Category: Hair Transplantation

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Hair Loss InformationSedation and Hair Transplant Surgery – Hair Loss Information – Balding Blog

Dr. Rassman,
I enjoy your blog! One questions I had was if any hair transplant surgeons use level 2 sedation? I recently found a blog where a surgeon uses level 2 sedation instead of injection. What are the differences or risks for each one? Is one more preferred than the other?

Regards

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Nitrous oxideLevel 2 sedation scale is considered: “cooperative, tranquil, and oriented” according to the Ramsay scale. To some this can be achieved with no drugs. To some this can mean a shot of Vodka. In the doctors office this can be a shot of a sedative or a pill (like Xanax). It can also be breathing in laughing gas.

Level 2 sedation is not anesthesia.

At NHI we have evolved our sedation and anesthesia routine. We offer nitrous oxide (laughing gas) for sedation. In addition we also offer a single shot for sedation or a Xanax pill to take by mouth. Some patients choose all of the above and have a great Level 2 sedation experience. The laughing gas has the most immediate on/off response, followed by the injection. Finally the oral Xanax takes the longest for a patient to reach the Level 2 sedation.

We do monitor the breathing, oxygenation status, and cardiac status during the procedure, and if the breathing slows down, an alarm goes off. Level 2 sedation can quickly turn disastrous if the physician or the clinic is not prepared to handle the consequences of the medications.

To achieve Level 2 sedation your surgeon should be certified in ACLS (Advanced Cardiac Life Support) and the facility should be equipped to handle emergencies. Luckily Dr Pak is also Board Certified in Emergency Medicine so we are well prepared for any medical emergencies.

For Level 2 sedation we also take an additional voluntary step to be accredited by the AAAHC (Accreditation Association for Ambulatory Heath Care) as an out patient surgery center. Very few hair transplant clinics have this AAAHC rating (something to ask about when doing your research).

So that’s what we do. I can not comment on other doctor’s drugs and uses.

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Hair Loss InformationHair Transplants with Scalp Micro-Pigmentation (with Photos) – Hair Loss Information – Balding Blog

This is a hair transplant patient who wanted his hair thicker, but had depleted his donor supply so that more transplants would not be productive. Many doctors would try still another procedure, but this was not my approach. Instead, I put pigment into the areas where he wanted more thickness. He loved the results of his transplants for his Norwood class 6 pattern and over the years he received a total of 6,905 grafts for that pattern, but as with many patients who have advanced hair loss, the supply did not eventually sustain the demand for hair.

With the addition of scalp micro-pigmentation (SMP) to augment the fullness, he felt that the results were exceptional. After his first SMP session he used a hat, but slowly and cautiously he showed off his shorn scalp to his friends without creating much fanfare. In a social setting, his friends saw the new look and all he got was compliments on how good he looked with his new hairstyle.

The first photo (left) is of the patient’s hairline after all of his transplant work (last procedure was almost 4 years ago); The next photo (middle) is immediately after shaving his head; The last photo (right) is 2 weeks after his first SMP session. Click the photos to enlarge:

 

He came in for his second touch-up SMP procedure, but this time we went a little denser with the pigment. The key in the plan I put together was that the SMP would be placed in behind the leading frontal hairline that we created with transplants so that he could let his hair grow out whenever he wished. As the interval between the first and second procedure was 2 weeks, he let his hair grow out over that time to sense what it would look like when he let it grow out long. He could not have been more pleased with the result! I’ll post some photos of the results in the coming weeks.

Since my post from last week, I have come under fire on some forums and even on this site for changing my stance on scalp pigmentation (from being somewhat negative in past posts to my current enthusiasm). Really, the change in my view reflected a better command on the art, something that I hadn’t previously seen when I made my earlier comments about the tattoos that I saw in my office over the years. I realize now that I should’ve been more open-minded to possible advancements.

Nothing is perfect in this world. This patient would have rather gone the transplant route or have taken a magic pill that would get him his hair back, but it was not a reasonable option for him… so as a second best option, SMP more than met his goals. Now I must note that due to his nearly 7000 grafts that were transplanted, he does have a linear scar in the back of the head. We’re still working with him to cover it with SMP and will post resulting photos soon.

