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I’m worried that the combination of continued balding and my very fine hair will make it difficult to naturally and densely cover my scalp via transplant. In the case of having a fraternal twin, female family members, or maybe even friends with hair to spare, is it ever possible to retrieve grafts from a donor that is not the patient? Would grafts from a female donor be viable on a male MPB scalp? Thanks!

Unfortunately, transplanting hair from any person other than an identical twin will fail and get rejected. Hair is like any other organ transplant, which would require anti-rejection medication that could lead to further health complications. I’ve written about this process and the medication required before.

Hello Dr. Rassman,

As you seem to be the leader in your industry (in my opinion, at least), I assume many patients travel from afar to see you. Do you treat Canadian residents? I am in the eastern part of Canada, and while there seem to be some good surgeons in my area, I feel a visit to you is my best option. Any thoughts about this? Thank you.

Yes, I can treat any patient that sees me from any part of the world. We also offer a travel discount for surgical patients. Before we arrange that we should have a telephone consultation and that works best if you send me photos so I can see what your problem areas are. If you’d like to setup a phone consult, you can fill out this form so that someone on my staff can get back to you to schedule it and get those photos.

Here’s the info about the travel discount from our website:

“If you live more than 150 miles from the office where your surgery is performed, you are eligible to participate in our travel program. NHI will reimburse you for up to 5% of your net procedure cost for reasonable transportation expenses incurred while traveling to one of our facilities for a seminar, consultation or procedure. If you drive to one of our facilities, you can choose to be reimbursed for either mileage or gasoline expenses. If you fly to one of our offices, please note that frequent flyer miles are not reimbursable. NHI can only reimburse you for your flight-related out-of-pocket expenses. In all cases, please remember to provide receipts. In addition, you will receive one night’s stay at a pre-selected area hotel at our expense. This program is based on a minimum procedure fee of $3,000.00.“

This is a comment I received in response to this past Friday’s post, Hair Transplant 10 Months After One Procedure:

The results look great.

I do have a question though. I’ve often read that it’s frowned upon to transplant to the crown at a younger age because you might not have the hair to cover the front as you get balder (and who wants to be bald in the front and have hair in the crown?)

Was the crown covered because he has hair density similar to his father, or maybe he’s older than I think and not on pace for a Norwood VII?

The patient is in his early 40s and is a very special case. His density is very, very high (like his father and his brother), which means that he easily has a total of 10,000-14,000 graft capability. I could’ve easily taken out 5,000 grafts had the grafts been needed. He is in a good situation to stop doing hair transplants now and with the Propecia that he takes religiously he probably will not lose much more anytime soon. I don’t expect him to follow his father’s Norwood 7 pattern.

If the patient was to lose more hair between the frontal area and the crown (which was transplanted in this first procedure), he would have lots of reserve still left. It is important to note that very high hair density was critical in this decision process.

This patient is the 3rd member of his family to receive a hair transplant from us. His older brother received approximately 9000 grafts in the early 90’s, and his father (a full Norwood Class 7) has had close to 10,000 grafts transplanted with one of the most remarkable results I’ve ever seen as he almost had a full head of hair. He still has reserves of hair for more transplants, which I do not believe he needs.

Of particular interest, all 3 family members had very high densities. In fact, the father and the older brother had the highest densities that I have ever recorded in the donor area: around 4 hairs per square mm. This sort of high density reflects a hair population on the head of approximately 200,000 hairs, when normal for a Caucasian is around 100,000. Along with the artistic skill of the surgeon, this is what enabled us to transplant so many grafts in a single session.

So now the youngest son has followed in his family’s footsteps with 3188 grafts — approximately 1400 grafts in and behind the frontal hairline, with the rest of the grafts transplanted into the crown. Despite being only 10 months out from his first and only hair transplant, this patient is already extremely pleased with the results he’s seeing. Click the photos to enlarge!

After one procedure of 3188 grafts:

Before:

Transplant area immediately after the procedure:

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Update: More info can be found here!

I recently met with a hair transplant doctor from Asia who confided with me that the results from those doctors who use the Choi implanter are generally poor. For reasons unclear to me, it seems that many of the doctors in Asia have not mastered the techniques for manual preparation and the placing of grafts. Many Asian doctors depend upon the Choi implanter to perform the task of implanting the grafts. Because the Choi implanter requires very closely trimmed grafts for the grafts to fit inside the small needles, I would assume that the failures of hair transplants to grow reflect damage produced by very close trimming of the grafts and the longer periods of time that the grafts are kept out of the body. The skinny grafts produced for the Choi implanter can dry out fast and the grafts can die in a matter of 10-20 seconds when they are exposed to the air. I’ve written about Choi failures in the past. Of interest, there are very few North American doctors using the Choi implanter.

Apparently the public’s perception of the quality of results are well known in some of these countries and many patients flee to the United States and Canada for higher quality hair transplant services. Because I need to protect the identity of my informant physician, I will not report even the name of the specific countries he was talking about, but I have heard of this problem at the annual medical meetings from other sources as well. Do your research and keep this information in mind if you’re considering a transplant and always ask to see patients who have had it done.

