Hair Transplantation – Page 75

November 2, 2009

Hair Loss InformationHair Transplant 10 Months After One Procedure, Follow-Up – Hair Loss Information – Balding Blog

This is a comment I received in response to this past Friday’s post, Hair Transplant 10 Months After One Procedure:

The results look great.

I do have a question though. I’ve often read that it’s frowned upon to transplant to the crown at a younger age because you might not have the hair to cover the front as you get balder (and who wants to be bald in the front and have hair in the crown?)

Was the crown covered because he has hair density similar to his father, or maybe he’s older than I think and not on pace for a Norwood VII?

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Patient photo The patient is in his early 40s and is a very special case. His density is very, very high (like his father and his brother), which means that he easily has a total of 10,000-14,000 graft capability. I could’ve easily taken out 5,000 grafts had the grafts been needed. He is in a good situation to stop doing hair transplants now and with the Propecia that he takes religiously he probably will not lose much more anytime soon. I don’t expect him to follow his father’s Norwood 7 pattern.

If the patient was to lose more hair between the frontal area and the crown (which was transplanted in this first procedure), he would have lots of reserve still left. It is important to note that very high hair density was critical in this decision process.

October 30, 2009

Hair Loss InformationHair Transplant 10 Months After One Procedure (with Photos) – Hair Loss Information – Balding Blog

This patient is the 3rd member of his family to receive a hair transplant from us. His older brother received approximately 9000 grafts in the early 90’s, and his father (a full Norwood Class 7) has had close to 10,000 grafts transplanted with one of the most remarkable results I’ve ever seen as he almost had a full head of hair. He still has reserves of hair for more transplants, which I do not believe he needs.

Of particular interest, all 3 family members had very high densities. In fact, the father and the older brother had the highest densities that I have ever recorded in the donor area: around 4 hairs per square mm. This sort of high density reflects a hair population on the head of approximately 200,000 hairs, when normal for a Caucasian is around 100,000. Along with the artistic skill of the surgeon, this is what enabled us to transplant so many grafts in a single session.

So now the youngest son has followed in his family’s footsteps with 3188 grafts — approximately 1400 grafts in and behind the frontal hairline, with the rest of the grafts transplanted into the crown. Despite being only 10 months out from his first and only hair transplant, this patient is already extremely pleased with the results he’s seeing. Click the photos to enlarge!

After one procedure of 3188 grafts:

Before:

Transplant area immediately after the procedure:

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Update: More info can be found here!

October 29, 2009

Hair Loss InformationSome Hair Transplants in Asia May Not Be Well Done! – Hair Loss Information – Balding Blog

I recently met with a hair transplant doctor from Asia who confided with me that the results from those doctors who use the Choi implanter are generally poor. For reasons unclear to me, it seems that many of the doctors in Asia have not mastered the techniques for manual preparation and the placing of grafts. Many Asian doctors depend upon the Choi implanter to perform the task of implanting the grafts. Because the Choi implanter requires very closely trimmed grafts for the grafts to fit inside the small needles, I would assume that the failures of hair transplants to grow reflect damage produced by very close trimming of the grafts and the longer periods of time that the grafts are kept out of the body. The skinny grafts produced for the Choi implanter can dry out fast and the grafts can die in a matter of 10-20 seconds when they are exposed to the air. I’ve written about Choi failures in the past. Of interest, there are very few North American doctors using the Choi implanter.

Apparently the public’s perception of the quality of results are well known in some of these countries and many patients flee to the United States and Canada for higher quality hair transplant services. Because I need to protect the identity of my informant physician, I will not report even the name of the specific countries he was talking about, but I have heard of this problem at the annual medical meetings from other sources as well. Do your research and keep this information in mind if you’re considering a transplant and always ask to see patients who have had it done.

October 29, 2009

Hair Loss InformationSwelling the Scalp Before Inserting Grafts? – Hair Loss Information – Balding Blog

I have heard that another hair transplant firm injects something into your scalp that swells your scalp before inserting the grafts?

I also want to get eyelid surgery. Should the eyes or hair come first? How much time should elapse before the second surgery? It would be nice to heal from both at the same time.

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I do not inject anything into the recipient area to swell the scalp. The doctors who do these injections think that by stretching the scalp with saline, the grafts can be put closer together. I do not believe that this is the case.
It might be better to do the hair transplant before the eye surgery, because if swelling occurs after a hair transplant and the eyes were freshly done, that could cause more discomfort. I’d give it about 2 weeks after your hair transplant before you undergo the eyelid procedure.

October 27, 2009

Hair Loss InformationRestoring Mixed Race Asian-Caucasian Hairline – Hair Loss Information – Balding Blog

Hi Dr Rassman,

I am mixed race chinese-caucasian 25 year old and have noticed some frontal recession behind the hairline and while it is very minor at this point unnoticible unless under bright light (which I am combating with propecia)… if my hairline were to recede… which hairline do you recommend when getting a transplant, the flatter asian one or the more pointed caucasian one? Which one will allow me to use less hair for the hairline in order to save my donor hair for other parts in case I need it? Did you give Jon Gosselin (great job on him by the way) a caucasian hairline? Which do most people choose who are in this situation? I have brown caucasian hair fairly thick hair shafts, but a flat asian hairline in my case.

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The basic difference between the Asian and Caucasian hairline shape is, as you point out, that Asians have a flatter hairline. This is not always the case, though. The convex Caucasian hairline works well in most men and that is what we did for Jon Gosselin. Sometimes, we lower the corners slightly in the Asian hairline reconstruction.

