Category: FUE

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Hair Loss InformationPimples After Surgery Caused Skin Change – Hair Loss Information – Balding Blog

Dear dr. Rassman. Thank you for having time to answer questions concerning hair loss.

I am a black man. I had an FUE operation about 6 months ago. The donor area at the back of my head healed very well, but in the receiving area I got small pimples almost in every grafts incision (1000 grafts) in the front area of my head which looks different from the rest of the smooth skin. The hair is growing but it is not that dense to cover this area. These pimples are well seen especially from certain angles or according to the light reflection. I am really worried about if these skin changes will be permanent. What shall I do? Do you have any advice for me???

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Pimples can be caused by sebum collections below the skin edge, but should have gone away within the first few months. FUE grafts should be trimmed, for if they are not trimmed and divided into their respective follicular unit, they will contain too much skin. The added skin will produce a skin deformity at the recipient site like the cobblestonning I talk much about in my published articles. The way light is reflected is an indication that too much skin may be have been left on the FUE graft or that the FUE graft was not separated into individual follicular units. Rarely, people with dark skin will tend to cause more scarring than those with very fair skin. Changes in the recipient area with a hair transplant do occur if you had atrophic skin (skin that lost much of the supportive infrastructure from blood vessels to glands, muscles and fat) or your hair is coarser, or if the surgical instrument used was large (by large I mean greater than 1mm, as a slit graft) or combinations of any of these factors. Today’s surgeons will use very small cutting instruments to minimize the skin wounds, hence the pitting or skin changes that could occur when the wounds are made too large. Skin deformities in the recipient area are rarely detected with small cutting instruments. Without seeing you directly, it would be hard to determine if any of these factors (or other factors) are playing a role here. I would expect that most people should not have this complaint, but just the other day I met a patient who had surgery from another medical practice with a similar complaint and I barely could see what was bothering him. This man had a body dysmorphic disorder. To determine your situation, either come in to my office (if you are in California) or at the least, send photos to the address on the Contact page.

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Coverage with FUE – Hair Loss Information – Balding Blog

I’ve heard that 20 to 40 fue per centimeter is recommended.Is this true? Does this give someone enough coverage? What do you recommend? I hope I asked the question correctly.

Thank You

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This is a good, but difficult question to answer. What you are really asking is: “What density of follicular units is enough to give you good coverage?” Whatever the harvesting mechanism used, (FUE or standard strip harvesting) the amount of density achieved reflects fullness as modified by hair and skin color, hair thickness of each hair shaft, and the character of the hair (curly or straight). The health of the scalp determines just how close you can place the grafts (for scalp that is atrophic and lost its infrastructure of blood vessels, glandular structures and fat less densities are often better).

The normal density of a person is 100 follicular units per square centimeter (200 hairs), so clearly the amount that is placed will depend upon what you buy, the size of the balding area, etc. For blonde people, low density is often able to look full, while in a black hair person with white skin, higher densities are often needed.

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FUE Yield – Hair Loss Information – Balding Blog

Happy New Year Dr. Rassman, thanks for your great work on this site and in real life. Baldingblog is not only informative, but it’s usually fun to read too.

My question is about your reference (in a previous blog answer) to the conference about FUE this past year. Who was the one doctor who you said showed good FUE yield?

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Thanks for your kind words. To be honest, I am not comfortable with identifying doctors that are better (by rumor) than others, unless I personally observe them myself over a few difficult cases. It can be easy to get close to 100% yield from an FUE in a “FOX positive” patient, but as I do not know the classification of the patients presented at the conference, I can not rate any doctor based on their yield unless they were classified on the FOX system that we defined. If I recommended one doctor who has 100% yield on a FOX 1 class patient and then if you went to him and were a FOX 5 class patient with a poor yield, then I would have done a disservice to you (see Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation for full details about the FOX test). Your best bet is to challenge the doctor by asking for his yield. If he does not want to address this or did not understand your question, then you should get out of there. I always classify my patients before doing the surgery.

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Size of FUE Procedure? – Hair Loss Information – Balding Blog

I have read the stories at your site and I think its a great idea to make this forum.

My question is: I am having a FUE transplant in 2 months, and have agreed to have 1500 grafts. How many grafts is it possible to move? Maybe it is an individual answer for each person. My situation is that i have had a strip transplant 7 years ago. It was okay but left me with the traditional scar in the back. I am not bald but my hair is thin from front to crown and now I will have a fill in with 1500 grafts if there are enough available, as my doctor says.

