Scarring in Donor & Recipient Area, Body Hair, FUE

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

Hi Dr. Rassman,

I’m considering going in for a FUE hair transplant and I understand that there is minimal scarring involved. I was reading up on the New Hair Institute web site and noticed there are many “mini” scars. Will these scars be only in the donor area or where there is transplanted hair?

I’m also considering using body hair as a viable source for donor hair. I’ve seen a few surgeons doing this. Have you personally performed such an operation? I would love to hear your thoughts on this procedure.

Best regards.

Follicular Unit Extraction (FUE) produces very small scars in the donor area, usually less than 1mm (there are 25mm to an inch). The only way most people could see these scars is a complete shave of the head (not a short hair cut, which probably would not show any of these scars). In the recipient site, the grafts are always trimmed (in our office, anyway) to cut away the unnecessary skin so that these grafts should not produce any visible scar in the recipient area. My understanding from the recent ISHRS meeting in San Diego, is that most surgeons doing FUE do not trim the grafts and therefore may get very small recipient area scars.

I have commented on body hair transplants before, but I’ll recap the biggest problem with them. Due to the short growth cycle, body hair will not show up very well (quantity) because for every body hair that is transplanted, less than half of them will be in growth phase at any one time. That means that less than 50% of the hairs will grow according to what you can see. At the meeting in San Diego, one doctor who does a lot of body hair transplants showed two patients who had them done. The growth in numbers was far less than 50% of what the two patients and the doctor reported was put in at the time of the surgery. The only good news about what I learned at the meeting with regard to body hair is that the length of the hair does double to what the person had in the chest or back (natural position). I would want to have a face to face meeting to understand your focus on the body hair, why you wanted it, and to see what else was available to meet your needs.

Tags: hairtransplant, hair transplant, fue, body hair, bht, bodyhair, hairloss, hair loss, scar

Anticoagulants and Hair Transplants

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

What if your on coumadin, do you have to wait until your off the medication? I am told yes.

Just to clear it up for the readers out there, I believe you’re referring to waiting until you’re off coumadin before having a hair transplant.

It is wise to reduce or stop coumadin (an anticoagulant) prior to having a hair transplant. I have had the misfortune to do a hair transplant on a number of patients on coumadin (it can be reversed with Vitamin K) and on Plavix (can not be reversed). There was very mild bleeding from the recipient site the night of the surgery. The surgeon must understand why a person is on these medications and weigh out the safety of stopping them or staying on a lower dose of these medications. Each case is medically evaluated independently.

Tags: hair transplant, hairtransplant, coumadin, plavix, anticoagulant

Filling in Linear Scar from Previous Hair Transplant

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

I have had a previous hair transplant and had a line scar that I wanted to fill in using your FOX procedure. Is this possible?

Thanks

Yes, it is possible. If it is a line scar only (1-2mm size), then a trichophytic type of incision may work better. I would like to see the scar. If you can send me a photo, that would help — please take the picture with a ruler next to the scar to help determine size. Or, if you’re local to California and you can make it to one of my offices, that would be even better.

Tags: hairloss, hair loss, hairtransplant, hair transplant, scar, fue, fox

Man Unaware of Shock Loss After Transplant

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

I am 37 years old male and I had hair transplant with 800 grafts four years ago. after hair transplant i lost my original hair which i had before transplant and now i left with only the hair which i transplanted. i have two question. first, is it normal for everybody that once you did hairtransplant you will lose your original hairs due to shock that our scalp get. my other question is regarding after transplant. since last year after getting shower the next day when i touch my scalp i notice the dead hair bulb ( i think it is called hair bulb or hair follicule, the material which hair grows from it ). it scared me alot. i have oily skin and when i touch my scalp i notice them it is like more then 10 per day. would you please give me some idea that why i lose my hair bulb besides my hair. and what should i do to prevent it.
thank you

Shock loss after a hair transplant occurs in some patients and it is best prevented by taking Propecia (which I prescribe to everyone having a hair transplant just to minimize this possibility). It is probably related to the degree of miniaturized or weak hairs that were in active loss phase when you had your transplant.

