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Last week, I met with two patients who came to me with thinning hair. One was 19 and the other was 22. The 19 year old had very early miniaturization, evident by the measurements that were taken of his scalp, and I built a Master Plan for him and advised him to go on Propecia. The 22 year old had clear thinning in the frontal 2 inches of his hairline with 40-50% miniaturization and a thin type hair shaft. The thin hair shaft made his miniaturization look worse than if his hair had been more coarse.

Both of these young men went to these doctors before they came to see me (and no, I won’t name names). In my opinion, both patients should not have hair transplants at this time; certainly the 19 year old is not a candidate at all and probably will not be for years, and the 22 year old may become a candidate if the Propecia does not stop or reverse his hair loss to meet his goals. However, the 22 year old might be able to avoid a hair transplant if the Propecia works well for him. The lack of ethics of the two doctors who viewed both men and gave them both recommendations of 3000 grafts each reflect the ‘scum’ of the hair transplant industry. I know I’ve written on this topic a few times before, but it truly outrages me and demands this repetition. Performing surgery when it could be avoided with a simple daily medication shows that the doctors were chasing their patient’s pocketbooks, not pursuing their patients best interests. Fortunately, both patients liked my advice and will see me for a follow-up in a year or so. I am sure that they will get calls from these two doctors and/or their sales staffs and I strongly advised them to resist sales pressures to sell them what they do not need.

To make matters worse, in my normal examination I measured the hair density of the donor hair on these patients and found them both to be lower than average. That means that they might be limited as to what they can expect from a hair transplant when and if they balded. Both of the doctors that they met with just ran their hands over the patients’ scalp in the back of their heads and magically reported that they were unusually blessed with “lots of donor hair”. Neither of these doctors made a measurement of the donor density on either of these patients and as if by magic — *poof* — they had enough hair to meet the doctor’s income requirement. These scams are unfortunately common in this industry and I always warn patients that if the doctor does not precisely measure the donor density, they should run for the hills when told that their donor supply is good. Worst of all is the fact that if these men had undergone hair transplantation, their donor hair (which was limited in the first place) would be depleted, wasted, and worse yet, put in the wrong place. Over and over again I warn patients to do their diligence on the doctors they see and choose. This again, is a Buyer Beware market.

Tags: hairtransplant, hair transplant, hairloss, hair loss, doctor, physician, propecia, finasteride



Quick question: what is the most density one can achieve after a hair transplant? I’m a little more than 6.5 months after my first hair transplant (temple and front), and wondering if I’ll
ever be able to slick my hair back like I used to. I’m seeing growth, but the density surely isn’t near what I’ll need in order to reach my goal (at least right now it isn’t).

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The issue is fullness, not density. At 6 months, I would not expect much fullness, but each successive month I would expect to see more and more. At 8 months you should see about 80% of what will eventually be there. The fullness may not directly relate to the density, as there are many variables (hair shaft thickness, hair character, hair and skin color, degree of baldness), so any absolute number without taking these other attributes into consideration does not mean much.

Tags: density, fullness, hairtransplant, hair transplant, hairloss, hair loss


Dear Dr Rassman

I am inquiring why some transplant surgeons can achieve significantly greater density than other surgeons on patients with similar hair loss and hair characteristics using the same number of grafts. is this due to the way the hairs are implanted to create the illusion of higher density?

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There are many factors that distinguish one hair transplant from another with the same number of grafts. They include:

  1. The artistic skill of the surgeon and the way the grafts are distributed (as well as the direction of the hair shafts)
  2. Hair thickness
  3. Hair character (curly or straight)
  4. Color and contrast between hair and skin color
  5. The number of hairs per follicular unit (relates to the way the harvesting is done and the density of the original hair)
  6. Styling (layering works better on some people, particularly those with straight or slightly wavy hair
Tags: hairtransplant, hair transplant, hairloss, hair loss, density


Dear doctor, good work on the site, it is very helpful.

I have a few questions about hair transplant procedures.

  1. Is a short haircut such as a buzzcut or crew cut probable with a transplant, or would the hair look too thin on top?
  2. Does the balding process ever stop?, does the donor area ever bald?
  3. How many grafts can someone actually have?

