Pain in Donor Area a Week After FUE

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

Hi Doctor,

I had a 1500 FUE session 7 days back. My donor and recipient sites has healed well. Everything looks normal. But since the 3rd day, I have been having a lot of pain in the donor area. Its a burning pain. For some reason it gets better at times and worse for no reason. The whole area, although well healed and looks normal from the outside, is sensitive to touch and a bit numb too. Is this normal? I talked to my doctor. He asked me to keep taking the pain killers and give it more time. Is this something to be worried about? Is it going to get better? How much time would it take? Can this be a nerve damage of some type? Is that a possibility? I would appreciate any info/help on this. I was told there is almost a zero chance of nerve damage in FUE.

Thanks.

Pain is subjective and it certainly is reasonable to have post-operative pain as many small nerve endings were traumatized. There is always some degree of nerve damage when you cut through the skin (that is why it hurts). The main issue could be major nerve damage that runs along the back side of your scalp. These are the greater occipital and lesser occipital nerves. My recommendation is to follow up with your doctor and have him/her examine you.

By the way, not all follicular unit extraction (FUE) is the same; each doctor can use a slightly different technique and different instruments. So I couldn’t say how slim your chances were of having a complication, because I don’t know how the procedure was done. You’re not alone though, as I had a similar question posed here.

Tags: fue, hair transplant, pain, nerve damage, nerves

Hair Transplant Failures and Survival Rates

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

SurvivalAn article written by Dr. Michael Beehner in the most recent issue of the Hair Transplant Forum (print newsletter published by the ISHRS) discussed survival of hairs in a hair transplant. He had done a study where he created five 1cm square boxes of grafts on a human volunteer just in front of the crown of the head. He separated grafts into each box focusing upon how the grafts were harvested and trimmed. One and two-hair grafts were studied. The tests followed the growth as long as 19 months. He showed that one-hair grafts which were trimmed very close and skeletonized had a 48% survival after 19 months. It was also shown in other publications, that grafts that are allowed to dry when out of the body also fail to grow. Grafts are out of the body when they are put into recipient sites, so the skill and experience of the staff clearly relates to the end results one expects to see.

Of interest, he noted that there was a significant increase in hair growth between the 14th and the 19th month of the study, reaffirming my own view that the transplant results get better over time. Doctors who create “chubby” grafts and leave the sebaceous gland with the grafts and a good fatty cover to the hair shafts, get growth in the 98% range at 19 months (up from 66% at 14 months), according to the study. Chubby grafts will also leave behind telogen hairs within the grafts that in some previous studies reported hair growth that exceeded 100%. There is a clear difference between the number of hairs that survive the transplant and the number of graft that are transplanted (as each graft can have more than one hair).

Lately, quite a number of our readers have written me about poor growth from their hair transplants and we’ve posted quite a few of those here. I have always directed these people back to their doctors and suggested that if they do not get the answers they want and need, they should get a second opinion. The main bit I hope you learn from this is that there’s really no substitute for a team consisting of a knowledgeable surgeon and an experienced, skilled staff. You don’t want to have your time, money, and available donor grafts wasted by a surgeon or his/her clinical team.

Tags: hair transplant, failure, hairloss, hair loss, clinical study, hair growth, hair grafts

Using Toppik to Provide More Density After a Hair Transplant

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

If you don’t have enough density to cover a full Norwood 6 with a transplant, what is your opinion of doing light coverage and then using Toppik and/or other concealers (for life) in order to give the appearance of more hair?

ToppikI’ve posted a couple cases about this. Those with very fine hair will have a harder time obtaining coverage, and the use of concealers with the transplants can work quite well. So yes, I absolutely think it’s a good idea if you want to use these camouflaging agents.

See these posts for some good examples:

  1. Use of Concealers (with Photos)
  2. Can a Class 8 Person be Transplanted? (with Photos)
Tags: toppik, dermmatch, concealer, hair transplant, hair loss, hairloss

Scratching Out FUE Grafts a Month After Surgery?

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

Hi Dr. Rassman,

I’ve had a hair transplant a month ago. Is it still possible for me to scratch my implanted FUE out?

Thank you

I would usually say no, but I have seen some strange results and methods of hair transplants over the years. Not all FUE (follicular unit extraction) is the same and not all hair transplants are the same. If you are able to pull out a graft one month after surgery, then it was never going to grow anyways. Under most circumstances though, the graft has already taken hold by then.

