My Consultation Questions with Dr. Rassman

[htownballa]

Hey guys,

I have scheduled an appointment with Dr. Rassman in LA this coming Tuesday, September 12. My goal is basically to understand my hairloss situation better and get it "mapped for miniturization". If you dont know what that is he explains what he does in http://www.baldingblog.com. Anyways, the following is a list of questions I will ask him during my consult. Let me know if there is anything I should add or edit. You guys are a big support.

1. Get my hair mapped for miniturization (so I know exactly how much hair is thinned and can quantify my progress with Propecia)

2. Is thinning on sides indicator of DUPA? (the hair above and around my ears seems to be thinning...if i have diffuse alopecia I am screwed in terms of a transplant, as I have no stable donor hair)

3. Hair characteristics- thickness, waviness, donor density? approx how many grafts would you estimate I have for surgical use?

4. Estimated future pattern of baldness (based on mapping and family history)

5. Formulate a master plan (what he will suggest I do and when he thinks surgery would be appropriate in terms of potential risks)

6. Is my hairline considered mature right now or receded? IF I got surgery would it be wise to lower it? (not sure what Norwood I am)

7. Significant risk of shockloss for me? What can I do to reduce it?

8. Do you use custom-cut blades, according to my FU size?

9. What density do you think I need for a non-see thru front

10. If I go strip route, is it better to do larger or smaller session in terms of results and shock loss?

11. What do you think of this plan: pack it dense in front with sparse crown if it does eventuall go? would this look foolish in the future?

12. Lastly, based on his experience, how effective does he think finasteride will be in keeping my hair? (this is just so maybe he will give me some piece of mind)

 

[Guest]

Outstanding questions!

 

[Guest]

htownballa,

Wow, you certainly have done your research before making any decisions and I commend you for that! You probably know he was formerly partnered with Dr. Bob Bernstein in NYC for years, involved in the development the FOXX test for FUE, etc.

Have you seen a Norwood scale? Where do you think you are and how extensive is male pattern baldness in both sides of your family history?

There really is no way for any clinician to know how patients will respond to any medications until they try them as prescribed for an adequate trial period. Then you and Dr. Rassman can regroup in the future to assess the results. If finasteride does not work well for you, there are other options. Have you tried minoxidil?

Also be sure you get an estimate of total grafts he thinks he can get utilizing either strip or FUE. Are you getting some other opinions or have you done so already? Best wishes on your consult.

 

[htownballa]

Hey Gillenator,

Thanks a lot for the quick reply. You telling me I'm asking good questions is very comforting since you are so knowledgeable about hair transplants.

I'm not committed to using Dr. Rassman for surgery, but I really like the way he quantifies hairloss so your not stuck playing a guessing game. As for the Norwood scale I would guess my hairline is anywhere from a NW1.5-NW2.5, but I have visible thinning in my frontal zone and midscalp. I'm too scared to look at my crown right now lol.

In terms of family history, my father is a NW4 and is in his mid 50s. My paternal grandfather was NW6 or NW7 in his 60s when he died. My dads 2 older brothers are both NW5s. Everyone on my moms side has a full head of hair except 1 male cousin( unfortunately he is my only male cousin on that side ). Considering my dad and my paternal grandfather did not start balding until their late 30s I have no idea what to make of my balding pattern since I'm only 24 right now. I'm sure that's not a good sign though. :freaked2:

My plan right now is to stick to the finasteride and Tricomin combo for a year and see where that takes me. If I'm not satisfied I will add something else. Starting minoxidil does not appeal to me at the moment due to messiness, hassle, and the fact that it doesnt slow the fundamental balding process.

Also, I plan to get many consultations with all the top docs ie H&W, Armani, Shapiro, Cole etc...I am going to wait for a few years anyways before I get a hair transplant (im in medical school and cant afford to take time off). Hopefully a new improved technology like BHT will be mainstream by then?

PS You are right about him not predicting the affect finasteride will have on me, I just hoped he would tell me "Oh dont worry son, Propecia will DEFINITELY get you back to where you were a couple of years ago!"

 

[Guest]

good luck htownballa- great questions you have there.

and i had no idea you were in medical school. that's great.

i'm not interested in a transplant at the moment but i would love to get my scalp mapped for miniaturization. unfortunately i'm not in LA so i can't see rassman.can you ask dr rassman if he knows of any good docs in upstate ny who could do that? or do you know of any online resource to find docs who could do that?

thanks. good luck.

