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Snippet from the article:

In the dozen years since the Da Vinci robot has been approved for surgeries in the United States, it’s been embraced by health care providers and patients alike. Surgeons routinely use the multi-armed metal assistant to remove cancerous prostate glands and uteruses, repair heart valves and perform gastric bypass operations, among many other procedures.

Read the rest at Kaiser Health News — Questions Arise About Robotic Surgery’s Cost, Effectiveness

Although this article reflects upon robots used for abdominal, prostate, cardiac surgery, etc… some of the questions asked will apply to the ARTAS robotic hair transplant FUE system. More from the article: “At this time, health insurers generally pay for robotic surgery just as they would any other surgical procedure, and patient out-of-pocket costs are typically no different either. That could change, some say, as more comprehensive data become available that clarifies when robotic-assisted surgery helps improve patient outcomes—and when it doesn’t.”

Robotic FUE with the ARTAS system does what appears to be an excellent job at the FUE itself; however, as the grafts that are created are removed manually, stored in traditional solutions, and placed manually, defects in process that were present before the robot was used will continue even with efficient drilling of the grafts.

“Robot-assisted surgeries are generally more expensive than other methods, however, and don’t necessarily improve patient outcomes long-term,” says the article. Although this statement is not referring to the FUE robot, the message is clear. What is it that the public is buying and what will the long term results actually be for the FUE robots?

Many of the ARTAS systems that have been sold to date were purchased by experienced hair restoration surgeons, so I suspect in their hands, the long term results will be good for them; however, for the novice doctor or the doctor who has not put together the system of people skills behind the robot for moving, storing, and placing the grafts, an imbalance in long term results may result. It will be years before we know, though.

Unrelated to hair loss, but this is a case of anesthesia possibly leading to the death of a man having his wisdom teeth pulled.

Snippet from the article:

Marek’s family provided Fox 5 with his medical records. The ambulance report by American Medical Response showed Marek was undergoing surgery when he began to cough.

“When he coughed they administered propofol and that’s when he went into cardiac arrest,” his mother, April Lapinski, said.

He was immediately taken to the hospital, where he died. The ambulance report also noted a piece of gauze was found in Marek’s airway.

Read the rest — San Diego man dies while getting wisdom teeth pulled

There is absolutely no guarantees when a general anesthetic is used. Safety is paramount in all of the decisions we make when it comes to anesthesia. We use local anesthesia in our practice, which is probably the safest anesthetic available, but still there is risk of things like overdose, allergic reaction, infection, etc…

A couple of months ago, a man who was scheduled for a hair transplant cancelled his procedure for family reasons. The night of the scheduled surgery, he had a heart attack and almost died. Of course, I was concerned about his well being, but I could not help but connect the dots, for if he had his hair transplant that day, his heart attack would probably have happened anyway… but the connection to the hair transplant would have been a direct one-to-one connection.

A while ago, I read a medical article which studied outpatient surgery and the risks associated with it. There was no selection of patients with regard to age, general health, etc. The article studied a 30 day period after the surgery and reported a death rate of 1 in 20,000 patients. That means that in any surgery, any general anesthetic has risks. The above article does not reference the overall competency of the person administering propofol, but as we saw in the Michael Jackson case, expertise in the use of any medication is clearly a major factor when risks are considered.

As I have previously reported nearly six years ago, one patient in the US died from a hair transplant while it was being done. Supposedly it was under local anesthesia. All I know is that the surgeon lost his medical license as a result of the death.

Happy New Yr Mr. Rassman.

Currently, I shave my sides with a trimmer to 0.25 number and keep the little existing hair on my scalp shaved at 0.5 number. This is because I dont have hair to show off anyways, so might as well give it a shaved look. Even though I have some donor area, I am sure it wont be enough for hair transplant to give it a long full hair appearance.

As an alternative, I would like to have a shaved look but without SMP / using chemicals. I would like to achieve this with BHT but I do see from your previous posts that you are not a big fan of BHT because of the different texture and the growth rate of hair.

