Crown Transplants or Propecia? – Hair Loss Information – Balding Blog

Here is an example of a patient of ours who refused to take Propecia, but had 2,027 grafts transplanted in 2001. He had a remarkable change from the transplant, even filling in some of the upper part of the crown. At his recent visit a few days ago, I suggested again, that he try Propecia before undergoing a hair transplant, even though his results from the single procedure he had was remarkable. Much of the original hair in the upper crown that he had a few years ago, fell out. But even if the transplants still saved the day, he may have avoided the loss with Propecia.

Why would I suggest Propecia rather than transplants? First, I tell my patients that I make my living doing transplants, so if I recommend the drug approach rather than a transplant, I must be thinking of something other than the money I might make from the transplant. The answer should be obvious to the readers. I care about what is best for the patient. The drug, in many patients, will postpone or make transplants unnecessary. If this man succeeds at regrowing hair in the crown with Propecia, he will avoid surgery, saving money and donor hair for some time down the road when/if he might need it. A doctor should always put his patient’s interest first and foremost and if this young man was my son, that is what I would recommend for him. If the drug does not work, then a transplant is a reasonable option. He should wait for 8 months before facing that decision again. He was very appreciative.

Below: His “before” photo in 2001 is on the left, and “after” photo in 2005 is on the right.



Hair Loss InformationHair Obsession – Hair Loss Information – Balding Blog

i have had a full head of thin, wavy hair most of my life, and am now 53 years old. I had some loss many years ago from using alcohol based mousse, and had one transplant(okay). Recently, I had some hair color (nasty alcohol based stuff from Walgreen’s)in my hair for Halloween 2004. Anyway, I left it in for a day(extremely stupid), and then had several weeks of an itchy scalp in December, which I treated with tea tree/jojoba oil. I noticed some hair loss in January, had 1000 grafts put in and now I just had another ” greater loss” bout in July and August of this year, which I am extremely unhappy about. I now have a minor tingling on the left side of my frontal area, and I am extremely parnoid I am losing more. I am using tea tree oil shampoo/conditioner. I went to back to the doctors who did my transplants, who told me I would look worse if I had not been given the 1000 grafts, which I have a hard time seeing where they are.(as some were supposed to be put in the area that has receded!)I asked to possibly get my old hairline back, and the doctor said that only celebrities and media people only wanted a “1”, and now me. They offered to put in another 1000 grafts for $4/graft, but I want an effective job this time, asI do not have unlimited donor area. The more I think about it, the more I am insulted. The doctor said I had no infection/disease in the scalp. I want more work, but done right. PLEASE, PLEASE ADVISE.

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You are hair obsessed. Please don’t take this comment the wrong way, but you are probably causing your own problems because of this obsession. I too would be insulted if the doctor who precipitated reactive hair loss with the second transplant (that is what it sounds like), told me that I needed another one at a discounted price to solve the failure of the last transplant (which was supposed to solve your problem). Sounds more like a huckster is playing you for your hair obsession and selling you hair like you needed a new car.

On this blog, I often say that you need to have a good doctor make an assessment of what is really happening to you. This is a buyer beware field and it is easy to sell hair to a hair obsessed person like you. I am not saying that you did not need a hair transplant, but it sounds like you were not clearly informed of what you were buying into. I often take a stand against transplants when I am not convinced that hair transplants will address the problem. I am rarely wrong but some of the patients who I turn down just go to another doctor who might be enthusiastic to take his money. Talk to a good doctor, not a huckster and find out what happened and what is going on with your hair problem.

Hair Loss InformationNo New Growth 10 Months After Transplant – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

About 3 months ago, I wrote to you concerning my situation at 7 months post-op. I had diffuse thinning in the frontal area and was a norwood 3 prior to surgery, and had 1700 grafts put in. At 7 months I was looking thinner than before my surgery, and could only find a few new hairs that were growing in, all very small (less than 1/2 inch).

Now, at 10 months these hairs (i can find only about 10) all seem to be the exact same size as they were at 7 months, and I have seen no new growth. This is very frustrating for me and I was wondering what your thoughts were. I took your advice and went to see one of your colleagues in San Jose, and he told me that I should wait until a year has passed to judge my results. But why do these hairs seem to be growing in so incredibly slowly if at all? If you could just mention what some of the possibilities may be I would greatly appreciate it.

Thanks for your time.

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To keep the blog readers up to speed, your original question (and my answer) can be found here: Transplant Failure To Grow.

You should see growth by this time. I would suggest that you make an appointment to see me personally. I will try to judge what has happened. Please try to get the preoperative pictures from your doctor so that I can make a judgment as to how much original hair was there at the time of the transplant. That will help a great deal because sometimes when people report these complaints, they lost much of their natural hair and the loss may cancel out the gain. Alternatively, the growth of the transplants can be estimated by someone experienced in this field.

