i noticed that in your after photos there is still redness in the receipient area even months after the transplants.
It is very rare (almost improbable) that you would ever see redness on the transplanted area of the scalp MONTHS after surgery. Perhaps you are looking at early photos. Please email me the photos you are referring to and I would be delighted to review them and comment on them publicly.
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Dear Dr. Rassman.
I have a 3-in-1 question for you. Thanks for answering my previous question about Propecia. I am trying to cover my loss by all available means (Propecia, supplements, Minox and finally a transplant.)
First, I noticed you talk about getting one’s head mapped for miniaturization. I have spoken to five dermatologists here in Arizona, including two who specialize in hair transplants, and none of them have an idea what “mapping head for miniaturization” is. One of them even went as far as suggesting it was just a gimmick to get people to go on with the surgery. (Which I doubt.) I absolutely need to know to what degree my loss might be, so I can plan for the future, transplant and money-wise. The dermatologist who prescribed Propecia for me only took a 30 second look at my hair and gave me the prescription. I think that was a bit wrong, as it might be something else what’s causing my loss, though there is a history of it in my family. So…
Is there a doctor you can refer me to, who can perform the mapping, here in Az? The doctor who mentioned the “gimmick” said such analysis is pointless, as one miniaturized hair might be non-miniaturized by the next cycle. (I doubt it.)
Second. Another concern is how much it can evolve. I know balding is a progress, but I would like to know if a mapping can ascertain if I’ll be a say, class 4 for the rest of my life as it can be obvious some hairs are not affected by DHT, or if it will only tell me what class I am at a certain point in time, with the potential for more balding.
Third. I am concerned I might not have enough hair to leave me satisfied with my appearance even after a transplant. My main concern is thinning, as the recession is not that noticeable. I am curious to know if you can transplant hair from other parts of the body like chest or belly. I have long enough hair there that looks identical to my head hair, save for not growing longer than 1 or 1 1/2 inches. I wonder if this hair can be successfully transplanted to provide thickness, or work as “guard hairs” for the frontal hairline. I noticed my brother’s frontal hair is just like that. Other doctors in Australia (Who happen to follow your procedures and credit you with the techniques they use) have been successful in patching people up with body hair, with amazing results.
Sorry for the long post, and if some of my questions are not too clear. Keep up the good work, doctor, and hope to be stepping up into one of your offices soon.
I just answered a similar question a couple of weeks ago, but I’m going to get a little more in depth this time…
The hair transplant medical field is not as standardized as one may think. There is the International Society of Hair Restoration Surgery (ISHRS), but not all hair transplant doctors belong to the society or practice the same way. Some doctors do not use microscopes for dissection. Some doctors do not use hair densitometers to determine miniaturization. Some doctors do not use follicular units. These should be the standard of practice in my opinion, but there is really no way to enforce these practices. Unfortunately, hair transplantation is not a highly regulated medical field. There are doctors who coin new terminology to promote their expertise. There are doctors that even claim that they were the ones who invented certain procedures by subtly changing minor details. It is alarming, but these things happen. To be fair, it happens in other industries as well. It is the basic theme of “buyer beware” that I often state in my posts here.
Your question on minaturization is an example of such variation in clinical practice. Hair generally loses its shaft thickness as it is lost. This thinning of the shaft is called miniaturization, a standard term in modern dermatology. Miniaturization occurs at different speeds in different areas of the scalp and over time it is (in men) often progressive. By getting a picture of the degree of miniaturization by area (a snapshot of the health of your scalp hair in each area), it allows the physician to determine not only the health of the hair in each paticular area, but it allows the physician the ability to follow the progression of the miniaturized process by area caused by the genetic process — or the improvement when a person is treated with drugs like Propecia.
Miniaturization measurements do not predict your future hair loss or the rate of that hair loss with certainty, because there are many factors involved in hair loss. It does give a trained doctor an extra set of vital information on the progression of the individual’s hair loss by monitoring and quantitatively documenting the effectiveness of medical treatments such. There is no science or measurement in when a doctor runs their fingers through your hair. Contrary to popular belief, mapping for miniaturization is often used to deter what is going on and allows the doctor to refine the diagnosis. Women have unique miniaturization patterns that differ from men and men each have different miniaturization patterns depending upon the extent and speed of their hair loss. Men who are not balding should show no miniaturization present (see example here).
With respect to body hair transplants, I am fully aware that there are internet advertisements and post-operative pictures with doctors proclaiming success. My reservation is that pictures do not always tell the truth. You need to meet these patients face to face and see their results and see the scars from their donor sites. At NHI we have monthly Open House events where we encourage all potential patients to come and see actual patients and learn and see a real hair transplant surgery. Furthermore, body hairs grow at different rates and have different (longer) dormant cycles where its transplantation may not be of clinical benefit (see Transplanting Chest, Leg, and Thigh Hair). Finally, hair transplants and even body hair transplants will NEVER restore your hair back to its childhood densities. It may be hard to believe, but you only need about 30 percent of your original hair density to preserve the same appearance.
I do not have donor hair (enough) for a trnsplant what would be my next option. currently, I am using a hair system with HMW. I find it to be quite expensive and there times when you still feel uncomfortable when it needs to be replaced. I would like to find a new alternative which would make me comfortable and make me feel connected to my hair:-)!!! What is the next best thing to a transplant. Why cant’t human hair be sewn into my scalp, just looking for solutions that I can still treat wash hopefully will grow like human hair.
First, have you had your head mapped out for miniaturization? What is the donor density? What is the laxity of your scalp? Do you have Diffuse Unpatterned Alopecia (DUPA)?
These are the questions that I would want to know to determine if you have enough donor hair for a transplant. Even the baldest of men (Norwood Class 7) can get great results from proper distribution if there is adequate supplies (see Patient ZU).
Alternatives may mean that you get less than a full head of hair. A thinner look can work for many people. Better coverage in the front at the expense of the crown can also work for the very bald person without enough donor hair. You should come to one of our Open House events to see some patiens with these alternative approaches. At these events we have some patients who choose to be thin either because of donor supply limitations, very fine hair or just limited budgets. Some choose to transplant the front and spare the crown. At these open house events we try to give our guests the opportunity to see a wide sampling of what hair transplants do and how normal people deal the the decisions involved in the process. It is important to think of the hair transplant doctor as a partner working with you to maximize your the value of what he/she can do for you.
I would like to know how a hair follicle falls off. I was told that as DHT accmulates at the bottom of hair follicles hair falls off. This DHT is produmed by male harmones. Is this true? If this is the case even after hair transplantation DHT will be accumulating and it will cause the transplanted follicle to fall off. Then how is hair transplantation a permanent solution?
This is a good question. When hair is made by the body, it goes through many stages — from a single microscopic cell to a complex hair organ which contains hair, glands, nerves, blood vessels and muscles. Some people have genetic defects in some of their hairs on their head and men with male pattern balding have such defects in hair that correspond to the patterns of hair loss that they show. These defects do not allow the hair to grow from its single cell form into this complex organ which each hair follicles becomes. The defect is ingrained in each hair follicle that is impacted and it is never ingrained in hair follicles in the side and back of the head. As the transplanted hair comes from the sides and back of the head, the defect for making the hair fall out is not present in these follicles, so the transplanted hair grows. The hormone DHT causes the hair loss when the defect is present, but the hormone DHT does not affect the permanent hair from the sides and back of the head.
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I have been diagnosed with HIV which is now under reasonable control. For a period of time I was very sick, but now with the proper balance of medications, I am healthy and active. The problem is that I lost a great deal of hair from the time I got sick 2 years ago to the present. I am 54 years young and I do not like looking 80 whic is what I feel I look like when I saw a recent picture of myself. Can I have hair transplants or does the my HIV status impact either my candidacy for surgery or the results of hair transplants? Will the doctors turn me down for surgery because I am HIV positive?
A healthy person who is HIV positive may be a good a candidate as an HIV negative person. Your sickness probably caused the ‘expression’ of your genetic balding process on an accelerated timeline. At your age, I would be surprised if it continued to progress, but after mapping out your hair for miniaturization, I would go on Propecia to protect you hair from further loss and then be evaluated for a hair transplant if you want to change your look.
Under most state laws, doctors can not discriminate against someone who is HIV positive. Some doctors fudge on this and do what I call ‘closet’ discrimination where there are convenient reasons to turn down patients, but not only is this against the law, it is against the oath we as doctors are supposed to adhere to. If you are healthy, you can expect that you should be a reasonable candidate, certainly one worth evaluating. I perform hair transplants on many such patients each year.
I hate my look. I answered an ad in the newspaper when I was in my early 20s and very depressed about losing my hair. It was not bad then, just starting to thin in the front. The doctor’s sales guy came in and did a job on me, telling me that it was on special and that he would give me 50 free grafts on top of the reduced price and I would never have to deal with the balding again. I scheduled for surgery done the next morning. This was 8 years ago and have hated myself ever since. I did not see how bad they looked until the hair fell out in the front, all within a few months of the surgery. Now I just want to become bald. Can I do it?
My astute readers will notice that this is the 3rd blog entry I’ve made in the past week relating to this very issue (see also: Alas, Bald Again and Years After Transplant, I Want To Shave My Head ), but it is very important to drive home the fact that hair transplants are forever. I know that these deforming surgeries are what most people think that a hair transplant is, but based upon what I see in these pictures, I would expect that you had this 15 or more years ago, not 8. This is malpractice today and I believe even so 8 years ago. The way the doctor unleashed the salesman on you was downright immoral and I would report that doctor, at the least, to the medical board of the state. In California, the medical board takes responsibility to protect consumers against such behavior.
I think that going backwards and becoming bald may not be your best choice, because even if each of these plugs were removed, the scalp skin would then show the individual scars from each excision and the reflection of any light in the room would show the deformity. I suspect that the situation can be improved as shown in these articles and this patient example (see Dean’s Story link below).
You need a good doctor working with you one-on-one who has the experience to address YOUR needs. This requires both a very experienced hair transplant surgeon, one with good communication skills, compassion, and understanding. Then the two of you can work out what your real options are. For those readers who are seeing this scary picture, don’t think that this is the standard of care (take a look at what is the standard of care today in our Photo Gallery).
Note: This work was NOT performed by New Hair Institute. Click the photos to enlarge.
I have wonderful results from the transplants you have given me, but now I want more hair in the crown. Can I do it one more time?
This is not an uncommon question. I have shown his before and after pictures here, with permission. He has received 3,218 grafts in three procedures. The first procedure was a limited FUE surgery placed into the corners with 484 grafts. This gave him a nice result, but he wanted more fullness so another procedure was performed in the front to finish out the hairline reconstruction. Had he elected to allow me to dense pack the frontal hairline and use a more traditional approach (strip harvesting), I would have done the entire procedure in the front (1391 grafts) in a single procedure, but the FUE limited the harvesting in the early days (2001) when this was considered a large FUE procedure for me. He elected to come back a third time now to address the top and back of his head. His third procedure had 1,827 grafts and it achieved wonderful, natural results. Now he wants a tighter swirl in the crown and a second procedure into the crown (a 4th procedure overall) will finish the job.
A good Master Plan might have reduced his entire process to two procedures (front and back), but sometimes it takes a slower approach to make the patient feel comfortable with the process. He now has 3,218 grafts total and will receive another 1000 in the crown in the very near future.
Before (click photos to enlarge):
After:
Can hair be transplanted from another person? Is this even remotely possible or in the possible future at all? We transplant skin, organs, etc from other donars. Why not hair?
Medical science has made it possible to transplant human organs such as heart, kidney, liver, or other critical organs from one person to another. However, the recipients of these organs have to be on life-long immune suppressing medications, which make them prone to life threatening infections. Otherwise, the transplanted organs would be rejected by the recipient’s immune system. Even the face transplant that hit the news recently required these dangerous medications to prevent the rejection of the face on that particular patients.
Hair, being an organ, can be transplanted from one person to another; however, to stop your body from rejecting the hair, dangerous drugs would have to be taken. As balding is not life threatening, taking these dangerous drugs may produce life threatening infections and this risk makes person to person hair transplants not acceptable by medical standards.
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I am 21years old and I am starting to look like my dad. According to your balding classification, my pattern is now like a a Class 4a pattern but my dad is a Class 6 or 7 pattern. I went to a hair transplant doctor and he said I was too young. I already have no hair halfway down my head, Would you transplant me?
First, you must recognize that this process is an important lesson in planning for both you and I. I believe that young men like you can receive surgery, but before that happens, you need to have a Master Plan that takes into account all of those elements that make a 20 year old different than a 26 year old or a 50 year old. These would be my criteria:
I must be sold on taking you on as a patient. I must have faith that you know enough about the process (over time) to appreciate the things I said above. Although I rarely do a hair transplant on someone under the age of 25 (I do some), the concept of your becoming a Class 7 balding man is the worst case for both of us. You do not have to become bald to get hair as that would be unreasonable on my part. Are you prepared to manage the worst case in a cooperative manner with me?
To state emphatically that you are not a candidate for a hair transplant is an unduly hard position. Each and every patient needs to be assessed individually, weighing all of the elements above (and everything else that is relevant) before any decisions are made. I try not make decisions about any of my patients on any one issue, including age. I want to get to know the person inside the head, well beyond what is evolving on top of the head.
i would like information on moustache restoration as mine is thin
The use of hair transplants for the moustache is relatively easy to do technically, but may be more difficult from a planning point of view. The hair usually would come from the back of the head and you therefore must be reasonably sure that the character of your hair from the back of the head will look like your existing moustache. If you have a coarse, brown haired moustache and fine, blonde hair in the back of your head, a transplant using scalp hair might not be the right decision. To get around this, one could use pubic hair which is more coarse than a fine character scalp hair transplant. Get an expert to find out what is reasonable.