Tags: fue, hair transplant, hair loss, hairloss

No Growth 7 Months After from My Hair Transplant (with Photos)

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

Thanks for the informative site! I’ve searched for similar questions and answers, you’ve addressed delayed and no growth from transplants before, so hopefully this isn’t repeating too much from others. I’m 29 and had a hair transplant with a reputable IAHRS doctor seven months ago. 2400 grafts total were used, placed in the front 1/3 of my scalp to thicken my front and fill up my hairline.

It’s been seven months and the only growth that has occurred are a couple or so dozen hairs that didn’t shed during the two weeks following surgery. Those started growing further at about 3 months and are still growing, but it looks as though nothing else has even begun to pop through. The only possible explanation I can think of is concerning ridding my transplanted area of scabs post-op. 14 days after surgery, the scabs started to raise up and I went through with the balls of my fingers and gently rubbed them off, in some cases gently picked them a bit to rub them off (a few also peeled like dead sking does). There was no sign of trauma and with the scabs came the small hairs. So I shed about 90% or so of the hairs at 14 days. I discussed this with my doctor and he said there shouldn’t have been graft damage and any grafts coming out would’ve been followed by bleeding.

Is there any explanation(s) for this delayed or potentially little growth from my transplant? I’ve read articles about some transplants having delayed growth for up to a year due to different types of hair cycles. Could the rubbing and slight picking off of scabs after 14 days taken the grafts out or traumatized them to lay dormant longer? I’m sending before and after photos. Thanks!

You sent a lot of photos, but unfortunately most of them were from a distance and poor quality, so they don’t help me see much. The two best photos are shown below (click to enlarge) — the left photo is from 1 day post, the right photo is from 7 months post surgery. There does not appear to be any growth and I would expect that something should have shown by now.

 

Sometimes transplanted hairs can take up to 12 months before it grows, but usually there is some growth by 7 months. You should see some results between 5-6 months post surgery. I would give it up to a few more months, but definitely follow up with your hair transplant surgeon. I really do not like the unusual zig-zag hairline the doctor placed, as evident in the 1 day post-procedure photo.

There are MANY factors that go into a successful hair transplant surgery. Each and every hair graft/follicle can easily dry up and die if not handled and transplanted by a professional medical team. That is why choosing the right doctor and the right medical group is very important. In other words, it is not like buying a car from a dealer who can get you the cheapest out the door price. Despite what the consumers may think, not all hair transplants are equal (even if they advertise the latest techniques).

Tags: hair transplant, hair growth, surgery, hair restoration

Estimating Graft Count for 2 Inches of Hair

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

Dear Dr. Rassman. I was wondering roughly how many grafts, single to double hairs, would be required to fill an area of 2 inches? I have straight medium weight, dirty blond hair.

The average hair density is 1250 hairs per square inch (or 600 follicular units). So a 2 square inch area would contain about 2400 follicular units.

For the appearance of fullness, medium weight hair is certainly better than fine hair, and dirty blond hair with a white skin is better than black hair on white skin (less contrast is better). Take a look at the NHI Patient Photo Galleries, where there are well over 300 patients showcased with before and after photographs, and the number of grafts they received to obtain those results. Also, take a look at LA Sportscaster Steve Hartman‘s photos and see if the area you have roughly parallels his. His hair was medium weight, though he has black hair and white skin.

Tags: hair transplant, hair loss, hairloss, grafts

Hair Transplant Doctors That Charge By the Session vs By the Graft

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

Can you please translate this.

I always thought that most hair loss surgeons charged by the graft. However, I noticed the following on a certain surgeon’s website. The surgeon is very well known and highly respected, so I don’t believe he is playing a pricing game, but I have no idea of what is meant by “charging by the session and NOT by the graft.”

Also, how could charging by the graft be misleading, like the wording claims? Please explain what he is trying to say and clarify how you charge.

From a certain surgeon’s website: “At (name removed), we try to keep hair surgery affordable. We charge by the session, not by the graft or hair, which can be misleading and overly expensive.“

CountingMost hair transplant clinics do charge by the graft. I think the surgeon who made the above statement clearly believes session charges are less misleading and have a greater value than graft charges. At one time, I entertained the idea of doing a session charge rather than a per graft charge, but I ran into a problem working through the details of the charging mechanism. For example, if a person had a session charge for 400-800 grafts and then another charge for 801-1200 grafts, would the person who paid for 801 grafts feel cheated when he knew that someone else paid a lesser price for 799 grafts? I think that a patient would want to know just what they are getting and per graft charges really reflect, in my opinion, the amount of work done and the value in transplanted hair to the outcome. Iin this example, there is almost no difference between a charge by the graft for 799 vs 801 grafts, compared with a big step up in pricing for a session charge.

