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Hello Dr Rassman,
I would like to start with complicating you on your website. I think that what you are doing, in providing free information with such dedicated professionalism, which must be so time consuming is a testament to you as as a surgeon.

Doctor my question is a simple one. I had a hair transplant almost a year ago and I am living a life of hell since. I am now suffering from Trichodynia and every morning I wake up I say to myself I cannot wait for the day to end. I go to bed hoping the pain will be gone when I wake up each morning. I am emailing you as a last resort. I have been to a pain specialist who has prescribed amitriptyline and lyrica together. I am on this medication for 4 months now and as the dosage goes up there really is no difference in my condition. My transplant was also a failure along with being left with a scar of between 5 and 10mm. Please please help me doc. I did not have any pain pre surgery. Kind regards

For those readers who does not know about trichodynia, it is a condition where the patient experiences a painful, burning sensation on their scalp. From Wikipedia — “Often there is an underlying psychosomatic cause, such as stress, depression or anxiety.” It also could be caused by trauma to a nerve(s) from the surgical wounds created during a hair transplant.

I do not know the cause of your pain and the answer you desire is not so simple. You state that the pain started after a hair transplant surgery, but I do not know if there is an actual correlation or just coincidence with the hair transplant. You need to find a physician who will listen to you and examine you. I would want to know where the pain is, if there are any sensory defects in the nerve distributions of the major and minor nerves of the scalp. Without a full history and physical, I really cannot offer much help. You are more than welcome to make an appointment to see me or Dr. Pak either in Los Angles or San Jose.

Hello, I had a hair transplant early in january, roughly two months ago, it was only a small procedure of about 700 grafts. However I have been reading about the scabbing process and I am very concerned that I may have damaged my grafts. I was very careful after surgery for about two weeks, the scabs were still strongly in place so i followed advice and scrubbed a little harder and let them soak. During weeks 3 - 4 the scabs were still there, not attached to my head but somewhere near the end of the grafts, most of them being lose. The area was very itchy and the scabs looked a mess being very flakey in my hair.

Anyway over 2 or 3 days i used my finger to rub and loosen the remaining scabs, considering it was nearly 4 weeks on i thought this would be ok. When picking the scabs off some of the grafts were still attached to the scabs. I have been told that it is natural for the grafts to come out first with the scabs and that after 2 weeks the grafts are fixed in place so its hard to damage them. However i am very worried that the result i achieve will be poor because I didn’t just let the scabs be, the rate they were going i think it could have been about 5 weeks before they would have gone. I know picking (encouraging) the scabs to come off when the hair is dry is wrong, but i didn’t at the time. Do you think any permanent damage will have been done?

kind regards.

I do not know why your scabs would be there at a month after surgery. Just washing your hair with soap and water should’ve taken them off. I would like to know if the grafts were the large plugs, which used to produce scabs lasting 2-3 months with poor hygiene.

We did a graft anchoring study, which basically concluded that as long as the scabs are in place, the grafts might come out. Pulling scabs and grafts from the scalp just is a set-up for infection (folliculitis). Good hygiene should have started the day after surgery. Where were your post-operative instructions? The surgeon should’ve provided them to you.

Snippet from the article:

You can’t blame Joseph R. Garcia for gazing in the mirror and dreaming of luxuriant locks sprouting from his balding pate — if that was his wish when he strolled into a Park Ridge pharmacy in November and again in January. But did he really need 23 bottles of Rogaine?

Garcia, 39, was charged this month with two counts of felony retail theft for allegedly stealing 16 bottles of the hair regrowth treatment Nov. 30 from a Park Ridge CVS drugstore and then making off with another seven bottles from the same store in January, investigators say. In all, the CVS store is out about $1,000 in hair-treatment products, police say.

Read the full story — Suspect accused of stealing 23 bottles of Rogaine from CVS

Now that is commitment, possibly out of desperation! Some people will truly do anything to keep their hair. This guy even went back to the same store months later to steal more! I’m not interesting in stealing, but honestly, how does one even smuggle 16 bottles out of a store at one time (and then another 7 bottles a second time)? But then it begs the real question — WHY? Maybe he was stealing for a group of balding friends, or perhaps he was stockpiling Rogaine for the future. Either way, such a dumb move.

What is the best way to finance a hair transplant? I will be graduating in May and will turn 24 in July. I have done the research and about 2,000 grafts are needed in my frontal hairline. My receded hair line itches at me daily. What is the best way to plan for about 2,000 grafts? Obviously every office is different on pricing, but I want to fix my hairline before I get started in my profession (public speaking and sales) - what is the best way to go about this for a broke college graduate?

Different physicians/clinics will likely have financing available, though some patients opt to pay cash or put it on a credit card. We do offer financing if you elect to have your surgery at New Hair Institute, and that info is available here.

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).

