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 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

When Are Transplanted Hairs Safe?

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

Hello doctor,

I had a hair transplant and I’m at month 3, I’m a little paranoid thinking about the weeks when I saw hairs falling out with the bulb on the hair shaft when I scratched my head..

That was around week 3, my question is, how long does it take until the hairs root?

Thank you this blog has been most helpful

At 7-14 days, most hair transplants will not be affected by whatever you do. If all of the scabbing is gone, you are generally safe. If you tried to pluck one or even a few out after the scabs are gone, I doubt that it will impact the graft at the root, regardless of what you see.

So at week 3 or month 3, you’re fine.

Tags: hair transplant, post-operative

I Had a Hair Transplant with Trichophytic Closure Technique — What Does My Scar Show?

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

Dr. Rasmann

I want to thank you for all the information you provide on here to help educate everybody looking into a H.T.

I recently had a procedure using the trychophytic closure technique. I am 10 days out and the staples have just been removed. Is what I am seeing in the donor the hair that will permanently not grow? or is this just a result of the donor area being shaved and the hair still having to grow in. thanks in advance

Click the photo to enlarge:

 

Having a trichophytic closure technique used is not a guarantee you will have a nice, thin and neat scar. The photo isn’t clear and I can not tell what is shaved from what might be an early stretch of the scar. You will have to wait it out.

If you have a visible scar after 5-6 months, it can be successfully covered with Scalp MicroPigmentation (SMP). This is a great option and we have a photo gallery of examples here.

Tags: hair transplant, scarring, hairloss, hair loss

Applying Betadine After a Hair Transplant

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

after hair transplant about 15 days, I have been infected with pimple not sure it is folliculitis or not. My doctor let me take doxycycline and use betadine leave it for 5 minutes and wash. If I use betadine 2 or 3 times a days can it affect graft survival?

Betadine is a strong antiseptic containing an iodine solution that will significantly reduce the presence of skin bacteria. Infections 15 days after a hair transplant rarely are caused by skin bacteria. Many times the cause is as simple as scratching the scalp, thereby breaking the skin and introducing a source for skin bacteria to invade into and through the skin. When applied topically, Betadine will not hurt the grafts at this stage.

I am not sure what the problem is that you’re experiencing, so it is impossible for me to comment on a treatment. At the least, a picture may help. But since you’re under the care of your doctor, I’d go with his/her treatment plan.

Tags: hair transplant, hairloss, hair loss, graft survival, betadine, iodine

Accelerated Follicular Restoration to Speed Up Growth After a Hair Transplant?

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

Any thoughts on this Help Hair product that claims to accelerate the growth process after a transplant, so that it only takes 6 months to see the full results after surgery? It claims to reduce or eliminate the telogen phase after a hair transplant!

Press release from 2011 – link
Product page (with link to a study of 115 hair transplant patients) – link

I have been following the Help Hair product for some time, but I have been reluctant to hop on board because of the lack of clinical evidence that it works. On a positive note, it is logical, and the theory that “increased anabolic metabolism can affect regeneration of the hair follicle” makes sense (after all, we are what we eat). The change in diet brought on by this product may have no effect on a person who is healthy and eats healthy foods, but there may be a fine line between those with a good diet and those who might benefit from a better diet.

If I saw a good scientific study, I might want to endorse this product’s use in our practice, but as this increases the costs for our patients, I really want to see better evidence.

In our practice and in the years I have been doing hair transplants, most of the grafts routinely have started to grow within 6 months, and once hair starts to grow, it grows at 1/2 inch per month. So for example, for the transplanted hairs that grow out by the 5th month, we will see 1/2 inch length at the 6th month. I would be interested to see reports of when the hair actually starts to grow, and then use the 1/2 inch rule to determine when the “full results” are actually achieved.

Tags: afr, accelerated follicular restoration, help hair, hair transplant

Having Sex After a Hair Transplant?

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

Can you have sex after a hair transplant? Just wondering!

I tell my patients that they can have sex after a hair transplant and use sound judgement. You can also exercise after a hair transplant, but must also use sound judgement. In general, we ask patients to take it easy for the first two weeks…. but some patients who have very active lifestyles will do light exercises even after 2-3 days and be fine.

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

I See More Scabs 8 Days After My Hair Transplant

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

doctor, after my hair transplant i had shedding at the 3rd day after the operation. it comes with a hair and dark scab. is this the sign of losing graft? And on the 8th day i have a lot of scabs, more than first week. is this normal?

Grafts could come out at the 3rd day after your surgery, so if there are many then you could have a problem. I don’t know about your management of your recipient area after surgery. I generally recommend a specific washing procedure starting the next day after surgery and this keeps the eschars (scabs) down. Leave the eschars you have alone until they fall out, probably in a week or so.

Tags: hair transplant, scabbing, hairloss, hair loss

Should I Use Vaseline On My Eyebrow Transplants?

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

VaselineDoctor, compare about eyebrow transplant and hair transplant. Which has higher success rate and why?

3-4 days after eyebrow transplant I have a very little crust and scabs. Is it a good sign? Do I have to use vaseline petroleum to my eyebrow right away after procedure?

Hair transplant results are the same for eyebrow or scalp. The eyebrows tend to crust less, but the key to keeping crusting down is to use a good washing technique daily after the transplant. I have never recommended Vaseline petroleum after a hair transplant.

