Month: January 2007

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Washing Scalp After Transplant – Hair Loss Information – Balding Blog

I am day 4 post op right now. I have been pouring shampoo-filled water on my head followed by a round of conditioner. I am not touching my scalp at all except for gently massaging around the donor area a couple of times. At what point should i change how i wash. Can you please detail how to wash my hair when it is time to change what i am doing now? Also I still have pain in the donor area. Is this normal? How long will this last? Lastly, are there any post-op products that promote scabs to fall off and protect against infection? Thank you for taking the time to read this and for your reply.

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For starters, you should be asking your transplant surgeon these question. Of course, I will do the best I can to help and will expand upon your question to supply other bits of information that may help my general readership.

Washing your head after a hair transplant has been arbitrary among hair transplant surgeons for years. The dilemma is that there is a risk of grafts dislodging in the first few days after surgery if the grafts get manipulated. On the other hand, washing reduces the chance of scab formation which gives you acceleration of the healing and normalcy of your scalp. Fortunately, this issue was studied recently (see this PDF file — Graft anchoring in hair transplantation). This study showed that presence of scabbing after surgery extends the interval that grafts are at risk of being dislodged. The study emphasizes that preventing scab formation would shorten the high risk period during which new grafts may fall out. I recommend frequent, but gentle hair washing in the first few days following you operation without rubbing or scratching in the recipient area. Professional hair washing for the first days after surgery is advisable and I personally offer this service to all of my patients during this time. Some products have been claimed to reduce the scabbing and infection after surgery with no documented evidence to support them.

Fortunately, infection is not a common complication after a hair transplant in healthy individuals, thanks to good blood supply of the scalp skin. As a general rule the donor and recipient wounds are almost completely sealed in within a few hours and certainly by the next day after a hair transplant. External factors should not cause infection in these areas beyond this time. If you do not learn to wash with some vigor, then the evidence of a hair transplant in its healing phase may take weeks to disappear rather than a day or two (crusts that are not washed away in the first or second day tend to linger for weeks). The actual details of how to wash should be obtained from your doctor. After a week, if the scabs are still there, you can wash your hair and then leave the shampoo on for 10 minutes or so, gently massaging the scabs after the 10 minute waiting period.

Folliculitis (a cyst in the recipient area which may become infected) is the most common cause of post operative infection in people who do not pick on their transplanted site. For those that pick, the infection risk rises. There are a number of factors that contribute to these cystic ‘pimples’ that appear after 4-6 weeks. Some people believe that these are caused by remnants of hair left behind from the grafts or are foreign body reactions to the glands of the hairs which may survive below the skin after the hair is shed. These glands (which lie along the hair shaft about 3 mm down from the skin) almost certainly produce sebum (a waxy secretion) which can not exit the skin, because it needs a hair shaft to find its way out. These cysts are best treated with warm soaks and frequent shampoos to promote their external drainage. When a doctor employs staff without extensive experience or with poor eyesight, grafts are put in one on top of another (piggybacking), which buries the first graft. These buried grafts causes cysts that frequently get infected and at times require antibiotics or even surgical drainage.

Pain in the donor area could persist for the first 2 or 3 days after surgery. Soreness continues to subside within the first week, and rarely require pain medications after the first day. Mild numbness in the donor area may persist for a few weeks.

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Prednisone and Female Hair Loss – Hair Loss Information by Dr. William Rassman

I have been taking prednisone for almost a year and do not know when I will be able to discontinue it. I am 44 years old (female) and my normal thick red hair is thinning dramatically. Are there any supplements that will slow the thinning process down?

Steroids have the effect of thinning out the hair. I do not know of anything that you can take to minimize the impact of the prednisone, but you should still get your hair mapped out for miniaturization and get a diagnosis. Although the prednisone may be the cause of the hair thinning, you still may have other problems and a good medical evaluation would be indicated.

Balding Forum - Hair Loss Discussion

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Olive Oil, Honey, and Cinnamon Cures Hair Loss?! – Hair Loss Information by Dr. William Rassman

According to Pakistan’s Daily Times, a hair loss treatment of honey, oil, and cinnamon is effective.

The referenced article made me smile. I suspect the readers will also smile. Although the article talks only briefly about hair loss, the exact wording is as follows:

Hair loss: Those suffering from hair loss or baldness, may apply a paste of hot olive oil, one tablespoon of honey, one teaspoon of cinnamon powder before a bath and keep it for approximately 15 minutes, and then wash the hair. It was found very effective if kept for 5 minutes.

In Southeast Asia, cow dung is an inexpensive alternative. Not western style, right? Go ahead and try this concoction out, but be sure to stay away from bees.

Balding Forum - Hair Loss Discussion

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Can You Clarify Why There Is a Time Period it Takes for Propecia to Start? – Hair Loss Information by Dr. William Rassman

Doctor Rassman, I appreciate your great blog. There is no more informative site on hair transplants. I am 51 yr old male with the following question on propecia:

Having gone through all of your archives, and other sites, I still am confused as to what exactly happens when one takes propecia that makes it necessary to weight six to eight months before we can tell if hair loss is being stopped. I know you use the terminology of anagen cycle but could you be more detailed and explain this a bit better. I have read web sites claiming hair loss stops in 4 months on propecia, but other doctors, like yourself and Dr. Bernstein suggest no benefits with regards to stopping hair loss until at least the 6th to 8th month. Could you clarify this, please. Knowledge is power.