This is in reference to this response.

You mentioned needing to see the eyebrows and forehead lifted by an individual to see where exactly to construct a hairline. I read a lot of doctors ask the patient to lift their forehead to help construct a hairline as well. My understanding was it showed the extent to where the muscles of the forehead ended which would basically indicate the lowest possible position of one’s hairline. Anyhow, regardless if I was correct or wrong in my understanding, what about individuals such as myself who cannot move or lift their forehead through use of the muscles located there? I was told by my doctor that these muscles were “underdeveloped” or weak and I have never been one either to voluntarily or involuntarily move my forehead in which to show creases or wrinkles. How would a doctor determine where a proper hairline should be located in my case and others? Thank you!

We do not base a hairline on forehead muscle per se, but it does give a generalized reference point. It does not matter if you cannot lift your forehead to delineate a muscle. An anatomically correct hairline is made with the general proportions of a person’s face using the rule of thirds the way artists draw a face. Alternatives that we use are in equalizing the chin to nose distance with the distance from the glabella (groove between the eyes above the nose) and a similar distance upward.

Hairline position is not an exact science — it is an artistic design based on proportions and knowledge of human anatomy and form, and takes into account what the patient believes fits his facial proportions. We often find that this process becomes a negotiation to arrive at the ideal location.

i am 20 years old and live in Mi. I started losing my hair since when i was 17 years old and after 3 years that now i am 20 years old i have lost enough hairs that i look 10 times older than my age. I have lost a lot of hairs from and middle and day by day it is increasing due to this reason i am losing confidence and every time try to cover my head with something so people don’t see my baldness and right now i have short hairs which make it more obvious and make me look a 30 year old like man.

Please advice me should i get done hair transplant from your surgical institution or is there any other way to get my hairs back. Because i told you i have almost lost a lot of confidence in myself. Please doctor your advice is required. Thank you

At 20 years old, you’re more than likely not a candidate for hair transplantation. I understand that you’re losing confidence and covering your head — this is common among many men that are seeing hair loss. I don’t know how bad your loss is, but my suggestion is:

1. Get your hair mapped out for miniaturization to make a diagnosis on the presence and degree of pending hair loss
2. Talk to your doctor about a prescription of Propecia. I’ve seen this medication work well in younger men with early hair loss like you describe.

There are many doctors that would be more than willing to take your money, but realize that you’re just going to cause problems for yourself in the future if you rush to surgically treat your hair loss today.

19yrs ago, my hair was burnt w/relaxer on the scalp and then combed out removing my hair. the forehead and top of my head were most effected. Though i’m 37, the hair has slowly been growing back. so im wondering if there’s a hair regrowth product for someone who lost their hair through mal-treatment instead of balding

This is a very difficult question that I can not provide a straightforward answer to without examining you. Based upon a 19 year history since the initial injury, it is highly probable that the hair will not be significantly better over time, nor are there any treatments I can think of that might work after that much time.

Hello Dr. Rassman, I just have a question. How long should one leave the shampoo on the hair? I ask this ’cause I usually leave it on for quite some time (around 10 minutes), could this affect (or benefit) my hair or cause any other effects (hair falling out, etc)? Thanks.

You can leave the shampoo in your hair as long as you like. It should not cause hair loss, nor will it grow hair. It’ll just be a longer shower. Follow the directions on the shampoo label if you are still worried. Is there a particular reason you leave it in your hair for 10 minutes? That does seem quite excessive.

Hi, thank you so much for all your help and knowledge. We greatly appreciate it!

Can you please tell me your thoughts as to when if ever we will see a more progressive approach to fixing hair loss? Such as through stem cells or tissue engineering. i am holding out getting a Hair Transplant in hopes one day this will come. Do you think holding out will be worth any wait?

Thank you for your help!

Imagine that your father and grandfather had prostate cancer and that you run a very high risk of developing the same disease. Rather than get tested to get a diagnosis for you in advance of getting this terrible disease, you decide to just wait until a cure is available. Then you die because the cure never came in time to save you. I realize this logic may be a stretch to bring up the point I am trying to make, but stick with me…

Waiting just means paying the piper of the process as time, whether it is cancer or hair loss, just works against you. Hair cloning or a hair loss cure are still not even close to being available to the public. In fact, I believe it will take decades before some more solid solution to hair loss comes along. People still think that hair transplants can be socially detected on any person who had it done, will always cause terrible scarring, are extremely painful, etc. Well, it may be the perfect solution today. I would challenge you to pick out a hair transplant amongst my patient population (assuming I started the transplant process on the patient being examined myself).

Drugs like Propecia are great at stopping or slowing hair loss with minimal side effects for 99% of men. Why hold out? You could be enjoying your hair now instead of waiting on something that isn’t guaranteed to come in your lifetime. The decision ultimately is up to you.