Hair Transplantation – Page 146

April 12, 2007

I’m Worse Off Now AFTER My Hair Transplant – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

I had a my first procedure done over 1 year ago (1900 grafts) by a reputable surgeon but am extremely disappointed with my results. I have noticeably less hair now than prior to surgery. My doctor said the procedure went fine, but I have lost more native hair than transplanted hair received which is the source of my visible concern. My question – how do I know if this is correct. How can I know that the 1900 grafts survived or if there was in fact a problem with my procedure I am not aware of. I am 49 and have been on Propecia for several years. Have you ever heard of this situation? I feel like I’m in the middle of a nightmare – I have paid a small fortune to fast track my hair loss. I don’t know where to go from here. Please help!

I hear and see situations similar to yours nearly everyday. If you were a young man (under 25) and not on Propecia, I would predict the hair loss as almost a certainty. Hair transplant surgery should take into account a Master Plan to plan for future losses.

You should not have lost native hair at your age (49), as men of this age have hair that rarely reacts with shock loss, particularly as you are on Propecia. Although this is a risk that patients must be made fully aware of before having the surgery, there are too many uncertainties here for me to draw conclusions without examining you myself and see what happened to the transplants you had. Hopefully, you have good before pictures taken for an expert to draw conclusions. You need to have a second opinion.

April 12, 2007

Very Thin Hair on Sides and Back — Is Body Hair Transplantation a Possibility? – Hair Loss Information by Dr. William Rassman

my body is very hairy (face, chest, back, etc). will taking any of these medications increase body hair? Since I hardly have any donor hair on my head, is body hair transplant a possibility? Where can I get good information on this subject?

Thanks for your assistance.

Best regards

I have written about body hair transplants extensively in this blog (search for body hair transplants). Be very careful with body hair transplants; the failure rate is very high.

I would be concerned that if your hair is see-through on the sides and back of your head (I assume that is what you mean by having little donor hair), that you may have Diffuse Unpatterned Alopecia (DUPA).

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April 12, 2007

Weightlifting After Hair Transplant Surgery – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman, I had a strip procedure done 3 months ago. How long should I wait before I start lifting weights? I’ve been hearing so many different things. Any info would be greatly appreciated…thanks

You can start lifting weights now. By 3 months, the healing is fairly secure in the strip area.

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April 11, 2007

Patient Kept Hairline with Propecia, but Density is Poor (with Photos) – Hair Loss Information – Balding Blog

The photos below are of a 24 year old man who started taking Propecia (finasteride) at the age of 18. At 21, he switched to Avodart (dutasteride), but on seeing no improvement or reversal of his hair loss he switched back to Propecia, which he has maintained through today. His donor density is 25% less than the average Caucasian, which obviously means that his supply of donor hair is limited. Plus, he has black hair and very white skin and he is miniaturized to 90%.

I suspect that the hair he has is only there due to the Propecia routine he has followed strictly over the past 6 years. Starting hair transplants at this time would be the wrong thing to do, as it most certainly will accelerate the remaining hair loss. With thickening products and the use of Toppik, he does not look balding and I suggested that he continue that approach until it fails to work. Only then can the transplant option be used, but he will have to give up any thought of crown hair and accept only a frontal hair transplant.

April 10, 2007

Wearing a Baseball Cap After a Hair Transplant – Hair Loss Information by Dr. William Rassman

How soon after a procedure can a patient wear a baseball hat to conceal the procedure?

Would a slighty oversized, baseball hat, placed gently on the head be OK?

You can wear a cap on the same day. In fact, at NHI we discharge almost all of our patients with a baseball cap. Written on the baseball cap is, “Look at me! I just had a hair transplant!”

Hey, I’m kidding!

All joking aside, as long as you wear the cap loosely it is OK and a good cover for even the most extensive hair transplants we do. The baseball cap we supply is plain blue with no markings on it.

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April 9, 2007

Hair Transplants for Men in Their Early 20s – Hair Loss Information by Dr. William Rassman

For those of us in our early 20 thinking about hair transplants, do you have before/after photos of men who decided to get a transplant at an early age? I’m interested to see what the balding progression would look like, especially if the man uses propecia.