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FUE in the 1500 graft range is a big procedure. Follicular Unit Extraction (FUE) is a procedure you must be careful of when considering a hair transplant. A graft removed by FUE has a risk of being damaged when it is extracted. That damage can come from:

  1. grafts that have many transected hairs when they are taken out, producing fewer hairs removed
  2. grafts that are buried inside and left behind, which can cause infections and foreign body reactions
  3. grafts that lose the fat that surrounds them, making them vulnerable to fast drying or growth center damage which will impact graft survival and hair growth

More and more doctors are performing FUE, but few have the skills to do them with a very high hair (not graft) yield. For example, if you take out a 4 hair graft, but three hairs are transected and one comes out, does that reflect 100% success or 25% success? This is a very important focus for the individual who is purchasing FUE, as some doctors call such a graft as 100% successful because one hair came out, as it would have in a one hair graft. I would call it 25% success and a kill of 75% of valuable donor hair. Whatever doctor you are considering, please check this point out by asking for a direct answer to this.

At a meeting in the past year, a series of doctors demonstrated their skills in FUE and each had claimed expertise in the art, but alas, only one had good hair yields. This is no surprise to me, no surprise at all. Some doctors claim expertise with limited (or no) experience, and some claim experience without any audit of hair yield in place for each procedure. When I published the first paper ever published on this technique, a doctor who had built no significant presence in the field announced expertise within 60 days of my publication, announcing to the world that he invented the procedure. I remember him well, because he called me to ask me how to do the procedure and I gave him advice on some of the details he wanted to know. When I read about his self-declared expertise, I felt sorry for the patients who would fall into the “spider’s web”.

For more information about FUE, please see:

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Hair Loss InformationThe “Sean Connery” of Hair Restoration? – Hair Loss Information – Balding Blog

Hello, doctor. I do not mean any disrespect in my question, but I do believe it is an important one. I am considering surgical hair transplantation, and I’ve heard that you are one of the better surgeons in Los Angeles. My concern… my question is, how old are you? I ask this for two reasons. (1) Have you passed your surgical peak? (2) Will you be there in a couple of years when I may conisder another procedure?

Thank you. Again, no disrespect intended, but I am looking for a relationship with a physician who is not only qualified but who will be there when I need them.

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What crystal ball does anyone of us have? Do you know when you cross the street that you will make it to the other side and not get hit by a car?

I am 63 years young. I have performed surgery on a couple of billionaires this past year and a number of top celebrities, one head of state, many CEOs of large companies, four patients from the TV show Extreme Makeover, construction workers, a bus driver, a grandmother and a mother of 7 kids, and many others who asked similar questions. My health is good, my maternal grandmother lived to 114, my maternal grandfather died at work when he was 102, my father’s grandmother lived to 99, and many uncles and aunts lived into their 80-90s. Like Sean Connery, I like to think that I get better with age. Mr. Connery turned 75 a few months ago, so he’s got many years on me yet.

I received the hair restoration industry’s equivalent to the Acadamy Award for Best Actor, called the Golden Follicle Award in 2004 at age 62, published the FUE technique when I was 59, and am probably one of the few doctors world-wide who does it well today. The FUE technique has to be the most taxing surgery in hair restoration that there is. I wrote chapters in text books and published scientific and other papers in the past 18 months numbering about a half dozen. I can not run the marathon (nor could I when I was 23), bench press some 500 pounds (also not able to do it when I was 23), or sprint the 100 yard dash (no comment is needed here but for that I am clearly out of shape). However, I ski regularly, scuba yearly to depths of 100 feet, ride my bike about 16 miles a day when I am not over-working and can play the piano for hours (my fingers, at least, hold up well). I can work longer hours than any of my staff and can get along on 3 hours of sleep per night if I must. If you get a younger doctor, ask to see patients of his/her which were done this year. I can show off many of my patients (which we do monthly) at our open house events and have done it for 14 years consistently. I tend to take my responsibility seriously, and have often helped my patients through many personal health crisis that were unrelated to their hair transplant. One patient of mine stands out (age 44) when he discovered that he had John Ritter‘s vascular diagnosis (actor known best for his role in “Three’s Company”). Mr. Ritter died just a few days from his 55th birthday from a rupture of his ascending aortic, so I became involved in the diagnoses and open heart surgery decisions that saved my patient’s life from Ritter’s fate. There is no doubt that had this patient not had a hair transplant, his diagnosis would probably have not been made and as his cardiac surgeon told him, he probably would have died in a year or so. If you would like, I can ask this patient for a reference that would back up this claim.

