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Doctor, love the blog, lots of useful information. I was hoping you could give a little career advice. What would you say to the students in medical school interested in getting into the field of hair transplantation? Would this not be a wise decision with companies such as histogen/replicell potentially achieving positive results using non-invasive techniques?

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For a medical student thinking of a specialty to choose, I would not recommend hair transplant surgery. Not because it is not a great field, but mainly because there is no formal hair transplant surgery training or residency that would give you the requisite skills you should have. There is no consistency in the field of hair transplantation. I do believe the community of hair transplant doctors is improving and striving for consistency and it has greatly improved in the last decade. In fact, there is a board certification for hair transplant doctors, but it isn’t recognized by the American Board of Medical Specialties (ABMS).

If you still would like to pursue the hair transplant field, I would pursue a ABMS approved residency program of your interest. First get basic training in some official specialty like dermatology, and then get a fellowship under some well recognized expert in the hair transplant field who will take you under his wing.

Tags: hair transplant, medical student, doctor


Dr. Rassman
I’ve been a licensed cosmetologist and cosmetology instructor for 20 years. I’ve witnessed all types of causes of hair loss from simple improper hair care, chemical damage, braids and hair extention damage, alopecia, medications, lupus,chemo and radiation.

I now find myself ready to embrace a higher level in my profession. I’m eager about becoming a trichologist and a hair transplant technician and was wondering if you had and advice on how and where I should start to embark on these two career paths. My passion and curiosity about the hair and scalp has got me wanting to absorb all I can so I may better service the public and feed my need for more knowledge. Any insight you have would be greatly appreciated.

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The training of a hair transplant technician is done only by doctors who are looking for new people and are willing to take on a trainee. Most people come from a medical assistant school and most states certify MAs, although the doctor can do the training in specific cases.

You need to contact a hair transplant doctor in your area and ask if he/she is taking on new people. It is a great career and for those who master the technical skill, they are generally well paid.

Tags: hair transplant, surgical, technician, tech


Hello, first of thanks for this blog it helps dismiss all the paranoia and rubbish that is usually on the internet concerning hairloss. Im 17 and im worried about hairloss. I don’t know whether I’m a Norwood 2, perhaps a 3 its difficult to tell, but I’m somewhere around there, I’ve read your blog regularly and educated myself on the process of the hairline maturing and how it usually forms a gradual convex recession that is common to see on most fully developed males. My hairline though a Norwood 2 is not convex or gradually receded but more sudden almost exactly like that on the Norwood scale – is it safe to assume that if my hairline is not developing into a convex or gradual shape then what I am experiencing is male pattern baldness at an early age? I’ve never had a straight juvenile hairline like you’ve described, its always receded a little.

One more thing, I’ve read your blogs on getting miniaturization mapping done. Where I live the health care system does not offer such a test. I did however go to my doctor, who, in the final stage of MPB himself, ran his hands through my hair made a few “uhuh” and “yes”, sat back down and said it looks fine to him, and that my hair is the same density all the way round, he always said that I was far too young to be effected by MPB, but then went on to say that he started going bald at 18 only a few months older than I am. He then prescribed me a anti-fungal shampoo “just in cause”. I remember reading somewhere where you said if your doctor reacts like this run for the hills or something like that. Is it possible my doctor did a fair examination or should I seek further consultation?


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NW2I am going to assume you do not look bald at Norwood 2. You are very worried about some thinning in the front. The doctor you saw is likely a general internist who does not see hair loss patients as his primary practice. And even if that doctor is the most caring and sympathetic doctor in the world, if he does not treat patients with hair loss on a day-to-day basis as his number one priority, they would most likely not pay attention to young men who do not look bald. I do not think it is the doctor’s fault, but it is just the way doctors are trained. You see, hair loss is not considered an illness or a disease. It does not affect your health. So doctors really do not learn about it and its treatment in medical school.

If you want a good examination and evaluation of your hair loss state, you need to find a hair transplant doctor in your area. You can check for doctors that specialize in this or since you indicated that you’re in the UK, you can see Dr Bessam Farjo in London.

Tags: hairloss, hair loss, doctor


Scam AlertI’m often outspoken about the problems with ethics in our industry, and I know I just wrote about transplant failures a couple months ago… but I continue to see a large number of patients who are unsatisfied with the growth after their hair transplants. Part of me really hates writing these types of posts, because I just know I am turning some people off to the idea of surgery altogether. But really, these posts should serve as a way to educate yourselves. Transplant failure is a problem that can not be denied and an increasing number who received surgery from various doctors all over the world are visiting my office to ask for help as to why they aren’t seeing the growth they were promised. I’ve even received emails about the same issue. Although there are a number of reasons why a transplant could fail, it seems that these failures are mostly technical in nature and related to the hair transplant staff. In other words, the problem is avoidable.

