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Why would Elton John and William Shatner wear toupees when hair restoration is easily available?

Surgery is a personal decision, so I can’t speak for everyone… but I can make an educated guess. Hair restoration or hair transplant surgery is in essence about moving your existing hairs around. If you don’t have lots to move around you cannot cover a huge area of balding or achieve the look of a 16 year old fullness.

Moreover, many older celebrities with their financial success have had a hair transplant surgery 10, 20, 30 years ago when hair transplant surgery results were not the best. So with their fortune they depleted their donor hair supply and do not have enough donor to fix the problem. As a result, their only option is a wig and or toupee.

For people undergoing eyebrow transplants, the biggest problem is the increase rate of growth of the transplanted hair, which requires the candidates to make frequent visits to the parlor (weekly!) or perform some sort DIY at home. My questions are:

Why don’t surgeons “STRESS” this and its implications? Most surgeons who I have personally consulted have stated this very casually, and some even neglected it. It was only after I spoke to a few women who had had eyebrow transplant that I understood how much of a severe problem this is, which, if not treated weekly, can result in severe social embarrassment.

We’ve written about the need to trim transplanted eyebrows more frequently due to the more rapid growth rate than the rest of the eyebrow hairs. I can assure you that not all surgeons try to hide this. Maybe you saw the wrong surgeons. Generally, you should consider trimming the new eyebrow hair three times a week, as the transplanted hair will grow at a rate of 1/2 inch per month.

I often write “buyer beware” about the many hair products we’re asked about. It also applies to the doctors.

Thanks very much for the informative blog.

Say a strip patient is about 6 months out from FUT surgery and now has buyers regret (please, no reminder about thinking things through first!), and wants to fill in the scar with FUE/beard hair/etc. Is there any advantage to do it at this time or does one need to wait one year. I wonder if scar is more or less vascular when healing. Thanks.

If the donor scar has healed, you don’t need more surgery, and the scar is narrow, then follicular unit extraction (FUE) to the linear scar is possible. FUE does not fill in wide scars well, though. Scalp MicroPigmentation (SMP), on the other hand, may be a better approach. Explore it all.

My question regards shock loss and the use of Propecia to prevent it. What I don’t understand is, if Propecia’s role is to prevent the conversion of testosterone into DHT, but shock loss is due to trauma rather than DHT, how does the use of Propecia prevent shock loss? It seems like if shock loss is due to the trauma of the surgery, a DHT blocker would not help much. Thank you for your insight.

While we do say that Propecia can prevent shock loss (hair loss following a hair transplant), there is no study I can cite that shows it. The appearance of Propecia on the market in the early days clearly changed the course of hair loss after transplant surgery. We have extensive experience both before and after Propecia became available. In the days before Propecia, I can tell you that the accelerated hair loss after surgery was a real problem which I had to confront, and I frequently chased the hair loss after the first transplant. After the drug was introduced, the accelerated hair loss on patients with Propecia seemed to disappear.

The important idea is that when a patient is on Propecia it is working on the DHT susceptible hairs. Thus when a hair is transplanted in those areas, Propecia will still be ‘helping’ to sustain the native hairs. We do not know the mechanism, but we can postulate that hairs that have been exposed to Propecia seem to be more resilient.

Finally, you do not have to be on Propecia to have hair transplant surgery, particularly if you are above the age of 40-50, have had a stable hair loss pattern that has not advanced in the past 10 years, or have had a recent hair transplant in the previous 2-3 years without experiencing accelerated hair loss.

Dear Dr. Rassman,

I will try to keep this simple: Once a man with hairloss can make out his “horseshoe” pattern, is it possible or common for any of the “horseshoe” hair to bald at a later point?

I am 26 and, while I don’t have any bald spots, the hair on top of my head is thinner and more limp than the hair on the sides and back of my head. My “horseshoe” hair goes all the way up the sides of my head, and does not dip down low at the back of my head. Given that this hair has remained unaffected for the past 8 years since I’ve been thinning, is this indicative of hair that will remain unaffected for the remainder of my life?

The thinning in a young man at 26 years old which can produce an apparent horseshoe pattern, may be stable for years in the horseshoe itself. I have seen men that have a horseshoe pattern which is much more narrow than most Class 7 pattern patients. I often classify them as a Class 8 pattern to reflect the narrow band.

