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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!

Hello Dr. Rassman,

Thanks for this Q&A forum! I have three questions as below and your response would be greatly appreciated!

1. As you can see in my picture [editor's note: see below!], which you can use on the forum with the response btw, seems like I have diffuse thinning. Im not sure what Norwood pattern this is, but does my pattern rule me out for a FUE hair transplant? I think I read somewhere that diffuse thinning candidates are not sutable for hair transplants. The hair in the back of head is pretty thick and looking at my dad and my older brother, I see no danger of losing hair in the back. It’s mostly crown thinning and almost bald on the top. I’m 39 years old

2. You mentioned that South Asians have less density than say those of European descent. I always thought it was the reverse? based on what I see in terms of density in the back of my head, looks like I should be able to get more drafts from my donor area??

3. Is there any way to reduce/eliminate shock loss from neighboring areas after a FUE transplant? Does one have to take propecia to eliminate shock loss? I tried finestaride (.25 mg) for a month and the side effects were frightening, so I stopped.

Thanks in advance!

Thanks for allowing me to post this photo. Click it to enlarge!

1. Looking at the only photo you sent, you look like you have LOTS of hair on your side and thinning hair on top. I have no idea how your hair looks like on the back (donor area) and what percentage of your hair are miniaturized in key areas. So in short, I cannot tell you if you really have diffuse thinning and I cannot give you a personalized diagnosis… but with little that I do see and what you described as mostly thinning at the top, I don’t think you have diffuse thinning. You most likely have an early Norwood Class 5 or 6 pattern. I would see a physician (hair transplant physician if possible) for a good diagnosis and a miniaturization study.
2. Asians have less hair density than their European counterpart, but much of the time Asian hair is thicker and coarser as compared to the European fine hair. This can make Asian hair look more full. I have no idea what your density is. Your guess is as good as mine (its only a guess) so go to a good doctor and have it measured.
3. Propecia (finasteride in 1mg strength) does not “eliminate” shock loss. It decreases the risk. There is no guarantee you will or will not have shock loss after a hair transplant surgery. Generally younger men in their early 20’s and men who are losing hair rapidly have more chance of shock loss.

Finally, I do not know what frightened you in to stopping finasteride. If you have side effects I would discuss them with your doctor to find out if it really is a side effect or something unrelated. Negative sexual side effects occurs in 1 to 2% of men who take the medication and they are reversible.

I’ve read that the average density of hair in the donor area is 2.0 hairs per square millimeter. I have a density of 2.2, which obviously is above average but how much? Is it slightly, moderate, or very high? Also, what’s the highest density you’ve ever seen on a patient?

The difference between a 2 or 2.2 density could be the normal variation around your scalp. High densities have ranged from 2.6-4.0. Let’s take a look at a patient with a density of 4.0, who has now had nearly 9200 grafts transplanted. Before on the left, after on the right (obviously). Click the photos to enlarge.

To see more photos of this this patient’s remarkable transformation, click on Patient ZU.

This patient was amazed by the results he saw from his single session hair transplant (2750 grafts). It’s been 3 and a half years since his procedure took place and in that time he’d forgotten what he started with. When he and his family member came in for a visit this week and saw his before pictures, neither of them believed that it was him. He’s allowed me to post these here so you can see why he was so pleased when comparing the before and after photos.

I used a hair band to keep his hair back when taking the after photos, since it has a tendency to fall forward on its own. His hair is fine so another session to thicken it up is indicated and is something we wants. The reason I only took out 2750 grafts, was because that was the maximum ’safe’ amount to remove. Any larger amount would have produced wound problems. His scalp is still slightly tight, so he will exercise his scalp for 3 months and then he should be loose enough to get out another 2500+ grafts. Click the photos to enlarge.

After hair transplant of 2750 grafts

Before

As a young man 25 years ago, he had a hair transplant with the old fashion plugs. After seeing what it looked like (it was partly hidden with some hair at the time), he came to the conclusion that he made a mistake and immediately went to using a wig. Between his wig and a baseball cap, he had hidden his secret. About a year ago, he realized that maybe he could undo his plugs and after a year doing internet research, he came to my office to ask me an important question I’ve heard quite a few times before — “Can you just remove these plugs and make me bald so I can shave my head?”

Remember, this is NOT the standard of care today. Click the photo to enlarge.

To see the deformity, he lifted up his wig, which was tightly held to the scalp with tape. Although he is a Norwood Class 5A pattern with high density in the donor area, he never really wants to do hair transplants again, and just wants to be a normal bald man. This is a common finding in people who lived with the horror of the plug deformities of the old transplant work. Unfortunately, this type of problem is what so many people believe is today’s standard of care. Nothing could be farther from the truth as today’s hair transplants can not be told apart from a normal natural head of hair in a non-balding patient.

We agreed that I would remove each plug one-by-one and sew him up, making him a normal bald man. Removing these plugs may leave some minimal scarring. He wants me to transplant the hair extracted from these plugs and put them into the place they came from, to hide two obvious small neck scars. This should easily be done in one surgical session.