So how does one avoid losing donor hair or paying for grafts that aren’t going to grow? Finding a surgeon with a staff that knows what they’re doing is a good start. An experienced staff is hard to hire, and I have been training my own technicians for years. The drop-out rate from training is high, but for those that we retained, the high quality of our work reflects the quality of our staff. I know what I am about to say is self-serving, but I do very limited promotion here and wanted to point out that we have a travel reimbursement program which offsets the cost of travel and hotel for those patients coming from out-of town. With our standby rates, it is hard to compete with the value NHI offers and in 8 months, few worry about what actually grew out.

Tags: hair transplant, failure, hairloss, hair loss, hair growth, scam


MoneyI’ve been thinking about the case I wrote about last week — “How Many FUE Grafts Actually Grew?” — about how a patient (we’ll call him Mr. Smith) came to NHI after feeling royally screwed over by another clinic he went to for his follicular unit extraction (FUE) procedure. It’s quite an interesting case of being scammed by a doctor that advertised super low prices, so I really suggest you read it if you have the time. Even so, I want to talk a little about value in surgery…

If you run the numbers, you will see that the actual growth of hair was only 25% of what he got transplanted. There were two consequences of this:

  1. Of great importance is the loss of your finite (limited) supply of donor hair. In the case of Mr. Smith, his surgeon killed 3 out of 4 hairs that were transplanted. These hairs are forever lost to the patient. I also believe that there was damage produced to the donor area, evident by a thin see-through appearance. His donor supply is significantly worse off following his FUE procedure than if a scar formed from a strip surgery, which could have been easily hidden by surrounding hairs. FUE is not always the answer to harvesting hair without post-surgical consequences, as seen in Mr Smith’s case.
  2. Of lesser importance, the cost per graft was multiple times higher than what the patient thought. Let’s assume that Mr. Smith paid $5/graft. When measured against growth, his actual costs were $15/graft for the work that was done. The rate he paid had nothing to do with the value he actually received (in his end result), as he really was paying more for less. That’s quite a bit of money out of his pocket.

The lesson here is that experience in a hair transplant surgeon and his team is directly related to the actual costs when measured by the yield of what actually grew from the hair transplant. My advice to prospective patients is to change the way you look at value! In our practice, we allow prospective patients to meet our patients to see what type of results they got. As these Open House events are open to all patients (or future patients), anyone with results like shown in Mr. Smith’s example will be as evident as the nose on your face. This will help you in the education and selection process. This type of surgery is forever, and unfortunately some patients have to learn the hard way when they try to pinch pennies by going to a surgeon that has no business messing with your hair.

Tags: hair transplant, fue, value, price, fees, hairloss, hair loss


MegaphoneAs regular readers might know since I’ve mentioned it in the past, I’m part of an email group of hair transplant doctors. We share clinical stories, exchange ideas, etc. There was an article in O Magazine about female hair loss and we were asked about percentages of female patients that are candidates for surgery. Dr. Robert Bernstein had said around 20%, but one physician in the group disagreed with him and stated that close to 80% of his female patients are surgical candidates! From my own personal observations, some doctors will perform surgery on the majority of female patients that come through their door, but in my opinion, that would just be taking advantage of these women. Ask the doctor you selected what percentage of the hair transplant practice is women. If the number is high (over 20%) then I would seek another doctor.

Every once in a while a doctor will say something completely outrageous, and without mentioning who the doctor is, I wanted to share my reply to the group of doctors with you all. It will likely ruffle some feathers, but it needed to be said:



Can you tell me about the Neograft technology. Is it better that what is out there?

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NeoGraftAutomation of the hair transplant process has been a goal of doctors from the earliest part of their career because of the tedious manual processes used today. In particular, with the large sessions, fatigue becomes a problem and the skill sets required of the staff take years to acquire proficiency.

I have been a pioneer of many of these devices, receiving patents on some of them. Included was the Carousel, and a series of follicular unit extraction (FUE) techniques devised for faster extraction. The NeoGraft machine is just one of the newer devices, but unfortunately it has its problems.