Thank you for the help

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  1. When you have a hair transplant, the density of your transplant rarely will exceed 35% in one session, so if you cut it short, the reduced density will show a thinner look. Repeat sessions can solve the problem, but these are only a good idea on people who are not very bald.
  2. Balding is a progressive process over a man’s lifetime if he is genetically prone to balding. It generally slows down in men over 40.
  3. The total number of grafts available for a hair transplant depends upon the donor density (higher densities can provide more grafts), and the scalp laxity (looser scalps are easier to harvest). In patients with very high donor densities, there could be easily 15,000 grafts. In Asians with generally lower normal densities, the number of available grafts could be in the 5,000-6,000 graft range.
Tags: hairloss, hair loss, hairtransplant, hair transplant, balding, grafts, density


Hi Dr…. is it really possible to pack 70 to 120 cm2 in a hair transplant???? Please let me know because a doc told me he can do this….

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Some people can do the impossible. Putting that density together is crazy. The normal density is 100 follicular units per square cm, so why put in a number that is greater than normal? The real issue here is not if it can be done, but whether or not they will actually grow. What you are hearing/reading are stupid comments by an ignorant doctor.

Tags: hairtransplant, hair transplant, dense packing, density, hairloss, hair loss


(female) I am aware that dropping a 100 hairs a day is normal. However, when I met a trichologist about 2 years ago, she told me that for Asians, a 100 hairs is considered a sign of hair thinning. This is because that most tests are done on Caucasians and they have apparently more hair on their scalp. The ideal would be 50 hairs per day for Asians. What are your views on this?

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Assuming that you have a typical density for an Asian (1.6 hairs per square mm on average) then I would expect your daily loss of hair would be about 80 hairs.

Tags: asian, hairloss, hair loss


I am considering doing an FUE, and later on need I recognize that I may want another transplant, won’t the FUE cause my donor availablity to be less as compared to having the strip transplant?

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I think that you must put the various surgeries that you may want into a Master Plan for your hair loss. If you are not going to be very bald, then an FUE solution is not an unreasonable one. The long term yields for an FUE may have to do with donor density, but for strip harvesting, I have exceeded 10,000 grafts over more than one surgery. With regard to your query, I do not believe that anyone really knows whether FUE will cause your donor availability to be less than that of the strip procedure, but I would personally doubt that FUE will yield more hair for transplantation than strip harvesting. There may be a role for combined FUE and strip at the end of the process.

Tags: hairtransplant, hair transplant, fue, strip, harvest


I am a 31 year old female with a 17 month old son. At about the time he turned one, I started to notice hair loss. It’s all over my head, and has caused my hair to thin a lot. It is still happening. I have been to the doctor and was tested for thyroid. It was negative. What I am wondering is, could this hair loss still be related to my pregnancy? It has also been an extremely stressful time – but could this long period of hairloss be related to stress? Will my hair grow back? And can continued stress mean continued hair loss?

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Hair loss in women can sometimes be caused by underlying medical conditions, so it is important for you to be evaluated by your own physician. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. It is also important to review the use of medications that can cause hair loss, such as oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone. The following laboratory tests are often useful if underlying problems are suspected: Estradiol, FSH, LH, SHBG, Prolactin, T4, TSH, ANA, Iron, TIBC, Ferritin, Free and Total Testosterone. Your scalp should also be mapped out for miniaturization to define patterns in genetic hair loss that are typical for women. Pregnancy can activate genetic hair loss in some women.

Tags: hairloss, hair loss, female, women, woman, pregnancy, pregnant


I have read that hair diameter is thickest near the bulb and thinnest as it reaches the tip. Recently I have seen some fallen hairs with the diameter thickest at the center and thinner as it reaches the bulb and tip. Is this indicative of hair loss?

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The hair shaft should be uniform in its thickness through its entire length when the hair is shed during the normal growth phase that all hairs go through. If there is active miniaturization that radically sets in, then that could explain what you see in some of the hairs that you observed. In the miniaturized hair, the hair probably grows slower than in the normal state, so a hair that you are looking at (lets say one inch long) might have taken some time to find its way out (more than the normal 1/2 inch of growth per month). The best indication of hair loss is to assess the degree of miniaturization that is present throughout the scalp, particularly the areas that are thinning. I hope that this helps.

Tags: hairloss, hair loss, diameter, density, miniaturization


Dear Dr. I am 29 year old Indian. I want to measure my hair density before undergoing hair transplantation. My doctor has trichoscan with him. I want to know if it is as accurate as your densitometer. Please reply.

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Probably yes, assuming that he can see the individual hairs. Ask him to show you the miniaturization so you will know as much as your doctor knows.

Tags: trichoscan, density, hairloss, hair loss, miniaturization


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