Hair Transplantation – Page 93

March 6, 2009

Hair Loss InformationI Just Had a Hair Transplant, But My Doctor Told Me I Don’t Have Great Donor Hair – Hair Loss Information – Balding Blog

Doctor can you please help me with this topic. A few days ago I had my first HT procedure for 4300 grafts. My Doctor told me that the hair under my ear is thinning therefore not leaving me with the best of donor hair. How is it possible that hair from the back is falling out?

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Screwed There are some inconsistencies in what you’ve told me. 4300 grafts in one surgery indicates that the donor area is very rich with hair and the densities are high. That is not consistent with problems in the donor area, which can be seen in diffuse unpatterned alopecia (DUPA), for example. People with DUPA never can get yields like you have received. When I learn of a single procedure of 4300 grafts, I assume one or more of the following:

Very high densities
Loose scalp
Grafts cut down into one hair grafts — which means in normal densities, you got about 2300 grafts (and paid more money for less actual grafts)
Doctor who is dishonest and lied about the numbers to rip the patient off

That last item is far more common than I would want to see. The times that I get 4300 grafts (usually over 9,000 hairs) from a donor site (without cutting the grafts into 1-hair grafts) are substantially less than 5% of all patients. As the originator of the megasession, I feel this makes me an expert on the subject.

Poor donor hair under the ears almost always reflects upon donor hair in the back of the head to some degree. The existence of a poor donor supply on the sides of your donor area should be similar to the hair in the back of your donor supply and as such, 4300 grafts just does not calculate in my book. I wrote the original articles in the medical literature dating back to 1993 on this very subject (see NHI Medical Publications).

For your sake, my fingers are crossed that your grafts grow in nicely and you got the 4300 grafts you paid for… and I am hopeful that you did not get screwed.

March 6, 2009

I’m 19 and Want A Nice Hairline Now with Hair Transplants – Hair Loss Information by Dr. William Rassman

Hi Doctor Rassman and Staff, thank you for this informative blog. I am 19 years old and I was wondering if you guys would consider filling in temples and creating a lower hairline for a person my age. I know you say you do not do this because of future balding, but I would rather have this done so I can have a few years with a nice hairline, than have no years at all. I am in college and I am forced to wear my hair long and for the most part no one realizes I am starting to bald. I just want to be able to have a short hair style again.

Thank You

Before I could give you an opinion, I would need to see you and probably even meet you. I would then be able to determine if you are just experiencing a maturing hairline, which would be likely at your age, or actually have male pattern baldness. There is no substitute for an in-person examination, and over the internet does not meet my needs as a doctor. Some of the doctors in this business would want to rush you into the surgery even if you are just evolving into a maturing hairline. Any doctor too enthusiastic about performing a surgery on you might not be honorable.

Whoever you take on as your doctor, make sure that they are not just doing it to make a buck. Think long term! The great majority of 19 year olds aren’t candidates for a hair transplant because most are experiencing changes of the maturing hiarline, and there are dishonest doctors who will prey upon someone with cash in hand… like you, who may not want to accept the maturing hairline. A young man with a maturing hairline can cut his hair short, so first find out what is going on with you before you jump into a life time of hair transplants chasing what you may never catch (your 13 year old hairline).

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March 5, 2009

Hair Loss InformationI Heard My Surgeon Discuss Mistakes Made During My Surgery! – Hair Loss Information – Balding Blog

hi Dr,
i just had a FUE procedurefor 1500 grafts a few days ago. I am very worried now because of some mistakes that took place during the surgery. I overheard the surgeon making comments like ” How come i insert in follicle with 3 hairs, but 1 hair is left outside?” Eventually, the problem is caused by her assistant failing to insert the graft properly into the special insertion tool. I think the affected grafts are quite an an amount cause she took some time to find out the cause of the problem. I dont dare to question her as i am scared she might be offended. I also didnt know if the surgeon did took out the “wrongly inserted” grafts and reinsert it back properly. If that is case, how much will it affect the grafts survival rate??

