Hair Transplantation – Page 180

February 21, 2006

Not Satisfied With Hair Transplant – Hair Loss Information – Balding Blog

I had 1000 fue 13 months ago — 850 in crown and 150 in front middle of my hairline. I have had reasonable results on the crown, but you can still see a bald patch on my hairline. 150 were placed in a small area in the middle of my hairline, but only approx 50 have survived. A slight wind and it looks like a middle part. Do you think the clinic I went to should rectify this?

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Any individual clinic is not required to replace what does not grow, but doing so is a good business practice. As you know, a hair transplant is a surgical procedure. There are two causes for non-growth:

A technical failure in the hands of the surgeon or transplant team (common when it happens). Team failure is most common because the majority of the graft management is in their hands. A good quality control process is required and many doctors are just not that type of manager. A transplant is only as good as the weakest person on the team. The term for this failure is “H factor” (human team factor).
A failure on your side for healing, skin problems, diseases (such as autoimmune disease), poor blood supply (rare but made worse if the surgeon does not use proper judgment in creating the density and matching it with the ‘hole’ size used).

The public tends to think of a transplant as a commodity, offered by various clinics with a marketing program to ‘sell’ and ‘sell hard’ whatever solution to balding and vulnerable patients. I am not against these clinics at all, but realize that a few of them will give you a better quality of work than you may be able to purchase from a doctor who does one or two such surgeries per month. The doctors who dabble in this do not have an organized team, so either they reduce the size of the transplant sessions to match the team, or they develop sub-standard techniques that are not at the state of the art. Some of the larger clinics with many offices, have variable quality of teams (in turn, equals variable qualities of work). I have seen the same national U.S. clinic produce good work from one office and almost malpractice work from another, yet each office publicizes the best sum result of all the offices put together. I have two offices now, one in Southern California (14 years) and one in Northern California (10 years), so quality control has never been the problem for us.

February 17, 2006

Slowly Losing My Transplanted Hair – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I am a 49 year old man. I had a transplant of 1800 hairs about 4 years ago. One year after the transplant, I was very pleased with the result. In fact, it looked so good that I resisted the temptation to do a second “fill-in” procedure. Everyone commented on how great it looked.

But since then, I have been very slowly losing my transplanted hair. It watch it very closely and I see the individual hairs miniaturize and then finally disappear. I estimate that I have lost 25 to 30 percent of the transplant. I would like to get another transplant but feel like there is no point if the hair will eventually be lost.

I have an excellent diet and health and also take Propecia. I was led to believe that I would keep my transplanted hair forever…

Could you give me some advice?

Thank you!

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Most men who report this are actually seeing the original hair population drop out, not the transplanted hair. Losing transplants over time is rare, but if it is really transplanted hair being lost, the miniaturization will be evident in your existing donor area. By mapping over the donor area for miniaturization, that diagnosis will be evident. See our article referring to Diffuse Unpatterned Alopecia, which states:

The diffuse androgenetic alopecias, that we will refer to simply as DA and which consist of Diffuse Patterned Alopecia (DPA) and Diffuse Unpatterned Alopecia (DUPA), can be further divided into various stages of progression with DA 0 representing the pre-balding state. The earliest stage of loss, in these diffuse alopecias, DA 1 , would be characterized clinically by a “slightly thinning” look in the front, top, and vertex, best visualized under strong lights or when the hair is wet. At other times it might not be noticeable. Almost all patients have subjective complaints of less fullness in the affected areas. Preliminary densitometry studies in the thinning area of these patients have revealed miniaturization to be in the range of 20-50%. DA 2 represents the stage when there is obvious thinning evident under normal lighting, but if the hair is styled properly, the degree of hair loss may be acceptable. Miniaturization for DA 2 is on the order of 50-75%. Patients with DA 3 have significant hair loss in the transplanted area, and the coverage it provides is no longer adequate. The frontal hairline, though still recognizable in it’s position as the mature hairline, does not have enough density to frame the face. Miniaturization in DA 3 is usually around 75-95%. The DA 4 patient has lost most of his terminal hair in the balding area (miniaturization > 95%), generally has involvement of the crown, and is similar in appearance to the typical Norwood Class VII.

We feel that the early identification of the diffuse alopecia patient is important in order to screen out those who will not be surgical candidates. In addition, because the diffuse alopecias are often associated with a rather rapid progression through the four stages described, the young patient is often not emotionally prepared for this degree of hair loss, especially with DUPA. Long-term planning and careful patient counseling is, therefore, critical before any restoration should be considered. We have not yet determined the exact incidence of the diffuse androgenetic alopecias in the general male population, but they appear to be significantly more common than are the Norwood Class A’s.

