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Hi Doc

Love your website please keep up the good work it is very much appreciated. I have been reading your website extensively and understand the difficulties with transplanting body hair ie arms, legs, chest on to the scalp different rate of growth etc. However would it be possible in the following scenario:

I usually have my hair shaved ie blade 0 or 1, thankfully I have one of those heads that look better shaved rather then with hair! I am 33 years old with black hair Norwood class 4 I am loosing may hair slowly but its not apparent yet.

Now with the combination of SMP to give it that shadow look and transplanted hair from chest, arms to give it ‘texture’ as the hair will always be blade 1. In this scenario would it be possible to use body hair combined with SMP?

Thanks Doc

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We have been using FUE grafts for added texture on a person like you who gets Scalp MicroPigmentation (SMP). However, we use scalp hair… not body hair. Body hair transplant success rates are variable and the texture is not the same. If you are going for the “stubble” look, scalp hair will give you a better texture.

That said, we’ve found that after having the SMP done to the full head, most people usually realize that having a hair transplant to get the “stubble” texture is not an issue (as they once thought).

Tags: smp, pigment, hair transplant, hairloss, hair loss


This patient is clearly not balding, or marginally so. He is in his mid 30’s and he did not like the corner ‘recession’. At worst, he may be a Norwood class 2 or 3. He just wanted a cosmetic improvement to lower his hairline the way it always was before it moved upward. His hair was medium coarse so only 800 grafts were needed and the probability will be that this one session might meet his orbjective because of the medium-coarse hair. The risk of shock loss was discussed and was considered minimum. He is not on Propecia (finasteride). He did not experience any shock loss anytime after the procedure.

The following results photos were taken only 5 days after follicular unit extraction (FUE) surgery of 800 grafts. What you see are small scabs with short hair stubble. These scabs and hairs will fall out within a week from the date of surgery and he will look like he never had surgery by that time. The transplanted hairs will start to grow in the coming months.

The reason I wanted to show these photos is to point out how easy it was for the patient and his recovery. You can barely notice anything in his donor or his recipient areas.

Click the photos to enlarge.

After (just 5 days post-surgery):




Tags: fue, hair transplant, results, hairloss, hair loss


Dr. Rassman / Dr. Pak,
If, after consulting with you and establishing a masterplan, a patient were to undergo SMP with the intention of having a hair transplant in the near future, are there aspects of the procedure that require particular consideration?

For example:-
(a) Would the SMP hairline have to be positioned slightly further back than the original hairline to allow for the creation of a transition zone during an HT?
(b) Are the SMP dots used as a template for an HT?
(c) Would the integrity and visual effect of SMP ink be damaged or compromised by HT-surgery incisions?
(d) Do you advocate using a darker pigment to provide better camouflage to the scalp, or do you always match the ink to the patient’s existing hair colour, even if it’s greying/white?

Or is it advisable to have SMP after a hair transplant? Thank you.

Merry Christmas & Happy New Year!

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Each and every patient is different and there is no rule. You can have Scalp MicroPigmentation (SMP) first and a hair transplant later. Or you can have the transplant first and SMP later. I have had patients who had SMP on a completely bald scalp and later had a small FUE surgery to add texture to the hairline.

The hairline for SMP and a hair transplant is placed in the same proportionate height according to what the patient and doctor agrees on. If a patient ever considers having a full HT later on in life they should let the doctor know of this possibility so the SMP hairline can be placed slightly back to make room for some transition zone… but in my experience (in practice) this rarely happens, because most bald patients who are undergoing SMP will never consider a full HT since it will never give them complete full hair coverage. Most bald SMP patients would rather have a good hairline and later consider an FUE option for added texture (not fullness).

I do not advocate darker ink for better camouflage. I advocate a specific shade of ink that matches the complexion of skin and hair combination. If the patient’s hair turns grey later on in life, the SMP shade will make the roots look dark. If you apply SMP all over the scalp it would not matter if the hair turns grey, because there is a base SMP color. Many patients with grey hair have SMP and it actually makes their hair look less grey and they look a little younger. If there is ever a drastic mismatch where your hair turns completely white (not grey) like Santa Claus, then I suppose one must consider dying their hair. Completely white hair will not work with SMP unless you shave the white hair.

Tags: smp, pigment, scalp micropigmentation, hairloss, hair loss, hair transplant


What do you make of this new technique called donor doubling? They are able to bisect the fair follicle basically doubling the yield from one follicle. This sounds too good to be true.

Link – Dr. Mwamba Discuses his New “Donor Doubling” Hair Transplant Technique

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We have seen this in the past, but worded with different terms. In general, if things sound “too good to be true” then it probably is! We have researched and tested the Acell (two years ago with Dr. Bernstein in N.Y.) for it’s acclaimed “cloning” potential touted by certain doctors. In short, it did not work in our hands. If it really did, these doctors would be on the front pages of Time Magazine and would be billionaires.

One of the issues in the world of hair transplant restoration is that there is very little University based or academic based research. Hair transplant surgeons earn a living based on CASH for service. There is no insurance or academics involved. There are few government sponsored or private research grants for physicians or researchers in hair restoration.

I realize there are societies such as ISHRS and AHRS that give the consumer / patient the perception of organization and research, but these organizations cannot and do not enforce or discipline to its members. It has no power to standardize medical procedures or grant classic American Board of Medical Specialties (ABMS) “board certification” type of endorsements to the hair transplant doctors. There is nothing wrong with these organizations, but consumers and patients must understand hair transplant doctors do NOT receive ABMS-equivalent board certification. Anyone who graduated medical school with one year residency can attend a seminar and set up shop as a hair transplant doctor. There is no formalized training like a typical medical residency program that the public thinks of. There are good intentioned surgeons who try to conduct research to advance the field of hair restoration, but there are also dishonest doctors who take advantage of their patients and get away with it.



