i saw the ‘Follicular Unit Extraction’ video on ur website. i want to know whether the donner area will have any scars and weather the donner area will grow any hair in future. how about a person who wants to keep very short hair??
The FUE will produce scars that are punctate, which that means they look like very small dots. The hair can be cut very short, but not shaved completely. A shaved scalp will show these small dots.
Hi Doc, Does the stiches which takes place at donor area hurt after HT? any headaches does it has to be protected from Sun etc for a long time
Thanks
Stitches are something you feel, but I would not say that they hurt. I am talking from my experience with stitches after my two hair transplants. The back hair covers the stitched area so you do not have to worry about the sun.
Can you show me a typical donor wound scar?
Here’s a photo of a typical donor wound scar after a single surgery in a person who heals normally. The scar measures 1mm (in the ruler, each line is 1/2mm). He came in for a second surgery this week and I am hoping that the scar from this week’s procedure will turn out as well today as it did before. The risk of significant scarring (greater than 3mm) is 5% for the first surgery, 10% for the second surgery, and higher still for a third surgery. Usually the combed hair in the back will cover most scars.
I apologize that the photo isn’t perfectly focused, but the scar still shows well here. Click to enlarge.
How the donor area exactly look after HT ? I have no idea…does it look very ugly and scary ? My doc is not exploring it completely….plz help me sir.
If your doctor does not answer this question for you by showing you patients so that you can examine the donor scar yourself, then go to another doctor who will do this for you. You should be frightened if you are not getting good answers.
Take a look at the two sets of photos below. These patients (who both had Follicular Unit Transplantation) consecutively came into the office for a routine follow-up visit. All scars were easily covered by the combed hair and to see the scar, a comb had to lift up the hair. Click the photos to see full-size.
Patient 1:
Patient 2:
For further photos of donor scarring, see Trichophytic Closure Photos.
i underwent a couple of strip transplants and i got slit marks and mild pitting in some sections of the recipient area including part of the hairline. a surgeon told me about microdermabrasion or dermabrasion (laser or mechanical), the pitting on my head is not so severe and i don’t think that a FUE extraction of my pitted monofollicular is the logical thingh to do. ANY SUGGESTIONS?
thanks.
Get a second opinion? I cannot help you without seeing the results and examining you in person. Mild pitting can be an unfortunate consequence of such surgery, especially if the grafts sites are too big or too much skin was transplanted with the hair grafts. I have heard other doctors describing microdermabrasion/dermabrasion to correct such problem, but these techniques may remove pigment from the skin that is worked on. This means that you may end up with a shine on the skin and some skin discoloration, which may look even worse.
Hi Dr.,
(male) I have a couple questions. The first one is I had a hair transplant (strip) in March of ’05 and I was wondering if the scar is fully healed by now. Im wondering this because sometimes when i lift weights the back of my head will hurt or feel strained and I do not know if it is due to the scar or if the strain feeling might just be on the muscles around that region. I lifted some amount before 8 months passed on my surgery and at that 8 month mark, the doctor said that I had a 1mm scar. So is it safe to say that it will stay 1mm since it has been so long and since it was that size at 8 months?
Also, I am heading over to california for vacation and would like to meet you in your san jose office so you can look and access everything going on on my head because I trust you will be able to make the best assessment on everything from hair loss to my transplant. Thanks so much.
Best to evaluate your scar and be sure that you have not developed a small neuroma that might be causing the pain. At 8 months, you should be completely healed. Tapping the scar will replicate the symptoms if it is a neuroma and we would be happy to evaluate that for you.
If you’d like to setup a free consultation, you can call my office at 800-NEW-HAIR or fill out our Info Request form and someone from my staff will get back to you to schedule.
Hi – I’ve been bumping around your website and I see where jerks must’ve emailed you a million false emails – this is not one of them : )
I’ve got minimal hair in my beard on the sides of my chin, and I would love to find a solution for it so that I can grow a full beard. My little brother had hair transplants from the back of his head to his hairline (receding hairline) – but he shaves his hair closely and the line in the back looks really silly.
I also shave my head closely (not bald, like a 1 level crew cut) – so I’m hoping to find a solution for my beard (have full head of hair on top, so only looking at the beard). I’m wondering if it’s possible to either get the hair from my neck below a normal beard line (that low neck hair 3 inches below the chin where you have whiskers but everybody shaves it off anyway) grafted up into the cheeks/chin area – or if it’s possible to get the hair below my normal hairline in the back and put that in the cheeks near the chin area? I just don’t want that silly line in the back of my head (I call it a “scalp zipper” (privately I don’t make fun of him obviously).
Also, I know it’s a specific cost to the individual based on how many grafts and sessions are required – but if I assumed about 1,000 grafts in 1 session, how much would I be looking at (high and low range)?