Charging by the graft is like a lawyer charging by the hour. If the lawyer is honest in his hourly billing, the client actually pays for what he gets; likewise, if the surgeon actually delivers the grafts that he says he transplanted, the same question of honesty is raised by the patient who should ask, “How do I know what I purchased in number of grafts were actually delivered?”. Here’s a few posts about ethics in graft counting that may interest you:

Tags: ethics, graft count, hair transplant, physician, hair transplant fees, hairloss, hairloss

Does Transplanted Crown Hair Grow Slower Than Other Scalp Areas?

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

Hello Dr. Rassman. I got a ht done just under 6 months ago and i’ve noticed that the crown has shown little to no growth while the top front half of my head has shown a significant amount of growth. Could it possibly be the crown is the last place that sees the new hair growth?? the difference between the front and crown is very drastic and looks as if no hair was even transplanted in the crown. Im on week 25 so should the new hair in the crown have grown by now or is still too early? also, i still have those little red dots on my crown area but nowhere else on my scalp.

thanks in advance

Little red dots on your recipient area may reflect folliculitis and this can, on occasion, kill the transplants if not treated in a timely manner. You need to discuss this with your surgeon as he/she has a vested interest in your outcome.

I have often seen differences in the rate of growth from front to back or right to left. I would not worry a great deal if this is a rate dependent variable, unless you do not see the results you expect by the 8th month. I would expect some growth in most patients by now, but again, see your surgeon and discuss your concerns.

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

What If My Transplanted Hair is Pulled Out?

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

I have had two hair transplants. The last one being about 3 years ago. When I get highlights put in my hair, the hair experiences a lot of pulling during the process. If the transplanted hair is accidentally pulled out (in such a manner) does it grow back or is it gone forever? Thanks!

I’ve written about this in the past, but I recall a time when one of my patients was mugged about a year after his hair transplant. During the robbery they held him by his hair, beat him badly and when they finished beating him up, they pulled out his transplanted hair. He came to see me immediately after the beating and he was missing about 3 square inches of frontal hair (all transplanted). It grew back in 6 months.

An acute pulling out of the hair will not cause it to be lost, but chronic pulling will cause traction alopecia. There are many things that are chronic hair pulling experiences, most notably wigs at the points of attachment. These men who have such attachments will develop bald spots on the scalp that are permanent.

Tags: hair transplant, hair pulling, hairloss, hair loss, traction alopecia

Protecting Against Shock Hair Loss

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

I have researched that after the hair transplant surgery, there are some patients who are experiencing a common side effects which is Shock Loss. I would like to know if this is the fault of the surgeon during the incission? Is there a way to prevent the further trauma to avoid more hair loss after the transplant? I am thinking of having this procedure done, but very much concern of loosing more hairs after the hair transplant. Please educate me. Propecia is commonly prescribed to patients before the surgery, but do you have to take this drug for the entire life or the remaining hairs will soon fall out

Shock loss is a hair loss process that accelerates immediately after getting a hair transplant. It usually occurs in the first 4 months after the surgery. Generally, Propecia will protect against most post-surgical hair loss from shock and it should be taken for a period to discuss with your doctor. The longer you take it, the better, but as hair loss is a progressive process it will kick in again when you stop the drug.

I generally recommend for patients to stay on Propecia for 9 months minimum just to deal with the threat of the shock loss, but that is not a hard rule. Everything depends upon your examination and the relationship you build with your doctor. I generally think that if you are serious about preventing any loss, men with genetic loss are best treated long term (lifetime is long term) with Propecia (finasteride).

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

My Boyfriend’s Hair Transplant Didn’t Grow Back After Shaving His Head!

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

Dear Dr. Rassman,
My boyfriend had a FUE operation using hair both from the back of his head and his chest (all together about 1200 follicular) to cover the toothbrush look of his previous punch graft operations on the frontal part of his head. After less than six months the result was so great that everybody was under the impression that with another operation or two on the crown part of his head he would have a 70 to 80 percent of his previous normal hair days look back.

Approximately eight months after the operation he completely shaved his head with a Gillette Fusion razor with the hope that his new and old hair may look thicker and more ready for the next operation, but to everybody’s surprise (not to mention his horror) only 40 to 50 percent of his newly transplanted hair has grown back (after two and half months now) and the look of his frontal head now can be described as balding with previous plugs being visible again. I would really appreciate your comment and/or advice on the matter.

