Hair Stands Straight Up After Transplant

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

I had a procedure of 3000 grafts placed in the front and now 8 months later, the hair that grew out stands straight up like toothpicks coming out perpendicular to the scalp. Can this be fixed?

ToothpicksThe direction that hair grows after a transplant is determined by the transplant surgeon. Some doctors place the hair straight upward reaching for the sky like you reported, while others place them in a radial direction so that the hair looks like the spokes of a bicycle wheel. Some hair restoration procedures (like those of flaps), have hair that grows 90 degrees off pointing to the side. In all of these situations, the transplants or flaps permanently point the direction of the hair.

These are tricky repairs and most of the time the repairs are not able to correct the entire directional issue. I would advise setting up a consultation with me or a good hair transplant doctor in your area with lots of experience (I’m not sure where you’re located) to ascertain what, if anything, can be done to correct the problem.

Tags: hair transplant, hair direction, hair restoration, repair

My Grafts Started Growing a Month After My Transplant, Then Stopped

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

Dear Dr. Rassman/other doctors at Balding Blog,

I have gone through a FUE hair transplant 2 months ago and I have some concerns. I appreciate and look forward to your answers. (I have directed them to my surgeon already and just want to get a second opinion from a reputable source)

Around 1100 grafts were transplanted to my temporal area (to fill up the balding area in my left and right front part of my head). A few days after the FUE surgery, I noticed that all my grafts were around 2mm long. It has been 2 months since the surgery, and I noticed that around 5% of the grafts kept growing (at 2 months now, they are around 2cm long). At the 4-week mark, around 85% of the grafts have grown to 5-6 mm long but have stopped growing since then (so they experienced no growths since 4 weeks ago) and 10% of the grafts never grow at all since the surgery (still at their original transplanted 2 mm length).

Would you please tell me if the above situation normal or not? Assuming the 5% that keep growing will still continue to grow, for the rest of the transplanted hairs, after they shred, will they come back? I am a bit concerned that for the 10% that experienced no growth at all since the surgery, they will never come back after shredding. And is it normal for around 85% of the transplanted hairs to grow from around 2mm to 5mm after a month, then stop growing at the 1-month mark and begin their shredding phase and then come back a few months later?

Thanks.

Sometimes after a hair transplant surgery it may seem like the hairs are growing a few millimeters, but they are usually just hairs being pushed out before they fall out (since a hair shaft can be as long as 5mm beneath your scalp). If you gently tug on those hairs you may notice how easily they come out. Otherwise, I suppose anything is possible.

With regard to your observations on the rate of growth, I would wait another 2-3 months and then reassess your situation, hopefully with your doctor. At that time, please feel free to send me a follow-up if you’d like to update our readers.

Tags: hair transplant, hair grafts, regrowth

Do Hair Transplants Take Longer to Grow After Multiple Surgeries?

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

I have undergone my 3rd hair transplant surgery in March 2010 and I am at the 8 month mark. I am mostly satisfied with my results, but hoping for some more growth and increased density. I was wondering if the transplanted hair takes longer to emerge and mature when you have had successive hair transplants. I was told by my doctor that the hair transplants take longer to emerge after the third hair transplant and i should expect some more hair growth and increase in density.

I would like to get your thoughts around this. Thank you.

I’m not sure why your surgeon would’ve told you it takes longer for hair to grow after the multiple procedures, because the growth period is roughly the same for each surgery. The third surgery should grow at about the same time as the first one did. If you are concerned about growth, speak with your doctor again. I occasionally see some growth occur between 8-12 months, but that is usually in addition to what is grown by the 8th month.

You should be alarmed if there is no growth within the one year time frame, but less concerned if it has only been under 6 months. In your case at 8 months, you should see some good growth by now with hopefully a little more in the coming months.

Tags: hair transplant, hairloss, hair loss, hair growth

What If I Need Chemotherapy After I Have a Hair Transplant?

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

If you get a hair transplant and later get diagnosed with cancer, need chemotherapy and lose your hair, what do you do about the scarring and dots where the transplanted hair previously was?

I would think that if you have cancer, a hair transplant or its scar would be one of the last things on your mind. If you do end up going through chemotherapy and lose all your hair, you will see the scarring.

But while most of us do not plan on having cancer or chemo in our lifetime, if it happens to you and you are worried about the scar, you can wear a hat or a wig as most chemo patients do.

