Transplanted Hairs Won’t Fall Out After Transplant

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

Dear Dr. Rassman,
This matter has become quite stressful to me. I went for a hair transplant a month ago, when I had a bit less than a 1000 grafts transplanted on my crown area. It was an FUE procedure. Most say that grafts should fall in 2-3 weeks following the procedure yet most of the grafts are still there on my head. They are not growing and they are not falling, period. The shaved donor area has grown but the recipient area still shows these tiny hairs with no significant change. I am becoming very worried about this matter. Is this normal ? I contacted the doctor and he said to give it more time, as hairs are supposed to fall. Any opinions/advice from your side would be very helpful.

I am starting to feel that I wasted 1000 very good grafts (as the doc said the quality was great, I had many 3-4 hairs follicles). Many thanks and best regards.

I will say every surgery is different and the hairs will probably fall out eventually, especially when the new hairs grow in. It’s not “normal” to have them stay in your head. Even if it does (or doesn’t) fall out, the success of the surgery is still not related to the initial hairs falling out. You will only know how successful your surgery was in about 10 to 12 months.

You already spoke to the doctor who performed your surgery, so I’m not sure what kind of assurance I can provide. I don’t know you and I did not perform your surgery, so I have no way to know about your healing. It’s possible that there was a problem with the surgery, but it’s also possible that it will all turn out fine and you’ll be pleasantly surprised. I wish I was able to provide some real info, but I’m limited without knowing more about your surgery or even having an examination.

Think positively, be patient, and good luck.

Tags: hair transplant, hair growth, fue

Do Drs Rassman and Bernstein Disagree on Shock Loss?

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

I’ve studied a number of HT docs for hair loss info and I’d say you and Dr. Bernstein are at the top of my list as far as knowledge and being trustworthy. You say that shock loss or additional hair loss from a transplant is uncommon these day though Dr. Bernstein says that you will probably have some loss from the transplant itself. I think he said it would be unrealistic not to expect some loss. Obviously a confusing contradiction for me. Could you address this?

I also find your history with Dr. Bernstein interesting. How do you 2 originally connect? You were partners at one time?

Dr. Robert Bernstein and I do not disagree on much. Hair loss secondary to a transplant is what is commonly called shock loss (it is a matter of degree of loss) and I think that is where your problem is. Traditional shock loss has been satisfactorily treated with finasteride in young men, but hair transplants do damage some existing native hair. Hair that is miniaturized is what is lost first, so what you see may not be a radical change even if you lose some miniaturized hairs that did not contribute to the hair bulk you have.

As for the second part of your email — Dr. Bernstein worked at New Hair Institute with me for 10 years before he opened his own practice in New York. We are good friends and colleagues. We published many groundbreaking medical articles over the years.

Tags: bernstein, shock loss, hairloss, hair loss

Raised Scars from Hair Plugs

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

I was wondering if there is anything that can be done with raised scars on the top of the scalp from hair transplant plugs? I read there is a possibility of cortisone injections? What about just making the top of the head more dense with SMP?

Everyone is different, so there’s no exact solution I can provide without seeing you and getting a better understanding of your individual case. Special cortisone injections may help, but that depends upon what we are treating. If the elevations are due to the mass displacement of the old plugs in atrophic skin, then the cortisone shots might not help.

Hair transplants around the plugs (especially in the frontal hairline) does wonders for camouflaging them, correcting the abnormal hairline — and then even Scalp MicroPigmentation (SMP), when properly used in the right places, might help further.

I would have to see you to determine what can be done appropriately. Out of curiosity, how long ago was your hair transplant that you got the old plugs done?

Tags: hair transplant, hair plugs

One Side of My Hair Transplant Is Growing Faster Than The Other

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

Hello doctor,

Just over 4 months into my HT I’ve noticed 1 side is growing faster than the other side! Should I be worried?

I wouldn’t be worried at this stage. The other side should catch up in the next couple of months. We frequently see different rates of growth in different areas for reasons that I can not explain. For example, when we transplant the front and the crown, often one area grows significantly ahead of the other area.

You’re only 4 months post-surgery, so give it at least 2-4 more months to give it a chance to grow in. The full results will be seen within the next 8 months (a year after your surgery).

Tags: hair transplant, hair growth

10 Days After FUE Surgery, I Rubbed My Transplants By Mistake!

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

Dear Sir,

First of all, thanks for this useful guide for those who are in this trip to recover the lost hair.

