How Do I Know I Didn’t Get Cheated on the Grafts I Paid For?

Hello Doc,

I had my first hair transplant 6 months ago in Texas and I received 1613 hair follicles in the frontal region (That’s what my Doctor claims 1500 + courtesy grafts). I lost all the transplanted follicles within first 2 months and I see few hair follicles growing in the sides.

From the day one I had doubt that I didn’t receive the number of follicles I paid for (1500). I felt I received only 1000-1100 grafts, My buddy did count the number of incisions made 2 days after the surgery. I also went to a hair transplant surgeon to get a second opinion but the surgeon refused to do the counting as he felt it was unethical thing to do. However he convinced me that I would have received the number of Grafts I paid for. He also told me the incisions are microscopic and I cannot count it accurately. As the days went by scabs started to form and I did my research by comparing the photos of people who received same number of grafts as me in the frontal region.

After all the research I’m still convinced that I didn’t receive what I paid for and I feel cheated. It took me great pain and sacrifice to get that surgery and I feel its not even worth it. I have decided to wait for few more months to see, how may hair follicles will grow and how far it covers my bald spot.

My question to you is

1) Is it normal to feel what i’m going through
2) Can someone count the number of incision/grafts accurately after the hair transplant ?
3) Lets say if I get a HT from you, How Am I insured that I receive what I paid for ?
4) Do HT surgeons really cheat ? or Am I just being paranoid ?
5) Lastly In case im really cheated , What Can I do ??

I don’t mean disrespect you or the HT surgeons community But I’m very disappointed with my situation. Please answer all my questions and relieve me from this confusion.

Thanks in advance.

I don’t know if it’s “normal” to necessarily worry about getting cheated, but I suppose that depends on your level of trust with the doctor.

On occasion, I have been requested to count the grafts for someone that wasn’t my surgical patient. I had one of my patients feel that he was cheated and took a professional photograph of his head the very next day. He had a large photo printed and placed pins in the wounds that he could see (in the photo, of course) and found that only 50% of the wounds were pinned after the analysis was done. So I managed it by showing him: (a) the count sheets of the 5 individual technicians who did the cutting of the grafts from the strip and we added them up together, (b) I had him come in to watch a surgery on his second day to see if he could identify the wounds in all lighting conditions with good photographs (he could not), and yet he watched us place the grafts to know that the counting process is intricate. He saw that there were two counts that were done simultaneously — one by me audited by an assistant working next to me as the sites were made, and one by the staff cutting up the hairs and grafts from the strip. I invested a great deal of time to address his concerns. I am not sure, to this day, if all of my efforts were successful.

In three people that came to see me to count their hairs and grafts on the 3rd-6th day after surgery, in two of them I found that the counts did not match up. One was off by over half of the amount claimed, one had 90% of what was paid for… and the third was on target.

On another patient, I counted the grafts and the hairs that grew 8+ months after the surgery (the man was relatively bald in the front and top where the grafts were placed) and found that many of the grafts did not grow to the numbers transplanted (about 2000 grafts out of 7600 graft he paid for), and the hairs in each graft had low hair counts. This was done under the assumption that everything on his head in the transplanted area were grafts. I had inside information on this last patient from one of the doctor’s technicians who claimed that this was far more common in that particular doctor’s practice than he could stomach, so he quit working for there.

There is little recourse for the patient if he feels that something improper has occurred, as an investigation would be difficult. I think that most doctors are honest and try to do their best when they deliver a service like a hair transplant or, for that matter, any cosmetic procedure. This, of course as I have said many times before, is a buyer beware issue, and each and every prospective patient should do their research before making a final doctor selection.

How do I remove scabs from a Hair Transplant?

Use a surgical sponge without soap, then dip it into a shampoo solution and make a lot of suds. With the sponge full of soapy shampoo, roll if back to forward on the grafts. Press on the sponge. Little squirts will come from the holes in the sponge and take off all scabs. Repeat it until it is clean. If any scabs remain, then get a Q-tip, dip it into the shampoo water and roll in over residual crusts over and over again until takes off the last of the scabs. Repeat this daily to keep the scabs off. You will look clean of scabs if you follow this routine. Read my article on graft anchoring here: https://newhair.com/wp-content/uploads/2018/11/mp-2006-graft-anchoring.pdf

This is what you should look like:


2021-10-10 10:01:34How do I remove scabs from a Hair Transplant?