Hair Loss InformationFilling In Thinning Areas – Hair Loss Information – Balding Blog

I have a question. I would like to know if areas which are only slightly thinning can be filled in as most doctors will not do this. Also laser therapy,does it actually regrow hair and is it worth spending my money on. I hope you can answer my questions. Thank you kindly

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Transplantation of hair is generally not a good option to take just to thicken an almost normal head of hair. Hair lasers (called Low Level Laser Therapy) is gaining popularity. Many article writtin in Europe indicate benefit from LLLT and one new article in the US in a new medical journal has suggested benefits to this therapy. A study I am aware of is presently being done will conclusively establish the value of this modality shortly.See my extensive written piece on lasers here.

Hair Loss InformationBody Hair Transplantation – Hair Loss Information – Balding Blog

Two different BaldingBlog readers had two similar questions…

Dr. Rassman,
recently some hair transplant surgeons reported very good results from body hair transplants. Other doctors remain more cautious and say it may yield good results in some, but not all patients. What’s your view on this?

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Dr. Rassman,
Would you ever consider using bodyhair for some of the grafts in the scalp? I was wondering because it would seem a good way to increase density results. I am a bit paranoid about using only scalp hair to graft because I would not want to run out before getting decent density. I would think that you could mix in some sideburn or beard hair with regular scalp hair in the crown. What is your take on this. Thanks for your time.

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Body hair has generally low densities (contrary to what it looks like on some men) so they do not make for a good donor supply in terms of quantity. A focus upon head hair should be primary. Then if you run out, moving to other body parts may be reasonable, especially as some studies are now appearing that indicate that this type of transplant works (leg and body to head or neck). What is still missing is the yield rates from the leg or body and the growth success from these areas.

As far as using sideburn or beard hair, this is an option in certain circumstances. They should only be considered as a last resort, when all usuable scalp donor hair is used. The other time that sideburn or temple hair can be used is when a patient is going to have a face lift and the sideburn/brow area is going to be excised as the brow is raised up.

Until the research information about body hair transplants is in our hands, it must be looked at as if it were human experimentation. A number of our patients have volunteered for this, so I am clearly interested in following the experience of others who I trust and then possibly get involved myself. I just do not want to sell hype and disappoint anyone.

I have performed one body hair transplant. The transplant was done from the abdomen to the eyebrows and it failed to yield hair in 10 months. I lost contact with the patient so I do not know if the transplant showed delayed growth or reflected some mechanism that caused it to fail. What I believe is that we need better scientific evidence on the following questions:

  1. Does it works reliably 100% of the time?
  2. If #1 is true, is that for all donor sites?
  3. What is the yield of viable grafts?
  4. What are the risks of body scarring / complications?
  5. Is it cost effective?

I would want to see many successful patients before I recommend it routinely for my patients.

While I can perform body hair transplants, I choose not to until they have been proven as a reliable procedure. If I make representations to my patients, I must be able to support what I say. If I embark on body hair transplants now (even on a limited basis), my patients must know the many uncertainties associated with the procedure. Until my comfort level is higher, I will not be doing body hair transplants.

Hair Loss InformationHair Transplantation in Filipino Man – Hair Loss Information – Balding Blog

I am a filipino male with brownish black hair that is semi thick in nature. My hairline is receeding and would like to have the FUT procedure done. but before this takes place, have you done this procedure on clients that fit my description, and if so, may i see pictures of them? may i also call them if possible. as far as medication goes, do i need to take propecia, rogaine or any other prescription? because i rather not. my next question is time off work. because i am self employed and serve clients face to face i can not afford to take more than 5 days off from work. is there way to discreetly hide my surgery as it heals? my last question is i enjoy having my hair cut very short, is possible to do that without showing that i have had hair transplant surgery? do you have pictures of your clients like this?

thank you

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What you have is typical for our practice. Our website has many, many patient pictures of what you are talking about in our Before and After Photo Galleries. Our monthly open house events allow you to meet former patients and see the results for yourself. You do not have to rely solely on photographs when you get to meet the patients in person. In addition, an open house allows you to see a surgery, talk with the patient having the procedure, and see how he looks immediately after surgery. We also invite patients who have had surgery during the previous week to stop by, but I can not guarantee that they would have the same hair characteristics as you.

The use of medications relates to the natural hair that you are losing. Medications may be necessary to hold on to hair that is genetically not going to last, but medication is not needed for the hair that is transplanted. I strongly recommend that my patients use Propecia, to maintain their existing hair.

You can return to work fairly fast. I have performed FUT surgery on a number of celebrities who have appeared on television within days or even hours of their surgery. I have had a few people run a marathon within 5-7 days of the surgery. Going back to work is easy, but the question relates to just how bald you are and if you care if someone notices that you had a hair transplant. For the very bald man, this can be an issue, yet for those not very bald, they can be undetectable within a day or two. There can be a little redness in the recipient area for the first few days and if you allow your hair to grow a little longer than usual, it will hide the donor area nicely. If you do schedule a surgery, you may want to shoot for a Friday, taking the following week off, then you will have nine full days before your next work day. As far as wearing your hair short after the healing is completed, that will be up to you. FUT surgery will leave a thin scar in the donor area, the length of which is determined by the number of grafts you need, your hair density, and scalp laxity.

