Pimples On Scalp After Transplant Surgery — Will That Change My Surgical Resutls?

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

I had a hair transplant done about 7 weeks ago, with about 1200 follicles transplanted. Up until a month ago everything went as my doc had said. For the last 15-20 days i am seeing many bumps in transplanted site, which I showed to my doc. Firstly i took 50mg cynomycin and when my condition didn’t improve i was advised to increase the dose to 100mg (took total of 10 days). Now I am supposed to be using 4 doses of 750mg of amikacin injection, but so far I took 2 of them. Still, my condition is more or less the same. At this time there are more than 10 bumps and so far I have drained pus from more than 20 such bumps.

My doc got the pus checked for bacterial or fungal growth but there was none in lab finding. In all these days i took even more care than doc has asked to. I want to know if transplant has failed and have these bumps and pus damaged follicles? will these change the final result?

Only your doctor can tell you what is going on and if your transplanted hairs will grow. After all, he was your surgeon and only he fully knows what happened.

In general, pimples after surgery can be common and they can persist for many months, reflecting the production of sebum under the skin from the sebaceous gland that was part of the follicular unit. In some patients, until there is hair growth the sebum collects in small pockets (unable to escape along the non-yet-existent hair shaft). We often drain them with a simple, sterile needle in the office. Transplanted hairs usually grow despite these pimples.

Most patients that experience pimples do not take antibiotics and do well, so it seems that in your case there may be something more than just pimples (with all the antibiotic you are taking). Again, this is something you and your doctor need to talk about as there are other diseases that show up in some patients with autoimmune diseases.

Tags: pimples, acne, hair transplant, surgery

Why Is One Area of My Transplant Growing at 7 Weeks But Other Areas Aren’t?

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

I am in week 7 after my HT and I am seeing plenty of fine new hairs in the left frontal area sprouting up while the right side shows not even a third of that growth. I realize that the transplanted hairs grow at different rates but the difference is too great to ignore. Another cause for concern is that the right side was also the first to shed (I noticed it as early as 10 days after the procedure) so I would assume it would have a ‘head start’ over the other side.

I know that growth usually starts after 2 to 4 months but it still leaves the burning question: why has one area started to show this kind of growth and not the other? My worst fear is that many of the grafts placed in the right area were somehow inferior or died off. I have voiced this to my surgeon, who is very respected and well known, and he tells me to just wait for the full effect after 11 months. I just wanted to hear your opinion. Thank you

I frequently see different start rates on graft growth from different areas. I don’t have an exact answer for why one side grew faster for you. Assuming that the team members that placed your grafts were highly skilled, the only thing I can suggest is to follow your surgeon’s advice and wait it out.

Tags: hair transplant, hair growth

Are Most Hair Transplant Surgeons Also Hair Transplant Patients?

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

Dr. Rassman,
Thank you for helping hundreds if not thousands of people in understanding hair loss. Because of your blog I went to a dermatologist and got a miniaturization study done. Here is my question:

Would you say that a large percentage of hair transplant surgeons are patients of hair transplants themselves?

Cheers

Some hair transplant surgeons are themselves patients; however, I would not say that the majority are so.

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

My Job Requires I Wear a Helmet for Hours Each Day — Can I Get a Hair Transplant?

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

Hi great doctors,

I’m planning to go for a hair transplant. However I need to go back to work about 1 week after my transplant, and my job requires me to wear a helmet for 4-5 hours each day. What are your thoughts on the helmet affecting my donor area or grafts?

Appreciate your kind advice. Thank you

HelmetI would need to know what your balding pattern is, where the transplants will be going, and what type of harvesting technique (FUE or strip surgery) you plan on having. It would also be helpful to know the type of helmet that you intend to use. I might be able to ascertain your situation from this information.

