Hi Doctors,
Just wanted to say thank you to your commitment to this website — as a medical student (University of Virginia) I’m impressed daily by your not only your expertise but your willingness to provide honest advice, even when this is not advantageous to you, financially or otherwise. I see too many doctors doing otherwise on a daily basis, unfortunately.
Best
We appreciate your kind words. 🙂
I had a hair transplant 3 weeks ago and the scabs are still present. I can not take off my hat. As an executive of a large company, I took off the first 2 weeks, and had to go to work with a baseball hat on. Having a hair transplant was a terrible decision. Whey don’t you guys tell people like me what to expect? I think you can tell that I am angry as hell.
I am certain that we did not do your hair transplant as our patients are devoid of any major scabs after about a week if washed twice a day. More importantly we make every effort to educate our patients of what to expect.
In fact, my wife (Mrs. Rassman) had a hair transplant in the frontal hairline just a few weeks ago, and the transplant was barely detectable by the first day after surgery. The key to keeping a hair transplant less noticeable is to have a washing program that keeps the scabs off. Most of our patients leave the operating room without much evidence of the surgery because we wash the scalp very thoroughly before leaving the operating room. We have the patient usually come back the next day and we wash their hair ourselves and instruct the patient in the washing process. The old adage that cleanliness is close to godliness, applies here in the post operative care of a hair transplant. Your doctor should have explained this to you.
I rely on your blog as an authority in Hair Transplant information as well as hair loss information, but I don’t understand why you guys have absolutely no faith in any treatments that are not backed by the FDA. You have lots of people on here claiming that they are getting results from other treatments and you just waive those off with, “well the FDA hasn’t said anything about Nioxin so I doubt have any real benefits” or Regenix or Nizoral.
If we wanted the advice of the FDA we could manage to find their website, but then again they are the federal body that told us Rezulin and Vioxx were okay.
So my question really is why be so close minded to alternative treatments other than lasers, minoxidil and finasteride. We get that those have been approved by the FDA, but why not look more closely at the alternative treatments that have not been approved or even looked at by the FDA, instead of just non-chalantly poo-pooing anyone on here you seems to have good results from them.
Anyways, great blog regardless. Thanks for all of your contributions.
I’ve never told anyone to flat out “do not use that product” unless I knew it to be harmful to them. Most of these products are a waste of time and money, and when I’m asked about my opinions I’m going to provide them. There is no regulation on many of the products I’m asked about, and countless companies will take advantage of the balding public’s desire for hair growth. In fact, I’ve often told people that write in with positive experiences with a non-FDA approved hair treatment that I’m glad they’re getting good results and to continue using it as they see fit. However, as a medical doctor I’m not going to recommend possible garbage to thousands of people that visit my site daily. I will, however, recommend proven treatments that have been tested and shown to be safe.
Yes, the FDA isn’t perfect. I’ve addressed that topic many times. But until something better comes along, it’s what we have. I’d certainly trust the FDA before I’d trust most messages posted by anonymous people on internet boards just eager to tell you all about the latest new hair loss cure that they happen to be selling if you click their affiliate link. I mean, the last time I looked, the FDA didn’t have links to buy the products they approve… but I can’t say the same thing for those people that spam web boards. Oh, and for the record — I think the hair lasers are also a scam and I’ve been highly critical of them (they’re not FDA approved, just cleared for safety).
I am 18 years old and I am seeing my hairline rising. Can we stop this change with Propecia?
The mature hairline is present in about 90%+ of men as they mature. I don’t have any experience with stopping the hair loss in the very front of the hairline that is typical of children. At 18, without seeing you, I don’t know where you are in the process; however, I don’t believe that the zone between the leading edge of your juvenile hairline and the place where a mature hairline will end up (see reference above) is mediated by the balding gene as this is not balding in the typical sense of the word. These hairs undergo Apoptosis (cell death) and that is programmed into your genetics. I have had young men on Propecia in the past, and I do not remember any of them where the transition from juvenile hairline to mature hairline was stopped by this drug.
There was a movie named Network that came out over 30 years ago and contained a great line that became a very memorable quote:
“I’m mad as hell, and I’m not going to take this anymore!”
Well, this line came to mind and I want to tell you, my readership, how mad I am and why. Unfortunately, I can not directly act on what is making me mad, except by speaking my mind through this blog. There is a new scam going on in the hair transplant industry, which plays off uninformed patients who come to visit a doctor for hair restoration surgery and who want to rightfully trust that doctor. The scam is simply to get a young man or woman to trust in the doctor through skilled sales and presentation skills, and then when they make up their mind to have a hair restoration procedure, they get what they would not have expected.
The fee structures in the hair transplant industry is based upon a fee per delivered graft. Usually, the prices run all over the place. I have seen three people in the past week alone who received over 2800 grafts, supposedly in their ‘balding’ area. They get poor densities transplanted into the balding area and many more grafts are placed into normal hair. One of the three patients was sold 3300 grafts at $4/graft, and I calculated that he could have never gotten that many grafts because the density of his donor area and the tightness of his scalp would never have allowed that number. Add to that was that my examination only saw about 400 grafts that grew and I suspect that the patient was swindled. Worse than the financial loss, was that valuable donor hair was lost and damage was inflicted in the recipient areas that were transplanted.
I am certain that this scam is being perpetuated all across the world, as I have seen patients coming to visit me from throughout the United States and Europe. All I am addressing here is the intent to defraud. I am not addressing the second class work performed by doctors who try to deliver first class work.
