I Bumped My Head 2 Weeks After My Transplant

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

Hi Dr Rassman, big fan of your blog, lots of info very helpful!

I had an fue transplant with a good clinic about 3.5 weeks ago. On day 14 I bumped my head on my left temple, not very hard. I wouldn’t of even paid attention to it if I hadn’t undergone an HT 14 days prior. Anyway no blood or visible damage to the skin occured although it may of been slightly pink (it was pink anyway because of the op). Could this of caused any damage to the new grafts at all? My patient advisor says its unlikely, but I wanted an opinion from somebody else like yourself.

Although there wasn’t any bleeding or even a scratch, could this damage what the grafts are doing under the skin?

Many thanks

I would doubt that you did any damage. Two weeks after your procedure, I wouldn’t be concerned about a slight bump to the head.

Tags: hair transplant, injury, trauma

24 Hours After My Transplant, I Found a Loose Graft

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

After shampooing gently using the cup method 24 hours later, I noticed a hair graft with skin still attached laying on top of my hair just as I was starting to comb my hair. I didn’t see any blood anywhere when I checked. Could this be a lost graft or could the follicle still be intact under the skin?

-Thanks.

It’s probably a lost graft. Have your doctor examine the area. At 24 hours after surgery, the grafts haven’t taken root yet. If the loose grafts are caught early enough and in the right circumstance, your doctor can usually push it back in and save it. Otherwise, it is expected you will lose a few grafts no matter how careful you are.

Tags: hair transplant, grafts

How Long Can Shock Loss Last?

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

Hi, Im 23 and i had a hair transplant almost 4 months ago. I’ve been on propecia for 3 + years with good results. I have an observation and a question for you regarding shock loss.

I’ve noticed that i’m losing a fair amount of native hairs in my recipient area, BUT, i’m really only losing these hairs after i workout really hard. For instance I went for a very intense run two months and right after i was finished i ran my hands through my hair and i noticed a mass amount of hair falling out from my recipient area. Do you think my workouts are contributing to the process of shock loss? If so how long will this last? ( how long can shock loss last?)

For starters, shock loss usually slows down between 3-5 months following your hair transplant. I really can’t fully address your concerns, because I haven’t had the opportunity to examine you before and after your surgery.

In our office, we offer the use of a device called HairCheck, which is a way of measuring hair bulk. We would’ve had measurements of before your surgery and if you really had shock loss after the surgery, we would actually be able to calculate how much hair you lost. This test could have been repeated monthly after noticing the problem. The first thing is to diagnose what is really happening.

Many men in your young age group are riskier patients for shock hair loss. Based upon your report, I can’t confirm your opinion without at least seeing you and all of your before photos. I would want to know what your patterned hair loss was like, where the recipient sites were placed (I hope that it was not placed in areas where you had significant amounts of native hair), and I would want to be able to predict the status of your miniaturization throughout the scalp. If you had significant miniaturization present and rapid hair loss present before your surgery, that would be an alert of an unusual risk for shock loss.

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

How Soon After a Transplant Can I Use Toppik?

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

ToppikI just had a 2000+ graft transplant 5 days ago. I trust my doctor implicitly and felt his staff was wonderful and professional.

My question is regarding post-op care. There doesn’t seem to be a consensus among surgeons. I suspect this is because good evidenced based studies are lacking but I was particularly curious for an opinion regarding concealing products like Toppik. I’ve heard ranges regarding safe use from 2 days post op to 1 year. Seemed like quite a range? Do you have an opinion? Thanks.

Generally you can use hair camouflaging products, such as Toppik, as soon as the scabbing is gone. That depends upon your cleaning technique or just the type of instruments your surgeon used during the procedure. If the granules get under scabs, they will act like a foreign body.

Refer to your transplant surgeon, of course.

Tags: toppik, hair transplant, hair restoration

Is the Donor Hair Really Permanent?

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

My grandfather’s has what you call a Class 7 pattern and the hair around the back and sides is very thin. I asked him if his hair was always that thin and he replied that when he was my age, his rim hair was much thicker. He became bald in his later 20s. Is the donor hair really permanent?

