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Using Toppik for Norwood 6 or 7 Patients That Can’t Have Full Coverage from a Transplant

Dr. Rassman,

What is your opinion on using products such as Toppik to enhance a hair transplant on a Norwood 6 or 7 patient who cannot achieve full coverage? Obviously the need to use a product like Toppik long-term may not be ideal, but for a man whose hair loss is too extensive to achieve full coverage from donor hair, a keratin hair-binding product combined with a hair transplant may be the most effective and natural looking solution for a lot of men with extensive balding.

A bald Norwood class 6 or 7 patient does not do well with a concealer like Toppik, which works better with some hair. Many men who use this product without hair in the bald area will actually show the Toppik itself, which is often irregular in the way it is put down. If used to enhance a hair transplant that is not thick enough, it might work if it can be applied so that the Toppik can not be detected. The keratin hair granular product has significant disadvantages, as it can come off on your clothes, your sheets and pillows, and when someone runs their fingers through your hair.

There is another treatment which is a permanent concealer that can thicken up a hair transplant look — Scalp MicroPigmentation (SMP). If you look at the SMP site, you will see examples of this type of concealer and most of these patients (who have hair that is just not thick enough) can avoid another hair transplant with the SMP alone. We have successfully used this SMP technique to address individuals whose balding patterns are too large and the transplants too few to get the coverage they want.

As everyone is different, I would suggest that you request a virtual consultation with me and send photographs in good lighting so that I can understand your problem as you see it. Also, please include a phone number.

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Using the Sides of the Head as Donor Hair?

Greetings,
Solid good data base you have built on this blog Dr. rassman. Thank you

My question is: Can you transplant hair from the upper sides of the head “left and right” about 3 inches above the ears, or is it only possible as a donor area to be from the lower back above the nick ? Reason I’m asking this question is because I have what i want to define as “Global hair loss/damage”. Meaning even in the donor area it’s clearly visible that i do not have a normal hair distribution/density “there is holes among the donor area” but, in my sides “just below the flat crown of my head” the hair is extremely healthy/dense/thick and can grow for long time with out being damaged.

Your time and answers are greatly appreciated

NW7First I though you were describing diffuse unpatterned alopecia (DUPA), but if there are clearly areas of your scalp that are full and lush, and they are about 3 inches above the ear, I would rule out DUPA on first glance. I would have to examine you to understand what you are telling me.

As a rule, however, the donor fringe is only 2 1/2 inches high on the back of your head and about 3 inches high on the side above the ear. Donor hair implies that the hair is permanent when full balding (up to a Class 7) occurs. Note the diagram at right of a Class 7 figure and you will see the 3 inches high fringe above the ear. Donor hair taken above the 3 inch level will not be permanent hair for the advanced balding patient.

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Using the Restroom During the Hair Transplant Procedure

Hi Dr Rassman,

I am a male and recently discovered i have interstitial cystitis. Am using minoxidil but cannot take finasteride anymore. So my questions is the following: During a HT session and when one is awake is it possible to do the procedure on someone who would have to use the restroom or are there ways to work around it?

Our patients have a private restroom available to them right outside the operating room next to where the transplant is done. Getting up during the surgery to use the facilities (as long as you let us know and don’t just jump up from the chair) is not a problem.


2008-05-23 08:32:33Using the Restroom During the Hair Transplant Procedure

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Using the LaserComb After a Hair Transplant

I used the Hairmax Lasercomb for 6 months or so. I expected major new growth but saw nothing to that extent. The only thing the product really did was make my remaining hair appear healthier. Overall i don’t know what to think of the Lasercomb. From what i’ve read it doesnt seem to target DHT or regrow the long lost hair lost due to DHT. “It is only to be believed to promote healthy anagen hair growth” (From hair follicles that have not been damages from DHT im guessing?). So wouldn’t the LaserComb be great for newly transplanted patients?

I’m two weeks post op. My grafts are securely anchored and the transplanted hairs are shedding, would it be safe for me to use the lasercomb and how effective would it be?

I don’t think that the LaserComb would produce any harm to transplanted hairs. I doubt it’ll be “great” for them, but if you’re happy with your hair health on non-transplanted hairs, by all means…


2009-04-30 14:27:14Using the LaserComb After a Hair Transplant

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Using Tanning Products on Scalp

I would like to shave my head but my scalp looks pale (im 23-male-Indian)…Someone suggested using Tanning product on the scalp…
Will i lose or stop the growth of existing hair if i do this?
ps: i suffer from MPB – (diffused)
pps: I cant use propecia due to liver probs…so am considering hair transplant after some years…Thanks
ppps: Minoxydyl isnt helping much..

