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One thing I’ve read about online is that some people are suffering from long lasting redness in the donor area after a hair transplant. What should be done to eliminate the redness within a 2 week period before someone can go to work without being noticed he had HT?

I ask this question, because i tried your test for redness and my skin looks very sensitive.

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If your skin is prone to redness, then there really is no way around it (just like if you’re born with the gene for balding, you really can’t stop the balding… it will happen). Typically, most doctors give a small dose of cortico-steroid to minimize the redness.

Otherwise, if you’re not a Norwood 6 or 7 and have some existing hair near the transplant area, you can try growing that hair out a little prior to the procedure so that you can use styling techniques to cover any redness that may be otherwise visible.

Tags: hair transplant, redness, surgery, hairloss, hair loss


What do you tell prospective clients who say that they want hair restoration surgery, but it is absolutely imperative that all signs of the procedures, as well as the result, be undetectable? Let’s say for example that I was able to take 3 weeks off of work to have this done while I go on “vacation”; with what degree of certainty could you say that signs of the procedure, including scabbing, and what I’m more worried about being the “pinkish” scalp, would have subsided within a lets say 17 day period?

As is the nature with the internet, I have read posts with wildly different interpretations, and have also seen very different outcomes in the online photo-blogs I’ve looked at. I have no doubt you must receive hundreds upon hundreds of questions, so thanks so much for what you do for so many of us in this frustrating predicament; any help with my question would be greatly appreciated.

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Every patient is different, but in general the scabs and the redness (if there is any) goes away anywhere between a few days to around 2 weeks. On the other hand, the short hairs from the transplant look like a newly grown beard, and in a woman that might make it detectable if she does not style her hair to cover it; however, these short hair will all fall out in about 3 weeks, so by that point there should be no trace of a transplant. The hairs that fall out will reappear somewhere between 3-6 months and then start growing at about 1/2 inch per month.

Most people have no signs of the surgery between 3-4 weeks afterward; however, on rare occasions there have been some patients that will hold redness in the recipient area for up to 8 weeks. With a simple scratch test (where you scratch your forehead with your fingernail with some moderate pressure), the skin might produce a red mark in the scratched area within a few minutes of doing this. That indicates a positive scratch test, and those with the positive scratch test will often hold the pinkness of the recipient sites for a few weeks.

Tags: redness, hair transplant, surgery, hairloss, hair loss


Dear doctor,

So far I have read that transplanting back a juvenile hairline (from a mature, assuming the person is not balding) is a bad idea due to the risk that the patient may suffer from balding in the future, leaving a permanent transplanted section at the front, which would look ridiculous.

Could this not be avoided by transplanting hairs from the top of the head (rather than from the ‘permanent’ zone of the back/sides) to the front, so if that person does end up balding, those follicles will be equally affected by the DHT, and so will not remain permanent? What’s more, those transplanted follicles could therefore be treated by minoxidil and propecia if need be?

On the other hand, if the person doesn’t bald, they will retain the lower hairline. It seems like a win-win situation. I only ask because I think my hairline is maturing (it remains to be seen if it will become balding) and I want to maintain a straighter hairline because it looked much better on me and had better styling options.

Many thanks

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Yes, you can technically take hair from the crown and put it in the hairline… but if you harvest from the crown, then you’ll have a potentially bald-looking crown. I wouldn’t recommend this being done.

For example, let’s say your genetics might just have crown loss in your future, in that case you would’ve had an unnecessary surgical procedure if those transplanted hairs start falling out with the rest of your crown hair. You must remember that Propecia doesn’t protect you from hair loss forever, as your genetics will eventually win out at some point down the road.

I think you need to understand the importance of a Master Plan, where the doctor and the patient plan out a specific plan on how to address the evolving balding process. If you plan it right, you don’t have to worry about the “ridiculous” look of a partial job.

Tags: hair transplant, crown hair loss, hairloss, hair loss


If you have no donor supply left would it be possible to use body hair to help with density. I understand your positions on BHT having read your posts on the topic, however is that something you would ever consider?

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There are few indications for body hair transplants (BHT). From what I have seen, the results are quite variable. It might be a waste of your money doing it, especially if it did not meet your objectives. I occasionally refer patients who are committed to body hair, but I do not do them myself.

Tags: body hair transplant, bht, body hair, hairloss, hair loss, hair transplant


If a younger patient (late 20s) wanted to ‘touch up’ their hairline to make it more symmetrical with a small transplant e.g 10cm surface area…approximately what density should this be at if you were to consider that the patient has fine hair and wants to be cautious with regard to future loss?

I’ve seen some surgeons using ‘dense packing’ produce great looking results, but i know these can be risky as future loss can leave a bad result…but would it be ok to transplant at a lower density in this case? And do you ever perform ‘touch ups’ to the hairline of a younger patient if they’re not on medication?