Look at the Norwood classification below and you will see the progression of hair loss that is possible. Some people follow the loss pattern going from a Class 2, to a 3, then to a 4, and then on and on. Others will thin in the Class 6 pattern and not go through the various stages. What is important to be aware of, is that only about 7% of men progress to a full Class 7 pattern so just because you are a Class 3 pattern balding person, it does not mean that you will advance to a Class 4, 5, 6 or 7 pattern. The genetic factors that determine the final pattern vary between people.

The problem with young men (under the age of 25) is that their balding patterns are often not quite clearly defined. I generally like to wait until at least 25 years old, following the patient with miniaturization mapping regularly to understand the progression of the balding process and the effects of drugs like Propecia. If one transplants a 20 year old before the pattern is fixed, a long term Master Plan can not be derived. If this 20 year old becomes a Class 7 patient, transplanting him as if he is limited to a Class 3 pattern might start using up more hair for future pattern loss than he has. The problem is that we do not want to run out of donor hair and look freaky as the pattern progresses.

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April 6, 2007

The New Scam in Hair Transplantation – Hair Loss Information – Balding Blog

Shell game There was a movie named Network that came out over 30 years ago and contained a great line that became a very memorable quote:

“I’m mad as hell, and I’m not going to take this anymore!”

Well, this line came to mind and I want to tell you, my readership, how mad I am and why. Unfortunately, I can not directly act on what is making me mad, except by speaking my mind through this blog. There is a new scam going on in the hair transplant industry, which plays off uninformed patients who come to visit a doctor for hair restoration surgery and who want to rightfully trust that doctor. The scam is simply to get a young man or woman to trust in the doctor through skilled sales and presentation skills, and then when they make up their mind to have a hair restoration procedure, they get what they would not have expected.

The fee structures in the hair transplant industry is based upon a fee per delivered graft. Usually, the prices run all over the place. I have seen three people in the past week alone who received over 2800 grafts, supposedly in their ‘balding’ area. They get poor densities transplanted into the balding area and many more grafts are placed into normal hair. One of the three patients was sold 3300 grafts at $4/graft, and I calculated that he could have never gotten that many grafts because the density of his donor area and the tightness of his scalp would never have allowed that number. Add to that was that my examination only saw about 400 grafts that grew and I suspect that the patient was swindled. Worse than the financial loss, was that valuable donor hair was lost and damage was inflicted in the recipient areas that were transplanted.

I am certain that this scam is being perpetuated all across the world, as I have seen patients coming to visit me from throughout the United States and Europe. All I am addressing here is the intent to defraud. I am not addressing the second class work performed by doctors who try to deliver first class work.

What can you do to protect yourself? The answer to this question is to do careful research. Read the blog entry Patient’s Guide — How Many Grafts Will I Need?, which teaches you how to determine the number of grafts for a given balding area. When I wrote this piece, I did so to explain the economics of hair distribution to arm those prospective patients with enough information to be well informed about the pending purchase of hair transplant grafts, but now it seems that doctors are reacting to the competitive challenge by dropping the price per graft and raising the numbers, many time a multiple of what is needed. Many times the doctor does not even transplant the numbers he/she commits to (I believe this is less common, because their staffs would see that). If you understand the process of calculating the number of grafts, you will be able to determine for yourself how many transplanted grafts you need, so if you (for example) calculate 1000 graft needed and the doctor recommends 3000 grafts, then you know that the doctor is in for the ‘SCAM’. Never forget (that like any service business, even a doctor’s cosmetic surgery activities) that it is a Buyer Beware business.

There is nothing that I can do except to vent here on my blog. I am appalled at the behavior of this group of scum doctors, for they are not only crooks, but they dishonor the good doctors who are in the hair restoration field. If I come out publicly and identify the doctors who I am certain are involved in this scam, I will be open to legal actions by those involved. The medical board has no power to deal with it, as the decisions on what to do falls outside their domain and the doctors would withdraw into the practice of medicine. The only place where these doctors can get attacked is in the courts on a malpractice action. I can play a role as an expert witness to those that wish to take action and would offer my services to the victims of these crimes and their lawyers.

April 6, 2007

New Hairs Are Growing In Wavy and Wirey After Transplant 6 Months Ago – Hair Loss Information by Dr. William Rassman

I am into my 6 month since my procedure of 3571 grafts and notice that the donor hair excised from the rear of my scalp which was previously long and straight are now growing out somewhat wavy and wirey – similar to beard/pubic hair.

Is this something to expect and that is normal at this time frame? Will these donors eventually be “re-trained” and straighten from regular combing/styling to evenly match my surrounding hairs???

