Scabs After Hair Transplant (with Photos)

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

So I think I am finally ready to have a procedure, on average, how long does it take for the scabbing to go away? I do not want to go back to work before it does.

The last two patients done this past week had no scabs when they left surgery or on the days following surgery. This is what we expect in over 90% of patients and most can go out into the real world without a hat on. Some people keep the scabs longer. The length of time relates to the:

  1. size of the wound (the smaller the wound the shorter the scab period)
  2. washing skills
  3. patient variables

Two of these are in control of the doctor and the patient, while the third is not controlled be addressing #1 and #2 alone.

Update: Here are 2 photos of a patient — the photo on the left was taken under an hour after the surgery of 1500 grafts was complete; the photo on the right was taken 11 days after surgery. This is the typical post-operative appearance of our patient surgeries. Click to enlarge.

 

Tags: scabs, scabbing, hairtransplant, hair transplant, aftercare

I Want a Hair Transplant, But I Won’t Take Propecia to Maintain

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

Hi, I have read before that you will only do HTs on men who agree to take propecia, and are hesitant to do it on young people. I am 22 and cannot take Propecia due to side effects, but I now have a prominent bald spot in the front of my head. The thing is, I would be happy to get a HT very soon, and I couldn’t care less if it looks stupid 10 years from now and I have a visible ugly scar. It won’t look as stupid as being 22 with a bald spot at the front. This is the prime of my life, and I’m much more concerned with my physical appearance over the next 8 years than I will be for the rest of the years of my life. So why not do HTs on people like me? Of course I want an ethical doctor, but really your 20’s are when looks matter the most.

PropeciaAt the age of 22 (unless you are already completely bald) you would generally not be a good candidate for a hair transplant surgery, particularly with your attitude, which appears immature to me. Surgery can sometimes accelerate hair loss and you may look worse after a surgery. Hair transplantation is a permanent process. 10 years from now you will be 32 years old and you will definitely care how you look. Three of the contributing editors on this site are in their 30s and I don’t believe any one of them would agree with your comment, “I couldn’t care less if it looks stupid 10 years from now and I have a visible ugly scar“. Even at 64 years old, you will care how you look. Trust me. I have seen plenty of men with your mentality who regret having had a bad surgery in their early twenties and having had accelerated hair loss.

I am not saying you should absolutely not have surgery, because I do not know your specific situation and degree of hair loss, but there has to be some maturity and understanding and realistic expectations with a hair transplant surgery. You should start with a good consultation with a doctor you trust. If it seems that I have been harsh with you, it is because I’m not trying to make a sale, but I am absolutely certain that 90% of the hair transplant doctors out there would love to get your money.

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

Since There’s Pulling Involved in Closing the Linear Scar, Won’t It Look Like I Had a Face Lift?

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

Any recommended surgeons for this procedure.. so its not so much “hair transplanting”. it more involves cutting your scalp and pulling your hairline forward..Since there’s pulling involved..wouldnt this cause the skin of your faced to be pulled also, making it look as though you had a face lift. Please explain the procedure?. What are some of the side effects of this surgery?? What are suturs, what is the purpose and why does it have to be removed? This sounds dangerous.

Thanks

Your question is very good and I suggest that you read the Single Strip Harvesting page on the NHI website, which explains the fundamentals of the surgery in better detail.

The donor hair from a hair transplant procedure is taken from the back of your scalp and as only about 1/2 inch width is taken, this will not pull your face back like a face lift, not in the slightest. If it did, then my business would boom and I could offer two types of surgery for the price of one!

Sutures are stitches that a doctor uses to close a open wound in surgery. Hair transplant is a very safe outpatient procedure.

Tags: hairloss, hair loss, face lift, hairtransplant, hair transplant, surgery, procedure, outpatient

What Makes a Norwood Class 7 Not a Good Transplant Candidate?

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

I have heard many people say that Norwood 7s are not good hair transplant candidates. However, two of the most successful hair transplants (Bobman and Jotronic) from another medical group were both Norwood 6’s heading towards level 7. What stops them from progressing further after their transplants? If you get a transplant as a 6, is it really that noticeable if you slowly progress to a 7? Is there something I’m missing altogether?

