As Seen on


In the interest of keeping things as private as possible, I have removed the Doctor’s name from this email I received…

Hi Dr. Rassman,
I read your recent comment about young guys under 30 years old who get an HT and are not on Propecia. I fit into that profile. I recently had a HT with [another doctor] and its 4 months post -op now. had a lot of shockloss of original hair post op and am really concerned now that I read your comment online [see: Hair Loss After Transplants]. Since I had sexual side effects when on Propecia, I had to quit it and cannot tolerate being on it.

I received a total of 3366 grafts in total. Am attaching Before Hair transplant pictures with this email and 6 weeks post op pictures. According to [my hair transplant doctor], he feels that the shockloss will mostly come back and eventually I will have good results. He recently asked me to take Saw Palmetto and see if I can tolerate being on it. Started taking 320 mg of Saw Palmetto twice a day recently.

Please advice what I can expect from the procedure. Do you think that I will permenantly lose a lot of original hair that has fallen due to shockloss for good? Or will it mostly come back?

I’m seeing growth in the 4th month but not sure if the shockloss hair is coming back or it is the new grafts that are growing in. To highlight my case, I mostly had diffuse thinning in frontal 1/4 of my scalp. The hair that was there was strong and had a thick shaft, there might be other miniaturized hairs, but looking at my pre-op pictures you will get an idea of the state of the existing hair follicle.

Thanks a lot for your time and effort.

My current regimen includes : minoxidil 5%, topical Spironolactone 5% cream from Lee’s, 3000 Mg of MSM, 2% Nizoral trice a week, Recently added : betnovate topical lotion, 320 mg Saw palmetto twice a day, Folligen lotion.

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I have had an opportunity to review your questions and photographs. For our general audience who are reading this, I will summarize the salient points.

You appeared to have a large surgical session with dense packing based upon the number of grafts reported by you. The frontal area appears to have been shaved for the procedure and the growth of the hair does not reflect the normal growth that one would expect in 3 months. This is a case of hair loss transplant shock in a young man, just as my previous responsive email reported to another young man. There is a possibility that the hair that you lost may come back. Most likely though, it will not return. Other medications have not been shown to be effective (like Propecia). In people like you, I generally try to cover the short term transplant period with half of the Propecia dose, even if it causes some drop in sexual performance just to protect the hair.

The good news however is that the new grafts that you had done should (hopefully) more than offset any loss you may have. You will know reasonably well at about the 7-8th month by comparing the two sides. The left side that seemed to suffer more of the reactive hair loss needs to be compared to the right side. If the hair loss was reversed, the densities of the two sides will be the same. Please drop me a line or send me photographs at the 7-8th month and I would be happy to give you further insights. Good luck.


Rick asked…

Unlike the 62 year old man, I’ll soon be 48 & my loss started about the age of 25, gradually. Now, I am about a VI hair loss on this website’s Norwood Scale & will this new minimal hair transplant I saw on Ch. 4, Bruce Hensel, work for me ? I think the root cause(no pun intended !) is primarily stress. Many thanks in advance.

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Stress is one of the four causes of hair loss in the genetically prone individual. Yes, the minimally invasive surgery, the FOX™ Procedure (Follicular Unit Extraction) can work, but before embarking upon that route, plan on a visit to a competent doctor’s office. If you are in California or the New York area, we have easy access. I assume that since you referenced NBC Channel 4 News, you are local to the Los Angeles area. If you would like more information from me directed at you and your condition, please call for a free consultation or at the very least, send me a photo of your hair loss from a series of views. A good digital camera will work, or call my office at 800-NEW-HAIR or fill out the form on my website and we will send you a disposable camera.


Essie writes…

I have discord lupus and the scarring on my face I know can not be repaired. I also have hair loss in the very front top of my head and where there was hair, there is now scarred scalp. I just want to know if it is possible for even a little encouragement for this head of mine.