The donor hair around the sides and the back of the head in some men is not permanent.

I have seen men like your grandfather in my office and their donor density is very low, but as they are usually coming for a hair transplant assessment, I, of course, turn them down. There is some miniaturization in the donor hair in these men and I suspect that the miniaturization process that impacted their original frontal hair extends to the donor region. These men are clearly not surgical candidates.

On very rare occasions (about once every few years) I see someone who lost hair bulk in the transplanted hair. These men have a drop in donor density as well, so I must assume that these men are losing this sacred donor hair. This introduces two more risk for patients who have transplants: (a) the loss of some of the transplants over time as the donor hair dies off, or (b) the hair becomes finer with age (a common finding). The few who I have seen that reported transplanted hair loss to me, fortunately did not lose all of their transplanted hair, but it is a risk. I have only been doing hair transplants for 20 years, a relatively short period of time in the life of my patients.

Amongst those men I have transplanted above the age of 70, they never showed miniaturization in the donor area and they behaved like the young men I transplanted. One of my most unusual patients who came to my office frequently during our Open House events, was a Class 7 patient who received 9900 grafts over 9 years and he maintained his donor density through the entire process without miniaturization. He was 74 years old.

Tags: hairloss, hair loss, donor hair, hair transplant

My Transplanted Hair Keeps Falling Out

/by William Rassman, M.D./5 /,


Doctor, I’m having the worst time of my life and I’m hoping you’d take the time to answer my question.

I’ve had 5 HTs over the past decade all in the frontal area totalling around 4000 grafts including one at NHI back in 2000. The problem is I keep losing more hair in the area and it keeps getting thinner. My last 2 HTs were done by a very reputable doctor here but when I went to see him last time to get his opinion he said I am apparently one of the rare cases where transplanted hairs end up dying over time. This was a complete shock to me. From what I see, there seems to be very gradual loss -in an area that I think is totally made of transplanted hairs- over time but then at one certain time I lose a whole bunch of hair in a period of 1-2months. I am told that there’s no point of getting more HTs because they’ll end up dying. I am devastated and don’t know what to do. Am I really out of luck ?? Is there anything left for me to do?? I’ve been using Fin and minox for a long time.

I’m going crazy looking for an answer. I’m thinking about FUEs to fill in the thin areas but don’t know if I should do it. I hope that you have the time to reply to this as this doesn’t seem to be a common problem here. I appreciate it.

As a former patient, I feel compelled to answer your question. There are rare cases where transplanted hair is lost over time. On the few times I have seen it, I really do not have an explanation.

It is possible that you could have a telogen effluvium or a more diffuse type of hair. Your donor hair should be having the same process going on so the presence of miniaturization in the donor area may point to a clue for a diffuse type of hair loss like diffuse unpatterned alopecia (DUPA)… but without examining you, I can not tell you much.

There may be other options, as there may be other causes (metabolic abnormalities, dietary deficiencies, the existence of hormonal problems, etc), and these are things that I would want to know and would ask that if you visited me in Los Angeles.

Tags: hairloss, hair loss, hair transplant, diffuse

I Scratched My Fresh Transplant Area While I Slept!

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

hello doctors,

im 21 yo this year and had my hair transplant 3 days ago. when i was sleeping last night, i accidentally scratched the area where it was transplanted and soon it started to bleed, i went to check in the mirror, and noticed significant blood and a single hair was dislodged on my forehead. i just want to know if there were more then just one hair graft dislodged? as i have checked and seems that theres only 1 hair graft that is missing. will it affect other hair graft too?

I remember a patient who had 3 transplants and seemed to love to scratch his head while he was sleeping. He lost some grafts (as did you). I told him to wear a boxing glove, which seemed to stop the late night scratching as he fought with himself at night.

Tags: hair transplant, hairloss, hair loss

Ingrown Hairs / Pimples Months After Hair Transplant

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

3 months after my transplants i’m still getting ingrown hairs (pimples on my scalp). also i see no hair growth as of yet. do i have anything to worry about yet? also i was told the ingrown hairs is a good sign because it suggest there is growth beginning under the scalp. is that true?

