Author: Dr. William Rassman

Modern day hair restoration procedures usually provide very satisfying results when performed by reputable accredited hair transplant surgeons. Major skin related permanent side effects or severe health problems during and after a hair transplant procedure is becoming a rarity.

However, even the best surgeons out there will have some bad results due to unforeseen circumstances or, in rare cases, the surgeon or assisting technician having a bad day. Nevertheless, this risk is much smaller in countries such as the US where official accreditation is indicative of at least a minimum level of competency.

On the other hand, if you get a hair transplant abroad in order to save money, you will need be very careful in selecting your surgeon. You want to make sure the surgeon is accredited by the non-profit ISHRS, is locally board certified, has decent online reviews, and allows you to meet a few of his or her past patients.

Earlier today, this issue was brought forward front and center into my mind after Pakistan based actor Sajid Hasan posted a graphic video online about his botched hair transplant gone wrong. It seems like the person who did this procedure several weeks ago might have been a medical doctor or general surgeon, and not even an official hair transplant surgeon.

Besides having persistent health-related side effects, Mr. Hasan’s scalp currently looks like something that was worked upon by a butcher.

 

In the 27 years I have been doing hair transplants with as many a 7 doctors working for me, we have performed over 16,000 surgeries and never saw a case like Mr. Hasan’s. I have, however, seen many cases of necrosis which came to me after the hair transplants were done. I have, with associates, perform balloon expander surgeries on these patients to address the area of necrosis. If these areas of necrosis were not large, they often can be treated with wound care and then transplanted with proper techniques. Mr. Hasan does not have to live with this deformity.

Guess if you know this famous celebrity on the left. Our patient has a hair loss pattern similar to Prince William, Duke of Cambridge shown on the right above. They both had the same original pattern of balding but our patient did something about it.

He is actually is on a weekly Reality TV show and his hair is the result of an absolute commitment to getting the most hair he can and had it done over the last 13 years! He had 9985 grafts and is back again for a bit more which will bring him up to well over 10,000 grafts. He had agreed to speak on TV about his wonderful experience with us. So stay tuned.

Compare this post to the one from BaldingBlog on Monday March 30th 2015. It is like night and day. The patient above relished the experience, every part of it while the patient from 3/30/15 went through a kind of hell that no person deserves. I hear this often from the patients who had surgery in the days before we introduced the follicular unit transplants in 1993.

Another previous patient came in for a touch-up yesterday, Dr. Pak did the surgery of 1000 grafts and I met him in the lobby. I knew him, of course, but I wondered if he needed to be seen more quickly as I had just finished a consultation. IF he was in a rush, I would expedite the visit. He told me, much to my surprise, that he had surgery yesterday and I had no clue that he was one day our of surgery. I even looked closely at his head, and could not find the 1000 grafts that were placed between the thinning hairs on the front and top area. Both these men were present at the same time, got to know each other and laughed with each other about their experience with us. This is part of the pleasure of this business that I have every day i.e. the interpersonal relationships we build and maintain over time, often a lifetime.

Here are some considerations I’ve had before jumping into the HT route and wanted to share these with the community to get feedback and possibly provide some additional options for those in a similar position:

Background on me: 29M diffuse thinning throughout top of head. Finasteride/Minox for the last ~6 years that has slowed, but not stopped hair loss. When I first began noticing hair loss, I always considered a HT a possibility, but now my hair has progressed to where I think it may be appropriate to start considering it as an real option.

Everything you’ll read on the hairloss forums essentially boils down to the fact that getting a HT is a one way street. In almost all cases (especially if you are young) you will need a total of 2-4 surgeries. You will need to be financially and mentally ready for that. Even after that, you may not get the results you were really targeting.

The biggest hang-up for me, and undoubtedly for some of you, is that there’s not really any going back from the HT route. Regardless of if you go FUE or FUT, there will be scarring. If you get an unsatisfactory result, you will not be able to completely shave your head down without exposing those scars.

Here is the plan that I’m circling towards and may offer an avenue for some of you as well (I think this may be partiucularly suited for diffuse thinner like myself):

1. Go for an initial moderate-large size FUE procedure (2.5K-3.5 grafts). I’d really only go with this if you have the funds to go with a top surgeon

2. Enjoy your denser hair for 5-10 (hopefully!) years and then go for a second FUE procedure as age takes its toll and continues to take your native hair

3. At this point, in all honesty, you really won’t be able to shave your head with all the FUE scarring. If you still have areas that you’re not happy about, I think it’s wortwhile to look at SMP (maybe temporary at first) into both the FUE scars and in the transplanted recipient area. This helps boost the illusion of density even if you are out of available donor grafts.

I think having a plan for that 3rd step is crucial because there are so many results on here and the forums that end in regret and the person gets stuck because their result is sub-optimal AND they can no longer shave their head due to the scarring.

Hoping to discuss this plan with all you on here perhaps give me something else that I had not considered.

The Master Plan I always discuss with my patients is what happens now for the near and distant future. If hair transplants are in the future for you, you absolutely must know your donor density (a number) which will will deplete with each hair transplant. For FUE, the limit is half of the number as for a strip surgery and if you are not aware of this, then you could end up deformed as I often discuss on this site.

I suffer from MPB, which I’ve successfully been treating with RU58841 plus DHT-blocking shampoo+conditioner and obviously all the must-have daily supplements . My MPB has stopped, I shed zero hair, maybe 5 hairs every time I wash my hair. My hair’s very thick and dense. But my hair/hairline is still disgusting and I can’t style my hair the way I want to style it.In any way . The only difference between those photos and the current me is that my hair’s a bit longer now, hairline’s the same sadly and my eyebrows are now thick due to minoxidl on eyebrows.

A hair transplant clinic I’ve recently been to in person refused to give me a HT just for the temples, to fill them in, because apparently to them they wouldn’t be able to achieve the same density on the temples with the transplanted hair as my native hair so it’d look fake according to them. But I desperately want and need to not only reduce my forehead’s size which is absolutely disgusting to look at, but also to get my temples back. I’m still fucking ugly, and the first step to fix this problem would be to fix my forehead/hairline issue, I swear every time I look at my huge forehead and slick bald temples I feel throwing up on the spot.

So do I get a HT or a Forehead Reduction Surgery (aka hairline lowering surgery)?

In my opinion, young men should never get a hairline advancement surgery because young men don’t know where their hair is going to be lost. If the hair is lost behind where the advancement is, they are stuck with a surgical scar that will become progressively obvious. For many young women, hairline advancement surgeries work nicely because they don’t go on to recession of the hairline as young men do.

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.