Can I Just Let the Scabs Come Off On Their Own Over a Few Weeks After My Hair Transplant?

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

Dr. Rassman,

Your website has been quite helpful. I had a quick question regarding a hair transplant I got almost 3 weeks ago now. I got 1000 grafts mainly in the vertex area and I grew my hair long to cover up the area until it healed. Since I can cover it up well I have been extremely careful with washing and letting the scabs try to come off by themselves. I wash the area as if I was still in the first few days as I try not to rub the area or pull on the grafts. My question is, letting the scabs take longer to heal and fall off, even at week 3 now, is it bad for the grafts to still have the scabs, or if im comfortable how it looks, is it safe to remain careful. Anytime I do try to break up some scabs I feel like they are pulling grafts out so Id rather just wait it out if that is safe for the grafts. One last thing is that I am not sure if you would consider what I have at this point scabbing, as it is just mostly white crusts covering the grafts. Thanks so much Dr. Rassman.

Once you allow the scabs to form after a hair transplant, they can take weeks to come off by themselves. This will not damage your grafts, just give you a cosmetic problem you would not have had had you washed them off as they formed.

Tags: scabs, scabbing, hairtransplant, hair transplant

I’m Scared and Nervous About My Upcoming Hair Transplant Surgery!

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

Dr Rassman . i’m really confused going in for a hair transplant. i have booked a session but am not sure yet. they say “when in doubt- wait” should i wait or just close my eyes and jump? do we really get whats promised? why am i so so so damn scared? is it natural? are HT really worth for common man or only for celebs? should i wait for technology to get better or few more people to get it done?

going through this site i have become a big fan of your work. i’m 27 yr old going for a transplant. i dont look as bald as people who normally go in for a hair transplant. i read about your take on ‘shock loss’ post hair transplant. i dont want to take any propecia or finasteride as my wife and i are planning to start a family. is this a big risk i’m taking going for a HT now because of ‘shock loss’ possibility? is it worth the risk?

Fear of the unknown is natural, but one of the things that your doctor should be doing is educating you enough to manage this decision. A good decision today will be a good decision tomorrow. You should get another opinion if your doctor isn’t providing you with all of the information you’re seeking. Absolutely do not rush into something that you think you’ll regret down the line. Make an informed choice.

I posted this list of links a few months ago, but they’re important to read. For more information on doctors — what to avoid, how to find a good one, what some don’t want you to know — see:

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

Facial Hair Transplants

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

Please send me more information about transplants, hair to face. tell me how the process works and if that really works and in how much time it takes. i need to know the average price. send me back an email as soon possible thank you.

You can transplant scalp hair to your face, but you must have similarity in the hair, because it will come with its characteristics. If your hair is fine and your beard it coarse, there may not be a match. Meet with a good hair transplant surgeon and discuss the issues, including his/her fee schedule.

Tags: hairtransplant, hair transplant, facial hair, beard, moustache, mustache

I’m Taking Propecia — Can I Still Have Shock Loss After a Hair Transplant?

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

Its been 8 months since my 2nd HT and I got 2100 grafts. of those 2100, i got 400 grafts in the temple area with left side getting 250 grafts and the right side 150 grafts. My recipient temple area was fairly dense but the doctor suggested that I should get 400 grafts in the temple region. Can the newly placed grafts in the temple area destroy my existing hair follicles?

I had this HT in september 2007 and I have been on propecia since september 2005. can this HT still damage the existing surrounding hairs?

Whatever damage you had from the hair transplant (shock loss) should be over by now. Ask your doctor these questions. What you are seeing with your eyes is real, so he should be able to comment on what he sees when he examines you. Although the use of Propecia has shown good value at preventing shock loss, it is not 100% the case. When it comes to hair loss, there is no sure thing.

For more information about shock loss, please see:

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

How Do I Know If I’ll Have Enough Donor Hair for Another Transplant Later?

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

Dr. Rassman, i have had a hair transplant using the strip method. I have a long scar across my head. You can not see it however as it is unnoticable. My question is, i only had a transplant in the temple area for a receding hair line and the areas are very small. I had good density however the length of the scar looks massive in relation to how many hairs have been transplanted. If i need another transplant later in life will there still be enough donor hair. Obviously you havent seen me so you couldnt tell me , but with strip methods is there any left over hair as they can determine how many hairs there will be. Im worried that they have used all my donor supply. I am happy with the transplant.

