Hello Dr Rassman
Is FUE able to harvest in regions that were considered unaccessible with strips? I think about the temple areas and also the region called the “pigtail”, which in my case seems very dense.Thanks
Yes, harvesting the areas you are talking about can work. It is very difficult to do and the yield will probably be less, because hair densities tend to drop on the sides of the head.
This Norwood Class 3A patient came in for a check-up 10 days after his hair transplant procedure of 2,000 grafts. The scabs are gone and the recipient area is very clean with no visible redness. I wanted to show this patient because I’m constantly asked, “What will I look like after surgery?” — and with proper washing techniques, this is a typical result. Please click the photos to enlarge.
10 days after hair transplant surgery:
Before:
Dear Dr:
I visit your website everyday and find it really informative and reassuring….in some instances.
My question is, I see a lot of young people (between the age of 25-30) getting hair transplants. Now, I remember one time you had posted a message saying that people under the age of 35 should not be getting hair transplants because it is hard to tell the “final pattern” of a person’s baldness. So, why do you as well as other doctors elect to do transplants on young patients (even as young as 22 who have minor thinning but will go bald later on in life) when you know in the future the hair behind the transplants will fall out. It doesn’t make sense?
I’m sorry if I targeting you personally, I don’t mean to do that.
Your question is a good one, but firstly, I’ve never used the age of 35 as a minimum requirement. I will readily transplant any man if:
Once the pattern is clear, the scalp is mapped for miniaturization, and the patient is on Propecia (finasteride 1mg), I don’t see how you could say that I’d “know” the native hair behind the transplants will fall out. That is not necessarily true, and is precisely why it is important to seek out a physician that will microscopically examine your hair rather than just waving their hands around the head like a magician and tell you what you want to hear.
Dr. Rassman,
Thank you for taking your time to read this. I know that hair transplantation has improved greatly in the past decade. Do you think that the improvments have plateaued or can we expect even better results in the hair transplant community in the future.
Thank you for all you do.
I am hoping that the follicular unit extraction (FUE) technology will be improved from an instrument point of view. I personally believe that this technology has great room for improvement. With regard to strip harvesting, I think that we have only improved in our overall efficiency, not in a better technique. We are all waiting for breakthroughs in hair cloning, hair replication or stem cell work for creating new hair.
Paid advertisements (not an endorsement):
hello doctor
i’m three months post a hair transplant operation, i started to note a scalp pimples appeared stating from the second month after the operation, i had told by the doctor who did the operation to me don’t burst these pimples as this could lead to follicular death!, but sometimes i got to burst the white head of the pimples spontaneously. is it true what he told me about damaging the FUE???? this could happen when combing or whatever i do actions to my scalp by mistake.
also i read on the internet that this is normal and a very good sign to hair regrowth underneath the scalp.
another question please, now and after the third month hair density is very thin, is it normal ? and what is going to happen in the next 3 months, can i really got 5 or 6 times the hairs which i got now ? or it depends on something i don’t know it ?
thank you so much
Many of your questions should be asked of your surgeon. I do not know enough about your case to address most of your questions. Some people do develop cysts after surgery and they tend to ‘pop’ by themselves with warm compress soaks. If you develop folliculitis, then you could lose a graft under the skin, but folliculitis needs to be treated, again by your doctor, not me over the internet.
Paid advertisements (not an endorsement):
dear doctor rassman.
i am in a bit of a confusing state. i had a transplant with a reputable doctor in canada 9 months ago to restore the hairline and provide some coveredge on the top and not the crown (i was a norwood 5).
i had roughly 3600 grafts, mainly focusing on the hairline. 9 months have past and i can say honestly that im not impressed. whilst i see an improvement on the top of the scalp, the main area which is the hairline is unexceptional. from temple to temple, it still looks like a receded hairline and the surprising thing is, its just the hairline area which is from temple to temple and approximately half an inch in lenght i.e. hairline lenght (temple to temple) x half inch which has shown no improvement. its extremely thin and whilst i can feel some stubble in various regions there, i honestly think that for 9 months, it is unexceptional. my head is visible through my hairline and anyone can say that i am balding.
i have been imforming my doctor on regular basis and he says i should wait a full 12 months before coming to a conclusion. i have not been satisfied with my hairline for the past 9 months, is there any hope that the next 3 months could make a difference?
At about 9 months you should have 90% of your results in. You might get a second opinion if your doctor is not being responsive. Some rare people have slow growth, but usually by 9 months, much if not most of the hair should be growing. An expert doctor will tell you how many grafts are growing. 3600 grafts is a lot of hair moved — you must have been fairly bald.
If you email me some before and after photos and point out the areas that were transplanted, I might be able to help you over the internet. Be sure they are good quality digital pictures (various angles will help) and please reference this post when sending.
