Author: Dr. William Rassman

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Hair Transplant On Vertex Crown

I am a 26 year old male with vertex hair loss only. My hairline and frontal hair is very strong, yet my vertex is almost slick bald for a few years now. I was thinking about having a hair transplant, yet I am not sure whether I will lose my hair in the front or not.

I have been to a hair transplant surgeon and he was very surprised with my unusual pattern of loss and suggested that I get a hair transplant (I strictly do not want to use any medication).

I am left confused here. I do want to replace the hair that I lost in my crown, however I certainly do not want to have a weird loss pattern if I start losing frontal hair in the future. My question is, how long should I wait to find out my eventual hair loss pattern or should I cross my fingers and go forward with the process now? I know a diagnosis without a physical examination is impossible, but a second opinion cannot hurt I guess.

There seems to be a disconnect between you and your doctor. If he recommend surgery what is the problem? What is the “weird” hair loss pattern? Is your doctor a novice where he has never seen a person like you before? Maybe you need a second opinion from another doctor (in person). Some people do not fit into a classic Norwood balding pattern. Some people only bald on the top vertex area just as Dr. Rassman had (no frontal or top balding and only a bald crown). You definitely need a good diagnosis and a Master Plan of action. What we do in such a situation for someone of your age, is that we perform a bulk analysis of your hair in front and on top. then compare the hair bulk from the same sized area in back of your head (the permanent zone used for hair transplants). Most people your age, will show some decreased hair bulk in the frontal area and on the top of the head if they have any balding present elsewhere in their head.

A person with a balding crown may increase the size of the balding area as they age. If they have a hair transplant and they the crown balding area enlarges, you must transplant the wider balding area or you will be left with a hair ‘island’ in a larger balding area. The implications of transplanting the crown should be known to you, of just research it on the internet or our website (https://newhair.com/resources/assessing-hair-loss/), purchase our book ‘Hair Loss For Dummies’ which can be ordered through Amazon or our office, or visit one of our badlingblog editors if you are in Los Angeles, Koream or England.

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Hair Transplant Patients Under 30 Years Old?

Hello Dr.Rassman

Really informative website, love it. I just have a couple questions.

1. Just wanted to know how come there is a lack of hair transplant photos on the NHI website of patients 30 and under?
2. How many patients under the age of 30 that you have done surgeries on, either in the front or crown of the scalp, have to come back for more additional procedures to make it look thicker and fill in areas or because they are losing hair behind their transplanted hair?

Thank you kindly.

There are many photos on our NHI website, and I’m sure there are some younger patients in there. If there is a lack of these younger patients, it isn’t on purpose — we post the photos that our patients allow us to post, and many of the younger patients don’t wish to appear on our site.

Our average age for transplant patients is around 30 to 40s, but we have done surgery in men as young as 20 (who was a bald NW 6) to as old as 80. This becomes a one-on-one assessment comparing the risks of too early transplants with waiting too long. It’s not something that I can easily convey here in this post.

Men with frontal hairline loss often come to surgery earlier, because they are bothered by the man in the mirror. Younger men who are rapidly losing hair will likely benefit from finasteride (Propecia) over surgery in certain cases. It is not unusual for a young man under 30 with fine hair to have two procedures with us.

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Pain with a Hair Transplant

I don’t like pain so I have stayed away from hair transplants. If I take the plunge, how much will it really hurt?

Pain is relative. When I discuss pain, I always discuss safety at the same time, for it is not worth putting someone’s health at risk to wipe out pain. Some people handle pain better than others so there are no absolute rules here. Most people tell me that it is like having your dentist making an injection in your gums, but the pain comes in two flavors:

  1. The pain from the administration of the anesthesia itself (like what the dentist does to numb your gums and nerves)
  2. The post operative pain. There is no pain once the local anesthesia takes effect, most patients either fall asleep or just relax and watch a movie during the procedure.

If the hair transplant is performed completely under local anesthesia, the risks to your health are almost non-existent. You almost never hear of a person dying from filling a cavity in a dental office, but many die crossing the street. Laughing gas, prior to the local injections of Xylocaine, helps with reducing the pain from the injections but doesn’t eliminate it. In some cases, the doctor will administer stronger medications that will block even more pain and will allow the patient to more fully relax. The risks to health of being “put out” completely are slightly higher than putting up with subdued pain with laughing gas. The choice is made between you and the doctor. I have found varying reactions to the injection pain, from “no big deal” to the other extreme. The pain from the injection rarely lasts more than a minute. During the surgery we make sure that you are kept pain free, and the medications given last for about a four hour period after you leave the office.

