Hair Transplantation – Page 171

June 14, 2006

Touch-Up Hair Transplants? – Hair Loss Information by Dr. William Rassman

Hi, Dr. Rasman I am a 22 year old Korean male that is confused whether I am suffering from a maturing hairline or male pattern baldness receding hairline. Everytime I take a shower and put my hands through my hair there is usually 2-5 strands of hair in my hands. This is especially the case towards the front of my hairline and occasionally the back. This depresses me a lot in the fact that I used to value my nice long soft hair as a teen and now feel unattractive that I can’t pull it off anymore. Many wouldn’t realize that I’m losing hair and just think I look older or have a big forehead. I was wondering if there is such thing as a touch up hair transplantation and if I could be a candidate. Although I know I shouldn’t let it bother me too much, it does do quite a damage to my self-esteem. Thank you and appreciate your help!

Can you email me pictures of your hairline and forehead with your eyebrows lifted high? Generally the youthful hairline touches the highest crease of the wrinkled brow. The mature hairline usually goes up by about 1/2 – 2/3rd of an inch in Caucasian males. Asians have slightly different maturing patterns, particularly with regard to the shape of the hairline, which is flat rather than receeded. You should be evaluated by an expert and as you are a Los Angeles resident, I welcome a visit to my office to help you with this problem. I will also map out your hair for miniaturization and see if any balding is evident today.

At the age of 22, I would not rush to get a transplant. Touch up transplants are like being partly pregnant (metaphorically speaking) — it is not a good idea. Starting a hair transplant process at your age may ‘hook’ you too early and make little sense to reasonable Master Plan for your future hair loss.

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June 13, 2006

Female Temple and Sideburn Hair Transplant (with Photos) – Hair Loss Information – Balding Blog

I have lost my sideburns and thinned out my temples after I had plastic surgery. Can you put the hair back with hair transplants?

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Yes, complications of hair loss in face lifts and brow lifts are the most common type of hair transplant I perform on women. Here is a great example of the before and after picture on one such patient with red hair who had more than one face lift. Note that the entire side burn area was bare ‘before’ the hair transplant as was much of the temple hair. When the face is lifted tightly, the side burn and side hair around the ear is often either weakened or removed during the repair process. The more facelifts a person has, the greater the price to hair loss and my role in restoring the hair becomes more critical. Women want to pull their hair back as a styling option and many face lift patients can not do this. Clearly, this red-head can wear her hair in a bun showing off the side hair as she did as a younger woman.

The photo on the left is before, the photo on the right is after. Note the scars from the last recent face lift she had on the picture on the left. The transplants hid the scars nicely. Click to enlarge.

Before
After

June 12, 2006

Shaving The Recipient Area Prior to Transplant – Hair Loss Information by Dr. William Rassman

Dr. Rassman:

I would appreciate your comments regarding the following: I have read of a debate or difference of opinion between hair transplant doctors on the value of shaving a patient’s hair in the recipient area prior to the transplant. Some doctors are proponents of having the patient cut the hair very short in the recipient area. These doctors claim that closely trimming the recipient area hair results in maximum density and no transection. Their contention is that when recipient areas are trimmed short, the doctor has an easier time of placing new recipient sites in the place of absent follicular units and alongside miniaturized follicular units. Also, by clipping the hair short, there is a lower risk of transection of existing hair. The final argument in support of clipping the hair short is that hair exits the scalp at an exact angle and the only way to precisely match that angle is to clip the hair short. Some doctors are so convinced of the benefits or trimming the hair in the recipient area that it is not an option for the patient. They are insisting that the patient do it.

On the other hand, other top transplant docs believe that it is not necessary for a patient to closely crop the recipient area hair and that while it may make things easier for the doc and the techs who do the graft placement, it does not lead to better density or less transection.

What is your opinion? Does closely cropping the hair in the recipient area give a better result? Is it of no value? Or, does the answer lie somewhere in-between?

There are many views and theories on this topic. Instead of making it complicated, I believe it is the doctor’s personal preference which (you may argue) may have a direct impact on the outcome. At NHI, we only cut the part of the donor area hair that we will removed just prior to surgery so that the surgery can be easily hidden after the surgery. On rare occasions, we will ask the patient to allow us to clip the recipient area hair (usually when we have complicated plugs to remove). We place a great deal of importance on the absence of detection and if a person shaves the head or cuts it short, it is an announcement that the person has had a hair transplant. I have trained many doctors on how to keep the hair long so that social disruptions are minimized and have learned to work between the longer hairs.

