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You recently stated that you would need to see a well-controlled scientific study to be convinced that PRP would be worth the cost. I was wondering if you were aware of any such study. I’m sure doctors and patients alike would be eager to see the results if in fact a study is currently underway.

The popularity of PRP treatment seems to be increasing and I get the impression (just from what I read online) that more and more doctors are adopting the practice.

Platelet-rich plasma (PRP) is a great marketing gimmick, but there is no good scientific evidence that it has any value. Most of the studies that I do know of don’t provide the quality of data I demand before I’d consider using it. Also, we have not heard from the FDA, which may be interested in the claims made by those who promote it.

I am not aware of a well designed scientific study going on with good double blind controls, but maybe there is such a study being conducted. If so, when it is published, I will certainly know about it. As a surgeon quoted in this recent article about PRP says, “there currently is minimal evidence of this clinically and more research must be performed“.

Hello Doctors,

I just read an article from a writer for the local paper about her 100 pound weight loss following gastric bypass, which is something I’ve considered doing for myself. One thing that stuck out to me was that she says, “One common post-surgery side effect is hair loss. And I have been losing my hair. I knew about this before surgery, so I am dealing with it. I don’t like it, but it will grow back, and I have also lost most of my eyebrows, but that too will grow back.” See article here.

So my question is, how common is this loss? Scalp hair loss is a problem in itself, but to lose my eyebrows too would be devastating. How long could something like this take to regrow (or will it not regrow)? My husband visits this site quite frequently and when I mentioned the story, he suggested I write to you. Thanks for your help.

A gastric bypass surgery causes weight loss and in many cases can produce signs of malnutrition. Weight loss is often associated with hair loss, particularly in men who have genetic hair loss. For women who do not have genetic hair loss, the hair loss may reverse as nutrition gets better and the weight stabilizes, but for men with genetic hair loss, it often accelerates the genetic process. For men in this situation, it’s best to take finasteride prior to having the gastric bypass, and maintaining this drug for life. Even with the DHT block offered by the drug finasteride, hair loss may still occur.

The good news is that hair transplantation can be used to replace the lost hair in the same way as in a person with hair loss that didn’t have the gastric bypass. As far as eyebrow loss, it would be unusual, but again, hair transplants into the eyebrow easily can solve that problem as well.

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 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.

I had a question regarding a moustache transplant. I have a sparse moustache and thin hair on my head. I’m concerned that my head hair would not be thick enough for facial hair. I was wondering if it is possible to transplant my much thicker coarser beard hair on my neck to thicken my moustache without too much scarring. My beard goes all the way down to my chest and I hate shaving it anyways. Thanks

Hair from anywhere on the body can be transplanted to another location. Follicular unit extraction (FUE) is a good way to do a limited number of hair transplants into a mustache. This is something that you and your doctor should discuss.

Remember, however, that hair from different areas on the body have different hair cycles, which means that if the telogen (resting) cycle is long and the anagen (growing) cycle is short, then less of the hairs will be working for you at any one time. You can learn more about hair growth cycles here.

Does Hair Transplant cure Migraine too?

NYTimes.com - Plastic Surgery May Also Ease Migraines

Personal experience — after HT, forehead lines decreased considerably. Perhaps because of increased skin tension after a part of skin is removed?

From the article:

The double-blind study, published in the journal Plastic and Reconstructive Surgery, found that more than 80 percent of patients who underwent surgery in one of three “trigger sites” significantly reduced their number of headaches compared with more than 55 percent of the group who had sham surgery. More than half of the patients with the real surgery reported a “complete elimination” of headaches compared with about 4 percent of the placebo group.

No, a hair transplant would not cure migraines. Maybe it causes less headaches as you are not so preoccupied with balding, but a hair transplant wouldn’t be among the trigger sites the article refers to. Plus, this is all very experimental. Lots of work remains to be done, but thank you for bringing this to my attention.

Dr. Rassman,

I understand your skepticism and reluctance to accept or recommend PRP on the scalp. I was wondering though, what would it take to establish a definitive verdict in regard to effectiveness (or lack thereof) of PRP? There have been some very promising sounding testimonials and pictures that some doctors have produced. But nothing that I guess would qualify as a comprehensive medical study.

I would need a well-controlled scientific study and if it proved to have value, I would likely become a convert. I generally keep an open mind about new techniques and love to see things progress as long as they’re safe and effective. The last thing I want to do is give false hope and waste anyone’s time or money.

What are the chances of some sort of balding from the hairline lowering procedure on men??? Im 27 years old and have not have any balding whatsoever yet and have no history of balding in my family. I am also Brazilian.

Any surgery like you describe (since it is stressful) could kick-start hair loss in men. With that being said, I generally recommend that the hairline lowering procedure (where a piece of forehead is removed and the hairline is brought down) is not a procedure for men. On the remote possibility that there is late onset balding in your case, you will be left with an obvious scar as the hairline recedes. If, on the other hand, you elect to lower the hairline with hair transplants, then there will be no loss of the leading edge of the hairline, as hair transplants are permanent.

The worst case scenario of having hair transplantation to restore or lower the hairline is that the hair behind it might recede, leaving a gap between the transplanted hairline and the hair behind it. In that worst case scenario, you can transplant the hair and fill in the gaps.

Snippet from the article at MSNBC:

Thanks to advances in technology, hair-transplant procedures are sprouting up all over the country and the human body. While the majority of transplants still involve the scalp (and that remains the primary donor area), doctors are now able to harvest and replant hair follicles into eyebrows, eyelashes, beards, mustaches, sideburns, chests and beyond, allowing a growing number of people to become members of what you might call the “movable hair club.”

Nearly 99,000 surgical hair restoration procedures were performed in the United States in 2008, according to the International Society of Hair Restoration Surgery, a non-profit medical association. Of that number, approximately 93,000 procedures were scalp transplants (hair transplants to fill in bald or thinning areas), followed by 3,484 eyebrows, 1,369 mustache/beard procedures and eyelashes with 531 procedures.

Read the full text — Hair here, then there: Odd transplants take root

I guess it is still news that hair from the scalp can be transplanted to any part of the body, but we’ve been doing this for many years. There are some examples of transplanted eyebrows and sideburns here (scroll towards the bottom of the page).

I’m hoping you can help us. When my daughter was 20 months old, she was diagnosed with a brain tumor. After numerous brain surgeries and chemo, we decided to have a bone marrow transplant just before her fourth birthday. Thankfully, this saved her life. She also had focal radiation to the tumor site - on the right side of her head - and unfortunately most of the hair on that quarter of her head did not grow back.

She has worn hair pieces since she has been five years old. We’ve talked to people about hair transplants in the past, but were told there was too much area to cover and also, that hair transplants do not work on the side of the head.

I’m wondering if this still holds true for this procedure. I could send you some photos so you could see the extent of the hair loss if you think that would help. Please let me know your thoughts.

Thank you

Most people with large defects are treated with balloon expanders, which stretch the normal scalp to cover the defective areas. There are a few doctors who are very skilled in this specialized technique and although I have assisted in this type of surgery, I would not consider myself at the lever of expertise needed. I have seen these expanders done in children, but every person and every situation is different. I would suggest that you send me photographs and I will forward them on to such a specialist. I have seen some miraculous results from this type of reconstructive surgery.

Usually, at the end of the expansion surgery, hair transplants are done to refine the work and cover remaining scars.