Necrosis Following a Hair Transplant Over a Month Ago

/by William Rassman, M.D./0 /,

I am 26 years old and 40 days ago I did FUT. My doctor transplanted 2100 grafts on my vertex, but unfortunately on back of my head there is 2 parts that is like 2 circles (3 cm in 3cm,each circle) that my doctor told me it is necrosis. I was just wondering if it will recover and my hair will be restored on back of my head or not ?! if not, please note how I can do? Or if it will cure, how long would it take?

Best Regards

In essence, “necrosis” means there is dead tissue. It is sometime referred to as gangrene. If you have necrosis in the donor area, healing will be an issue… and if it heals I doubt you will have regrowth of hair in those areas again. I really couldn’t tell you how long it might take to heal, because this is a function of the size of the dead skin and I do not know the severity of your problem. There are other complications that will also likely be of concern, such as infection and deformities.

Donor necrosis is more common in strip surgery when the wound is made too wide. This can cause significant scarring, so much so that it may require extreme measures to fix (such as the use of balloon expanders). I’ve thankfully never had significant donor necrosis in my patients, and necrosis in the recipient area is very, very rare.

Past posts about necrotic tissue following hair transplantation can be found here and here.

Tags: necrosis, hair transplant, hairloss, hair loss

Shower After a Hair Transplant?

/by William Rassman, M.D./0 /,

I recently had a hair transplant and i was curious how long i should wait before going back to my usual routine of showering every other day? My main concern is folliculitis or infection.

ShowerYou should really ask your doctor about the washing issue and what he/she recommends you do following your surgery. Your surgeon should’ve provided you with aftercare instructions. For my patients, I recommend gentle showers and hair washing the very next day after a hair transplant.

I just saw a man from overseas who told me that by the 5th day after his surgery he could not see any scabbing, nor could he see the graft recipient sites (he had hair present from a previous transplant and the new procedure just filled in between the grafts). If it is washed well by the staff the day after the transplant, then the scabbing can be minimized.

Tags: showering, shower, cleaning, hairloss, hair loss, hair transplant

Keloid After Trichophytic Closure

/by William Rassman, M.D./0 /

i did a hair transplant surgery,and my surgeon said he used trychophytic closure, but the scar is about 4months old now and its turning into keloid strip. please i want to know if i successfull use the silicone get to heal the keloid, will hair grow out from the scar ever again ?

Keloid formation has nothing to do with a good surgeon or a trichophytic closure. Certain people are just more prone to getting keloids no matter what. It is a genetic predisposition. You can try using the over the counter ointments to diminish keloids, but I do not think it will work well on the scalp because of the hair that is in the way. Sometimes doctors inject steroids to “flatten” out the keloid and this is particularly valuable if the keloid is detected early.

Most people really do not have keloids when they report them, but rather hypertrophic scars (which are usually elevated scars). True keloids look like grapes growing from the wound.

Tags: keloid, scarring, scar, trichophytic

I Left My Propecia In the Car Overnight and Everything Froze

/by William Rassman, M.D./1 /

Hello,
I live in the midwest and it’s very cold and snowy. A few days ago I accidentally left my Propecia in my car overnight. When I went out the next morning, my water bottle and everything in the car was frozen so it had gotten quite cold the night before. This is the first and only time this has happened. Do you think the rest of the prescription is okay?

I spoke with a rep at Merck about this and was told that freezing may alter the value of Propecia. The safest thing to do is to replace what you are using with fresh medications. Or you can chance it, but that’s entirely up to you.

Tags: propecia, finasteride, cold, freezing, temperature, hairloss, hair loss

I Think My Hairline is Receding But I’ve Always Had a High Hairline

/by William Rassman, M.D./3 /

First off, I would like to say that I have learned so much from your wonderful blog–thank you. I am a 22 year old male with a receding hairline but there doesn’t appear to be miniaturization behind where the hairline currently is. I don’t see any crown thinning either. What do you think about this? Unfortunately, I had a high hairline to start with. I first noticed this in late 2009 so it has probably been occurring for over two years. Should I get on propecia? I do have mpb, right? I am severely depressed by this situation and I appreciate your help–I want to be proactive and treat it. (I will send pictures in a few minutes with my name as the subject. You may use them on your site)

Genetic history: Early cases of mpb have almost no precedent in my genetic history. My dad, his brother, and their father all had/have sharp but intact hairlines with crown thinning that didn’t start until their late 30s and stopped after about ten years leaving them with a nearly bald crown area. My mom has no brothers neither does my maternal grandfather but he and his father both kept full heads of hair their whole lives.

