Repair: Old Plug Removal, SMP Into Hair Transplant Scar

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

This is a Norwood 6 patient who had a hair transplant done at a clinic in Europe in the 1990s with the old pluggy technique. He wanted to shave his head, but the old hair transplant donor scar and the visible plugs were a problem for him.

This patient chose a combination of (1) SMP to camouflage his old scar, and (2) the surgical removal of his old plugs. The hairs that were in the plugs were redistributed into the crown. We also transplanted a few hundred FUE grafts taken from the donor area and used them on the top of the scalp. As he does not live in the United States, he will return at his convenience on another visit for the needed touch ups. He will likely go on to cover his entire head with SMP, may also undergo more FUE grafting into the frontal hairline, which will make it appear even more natural.

At the point I last saw him, the patient was very satisfied with removing his old plugs with FUE and having SMP done into the old scar. He can stop here if he is satisfied with the result, but I anticipate more work to be done. The after photo shows the temporary redness common just after surgery. We will keep you posted when he returns to the US.

The before (left) and after (right) photos show a work in progress. Click photos to enlarge.

 

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

Wearing My Pilot Helmet After a Hair Transplant

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

I just had a transplant procedure done just over a week ago. I’m a pilot who wears a helmet to fly with. How long should I go before wearing my helmet again?

I don’t think you should have any issues with wearing a pilot’s helmet after one week. The grafts shouldn’t be an issue by this point, but the donor scar might be uncomfortable if there is a lot of pressure on your donor area from the helmet.

It really can depend on how large the surgical procedure is, so please talk with your surgeon. I would think your surgeon should be more accessible than me here on the Internet.

Tags: pilot, aircraft, helmet, hair transplant, surgery

I Had An Injury 7 Months After My Hair Transplant

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

Dr.Rassman
I had a ht in October of 2010 and things were going well up until the seventh month when I was injured and lost allot of blood. I would like to know, would this loss of allot of blood affect my ht even though things were looking good before this happened. If it would hurt it, does that mean the hair i’ve lost from the transplanted areas will never grow back or will they grow back after I’m back to normal. I’m in my ninth month and things look much worse than they did in my fifth month. I didn’t think the injury I had would have any effect upon my HT results. I’ve been told that right now my hemoglobin is just a little bit lower than it should be. Do you think I’ve wasted all my money and will have to have this done over again. I’m hoping lost transplanted hair will grow back again.

I am assuming that your injury did not directly impact your transplant area. If that is the case, then the hair transplant should grow like your normal hair if the original surgery was successfully and skillfully done.

If you are having hair loss in the transplanted area, see your surgeon and get his/her opinion. I can not tell you much without seeing you.

Tags: hair transplant, hairloss, hair loss, injury, surgery

Do Transplanted Hairs Take on Characteristics of Hair That Used to Be There?

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

Hi,

I used to have a kind of cowlick on one of my temples. Over the years my hair in that area has gone. Since then I have had 2 successful transplants including replacing the hair in that same area. The new hair on the same temple has grown into a cowlick again even though the transplanted hair from my donor area is straight and the rest of the transplanted hair is straight.

Is this unusual in that transplanted hair has somehow taken on the characteristics of hair that was previously there? Do the cells on the scalp somehow have a ‘memory’ or ability to control the characteristics of what new hairs are placed there? Hope this makes sense!

Thanks

The transplanted hair almost always takes on the character of its source. In body hair transplants (chest to scalp) the donor hair often changes a bit, getting longer than when it was growing on the chest. There is no memory that I know of, but I do believe that the character of the skin may influence the character of the hair on a mechanical basis alone.

Tags: hair character, hair transplant, hairloss, hair loss

If Propecia Doesn’t Work Forever, What’s the Point In Using It At All?

