Day: January 1, 2023

Thank you for the baldingblog. The answers you’ve give over the years are a very valuable resource for patients before, during and after hair transplants.

It’s now 9 weeks after my FUE. My recipient area is very red and incision marks are all visible. The color and texture of the recipient area improved until the 2 week mark, but since then it hasn’t changed in the last 7 weeks. I understand from your baldingblog that your patients have at most 6 to 8 weeks of redness (you wrote about it in separate posts in March and May, 2014). Unfortunately, my redness has lasted longer than that and shows no signs of improving any time soon. For what it’s worth, I’ve seen internet posts by guys who have had similar redness, so I imagine this is a topic of interest for quite a few men.

I’ve had no sun exposure, swelling, pus, warmth, fever, or health issues. I did thorough blood both tests before the operation as well as last week; all results were and still are good. There’s no hair growth yet obviously, but at 9 weeks, that’s normal. My HT surgeon said it’s the reddest he’s ever seen. He has no idea what’s going on. He said it doesn’t seem infected or to have any problems except that it’s still very, very red with incision marks still visible to the naked eye. He very honestly told me that he doesn’t know what to advise and suggested speaking to other doctors. I’ve consulted several doctors, both hair surgeons and dermatologists. They all have very different ideas for diagnosis and treatment, as well as reasons why the other proposed treatments aren’t good. I’m confused by the different ideas and would like to ask your opinion about them:

Treatment #1.
Diagnosis: small dilated blood vessels near the surface of the skin (“broken capillaries”), i.e. a form of telangiectasias caused by the trauma of surgery. If you push with finger on the redness and release, the skin becomes white for a second and then returns to red. That brief whiteness happens because of these dilated blood vessels. Treatment: pulsed dye laser (“V-beam”). Targets only the red wavelength of the capillaries, so the laser will reduce the redness but not hurt the (soon-to-arrive) growth of the transplanted follicles.

Counter-argument: The range of wavelengths of the V-beam laser cannot be made so narrow as to ONLY work on the blood vessels. The laser will probably hurt the hair follicles and harm my eventual transplant result.

Treatment #2.
Diagnosis: inflammation caused by the HT surgery. Treatment: 100 little PRP injections throughout the red area as an anti-inflammatory to stimulate angiogenesis. In addition to promoting healing of the redness, it will help the eventual hair growth.

Counter-argument: PRP won’t help much, while 100 injections into an already red area would just irritate the skin more and cause even more redness.

Treatment #3.
Diagnosis: inflammation similar to eczema. Treatment: a mid-level topical corticosteroid with potency around 100-150x hyrocortisone, perhaps mixed with an anti-bacterium. It’s anti-inflammatory, immunosuppressive, vasoconstrictive. Doesn’t affect the hair follicles. Try it 3-4 weeks. If it helps, great; if not, stop after a month and there’s no danger of harm or long-term damage.

Counter-argument: The vasco-constrictive properties of steroids is exactly what I don’t want while my body is trying to heal itself now. And steroids have lots of bad side affects: red skin syndrome from withdrawal, thinning of the skin, etc.

Treatment #4.
Diagnosis: That’s life. I’m blonde, light blue eyes, fair skin (stereotypical Scandinavian look). Redness can happen. Treatment: can’t do anything. Will take 6 months to 1 year to heal. Bad luck. Buy lots of hats.

Continue reading “Patient with persistent redness in the recipient area (with Photos)”

This patient with frontal balding (Class 3A pattern) had surgery 4 days ago. He has black hair and white skin, making the grafts very obvious, but as I always tell my patients, keep their hair long so that they could get good camouflage for the grafts, and so that is what these photos of a fresh hair transplant show. The hair already gut pushed out a bit so it looked like the hairs were growing. Note, at 4 days, there are no scabs present and this is typical of our patients because of our special focus on keeping the blood from building up during the surgery and after the surgery in the post operative special washing instructions are followed carefully by each of our patients.