Dear Sir,

First of all, thanks for this useful guide for those who are in this trip to recover the lost hair.

I am in my 10th day after FUE surgery and today in the shower by mistake i rub my transplanted hair once by mistake (only one gentle pass with my hand), apparently there was no bleeding or lost hairs. The problem that i see after reading this blog is that i still have many scabs so i am concerned if probably i damaged many grafts. Am I right or wrong?

Thanks a lot for your work and attention and apologies for my english because is not my native language.

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You are probably safe from losing the value of these grafts; however, there is no certainty in life. If it was just a gentle pass with no bleeding or grafts coming loose, I wouldn’t be concerned…. but if you are truly worried, you should follow up with your surgeon and have him/her examine your scalp.

Tags: hair transplant, surgery


I was interested in getting a strip surgery in a couple of years. I was wondering if it better for a person to get a large session done at one time such as 4500 grafts? Or is it better for a person to get a smaller session such as 2500 grafts, and then wait for a few months and get additional 2000 grafts? Also, I have noticed that doctors provide a discount after 2500 grafts. Are they encouraging people get larger sessions done?

On the hair loss forums I have seen a person picture where he got 4000 grafts implanted through the FUE method. This man paid for 4000 grafts, but his surgery resulted in a failure. In the end he lost money, and had to live in embarrassment for the rest of this life. I was wondering if the strip surgery has similar risks for large sessions?

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It is not all about numbers. You need a doctor who understands the progression of your hair loss — how to address future hair loss along with present hair loss. You need a plan rather than just thinking of short term goals. Each and every patient is different, with different needs and different hair loss degrees. To some it may be reasonable to have a 4000 graft surgery and be done with the entire ordeal. But with 4000 grafts at one time may come a large donor scar. My point is that your surgeon should discuss all of these factors and give you a Master Plan tailored to your genetic hair loss pattern and your social needs.

We are all born with a finite amount of hair. Some people have more donor hair and some people have less. The availability of hair is a demand (how much you need) / supply (how much you have) issue that must be understood by everyone who is going to have a hair transplant.

The cost of the surgery, while it is a factor, should not be the main factor in your decision making process. Hair transplant surgery is permanent and I am always flabbergasted at the patients who seek out the lowest bidder. This is not like buying a car. The surgeon and the medical group, no matter what they advertise, are ALL different in their techniques and results. Not all strip surgery is the same and not all FUE surgery is the same. As you clearly point out with the failure of the 4000 graft FUE surgery you saw on a forum, the results will be forever and any hair loss from failed or poorly done hair transplants can not be priced just by doing another transplant. The hair supply reduces with every transplant, so losing money can be replaced by more money, but if the hair is gone, then there is no solution. Valuable donor hair reflects more value than losing money.


Dr. Rassman,

I am almost 3 months post surgery (FUE) having had about 2300 grafts with a skilled and well respected surgeon.

I have a number of transplanted hairs in the front of my scalp that have not shed nor have they grown. I scrub them, and nothing. They remain. I have a few rogue hairs that did start to grow (very few, maybe 5-10) without having fallen out post op, but moreso, a couple hundred perhaps, that are just like beard stubble, and wont fall out nor are they growing.

Can you shed (no pun intended) some light as to what may be going on, what the effect of this may be, either negative or positive, and contribute any other thoughts to this as I am not panicking, but as the weeks roll by, I am growing more and more concerned.

As an aside, at nearly 11 weeks, there is no other new growth yet beginning, which I understand is not abnormal.

Thanks again

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This can be all normal for the course. Hairs that remain are leftover from the old grafts and they can be identified by a slight pull with tweezers. They will come out or you can just leave them alone. I see this on occasion after a hair transplant.

With regard to the growth, wait it out. Don’t panic — if a good surgeon did it, then the results will be apparent starting at 5-6 months.

Tags: hair transplant, hairloss, hair loss, grafts


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.

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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.

Tags: artas®, fue, hair transplant, robot surgery, kaiser, hairloss, hair loss


Hey doc. I’m just wondering something. Since you’re willing to trial the laser hat technology would you also be willing to try out Dr Gho’s smaller 0.3m FUE punch.

I don’t really care about the supposed hair multiplication stuff that he claims but I am really interested in the size of his punch. And I am interested in the size of his punch because cosmetically speaking its really hard to see any white dot scaring on any of his patients.

Lots of people on various forums are showing really good photographic evidence of what I would simply call really really really refined FUE. The proof does seem to be out there and since I know for a fact you fight for the balding brothers would you be willing to try that out on willing patients? in the name of science and progressing FUE technology.


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I assume you mean a 0.3mm punch, not 0.3m.

I am open to any innovation, but I am also a realist. Have you actually gotten out your microcaliper and measured what a 0.3mm diameter punch really looks like? It is smaller than a hair follicle, and smaller than a hypodermic 30 Gauge needle (OD). See the needle gauge comparison list here.

Tags: fue, punch, surgery, hair transplant


Dr. Rassman
I saw a story that showed a hair transplant using the ARTAS system. The only downside to ARTAS is the machine only extracts grafts and doesn’t place them. I know you mentioned you had a patent to placing the grafts once they are extracted. Any idea on when Restoration Robotics will use that patent of yours?

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The folks at Restoration Robotics know about my patents for placement of grafts. I am not privileged to know what they have planned for future versions of their ARTAS system, but I am sure that they will eventually automate the placement of grafts.

I don’t know how far along, if at all, they are with going down that path, but it would be the next logical step in their automation process.

Tags: fue, robot, restoration robotics, artas®


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