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Hair Loss InformationMegasession Results (with Photos) – Hair Loss Information – Balding Blog

What does a 3000 graft operation look like in a person with a Class 6 Norwood balding pattern, fine hair and moderate contrast between hair and skin color?

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The below patient is in his late 60s and had one hair transplant procedure of 3,164 grafts. The grafts were placed to cover the entire balding area. In helping you understand the issues related to fullness, the area covered placed about 6000 hairs (in 3,164 grafts) in an area that originally had 50,000 hairs. That means that what you are looking at about 12% of his original hair density (before he went bald). Clearly, the math points out that a return to his original fullness is not possible. Many times people ask me how many grafts one needs to get a full head of hair. The answer to that question depends upon the thickness of the hair shaft, the character of the hair (straight or wavy), the color contrast between hair and skin color (the lower the contrast the better) and the size of the bald area being treated. I have placed 3000 grafts into an area 1/4 the size of this man’s bald area and the results were a much fuller appearance.

There is a general misconception in the hair restoration community that one can tackle a man with this degree of balding and replace the fullness to his original look in one session with as few as 1500 grafts. Many unethical doctors make that representation and I find it difficult to ‘compete’ with a doctor who promises a full head of hair with half the number of grafts I showed here (probably at half the price because of fewer numbers and salesmen that promote such misconceptions). I try to show how important it is for today’s buyer to understand just what he is buying and what he can expect. Be careful when a doctor shows you just a single view of a result, places the photo in a shadow, and does not really cover the entire transplanted area. That is the reason we have open house events monthly and have been doing them for 14 years. Visitors can see and interview patients, examining just what they are going to get without tricks of photography or slick salesmen to tell you what you might want to hear, true or not. With that said, the man shown below felt transformed in just the one procedure. He wanted a second session to increase the fullness further and after these pictures were taken, a second procedure of 3000 more grafts were done with a similar distribution, though it is far too early to show the results of that procedure. Please click each photo to enlarge.

The 1st set (below) are the before photos.




 

The 2nd set (below), are the after photos, taken 10 months after one procedure.




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Hair Loss InformationItch and Dandruff from Propecia? – Hair Loss Information – Balding Blog

Hi Doc,
I recently came in for an open house at NHI and it was very helpful. Unfortunately, I forgot to ask one question. I’ve been on propecia for about a month, hoping that it reverses some of my miniaturization (you said about 50% in the crown and 40% in the mid scalp from what I remember). Almost immediately after starting propecia a month ago, my scalp started itching and I’ve noticed slight dandruff. I’ve seen other posts on propecia as a cause for this annoyance, but never any scientific evidence (I believe there is evidence that Rogaine causes thes same effects).

I’m not sure if this is expected or can cause further loss due to irritation of the scalp; any inputs? I’ve starting using Novarel 1% dandruff shampoo to hopefully manage the itching/slight dandruff.
Thanks!

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Treat your dandruff as you are doing, as there is no evidence that Propecia causes dandruff. Wait out the 8 months. Hopefully with good dandruff treatment and shampoos, the problem will abate. Glad to hear that you came to an NHI Open House and I hope that others reading this blog will do the same. Our next open house is on Thursday, January 12, from 4-7pm.

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Hair Loss InformationUsing FUE to Touch-Up Straight Hairline – Hair Loss Information – Balding Blog

Hi Dr. Rassman…
First of all, I want to thank you so much for creating balding blog, it gives us very valuable information from one of the top and best surgeon in the world. About five months ago, I had a 3000 graft transplant with Dr. XXXX in toronto to restore my hairline and part of my midscalp. growth is coming in good so far but I really dont like the hairline design. it is densly packed however the grafts follow and curve almost on a straight line letting everyone know its a transplant. I like the more jagged style where the hairline is kind distruped to give a more natural look like I have seen in some of NHI pictures. so I was wondering if you can probably FUE some areas on my hairline to give a more natural look, maybe 50-100 grafts depending on what you think is best just enough to distrupt the line pattern. Is there a minumum number of grafts needed for FUE procedures?? also is it okay to perform this procedure after six months of my initial transplant as I want to get this done ASAP. Thanks again Dr. Rassman

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The problem with straight lines is that they are too orderly, like Count Dracula’s appearance in the movies of the 1930’s. They accentuate a hairline when the hairline should be a zone of transition from a bald forehead to a thick head of hair. I fix these types of hairlines all of the time. Depending upon the color of your hair, it usually takes between 200-600 grafts in the frontal hairline to build a good transition zone. I wasn’t 100% sure by your email if you’d already had an FUE procedure or just wanted to use FUE for some “touch-up” work. If you have already had a strip procedure, it would be less expensive to do it with another strip procedure. An FUE procedure will work as well, but at twice the cost.

