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Pakistan’s prime minister has gotten a hair transplant a few years ago. His results are amazing. However, even with the hair transplant sometimes he looks like he has no hair in the frontal zone and sometimes he looks like he has a lot of hair in the frontal zone.

Here is a picture under the sunlight where his front zone looks empty. Photo

If Nawaz went for another procedure, is there any possibility he can get a result where even if he stood under the sun, his hair transplant results would show a fuller appearance in the frontal zone? Please give your advise.

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Nawaz SharifNawaz Sharif could fill up the frontal area with another procedure and get some more hair on the top of his head, but as has a Norwood class 7 balding pattern with what appears to be fine hair, I doubt that he will ever look completely full.

In our practice, we have performed hair transplants on people with fine and average weight hair. Those with fine hair, never really look full although I have done upwards of 9000 grafts on these people; however, with an average weight hair we have succeed in getting good coverage with a good styling technique to enhance the distribution of the transplants with about 9,000+ grafts. Many Asian class 7 pattern patients will not have the density to move that high number of grafts, so even with a better hair thickness, the ability to extract and move 9000 grafts may not be possible if the density is typical of most Asians.

Of course, one other way you can give the appearance of fullness would be through the use of Scalp MicroPigmentation (SMP).

Tags: narwaz, hairloss, hair loss, hair transplant


Hi Doctor Rassman:

I have a question about corrective surgery to repair Hair transplant scars and scalp reduction scars and lumps.

I had several hair transplants and a total of 7 scalp reductions back in the late 1980’s and early 1990’s from Dr. Martin Unger. With regards to the hair transplants, they were the typical 4 or 5 mm punch grafts I guess. The outcome was good but the donor area, which is covered pretty good by hair looks like a war zone if I were to shave my head or cut the hair anywhere shorter than a few cm’s on the sides and back.

I’d love to get FUE’s into the scar areas but I’m wondering how effective that would be in covering it up. I’m not interested in SMP cause if I do any corrective surgery, it is with the intention of wearing my hair very short and keeping it natural, using real hair.

With regards to the scalp reductions, as mentioned I had 7 of them. So I basically have hair up to the scalp reduction on both sides of the scar. I also have wavy hair so that helps to cover up the scar. But I would say the scar is about 5 or 6 inches long and maybe a quarter inch wide. Could that be filled up with FUE’s?

Another big problem after having 7 reductions is that at the crown / back of my head where the scar ends, there is a lump of excess skin left over from having the scalp excised seven times but excess skin build up behind the scar where the skin wasn’t cut out. It’s not a dog ear scar, just a lump, probably the size of quarter / half dollar and maybe 1cm high compared to the rest of the scalp, kinda like a mound. I’m sure you’ve seen that. It’s basically covered with moderate coating of hair but still visible if someone was looking at the back of my head from a close distance. God forbid if I let someone touch my hair. Even my wife and kids know NEVER to touch my hair. LOL!

So my question is, can that lump be excised or reduced in size?

Basically my intention is just to try to make my scalp, with very short hair, look as normal as possible. My hair, now if I keep it long looks like death. What I mean by that is it looks like it is on life support knowing that it should have fallen out decades ago but just as been kept growing by artificial means. LOL, hence I want to keep it short one or two cm long, shorter on the sides and back.

Back then I was young and naive and desperate and although I’m sure Dr. Unger had good intentions he never told me just to cut my hair short and move on. Now I’m using a shitload of treatment just to keep my hair for the sole purpose of not wanting to thin,especially on top so that the scalp reduction scar and is visible. Then I’d look like a freak. If I had no scars, hadn’t had any surgery, I’d just shave it cause hair to me now is not so important as it was back when I was 21 (I’m 49 now)

Just to show you how crazy my treatment is:
Proscar (5mg a day) Been on that since it first came out so going on 21 years.
Dutasteride (1 mg a day) been on that too since it first came out, maybe 8 years??
Minoxidil 5 and 15% daily
Nizoral shampoo


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While you may say your case is “crazy”, there are many men in your similar predicament. Dr. Pak and I have seen and treated many men in your similar situation with a combination of a hair transplant, scar reduction, and SMP.

I really cannot advise you on your specific options without examining you in person. Repair cases like yours are unique with each person. BaldingBlog is more for general question and answers. If you would like a consultation please email me at or call my office to speak to me or Dr. Pak at (310) 553-9113. It would be best if you email photographs (held absolutely confidential) and include your phone number, and either Dr. Pak or I will call you.