NeoGraft uses a vacuum system to assist in the removal of grafts that are first partially dissected with a sharp punch. The grafts that are “sucked” out of the scalp are collected in a chamber. The grafts are then removed from the chamber and drawn up, again by suction, into a needle and then injected into pre-made recipient sites using air pressure. The NeoGraft seems to eliminate some of the risks of mechanical injury to grafts in traditional FUE by not requiring forceps to remove grafts from the donor site or insert the grafts into the recipient area and, in theory, may save time by eliminating the need to extract grafts manually. A concern expressed by those who have seen the system in action is that the suction removal has a tendency to strip the surrounding tissue from the lower portion of the grafts or pull out just the upper part of the graft. Because the grafts are exposed to a great deal of air movement, the continuous flow of the vacuum adds to the risk of graft drying, a problem well known to be a major cause of poor graft survival. To our knowledge no independent studies have been performed to show that grafts are not harmed by this vacuum technique and it is our concern that the drying action of the air on the exposed grafts may limit their growth. As many of the grafts are stripped from their fat, the risks to the grafts are theoretically significant.

Restoration Robotics (RR) has a better way to do this with a robot, but it is not yet on the market and it will most probably be very expensive. RR have been successful at doing FUE, although slowly, but they have yet to demonstrate an ability to place grafts mechanically.

There is no substitute to learning and mastering the manual skills that are used in the best hair transplant clinics around the world. So without a good automation instrument, many of the doctors who use an unproven method for hair transplantation just makes the risks to the hair transplant procedure greater and the work by the doctors who use them possibly second class. Would you buy grafts from a second class surgical team and pay the consequences of poor growth?

Tags: neograft, fue, hair transplant, tool, hairloss, hair loss


I have a question about the norwood scale pictures. When the pictures show very little hair, is it supposed to represent literally that amount of hair, or any noticeable amount of thinning? I suppose an example would be 3 vs 4v. Does 3 mean there is no thinning at all and 4v mean they still have a decent head of hair, but the hair on top is thinner?

I’m sorry this question has been very hard to word, and i hope it makes sense.

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The Norwood chart is just a list of patterns showing how men bald and probably where they stop in the balding process. But in the 1970s when Dr. O’Tar Norwood updated Dr. Hamilton’s initial studies, he surveyed a large number of men and clearly most were in some phase of the balding process.

It is not a progression of hair loss. For example — you do not go from Norwood 2 to Norwood 7 as you age. If you are going to be a Norwood 7 you will likely have thinning in a Norwood 7 pattern. You may not “look” like a Norwood 7 now (with all the hairs gone), but you may show early signs of it, especially when you look at your hair under a microscope. This is the reason why we always endorse a miniaturization study. I hope this clarifies things a bit.

Tags: norwood chart, hairloss, hair loss, balding patterns


Hello, I just had a wonderful procedure. Their offices were clean, procedures were excellent, and the staff was very accommodating. In 2002 I had 800 grafts done by another group in San Francisco and then again I just did 3500 grafts. The follicles were transplanted throughout my scalp approximately 25 FU/CM2. I have a very nice NW2 hairline. Also, I had a very high number of 4-hair grafts. Over 400 of them! They excised a strip of 3500 grafts and got 3703!!!

Do most of your patients get about 25FU/cm2 and are happy with it? I think it will be ok but just need reassurance.

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A normal person will have 1250 hairs or 600 two-hair follicular units. When converted to cm/square, that would extrapolate to 100 follicular units per square cm. If you received 25 follicular units in 1 cm, that would suggest that in one procedure, the doctor returned 25% of your normal density on the transplanted area. This is often not really the case, as some areas will have higher densities put in and other areas lower densities. For a person with average weight hair, olive skin, and brown hair, 50% densities overall should be more than enough to produce a full appearance. If you had a high number of four-hair grafts, then that might mean that your overall densities are higher than average. I generally target 25% density return on the first session, but at times I will go higher or lower depending upon other factors.

Tags: hair transplant, density, surgery, follicular unit, hair restoration


I went to a local doctor for a consult and he mentioned that he uses a 2-3 bladed knife with the Haber spreader to insure that no transection occurs. He said that there is less transection with that than with the single bladed knife, when used properly. According to him, with the single blade, you must go down 2-3 times as deep to cut past the follicles, and if you are not right on target there will be some transection. Does this sound correct – does using a Haber spreader with a 2-3 bladed knife sound right?


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BladeMore than 2 blades with depth may cause hair transection. The use of spreading instruments such as the Haber spreader or a Kelly clamp will also work to minimize transection. If a two-bladed knife is used, it should have a built-in angle to minimize transection. A three (or greater)-bladed knife causes more transection and loss of hair from the donor area.

One vs two blades (with built-in knife angles for the 2-bladed instrument) are about equal to minimize hair loss from the harvest. I use a specially designed (by me) two-bladed knife that has a 30 degree angle built into the holder to minimize transection. Two-bladed knives like the one I use precisely control the width of the strip, so I prefer that to a single-bladed knife.

Tags: surgery, blades, blade, knife, knives, scalpel, hair transplant, hair restoration, hairloss, hair loss


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