ReCell Spray-On Skin in Hair Transplant Surgery?

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

Dr.Rassman/Dr.Pak,
Thought you might be interested in the following – ReCell Spray-On Skin

This technology was recently used to great effect here in the UK on a young child suffering from second-degree burns – Second Degree Burns Are Healed With ReCell Skin Spray

Do you think ReCell could be adapted for use in hair transplant surgery?

Interesting find, but scarring from hair transplant surgery has more to do with the tension created by the cut on the scalp (not a burn on the tissue or tissue damage). So I don’t think the product would have a great effect on hair transplant scars.

Tags: recell, scarring, scar

Shaved My Head After a Transplant and I’ve Got Pits at the Recipient Area

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

Ive shaved my head, have scar from hair transplant, that’s ok but how can I conceal the pits on top of my head, I can’t explain away that besides saying fell into cactus

The pits you are seeing, assuming that you had true follicular unit transplants, are probably the result of too much skin left at the surface of the graft. I make a point to cut off as much of the skin as possible without damaging the hair grafts at the time of surgery. When follicular unit extraction (FUE) is done, most surgeons do not trim the skin edge, leaving more skin present in the graft. These bits of skin in the graft can cause the type of pitting you are referring to.

Unfortunately, it can not reasonably be fixed. Some doctors suggest dermabrasion (filling down the skin with a rasp), but this just produces other types of deformities, often worse than the pitting you are referring to.

Tags: hair transplant, pitting, scarring

My Donor Scar is Still Partially Pink 18 Months After My Surgery

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

Hi. I have had 2 transplants including one with NHI. Both went well with great results however in both cases my scar was wider than most results I have seen (my scalp is not tight) and my scar is still very pink (at the back of the head but not on the sides) 18 months out from my last procedure. I will be getting further procedures at some stage & am wondering if it is likely that my scar will eventually fade (do you have patients that have scars that stay pink?) & if you have any recommendations for reducing pinkness after future procedures (any particular creams or potions?)

Thanks!

If you are one of our patients, you should come in for a visit when you are in the US, or send me a photograph and then we can speak over the phone.

Yes, there are treatments for very red scars that persist for long periods of time such as topical steroids. Their chronic use, however, could produce problems if it gets absorbed into the body with prolonged use, but for a short term use (a week), it should not be a problem. Most of the redness will continue to fade over time.

Tags: hair transplant, redness, surgery, scarring

Hair Transplant Now, Shaved Head in the Future

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

I don’t mind shaving my head in future when hair loss develops, but not now. What I want to have is a hairline to frame my face even if I shave my head.

Is there any technique performed by any surgeon which does not leaves VISIBLE scarring on the back of your head? If I want my head shaved in future, what do you advice me?

I’ve thought of FUE + (ScalpMicroPigmentation on the tiny dots) when I finally shave my head. What do you think about it?

Not everyone will have very visible scarring, but any wound to the scalp will leave a scar to some degree. Just to what degree you will scar, I have no way to know.

The combination of follicular unit extraction (FUE) and Scalp Micropigmentation (SMP) does work… but with that said, you need to be evaluated by a real expert to know where you stand.

Tags: smp, fue, follicular unit extraction, pigment, hairloss, hair loss, hair transplant

Is Scarring Common at the Recipient Sites?

/by William Rassman, M.D./3 /,

Thank you for the time and effort you put into answering all of our questions. My question regards scarring. I have heard some people say that scar tissue forms where the hairs are implanted during a transplant, and that this can result in bumps or raised spots on the hairline. Is this true? If so, is it common? If not, why don’t scars form where the hairs are implanted? After all, a wound of sorts must be made to implant the hair, so how would do you prevent hundreds or thousands of scars from forming after a hair transplant?