Tags: hairloss, hair loss, scalp reduction, hair transplant


Have you ever encountered a situation where an FUT patient developed persistent redness in the recipient area after surgery that never went away? Have you ever encountered a situation where a patient developed Rosacea and/or Telangiectasia as a result of surgery which caused permanent discoloration of the scalp?

If this happens, what is generally the cause? And what is generally the ultimate outcome for these patients?

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No, I’m not familiar with this occurring. I have never encountered a situation where a patient developed permanent discoloration of the scalp, such as rosacea (facial redness) and/or telangiectasia (spider veins) as a result of surgery.

When redness occurs it usually reflects sensitive skin, but it always goes away. Redness rarely lasts longer than a few weeks in the worst of cases. The one exception that I can recall was a patient that had redness to some degree last around 6 weeks, but that was unusual.

Tags: redness, hair transplant, rosacea, telangiectasia, skin discoloration


Dr Rassman,have you heard of Dr Carlos Wesley’s Pilofocus no scar procedure? I watched the video it looks pretty amazing. I am curious what you think.

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This was presented at this past October’s ISHRS meeting. Essentially, the procedure gets the hair from under the scalp with an endoscope. Although he was short on details, I would imagine that the scalp is lifted up with a gas (carbon dioxide) and then the hair follicles are plucked from below. If it looks/sounds too good to be true, then it is. We have no pictures or scientific material to base the claims that this is a valid procedure and I would imagine it would be very difficult and time consuming. A lot of work for very few hairs.

There is no such thing as scar-less surgery in the real world. Since I started offering Scalp MicroPigmentation (SMP), I have treated many Follicular Unit Extraction (FUE) patients who thought (and were told by their doctor) that their FUE surgery is “scar-less”. Even FUE produces some tiny scarring.

Tags: pilofocus, hair transplant, surgery, hair replacement, scarring



I had a face lift 4 years ago. I lost hair at the incision lines on my scalp and it has not grown back, which I expected. But 5 months ago, my hair began thinning all over my scalp, more so at the top. I have seen a dermatologist who diagnosed this as telogen effluvium

My question is could this be a delayed reaction to the face lift of 4 years ago, and if so, is the hair loss associated with a face left permanent? Why would it take 4 years to thin? My surgery went well, i was happy with the results and there were no complications.

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A face lift can cause hair loss around the scar. If no hair has grown back in over a year, then it is likely permanent. I do not know why you are noticing scalp loss after 4 years, but if what you’re experiencing is telogen effluvium, it is unrelated to the face lift. The effluvium does cause overall thinning and this may be causing you to notice the hair loss around the scar that was always present.

Tags: face lift, facial surgery, hairloss, hair loss


Snippet from the article:

An article in yesterday’s financial press surveys recent high-profile cases of alleged coronary-stenting overuse, described by a sources as “just the tip of the iceberg,” and alternates them with stories from some of the patients involved. Although there are a few comments from leaders in the cardiology community that try to put the cases in perspective, the 3500-word story ultimately portrays a subspecialty too often abused by practitioners bending or ignoring the guidelines in pursuit of procedure-based profits.

“When stents are used to restore blood flow in heart-attack patients, few dispute they are beneficial,” notes the story from reporters Peter Waldman, David Armstrong, and Sydney P Freedberg published yesterday in Bloomberg BusinessWeek . But heart attacks account for only about half of stenting procedures, it notes.

“Among the other half —elective-surgery patients in stable condition—overuse, death, injury, and fraud have accompanied the devices’ use as a go-to treatment,” the article says, citing “thousands of pages of court documents and regulatory filings, interviews with 37 cardiologists and 33 heart patients or their survivors, and more than a dozen medical studies.”

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Read the rest — Coronary-Stenting Abuse Cases Highlighted in Bloomberg Story

The harsh reality of the Bloomberg story shows that doctors can be immoral when it comes to making money and patient decisions, even with life threatening diseases such as coronary artery disease.

If a cardiologist abuses his power and influence on a patient with heart disease (fear of dying) to have a procedure that is highly remunerative to the cardiologist, then what do you think happens when a person with hair loss goes to a doctor who makes money doing a hair transplant surgery that may never help him, but pays the surgeon well? With hair, the situation is in many ways worse, as the doctors may not have mastered the surgery, yet can’t turn down a dollar in his/her pocket even if they really do not know what they are doing.

There are many hair transplant failures driven by a doctor’s greed for the almighty dollar. The main difference between the cardiologist doing an unnecessary procedure and a hair transplant surgeon doing a procedure that may not help the patient, is that the risk of death is far smaller with the hair transplant than the cardiac stinting.

Tags: cardiology, cardiologist, hair transplant, surgery


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


Unrelated to hair loss, but this is a case of anesthesia possibly leading to the death of a man having his wisdom teeth pulled.