How do I clean my donor area which seems full of scabs (with photo)?

I had 4500 grafts and can’t seem to get these scabs off . It is now 30 days since my surgery and although there are less scabs, they seem to remain. What do you think of the FUE area?

These crusts should never have formed. You should have been instructed in a washing protocol after the surgery that would give you no crusting. I’l bet you also had crust in the recipient area as well and had to wear a hat for cover. The donor area where the FUE was performed is too large, too high and too low which means that some of the grafts that were removed are not permanent hairs. The doctor seemed to want to push the numbers high so he/she extended the donor area outside the safe area. Is that what you asked the doctor to do?


2020-07-07 15:43:56How do I clean my donor area which seems full of scabs (with photo)?

How Do I Become A Hair Transplant Surgeon. I Want To Work For You One Day!

I have been following your blog for quite a few years now and it is an excellent source of information on balding.

I am 24 years old (male) and will begin my medical studies in California (or Alberta, Canada if I receive an acceptance there as well). I have been thinning for a while and have been paying attention, perhaps too closely, to hairlines and hair in general to the point that I believe I have a very good eye as to what looks good and natural and what doesn’t.

As such, I am wondering if it would be possible for me to someday work for you in the field of hair transplantation. If that were the case, what kind of residency would you think would be most appropriate for me to pursue?

Thank you for your time.

It is great to hear you are interested in the field of hair transplantation. You can read about Board Certification and what it means in Hair Transplant Surgery here

There is no clear prerequisite training in the field of hair transplantation nor an approved American Board of Medical Specialties (ABMS) board certification. Most hair transplant doctors receive training from mentors or apprenticeship programs. Of course you should have fundamental medical knowledge, surgical skills, and artistic skills. I cannot say which residency program will best prepare you. Many people think plastic surgeons will be best equipped but it does not mean they will make the best hair transplant surgeons.

How Do Hair Follicles Become DHT Sensitive?

According to what I read regarding Male pattern Baldness It is a problem of Hair Follicles being sensitive to DHT rather than excessive DHT.

  1. What does this really mean?

  2. How did I develop this condition?

  3. Is there any way to reverse this sensitivity?

  4. If not then why aren’t researchers and scientists working on it?

  5. Why is it so that DHT gets attached to my scalp follicles more than other parts of my body like my face?

  6. Does DHT lead to bone growth?

Note: I’m losing hair and I have a receding hairline and I’m thinning on the top. I still don’t have a proper beard.

DHT is a trigger in people who have the genes for balding. Each hair on your head has a life cycle (usually 3 years) and it sheds and regrows over and over again, unless, it has a limit genetically set on how many cycles you get. Some men (in the balding areas) have limits on these cycles, so when that limit is hit, the hairs miniaturize and eventually fall out. Finasteride slows this process down and is the ONLY medication available that is known to work.


2019-12-05 13:07:09How Do Hair Follicles Become DHT Sensitive?

How Do Fue Scars Look on a Shaved Head After Years?

FUE scars can show on a shaved head, especially if you had (1) many FUEs and (2) a large punch used to create the FUEs. If you shave your head you will see the areas where the follicular units were removed. Longer hair can always grow out to cover it. For people who have significant scarring in their donor area, we often do Scalp Micropgimentation (https://scalpmicropigmentation.com/). The people with most detectable scars, when the surgery was performed with small punches, are those people who may have had a lower donor density so that the missing follicular units are more detectable. In people who have higher donor densities, there is enough hair not to notice the missing follicular units.


2019-12-16 06:59:48How Do Fue Scars Look on a Shaved Head After Years?

How Did This Man Have 20 Foot Long Hair?

Hello Dr. Rassman
This man who died last year had hair 20 feet long. How did it ever reach this length, i thought anagen phase was only 7 years. Or is it just fallen hair dreadlocked to attached hair. here is the link — OddityCentral.com

Tran Van HayIndeed, that is odd. One explanation is that Tran Van Hay (the man with the longest hair) was stuck in a castle waiting for a prince to rescue him.