If there is pain following the transplant, it occurs the first night. To deal with that pain, we do give you medications to take with you that will block the pain. These medications are strong and I recommend that they be used for night use only. A sleeping aid is also given for you to use. The use of simple over-the-counter pain medications will work during the daytime. Rarely are there many complaints of pain after the first night.

Getting hair is far less painful than the emotional pain of going bald- at least, that is what my patients tell me. I feel that pain is a non-issue since we have effective ways to deal with it, most of them pleasantly.

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A Hair Transplant Patient Ponders the Connection Between Finasteride and Post Finasteride Syndrome

I’m just also wondering why, when so many men took 5 times the dosage for BPH prior to it ever even being used for hair loss, that we didn’t hear about all of this sexually related morbidity- especially when you consider who was doing most of that initial prescribing: Urologists. I mean, these would have also been the first line guys to field those complaints.
Seems the one side effect they did hear about was the hair growth- which led to the realization DHT was involved in hair loss. And exactly – in addition- where are the actual studies?
“His point needs to be addressed. These original patients were mostly over 55 years of age, but at 5 times the dose one would expect more post finasteride syndrome, yet it was never reported other than the limited numbers when subtracted from the placebo effect as sexual side effects were reported in the original study of finasteride at about 2% and I am certain that men over 55, may have a lower sex drive to account for a lack of reporting I take finasteride at the 1mg dose and don’t have sexual side effects”. Dr. Tim Carmen
“I’m not convinced that side effects are dose dependent, at least comparing 1mg to 5 mg. Most of the discussions about reduced side effects using 0.5mg are anecdotal. I believe that the subgroup of men with side effects are somehow more sensitive, which may be unrelated to dosage. They also seem to be an age group under 35yrs. Also, Merck researchers knew that finasteride could potentially grow hair, but needed to get FDA approval first for BPH”. Dr. Ed Epstein


2019-02-20 08:40:12A Hair Transplant Patient Ponders the Connection Between Finasteride and Post Finasteride Syndrome

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How long do I have to wait before I can get hair transplant over a recently excised 0.6 cm pox scar in my cheek?

Wait at least six months before transplanting a pox scar so that everything is healed before going forward with a hair transplant into the cheek. For a POX scar, Scalp MicroPigmentation is similar and faster with the results and probably much less expensive, see below. The picture shows a thumb size scar which was not transplanted but covered with Scalp MicroPigmentation, much smaller than the POX scar to which you are referring.

https://scalpmicropigmentation.com/scar-covering/

https://scalpmicropigmentation.com/wp-content/uploads/2016/04/scalp_micropigmentation-new_hair_institute-147-scalp_scars.jpg

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Hair Transplant Patients That Keep Their Hair Cut Short?

Hey! I realize that the whole idea of a hair transplant is to make less hair look like more as there is only a limited donor supply. This seems to work great for those who grow their hair out but I have never seen a transplant patient keep their hair short. I know there are scars that need covering, but just out of curiosity, do you have any examples of shorter hair post transplant? I just can’t imagine it working with less than 50% density.

I generally do not recommend keeping the hair short (crew cut length) after a hair transplant because the hair transplant does not create enough density. For a hair transplant, we generally target about 15 to 25% of the original density. If the transplants is limited to a specific small area, that number will be increased to possibly 35% of the original density. A second or third procedure can bring the density up to ~50% (maybe), but although that density often looks good with longer hair, it does not look very full when cut short. Some of our patients have tried to cut their hair short, and all of them eventually let the hair grow out unless they had Scalp Micropigmentation to diminish the contrast between the dark hair and fair skin. We target fullness, not density. Fullness is a reflection of the (a) thickness of each hair shaft and (b) density. The thicker the hair (e.g Coarse hair) the less density is needed. Fine hair produces a real fullness issue in some patients. If the hair is fine and dark against a light skin, even a 50% density may not look full enough with longer hair. In conclusion, we generally recommend that our patient exploit length to maximize fullness and minimize the number of procedures that are needed to obtain the results that they desire. One must understand the limitation of a hair transplant surgery which is where you are basically rearranging your hair from one location (back of the head) to another location (front of the head). If you move too much, the original area will be bald.