Also, are lower densities (i assume 25-30 per square cm?) going to give a very poor looking result for someone with fine hair?


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Each case is different, so you will need a diagnosis first to see if you are balding. Some young men get freaked out about a mature hairline (which is not balding), so it’s very important that you get a diagnosis before you can plan for surgery to address any cosmetic issues to the frontal hairline.

If someone wants a very full hairline (original non-balding density), for most people that would likely require more than one surgery, regardless of how densely packed the hair can get. If your hair was medium-coarse or thicker, you might get a reasonably full look in one session.

If it sounds too good to be true, it usually is. You should want to create a Master Plan with your surgeon to account for any future loss that might occur. Remember, you’re talking about a surgery to your scalp (particularly at the hairline, right in front of everyone that you interact with in person). You should want to make sure that if you do have hair loss progression, the results from any earlier surgery will remain natural in appearance.

Tags: hair transplant, hairline, hair restoration


In a caucasian male with brown, straight, fine hair…what sorts of transplant density would start to appear ‘full’? Is it possible to get a thickness so that the hairs can stand up or will they always ‘fall down’ because of the lack of surrounding hair?

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There is no magic number for density. Hair transplantation is about using a limited number of hairs to make your overall scalp hair appear fuller. The density varies from location to location to achieve this look.

For example, if we put a density of 10 hairs per square centimeter all over the entire bald area on a Norwood 6 patient, it will look very sparse with no significant cosmetic improvement. If you put 100 hairs in a square centimeter on the same patient you will quickly run out of hairs and will only be able to cover a small / partial area on the bald head. But if you vary the density from 50 hairs to 10 hairs and focus with the higher density in the front AND combine it with hair styling, you can achieve a full appearance.

Thus, the overall result of a hair transplant is not only about the density. It involves hair texture (thicker and curlier is better), hair color contrast against the skin (low contrast such as black hair on dark skin is better), and hair styling (longer hair, wavier hair is better than a straight buzz cut).

Tags: hair transplant, density, hair grafts, hair restoration


I met with one of my earliest transplant patients who had surgery in 1992 when I was just in practice for about 6 months. We performed 400 grafts on this patient and he reminded me of the troubles I had in using the glue to hold the grafts in place. At first I had to think about what he was talking about… and then I remembered the painful process of placing a large number of grafts close together.

In those early days, just 80 grafts was considered a big session. 400 grafts was a huge surgery and putting grafts close together caused them to pop out, so I came up with the use of a medical quality methyl methacrylate (a form of super glue) to hold the grafts in place. The problems I encountered was that the glue was stringy and I had to be able to limit the glue to one corner of the graft, holding it to the skin. I had to put the methyl methacrylate into an insulin syringe and then express it through a very tiny needle to produce a micro-drop.

I had to work out just how to do many grafts at one time to stop the popping before this “glue” bonded into the insulin syringe. The glue problem was never solved to my satisfaction, but eventually I developed a very sensitive touch so that when I placed the grafts and kept a steady hand, I did not disturb the adjacent grafts. Eventually I mastered this technique and taught it to my staff. Now the world does it that way.

The patient compared the procedure we did recently to the one I did to him in 1992 and we both has a good laugh. This most recent procedure was his third and the grafts that I placed in 1992 worked very well for him over the past 22 years.

Tags: hair transplant, history, surgery


Cheers doctor. I live in the UK and there is not much information regarding hair loss as there is in America. I have been steadily going bald for the past 14 years and have been on proscar for some time. My doctor was reluctant to put me on proscar but finally gave in, bless him. Anyways, fast forward to now, I am 32 years old and have been seeing an increase in my hair loss in my temple area, hairline, and behind it. It is not that noticeable yet because nobody has really commented on the loss but I know in certain lighting it is very apparent and when I style my hair in different ways it is apparent.

What are the stages I should be taking at this point?
A. Continue with the medication or not take it anymore because I am losing hair regardless
B. Wait for my hair loss to continue until I have a more prominent bald spot and then go for a procedure
C. Go for a procedure now and try and stay on top of my balding
D. Get those micro dot tattoos on my thinning area
E. Do nothing and hope for the best

I always wondered about people who stay on top of their balding but the problem is when they start losing the hair behind their implants or their donor hair runs out, that is what is sort of preventing me from doing anything. Your comments and feedback would really be appreciated. Cheers.

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There is no substitute for a good doctor to help you in this process. If you are really losing hair, then stopping Proscar (finasteride) could be a disaster that would lead to “catch-up” hair loss. I assume the Proscar you’re taking is cut into 4 or 5 pieces, and not the full table, which would be too much medication for treating hair loss.

You don’t need to necessarily wait for more prominent balding before you plan for surgery, but as hair loss is progressive, your pattern would need to be determined so that any surgery accounts for potential future balding. Having Scalp MicroPigmentation (SMP) is also a possibility, depending on the hairstyle you plan on having. I can’t really answer your questions without pictures at a minimum.