Thanks a million!!

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It sounds like the team used the Choi Implanter, which is as instrument that makes the recipient site and puts in the hair at the time the instrument is withdrawn (see image at right). It requires proper insertion of the graft into the instrument and it takes considerable dexterity to do this. These instruments are used throughout Asia and Europe, and in the hands of many doctors, the grafts often do not grow for a number of reasons, including:

Improper insertion of the hair graft into the instrument
Placing the grafts too deeply into the recipient area
Trimming problems in preparing the grafts for the instrument with removal of the hair growth centers
Graft drying, as it may be in the air for more than the 10-20 seconds it takes to kill the graft

I have seen a fair number of failures in this technique. I never understood why the surgical teams in these countries did not develop the ‘manual’ skills used in the United States, where the results may be more predictable. This instruments work in the hands of a few who developed the needed skills to overcome the above problems, but the use of these instruments suggests to the novice doctor that placing grafts into the recipient site is very, very, very simple.

I always say that doing a hair transplant is conceptually simple, but getting a successful hair transplant whatever technique or instrument the doctor uses will be seen in 8 months when the results are evident, one way or the other. A successful transplant is the sum of a whole ‘lot of steps and techniques’. The picture of the instrument shown here suggests simplicity, but by the time 8 months have gone elapsed and if there is poor graft growth, the doctor has your money and the rest can be just a nightmare of dashed hopes.

With regard to your other points, you can be meek and take the failures that may occur, or you can be proactively aggressive and let the doctor know of your dissatisfaction or your concerns. Be direct with your doctor and his/her answers should likewise be direct and to the points of your concern. In California, the state medical board or the courts protect patients. You indicated that you live in Singapore, and because I’m not familiar with the laws there, I don’t know what recourse you have.

March 5, 2009

Laser Assisted Hair Transplants? – Hair Loss Information by Dr. William Rassman

Need your comments on laser assisted hair transplant: http://www.hairscalplaserclinic.com

I had an opportunity to review this technology and in my opinion it is a bogus technology looking for Star Wars type recognition. This also reflects comments on the website for stem cells doubling hair somehow magically achieved from the donor area.

In his video on the website he talks about stem cell for doubling hairs with limited donor hairs. Need your thoughts about that.

There used to be a laser sold which made holes in the head for graft placement and most competent doctors have abandoned it. I never used it because it produced more damage than benefits. The procedure that is defined at the website you linked to, defies medical common sense. Seems to be more science fiction than science fact. As far as I’m aware, there is no such thing as laser assisted hair transplantation and certaintly I am not aware of any competent doctor who uses the laser.

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March 5, 2009

Natural Radial Inclination? – Hair Loss Information by Dr. William Rassman

I have a NATURAL RADIAL INCLINATION of my hairs and i’d like to “fill” some low density areas. Could it be a problem with a transplant or any skilled doctor should be able to match the inclination of my hairs?

I am not sure what you mean by a natural radial inclination. The only place where one has hair that points in a radial type of direction is the crown or vertex area. If this is the case you need to have a Master Plan of what you want accomplished with hair restoration surgery. If the area of low density is only in the crown area you may benefit from Propecia or minoxidil and may not need hair transplant surgery initially.

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March 4, 2009

I Had 5 Hair Transplants and 5 Scalp Reductions… – Hair Loss Information by Dr. William Rassman

Hi, (classification: Norwood 6)

I need some advice on scalp reductions please!!!

I started to lose my hair at the age of 17-18 and it had a profound impact on me. I went to a dermatologist who recommended a very good hair transplant doctor and at the age of 19, I had my first hair transplant which really helped my confidence. As the years progressed, I started to lose hair in the crown area and it was suggested to have a scalp reduction.