I am in my 10th day after FUE surgery and today in the shower by mistake i rub my transplanted hair once by mistake (only one gentle pass with my hand), apparently there was no bleeding or lost hairs. The problem that i see after reading this blog is that i still have many scabs so i am concerned if probably i damaged many grafts. Am I right or wrong?

Thanks a lot for your work and attention and apologies for my english because is not my native language.

You are probably safe from losing the value of these grafts; however, there is no certainty in life. If it was just a gentle pass with no bleeding or grafts coming loose, I wouldn’t be concerned…. but if you are truly worried, you should follow up with your surgeon and have him/her examine your scalp.

Tags: hair transplant, surgery

Dr Bernstein Said He Isn’t a Good Transplant Candidate

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

Dr. Rassman,

On Dr. Bernstein’s blog, he mentions that one of the reasons why he has not received a hair transplant is because he is not a good candidate. My question for you relates to that comment and is two parts. First, what would make Dr. Bernstein not a good candidate, and second, at what age can you tell whether a patient will become a bad candidate? For example, we know now that Dr. Bernstein was destined to turn into a bad candidate, but would a miniaturization study have shown evidence of that at age 25?

Thank you for a great blog!

The good transplant candidates have enough supply to meet demand. In Dr. Bernstein’s case, my best memory of his donor density is that it is low. So from a pure numbers point of view, he is not the best hair transplant candidate.

On the other hand, he told me many years ago that hair was important to him when he was young and single, but the techniques that were available at that time were terrible and deforming. For that reason, he never offered hair transplantation service in his practice until he joined forces with me and realized that the quality of the modern hair transplant met his standard; however, his focus on hair was not one of his priorities as he got older.

For those unaware of who we’re discussing, Dr. Robert Bernstein is a world class surgeon based in New York. You can find him at BernsteinMedical.com.

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

Can I Go to Work Less Than a Week After a Hair Transplant?

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

Really quick question. Can I go to work after a hair transplant in less than a week without it being swollen and scabby? Thanks!

Not everyone will heal the same, but this is an example of a patient from last week who had 3,169 grafts just 3 days from the day these pictures were taken. Please note that this was a large procedure and he had no post-operative scabbing or swelling. The secret to this type of post-operative look is the washing we do during the procedure and the daily washing we do after the procedure.

Click the photos to enlarge:

Just 3 days after hair transplant of 3169 grafts:

 

Before:

 

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

Board Certification in Hair Transplantation

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

Hi Doctor Rassman,

I’ve been trying to make sense of all the internet literature that states that “Board Certified” by ABHRS is not technically certification by medical standards. What would be the difference if ABMS were to include ABHRS? Would that keep incompetency to a minimum or make me safer?

Other statements made by AHLA such as, “the AHLC uses remarkably outdated information that is dangerous so avoid them etc.” It’s hard for me, to get a real confident feeling, not knowing how to determine whether I’m safe in my decision.

Thank you very much for your time and professional opinion

Hair transplant surgery is NOT technically certified by medical standards. In the United States there are 24 approved medical specialty boards that are overseen by the American Board of Medical Specialties (ABMS), a not-for-profit organization. Certification by an ABMS Member Board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training at a medical institution after earning their medical degree, and has successfully passed a level of competence via written or practical or oral examinations. I (Dr. Rassman) am ABMS Board Certified in General Surgery and my colleague Dr. Jae Pak is ABMS Board Certified in Emergency Medicine.

Hair transplant surgery is not a part of the ABMS so there can not be any physicians that are board certified as a hair transplant surgeon. This is mainly because there is no formal training or credentialing in hair transplant surgery. There is no standard curriculum. There is no oversight or direct review of the quality of the work being done. Unfortunately, there is no ABMS sanctioned facility to enroll and learn hair transplant surgery. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a private practice hair transplant surgeon. Even ABMS board certified plastic surgeons do not receive training in hair transplant surgery as part of their formal training.

In the mid-1990s the American Board of Hair Restoration Surgery (ABHRS) was formed by a group of hair transplant surgeons to create an organization that could independently certify hair transplant surgeons. But the ABHRS does not monitor doctor’s training quality and once the testing process is complete, they do not have any authority to enforce any form of discipline. In states like California, doctors are not allowed to call themselves “Board Certified” if the only certification they have is from the ABHRS or other non-ABMS approved boards. They must qualify which board they are claiming.