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If your disease is not active, then it is possible to use hair transplants to address the balding area. If the disease is active, it will attack the transplanted hair as it had the original hair. Sooner or later, the disease will burn out and then a transplant might become a good option for you.


I had a session of about 1600 graphs about 4 years ago. I have thin hair, and it had receded to about a grade 5 baldness. Because my hair is thin, and maybe because I didn’t get enough graphs, I’ve never really gotten the thickness or coverage that I was hoping for, and I am now considering having the transplants removed entirely. Have you had much success with laser removal of transplants? How much scarring is typically visible? I am concerned about having a bald head with little holes all over it.


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Your question comes right after I met a fellow in my office today who asked about the same subject, removing his transplants completely and going back to his normal balding state. You are correct to worry about the deforming issues if the grafts were anything but today’s modern follicular unit grafts with skin trimmed down when they were transplants. There are many things that an examination will show a good doctor and they include (1) the presence of cobblestonning of the skin along with other surgical scars in the recipient and donor area, (2) the number of grafts we are talking about removing and what type of grafts that was transplanted, (3) The distribution of the grafts, etc…. With that information, it would be easier to discuss this approach, but generally removing the grafts involve removing both the hair and the skin, each producing its challenges. The patient I just saw was more specific in his questions, so I am going to reference my letter to him reflecting the visit he and I had. This particular patient did not want another hair transplant, even though it is the only good option for him to become normal looking.



Dr. Rassman,
I am considering hair transplant but have a question that I cannot find the answer to on any website. What are the long term cosmetic issues associated with a younger person (I am 26) who has hair transplant surgery?

In other words, my hair has begun to recede to an NW 3 (approx.). If I was to have transplants, and several years later my hair line continued to recede, wouldn’t that make an unnatural and strange looking hairline? I.e. there would be transplanted hair at the very front, then further up the scalp there would be a zone with thin or non-existent hair, then there would by my natural hairline.

I hope I have adequately explained myself. Any info you could provide would be great.


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This is a great subject, one that is important to everyone who undergoes a hair transplant. In essence, JX is asking, “How does the hair transplant fit into the changes that keep producing more hair loss?” Much of this material is covered in a book I wrote, The Patient’s Guide to Hair Restoration. You can get a free copy of it by calling my office at 800-NEW-HAIR, or visting our website.

Everyone will lose hair to whatever their genetic pattern will eventually be. Those with advanced balding, usually develop indications of their pattern by the mid-twenties. Most will have their pattern evident by the time they reach 30. It is rare that people will start with hair loss beyond their 30th birthday so a good examination by a competent doctor will show the signs of ‘miniaturization’ on microscopic examination of the hair throughout the head. JX reports a Class 3 pattern hair loss at 26 years of age. Assuming that the pattern will not progress much further (that there is no ‘miniaturization’ of the hair in the mid head or crown), it would be safe to assume that he will not develop an advanced hair loss pattern and that a hair transplant program will never make him abnormal as he progresses slightly from this pattern. If he wishes to get the hair transplanted in the front to return his hair to its normal mature position, he can do this easily. If he uses the drug Propecia, his ability to slow down or stop the hair loss is good. There is now 8 years of good data on Propecia’s ability to slow the hair loss down, but only time will tell us if the medication can continue to be effective in the long term.

I generally tell my patients to create a Worst Case Master Plan which assumes that progressive hair loss will occur. With that Master Plan, you can estimate what might happen and plan for it both economically and socially. The one evident thing to point out is that once a hair transplant process is started, it should be followed with more transplants until the loss stabilizes or it takes you to another hair loss pattern that is found normally in nature. Frontal hair loss only commits the patient to frontal work, not to crown work. Worst, worst case is that with transplants in the front, the balding in the back will reflect what many men have naturally: a full-haired frontal look and a balding or thinning crown. This last scenario is JX’s worst case. If he wishes to see his worst case, he can visit me and look at my before pictures. I had a normal full front of thick hair (naturally) and a bald crown (which I elected to transplant but could have left it alone as an alternative option).