With the technique we pioneered, we do two things that minimize recipient site scarring —

  1. We make very small wounds in the skin, essentially slits that approximate the size of the grafts. These heal very fast.
  2. When preparing the grafts for implantation, we cut off the skin disk at the skin level. To minimize the skin disk, we remove the top layer of the graft skin from the surface of the graft. This prevents the skin from surviving the transplant which could, in some individuals, produce the bump seen in recipient areas. The same process is done with grafts taken from strip surgery.

When doctors use grafts that have a larger surface area than what I described above, the bumps you referenced get more prominent. We have seen from the old days when plugs were done and the graft sizes ranged from 3-5 mm across, the skin always was deformed. Clearly the more skin that survives at the top of the graft, the more detectable will be the existence of the transplanted graft.

Tags: hairloss, hair loss, hair transplant, scarring

How Long Until I Can Have SMP Done After Having FUE Into My Strip Scar?

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

I recently had a FUE procedure to place hairs into my wide strip scar. How long do I need to wait before having SMP done to blend the scar?

Generally speaking, you should wait at minimum 2 to 3 months until the area has healed. Scalp MicroPigmentation (SMP) would not affect hair growth or hair loss.

Tags: smp, scarring, hair transplant, hairloss, hair loss, pigment

What Size FUE Punch Was Used?

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

Dr Rassman.

I was just browsing through your SMP site. Great work!

This particular client caught my eye: scalpmicropigmentation.com

What sized mm punch was used to extract his grafts? He wasn’t an NHI client, correct? Thanks for your time!

Actually, he wasn’t our surgical patient. I believe 1mm to 1.5mm punch was used, though I would guess more on the 1mm side.

I should point out that even while he wasn’t our FUE patient, he could have had the same punch scars produced if we did the surgery. What I mean is, FUE is NOT a scar-less surgery that many clinics claim it to be. Even 1mm punch will leave a scar. Even 0.8mm punch will leave a scar. Not everyone will develop scars to this degree, but as you can see in the photo, it’s a possibility.

Tags: follicular unit extraction, fue, scarring

How Long Should I Wait Before Considering Filling In My Strip Scar with FUE Grafts?

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

Thanks very much for the informative blog.

Say a strip patient is about 6 months out from FUT surgery and now has buyers regret (please, no reminder about thinking things through first!), and wants to fill in the scar with FUE/beard hair/etc. Is there any advantage to do it at this time or does one need to wait one year. I wonder if scar is more or less vascular when healing. Thanks.

If the donor scar has healed, you don’t need more surgery, and the scar is narrow, then follicular unit extraction (FUE) to the linear scar is possible. FUE does not fill in wide scars well, though. Scalp MicroPigmentation (SMP), on the other hand, may be a better approach. Explore it all.

Tags: smp, fue, surgery, hair transplant, pigment

When Does a Scalp Wound Result in Permanent Hair Loss?

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

Hello Doctor

How bad does a scalp wound has to be in order to mean permanent hair loss in the area ? I bleeding or crusting afterwards na indication for bye bye hair ?

Any cut on the skin will produce a scar, and on the scalp no hair will grow on that scar. Even with follicular unit extraction / FUE (advertised as “scarless” surgery by some) will produce a round punctuate scar.

In general, if the injury or wound is significant there will be permanent hair loss. Even a scratch could cause bleeding, but that doesn’t necessarily mean permanent hair loss will result. Only time will tell if your hair will grow back. This time frame is around one year. If you see no hair growth after one year, then it would be safe to bet it is permanent hair loss.

Tags: hairloss, hair loss, scalp wound, scar

I Had a Bottle Busted On My Head and Want the Scar Removed!

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

Hello. I had busted my head from a starbucks cappuccino bottle(Please don’t ask how It’s a personal issue..) And I was bleeding harshly from my head so my parents wrapped my head with some bandage really tight and put some healing glue over the scar. In like a week in a half it healed and the glue came off like a scab and I was left with a very smooth scar on the back of my head near the root of my head about the size of a quarter, the top part of your pointer finger(the first line part and up cant explain it good). I know hair isn’t growing back because its been three years.

