Category: Hair Transplantation

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Restoring the Crown – Hair Loss Information by Dr. William Rassman

Hello Dr.Rassman,
I am 25 yrs old and have experienced thinning (slightly noticeable) throughout as well as the formation of a bald spot at the crown of my head. I have sought help regarding this and was told that transplant procedures were not typically done to replace hair at the crown. Is there no way to correct hair loss at the crown surgically? I have been on Propecia for about a year now.

Take a look at Patient’s Guide- How Many Grafts Will I Need? and you will see that the crown loss can be huge and take up a considerable number of grafts that could deplete the donor supply. You can transplant hair anywhere on your body, including the crown! If you are bald (have no hair) on the crown area, a hair transplant may be indicated. At your age, if you are truly thinning with MPB, I would explore the possibility of a medical treatment such as Propecia. Propecia alone may restore your crown area. The misconception stems from the fact that hair transplant to the crown area often requires more hair to accomplish the task for patient satisfaction and many doctors are reluctant, because the patients may not have enough hair after filling up the crown to address frontal hair loss, if it should occur. The crown area typically requires more hair, because the hair on the crown does not layer well as the hair changes direction at the swirl. There are many patients with good results (when appropriately indicated) from hair transplant to the crown area. See NHI Photo Gallery – Crown for examples.

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Why Did Anyone Get Hair Plugs in the 80s?! – Hair Loss Information – Balding Blog

Looking at the old school method doctors used to perform hair transplants, with those really “pluggy” looks, Im curious as to why ANYONE in their right mind in the eighties would go in for that procedure! Was it ever done well?? I mean it really looks like crap and nothing like natural hair. Do you have any photos of one of those procedures done relatively well? Just curious. Thanks, really enjoy the blog!!!

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Atari joystickThey didn’t know any better back in those days. I know we’re only talking about 20-25 years ago, but technology is an interesting thing. One might say that there was so much excitement to get hair on a bald head, that men did not use their brains. Or that doctors were so trusted in those days, that when a doctor recommended hair plugs, everything was followed like the sheep to the slaughter. It may seen archaic now, but it was the state of the art back then and most men had plugs put into thinning hair so that they only saw more fullness — that is, until the hair all fell out around the plugs. There was a logic put together by the doctor that one could put the hair back in quarter sections, like a checkerboard with four squares. First you transplanted one square than the second, then the third, and then the last. In theory, the doctors and the patients wanted to believe that when all four squares were filled in, the hair was full. But reality took on another face, and the doctors started to push ‘touch-ups’ to fix the pluggy appearance of the rows of corn that grew on the head. It was not unusual for a patient to have 10 surgeries to get their hair back, but that was never a real possibility. I don’t know where common sense played a role and the men walking around with ‘doll’s hair’ were becoming more and more prevalent. Celebrities were leading the way and people like Frank Sinatra became the model that everyone wanted to follow (he had a pluggy transplant), but he really looked awful so he wore a wig and people thought that was his hair transplant, an illusion that doctors profited from and patients wanted to believe. It was an embarrassing con game perpetrated by the medical profession.

Have you seen the old Atari video games back in the 1980s? It was the best back then! Unfortunately, just like the Atari video games of the 80s, the results of the old plugs are not as impressive when viewed today.

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I’ve Been Rejected By Hair Transplant Doctors and I’m Desperate! – Hair Loss Information – Balding Blog

I am a 19 year old male, with a naturally high hairline. You can also call it receding if you like, it goes beyond that curve. It’s been like that since I was born. My hairline from centre of my brow is 5cm, top of my brow is 4.5cm. I do not suffer from genetic hairloss, nor does either my family bloodline. When I say genetic, I say this, because when I took minocycline, an antibiotic to help with acne, it made my skin very weak, dry, and fragile, thus some hair fell out because of this. I went off the medication, and I stopped dropping hair. Problem is, I’ve lost the hair I had while on medication, and hasn’t grown since. But I can live with that. It’s only a minor thinning area. No biggie.

I am the only one cursed with this dreadful big forehead in my family. My dad’s forehead is a bit bigger than normal, but mine surpasses his. I have to cope with this everyday of my life, and I finally decided to take up the courage, fight my embarassment and ask doctors around my area. When I finally gained the courage to pick up the phone, I was deeply disappointed as I was excluded, turned down, and rejected hair transplant.

I have contacted numerous hairloss centres and they rejected me for a hair transplant operation to lower my hairline. I feel truly disappointed at this point in time. They only offer treatments for people have lost/losing hair. She only recommended me rogaine, which is unnecessary in my case. I still have a clear vision of a lower hairline of about 2cm-2.5cm.

I am not doing this because I want to look pretty, I want to have a lower hairline, because I no longer can cope with the comments I receive from people. It really affects my daily life. I was made aware of my forehead from my sister, which I never was aware about, and ever since, I have been getting more comments. When I meet people, they would look up at my hair line, not at my face when talking. It makes me so uncomfortable, and the rest of the day I feel so bad and cannot stop looking in the mirror, thinking “I will never get help, even the doctors rejected me”. How many times must I be rejected because of my hairline? Friends, family, now doctors?

