Author: Dr. William Rassman

So if tissue levels remain for 6 days, would topical application every 4/5 days be theoretically still somewhat effective?

Some amount of finasteride stays in the tissues for more than two weeks after stopping the pill. Daily dosing is the ideal way to build appropriate tissue levels.

My practice has been 100% hair transplants since 1991 (27 years). That is all we do. I built a highly specialized team of people who I have personally trained. Many have been with me for years and once they are there, they don’t leave because the environment is great, the wages are good, the results are great and the patients appreciate everyone who worked on them. Since I only do hair transplants, I never get distracted by patients that come in for other reasons. My staff have been practicing and improving their skills every working day for years. We have no salesmen working for us and we do all of the consultations ourselves, one-on-one with each patient and give about an hour of our time which is free to the patient. Most of our patients do their research before coming to see us, so that they know who we are and why we are so highly rated. I have published almost every advance in the field over the past 27 years, from Follicular Unit Transplants, the Megasession, the FUE and we even invented the hair transplant robot with two patents issued to us and we licensed it to the company that built the ARTAS robot. We hold Open House events every month where you can meet our patients, one-on-one, see a surgery and get a free consultation with the doctor. I have been doing this for 27 years because I am proud of our patients and our work. Doctors who don’t do this full time can’t have the experience we do. We have performed over 16,000 hair transplant procedures since 1991 and the first FUE patients in the world was presented to the world through publications in peer reviewed journals. So, check us out on Realself and Yelp, but better than that, come to one of our Open House events so you can meet and see many patients who are examples of our work.

I just started taking Propecia and debated it for years. I started to feel the brain fog / dizziness after day one but I’m going to continue taking it to see if I stabilize if the symptom is just in my head from all these horror story posts I’ve read. I’ll update to let you know if it goes away over time. Although I am on birth control pills and have already messed with my hormones, would finasteride still be safe for me in treating my hair loss?

If you are a woman young enough to have children (even if you are on birth control pills), you should not use finasteride (Propecia) as if you were to get pregnant because the birth control pills failed you, you could have a child with sexual developmental problem while you carry the baby. This is not the case for men who father children who take finasteride. If for any reason you could not have children (example had a hysterectomy), the this drug is not risky for women.

People say that Finasteride loses its effectiveness. Is this actually true, since DHT levels are similar till 40? I don’t see the logic of why it would lose its effectiveness.

Studies comparing two groups (1) people who stay on finasteride vs (2) those that do not take it or stop it show that those on finasateride keep hair counts higher for longer. Some further studies by others seem to show that the spread between the two groups continue past 5 years and from my clinical experience I have seen it extend to 20 years. For those that take it and stop it, they shift to the lower curve fairly fast (3+ months) which I have also seen in my practice.

To determine if you are a good candidate for hair restoration, you need to know the following and put it all together (1) donor density, (2) degree of balding (you are advanced), (3) the thickness of your hair shafts (fine, medium or coarse, (4) the color of your hair compared to your skin (you have a high contrast between your brown hair and light skin which is not great) and (5) the degree of waviness of your hair (the more wavy, the better. If your donor density is low, the you might not have enough hair to cover the entire balding area and if you should continue to bald further, you may run out of donor hair before finishing. All of the hair in the center of your head is probably miniaturized and will sooner or later fall out. At 35, your hair loss should be slower. With all of this put together, your doctor can build a Master Plan for your hair restoration to account for not only the central hair that will almost certainly be lost, but the sides which may work their way down further than they are now.

The best thing you can do is to get a HAIRCHECK test of your scalp which will document all of the hair loss that you can’t see. With this test, you can establish a metric which will allow you to make decisions, such as the use of medications if you are indeed balding. If you start taking medications, you can track your results over a year when you repeat the HAIRCHECK test again.

See here for a good example of this process with photos: https://baldingblog.com/2017/01/10/value-haircheck-bulk-measurements-two-patients-seen-today/

Most likely about to start meds; would appreciate advice from tressless

Hi there, my question is as above. I have been lurking/debating a transplant for a few years now. I am getting back into researching who is out there now as this year I have more of the means to acquire one. In your opinion who would be among the best for FUE in North America currently? I remember Rahal for example being a big name a few years ago but unsure now. Thanks!

I’ve been trying to get some sort of idea of about how much a hair transplant would cost to just fill in my temples. I’ve been on finasteride and minoxidil for over a year now with great results, but my temples are still thinner than i would like.

Anyone able to give a rough estimate of what the cost might be just to fill in thin temples? I think 500 grafts would be the absolute most I would need. And yes I am in the process of setting up a consultation but I would like to have an idea beforehand.

Hair transplant pricing is all over the place; however, think about what you are actually buying. If you needed a heart transplant or brain surgery, would you try to find the least expensive place to do it? I have seen many men find a cheap hair transplant and then, when either it failed or the doctor who performed it, didn’t bother to build a Master Plan for your future and then you find out that you lost a significant amount of your donor supply that is limited, the fee becomes ridiculously high regardless of how little that you think you paid for it. I have seen many hair transplant result where the doctor ruined the donor area or did it too soon just to get your money. Make sure that the doctor is reputable and if he employs a salesmen, don’t trust the consultation or possibly even the surgery. Try to find dirt on the doctor from Yelp, Realself, and Reddit. There are many potholes in selecting a doctor so don’t fall into one.

Here is a review sent into Realself for me this morning about the consultation I gave him yesterday and that I told him not to do a hair transplant, which is why he came in to see me:

As the years have gone by, I have started to notice some thinning up top. After doing some research, I decided to setup a hair loss consultation with Dr. Rassman.

I chose to setup my appointment via an online form, and was surprised when I received a phone call from Dr. Rassman himself within 15 minutes! Turns out, he happened to see my consultation request while relaxing on his deck, and decided to give me a call! He was very friendly and personable on the phone, which made me feel better about my upcoming in-person consultation.

I arrived on the day of my consultation and was seen very promptly. Dr. Rassman was as friendly and jovial in-person as he was on the phone. He did a quick visual examination, and then performed an inspection using a device called the Haircheck. This devices takes measurement of hair density per square inch at different sites on the scalp, using the back of the head as a baseline to compare with other locations on the scalp. I had never seen this type of device used before, and I was impressed by Dr. Rassman’s objective and data-based approach to evaluating hair loss.

After the Haircheck inspection, he informed me that there was some thinning, but not enough to recommend a hair transplant. He then gave me a thorough description of my options and talked through the potential side effects, while interjecting some lighthearted humor, which made me feel at ease. He was very knowledgeable, and was up to date on the latest research. In addition, he answered all of my questions and promised to email me additional info. I was surprised and delighted to find that Dr. Rassman followed-through on his promise quickly, emailing the additional info in about an hour.

I suspect that many other surgeons would have simply taken my money and performed a hair transplant, but I respect Dr. Rassman for his candor and honesty in recommending against a hair transplant. If you are thinking about seeing someone about your hair loss, I would definitely recommend seeing Dr. Rassman for a consultation!