I want to have the scar removed from my head, the surgery is they cut it out then sew your scalp back together and your left with a lined scar that is barely visible when hair is grown a little. I do NOT want hair transplant please don’t give me information about it. Please explain as much as you can about the “scar removal” surgery I have in mind and also a cost for this.

What I would like to have is have a surgeon cut out the scar since its a little smaller than a quarter and stitch the scalp back together leaving me with just a tiny thin line scar that would be. No wider that the original sizer of the sizer or length. Also since I am african american, I want to cut my hair down low to about a 2 but I can’t cause of this baldspot, my dad is willing to try surgery but not until its reasonable. Remember it is about the size of a quarter which is very small compared to others.

Thank you please help me with my problem. Also the color of the scar is about my skin color maybe even a bit darker, I have black indian hair so a big brown baldspot sticks out. Please fill me in with everything you possibly can.

Scar removal from the scalp sometimes works well… and sometime doesn’t work well. That depends upon:

  1. Your healing abilities
  2. The location of the scar
  3. The direction of the excision scar
  4. The surgical technique used

I would have to see your scars to determine what I would do. From what you described here, I am at a loss. You need to see a cosmetic surgeon with experience in scar revision.

Tags: scar revision, bald spot, scalp scar

How Visible Are FUE Scars if I Shave My Head?

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

Does having an FUE procedure to hairline and mid scalp make it artistically unpleasant to shave your entire head? I like to wear my head closely cropped, but I’m unsure if the punctate scars from FUE are extremely visible when you closely shave your head

There are many variables that produce different scars with follicular unit extraction (FUE). These variables include:

  1. The size of the punch used (ranges of punch sizes are from 0.8-1.5mm). The larger the punch used, the bigger the scar.
  2. The density of your donor hair dictate the visibility of these scars. Low density donor sites tend to show the punctate scars more than individuals who have high density.

What I am referring to here is shaving your head bald, not clipping it to a #1 length. Shaving the head will almost always show the punctate scars. There’s an extreme photo example shown at this page to give you an idea of scarring from a large FUE session.

Tags: fue, follicular unit extraction

I Want a Scar Revision After 5 Hair Transplants

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

I have had 5 hair transplants. All were done by way of the strip method and I am very pleased with the ultimate outcome. However, the linear scar from my 4th surgery is horrible. It is very wide and red. The scars from my prior surgeries and the one subsequent surgery look fine. Because of concerns about elasticity issues, between the 4th and 5th HT I did scalp exercises to improve the donor elasticity which I found on Youtube. My Doctor said that the elasticity between my 4th and 5th surgeries was greatly improved and attributed it to these exercises. With this improvement, I am considering a scar revision with the hopes that the scar from my 4th surgery can turn out like the one from my 5th surgery. Is this realistic?

Lastly, in general would you recommend a plastic surgeon for the scar revision or a hair transplant Doctor? I traveled some distance to have my last hair transplant and don’t plan on making this trip again for a scar revision so I would look for local Doctor to do this procedure.
Thank you for your time

Scar revisions in the hands of an experienced surgeon that deals with hair transplant scar issues on a regular basis is generally better than a plastic surgeon for this type of work. Experience is everything in this process. I don’t know what is realistic to expect, as each case is unique and I haven’t seen you.

If you want to find a doctor in your area, I’d suggest using the physician search at ISHRS.org.

Tags: scar revision, hair transplant, scarring

FUE Back into the Linear Scar vs Scar Revision

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

I’m thinking about getting a strip method hair transplant and then just filling in the scar with FUE. Is that an option thats worth pursuing? I don’t want the line scar but I want every graft transplanted. I understand FUE has problems with transection or something.