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Hair Loss InformationWhat is the Megasession? – Hair Loss Information – Balding Blog

I found this story in my local news [from November 2005], Patients Thrilled with Hair Transplants. In referring to Dr xxx, it says “He’s pioneered a painstaking process using one-to-two-thousand grafts at a time.” I thought you pioneered this with the megasession. I’m just curious if the ABC news was wrong or this doctor is doing something unique.

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There is certainly some misrepresentation or failure to do adequate research here. I published information about the megasession in in early 1990s, and discussed the 1000, 1500, 2000, 3000 and 4000 graft sessions over a period of two years before anyone was doing this type of large session. In 1995, I presented 23 completed hair restoration patients at a medical convention in Las Vegas who had megasessions when most doctors were just starting to consider doing them. Why is this important, you may ask?

  1. If the doctor was the source of this mininformation, then his integrity is reflected in the statement. My publications on this subject in the various journals in the industry (see: Follicular Unit Transplantation Megasessions from 1995 as an example)
  2. The ability to do them reflects the focus that I pushed early in the development of this technology, which is to try to get the patient finished with as few surgeries as possible. I had coined the term ‘FastTrack’ for the ability to accelerate the time-line for a hair transplants into as few as one or two surgical sessions. That means that there was much to innovate as the technology that was available at the time I started this process was ackward for getting many grafts done at once. Take a look at the NHI Timeline, which will show when we announced what we did and when we did it. I would challenge others to produce such documentation, because it just is not there.

In the case of the article you are referring to, I am going to just assume that it was poor wording / research by the article’s writer. Be sure to be a perceptive shopper, always keeping in mind the “let the buyer beware” adage in your buying process.

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Hair Loss InformationPost-Transplant Shampoo Recommendation? – Hair Loss Information – Balding Blog

I had my HT one month ago and have been searching for a good shampoo and conditioner. On the blog I’vee seen entries talking about Regenix and Nioxin, which you seem to think have had anecdotal evidence of working. Would you recommend one over the other, or do you think its a waste of money. I just feel like I spent a lot of money and want to protect my investment as well as possible.
Thanks.

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Use whatever shampoo you like, as none will be better than the rest in getting you to where you finally want to be after a hair transplant. What is most important is to get the ‘scabs’ off with good washing and then keep clean. Do not scratch your recipient area.

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Hair Loss InformationTreating Alopecia with Acupuncture – Hair Loss Information – Balding Blog

hi dr. rassman! i came across your website and i found it to be very helpful. im a 14 year old girl and about a month ago i was made aware of a bald patch at the crown of my head about the size of a 10p.a few days ago,i noticed that it had grown to about 2inches by half an inch. this is the only patch that i am aware of. im only 14 and i am sooo soo depressed about it and am constantly crying about my hairloss. ive been to see several doctors and i know there is no cure accounted for. today i went to a chinese health practice and went for a consultation with a chinese doctor, i was asked many questions about my diet and health and then acupuncture was suggested to me. i was very shocked and scared but went ahead with the acupuncture session there and then. and i was given a selection of herbal remedies to help with the alopecia also. what i would like to know is, how effective is acupuncture for the treatment of alopecia as i am extremely confused and scared as whether or not go ahead with regular acupunture. i am absolutely terrified of needles and i know i will be crying the whole way through, but if there is that possibility of my hair growing back again, i would definitly go ahead with the treatment. please please give me any advice you can im very scared that i will lose more hair and im confused as to what to do about it! please help im desperate

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Acupunture should not help hair loss. Patches of hair loss are often caused by alopecia areata and this should be one of the diagnoses to consider. It sounds like you need a competent medical doctor to examine your case. It is impossible for me to make the diagnosis without seeing you, but if you send me digital photos to the address on the Contact page, I might be able to make a suggestion in the differential diagnosis.