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

Finasteride has been proven to help halt hair loss, but it has also been proven to lose efficacy after a certain amount of time. If this medicine only works for a finite period, what is the point of centering ones hair transplants around its short-term benefits? I understand if a person in their 20’s maintains intake of this drug it would keep them with a head of hair through their 30’s, but in their 40’s it will stop working and by that time their donor hair might be all used up. For a truly permanent solution, wouldn’t it be wise to wait until balding reaches a static level, and then go in for a hair transplant?

Nothing is that simple. Hair transplants (while permanent) are not the only answer. Did you know that you can have irreversible acceleration of the genetic hair loss from hair transplants? This is especially true if you are rapidly and actively thinning and if you are in your early 20s.

Another reason is that everybody’s goals and expectations are different. Propecia may not be a permanent solution, but what if it give you an extra 10 years of good looking hair without surgery? This option may not be satisfactory for you, but there are many others who would rather not have surgery and wouldn’t mind taking Propecia.

Tags: propecia, hair transplant, hairloss, hair loss

I Have OCD, Social Anxiety, and Early Hair Loss — I Want a Transplant Now!

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

Dear Dr. Rassman,

If one is in the early stages of MPB, is it possible to have a hair transplant straight away, and then keep having “top up” hair transplants as the hair behind the transplanted hair begins to recede? I wanted to take Propecia to begin with, but I am petrified after reading about the possibility of irreversible sexual side effects. I know that some people, including yourself, believe that these may all be in the mind, but the problem is, I am very fragile mentally (I suffer from depression, OCD, and social anxiety), and so I believe that I could be more likely to suffer from them because of this.

Many thanks.

If you are “petrified” about using Propecia, maybe the drug is not right for you. You are already biased against the drug and if you do have an obsessive-compulsive disorder and anxiety issues, it will be a difficult hurdle. I do find that most people who are very apprehensive about the side effects of Propecia almost always end up with the side effects. This has been corroborated by other hair transplant doctors in the past. In that sense I think there is something to be said about the negative placebo effect. I do not mean to shed a negative light onto your issue with medication, but in the end I believe you should speak to a doctor about your options.

With respect to hair transplants in men in their early 20’s with early stages on MPB, I generally do not recommend transplanting at that age, because you may do more harm than good. The process of hair transplantation may accelerate the MPB and you could end up looking even worse after surgery. This is a generalization and you also need to address this one-on-one with a qualified physician.

In the end, there is no easy answer and I do not have all the solutions.

Tags: hair transplant, ocd, anxiety, propecia, hairloss, hair loss

Female Corner Hairline Loss – An Interesting and Unique Situation (with Photos)

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

This patient had corner hair loss on one side of the hairline following a brow lift that she had done in 2003. We transplanted that weaker corner with 509 grafts in 2010. This is a unique case since we rarely just do the one corner, but the patient wanted to transplant just the left since the right corner did not show the same severe hair loss. We also treated the scar from the brow lift itself.

The corners of the female hairline often have slower growth than the middle of the hairline, so when one corner is transplanted with donor hair it will likely grow longer, thicker, and faster than the original corner hair. Why? Well, because her native hair in the hairline probably has a hair cycle measured in months rather than years. Now the hair that was transplanted at the left corner will most likely have to get cut frequently to maintain symmetry with the other side. We’re now planning another procedure to balance the sides out.

Anyway, this is a unique case and wanted to share. Click the photos below to enlarge.

AFTER – 9 months post-operation (509 grafts):

 

BEFORE:

 

Tags: hairline, female hair loss, brow lift, hair transplant, hair loss, hairloss

Why Do You Prefer to Prescribe Propecia Rather Than Transplanting?

/by William Rassman, M.D./23 /,

You have not made it clear why you would prefer to prescribe drugs for hairloss rather than a surgery. It is safer in every way to administer a hair transplant. Perhaps you realize that patients will opt out of treatment altogether since many men would never consider the very significant and costly method of pursuing a transplant?

