Growth After Hair Transplant

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

I had a hair transplant of 2010 grafts almost going on 5 months ago. My hair stylist tells me that the transplanted hair goes through a cycle and will fall out approx 3-4 months after the procedure then grows back in. Is this true? And why does it look really good in some light then in different light? When I go to work, the lights that are on there make me look like I had nothing done! I’ve been feeling very frustrated at this point.

LightAny hair (even non-transplanted hair) looks thinner under bright light or certain lighting conditions.

In general, transplanted hair falls out within the first month or so and new hairs start growing in 3 to 4 months later. I tell every patient to wait 7-8 months before judging the results. Patience is a virtue! I can’t tell you if your surgery was a success or not. You need to go back to your doctor and ask to see your before photos to compare for yourself. Also, ask your doctor his/her professional opinion on the matter. Whatever you decide to do, you will not know the results until 7-8 months after the transplant was done.

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

Temple Reconstruction Results (with Photos)

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

The patient elects to wear a hair system, which explains why it appears that he has a full head of hair in the After photos. The system, however, doesn’t extend to the sides of the head / temple peak area, which was the targeted transplant area. He had exploited his donor area with many transplant procedures and the available donor hair was limited. The areas which were circled were plugs that came down below the leading edge of the hair system and these were removed at the time of the transplant. These are very difficult reconstructions and your surgeon and his team must be experienced when balancing risks and rewards. Harvesting a tight donor area in particular, has wound risks. This patient has extremely fine hair and the density of his donor area was poor. These two issues (hair thickness and donor density) produce a great challenge and in this patient required two surgeries to achieve his goals. Click the photos below to enlarge.

After (two procedures totaling 2151 grafts):

 

Before:

 

Tags: temple, hair loss, hairloss, hair transplant, reconstruction, hair restoration

What If I Want a Hair Transplant Without Taking Propecia?

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

Hello Dr. Rassman,

I have been following your blog for over two years. I appreciate the work you do.

I had a question about hair transplant procedure. I understand that before or during hair transplantation, patients are prescribed propecia to help with the results. How would the results be affected if someone opts to get into hair transplantation but does not take propecia.

Your input will be greatly appreciated. Thank You.

Some of my patients do not take Propecia (finasteride 1mg) by their personal choice. It is your choice as well. The risk is that you may have increased shock hair loss without taking Propecia before surgery. Shock hair loss is common in men under 30 years old or those who are losing their hair actively when they have a hair transplant. Propecia will prevent this complication in most men.

My personal opinion is that you are investing a lot of money in a surgery to have hair so why not try to maximize your return by taking Propecia?

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

12 Days After My Hair Transplant, I Massaged the Scabs Away

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

I have a very important question?

After my surgery, i started getting scabs (crust- normal), which lasted about 10- 12 days. After the 12th day, i decided to massage the scabs with oil. I did that for two days and further massaged it with my hands in the shower, used shampoo to wash it up. Now, i feel like i have made a mistake. massaging the scabs away? does it mean that my hair follicles are also damages and my hair transplant is a failure? I am scared and confused. please reply ASAP

We performed a study on grafts being secure after a hair transplant by pulling our grafts on successive days. We found that at 12 days, the grafts are secure. If you were gentle on the washing technique, usually the scabs that remain will loosen easily with soap and water. I don’t think you did anything to be concerned about.

You can read the article in PDF format here — Graft Anchoring in Hair Transplantation

Tags: graft anchoring, hairloss, hair loss, hair transplant, scabs, scabbing, aftercare

Density and Coverage From a Hair Transplant

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

This is in response to Why Don’t More Men Get Their Hair Back? —

I believe that for many it is also the fact that the coverage and density you get from a hair transplant is not considered sufficient.

If you look at photos/videos of men having hair transplants, the density is at times not great – i.e. very much see through.

If density + coverage was good (cloning?!), then I believe alot more men would go and get it done even though the price would be fairly high.

The amount of hair that is generally needed to give a man the coverage he wants/needs is upwards of 25% of his original density. As each man is different, the coverage of a single hair (one out of many) reflects:

  1. The thickness of the hair shaft (coarse hair has up to 5 times the coverage of fine hair)
  2. The color contrast between hair and skin color (white/blond hair and light skin does better than black hair and light skin)

… so the hair requirements must be tailored to the particular patient. At our Open House events held each month, there are often 2 patients who stop by with black hair/white skin and a medium hair weight, and their results are spectacular. Sports news personality Steve Hartman had it done in one session and he does not have a see-through look, probably because his hair character is very good and wavy.

Generally, I tell patients to visit an Open House event so that questions such as those that you raised can be answered by meeting patients who have already had the procedure done. You are correct, of course, that people with fine hair may not get the fullness (density) they want and need, but such issues are best raised with the transplant surgeon.

Tags: hair transplant, hairloss, hair loss, density, coverage, hair restoration, surgery

I’m in My 60s and Losing Transplanted Hair — Would Avodart Stabilize That?

