Category: Hair Transplantation

Hi Drs. Rassman and Pak:

I was concerned about the recent story you posted today (8/9/12) of the guy who had a 3,000 graft transplant that failed. I consulted a very reputable transplant doctor in La Jolla (who will remain unnamed) who was/is prepared to transplant 3,600 FUs in one session on me because I have good scalp laxity and a good donor supply (I’m 54 by the way and never had any hair loss until about age 45 or so).

But now I am worried. Is this safe to do (3,600) in one procedure? Don’t you usually limit your procedures to about 2,000 grafts at a time, give or take (that’s all you did for Jon Gosselin on the TV show that was broadcast)?

Incidentally, and I don’t know if this is important, but I am one of those anti-Propecia people. I want hair, but not at the cost of taking Propecia. Never took it and never will. I’m not trying to stir that pot again, so don’t get me wrong, and I know many people disagree with me and that is fine. But I have made the decision never to take Propecia, ever. It’s just a horrible drug, in my opinion. If other people want to take it, that’s their business, it’s their funeral as far as I’m concerned and I couldn’t care less. Another way of looking at it is it’s none of my business.

So again, is 3,600 FUs all at once over the top, crazy? Risky? You know what the great British entrepreneur, Freddie Laker (of the now defunct Laker Airways fame),once said, “The only way to get ahead in life is to take a little risk and have a little luck.” I think that is very true. True with hair transplants too.

Thanks for the great blog.

We have performed as many as 5400 grafts in one surgery at NHI. That particular patient had an unusually high donor hair density and very loose scalp laxity. In general, a 3600 graft procedure is considered a high number, but along with this high number of grafts comes the price of a longer and/or higher scar. As I’ve written on this site before, I’ve had three strip surgeries totaling 2200 grafts and have a barely detectable scar. If your laxity allows it and your donor supply is good, the 3600 grafts in one surgery might be achievable.

I hope you can realize that every person is unique, and their goals and needs are highly individualized. Some people may not care and want one large surgery to be done with the process. Some people choose to have the procedure in stages (multiple procedures over time). This is why choosing your doctor and having them explain all these options is critical.

I often get emails from patients who are price shopping and care only about the monetary cost involved. They miss the point that cosmetic surgery / hair transplant surgery is not like buying a car where you get the same vehicle at a variety of dealerships.

I keep seeing more and more patients that come in to meet with me after the hair transplants they got elsewhere failed to grow. This seems to be the case in large session grafting, usually above 2000 grafts.

Last week I met with another young man who had 3000 grafts transplanted at a clinic with a doctor that I was not familiar with. Shockingly, he had a failure of graft growth to about 95% of what was put in. He is left with a scar behind his head and a significant depression from the failure. He refuses to remove his hat in public and he took much of the blame for the transplant failure. He told me that he thought he did his research, but it sounds like he was sold a bill of goods by the doctor about his reputation.

So many of these men blame themselves for the failure, not the doctor who deceived them. It was not a good meeting for me, and try as much as I could to deal with his depression with an optimistic view of his future, there was nothing I could say to lift his spirits. I am not sure why he came to me, as he did not want to do more transplants. I guess maybe he just wanted to get some sort of explanation of why his grafts didn’t grow.

Doctor,
I began to notice a bald spot on my upper left crown about 7 years ago (I am in my mid 30s) and have been on Propecia and Rogaine ever since. This regimen has given me good results. However, in the last few years, I have began to notice diffuse thinning on the top of my head (it is worst in summer). Currently, the bald spot is still on my upper left crown but the hair on my crown (and hairline) is thick.

My question is, when is someone with diffuse thinning a candidate for a hair restoration procedure? The diffuse thinning is getting to the point that it is noticeable even when I am not in bright lights. My potential donor hair is extremely thick.

Thank you

Believe it or not, the definition of “diffuse thinning” is highly variable for patients who are describing their hair status. So I would not know if you would be a candidate for a hair transplant surgery. You need a physical examination for that option.

In general, if you have thinning on the top or crown area, many patients who choose to have a hair transplant will get good results. For thinning in a young man, I generally recommend a trial of finasteride for 8-12 months prior to recommending surgery, as many young men will reverse enough of the thinning to avoid surgery.

Hello Doctor
I am having consultations with well respected surgeons in Europe. I’ve had two strip HTs in the past and i’m looking into another one. What astounds me is the very diverse opinions i’m getting regarding my donor area supply for another strip. One surgeon tells me it is depleted, another tells me it can yield no more than 1000 grafts, another one tells me i could have as much as 1300, the other one claims he can safely extract at least 2000 – 2200 grafts, and the last one claims i could have 800 grafts but it comes with risk.

I understand that the donor assessment is quite simple elasticity + density + strip size. Shouldn’t there be more or less unanimity on how much grafts can be extracted? How come i get such diverse opinions?

The answer is simple — there is no formal training that hair transplant doctors go through, so their experience and assessment can be highly variable (as well as their credentials).

Another possibility for the large graft range difference could be that some doctors are not equipped to do a 2200 graft case, and may only be able to do a 800 graft case (having less experienced staff or skills).

Out of curiosity, if you previously had two hair transplant surgeries and the results were satisfactory, why did you consult with four different doctors for your next procedure? My point being, if you were perfectly happy with the first surgeon and you trust him/her, wouldn’t you go back to the same surgeon?

Snippet from the article:

New England Patriots wide receiver Wes Welker has had a hair transplant and will appear in ads for the Rhode Island doctor who performed it.

Welker had the procedure done in Cranston this month during a five-hour session. It involved transplanting follicles to the parts of Welker’s scalp where his hair had begun thinning.

Read the rest — Patriots wide receiver Welker has hair transplant

This was sent to me by a reader, but there’s nothing I can really add. There are no after photos yet, since the surgery just happened… but if you want to see what he looked like before the surgery, check it out here.