In the past, we’ve had patients that are firefighters, daily motorcycle riders, race car drivers, pilots, and other professions that wear helmets on a regular daily basis and they have had no issues with having a hair transplant surgery. We generally recommend one to two weeks without wearing a helmet following a hair transplant, though.

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

If I Have Another Strip Procedure, Will The Scar Be More Noticeable?

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

hello
16 months ago i had a hair transplant using the strip method which has left me a scar on the back of my head. if i was to have another transplant with the trichophytic closure procedure, would this problem of the scar not be so visible if i were to cut my hair shorter?

i would appreciate some advice just so i can be sorted out. kind regards

A second strip surgery in a person who had a sizable scar after the first surgery can produce an even larger scar the second time, but this is not always the case. There are times that a second surgery can reduce the scar from the first surgery. Considering the size of the scar, it might be excised and then closed with a trichophytic closure; however, the scar may return nevertheless.

One of the new and innovative ways to treat a hair transplant scar is with Scalp MicroPigmentation (SMP). See examples here.

Tags: hair transplant, scar, scarring, hairloss, hair loss, smp

HairDX Showed I Had Only a 30% Chance of Propecia Response

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

Dr Rassman, If you had a male patient who was 43 years old and is only approaching a Norwood 2A pattern, showed to have the balding gene based upon the HairDX testing and showed to have only a 30% chance to respond to Propecia based upon the HairDX, would you still advise the patient still continue taking Propecia. Also has father who is a NW7 and started balding at 18.

Secondly, would he still be a good candidate for a hair transplant to thicken the hairline even if he may not respond well to Propecia? My doctor advised me to continue taking the Propecia. Would you do the same?

I am not your doctor and you need to discuss your treatment option with the doctor who ordered the HairDX test. Is a 30% chance a worthwhile investment for you to take a pill a day? You can discuss your risks and benefits with your doctor.

I would not know if you would be a good candidate for hair transplant surgery because I do not know what you want or what your goals and expectations are, as I have not examined you. If you indeed have a Norwood class 2A pattern of “balding”, I would doubt that you are a candidate for a hair transplant at your age, but I would have to see you (or at least see some good pictures) before drawing any conclusions.

Hair transplantation is an elective cosmetic surgery. If want to lower or thicken your hairline and change your look that is your prerogative, but your response to Propecia and your candidacy for surgery are not related. The hair transplant surgeon’s job is to guide you, give you realistic expectations, and an overall Master Plan.

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

Shady Hair Transplant Centers Require Research to Identify

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

Where can I turn to if I feel like I was ripped off by my hair transplant doc? After looking him up on the web I am now not even sure he is a legit doctor.

I’m not sure where this doctor (or fake doctor) is located, but if he is in California, then I would contact the Medical Board of California. They are looking for victims who have been harmed through unauthorized treatments, to come forward so that they can investigate and if appropriate prosecute doctors and clinics that break the law. Some people pass themselves as licensed doctors and their victims are reluctant to go to the medical board in many situations.

Here’s an example of a fake doctor that we’ve reported on before —

Tags: scam, hair transplant, john lord, medical board, fraud, criminal, death

Transplanting a Patient with a History of Keloids?

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

If I am prone to forming keloids is it still possible to safely undergo hair transplant surgery w/out forming additional keloids? And have you ever done a hair transplant on someone who has a history of keloids?

Many patients undergo hair transplantation despite a history of keloids, and most of them do well. Keloids can appear on the frontal hairline, but that is relatively rare. Keloid scarring is more likely to form on the donor scar, but the surrounding hairs will cover it so that it’s generally not a problem.

Tags: keloids, scarring, scar, hair transplant, surgery

Can I Bring the Temple Peaks In with Surgery Without Filling in the Hairline?

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

Dr. Rassman,

I am 26 y/o, I have a very high hairline with uneven and very receded temple points. I do have some thinning on top and a family history of hair loss, but I believe that medication has been very beneficial for me. I take it every three days and have had almost the same benefit as everyday but without the side effects.