Tags: hair transplant, surgery, board certified, medical board, hairloss, hair loss

Do Hairs Within a Trichophytic Closure Grow At the Same Rate as the Newly Transplanted Hairs?

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

Hello Doctor,

I had a hair transplant with the Trichophytic closure method, I was wondering, does the hairs within the scar take the same amount of time to grow through the scar as the newly transplanted ones?

My scar looks good..however, I’ve noticed some small patches where hair hasn’t grown through yet.

Thanks again for this fantastic website

After a hair transplant surgery you may experience hair loss around the donor area with or without trichophytic closure. There can even be large patches of hair loss. The hair loss is temporary and it usually grows back after several months and it can take as long as a year. Transplanted hair takes several months to grow as well (up to one year). The hairs in the trichophytic area should grow at the same rate as the recipient area hairs.

Tags: trichophytic, hair transplant, wound healing, hairloss, hair loss, hair growth

How Long Does Shock Loss Last?

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

I had a hair transplant done 4 weeks ago and noticed i had thinned considerably on the front side of my scalp. I hear this “shock loss” process is a temporary stage.

How long would you say that this “shock loss” process will end?

Shock loss following a hair transplant usually occurs within 1-4 months of the surgery. The process might be temporary, but the results are likely permanent (the hair won’t regrow).

I just wrote a blog post about shock loss last week that explains more about ways to avoid it and why it occurs.

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

How Can Shock Loss Be Avoided If You Transplant Into a Thinning Area?

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

Doctor, I just watched a video of a transplant and I don’t see how you avoid shock loss or at least loss to hairs in the recipient area when filling in a thinning area as opposed to a bald area. Propecia or not, that’s a lot of trauma. There has to be some TE going on there. Maybe you have techniques that can minimize it but I have to believe you can’t avoid it. And you’re going to lose some nearby hair after a procedure.

Again I’m talking about a thinning area not bald. Maybe 30% or more of original hair left. You say it doesn’t happen much anymore because of Propecia, From what I just watched just doesn’t seem possible to me. it would certainly seem it would accelerate loss to any hairs that are miniaturized or about to be.

I speak from my experience over 23 years. In the days before Propecia, when we did a hair transplant, almost every patient developed some degree of shock loss. It was so common that I always told the patient to expect it, and that if it happened (which it usually did) we might have to do another transplant just to address the shock loss. I often increased the number of grafts just to address this possibility.

When Propecia came on the market and many patients who eventually asked to have a transplant after the drug failed to meet their expectations, I noticed quickly that the shock loss problem was far less frequent that on those patients not on the drug. Although I never reported this in a medical journal publication, it was not just my own experience, but the experience of many other doctors as well.

Hair loss following a hair transplant procedure is most often in the hairs that are miniaturized, or at the end of their normal life span. These hairs, I suspect, are far more sensitive to the trauma of the anesthetics and/or the surgery. The use of finasteride (Propecia) is not foolproof for preventing shock loss, but it is darn good.

As we don’t really see the hair loss and/or miniaturized hairs in the parts of the scalp that doesn’t look like there is balding present, even since I have been performing bulk analysis of the hair, I know now with absolute certainty what I suspected for many years — in many men, 50% of the hair that may be in a miniaturized state to some degree is where the shock loss occurs. I call this clinical observation by a questioning mind, like mine.

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

Is This Necrosis After My Hair Transplant?

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

Dear Dr. Rassman
I’m a 54 years old male. I had a hair transplant operation on 30 June 2013 by FUT method followed by FIT method on 1st July to complete the transplantation. From the second day after operation I noticed that a big area in recipient part between crown and front of my head, the skin is so irritated (fig.1) and after 1 week it became completely black and was necrosed (fig.2).

Photos: Figure 1, Figure 2

I rang to my surgeon to consult on this issue. He said at your age this problem sometimes happens and I should wait until the skin being repaired and to speed up this procedure I should put warm towel on the necrosis area as well as making it oily by Vaseline to avoid dryness. I really don’t believe in the opinion of my doctor to relate this problem to my age, so I would highly appreciate if you let me know your opinion regarding the reason of this problem, is there any special treatment for such necrosis?

As the recovery procedure of the skin is so slow as shown in figs 3 and 4, I’m not sure that the transplanted follicles are not damaged. I thank you so much if receiving your valuable comments.

