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Is a hair transplant really as painful as Marc Jacobs suggests?

The article says: “Jacobs said the transplant was excruciating, remembering, ‘I couldn’t sleep on my side, and I couldn’t put my head back.’ He said it hurt more than his tattoos but that it was definitely worth it. Ouch.”

Marc Jacobs Dishes On Painful Hair Transplant: ‘I Couldn’t Put My Head Back’

There is some level of pain involved, as let’s not fool ourselves into thinking this isn’t a surgical procedure we’re talking about. That being said, everyone will have a different idea of what is painful and what is just annoying. I’ve previously written about what pain patients can expect from a hair transplant — Pain with a Hair Transplant.

During the surgery itself, some patients find the initial injections more annoying than painful… and once those injections numb the area, you certainly shouldn’t feel any pain during the hair transplant procedure. After the surgery, depending on the type of procedure that was done, you might have to sleep on your side instead of on your back.

It’s impossible to say whether you’ll find a hair transplant to be as painful as Marc Jacobs says, but as physicians we definitely try to minimize pain (and annoyance) as much as we can. Remember though, pain is temporary… hair transplants are forever.

You have stated many times that Propecia usually slows down the balding process, but does not stop it completely.

Let’s say someone has started thinning in areas that Propecia typically works on. How long can the average person expect to keep that hair assuming the drug works?

If Propecia works for five years and then all of that hair falls out soon after, does it really matter if someone is on the drug before they get a transplant? The hair will just fall out anyways.

Thanks for your time.

Yes, nothing stops hair loss completely. But I would like to answer your question with another question — Wouldn’t you want to keep your existing hair as long as possible along with the transplanted hair?

Taking Propecia before a hair transplant also protects against shock loss, which is additional thinning that occurs following the surgery.

I’ve had some patients that have taken Propecia for over a decade still with great results, yet I’ve also seen patients with hair loss progressing again after just a few years on the drug. As for the average person and what they can expect, the numbers are available at the Propecia site here.

I attended one of your in-person consultations/transplant observation sessions about 9 months ago and it was very informative. I was told by Dr. Pak that the amount of hair that I had remaining did not put me in a position to really need a transplant at this time (possibly some work on my hairline). He did prescribe me finasteride, which I have been diligently taking for nearly 9 months.

The problem is that I seem to have thinned in the crown area considerably in the past 9 months - could I be having an adverse affect to finasteride? I have also heard about “shedding” periods or thinning due to your body trying to compensate for the reduction of DHT caused by finasteride - should I stay the course or could my body be reacting adversely to fin? One thing to note, I also went through a similar thining period 14 years ago (in college) when I started using minoxidil and Nioxin shampoo(I was also working out alot, sticking to a heavy protein diet) - when I got off, I seemed to have regrown or gotten thicker hair.

Your insight would be appreciated. Thank you.

You are our patient, so please call our office at 310-553-9113 if you’d like to speak with a doctor. We are available to you!

In general Propecia (finasteride) does not cause hair loss and if you have seen hair loss while you are on it, it is probably related to the speed of your genetic hair loss… not the Propecia itself. Your genetic predisposition is what causes hair loss. There is no drug that absolutely stops this process, and I always try to stress this point when I meet with the patients one to one.

The International Society of Hair Restoration Surgery (ISHRS) site has posted a great comparison of the strip harvesting and FUE techniques. Here’s the first paragraph from the article:

Ten years ago the use of follicular unit extraction (FUE) was advocated as an alternative to traditional strip harvesting of the donor tissue. The use of the technique has been slow to be accepted as a new standard. Many physicians have, in fact, tried the technique but with markedly varying success. The recent promotion of mechanical devices and powered follicular extraction devices has sparked renewed interest and controversy regarding this method of harvesting. A great deal of discussion by physicians, ancillary personnel, and the general public has occurred on the Internet and multiple media sources about the value of FUE versus strip harvesting and vice versa. Sadly, many of the claims of “superiority” of the newer technique seem more related to marketing and self-promotion rather than a clear scientific evaluation.

Read the full text — Comparison between Strip Harvesting and Follicular Unit Extraction: A Fair and Balanced View

The article discuss the donor area, scarring, graft survival, technical skills required, costs, complications, and much more. It’s a very complete guide to hair restoration techniques, so I wanted to bring attention to it here!

Hair characteristics plays a big role in the final appears of a hair transplant, but does any characteristics have more of an advantage than the other? If there were two men who had the same amount of grafts transplanted; one with relatively fine blond hair (that closely matches his skin shade) and another man with relatively course dark hair (that drastically contrasts his skin shade),who do think would have a fuller appears?