My question is regarding the temples (or sides) of my hairline. With a very high AND wide hairline, I feel its making me especially conscious of my hair loss. I’m wary about having anything done to the top of my hairline because I’m sure I don’t want to be stuck coming back for multiple surgeries if/when my hair continues to fall out.

If I were to have something done to bring the sides (temples) of my hairline in to better frame my face and add symmetry to my hairline, would I be right in thinking that this can be done and could achieve a natural looking result without lowering my hairline? and in the case that I do continue to lose hair on the top, it wouldn’t require that I come back for additional surgeries?

This is an individual decision between doctor and patient. What is best for you will depend on many factors — for us, these factors can be analyzed and recommendations given.

Yes, a good hair transplant surgeon can replace the temple peaks. An experienced surgeon is critical for making sure it is done right and for making the proper analysis of what to do. You never want to have a cosmetic surgery with results that look unnatural, so an experienced surgeon with a good eye will be able to tell you what’s achievable for your particular case.

Tags: hair transplant, temples, temple peaks, hairline

My Eyebrows Have Gotten Thinner Since I Was a Child

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

I am a male, only 18 years old and starting back in elementary school my eyebrows have gotten less and less hair. Now its evolved to on both eyebrows only half being thick. It looks like half eyebrows, goes from normal looking to just bald. Is there anything i can do? It can be very embarrassing. I am not plucking or pulling my hair. They just keep getting thinner.

The most common cause of loss of eyebrow hair is plucking of the hair. I realize you said that you aren’t pulling or plucking, but many people who do pull out their hair (including eyebrows) deny that they do it. This is an obsessive compulsive disorder called trichotillomania. If the loss of eyebrows are not connected to plucking or pulling them, I wonder if you have any other hair loss or if it is limited to just your eyebrows.

Eyebrow transplants are an excellent solution for thin eyebrows. I have seen loss as your describe in the outer half of the eyebrow and have replaced the hair with scalp hair, which is very effective. Scalp hair in the eyebrows must be trimmed about twice a week to keep them short and they need to be cut on a slight angle to create a point to their ends.

Tags: eyebrows, hairloss, hair loss, eyebrow transplant

Why Do Technicians Do the Graft Placing in a Hair Transplant?

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

I see in many hair transplant surgery photos that technicians place the grafts on the scalp. Since the placing is so crucial (angle, position, etc) how do surgeons leave this to technicians? Also, the survival of the extracted hair follicles is also a crucial matter, how safe is to leave the follicles’ processing to technicians?

is there a center where technicians intervene minimally and where skilled surgeons take charge in most of the procedure? in other kinds of surgeries I have watched, technicians and nurses are just there to pass the instruments to the surgeon, hold them, and generally do not interfere with the main procedure, so I really need to know a HT center mostly crewed by surgeons and not a big name surgeon that leaves the procedure to technicians

The total man-hours to do a surgery of 2500 grafts may be 30-40 hours. No doctor can do it all and I would not want them to try to do it all, because by the time the doctor finished, the grafts would be dead. This is a team surgery and graft survival is a complex process that requires many skilled people to do the job.

My technicians are highly skilled, working 8 hours/day doing either cutting the grafts or placing the grafts. When I used to do much of this work, I worked along side of the technicians and set the standards for training, and the skills needed for cutting and placing. Today, I still work along side of the technicians, though I work more in a supervisory role.

If you employed 4 surgeons in addition to myself, the costs would be out of sight for most of our patients and the quality would not be as good as the surgeons will most likely not have the manual skills that the technicians have. The secrets to success in getting the results that the patients want and need is that such a team approach needs (1) skills, (2) speed, (3) good and tight quality control systems, (4) good organization.