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

Hello Dr. Rassman,
In your opinion, would avodart as a substitute for propecia in my situation be ok to take & would the avodart dosage be more effective in stabilizing hair loss? I’m in my 60’s & the avodart sterility side effects don’t concern me. I have been taking propecia for approx. 8 years, & have been experiencing substantial hair loss in the last few years of even previously transplanted hairs from two HT’s as I was a Norwood 6-7, & had very thin, fine hair in my donor site, & quite bald on top.

I’m out of state now, but my surgeon is very well known & extremely skilled & I respect him & was enormously happy with my HT’s I had 7-8 years ago. I’m assuming my donor hair is one of the few cases where it wasn’t destined to last a lifetime. I still some have hairs on top, but quite thin & sparse.

I realize you won’t give specific suggestions concerning Avodart, but any direction would be appreciated. I don’ want to go back to wearing a hairpiece (over 30 years)! Thank you!

Taking Avodart (dutasteride) for a man over 55 years old and not concerned about fathering more children is a reasonable approach. I have heard from the transplant physician community that when hair loss is not stopped with Propecia, the use of Avodart may help.

I am curious about the loss of your transplanted hair, however. This should not typically occur and should be discussed with your surgeon. Don’t just assume! Talk to your doctor!

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

I’m in My 60s and Worried About Possible Shock Loss

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

I’m thinking about an HT, and after reading all your topics I see my biggest concern is shock loss. I’m a 61 year old male and have a high degree of miniaturization in the proposed recipient area. In one of your responses, I believe you recommended not having an HT for thinning hair?

You often recommend Propecia for younger men and say it might prevent shock loss for possibly 90+ cases? You also recommend taking Propecia 2 weeks to a month in advance of the HT(but even the day before the HT is better than not at all?). Would this advice apply to an older guy like me? Or if I’m correct that you would not advise cases of older age onset thinning to not seek HT?

Propecia works at any age to prevent shock loss. It is best to use this medication in advance of the surgery (at least 2-4 weeks). Older men generally have less hair transplant shock loss than younger men. I would need to know more about your miniaturization and your last 1-2 year history of hair loss. At 61 years old, few men are actively losing hair.

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

Using Baby Oil on Recent Hair Transplant?

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

Dear Sir,
I had recently done a hairtransplant surgery and starting from day one i started spraying the grafted area with johnson baby oil at night before going to bed and washing my hair with johnson baby shampoo every other morning and evening.

Do you think that gohnson baby oil might cause a problem to the grafts if the grafts are washed regularily.

your quick response will be appreciated
Best Regards

I don’t know why you need this routine, but I can not find a problem with it, provided that the daily wash is done properly. I hope you received aftercare instructions from your doctor.

Tags: baby oil, baby shampoo, hairloss, hair loss, hair transplant, aftercare

Developed Scabs 13 Days After My Hair Transplant

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

After 13 days post transplant, I developed lots of scabs on my head. I used a brush to help remove these scabs as it is said the scabs can damage the regrowth process. But using the brush removed much of the transplanted hair in one go along with the scabs. Was using a brush a mistake? Or would the hair roots not have been affected by the brush as it was on the 13th day?

Great work on the site, a real help.

Cheers

I do thank you for reading the site and I am more than happy to give you general information, but shouldn’t you be asking your post-surgical questions to the doctor who performed your surgery? Answering such specific and personal post-operative questions (simple as they may be) could be potentially misleading just by the fact that I do not know what was done in your particular case. I mean, developing scabs on 13th day (with no scabs prior) is very strange if I am reading your question literally!

Small scabbing (1 to 2mm size) on the transplanted recipient sides after a normal follicular unit hair transplant surgery is common, but very minimal. With daily hair washing it should resolve in a week or two. I am not sure how you brush your scabs away, but if the hair grafts are not locked in by that time, you run some risk of pulling them out with the scabs. I would ask your doctor and have it checked out to make sure it is healing properly. See our published article on the subject — Graft Anchoring in Hair Transplantation (PDF file).

Tags: hair transplant, hairloss, hair loss, scabs, scabbing, anchoring

Can a Hair Transplant Cure Migraines?

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

Does Hair Transplant cure Migraine too?

NYTimes.com – Plastic Surgery May Also Ease Migraines

Personal experience — after HT, forehead lines decreased considerably. Perhaps because of increased skin tension after a part of skin is removed?

MigraineFrom the article:

The double-blind study, published in the journal Plastic and Reconstructive Surgery, found that more than 80 percent of patients who underwent surgery in one of three “trigger sites” significantly reduced their number of headaches compared with more than 55 percent of the group who had sham surgery. More than half of the patients with the real surgery reported a “complete elimination” of headaches compared with about 4 percent of the placebo group.

No, a hair transplant would not cure migraines. Maybe it causes less headaches as you are not so preoccupied with balding, but a hair transplant wouldn’t be among the trigger sites the article refers to. Plus, this is all very experimental. Lots of work remains to be done, but thank you for bringing this to my attention.

