Wonderful blog you have up here, Dr. Rassman. I just wanted to know how scalp laxity affects a person who is willing to get a hair transplant. If i have a very loose scalp, how will it benefit me when i am getting a hair transplant procedure done?
Increased scalp laxity will allow the surgeon to harvest more hair in one surgery. It is like pinching a part of your skin. The more you can pinch your scalp (skin), the more hair comes with it.
Hi Dr Rassman,
Fantastic site, and I’m really enjoying your cautious matter-of-fact coverage of the new A-Cell technology!
I’m a 28 year old male, slowly but surely experiencing diffused patterned alopecia. So far it’s not visible except when wet, but miniaturisation mapping shows I’m probably headed for a NW7.
I’m interested in whether you think it’s possible in theory for a surgeon to insert A-Cell treated hairs into the balding areas, thus gradually replacing the DHT-affected hair with permanent hair, and ensuring coverage “continuity”. Obviously this will depend on whether the A-Cell hair is in fact permanent.
Also, I believe you indicated in a previous post that finasteride is recommended to prevent shock loss. Do you believe this will be an ongoing necessity? i.e. assuming the new hairs take root and are unaffected by DHT, would a patient need to remain on finasteride indefinitely or only for the months following surgery?
Perhaps you need a good diagnosis of what you have. Do you have diffuse patterned alopecia (DPA) or androgenic alopecia (AGA)? I suppose you can have both, but that would be rare. It’s important to determine the proper diagnosis, because diffuse patterned or unpatterned alopecia is generally a contra-indication to a hair transplant surgery. The donor hair area is questionable in its permanence in those cases.
Thus, even ACell technology would fall into the same uncertainty. In other words, the hairs transplanted with ACell may not be permanent if the donor hair is not permanent. The technology is so new that I do not have an answer for you.
Finally, Propecia (finasteride 1mg) is recommended for men with androgenic alopecia (AGA). Patients who take Propecia need to take it indefinitely if they wish to slow down or keep the hairs that are at risk from falling out. Many doctors (including us) recommend Propecia to decrease the risk of shock loss. For practical reasons, patients who do not want to be taking Propecia indefinitely (but wish to decrease the risk of shock loss), usually take the medication for about one year. Once they stop taking the Propecia they risk the same ‘catch-up’ hair loss phenomenon. The main thing one needs to understand is that Propecia is an OPTIONAL medication and the only thing that we (doctors) can do is to recommend it.
Hey. I’ve had brain surgery back in 2000 and an additional one in 2004. I have a scar on the front of my scalp going from my right side of my head to the top of my forehead. Its not from left to right but almost there. And I have some kind of missing spot on the back of my head. I dont know where that came from. But I was wondering if u had any suggestions on getting hair to grow inside my scars so I have no noticible scars?
We (NHI) have been treating scars of all types on the scalp with hair transplants (especially brains surgery / craniotomy scars). The process is as simple as a hair transplant on the scar itself.
The entire process may take more than one procedure to fill in the scar, as hairs are transplanted directly on the scar and may not fully grow. Whether or not the scarring remains noticeable will remain to be seen. I wouldn’t want to make any wild promises without seeing you.
What are your thoughts on Dr. Gho’s partial extraction stuff? There’s a new study in the Journal of Dermatological Treatment:
Link: Donor hair follicle preservation by partial follicular unit extraction.
We are aware of this and I believe I’ve commented on partial unit extraction before. Similar work has been done by others with very different results, so I am a little skeptical. First of all, only five individuals were used in the study and between 100-150 grafts were harvested. The results look very promising, but I do not understand how you can achieve a success rate over 100% (104.1%) like is mentioned in the results.
It is also difficult to understand how one could keep track of where the 100 to 150 grafts were harvested from to see if they regrew hair. Think about this. Unless you make a clear mark (like a circular tattoo) around where you harvested the grafts, how can you say the hairs grew back? In the end, with all due respect to Dr Gho, I remain a bit of a skeptic.
I am sorry to ask so many questions and I did try and search for the ones I have. If they are redundant, I apologize. Also, if you could keep my info as anonymous, I would appreciate it.
- For pricing is the $6 for 2,500 and $2.50 per session or per patient. As in: If you do 2,800 one session and 2,900 another. Would I still be paying $6 for 5,000 over 2 sessions or is it $6 for the first 2,500 and $2.50 for the rest, no matter how many grafts or session I have after?
- Second, I know you can’t technically answer this without a master plan. But I am going to be 23 in a couple months and my hairline is shot/receding pretty bad. I’m quickly starting to realize I may become a Norwood 3 to a 6. I’m still not sure yet. Anyways, no matter the Norwood I still want to start building a strong hairline. I’m impressed with the wig technology now, except for one thing…the hairline. If I would get an amazing hairline back and then wear a piece to hide the rest until something logical comes by, I think that would be the best option right now. If I saw you and you said I was a good candidate for this would you say this is a decent plan?
- Theoretically speaking, if I got one surgery with 2,800. Do I have to wait for the 2,800 to completely grow in the 12 to 18 month span to get another or could I schedule another session closer to the other a couple months later.
I believe there is confusion with respect to the NHI surgical fees. That pricing applies to traditional strip surgeries performed by us in our Los Angeles office. The standard fee is $6 per graft up to 2500 grafts. Anything beyond 2500 grafts would be charged at $2.50 starting with the 2501st graft. So graft #1-2500 are one price, #2501+ are lower. Like a taxi ride, the meter starts all over again on the next trip.