I have no way to know if you have MPB (particularly since you said you had a high hairline to start with, the hairline could just be maturing from the high starting point). I looked at the photos and your hairline appears strong. The key is that I don’t have any older photos or measurements to compare to your current hairline.

I couldn’t tell you to get on Propecia, as that is a prescription medication and I’m not your doctor. You should take photos with your eyebrows lifted high so that the forehead creases heavily. That will help me tell if this is a change in the maturing of your hairline or just recession.

I wouldn’t suggest being proactive when it comes to treating hair loss, as you could end up using medication that you don’t need. I’d see a physician in your area (you can check ISHRS.org to find a hair transplant surgeon — they know hair, just don’t rush yourself into surgery at 22 years old).

—

Update March 10, 2011: Photos from reader added. Click to enlarge.

 

Tags: hairloss, hair loss, mpb, propecia, hairline

Scalp Micro-Pigmentation Use in Covering Scars (with Photos)

/by William Rassman, M.D./0 /,

This is a typical patient with a series of scars, some from a hair transplant (the large smiley scar). This man elected to cut his hair very short and get pigmentation into the scar. Although an additional session would be a good idea to camouflage the scar better, he stopped at what you see below (on the right). Now if he grows his hair out, the scar should be close to invisible. The red ‘blotch’ you see on the back of his head has been with him most of his life.

The photo on the left is before SMP; The photo on the right is after SMP. Click to enlarge:

 

Tags: smp, scalp micropigmentation, scarring, hair transplant, hair loss, hairloss

Toppik Before and After Contest at TheBeautyPlace.com

/by William Rassman, M.D./0 /

Hi there!

I wanted to see if you would please make your readers aware of a Toppik Before and After contest we, TheBeautyPlace.com, are holding? TheBeautyPlace.com is an online store that sells hair and skin care products including products for hair loss. Thank you!

Link: Contest page

For those of us in this field, we recognize the value of Toppik to thicken up the thinning appearance in men and women. The contest is for Toppik users to submit their before and after photos for a chance to win Toppik products. Contest ends March 19 — see the full contest rules and prizes at the link above.

BaldingBlog isn’t involved with the contest (we don’t sponsor or endorse it), but we’re just passing along the info. Good luck!

Tags: toppik, contest, thebeautyplace

In the News – Merck Sued in Connecticut for Not Disclosing Propecia Side Effects

/by William Rassman, M.D./2 /

Snippet from the article:

A Connecticut law firm has filed a lawsuit against pharmaceutical manufacturer Merck & Co. on behalf of men who have taken Propecia, a prescription drug that combats hair loss but, its critics say, can also cause severe side effects such as sexual dysfunction and mental impairment.

Attorney Edward Jazlowiecki of Bristol has joined two other firms, in New Jersey and New York, in filing the suit, which alleges that Merck has failed to fully disclose the serious side effects of Propecia and failed to adjust its warnings in the American market even after European regulators forced the company to carry a stronger warning label.

Read the rest — Lawsuit Blames Hair Loss Drug For Sexual Dysfunction And Mental Problems

As one might expect, Merck says that, “The company intends to vigorously defend against the lawsuit.”

Tags: merck, propecia, lawsuit

What Happens to the Scalp Micro-Pigmentation Once You Turn Gray?

/by William Rassman, M.D./0 /

Dr. Rassman

I see that you have recently begun offering micropigmentation. This is something that’s intrigued me for some time but, until you began offering it, there never seemed to be any reliable results posted anywhere. I’ve got a couple of questions off the record as I’m somewhat interested in pursuing this as a complement to my hair transplants.