Regarding your second question of a ‘dead hair bulb’, I do not know what you are describing. It is normal to lose up to 100 hairs a day. What you are probably seeing is a hair shaft with a little sebum (mucus) plug attached at the end.

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

Getting a Lot of Scalp Pimples 6 Months After Hair Transplant

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

did second transplant 6 months ago.i seem to have alot of pimples and they are getting worse.is there any cure.tried with pills already but doesn’t work.thanks.age 27-sex male

Six months after a hair transplant should be enough time to end any cycle of pimples. I’m not sure what pills you might’ve taken to eliminate the scalp pimples, but I suggest you go back to your hair transplant surgeon and get yourself evaluated. You have a doctor, take him/her to task. Patient aftercare is important, and your doctor should be willing to answer your concerns.

Tags: hairtransplant, hair transplant, aftercare, scalp, pimple

Trigrowthic Suturing Technique

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

Dear Dr. Rassman,

I’ve asked you this question before but had not received an answer. I recently read about a so-called new “trigrowthic” suturing technique that promises to leave no visible scarring post strip op. Have you looked into this procedure before and is it to be believed? Thanks.

“What’s in a name? That which we call a rose
By any other word would smell as sweet.”

–From Romeo and Juliet (II, ii, 1-2)

The use of trichophytic closures have been around for years — in fact, that closure has been used in plastic surgery for more than two decades. The hair industry adopted it recently as a standard of wound closure. You could change its name and correctly say that you invented that name, but it would be improper to say that you invented the procedure. The doctors you have referenced here are recycling techniques under a new, original name and as such, if they are claiming inventiveness, then they might be deemed dishonest.

There is NO such technique that can provide results with no visible scarring. ALL cuts on the skin will leave a scar and the scarring is unique to individual patients. Some patients have minimal scarring, while others have more scarring — it is dependent on their genetic makeup, which no one can tell with just a physical examination. Some of our patients heal well and have very minimal scarring that is hard to detect with a regular hair style, but even these patients will have a visible scar if they shave their head bald.

We routinely use a trichophytic closure which I assume is similar to what you have read. For more information about the trichophytic closure, please see:

Tags: trigrowthic, trichophytic, hairloss, hair loss, hairtransplant, hair transplant, closure, wound, scarring

High Side Hairline (Above Ears) — Can It Be Lowered?

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

hi there,
i’ve been reading some of these articles about high hairlines, and most of them talk about the hairline at the forehead. however, with me, my hairline at my forehead is fine, its the hairline at the side of my head (near my ears) thats high. its been a real issue with me ever since i was a kid and i’d always need long hair to cover it up so that it wouldn’t seem as if i’m balding (which i’m not). my doctor says that i am not vulnerable to balding when i get older. i am an 18 yr old filipino male. and i was wondering if there are any treatments to this surgically/nonsurgically. i’d prefer nonsurgical more than surgical. but if there is anything at all, pls tell me. thx

Some people have a genetic high temple hairline (above ears) which can be treated with hair transplants very effectively. There are no other treatments for this that I know of.

Tags: hairtransplant, hair transplant, hairline, side

Large 5000+ Graft Transplants

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

I read about megasessions of 5000 or more grafts. Particularly from a Canadian group. Yet unless the average Canadian hat size is larger, that is near impossible unless they are doing it on the graft dissection end of things. How can one doc get so much more hair then others??Larger heads, larger incisions??

Large sessions, really large ones, were defined by me in 1993-4 timeframe when I reported first breaking 2000 grafts/session, then 3000, and finally in early 1994 I reported my first of many 4000+ graft sessions. These are not typical. First, the surgical team must be trained in doing large sessions with fast, efficient cutting and placing. The following points must be available for the surgery to be successful:

  1. The sessions should not take more than 8 hours, for beyond that time, the grafts out of the body that are awaiting placement produces reduced graft growth.
  2. The surgeon must know the nuances of prolonged anesthesia without increasing the risks to the patient.
  3. The patient’s scalp laxity must be very loose so that a wide strip can be taken safely (often these strips measure greater than 2cm in width and 10 inches in length).
  4. The patient’s density must be high (50% higher than normal densities).
  5. And as you said, the head should be a larger size to yield wider and longer strips.