Another explanation is that while the anagen phase may last as long as 7 years (rate of hair growth at 1/2 inch/month) and produce approximately 4 feet of hair length, if the hair at the catagen/telogen phase (when the hair disconnects from the scalp) was intertwined with the hairs that remain in anagen (growth phase) the hairs will add length. This would create a dreadlock of sorts, but each strand will stay intertwined with the growing hairs. Note that in the photo at the right, that isn’t a hat he’s wearing.

My 114 year old grandmother (she actually lived to 114) had hair that was many feet longer than the 4 feet limit discussed above. I wasn’t yet a doctor when I saw her hair taken out of the bun she had it in. As a hair specialist today, I know that 6-8 feet hair length is not possible. Her hair was washed on rare occasions. When it was washed, it was a festive event when granddaughters worked to unravel her bun and let the hair fall to the floor. The hair was washed with soap and water (not shampoo or conditioner) and rung out by hand, but it was never brushed or combed. In hindsight, I believe I witnessed the hair “dreads” that formed from the failure to brush or comb the hair, where the hair that was growing had meshed with the disconnected loose hair. I remember that her hair was never aggressively combed or brushed, just washed and rung out and then allowed to dry on its own. Those were the days before hair dryers were common in the home (I remember this was in the 1960s, when she was already in her hundreds).

How Did Pro Hockey Player Ryan Getzlaf Lose Hair So Quickly?

Good day Dr.Rassman and company. Here is a picture of professional hockey player Ryan Getzlaf back in 2003 when he had gotten drafted to the Anaheim Ducks.

This is him in: 2003, 2010, 2012

How did he lose hair so fast?

According to Google, Ryan Getzlaf is 27 years old now… so he was a teenager in that first photo from 2003 and his juvenile hairline is clearly evident. In young men (under 35 years old) hair loss is not a steady process, as it may come in spurts. Hair loss over an 8-9 year time frame is not fast from a genetic point of view.

How Did People Come Up with the Idea that Saw Palmetto Reduced DHT?

Okay, let’s say theoretically that saw palmetto does in fact help to block DHT. My question is, how the hell did they figure out that saw palmetto berries reduce DHT and not other berries out there such as cranberries and/or bilberries?

Saw palmettoSaw palmetto has been around for hundreds of years and has been used successfully for treating prostate enlargement. Native Americans used saw palmetto to relieve urinary symptoms in older men who had difficulty in urinating. It has been shown to reduce prostate size and it is used quite frequently in Europe.

There are many potential side effects of saw palmetto, including abdominal pain, diarrhea, nausea and vomiting, erectile dysfunction, breast tenderness and loss of libido. That is the connection that made people think that there is a DHT blockade in process, as so much seems to parallel finasteride’s side effects. Some think that since finasteride works for the prostate and hair, then if saw palmetto works for prostate issues it must also work for treating hair loss. Unfortunately, saw palmetto has never been studied in any well planned clinical endeavor for treating hair loss.

How Deep Do You Make the Holes When Placing Hairs?

Thanks for the great site and the time you put into it. I have a couple questions. First of all, I watched the episode of John and Kate plus Eight and thought it was very informative.

I would like to ask that when you make the sites for the grafts, how deep do you go into the scalp? Second question, I receive finasteride from a doctor here in Canada. The pills are a capsule not a tablet. Do you have any knowledge of finasteride being sold in capsules? I’m just curious if i’m getting the real thing.

PropeciaI do not know about the capsule form of finasteride. There are many phony drugs on the market. Only Propecia, which has a distinct look (see photo at right), is guaranteed to contain 1mg of finasteride, because the drug company Merck controls the patent on it and no one else can legally manufacture and sell it in North America. The only way is to send it off to a laboratory for analysis.

With respect to how deep I make the incision (or holes) — they are about 5mm-6mm deep, which is about the length of the hair follicle. Some people (like Asians) have longer follicles than Caucasians. One of the most important jobs of the surgeon is to make sure that the incisions are uniform and deep enough to take the full follicular unit, as well as control the direction and the angle of the incisions. The hairs will grow in the direction that the incision was made. Sometimes when doctors do not make the correct angle, your hair may grow out in an improper direction making it difficult to manage and may be unnatural looking.


2008-07-25 14:09:37How Deep Do You Make the Holes When Placing Hairs?