What can you do to protect yourself? The answer to this question is to do careful research. Read the blog entry Patient’s Guide — How Many Grafts Will I Need?, which teaches you how to determine the number of grafts for a given balding area. When I wrote this piece, I did so to explain the economics of hair distribution to arm those prospective patients with enough information to be well informed about the pending purchase of hair transplant grafts, but now it seems that doctors are reacting to the competitive challenge by dropping the price per graft and raising the numbers, many time a multiple of what is needed. Many times the doctor does not even transplant the numbers he/she commits to (I believe this is less common, because their staffs would see that). If you understand the process of calculating the number of grafts, you will be able to determine for yourself how many transplanted grafts you need, so if you (for example) calculate 1000 graft needed and the doctor recommends 3000 grafts, then you know that the doctor is in for the ‘SCAM’. Never forget (that like any service business, even a doctor’s cosmetic surgery activities) that it is a Buyer Beware business.
There is nothing that I can do except to vent here on my blog. I am appalled at the behavior of this group of scum doctors, for they are not only crooks, but they dishonor the good doctors who are in the hair restoration field. If I come out publicly and identify the doctors who I am certain are involved in this scam, I will be open to legal actions by those involved. The medical board has no power to deal with it, as the decisions on what to do falls outside their domain and the doctors would withdraw into the practice of medicine. The only place where these doctors can get attacked is in the courts on a malpractice action. I can play a role as an expert witness to those that wish to take action and would offer my services to the victims of these crimes and their lawyers.
Young man started treating balding in the old days (15+ years ago) first with scalp reductions trying to cut out the bald spot, eventually getting transplants into the bald spot. He continued to bald and ended up with an oasis of hair surrounded by a bald scalp. This is the way it was, thankfully, not today. In those old days he rushed to get a hair transplant in the front, getting the old type of plugs transplanted into his head yet he continued to bald leaving him with terrible looking plugs, like a corn field on his head. The more transplants he did, the balder he got. His doctors made a lot of money out of him with multiple transplant sessions and three scalp reductions (where the bald spot was removed surgically for the thousands of dollars) never thinking of any Master Plan which would accommodate his balding progression. In the old days, Propecia/finasteride was not on the market so he could not slow the process down.
What can we learn from this and let’s compare the 1980’s to today.
1- The balding progression time-line has changed because of the use of finasteride today and this drug will absolutely slow hair loss down so that many people may not reach their final balding pattern in the youth. A balding man who might develop a Class 6 pattern without surgery in 1985, might develop that pattern before they are 30, but today on Propecia/finasteride, they might not develop that balding pattern for 10 or 20 years later, but it can happen sooner and it may be safe to assume that it will happen sometime in his older age.
2- If you have a 2 inch round balding spot in the back of the head and get it transplanted, you may lose hair around it to a 3 inch round bald spot in 5 years, it will look like you have an Island of Hair with surrounded by your bald scalp and your hair around that area. This is why I don’t like to transplant the crown, particularly if the drug finasteride can restore the hair. If the hair is not restored by the drug (with or without minoxidil) and the density of the hair in the donor area is average or better than average and if the frontal balding pattern has been addressed with transplants, then the crown can be transplanted provided there is enough hair to finish what was started (worst case planning is critical) and the patients final balding pattern can be defined by the surgeon. Only an experienced doctor who is not after your money but cares about your long term look, can make this judgment. Today, many doctors will transplant the crown without regard to this Master Plan I am talking about here.
3- The same rules apply to frontal balding. What is the worst case scenario? Finasteride does not usually work to reverse frontal hair loss but it will slow down the frontal balding process. So when you get your frontal area transplanted, ask your doctor what is his/her thinking about the progression of your frontal hair loss. If there the doctor has no good answer to this question, get the hell out of his/her office.
Why am I discussing this with you today. Because even today, we continue to bald no matter what we do. If we are lucky, we can slow the time line down enough never to face the end stage of balding that we are genetically programmed for, even with the use of finasteride. But to be safe, you must assume that you will not be the lucky one and figure out a worst case scenario with your doctor. You and a good doctor can build a Personalized Master Plan for your short and long term hair loss. Think about this and its meaning. Good planning is always the right way to go in managing your hair loss.
i am 18 years old i have dark brown beard and i layed out in the sun for about 10 minutes and noticed when i looked in the mirror my beard lightened to a lighter brown. I Dyed my beard black a couple times using just for men beard dye and i got a very bad reaction and a burning sensation on my mustache and now every time i try to grow a mustache it looks tinted with blonde and very weak i did this in october of 2007, Do you think i have permantly damaged my roots or is there anyway i can grow a healthy mustache again or anything i can take or rub on it that would help, please i dont look right without a mustache i need any help or advice anyone can give me thank you.
Any bleaching of the beard will be short lived if you shave, as the new hair growing out should be your normal color. I don’t know if you burned your hair with chemicals as they may be one of the few ways to get what you seem to be describing. Best to see a doctor.
I have seen many people who had their hair pulled out. If it is a single pull, it will come back in about 6 months. In contrast, repeated pulls can cause traction alopecia.
2018-03-02 06:24:192018-06-22 11:40:04I Got into a Fight and About a 4 Inch Area of My Hair Was Pulled Out. Will It Come Back?
Can you image going out in public with this look on the left? The patient on the left is not our patient but compare our patient on the right and see the difference. We are obsessed with an undetectable look beginning when you leave our office. What this doctor did, was to leave his grafts elevated. These elevated grafts will remain visible for weeks after the surgery and they will crust over. I have seen patient photos showing this to last up to a month. I look at it as a month of hiding because of a poorly executed hair transplant. Both of these patients had the same hair transplant distribution
2019-09-22 10:29:172019-09-22 10:30:17These are elevated grafts immediately after the hair transplant (photos)