Large sessions are no more risky than smaller sessions, but the above criteria must be met or the yield would not be there. My record number of grafts in any one session to date is 5800 grafts. I remember that patient well, because had his balding pattern been more advanced, I would have gotten 10,000 grafts from him with ease. His density was twice average densities, his head was larger than normal, his scalp was loose (actually, very loose), he was young and healthy and we completed the surgery in 7 hours.

Good question and thanks for asking it.

Tags: hairtransplant, hair transplant, largesession, session, densepacking, megasession

Are Pimples on Scalp After Transplant a Good Sign?

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

3.5 Weeks after a Hair Transplant, Is it normal to see pimples in the head so early on? I have maybe 3 or 4, one at the hairline and the rest in between my grafted area… I hear pimples on the head is a good sign that hair is trying to break through the surface, at almost 1 month post-op, is it possible to start hair regrowth? I do have fairly thick hair and my hair does grow fast elsewhere, just thinned in the front. I would be a 3 on the scale… Thanks!

Pimples are never a good sign. They do happen for a number of reasons after a hair transplant:

  1. Small cysts form from sebum build-up in the sebaceous gland that remains after the hair has shed.
  2. Small bits of remaining hair shaft are below the skin and are shed. Hair is a foreign body and as such is rejected through small cysts that come to the surface. These remnants of hair follicles or sebaceous glands may get infected and require antibiotics. Generally, they can be successfully treated with warm soaks. Be sure that these do not turn into folliculitis by visiting your doctor and establishing a good dialogue with him/her.
  3. In less than a good surgeon’s hands, cysts may reflect ‘piggybacking’ of one graft placed on top of another.
Tags: hairtransplant, hair transplant, scalp, pimple, cyts

I Had 3 Procedures — Did I Receive Optimal Care?

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

Thank you for sharing your time and expertise with the hair loss community. I’ve had three successful transplants with a prominent hair transplant surgeon between the years of 2003-2005. The graph count of all three sessions was approximately 5,200. Lately I’ve noticed hair transplant sites lauding the success of a few doctors who are able to surpass 5,000 graphs in one session. Surely I would have preferred to receive my 5,000 graphs in one session as compared to three. Did I receive optimal care by my physican or did he lack the skill, resources, and know-how to produce the results (5,000 graphs)in one session? Or, are there factors that make it necessary for a person to have three smaller sessions as compared to one larger one? I’m a 48 year old male. Thanks again!

Sometimes large sessions (5000+) may not be possible on some patients when the size of the bald area is small. If the size of the bald area is large, to get a large session you need three things:

  1. good laxity (looseness) of the donor scalp
  2. very good densities in the donor area
  3. a specialized surgical team capable of doing this work in less than 8 hours

You should always have a good, trusting relationship with your doctor. I cannot comment on optimal care and would not suggest that you received less than optimal care. Maybe your surgeon’s team is not capable of performing these large sessions in the ascribed time period. Maybe your scalp is too tight or your balding area is too small. If you describe your surgery to be a success and are pleased with the results, then that is the determinant for the quality you recieved and I would go by the results you obtained when compared to the expectations you had prior to starting the process.

Tags: hairloss, hair loss, hairtransplant, hair transplant, doctor, surgeon, care

Pinpoint Procedure for Hair Transplants?

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

hello, i just had approx 1500 grafts strip procedure 8/25/06. the doctor used what they call the pinpoint procedure using a surrenge needle to make the inscions. what is your take on this procedure and will i need to have FUE in the future to create a natural looking hairline or does the pinpoint procedure have good enough results for a natural lookng hairline?? your advine would be greatly appreciated.
thanks

Some doctors seem to make up terms that do nothing but confuse the public with marketing mumbo jumbo. With your confusion, this sounds like such a case. I did search for the term using Google and found the description for the “Pinpoint” technique appears to be follicular unit transplantation, of which I wrote a published classic article on the subject over a decade ago. Based on the limited text available on the doctor’s site, I don’t see anything different, new, or innovative about this technique.

