Author: Dr. William Rassman

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Hair Loss InformationTransplanted Hairline at 3 Months (with Photos) – Hair Loss Information – Balding Blog

I am concerned about transplants in the front of my existing hairline. Will they be noticable if I lower my hairline 2/3rds of an inch?

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Here are some 3 month follow-up photos of a patient with dark hair. He had received about 700 grafts in front of an existing hairline. Since it is only a few months after the transplant, only some of the hair is growing and I expect much more to grow out in the subsequent months.

What is important to note is that the patient styles his hair forward so there is no way to tell that these little hairs are growing. Even if he did not do that, it was not clearly evident that these transplants are even there. The point is, it is easy to ‘hide’ transplants even in the front of the existing hairline, because these hairs grow from nothing (bald forehead) to something (fine hairs) very slowly. Most men are very sensitive to having their hair transplants seen by anyone, so I thought that these pictures would show a ‘worst case’ where the hair is growing directly from the forehead (its future home).




Please click the photos to enlarge.

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Hair Loss InformationHow Much Transplantable Hair Does A Person Have? – Hair Loss Information – Balding Blog

How many grafts can be transplanted in a person in his lifetime?

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Simple Answer: It depends.

From my personal experience at NHI with over 18,000 hair transplant surgeries from the various clinics I have managed, the most transplanted hair grafts on a single patient done under my care was about 10,000 (over several surgeries). There are many patients between 8,000-10,000 grafts. These are often the exceptional case in which the patient had a very high density donor hair supply. Most Norwood Class 7 patients are happy with about 5,000 to 7,000 grafts.

We are born with 100,000 (average) to 200,000 (exceptionally high) hairs. Of those, only the back and side part of your scalp is considered permanent hair if you have male pattern hair loss. If you roughly estimate the back part of your scalp to be 30% of your total scalp area, then you can argue that 30,000 to 60,000 hairs in the back part of your scalp can be considered permanent, leaving with about half (theoretically) able to be moved somehow. For a typical hair transplant to be undetectable (so that your donor area scar is not noticeable) I suspect you can safely get 8,000-10,000+ hair grafts over several hair transplant procedures provided that the donor supply can be maintained healthy and scarring is minimal and able to be controlled.

Some doctors love to push the numbers. The push to high numbers are for money (to the doctor as he charges per graft), his ego (he can say he has patients with high numbers putting him in the ‘mile high club’), or the agenda of his patient. Please be careful that you as a patient know what you are getting into and best be sure that your doctor has the experience by personally meeting some of those patients who have these numbers actually done successfully.

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Hair Loss InformationIf I Quit Smoking, Will My Hair Regrow? – Hair Loss Information – Balding Blog

While it is a reasonable hypothesis that smoking can cause hair loss, will giving up smoking lead to/assist in hair regrowth – or is the damage that has been done by smoking permanent? i.e is it reversible?
Thanks in advance.

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Generally it is believed that damage from smoking is additive. We know that about the lungs, heart disease, and emphysema. We also know that for those that stop smoking, the additive impact does slow or stop, but the smoking-induced coronary disease or emphysema does not go away. Now if you extend that logic to hair loss, then by stopping your smoking, you may stop whatever balding smoking is causing, but it would not reverse.

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At Age 19, Do I Need to Take Propecia Before a Transplant? – Hair Loss Information by Dr. William Rassman

hello im 19 from london, i want a hair transplant, but dont want telogen shock, i would like to have a hair transplant as soon as possible, but do i need to be taking a drug eg propecia to avoid it long before my operation or can i start just before, also would it be worth having the operation w/out drugs and hopeing telogen shock did not occur

At 19, I would be hesitant to have a hair transplant. You need to have your hair loss measured and should absolutely be on Propecia for a trial of at least a year. Have measurements for miniaturization taken prior to starting Propecia so that they could be compared after a year on the drug, and a good doctor can then determine if you have the hair loss under control. The last thing you should be considering at this time is a hair transplant. As I say all the time, Let the Buyer Beware. No one will protect you other than you. Look at my website and become familiar with what we do and the field of hair transplantation in general.