Most people will be able to get about 5,000 grafts from their donor area. Clearly, that depends upon the donor density and the scalp laxity you have. I have seen some people exploit their donor density after 3,000 grafts, but that is unusual. I have taken as many as 10,000 grafts in others. The efficiency of the harvest is critically important. Discuss this with your doctor and he/she should give you good answers to this question, as it relates to your donor supply and scalp laxity.

For more, see:

Tags: density, laxity, hairloss, hair loss, hairtransplant, hair transplant

Reader Profile — What Is My Degree of Hair Loss? (with Photos)

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

Hello, I am turning 26 in a few months, I would like to know what transplant procedure would best suit my current hair loss pattern. I have researched the strip method, also the individual extraction method, I like the individual method better, it seems to be less evasive and less surgical, however, the cost appears to be higher, why is that? Would I qualify for the single extraction? What degree of a transplant do I require to restore my hairline to a even more full appearance? Any estimates in cost? Thank you for viewing my questions and looking over my pictures, you have my permission to use them on your site if they help in any way. If you require photos from any other angles please let me know. I am not on Propecia, I have been reading about Provilus, is that a good alternative? I am more interested in the natural ingredients if they have similar results.

Thank you again, I hope to hear back from you with some positive ideas!

Reader

 

Norwood 4AFirst, thank you for permission to post your photos! If I was able to map out your scalp for miniaturization, I’d be able to tell if the top and crown of your head, which appears normal now, has any early signs of balding there. The pattern you present with is between and Norwood 3A and 4A pattern and I suspect that there is miniaturization in the 4A pattern area where part of the forelock still persists. If you took Propecia (necessary to prevent further loss and the possibility of shock loss after transplantation), then transplanting the frontal area with about 2000 grafts would suffice in most men with your pattern. I would have to know more about your hair characteristics (straight vs curly, coarse vs fine) as this will tell me the value of your hair, part of the essential formula for estimating hair replacement.

Provillus will not give you the same protection against shock hair loss that Propecia (finasteride 1mg) would, so if you get a hair transplant, you need to be aware of this. For your information, the main ingredient in Provillus that does work is saw palmetto, which as I’ve stated many times before, is a weak DHT blocker at best.

The follicular unit extraction (FUE) technique is very labor intensive and the time it takes to do it is much more than a standard strip procedure. That is why the cost is higher. Also, the results from FUE are variable while the strip procedure is predictable nearly 100% of the time. For more info on FUE, please see:

Tags: fue, hairtransplant, hair transplant, photo, hairloss, hair loss, propecia, finasteride, provillus

I Don’t Want to Take Propecia Until After I’m Married

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

i am a 24 yr old sikh male living in the uk. up until the age of 18 i had long uncut hair but then in 2003 i cut my hair. my hair has always been thin in texture from a young age. at first when i cut my hair it seemed to be quite thick on top and didnt seem to concern me too much. however after a few months of getting it cut i began to realise that a lot more of my scalp was visible, particularly in well lit areas.

so in following summer of 2004 i shaved my hair off completely in hope that it would grow back thicker which was really a waste of time. by summer 2005 i had realised that my scalp was a bit more visible than before so then i made the decision to start using rogaine. this seemed to work at good effect and by jan 2006 i had grown my hair a bit longer and had a new style cut. my hair appeared to be a lot better than before and a lot of people did notice. this however may have been due to the new style as well. but by summer 2007 i began to realise that my hair was appearing to be thinner again and i also noticed that at my crown the balding area had increased. the fact i have got a double crown does not help appearance either. so in late december 2007 i decided to switch rogaine for a private minoxidil 5% containing MPG. this too at first appeared to have made a slight improvement, and is a lot easier to apply than the rogaine. however by now in may 2008, i am still not to happy with the density of my hair. i went to a trichologist late last year, he advised me that i should not consider a hair transplant until i am least 25 and that i still have a bit too much hair for a HT. he advised me to take propecia, however i am scared of using the drug due to all the reported side effects. i would be willing to use the propecia, preferbly in a few years and after marriage! both my mother and fathers family have cases of hair loss, my father is bald apart from the hair on his back and sides. both my sisters have fine hair aswel, but they have a full head of hair.

i have seen pictures of hair transplants on patients who have diffused thinning and this would be my preferred method of sorting my hair out, however i am aware that i need to consider the long term instead of the short term. can you please give me some advice on what to do? thanks.