Tags: chemotherapy, chemo, cancer, hair transplant

ACell Hair Multiplication Study at NHI

/by William Rassman, M.D./14 /, ,

ACellLast week I wrote about the ACell presentation at the recent International Society for Hair Restoration Surgery (ISHRS) meeting that may have opened the possibility for a patient’s hair to be multiplied in his or her own scalp. ACell’s MatriStem has had some early success with growing hairs that were plucked and then placed into recipient sites on the patient’s scalp, and although this is a major breakthrough, significant work remains before this becomes a practical hair loss treatment.

For those that missed my post from last week, here is a little background —

    ACell, Inc. has developed and refined an Extracellular Matrix (ECM), a natural biological material derived from porcine (pig) tissue. When ACell’s MatriStem product is placed into a surgical site or wound, it is reabsorbed and replaced with new, more supple tissue, rather than a firm scar. The ECM stimulates the body’s own cells to form new tissue specific to that site. When applied to hairs plucked from elsewhere on the body, this is called “auto-cloning”, as new hairs are derived from the process.

We are currently studying the use of ACell for scalp hair multiplication (auto-cloning) as well as the facilitation of wound healing in follicular unit transplantation procedures. For those individuals interested in auto-cloning, we will be happy to see you in the office for a more in-depth discussion of the opportunity. Details will not be discussed over the phone but will be covered by the doctor during your consultation.

People interested in working with us in a study can participate at no cost, but because of the newness of the process, we will be selective as to which patients we accept. A limited number of patients who are not selected for a study may be eligible to obtain this procedure as well for a special fee. We will also be using ACell in the donor area of on our traditional strip surgery patients to promote better wound healing at no additional cost. Please call my office at 310-553-9113 to set up an appointment for a qualifying examination.

Tags: acell, hair multiplication, new hair institute, matristem, hair multiplication

I Have a Hairline Like Joel McHale

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

Dr Rassman and co.,

Firstly, wonderful job on the blog. The content is balanced, informative and insightful to my research – big props! I am early and my research and considering coming to one of your seminars, as I am located close to your San Jose office.

I was hoping you could first give me some perspective. I believe I am around a stage 2 and wanted to get a confirmation on this. My hair line is almost identical to Joel McHale’s pictured here: photo

I am planning on going the FUE route and I am wondering about how many grafts it would take a patient, such as the one in the picture, to have a better hairline upfront.

Thank you in advance.

Joel McHaleThe photo you linked to of actor Joel McHale (from the shows “Community” and “The Soup”) might show what appears to be a Norwood class 2 or 3, but we’ve written in the past about his possible hair transplant. Without a close look at his hairline, I can not tell for sure what class he’s at now.

Without seeing you or at least seeing good pictures, I can not give you an opinion about your individual case. Graft needs depend on more than just looking at the size of a bald area. We need to also consider hair character, skin contrast, etc.

I also generally do not advise surgery on Norwood 2 patients or younger patients unless they fully understand they will never have a full hair density they desire. Plus, they need to understand that they may continue to lose hair in the future. In fact, hair transplants may precipitate more hair loss as a direct result of surgery itself.

Tags: actor, celebrity, soup, community, joel mchale, hairline, hairloss, hair loss, hair transplant

How Many Grafts Would Be Needed to Fill In a Norwood 7?

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

Hello, I’m dealing with MPB and am currently at 3 or 4 on the Norwood scale. I’m considering a transplant sometime soon. I have no allusions of obtaining a pompadour, rather I would just like to cut my hair short after the procedure and have it look like a buzz cut.

My question is, worst case scenerio, if someone came in with a Norwood 7, how many grafts would it roughly take to completely fill in the bald area. I understand there are a lot of contributing factors (ie. available donor area, quality of donor hair, et cetera), but I would just like a rough estimate (3,000-5,000?) if possible. Thanks in advance!

There are many ways to answer this question, but it varies by the quality and the availability of the hair to tackle the job. Every person needs a Master Plan when undergoing any surgical hair restoration procedure. The available supply varies in individuals and some people will never have enough hair to fill in a Class 7 pattern. Everyone is different with their own preference for hair styles.

Generally speaking, hair transplant surgery is limited by the number of grafts (hairs) you can donate. A few thousand hairs will never look like tens of thousands of hairs. Thus, hair transplantation takes advantage of hair color, skin color, hair texture, hairstyle, and hair length. The longer you keep your hair, the more full it will look. In other words, keeping your hair short in a buzz cut will not be the best hair style choice if you are considering a hair transplant surgery. These are the some of the issues you need to discuss with a hair transplant surgeon before you consider the surgery.

