Category: Hair Transplantation

thanx for the informative blog. i have a question, despite of such enormity of hair loss problem , why the hair transplantation is not so common.

It takes time for people to accept a new breakthrough in surgery. If you look at female breast augmentation, it took more than a decade for women to feel comfortable enough with it to step up and undergo the surgery. Most people think that hair transplants can always be seen and when they run into a person with plugs coming our of the scalp, they get the idea that this is a hair transplant and say to themselves, “This will never be me!” Today’s hair transplant can not be detected, so the good work done regularly is not something that the average person can detect unless you can remember what someone looked like before they got the hair transplant. A woman with an “A” breast size can be detected when she gets breast augmentation and one day comes out with a “C” or “D” size showing good cleavage. Only a bald man who now has hair, can be detected much like the woman with the newly larger breasts.

I was curious, if drugs like propecia only slow mpb and genes usually overcome them after time and you get hair transplants, what do you do later on when the drugs looses it’s effect and you loose hair in the non transplanted areas, and by chance you don’t have the donor hair to compensate. Thank you for your time.

Great question! The treatment of male pattern baldness with drugs and possible transplants requires a good Master Plan with your doctor. The Master Plan will balance the eventual worst case scenario for your balding pattern (only 7% of men go all the way to a Norwood Class 7 pattern — see illustration at right), the donor supply, and the reconstruction. For example, a person who has a Class 3A balding pattern at 35 years old, has a worst case scenario of a Class 5A pattern, but probably wont get there if he is treated with Propecia (finasteride 1mg) and is a good responder. I find that I can restore almost all Class 5A patterns with reasonable hair density, good laxity and average or better than average hair weight. When you discuss your balding problem with your doctor, this should become the central focus on your consultation.

Like you suggest, going into transplants blindly could not work in your favor if your hair loss pattern eventually works to a Class 7 pattern. With that said, people who may evolve into a Class 7 pattern could accept coverage in the front and top, leaving the crown out of the reconstruction if their pattern goes too far. A frontal reconstruction with a Class 7 pattern looks great in the mirror and is a reasonable option for the worst of the balding patients.

Good day Dr. Rassman,
First, I want to thank you for having this blog. I find it very useful; I visit this blog regularly.

My question: From some of your previous answers, it seems that you are not a proponent of body hair transplants, and you have given good reasons why. However, if it would be all right, may I ask your opinion of some of the latest works, with body hair transplants?

I am familiar with the body transplants that are being done. I am softening my position on them in very special situations. I met a man yesterday who does not have enough donor hair for the crown, but has gorilla hair on his back. He is aware of the limitation in telogen hairs and nevertheless wants to have his back hair moved to the crown. He is realistic and reasonable and I will therefore do this for him. So you see, I am open minded on the subject and as always, will do what my patient needs if the requests are reasonable.

Hi,

You recently said that you shouldn’t transplant into an area in preparation for future loss. However quite a few before and after photo’s I see on your website, have patients with some degree of hair already on the area to be transplanted, i.e: not totally bald. DO you have to wait until the area is completely free of hair? How do you know how much hair will be lost as many people I see that are balding have lost say 75% density of their hair in the classic MPB area’s even when they are older, and it is likely no more will be lost. Is there a way to tell from your miniturisation tests what approximate percentage of density will be lost from certain areas or is it a case of time will tell?

I am 25 and have been on Propecia for around 13 months with pretty average results in the frontal third, but the back two thirds of my head seem to be thinning much slower. As far as I can tell I am eventually heading towards a Va. Although I am at an early stage. The frontal third of my hair is thinning much faster and I would say is down to about 40% original density.

Assuming I came into you and got a miniturisation done and you said I had approx 7000 grafts that could be taken, and I was a suitable candidate etc, could you place say 1500/2000 grafts in the frontal third and leave the rest till the future, even if the frontal third still had around 25-30% original density? (I would wait for another year or two and it was more noticable) I would be happy to have a thicker front third and a thinner back and use dermatch to cover that up.

Thanks, I know it’s vague but am just unsure about how long you have to wait and to what degree of density loss you have to wait before you can get a transplant!

Best regards

It seem that you’re basically asking me to give you a consultation and recommendation without seeing you. Everybody is different! I do not wait until someone goes bald to transplant them, but that means that I must be able to understand the patient well, measure the quality and the quantity of the hair in the donor area, estimate where the hair loss is going, etc.

Some patients are not happy with mild thinning and recession and decide to have a hair transplant. Some patients accept some thinning and stay with Propecia (finasteride 1mg) and never have hair transplants. You don’t have to be bald to have a hair transplant, as you can tell from the hundreds of before and after pictures on our website — Patient Photo Galleries.

So without knowing much about your particular needs, the answers are eluding me.

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