Ingrown hairs are caused by three factors:

  1. Leftover remnants of the hair transplant inside the recipient site, which then go on to produce reactive pustules
  2. Hair grafts that are piggybacked one on the other as a result of a technical problem during surgery
  3. Folliculitis that evolves into abscess formation

Usually, the third one comes about with less than skilled technicians or technicians with poor eyesight. The other two are just the risks of the process. We see an occasional eruption and on some patients more than a few eruptions. The may come from a progressive folliculitis (infection of a hair follicle) or from one of the other causes listed above.

On very rare occasions, the follicular remnants will act like a foreign body and stimulate an autoimmune process (folliculitis decalvans). Fortunately, we have seen less than a half dozen such reactions in the 20 years history of this practice, but when they occur they are very difficult to treat both in time and visible problems at the wound sites.

Tags: hair transplant, pimple, acne, ingrown hair, hair restoration, surgery

How Do I Know if My Donor Area is Depleted?

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

How can someone figure if their donor region has been depleted? Is it evident by the appearance and volume of the donor region; would someone who has a depleted donor region have somewhat of a see through look in that area? I have had two FUHT both around the same size, 1350 grafts each, totaling 2700 grafts. Both of the strips were about six inches long and 5/8 of an inch wide and were remove from the exact same region of my scalp, second strip removed from the previous scar. My doctor says he could easily get another strip totaling 1300 grafts if not more from on top of my now existing scar. I’m a little skeptical of this. Although my donor area still appears just as thick as it ever was, that seems like a lot of grafts from just that small region. I would have totaled 4000 grafts and barely even touched either of the sides of my donor region, having just used the back region. Is this plausible? Side note my donor density is slightly above average

Usually 2700 grafts will not deplete the donor area. You need to have expertise in examining a donor area to make that assessment. If you do not trust your doctor’s opinion, get a second opinion. The depleted donor area usually has a see-through appearance, especially when the hair is lifted up.

Tags: donor area, hair transplant, hairloss, hair loss

Histamine Positive Skin and Hair Transplantation

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

Hi,
I would first like to thank you for this very informative site. My question has to do with post operational side effects. Specifically, I had FUE/FUT 1.5 months ago. Unfortunately I have something my doctor called histamine positive skin. As a result there is redness in the recipient area. My first question is related to that.

How long would it take for such redness to fade away and what can I do to reduce that amount of time? Additionally, in the donor area, there is a significant amount of redness and the hair growth appears limited. Is this to be expected? And what is the time frame for full recovery of the donor area? My doctor is quick to say it will all be fine in a few months but I wanted a second opinion as well as anything I should keep an eye on to better facilitate the recovery of that area.

This was my first surgery and I only had 1000 grafts transplanted.

If your doctor was helpful enough to explain a histamine reaction to you, how is it possible that you were not told how long it would last? I often do a scratch test to the scalp or forehead to preselect those patients who are histamine positive. In general, every patient is different and the redness can last several weeks to months. 1 to 2 months would seem on the long side.

Unfortunately this is not a place for second opinions as I do not know what you are really experiencing. All hair transplants are not the same, especially FUE, as there are many variables such as size of punch, techniques of extraction, the drugs you take, the allergies you have, etc, etc.

Tags: histamine positive, redness, hairloss, hair loss, hair transplant, surgery

Necrosis Following a Hair Transplant Over a Month Ago

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

I am 26 years old and 40 days ago I did FUT. My doctor transplanted 2100 grafts on my vertex, but unfortunately on back of my head there is 2 parts that is like 2 circles (3 cm in 3cm,each circle) that my doctor told me it is necrosis. I was just wondering if it will recover and my hair will be restored on back of my head or not ?! if not, please note how I can do? Or if it will cure, how long would it take?