I don’t know what I can say that hasn’t already been said on this site —

I’m not sure I quite follow the logic about waiting until after marriage to start Propecia (finasteride 1mg). The side effects from Propecia occur in less than 2% of men and most claims you read about on the Internet are unsubstantiated. Without seeing your hair, I couldn’t tell you if you’re a transplant candidate, but if you’ve already seen a doctor and were told that surgery was not recommended, I’d listen to him. You could’ve very easily gone to someone that would’ve taken your money and performed a surgery on you just to appease you. I don’t know which doctor you went to, but by not doing surgery on you, he likely did you a favor. You are, of course, entitled to go to another doctor and I’m sure eventually you will find a surgeon that is more than willing to take your money.

See the following for more:

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

Any Idea Why I’m Still Experiencing Pain in My Scalp 5 Years After a Hair Transplant?

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

im am experiencing increasing amount of pain and discomfort causing lack of sleep and loss of concentration and its been 5 years since i had a hair transplant and 4 years since scar revision which has caused this pain (pulling, burning). I ve seen many doctors, neurologists and have been to pain clinics with no success. any thoughts as to why this is happening? thanks

Did you follow up with the doctor who performed your surgery? I do not even know if your pain is related to the surgery. It is possible (speculative) that you have a nerve entrapment which can sometimes be determined in your examination. I have seen patients present to me with a long-term nerve problem from this cause. I am sorry, but there really is no way for me to tell especially after what you tell me of seeing all the specialists. If those doctors (who actually examined you) cannot help you, I highly doubt I can tell you what is going on, certainly not without a direct examination.

Tags: hair transplant, hairtransplant, pain, burning, nerve

Transplanting Men In Their Early 20s

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

Dr. Rassman,
I am about to turn 23 and recently (though I believe it started a year or two ago) I have noticed more and more that my hairline is thinning and receding. The recession isn’t in the dramatic “m” pattern, more of a general recession all the way across, though when pulled back can definitely see the edges going back further (the furthest on the left, the hairline all the way across has become a bit uneven and can see lone hairs as well as other thinned hairs).

My main question is what your feeling on a hairline transplant would be for someone my age. I think I would be more than happy with a transplanted area about a half inch wide or so across the forehead(i’m not sure how many graphs this would approximate to…essentially lowering my hairline a half inch or so). The rest of my head, both behind the hairline and on the crown seem to all be fine. I know I saw a video on newhair.com which showed the results of someone 24 who had a transplant which prompted me to inquire for myself.

I greatly appreciate your time and information

I have transplanted hair in men of your age. There is no 100% applicable age rule, but there are some requirements that must be met, including:

  • Maturity
  • Realistic expectation
  • Being on Propecia
  • Enough balding to make a difference
  • Enough donor hair to do the short term and long term job
  • A pattern of hair loss that I can anticipate

It would be best to come to an open house event where you can meet with myself or Dr Pak, meet directly with a dozen patients who had the surgery, and view an ongoing surgery that day. There is no better way to do your research in my opinion.

Tags: hairtransplant, hair transplant, hair loss, hairloss, young

I Have No Hair Loss, But I Want a Forelock Transplanted to Frame My Face

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

I would like to first say how much I appreciate your site here and how valuable a resource it is.

I am now 24 and have been fortunate to not have any experience with any extensive hair loss. It is not in my families history but I do take avodart at 2.5 mg just in case that I inherited the genes my uncle on my father’s side has. Strangely he (my uncle) has almost completely lost all the hair on the top of his head while my father has almost retained his preadolescence hair. They are both about the same age and well into their 60s. Anyways, I am seeking advice about something I would like to do about getting a forelock. I know this sounds strange but I am really into the look and being of the theatrical I would like to go into acting and I think a slight forelock at the front middle would frame my face nicely. Having some experience with photoshop I think I have a pretty good idea about how this would turn out. I think the look suits me (much as it does other actors such as Colin Farrel, but would not want mine to be so blunt). I would not mind sending you pictures of the befores and afters I have done.

I know it is risky even with medication but I am absolutely certain that I would like to have the procedure. Thank you for your time and feel free to get back to me at your convenience.

First of all, if you do not have hair loss, I would highly advise you reconsider taking Avodart (dutasteride) 2.5mg. I can’t see how your doctor could’ve possibly prescribed this to you! Not only can it affect your sperm production and the long term effects in young men are not well established, but as far as I’m aware, the dosage that has been commonly used (off-label) for treating hair loss is 0.5mg — so you’re taking 5x the dosage and you’re not even losing hair, I’m worried that you’re going to end up getting yourself in a corner. It is simply not a medication that has been FDA approved for treating hair loss despite the fact people do take it off-label.

