Category: Uncategorized

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Hair Transplant Doctors That Charge By the Session vs By the Graft

Can you please translate this.

I always thought that most hair loss surgeons charged by the graft. However, I noticed the following on a certain surgeon’s website. The surgeon is very well known and highly respected, so I don’t believe he is playing a pricing game, but I have no idea of what is meant by “charging by the session and NOT by the graft.”

Also, how could charging by the graft be misleading, like the wording claims? Please explain what he is trying to say and clarify how you charge.

From a certain surgeon’s website: “At (name removed), we try to keep hair surgery affordable. We charge by the session, not by the graft or hair, which can be misleading and overly expensive.“

Most hair transplant clinics do charge by the graft. I think the surgeon who made the above statement clearly believes session charges are less misleading and have a greater value than graft charges. At one time, I entertained the idea of doing a session charge rather than a per graft charge, but I ran into a problem working through the details of the charging mechanism. For example, if a person had a session charge for 400-800 grafts and then another charge for 801-1200 grafts, would the person who paid for 801 grafts feel cheated when he knew that someone else paid a lesser price for 799 grafts? I think that a patient would want to know just what they are getting and per graft charges really reflect, in my opinion, the amount of work done and the value in transplanted hair to the outcome. Iin this example, there is almost no difference between a charge by the graft for 799 vs 801 grafts, compared with a big step up in pricing for a session charge.

Charging by the graft is like a lawyer charging by the hour. If the lawyer is honest in his hourly billing, the client actually pays for what he gets; likewise, if the surgeon actually delivers the grafts that he says he transplanted, the same question of honesty is raised by the patient who should ask, “How do I know what I purchased in number of grafts were actually delivered?”. Here’s a few posts about ethics in graft counting that may interest you:

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Hair Transplant Patients Under 30 Years Old?

Hello Dr.Rassman

Really informative website, love it. I just have a couple questions.

1. Just wanted to know how come there is a lack of hair transplant photos on the NHI website of patients 30 and under?
2. How many patients under the age of 30 that you have done surgeries on, either in the front or crown of the scalp, have to come back for more additional procedures to make it look thicker and fill in areas or because they are losing hair behind their transplanted hair?

Thank you kindly.

There are many photos on our NHI website, and I’m sure there are some younger patients in there. If there is a lack of these younger patients, it isn’t on purpose — we post the photos that our patients allow us to post, and many of the younger patients don’t wish to appear on our site.

Our average age for transplant patients is around 30 to 40s, but we have done surgery in men as young as 20 (who was a bald NW 6) to as old as 80. This becomes a one-on-one assessment comparing the risks of too early transplants with waiting too long. It’s not something that I can easily convey here in this post.

Men with frontal hairline loss often come to surgery earlier, because they are bothered by the man in the mirror. Younger men who are rapidly losing hair will likely benefit from finasteride (Propecia) over surgery in certain cases. It is not unusual for a young man under 30 with fine hair to have two procedures with us.

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Hair Transplant Safety and Efficacy Standards?

Dear Dr. Rassman,
I find your blog very informative. I am looking for answers to the following questions:

  1. How is the success measured in hair transplant?
  2. What is the life span of transplanted hair follicles? (without any minoxidil/propecia)
  3. How does hair transplant compare to just minox/prop in terms of effectiveness and durability?
  4. Is hair transplant surgery proven via large scale studies done in compliance with standards that you would like to see in any other hairloss treatment before you could accept them?
  1. The patient and doctor have to have specific and attainable goals before any surgery. No surgery will make you look like Elvis… in other words, no surgery will replace all the hairs you lost. So the success of the surgery is measured by the patient with realistic goals in mind.
  2. Transplanted hair has the same life span as the hair on the back of the head (the donor area), because that is where it comes from. As long as there is no disease present that would cause that area to lose hair (uncommon), the hair’s life span is until you die.
  3. Transplanted hair is genetically “strong” hair that is not affected by DHT or genetic balding. Drugs (Rogaine and Propecia) are meant for balding and thinning hair that is affected by DHT (genetic balding).
  4. Hair transplantation in one form or another has been practiced on a commercial scale since the 1950s! I have seen a number of patients who were transplanted in the 1950s and 1960s with the old hair plugs and they are still growing (for better or worse). It is in essence an autologous organ transplant, with each hair being its own organ, and it has been proven to work. Numerous studies exist that prove its success, but the cosmetic success and making it look natural is another issue that involves technique and artistry. I would argue the LARGE scale studies are right in front of you when you look at all the NHI patients in our gallery.
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Using Non-FDA Approved Medications As Last Resort?

Hello Dr.

  1. 27 yr old male, Norwood 2~2.5
  2. use propecia regularly for 3 years. This has helped greatly in preventing mpb.
  3. use minox once a day (used to do 2x a day) 1ml on hairline and 1ml on crown
  4. Within the last year my temples have drastically recided (sp?) and now my hairline is starting to go.
  5. I am noticing even beyond my hairline there is diffuse thinning and it’s frightening to look at.