I have many Class 6 and 7 patients with great results from a hair transplant, so yes, it can be done well, but this is an issue of supply and demand with regard to donor hair. In other words, is there enough supply in the back of the head to meet the demands of the bald top? Take a look at Patient ZU from a past blog post (photos below) — now he has 9900 grafts and yet still has plenty of donor hair for more transplant procedures (which he does not need now) and that is because of two reasons:

  1. His scalp had a great laxity to it.
  2. He had a donor density which reflected an original hair population of 175,000 hairs on his head (normal is about 100,000 hairs).

Not everyone is a candidate and the issues that the doctor and the patient must face are one of realistic expectations and an excellent doctor/patient relationship.

Patient ZU – Before:
 Patient ZU – After:

 

Update: More photos! Click to enlarge.

 

Tags: hairtransplant, hair transplant, hairloss, hiar loss, supply, demand, laxity, density

My Doctor Told Me I Needed to Take Propecia to Make My Hair Transplants Grow

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

I just had a hair transplant (2 procedures) with a total graft count of about 4100. The area in the crown and just above it only grew partially. My Dr. told me to take propecia to see if it would help. The question is, if it does help and the new transplanted hair begins to grow, will i need to continue the propecia because that hair is “genetically programmed’ to last? Is there any reason that the transplants in that area didn’t grow?

Propecia (finasteride 1mg) will not do much with the transplanted hair. It may help with preventing the shock loss associated with a hair transplant and keeping your native (non-transplanted) hair from falling out, but the story that you need to take Propecia to grow your transplanted hair is just not true. You need to ask your doctor about this and have him/her explain to you WHY it is being recommended. Maybe you misunderstood your doctor’s advice.

If transplants in an area fail to show any growth after a year, there was something terribly wrong with the surgery. As always, I am flattered you would ask me, but having had surgery twice, you should have a good relationship with your doctor to ask questions pertinent to hair growth.

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

Hair Continued Thinning After Hair Transplant, Now I Want to Undo It All

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

Dr. Rassman,

I had a transplant procedure 7 or so years ago. Since then, my hair has continued to thin and even though the hairline was done well, one can discern that they are transplants. If I was to have the donor scar repaired and buzz my head to a # 1 clipper, would the transplant sites be very discernable (on top of my head?) If I was to pluck them out, would the recipient sites have scars? I am not really sure what to do. If I hadn’t gotten the procedure done I would probably shave my head close. I would also like to know if I had additional procedures done, would I be able to go with a buzz (#1) cut? Thank You

A hair transplant is forever, which means you shouldn’t do it unless you fully understand what is going to happen to you, even in the worst case scenario. I don’t know how to answer your question without seeing you. If the transplants were follicular unit transplants (FUTs), there is a good possibility you could shave the hairline, but based upon the what you describe, I suspect that the grafts were not follicular units. When there is any significant amount of skin in the transplanted graft, the skin will have some deformities associated with it. The larger the amounts of skin (which comes with procedures like minigrafts, micrografts, larger plugs, follicular families, double follicular units, etc), the harder it would be to get away with shaving the frontal scalp. Most people like you are easy to fix with more transplants, but it has to be done with FUTs and in enough numbers to fill in the problem area, but again I can not say this for sure without seeing you or your photos.

As you indicated that you’re in New Jersey, Dr. Robert Bernstein has offices in your area, so I would suggest that you see him for a straight answer, or you can send me photos to the address on the Contact page (reference this post, please).

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

Can You Keep This Patient’s Hair Looking Dense If He Loses More Hair?

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

Hi Dr. Rassman
Browsing the NHI site i found this 25 year-old man, Patient QE. Very good job. My question is that if this man becomes a type 4a in a few years, can you give him the density he has now?

Norwood Class 4AThis is an important question, because the doctor is putting hair where it has disappeared, but the process of losing hair is not static. With progressive hair loss that comes with genetic alopecia, you need to have a Master Plan and a good doctor. The doctor should lay out the worst case scenario for you and the remaining hair after the hair reconstruction should be present in adequate reserves to make up for any progressive hair loss that should occur.

Your particular question is good, because the patient you are referring to could eventually develop a Class 4A pattern and almost everyone with a reasonable hair density can follow hair loss to the Norwood Class 4A or even a 5A pattern with another transplant procedure. If the patient stays on Propecia, then it is likely that the hair loss process will be slowed.

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

Why Don’t Hair Transplant Doctors Get Hair Transplants Themselves?

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

I see a lot of hair transplant doctors’ pictures who have receding hairlines or who are bald. How come they don’t get hair transplants themselves?

