Dr. William Rassman1530037930

The depth of the needles is not deep (significantly under 1.5mm) while the hair follicles reside in the dermis which is well below the area where the ink resides. This solution is not for everyone. Patients fall in two general categories (1) those who have had no surgeries or surgical treatments and (2) those who have had surgeries in one form or another and have problems that they perceive from these surgeries. These two patient types are very different. Those with problems following surgery may find that the solutions that they think are best solved with SMP, may find other solutions including another surgery like an FUE procedure might be an alternative. Of all of the groups offering some form of pigment treatment, we are the only medical group that specializes in medical and surgical hair restoration so the options in my command reflect 21 years of experience performing hair restoration and defining the FUT, the FUE and the megasessions in the medical literature. By our nature, Dr. Pak and I are creative thinkers and can think out of the box as we examine every candidate for SMP (for example) and first and foremost, we try to get into the head of the prospective patient like any good doctor would do. Turning someone down for SMP (or transplants for that matter) for unrealistic expectations reflect the judgments we make every time we meet a new patient and it is never a financial decision on our part.

The best way to determine what you are going to look like after Scalp Micropigmentation (SMP), is to meet (one on one) with people who had it done. The New Hair Institute makes this opportunity happen once a month where people have have had procedures (hair transplants or SMP) come to talk about their experience and allow prospective patients the opportunity to look at them up-close (Upcoming Events - NHI). Some times we will actually be performing SMP at these events. Would it be worth a visit to Los Angeles to see what I am talking about? Well, if you declined to do this diligence and things went wrong with the choice of who does it, you will have the results of a poor decision for the rest of your life (it is permanent). If you elect to take me up on my suggestion, please call in advance to make sure that at least one SMP patient was scheduled to be at the next open house event.

Most clents request a natural hairline regardless of whether it is Scalp Micropigmentation (SMP) or a hair transplant. But there are others patients who think that a flat, low and solid line is what they want, but this is just not normal. I always discourage flat, solid and abnormally low hairlines and try to educate the patient on this very issue. Unfortunately, inexperienced hair transplant surgeons or SMP tattooists, don’t really understand what constitutes a natural hairline. A natural hairline should reflect a transition from a bare forehead to the thick hair that we normally have on the top of our head. A transition zone must be built and it is eased from no hair on the forehead to thick hair on the top of the head. If you look at the normal non-balding man or woman, there is no hairline, but there is a transitional zone in the front. Creating the zone is an art form that took me years to perfect. The pictures in cited by 'scar5' above, shows the zone reasonably well. I can not answer this question without showing you one of the baldest men I have ever transplanted: Full Face Photos - Patient - NHI. He wore a wig for most of his life and had no idea where his natural hairline belonged. The challenge here was to create a natural looking hairline. This is an artistic process that takes years to perfect.. and it is in the hands of the surgeon or the SMP operator. I would recommend that everyone investigating hairlines, to (1) meet patients up front who had SMP or transplants done, or (2) look carefully at the pictures offered on the websites. We often repair the unnatural hairlines that other SMP operators have created. We recently had one such patient and we removed the frontal hairline because it was not natural and could not be repaired by SMP alone. Then we rebuilt it. If the hairline is not graduated and soft, the person doing the work may not be the artist for you.

The question, 'which comes first' is a good one. The answer to this is not an easy one. From our experience, I think that seeing the problem will allow us to recommend the path. There is no difficulty performing FUE after the Scalp Micropigmentation (SMP). What I have been doing is to do a test area and then see if the problem is solved in the test area to your satisfaction. The SMP solution is often less expensive than the transplant solution to the 'to thin' problem often experienced by transplant patients. In my earlier communications here, I discussed realistic expectations. If you compare SMP to the well known concealer Toppik, there is no real comparison as it is an 'apples to oranges comparison'. Toppik is superior for blanketing the scalp with color so in many ways, it reduces the contrast between hair and scalp better at the expense of giving the SMP client a painted look. SMP, on the other hand, are micro-dots at or slightly larger than the cut end of a hair and these 'dots' are placed close to each other. There is white space (assuming a fair complexion Caucasian) between the dots as seen in: Picture 9999 « Album 2 « Gallery 9 « Gallery – SMP for Thinning Hair | Scalp MicroPigment SMPScalp MicroPigment SMP (expand the photo). This is not a solid color application. Some of our prospects wants more of a blanket of color, but that is not what I recommend, not at all. In fact I often have to push on this very point, something that our Toppik users do not want to hear. If the patient in the photo used Toppik, then there would be a 'black' scalp. For African Americans, this is not a problem but for those individuals where the contrast between hair and skin is high (the woman shown had black hair), so realistic expectations are very important. If the applications of pigment have many repeat sessions, there is a bleeding effect as the color may spread to the skin producing a situation far less satisfactory. For many patients who are out of donor hair (we have done a few of these) the SMP process may work out well. I know you are all worried about scars, but if you review the scar section of the above website, you will see some bad scars where the scars have almost disappeared. If the patient wishes to keep the hair long, the scars are well hidden below the hair. I would encourage you to make the trip from Arizona to our next Open House. Schedules are at: Upcoming Events - NHI.

