Category: Other

I noticed that many of the photos show red head where the transplants are. Is that what I am going to look like and have to walk around with?

The pictures we show that are ‘bloody’ red or pink, reflect the time that they were taken (usually minutes after the surgery). Most are in the first 24 hours after the surgery when we have access to the patients. After that, the patients wash their own hair and the pinkness goes away faiirly quickly. What I mean by fairly quickly is that most people with dark, medium, or olive skin color rarely show any red color within 24-48 hours of the transplant. People with very fair, pale skin tend to show more pink or red in the wounds, but these people fall into two categories:

1. The first are the people who have what I am going to call ‘Histamine’ positive skin. These pale skinned people tend to develop redness in any scratch or trauma to the skin. They store higher amounts of the chemical Histamine at the ends of nerves which release to cause vaso-dilitation of the blood vessels. If you are one of these people, you can easily see it, just by taking your fingernail and scratching your arm. The people who are Histamine positive will develop a red-streak within a minute of the finger nail scratch. When we know that people are in this category, I treat them with two medications to minimize the redness and how long it lasts.
2. The second group of people are those who are not Histamine positive and they will respond like all other people with the redness or pinkness gone in just a day or two.

If you come to one of our open house events, we usually have someone there who had surgery earlier in the week. This allows you to see the post operative wound and the issue of social detectability, within a week of surgery.

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A former patient came to my office last week complaining that the hair from the transplant last year did not grow. He wanted to discuss his options with me. When he came in, I pulled out his before pictures to be sure that both he and I would be talking about the presence or absence or change. As he looked at his before pictures, I asked him again to repeat the complaint. He repeated it despite looking at a before picture of himself — when he was a bald man. Then I gave him a mirror and asked him to look at the pictures from one year earlier, and then look back at the man in his mirror. I asked him if there was a difference.

He looked confused. When I probed his confusion, he told me that his wife was totally convinced that the hair did not grow. She reported to him that she had watched for his hair growth very closely and never saw the growth occur. He did admit that the man in the mirror was hairy and the man in the picture was bald. To help him through whatever problem he was having, I told him to think about planting grass seed or watching a child grow. The more closely you watch, the less change you see. Clearly, his wife had that problem and complained over the past year that the transplant was a waste of money. Then I suggested that he take home pictures of himself before the surgery to show to his wife, and see if her view changed. That seemed to solve the problem and he left very happy.

We see the same thing echoed by many men who are amazed that their hair transplant was never detected, even by them. In the workplace, the change occurs so slowly, that people who see you every day never notice any change. We quickly adjust to what we see before us, not the image we stored in our memories.

I always enjoy these return visits a year or so after the initial transplants were done, to be able to compare the image stored in the before photos to the ‘hairy’ person in front of me.

My father-in-law has the worst comb-over you can ever imagine. It runs from just above the ear on one side to the other side. My wife and I talk about it every time the family gets together. I can’t believe that anyone wants to look so foolish. How do he not see what is so clear for everyone around him? How can I tell him just to cut it short and join the bald man’s fraternity of normal looking balding men.

These comb-over styles start when there is just a little thinning, and as the thinning gets worse, the side hairline creeps down ever so slightly year after year and the hair grows longer and longer on the parted side of the head. The man who is inadvertently migrating to the comb-over never notices the end look. He is watching it so slowly that he blocks any vision of the look everyone else can see. You can see it and everyone else can see it, but a classic case of denial is fully deployed in such people.

I have seen many men in my office that employ the comb-over that progressively works less well for them over time. Men like your father-in-law rarely come to the office. When I get to see them on the street or in airports , I want to go over and tell them what I can do for them to help them solve the problem – but that would not be ethical of me, like ambulance chasing. Your wife (his daughter) could approach him, but be sure that your mother-in-law sees this as a problem before the ‘talk’ or you could be heading off of a steep cliff.

Is it true that sun burns on the bald scalp causes skin cancer? Can hair transplants solve this problem?