It is possible that in many instances diffuse, unpatterned alopecia is not a true “androgenetic” alopecia at all but actually represents a similar pathophysiology to what has been termed “senile alopecia,” 2 only occurring at a younger age. These authors evaluate the donor area for a miniaturization in every person consulted in our office for hair loss. We believe that some degree of clinically significant diffuse androgenetic alopecia occurs in a substantial number of men as they age. We have observed this in men as young as 17. Regardless of what the actual pathophysiology might prove to be, these authors believe that it is important to make a quantitative assessment of miniaturization , using densitometry, when evaluating each patient so that the physician can more accurately determine the total available supply of stable donor hair.

February 17, 2006

Doctors Pushing Transplants to Norwood Class 2 Patient – Balding Blog

Dear Dr. Rassman,

I’m a 22 year old male. I’ve been thinning since the age of 17, to my knowledge (probably a little prior) and have maintained my hair, somewhat, it’s thinner as time goes by but i have used lexington’s lasercomb for 9 months and have not lost any more hair and my crown actually got thicker,
but the front has stayed the same (no complaints). I would classify myself as a NW2, but no bald spots, just much thinning in a NW5 pattern, you can clearly see the pattern if you look for it, but i am wanting to get an HT to give myself a natural look. I visited a clinic here and they say with 1500 to 2000 i would be okay, and i agree but only if i do not continue to thin.

I am just concerned that, although i am maintaining quite well right now, would under going a procedure induce loss? I would think without treatment, yes? But how many individuals are on a treatment and halted their loss, but still have shock loss? Ideally, I would like to get this done, and maintain the results, but my concern is that I’ll lose my natural standing hairs and the HT will look horrible and pluggy and i’ll need to play “catch up”. What do you think? I realize I’m young, but if it wasn’t for being able to control my loss, i’d not consider an HT, as that would be ridiculous if you can’t maintain your hair prior at this point.

Thanks for your time.

If you are a Norwood Class 2, then I find it a poor practice for a doctor to recommend transplants in someone at your age. You are correct to be concerned about hair loss and the things that might go wrong. Starting too early is just asking for trouble.

Shock loss following a hair transplant occurs more often in patients under 30 years old, more so if they are not on Propecia (probably 80% risk). You may not have a noticeable improvement from doing a hair transplant at your age and may only see the down side without seeing any short term benefits. Better to wait until you can determine your true pattern of hair loss.

With what you are telling me, I might think that the doctor is thinking more about his/her car payment rather than your hair and what is best for you. Once you start this process, you are committed for life on a hair transplant timeline without a Master Plan. I am not saying that your doctor is unethical, but I’ve heard about these types of situations before. Please read more about doctor ethics in past blog entries:

February 17, 2006

Gap in Right Eyebrow from Cyst – Balding Blog

When i was younger about 10 i had a cyst develop on my eyebrow. They hospital removed this cyst but there was a fairly wide gap on my right eyebrow which will not grow back, is there any possible way i can get hair on my eyebrow like a transplant?
thanks

Hair transplants are a good fix for this as they can fill in the gap of your eyebrow. I do not believe any medicine will help in your case. Some examples of eyebrow transplants can be found here, here, and here. For past blog entries about eyebrow transplantation, please click here.

February 16, 2006

Actor Salman Khan and Hair Loss – Hair Loss Information by Dr. William Rassman

NOTE: I do not know who performed hair transplants on Salman Khan. I get many emails asking who did his surgery, and I have no idea. Sorry.

Dear doc,
Have you heard about Salman Khan, the most famous Indian actor? He is open about undergoing a hair transplant. Might help us if you have some information. Thank You.

ps: Thanks, you are doing a wonderful job which will earn you good Karma

I looked at his website and I did not see his present balding problem, so the hair transplant appears like a good one, at least from the pictures shown. I do not have any information on Mr. Khan, however.

Celebrities need image for much of the persona they create for their professional career. I have transplanted many of them in my Beverly Hills office so I am very familiar with the mind set and the importance of image on career. Some of the actors who were at the beginning of their career believe that the hair transplant was pivotal because of the confidence they got in themselves when they returned to their normal hairlines (at least their image of what they thought their normal should look like). It is difficult to be creative and free if you are bogged down with issues of self confidence and as looks are so important in the modeling, TV and movie business, I have found models and actors far more courageous and driven than the typical man who suffers from image in silence.

February 15, 2006

Making Grafts Finer for Eyebrow Transplantation – Hair Loss Information by Dr. William Rassman

is it possible to transplant finer, smaller or thinner eyebrow hair follicles in areas surrounding or outside the edges of the thicker darker hairs of the eyebrow?

You can decrease the diameter of the hair follicle (make it finer) by damaging it in a controlled manner during the transplant procedure. This may reduce the survival of some of the hairs, but the procedure works well only in very experienced hands.