The normal height of the posterior part of the horseshoe is somewhere between 2 1/2 and 3 inches high (not counting neck hair). If this Class 8 patient was to have a hair transplant to cover his entire head (assuming the Class 7 pattern) he will likely have moved some of his non-permanent hair in the procedures. With the strip method of harvesting, the scars can be vary bad for cases this large. I have unfortunately seen this type of pattern with the scars produced by overly aggressive surgeons, and each one is a real challenge.

I couldn’t tell if it’ll dip down further as the years progress, but measuring the bulk of the remaining hair should be able to tell you if that area is continuing to thin.

Dr. Rassman,

I was wondering if you could shine some light on this in effort to give hope to NW5+ men. I think a great option for high NW men would be to obtain a low density (30/cm) transplant and supplement it with SMP.

What do you think? Also, with this strategy, would it be possible to keep hair at a 2 guard without it looking funny/weird?

Thanks!

A low density hair transplant with SMP (Scalp MicroPigmentation) in the scalp may or may not be enough to achieve a fully normal appearance. There is certainly a threshold where where too few transplants will not be adequately augmented by SMP.

Hi Dr Rassman

I was just wondering if you could explain why grafts enter a dormant phase immediately after being transplanted, and only start recovering after 8-10 months?

I’d also be interested to know why they initially grow back much finer, and then thicken up later. Essentially the follicle itself hasn’t changed, so why does the hair diameter it produces fluctuate in this way?

Many thanks

I do not know why there is a dormant phase after a hair transplant. To put it simply, when you have hair transplant surgery, your follicle was removed from your body, handled, cut, manipulated, put in solutions, manipulated some more, and put back into another new location on your body. If I was that follicle and I survived all of that, I’d be traumatized and go dormant for awhile. In all seriousness though, I do not have a professorial explanation.

The simple fact is that most follicles go dormant (telogen) and start to regrow in a period of 3 to 12 months. Most patients see results starting on the 6th month to 12th month. Some lucky minority of patients (< 5%) see results within a month! This is what we have observed over the last 20 years in thousands of patients.

Hey Doc,
You have a great site going. Thanks for all you do. I am a 20 year old male and my hairline is receding at the corners. The only family history of balding that I have is my maternal grandfather who was completely bald by the time he was thirty. I am currently on finasteride, but I was wondering about a transplant.

Would it be a bad thing to have smaller transplants over the next fifteen years instead of just waiting until you’ve reached your final pattern? For example, could I have one to fill in the corners, and then another in ten years to fill in whatever else is thinning or gone? As of right now, I am about a NW 2.5 with no evidence of thinning in the crown.

Not everyone has the exact same goal, and some patients have transplants to keep ahead of their thinning. This issue is up to both you and the doctor to plan out the Master Plan. Generally, most patients do not wait until they are completely bald… but in your case at 20 years old with early loss, you would likely not be a candidate just yet.

Hi,
I am a 55 year old female that had hair grafts and was not informed not to use hair conditioner.

Can you tell me if I used Ovation Cell Therapy a month after my hair grafts if this would have caused any damage to my hair from prior grafts? I started losing a lot of my hair in my temple area from previous hair grafts. I have had four (4) hair restoration surgery’s over a period of 7 years and started losing hair after using Ovation Cell Therapy. I really only want to know for my own peace of mind.

Thanks in advance for you help and please advise

I am unfamiliar with the side effects of Ovation Cell Therapy. It looks like it’s a shampoo/moisturizer treatment, and I wouldn’t expect it to cause damage to transplanted hair. Have you talked to your surgeon? Do you have a possible allergy to any of the ingredients?

Greetings Doctor,

I recently had an FUE procedure that involved 2,500 grafts, about two months ago. I’m a bit concerned as I went through some personal matters that caused high levels of depression; all within the same week I had the procedure.

No grafts popped and the scalp healed well, however is it possible that due to the depression, that it could affect the outcome? Is it a possibility, that I developed Telogen effluvium and caused some of the grafts to become void?

I’m just concerned as this procedure costed a pretty penny. Thank you for your time and patience, Doctor.

Why are you not asking this question to your surgeon? Have an open line of communication with your doctor, especially in the months following your surgery.

An FUE procedure of 2500 grafts is a very high number of grafts for anyone and I am always cautious when I hear patients having those numbers. In the end, only time will tell how your outcome will be. At least take some comfort in the fact that depression and emotional stress will not impact the growth or outcome.