Can you imagine having to walk around with this presentation? This man has to wear a hat all of the time because his hairline presentation is terrible. If he is a professional man or does something that will not allow him to wear a hat for his living, he is just out-of-luck. Selecting a doctor is critical. If this man chose to purchase a hair transplant because it was inexpensive, he not only got robbed, but his deformity has damaged him in every-day life. The good news is that a hair transplant performed by a good doctor can fix it, but it will take from 4-8 months for the new hair transplants to grow out. While he is waiting, he is stuck with this look. Maybe a frontal wig will work, but this runs the risk of hair loss, so he has to make sure that he doesn’t walk into another pot-hole.

The problem I see in this patient is not only what appears to be excessive FUE depletion of the donor area, but that FUE extractions went well beyond the donor area into the crown and even the upper neck. Much of the hair extracted was too high in this man’s head or too low near the neck, which will not be permanent hair.

This is courtesy of Dr. Bradley Wolfe and he comments as I do, that many, many men are similar to this man with great reversal of their hair loss without side effects from finasteride.

Background
I have had 4 hair transplants (three strips and one FUE) sum totaling north of 10k grafts over the last 10 years. I was also on Propecia. I was pretty happy with my hair post HT #3, however I always had the jitters in public. Due to a temporary health issue I had to stop Propecia because it significant diminished ability to recollect memories while on the medication and I decided to stay off completely. Fast forward to today and I again was not happy with my hair. I have always hated the balding look; I want either a shaved head with no hair, or hair. Due to the strip scar shaving my head was no longer an option. I have been wearing a hat 90% of the time when going out of the house for the past 3 years.

I had seen pictures of SMP and did some casual research a couple of years back. However, in January, I decided to go forward with SMP. I live in San Diego so I visited two clinics, a non-medical place and then Dr. Pak at New Hair in Los Angeles and both a few miles from each.

I visited the non-medical place and spoke with practitioner there, a very nice guy who actually sold me on the procedure (he had it done himself). He did remind me more of a tattoo artist than a medical professional. He instructed me that there would be two 4 hour sessions to achieve good results and also gave me a price.

I also saw Dr. Pak, who was also very pleasant, but wasn’t necessarily positively on SMP. He answered my questions, showed me some results, and told me that it would take 2 to 3 sessions to achieve good results. Unlike the first place, Dr. Pak’s sessions took 6-8 hours each.

I was really leaning toward the non-medical place because of the years they have been in the business. However, I decided to go with Dr. Pak (even though he was more expensive) because of two reasons: (1) it was a medical office (vs a nice tattoo parlor) and (2) I have the option of anesthesia.

I shaved my head a few days in advance and one of my daughters commented that I looked like I was wearing a bald cap (even with 10,000 grafts placed there over many years). Honestly, I was really shocked by the width of my scar.

SMP Session 1 (02/07/2014)
I arrived at the office at 7am (had to leave San Diego around 4:30am to get there). Christine took me in, had me sign some forms and a lunch order. Pulse and BP were done. Versed was an option, but only if I stayed in LA for the night. I had to get back to San Diego that evening as my daughters were coming home from school in the afternoon. So Dr. Pak gave me nitrous oxide (so I was unaware of the injections) and then the Lidocaine injections. I remember the injections from the hair transplants years before while waning off of Versed, they can be really painful.

Dr. Pak did the front hairline back to mid scalp himself; he has an amazing attention to detail. Christine (Dr. Pak’s SMP assistant) worked on me almost continuously for 8 hours that day (excluding a 30 minute lunch break). She was amazing, always making sure I was comfortable, anesthetic was still working, etc. She brought me my lunch order on a nicely appointed tray.

Dr. Pak and another assistant, worked on me on and off during the day. As Dr. Pak came in telling me he would do sections himself or instruct Christine to blend more here and there (this happened many times throughout the day). Things I thought looked awesome, he was clearly very demanding on hard to please.

They have an internet enabled TV to keep patients occupied (Netflix, YouTube, and so on), it really did make the time go by fast.

