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

Is It Likely That I’ll Lose Hair After a Facelift and Brow Lift?

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

I am considering a facelift and brow lift with a trichophytic incision due to a slightly high forehead and bald areas above my ears. I have been losing hair like crazy from menopause-common in the women in my family. I am afraid of more hair loss as my hair is already thin at the front,sides and recedes at the place men usually recede on the sides of my head. The surgeon doesn’t seem to think this is a problem. He cuts along the front of the hairline then back into the hairline and then down to the ears. What is your opinion of the likelihood I will lose more hair since I lose hair where ever I am cut? Thanks

Hair loss around the facelift / brow lift scar is a risk and while your hair will likely hide any scar or hair loss, it is still a risk you should be aware of. My opinion and observation is definitely skewed, because I only see the worst cases when hair loss occurs after a facelift/brow lift in which time they come to me for a hair transplant. If you are already losing hair or are actively having thinning of your hair, there is also a small possibility that surgery (as a stressor on your body) may precipitate more hair loss. As stated, these are small risks, but something you should consider to weigh out when looking at the risks versus the benefits of these procedures.

Tags: hairloss, hair loss, facelift, face lift, brow lift, plastic surgery

18 Year Old Man Wants Options for a Lower Hairline

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

Hey doc, I’m an 18 year old male with a big forehead for someone my size, and it’s really bugging me. What option would be the best to remedy this for a guy who is my age, who is not balding or has ever had any form of hair loss, whose father did not start balding until his 50s, and who only needs to lower his hairline by 1-2cm?

I know that my two choices are forehead reduction surgery (but I’m kinda wary about the possible visible scar if I start balding), and hair transplantation. Which would the costs generally be for each option for a hairline 1-2cm lower?

At 18 years old, you really won’t know if you will bald, so if you move your hairline down with transplant and should start to recede in the future, you will have a vacant space behind the newly lowered hairline. If you move down your hairline with a hairline lowering procedure and should bald, then the scar from the procedure may show as you continue to recede. Many surgeons will not tackle lowering the hairline on an 18 year old male. For women though, it is generally no problem!

The cost of either procedure (hairline lowering or hair transplants to the hairline) may run about the same.

Tags: teen, hairline, lowering, hairloss, hair loss, mpb

Implanting Artificial Hair for Alopecia Areata Patient?

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

HELLO Dr. Rassman

I am a 24 year old male and suffer from Alopecia Areata. Is it possible too have false hair transplants as i have no hair on my scalp, i only want eyebrow hair is this a possibility and what are the procedures!!

Implanting artificial hair is dangerous and leads to massive infection. This is not a solution. Usually, alopecia areata does not cause complete loss of the scalp hair, and you may have alopecia totalis or alopecia universalis.

Tags: fake, artificial, hairloss, hair loss, alopecia, infection

Hair Loss from Z-Plasty Incision in Scalp

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

Doctor, I recently have had a spot removed from the top of my head. It was necessary to do a z plasty, which is roughly 4 inches in the longest part. I have no natural hair loss, but have been on Propecia for roughly 14 months. Since the surgery, (6 weeks ago) I have significantly thinned in a z pattern on my head, where the incision was made. It actually looks worse than it did 1 week after the surgery. I am very concerned and would like your opinion if I am experiencing what some might classify as shock loss, and if my being on propecia for a year prior would lend itself to me getting my hair back. Thank you

Having any scalp surgery in an area where you are genetically balding will accelerate the hair loss, and it quite possibly may be permanent. Even a scalp surgery like what you described can cause hair loss in non-balding people. Shock loss is usually best prevented by Propecia (finasteride 1mg) in men with genetic hair loss. You will know what will happen in 6-8 months. You may need transplants there if it does not self correct.

For those curious about a Z-plasty, Wikipedia has a nice explanation here.

Tags: z-plasty, surgery, scalp, hairloss, hiar loss, technique

Removing a Cowlick in the Hairline?

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

I am 19 years old and am interested in the surgery your company offers for hairlines. My father recently had a follicle hair transplant done and he was greatly satisfied with the results. He chose to have this transplant done due to balding. My case is different however.

I have a cowlick in the center of my hairline which is wierd and I hate it. I am interested in a transplant that could fix this hairline issue and possibly get rid of my cowlick structure. Is this possible? I must also add that I am only 18 years of age. What would be the average cost for such a procedure that I am requesting? Is there another type of surgery that could fix this issue? (such as brow lift, or etc)?

These cowlicks are interesting and I have always personally liked their look, but many of the men who have it might not agree with me. If you want to remove it, there are some options including laser hair removal and follicular unit extraction (FUE). I would be reluctant to do this surgically on a 19 year old without your parents involved in this decision.

