Megasession vs Multiple Smaller Sessions? – Hair Loss Information – Balding Blog

Dr Rassman

Let’s assume someone’s donor area may yield, say, 5000 grafts using the strip technique. Is it better to have 1 mega session or 3 smaller ones? Is the yield better when cutting the skin only once (or twice) with megasessions compared to 3 or 4 times with in smaller operations?

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I have always believed that less surgery is better than more surgery in people with more extensive balding patterns. If you can get 6,000 grafts in two sessions, why go for 6 sessions of 1000 grafts each? If the density and laxity allow for it, most of my patients prefer to have one larger session and hopefully just be done with the surgical process quicker. This means in a practical sense that 6-7 months after the first session of 3000 grafts, you can see results which will impact your ability to style your hair.

Alternatively, I can make an argument against the large session. Multiple FUE procedures or smaller strip sessions have a relatively short recovery time, but for FUE, the shaving of the donor area can be a problem unless you elect to keep your hair short, so regrowth of the donor area usually occurs in about 10 days. Smaller strip cases will have their donor scar covered by the existing donor hair.

Incremental surgeries have really no downside other than the length of time from the point you start to the time you finish. It is possible that more surgeries could give you wider scars, but this has never been studied with any direct comparison. Few patients approach me with a desire for multiple smaller surgeries and prolonged benefits, as they want the benefits quickly and would like to say goodbye to me and the hair transplant process altogether. I am, however, open to performing multiple smaller surgeries.

Is There a Part of the Scalp More Likely to Have Shock Loss? – Hair Loss Information – Balding Blog

hello.
My question is, if shock loss is one of the side effects with a HT would the doctor insert more graphs in a particular area knowing that shock loss would occur? This way a patient doesn’t feel as if he or she didn’t get a proper procedure done and it looks as if more hair is there then the patient originally began with.

As well, are the hair line and frontal areas more susceptible to shock loss versus the back, top part (Crown) and sides of the head?

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Shock!The areas most likely to have shock loss are the areas where miniaturization is present. There isn’t one part of the scalp that is more susceptible than another. The more miniaturized the hair is, the greater the risk over time.

Shock loss doesn’t occur for all patients, and taking finasteride prior to surgery usually protects the body from hair transplant induced shock.

Hair Loss InformationDoesn’t the Scalp Still Shine with SMP? – Hair Loss Information – Balding Blog

Hey Dr Rassman. i hope your day is treating you well. As i am a frequent reader of this ever informative blog of yours a few questions have sparked my interest over the last week. It is in regard to the new micro pigmentation service NHI is offering. Now in the past i have noticed you were quite the skeptic about this type of procedure. I recall reading a few comments made by yourself which made me think they were: wouldn’t the scalp still shine? The lack of a ”sandpaper feel due to there being no actual stubble on the scalp and hair is 3 dimensional a tattoo is not.

However I was doing some thinking and this came to mind. If a patient were to come and request to have as many grafts that their doner supply would allow then have the tattooing procedure done in between those grafts and also had the scar camouflaged in the back of the scalp wouldn’t it be nearly impossible to tell the persons head of hair from a non balding person ? It would eliminate all of those issues i previously mentioned. Like for those individuals with high donor densities if someone had 10,000 grafts placed on their scalp then had the micro pigmentation procedure done i would think they would be able to get close to their juvenile hairline back and they would also be able to grow their hair out to probably a number 1 clipper with out it looking to odd. What are your thoughts on this ?

as I presently support the shaved head look but my hairloss is progressing i like the look i would just like more coverage. I have been on finasteride for 3 years when i first started it i was 20 and an early norwood three now my hair is really thin through out the top half of my scalp. I totally anticipate being completely bald by the time im 25 whether im on the medication or not.

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HeadlubeYour scalp can shine with the oil that your scalp produces, so scalp micropigmentation (SMP) patients often use matting products available at cosmetic stores. There’s various brands of shine control lotions for the scalp, including HeadLube.

SMP has a use with some negatives and some positives. There is a natural symbiosis between hair transplants and SMP in some individuals. SMP is far less expensive than hair transplants, but you can not have it both ways (SMP in part with a limited hair transplant) unless the Master Plan takes into account what is happening to you now and later. There is a balance between SMP and hair transplants, but I can not give you an opinion over the internet.