So my idea is to use the body hair on the the top of the scalp. It may not grow in the same pace / texture with the rest of the existing hair but what if I want to keep shaving it (or trimming to 0.5 number). Will it help? My logic says if I am shaving it / trimming it, it would probably.

My concern is:
1) ARE THERE ever SCARS in the recipient area? This question is relevant here because I will be shaving / keeping my scalp hair very short (0.25 or 0.5 number on the trimmer)

2) In your experience, while transplanting hair (whether hair from back of the head or body hair) into the recipient area, can existing hair get damaged?

Thanks for all your good work, may the force be with you.

I will be direct to your questions.

1) Visible recipient site scars are rare if the instrument is very small and a slit is used. But with any surgery, there is a small (rare) risk of keloid and scarring.

2) Existing hair is rarely damaged, unless perhaps there is shock loss, which is typical of young men under the age of 30 who do not take the drug finasteride. (This is not an absolute rule as some men decline to take finasteride. It is a case by case basis.) In general, the younger they are, the greater the risk of shock loss.

Hey Dr Rassman, I noticed that Dr. Umar was considered for recommendation on the Hair Transplant Network. The site also featured patient examples of his FUE procedures which combined body hair harvested from numerous locations and scalp hair. The results look pretty impressive.

Has your stance changed at all in regards to the legitimacy of body hair in transplantation?

There are obviously differences of opinion here, but to be endorsed by a website that is supported by and paid for by the physician (the doctors pay a monthly fee to be on that site) does not make it a new standard.

Plain and simple — today, body hair transplantation (BHT) is not a Gold Standard in treatment for hair loss. Other doctors still have a right (as licensed physicians) to offer this. I do not believe in using body hair transplants for most cases, because I have seen many cases where after it is transplanted, the body hair still looks like body hair sitting on the scalp. The shaft thickness of body hair is thinner than scalp hair in most people, so on a value comparison between scalp and body hair, you are miles ahead with scalp hair transplants. BHT is best used when you are out of donor hair and the body hair can be placed as a fill-in to traditional transplanted areas.

Remember, the body hair has long telogen cycles and depending on which body part, the telogen cycle is often longer than the anagen cycle. That means the hair will not grow in these telogen cycles. Also, body hair does not usually grow long like scalp hair.

Hi,

I have done a lot of research in relation to hair transplants and forehead reduction as I have been experiencing hair loss over the last few years and I also have a large forehead. As I am only 20 years old I know it’s not recommended to have a hair transplant as there may not be enough donor hair to be transplanted to keep up with further hair loss I may experience over time.

Would it be possible to have forehead reduction surgery to lower my hairline and reduce the size of my forehead and also have a hair transplant to replace hair that I have already lost? I have dark red, wavy/straight hair and my hair is thick at the back where the donor area would be (not sure if this would make a difference).

I’m currently at the Norwood II stage and I am already extremely self conscious about my hairloss and large forehead and it has effected my confidence. I’ve considered using Propecia and Rogaine but I’m terrified in case I experience excessive shedding or erection problems from Propecia as I have read a lot of reviews from people who experienced these side effects.

I am getting desperate now so any advice you could give me would be much appreciated.

Thanks

Great question. I assume you are a male. This makes a difference, as females with this problem can safely have a hairline lowering procedure, as they will not lose the hair above that was moved down. A male with active hair loss will most likely lose the lower hairline and be no better off (possibly worse off) after a hairline lowering procedure.

At 20 years old with no clear examination or diagnosis of male pattern baldness, a forehead reduction may make things worse if you progress to a Norwood 6 (for example). You need a Master Plan and a clear diagnosis. You are young, so let’s start it right, come pay us a visit at the New Hair Institute to have the degree of your hair loss diagnosed.

Snippet from the article:

Thick, handsome mustaches have long been prized by men throughout the Middle East as symbols of masculine virility, wisdom and maturity.