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No Results from Propecia After 6 Months – Hair Loss Information by Dr. William Rassman

i have been taking propecia for more than 6 months now and i didnt see any noticable results. they continue to fall. also the last month i begin taking minoxodil 2% in parallel with propecia. Moreover i drink some herbs which i was informed that they are dht blockers. why i do not see results yet? do i have to wait longer?

In some cases, people that take Propecia may have to wait up to a year to see the results, but my concern is over what results you are trying to find. That is why I always want to map out the scalp for miniaturization, so that what is happening can have numbers (metrics) put to it. If the miniaturization goes down, then the drug is working to reverse the process. If the miniaturization stays the same, then the drug is holding the loss off and things may not be getting worse. If the miniaturization goes up, then the drug is not holding your hair for you and you are losing more hair even though you are taking the best drug out there. In most people, Propecia will either stop or slow down the hair loss or improve hair growth and the diameter of each hair (miniaturized hairs have smaller diameters). According to Merck, Propecia is effective in over 90% of the population of young men with hair loss, but effective in what is the question. You may not actually see improved hair fullness, but that does not mean the medication is not working. In your case, Propecia may slow down or stop further hair loss, but not regrow hair in the bald areas. If you were to stop taking it, you may experience accelerated hair loss and lose all of the hair that had been saved by Propecia.

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Seborrheic Dermatitis and Artificial Hair – Hair Loss Information by Dr. William Rassman

I am female and have had seborrheic dermatitis for several years and have consistently scratched at it over several years causing gradual hair loss that I have recently noticed, which has led me to stop scratching despite the itching. Is it possible to regrow my hair after such an extended period of time? If not, I was wondering if you might know the cost of artificial hair surgeries, NOT hair transplants.

Scratching your hair can cause Traction Alopecia, which sounds like the diagnosis. Wait out a period of 6-12 months without scratching and see if it returns.

With regard to the artificial hair, the process has been banned in many countries (it is not FDA approved and is known to cause many problems). First, you would have to find a country that lets the product be used at all, then finding a doctor is the second problem, but worse is that many of the people who get artificial hair, get infections in the scalp so the cost must include the costs to control infection and replace the rejected hair (almost a daily process). I do not have information on costs, however.

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Transplanted Hair Fell Out After I Had Spinal Surgery – Hair Loss Information by Dr. William Rassman

I had a hair transplant 8 months ago to supplement the hair transplant I had 25 years earlier. This recent hair transplant was to soften the hairline and add fullness. After about 3-5 months the hairgrafts were successful and I was quite pleased with the result. However, in late January I had major surgery (spinal fusion with titanium implants). Since that time it appears that many of the recent grafts have fallen out revealing the crude hairline from my original hair transplant and less fullness than before spinal surgery. Is this a form of “shock loss”? If so, will these grafts recovery and grow hair?

It is highly unusual for transplanted hair (taken from the correct donor area) to fall out. In the few instances I have seen it, every time I have observiced ‘permanent hair’ falling out for some reason, the hair returned. This was never in response to another surgery (e.g spinal surgery), but rather usually a response to another hair transplant. If this is truely hair taken from the permanent zone, it will almost certainly return. What I said abobe applies to men’s permanent donor hair zone.

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Hair Loss InformationVery Unhappy With My Hair Surgeon, 4 Months Post – Hair Loss Information – Balding Blog

Hi Dr. R!! 4 months ago I had transplantation surgery with Dr. X [doctor’s name removed]. I have been unhappy with every aspect of the surgery (Hardly any filling of my front hairline) 1600 grafts “supposedly” and the negative responses to my many questions following up. What do you know about him? I am Very discouraged after 4 and a half months and many $$$…Thanks!