There are general rules I use to determine what a person will look like so I can help set expectations with my patients. Amongst the rules are:

1. People with blonde hair and white skin, people with brown hair and brown skin, and people with dark skin and dark hair do well — in other words, less contrast between skin and hair color.
2. Coarse hair works better than fine hair on a per hair basis, because coarse hair has more bulk to it
3. Curly hair is better than straight hair as it wants to cover the scalp. With the African hair type, the hair that ‘mats’ covers bests
4. The density of the hair will tell me much about how much hair can be moved. The more hair in the smallest area is obviously better
5. The size of the balding or thinning area when compared with the donor supply tells me much about supply and demand

To assess the various elements, a very complex multivariate analysis would have to be done to really answer your question above, but the general answer is that in my hands (for example) it is experience and my artistic abilities that allows me to help you set expectations. Ask you doctor about your characteristics.

Dear Dr. Rassman,

first of all, what a fantastic blog! And what a distinguished hair transplant surgeon you are. Once I decide that I need a hair transplant, I will come to your office and would request you to personally do it.

In the meantime, I have one suggestion of something that I think is missing in the hair restoration / hair style business, and I just wanted to share this with you as an inspiration, maybe it is something you might want to try.

On the one hand, there are hair transplant surgeons like yourself, who can map out my scalp, do a master plan, do surgery. Then, there are hair stylists who can discuss with me hair styles etc. What I think is missing is marrying the two, in terms of a consultation. I would immediately pay $200 if I could come in and have a conversation with yourself or one of the other doctors in your office, and an expert hair stylist, discussing what kind of looks a combination of say hair transplant surgery, Toppik, and hair styling could do. I have never seen anyone approach this subject from this angle, and I am thinking esp in LA there might demand for such a wholistic approach in terms of consultation.

Thanks, and keep up the great work!

There are many clinics who have your sense of business idea. We as physicians do consult our patients regarding different types of hair styles and adjunct products, such as Toppik or DermMatch, to enhance the look of the hair transplants or hair style in general.

It would be great if we can partner with a celebrity hair stylist as well and the opportunity remains open. On occasion, we have patients come into the office with their stylists for advice, and there have been some particularly helpful discussions.

Sherman Frankel suggests (here) that Proscar can be dissolved in ethanol if someone using finasteride for hair loss wanted more precise dosage. I have read this on the website HairlossTalk.com as well. Currently I am using Proscar 1 mg a day with no side effects but I am concerned that my dosages are not as precise as they could be. Also if I ever wanted to wean off the drug when I stop using it I could never cut the Proscar tablet smaller than 0.5 mg.

Do you have thoughts about dissolving Proscar in hard alcohol for consistent dosage? My pharmacist and doctor do not know the answer.

Seriously, is cutting a pill in quarters that hard?! It does not have to be an exact science as long as you take it everyday.

I do not see anything wrong with dissolving the pill in ethanol, but I would think it would be more of a hassle… unless you are looking for a reason to take a shot with your medication. Plus the article you referenced discusses dissolving finasteride so that you can take 0.2mg daily instead of the recommended 1mg dose.

Dear Doctors at BladingBlog.com,

I am in Asia and I would to do find a very good FUE doctor in Asia who is specialized in both hair and eyebrow transplant. I came across your blog and found Dr. Jino Kim, and also I have visted his Korean blog too (though I don’t understand Korean but I have checked out the before and after photos there).

Since Dr. Jino Kim is running his hair clinic also under the name New Hair Institute, I wonder if Dr. Kim was also trained under either/both doctors (Dr. Rassman and Dr. Pak) at the New Hair Institue in the US?

Would you please tell me if Dr. Jino Kim is specialized in FUT or FUE and is he also specialized in eyebrow transplant (other than hair transplant, because in his Korean blog I only see a few photos of eyebrow transplant).

Thanks.

Dr. Jino Kim in South Korea has been trained by us and is endorsed by us. He is part of our New Hair Institute in Korea and Dr. Pak visits his clinic every year to make sure the quality is on par with NHI in the US. With regard to the techniques that office uses, they do perform the FUT (strip) and FUE techniques, plus eyebrow transplants. You can contact Dr. Kim at BaldingBlog Korea for further information.

Hey Doc. Thanks again for your blog. Last night I was pondering the future and was wondering whether or not you could help me with something that has been niggling away at me for a couple of weeks now.

Can you please give us a history on the failed ideas and companies that made promises for a hair loss cure 20 - 50 years ago. Just the ones that had any scientific merit would suffice, well of course the others might provide some good comic relief so its your call

My own thoughts are as follows, food for thought?

It is my understanding that the failed promises of 50 years ago did not include stem cell research, regenerative medicine, and whatever modern approach to ‘hair cloning’, companies like Histogen and Aderans use today. They simply could not have had today’s recent scientific break through technology to back them up.

In which case what where the promises back in the day? Or were the doctors of 50 years ago merely just saying that ‘there will be a cure in 3-5 years’ to spread hope. Very kind of them.

What about Propecia people may say? I agree that Propecia has been around for a long time but that was an accidental find by researchers hunting out a cure for mens prostate problems. In other words exactly like your recent article on how researchers discovered they could change human cells from one type of cell to a skin cell complete with hair follicles. In that article you state why would they change their research. Well I’d say for exactly the same reason that Propecia did when they accidentally became a billion dollar company.

