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Good Morning Doctor,

My husband is consider hair restoration surgery. We are looking for a qualified surgeon. Are there training programs for hair restoration surgery I SHOULD be asking our doctor if he or she attended? It seems like a lot of dermatologists are doing this surgery, but I don’t see a training program or fellowship in hair restoration in their title or advertisements. Is this something the doctor learns on his/her own? What should I look for to be sure I’m getting a good doctor?

Thanks.

I’ve written about this many times. The first link below is probably the most comprehensive of the articles I wrote on the subject, but the others should also prove helpful:

• Hair Transplant Doctor Training
• Hair Restoration Society Credentialing
• The American Board of Hair Restoration Surgery

Many doctors do learn this on their own and some of those doctors learned it well, while others never learn it. I’ve discussed how to select a doctor and what to look out for in the following posts:

• The New Scam in Hair Transplantation
• Dishonest Doctors Are Still Out There
• Dishonest Doctors and FUE
• The Truth About Cheap Hair Transplants
• Marketing and Ethics
• Doctor Availability

Im sure these are some basic questions you’ve answered before, so feel free to direct me to a previous answer. I’m 42, and my hair is starting to both thin and recede, It bothers me quite a bit.

1. you say very often get examined by a professional. where do i start? is this my regular doctor, or i need to go somewhere else.
2. What is the difference between rogaine and propecia, and who would be best to recommend what would make the most sense for me?

thanks very much for any help you can provide.

You should go to a good dermatologist with an interest in hair loss. Call his/her office to find out if they are the best one to treat you. Alternatively, you can see a hair transplant doctor (they have an obvious interest in hair), but don’t get yourself rushed into surgery. I see quite a number of men with problems like you describe.

There are huge differences between Rogaine (minoxidil) or Propecia (finasteride). For starters, Propecia is an oral prescription medication and Rogaine is a topical over-the-counter medication. They each have their own set of possible side effects and they both are currently the only FDA approved medications for treating hair loss. I usually recommend Propecia for early hair loss, but as it is a prescription medication, your doctor will be able to give you all the proper information about it. I wrote about this briefly before — “The two drugs work differently. Propecia is more predictable than minoxidil, but they could work together. I have seen hair come back with minoxidil, however I have seen more patients show great benefits from Propecia.”

For more, Wikipedia has good info about minoxidil and finasteride.

Please note: the above image is not an endorsement of child doctors.

This young man had a hair transplant by a doctor who had done very few transplants on his own. He might have actually been this doctor’s first hair transplant patient. The procedure, which occurred around 5 years ago, failed after the doctor attempted transplanting around 1200 grafts. The patient was lucky (in a way) that the balding area was well covered by his existing comb-forward hair stying. His photos are below (click to enlarge) –

Doing modern hair transplants requires experienced doctors and experienced teams of people. Always check on the experience of your doctor. For more information about finding a good doctor and knowing what to look out for, please see:

• The Truth About Cheap Hair Transplants
• Doctor Availability
• Dishonest Doctors and FUE

First of all I want to thank you for this great site.

In Dec. of 2006 I went to a T.P. doctor, mainly to get a prescription for propecia and to hear what he had to say about how good of a candidate I would be for a hair transplant. I found out at that time that he still used the mini & micro minigraft procedure, with magnification and backlighting.(no steroscopic microscope). In Dec. 2007 I was looking at his web site,and to his credit, is now doing follicular unit grafting using stereoscopic microscopes.

My question is this,how difficult is it for his staff to learn to use microscopes and to be cutting in follicular units instead of minigrafts? I guess what I really want to know is how much time should I give them, to learn the “new” procedure before I go back for another consultation?

Do you have any photos that show the difference between minigrafting and folicular unit graphing on the scalp?

Thanks again.

P.S. How much does a stereoscopic microscope cost? This doctor has been doing hair transplants for 14 years and is now just getting some.They must cost alot!

Cost for hair transplant at New Hair Institute… as low as $5 per graft.
Cost of microscope at a local scientific store… around $500.
Cost of a well done follicular unit hair transplant… priceless.

The difference between minigraft and follicular unit transplantation is small, but can be significant when you look closely at the growing hair. Minigrafts and micrografts transplant skin between the hair follicles and this skin can produce changes in the scalp at the point the hair exits the skin. There may be cobblestoning from the transplanted skin. Follicular unit transplantation only transplants the natural occurring units of hair as they exit the scalp and most of the skin edge is removed so that the point of exit of the hair is normal.

More importantly, the difference when using a microscope for dissection is that you do not waste good follicular units since you can see minute details (under the microscope).

For more details, read our published articles on the subject:

• Follicular Unit Transplantation
• Follicular Unit Transplantation Megasessions
• The Aesthetics of Follicular Transplantation
• Follicular Transplantation: Patient Evaluation and Surgical Planning?