Typically a Norwood 7 patient will require 7000+ grafts to cover the entire balding scalp, but I must reiterate that it will NEVER be enough to look full with a buzzed haircut (even if you transplant 8000 grafts). You must understand that a Norwood 7 patient likely lost about 70,000+ hairs from a 100,000 hair starting point.

Tags: norwood, hairloss, hair loss, hair transplant

Hair Transplant and Hypohidrotic Ectodermal Dysplasia

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

Hi. Yesterday i was diagnosed with Hypohidrotic ectodermal dysplasia. I was wondering if you know anything about having this disease and hair transplants. Since I was born with this can insurance cover it? I have spots and places where my hair will not grow. It requires me to wear hair extentions , and im thinking about a wig. Anyway , i was wondering if you knew anything about this.

Thank you

Yes, I do know about ectodermal dysplasia. It is a genetic trait which can affect hair (among other things). I do not know how insurance coverage plays a factor in this, but I doubt that hair transplantation will be an option. With ectodermal dysplasia there are defects in the hair and skin that may make hair transplants not possible.

Tags: ectodermal dysplasia, hair transplant, hairloss, hair loss

What Caused My Transplanted Hair to Thin 6 Months After My Surgery?

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

I’m 6 months into my hair transplant and it seems to be getting thinner from about 2 months ago. I was under a great deal of stress a few months back. Could that cause a thinning of the newly transplanted hair. I use Rogaine and Avodart every day. The doctor said it was ok to use on the new hair. At the 4 month mark it really looked promising. However it has definitely thinned since then. Any suggestions on the cause?

Hair transplant surgery is highly variable in terms of the individual patient, as well as the techniques used by clinics and doctors. Many people who have a hair transplant will actually lose some of their original hair and that may be the cause of what you are seeing.

The general estimate is that it can take 4-8 months to see results, and usually the majority of the results are visible by the 8th-12th month. I’d follow up with the doctor that did your surgery.

Tags: stress, hair transplant, hairloss, hair loss

My Hair Transplant Scar is Wider Than My Surgeon Promised

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

I recieved a transplant of about 3,000 grafts from another doctor about 12 months ago. 720 are 1 hair and 2,140 are 2 and 3 hair grafts. I am 23 years old and I am not very satisfied with the results. Hair is not as thick as I would hope and the scar is wider than promised.

I was looking into doctors that could possible thicken up the front a little bit and try and reduce my scar as much as possible so I can keep my hair shorter. I was seeing what your thoughts would be on this. I am not able to make it into your office very soon but I can forward some pictures for now so you could give me some initial thoughts if possible before a consultation.

Before undergoing a hair transplant surgery, you must fully understand the limitations and have reasonable expectations. The scarring is also highly variable in each individual and there is no way anyone can predict how the scar will turn out with total accuracy. Everyone wants a great outcome and minimal scarring, but you must understand surgery is not an exact science and no matter how great your surgeon is there is always a variability.

You stated that the results are thinner than you expected. The 3000 grafts that you received was spread over your balding area, so if your balding area was large (Norwood Class 4,5 6, or 7) then I might expect thinner results than if your balding pattern was a Class 3 or less. Also, the thickness of the hair shafts (fine vs coarse hair) will reflect the fullness that you received. The growth of the transplants (100% or 50% growth) may play a role as well. If I was able to see you, I would have an appreciation of these factors and then give you an opinion.

You can always email us or call us at (800) NEW-HAIR to set up a phone consultation. We usually request photos in advance and you can arrange a time to speak to one of the physicians to facilitate the consultation.

Tags: hair transplant, scarring, hair restoration, surgery

Hair Transplants for Woman Losing Hair from Antidepressants?

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

Dear Doctor

After reacting to several tricyclic antidepressants I developed telogen effluvium extending an already high forehead and thinning the temples. Large regrowth resulting in thickening hair has not really occurred. I have received conflicting advice from several doctors, ie. lowering the hairline surgically with transplants to the temples or lowering the hairline and thickening the temples using a transplant alone. The lowering would be in the region of 1-1,5cm. What would you advise here? Thank you.

Withing seeing you and examining you, I can not comment on your questions. I’m assuming you’re female based on the name you used (though I’ll keep that private). Female hair loss is difficult and complex to discover a cause for, especially when it is related to drug causes.

I don’t know how long you took the medications, how long you’ve been waiting for regrowth, hair loss history, etc… and honestly, I couldn’t suggest hair transplants without knowing much more about your situation. Make an appointment with us or check the ISHRS for an expert near where you live.