I would use a non-surgical recommendation for a wide range of problems (e.g. many forms of heart disease, Parkinson’s disease, epilepsy, herniated lumbar disc). In some situations, I would recommend hair transplants as I get to know the patient if I am convinced that it is in his best interest. That puts the burden on the patient to convince me about his agenda.

I am not a plumber who is fixing a leaky pipe. I am a caring, responsible doctor who always does the best thing for his patient. Think about how strongly I must feel about this. I would rather offer a free consultation and then prescribe Propecia for a total fee to me of $85. My average surgical fee exceeds $5000… so I must really believe in the welfare of my patients to turn that down.

Tags: propecia, hair transplant, hairloss, hair loss

A Couple Months After My Transplant, My Scalp Was Exposed to the Sun

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

A week ago my grafts were exposed to the sun for approximately 10 mins. I didn’t burn but I did go slightly pink most noticeably on my right temple. To be honest I didn’t worry about it at all at first as from what I gathered from researching previous posts here your pretty much safe up to a first degree burn.

Over the last couple of days however I’ve lost a few newly sprouted transplanted hairs where the discolouration is on my scalp. In fact they emerged just before I was exposed to the sun so only 1 week old. I’m slightly concerned as I assume the only reason this would happen is if the follicles were going back into a resting phase or if they have died.

Is it possible sun exposure can cause follicles to shed but then regrow? I’m 9 weeks post op and had just experienced some early growth about week 7/8. Your opinion would be greatly valued.

SunnyI wouldn’t think you have anything to worry about regarding your sun exposure. I don’t know why your newly emerged grafts disappeared, but 10 minutes in the sun will not harm the follicles and I doubt it will affect your scar. The ultraviolet light is what you want to avoid, so in the future I’d recommend applying sunscreen to your scalp (SPF 45 or higher).

If you are still worried, follow up with your doctor.

Tags: hair transplant, sun exposure, hairloss, hair loss

How Full of a Transplant Could the Baldest Pattern Yield?

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

There’s little I can do to make this question less vague, but if an average man, with an averagely sized head, and average hair density/ thickness, who has reached the worst class of male pattern baldness, ever be able to achieve a look of a full head of hair through transplants? I’m not yet there, but discovering hair transplants gave me hope. Discovering their limits kinda scared me a little.

By a ‘full’ head of hair, I am aware that the original density will never be achieved, but is it possible to perform a procedure giving the appearance of a full, even head of hair with no signs of balding? Thank you.

Norwood 7The appearance of a full head of hair (just what you said) is what this is about. If you look at this patient, you will see a fully advanced Class 7 pattern, which is about as bald as you can get. He had almost 10,000 grafts to get this coverage (about 25,000 hairs transplanted). Considering that the average man you discussed above has 100,000 birth hairs, that means that the patient in the link would have moved his entire donor area to cover his head, leaving him almost bald on the side and back of his head. Obviously, this did not happen here, because this patient had a very high density to start (probably born with 200,000 hairs). I know that because with his high density, he could have had another 5000 grafts transplanted if he needed it.

I did not present this man to confuse you, but rather to show you what the worst case balding could look like if the supply of donor hair has very high. Many of our patients with advanced balding may only have 7,000 grafts of donor supply, which then must be distributed artistically by a skillful, experienced surgeon to create the illusion of a full head of hair.

I would suggest that you look at our website and the hundreds of patient examples shown in our Patient Photo Galleries. If it is said that a picture is worth a 1000 words, here’s 1000 pictures that are clearly worth more than that.

Tags: hair transplant, patients, density, hairloss, hair loss

Correcting a Bad Hair Transplant

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

What if my transplant is bad and I’m scarred badly?

I really don’t have enough info about what is bad about your transplant, but since I’m sure I’ve answered questions about repairs before, perhaps another physician’s opinion would be valuable to the readers of this site. Coincidentally, I recently read a post on the IAHRS site from Melike Kulahci, MD that answers your question about corrective procedures — Is It Possible To Have a Normal Looking Head After a Bad Hair Transplant?