The hair on our head does not allow the pigment of the scalp to fully express itself without some sunlight. That is why the skin under the hair is lighter in color than face skin. This is present in everyone with hair, but clearly more visible when a dark skin person shaves the head than when a fair complection person with white skin shaves their head. You can tan your head or go to a tanning salon, or it will tan on its own once exposed to some reasonable amount of sun.

Most tanning products should not impact or accelerate hair loss. Propecia is the best medication for preventing hair loss in young men, far superior to anything out there. Your doctor will be your best advocate for you while considering this option, because caution should be used in the administration of Propecia in patients with liver function abnormalities, as finasteride is metabolized extensively in the liver. It is possible that it can be taken at smaller doses if your liver has some dysfunction, but if your liver is working normally, you should be able to take Propecia at the normal dose. Careful monitoring is important and you should be under the direction of a good, caring doctor in approaching this medication’s use.


2006-01-03 12:16:46Using Tanning Products on Scalp

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Using Staples to Close Strip Surgery

Dear Dr. Rassman,

In one of your previous posts, you said that a scar from a strip surgery will be at about 80% of healing after 6 weeks. From that logic, I wonder if keeping the staples longer after a strip surgery (for 6-8 weeks, rather than the usual 14 days for instance) would help in getting a better scar…

I know that for practical and cosmetic reasons, keeping the staples longer can be problematic for many people, but in special cases where there is more tightness due to past surgeries (or a history of enlarged strip scar) wouldn’t this be a good solution to help getting a finer scar?

Or, would this in return create other problems such as:

1-skin growth around the staples?
2-Train marks?
3-Shock loss around the scar?

Thanks for your help

Scar formation and wound healing is not that simple. Aside from the technical aspect, everyone heals differently and scars differently. Leaving staples in for about 10 to 14 days is what we generally do. We leave the staples in for up to 21 days in some patients. Sometimes leaving staples in longer will cause the familiar Frankenstein or train track marks (as you state).

In the end there is no universal solution to closing a tight scalp. One solution does not fit all patients and it is up to the physician to address it on his/her individual basis. I know this may not be what you are looking for, but it points to the fact that sometimes there is just no specific answer. Leaving the staples in for 6-8 weeks will cause undo pain in most patients.

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Using SMP to Create More Fullness in Transplanted Patient (with Photos)

This patient received 1260 grafts in 1998, but over the years he continued to thin in the front and top of his head. He came in last month for Scalp MicroPigmentation (SMP) in hopes of adding fullness to the area immediately behind the frontal hairline. The results are spectacular and he avoided another surgery as a result.

The use of SMP for patients who were previously transplanted to create the illusion of fullness in areas where there is existing hair is nicely demonstrated with this patient. Click the photos to enlarge.

AFTER SMP:

 

BEFORE SMP:

 

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Using Smaller Needles in FUE?

Hi Dr. Rassman.
Why doesn’t the surgeons use a small needle? I have seen needles reported down to 0.4-0.6 mm. This should be good for less scarring in the donor area.

One doctor proclaims that he does hair multiplication and he also claims that he uses less invasive surgical instruments.

Thanks

Be careful not to believe everything you read. A 0.4mm punch for follicular unit extraction (FUE) is very difficult and I would doubt repetitive in each grafts. I would like to see the results he gets and examine the grafts before I believe what I am told. I have done this on a number of occasions, and you would be amazed at what I found.

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Using Saw Palmetto to Treat Hair Loss

I need to know once and for all. Does saw palmetto work for pattern hair loss?

Saw palmetto plantMost of the excitement for using saw palmetto as a treatment for androgenic hair loss is based on its mechanism of action and the evidence that it works for prostate problems like benign prostatic hypertrophy (BPH). Besides anecdotal reports, there is actually little evidence that it also works for hair loss.

There has been only one study thus far published in the medical literature examining saw palmetto to treat pattern baldness. In this small study, 6 out of then 10 subjects with androgenic alopecia who received saw palmetto were reported to benefit from the treatment. This is far too small a study to draw any conclusions on its efficacy for pattern hair loss.

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Using Rogaine with a Heart Arrhythmia?

Hi Doctor. I am a 58 year old male with a-fib. I have been taking Tambocor twice a day for 3 years and I would like to start using Rogaine. What are your thoughts on this?

Thanks

My thoughts are… you really need to ask your doctor.

Rogaine can cause a decrease in your blood pressure as a side effect. I do not know the state or severity of your atrial fibrillation or how well it is controlled or if you would have side effects with other medications. Only your doctor can give you specific information with respect to your treatment.


2010-07-30 10:15:43Using Rogaine with a Heart Arrhythmia?