If you are considering a hair transplant to your forelock you should start off by seeing a good hair transplant surgeon that you trust. If you are not balding and want a strong forelock (not a widow’s peak?), then it is pure cosmetic surgery, which is something that we do. I really cannot advise you on what you are doing or what my opinion is on your goal, because I really don’t know if you have realistic expectations and/or goals. These are things that need to be done during an office visit.

Tags: hairtransplant, hair transplant, avodart, dutasteride, hairloss, hair loss, forelock, widows peak

In the News – Restoration Robotics and the Automated Hair Transplant

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

From the article:

A robot that can pluck and move individual hair follicles on a person’s head makes hair transplants look more natural than those performed by humans, a US company claims.

The robot can also perform the procedure twice as fast as human clinicians, with less pain and scarring for the patient, says Restoration Robotics of Mountain View, California.

Read the full text at NewScientist.com – Surgical robot gives hair transplants a natural look

I am well aware of Restoration Robotics. They approached me a year or so ago to obtain rights to use our U.S. Patent to perform such surgery. Dr. Pak was the engineer back in 1998 when he helped me design the first prototype. I am eager to finally see this project get on its way.

I must disclose that if they succeed, I have a financial interest in their success from the license grant.

Tags: fue, robots, robotics, hairtransplant, hair transplant

Over 2 Months After Transplant, I Colored My Hair and Now My Scalp Is Scabby and Raw

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

Hi, I am a male 25, I have had two previous hair transplants in the FRONT of my scalp..turned out GREAT. On March 4th 2008 I had my THIRD hair transplant on the CROWN area..I had 1500 grafts, its been two and a half months. On April 18th I coloured my hair. i didnt leave it on that long (10mins)… on the crown area I have scabs still and when i wash them off, the crown area is extremely pink and RAW with puss. Is this normal?

Also I lost MORE hair around the crown then before my surgery? no hairs have grown yet..is it normal for me to have puss and scabs two and a half months after surgery? Thanks

You seem to have two problems going on. Concerning the dye, you may have sustained a chemical burn and this can cause permanent hair loss. If you are losing more hair since the transplant I would want to know if you were taking Propecia (finasteride) before the surgery to protect against shock loss. The chemical dyes may have also impacted the hair you have in your crown area. See your hair transplant doctor and ask him/her to examine you and render an opinion. Pus and scabs two months after surgery is not a normal occurrence.

Tags: hairtransplant, hair transplant, coloring, dye, propecia, finasteride, chemical burn, burn

Dr Rassman, Why Do You Insist on Young Men Taking Pills Rather Than Just Get a Hair Transplant?

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

Dr. Rassman,

I’m wondering why you seem to insist upon young men trying Propecia first before pursuing a hair transplant. What with the possible side effects and the need to continually take it, a miniturization examination and possible transplant seem a far safer – and even cost effective – plan in the end.

As a doctor, I do what is appropriate for all my patients, not for my bank account. If you do not need a hair transplant surgery and may benefit more from taking a simple daily pill, that is the best for the patient.

From a side effect point of view, most men do not get side effects, so it is worth a try. Moreover, Propecia is a safe medicine. Even after or before having a hair transplant surgery, I mostly recommend taking Propecia so that my patients do not lose more of their native hair. From a cost effective point of view, a lifetime supply of finasteride is much less than a hair transplant procedure, especially if you take the generic finasteride 5mg and cut it into 1/4 pills.

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

Two Doctors with Good Reputations, One With a Much Better Price

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

I am a healthy and robust 75 year old male. I have visited two local hair transplant doctors. They both have good general reputations. They suggest 1500 front and hairline grafts. I don’t know which to choose. One of them is willing to give me a much better price. Also, my big concern is shock loss. Any advice?

Please read through the information I’ve supplied in the very lengthy post called The Truth About Cheap Hair Transplants to get tips on how to select a doctor. You should put price into the formula only after all other criteria have been met. Then, of course, it is a free enterprise society and the prices may be the only distinguishing characteristic.

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

Skin Necrosis After Hair Transplant Infection

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

Hello. I’ve had my third FUT surgery about 2 months ago and due to infection the sutures incision line didn’t heal and skin necrosis happened. 16cm (6.7 inches) to 3 cm (1.2 inches) split skin graft was implemented 3 weeks ago on my donor area. Can FUE be a solution to cover up this area? And how many grafts may be sufficient?

Best regards

FUE is not the way to go in your case. A balloon expander for a problem of this size is the right thing to do. You can learn more about tissue expansion at American Society of Plastic Surgeons.

Tags: tissue expander, expansion, hairtransplant, hair transplant, hairloss, hair loss, necrosis