We are indeed the only medical group that offers SMP. As a doctor, we have the best interest of the patient at heart, not how much money we can get out of everyone who comes our way. I think that you would find that we (Drs. Pak, Bernstein, Shapiro and some others) take the view that the patient is king and our job is to serve the patient. I know that our group and Dr. Bernstein reject many patients for surgery (including SMP for us) because they are too young, have unrealistic expectations or frankly are not willing to educate themselves in the preparation for such procedures). One day I will tell some interesting stories from the patients we reject for surgery or SMP (for the above reasons). We will try to produce better videos and other visual aids to help you understand the process better. William Rassman, M.D.

I agree that in-person viewing is the best way to understand the process. Today's patient was asked if he would do a video with us and speak about the experience. He has had two FUE procedures in the past, some incomplete as he lost additional hair. He had SMP to treat the FUE scars in the back of his head (the initial results looked great and I could not see the FUE scars when I was leaving today. Dr. Pak just started on his front, top and crown. The patient promised to come to our next Open House for those who want to see his results. For those of you that can not or are not willing to come to Los Angeles, maybe the video we will do and telephone can help even more (skype call). Will that be a reasonable substitute. Thoughts? As an aside, if I were going to do it and the only person doing it as in Texas, Florida or NY, I would fly there to see for my self what I would be getting into. I always tell patients that much of what we do (hair transplants and SMP) is not practically reversible. The cost of a trip is far less than making the wrong decision. Recognizing this, we offer a travel reimbursement program to rebate you up to 5% of the total fee paid to us for travel expenses. That would reduce your costs and it would even apply for a consult visit.

I spoke to Dr. Pak about videos and will focus on the few patients that will permit the filming. I have a face mask that might help them sign our consent for video. The suggestion is good. At our next Open House, I will ask the SMP patients if they will participate in a video and will be prepared to 'shoot it'. A patient with FUE scars came in after he tried to shave his head and found visible scars. He kept his hair longer than he would have liked. See pictures here: Picture 9999 « Album 3 « Gallery 26 « Gallery – SMP for Scalp Scar | Scalp MicroPigment SMPScalp MicroPigment SMP. The doctor who did his FUE must have used a larger punch (possibly 1.25 or 1.5mm). What this photo shows is that the FUE does have scars associated with it (FUE is not without scars). The smaller the punch, the smaller the scars. Notice the before and after SMP pictures. It looked much better and he was able to walk around with his head shaved after the first session of the SMP. The scars that remained, can be seen if you look carefully. Another session would be a good idea for him to close up the remaining 'white' areas.

You said: "I think it is indeed god of Dr. Rassman to have checked in". Just for your information, I am not God. If you are indeed intersted in learning about SMP, you should consider a visit to one of our Open House events where you can actually see the results first hand and up close. We are often performing an SMP procedure at these events as well (go to: Upcoming Events - NHI). Thanks for your insights. William Rassman, M.D.

Scalp Micropigmentation is not for everyone. We make it a point not to sell this procedure but rather spend considerable time getting to know the problem the SMP is going to treat and the mental state of the patient (is he/she realistic in their expectation). We spend a great deal of time with each SMP prospect because so many of them really don't understand the process and as a good doctor, we must teach the patient as much as diagnose and treat them. We have Open House events every month and at these events our patients (people who had transplants in the past or people who had SMP) come to these events. Last week at the monthly open house, there were three SMP patients there so that prospective candidates can judge, first hand, what it is all about and what they are going to look like after the process is done. We even performed SMP on one of our patients for everyone to see. Nothing is a secret when it comes to good education. It takes hours and hours to do the SMP right. The typical patient who decides to do his entire head and shave it (keeping it shaved or clipped) will take 4-6 hours on the first of what may be 2-3 sessions. The reason for second and third sessions is because the pigment often fades in blotches and we want uniformity so we touch it up again and often again. The web-site scalpmicropigment.com covers the many issue (good and bad) and provides a balanced view of the process. Our best SMP artist is Dr. Jae Pak, himself. It took a long time to learn the process and refine it. We have two additional staff that have mastered it as well and like a hair transplant, the process is a team effort. Also, like a transplant, the process is tedious, very much so. It is very important to educate the patient audience. The doctors also need an education on the benefits of the process. It is not uncommon for us to treat people who have had many hair transplants and have depleted the donor supply. Our work with scars produce fantastic results. With some patients work incomplete (because of poor planning on the transplant surgeons part), the SMP process offers a reasonable alternative way of filling in a thin transplant (pigment between longer hairs). Again, this process is not for everyone. Feel free to write me here on the hair transplant network or to my private email at wrassman@newhair.com. William Rassman, M.D.