Some men (who are completely bald) choose to have hair transplants in the frontal hairline so that they can wear a wig on the top and still keep a natural looking hairline. It could be a decent plan for you.
Generally, patients need to wait about one full year before they can have another hair transplant surgery. This is because we need to assess how the new transplanted hair has grown and also to make sure the donor scalp has returned back to its flexible/elastic state. Some people can accelerate that timeline to 8 months.
Hi Doc!
Are there any unavoidable obstacles that prevent developing a hair transplant technique that is completely scarless? I am also curious about how much do you know about CIT and its look when shaved to completely bald. Another hot topic is ACell. Only a part of the donor hair follicle is needed if I’m right. Does this help to prevent scarring? And how good are the existing ACell-friendly extraction procedures?Sorry if some of the questions are silly, and thanks for your answers!
There is no surgery in the world that is truly scar-less. There are techniques to minimize scars, but any cut on your body will always produce a scar to some degree. Even for a traditional strip hair transplant surgery the scar is rarely seen (because it is covered by hair).
With respect to ACell, it is not a proven technology and any answer is just speculative at this point.
Dr. Rassman,
Good day sir. Big fan of the blog and all the information you provide. I will keep it short and sweet.
With all the advancements in FUE harvesting, do you think the strip method will become obsolete in the not too distant future?
Thanks and have a good day!
I really believe there will always be a place for hair transplantation with the strip technique. Follicular unit extraction (FUE) is not always the perfect or a preferred surgery, as many people seem to think. Grafts extracted using FUE are not the same as grafts cut under the microscope, and the growth and success is definitely different no matter how good the surgeon is. I speak from experience, as I was the first to publish about the FUE technique in 2002. Shortly after that publication, surgeons all over the world quickly jumped on the bandwagon to adopt it in their practices with varying results. Over the years, I have seen FUE promoted and sold to naive patients as a “better” surgery than the strip, but this is mostly marketing hype and leads to misinformation.
The two techniques (FUE and strip) both have their own unique place in hair transplant surgeries. For example, if you have a Norwood Class 4-6 balding pattern, a strip method of 3000 to 4000 grafts would be a perfect surgery to achieve a full look in ONE shot with a relatively lower cost than the FUE surgery. The strip scar wouldn’t be noticed by anyone unless you decided to shave your head (and if you were going to do that, why even have the surgery). Plus, I would almost never advise a Norwood 6 patient to have the FUE surgery, because there’s a higher incidence of transected hairs in the grafts from that technique. This would be a liability to someone who can’t afford to lose a single hair! Now on the other hand, if you are a Norwood 2 or 3 and wanting your front corners filled in, an FUE surgery may be perfect — especially if the hair is worn buzz-cut short.
Even if the ACell auto-cloning technology proves itself, the strip surgery may still remain the ‘workhorse’ of transplant surgeries. We may be doing combination of all the techniques combined.
Are people with DUPA candidates for a body hair transplant?
Body hair transplants (BHT) are not considered a standard method of hair transplantation and may not give you a normal amount of bulk. I realize some doctors perform BHT with success (depending on how you define it), but the visual appearance of the hair that grows is clearly not normal. Body hair simply does not grow like scalp hair and is not the same texture.
In my opinion, even if you are desperate for hair, I would be cautious with this approach and demand to see patients who have had it done before you agree to such a radical approach to your DUPA problem. Any surgery can make the situation worse, and that risk is real.
(female)
Hello Dr. I was recently diagnosed with seborrheic dermatitis in my left eyebrow, in which I have lost a lot of hair density. I was wondering how long I should wait to see if the hairs come back? As a general rule of thumb what is the standard time I should allow them before determining they wont grown back and opting for a brow transplant? Thanks!
Many patients who suffer from eyebrow hair loss find hair transplantation may be a good option. Generally, I would wait at least one year to see if your eyebrows would naturally regrow before considering a transplant. You should also realize that when you transplant scalp hair to the eyebrow, the hairs will continue to grow like scalp hair. In other words, you would need to trim your eyebrow every week or so. You may also need more than one surgery to achieve the “perfect” eyebrow.
Dear Dr,
I have a large patch of baldness and when I discussed with different Drs they said from 5000 to 12000 grafts. How do we know how many follicles are transplanted? Of course it is not possible to count. Is it the area of strip? Then how many units will be there if a 10cm strip with 1.5 mm width contain? Price varies with the number of units, thats why i posed this question. kindly reply
I am very curious which doctors you spoke to, because getting 5,000 to 12,000 grafts from one surgery would be considered impossible. Maybe you are confusing grafts with hairs. One graft can contain 1, 2, or 3 hairs. So 2500 grafts can contain 5000 hairs (for example).
In general, an average Caucasian male with a 2 hairs per square millimeter donor hair density and an average scalp elasticity has about 5,000 to 7,000 grafts to donate in their lifetime (but not at once). You simply cannot harvest 12,000 grafts in one surgery. An average maximum or upper limit of a hair transplant surgery is around 3,000 grafts. I only recall a few patients in my 15 years where I was able to harvest 5,000 grafts in a single surgery, and those patients had abnormally high donor hair densities. There are some doctors who split the grafts into smaller units and this will push up the graft count, not the hair count. I tend to think that the doctors that split grafts are only doing so to charge the patient more (if they charge per graft).
You need to ask your questions to these doctors and have them explain what they are talking about to you in detail. I do not know your hair density or how flexible your scalp is, but if you were to get 12,000 grafts in a single session, you would be alone amongst all patients I have encountered.