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Dr Jekyll and Mr HydeI won’t comment on the doctor, but I will say that after 4 1/2 months you will not see the results of your surgery. The first and final element of what Dr. X did for you will be in the results that you get as compared with your expectations at about the 8th month after surgery.

Clearly you have a problem with Dr. ‘X’, so possibly you did not do your homework. A caring physician should be a critical qualifier in choosing your doctor. By showing concern, it would mean that he/she would be making an attempt to establish good communication with you. By listening to you, reading your body language, and being available to you after he/she ‘got your money’, the doctor would be showing the essence of the man/woman. By not doing these things, the doctor would show the “Mr. Hyde” from the “Dr. Jekyll”. Any cosmetic surgery, particularly one that is not an ‘emergency surgery’, is a procedure where the choice of a doctor should reflect good market research on the patient’s part. Things everyone should look for:

  • A good office environment.
  • In the meeting with the doctor, does he engender your faith and trust?
  • Is a salesmen used to insulate him from his patients?
  • References from other patients, so that you can view the results of his art and craft.
  • History with the Better Business Bureau, record with the medical board of the state / country the doctor practices in (license clean of violation, probations, compaints).
  • Training and credentials.
  • Staff rapport with you, the patient.

Those are things that spell out a good decision in doctor selection. I have always believed that a good decision today is a good decision tomorrow. These types of decisions include the doctor choice.

Now with that said, I suspect that even if you get good results from this surgery (which can be seen 7-8 months after a hair transplant is done), Dr. X just did not make the grade for you.

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Hair Loss InformationPropecia’s Major Side Effects – Hair Loss Information – Balding Blog

Hi Dr., I am a 20 year old male who is goin bald and is considering a hair transplant. I was wondering what you recommened to maintain hair after a transplant, other than propecia because i have heard of major side effects. What is your opinion on rogaine and other topical treatments ?

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I often receive questions on finasteride (Propecia) from patients like you quoting “adverse” or “major” side effects. All drugs have side effects (even Tylenol), but when used correctly under the supervision of a qualified medical doctor it serves its purpose. I often find people are misinformed from the mass amounts of uncorroborated information available on the internet or just word of mouth. It is the source of folk legends and superstition. It is one of the reasons why these medications can only be prescribed by a medical doctor.

Propecia has been well studied for male pattern hair loss in men. The following is taken directly from the Healthcare Professional Information Label for Propecia (finasteride 1mg).

Drug related adverse experience for healthy men taking Propecia during a 12 month period:

  945 men on
Propecia		 934 men on
placebo (sugar pill)
Decreased Libido 1.8 1.3
Erectile Dysfunction 1.3 0.7
Ejaculation Disorder 1.2 0.7

Rough translation: 1 in 100 (1%) patients had some form of sexual dysfunction. “Resolution occurred in men who discontinued therapy with Propecia due to these side effects and in most of those who continued therapy”.

There have been incidence of breast enlargement or tenderness (gynecomastia) reported. This occurred in 1 in 200 (0.5%) patients taking Proscar which contains 5mg finasteride (5 times the dose of Propecia) in a 12 month period. There is probably less than a 1 in 300 chance of gynecomastia from Propecia (which is 1mg rather than 5mg finasteride). This is also reversible.

Please note inb my practice experience there is a 1 in 10 chance of INCREASED libido (some may call this an “adverse” or “major” side effect for married men). I experienced this when I started taking it myself.

I believe the take home message for anyone who is serously concerned about their hair loss is to be make an appointment with a medical doctor (primary care doctor, dermatologist, or a hair transplant doctor) to discuss possible medical causes and its treatment options.

With regard to your second question, some doctors recommend the use of Rogaine (minoxidil) with a hair transplant on the belief that it accelerates the hair growth. I have used it on patients (half of the head with minoxidil and have without anything) and there was no difference with the use of minoxidil. The beauty of the hair transplant process, with the robust donor hair from the back and sides, is that no matter what you do or do not do with additional medications, the transplanted hair grows.