Author: Dr. William Rassman

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Taking Scabs off after transplant

I’ve been soaking and massaging twice a day per my doctor’s orders. I’m on day 5 now and quite a bit of scabbing has come off, but there’s still some left to go. I’m being gentle and no bleeding at all, so I’m just going to keep at it.

It is tricky to get scabs off at 5 days as the grafts get attached under the scabs so when the scabs come off, the grafts can be pulled out. The risk goes away at the 12th day. Read this article I wrote with Dr. Robert Bernstein: https://newhair.com/wp-content/uploads/2018/11/mp-2006-graft-anchoring.pdf


2021-10-03 09:38:48Taking Scabs off after transplant

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I had 4500 grafts last week. Was my donor area over-harvested (photo)?

Your donor area appears over-harvested especially because I see that the doctor went out of the permanent zone, into your neck hair which is not permanent and above the permanent zone on the right side. The area itself, looks like the density has been significantly depleted. Time will tell as you allow the donor hair to grow out.

donor area overharvested

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Needle size for microneedling

I started out 1.5mm, but now I’m concerned about scar tissue. I’ve heard 0.6mm might be better, but the redness goes away pretty fast. I started out doing once-a-week needling, but then I’ve seen people who did it twice a week at a lower depth followed by minoxidil that had great results

Microneedling depth should be able to reach the stem cells at the top of the hair follicles which lie about 1mm below the skin so 1 of 1.5 mm microneedles are about right. These stem cells have some cells that specialize in hair cycling so that when stimulated, the command goes out to the other stem cells to kick in the anagen cycle (theory at present).

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How a hair transplant changes a man’s life

Have your patients reported to you that their life improved was improved from getting a hair transplant (E.g. Confidence, more time etc)? I’m thinking about getting it done and I’m really worried about the first day travelling home.

Almost all of my hair transplant patient regret not doing it earlier. The average age for a hair transplant in my practice is mid-thirties. The older the man is, the more they regret not getting a hair transplant and living with balding. Almost 100% tell me hair transplants were a life changing process. I started doing large session transplants in 1991 with follicular units back then. I never did a ‘plug’ surgery

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Minoxidil plus finasteride 18 months (photos)

June 2021 vs. today (11.2.2022), 1.5 years on 1mg fin every day, Niz 3x per week, and 1 month on 2.5mg oral min every day.

Nice improvement. Stay on your routine and it will only get better. It may take another full year to see more value of what you are doing and it is even more likely that it will get better if you add weekly microneedling to your routine. If this is not enough and you are over 25, then a hair transplant will give you a normal hairline, something to consider.

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47 Year Old Female with Hairline Problem

I’m a 47 year old female. About 7 months ago, I noticed a thin spot on right side of my hairline, then a few months later, the left seemed thinner. It’s my underneath area, temple up to the sides of my widows peak. It seemed to be rapid because last summer I had full hair there. I’m so upset. I don’t know if it’s from my father or hormones. I have no prior hair loss. I don’t know when it will stop or if I need minoxidil. I’m taking stinging nettle and pumpkin seed oil. My thyroid seems ok but I have not checked my iron levels but because it resembles a bit of a male pattern. I wonder if it’s too much DHT. Please help.

Women are complex when it comes to hair loss as there are many causes that require an expert to evaluate. It takes many blood tests and a good examination by someone like me. As women get close to menopause, hair loss problems increase as estrogen levels in your body drop. Estrogen is the protector for good hair, so when menopause occurs, some women experience genetic hair loss. See an expert.


2018-10-10 12:18:4947 Year Old Female with Hairline Problem

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Is finasteride working?

I have been on finasteride but still encountering recession in my hairline in terms of miniaturization. But i noticed that my hair fall has actually decreased, so is the fin working or…? Was wondering am i really having Androgenetic alopecia

Yes, it is working but possibly not well on your hairline.

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48 Years Old With Shock Loss After Transplant

Dr Rassman
I recently had transplant surgery at a reputable office to combat thinning hair on top and a receding hair line. I am 48 years old. I was suprised by what I believe was a fair amount of shock loss around the graft areas given my age. I was not on propecia pre-surgery but began taking it a few days following the procedure after reading your column. Now I believe propecia can also cause shedding in the early months. Could you explain the difference between shedding and shock loss and what you believe I am experiencing. Maybe a combination of both.

Thank you

It sounds like you experienced shock loss and if this is in the miniaturized hair, the hair may not come back. Treating thinning with transplants is not something I do often. In many people with miniaturized hair, transplanting into that ‘unhealthy’ hair does little to really increase the fullness. I believe that for most people like you, any benefit you will get in the long term may be lost in the short term, making transplants a poor decision. I would think that Propecia should have been used in advance of your hair transplant procedure just to minimize this risk. The transplants done may offset the hair loss and the Propecia may bring some of the hair back. Only time will tell. Once the glass of milk falls and the milk spills out, it may be impossible to bring it back.


2006-05-19 08:58:1948 Years Old With Shock Loss After Transplant

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5 Months After My Transplant, Nothing Has Grown In and Now I’m Losing Hair All Over!

Hi Dr. Rassman,

I find your blog to be incredibly informative and helpful to those with concerns after their hair transplants. I decided to undergo a transplant exactly 5 months ago as preventative maintenance. 1,700 grafts to fill-in the thinning top portion of my head. I still have hair on my head, but under direct light you could visibly see through to my scalp. I followed my doctor’s instructions and had no major issues after the surgery.

At 5 months, the incision scar is still pink and I have occasional pimples on the top of my head (with what seems to be a noticeable increase in grease on my head). Also, after the surgery I had shock fallout. But it seems that ever since my surgery for the last five months my shedding has been consistently increased. Not just from the top of my head, but all over (sides and back). I have yet to see any growth from the grafts. But I have noticed white streaks in my hair. I have pitch black hair, and there are now random strips of white developing throughout my hair (I had never had white hair before the surgery). Is it possible that the shock of surgery would cause some of my hairs to begin to turn white?

And I’m also concerned at this point that my grafts will not grow in and that I will continue to get thinner and thinner since my fallout has increased. Thank you for your input and advice.

In my practice, we never recommend a hair transplant surgery for “preventive maintenance”, mainly because most patients would not likely see much of a result as they continue to bald and run the risk of being worse off. There is also a good possibility that the surgically induced hair loss might make it look worse, something we call “shock loss”.

If you are really losing hair on the sides, maybe something else is going on like diffuse unpatterned alopecia (DUPA). Shock loss doesn’t usually cause hair to fall out from the back and sides of the head. White hair does appear with stress on some people, but I really do not understand the cause. It sounds like you need a good doctor to talk with and be examined by. Perhaps the surgeon that did your transplant would be a place to start.

In general it takes about 6 to 8 months before you can see results and I tell my patients that most people can see 80% of the impact from a hair transplant in 8 months. You should notice growth beginning about now and see improvement in the next 3 months. If you are young and had the transplant without taking the drug finasteride, and assuming that your preventive hair transplants were not really needed, then you will most likely not have as much hair as you did before the transplant (based upon what you are saying here). Hopefully though, over the next 3 months you’ll see some gains.