I have heard that people who have transplants get more loss because transplants produces hair loss of normal hair. Is this true?

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First let’s answer this question in the typical young man, for the answer differs slightly than the older men. If a man (under the age of 30) has a transplant and does not take the drug Propecia, the normal course of hair loss that he could expect without the transplant could occur in a shorter period of time (e.g. two years of hair loss in as short as 6 months of time). To understand this lets focus on the causes of hair loss for a brief moment. The four causes are (1) hormones, (2) genes, (3) time and (4) stress. The stress of a surgery in a genetically impaired patient who is undergoing active hair loss (most young men under 30) are being attacked by hormones actively. In guys over the age of 30 when time has already taken its toll and the hair that was going to die, did die, the sensitivity to hair loss is less. In the days before the drug Propecia was released, these men under 30 lost enough hair from a transplant that they had to play ‘catch up’ (which meant that some hair was lost earlier than they expected and this required more transplants to treat). The drug Propecia has almost completely stopped this from happening and we use it on most men to prevent it from happening today.

In men who are older, the risks of reactive hair loss go down, as the hormone attack on the susceptible hair follicles have already done their damage. I have seen far less reactive hair loss on men over 30 and the older the man gets, the less risk there is to reactive hair loss.

In women, the problem differs. Some women, whose hair is easily stressed, could experience a temporary hair loss from a transplant (a minority) but in my many years in the field, I do not recall any female that had permanent hair loss from a transplant.

Previous hair transplanted grafts almost never suffer from reactive hair loss (far less than 1% of transplanted patients).


Thanks to everyone for the great emails. Keep them coming in! Here’s one I received on Tuesday, but didn’t get a chance to answer until today…

Dear Dr. Rassman,
I have a slightly below average donor density and I am wondering if a hair transplant would be sutable for me. I am 33 years old and last year started receding agressively. I think I am NW 5 heading to 6. How many graft can you take from my donor for me to have a full coverage? In other words: How many total grafts does my donor have?
Thank you for your attention.

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There are five characteristics that vary with each person, that determine the value of the hair for a hair restoration procedure. They are:

  • Density of the hair. Yours is lower than average, but that in itself does not necessarily mean that you are not a good candidate
  • Hair shaft thickness. The coarser the hair, the better it supplies bulk. Hair bulk is a critical element in producing fullness and coverage.
  • The size of the balding area. The more bald you are, the more hair you might need. Sometimes, the goals may be changes to adjust to limited supply or a demand that is too high. That is something you must work through with your doctor.
  • The characteristics of your hair. African hair is the best because it wants to cover, good wavy hair is the next best because it wants to flow together. The Italians and French had the best wavy hair. Straight is the most challenging, as found in many Asians.
  • Color/contrast between hair and skin color. This is critically important. A Class 6 pattern blonde person could reduce his hair population to 85% of its original density and still look full as the blonde hair and blonde skin have low contrast. The same applies to black hair and black skin, brown hair and brown hair, sandy hair and sandy skin and any skin color with white hair. Salt and pepper hair works very well and I have produced some amazing results in very bald men with very little hair.

The amount of hair needed to transplant depends upon many things. Look at our website and see the hundreds of patients there, many who show balding patterns similar to your. The number of grafts are clearly defined for you to see.


I am African American, and was diagnosed with cancer a year ago (Hodgkin’s). I was told that Chemo would definitely leave me bald. I was one of the lucky ones that did not go completly bald, but my hair sheded a lot leaving it fragile and very very thin. Now that I am cancer free (praise God), I would like to know if there is anything I can do to grow my hair back. I also have anemia, something I’ve had all my life (not cancer related). I have not had Any chemicals on my hair in about seventeen months. Can I use perms again?

Thank you for your response in advance, for this is a very touchy and hard to speak on subject with the oncologist, I think they feel my concerns are vain.