We offer scalp micropigmentation (a tattoo essentially that mimics the sutbble of a shaved scalp). We have been doing it close to two years now with some wonderful results (see scalpmicropigment.com). To answer your question about removal of the tattoo with a laser, yes it works reasonably well. We had one patient who had the hairline placed in a position that he was not comfortable with, one that was far too flat without the normal appearing mature hairline. We had it tattooed and then once the hairline was 'erased' we redid it for him. He was more than happy. Hopefully, he will agree to allow us to use his before and after pictures which will appear on the scalpmicropigment.com site when that occurs. William Rassman, M.D.

The patient actually received 3790 grafts (sorry for the typo), 1350 in the first procedure and 1025 in the second. The patient lost some hair behind the original transplant. After the second procedure, the patient had a stretched scar measuring 1cm in width in its widest portion. The third and forth procedures were combination of two hair transplant procedures with scar revisions. The grafts were placed to thicken the work previously done. The entire scar was removed and closure tensions were low at both procedures and although some scar returned, the scar was improved. All strip procedures produce scars. In some patients, the scars widen. I believe that the scars that stretch are more tied to the patient's healing characteristics than the surgical technique or the size of the strip. In this patient, there was no wound tension at the wound closure on any of his procedures, but scar revisions are less than a perfect process. I have not seen any patients where the scar revisions made the scars worse (although I heard of one patient who had a genetic collagen defect and had his scar widen when an attempt at repair was done). Most patients get some improvement from a scar repair, possibly because the strip is limited in width. Amongst physicians who perform strip surgery, there is no general agreement as to the proper scar repair technique. Many surgeons close the wounds with a single running skin suture, while others close the wound with a two layer closure to guarantee a lower wound tension. In the two layer closure, the deep layer can be closed with interrupted absorbable sutures, or they can be running sutures. I have been using a running quill suture for my scar repairs and the sutures are anchored in the occipitalis fascis (deep layer) which is imbricated to take up the tension at the closure. With these closures, the skin tension is often very low, yet the scar may still return despite the logical value of the deep layer. Comments were made by some of the posters of my classification of this patient's balding pattern as a Norwood Class 3. I would rather consider it a 3A evolving into a 4A pattern. The nubbin of hair in the center on the original pictures was highly miniaturized. There was critical comment about the shape of this patient's hairline. I recommend on most of my Caucasian patients is what I discuss as the normal mature hairline as shown in: http://www.baldingblog.com/200...-mature-with-photos/ . The midline is measured one fingerbreadth above the highest crease of the wrinkled brow and the shape is convex. In many Asians, some people from the middle east and many Africans, the hairline is flat. The child's hairline is lower, located at the highest crease of the wrinkled brow and is concave in shape (look at your children if you do not believe me) as are women's hairlines.