This man stopped by this week and he’s given me permission to post his photos showing the results of his hair transplants started 15 years ago. He had a total of 4085 grafts over three surgeries done incrementally as he lost more and more hair. Had he not had these procedures, he would’ve been showing a Norwood Class 6 or 7.

Forgive the quality of the before photo below, as it was from an old scan (the days before we had digital cameras).

Click the photos to enlarge. Left = Before (15 years ago); Right = After (this week)

The reason for his visit was to inquire about filling in the crown, but I suggested that more surgery may not be in his interest. His scalp is tight and his donor area is depleted. Instead, we applied DermMatch to the crown, making a big impact. The use of concealers are discussed in my book, Hair Loss and Replacement for Dummies, a worthwhile read with suggestions on alternatives for hair transplants.

Click the photos to enlarge. Left = Before DermMatch; Right = After DermMatch

Hi Dr. Rassman,

just wondering if you could place some images or a few examples of actual balding people of all the norwood scales say from 2 to 7, so all us readers can have something to refer to? So we can get a better idea of what stage were at.

Thanks!

There are over 300 different patients posted on the NHI website and they should each have the Norwood class listed. It’s not always easy to tell from just one angle, so be sure to click each to see more photos of that particular patient (and to see their hair transplant results).

Here are examples of each of the main Norwood classes:

Norwood Class 2	Norwood Class 3	Norwood Class 4
Norwood Class 5	Norwood Class 6	Norwood Class 7

Here are some of the variant classes: Norwood 3A, Norwood 4A, Norwood 5A, and Norwood 3V.

To see more patients, check out:

• Full Face Photo Gallery
• Hairline Photo Gallery
• Repair Work Photo Gallery
• Other (Crown, Temple, Female, Eyebrow) Photo Gallery

This is a patient who had reversal of frontal hair loss by just taking Propecia for 2 years. The miniaturization in the frontal area was 50% 2 years ago and now is 30%. This is rare to get such a good response to Propecia. The patient is 25 years old and I suggested that he wait 1-2 years to see what was going to happen on the drug. As it turns out, waiting and postponing surgery at 23 when I saw him initially was a good choice. No surgery is needed now.

Before on the left; After 2 years of Propecia (no surgery) on the right. Click to enlarge.

This patient received 250 grafts just a few years ago (not from me, obviously). He knew things were going wrong when the doctor put wooden toothpicks (which could leave behind splinters) into the recipient sites which were made on his head. He overheard the staff chuckling at how he looked. He told me that before selecting his original doctor, he researched the field over the internet and had a few doctor consultations. He selected the original doctor because he was promised a great result and he believed that promise. As the hair started to grow, he became very self conscious and progressively depressed. Going out into social situations made him uncomfortable, even just going out of his house (something he rarely did once the grafts started to grow).

Cosmetic surgery of any type reflects people and their innermost feelings about themselves. I wonder if doctors understand how substandard cosmetic surgery like this can impact a person’s life. This nice young man’s life was in ruins and his fear of going to still another doctor who could possibly do even more harm, did not drive him to learn how to correct the problem until very recently when he ran into us on the internet. First, we spoke over the phone and then he set up a surgery with me and flew in. When I saw him this week, he was frightened with flashbacks of his original horrific experience

Just to be sure everyone is clear — the photos that are shown below are of this man’s substandard work and an example of what a doctor could do if he/she does not use state of the art hair transplantation technology. The term “hair plugs” is still incorrectly used for the modern technology we invented, but the lingering images (reinforced by patients such as this) are hard to abandon. Looking at the results that were once commonplace, one can clearly see that referring to this old technique as “plugs” is not out of line. Fortunately, I took steps to correct the appearance of these plugs by coring some of them out and transplanting more hair to fill in the entire frontal area. All of the plugs that were removed were cut into follicular units, and then re-transplanted into the scalp. I expect that he’ll be much, much better off after this first procedure with me of 2600 grafts grows in, which was done this week.

Here are the photos of his pluggy look referenced here (click to enlarge):

Dear Mr Rassman,

First of all thank you for your very informative and helpful site.

I am 30 years old and lately I started worrying about my temples. I have a feeling that I have rececing temples and want to take action in case this is the case. Unfortunately I do not have old photos taken from the right angle to compare. Could you please tell me what you think and my Norwood class according to the attached photos. I do not have any balding or thinning on top.

By the way, you can use my photos on your blog if you please.

Kind regards

Click the photos to enlarge:

First of all, thanks for allowing me to publish these. What I believe you’re talking about are the corners of the hairline, not the temples. The temples are below the corners (above the ear) and those look fine in the photos you provided. People seem to get the temples and corners confused all the time when labeling them.

It appears that your hairline is now convex in shape and the central area does meet the side areas, suggesting that the maturing hairline is locking into place. If there is no miniaturization present, I would do nothing other than observe your hairline yearly. This is a Norwood Class I or II.