This patient came to see us in March 2007 for 1004 grafts and then for a follow-up procedure in May 2009 of another 1045 grafts. All of these grafts were placed into the hairline to cover up old plugs. On his recent visit to the office, I couldn’t even find the old plugs… and when I told him that, he smiled ear to ear. Click the photos to enlarge.
AFTER (2049 GRAFTS TOTAL):
BEFORE:
Is it possible for Prince William to have a hair transplant, and reach his father’s level of baldness ? Having a similar pattern of baldness I felt sorry for Prince William during his wedding. I believe his hair loss made him less attractive. In fact, my sister even said that Prince Harry is more attractive now. I can say the credit goes to the fullness of hair. Would a frontal coverage for that type of hair loss would be good in the long run. How would you apply a master plan toward a case like this ?
Based on pictures alone, Prince William would likely be a great candidate for a hair transplant. We have treated many men with even more hair loss than he shows.
Here’s an open letter to the royal:
It would be an honor if you would consider having NHI establish a Master Plan for your hair loss. If a hair transplant surgery could meet your goals, please consider us when choosing your doctors.
Thank you and best regards!
I am considering surgery – FUE. I have been on propecia for 3 years now and it’s difficult to tell the effect it’s had. I mean it could be working, I haven’t seen any more hair loss really. It may have stabilised the hair loss. Or has the hair loss could have simply gone into some kind of rest bite!? If I go for FUE, would you recommend I stay on propecia – I would rather be safe than sorry! Although it does cost a lot, I currently purchase my medication for £62 per month.
On another note, about a year ago I started minoxidil to improve the density of my hair. I think it’s had some kind of small positive effect, not much though. But here’s the issue I have. If I decide on a FUE, do I have to continue on minoxidil – because I cannot afford to both this and propecia.
You need to continue Propecia and minoxidil to see their benefits. As soon as you stop one or the other (or both), the benefits from that medication will be gone. In other words, you’ll see hair loss. The transplanted hair won’t be the issue, as it is permanent if taken from the donor area, but it is the remaining hair around the transplant area that will be unprotected. Propecia also helps protect from shock loss following transplant surgery.
Some patients choose to use generic finasteride in 5mg (prostate medication) and cut it to smaller pieces. Propecia is 1mg finasteride and not available (at least in the US) as a generic. The 5mg generic will be a lot cheaper than the 1mg name brand. You just need to find a doctor to prescribe this to you. Or if the 1mg generic is available in your country, that might be a way to save money. Also, your doctor should be able to show you some analysis from before you started Propecia and compare it to today to find out if there are real results. Hopefully your doctor has such information for you.
Dr. Rassman,
In many of your posts regarding body hair transplant, I see that you tend to discourage the use of body hair for transplants. Some of the reasons include the fact that body hair is curly and does not grow long enough. I am a black person who grows a short Afro. I have a bald spot of the right front side of my scalp which I have managed to concealed with my own pubic hair. It just so happens that my pubic hair is just as curly and has the same texture as my scalp hair. So what I do from time to time, is cut my public hair, wash it thoroughly and then get it entangled with my scalp hair in the balding area. The entangling is due to the curliness of the hair and it holds even in the wind.
So far no one seems to notice. In fact, when I first saw a hair loss doctor, he was amazed at how well I concealed my hair loss.
In any case, I think transplanting hair from the pubic area for African Americans may be a viable option since both the pubic and scalp hair in African Americans is curly and perhaps has the same texture in most African American(as is my case). In any, what is your take on this issue.
I have done a few pubic hair to scalp transplants and they work very well. I recall one African American fellow in particular and a few Caucasian patients that had this done over the past many years. The FUE technique may have a good role here.
I have also seen another person who used pubic hair to entangle with their afro to add bulk with the same observations you demonstrate. It’s certainly not for everybody, and I still say scalp hair works best.
I have lived my whole life without sideburns as I have never been able to grow them. Are sideburn transplants an option? Are they at all common where a doctor would be comfortable doing one? I would also be interested to know if you’ve done any and if there were any problems.
Thanks.
Also, any photos you have of clients before and after a sideburn transplant would be appreciated.
Yes, sideburn transplants are commonly done by experienced hair transplant surgeons. We actually do this procedure on more women than men, because many women who have facelifts lose their sideburns and often have scars that need to be hidden with the transplants.
You can see some excellent photos in our hair restoration gallery.
(It should go without saying, but the photo at right of Elvis Presley is meant to show sideburns, not to suggest that he had transplants.)
Hello, I was hoping you could answer these two questions:
1. With the advent of the Scalp Micro-Pigmentation, have you had any patients experience “shock loss” following the procedure?
I’m seriously considering the procedure but am a bit wary that the trauma to the scalp caused by the needle will cause shock loss.2. Drawing on your years of experience, have you noticed a certain threshold (or range) for transplanted grafts where a patient is more prone to experience shock loss?
i.e. Is a patient who receives 1500+ grafts in one session more susceptible to shock loss than a patient who has two transplant surgerys of 750 grafts each session, say, three or four months apart?
Thank you in advance for your help.
Best
We haven’t experienced “shock loss” per se in patients that had Scalp MicroPigmentation (SMP). One or two patients did report some hair loss initially, but it was not significant to be noticed. The risk is probably in the use of the anesthesia, rather than the SMP.