As a side issue, transplanting into a cowlick to restore it, does present interesting challenges.

Tags: hairline, cowlick

Female Hair Loss Continuing After Serious Surgery a Year Ago — My Doctor Dismissed My Concerns

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

(female)
Hello,

I’m having a hard time with hair loss since a serious surgery in May of 2007 (it lasted approximately 6 hours). It is now April of 2008 and I’ve noticed a steady and very noticeable loss in hair (I can see my scalp from the back- very little coverage of hair).

I have no known genetic hair loss in my family (that I’m aware of) my grandparents and parents have full, very thick, heads of hair and I had a full head of healthy hair prior to my surgery. My Dr. dismissed my concerns as attached to the surgery in May, however, I have not seen any return of hair since then, but rather a continuing loss.

When should I expect the hair to regrow? Is it unusual for hair loss to continue 10 months after surgery (note: the loss didn’t start until a few months after surgery and it was dramatic loss all of a sudden rather than slow shedding). Sometimes I find that my scalp hurts- it’s a hard feeling to explain. It is not severe pain, but rather a dull sort of sensation all over my scalp. I’m very concerned and have tried one treatment (oil and shampoo system -the oil treatment was twice a week for three months-that was supposed to stimulate growth). It did not seem to help at all.

What do you recommend I do? Is this normal or the sign of something irreversible? Thank you for your help. I do hope you can answer my question. I’m desperate to find some solution.

Hair loss after a surgery or from a severe stress is called telogen effluvium. If it lasts less than a year as it normally does, it will reverse after the stress abates. Some people go on to a chronic telogen effluvium. Both forms may be treated with minoxidil while you are waiting for it to reverse. More information about telogen effluvium can be found at eMedicine.

Tags: telogen effluvium, hairloss, hair loss, chronic telogen effluvium, stress, surgery

My Hair Grows Differently After Brow and Face Lift

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

If I may piggy-back on the previous inquiry regarding loss of sensitivity of the scalp and hair loss. 3 weeks ago I underwent a brow and face lift and now the top and sides of my head are totally numb. I also cannot get my hair to lay the way it did previously…it’s like it’s developed a totaly new growth pattern and new cowlicks that make the hair impossible to manage… My surgeon says it may take 3-4 months for the feeling to come back. he can’t comment on my hair except to be patient. Is this sort of development to be expected? What should I do?

Your doctor is probably correct. You must wait this process out. If it does not get better, then be sure to speak with your doctor further. Brow lifts can cause changes in hair growth because of scarring and the pull on the existing hair, reduction of thickness of the hair shaft caused by blood supply problems, and the inducement of genetic changes that may be programmed and not ‘expressed’ without the brow lift. There are probably other factors, but I do not believe that anyone knows them all.

Tags: browlift, facelift, face lift, brow lift, hairloss, hair loss

In the News – Eyebrow Transplants

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

There’s a new article about transplanting eyebrows, and features quotes from myself and my colleague Dr Bernstein, and contains before and after photos of an eyebrow patient of mine. Here’s a snippet from the story:

Throughout the country, follically-challenged and over-tweezed women (and some men) are discovering a new solution to their eyebrow woes that does not involve tattoos or makeup pencils.

Eyebrow transplants accounted for just 3 percent of all hair transplants in 2006, according to the International Society of Hair Restoration Surgery, but they grew by 35 percent over the previous two years and appear to be gaining momentum

Read the rest of the article here — Transplant perks up fading eyebrows

Tags: eyebrow, eyebrows, hairtransplant, hair transplant, eyebrow transplant, rassman, bernstein, hairloss, hair loss

Proper Medical Evaluation Before a Hair Transplant Saved My Life!

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

Dear Dr. Rassman:

I wanted to let you know that I am coming along nicely after my recent procedure; and how appreciative I am of your and the entire NHI’s staff’s courtesy, kindness and care. I also wanted to take the opportunity of alerting the general public as to the necessity of proper medical evaluation prior to any procedure. As you recall, I presented to you about 9 months ago; with a past medical history significant for cardiac disease. Your recommendation was that I have this more carefully evaluated before we consider hair restoration. Within some weeks, I was on an operating table receiving what was literally a lifesaving procedure. If it hadn’t been for your clinical instinct; I might not be here at all today; let alone in my soon to be more hirsute state!

Doctors should be responsible for the entire patient while the patient is under his/her care. I always take a personal interest in my patients and I’m happy to have helped!

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

Surgical Hairline Lowering Is Not Permanent?