Well, i’m 33 years old and i’ve had 5 transplants and 5 scalp reductions. Along with some cover up, my hair looks pretty good! But i’m still losing hair in the crown area! My question is: Do scalp reductions really work? What about stretch back? I still wonder back to the days when I was 17, and wonder if I had just shaved my head bald!!

Your thoughts and opinions are appreciated, thanks.

Scalp reductions do not work well and have caused misery for many patients, including myself (having had three of them and ended up more bald in the crown then before I started). I went on a campaign to discredit that surgery and I believe that my opinion is now shared by most competent doctors. That is why scalp reductions are not the standard of care for balding men today.

You probably should not have had a hair transplant in your late teen years — and as you can see now, you’re probably out of donor hair and options. As you wonder back to your days, I agree with you. Sometimes bald is beautiful!

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March 3, 2009

Could FUE2 Replace the Strip Method? (Part 2) – Hair Loss Information by Dr. William Rassman

This is Part 2 of 2. If you missed Part 1 from yesterday, that can be found here.

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What is FUE2?

Ever since we announced the FUE2 technique a few months back, people have asked me how it is different from the traditional FUE procedure I invented and published in the medical journals back in 2002. The basic difference is the addition of a water jet for enhancing the dissection of the excised graft. The pressure of the water jet adds to creating a plane of dissection which produces clean grafts as good in most situations as strip harvested grafts (the golden standard for follicular unit transplants).

What is better, the strip or the FUE2? First lets assume that the FUE2 produces comparable quality grafts to the strip harvesting method. When the donor density is low, the missing follicular units from FUE2 become obvious when the hair is cut short. There can be a moth eaten look in these low density people. In high density people, the FUE does not show up so there is generally not a moth eaten appearance, but the many white dots created by the FUE scar can be seen and this will absolutely limit a shaved head. When a strip is performed and a good wide lower trichophytic closure is created, the scar is less in most patients than any scar from FUE. The problem is that most FUE doctors have created illusions around what they do and produce hype that will never be substantiated in most patients, particularly those with low to average densities and a high number of FUE grafts. I always tell the patient that I get 50% more $$$ for an FUE procedure (graft for graft), so if I recommend the strip as a viable alternative, it is clearly not a financial issue for me. The results of the evolution in my thinking is based upon following many patients (mine and other doctor’s patients) with regard to scarring.

THE FUE2 is a better procedure than the standard FUE, but not better with regard to strip harvesting in quantity and quality. FUE fails to grow at the 90% plus rate much of the time in most doctor’s hands, but strip grafts do not. I am afraid to tell you that honest doctors who do FUE are few and far between, but they do exist. With our FUE2 procedure, we clearly can do it better than most doctors. And as our survival rate following FUE2 is comparable to strip harvesting and significantly better than traditional FUE, the choice with us is clearly in the hands of the patient. I try to present a balanced approach in the analysis when patients come to my office and ask about FUE.

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March 2, 2009

Hair Loss InformationWhy Are Some Transplant Scars More Noticeable Than Others? – Hair Loss Information – Balding Blog

How come some people’s scarring on the back shows up so noticeably, and others don’t? Does it all depend on how many grafts you use?

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Scarring is a complex problem related to:

The healing properties of the patient
The size of the strip
The techniques used at the time of the surgery
The skill of the surgeon

We are all different, so assuming you compare 100 of my patients (where I did all of the surgery) that only received 1000 grafts, for example, the variation in healing will become evident, assuming that the exact same technique was used on each closure.

When I performed general surgery and did an appendectomy, I used to brag how wonderful my scars were, and how you could rarely find them. That was the case in 19 out of every 20 patients. The 20th patient would be excluded from my bragging. Get it?

March 2, 2009

Hair Loss InformationCould FUE2 Replace the Strip Method? (Part 1) – Hair Loss Information – Balding Blog

This is a long piece, so I’m breaking it up into 2 separate parts. Here’s part 1, with the 2nd part coming at the same time tomorrow…

Do you believe that the FUE 2 (or standard high yield FUE) process could completely replace the strip method of hair transplantation? Why or why not?