But not all mustaches are created equal, and in recent years, increasing numbers of Middle Eastern men have been going under the knife to attain the perfect specimen.

Turkish plastic surgeon Selahattin Tulunay says the number of mustache implants he performs has boomed in the last few years. He now performs 50-60 of the procedures a month, on patients who hail mostly from the Middle East and travel to Turkey as medical tourists.

He said his patients generally want thick mustaches as they felt they would make them look mature and dignified.

Read the rest at CNN — Mideast men go under knife for manly mustaches

The article was published just in time for Movember.

What is the evidence for PRP and hair loss prevention and/or hair regrowth? Is there any evidence that it works along the frontal hairline? What are the biggest risks associated with this procedure? For those that couldn’t tolerate Propecia, is this a viable option? Thank you in advance for your assistance.

PRP means platelet rich plasma, and this is obtained by putting some of your blood in a tube, then spinning it down so that the plasma segment from the mix allows the red blood cells to fall to the bottom of the blood tube. The plasma is on the top of the tube and it is drawn off and then used by doctors to re-inject into your body. Some doctors use this plasma injection during the transplant process. Some doctors use it without transplants, as you suggested here, which is then injected into the balding area.

Some doctors claim that the injection of plasma into the bald skin will reverse balding or slow it down, but there is absolutely no proof that there is any benefit of the process. There is one benefit to the surgeon, though — the professional fee he pockets from performing this technique.

My advice to you is to stick to treatments that work and do not volunteer your body to unproven experimentation. If you can’t tolerate finasteride (Propecia), work this out with your doctor.

Hello,

I found a website about Ars Medical, a clinic in Switzerland that does stem cells autologous transplantation in order to regrow lost hair. Here is an excerpt: “In ARS Medical, the physicians perform Autologous Transplantation of your own Stem Cells that are harvested from your fat and are activated by specific technique before use. This hair treatment is absolutely natural and safe. There is no risk of side affects of other treatments , such as allergic reactions, infection or irritation to the skin of the scalp.”

Their website is available here: ardsmedical.info

Could you please tell me what is your opinion about this technique? Is is safe and effective?

I have read several articles and from what I could understand, the research is still in progress and not yet reliable.

Best regards

I do not know if it is safe or effective. I wonder if they will be publishing their research or results in peer reviewed journals. Without such publications I would put their claims into the trash heap, and coming to market prior to proof in the medical establishment is borderline scam territory. The site doesn’t show any photos of patients, doesn’t list any doctors that work there, and looks to focus more on selling their shampoos.

I think you said it best yourself, “not yet reliable.” What more can I add to that?

I am going to have a face/neck lift in the next few months. The skin on which my sideburns are will be cut out as part of the procedure. I wonder whether I could use those hairs to fill up my eyebrows? Could they be ’saved’ by the surgeon temporarily for the hair surgeon?

Face lift and hair transplant can be done with the extra hairs harvested from the face lift surgery. But it needs to be coordinated by a hair transplant doctor and be done on the same day.

So technically yes, the hairs could be transplanted to your eyebrows… but both procedures need to be organized so that the grafts are not kept out of the body for too long.

Dear Dr Rassman, please excuse my question if it is stupid. I’m not medically trained!

What is normally discussed is the movement of hair follicles *from* the donor site *to* the recipient site. And this inevitably leaves some form of scarring in the donor area. But is it technically possible (in FUE) to also implant skin *from* the recipient area *to* the donor area, in such a manner to “eliminate” scarring? i.e. for every follicle the surgeon would swap tissues A and B, where A would be the tissue originally at the recipient site, and B the tissue originally at the donor site.

I’m sure this would be more costly for the patient, buy I’m wondering: has this ever been tested? And would it eliminate scarring?

A number of years ago, a well-known doctor preached that small punch extractions of scars would produce “mini-scalp reductions”. It never worked. This sounds like what you are asking about, and if one removes scar from a scarred area, you just get scar to replace it. Not such a good idea.

By the way, there are no stupid questions. Your question reflects an inquiring mind.