Some doctors have had poor transplants themselves and although it might be hard to believe, comments made amongst the staff at the hotels that host our medical meetings have been overheard. People just don’t expect to see doctors with poor results, considering that they are in the business! Others decide that they do not want a hair transplant for personal reasons and I respect that the procedure is not for everyone. Quite a number of doctors in this business have had transplants and some even have their photographs on the Internet showing nice results, but of course, I can not tell you who they are for privacy reasons.

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

FastTrack Method?

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

I was looking at the fast track method and was wondering if you had any pictures of the procedure. I am a little confused as to how it is different besides it is more hair in one session.

“FastTrack” as we define it, is putting more hair with dense packing (hairs closer together). The term was how we originally introduced the technique in 1993, when there was nothing comparable performed by other surgeons. Today, the combination of maximizing the number of graft per square centimeter is performed by a small group of surgeons worldwide today.

If you want to see an example of it in a patient followed closely over 15 months, look at radio broadcaster Steve Hartman‘s hair transplantation procedure, where he achieved a full look without multiple surgeries.

Tags: fasttrack, fast track, hairtransplant, hair transplant, hairloss, hair loss

I Counted The Touches to My Scalp During the Hair Transplant

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

Hi Dr Rassman,

I received a front hairline transplant back in December of 07′ by a NYC transplant physician. He recommended 2100 grafts for good density. After cutting the donor area and microscopically separating the grafts I ended up with 2168 grafts so they say. During the actual procedure there were three doctor assistants applying the grafts within the incisions(cut by the doctor) in my scalp. One assistant was on the left side the other on the right and one was stationed from behind. I decided to count the number of times my scalp was touched by the transplanting instruments. During the entire procedure I came up with 220 in a period of two hours with a break in between. How could I have received 2168 grafts. A graft consists of 1 -4 hairs. If each graft contained 4 hairs which is very unlikely that adds up to 880 hairs. I think I got ripped off. What is your opinion? I am thinking about taking legal action.

As I’ve said many, many times before, you must have a good doctor/patient relationship before venturing into a permanent cosmetic procedure like a hair transplant. Counting the touches during surgery sounds like you had trust issues.

You had anesthesia which numbed your scalp, so I can not imagine how you could count what I would expect you could not feel. I obviously do not know the circumstances of your surgery, but before thinking of legal actions you should consider discussing your issues with your surgeon. Get a second opinion and let the second doctor look at the transplanted area. A second doctor should tell you if you got what you bought.

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

I Want a Hair Transplant to Strengthen My Hairline, But I’m Worried It Would Accelerate My Loss

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

Hi Dr. Rassman. Thank you for this website. I visit every single day and gain some comfort in the support here.

I am a 38 yo male with stong family history on both sides of my family. I started to thin in the front/hairline of my scalp at 22 years old, and started minoxidil immediately. After adding Propecia when it came on the market, I feel have done a good job at slowing down the blading process. My father and only brother were both almost totally bald at my age. I am probably a Norwood 3 – my mid-scalp and crown are still quite thick. My hairline has suffered and is loosing ground slowly every year. Temples are receeding and “widow’s peak” is now almost gone. Watching this happen, as everyone here knows, is devastating. I am contemplating having a consult with Dr. Bernstein for a transplant as he is close to me (NYC), but I am concerned that having a transplant to strengthen my hairline may accelerate my recession and compromise what I do have. I also am not sure whether to opt for FUE or FUT since I beleive around 1000 grafts would do the trick for me at this point. After viewing some of the photos on Dr. Berstein’s website et al., where he strengthens hairlines with approx. 900 or so grafts, the results look so amazing that I want to move forward. Any advice?

Dr Robert Bernstein is a great doctor who worked with me for over 10 years. If you were contemplating seeing Dr. Bernstein, go see him and he will be able to give you good medical advice after he has examined you. At 38 years old, with the type of hair loss you describe above, a transplant can be a good option (obviously I haven’t seen you so I can’t say for 100%). Follicular unit extraction (FUE) or follicular unit transplantation (FUT or “strip procedure”) will both work, but the likelihood of less surgeries with the strip technique has its advantages.