Snippet from the article:

Marek’s family provided Fox 5 with his medical records. The ambulance report by American Medical Response showed Marek was undergoing surgery when he began to cough.

“When he coughed they administered propofol and that’s when he went into cardiac arrest,” his mother, April Lapinski, said.

He was immediately taken to the hospital, where he died. The ambulance report also noted a piece of gauze was found in Marek’s airway.

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PropofolRead the rest — San Diego man dies while getting wisdom teeth pulled

There is absolutely no guarantees when a general anesthetic is used. Safety is paramount in all of the decisions we make when it comes to anesthesia. We use local anesthesia in our practice, which is probably the safest anesthetic available, but still there is risk of things like overdose, allergic reaction, infection, etc…

A couple of months ago, a man who was scheduled for a hair transplant cancelled his procedure for family reasons. The night of the scheduled surgery, he had a heart attack and almost died. Of course, I was concerned about his well being, but I could not help but connect the dots, for if he had his hair transplant that day, his heart attack would probably have happened anyway… but the connection to the hair transplant would have been a direct one-to-one connection.

A while ago, I read a medical article which studied outpatient surgery and the risks associated with it. There was no selection of patients with regard to age, general health, etc. The article studied a 30 day period after the surgery and reported a death rate of 1 in 20,000 patients. That means that in any surgery, any general anesthetic has risks. The above article does not reference the overall competency of the person administering propofol, but as we saw in the Michael Jackson case, expertise in the use of any medication is clearly a major factor when risks are considered.

As I have previously reported nearly six years ago, one patient in the US died from a hair transplant while it was being done. Supposedly it was under local anesthesia. All I know is that the surgeon lost his medical license as a result of the death.

Tags: surgery, death, anesthesia


Happy New Yr Mr. Rassman.

Currently, I shave my sides with a trimmer to 0.25 number and keep the little existing hair on my scalp shaved at 0.5 number. This is because I dont have hair to show off anyways, so might as well give it a shaved look. Even though I have some donor area, I am sure it wont be enough for hair transplant to give it a long full hair appearance.

As an alternative, I would like to have a shaved look but without SMP / using chemicals. I would like to achieve this with BHT but I do see from your previous posts that you are not a big fan of BHT because of the different texture and the growth rate of hair.

So my idea is to use the body hair on the the top of the scalp. It may not grow in the same pace / texture with the rest of the existing hair but what if I want to keep shaving it (or trimming to 0.5 number). Will it help? My logic says if I am shaving it / trimming it, it would probably.

My concern is:
1) ARE THERE ever SCARS in the recipient area? This question is relevant here because I will be shaving / keeping my scalp hair very short (0.25 or 0.5 number on the trimmer)

2) In your experience, while transplanting hair (whether hair from back of the head or body hair) into the recipient area, can existing hair get damaged?

Thanks for all your good work, may the force be with you.

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I will be direct to your questions.

1) Visible recipient site scars are rare if the instrument is very small and a slit is used. But with any surgery, there is a small (rare) risk of keloid and scarring.

2) Existing hair is rarely damaged, unless perhaps there is shock loss, which is typical of young men under the age of 30 who do not take the drug finasteride. (This is not an absolute rule as some men decline to take finasteride. It is a case by case basis.) In general, the younger they are, the greater the risk of shock loss.

Tags: body hair, bht, fue, scarring


Hey Dr Rassman, I noticed that Dr. Umar was considered for recommendation on the Hair Transplant Network. The site also featured patient examples of his FUE procedures which combined body hair harvested from numerous locations and scalp hair. The results look pretty impressive.

Has your stance changed at all in regards to the legitimacy of body hair in transplantation?

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There are obviously differences of opinion here, but to be endorsed by a website that is supported by and paid for by the physician (the doctors pay a monthly fee to be on that site) does not make it a new standard.

Plain and simple — today, body hair transplantation (BHT) is not a Gold Standard in treatment for hair loss. Other doctors still have a right (as licensed physicians) to offer this. I do not believe in using body hair transplants for most cases, because I have seen many cases where after it is transplanted, the body hair still looks like body hair sitting on the scalp. The shaft thickness of body hair is thinner than scalp hair in most people, so on a value comparison between scalp and body hair, you are miles ahead with scalp hair transplants. BHT is best used when you are out of donor hair and the body hair can be placed as a fill-in to traditional transplanted areas.

Remember, the body hair has long telogen cycles and depending on which body part, the telogen cycle is often longer than the anagen cycle. That means the hair will not grow in these telogen cycles. Also, body hair does not usually grow long like scalp hair.

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


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