Five days after 1400 FUE grafts with photos

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

This patient had an FUE 5 days earlier. What I want our readers to note, is that there is not only no crusting on the recipient area, but the donor area is completely healed, I get emails frequently which show terrible crusting after a hair transplant in the recipient area. I tell everyone our routine, which I will now repeat here:

I don’t like the idea of anyone removing grafts that have scabs on them because we have published a paper in a formal medical journal, that when a person pulls off a scab (crust) from a recipient area in less than 12 days (possibly longer), the risk of losing the graft is very high. See the medical paper we wrote here: https://baldingblog.com/wp-content/uploads/pdf/mp-2006-graft-anchoring.pdf

In FUE or any transplant including a beard transplant it should be treated just like a regular hair transplant with regard to the recipient area, but if the donor area has open wounds (FUE), it requires daily washing with soap and water. Within 3 days of surgery, you can resume full activities, heavy exercises if you wish. The recipient area requires daily washes as well to keep the recipient area free of crusts. I generally recommend the use of a sponge and supply my patient with a surgical sponge to fill with soapy water and press on the recipient area daily in a rolling motion, never rubbing. By repeating this daily, all crusts can be washed off without any fear of losing grafts. IF any crust are present, use a Q tip and dip it into soapy water, and roll it on the crusts and that will lift them off without dislodging them, but never rub them, just roll the Q tip on the recipient crust. I like to see no evidence of any crusting in the recipient area and the crusts from the donor area gone in 5+ days with daily washing.

PAK20057PAK20058

Value of HAIRCHECK instrument

/by William Rassman, M.D./4 /

Today I had an 18 year old man visit me worried about early frontal recession. My eyes told me that he was developing a maturing hairline and not balding. So to confirm my suspicions, I ran a HAIRCHECK test on him. What I found was an unusual reading, where the hair which we measured in the back of the head (donor area) had less bulk than the front, top and crown areas. This perplexed me, so we discussed his hair hygiene today. He told me that although he washed his hair with water this morning, he put shampoo selectively only on the back of his head hair to get out the oily feel in the back of the head. This caused a reduction of bulk by about 40% which I attributed to the removal of oil in the hair in the donor area but not \in front, top and crown, area.

I was impressed that the measurements I took were able to detect the differences in the way he washed parts of his head. Imagine what it will do for you if you find yourself concerned about balding. This is the MOST sensitive test for balding on the market available anywhere.

Patient heavily documented his balding with good microscopic photos and excellent questions

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

I recently heard from a patient who heavily documented his balding with 18 microscopic photos at different parts of his scalp, but mostly in the mid-scalp. I have attached ome of these photos below. His questions related to the miniaturization he saw on the photos and wanted my opinion on his interpretation of the miniaturization. He counted each hair in each field and each follicular group and how many hairs each follicular group had.
microscoopic view (1)

Note that there are large hairs (we call these terminal hairs) and hairs with smaller hair shafts (we call these miniaturized hairs) and there are very small short fine hairs (we call these vellus hairs). Note in the photos that in the far left (middle) there are two follicular groups that have two hairs each, but one hair in each group is much smaller than the big fat ones next to them. These Follicular groups are in the process of losing one out of two of its hairs from genetic balding. Maybe these groups had three or four hairs at one time, but they might have reduced that number from 3 or 4 to 2, and now they are going down to one. This is how the balding process works, hair by hair.

I further told him: You are in some ‘state’ of the balding process. To find out where you are actually at, I perform a HAIRCHECK measurement on all of my patients and from this measurement I can tell to within 10% just how much hair you already lost by region. If you are not in California, find some doctor who has the HAIRCHECK instrument and can do the testing for you. Taking the drug finasteride is the single most valuable thing you can do provided you do not get the side effects; however, before making that decision I would get a HAIRCHECK test.