Tags: eyebrow transplant, hair transplant, vaseline, hair loss, hairloss

Is There a Way to Tell FUE Success After Just a Week or Month?

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

Hi Doctors, great blog here! It’s an amazing cross-reference and informative place.

Just wanted to know if there are any signs of a successful FUE transplant? (other than growth of hair at 8-10 months!!).

Can the patient tell within a week, or a month, whether the surgery he had would be, say, at least 80-90% successful? Are there any signs which suggest that yes the transplant was a success, and that the roots did not dry out, and were placed correctly etc.? ( I’m guessing, that if the transplanted hair kept growing till it fell out after 3/4 weeks, that means the roots were alive and firmly in place, and the surgery was good? )

I only ask about FUE, because it seems the more delicate procedure with a higher trans-section rate.

Thank you Doctor.

I know the anxiety you have. Everyone with a hair transplant wants to accelerate the clock, but it makes no real difference if the transplant is FUE or strip. In either case, you will start seeing the results (at least some results) somewhere between 4-6 months, with good growth by the 8th month. At one month, the hair sheds in probably 19 out of 20 people. Just be patient.

Tags: hair transplant, hair restoration, success

Should I Avoid Green Tea and Protein for 2 Weeks After My FUE Procedure?

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

Hello Dr. Rassman.

I and other readers would be thankful if you could tell us a little about some of these basic points –

1. I was told to avoid green tea because it has anti-oxidants for 2 weeks after my FUE transplant. Do antioxidants hinder with growth of new implanted grafts?
2. I was also told to avoid protein and vitamin supplements for 2 weeks for the same reason as above. Is that right?
3. I am spraying saline solution on my implanted area every hour for a week. Told to wash only after 1 week. What exactly does saline do?
4. Finally, do Soya milk/ foods really block DHT that affects male pattern baldness?

Thanks a lot, and keep up the good work!

I would add that you should not go outside during the day after your surgery due to antioxidant effects from the sun. Also not driving your car for the first year after the surgery due to the risk of car accidents, which can cause great stress. Perhaps meditating for an hour a day in a downward dog position can also promote hair growth and circulation to the scalp. I’m being sarcastic, of course.

Where do you get this information? Did your doctor tell you this? Always follow the post-operative instructions given to you by your doctor. If these are truly basic points, you should not have to worry because your discharge information should have them.

In the spirit of BaldingBlog being a source of education for general hair loss issues, I would add that green tea, protein, vitamins, and soy milk have nothing to do with a hair transplant surgery or treating genetic male pattern baldness. If you believe what you read online, it is your prerogative to not drink green tea, etc. Otherwise, in matters of personal health and YOUR surgery, it is best to ask your doctor face to face.

Tags: hair loss, hairloss, hair transplant

Taking Ibuprofen After My Hair Transplant

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

Hello there Doctor Rassman!

My compliments on a great blog here. I’ve just had a FUE done for my hairline today. I have 2 simple Q’s –

1. Is Ibuprofen recommended after surgery? My surgeon has prescribed it twice a day for 5 days, but I read on the internet that it promotes bleeding?

2. On reaching home, I have been spraying the recipient area with saline solution every 30 mins as prescribed. I am seeing some drops of blood oozing out of the recipient area. Is this normal? I couldn’t spot any hairs in the blood so just concerned that none of the hair roots have fallen out due to this bleeding.

Thanks for your time and help

1. Ibuprofen in general can cause bleeding, but you need to understand and takes things into context. Believe what your doctor (a real live person you trusted to perform your surgery) over what you read on the Internet.

2. A little bit of bleeding should be normal since you just had your procedure done. It was surgery, after all. Many doctors have different post operative instructions, so if you are concerned you should contact your surgeon.

Tags: hair transplant, bleeding, ibuprofen

My Scalp is Red Years After My Hair Transplants

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

Hi Doc. I’ve had 2 hair transplants. Both over 2 years ago. One in Australia and one in North Carolina.

Today my new girlfriend mentioned to me that “where my hair is it looks red and sore”…. this is very disturbing as I have often thought the skin around my recipient area had a sort of raised redness about it. But I never thought anybody else would notice.

Before you say “see my doctor” I just want to know if you’re aware of this happening and whether or not there are any skin creams that might help my skin go back to normal. If not skin creams… is there anything you can do?

Redness can be an issue for some patients even years after surgery. I’ve seen this on occasion from old (bad) hair transplant days, but I rarely see this anymore. Maybe you have a skin problem, though it’s all a guessing game without an examination.

Tags: surgery, hair transplant, redness

Losing Grafts After a Hair Transplant?

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

Hi Dr,

Thank you so much for this wonderful blog. I just recently got an HT with a very reputable clinic. My question concerns shedding of the grafts. I notice shedding began around the 9 day mark. Is this considered normal? Also, i had crusts on my head for approximately 9 days, and i noticed there were a couple of crusts that fell off with a hair in it. My question is, is it possible i lost a graft in one of these crusts. Or would there be some noticeable bleeding from the graft from being dislodged?

Thanks

At 9 days, I would expect that the grafts will grow out nicely. In a published article where we tried to identify when the grafts would be stable to grow out normally, we determined that stability occurs usually in a week or so. When the grafts fall out with the hairs in it after a week, they leave behind the stem cells in the recipient site. Don’t worry, it sounds like you will be fine.

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