Sun is a known carcinogen, which means in simple English that heavy doses of sun exposure can cause cancer in susceptible people. Susceptibility varies with skin color and the type of skin you have, but if you have a full head of hair, skin cancers are far less common than on someone with a bald head. I remember that my bald spot would burn during the summers when I went on vacation. After having my hair transplanted into the crown, I do not remember getting a sun burn. I have had many dermatologists send me patients who have had many skin cancers on the balding scalp. The patients echo my own experience and I am often told that the hair transplant helps to reduce the sun burn. I suspect that anything that reduces sun burn will help deal with the cancer problem, but hair transplants alone may not be adequate cover, especially if the supply / donor ratio is low.

I am 44 and have just started to lose my hair. I have lost 70% of the first inch of my hairline and the back of my head started to thin as well. I started Propecia when I started to bald along with many other vitamins and minerals as well. Now I want to get all of my hair back. I visited a doctor who thought that the hairline I wanted was too low so he recommended that I put it higher. I don’t like what he said because the hairline he showed me was not me. My friends want to see me and I want to see me. Can I dictate where the hairline should be or must I listen to what the doctor wants.

Not having you in front of me is a problem, but I can make certain assumptions. At 44, with hair loss in the front and crown, you will probably not get very bald. However, since your hair loss started late in life, this assumption may not be an accurate reflection of your perception of the hairl loss you will see over time. What you must ask is the following question: “Given the worst case for hair loss in your future, can you live with the hairline that you have asked for?” If the answer is yes, then you must convince the doctor you will select to see it your way. I often argue with the patient but it is always a pro-patient argument challenging the patient to look at his new hairline many ways. Hair transplants are permanent, so that is both the good news and the bad news. In a consultation, you might say ‘black’ and I might respond with ‘white’, not because I believe ‘white’ but I want to make sure you understand all of the choices and consequences of selecting ‘black’ as the option. Clearly the relationship and trust you develop with your doctor will point you and your doctor to the correct decision. There are no absolute rules here, just judgments which we hope will be kind to us as we get older. Isn’t that what life is about?

My girlfriends and I don’t think that they have hair loss problems (at least not yet), but we would LOVE to have fuller hair so that we wouldn’t need to use hair extensions (which I assume all the celebs use because no one has hair like that!). Could transplants do this for us too?

It is important to understand that many of the accoutrements that adorn our bodies arose from our more primitive, less sophisticated past. The use of wigs date back to the Egyptians in the years between 4000-300 BC. They were used extensively by men and women. The Greeks were the first to popularize wigs and braids and they began the long torturous route to hair styles that cycled in popularity for the next few thousand years. In the middle ages (1200-1400 AD), single women showed their health and vitality by demonstrating full heads of hair, much of it coming from animals. Once married, only the husband could see the head uncovered, so it was the young single, female that had to appear healthy and capable of producing healthy children. As the populations started to concentrate more and more, the disease tuberculosis, took its course on the malnourished females whose heads were uncovered, so advertising ones health required hiding (1) a thinning head of hair with a wig or with braids and (2) the absence of significant body fat with clothing. Sexual attractiveness and a healthy appearance were inextricably linked. Paintings since the late renaissance, show women with much abundant body fat and full heads of hair. As tuberculosis is blind to socioeconomic conditions, the successful artisans were engaged by wealthier clients to create the illusion of health with abundant hair and lots of braids. As the hair became thicker, it hid elements of the face that may have reflected the signs of illness or malnutrition. Braids became common place and the use of wigs and other hair extensions remain part of our cultural heritage.

Now to directly answer your question, no, hair transplantation should not be used to increase the fullness of a normal head of hair, but the use of hair extensions and other such devices come with a price. That cost can be hair loss caused by the continuous pulling that these devices produce on the hair as they are attached. Hair loss from such attachments (Traction Alopecia) can be permanent. My advice to you is to respect your hair and watch carefully for any signs of Traction Alopecia.

Yesterday I had a visitor from Saudi Arabia, a well known woman who is actively involved in the womens’ rights movement. She was sent to see me for thinning hair by a former patient I did some 10 years earlier. She came with a message for me, “Tell Dr. Rassman that for the past 10 years, I have been enjoying the hair that he gave me more than I would have ever expected”.

This message epitomizes what I experience every day, a sense of worth communicated by heartfelt patient appreciation.