I guess in the end, my question is: Can I get hair transplants to lower my hairline from elsewhere? Are there any other possible ways to lower my hairline by 2cm to 2.5cm?

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Hair loss is indeed a dreadful situation for those who are afflicted with the unfortunate fate of the hair loss gene. Add to that a congenital high hairline and it can certainly impact a person’s view of themselves. While I sympathize with the negative social implications of a high / receding hairline in your teenage years, hair transplant surgery is permanent. It is not a short, quick fix. In other words, at your age it is almost impossible to predict how much balding you will have and a quick fix may just accelerate your hair loss. You need to start by getting your hair mapped for miniaturization and have a Master Plan of how to tackle your hair loss problem. You may be a candidate for medications such a Propecia. Propecia will not lower your hairline, though. Your “clear vision” of a 2cm to 2.5cm lowering of your hairline may be attainable, but the timing may not be right due to the risk of further hair loss.

Finally, you can probably have a hair transplant elsewhere by doctors who will gladly accept your money. But, that would be in the doctor’s interest, not yours. Whatever you do, even if you find someone to do the surgery, please get another opinion and just don’t get on the first bus that comes along.

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Hair Loss InformationDr Cole’s Body Hair Transplant Instrument – Hair Loss Information – Balding Blog

Dear Dr. Rassman,
I am interested in body hair transplantation. Dr. John Cole does this procedure using special instruments he invented that have improved the results of BHT somewhat. What is your opinion of this procedure and how well do you think it works?

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Body hair transplantation is still considered experimental in my opinion. Furthermore, body hair does not have the same growth cycle as scalp hair and most of the body hair is dormant (not growing). Thus, the success or growth of a body hair transplant is highly variable and rarely will more than 50% of the body hair be growing at any one time. Body hair also has a finite length of growth and a different texture than scalp hair. These factors make body hair transplants somewhat controversial. With respect to the instruments, there are many doctors who invent specialized instruments for their practice. I do not know enough of Dr. Cole’s particular instrument to comment on its efficacy other than to quote Shakespeare, “There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy.” — From Hamlet (I, v, 166-167).

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Hair Loss Information20 Year Old Just Had a Hair Transplant to Cover a Scar – Hair Loss Information – Balding Blog

Hello Doctor,
Thank you for taking the time to read this. I find your site highly informative and at times humorous. I’m a 20 year old student; recently I had a hair transplant (around
1000 grafts) at the back of my head to cover an old scar. Judging by my close relatives, I will not inherit hereditary baldness.

It has been four months since the transplant and the grafts are growing quite well. However I have fairly long hair and the growth is slower than I would like. Could I use minoxidl to boost the growth rate? Also can you please explain the initial loss of hair that occurs with minoxidil usage, what causes it?

Once again thank you for reading this.

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I am pleased that you enjoy reading my blog and that your hair transplant went well. However there is not much you can do in accelerating hair growth. Rogaine / minoxidil will not boost the growth rate. As you are only 4 months from surgery, I would expect more growth over the next 3-4 months, so be patient.

With respect to the hair loss that sometimes occurs with the use of minoxidil, it is believed that the hair loss occurs from the “resetting” of the hair cycle.

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Hair Loss InformationDealing with Unhappy Patients – Hair Loss Information – Balding Blog

Dr. Rassman, how do you deal with patients that are not happy with their results, or suffer complications, such as shock loss, grafts not growing, and incorrectly misplaced hair. How often do you encounter this? Thanks.

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My philosophy on patient care is that a doctor and patient relationship should be a partnership. Both parties should understand one another and treat one another with respect. I found that through the years from my days as a surgeon, mutual respect and partnership have always kept my patients happy. Setting realistic expectations are much of it, and listening to what people are telling you helps work through the partnership. We have had monthly open house events for the past 14 years where patients who have had surgery show off their results and prospective patients can talk to them and see what they got. Prospective patients can also see a live surgery (just imagine that we were doing this for 14 years on monthly basis in every office we had). Of course there have been unhappy patients along the way, but the partnership and respect goes a long way in resolving any unforeseen issues and a good dialogue usually does not pit one side against the other.

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Hair Loss InformationNo Hair Growth 6 Months After Hair Transplant – Hair Loss Information – Balding Blog

Greetings doctor. As with most balding individuals I am stressing about saving my hair. I am African-American and I take Propecia currently to prevent future loss in the crown of the head, which is still pretty thick. I had 1100 grafts placed in the front of my head via a hair transplant in late October of 2006. It is now approaching 6 months since the transplant and I am not seeing any hair grow in (fine or otherwise), nor any stubble, shafts or anything. I went through the shock loss and feel the area itching sometimes, but no results. Is this normal? Should I wait for a few more months or should I get a refund since the hair is not growing? Any help would be appreciated. Thanks.

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Wait out a full 8-10 months before drawing any conclusions. At 6 months, I suspect you will see growth in another month or two.

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Difference Between Norwood Class 7 Patients (with Photos) – Hair Loss Information – Balding Blog

Why is there such a difference between these two previous post’s photographs. They are both, by your report, Class 7 patients.