Wavy It is possible that the microscopic scars at the level of the recipient graft is influencing the direction of hair growth and the character of the hair. Also, I have seen some changes in the texture of the hair shaft after a hair transplant which often (when it happens) corrects after one hair cycle (approximately 3 years). Also, many people have reported that the recipient area is more wavy than it was originally which might be the manifestation of what I just discussed. It could be that the hair was just thicker and healthier, so what you could be observing is just the normal hair (not the miniaturized hair that was normally in the front which is finer and may have a very poor character). Rarely, transplanted hair can become kinky, but I only recall having seeing this a couple of times. The use of gels, mousses, and good conditioners will help you gain control over this new hair — just experiment and find out what works for you.

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April 5, 2007

Hair Loss InformationThe Pros and Cons for FUE / Strip Harvesting – Hair Loss Information – Balding Blog

I’ve put together a nice list of things to consider if you’re interested in having a hair transplant, particularly when comparing the Follicular Unit Extraction (FUE) technique and the Follicular Unit Transplant (FUT / strip) technique.

FUE pros

There will not be a detectable scar in donor area. Of course the scar will be present after every skin incision, but since scars are very small and scattered in a larger area, they are not detectable even on a head with a close crew cut.
There are no sutures or staples to be removed. The small pointy wounds on the back of the head will be left to be closed on their own with no sutures or bandages.
There is minimal or no pain in donor area after the removing the grafts.

FUE cons

Not everyone is a good candidate for this procedure. We always test our patients before doing the actual procedure with several biopsies with different methods and view the grafts under microscope to see whether we can harvest them without damaging the hair follicles. If we see a lot of transected (damaged) follicles, we can not proceed with this procedure.
It is more expensive (almost double the cost compared to the strip procedure). Follicular Unit Extraction is very tedious and every graft should be individually extracted by the surgeon as opposed to the strip method where skin is removed first and grafts are harvested under a microscope.
It takes more time, sometimes up to twice the time when compared to a strip procedure for the same number of grafts. A procedure to harvest one thousand grafts may take six to eight hours.
A large area of the scalp needs to be shaved or clipped very short. This is not acceptable for many patients.

There are a few issues that are important to look at and understand. Hairs within a graft can be killed by improper harvesting (e.g. drying, cutting it at a critical point in the anatomy of the hair follicle within a follicular unit). This can happen if there is poor cutting techniques in strip harvesting, or in actual transection of hairs within a follicular unit during an FUE procedure. I personally do not believe most of the doctors who claim 95+% successful hair counts from FUE and I would love to pay a visit to some of these doctors and actually do the hair count from their FUE extracted grafts.

Thick grafts (those that are transplanted with fat around the follicular unit) can tolerate air exposure longer than a skinny graft (which can dry in seconds when exposed to the air). But tolerating air exposure for longer than 10-20 seconds suggests to me that hair follicle death may occur and the staff do not have strict quality control process implemented. What is important is not how many hairs are extracted successfully and anatomically intact. The important question to ask is, “Will they grow?”

The best part about strip harvesting is that there is a very high yield with the experienced team. The risks of scar formation that is detectable (greater than 3mm wide) is about 5% with the first procedure, 10% with a second procedure, and higher with a third procedure. Other than the scar possibilities and a slightly more painful recover period of a day or two, the strip procedure is more cost effective and more efficient from a time and yield point of view.

April 4, 2007

I Want to Look Into Hair Restoration In 4 Years – Hair Loss Information by Dr. William Rassman

Hello
I’m only 16 and i have a terrible baldness. Rogaine and propecia didn’t have any effect on me after a year of use so i think that the only solution is an operation later(after 3 years).so i’d like to know if the method of hair restoration can be used in 2010 and if i can do operate at the age of 20 years old.

Severe balding at age 16 is not common. You should be evaluated by a hair specialist to confirm your diagnosis and rule out other causes that may result in premature hair loss. If you are diagnosed with androgenetic alopecia or male pattern baldness with no other causes involved, the best thing is to prevent further loss by taking the medication finasteride. Only after examination of your hair loss and the changes in its pattern, can we tell you what is the best timing for a hair transplant procedure. Hair transplants a rarely performed in men under the age of 24 years old. Please get good metrics on your hair situation by getting your hair mapped out for miniaturization so you can follow scientifically what is happening to you.

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