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

I have read in a couple of blogs on the web that the surgical hairline lowering procedure is not permanant -ie. in 10 years after the procedure, the skin can stretch back and pull the hairline back to its original position. Is this true?

It may be true. Many brow lifts (just the reverse of hairline lowering) will stretch back. As we get older, the skin loosens and stretch-back may occur to some degree.

Tags: hairline, lowering, brow lift, browlift, plastic surgery, hairline lowering

Dissecting Cellulitis of the Scalp

/by William Rassman, M.D./302 /,

I am a family medicine resident finishing up my last year. I unfortunately have a condition which I discovered doing my own research called Dissecting Cellulitis of the Scalp. It is horrible!!! This is a rare condition that usually affects black men in their 20’s. It is a very painful, cosmetically disfiguring disease that I have dealt with for about 4 years now. I have tried all of the antibiotics and medical treatment that you can think of and have seen many dermatologists that in my opinion, are not really aware of how tough this is to treat. I have read some studies that state that Laser therapy has been used with some success and others that state that complete scalp excision is successful. Of course, I don’t want my whole scalp taken off, but I am willing to try Laser therapy if it really has good results. At this point, I am really ready to try anything. If you are familiar with this or can even refer me to someone who is, I would really appreciate it.

This is a rare condition and as you said it is very difficult to treat. Before going as far as having surgical excision of your scalp, I found a case study in which they had success in treating recalcitrant dissecting cellulitis with Nd:YAG laser. The study was published in Dermatologic Surgery in August 2004, Volume 30 Issue 8, and was written by Eric C. Parlette MD, Nathan Kroeger, EVictor Ross MD — Laser Treatment of Recalcitrant Folliculitis Decalvans.

Unfortunately, I can’t post the text here and the publisher charges a fee to view the text, but it may be worth looking into. Good luck.

Tags: folliculitis decalvans, laser, dissecting cellulitis, dcs, hairloss, hair loss

Eyelash Transplants

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

EyelashesI just spoke to a lady who had eyelash transplants 18 months ago. She wanted to know my opinion on her complications, which include: loss of native eyelashes, failure of the transplanted eyelashes to grow, and some infection.

This is the problem I am hearing from many people who have had this procedure and therefore I urge most people to avoid doing this surgery.

Note: The photo here is likely a goal of eyelash transplant surgery, but it may not be obtainable. Photo for illustrative purposes.

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

Had a Hair Transplant 4 Weeks Ago and My Donor Area Still Hurts When I Lay on a Pillow

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

Hey doc, first of all I would like to say that your website is excellent and very helpful. I tried to look up my question but unfortunately couldn’t find the answer.

I had a transplant on the 2nd of Jan 08 (this month) every thing is in order except that my scalp above my donor area hurts if it gets in contact with any thing, even if I put my head on a pillow. I was wondering if this is normal as the surgeon has to pull the scalp in order to stitch it up and the scalp is obviously not at the old location. How long will it take before I get rid of this problem? I thank you for your time.

I would strongly recommend that you make an appointment with your hair transplant surgeon to make sure that everything is alright. Since we did not perform your surgery I can not tell you if this is normal or not (I don’t know how the surgery was performed, the number of grafts, the doctor’s techniques, etc). Certainly some pain after a surgery is possible even after 4 weeks, but it should be quite minimal.

Tags: hairtransplant, hair transplant, hair loss, hairloss, surgery, procedure, pain

Could a New Breakthrough Mean Using Hair Transplants from Another Person as a Donor?

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

Dear Dr. Rassman,

I understand that hair cannot be donated from another person, yet why is it possible that organs can be?

I was reading an article today, Doctors Report Transplant Breakthrough, that mentions the possibility that organ recipients could one day not have to take anti-rejection drugs the rest of their life. If this prove to be true, can hair transplants from other people be a reality?

Unless the genetics are a perfect match, any organ that is transplanted (including hair, which is an organ) has until now forced the patient to take drugs to knock down the rejection process. The reason that a hair transplant works is that each person is his own donor and therefore has perfectly matched genetics. The drugs that you take for controlling organ rejection from a heart or kidney can kill you, but not having a heart or a kidney will kill you anyway. Rejecting hair from another person won’t kill you… just leave you bald and it it 100% certain that the hair from another person will reject.

The five patients in this article all had kidney transplants and were on anti-rejection medication for a period of time and have received marrow from the donor. I would not want to be the first volunteer for such procedures, and the relationship between these patients and a potential to harvest hair from others are decades away.

Tags: hair transplant, hairtransplant, patient, donor, hairloss, hair loss, marrow, kidney