The FUE2 procedure utilizes a 'water jet' principal which is used with the extraction. This facilitates that the dissection is both mechanical with a punch and this is assisted by the water jet which sets up about half of the extraction (estimate). This principle reduces the damage associated with FUE. I have filed US and International patents on the details of how this is done so I am not willing to expand upon this here at this time. The FUE2 technique reduces the transection rate and the damage to the extracted grafts. The machinery to exploit the water jet cost about $45,000 so until I can get the costs down, I doubt that it will take off in the marketlace even if I released it today. The pictures of the FUE2 which is shown on my web-site (newhair.com and http://www.newhair.com/fue2/) demonstrates a superior graft that is equal to a graft taken by the strip method. Although these are the usual results from the FUE2 technique, sometimes the damage that is seen in the standard FUE occurs. There is obviously some difference in the 'tissues' of those patients that get damage. By damage I mean that the dissection of the traditional FUE leaves the distal follicular units skeletonized close to 100% of the time and this reduces the size of the hairs that are generated when compared to non-skeletonized FUE grafts. Also, transection of some hairs occurs in a few patients, even in the FUE2 technique. With the strip harvesting method, dissection if 100% in quality and the variations that we see, even in the FUE2, does not occur. For this and other reasons, I believe that the strip method of harvesting is far better because it is 100% predictable and replicable. When one looks at the results of double trichophytic wound closures in strip harvesting, even the FUE2 can not compare in the degree of scarring as shown in my recent post on baldingblog.com http://www.baldingblog.com/200...-grafts-with-photos/ . With such quality of the scar and with predictability of the strip harvesting in better than 95% of patients, the strip is superior to the FUE or the FUE2 providing that the patient is not an unusual healer and the scar, if it formed from the strip, can not exceed 3-4 mm maximize width. Stretching of the incision beyond 3-4mm will produce a scar, even in the double trichophytic wound closure. The scars from FUE are not trivial and after seeing the scars in the many patients who visited my office after they have had FUE, I detect significant scarring (punctate scars) which would not allow a patient to shave their head. As the official 'inventor' of the FUE, my obligation is not to exploit a procedure that may be inferior and has problems with it, so unlike some other doctor who promote FUE surgery heavily as scarless with great yields, I call it like it is. With regard to gimmicks, I hope that the above clearly supplies you enough information (which is far more than I have even released to date) on the FUE2 technique and how it differs from the FUE. I ask that you respect the proprietary nature of the technology which I have discussed here while it works its way through the US and European Patent office. I have asked for an opinion by the most prominent doctors who do successful FUEs in their practice, and on viewing the FUE2 grafts that are shown on my web-site and were shown to them privately, every doctor shown these photos agrees that the FUE2 quality graft is superior to their FUE graft in their hands. They too were skeptical and probed how this was accomplished. I am not nor have I ever been into gimmickry nor have I misrepresented myself or what we do. I appreciate your inquiry and hope that I adequately answered your questions. I would welcome further inquiries on baldingblog if there any more open questions. William Rassman, M.D.