 

[htownballa]

Jayman, I know Dr. Bernstein, who was Dr. Rassman's surgical partner back in the day will map your scalp for sure. I know he is in NY, but I don't know if he is in upstate NY or not. I think Dr. Alan Feller and Dr. Dorin are also in NY, and they are top notch docs. Hope this helps

 

[Guest]

yeah i doubt they're in upstate. most of them are in NYC.

thank you though. i just gotta try to find one around here who does test miniaturization.

 

[Guest]

JayMan,

Dr. Dorin is partnered with Dr. True in NYC and either can help you with the evaluation along with the others mentioned. Dr. True is probably the most experienced in your area along with Dr. Bernstein.

Rarely do patients bring up the issue of miniturization but as you know, it is the first initial visiual onset of male pattern baldness. And this is when guys want to get on the meds to minimize the effects, and hopefully not need a hair transplant!

 

[Guest]

htownballa,

You're welcome and glad to hear you're in no rush to get a hair transplant. At twenty-four and the lower Norwood class you are in, you have lots of time to see how you respond to the meds. And I wish you all the best in med school. Maybe you'll become one of the finer hair transplant surgeons in the future!

I just read your family history and since there are several men who reached the advanced stages of male pattern baldness, you really want to approach this whole thing very methodically. Let me explain.

Try to wait until you are thirty something because if you don't advance alot by then, and the hairloss meds continue to have efficacy, you'll be in better shape because the other older men in your family history did not have the benefit of finasteride, dutasteride, etc.

Then and only then would I consider starting conservative work in the frontal to mid-scalp zones. The reason for this approach is you still want to see how your male pattern baldness is progressing even into your forties. If things are still stable, you can get more work done, strengthen your hairline without lowering it, that type of thing.

But, if you do start losing hair fast in your thirties, forties, you'll be very happy that you took a conservative approach that will be able to stand on it's own, especially with the lower density levels. That will still leave you with some donor to do very light touch-ups and still maintain a nice frame to your face. We can always adjust our goals as time dictates our hairloss destiny, right? It's good that you recognize that nothing needs to be cut in stone.

I also hope you find out that you have higher donor density levels, and the more coarser grade of hair, the better. Keep us all in the loop hair transplant! :wink:

 

[htownballa]

Gillenator thanks for the reply. I just got back from my consult with Dr. Rassman and I must say I am disappointed. I was hoping to build a master plan with him if my hairloss progressed, but he seemed content to not have one and just see what Propecia does. The following are the answers to my questions

1) Hair Mapping: He basically stated that my hair has over 50% miniturization in the frontal zone, with extensive thinning (greater than 50% miniturization) the frontal corners especially. He stated that Propecia would probably maintain hair in the region but not regrow any. He also told me Rogaine would be useless here.

2) Diffuse Alopecia? He told me that the thinning around my ears was probably genetic and not an indicator of DUPA

3) Hair characteristics: Ok this is where I was really disappointed. He said my hair has a slight wave, with medium thickness. He said I had decent contrast with medium brown skin and black hair. However, he said my donor denisty was only 1.5 units/mm squared while the average caucasian was 2.0 units/mm squared. This translated into roughly 4-6000 grafts for surgical use. Bummer!

4)Estimated future pattern of baldness? He would not care to make a guess

5) Master plan? This is where I wanted more input from him...he told me to stick to the propecia and wait a while, but if I wanted to, I could have an 800 graft transplant to the front...this really confuses me because I can't imagine much cosmetic benefit from 800 grafts on an early NW3...He also added that anyone who gives me an estimate of more grafts is probably ripping me off

6) What is my Norwood? NW2.75

7) Risk of shockloss? He basically told me that if I came back to him in a couple of years while still taking Propecia I would not have a high risk of shockloss after a transplant

8 ) What density would I need for a non-see thru front? He said I would not need a very high density due to my color contrast, but I am skeptical about this... His definition of see-thru is probably different than mine

9) Session size with strip? Did not ask him this

10) Should I pack in dense up in the front while having a sparse crown? He told me since I only had 4-6000 grafts I would need to put ALL my grafts in the front leaving the crown bare. DAMN!

Ok guys, these are the results of my Q and A session with Dr. Rassman. I will try and get a second opinion soon from the other top docs and see what they tell me. Only problem is that I am in Texas and I dont know any other good docs besides the Limmers. I might just settle for an email from H&W and Armani, as I'm not sure if I should travel just for an opinion. Please give me your thoughts and opinions on my situation. Thanks

 

[Guest]

hair transplant,

Wow, sorry to hear of the disappointment. I thought maybe you lived in CA. Did you get any opinions from the Limmers? The father Bobby goes back as far in time as Rassman.

Get more opinions, and keep us in the loop!