Lastly, I didn’t see very many photos on your website of successful beard transplants. Any good websites out there? I’d also love to hear about horror stories from recent years and how to avoid them.
This is a serious email and I am looking to do something in the next few months if I find a good solution – would love to hear back from you.
The procedure known as follicular unit extraction (FUE) was first published by me in 2002 and it discusses minimally invasive hair transplants where individual follicular units are removed one at a time. There is no linear scar with this technique and you can clip your hair short as you want. I would not take it from the neck, because neck hair is not permanent. See:
I have had too many hair restoration procedures, the doctor told me last week. Now I am struggling to manage this big bald area on the back of my head. I saw (what I think was) a good doctor who said that the entire back of my head was solid scar. Any suggestions?
I am assuming that having long hair does not cover the scarred area. One might consider the use of tattoo treatments to the donor area, starting off with a temporary henna tattoo in the balding donor area with a color that closely matches your hair color. Be sure that the tattoo artist who does it, does it will a stipple effect so that it looks like hair (not like the picture on the right). The henna tattoo is temporary and usually goes away in a few weeks and if it works (temporary) then you could step up and have it permanently done. I have seen a few people who have done this and it covered reasonably well but it is best woven with some hair to augment the effect. Be careful and be sure that you use somone who is knowledgeable in henna, as there are some potentially harmful variations out there. I’m not a henna expert, so I am just going by what I’ve read (for more, see Wikipedia – Henna).
You generally need some hair in the scar and most of the time a limited transplant into the scarred scalp can put enough hair to blend with the tattoo, It might be worth a try and with a temporary tattoo there as there is no long-term risk.
Hello. I had an FUT procedure done at [name removed] about 8 months ago. I see visible, what look like holes on my recipient area from overhead lighting, almost like scarring. Obviously, I wasn’t expecting this as I had heard that new techniques show no visible recipient scarring or mini holes. Will this EVER heal in time, because now i am freaking out about it. If so, how long does this take to go away?
In addition, my hair is darker on the sides than the top so the recipient hair does not match in color. Will this change in time? My doctor tells me the sun will change it and it will eventually grow in lighter at the roots but I don’t know if I trust anything they say anymore.
I wish I had never done this and don’t know where to go from here. Any answers and direction would be very helpful because I am freaked out now.
Generally by 8 to 12 months most of your hair transplants should have grown and you should not have the visible holes or scarring that you are describing. As you do, then this is probably permanent. Sometimes certain patients are more prone to scarring than others, but that is not what you seem to be describing and it is very, very, very rare in the recipient area. With respect to hair color, your hair color should generally match the hair on the back and sides of your head.
Obviously it is very difficult and practically impossible to give personalized advice this way. If I viewed the recipient site ‘holes’ you are talking about, what you call ‘holes’, I may call something else. If you like to have a formal consult, I would be happy to review your case. Please call my office at 800-NEW-HAIR to arrange this or send photos to the address on the contact page (reference this posting, please). You pictures and your correspondence with us will be maintained confidential (it is also the law that protects privacy).
Dr. Rassman,
I am a 25 year old male with extremely thin hair. Normally this would not be a concern but I had a medial temporal head fracture and a 12 inch scar on the left side of my skull. I do not want to loose the rest of my hair but dont want it to look to obvious that I had a procedure.
1. Is getting a transplant a life long quest with someone my age?
2. Should I resort to other methodologies before trying surgery?
You can always send a photo of your scar to me for review (reference this post), or if you are near one of our offices, you could come in for a consult.
I have a 1 to 2mm scar from a strip proceedure. Can you tell me will new closure techniques be able to improve this. My scar starts to show when I cut my hair to a grade 3. Is fue into the scar a better option for someone like me? Can you do the surgery or recommend someone in Europe?
Many Thank
A 2mm scar is fairly small, so I would hope that an excision and trichophytic closure would be the best way to go. I do not have a surgical recommendation for you in Europe, although the techniques that I would use are fairly straight forward in the hands of an expert. As I do not travel to Europe to perform surgery, if you wanted me to do it you’d have to travel to California to see me.
Here’s a story about a dermatologist who had a hair transplant when he was 25 years old, in 1975. Forgive the blurriness of the photo below.
What is particularly important about this first picture is the amount of hair that he actually had when the transplant process was started. He was clearly thinning his hair in the Norwood Class 6 balding pattern and if he were treated today, he would have been put on finasteride (Propecia) to halt the hair loss and hopefully lock in the Norwood Class 6 pattern. When he had the plugs put in, the hair was still there, although clearly heavily miniaturized. The photo above was taken in the first month after the surgery and the hideous looking islands reflected grafts that contained between 20-30 hairs and crusting after the surgery. The crusts which are shown here are only a few weeks old, but in those days, the patients were deformed for months after the surgery as the healing progressed very slowly. The only good news for this man was that many of the hairs failed to grow, reducing the pluggy appearance, simply because of the failure of hairs to grow. His first procedure put two lines of plugs in the frontal hairline, which were followed up with many more plugs at another surgical session.