Response to comments on the Jon and Kate Plus Eight show: In this patient (Jon), I agreed to do the surgery in exchange for the opportunity to get some public exposure and the opportunity fell my way. In a year or so, if he still had the show, he will return to our office (all recorded I am sure on his show) and so we will all be able to see his results. The show's producers were in charge of the presentation, the heavy emphasis on the pain focus (which was mostly theatrical) and the way the show was put together. If the show folded tomorrow, I would follow him through the entire transplant process at my cost, no matter how many surgeries it took provided that it was in the interest of the patient. I see from the various comments on this forum that the opinions on the Jon and Kate show vary from (1) he had so much hair that he should not have had a hair transplant, to (2) we did not do enough grafts it should have been 3000 or more. First you should know that he has a Norwood Class 4 balding pattern with his hairline recession up about 1 inch in the center and 2 inches up on the sides from where his mature hairline belongs. What is left of his forelock was very weak and needed considerable reinforcement with transplants. I know that it is easy to criticize what was done from the sidelines as some of you did, but without information at hand, it is best to write to me to ask me directly (wrassman@newhair.com). I will address a number of points related to the number of grafts I transplanted on him. He is half Asian, but his hair density was all Asian which means that the densities were low. Asians have 80% of the densities of Caucasians. There was a substantial reduction of densities on the sides above and slightly in front of the ears, so the reasonableness to take a longer strip (I did a strip of 22cm) would not have been a medically prudent decision so I decided not to extend the strip beyond the 22cm length. The strip width measured 1.8 cm which is a reasonable strip width and the laxity of the scalp easily handled that width. Anyone who understands the way densities are calculated, can back calculate what the densities were on this patient (I published the methods to measure hair density in 1993). If any doctor were to take out a longer or wider strip on this patient to get as many as 3,000 grafts, I doubt that the patient would have done well (exposing the patient to possible necrosis and to a traumatic telogen effluvium). Many of the readers may not know about my experience with large hair transplant sessions (megasessions), dense packing, Follicular Unit Transplantation or the science of hair density measurements. I performed the first 2000 graft session in late 1992, the first 3000 and 4000 graft sessions in 1993 and published these milestones in the Hair Transplant Forum. I believe I coined the term dense packing and was heavily criticized by the hair transplant community for both the megasession surgeries and dense packing and these criticism were also published in the Hair Transplant Forum in 1993-5 time-frame. I have been doing these Megasessions and dense packing techniques since 1993 routinely and most doctors who do them today would credit me with the practical breakthroughs in this area. With Dr. Bernstein, we were the first to identify the procedure we called Follicular Unit Transplantation (FUT) and adopted Dr. Limmer's technique of microscopic dissection, publishing many articles on FUT in peer reviewed journals dating back to 1995. The editors of the journal felt that our work would become the Standard of Care for all time and I am proud that the hair transplant network has taken the flag for our technique. My focus in 1992 on hair density measurement is noteworthy with the patent of the video recording device granted to me (I do not enforce that patent) and the first journal article on the subject which was published by me in 1993. Worthy of note are (1) my cv (can be seen listing almost all of my publications on these subject [ http://www.newhair.com/info/doctor-rassman-cv.asp ], and (2) the Forum's Pioneer of the Month from earlier this year with review of many of my contributions over my career (see: http://www.baldingblog.com/2008/02/08/dr-rassman-named-...-the-month-by-ishrs/ }. I don't doubt that I do speak with authority on these particular subjects and I would hope that Pat Hennessey would comment on my experience in this area. Enough touting my own horn and for that I appologize. There seems to be an epidemic of large session hair transplants sessions that are reported to be common and increasing in frequency. This seems to be new in this industry. Hasson and Wong popularized my original megasessions and others are now touting expertise in this arena possibly because they may have felt left out by not doing them. I personally feel that those doctors that start doing these large sessions may be putting their patients at risk in many ways. I personally do not believe that it is reasonable to put 3000+ grafts in the first 1 ??“ 1 ?? cm of hairline and certainly it is not possible on many patients. I also do not believe that many patients will safely yield 3000+ grafts so I am mystified by the reports of such numbers unless the follicular units are being divided up into one hair grafts (then they are no longer FUT of course). I must therefore conclude that there is some lack of honesty with some doctors who routinely report performing surgeries of this magnitude through their websites and in their P/R efforts. If one were to transplant just one session of 3000 graft in a person with average density all in the first inch or so of the hairline, that might not leave enough hair for future hair loss (ignoring what I call a reasonable Master Plan for hair loss) and it may reflect greedy doctors interested in filling their wallets rather than perform what is in the best interests of their patients. I read this forum with interest and what I particularly like is that the readers who comment on the material presented try hard to understand the technical nuances of the various procedures, but at times those comments are slow to find their way to these pages. For those of you who want to see photos of my work and who complain that I do not show our results assuming that I do not have photos available, you can see well over 300 of them between two of my websites http://www.newhair.com/next/hair-restoration-photos.asp . or http://www.baldingblog.com .

Hair Shedding with Propecia Many of the patients in this community ask me about the hair shedding that is seen with starting on Propecia (finasteride). Below you can find my answer to one of these patients. "You are not the only person experiencing this problem with finasteride. Hair shedding after finasteride is seen in many patients to some degrees and it is probably due to the increased recycling of hair, although its exact mechanism is not known. Remember that losing up to 200 hairs per day is normal. Don't blame it all on Propecia; the hair shedding might have been accelerated as result of the stress that is seen in balding patients. The positive result of finasteride is unlikely to be seen anytime before 6 months after starting the medication and the shed hair is most likely to be replaced by new hair after a few months. To know for sure whether or not finasteride is working for you, you need to be evaluated with a miniaturization study before and a few months after starting the medication and the result of the two studies should be compared. You can take a deep breath if you see the rate of miniaturization has not been notably changed despite of experiencing the hair shedding."

Hair Shedding with Propecia Many of the patients in this community ask me about the hair shedding that is seen with starting on Propecia (finasteride). Below you can find my answer to one of these patients. "You are not the only person experiencing this problem with finasteride. Hair shedding after finasteride is seen in many patients to some degrees and it is probably due to the increased recycling of hair, although its exact mechanism is not known. Remember that losing up to 200 hairs per day is normal. Don't blame it all on Propecia; the hair shedding might have been accelerated as result of the stress that is seen in balding patients. The positive result of finasteride is unlikely to be seen anytime before 6 months after starting the medication and the shed hair is most likely to be replaced by new hair after a few months. To know for sure whether or not finasteride is working for you, you need to be evaluated with a miniaturization study before and a few months after starting the medication and the result of the two studies should be compared. You can take a deep breath if you see the rate of miniaturization has not been notably changed despite of experiencing the hair shedding."