It sounds like you need a Master Plan (I know I talk about that a lot), because you are changing with regard to your hair loss. Whatever you do, it should fit into the life plan; if you do go really bald, you’ll want to have a plan for what you’ll look like in the future if you make decisions about today’s problem. Come see me.

Hair Loss InformationCould SMP Damage Previously Transplanted Hair? – Hair Loss Information – Balding Blog

Dear Dr. Rassman,

I am interested in your new SMP process. I have had approximately 3000 grafts in the past and am running low on donor area.

My question is, will the SMP damage the hair that I have already had transplanted? The purpose of SMP in my case is to make the hair look thicker when it grows out.

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The SMP (scalp micropigmentation) process works really well for this problem (low on donor hair), provided that you have enough hair to take advantage of the reduced contrast between scalp and skin color. SMP will not damage the previous hair transplants or any naturally growing hair that is present.

Hair Loss InformationHistamine Positive Skin and Hair Transplantation – Hair Loss Information – Balding Blog

Hi,
I would first like to thank you for this very informative site. My question has to do with post operational side effects. Specifically, I had FUE/FUT 1.5 months ago. Unfortunately I have something my doctor called histamine positive skin. As a result there is redness in the recipient area. My first question is related to that.

How long would it take for such redness to fade away and what can I do to reduce that amount of time? Additionally, in the donor area, there is a significant amount of redness and the hair growth appears limited. Is this to be expected? And what is the time frame for full recovery of the donor area? My doctor is quick to say it will all be fine in a few months but I wanted a second opinion as well as anything I should keep an eye on to better facilitate the recovery of that area.

This was my first surgery and I only had 1000 grafts transplanted.

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If your doctor was helpful enough to explain a histamine reaction to you, how is it possible that you were not told how long it would last? I often do a scratch test to the scalp or forehead to preselect those patients who are histamine positive. In general, every patient is different and the redness can last several weeks to months. 1 to 2 months would seem on the long side.

Unfortunately this is not a place for second opinions as I do not know what you are really experiencing. All hair transplants are not the same, especially FUE, as there are many variables such as size of punch, techniques of extraction, the drugs you take, the allergies you have, etc, etc.

Hair Loss InformationI Am a Bad Scar Former – Would FUE Be an Option? – Hair Loss Information – Balding Blog

I have hypertrophic scars from numerous cutaneous surgeries, and even under modest tension my scars tend to spread quit a bit. None of them have an adequate cosmetic result in my mind for a hair bearing region. As a result, harvesting grafts with a strip is something I am not considering. Given my propensity for making ugly scars, am I likely to have abnormally visible scarring from follicular unit extraction at the harvest or transplant site, or are these so small that hypertrophy and spreading are of little concern?

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Nobody wants a bad scar, but for hair transplant surgery (or any surgery on the scalp), the scar should always be hidden under the hair if you keep it at a normal length (more than 2 inches). Even a bad scar can still be hidden after a haircut with a #3 clipper most of the time. I also realize many men would like to cut their hair very short in the back where the scar may be visible, and that’s when follicular unit extraction (FUE) may be a better option. However, if you have a tendency to have hypertrophic scars, then even the FUE may leave you with hundreds of noticeable dots.

As with everything in life, you need to have some perspective on what you are doing and what you are willing to give up. Nothing is perfect. There is no such thing as scar-less surgery. There are men who choose to have hair in the front and top, but sacrificing the gain with a scar in the back of their head. There are men who do not want any scars on the back of the head (linear or otherwise), and for them surgery is simply not an option. There has to be some give and take that you have to be comfortable with.

Think about cosmetic surgery on women: Women who want larger breasts will sacrifice their gain in cup size with a scar under the breast, around the areola, in the armpit, or in their belly button. Women who want a face lift will sacrifice a youthful face for a scar along the back of their ear and behind their front hairline.

Remember, keeping your hair very short after a hair transplant will not give you the best cosmetic results no matter how many grafts you transplant. A very short hair style will look much thinner than a longer hair style, which covers more of your head. This is because the surgeon is working with a limited number of grafts to cover a big area.

Removing Only Part of the Follicle – Hair Loss Information – Balding Blog

Hello Doctor

There is a dutch clinic that advertizes the following method

“The most significant difference between the HST method and traditional hair tr*nspl*nt techniques is that with HST, only a tiny part of the hair follicle is removed, leaving the majority of it in the donor area where it will produce a new hair. This preserves the donor area for future treatments, which is why this technique should actually be referred to as hair multiplication, rather than tr*nspl*ntation.”