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Update Mar 8, 2011: More photos here!

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Hair Loss InformationNot Sure if I Have Enough Donor Hair 15 Years After My Last Transplant – Hair Loss Information – Balding Blog

I am a female, caucasion woman in her early 50’s. My hair color is blonde (treated now to hide the grey) and my scalp is fair. I had hair transplant surgery with NHI about 15 years ago (about 1800 grafts-I think in Palo Alto.) Anyway, 15 years later the transplanted hair is about all that is left at the top of my scalp. The doctor did tell me that since I have male pattern baldness (yes, he told me male pattern) that eventually the rest of my hair at the top would fall out, and I would be left with the transplanted hair. Which is where I am now. I am also noticing that my hair is more brittle (probably due to my age). I am so thankful that I had the surgery 15 years ago, because if I hadn’t I would be pretty much bald.

I have been using the Ovation Therapy system for about a month without much success. I’m contemplating another transplant, but don’t think I have enough donor hair to get the density of hair that I desire. I’m sure the cost is much more now too. I’m considering laser hair treatments. I know this isn’t your area (laser), but what are your thoughts? How do you suggest I proceed … next steps?

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You should come in to see me (Dr. Rassman) or Dr. Pak for an examination and an opinion. If you lost only the native hair and had only one session with us, you probably can have another. We’d have to see the donor hair to make any determination, though. We’re no longer in Palo Alto, but we do have an office in San Jose, so we’re still nearby.

As for laser hair treatments, I’ve been very outspoken about them in the past on this site. I’ve yet to see any great results in treating genetic hair loss by using this low level laser light technology (LLLT), but ultimately it is up to you.

With regard to the diagnosis of male pattern baldness, I’d have to assume the doctor must’ve slipped and actually meant female genetic balding… but we can straighten that out when we see you.

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Male Eyebrow Transplants (with Photos) – Hair Loss Information – Balding Blog

Hello Doctors
I am a 39 year old man and had a problem with my eyebrows since I was probably in my 20s. My eyebrows aren’t very thick. I never plucked them and do not know why they appear thin around the edges or when it exactly happened ,but I wanted to talk to you about what a transplant looks like in that area for men. My hair is otherwise great on the scalp and I have a strong hairline. Have you done any man eyebrow transplants? Thanks

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Here’s a male patient we haven’t shown before, with some beautiful eyebrow transplant results. I placed 189 grafts into his eyebrows with almost all single hair grafts taken from the scalp using follicular unit extraction (FUE).

In general, eyebrows are difficult to get control of the direction of the hair as it exits the skin, but these results turned out great! The after photo was taken about 7 months following his hair transplant.

Before photo on left // After photo on right. Click to enlarge.

 

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Who Invented the Strip Method? – Hair Loss Information – Balding Blog

Did you invent/discover the strip method for hair transplants??

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InventionNo, I did not invent the strip method in hair transplantation. I do not believe there was an official inventor of it. The surgical crowd moved somewhat together in the evolution of the strip, which was a neat solution to harvesting that became obvious.

When I was learning about the state-of-the-art donor harvesting, I saw some doctors use a large drill and attached from end to end the holes that were used to harvest the plugs. This caused an irregular wound of connected holes that were sewn together. Any reasonably good surgeon could have figured out that an irregular, sloppy wound would be better created by a controlled strip, and that is what the surgeons were evolving towards. So you see, there isn’t always an inventor.

I remember that there were few doing strips when I started doing hair transplants in 1991. Dr. Paul Straub demonstrated the method to me back then. I immediately went to the strip for harvesting, having never used a large drill as others were doing. A few doctors were already using this method, but the art at that time was still about establishing large grafts, not small ones. When I started doing the surgery, I began with small grafts… and made them smaller and smaller, which required more and more of them to get the amount of hair that would make a difference. This refined the look of the hair transplant as we know it today.