When you get to my age, you appreciate people for their value, hopefully gain wisdom, and with wisdom should come temperament that allows an artist to perform finer work, perfect his art, and refine and hone judgments that generally take years to define (just like Sean Connery has done for acting). I believe that what I bring is judgment and wisdom to my patient’s problem and potential surgery, and provided that my vision holds out and my hands remain as steady as they have for the past 35 years of doing surgery (from war torn Vietnam, to orthopedic, vascular, and general surgery), I fully expect to be doing hair transplants for some time, at least, on a selective basis.

Come meet with me and judge for yourself:

  1. if you like me
  2. if you respect me
  3. if you trust me
  4. if you think that I will be around for the duration of your needs

Your call, of course. When and if you come, please refer to this blog answer as I would love to connect with you, see the smile on your face and understand your motivation for writing this question to me. At the least, I enjoyed writing this answer, and at the most, maybe we will have things in common. I have made many friends amongst my patients, including many who did not ask traditional questions when they met with me.

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Hair Loss InformationUsing FUE to Touch-Up Straight Hairline – Hair Loss Information – Balding Blog

Hi Dr. Rassman…
First of all, I want to thank you so much for creating balding blog, it gives us very valuable information from one of the top and best surgeon in the world. About five months ago, I had a 3000 graft transplant with Dr. XXXX in toronto to restore my hairline and part of my midscalp. growth is coming in good so far but I really dont like the hairline design. it is densly packed however the grafts follow and curve almost on a straight line letting everyone know its a transplant. I like the more jagged style where the hairline is kind distruped to give a more natural look like I have seen in some of NHI pictures. so I was wondering if you can probably FUE some areas on my hairline to give a more natural look, maybe 50-100 grafts depending on what you think is best just enough to distrupt the line pattern. Is there a minumum number of grafts needed for FUE procedures?? also is it okay to perform this procedure after six months of my initial transplant as I want to get this done ASAP. Thanks again Dr. Rassman

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The problem with straight lines is that they are too orderly, like Count Dracula’s appearance in the movies of the 1930’s. They accentuate a hairline when the hairline should be a zone of transition from a bald forehead to a thick head of hair. I fix these types of hairlines all of the time. Depending upon the color of your hair, it usually takes between 200-600 grafts in the frontal hairline to build a good transition zone. I wasn’t 100% sure by your email if you’d already had an FUE procedure or just wanted to use FUE for some “touch-up” work. If you have already had a strip procedure, it would be less expensive to do it with another strip procedure. An FUE procedure will work as well, but at twice the cost.

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Hair Loss InformationFUE for Wavy or Curly Hair – Hair Loss Information – Balding Blog

I don’t see too many people on the website with wavy or curly hair. I have wavy hair and I’m wondering about how well this type of hair responds to the FOX procedure. For instance, does it inhibit harvesting and when it is transplanted would it go along with the naturally wavy pattern of the hair that is there now or would the individual hairs wave in different directions?

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I have performed the FOX Procedure (Follicular Unit Extraction / FUE) on many wavy/curly hair patients with great success. After shaving the hair down to a short buzz cut, most hairs will stand straight and show their angle as they exist in the skin. I will harvest the hair to the exact angle where the hair grows in order to extract the follicle with high yield. Most of the African American patients will have spiral roots to the hair below the skin, while Caucasian, Hispanic, and Asians do not. The yield of viable hair from FOX/FUE will depend on the physician’s expertise/skills.

The way your hair grows out reflects both the angle the hair is put it in and the character of the hair itself. When grown out, other than density considerations, you should not be able to tell the transplanted hair from your original hair.

As for the patients in the NHI photo galleries, we only post patients that have signed a photo release. Some folks just do not wish to participate, and that is totally fine. Upon first glance, I can spot quite a few curly haired patients, including:

More information about FUE can be found at the links below:

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Hair Loss InformationAdvised To Not Take Propecia? – Hair Loss Information – Balding Blog

HI Doc,

Im a 20yr old male and have just noticed that my hair is thinning out and im losing it. My hairline has been reduced and in the middle and back ive lost a significant amount of hair too. I can see through my scalp now in many parts. Also, in the front you can see through my scalp and actually count the hairs that are in front! I look at my pictures from last year and even this summer and im seeing a huge difference! im really getting scared.