Best Regards

In essence, “necrosis” means there is dead tissue. It is sometime referred to as gangrene. If you have necrosis in the donor area, healing will be an issue… and if it heals I doubt you will have regrowth of hair in those areas again. I really couldn’t tell you how long it might take to heal, because this is a function of the size of the dead skin and I do not know the severity of your problem. There are other complications that will also likely be of concern, such as infection and deformities.

Donor necrosis is more common in strip surgery when the wound is made too wide. This can cause significant scarring, so much so that it may require extreme measures to fix (such as the use of balloon expanders). I’ve thankfully never had significant donor necrosis in my patients, and necrosis in the recipient area is very, very rare.

Past posts about necrotic tissue following hair transplantation can be found here and here.

Tags: necrosis, hair transplant, hairloss, hair loss

Shower After a Hair Transplant?

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

I recently had a hair transplant and i was curious how long i should wait before going back to my usual routine of showering every other day? My main concern is folliculitis or infection.

ShowerYou should really ask your doctor about the washing issue and what he/she recommends you do following your surgery. Your surgeon should’ve provided you with aftercare instructions. For my patients, I recommend gentle showers and hair washing the very next day after a hair transplant.

I just saw a man from overseas who told me that by the 5th day after his surgery he could not see any scabbing, nor could he see the graft recipient sites (he had hair present from a previous transplant and the new procedure just filled in between the grafts). If it is washed well by the staff the day after the transplant, then the scabbing can be minimized.

Tags: showering, shower, cleaning, hairloss, hair loss, hair transplant

My Shock Loss Was So Bad, My Hair Looks Thinner 8 Months After the Transplant!

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

Hi Doc

i had previously done a minor HT of 500 grafts onto the thinning mid scalp. Shock loss was bad and now at 8 months post HT, my hair looked thinner than before.

my question is is it advisable to plant the hair grafts onto the thinning mid scalp or is it more advisable to plant only onto the bald area and leave my thinning mid scalp until more serious before i start to tackle them.

I would have hoped that you were on finasteride prior to getting a hair transplant, as this drug minimizes the shock loss some young men experience. Were you warned ahead of time about the possibility of shock loss?

Everyone is different and you certainly have a unique problem, though I don’t know much about your case (age, hair loss pattern, hair character, etc). I would have to see you, or at least you should email some good photos that show your scalp, and we might be able to setup a phone consultation.

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

Post-Operative Hair Transplant Itching?

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

I’m planning on having hair transplant surgery this year but am concerned about post-operative itching in the scalp, which I understand it to be expected. Can betamethasone dipropionate 0.05% cream be applied to the scalp to control itching post-operatively?

Thanks.

Talk to your surgeon about how he/she best treats post-operative issues (including itching). What you are asking about is a steroid that can be used on a limited basis, but your doctor will want to know what he/she is treating.

There’s a lot of other things that could go wrong with the surgery that I’d think most patients would by concerned about before even thinking about the itching. You’re about 20 steps ahead of yourself. Many men do not have excessive itching, and the use of good conditioners can keep the scalp moist enough to avoid it.

Tags: hair transplant, itch, steroid, hairloss, hair loss

Ichy, Red Scalp a Month After FUE Procedure

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

Hi dr,

1 month ago I had a fue hair transplantation, but almost all of the hair transplant are fallen out right now. they say this is normal but im concerned because some hairs fall flat like a triangle.

also i have many itches and redness on my head. maybe this is the healing process? I assume this is normal?

thanks

Wasn’t there a doctor who performed surgery on you? Did your doctor abandon you? You should be concerned and should be asking your doctor what is going on with your head. That doctor has more knowledge of you (by way of examination and access) than we do on the internet. What you’re describing a month after surgery is not normal. Not all FUE is performed the same way and not all hair transplants are the same.

The two people in this world that knows what is going on is you and your doctor. This is not a brush off — if there is redness and there is a concern over an operation you have had, the internet is not a place for reassurance.

You may have an active folliculitis that requires treatment, and if you do, the prolongation of the incubation period can only harm your grafts. This isn’t something I should be guessing about, though. Please speak to your doctor.

Tags: folliculitis, hair transplant, fue, hairloss, hair loss