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Unfortunately, some doctors are still in the middle ages when it comes to hair loss, but your oncologist should not be in that situation. Curing cancer is very important and getting back to normal is just as important. Chemotherapy may cause hair loss and sometimes it takes a couple of years for the hair to return to normal. You should be extra-gentle with the hair while you are waiting it out and not use chemicals that might damage the hair while it is fragile. Hair thickeners do not cause much of a problem. If your African hair allows the use of thickeners, you can increase the fullness of each hair shaft with their use. Your hair situation may be still the result of other elements that followed your treatment. Anemia is known to contribute to hair loss as is thyroid problems so a good evaluation of these other systems are important. Hormone assessment is also important, particularly if you are female. If you are a male, Propecia may have value.

Take the time to get you doctor to sit down with you and review every factor that may contribute to hair loss in your case, based upon his/her experience. I am sure that he/she sees this problem often so do not be shy or embarrassed about talking about it.


I just got word that the news item about the FOX™ Procedure that aired this past Monday on NBC in Los Angeles is now going to air tonight (April 13) on the 11pm news on NBC 10 in Philadelphia.

For those outside of the Philadelphia area, if you missed the airing in LA, or you just want to see it again — the video is posted on my earlier blog entry, found here.

More information on the FOX Procedure:

Update: Found the article on the NBC 10 website


Received this email yesterday…

Why would someone who has been in Cardiac, Orthopedic and General Surgery be doing Hair Transplants? Did you fail at these other fields?

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I would start off saying that I was very successful in every field I have been in. Part of the reason that I moved around a great deal was general boredom or lack of stimulus. In the hair restoration field, I have had the opportunity to become intimate with my patients. I have had similar intimacy with my patients when I treated their cancer, but the involvement with them was make the best out of a bad situation. If they survived the cancer, they wanted to forget it and I was more part of that period of their life (where forgetfulness is part of the denial process).

In hair restoration, the entire process up-scales as it progresses. The further down the path you take it, the more the intimacy and the pure pleasure you get with each milestone the patient achieves. First, getting to establish rapport is a challenge. Two people getting together, one with a problem and the other with a potential solution. The prospective client wants to determine: “Can I trust this doctor to do what it is he says he can do?” Once the relationship is cemented in place, you plan together what you are going to do. You share his/her intimate thoughts and fears and guide him/her though the plan like an architect experiences when he/she shows the plans for a new house to a home buyer/builder. This is a wonderful experience that for me only gets better as I deliver what it is I promise to deliver. While waiting out the growing stage, like a find lawn and garden, it takes time for the brown dirt to turn green and for the flowers to bud and bloom. But when the hair comes in, wow, what a HIGH it is for the doctor and patient to share.

I have been in the unique position of having done some of the most difficult surgeries on the human body. Early in my career, being able to perform them competently was my goal. The intimacy part of the process in the world of difficult surgery does not have the same significance with it as in the hair restoration business. The general surgery focused for me on issues of technical competence in the first half dozen years. Once I had proved to myself that I could perform almost all of the difficult surgery before me and treat the sickest of patients, the process becomes a matter or routine. Every sick patient in Intensive Care is so sick that they are as far from their normal selves as they could be. Aortic Aneurisms are the same. The ones that are acutely life saving (like those that are rupturing) brings up the adrenaline in the surgeon. Like a ride on a roller coaster, the feeling is frightening and wonderful, both at the same time. But the anxiety of holding a human life in your hands, no matter how exciting, still produces bad outcomes and brings heart break to surgeon and families. Half of all ruptured aortic aneurism patients die within a day of the event, even in the hands of the greatest surgeons. Hair, on the other hand, is almost a complete opposite experience for the surgeon. The results almost always come out the way a good surgeons predicts that they should. The key to success, like aortic aneurism surgery, is skill and in building a good surgical team. The hair restoration business is no different on this technical end where skill and team building is critical, but the patient is always awake and he/she is coming to see the doctor because he/she wants to be there (not has to be there like a ruptured aneurism). My days in the office make me feel that I have great value to people and because of the trust that is built, I have looked at many of my patients as friends for life.


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