Do you offer any advice on any other medication to add to the propecia and minox mix? It seems one would have to try a non-fda med as a last resort before surgery.

I was considering adding revivogen (non-fda approval considered) but I am unsure of how it’s anti dht properties will affect my hormonal levels (i.e. will the combo of propecia and revivogen cause a severe loss in the production of dht that would lead to make gyno?). Obviously propecia is a systemic medication, but what of topicals such as minox, revivogen, spiro, etc.? Are they systemic or only confined to the scalp.

As a Norwood Class 2, I think that you should be tested for miniaturization to see if there is balding behind the hairline. First, you need to measure just what is going on to determine if you really have the problem that you think that you have. Second, if the Propecia is working, why go to non-FDA medications and put yourself at possible risk? You need a doctor to take charge of you and give you the guidance you need.


2006-05-05 15:17:51Using Non-FDA Approved Medications As Last Resort?

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Hair Transplants for 20 Year Olds?

do you do procedures under the age of 25 im 20, because for some reasons other surgions like bernstein wouldnt……also is there another alternative other than propecia that doesnt have side effects to prevent further hair loss?

At 20 years old, you’re likely not a candidate for surgery unless there is obvious recession and you are realistic in your expectations. When Dr. Bernstein turns down a 20 year old, I generally follow his lead as we both are very concerned about your long term prognosis. Hair loss is progressive, so transplanting you now without planning for future hair loss is a bad idea, particularly if your future pattern is uncertain. You have a finite amount of hair that can be transplanted, so you don’t want to use it all up now and then continue to bald years down the line without enough reserves to follow the hair loss. There are many doctors eager to get your money, so you can find other doctors willing to transplant a young man of any age.

As for Propecia’s (finasteride) side effects — they are overblown. Propecia is easily the best medication for those men with early hair loss. The only alternative I recommend is minoxidil (Rogaine), as it is also FDA approved to treat hair loss. Minoxidil will not prevent hair loss in the same way that Propecia will, and has it’s own issues with side effects. Remember, each and every medication has the potential for side effects (look at Tylenol, for example), as each person is different and will respond differently to it.

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What is the value of a conditioner in a person with hair loss?

I heard shampooing everyday isn’t good so I am trying to space it out more and do twice a week or so. However, on the off days, I plan to use conditioner but not sure which one. Does conditioner help with hair loss? I never proactively used it in the past so I am not sure. Also how long do you guys keep the shampoo and conditioner in for?

One of the problems that make hair loss of fragile hair worse, it combing and brushing hair that pulls out miniaturized or weak hairs early. The use of good conditioners, solves the pulling problem because the comb and the brush glide through the hairs with less pulling.


2019-02-01 15:10:57What is the value of a conditioner in a person with hair loss?

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Haircut After Hair Transplant

When is it OK to have a haircut after a transplant, especially for the transplant area? Thanks.

After a couple of weeks you should be able to get a regular haircut. Don’t expect that the transplanted hair will grow out in less than 5 months.


2007-10-10 08:34:21Haircut After Hair Transplant

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Very Low Dose of Finasteride (Less than 0.25mg)

Dear Dr Rassman,

Have you had any patients who have taken very low doses of finasteride (i.e. less than 0.25mg)?

I am not keen to take propecia because I’m concerned of the effects to my internal body chemistry but would also love to keep my hair for longer. I have had issues with my sex drive previously and do not want to mess with my hormone balance too much as a man still in my 20’s. Another reason being that I’m an athlete and want to be at my peak physically. I’ve read a lot about how finasteride affects the hormones, particularly the obvious reduction in DHT but also the decrease in free (not total) testosterone and the rise in estrogen.

Then I read this forum post: Hairlosstalk.com

It seems that taking a dose as low as 0.05mg is enough to lower scalp DHT considerably while keeping 20% more DHT in the blood. Like the original poster in the forum thread who is considering crushing a pill and measuring smaller doses – this prospect is more appealing to me. If I could just lower my blood DHT by 40-50% instead of 70% then surely my hair would still get some benefit and I would be able to keep my hormones at a more normal level. I have ruled out taking 1mg but am really curious about taking 0.05mg if only I could just measure it accurately each time (I wouldn’t want to take fluctuating dosages each day).

It makes me wonder why propecia isn’t available at a much smaller dose (0.05mg or 0.1mg)

Could you comment please? I’d very much appreciate it. Thanks for such an informative blog.

Propecia (finasteride) at 1mg was determined to be the ideal dose for treating hair loss. Lower doses do work, but how low? I’ve said that 0.5mg produces 80% of the benefit, and 0.25mg probably give 50% of the benefit. I don’t have a clue about lower dosages.

But by dosing the 1mg level, it is the most effective treatment level to use… so why dose lower unless there are significant side effects?