My advice is to visit us at an open house event and get comfortable with what we do. Review our website, where hundreds of patients are shown, and get the book I wrote, The Patient’s Guide to Hair Restoration, which is probably the most comprehensive book ever written in this field.

Hair Loss InformationLosing Hair Grafts After Transplant – Hair Loss Information – Balding Blog

Hi, Dr. Rassman, I hope that this email finds you well. I had my surgery in June and have lost about 9 grafts (4 in the last 3 weeks or so). I didn’t lose this many last time. Should I be at all concerned?

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Nice to hear from you. I would doubt that you lost any hair grafts. After 5-10 days, once the scab is off, most of the grafts actually can not come out even if pulled on. What you may have lost was the remnant of the graft and the hair shaft. The growth center will remain and will grow its hair in 4-5 months. If you are at all concerned, call my office at 800-NEW-HAIR and make an appointment to come in. I will be happy to take a look at your early results.

Transplanting the Crown – Hair Loss Information – Balding Blog

What do you think about filling on the crown on 39 yr old because that is where my hair loss is. I was told that I am in good shape because most of a person’s hair loss happens between 20 and 40. They also told me because I am on propecia that chances are very good I can keep most of my hair. Please let me know you thoughts.

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A crown transplant uses hair from the donor area, which may be needed for frontal area transplantation should you continue to bald. If the hair loss is controlled, then transplanting the crown in a person of your age may be reasonable, provided that your donor density is good, your laxity is good, and the pattern of genetic hair loss is predicted. Being on Propecia may help slow or stall the hair loss, but long term planning is critical.

It is also reasonable to postpone transplants in the crown for 8 months or so if you are just starting on Propecia, as sometimes the drug has remarkable results on restoring hair loss in the crown. It generally takes more hair than most doctors think to fill in the crown, so balancing supply and demand in the short and long term requires special estimation skills when transplanting the crown. Be sure that the doctor you select has those skills.

Transplanting Someone Else’s Hair to Your Head – Hair Loss Information – Balding Blog

If one can transplant the face of another person, why can’t we transplant the hair from another person? Please read US plans first face transplant on BBC News for details about the face transplant.

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You are referring to the face transplants that have been recently approved by the FDA. The answer is that a face transplant is like a cadaver kidney transplant. Some genetic matching helps, but anti-rejection drugs are essential. The issue is best exemplified by the old adage “Does the punishment fit the crime?” One can easily transplant most people’s own hair (an autotransplant) so that rejection of the hair is never an issue. If you transplant someone else’s hair, then you would have to use anti-rejection drugs to stop the body from rejecting the hair organs from the other person. These drugs are dangerous and in themselves have great risks associated with them. In the very deformed people, the benefits outweigh the risk. As your own hair is easier to use, there is little need or demand for transplanting someone else’s hair to your head. The few that are very, very bald, or those who have run out of donor hair after receiving far too many old type hair transplant procedures, are left without a solution for today’s focused world.

Desperate for Hair that Looks Real – Hair Loss Information – Balding Blog

I’ve been losing my hair since i was 19 and now i’m 23. I’m pretty much at a strong norwood 3. I tried alot of things, but nothing has helped. My mom’s dad was bald and the rest of his family too. Basically don’t know what to do. I’ve read that i’m too young to get a transplant and have not made a move on it. Im also afraid to get one cause of the scars. I really don’t know what to do. It has pretty much ruined my life. I use to have girlfriends all the time now have not had one since 20. Pretty much so desperate i would sell my mustang just to pay for a transplant but i don’t know if i should if results don’t look real and if there is scars involved.

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First, be careful with statements like “I would sell my mustang just to pay for a transplant,” because many unscrupulous people will take your money and sell you hair. Realistic expectations, reasonable predictions based upon a good solid examination of your hair and hair loss distribution with good microscopic examination of the scalp, a good doctor with great integrity and lots of good experience, and some comparative shopping will tell you much about what you can do. Read my book, available online in PDF format here, or get one sent to you free. Visit my offices if you are in California. Natural results with a hair transplant are not difficult to obtain, but first you must know where you stand and what your long term ‘Master Plan’ should be before you jump to a hair transplant.

I know that if you do not feel good about yourself, if you do not have the self-esteem you want, then having a normal life becomes more difficult. A hair transplant may or may not solve these problems. The main reason we generally discourage men of your age in getting a hair transplant is that (1) you may not be able to determine when the hair loss will stop, (2) you may not be mature enough to understand both the financial and social remifications of the transplant process, and (3) you may not be able to get the realistic expectations that fit with your hair metrics (hair density, contrast in colors, character of the hair, laxity of the scalp, etc..). In effect, will you have enough hair supply to follow your hair loss to meet your expectations? Get a good doctor and develop a Master Plan with him/her. Then and only then, can you deal with the decision of “Should I or shouldn’t I?”