He eventually lost all of his hair native in the Norwood Class 6 pattern. The grafts were taken out of his donor area with hollow drills measuring slightly under 1/4 inch which left him with white spots about 1/4 inch round that could easily be seen through the thinned out donor area. After he completed his surgery, he developed a comb-over to hide the plugs, but the hairline was still deforming and even with a comb-forward style, he could not hide the hideous grafts.
In 1988, he went to Denver and had a few hundred micrografts placed in front of the hairline by the inventor of the micrograft. The focus was to put camouflage in front of the plugs. This surgery did much to soften his look. Still, on meeting people in his dermatology practice, eyes focused on his hairline and the top of his head. That convinced him that he needed to find a better solution. Eventually, he had grafts removed, received dermabrasion to smooth out the bumps and cobblestoning, and had about 8 laser hair removal procedures to kill off the hair that he worked so hard to put there. To deal with the deformities created by the harvesting techniques, he had finely stippled tattoos created to look like hair and this hides most of the scars on the side and back of his head. His final look, one of a bald man, seems to work for him. His approach to his problem was creative and it showed me the value of the old saying: “Necessity is the mother of invention”. This doctor, armed with a unique set of skills (dermatologist) and facing his deformities every day in the mirror, applied his talents to solve his problem. He got there and now people who see him as a doctor, look straight into his eyes, not at his head. Congratulations!
Note: Most people see someone just like this man walking down the street, at a movie, in a restaurant, or at an airport. There is a perception that this pluggy look is the look of a hair transplant, but this type of procedure, if done today, would be clear malpractice and not acceptable in this litigious legal climate. Unfortunately, tens of thousands of men had this awful surgery done worldwide years ago. The victims were many — far too many. Personally, I can not imagine why a doctor would ever perform such a surgery. Fortunately, there are many ways to treat this problem and becoming bald is just one option (see Repair – Dean’s Story for an example of using hair transplantation to correct the old plugs).
For even more information on repair, please see:
I am 30 y/o.I just want to know if hair transplant is still effective for me since i want to have my scar on the scalp be covered again with hair.I had an accident 20 years ago which left a big scar on my scalp.Would hair transplant be still effective?i know there is already poor blood supply on a scarred tissue which made me think that hair wont grow anymore on the scar after hair transplant.
I can’t answer your question without knowing more. Many large scalp scars are best treated with scalp expanders and the results can be very impressive. As you used the word ‘big’ scar, am I correct to assume that the scar is larger than a baseball? You can send photos (please reference this post) and I’ll be able to tell you more.
Dr. Rassman- I have no background in medicine, so I apologize if this might be a stupid question. I have a thin transplant scar on the back of my head and would like to shave my head. Would it be possible to do a scar revision that would involve taking skin and tissue from say my upper back and grafting it to the HT donor scar? Would that then leave minimal scarring? I know they do similiar type of work for burn patients.
You are semi-correct in stating that burn patients get skin grafting. However the burn patients still end up with a scar that is quite visible. To clarify, ALL scars and ALL cuts will be visible and unavoidable. Once you have scar on your scalp (as you have a linear strip surgery scar) it is impossible to hide if you shave your head. The best approach is to minimize the scar as much as possible with a scar revision (if indicated). Also you can consider FUE/FOX into the scar. FUE/FOX scars are scattered dots which are less than 1mm and are in random distribution, thus it does not stand out as a linear scar. Keep in mind if you SHAVE your head you will still have a scar.
Dear Dr. Rassman,
What are some possible contraindications in a strip surgery?
Also, is there any difference in the end cosmetic quality between FUE and strip? For example, would there be any difference in transplanted densities between the two?
Finally, if I were to get an FUE procedure done, would I most likely be able to shave my head later without noticeable “dot scarring”. I read on another forum that FUE creates a “confluence of scarring” where the tiny dot scars seem to merge into one another to create a big scar. Can you possibly clarify this?
Thanks
See the recent post, Is an FUE Procedure a Less Successful Hair Transplant?, which shows that if the quality of the extracted grafts are good, the end result will be the same for FUE or traditional strip surgery. Many FUE grafts are less than ideal, so there might be a difference if the extracted grafts are not perfect. ‘Dot’ scars may or may not be visible with a shaved scalp (razor shave). If your healing is good and the punch size is very small (0.9mm or less), the ‘dots’ may not be visible unless you look very closely. A short hair clipping (1/4 inch length) will not generally show ‘dots’.