October 26, 2009

Staples vs Sutures – Hair Loss Information – Balding Blog

Is there a difference between “internal sutures” and staples? Does one result in a less detectable scar?

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Anything going through the skin produces a highway for bacteria to grow. Staples and sutures do just that, so bacteria can invade the body through the holes created by the needles, sutures, or threads, and through the use of stainless steel staples.

The final answers to your question relate to the opinions of doctors. I have waffled both ways in the many years of being a surgeon, and now I prefer staples over absorbable sutures. I don’t like leaving a foreign body like a suture in for very long and the absorbable suture is a foreign body. At least with staples or non-absorbable sutures, they can be removed by the surgeon when healing has occurred and wound strength builds enough to hold the wound edges together. At between 2-4 weeks, collagen production forms a lattice of ‘cable-like’ material that progressively gets laid down so that the wound will hold together. See Wikipedia for a better understanding of the various phases of wound healing. Some excellent videos covering wound healing can be found at Google Video.

October 26, 2009

Hair Loss InformationNo Growth 6 Months After My Hair Transplant! – Hair Loss Information – Balding Blog

I had a transplant done exactly 6 months ago. I was under the impression that between months 5 and 6 post-operation I would start to see the new grafts growing in. I have seen nothing, or very little. Does this mean it won’t grow in or something is wrong? I’m getting a little worried about it.

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Why don’t you call your doctor who performed the surgery and ask for a follow up appointment? If I paid for something that didn’t turn out the way I thought it would, I’d contact the seller. Although you could apply that logic to buying a used car, this same principle goes for cosmetic surgery. If you were told one thing and it hasn’t happened, take charge and find out from the doctor!

Generally speaking, it takes on the average 4 months to see some growth, but it can take as long as 12 months. Everybody is different and not all surgeries are the same. You may be a late bloomer!

October 23, 2009

Will Hairline Lowering Look Better than Hair Transplants? – Hair Loss Information – Balding Blog

Hi Dr Rassman, i have spoken to you before and cannot decide between scalp advancement or hair transplants. I spoke to beverly hills institute and they told me dr mayer and dr fleming are the ones who started scalp advancement and having hair transplants will not look as good and that i will only be disappointed…i am now confused because i thought dr kabaker initiated this procedure. Also the doctor i went and saw suggested 2000 grafts however he seems to think a scalp advancement may be a better option….why is this so it seems so extreme as i have a young family i am scared …thanks for listening

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You have every right to question the things that are unknown to you. It is a surgery on YOUR body that you will carry for the rest of your life. Different doctors will have their own opinions, as doctors are human and they tend to ‘sell’ what they do best. My point is that there is no clear and definite answer to your question. You need to do your due diligence and research and speak with former patients. You need to try to see the before and after results (not just pictures) of the doctors and procedures you’re researching. This may be easier said than done, but not for our hair transplant practice, as we do this all of the time. We do this in our monthly Open House events where my prospective patients have an opportunity to meet my past patients who have had the surgery, so they can see the results for themselves.

To clarify some facts: Dr. Kabaker is well known to perform hairline lowering procedures. He is not the only one that does this, as many plastic surgeons who do browlifts can easily do hairline lowering procedures. Dr Fleming is well known for his scalp reductions and flap procedures, not for hair transplants and therefore they will sell what they do best. Scalp reduction is different than hairline lowering.

If you have a hairline lowering procedure you may need a small hair transplant procedure to hide the inevitable scar at the frontal edge, but the procedure is literally instantaneous while you must wait for 6+ months for the hair transplants to grow out. If you have a hair transplant procedure you many need a second hair transplant procedure to meet the density goal that you desire no matter what anyone tells you. Just remember that if it sounds too good to be true… well, you know the rest.

October 23, 2009

Can Norwood 5A Get Full Coverage from Transplantation? – Hair Loss Information – Balding Blog

Greeting Dr Rassman,
my question is the following : How often do you see people with Norwood “A”-pattern hair loss that reach Norwood 7 (or 6) AND how difficult is a 5a pattern to treat with transplants (can they get full coverage). My grandfather has a Norwood 7 (in “one go”, so no separate vertex balding), my father is maybe thinning into a 5a, that’s why I’m curious.

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Norwood 5A I generally like the results on the ‘A’ pattern balding patient, provided that they have a good density and scalp laxity. Even a Norwood 7 can get full coverage (see here). Hair transplants are about hair supply and the demand for hair as determined by the balding pattern (size of the bald area).

October 20, 2009

Why Can’t You Name Those Unethical Physicians? – Balding Blog

In response to Areas of Unethical Behavior Practiced Today:

“I ask you to consider your obligation under our oaths and our respective state medical board license agencies to report these doctors.”

Why not name the unethical physicians here then, so that would-be victims can be warned ? How else are patients supposed to find out, if not from web pages like this one ? I understand the fear of libel, but is that more important than the obligation under oath referred to above?

This isn’t the 1950s Hollywood blacklist and I can not go around identifying various surgeons without them bringing on legal actions against me. While you might think it is a noble thing to do, such actions could consume all of my finances and my time and I could live in the courts rather than do surgery. I have written to the Medical Board of California whenever I’ve identified a sleazy practice for California based physicians. The State of California is good at follow-through. If the sleazy doctor is located in another state, it may not be that simple. California will always create an investigation if they receive a complaint from either another doctor or a patient who has been wronged, but some of these sleazy doctors work outside of the United States and that produces even more problems for patients who have been victimized.

If you follow my instructions on how to pick a hair transplant surgeon, you can avoid the traps and not become a victim. You need to be an educated buyer in any medical treatment. Health care, like cosmetic surgery, is a buyer beware market!