RazorFUE is not a perfect technique and it has a higher failure rate than the standard strip surgery, as the follicular units are often stripped of fat at the bottom of the grafts. Also, body hair transplants do not work to my satisfaction, because body hair does not grow the way scalp hair does. Body hairs do not grow continuously like scalp hair, as it is in its resting phase much longer. That is why most doctors do not perform body hair transplants; it’s not because body hair transplant is difficult.

Aside from these generalizations, I would only be guessing as to what caused the hair to not regrow after shaving it. And providing a guess would not be fair to you, your boyfriend, and even the surgeon. He needs to go back to his surgeon and follow up with this issue.

Tags: fue, body hair, bht, hair transplant, hairloss, hair loss

Is Elocon Safe to Use on Transplanted Hair?

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

Hello Doctor

this Elocon lotion is supposed to be massaged on the scalp topically in order to fight seb derm (a few drops per application, once a day for a few days)

Is it safe to use it on
a ) transplanted hair
b ) healthy non transplanted hair

Is there a hair loss risk , and if so , permanent or temporary ?

Thank you in advance

EloconElocon (mometasone) is a topical steroid and there is plenty of information on the Drugs.com site. It specifically states that Elocon can cause “swollen hair follicles”. Does this mean that you may lose hair? Well, the term swollen hair follicles is not one I am familiar with. Steroids applied to an area of hair loss can accelerate hair loss.

If I can provide some help it is that healthy non-transplanted hair is equal to transplanted hair. It is YOUR hair! I mean, that is one reason people get hair transplants and not wigs! So if a drug can harm your healthy hair, it can also harm your transplanted hair.

In the end, Elocon is a medication that needs to be prescribed by a physician. The use of topical steroids can be dangerous when not controlled by a doctor, so you need to discuss with your physician the risks and benefits of using such medication. Please do not read this as my trying to brush you off or not address your issues. My role here is limited and I give general opinions.

Tags: mometasone, elocon, steroid, hairloss, hair loss, hair transplant

I Don’t Trust My Doctor After My Hair Transplant Consultation

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

I am planning to undergo hair transplant. I have consulted a doctor in Delhi (India). He has suggested that I will require 3500 grafts. He says he will perform the hair transplant from 9:30 AM to 5:00 PM. My concern is: Can he place 3500 grafts in one session in one session or is he just cheating me? Because placing 3500 grafts skillfully might require more time.

Please advise whether 3500 grafts can be placed in one session.

It would be rare for an Indian to have enough density to allow for even 2500 grafts, as the typical Indian has a much lower density than Caucasians (who might yield 3500 grafts). With the time he quoted, it would be unusual for that to occur as well. In the hands of experienced hair transplant surgeons in the US like me, it generally takes 7-8 hours. Plus, you are questioning his honesty and that alone should raise a flag.

To be sure that he can do this procedure, ask to meet other patients who have had this done so you can see the results of that work. There is no substitute for meeting and seeing patients who have experienced this.

Tags: hair transplant, hairloss, hair loss, surgery

Splitting Follicular Units, Surgeon Precautions?

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

Is it possible and convenient for you to provide the clarification on the following?

  1. What are the effects of keeping donor hair out of body for a long time?
  2. What is the advantage of follicular units not be split.
  3. What are other precautions/questions should I be asking the surgeon over here in India?

Yes, it is possible to clarify:

  1. If they are kept moist ALL of the time, they can stay out of the body for up to 8 hours safely without loss.
  2. They are naturally that way and they look best. If the units are split into smaller than follicular unit, you have the risk of follicular death.
  3. I’ve written much about things to look out for when choosing a hair transplant surgeon. Check out these featured posts: Selecting a Hair Transplant Doctor and How to Avoid Dishonest Hair Transplant Doctors.
Tags: hair transplant, hairloss, hair loss, follicular units, surgeon

Transplanting Hair Into a Cleft Lip Scar, Follow-Up

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

This is a follow-up to a post last week, Transplanting Hair Into a Cleft Lip Scar:

Hi Dr. Rassman, this is a continuation from the cleft lip question. I forgot to add, the failed surgery was due to laser surgery. It became a hypertrophic scar after the laser surgery. So not sure if hair transplant is possible for that??

thanks for answer the question though

For a specific case, I’d need to make an examination to see what could be possible. Generally, transplanted hair grafts in real hypertrophic scars (keloids) often do not grow as well.

Tags: keloid, scarring, hair transplant, cleft lip, hair loss, hairloss, facial hair