Photos: Figure 3, Figure 4

Sincerely yours

I am not clear on your history as you note a FUT (as in strip surgery) and FIT (as in Follicular Isolation Technique). There are some doctors who combined FUT and FUE (called FIT by one particular surgeon).

In my 23 years in this industry, we have performed hair restoration surgery in over 15,000 patients (with as many as 8 doctors working for the New Hair Institute at one time), so my experience is in the thousands of patients we have treated at NHI. Although I have never personally seen this complication in any patient that I have treated, I have been aware of this complication in patients who have either consulted with me or I have heard about it through other doctors’ reports at medical meetings. This problem was more common in the 1993-1996 time frame, as doctors were increasing the number of grafts they were performing and not reducing the size of the punch or slit equipment. These doctors devascularized the scalp because their wound areas were too large. Based upon this, I have assumed that the blood supply was negatively impacted for this problem.

The central area of the scalp (where your problem is demonstrated) was the place where this complication has been seen. The least vascular area of the head is probably at that exact location. As you may know, balding produces an atrophic skin that is thin and not vascular with little infrastructure (fat) under the skin (where a normal scalp would be rich in blood supply, with many nerves per follicle, many hair follicles, considerable amounts of fat, etc..). The reason that the skin becomes atrophic in balding men is because the bald scalp does not need a rich blood supply, so the body withdraws the blood vessels in response to lack of demand. When a hair transplant is done, the demand of the new hair increases the blood supply and eventually the scalp is no longer atrophic and becomes rich in blood supply again.

I am certain that age is not an issue. My oldest patients have been in their 80’s and we routinely operate on men in their 60s and 70s. I have done surgery on diabetics and in these people, I have not seen vascular problems either, but I often do not ‘dense pack’ these diabetic people for fear of such a complication. I personally had a hair transplant last year (at the age of 70) with no issue. I had an atrophic scalp resulting from 3 scalp reductions done in 1991-1992 that left my skin very, very thin and atrophic, yet I suffered no vascular effects from the transplant into my atrophic skin.

Read more

In the News – Beard Transplants Are Becoming More Popular

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

Snippet from the article:

The number of men opting for a ‘beard transplant’ has rocketed in the past year, according to experts.

Pogonophobia (the fear of beards) may be rife at the BBC, but statistics revealed today show that more and more men in the UK want a beard, just like Jeremy Paxman.

Having pioneered the world’s first facial hair transplant in 1996, Dr Bessam Farjo, founder of The Farjo Hair Institute, has seen a six-fold year on year increase in the amount of men having surgery to boost their facial follicles over the last five years.

Read the rest — Beard implants growing on us!

Tags: hair transplant, beard transplant, facial hair, hairloss, hair loss

If I Take Propecia After a Transplant, How Will I Know If My Hair Growth is From the Drug or the Surgery?

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

I just had my hair transplant. Going on Propecia in case of any shock loss. My question is how am I gonna know how much of my hair transplant is coming in thicker vs any hair I gain from taking Propecia both a year from now?? Thank you in advance

Propecia is great to take to prevent shock loss, but it doesn’t necessarily guarantee regrowth of the hair you had previously. I would expect it to hold the remaining hair and protect from shock loss, though. The transplant growth will start coming in at 4-5 months and maximize after 8-12 months. That is the way you should see the difference from the impact of the transplant. Going on the drug before the transplant is what I recommend in most young men as a prevention for shock hair loss, and the additive effect of the drug with the transplant can only help if it brings back any hair.

If you do have regrowth from Propecia and your hair transplant grew in at the same time, I’m not sure how you would really know which hairs was which unless you had a visual examination of the hairs to see if they grew from a transplant site or not.

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

Patient Results Follow-Up – Crown Restoration with 1870 Grafts (with Photos)

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

This is a follow-up of a patient we posted about a couple years ago. He recently came in for a visit and we took some updated photos of his crown now that more time has passed since his hair transplant.

He had a 3.5″ by 3.5″ very thin area in the crown, which was transplanted over 3 years ago with 1870 grafts. I measured his hair bulk as well and it showed that the transplanted area reflected 50% of the donor hair bulk. The results speak for themselves and I personally identified with him, as that was my status before my ~2400 grafts in my crown.

Click the photos below to enlarge.

After (1 procedure of 1870 grafts) on left // Before on right:

 

Tags: hair transplant, hair restoration, surgery, hairloss, hair loss, crown