This young man had a hair transplant by a doctor who had done very few transplants on his own. He might have actually been this doctor’s first hair transplant patient. The procedure, which occurred around 5 years ago, failed after the doctor attempted transplanting around 1200 grafts. The patient was lucky (in a way) that the balding area was well covered by his existing comb-forward hair stying. His photos are below (click to enlarge) —
Doing modern hair transplants requires experienced doctors and experienced teams of people. Always check on the experience of your doctor. For more information about finding a good doctor and knowing what to look out for, please see:
Thanks so much for this resource! I am 3 weeks post op from a HT of 4200 units. I was on propecia for 30 days prior to HT and began Rogaine / Minoxidil 2 weeks post op. I had temple work and work at the front of my hairline. I want to get the best result and minimize shock loss. I have heard Rogaine can cause shedding. Am I at risk for shedding in healthy hair zones if I apply Rogaine in it’s correct dosage to the entire top of my head, temples and along the donor scar?
Rogaine (minoxidil) on healthy hair most likely will not cause shedding, but I would strongly suggest that it only should be applied to areas of concern and not the rest of the head for two key reasons:
It is also worth noting that minoxidil will not influence the hair transplants to grow any better or any faster.
Why don’t you offer double follicular unit grafts (DFU)?
Double follicular units (DFUs) are 3-4 haired grafts that have a slight gap containing skin between the hair follicular units (the natural growing anatomical units). Some people claim that if they use them, they can get more density per square cm and that the advantage is that more density can be created with fewer incisions… which means less grafts/cost to the patient.
DFUs are essentially the old type of minigrafts and the problem with them is not only a slightly pluggy look (for those people with dark hair and white skin), but also that there is skin transplanted with the follicles. This skin becomes depigmented and forms a whitish plaque on the scalp on close inspection, particularly noticed if you have a tan or olive skin. So while it is true that this can provide more density at less financial cost, the price is in a lesser quality transplant. The older large plugs had the highest densities, so if one takes the logic that DFUs are less expensive than follicular units and are the way to go, you can also look like you have doll’s hair for about a tenth of the cost of a fdu. You get what you pay for; do not lose sight of the fact that this is a surgical procedure on your head.
So to answer your question about why we don’t offer DFU, to be blunt, it’s because we don’t offer grafts that can be detected as a hair transplant, even on close inspection. The question should be, would I do it if someone specifically asked me to do it, to which my answer would be that I would consider it if there was complete informed consent present at the time the decision was made.
Paid advertisements (not an endorsement):
i know from reading your other entries that proscar doesn’t “cure” balding but i’m noticing some serious hairloss lately and i read something in the blog about a guy that “doubled” his dose to a half pill a day…. do meds work that way? will it help? could it help?
also i am thinking about getting a hair transplant. couple things i’d like to know
– i’m not really bald but my crown is thin, is it possible to just thicken it up and kind of blend it into my hairline. in otherwords anticipate the loss most likely to come.
– i keep the top of my hair longer but shave the sides to about 1/4 inch. would the scar be visible provided the job is done well.
– approximately how many graphs would i need to fill in a thin crown? I know it’s hard without seeing a pic, but just an idea..Thanks a million your site is amazing!
Firstly, Proscar is 5mg of finasteride, Propecia is 1mg of finasteride. The recommended dosage for treating hair loss is 1mg. I would seriously consider not taking more than the 1mg dosage… 1.25mg at most. And I only say 1.25mg because some people will buy the 5mg pill and cut it into 4 parts (easier than cutting it into 5 equal pieces) to take 1.25mg daily. Taking two 5mg Proscar will likely produce substantial side effects and have no more value than the 1mg dose.
You don’t want to have hair transplant surgery without determining where your hair loss is likely to go. You have a limited donor area to harvest hair from and if you use it all up early on and continue to bald in more visible areas (such as the frontal region) then you’ll be out of luck. Miniaturization mapping over time will give a likely path to where your hair loss is at and where it is going to end up. Age plays a role as well.
If you had a FUE (follicular unit extraction) transplant, there would be small dot scars on the back of the head and keeping the hair short would not show any significant scarring. If you had a FUT (follicular unit transplant) strip procedure, you may see a linear scar in the back of the head if your hair was very short, but to what degree really depends on how you heal, skill of the surgeon, etc. Without seeing the area, I couldn’t estimate the amount of grafts; I’d need to know your hair color, hair characteristics (wavy, straight, fine, etc), and whether you’re even a candidate for hair transplantation.
Transplants should never, ever be used to build up what you may lose in the future. Plus, I need to point out that finasteride works quite well in early hair loss, particularly in the crown. It is very possible that you can avoid surgery and just take a daily pill — you will know in about 8 months if it is working. I would look into this by seeing a doctor. Propecia (finasteride 1mg) is available by prescription only.
