Category: Other

Dear Dr. Rassman,
I will like to know if you can you tell that someone had a hair transplant by looking at it?

Hair grows naturally in units of 1, 2, and 3 hairs each. The frontal hairline always has single hairs and a transition zone of these single hairs starts at the forehead (more widely spaced) and they then get closer together as you look further back into the actual denser hair. Within ¼ of an inch, these single hairs get noticeably denser and then groups of 2 hairs start appearing. I say this because to make a hair transplant look like God’s work, God’s design must be copied. The single hair leading edge of a non-transplanted person is erratic and disorderly. It is not heavy, so the idea that there is a ‘line’ with a hairline is a misconception. The transition zone makes the hairline imperceptible. If the pattern is created by the transplant surgeon with enough hair to mimic the normal transition zone, an observer should not be able to see a hairline nor a hair transplant. At our open house events (which we hold every month at each office) the people are amazed that they can not pick out those who had hair transplants from those that did not.

So simply answered, in 95% of all cases, a hair transplant should not be detectable as a hair transplant if there is enough hair to address the needs of the patient. Look at this video of a completely transplanted frontal hairline worked with a comb. Please note that this patient has a high contrast black hair against a light skin color (the most demanding combination). If there is anything abnormal looking about a hair transplant, it will always show up in someone with black hair and light skin.

• Undetectable Hair Transplant – Flash required

My husband is considering a transplant operation as one way to address his waning male libido – and yes, he has thinned quite a bit since he turned 50. A friend told him that since he (the friend) had hair transplants he was feeling more confident in ALL areas of his life, including his sex drive. Is this true? Better than Viagra?

Libido is a complex characteristic of the human male or female and is not related to just one factor. Clearly, what men think of their manhood, their attractiveness, their self-esteem, the influence of the woman in their life, directly impacts their libido. One of the important determining elements for libido has to do with a man’s emotional state and sense of well being. The second, is a man’s reaction to his hormonal influences and brain regulators that drive libido. We know that Testosterone is the most potent hormone that in determining the sex drive in men (and in women). Third, is the physical ability of a man’s penis to react to his sexual wants and needs. Penile function is another complex process and the failure of a penis to become erect, even in the motivated sexually driven male, will perpetuate (or make worse) sexual dysfunction.

With regard to your comment on the increased confidence of men who have had a hair transplant, well, this is a very common message my patients pass on to me. For example: One well known, rich, successful and happily married businessman came to me with a Class 6 (fairly bald) pattern. He had two transplant sessions totaling about 5000 grafts. He was dynamic and was known for his charismatic style in public – but there was a piece of the inner, sexual man what was influenced by his hair loss. His wife came to me a couple of years after I had finished his hair restoration process. When he told her of his decision to have a hair transplant, she was outwardly supportive, but secretly did not feel it was necessary. She told me that after her husband had his hair back, the man she married came back and her confession brought tears to my eyes. She told me that her love had never diminished as he was balding, because he was still the same man she fell in love with and married. Now she wanted me to share her joy in the decision and to thank me for my role in his restoration two years earlier.

This story should shed light on the secret inner man which is in every man. The inner man does not like aging, Balding is a reminder of the aging process that men hate. The problem for most men, however, is that the transplant route is imbued with negative connotations and men tend to be averse to the idea that their vanity is a problem for them. Facing their vanity without the support of a loving and understanding wife, can be a difficult decision for a married man. For the recently divorced man, on the other hand, hair transplantation is a common process during the post divorce period and with the change in their image (even the possibilities of a potentially painful surgery), a hair transplant is often moved to the forefront. With a change in the physical appearance that comes with a normal looking head of hair, comes a confidence and a libido to match provided the plumbing is in good condition.

How soon after a transplant procedure can you resume using cover ups such as, Couvre or GLH, until your newly transplanted hair grows in?
Thank You!

The use of Couvre and other scalp coloring agents, which tend to be powdery, can be safely used after the scabbing is gone. Scabbing is gone as early as 1-2 days on the short side, and 5-9 days on the long side. The difference between the short and long side reflect two controllable variables and one non-controllable one. The controllable ones are (1) size of the wounds, the smaller the wounds the shorter the healing time, and (2) the washing technique used at the surgery, the end of the surgery and the next day or two after the surgery. Good aggressive washing gets rid of scabs (in many of our patients) in a day or two. We offer hair washes for all of our patients after the surgery and as often as they feel that they are helpful. Patients are rightfully afraid to be too aggressive with the wash, out of fear that the grafts will be washed out of their recipient site. The non-controllable variable is the patient’s individual and unique reaction to the surgery. Some patients tend to exude more ‘transudate’ from the wounds (the yellowish fluid that brings blood-coagulating elements will often form scabs) and some patients may have microscopic bleeding at the wound site after the surgery (forming clots). All of these scabs and clots can be washed off the next day with properly administered washing techniques.