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June 8, 2006

Buzzed Hair Style After Transplant – Hair Loss Information by Dr. William Rassman

Dear Dr.Rassman,

At age 30 I had three procedures with a doctor in Pittsburgh.The results were excellent.The focus areas were creating a hairline and giving me forward density.The scar seems almost invisible now through the hair. My question is I’m now 40 and would like to shave my head with a number 2 clipper.With the hair cut short is it common for the donor scar to be visible? Greatly appreciate your thoughts on the matter.

Each and every person is different. Some people with no scar can not cut their hair with a number 2 clipper if their hair is straight and coarse, because there can be a subtle difference in angle above and below the area that was cut. Small scars may not be seen with the same shave if the hair character is good and the scar is minimal, yet larger scars may behave differently. Best to try it on a vacation with your hair cut short and see what you got. We can speculate, but the ultimate test is to just try it out. I have many patients who cut thier hair short, even to a crew cut after a hair transplant with no problem at all.

June 8, 2006

Can Extracted Hairs Regrow in Donor Area? – Hair Loss Information by Dr. William Rassman

Can hair ever grow back in the donor areas from which follicular units have been extracted? (Similarly, would hair ever grow back if I combed out a follicle?) I assume follicles don’t regenerate.

When hair is extracted with Follicular Unit Extraction techniques (FUE) the root and growth center of the hair is removed and relocated, so it will never grow back. If the hair is pulled out, the root is always left behind, so that it will always regrow.

You are born with an average of 100,000 hairs. When they are moved, the number will remain at 100,000 (minus whatever you’ve lost from genetic balding) if they are not damaged with the move. In the hands of a good hair transplant doctor, moving hair around is just a relocation process.

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June 8, 2006

Recreating the Spiral in the Crown – Hair Loss Information by Dr. William Rassman

I am a 45 year old male who is thinning in the front and who is developing a moderate bald spot on the crown. Both issues can be successfully masked by products such as Toppik, but eventually this solution will fail. My question for you is twofold:

1) Is Propecia (finasteride) efficacious in slowing or stopping hair loss in someone of my age.
2) Is it possible to recreate the natural “spiral” pattern at the crown, as it occurs with one’s original hair pattern, with a transplant.

Thanks for your time.

Assuming that your hair is healthy and that there is no significant miniaturization in the donor area, yes, Propecia can positively impact the crown area with some regrowth in about 30% – 40% of men of your age.
Assuming the supply/demand ratio of your donor hair / recipient area is favorable, you can easily replace the spiral pattern in the crown. It requires a skillful, experienced surgeon.

June 7, 2006

Doctor Using Laser to Transplant Hair? – Balding Blog

hi dr, i live in tampa and there is a dr markou over here that i really trust & appreciate, he uses a laser to do transplants, not the old laser version but some new technology, is this safe, could you please comment on it,

can a miniatuization tell you what the hair was like before?

Laser hair transplants as I know them, produce damage and are second class transplants. If there is a new technology, I would love to learn about it. Generally, I advise people looking at laser hair transplants to run hard and fast away from those suggesting it.

With regard to miniaturization, please read the many entries on this blog about the subject. A good starting point was my recent post, Miniaturization or Gimmick?

June 7, 2006

My Hair Is Thinner After Transplant – Hair Loss Information by Dr. William Rassman

I had a hair transplant in August 2005. The doctor used the slit technique and placed 900 grafts in the frontal 2.5 inches of my scalp. He told me that the “see throughness” would be corrected. I am a 33 year old female who did not notice thinning until after the birth of my son. I waited until he was 22 months old to have the surgery to rule out any acceleration in my hair loss and make sure I was done with the post-partum shed. I had previously seen one other transplant doctor before electing to have the surgery, and he had suggested two procedures in the frontal area, covering about the first 1.5 inches of my scalp. I chose the second surgeon because he said he did two female transplants a week (thus he had experience with women) and could do the whole thing in one procedure.