1. I have heard that another hair transplant firm injects something into your scalp that swells your scalp before inserting the grafts?
2. I also want to get eyelid surgery. Should the eyes or hair come first? How much time should elapse before the second surgery? It would be nice to heal from both at the same time.

1. I do not inject anything into the recipient area to swell the scalp. The doctors who do these injections think that by stretching the scalp with saline, the grafts can be put closer together. I do not believe that this is the case.
2. It might be better to do the hair transplant before the eye surgery, because if swelling occurs after a hair transplant and the eyes were freshly done, that could cause more discomfort. I’d give it about 2 weeks after your hair transplant before you undergo the eyelid procedure.

Hi Dr Rassman,

I am mixed race chinese-caucasian 25 year old and have noticed some frontal recession behind the hairline and while it is very minor at this point unnoticible unless under bright light (which I am combating with propecia)… if my hairline were to recede… which hairline do you recommend when getting a transplant, the flatter asian one or the more pointed caucasian one? Which one will allow me to use less hair for the hairline in order to save my donor hair for other parts in case I need it? Did you give Jon Gosselin (great job on him by the way) a caucasian hairline? Which do most people choose who are in this situation? I have brown caucasian hair fairly thick hair shafts, but a flat asian hairline in my case.

The basic difference between the Asian and Caucasian hairline shape is, as you point out, that Asians have a flatter hairline. This is not always the case, though. The convex Caucasian hairline works well in most men and that is what we did for Jon Gosselin. Sometimes, we lower the corners slightly in the Asian hairline reconstruction.

Is there a difference between “internal sutures” and staples? Does one result in a less detectable scar?

Anything going through the skin produces a highway for bacteria to grow. Staples and sutures do just that, so bacteria can invade the body through the holes created by the needles, sutures, or threads, and through the use of stainless steel staples.

The final answers to your question relate to the opinions of doctors. I have waffled both ways in the many years of being a surgeon, and now I prefer staples over absorbable sutures. I don’t like leaving a foreign body like a suture in for very long and the absorbable suture is a foreign body. At least with staples or non-absorbable sutures, they can be removed by the surgeon when healing has occurred and wound strength builds enough to hold the wound edges together. At between 2-4 weeks, collagen production forms a lattice of ‘cable-like’ material that progressively gets laid down so that the wound will hold together. See Wikipedia for a better understanding of the various phases of wound healing. Some excellent videos covering wound healing can be found at Google Video.

I had a transplant done exactly 6 months ago. I was under the impression that between months 5 and 6 post-operation I would start to see the new grafts growing in. I have seen nothing, or very little. Does this mean it won’t grow in or something is wrong? I’m getting a little worried about it.

Why don’t you call your doctor who performed the surgery and ask for a follow up appointment? If I paid for something that didn’t turn out the way I thought it would, I’d contact the seller. Although you could apply that logic to buying a used car, this same principle goes for cosmetic surgery. If you were told one thing and it hasn’t happened, take charge and find out from the doctor!

Generally speaking, it takes on the average 4 months to see some growth, but it can take as long as 12 months. Everybody is different and not all surgeries are the same. You may be a late bloomer!

Hi Dr Rassman, i have spoken to you before and cannot decide between scalp advancement or hair transplants. I spoke to beverly hills institute and they told me dr mayer and dr fleming are the ones who started scalp advancement and having hair transplants will not look as good and that i will only be disappointed…i am now confused because i thought dr kabaker initiated this procedure. Also the doctor i went and saw suggested 2000 grafts however he seems to think a scalp advancement may be a better option….why is this so it seems so extreme as i have a young family i am scared …thanks for listening

You have every right to question the things that are unknown to you. It is a surgery on YOUR body that you will carry for the rest of your life. Different doctors will have their own opinions, as doctors are human and they tend to ’sell’ what they do best. My point is that there is no clear and definite answer to your question. You need to do your due diligence and research and speak with former patients. You need to try to see the before and after results (not just pictures) of the doctors and procedures you’re researching. This may be easier said than done, but not for our hair transplant practice, as we do this all of the time. We do this in our monthly Open House events where my prospective patients have an opportunity to meet my past patients who have had the surgery, so they can see the results for themselves.

To clarify some facts: Dr. Kabaker is well known to perform hairline lowering procedures. He is not the only one that does this, as many plastic surgeons who do browlifts can easily do hairline lowering procedures. Dr Fleming is well known for his scalp reductions and flap procedures, not for hair transplants and therefore they will sell what they do best. Scalp reduction is different than hairline lowering.

If you have a hairline lowering procedure you may need a small hair transplant procedure to hide the inevitable scar at the frontal edge, but the procedure is literally instantaneous while you must wait for 6+ months for the hair transplants to grow out. If you have a hair transplant procedure you many need a second hair transplant procedure to meet the density goal that you desire no matter what anyone tells you. Just remember that if it sounds too good to be true… well, you know the rest.