Im using rogaine now, started a week ago. I want to take propecia but been advised not to. i ve also looked in getting FUE or FUT! Please let me know what you think? And also do the hairs extacted from the donor area grwo back or not?

Thank you very much for this amaizng service!

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Propecia is only for male patients treating male pattern baldness and it is the ideal drug to prevent or possibly reverse your hair loss.

I would say that you are too young to consider any type of hair transplant. At the very least, you should try the medications and then develop a Master Plan for your future with a good doctor. You need to be evaluated for miniaturization. I am the physician who helped shape the Follicular Unit Extraction (FUE) procedure, which extracts 1 follicular unit at a time using special instruments leaving very minimal scarring. The hairs are moved from the donor area — so no, they can not grow back into the donor area.

More information can be found at the links below:

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Donor Scars from FUE – Hair Loss Information – Balding Blog

Dear Dr. Rassman,
I have had a FUE procedure from another doctor and have some white donor scars that you show on your website. If there anything that can be done to make this scarring less visible. (permanently and not a coverup). Thank you

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This is unfortunately the reality of FUE. Tattoos can be placed in each one, but do not tattoo the entire white area — just speckle it. Questions to ask:

  1. What size punches did your doctor use? They should have been 1mm or less.
  2. Did your doctor tell you that this was a natural outcome of the surgery? They are obligated to tell you this in the informed consent.
  3. Did you see patients who had an FUE prior to having one? We often show these patients in our monthly open house events at our Los Angeles and San Jose offices.

I personally don’t like surprises. Good reading, shopping, and solid research is needed for anything like FUE or hair transplants.

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Hair Loss InformationDeformed Hair Plugs – I Just Want to Be Bald – Hair Loss Information – Balding Blog

I have been mutilated by your hair transplant community and I am angry as hell about it. It has forced me to modify my life to address the deformities of my hair, so I do not and can not have a normal life. I have lived in hats and closets for years, and now I just want to go bald and look bald. How do I do that? I have scars on the back of my head that is wide and long (5 of them), holes in the back of my head from the first surgeon who drilled them out before the second surgeon cut them out, I have pits in my head in the front and top and my hair line looks like a Frankenstein movie part that am auditioning for.

I was told about FUE-extraction but I know that it will lead to more scars. Another doctor told me to do a second step would be to do a scar revision as well, but with than number of scars, I really can not imagine that this can be done. I want to shave my head every day and want my head to be smooth. I have very little money and that makes the problem worse.

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There are many things you could do to come out of the ‘closet’ that you are forced to live in. Technology and your decisions processes of ‘old’ (many years ago I suspect) meant that you made decisions at the time that were not wise in hindsight. You can and should get out of your situation and with today’s technology, you probably can.

I am sorry to say, but your plan may just get you in a worse situation than you have now. Scar revisions can be done but you will need to camouflage the new scars (which you will have) with longer hair. There are lots of tricks to make the scars better, like a trychophytic incision which allows hair to grow up from the scar from the edges, but no single solution short of FUE (at the proper time) can address the tendency for scars to widen. Dr. Nordstrom in Helsinki has developed a special suture to address these scars and he is a reputable surgeon, but you have many scars, so that this approach is not a good one unless you get it down to a single scar. Balloon expansion of your scalp, where you will look very bizarre for up to 3 months as your head is expanded to the size of a soccer ball, can deal with the multiple scars, reducing them into a single scar with reasonably assurance of success hopefully achieving only a single small scar is a reasonable approach for multiple scars in the donor area. With the pitting you describe, the scars and the progressive hair loss, adding dermabrasion will be a disaster producing still another set of problems, more than you need.

The key here is to establish reasonable goals with a good surgeon who has lots of experience dealing with people in your situation. I think that your goal should not be to shave your head or to restore you to a hairy man, but to restore you to a normal looking balding male without a freaky, man-made look. With a frame built to your face that is normal looking, and the plugs removed, camouflaged, and properly dealt with, you can achieve this goal. Trying to go bald with what you tell me you look like, will make the scars obvious. A hair system (wig) could be considered as well, though I generally recommend to stay away from those for a variety of reasons.

Be careful not to step off another cliff. You have a bad problem, but if you look at our war stories (see Dean’s Story link below), you might realize that others have been there and fixed that under my care. Get a good doctor first, bond with him/her and then develop a plan that you can afford and live with. Then stick to it.

For more repair information: