Category: Hair Transplantation

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Hair Transplant for Pro Soccer Player – Hair Loss Information by Dr. William Rassman

Hello Dr Rassman,
Your site is very helpfull and I appreciate what you are doing to help and support those who are suffering with hair loss.

I am a 22 yr ol male and I play professional soccer in the UK and am seriously considering coming over to you for a consultation in hope of having a hair transplant. I was wondering however if the surgery will affect in the long term my ability to head the ball and my sporting performance and also if taking propecia will affect my performance. I look forward to hearing from you.

SoccerFirst, be aware that Propecia is banned for many professional sports players, because it masks steroid use. A hair transplant will not stop you from engaging in full sports within a couple of weeks after the surgery. “Heading” the ball should not be a problem either. If you want to get to full sports in a few days after surgery, you might be a candidate for FUE as a harvesting approach.

Please send me pictures showing the degree of balding and I can be more informative. Your confidentiality is convered under laws that protect you when dealing with a doctor.

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From Bowling Ball to Gorilla (with Photos) – Hair Loss Information – Balding Blog

Patient ZU is in his mid 60’s and he is what we call a Class 7 Norwood scale balding person (click name to see his before picture). He came to an open house last week and he has now filled out nicely. He told every person at the open house that he looked like a ‘bowling ball’ before his hair restoration, smiling as he made that reference. I talked about him before on this site (and posted some photos), but when last I spoke of this patient, I had said I’d post updated photos of results from his last procedure when I got the pictures. Well, now I have them. He had a total of 8,300 grafts. Would you believe that he still wants more hair? The crown area needs more fill and his comb-back styling is now working well for him, but he believes that with more hair it will work better. I guess when you have been deprived of hair for 40 years, you may over-react. Patients continuously tell me that when it come to hair, like money, more is better.


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I Have An Egg-Shaped Head – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

First off, I’d like to thank you for the informative blog. I’ve been able to get an idea of what to expect and what to ask for. Always a good thing.

I’m a 22 year old male with a Pattern 3 hairline. I’ve always had a fairly high forehead, as well as an egg shaped head with temples pretty deep into the sides, so my current receding hairline doesn’t do me much good considering I work as a model. My father is in his late forties and starting to get to Pattern 3 Vertex, we have the same head shape and both started receding around the same time, our late teens. I’m considering getting my scalp mapped out when I return to Toronto [I travel a lot] and see what to expect. I should mention that I have very fine straight hair.

I’m wondering if you could let me know what options I have considering my head shape, as well as age and hair type and also if you have any doctors you can recommend that are in the Toronto area.

I look forward to your reply, thank you for your time.

The shape of the head is often more of an issue as hair is lost. A good head of hair hides the wide variations of shape that makes us each far more different than we think. Hair transplants do address head shape, because it allows men to go back and hide their peculiar shape under a mat of hair. Sounds like you will follow your father’s pattern. Toronto has some very good and some not-so-good doctors. I always tell patients that the axiom is Buyer Beware, so follow the guidelines I wrote about on how to pick a doctor (see: What To Look For In a Doctor). You can find a list of doctors in Toronto or for any other place by using the phsyician search at ISHRS.org.

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Continued Balding After a Hair Transplant – Hair Loss Information by Dr. William Rassman

What happens if you continue to bald after you have had a hair transplant?

There is no doubt that everyone that has had a hair transplant will continue to lose some hair. The question is not if, but when and by how much. It has to be put into perspective with your appearance over time. The correct answer to the question is that the first transplant must be done according to a Master Plan, one that anticipates further hair loss so that the look you evolve into will always look natural. If the look is not going to be natural, for whatever reason, then your doctor MUST tell you this at the time he/she performs the transplant. There is a logic to both the balding process and the transplant process and these two processes must be coordinated. I can not go into all of the possibilities of this on the blog, but I wrote a book on the subject which covers the process in great detail, titled The Patient’s Guide to Hair Restoration. Mapping out the scalp for miniaturization may tell you something about what the future has in store for you and you need to have as much anticipation of what may be as you can get.

Just the other day a young man came in to show me his progressive hair loss since his hair transplant at NHI nearly 5 years ago. Much of the remaining frontal hair (going back about 4 inches) is transplanted, but the non-bald areas are receding further back behind the transplanted frontal hair (he moved from a Norwood Class 4A pattern, more towards a Class 5A pattern). He had been told that this could happen and was put on Propecia to minimize either the possibility that this will happen or at the least, the speed by which it might happen. Unfortunately, he had stopped taking Propecia after the transplant was done, because he felt it was not helping grow more hair and since his transplant looked so good he had a false sense of security. Had he continued taking the drug, the progression may not have happened. I don’t know that for sure, though. He elected to now go on Propecia again to prevent further progression, but may be stuck having to undergo another transplant to fill in the areas he lost if the drug does not reverse it in the next 8 months or so.

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Laser Comb and Transplants – Hair Loss Information by Dr. William Rassman

Hi there. I am a 25 year old UK doctor (straight black hair/olive skin). I first noticed hair loss about 4 years ago. It has progressed at a slow rate. I have not receeded at all but am a diffuse thinner – the main areas are at the front-top of my head (about 1.5 cms behind my adequately thick frontal hairline) and also at the crown.

My hair looks quite thin in these areas when wet (with very visible scalp) but if I blow dry my hair and wear it choppy/spiky/drawn towards the middle, it still looks good and my friends/family don’t think I look bald. I started propecia (with full compliance) 2 years ago with a good result – pretty much halted hair loss and possibly even grew back a little hair in the thinning areas.

However, over the last couple of months I have started to thin a bit further in these areas. I am considering buying a laser comb. (Not keen for topicals).

My questions to you are:
1. I know the laser comb currently has no FDA approval for hair loss but does have good(ish) reviews – do you think it is the most logical next step or should I go for minoxidil?

2. Transplants – (which I realise would be a bad decision at my current level of hair loss): It sounds like for a successful transplant I will have to endure a period of going almost entirely bald first in order to assess what needs filling in and to avoid just losing original hair around the transplants over the following years – is this true or can you transplant around thinning hair?

Thanks

From your writing, it appears to me that you are experiencing male genetic hair loss which has responded to Propecia. I am glad to hear that you have been compliant on Propecia for 2 years, but as you know, Propecia may not solve the problem completely. The science is out on the various laser treatments including the laser comb/brush. As for the minoxidil, you can try it, but I would not recommended stopping the Propecia.

In terms of the hair transplant, there is a delicate balance of timing here. People do not have to go bald to get hair transplants, but preventive hair transplants are not indicated unless the thinning has moved past a particular point (something that a good, honest doctor who specializes in this field should be able to tell you). Patience is a virtue, but failure to make a timely decision is a liability. Quite a balancing act! You need to have your scalp hair mapped out to find out how far back the miniaturization is going, so that you can develop a Master Plan before attempting any surgery.

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Difference Between FUT and FUE – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman,
Thank you for the very informative blog. My question: what is the difference between FUE and the strip surgery? What are the advantages and disadvantages to each? And do you perform both procedures?

Briefly, FUE is more expensive and time consuming and will yield less hair grafts due to the longer procedure time and technical complexities. FUE, however, does not leave a linear scar seen in the “strip” surgery. The traditional “strip” surgery is more suited for large hair transplant sessions. It does produce a linear scar, but with new scar reducing techniques such as the trichophytic closure, it is a great surgery for patients who want the most hair in one session.

Finally, our surgeons at NHI are very proficient and well trained in the FUE and the “strip” procedure. In fact we wrote the pioneering medical article on Follicular Unit Extraction (FUE). And way back in 1998, Dr. Jae Pak (with his engineering background) and I had developed an automated video FUE technique, which was awarded a U.S. Patent.

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I Can’t Take Propecia, I Don’t Want to Bald – Hair Loss Information by Dr. William Rassman

Dr. Rassman, what approach do you take with young men who are not able to take Propecia. Do you never do transplants in them? Do you sometimes do transplants? I am a norwood 2 going on a norwood 3. I am considering getting small transplants to keep up with my hairloss starting in about a year when I will be 23 years old. Is is a bad idea? Going bald is not an option for me, so its either transplants or a system.

I hope you read the blog entry from last week where a patient whom I did not recommend getting a hair transplant was not happy with my recommendation and got a hair transplant from another doctor. Now he is worse off and more bald because he lost more hair due to shock loss.

I would not normally recommend a hair transplant to a Norwood class 2/3, but every patient is different and it would be impossible for me to give you personal medical advice without a person to person consult. You may be a Norwood 2/3 now but without a good exam and a good medical history, there is no way of knowing what Norwood class you would be at the age of 50 (this is where the Master Plan comes in). If you have miniaturization in the areas behind the frontal corners (like the top and crown of your head), then it would be suggestive that you are in for a lot of balding in your future and fixing a Class 2 pattern may not be good timing just now. Alternatively, if there is no miniaturization in the rest of your head and your family history does not show advanced balding, then maybe with the right doctor / patient relationship, a hair transplant could be considered. I am not excited about the idea of doing a hair transplant on someone with such a pattern and at your age, because the pattern of your future hair loss is not going to show up for another few years.

I would also question why you are not able to take Propecia.

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Hair Loss InformationTransplanting Chest, Leg, and Thigh Hair – Hair Loss Information – Balding Blog

I have read some doctors preaching the use of chest and leg hair for hair transplants. I have also read your comments and general lack of enthusiasm for this. What is behind your strong opinions against this?

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Scalp hair is better understood and tested for over 50 years. Although the art form has only been reasonable for the past decade or so, the facts concerning hair growth from a scalp source as donor hair are well understood. It is always important for me to inform patients about their risks, expected growth rate, and reasonable results that they should target. We have no body of evidence that hair taken from body or leg parts will work to any reasonable degree, but there seems to be (as P.T. Barnum said) a sucker born every minute. I do not want to be part of such a process, at least until it is clarified as something real.

In the book by Elise A. Olsen, Disorders of Hair Growth, the rest cycles of hair are stated. Although I can not attest for the science of these figures, let’s take them at face value for a moment and see what it means if correct. All hair cycles go through various growth phases, so the length of these growth phases are critically important to understand. For head hair, growth cycles range from 2-7 years, with a sleep period of 3-6 months. Generally it is believed that head/scalp hair is in its resting phase for about 10% of the hair population, which means that of all hairs growing on the head, another 10% is lying dorment awaiting its growth phase.

  • Leg hair has a cycle between 7-12 months, but between 62-88% of these hairs are in their dormant phase.
  • Thigh hair has a cycle of 3-5 months, but between 64-83% of these hairs are in their dormant phase.
  • Arm hair have a cycle of 3-7 months, but between 72-86% of these hairs are in their dormant phase.

With chest, arm, and body hair, the above numbers suggest that there is a large number of sleeping follicles at any one time. If this is true, then there will be questionable value from a hair transplant using these body parts from fullness or coverage point of view. Add to that the pain of hundreds or thousands of small wounds created all over your body might produce. I wonder about the doctors who are routinely performing this type of surgery and ask about their motives. I have concluded that any doctor who offers this must let his patient know that this is not a tested procedure, falling in the experimental rather than the clinical hair transplant offerings. I’d also hope they reveal the figures related to sleep cycle of the hairs from the various body parts as discussed above so that their patients are well informed.

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Avoiding Hair Salesmen – Hair Loss Information by Dr. William Rassman

SalesmanI just saw a 23 year old man come back to see me after he had a hair transplant with another medical group known for ‘overselling’ hair transplants using pressure tactics with an aggressive sales force. He had seen me just a few months earlier and I told him that I felt that he was not a good candidate for a hair transplant at this time, because he was too early in the hair loss process. I further told him that if he had a surgery without a course of Propecia, he might accelerate the hair loss. I thought we had agreed that he would go on Propecia in an attempt to slow down the hair loss he was experiencing and then return in 8 months for further evaluation.

He went to another doctor for another opinion and then, under pressure by their salesman, he had a hair transplant. On his visit with me yesterday, it is now 5 months after his surgery and he looked fairly bald now, with a reactive hair loss. Prior to his surgery he was a Class 3 pattern balding and now he showed a full Norwood Class 6 pattern. The 1000 grafts he received at the surgery were insignificant in view of the hair loss he had. The patient never took the Propecia (which might have protected him from the loss he experienced).

Some clinics still exist today who ’sell’ hair transplants like a used car. This young man is now hooked on the hair transplant process, like it or not. Will he ever be normal? Will his supply of donor hair meet the demands of his progressive balding? Will he have enough money to follow the course he is now on? Did he ever really have Informed Consent offered to him? What are his options?

I am not going to answer these questions, because by posing them I have in a way brought the purpose of this blog entry to your attention. For those shopping for a hair transplant today, it is still appropriate to warn: Let the buyer beware!

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Itchy Scalp After Transplants – Hair Loss Information by Dr. William Rassman

I am a 53 year old male who was blessed, until November 2004, with a mostly full, but fine head of hair. At Halloween, I put hair coloring in my hair for a costume, did not wash it out until the following Monday morning (the color came out when I slept and I did think about the chemicals still being there – when I read the can later, it said not to use on fine hair – I was extremely mad at myself). Anyway, I had six weeks of an itchy scalp and some hair loss with it.

This past summer, I had another 8 week bout with itchiness and even more hair loss- I started using tea tree oil shampoo and creme rinse, and Jason’s thin-to-thick shampoo and rinse, as well as putting jojoba oil with tea tree oil into my scalp at night. I visited two Chicago area doctors who told me itchiness was part of the active balding time and nothing was wrong with my scalp. I visited them after this bout ended, with loss that I now wanted to do something about. I decided to go to female doctor at the end of October 2005. Everything went fine until a couple of months ago, four months after the transplants. I started to notice hair coming in, but then the itchiness/sensitivity started. I thought that was just irritation from the new hairs, but then I started to worry that maybe this was not the case. Anyway, the hairs placed deeper in the middle front and the majority of the right side transplants came in, but the front middle (new V) and the front left side mostly did not. I am very unhappy about this, and I just hate this feeling of itchiness /sensitivity that is only on the left side this time. (two months and running-getting better) I was / am taking propecia three times a week, as I had a lowered libido with daily use. (Dr. told me to go to 3x a week) I was not using Rogaine until a week ago, where I started to use Scalpmed, another minoxidal product.

Do I possibly have some stress loss of new hairs? Should I go back to using Propecia more often? I can accept the more frequent use until the hairs come in, if they still can. I was told by an assistant than it will take 18 months for the complete result.

I am in great need of some guidance. Thank you

If you have a good doctor, you should be discussing these things with that doctor. You asked about itchiness and was told that it is caused by male pattern balding. That is not the case as there is no evidence that the two are connected directly unless it is the result of sunburns or other things that dry your scalp skin. You had transplants about 7 months ago. I generally tell patients that 80% of the results will be in by the 8th month and 95% should be in within a year. If one side grows slower than the other, that is ok, but if one side does not grow and the other side grows out well, then the technical people placing (different technicians placing the grafts into the different sides of the transplanted area) may have caused a problem that killed off hair. Less skilled technicians may damage the grafts when moving them around or take longer to place them and in the process of placing the grafts, they just dry them out (just 10-15 seconds exposure of these grafts to the air can kill them). Wait out the full 8 months first before thinking of the worst.

Taking Propecia three times a week makes no sense to me, because it is completely out of your body in a day. Taking 1/2 tablet of Propecia each day has about 80% of the benefits of taking a full tablet if you have a libido problem. Rogaine (which is minoxidil, also contained in ScalpMed) can dry the skin and make it itch and that is not commenting on the other additives in each of the commercial products containing minoxidil. Propecia will have no effect on the new hairs, nor will the minoxidil impact the hairs from the donor area. I think that you need to sit down with your doctor and get answers from your doctor, real answers and not be talking to his technicians. This is what a doctor/patient relationship is about.