Dr. Rassman,

My main concern is being able to start using Propecia as soon as possible in order to slow down any further miniaturization and slow the progression of any further receding. The other concern I have is regarding the miniaturization study. I live in Minnesota and since your only offices are in California, the distance factor will create cost issues for me.

What options would I have with such a long distance and cost factors?

You can use a video microscope and look at your own hair. These run about $200-400 or so and are often sold online (price varies per vendor and tool used). I like the ProScope (the USB version for computers is more costly than the version that connects directly to the TV) and have them in my offices along with specialized software we developed for keeping records of the patient’s mapped scalp. You need to estimate the number of small hair shafts as compared with the larger, normal size hair shafts. It is often difficult to tell the difference between vellus hair and miniaturized hair, so I use an estimate of 20% as the normal level of miniaturized/vellus hairs. Any number in excess of this in different parts of the scalp is thinning/balding.

Alternatively, of course, try to find a doctor who will manage your entire hair loss process by developing a Master Plan, which should be the bible for your hair loss management.

I have heard alot about the Implanter Carousel which i find very interesting and a great method of preserving the hairs and keeping them moist in the ‘carousel’ unlike the choi implanter were the hairs are left on a tray open to drying with warm air until they are put into the implanter. If you dont mind me asking, was the choi implanter an influence with its design and was the carousel, put simply, designed to better the disadvantages of the choi implanter. As they are an automated method of implanting the hair would that not take remove the artistry of a manual job. You once said on a answer to a blog on the subject of ‘The choi implanter’, ‘The Choi implanter is just a surgical tool. It makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills with the more traditional transplant tools used throughout the world. An instrument is only as good as the person using it, so I can not package the tool with the technique. The Choi generally requires ‘skinny’ grafts, which tend to dry out more easily, therefore, this instrument requires special skills, different than those that do not have to make the grafts skinny’. My question is how is the carousel different in the sense that an automated implanter such as the choi implanter makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills. Thank you, for all your advise.

It sounds like you know all the technical difficulties associated with follicular unit transplantation — are you a hair transplant surgeon?

As you mentioned, I wrote about the Choi Implanter before — What is the Choi Implanter?. There’s nothing else I can really add to that. The Hair Implanter Carousel was patented back in the 1990s and it works distinctly different from the Choi Implanter. It was designed to take advantage of a ‘machine gun’ approach to loading the grafts for implantation and percutaneous use and keeping them moist (as you wrote). I’ve used both and found the Carousel to be much easier than the Choi. The drying of the grafts was not a problem for the Carousel as it was for the Choi. Unfortunately, the instrument manufacturer was unable to produce a consistently high quality product and we ended up in court trying to get my money back for the build out of the Carousel, rather than getting the tool into the transplant surgeons’ hands.

A paper about the Carousel was published in 1998 and three videos of the instrument can be seen below:

Read more of “Hair Implanter Carousel (with Videos)”…

I have sent this question to this blog several times, however have had no response. I understand you have extremely high volumes of email, but i feel i might of had no reply due to the question its self as it may be considered that i am being purposely insulting. My question is as follows. The carousel i think is an extremely well designed implanter. And i imagine its results are alo very good, however i have seen in one of your replies to a question about the choi implanter were you said, ‘The Choi implanter is just a surgical tool. It makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills with the more traditional transplant tools used throughout the world.”

This to me seems a contradiction when the carousel is also an automated surgical tool, which also makes some of the transplant easier to do. I admit that the carousel could be considered to be better in the sense that it may harvest the hairs better, however its still like the choi implanter. One could say the carousel is a better evolved version of the choi implanter. The carousel and the choi implanter do the same job in almost exactly the same way. Please will you reply as i would find an explanation really interesting. Thanks.

Practically speaking, the Carousel and Choi implanter are similar in that both make a recipient site directly into intact skin and then place a follicular unit into such sites. Mechanically speaking, the way they place the follicular unit in the site is different. The main limitation of the Choi implanter is that you have to load one follicular unit at a time, make the site with the implanter, place the FU in the site and load it back again before you can continue. For the Choi, a single hair graft is pulled into the instrument by a hair (being backed in). The advantage of the Carousel implanter is that it holds 100 follicular units, making the process smoother. The discussion is moot, however, because the Carousel is not currently on the market and can not therefore be used by any surgeon.

Note: The image to the right is of the Carousel implanter.

Do you have any insight on Dr. [name removed]? As in do you think hes skilled and ethical? Please would like your advice

Over and over again I am asked such questions. I just can not answer them, because I could be at legal risk if I thought badly about a particular doctor and voice my opinion over the internet… and there are many doctors in this field who I might not speak highly about.

