Dr. Rassman, I have a question regarding a statement you made on your Q/A blog. You said: “I wouldn’t allow any doctor to transplant into an area that has not fallen out under the excuse that there’s anticipated hair loss (behind the leading edge of your loss), as this will only accelerate the thinning. Some doctors do this, and it isn’t in your best interest, only serving to put your money in his pocket.”
I have had in-person consults with Dr. Pak in the San Jose previously. During the consult when discussing what I’d like done and the procedure itself, Dr. Pak has mentioned that he has to consider my future hairloss when he’s doing a procedure. He said he would work within my current frontal hair to add density to what I have.
So when considering what you stated in the above quote, how does that comport?
Almost everyone we transplant has a zone between the bald area and the balding area. We allow the transplant to ‘spill’ into the balding area just in the areas that are evidently in the balding process. We never go back behind it into the area where the hair is normal and not miniaturized.
What I see often is someone with an early Norwood class 3 balding pattern who has some minimal miniaturization behind it (let’s say 25% miniaturized hairs). I might transplant hair about 1/2 – 1 cm behind the posterior bald edge, but not far into the area where there is 25% miniaturization.
Unfortunately, many doctors will transplant 1-3 inches or more behind the bald area, suggesting that it would be to prevent future balding, and it is that process that I warn about. I have recently seen a patient who needed about 800 grafts for corner balding in the frontal area, but his doctor put in 3500 grafts to prevent the balding from spreading. Not only did that cost the patient a bundle of money, but it also almost certainly damaged hair in the normal areas that got the grafts and did not need them.