  1. People often raise the question about how this will look as a person ages and their hair becomes gray or white. I’ve always thought that it may look odd as the dark dots are sure to stand out at that time. How do you propose patients will deal with this issue?
  2. Over a lifetime, if cared for properly, how often do you expect a patient will have to touch up the work and will this cause it to become less defined over time?
  3. Do you publish your fees?

Thanks for your time! Also, thanks for your Balding Blog. I’m a regular reader and you even published two of my questions in the past.

Thank you for your insightful questions. I will answer them as best I can below:

  1. The pigmentation ‘dots’ are very small and for a person with hair that is not black (light brown for example) the pigment color can mimic the hair around the fringe, almost a dark gray which will not be a problem with age. We generally make the color match the hair color (shade). Remember that as the hair grows out from the scalp, it is exposed to sunlight (normally) and the hair in almost all people who do not have black hair will see some hair lightening, so we address that up-front as we select the initial color we use.
  2. Over time, the pigment may fade and might need a touch-up. Our base charge will cover someone for 3 months to deal with color absorption of the pigment. Everyone is different with regard to the amount of pigment that is absorbed after the initial treatment. For a second treatment and beyond, pigmentation absorption is much slower, but it might fade more after a few years. Touch-ups may be desired.
  3. Fees are individually determined at the time of the consultation, but they range from $2000 – $6000 depending upon the amount of work. This will include as many touch-up sessions as is needed to achieve the initial goals. It may take two or more sessions.

We will soon be trying a new pigment that is supposed to be reversible with one laser treatment, so even though we do not recommend that people consider this a reversible process, it possibly is. We plan to make it available after we determine how beneficial this pigment actually is.

Tags: scalp micro-pigmentation, pigment, tattoo, hairloss, hair loss, smp

Follow-Up: Hair Transplants with Scalp Micro-Pigmentation

/by William Rassman, M.D./2 /,

I received a few emails asking for more views of the Scalp Micro-Pigmentation (SMP) patient we featured last week. One specific request was to see what the scalp looked like immediately following a session. Here we go…

Going from left to right (click the photos to enlarge):

  1. First photo is his transplanted hair (before SMP). Keep in mind that he was a Norwood 6, so most of what you see there is transplanted (6900+ grafts). He wanted it to look even thicker and opted for SMP for this.
  2. Next photo is 2 weeks following the first SMP session.
  3. Last photo is immediately following his second SMP session. Patients are instructed to not wash their scalp for 3 days following a procedure. The pigment appears darker at this point than it will be once washed.

 

I’ll update this post in the next day or two with a photo of the patient after he’s washed his scalp.

Tags: smp, scalp micro-pigmentation, hair loss, hairloss, hair transplant

My Shock Loss Was So Bad, My Hair Looks Thinner 8 Months After the Transplant!

/by William Rassman, M.D./1 /, ,

Hi Doc

i had previously done a minor HT of 500 grafts onto the thinning mid scalp. Shock loss was bad and now at 8 months post HT, my hair looked thinner than before.

my question is is it advisable to plant the hair grafts onto the thinning mid scalp or is it more advisable to plant only onto the bald area and leave my thinning mid scalp until more serious before i start to tackle them.

I would have hoped that you were on finasteride prior to getting a hair transplant, as this drug minimizes the shock loss some young men experience. Were you warned ahead of time about the possibility of shock loss?

Everyone is different and you certainly have a unique problem, though I don’t know much about your case (age, hair loss pattern, hair character, etc). I would have to see you, or at least you should email some good photos that show your scalp, and we might be able to setup a phone consultation.

Tags: shock loss, finasteride, hairloss, hair loss, propecia

Does Hair Regrow If Pulled Out by the Root?

/by William Rassman, M.D./2 /

Hey, i just want to know if the hair that its pulled out from the root grows back up?

Also can harsh brushing of the hair lead to hair loss?

Hair pulled out from the root will regrow, but continuous pulling could eventually lead to permanent loss. Same goes for harsh brushing. If it’s ripping the hair from the scalp over and over, it’s possible that it could eventually cease to grow. I guess it depends on how harsh we’re talking… but generally, brushing your hair won’t cause a problem.