After the scabs are gone, these powdery agents can be used until the new hair wipes out the need for them (usually 5-8 months after the surgery).

I was wondering why you are running this baldingblog.com site rather than participating in one or more of the many chat groups on the internet?

The chat groups have a scattered agenda. Many are using it as a magnet for doctor advertising, charging doctors a fee for participation and favoring those that participate. Some of these sites have a combination of content focused on hair loss and chat activities. These sites are frequented by many of the same people who dominate the chat agenda, so it is less focused upon subject content and more focused upon selling something. With the anonimity of the internet, you can not always be sure which of the posters are honestly trying to help and which are trying to line their own pockets. Some of these sites thrive on things that go wrong. In our practice, things rarely go wrong, so a site that focused on the exceptions rather than the rule, gives a false impression of the process to the new inquirer who wants to learn about the reality of today’s modern hair transplant process. I have always liked to have free forums where new people can get answers without intimidation or salesmen hawking their every move. In my office, I started having open house events and hotel seminars 13 years ago with patient participation long before a hair transplant recipient ever came ‘out of the closet’ where he hid his hair transplants. We never used a salesmen anywhere in our business model. In those days, the ‘standard of care’ was the pluggy graft, so showing off a patient without plugs made our seminars and open house events very successful. Those who came, expected to see pluggy patients and what they saw were normal looking people where the hair transplant could not be seen. At these events, I always held an open forum, allowing interruptions as the audience fell into the tempo of the subject material and conversations. It was the audience that ran the ‘show’ not me. The BaldingBlog.com site allows the type of freedom that I have in our seminars and it put the agenda into the hands of the questioner. I am more a responsive participant as a content expert. I have had many emails that I do not put on the BaldingBlog because I am frequently responding to a follow-up question that may not have a public interest.

I have in the past experimented with participating in these chats, but many of the aggressive participants love to go after a doctor who is not paying his ‘right of way’ for immunity in the for-profit sites. Some of the comments have been tasteless. Hearsay comments dominate. If I go down in the mud with those that are hair obsessed or angry, I generally get frustrated. Arguing with an irrational person is akin to a Jerry Springer milieu rather than an educational and informative framework. The worst part of anonymous free speech is that some of these chat groups don’t care if any statement can’t be proved to be true. One can say that Dr. X is a murderer, a heartless transplant mutilator, a mercenary who is driven by the almighty dollar, and if there is no recourse to identify the person who sends out such comments, then you can not necessarily believe anything you read. I have seen people say that they have personally seen patients of Dr. X …. Or that they are a patient of Dr. X and certifies to the crime personally. Defending oneself from baseless attacks are pointless and a wasteful use of time. I would doubt that any of this audience would want to read the JerrySpringerBaldingBlog.

Hello,
I’m considering hair transplants, but my wife saw a talk show recently with a hair expert. In the segment, the expert said that a significant number of transplanted hairs fall out in both the short and long terms following the procedure. He said figure five years before you return to your original look.

How is loss of transplanted hair measured, and is the permanency guaranteed in some way?

Most transplants fall out within a month of being put into their new location. The new hair goes through a rest phase and some 2-5 months after the transplant was done, they start to grow and will continue to grow for the rest of your life. Hair grows at about ½ inch per month so you can calculate the hair length from the point the hair starts to grow multiplied by the number of months the hair has been out. The hair growth is not like a horse race, where every hair starts to grow at the exact same time. The growth comes in waves, some earlier and some later. We generally expect that 100% of the hair that is transplanted, will grow. Some if it may start immeciately, some in a month, two or three, and some may not start to grow for 6 or more months. Good growth reflects a skilled surgical team who does this all of the time. Less than a skilled team may take a toll on less than 100% growth.

You asked about measurement of hair. I invented and obtained a patent for a device I called the ‘densitometer’ over 10 years ago. This invention covers almost all of the measuring devices presently used today. What it allows is the direct visualization of an area of scalp. If you cut the hair (an area about the size of a pea), you can actually measure hair densities by counting hairs in the cut pea sized area. This measurement is performed on every patient we analyze prior to a hair transplant. This measurement tells me what the total supply of hair is in that particular patient (hairs per square mm) or the overall thickness of each hair shaft in the field of view. Caucasians, have the highest densities, African hair is usually the lowest and Asian hair is somewhere in between Caucasian and African hair. But within the races, there is a wide variation of densities so there is no substitute to good measurements. After a transplant is done, the same measurement process can be performed to reassess the donor area or even the recipient area. It is, however, impractical to take such measurements in the recipient area because it would require shaving too much of the scalp (a pea sized area may not be representative of the entire recipient area). The judgment of a good honest doctor and the results that you saw on other patients may be your best guide to determine what the yield of the transplant procedure actually was.

