Category: Hair Transplantation

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Hair Loss InformationImportance of Scalp Laxity, FUT Scar Concern, FUE Drawbacks – Hair Loss Information – Balding Blog

Hi Doctor Rassman,

I have a few questions concerning transplants.

— How big of an issue is scalp laxity? I.e., do you often have patients who still possess donor hair, but who are unable to have FUT a 2nd/3rd/4th time because their scalp has become too tight? Should this be a concern in planning for the future?

— You’ve said that one of the drawbacks of FUE is that it can waste precious donor hair (i.e. some hair doesn’t survive the transplant procedure?) — just how much hair might be “wasted” by going with FUE rather than FUT?

— Why are some readers so concerned about FUT scars? In most of the photos I’ve seen, the scar is a very thin hairless line — not a repulsive, gnarled mass or anything like that. Even if one cropped one’s hair short so that the scar were visible, what’s the big deal?

Thank you so much for taking the time to do this blog.

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Scalp laxity become tighter after successive procedure, but this is not usual. The use of scalp exercises solves the problem. It sometimes takes 30 minutes/day for 3 months to adequately address the scalp laxity.

In our original article when we introduced the FUE technique a decade ago, we reported a situation where patients differed with transection rates. We believe that if you assume that the surgeon does FUE perfectly, that some percentage of patients will have unacceptably high transection rates. Although this has become less of a problem as we perfected our FUE skills, it is still present in about 10% of patients. It will be interesting to see if the ARTAS robot can impact these problems in those patients. As Dr. Robert Bernstein (co-author on the original FUE article) just got an ARTAS robot, it will be interesting to see if he experiences the 10% patient problems with transection. FUT should produce less than 5% damage in the hands of a good surgeon.

FUT scars are, as you said, not a problem in 95% of patients on the first procedure. Rarely can you see the scar when the hair is kept long. Even after a second procedure the incidence of scarring is not high either, but if it can be seen, it is only seen if the hair is cut very short or if one lifts the hair to examine it. I would ask, even if the scar is visible, how many times would a person with such a scar that is hidden with longer hair (1 inch in length) gets stopped on the street and asked about it.

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Hair Loss InformationSoccer Star Wayne Rooney’s Transplant Looking Thin Already? – Hair Loss Information – Balding Blog

Wayne Rooneyjust saw this article online about Wayne Rooney’s hair. Seems like it is thinning on top, what are your views?

Link: Time to ask for a refund? Wayne Rooney’s hair appears to be thinning… just months after £30,000 transplant

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The UK press is sure being hard on this guy. It takes around 8 months to see even 80% of the results of a hair transplant. I don’t think enough time has passed to see the final result here.

Loss of the original frontal hair is not uncommon with a transplant if a person is not on finasteride. I suspect that he does not take finasteride, because it is a drug that is detected when screening professional athletes. Many organizations ban finasteride since it can be used to mask steroid use. Because of this, he may not get his ideal result until perhaps after a second hair transplant, which would address the loss of native hair caused by the first hair transplant.

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I Can’t Take Propecia Because of the Sexual Side Effects – Hair Loss Information – Balding Blog

I can’t take Propecia because of the sexual side effects and after I visited your office, the news as to where my balding might be going (as you said the worst case) could be a Class 6 pattern. I already had two hair transplants and I have a scar on the back of my head so I can not even shave my head. I am 21 years old now, so I get depressed when I think that I am going down the toilet with my hair problems. I don’t want to give up my girlfriend as sex is important to us and the Propecia stopped that cold. What can I do?

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Norwood 6There are no easy answers. Your examination in the office showed that you have already lost 61% of the hair in the crown, 26% of the hair on the top, and 32% of the hair in the front. With my naked eye and your blond hair color, one can’t really make out the balding at this time. The crown is fast approaching the point where the balding can be detected in bright light. You are lucky, because if you had dark brown or black hair, the hair loss in the crown would be very evident, but in blond men, the loss may approach 90% with average weight hair before it would show.

If you can not take finasteride because of the sexual side effects, these numbers suggest that you may eventually end up with a Class 6 pattern (worst case). At 21 years old, you have a lot of balding that may show up as you go through your 20s. If you want to shave your head, you might want to consider Scalp MicroPigmentation (SMP), and provided that the area pigmented was in the distribution of your existing hair, you would have the option to keep it long and/or shave it. We can discuss this option at your convenience.

There is no substitute for Propecia (finasteride) on the market. You might get some benefit by taking 25% of the therapeutic dose (0.25 mg) and this might allow you to get some of the benefits of this drug without the sexual side-effects. Young men (20 years old) who start the transplant process without a good Master Plan and have side effects from finasteride, probably should not have started the transplant process at all, as there may not be enough donor hair to complete the process. Your first transplant doctor should have discussed these issues with you before you started this process. Fortunately, there is the SMP option if you get caught between a rock and a hard place.

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Pricing a Hair Transplant on a Sliding Scale? – Balding Blog

Dear Dr. Rassman:

I thank you for the useful information on this blog and your ethical approach in giving honest answers even if they are not financially beneficial to your practice. My question is the following: Do you utilize a sliding scale when quoting prices for patients? For example, if a one person earns a $60,000.00 salary and if another person earns a $160,000.00 salary, would the person who earns $60,000.00 be quoted a reduced fee?