Tags: hairloss, hair loss, pulling hair

Sedation and Hair Transplant Surgery

/by William Rassman, M.D./0 /, ,

Dr. Rassman,
I enjoy your blog! One questions I had was if any hair transplant surgeons use level 2 sedation? I recently found a blog where a surgeon uses level 2 sedation instead of injection. What are the differences or risks for each one? Is one more preferred than the other?

Regards

Nitrous oxideLevel 2 sedation scale is considered: “cooperative, tranquil, and oriented” according to the Ramsay scale. To some this can be achieved with no drugs. To some this can mean a shot of Vodka. In the doctors office this can be a shot of a sedative or a pill (like Xanax). It can also be breathing in laughing gas.

Level 2 sedation is not anesthesia.

At NHI we have evolved our sedation and anesthesia routine. We offer nitrous oxide (laughing gas) for sedation. In addition we also offer a single shot for sedation or a Xanax pill to take by mouth. Some patients choose all of the above and have a great Level 2 sedation experience. The laughing gas has the most immediate on/off response, followed by the injection. Finally the oral Xanax takes the longest for a patient to reach the Level 2 sedation.

We do monitor the breathing, oxygenation status, and cardiac status during the procedure, and if the breathing slows down, an alarm goes off. Level 2 sedation can quickly turn disastrous if the physician or the clinic is not prepared to handle the consequences of the medications.

To achieve Level 2 sedation your surgeon should be certified in ACLS (Advanced Cardiac Life Support) and the facility should be equipped to handle emergencies. Luckily Dr Pak is also Board Certified in Emergency Medicine so we are well prepared for any medical emergencies.

For Level 2 sedation we also take an additional voluntary step to be accredited by the AAAHC (Accreditation Association for Ambulatory Heath Care) as an out patient surgery center. Very few hair transplant clinics have this AAAHC rating (something to ask about when doing your research).

So that’s what we do. I can not comment on other doctor’s drugs and uses.

Tags: surgery, sedation, hair transplant, hairloss, hair loss, sedative, surgical techniques

My Nipple Got Puffy After Taking Finasteride for 2 Years

/by William Rassman, M.D./2 /

Hi. I have been taking proscar cut into 4 for two and a half years, with excellent results. For about 4 months I have had pain under my right nipple and a small lump has developed. The nipple is puffy and the areola is swolen. In the last week the same has happened under the left nipple. Reading the blog has made me realise gynecomastia is a rare but well known side effect of finasteride. I am seriously worried about continuing the medication. But I am also reluctant to stop due to the success on the MPB. Could you advise a course of action. If I gave up the meds for two/three weeks, to give the gyno a chance to subside, and started taking a reduced 0.5mg of fin would this be suffiecient to prevent catch up hairloss and maintain the benefits in the future?
Thanks for a great blog

This is a question you need to ask to the doctor who is prescribing you the medication and treating your androgenic alopecia. Gynecomastia is a possible side effect of Propecia (finasteride). From my recollection, there have been 3 patients who have reported gynecomastia to me, but it reversed when they stopped taking the medication. Sometimes you need to consider the risks and benefits of taking a medication.

Finally, while the gynecomastia may be a side effect of Propecia (finasteride), it may also be a unrelated issue which some men experience. No matter what the cause, you need to follow up with a physician and have a complete examination.

Tags: gynecomastia, propecia, finasteride, nipple, hairloss, hair loss

After Plucking My Eyebrows, They’re Regrowing in Different Directions

/by William Rassman, M.D./0 /

Hello Dr,
I over tweezed my brows and now that the hair is growing in, it is growing in one eyebrow in different and odd directions. I was wondering if I tweezed them out in the right direction if they would start growing that way the next time they sprout out? I don’t want to pluck them out if they won’t. Thanks for your help!!

TweezingThat’s an interesting question. I don’t have personal experience with eyebrow plucking and I do not know the answer to this one. I am sure you will know the answer when they fall out (go into telogen, part of the normal hair cycle) and then regrow.

Keep in mind that continuously tweezing of the hair could eventually result in permanent loss.

Tags: eyebrow, hair direction