A very famous dutch soccer player ( Snejder ) supposedly undergone this procedure . Anyone who saw the Bayern Munich – Inter Milan game this week definately noticed the difference on his head

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I’m not sure why “transplant” is censored on that clinic’s site…

I know who you’re referring to and I have heard this doctor speak on the subject of partial unit extraction. One of the problems — there was never any physicians actually looking at what he was doing, and as such, there is no peer review or comments by other qualified academic doctors that could back up the claims that he actually has growth of full healthy hairs from fragments of hairs. This very subject has been extensively studied by other physicians and the ability to grow full, healthy normal hairs is clearly not possible. I do not believe that what this doctor is reporting is real.

Past posts about this here and here.

Would Cosmetic Eyebrow Tattooing Cause Further Loss? – Hair Loss Information – Balding Blog

Hello dr,
I was considering getting my eyebrows filled in with a tattoo. I have a decent amount of hair but have some sparse areas due to overplucking as a teen. I was wondering if tattooing the area will make the hairs fall out? I hear that it doesn’t from the techs who perform it but not sure if they are just saying that to get more business. I would love your thoughts as a hair loss expert on this matter. Thank you

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The use of hair transplantation is probably the best solution available today for eyebrow restoration. Take a look at this post from last month and you will see the absolutely natural appearance of an eyebrow transplant.

I wouldn’t expect the tattooing to cause eyebrow loss, but I’d be more concerned about the tattooed eyebrows looking natural, particularly on close inspection. I guess it depends on the color of your brows and how sparse they currently are.

If I Can Only Afford 1 Transplant Procedure, But I Might Need More? – Hair Loss Information – Balding Blog

Hello Doctor,

I am a hair loss sufferer, but my hair loss is more of a diffused type, with thinning across the scalp. I am considering hair transplant but would like to get your opinion before I make the decision since I am living in India and will be traveling to US for the transplant and want to make sure the trip is worthwhile.

I have been saving for a hair transplant for the last few years and at this point I can afford a little more than 2000 grafts. Do you think hair transplant is the right option for someone if they cannot afford any follow up procedures after the first transplant? Do you think I should keep saving for some more time so that I can get maximum amount of grafts in one go that can last me for a much longer period without having to go for a second surgery for a very long time?

All my calculations are based on $5 per hair graft that I got from your site for prior fixed appointments. Also is the $5 per graft inclusive of all charges or are there some overheads as well.

Thanks

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MoneyAt NHI, our fees are fully inclusive without any additional charges. The $5/graft fee you mentioned is for Dr. Pak’s standby rate, so you’d need to be a little flexible with the scheduling. We do offer a travel discount, too.

Indians generally have lower hair densities than Caucasians by about 20%. Assuming that you take the pill finasteride and you are under 30 years old, the following may apply:

  1. Class 3 pattern — may work well with between 1300-1800 grafts, depending upon hair shaft bulk. Coarse hair is better than fine hair.
  2. Class 4A pattern — can be filled nicely with about 2000 grafts.
  3. Class 5, 6, and 7 patterns — you may not have enough hair to cover the crown.

Many men elect to have one surgery and be done with it, or have multiple surgeries over time. It’s up to you. I haven’t seen you, so keep that in mind. I’m not sure how many grafts you’d actually need or what your hair loss pattern even is. You should send me photos if you’re considering surgery and I’ll be able to hopefully tell you a little more.

Photo credit: Origami artist Won Park

Hair Loss InformationSMP for High Contrast Scalp and Hair – Hair Loss Information – Balding Blog

Dr. Rassman,

For patients who have high contrast scalp and hair (ie. dark hair and fair skin). Wouldn’t a combination of SMP and surgery help minimize some of that contrast and maybe achieve a more fuller look?

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Yes! It would be advantageous to complement the scalp micro-pigmentation (SMP) with a hair transplant for a full and realistic (3-dimensional) look. No one treatment is perfect. Hair transplantation can never give you the complete fullness you once had, since it is just rearranging what you currently have. But hair transplants can give you a good hairline, adequate coverage, and even almost normal densities if the area covered is small.

SMP can give you the look of fullness but it will not be real hair, since it is like using concealers (think DermMatch or Toppik) but without the daily applications because it is permanent.