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What Percent of Patients Get Transplants and Skip Propecia? – Hair Loss Information – Balding Blog

Hi Drs. Rassman, et al., and thanks for your great site. I was wondering what percentage of patients in your practice elect to have hair transplant surgery as the sole treatment option for male pattern baldness and forgo Propecia. And, of those who do not use finasteride, how do their results compare long range with those who do? Is the difference significant? I plan a hair transplant procedure this year but have decided against using Propecia due to the controversy surrounding its side effects.

Thanks again!

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Controversy surrounding Propecia’s side effects are nothing more than circumstantial and hearsay. I realize most of you reading BaldingBlog are smart or savvy enough to use the Internet to conduct your research and form opinions. What some people seem to be missing though is that the Internet is not the source of medical information for self assessment, treatment, and management. I am not your doctor, but if you have concerns with medications (such a Propecia) talk with your doctor and get the real facts.

I will say again that in my 10+ years of prescribing and managing thousands of patients on Propecia (including my sons), I have yet to see the exaggerated side effects that I read on the Internet. I recommend it to almost all my male patients that have hair transplant surgery to preserve the existing hair as well as minimizing the shock loss that occurs in a limited number of patients. While I have not documented the exact numbers, I would say that in my practice well over 75% of my patients who have surgery take Propecia (finasteride). There are patients who do elect not to take Propecia and that is perfectly OK as well.

In general, I feel most patients who continue to take Propecia seem happier in the long run, because the hair loss has been arrested. It may be my perception, but those who do not take Propecia tend to come back for another hair transplant surgery as they lose more of their existing hair faster… and hey, that is fine by me. It is my practice to give my patients all the information they need (on surgery and medication) and come up with the Master Plan in managing their own hair loss. The ultimate decision is left to the patient themselves.

Young men (those under 30), in particular, are in a rapid mode for their hair loss. On the other hand, men over 50 are not prone to the acceleration of hair loss seen with the young man. Those men between 30-50 years old are somewhere in between the two groups. There are tests that we do routinely to advise men what to expect with their hair loss and when to expect it. It is so important to develop a Master Plan, bond with your doctor who you should visit and follow with yearly examinations, as the tests we now use (bulk assessment, miniaturization studies) clearly define just how progressive the hair loss will be and how effective we are at controlling it. Using Propecia (finasteride) does require, in my opinion, that these tests get done to allow you to follow the Master Plan and change it accordingly.

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Hair Transplant for a 21 Year Old Woman Losing Hair? – Hair Loss Information – Balding Blog

Dear doctor

I am a 21 year old female. I’ve been losing my hair since i had my first period when i was 12. Now i have very thin hair and almost no hair on the front of my scalp. i went to many doctors here in the middle east and all of them said its genetic. Now i am using Regaine 2%. I am thinking of doing a hair transplant. what do you think? And if there is any recommendation of my case?

Thank you

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I can’t tell if you’re a candidate without an exam. Many women are unfortunately not hair transplant candidates, though. I’m not sure what tests the doctors you’ve seen might have run, but if you went to many doctors and all of them say it was genetics, I won’t argue the point.

How long have you been using the Rogaine? Also, have you looked into using a topical camouflage like DermMatch or Toppik? Here are some examples:

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Should I Have a Transplant Now Even Though My Left Side Hasn’t Receded? – Hair Loss Information – Balding Blog

I’m 22 and have planned a hair transplant to fill in my temporal recession. One of my concerns though is that my right temple has receded further than my left temple, however, I assume over time my left temple will eventually recede as well. Right now the hairs on my left temple are definitely thinner and weaker than my other hairs.

In doing a hair transplant should I wait until these hairs recede or can I still have a transplant now? I don’t know have any notice hair loss except around my temples and thinning above my forelocks

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A quick fix is never the answer, and at such a young age a hair transplant can accelerate more hair loss. You should see a hair transplant doctor to get his/her opinion. I’m certainly not suggesting you have the surgery right now, but your doctor should come up with a Master Plan for treating your loss.

Remember, genetic hair loss is progressive — so treating a minor issue now could result in those grafts not being available if you continue to thin elsewhere.