Author: Dr. William Rassman

Posted on

A Recent Visit to an Arizona Transplant Surgeon – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman.

Sorry if I’m bombarding you with a lot of questions recently.

I recently met with a hair restoration surgeon here in my city. Let me tell you quickly about how my meeting went, and my impressions:

  1. Uses FUT.
  2. Doesn’t use the Norwood scale. (uh-oh)
  3. Just ran hands on back of my head and said I had good healthy hair. (First red flag. Even I can do that.)
  4. Recommended 2500 grafts. (Second red flag.)
  5. Scalp mapping= Useless.
  6. Got me to speak with a consultant.
  7. Not much regard for developing a master plan. (Third and final red flag.)

In regards to recession, I’m a class 2. If all my thinning hair were to fall off, I’d be a class 3 or 3A. My grandfather on mother’s side was a 5/6. One uncle is a mild 3, other is a 5. My dad barely had a mature hairline. He died with lots of hair. No loss on any of my uncles on his side.

Taking all of this into consideration, I have decided to make a trip to California and meet you or one of your specialists. I don’t want to blow my money and my donor hair lowering my hairline to what it was four years ago, if 10 years down the road I’m going to have the top and crown all bare.

I’ll be calling you soon to see if I can send you some pics of my current condition. 2500 grafts seems excessive to me, after seeing what you do with only 1500-1800 on types 4 or 5. (Or your type 3 patient who only had 860 grafts and looks like a 17-year old now)

Please post this on your blog, Doctor, so others may be aware of the danger of making a bad decision based on impulse. Bad hair transplants, just as the good ones, will stay with you forever.

Thanks for your time, and hope to visit your office soon.

Norwood 2
Norwood 6

Mapping out your scalp for miniaturization is critical for someone like you. Based on what you’ve described, you may be a Class 2 on the Norwood pattern scale on your way to a thinning, more advanced pattern that will reflect long term hair loss (thinning in the Class 6 pattern, possibly leading to balding in that same pattern). The thinning pattern can often be treated with Propecia, preventing further balding and avoiding any hair transplants.

Please send me photographs and then we will talk prior to planning a trip to California to see me. Once I view the photos and talk to you, possibly coming to Los Angeles will get us to the bottom of your diagnosis and Master Plan.

Posted on

I Want To Use Leg Hair To Fill in A Small Scalp Scar – Hair Loss Information by Dr. William Rassman

(female) Hi, I just wanted to say that I really appreciate the feedback you gave me about filling in the small scar on my head. I do however have another question. Since the scar on my head is so small, and I really don’t want to damage any further follicles on my head, is it possible to extract a few hairs from my leg or the back of my leg, and use it to fill in the scar? Because the hair on my legs doesn’t really differ from the hair on my head. And if transplanted, would the hair grow the same length as the rest of the surrounding hair?

Leg LampLeg hair has longer sleep cycles (as does most body hair) than scalp hair and that means that most of the hair is in its sleep cycle and not showing its presence. If you transplant 10 leg hairs and watch them grow, only about 2-3 of them will be evident at any one time (the others are there, but in telogen phase). Body hair also grows at different rates and it may not grow to regular scalp hair length. Furthermore, leg hair does not have the same quality and caliber as your scalp hair. More importantly, even if leg hair transplantation works, are you willing to live with a surgical scar on your leg?

The traditional FUE procedure (on the scalp) is a better solution and the hair is exactly the same quality that exists around it. In addition, it has only a 10-20% sleep phase at any one time. Although your idea sounds interesting, it is not a worthwhile endeavor.

Please see Transplanting Chest, Leg, and Thigh Hair for more.

Balding Forum - Hair Loss Discussion

Paid advertisements (not an endorsement):


Posted on

Is My Son Too Young For Transplant at 19? – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

My son is 19 and has always had a lot of forehead. He seems to have been experiencing a receeding hair line, and I would like to know if he is to young to consider hair transplants? If not is there a concern about having a procedure, and then the hair line receeding even potentially leaving a bare spot between the hair that was transplanted and the natural hair line now receeded?

The problem with a 19 year old is that if genetic balding is the correct diagnosis, the pattern is not predictable. In a 26 year old it will probably be predictable based upon the miniaturization patterns that develop by 26. That addresses your question directly, because if he is transplanted, the new hair will be in front of what is lost in the near term future so that a bare spot will develop and could progress. Worse, the balding pattern could develop to be very advanced so that a very bald person may emerge with a transplanted frontal hairline. These is our worst case problem, better to avoid until all of the information is at hand. A good doctor should map out his hair from miniaturization and then with knowing what is actually happening (assuming he has genetic balding), prescribe the use of Propecia with yearly monitoring of the miniaturization process. This will let you know how well it is being managed. The same applies to the maturing hairline, which must be differentiated from genetic balding.

Posted on

Limit Sun Exposure For Months After Hair Transplant? – Hair Loss Information by Dr. William Rassman

I recently had a hair transplant completed (approximately 1,500 follicular units). My doctor advised me to limit exposure of the transplant area to the sun to 10 to 15 minutes per day for the first two months following the transplant (this is the same advice given to every patient). Is this precaution necessary?