Tags: headache, migraine, hairloss, hair loss, hair transplant, surgery, study

Reactive Hair Loss?

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

Please explain to me what reactive hair loss is…..

This is usually another name for shock hair loss (or shock loss), which can occur in association with a hair transplant. We used to see this often in the days before Propecia (finasteride 1mg) was available, but the use of this drug in men before the hair transplant has prevented most surgical induced hair loss.

Tags: hairloss, hair loss, reactive hair loss, shock loss, hair transplant, surgery

Does Body Hair Transplantation Cost More?

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

Dear Doc,

I have a burning question regarding hair transplant if hairs can be harvasted from areas of the head that are deemed to be sufficent can the same be done from other areas of the body i.e arms, legs etc. I understand the hairs are gentially different, growth rate etc but in principle could it be done and retrospectifcally will it cost more then harvesting hair from the head?

Have you ever undertaken or known dr to undertake this procedure? outcomes?

Thanks doc

Body hair transplants are not generally considered accepted treatment for balding. It is considered more on the experimental side. As for costs, it really depends on the doctor. As body hair transplantation is done with follicular unit extraction (FUE), costs are likely higher than a traditional strip surgery using scalp hair anyway. That is moot though, as I don’t believe anyone should have this done if your scalp donor hair is usable. So while technically, body hair transplantation is possible (and is done), I personally do not believe it is viable for the reasons you are familiar with. I’ve written about it before.

As for outcomes…. I’ve seen some complete failures of body hair transplantation and even more poor, unnatural looking results from using body hair to transplant to the scalp. One particular patient I recall spent about $11,000 with a doctor who claimed to be an expert. The surgery was a failure and the patient was none too pleased, as one might expect (see story here). I’ve yet to see a natural looking body hair transplant that appeared anywhere near the quality of using scalp hair from the donor area.

Tags: body hair, bht, hair transplant, cost, fees, hairloss, hair loss

Insurance Company Pay for Hair Transplant?

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

In your experience as a medical professional have you ever seen an insurance company pay for a hair restoration as a preventive measure to certain skin cancers & not view it as simply cosmetic? Im very fair skinned & had a small piece of skin removed from my face today & am now waiting for the biopsy results. Thank you for your time & have a great day.

Insurance companies do not pay for cosmetic hair transplants that treat genetic balding, but insurance companies have paid for hair transplants for men and women with hair loss from accidents (burns/scarring).

Tags: hair transplant, cosmetic, hairloss, hair loss, genetic, accident, insurance

Possible to Change the Angle of Hair Grafts?

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

Hey Dr. Rassman,

Appreciate all you do on the blog as well as answering my questions in the past. I had a less than desirable result from a HT procedure to say the least. Make a long story short, if I ever need to get one again, which I will since I have small gaps on my head still, I will be visiting your office before.

The grafts that did grow, which was on the low side, are coming in at all different angles and growing in different directions than both the other grafts and of my current hair. When I mentioned this to my doctor and the dissatisfaction of my results, he mentioned that it might be possible to change the angle of the grafts with a new tool? Is this possible to your knowledge? If not, is there anything I can do or this is just the way my grafts will grow forever? Also, do you ever have any open houses in the New York area?

Thanks so much.

It is unfortunate that your grafts were placed at poor angles and your results are questionable. Your story of a bad procedure result illustrates the fact that hair transplant is for LIFE and you should do your research of the doctors and see their work first hand before going ahead with the surgery.

There is no tool or technique that will change the direction of your hair. I suppose you can individually excise them one by one and try to re-implant them, but that could potentially cause more damage, trauma, scarring, and failure to grow. Plus why would you place more trust and risk a poor outcome from the same doctor who already put the hairs in the wrong angle? You are a brave man!

I don’t have offices on the east coast any more, but Dr. Bernstein does have open houses in his NY office.

Tags: hairloss, hair loss, hair transplant, trust, surgeon, doctor

Do Men Have More Shock Loss Than Women?

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

I notice most females get transplanted hairs into diffusely thin areas and seem to get better results than men in those areas. In your experience, do men tend to get more shock loss than females? And if so why? Would a male who has female pattern balding (mostly diffuse thinning down the middle front area) have a higher chance for shock loss even if they are on Propecia versus a women with the same balding pattern?

Women are not always good hair transplant candidates because they usually have diffuse thinning, including in the “donor area” (rim of hair around the back and sides). Contrary to what you may have seen, women do not necessarily have better results than men. What you may be noticing is that women tend to keep their hair longer, curl their hair, layer their hair, or style their hair that is more conducive to disguising their hair loss.

There is no difference in shock loss for men (who are on Propecia) or women. Young men that are not on Propecia are the ones that get the worst shock loss, but both sexes can get it.

Tags: hairloss, hair loss, hair transplant, female hair loss, diffuse thinning