Tags: hair transplant, antidepressant, hairloss, hair loss, female hair loss

Prednisone After a Hair Transplant for Swelling

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

I consulted a hair transplant doc who prescribes prednisone for post-operative swelling. I wouldn’t want to take this due to its obvious side effects.

Have you ever heard of giving prednisone after a hair transplant and do you prescribe it?

Sounds weird to me (and unnecessary).

The use of short term prednisone following a hair transplant is common to prevent swelling in the first few days. Short term steroids are not usually a problem unless you are diabetic. This is a medical call by the doctor you are choosing. Please address this with your doctor so he/she can better explain the issue and address your particular concerns.

Tags: prednisone, steroid, hairloss, hair loss, hair transplant

Over a Year After My Hair Transplant, I Look Exactly the Same

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

This has been a great blog for unbiased info- appreciate it.

I had a transplant surgery about 13 months ago, mostly on my front area, as one side of my hairline was receding and thus giving me a comb over look. It wasn’t that bad yet, but I could foresee it becoming worse so I wanted to get it taken care of immediately.

Well, 6 grand later and 13 months and I look exactly the same. After the surgery, I had plenty of thin, short hair spurting where the transplant was done. I was told those would fall out and grow back in thicker. Well, they fell out and have yet to grow back. I followed all the guidelines for recovery, have remained on Propecia daily as well.

One thing I did notice during the surgery (I was awake) was that the actual doctor did very little of the ‘harvesting’. His interns/aids did 95% of that and the doctor would come in every hour to take a look. Would this have anything to do with the hair not having grown back?

In this economy, 6 grand is a lot to lose and I feel as if I’ve been duped here. At the consultation their representative assured me I’d have a full hairline again and this surgery would be all I needed for life providing I stay on Propecia. Well, unless something drastic happens with my appearance due to this surgery, I will have to have another surgery providing I can afford it in the future.

Also, from what I’ve read, Rogaine will not help me in the frontal areas for hair regrowth/maintaining. Is there anything that will help?

Appreciate your time so much!

How long were you on Propecia prior to the surgery? Have you considered that you have continued to lose your native (non-transplanted) hair and now are left with just the transplanted hair? It would sort of be a one-to-one trade off. Unfortunately, you will continue to lose more of your native hair even with Propecia. Some people respond better than others, but perhaps you weren’t a good responder to Propecia. I’m just guessing though, as I don’t have all the information.

Another possible scenario is that your surgery was a failure due to problems that occurred during the procedure. Again, I’m just guessing as I have no idea what was done during the procedure. I’ve written before about what issues could’ve resulted in the transplant to not grow, and it seems that most of the problems that occur are with the technical staff. Technicians are an important part of the procedure in cutting and placing the grafts, and the doctor does the cutting of the strip and placement/design of the graft sites. Have you spoken to the doctor that did your surgery?

I stress getting a Master Plan to remind readers as well as my patients before undergoing any surgery.

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

I Had FUE Surgery a Few Months Ago — Where’s the Growth?

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

Hi, i have had a Fue hair transplant on the 28th of May 2010. I Have not experienced or noticed any hair growth on the transplanted areas. I would like to enquire how long before the graphs become visable and noticable in the transplanted areas.

Thanking you for your assistance and helpful advice.

It generally takes anywhere from 4 to 12 months to see results from a successful hair transplant surgery, regardless of whether strip or FUE was used. You may be on schedule. Be patient and check in with your surgeon if you have concerns going forward.

Tags: hair transplant, fue, hair growth

Hair Transplant After Using Accutane

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

Hi Doc,
I was taking accutane for 6 months and 3 months after I stopped it I had a HT. Now at 4 months after my surgery I don’t see new growth. I didn’t noticed any hair loss during the accutane treatment and I didn’t have problems with wound healing. My scar has healed very good and the scabs have fallen 8-9 days after the surgery without shedding of the transplanted hairs. Should I be worried about the final result of the surgery?

AccutaneNot all hair transplants are the same. There are subtle things that different doctors or clinics do that can affect the surgery. In other words, you are not getting the same product as you would when you buy cars at different dealers. You need to ask your surgeon these things, because I don’t know what went on in your procedure or what techniques were used.

In general, it can take up to 6-8 months before you see results and up to a year to see the end result.

Accutane is well known to cause hair loss, but I do not know how that would impact a hair transplant in your case.

Tags: accutane, isotretinoin, hair loss, hairloss, hair transplant