Author: Dr. William Rassman

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If I Can Only Afford 1 Transplant Procedure, But I Might Need More?

Hello Doctor,

I am a hair loss sufferer, but my hair loss is more of a diffused type, with thinning across the scalp. I am considering hair transplant but would like to get your opinion before I make the decision since I am living in India and will be traveling to US for the transplant and want to make sure the trip is worthwhile.

I have been saving for a hair transplant for the last few years and at this point I can afford a little more than 2000 grafts. Do you think hair transplant is the right option for someone if they cannot afford any follow up procedures after the first transplant? Do you think I should keep saving for some more time so that I can get maximum amount of grafts in one go that can last me for a much longer period without having to go for a second surgery for a very long time?

All my calculations are based on $5 per hair graft that I got from your site for prior fixed appointments. Also is the $5 per graft inclusive of all charges or are there some overheads as well.

Thanks

MoneyAt NHI, our fees are fully inclusive without any additional charges. The $5/graft fee you mentioned is for Dr. Pak’s standby rate, so you’d need to be a little flexible with the scheduling. We do offer a travel discount, too.

Indians generally have lower hair densities than Caucasians by about 20%. Assuming that you take the pill finasteride and you are under 30 years old, the following may apply:

  1. Class 3 pattern — may work well with between 1300-1800 grafts, depending upon hair shaft bulk. Coarse hair is better than fine hair.
  2. Class 4A pattern — can be filled nicely with about 2000 grafts.
  3. Class 5, 6, and 7 patterns — you may not have enough hair to cover the crown.

Many men elect to have one surgery and be done with it, or have multiple surgeries over time. It’s up to you. I haven’t seen you, so keep that in mind. I’m not sure how many grafts you’d actually need or what your hair loss pattern even is. You should send me photos if you’re considering surgery and I’ll be able to hopefully tell you a little more.

Photo credit: Origami artist Won Park

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If I Have Little Hair Left at the Hairline, Would SMP Be Easy to Spot?

I have heard that scalp micro-pigmentation can look quite artificial if you have none or very little hair remaining on your frontal hairline. To what extent does it look artificial under the conditions I previously mentioned? Is it artificial to the point that anybody walking around with it can easily be spotted or is it more subtle (i.e you would really need to pay attention to the person)?

All of this is of course assuming that the head is either wet shaved or buzzed to a 0. I know it’s not perfect but with little existing hair remaining can micropigmentation still frame your frontal hair line in a somewhat natural and realistic way without catching the attention of every on-looker?

I don’t mind telling those I am close to but I wouldn’t want everybody looking at my head either. I’m 24 now, I still have a hairline but I will probably be totally bald (norwood 7) by the time I’m 30 or 35. I would just like to know and I don’t want to be pressured into doing it or anything like that.

If I understand your question correctly, you have lost much of the frontal edge of your hairline and want it put back with SMP. You seem to understand that if you have SMP done at the leading edge of the hairline where you lost the hair, that you must shave your entire head and keep it short. That’s the most important thing to know, and we call that the bold look on our website.

One should not be able to tell the SMP from normal hair, even close up, provided that the scalp is completely shaved. If you allow the surrounding hair to grow out too long, it will create an obvious change in depth that would make the areas with SMP look different. But if you keep it shaved, it will blend in just fine.

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If I Have Thinning In Certain Scalp Areas, Will They Eventually Go Fully Bald?

Hi doc,

If you have very early bulk reductions in a certain area of the scalp, does this necessarily mean that you will be bald in those areas, or can someone’s final pattern only reflect thinning in certain areas? I am a NW2-3 with very early bulk reductions on the top and crown of my head, does this mean I am destined to be at least a NW6?

We all have some genetic pattern, but not all balding men will develop advanced balding patterns. These patterns are often final, so a class 3 may remain a class 3 pattern for life. This is why I’d want to perform a bulk assessment of the hair on your head, everywhere on your scalp. If the bulk is reduced, that may point to the final pattern you will develop. Also, by making these measurements, we can follow the success or failure in the treatment of hair loss with drugs like finasteride (Propecia).

Stop worrying and get yourself evaluated. We are often more frightened by what might happen than what will happen.

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If I Don’t Use Conditioner After Shampooing, My Scalp Gets Red and Itchy

ConditionerMy hair is thinning and falling out. I’ve had a problem with acasional redness and serious flaking and itching. Only happens on my scalp. If I don’t condition after shampooing, it shows up that day. Otherwise, its alright.Could there be a fungus that is causing my hairloss? My family doesn’t have hairloss problem.

If hair conditioner works to prevent the problem, why don’t you just use conditioner? I would doubt it is a fungus if simply using a good conditioner corrects the problem, but you could go see your primary care physician if this is a concern. A dermatologist would be a good person to meet with, as well.

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If I Have Low Testosterone, Will That Make My Hair Loss Slow Down?

I have a question regarding hair loss and low testosterone. Over the past 4 years my hair has been slowly thinning and now it’s at a point where it’s noticeable. I know I’m going to be bald sooner than later. Anyways, I’ve also been dealing with severe depression, loss of libido, I work out but don’t really gain any muscle, etc. After reading some of the symptoms of low testosterone I think that this could be my problem.