If you purchased a car, whether a Chevy or a Mercedes, the price reflects the cost to deliver a quality product… not the income of the buyer. My staff is well paid and this reflects their skills to deliver a quality service, so the entire package of labor, surgical supplies, and the costs to run a surgical practice reflect the charge to the patient. The surgeon’s fee component is actually relatively low compared to the rest of the costs for the surgeon.

So to answer your question directly, the income of the patient does not reflect the fees we charge.




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Balding Forum - Hair Loss Discussion

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What’s the Point of Staying on Propecia Forever If I Want a Hair Transplant? – Balding Blog

If a man who has been on Propecia and after some years the hair loss continues and wants to get a hair transplant, what’s the point getting one if other places will just continue to thin where the drug used to be effective? Or should he just wait out a few years and see where it’s going and then get an HT? This is kinda complicated. Because all I read about men who got HT most of them never took Propecia before or just a few months before to prevent shock loss.

Propecia slows down the hair loss, but rarely completely reverses it, except on occasion in the crown… and even that is not permanent. Hair transplants have the potential to accelerate the hair loss process unless you are taking the drug (more so if you are in your early 20s and actively losing hair). Propecia may never stop you from achieving your final hair loss pattern, but it can slow it down so you do not spend your youth chasing the loss.




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Hair Loss InformationIf My Dermatitis is Active, Can I Still Get a Hair Transplant? – Hair Loss Information – Balding Blog

(female)
Does contact dermatitis affect my chances of having hair implanted. Over the past two years, my dermatitis has caused my hair to fall out and I want to get implant hair. Can I? That’s the question. Please let me know.

Thank you.

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At NHI, we have performed surgery on many patients with dermatitis or even psoriasis. Each and every patient is different and if you are interested in surgery, you need to be evaluated by a competent hair transplant surgeon.

There are cautions with regard to the pretreatment of active areas of local dermatitis or psoriasis for example, as complications do occur with such findings as a Koebner phenomenon in the areas where incisions are made in active areas of psoriasis or dermatitis.

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Hair Loss InformationThanks for the New Eyebrows! – Hair Loss Information – Balding Blog

4 years ago my brows were week from plucking in hopes of finding the best shape for my face. I had Dr Pak first perform some eyebrow restoration. Later that year Dr. Pak progressed w/ the first treatment w/ another treatment for density. The results were excellent…But being a perfectionist, I continued to pluck & reshaped the brows to being what I always wanted.

This last week I met with Dr Pak, who is a both a wonderful person & an expert Artist in this particular field of specialty for hair restoration. He performed a delicate procedure that was exactly what I was seeking and that resulted finally in a classic slanted full brow.

I could not be happier and many thanks to Dr Jae Pak as well as his assistant, who I found to be extremely kind & professional and who went the extra mile…so sweet & professional as well as fast & efficient. Dr Pak is incredible…one of a kind…understanding & extremely professional & another kiss to his assistant….love you both.

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As I’ve written on this site before, we have done many of these types of procedures and the results are very good, but there is an art in the transplant process and a technical skill that is very difficult for many doctors.

I’m glad your expectations have been met (or surpassed). Knowing how pleased you are with the results and the experience is the best part of what we do. Thank you for your incredibly kind words.

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Hair Loss InformationFlying in a Small Plane After a Hair Transplant – Hair Loss Information – Balding Blog

Dear Dr!
First, excuse my “not so good” English as I am not native English speaking. I had a FUE (1500 grafts) hair transplant done 3 weeks ago. Today, I joined a short flight (half an hour) with a small (2 seats) air-screw-plane with my brother in law who is an enthusiastic hobby-pilot.

i know that there is no problem to fly with a regular (big) commercial airplane. but these planes have cabins with controlled air pressure and so on. what about these small planes where there is no hermetic cabin and no controlled air pressure? we were flying as high as 3000 meters and during the descent i experienced some headache behind my front (the space right above my eyebrows). now I am worried that the change of air pressure during the flight only 3 weeks after the

transplant could have damaged my grafts due to changes of the vasculature. are these worries without any reason or not? I am very concerned about this.

Thank you very much for your answer. kind regards.

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Hair transplants should be considered fully healed by the third week after the procedure, which means that nothing that you would reasonably do can negatively impact the growth of the grafts… even flying, as you have described.

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Hair Loss InformationCan I Save My Fallen Hairs for Transplants? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,
Thanks for writing such an informative and entertaining blog. Keep up the great work. I have some questions:

(1) Everyday the grafts fall out from the head with the follicle on one end, is it possible to collect these grafts and preserve them in a certain condition for future surgeries? If possible, how? And for how long can they live?

(2)If I use tapes to attach a toupee 5 hours every month, will it hurt the scalp which will house the grafts of future transplants?

Thanks!

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The hairs that naturally fall out of your scalp are those that have gone through the normal cycling of hair (telogen, catagen, and anagen) and there is nothing on them that is ‘alive’. We all cycle our hair and when the hair falls out, its root goes into a resting stage and then re-grows a new hair 2-6 months later. Since the hairs that fall out are not alive, there is no chance that it will ever grow again, as dead is dead.

The tapes used on the scalp for attaching wigs can still cause traction alopecia (hair loss where the tapes are attached), even if the adhesive is kept on for long periods of time. Traction alopecia occurs in these areas, as I have seen in my exposure to such patients. The tape should not harm the skin or prevent future transplants into the area.