Today we see companies like Histogen, Aderans, and a few others that are actually showing positive results and backing them up with photographs. If they are legitimate images then the future looks promising. By promising who couldn’t do with just a little more transplant hair - maybe if we’re lucky Histogen will be able to simply increase the yield in our donor areas. That alone would be fantastic.

50 years ago things were different. Nobody had heard of, or at least practised, things like Nano Technology or Stem Cell research. I wasn’t even born. We didn’t have cellphones and the US military were not growing peoples limbs back!

With all the modern changes going on I’m just not sure if it is helpful to compare today’s tech with the tech of 50 years ago. All I hear is that 20-50 years ago they promised us that there will be a cure in 3-5 years. Well what were they promising - I’d love to know

Yours with love to all my balding brethren.

In regards to the accidental stem cell follicle discovery, I suppose it depends on the priorities of the researchers on whether they want to switch gears or start another study. It could be that the news of their accidental discovery was made public to garner interest in the project and to take on investors. I’m just guessing here, though.

Propecia is made by Merck, a large pharmaceutical company that didn’t become a billion dollar company by accident and makes more medication than just Propecia… but I see what you’re getting at and agree that money talks.

I do thank you for the input, but I am not a cloning expert nor a historian on cloning of hair. I could spend weeks or more researching the paths taken in hair loss cures over the past 50 years, and while it would likely make for interesting reading, it is beyond my scope at this time. What I do know is that doctors have been stating and vaguely projecting that cloning of hair is on the horizon within most of our lifetimes. I certainly hope that is the case, but the timelines have been moving with such frequency that it’s easy for people to grow skeptical until there’s an actual working model in place.

Dr. Rassman,

Long time no chat. Used to browse here everyday, but took some time off.

Question. I was walking in an apartment complex about two weeks ago, turned the corner, and walked into an air conditioner that was clearly too low with my head. I was fiddling with a bag in my hands, my keys, and some other things so I wasn’t looking up. Plus, I was a wearing a baseball cap, although not a typical baseball cap. More like one of those touristy ones that might say “Universal Studios” or “Los Angeles” on it. Not as thick. Also, I have a ponytail and I wear my hat above the ponytail, so it might hang a bit low. Anyhow, I didn’t see the AC as I turned the corner and smacked/walked into the part where the bottom meets the side and hit the top of my head in one particular spot. I took off my hat and checked for blood. Couldn’t find any, and was relieved. However, when I got to a bathroom, I checked again with a paper towel and blotched a little bit of blood — not too much — on the paper towel. Although there could have been more because I do have pretty thick hair in the spot. The spot where I was hit developed into a raised, red bruise about the size of a quarter. I used a handheld mirror to check the bruise. It looked pretty good actually. Couldn’t even spot any open skin amongst my hair. At most, it looked like a shallow scrape with no definite sides. It was pretty red though. I thought I lucked out. That the hat I was wearing actually absorbed some or a lot of the blow.

I kept looking at the sore for a few days, and was resolved to the fact that I lucked out. Then a few days later I checked again with my hand and noticed a raised scab had formed. It was hard to see amongst the hair, even under light and with a handheld mirror. The scab looked white to me, but my brother said it was dark. Not sure if he saw it well. A scab must mean that the scrape was a bit more than I originally thought right? I didn’t wash my hair as much as usual for about the next two week, which brings us to today, but with working out and using the sauna, my hair became pretty itchy sometimes. So I had to wash, using my usual natural oil shampoo, and massaged with the palms of my hand, something I usually do on the top. Further, it seems the hair on my head protects my scalp from the shower water, which is interesting.

So where am I going? Apparently my scab fell off a few days ago because it wasn’t where it was. My hair in the general area looked pretty dandruffy, although it was the scab and remnants. I’m wondering if I should be worried about a permanent scar and damage to the hair follicles? I’ve read that scar tissue does not contain hair follicles. I checked my hair tonight pretty good and I can’t find a scar, but it’s hard to be certain with my back to the mirror and using a handheld mirror to look over my head. I still think I lucked out because of my pretty thick hair and the hat, but I’m still a bit paranoid. Also, I’m wondering if the hair in the area of the bruise is particularly fragile to being pulled out by a comb or fingers or whatever? What do you think? Give me an honest answer. Not an answer that would make me a client.

So to summarize… you hit your head, which caused a bruise, followed by a scab. After the scab came off, you became worried that it would leave a scar and hair wouldn’t grow in that area again. You can’t see a scar, you don’t have a bald spot in the injury area, but you’re paranoid. You don’t wash your hair for weeks and now your scalp itches. Is that about it?

My honest answer is that it would terrify me if you were my client. By all accounts it’ll be fine. You can’t see a scar so I’m not sure what you’re worried about. Not everyone will see hair loss surrounding a scalp injury. It sounds like you’re borderline OCD about this.