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Norwood class 7 Thanks for asking this great, insightful question.

The rim of hair in a Class 7 balding pattern contains about 30,000-35,000 hairs. Considering that the normal total hair count of an adult is about 100,000 hairs, the only permanent hair that is never lost in any balding man, is the 3 inch high rim of hair schematically shown on the right (Norwood Class 7 pattern). The art of hair transplantation that I will show you below, reflects the way the surgeon redistributes these 30,000 (or less) hairs so that it looks like more than it is. The surgeon needs all of the help he/she can get from the characteristics of the hair on the patient’s head, including the quantity that can be safely moved.

The texture of the hair in these two patients is very different. The white/grey haired man (let’s call him ZU) has a hair shaft thickness that is easily three times the hair bulk (weight) as the blonde fellow (and for the sake of consistency, we’ll call him BF). The hair of ZU has a good character to it and holds a wave nicely, while BF has hair that lies limp and wimpy. Also, the donor supply of ZU is easily twice as good as BF and has a loose scalp which allows the surgeon to redistribute more hair from the permanent rim of hair around the sides and back. ZU received almost 10,000 grafts with easily 23,000 hairs in these grafts, while BF had only 4500 grafts (about 8,000 hairs). BF’s scalp was tight and his hair density was not as good as ZU. With that understanding, re-read the blog post titled Patient’s Guide — How Many Grafts Will I Need?, and it should be easy to see that we are not all created equal and the surgeon’s hands are ‘tied’ by patient’s hair characteristics (weight, texture, color, quantity) and therefore the hair transplant surgeon is not in control of every variable he/she needs. When putting the patient’s final results side-by-side, ZU has easily 8-9 times the amount of hair bulk (# of hairs and bulk) as BF. What is very important for you, the reader, to recognize here is that even BF is thrilled with his results. The thinly covered crown in BF (both men use a comb-back hair styling technique) is not of a concern for BF, because he looks at the man in the mirror and does not see his hair from behind. ZU also has a comb-back (which I showed in these photos by allowing the hair that is combed back to separate so you can see the scalp) with much better coverage of his crown area. ZU also had a considerable amount of hair transplanted into the crown, making his grooming easier and his crown looking fuller. From BF’s point of view, that man he sees in the mirror has a full head of groomable hair, just like ZU.

It is also important to note that these men started getting hair transplants at different points of their hair loss. ZU was already completely bald when he started getting transplants, where BF was thinning rapidly and on his way to being completely bald (it happened a few years before Propecia became available). So ZU had nothing on his scalp when we began transplanting his head, and BF eventually lost all of his natural hair up top (so what you see in the photos for both men is all transplanted hairs). If you took BF’s hair transplants away, he would look like ZU’s before photo.

This is reality and that is why I appreciated this question when it came in yesterday. People with a Class 7 balding pattern will never have enough hair to replace what was lost (and if any doctor said he/she can give such a person a full head of hair, well, he/she clearly is must be GOD). The key to a good hair transplant is the artistic hand of the surgeon and good styling from the patient, no matter what balding pattern exists.

ZU (before on left, after in middle, after crown on right — more photos here):

 

BF (before on left, after in middle, after crown on right):

 

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Hair Loss InformationScalp Massage After Hair Transplant – Hair Loss Information – Balding Blog

Dear Doctors;

I have two questions.

  1. Can you scratch your scalp with the tips of your fingers a month after your surgery? Very gently, not using the nails.
  2. How long should I wait to massage my scalp? I had my second surgery three months ago.

thank you so much.

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You should always find this out from your doctor, but I will try to help you…

  1. Yes, you can scratch your scalp a month after surgery with your fingertips, but it is something that I would rather see you not do. Generally, hair follicles are set into the recipient area after between 3-10 days and you would have to work hard to dig them out. The hair grafted skin should always be handled carefully for a few months after the recipient areas have been placed, because the skin is more prone to damage and infection.
  2. What kind of massage do you mean? Generally, you can massage your scalp a month out from surgery. After about 3 months or so, it may be a good idea to do exercises to loosen up the scalp. Ask you doctor how to do them.

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Hair Loss InformationWhat’s the Average Hair Transplant Patient Age? – Hair Loss Information – Balding Blog

hey doc, i’m considering a hair transplant down the road. whats the average age of transplant patients ? I am in my early 50’s and have been a nw 6 since my thirties. I am trying to decide if there is any point in getting a hair transplant at my age. I would just be doing it for myself and not to impress anyone

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22 years oldThe average age by my estimate is in the 40-50 year old range, but many young and older men will have hair transplants. I have done transplants on men as young as 22 (see photo of 22 year old patient at right) or old as 89 (see late 60s year old patient ZU). In the end you need to have a Master Plan for your hair loss. Most men decide on having a transplant not as a vanity issue or to impress others. It is mostly a personal issue about how it makes them feel and addressing something that has been bothersome to them for many years. I often hear regret from patients that they should have done it earlier than later on in life. It takes courage for a man to admit to themselves that they are vain, and to have a surgery to do something about it. There is a great deal of justified fear based upon the number of sleazy doctors in the field, but you need to do your research, for there are many good doctors as well.