So my question is: If you have lowered testosterone in your body will that cause you to lose hair slower? Lets say I do get diagnosed with low testosterone and receive treatment, will my hair start to fall out faster? Can lowered testosterone actually cause hair loss?

Any significant amount of testosterone could cause the gene for balding to express if you have it, and there is no level that you can control to reduce your balding. Testosterone levels don’t work as an accelerator pedal regarding the speed at which your hair loss progresses.


2011-08-05 11:34:11If I Have Low Testosterone, Will That Make My Hair Loss Slow Down?

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If I Lose Weight, Would My Hair Regrow?

Hi Doctor,

I was wondering if hair grows back if a person were to lose a significant amount of weight? Many sources on the Internet (I know not very reliable source of information) shows that losing weight may help regrow hair.

Currently, I am a male (29) at 300lbs and was wondering if I were to hit about 230lbs… would any hair come back?

Do levels of hormones balance out or is the body under less stress without all the weight?

Please Help

Good nutrition and medically supervised weight loss is the best way for you to control your risk of losing hair. Crash dieting can cause hair loss.

I do not believe that your hair will regrow when you lose weight and the stress that goes with it. Most male hair loss isn’t caused by stress, but by genetics, though stress could cause your genetics to kickstart the hair loss earlier than you would’ve otherwise had it begin.

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If I Have Increased Libido from Propecia, Does That Mean I’ll Lose Hair?

Drs

I have recently started a course of Propecia. Based on what I’ve read, I understand that the drug can, in rare cases, cause sexual side-effects, namely decreased libido, reduced ejaculate and even erectile dysfunction. I’ve found that it has had the reverse effects on me, that is, it has heightened my libido and increased my ejaculate, as well as the frequency with which I get erections.

Does that mean that the drug will, in my case, also have a reverse pathology on my hair loss (that is, make me lose more hair instead of arresting the hair loss process)?

Congrats! You are one of the few people with a good side effect appreciated by some men (but not all women married to those men). The results on saving your hair have no correlation with the sexual side effects of finasteride one way or the other.

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If I Have Another Strip Procedure, Will The Scar Be More Noticeable?

hello
16 months ago i had a hair transplant using the strip method which has left me a scar on the back of my head. if i was to have another transplant with the trichophytic closure procedure, would this problem of the scar not be so visible if i were to cut my hair shorter?

i would appreciate some advice just so i can be sorted out. kind regards

A second strip surgery in a person who had a sizable scar after the first surgery can produce an even larger scar the second time, but this is not always the case. There are times that a second surgery can reduce the scar from the first surgery. Considering the size of the scar, it might be excised and then closed with a trichophytic closure; however, the scar may return nevertheless.

One of the new and innovative ways to treat a hair transplant scar is with Scalp MicroPigmentation (SMP). See examples here.

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If I Never Saw Regrowth and Hair Loss Continued, Can I Stop Minoxidil?

How do you determine benefit from a treatment if there has never been regrowth and further loss? I’ve used 2% minoxidil once a day for many years with out regrowth and continued loss. I continued on the assumption the loss might have been worse without treatment. But that’s just a guess. How do I know if I’m just wasting time and money? Do you assume that after many years the hair is going to become minox dependent regardless what the seen results are and quiting is a bad idea?

This is the problem that many people have. If you stop the medication and nothing happens, then the medication was having no impact… but if you stop the medication and the existing miniaturized hairs were dependent upon the medication, then reactive hair loss from withdrawal will be the problem. Most of the time restarting the medication does not return you to same status as before you stopped the medication. It’s kind of a guess that you have to make.

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If I Lower My Hairline Now, I Won’t Have Enough Hair for the Top When It Balds

Hi Mr. Rassman,

A very worried man is writing to you. I am a Sikh and used to ties a turban for 8 years, but last year I decided to cut my hair. My hairline has receded considerably, and the hair on top is not thick, when light shines then alot of my scalp can be seen. However, there is too much hair on top for HT.

My worry is that if i lower my hairline, and dont have enough hair for the hair on top when its bald, then i will be left in a huge predicament.

You need a Master Plan for your hair loss. First I would need to know your age. Then I would want to know to what degree other men in your family have lost their hair. Next, I would want to determine your available donor hair supply so that I understand what you can depend upon for hair transplantation. I totally agree you need to balance the supply of donor hair with the worst case demand you might see from the balding. I would map out your head for miniaturization to determine where you are in the balding process and if you have your family pattern. Then, and only then, if you meet all of my requirements for a hair transplant candidate, I would plan out a ‘look’ with a hairline that will respect your long term ‘worst case’ scenario for hair loss. I generally like to put the hairline back where it belongs in a mature male hairline, but this does not include male Indians who have unusually youthful hairlines like what they had when they were 8 years old. Your concern of a hairline put too low for long term donor supply has not happened for me in all of the years I have been in this business and it should not happen to any competent doctor in the field either.


2006-12-12 14:06:03If I Lower My Hairline Now, I Won’t Have Enough Hair for the Top When It Balds