2014-07-10 15:27:28Hair Transplant Patients That Keep Their Hair Cut Short?

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Hair Transplant Research

Dear Doctor,
I have been doing a lot of research on hair transplants. I got 2 questions

1) what would you say as the minimum age for transplant? I saw you mentioning most people under 22 as too young.

2) I have seen a lot of amateur transplants by doctors. Which is why I want to get it done by best doctors. What is the transplant policy for your institute. How do you overcome issues such as post transplant check ups after few months?

Cheers

Before you undergo a hair transplant, you need to have a clear idea as to what degree your balding pattern will eventually go. This is not easy to determine on anyone under 25 years old, so that is a rule. All rules can be broken, of course and the examination and the Master Plan you and your doctor will determine will define what, if anything, should be done with regard to hair transplants.

Hair transplants generally do not need follow-up after the actual procedure is done. Most people just grow their hair and I like to connect with the patient at about the 8th month. Using digital photography, it is easy these days to connect over the internet.

A good reference point can be found in my blog post from November, 2005 — The Truth About Cheap Hair Transplants.

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Hair Transplant Questions

I am 20 years old and very nervous about losing my hair. Since about my senior year in highschool ive seen the front of my hair line recide. This is a very stressfull and private thing for me so I only talk to my family members about it. When I ask if it looks like im going bald the answer is always no. But my hair line from my senior pictures to now has deffinately changed. Its seems to be going back on the sides, right above the eyebrow.(im sure you know what im talking about. So I do have a couple of questions.

  1. Am I to young to get a hair transplant?
  2. How much hair do I have to lose to actually be able to get one. Im always reading different sites and all kids my ages ask almost hte same questions but everyone always says wait till you go more bald… Well I dont want to wait, I want to prevent it before it starts. I dont want any sign of thining hair or a reciding hairline. Its like my petpeve.
  3. Do hair transplants look like real hair, or can you tell the difference? Ive seen about 2 people in person that got them done..and one person It was pathetic he had like 3 strands of hair growing out of one section. Then about a 1/4 inch space and then more hair. If I get a transplant I want it to look so real that even I cant tell it was doen.

Also I was reading a question that someone posted on your site. And I read an answer by some John Doe. He said that there were scars from his transplant. This is the first time that ive ever heard anyhting about scars. Can you tell me more about that?

You have many questions, all good ones, but not easy to answer without writing a book. I actually wrote a book, The Patient’s Guide to Hair Restoration, which you can get by clicking here. The entire book is available in PDF format, but you can also order a complimentary print copy complete with photos at the Request Additional Info page. Many of these questions will be answered by the book or even in the previous blog questions from other young men about your age. No matter what I tell you, you must have a visit with a competent, caring doctor. Although I have performed hair transplants on patients as young as 18 years old, it is not my usual case, but before I would do this, I would want to know what is happening to you. Make an appointment with a good doctor who specializes in hair loss treatments. Dr. Robert Bernstein in New York is such a doctor, if you can handle the 5 hour drive to visit him. He is at (201) 585-1115.

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Hair Transplant Question?

Is the transplant of single hair from the side of the head to the bald spots on top the current top solution?

You must be over 26 to have a hair transplant. The State of the Art is single follicular units, which are taken from the rim of hair around the side and back of your head which is permanent hair that does not get impacted by the balding genes. Each follicular unit contains (in a group of hairs) from 1-4 hairs each.

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Hair Transplant Rejection?

Hello doctor

Is is possible for transplanted grafts to be rejected months or years after a successful HT? If so how often and to what extent does that happen?

For men, the hair on the back of the scalp is considered permanent. It may thin a bit with aging, but even old men in their 80s, 90s, 100s will have hair at the back of their heads. So if you harvest the hairs from this permanent area, the transplanted hairs will act like the hairs on the back of the head and will have the same life span. This concept is called “donor dominance”. This is why hair transplants work for men. For women, it may be different and there is a small risk the transplanted hairs may not be as permanent as men.

Theoretically it is not possible for successfully transplanted hairs to be “rejected” years or months after it has grown, but I have seen a handful of patients over the last 20 years who have had transplanted hairs fall out. This may be due to a diagnosed condition such as DUPA (diffuse unpatterned alopecia) or other esoteric medical conditions.


2013-12-16 12:37:56Hair Transplant Rejection?