Dr. Pak’s mother had SMP done and did report hair loss the first few days, but it was insignificant. She had her procedure six months ago and other than the initial few days of hair loss, everything else stabilized.
Patients experience shock hair loss when their hair loss is ACTIVE and dramatic to begin with. In general, shock hair loss is more of a factor in men in their early 20’s (actively losing hair) and those who are not on Propecia. Your doctor should be able to better assess your risks of shock loss to the benefits of a procedure. The number of grafts you receive in a session is probably not related to the degree of shock loss.
Hi Dr Rassman, big fan of your blog, lots of info very helpful!
I had an fue transplant with a good clinic about 3.5 weeks ago. On day 14 I bumped my head on my left temple, not very hard. I wouldn’t of even paid attention to it if I hadn’t undergone an HT 14 days prior. Anyway no blood or visible damage to the skin occured although it may of been slightly pink (it was pink anyway because of the op). Could this of caused any damage to the new grafts at all? My patient advisor says its unlikely, but I wanted an opinion from somebody else like yourself.
Although there wasn’t any bleeding or even a scratch, could this damage what the grafts are doing under the skin?
Many thanks
I would doubt that you did any damage. Two weeks after your procedure, I wouldn’t be concerned about a slight bump to the head.
Hello Dr. Rassman,
I have done a hair transplant surgery about 6 months ago and I am using Rogaine twice a day along with Hairman comb for maintaining my hair. I am not using Propecia as it is having sexual side effects. My question is that since I am not using propecia which stops DHT which causes hairloss, are my new hair follicles in danger of falling out? I am 26 years old.Another question that I have came across a clinic in London and they are offering Minoxidil 12.5% which stronger then the normal 5% Minoxidil. Minoxidil 12.5% have to be used only once a day. Switching to Minoxidil is a safe idea, please advise.
Your prompt response will be appreciated. Regards
Transplanted hair is from the donor area (back of the head), so it should not fall out from genetic causes. If you didn’t experience shock loss after your surgery, particularly since you’re a young man, you are quite lucky. There is a chance your loss could still progress, but there is no laser or topical treatment that will prevent that. Actually, there’s nothing that will 100% prevent all future hair loss (that would be called a “cure”, which doesn’t exist).
Propecia helps slow the progression of genetic male pattern baldness (MPB), but if that isn’t an option for you, I’m not sure what to tell you. Did you experience side effects yourself or are just frightened by what you’ve read on the internet?
Minoxidil has been proven safe and effective at 5%. If clinics are offering stronger medication, that doesn’t necessarily mean it will work better. You do run a higher risk of irritation and other side effects from minoxidil as the concentration is increased. Have you tried the 5% without success? I’m confused as to why you’d want to try a very high strength right off the bat.
Paid advertisements (not an endorsement):
I am a 58 year old female who had hair restoration done 18 months ago on my receeding hairline (1500 grafts). I have just learned from a derm. who specializes in hair loss and restoration that I now have alopecia areata. (This new derm. was not the doctor who peformed the original hair transplant. I went to this new Derm. b/c I wanted to know why my hair was still thinning. He took 3 scalp biopsies which confirmed areata.
Now in the temple area where I had the transplant every once in a while I get numbness and a burning sensation. Would this be possible nerve damage from the hair transplant. Just want a second option and thoughts. This new derm seems to think it is something to do with the transplant. By the way it took 3 derms to figure out what I had. The last derm. is great and is treating me right now. Your thoughts.
Second opinions are impossible to do over the internet through this blog. In general, I would want to know the following:
Any time a person has recipient sites in the scalp, small cutaneous nerves are injured. I would have to know more about your nerve problem. Good luck!
As I researched the field of scalp pigmentation, I found a few other places that offer a similar service. How do I determine which place is the best? Its all quite neat to me but I’ve seen some really bad work from people that claim to be experts.
We are the first doctors in the United States offering scalp micropigmentation (SMP). The creation of the hairline is fundamental to what we have been doing over the past 20 years, so incorporating this skill is critical to providing a quality service with a natural looking hairline. We are also the pioneers for today’s ”standard of care” in hair transplantation worldwide, as we published almost every breakthrough in the field of hair transplantation over the past two decades. When this hair transplant experience is combined with scalp pigmentation — something no one else to my knowledge is doing — we can get the best out of both worlds.
Although this process is relatively new to us, having started in the fall of 2010, we have introduced the use of local anesthesia to minimize any pain (common in tattoo procedures, especially on the scalp). Patients who have had hair transplants and want more fullness can add scalp micropigmentation to the areas that still look thin (examples here and here).
Transplanting stubble hair with FUE in the pigmented bald scalp just enhances the illusion that the pigmented scalp is just a short or shaved haircut. The use of SMP in the pluggy patient with transplants from the 1980-1990s can be nicely treated by special applications of the pigment dyes. I just performed a SMP procedure on a patient with massive scars on his head that looked like he had shotgun wounds all over his scalp, and in one session, he walked out without the need for a baseball hat.
Each day is more exciting than the previous one as we explore the uses of SMP in various scenarios presented by interested people. The happiness of our patients is almost immediate.