Tags: hairloss, hair loss, hair transplant, hairtransplant, pinpoint, pin point

Had a Hair Transplant a Year Ago — Could I Just Be a Slow Grower?

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

I had a transplant a year ago. My question is that for 10 months I noticed almost no growth. Now though I’m starting to see fine baby hairs sprouting up. Is this growth? Am I just a slow grower? Or is it the propecia that I’ve started taking? The hairs are just beyond the hair line. Thank you for your time

After a hair transplant surgery, it may take 8 months of so to see 80% of the benefits of a hair transplant and up to a year or slightly more to see the full benefit of the surgery. This is absolutely something you should discuss with your hair transplant surgeon. A failure to grow would be evident if the growth to this point is most of what you had transplanted.

Tags: hairtransplant, hair transplant, growth, doctor

Any Adolescent Hairline Transplant Photos?

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

Can you post a before & after photo of someone who you’ve lowered their hairline to an “adolescent hairline”. I know you’ve said in the past you usually only do this procedure on someone who makes their living by their looks & I wanted to see how much of a difference it would make. Thanks, great blog!

These three patients had their central hairline brought down to the childhood hairline position:

Also, please take a look at the hundreds of patient before and after photos on my website in the Patient Photo Galleries.

Tags: hairtransplant, hair transplant, hair loss, hairloss, photos, hair restoration, hairline

Transplanting to Eyebrows with Seborrheic Dermatitis

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

hi doctor ,I’m a 48 year old male who’s had seb derm in my eyebrows for the best part of thirty years .this has caused shedding of the eyebrows over the years as the scales seem to lift the hairs and they fall out . I’m now desperate as the loss is obvious and the patchiness makes me depressed and very self concious .I’m considering a transplant after having read of your success in this procedure ,but I’m concerned that the condition will continue and then I’ll lose the transplanted hairs . In your opinion ,do the transplanted hairs have more strength in the brow because they are implanted deeper ? have you had any feedback from patients who underwent this procedure as a consequence of eyebrow loss from sebderm like mine ?

The transplanted hair will behave like the hair in the back of your scalp (the donor hair) and they may be more resistant to the effects of the dermatitis. Scalp hair transplanted to the eyebrow will continue to grow long (as your scalp hair does in their original position) so you will need to trim it.

Tags: eyebrow, hairtransplant, hair transplant, dermatitis, hairloss, hair loss

I Had a Hair Transplant Almost 2 Weeks Ago and Am Very Worried About the Outcome

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

I am a 28 years old male. I had a hair transplant 12 days ago of 1890 grafts. My question is that all my scabs have not come out yet. I try to run water every day through my hair and shampoo it with head and shoulders citrus breeze. The scabs in the front of my head are coming out but at top portion are coming out one by one. I am noticing a black dot followed by little white bulb kind of thing with my scabs. Sometimes the white part is like very dry and hard like a bulb at times. There is however no pain. I am wondering if these are grafts. I am really scared and I don’t want to even touch the scabs. Please let me know if there is a possibility that the grafts dry up and are just falling off. I am very anxious am waiting for an answer to know if my hair transplant was a success or failure.
Thanks

The little scabbing is normal and it can take some weeks to go away (usually 1 to 2 weeks) if the washing has not been properly done. You should see the doctor who did your hair transplants and address these concerns to him/her. You should always have a strong patient to doctor relationship so that these concerns can be addressed one on one. In an ideal world you shouldn’t have to seek out a site like this to ask a question about your post operative report, although I am pleased to do it, for it educates my readership. Doctors have the obligation to educate their patients and give attention to the person’s needs (psychological or physical). Good luck.

Tags: hairtransplant, hair transplant, aftercare, scab, healing