Tags: hairtransplant, hair transplant, fue, bernstein, hairloss, hair loss

Pimples In Recipient Area Months After Hair Transplant

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

I had a hair transplant 5 months ago. I have been looking after the hair with regard to shampooing, cleaning the scalp well. I have also been using Minoxidil in the form of Rogain in the recipient area the front of my head. Lately the recipient area has begun to itch. I have avoided scratching it…but noticed some pimples. Then while shampooing I scratched a lot, and some pimples burst. There was slight bleeding, maybe pus for the first and only time. It does not itch now, but could this cause a graft to get damaged and lost? thank you for all your help

No, pimples do not harm grafts, especially after 5 months if they are infrequent. You should read your post-operative instruction sheet (if it was provided for you) as pimples can be a common nuisance after a hair transplant surgery. You should have your doctor look at your scalp to make sure that you do not have a spreading infection.

Tags: infection, pimple, acne, hairtransplant, hair transplant, hairloss, hair loss

3 Days After Hair Transplant, My Eye Is Swollen and Bruised!

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

Hi Dr. Rassman,

I had my hair transplant 3 days ago and I was told that i’m a bleeder. so my head was wrapped for 2 days and after washing off the wrap i looked swollen but after the 3rd day after waking up my eye is swollen and bruised is this normal?

The bruising is rare, but it is normal to have swelling after a hair transplant procedure if your surgeon did not use large dose steroids to prevent it. It should be found in the pre-operative or post-operative handout you hopefully received — and more importantly in your operative consent form. Most of the swelling should be gone by the 5th day.

Part of me is honored that you would be turning to me for hair transplant aftercare advice, but the other part of me is shocked that you would not be asking this question to the doctor you trusted to performed your surgery. You really should have an open line of communication with your surgeon. I really can’t stress enough how a good doctor/patient relationship is so very important.

Tags: hairtransplant, hair transplant, hairloss, hair loss, bruise, bruising, swelling

When a Graft Comes Out, When Will it Not Grow?

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

Hi Dr Rassman, I have an important question for you regarding the study of hair grafts you conducted with Dr Bernstein in 2006. The study states that the Dr. Was able to tell when the growth center for the hair had been pulled out by looking at what he pulled out by eye.

My question is this:

  • how do you physically identify when the growth center has been pulled out?
  • Is there always blood?
  • Does bloody mean that the centre has been removed for certain?
  • If a hair comes out and there is a dried out “bulb” shaped skin on the end of the scalp, does that mean that the graft has been lost or the graft was a dead one?
  • did this study account for partially loose scabs?

After about 4 to 5 days, some of my scabs started to loosen…i started to gently brush some of them with my fingers and some of them were loosely stuck by a strand of skin, which I pulled gently with enough force to remove the scab. My question is this-

  • how can I identify when I have pulled out a growth centre and when I haven’t?
  • Do you think there was a good chance that I pulled a graft out?
  • Lastly, your study includes 18 gauge needles only. What is the standard size needle use or what range sized needles do you use?

Thanks so much for your time and thanks for the study!!!

Firstly, here is the article you referenced, as originally published in Dermatologic Surgery in 2006 — Graft Anchoring In Hair Transplantation — PDF file or HTML

Your email is not clearly written, but I think that you are asking about the hairs we pulled out on varying days after surgery to determine if the graft growth center was left behind. To answer that question, we asked the pathologist to identify the critical parts of the hair that determines growth (the bulge area near the sebaceous gland in particular) and this would include all parts of the hair and what is called the dermal sheath. If this was pulled out, we could safely assume the the graft would not grow. This was not done with the naked eye, but rather by the pathologist under the microscope. By having a specialist look at the grafts that were pulled out, we had an impartial expert make the judgments. I hope that this answers your questions.

With regard to your other questions, please read the article carefully, as we put it all there. Without a microscope and experience, you probably would not be able to tell the status and that is why we put the article together, to be able to guess what is really happening. When the scab is present on the surface, it is likely that the graft growth center can come out.

Tags: graft, anchoring, hairloss, hair loss, hair transplant

Transplanting Only to the Temples

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

I have a question. A couple of years ago I lost a bit of hair around the temples but this process seems to have no progress at all. I shave my head.. well only to about 3mm, have very thick hair. My question is as follows, If I got these temples fixed to get a straight hairline would a buzz cut be appropriate ? would it look natural ? I’d be grateful for your reply.

Frontal hair loss can be fixed to near-perfection with a hair transplant, provided that you are a candidate for it. That would include such checklist items as:

  • your age
  • your miniaturization mapping of your scalp
  • your expectations are realistic

If you come to any of our free monthly open house events, you will meet some men who have completely replaced the frontal hairline to what I call perfection.

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