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Hair Loss InformationScalp Aches After Laser Therapy – Hair Loss Information – Balding Blog

I am a 23 yr old male, suffering from thinning hair. I went to a Dr, and he gave minoxydil as part of the treatment, and laser therapy as the other. He uses a laser pen like device, and runs it through my scalp for about 15 min. Well my question is that: everytime he does the laser therapy, my scalp aches a bit. I told him about it, and he says that it is normal, but i need more reassurance.
Thank you

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I am unfamiliar with this “laser pen” he is using, but if you think that the aching follows the use of the laser pen, then I would believe that the laser pen is the cause. Perhaps it would be helpful to read my past blog entries regarding the use of lasers in hair therapy, and more specifically, this blog entry about Low Laser Light Therapy. I’m sorry I couldn’t be more helpful, but if you could get me the actual name of the device, I might be able to research it further.

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Hair Loss InformationTestosterone Replacement Therapy and Hair Loss – Hair Loss Information – Balding Blog

Hello Dr. Rassman,
I am 40 years old, male. I have been on presription testosterone replacement therapy for about 1.5 years, due to chronically low levels of total and free testoserone. My doses are physiological (about 100mg/week). I have always had a very thick head of hair — and no MPB or baldness of any kind on either side of my family as far back as any generation can remember. I never experienced any hair loss or thinning until about 1 month ago, when I started noticing my hair suddenly started falling out in the shower and when I combed it, at the hairline, top of the head. It has become very visibly thinner in the past month. I have had every test my doctor could think of (blood, glands, brain scan, etc.), and he has ruled out pretty much everything he can think of. He started me on .5mg daily of Avodart (yes, I know – off label use, but he has seen great results with it over the last 3 years with his patients), but I have been on it for only a month. My doctor says that as long as I am on Avodart, even if the testosterone is causing the rapid hair thinning and loss, then this will stop it. He suggested that I do not stop TRT. My questions are:

  1. Do you think that these testosterone injections can cause hair loss to suddenly occur after almost 2 years with no previous problems; and
  2. Do you think that, assuming it is the testosterone that is causing the hair thinning/loss, that I can continue on TRT without further hair loss, provided I stay on Avodart?

Thanks you for your help on this one!

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Yes, testosterone replacement therapy can cause hair loss. Some people have the gene for hair loss that has not been expressed for a few generations. Testosterone can precipitate the gene’s expression. Some people believe that testosterone itself can cause you to lose hair.

With regard to your second question, Avodart will help block the effect on DHT receptors, but there is clearly a direct effect of testosterone on the gene as well, particularly if higher levels are achieved. Time will tell you.

I would get immediate mapping of your scalp hair for miniaturization to put some measurement to the process that you are observing. There is no substitute for good measurements to find out what is actually going on.

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Hair Loss InformationSee Through Hair and ‘Towheads’ – Hair Loss Information – Balding Blog

Hello Doctor. I am a 20 years old and I had suffered from thin hair all my life. Since I was young, it was noticiable that I didn’t have a full set of hair, and as I grew older, my hair just mantained the same volume. There is no actual hairloss, but there is just not enough hair. Something maybe like half of the density it should have. I’ve been taking Propecia for 2 years now, and although the hair seems to be thicker, there is no hair regrowth at all. I’ve always wonder is this is something different from baldness, given that I dont lose hair; i just never had enough hair to look normal. If so, what are my options.
Thank You so much

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I believe that your see through thin hair is just your genetics. Now that you are getting into the dating scene, you are more sensitive to your see through hair than you were before. We used to call people like you “towheads”, which implied see through hair. When I was young, people would always rub my hair for luck because it was thick, gorilla like and non-see through.

First, you need to have baselines made with good measurements for miniaturization, as I have talked about in many previous blog answers. It is critical to know if you are actually losing hair or just have thin hair and a changing view of your hair situation. This will give you comfort, at least, for knowing. If by chance that I have guessed right and you are a “tow head” and have no balding, then this is a situation that can be adequately address with hair thickening agents, of which there are many on the market today.

And yes, “towhead” is a real word. Here’s a link to towhead in the dictionary.