Side note: I have met Melike Kulahci, MD at the various physician meetings and she is clearly one of the outstanding doctors in this field today. We have shared some stories from time to time and we agree on most of the clinical issues before us.

Tags: hair transplant, corrective procedure, hairloss, hair loss

Is There Professional Jealousy of Dr Gho’s Technique?

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

Comment received in response to the recent post about Dr Gho’s technique:

Sorry doc, but the difference between his procedure and yours is that his does not deplete the donor. He has proven this over and over again both with patients and peer reviewed journal articles. He uses a smaller, wave tipped needle and a special storage solution to make this possible. I would suggest that you look into his procedure further before making blanket assumptions and accusations out of what appears to be professional jealousy? With respect.

I have no professional jealousy here. When I watched his video at one of the medical meetings where he presented his technique, what I clearly saw was FUE. I polled the doctors that viewed it (unofficially) and most people agreed that what they saw, looked like FUE to them. On my next trip to Amsterdam, I will call and ask him to allow me to view his technique up close.

Tags: gho, hst, stem cell, fue, hair transplant

Scars from Strip Harvesting Surgery

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

I have a terrible scar from a previous hair transplant in the donor area. What can be done about it?

If you find that you have a scar from your donor harvest that you find is unacceptable, these options need to be discussed with a competent doctor. The scar often has ridging from the nature of the closure and that will be determined by the doctor who evaluates you. Scars from the donor area are not uncommon and when the surgery is done by a competent surgeon doing standard of care work, scars may still form and be the result of the way your body heals. The treatment of scars are as follows:

  1. Do nothing
  2. Perform a scar revision with a surgeon who can do trichophytic repairs and use ACell in the wound to give you the best opportunity to heal it.
  3. Have FUE into the scar. This can fill in the scar, but hair direction may not be controlled by the surgeon, making the results often disappointing. Two sessions into the scar may be needed.
  4. The use of Scalp Pigmentation has been a significant breakthrough in our hands. Risks include change of color (unusual for the back of the head where hair covers the pigmented area protecting it from the sun). This will not address any ridging in the scar area.
Tags: scar revision, scarring, hair transplant, smp

ISHRS – Comparing Strip Harvesting and FUE

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

For whatever reason, we seem to receive questions about the same topic in clusters. One week, I’ll get a bunch of Rogaine questions… the next week, it’s Propecia time. This week, I got a few about the strip technique versus follicular unit extraction (FUE).

I found a nice article on the ISHRS site that compares strip harvesting to FUE, which I hope will answer some of those questions I’ve got in the past few days. Topics include graft survival, scar formation, and technical expertise.

Link: Comparison between Strip Harvesting and Follicular Unit Extraction: A Fair and Balanced View

Tags: fue, hair transplant, hairloss, hair loss

DUPA and BHT

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

hello mr Rassman long time reader here, you doing a great job here i must add. my question today is regarding my Diffuse Unpatterned Alopecia (DUPA). i’ve had dupa since the age of 17 im now 24 and i still have a decent amount of coverage.

i was thinking about a possible body hair transplant in the future and was wondering if hairs in the beard, pubic area and chest are viable as im looking for the fullest coverage. i for one don’t care about growing this hair out i would plan on keeping it very short shaved. as i am still 24 and still going through changes in terms of body hair i want to wait till im in my 30’s so i have more hair to harvest

what do you think of my chances in terms of having a transplant like this? would i need to take meds after this to maintain the new hair? is the hair permanent? thank you for your time

Body hair may or may not be permanent. I have never done a complete body hair transplant for a DUPA patient so I can not talk with experience under my belt. I suspect you can find someone willing to experiment on you to achieve the goal you defined above, but it would not be my recommendation.

Tags: bht, body hair transplant, dupa, diffuse unpatterned alopecia, hairloss, hair loss