I get this question quite a bit from patients who have already had the hair transplant strip surgery and then inquire about having a follicular unit extraction (FUE) procedure to follow it up. It makes little sense for the person that already has a strip scar (no matter how wide it is) to have an FUE into the donor harvest. If it’s just about treating the linear scar, better solutions would be a scar revision or Scalp MicroPigmentation (SMP). FUE grafts used in linear scars are generally wasteful and an expensive way to treat the scar with less than ideal results.

My complaints about the way the FUE technique is used are:

  1. It’s generally more expensive than a scar revision for those with a troublesome linear scar.
  2. The grafts do not come out of the sweet spot in the middle of the donor area (where the grafts are easily taken by a strip).
  3. In my opinion, the overall survival of the FUE grafts are not as good as those harvested from a strip in most doctor’s hands (I do not believe that is a problem in our hands).

As the first to publish a paper on FUE (introducing it to the medical community), I can speak with authority on these issues. The ARTAS FUE robot has not really changed the process, except for leveling the playing field for those doctors not skilled in the extraction technique. The FUE technique, as done in most doctor’s hands without the robot, is not as good as the grafts produced by a strip surgery. If there was a formal study, I would expect that each doctor would show variable comparative results when comparing their FUE results with this strip results, making such a comparison between FUE and strip surgery essentially worthless.

Read more

Patient Results – Over 7800 Grafts and a Scar Revision (with Photos)

/by William Rassman, M.D./3 /, ,

This patient had 3 strip procedures, which yielded 7846 total grafts. His donor scar in the back of his head was revised with reasonably good results and a reduction in the width of the scar. You will find before and after photos of his hair transplant and the scar revision below.

Click the photos below to enlarge:

Scar revision (Before on left / After on right):

 

After (3 procedures totaling 7846 grafts):

 

Before:

 

Tags: hair transplant, scar revision, hair restoration, surgery, hairloss, hair loss

Importance of Scalp Laxity, FUT Scar Concern, FUE Drawbacks

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

Hi Doctor Rassman,

I have a few questions concerning transplants.

— How big of an issue is scalp laxity? I.e., do you often have patients who still possess donor hair, but who are unable to have FUT a 2nd/3rd/4th time because their scalp has become too tight? Should this be a concern in planning for the future?

— You’ve said that one of the drawbacks of FUE is that it can waste precious donor hair (i.e. some hair doesn’t survive the transplant procedure?) — just how much hair might be “wasted” by going with FUE rather than FUT?

— Why are some readers so concerned about FUT scars? In most of the photos I’ve seen, the scar is a very thin hairless line — not a repulsive, gnarled mass or anything like that. Even if one cropped one’s hair short so that the scar were visible, what’s the big deal?

Thank you so much for taking the time to do this blog.

Scalp laxity become tighter after successive procedure, but this is not usual. The use of scalp exercises solves the problem. It sometimes takes 30 minutes/day for 3 months to adequately address the scalp laxity.

In our original article when we introduced the FUE technique a decade ago, we reported a situation where patients differed with transection rates. We believe that if you assume that the surgeon does FUE perfectly, that some percentage of patients will have unacceptably high transection rates. Although this has become less of a problem as we perfected our FUE skills, it is still present in about 10% of patients. It will be interesting to see if the ARTAS robot can impact these problems in those patients. As Dr. Robert Bernstein (co-author on the original FUE article) just got an ARTAS robot, it will be interesting to see if he experiences the 10% patient problems with transection. FUT should produce less than 5% damage in the hands of a good surgeon.

FUT scars are, as you said, not a problem in 95% of patients on the first procedure. Rarely can you see the scar when the hair is kept long. Even after a second procedure the incidence of scarring is not high either, but if it can be seen, it is only seen if the hair is cut very short or if one lifts the hair to examine it. I would ask, even if the scar is visible, how many times would a person with such a scar that is hidden with longer hair (1 inch in length) gets stopped on the street and asked about it.

Tags: scarring, laxity, hair transplant, hairloss, hair loss