Yes, it is necessary. There are two reasons to keep sun exposure down after a hair transplant:

  1. UV light damages new collagen
  2. Sun exposure will burn the skin from the recipient area. Skin that is in the donor area (back of the head) has always been covered by hair so that it has never seen sun since the day you were born unless you shaved your head through various periods in your life. People who get sun exposure after a hair transplant may see dots of sunburned skin, like measles.

I tell all of my patients to use a hat or use sunblock when going out into the sun for a period of 3 months. By that time the new tissues will be relatively healed so that damage from UV will not be particularly more harmful than in other skin areas.

Posted on

Masturbating, Ejaculation, and Hair Loss – Hair Loss Information by Dr. William Rassman

hey doc
this may seem weird but i heard that excessive ejaculation from masturbating can cause MPB due to the elevated testosterone levels in your body. Is this a myth or is it a fact?

The original source of this rumor goes back to early American culture. The old wives’ tale states that excessive masturbation causes hair loss or hair to grow on the palms of the offending hand. None of this is true of course. Hair loss in men comes about because of:

  1. The presence of an inherited genetic defect
  2. The presence of testosterone
  3. Time
  4. Stress

If masturbating is causing you stress, it will accelerate your hair loss if you are genetically predisposed. For most men, masturbating relieves stress so I suspect that this activity will help more than it will hurt you.

Balding Forum - Hair Loss Discussion

Paid advertisements (not an endorsement):


Posted on

No Growth 5 Months After My 2nd Transplant – Hair Loss Information by Dr. William Rassman

I am mid-way through my 5′th month after having had my 2′nd transplant. What is the longest time one has to wait to notice any growth as nothing has come through yet & I’m becoming concerned ?

I am worried that the 2′nd procedure hasn’t worked for some reason because after my 1’st transplant new sprouts of hair was apparent at the start of the 4′th month.

I had my 2′nd procedure literally 9-10 months after my 1’st.

I would appreciate any advice,

Thank-you

Many times, I have this complaint. I tell people that they must wait for a full 8 months to see 80-90% of the results from the transplant. Be patient and then write me again, sending pictures at the 8th month if you did not get the results in my then.

Posted on

Transplanting Grafts Into 1 Square Centimeter – Hair Loss Information by Dr. William Rassman

can you fit 100 grafts in a 1sq2 cm without damaging existing hair ?

Yes, the density or 100 grafts per square cm can be achieved in some people. Generally it would take fine hair and supple skin with good elasticity to do it. The issue of a successful transplant is a more important issue. By crowding the grafts at 100 per square cm, the blood supply may be compromised. Some very crude studies of this have been done and presented at the past few ISHRS meetings (the largest society in the industry), which have shown that as more than 40 grafts are put into a square cm, the successful growth of these grafts starts to fall off significantly. If there is hair already present in the transplanted recipient area, there is great likelihood that it would damage the existing hair as well as obtaining poor growth.

I have seen this issue become one where doctor’s ego is pushed at the expense of patient welfare. Just because a doctor says he can do this, does not mean that this type of density has value and will grow out. I did the first dense-packing ever reported at about 100 grafts per square cm in 1993, but the growth was less than that number, so I toned down these numbers and developed judgments that allowed me to know just how far I could push densities at the time of transplants. Everything is strategy and judgments in the field of surgey. So I smile when I hear doctors talk about the high densities that they can achieve, realizing that they may be less patient outcome focused, and more in love with their own image in the morning mirror.

Posted on

Recurrent Scalp Pimples – Hair Loss Information by Dr. William Rassman

(female) Every now and then I get bumps on my scalp that are tender, itchy. Awhile after I lightly scratch my head,some of the bumps have oozed and dried. I also notice my scalp is oilier than normal and I lose hair. Sometimes one of these bumps appear at my hairline and have a white head on it. What is this and what causes it?
Thank you.

Sounds like you get outbreaks of folliculitis for which you should see a good dermatologist to learn prevention techniques. Folliculitis reflects infections around the hair follicles, most often involving the sebaceous gland. The bacteria that cause these infections reside on the skin. Folliculitis can be caused by scratching of the skin, breaking the skin surface making it vulnerable to infection, or glands that are very oily with the openings of the hair follicle blocked with sebum. Good washing and hygene techniques usually work well to prevent the process.

Posted on

Swelled Lips from Propecia – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

I’m 22 years old and my hair line has been receding since i was 20. I know that male pattern baldness can skip a generation, but no one on my mother or father’s side of the family has any hair loss.

I started taking propecia. My sexual drive was waning and my lips were swelling up. How long do these side effects stay around for? And if these side effects don’t go away, what should I do to fight the hair loss.

Thanks.

I would worry about an allergic response to Propecia. Swelling of the lips could point to such a problem. I would assume that some doctor has prescribed the medication for you, so see that doctor and ask for more information from him/her. At 20, you need your hair mapped out for miniaturization to determine what you are treating with the drug, if you have genetic hair loss, and what benefits you may or may not be having with the drug.