitis decalvans. Also it would be helpful if you could tell me what to do to contain the hair loss to only the waxed area basically prevent it from spreading.

Folliculitis is a condition where the hair follicles get infected because of bacterial invasion, often secondary to some irritation or wound of the skin. Folliculitis can spread from one hair follicle to another by touching or scratching it, making it worse. It is a fairly common condition.

Folliculitis Decalvans is a rare condition affecting mainly the scalp leading to scarring alopecia. The cause of the condition is still unknown, abnormal host response to Staphylococcus aureus (a bacterial infection) has been postulated. Folliculitis Decalvans causes scarring with hair loss (alopecia). There are areas of “corn stalking” (grouped hairs arising within the area of alopecia), redness (erythema), crusting, and pustules. Due to severe scarring, permanent hair loss occurs in the involved sites.

As you may be aware, this is a diagnosis not for the amateur. Get a good dermatologist to take care of you, starting off with a proper diagnosis. Appropriate antibiotics will be recommended by the doctor, if indicated.

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Hair Raiser

I was just wondering if you had any information on Billy Jealousy’s new product, Hair Raiser. It claims to regrow lost hair and recently won an FHM grooming award.

It is said to contain Methyl nicotinate and 2 DHT blockers (Swertia and Licorice Extract). Their website says “Hair Raiser takes about 4 months of every day use to experience the beginning growth of terminal hair. Regrowth will not be experienced if hair follicle has been dead for more than 10 years. Hair Raiser was created by world renowned bio-chemist C. Sanders.“

I am not familiar C. Sanders, the bio-chemist — but I am familiar with Colonel Sanders, the purveyor of original recipe and extra crispy fried chicken. Kidding aside, if you have been following this blog, it has always been stressed that it is a “buyer beware” market. Anyone can claim effects of a cream/lotion/potion. What strikes me is that there is a 1989 U.S. Supreme Court decision preventing these products being advertised or sold in the U.S., yet these types of claims are made and products are sold every day. There are only 2 FDA approved medications to treat male pattern baldness: (1) topical minoxidil (such as Rogaine) and (2) oral finasteride (Propecia). Since Propecia is still protected under patent, I suspect this Hair Raiser product contains Minoxidil as one of the ingredients, if it actually does do anything for your lost hair.

More information on this product can probably be found at the official site, BillyJealousy.com.


2006-03-10 12:22:19Hair Raiser