Immediately after my surgery I was thinner and the doctor said it was normal to lose hair during the procedure; but that it would grow back. Three months after the procedure I had lost so much surrounding hair that it totally negated any gain from the 900 grafts, 25% of which kept growing from day one on, the rest of which had begun to grow at 3-4 months. Today, 10 months later, I am about 25% THINNER than I was before the surgery. The doctor said I suffered some permanent hair loss, probably hairs that were predestined to fall out anyway. Shouldn’t he have known this when he examined me, prior to the procedure????

Now I am very upset because two transplant doctors have told me I was not a candidate in the first place; that I hadn’t lost enough hair to have the surgery. If I choose at some point in the future to have another transplant, to try to put me back where I was beforehand, what is the likelihood that the grafted hairs, and/or additional surrounding permanent hairs will be shocked out? Are there any new techniques in the works that would minimize or eliminate the irritation to existing follicles? Is a smaller procedure (100-200 grafts) in the very frontal region less likely to put my surrounding hairs at risk? Lastly, is the individual follicle removal technique okay for me, as opposed to another strip technique? To give you some idea of the condition of my donor area, the doctor noted that my density was 3.5 out of 5.0.

Thank you in advance for any insight you can offer. I am sorry I don’t live in your area, as I would definitely come in for an in-person consult. I live in the Boston area and would appreciate any sound, competent and surgically conservative referrals you could give me.

I have said many times on this blog that if any doctor tells you that he/she does many hair transplants on women, that you should run for the hills. Women generally make poor hair transplant cases, because the hair from the side and back where the hair is taken from is not normal — so why would one put not normal hair into areas of thinning, where the hair is not normal as well? You need to see a good, honest doctor with a lot of experience in this field — seriously, someone who is impeccably honest. May I suggest that you make a trip to New York and see my colleague Dr. Robert Bernstein?

June 7, 2006

Stretching Wounds and Scars – Hair Loss Information by Dr. William Rassman

How will these new wound closures you discussed in this blog impact people who have scars that stretch? I have scars that stretch every place I have had a surgery, including my hair transplant scar.

A trichophytic closure will not work if the wound widens more than 2-3 mm, because the hair growth from the trichotomy will only grow up to 2-3 mm from the edge of the wound where the trichotomy was done. The stretching may be helped by a sub-fascial closure below the occipitals muscle fascia. The tension reduction of such closures has value in reducing the wound size, but not necessarily in obliterating it. You might have some form of Erlos Danlos Syndrome (see here, here, and here), which comes about from defective collagen by its very nature. The story of EDS is not black and white, for I believe that some people have small amounts of this defective collagen and these people are the ones that may get stretching of the scars. In such situations, even the sub-fascial closures will not work, because eventually the body must heal the wound and as the sutures dissolve, the value of the sutures that hold the wound together will decrease over time.

Scars are at times a price one pays with surgery. For strip harvesting, this could be a price you will pay. If you have FUE harvesting (Follicular Unit Extraction), then this stretched scar problem should not become an issue with regard to your healing, as there is no large line scar to stretch.

Now with that said, putting the scar issue in perspective, the scar only exceeds 3 mm in about 5% of cases. If that happens and it bothers the patient, then I make this my problem as well and we work to solve the problem with whatever it takes.

June 6, 2006

The Look of Hair Fullness – Hair Loss Information – Balding Blog

I would like to achieve even density on head, like I originally had before I lost it there. I dont mind my hair being short, but i would like to fill in the runways that run down the sides behind what is now an OK frontal area. How many grafts will it take and how much will it cost?

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I am not sure if you really understand your own question. The average person has 1250 hairs per square inch so if that is your target, the number of grafts (usually about half of the number of hairs or 625 grafts per square inch in your case) is easy to calculate by measuring the # of square inches you want to cover. But that number has no significance if you really just want to look full in those runways. The answer to looking full depends upon the color/contrast in your hair and skin color, the thickness of each hair shaft (coarse is better than fine and wavy is better than straight). If you are a blonde with white skin, you may only have to return 15% of the hair density, with coarse hair, you might get away with 25% of your original density in the runways, and if your hair is wavy with good body, who knows that value. Our charge per graft is lower during our Summer Special: $5.50 if you schedule an exact date and $4.50 if you take our standby rate. My personal rates are slightly higher.