The 5 year statement you asked about is difficult for me to answer as whoever gave this opinion may have been looking at a very advanced balding pattern and looking at the native hair in the recipient area, not the transplanted hair.

Since you are in Northern California, I would suggest you and your wife may want to come to our Open House (at our office on Wednesday, May 18th in San Jose) where you can see a surgery and meet former patients. They will share their experience with you. There is no substitute to meeting patients directly.

I have seen ads all over the newspapers on hair lasers. What is the deal on them?

When you probe what these devices actually do, you often hear either unjustified claims (which are not legal from an FDA or FCC point of view) or that “studies are being done” and naming prominent people involved in these studies (as if to justify their premature endorsements). We never hear about the final results of negative studies! Reports from prominent doctors in my community tell me that they have seen a very high disappointed group of early adopters who participate in these modalities, but then again, my community of doctors are not experts in these lasers and they may have been negative from the start, not keeping an open mind. Some doctors, on the other hand, have become enthusiastic about them, but most of their observations are based upon subjective observations. A small number of people report some gain from the lasers and some segments of the European medical community seem to be enthusiastic for its value.

I personally believe that the literature I read does suggest that there is some stimulation to the vasculature of the scalp and that this impacts hair regrowth, but if so, then the question should become “, Growth? By How Much?”. I really think we should wait for final results on hair growth with good scientific trials before the medical community endorses this modality. I am supportive, however, of all uses of this modality on an experimental basis. What concerns me is if a doctor focuses upon money-making add-ons with any less than proven value defined scientifically like questionable creams and potions (like having a large display of hair conditioners, shampoos, “scalp cleaners,” etc as a focus on their medical practice that claim to make the hair grow), then the objectivity of the doctor as a consumer advocate will be questionable when it comes to these modalities. Sorry to be such a curmudgeon, but I will have to wait until I see some convincing proof of value before endorsing such approaches for saving my patient’s hair.

I loved the question about the salesman and the consultation [see: Hair Salesman]. I am a professional salesman selling high end cars, and I fully understand this issue. When one is selling a car or a service, the businessman asks: how many people does one have to go through to get a sale? Now with that said, How many prospective candidates do you go through to make a sale?

We call this conversion rates. Taking 100 people coming through, how many will sooner or later (within 2 years) make the decision to have a surgery. I have found that the number for my practice is between 33-40% and for other doctors working for me it is about 25-30%. My ‘conversions’ are higher because most of the people who come to see me know about my reputation in advance and often have made up their mind in advance of the visit. I am often the last doctor that they will visit. Still, my conversion numbers are low because I turn down most women (they often can not be helped), young men (who are too young and therefore too early in the process), people with unrealistic expectation, etc.. A salesman would view that the right conversion rate should be the majority of people coming through the door-whether they truly needed the surgery or not. When I had worked for another medical group who had employed a full time sales force, the conversation rates ranged between 50-95%! They would have fired me for my low conversion rate if I was one of their salesmen. That tells me that those doctors who employ salesmen, insulate themselves from the patient. These doctors build more a money focused practice than a people focused practice. My style is to use the medical forums and meeting, my website, the internet and activities like this BaldingBlog to communicate and educate, then have the prospective patient come to see me after they are informed. I have built a boutique practice where I have Hollywood stars and heads of state or CEOs of large companies as often as blue collar workers.

I went to a hair transplant facility the other day and had a consultation. Most of the time I was there was spent with a salesman. Is this usual? Do they generally get a commission of I sign up.

Your question is a good one. Unfortunately, many doctors in this field do use salesmen as communicators for their patient interactions. Although I have never done this, I do understand the huge costs involved in patient education and communication. The salesmen do perform that role well, but in the ending part of the question, you raised the most important issue, the one which defines whose interests are being weighed during the consultation process. The laws of all states generally forbid the payment of commissions to ‘communicators’, but I have no doubt that most salesmen have incentives to sell the hair transplant process. The doctor, on the other hand, is sworn by oath to put your needs ahead of his financial interests. There is clearly a conflict between selling you the transplant and watching out for your needs. You might judge the doctor by how much of his time you are worth.

I am 34 years old and I have a receding hairline. Now, I am getting a bald spot on the top of my head. What should be my first course of action to save my hair?

The first course of action should be to see a competent doctor who understands the male pattern balding (MPB) process. He will examine the hair on different parts of your scalp and look for the amount of miniaturization that you are showing in various locations. The things he will identify will not be the level that you can see with the naked eye as balding occurs slowly and insidiously and can not be picked up without high powered examination of the hair. Based upon a proper examination, he should develop a master plan for you that will cover your worst case scenario and probably include the use of medications for MPB if that is your diagnosis.