Everyone responds differently to Propecia (finasteride). Some people get great results rapidly, while other go the ’slow route’. Usually, the better results (quicker) are seen in the younger man or the man who has had recent hair loss, more so in the crown than the front. The 8 month recommendation is a ‘catch-all’ recommendation, knowing that the good studies on the drug show effectiveness between 8-12 months. The visual benefits require hair length and as the hair grows at about 1/2 inch a month, it takes time for the hair that grows under the influence of the Propecia to work its way up the ‘visual’ shaft. Much of what we report here are statistics that we have learned work well. Be patient and wait it out if you have just started taking the medication.

Balding Forum - Hair Loss Discussion

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A Year After My Hair Transplant, I Still Look as Thin as Before! – Hair Loss Information by Dr. William Rassman

Dr. Rassman. I’m 41 years old. I got a hair transplant done in April 2006. After the transplant i was vcery happy with the quantity of hair that i got transplanted. I know the doctor told me that i would loose my hair because of the body reacting to the surgery. Now it’s Jan 2007 and i find that the amount of hair that was transplanted is not as much regrown. Now that i’m approaching my one year period soon, why is it that the amount of hair that was planted as not all regrown back. I was expected a least twice of what i see. When i comb myself i still look like someone who is loosing is hair, and i hate it, especially when i go under a light or out in the sun. What is your suggestion to my situation.

Setting expectations is as much the ‘art’ of what I do as doing the surgery. That is why I have open house events every month, so that people who are going to have surgery can see and meet someone with a similar balding pattern and hair color. Then, and only then, will expectations be set properly. If you expected too much, then the error was on setting expectations. If the hair did not grow, then the question should be ‘what went wrong?’. You can always get a second opinion, but first, ask the doctor who did it and find out if your doctor’s expectations were met.

Balding Forum - Hair Loss Discussion

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Hair Loss InformationForum Discussing Propecia Side Effects – Hair Loss Information – Balding Blog

hey doc

I was interesting in starting propecia to stop my hair fall but it seems that i’m freaked out now. look at this link please
http://finasteride.jconserv.net/viewtopic.php?t=189

could that be true??

please comment on this

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The site you sent does not contain balanced informational. Side effects are rare and are listed in the material supplied on Merck’s Propecia website.

You can follow those that run in panic mode, or are critical for unsubstantiated reasons, or are the exception to the rule. As the reference piece is extensive, please write to me again with any specific section that you want me to address, but first please review the link to the Propecia site above.

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Taking Propecia at Night vs Taking Propecia in Morning – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman, I have read in some of your earlier blog entries where you said that it is best to take Propecia in the morning because testosterone levels rise while you are asleep. But I was thinking that it would be better to take the medicine for you go to bed, because then while your testosterone levels rise during the night, propecia would be in your system to stop it from turning into DHT. What do you think?

Morning is better. If you take it by 7am when your testosterone is highest, only 25% of the drug will be left in your blood stream, as the half life is 4 hours.

Balding Forum - Hair Loss Discussion

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My Transplant Doctor’s Post-Op Paperwork is Incredibly Stringent – Hair Loss Information by Dr. William Rassman

I recently went for a transplant and the post op paperwork I was given by my doctor seems incredibly stringent. Things like, laying straight up/at a 45 degree angle for a week, no aerobic exercise for 3 months, no weight lifting for 6, can’t be in contact with smoke/dust/pets for 4 weeks, etc.

I’ve read a lot of stuff on your site that actually coincides with things he’s said, but the post op instructions are quite different from what I could gather. Is he just being overly cautious to try preserving grafts?

To doI generally recommend no sex for 15 years, no walking more than 1/4 mile for 4 years… no, no… I’m just kidding.

I tell most of my patients the following:

  • They can lie flat
  • Can have full aerobic exercise in 1 week (even run a marathon if they want)
  • Limit weightlifting greater than 25 lbs for 4 weeks and keep the back straight
  • No sit-ups or pull-ups for 4 weeks
  • May play with pets in 1 day (but no licking the transplants by your dog until the crusts are off — it had to be said)
  • Smoke and dust in the environment are not a problem unless you are not clean
  • Passive sex is ok for the first 2 nights, then everything after is a go

Does that help?

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Lost All Pubic Hair After Radiation Therapy – Hair Loss Information by Dr. William Rassman

I lost all my pubic hair after cancer radiation therapy. I am hirsute guy with hairy chest, legs, arms. The blank spot now looks terrible and I’m embarrassed in the gym shower etc. Is there anything I can do?

Transplants should work well. Head hair may grow in curly, so it is worth a try. Underarm hair may also work, but the yield may be less due to the shorter growth cycle. Beard hair works very well. In older men, that would be my first choice. What is your age?