So really, your next step should be to sit down with a good doctor (you are fortunate to have both Drs. Bessam and Nilofer Farjo in the UK) and build a Master Plan with them.

Tags: proscar, propecia, finasteride, hairloss, hair loss, smp, hair transplant


Hi Dr Rassman,

I am 30 years old and for the past four to five years have had some recession/thinning at the corners of my hairline. It is uneven (on the left side around a 6cm triangle shape in area) and on the right side around half that area. For years I’ve monitored the area (even went to see Dr Farjo two years ago who confirmed i had mild recession – not a mature hairline) and in terms of area of recession it has got no worse – maybe a little thinner in those areas but it has not spread.

The fact that I have a receded hairline REALLY bothers me because i have very dense hair in the middle and on top but it is thin on the sides making my hair very messy when i wake up etc. I would love to have it filled in slightly with a hair transplant to frame my face better and so I wouldn’t have to worry about styling it as soon as I wake. It consumes too much of my time/thoughts and I’d like to not have to worry about it so much. So here are my questions…

1) If my hair loss has been fairly stable for over three years is it likely that I won’t lose so much hair in future or does it not work like this? Dr farjo didn’t seem to think that I would not lose a great deal of hair in future but my dad is NW6 bald, My maternal grandfather was more NW3-4v in his later years with hair combed over.

2) If as I suspect it is just not possible to predict that I wont lose too much more hair in future, is there any way that I can have a hair transplant to the hairline corners without risking looking stupid in future if I do lose lots of hair behind it and can’t afford a future hair transplant or don’t have enough grafts left to cover it all (I have very fine hair by the way). What I mean is, is there any way for a HT surgeon to do a lower density transplant at the corners to stop it looking like the patient is looking like they have thick horns of hair left in future as they go more bald? By the way – I have ruled out the option of ever taking propecia as for me i can’t afford messing with my hormones (other health issues) and minoxidil never worked for me in this area (I sometimes wonder if it did more damage than good as it is when i used it years ago that the thinning progressed).

3. Finally… For someone with fine hair…what would be the density per square centimeter needed for a transplant at the hairline corners. I’d like to get an idea of how many grafts i might need if it is possible.

Thanks in advance for your help.

p.s. I realise my questions are quite specific and will of course go back to see a surgeon for an opinion but just can’t afford to at this moment hence my questions.

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Dr. Farjo will give you good advice on these issues. If he thinks your hair loss won’t progress to your father’s pattern, I would plan for that. Ask you dad when he started to lose hair. I suspect he started earlier than you and accelerated more quickly.

That said, since we never know with 100% certainty what is going to happen to the hair loss over time, you need to make plans for now and then be able to maneuver to another step if the hair loss progresses. You should have a Master Plan created with Dr. Farjo if you have not done that yet.

Concerning a transplant to your hairline corners and having very fine hair, if you do opt for surgery, be sure to have it done right. Creating a thinning or balding look with this hair is not in your best long term interest.

Tags: hairloss, hair loss, hair transplant


A couple weeks ago, we wrote a post titled: FUE vs Strip — A Technical Analysis. In it, we discussed how the anatomy of SOME follicular units in SOME patients get disrupted, stripping off the fat from the lower part of the hair follicles.

We had two patients this week that provided some good examples we can delve into —

1. Patient #1 had a strip surgery, and we harvested two 2-hair grafts and two 3-hair grafts for this example. Note that all of the anatomy is present (sebaceous gland, fat to the bottom of the hair follicles) as shown in the photo below (click to enlarge):


2. Patient #2 had FUE performed, and if you look carefully, the bottom of the grafts have some missing tissue on them. This resulted when these grafts were pulled from the scalp after the FUE was cored. Parts of the end of the graft (surrounding the bulb) are devoid of the capsule and fatty covering that can be seen in the strip grafts. The photo below shows 7 follicular units extracted by FUE in a FOX negative patient (click to enlarge):


From the left, grafts #1-3 had loss of fat with intact follicular sheath (glistening membrane surrounding the hair follicles). These grafts should grow well; however, no studies on such grafts have ever been done.

Grafts #4 and #6 showed that some hairs were pulled apart within the follicular unit, probably when it came out of the scalp (a common occurrence in FOX negative patients). The missing parts of the lower half of these follicles were probably not transected with the punch instrument and will not produce hair; however the remaining follicles should grow. Again though, no studies on such grafts have ever been done.

Grafts #5 and #7 show intact follicular sheaths; however there is some mechanical “fracture” at the end of the intact hair shafts. We do not know if this will impact graft growth, but these changes are not uncommon in the FOX negative patients. These grafts should grow well, but… well, no studies on such grafts have ever been done.




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