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

Transgender Teen Wants a Hair Transplant at 18 Years Old

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

So, at 17 years old, I’m in between a Norwood 2 and 3 hairline and was aiming to get a transplant. I understand that this is very young, but I’m transgendered and the hairloss has stopped with the use of hormone replacement therapy so I was curious as to if I’d be at least able book a surgery date when I’m 17, to have the surgery when I’m 18. I’d have parental consent too if that’s important.

Yes, you can do it if you find a surgeon willing to take you on. You run risk for balding based upon any testosterone production, but if you have your testicles removed, that would mitigate that risk. I am not an expert on the effectiveness of the drugs you are presently using without orchiectomy. I would let your doctors tell you those answers.

Tags: hair transplant, transgender, hairloss, hair loss

Any Patients Take Propecia and Still Have Shock Loss?

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

Just wondering as you have said a few times that being on propecia will decrease your chance shock loss after a hair transplant if you are under 30.

Have you had any patients under 30 who have had shock loss after being on propecia for a considerable period of time? And if so to what extent was the loss? Thanks

When I saw the great majority of shock loss cases, it was before the availability of Propecia (early 90s). Since that time, most of my patients take Propecia to protect themselves from shock loss, and there was far less of the fall out after the surgery… but it did still occur for some.

I don’t have statistics on the extent of loss or precise age, though.

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

Is My Crown Too Thin to Transplant? (with Photo)

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


Dear Dr. Rassman,

I am a 27 year old male who experienced extensive hair loss following the use of Accutane about 6 years ago. The hair loss stopped after about 18 months, but the original volume never recovered. I’ve been using Rogaine and Propecia for about 5 years. While my hair loss seems to have slowed (it’s been very gradually thinning ever since), the crown remains very thin to the point where it appears as an obvious bald spot, and my hair color (dark brown) exacerbates the problem.

I’ve attached some photos. I had a hair transplant evaluation two years ago by a dermatologist who specializes in hair science- he told me that while I have a thin crown, it wasn’t thin/bald enough to justify a hair transplant because the transplant would likely damage/destroy too many of my remaining crown hairs for there to be marginal gains in density. At the time of the evaluation, I had mistakenly left some hair thickening product in which may have influenced that evaluation.

My question is as follows: at what point in the balding process would most reputable doctors determine that the marginal gains of a hair transplant to the crown justify any damage/loss to whats left of the original hair in that area? Is there a certain metric that’s used (ie hairs per centimeter in the area)? Furthermore, I was just curious about the typical number of grafts required to restore a natural crown, given that the crown is very thin but not completely bald? Thanks!

 

Generally, men your age will respond to finasteride (Propecia) with regrowth in the crown, but clearly from your email, this was not your case. A good doctor should work with you through the specific logic and goals in your case. Treatment options may include Scalp MicroPigmentation / SMP (as long as you have hair there, this is a good option) or a hair transplant with between 1500-2000 grafts. The higher number is for individuals with fine hair.

Without an examination, it’s difficult for me to tell just how thin your crown is or what appropriate action you could take. There’s no exact metric to determine when the right time to transplant is. Everyone is different. Since it has been 2 years since your last evaluation with a physician, you should consider seeing a doctor again to find out if your options have changed.

Tags: hair loss, hairloss, crown, hair transplant

Press Release – Celebrity Hair Transplant Patients

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

Snippet from the press release —

Over 101,000 people in the United States underwent hair transplant surgeries in 2010. The International Society of Hair Restoration (ISHRS) also reports that just over 89 percent of those surgeries were performed on men, with the average age of these men ranging from 50 to 59. The scalp is the most common site for hair transplants, and 92.8 percent of hair transplant surgeries target that area.

Celebrities are no strangers to hair transplants. Many male celebrities undergo hair transplants to retain a fuller head of hair. Here are 14 celebrities who admit they underwent hair restoration surgery to help correct male pattern baldness.

Read the rest — 14 Male Celebrities Who Underwent Hair Transplants

See the list of celebrities at the link above.

Tags: celebrity, hair transplant, hairloss, hair loss