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There are practical problems with the FUE2 method of harvesting. First, the patient must have his hair clipped widely if he wants/needs extensive grafting above 600-800 grafts (the number of grafts which can be taken from a small area is very density dependent). Most people will not allow us to clip their hair that short and certainly people who have had previous strip harvesting will often not want to have their hair clipped that way either. Many patients who come for FUE end up switching to a strip technique, because of the haircut issue alone.

The FUE’s maximum number of grafts, compared to a strip harvest, will produce less hair with FUE. The strip method of harvesting obtains the donor hair from what the surgeon calls the sweet spot. The FUE can not get the number of grafts from the sweet spot as well as the strip, but the FUE may be limited at each surgery. I read a great deal about the reported FUE megasessions and although I am convinced that much of the hype of 3,000 graft FUE sessions are misrepresented and promoted based upon false claims by less than honorable doctors, the public wants to see this happen and they are ready to believe almost anything a slick doctor tries to sell.

So for the patient who is bald and needs a high numbers of grafts, the strip harvesting method is superior because more hair can be moved in a single session, minimizing the number of sessions when compared to FUE harvesting. For those people who want to get the job done quickly and they need graft numbers in the thousands of grafts, the strip method is far more time efficient.

On the other hand, a new dynamic can be created where people take multiple sessions of 500-800 grafts every 6-8 months until they add enough hair to create what they want. A slow approach has many advantages including:

Spreading the costs over a longer time
Developing a changed image very slowly so that nobody will ever recognize the change
Minimal pain and very fast recovery without limitations on any activities from weight lifting to scuba diving, and so on.

There is a place for both choices and for those men who are not very bald, the ability to achieve reasonable results in one or two sessions are a practical approach to the problem.

Check back for part 2 tomorrow…

March 2, 2009

Graft Count Estimates – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman,

I am a 32-year old male who had HT surgery in San Francisco in 2002. At the time they intended to do only 600 grafts, but since my car got towed during the consultation, the doctor threw in 100 free grafts, for a planned total of 700.

Interestingly enough, when they harvested the strip from the back of my head, they had 800 (!) grafts available, and of course all of those got put in. I have a very nicely shaped hairline and some diffuse crown thinning, but I have been taking propecia since 2002. My father is 67 next month and has a full head of black hair, but my mom’s father was bald by 25.

I’m considering going in for another 2000 grafts to really increase the density in the front and maybe lower the hairline if it’s appropriate. I’m going to be running for public office in 2010 (I don’t want to say which office to preserve my anonymity, but suffice to say this would be a career change). One doctor told me he felt I had a donor density of around 120 grafts/cm2 and another consultant (not a doc) said I probably had 7000 grafts available in my head. Would 2000 grafts deplete my donor density or does 7000 sound really likely? Moreover, what are the chances of them going to take out 2000 and getting like 2300, based on my previous HT.

Thanks!

You need an experienced doctor, not a salesman, to tell you what your density is and what your reserves are like. This conforms to the Master Plan I continuously talk about. Depleting the donor supply can occur with 2000 grafts, so you must be confident that your doctor levels with your and it honest about your future.

To estimate the number of graft, one must know the density of the donor area. A density of 2.1 hairs per mm square will produce approximately 100 follicular units per square cm. The calculation is relatively simple by figuring out the number of grafts one needs and plan on excising that size of a strip that conforms to the above density. There are adjustments that are required which reflect the amount of tumescence (fluid and local anesthesia) that is injected into the donor strip. As the density goes up by 20%, then the yield will go up by 20%. The same is true for 20% reductions in density (as occurs in the average Asian). The adjustments must be made and tied to the measured density of the donor area as seen in a number of sampled areas. I published the formulae for this process in International Journal of Aesthetic and Restorative Surgery back in 1995 (see article).

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