February 9, 2006

Hair Transplant in Young Adult – Hair Loss Information by Dr. William Rassman

When I turned 18 I noticed that my hairline began to recede a bit and as the months went by my hair got thinner in the frontal area of my scalp & still getting worse. I tried Rogaine for a while but it irritated my scalp and caused flaking and I didn’t see any results, I was also on propecia for 2 ½ months then later stopped (kinda expensive). A month ago I saw an ad on tv about this product called scalpmed, (& it looked really convincing believe you me) they say its better than propecia & rogaine with no side effects. When I told my parents about it they were willing to support me but when we visited the website there was no return address, and I tried calling their customer care # and there was no answer. Now my mom gets the impression that it must be a scam or something. Basically I am just frustrated, but I would like to know the procedures taken in your hair transplants? is it safe for my age? How much will it cost? I hear its expensive. I just think transplant might be the only solution right now. Finally I hope I didn’t take up your time Dr and am looking forward to hearing from you.

When tackling male pattern balding, do not experiment and lose valuable time. Drugs like Propecia work best if early hair loss is treated, so time works against you and transplants in a person under the age of 24 (mostly) may be too soon to develop a good Master Plan for your eventual ending hair loss pattern. I generally discourage transplants in some men when I can not ascertain the final hair loss pattern. You need to have a diagnosis, so mapping out your hair for miniaturization is critically important to get a base line for the diagnosis and treatment. After 8 months of Propecia, you can get another assessment for miniaturization and see if you gained hair numbers and hair bulk.

If you are in California, come by for a consultation. Then we will put the entire power of what I know to work for you.

February 7, 2006

Hair Transplants in Women vs Men – Hair Loss Information by Dr. William Rassman

I’m a 45 yr old woman who has been slowly losing my hair over the past 20 years. Currently, I have the typical female baldness (not completely bald, but lots of scalp showing through) just past the hairline. Blood tests revealed no thyroid issues, but I’m well on my way to menopause as far as hormone levels. I’m healthy as far as diet and exercise, have normal stressors in life, take no meds. There is no history of female baldness in the family, but my mother has always had thin, fine hair. I’m about ready to go the transplant route, but keep reading that it could be hormonal or vitamin based. My ob/gyn and dermatologist are both at a loss to explain it as other than bad luck. How do I know for sure if I’ve exhausted every avenue before resorting to transplants?

You must have the complete work-up of tests (see Female Hair Loss for info) and then get a good, caring, competent, and ethical doctor who understands when a transplant can help and what it will do for you. Setting realistic expectations is critical. Woman’s hair loss is very different than men’s hair loss with regard to the judgments and artistic distribution for transplantation. I use the metaphor that it is easier to make grass grow on an empty lot, than it is to make a green lawn even greener. Bald men scalps are like the ‘empty lot’ , so any hair artfully placed and distributed is easily appreciated. Women are more like the green lawn and making it greener is difficult as expectations may not relate to the reality of what the transplant will bring. That is why a choice in the correct hair transplant surgeon is so critical. You must be confident that the surgeon is going to give you transplants because it will help you, not just to put money in his/her pocket. Like all industries, the axion: ‘Let the Buyer Beware’, prevails.

February 7, 2006

Temple Hair Transplant – Balding Blog

Between the ages of 20-23 I went to an Norwood 2. Since the shedding of the hair at my temples, my hair has thickend elsewhere. Can a hair transplant be done just at the temples? Who could I contact for such a procedure?

What I am about to say relates to your age of 20-23. I would recommend first that you get your hair mapped out for miniaturization to determine the degree of the genetic hair loss that you have now and to get a good baseline for future reference. Then, based upon that examination (under the direction of a doctor), you may start on Propecia for your hair loss and take it for at least 8 months to 1 year and see if the temples return to the levels you want. Propecia may help regrow hair in the temple area. At the very least, it is worth an attempt. Beware of any person who would recommend surgery for you because he/she may not have your best interest in mind. I feel strongly that a trusting, supportive doctor-patient relationship is necessary in the hair restoration process. If you have any questions about the above information, I would be happy to answer them by email, telephone, or in person. If you live too far from California, I am more than happy to try to recommend a dermatologist in your area. I can be reached by phone at 800-NEW-HAIR.

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February 3, 2006

Hair Loss Information » Lichen Planopilaris and Hair Transplantation – Balding Blog

I am a 55 1/2 yr old female. I have been diagnosed with “lichen planopilaris”. I am tired of scalp injection. My doctor said the next step is probably 3 hair transplant. There seems to be no information on this disease. Is there anything else that can be done? In addition, I am on a generic rogaine formula. April will make 1 yr. on this product.

Any advice? Also, I know the cost for a transplant vary with different results.

See DermatologyChannel.net for more information on this disease. The problem with transplantation is that if the disease is active and is autoimmune in etiology, then a hair transplant may be doomed from the start. Inactivity of Lichen Planopilaris in the autoimmune arena must be determined before starting the costly hair transplantation process. If you and your doctor believe that it is under control and inactive now or sometime in the future, a test hair transplant with a limited number of grafts (about 10) taken with an FUE approach will tell you if a larger hair transplant procedure will work. Either these grafts will fail to grow (indicating that the disease is still active from an autoimmune perspective) or they will grow (indicating that the disease has become inactive). It should take 5-8 months to determine success or failure of the transplant. For those people who have an autoimmune cause, reactivation of the process is always an added risk.