There are some websites that claim to be consumer advocates and give such information to potential shoppers. Some of them provide a service and some do not. It is important for the readers to understand that many of these websites charge doctors a fair amount of money for an endorsement. That may not mean that if a doctor is not endorsed on the website, he/she is not a good doctor; it means that they do not want to pay thousands of dollars a year for such endorsements.

This is a buyer beware market, a theme I proclaim over and over again. In this blog, I tell consumers how to find a good doctor and I do not charge for any of that advice. So why do I add content to this blog day and after day addressing such questions as how to select a hair transplant doctor? The answer is that this is part of an overall philosophy I have to educate the public and to let the public know that there are many good doctors out there who perform quality hair transplants. Today’s modern hair transplant creates results which are indistinguishable from a person who never had a hair transplant and is blessed with a good head of hair. At our Open House events every month, many of our patients come in to help me illustrate that very point. I stress ethics in the field, tell the consumer how to hold a doctor responsible for their work and warn the consumer that this is a buyer beware market and the burden is on them, as a buyer, to do his/her research to get a quality job done.

For more information on doctors — what to avoid, how to find a good one, what some don’t want you to know — see:

• The New Scam in Hair Transplantation
• The American Board of Hair Restoration Surgery
• Dishonest Doctors Are Still Out There
• Dishonest Doctors and FUE
• Marketing and Ethics
• Doctor Availability

I have ceased to be amazed by the vast amount of information this site provides to all of us hair-obsessed patrons–Kudos to you balding blog!

My question is pretty simple (i think):

How soon is one able to tell what Norwood class he will develop into? Put another way, if you’ve been mapped for miniaturization, how accurate an assesment is this of your final balding
pattern?

I think I understand your question. You want to know if the mapping of your scalp for miniaturization will indicate your eventual hair loss pattern? The mapping of miniaturization will show you more about your balding pattern than you can see with your naked eye. Most likely, you would progress to a higher Norwood classification if there is miniaturization in the areas which appear hairy and the more miniaturization present, the more likely your balding will extend to those areas. You may not completely bald in the areas where miniaturization is present and if you took drugs, that may be more likely then if you let nature take it course. If you did nothing to arrest the process of MPB, the likelihood that you will see a more advanced pattern is high. But if you use medications like Propecia, you will be slowing down the process. If you’re looking for a numerical value to show the accuracy of a hair loss pattern, I unfortunately don’t have one for you.

Hi, I believe I asked a question some months back but you only responded by asking me to come in for a consultation. So, let me try to get into specifics before considering coming in. I have been undergoing some stress lately and noticed thinning of my vertex. My hairline is completely unchanged… same as it has been since high school. I am also underweight for my height. Male, 28 years old 6′2″ 160-165 lbs. I have been underweight for the last 4-5 years. My average weight was 180 lbs in the past but have been eating less due to shortage of time and decreased appetite from work, plus I exercise 5-6 days a week. Also, my protein intake has fallen drastically.

I am contemplating whether I am experiencing MPB or Telogen Effluvium. Few months back I noticed a lot more shedding from the vertex area, mostly in the shower. I would pull at my hair and more than 4-5 strands would come out at a time and would not stop until I have pulled out an average of 10-15 strands. This happened every morning in the shower. It has somewhat slowed down, but now I am seeing some hairs come out that underwent miniaturization. Maybe I am experiencing a combo of both Telogen Effluvium and MPB. But has there been cases where men only experience balding in the vertex only?

My father is balding at the age of 59 (typical horseshoe). My mother’s side shows no signs of hairloss from anyone. He informed me that he experienced loss in the front first. If I inherited his baldness, would I follow his pattern?

Detailed feedback would be appreciated. Is consultation by appt only?

Yes, consultations are by appointment only. Your case, like many, are not as cut-and-dry as you’d like it to be, so it would be difficult to just make random assumptions about your hair loss without an exam. I’m not trying to “rope” you into coming in, but I’m also not trying to steer you in the wrong direction. This does require an exam, which can and should be done locally. When I see a patient for the first time (let’s say you, for example), I would plan on spending an hour with you, which gives me time to:

• Get to know you
• Listen to the problem you will be defining
• Examine your scalp and hair in detail
• Discuss a ‘plan of attack’ based upon a Master Plan we would setup to manage your hair loss problem

MPB can be limited to only the vertex (crown), or it may start in the front and progress backward. Genetic hair loss generally occurs in patterns (see Norwood Chart). Telogen effluvium, on the other hand, would be diffuse and not only limited to a patterned area.

If you’d like to setup a free consultation, you can either call my office at 800-NEW-HAIR or fill out the form on my site to Request Additional Info and someone from my staff will get in contact with you.