I read in the non-medical group’s hair forums, that getting SMP done without anesthesia was common place and easily tolerated. There were points and time where the Lidocaine would wear off a bit. Christine and Dr. Pak would ask if I wanted more anesthetic when they noticed that I was starting to feel the pain. At points I would say I was fine and to continue on, I started to feel that I could have probably have done it without anesthetic, however, as I let the anesthetic wear off it got more and more painful. I really wanted to be the guy who could say he got SMP without anesthesia, but thats not me. I can tell you now there is absolutely no way I could have done SMP without anesthetic.

SMP Session 2 (02/14/2014)
Much of the same as procedure 1, except that the day went much longer, I arrived at 7am and left at 4:30, another 9 hours of treatment. At the end of the day he told me he wanted me back faster than the front office schedule would allow (early March), so he made time for me on what appeared to be a busy schedule for him.

SMP Session 3 (02/20/2014)
I brought my 11 year old daughter (as she was out of school that week), she played Minecraft on her laptop the whole time (Dr. Pak gave me the office WiFi password). My daughter commented on the service that they gave her. They had bought her lunch as well (she loves sushi), had a candy tray available for us, and gave her ice cream after lunch.

At the beginning of the day, Dr. Pak told me if I am unhappy with anything to call him, come back, and he will fix it. At the end of the day (after another 9 hours of work), he told me I know you are not a big fan of traffic (as I had complained about it on each visit, but it is a 3 hour drive home at 5pm), but I want you to come back as Dr. Pak was still not happy.

SMP Procedure 4 (04/03/2014)
My daughter had such a good time last time, she decided to join me again (and save me a bunch of time by allowing me to use the car pool lane). It was another 8 hour session (7am to 3pm), traffic difference from Los Angeles to San Diego was much better leaving at 3pm (only took about two hours to get home).

Only real difference in this session was another assistant named Tran performed the SMP instead of Christine. Tran was on vacation for my first three sessions. Tran was also very kind and always made sure I was comfortable. Dr. Pak went over my hairline and scar personally. Both Tran and Dr. Pak kept up the amazing attention to detail that NHI had showed me in the previous three sessions.

Dr. Pak mentioned in the previous sessions that I had a bit of shadow created by the unevenness in the scar on one side of my head. He said that a collagen injection should fill the area out. Again with his commitment to the final product and a satisfied customer, he did the collagen filler gratis.

Reactions
The first night out after session 3 (last Friday), I got near a 20-something waitress and a very large bouncer. I noticed that I had a much better reaction from this women , not sure if it was the look or the confidence associated with the look.

One of my friends (also a dual HT recipient) who now shaves his head, said you should shave a little closer. I think this is a great testament to the fact that SMP (when worn correctly) looks natural.

Another one of my close friends is a dermatologist (also on Propecia) was very impressed with the results.

Conclusion
If you are counting, we are talking about 34 hours in the chair; this doesn’t include the 6 hours of two needles going at the same time. All the shots and the sitting in place is somewhat grueling, however, I would do it again in a heartbeat. In fact, if I would have to go every month to achieve the final result I got.

I was completely enthralled with the results, as soon as I saw the results in session 1, I wanted to go hatless in public for the first time in 3 years.

In comparison to a hair transplant, SMP is an overnight miracle. I have been through the pain of the hair transplant (staples and sutures in my head) and then the 6 months of waiting, hoping to have hair like Brad Pitt and at the end of it I only became disappointed.

Dr. Pak, Christine, Tran, and all of the NHI staff had an amazing attention to detail, they worked hard to keep me comfortable and the overall customer service experience was excellent.

Dear Dr. Rassman: Had the 2nd of my three procedures today. Almost like a sculpture, it really now has started to take shape. Sure, I’ve looked at photos and seen real live guys at your Open House shows who’ve had this process, but there’s nothing like having SMP done to your own challenged head.

Once again, Kudos to the technicians who worker harder than stainless steal and have the patients of angels and Dr. Pak who stepped in mid-way and said: “Now it’s time to mail down your front hairline” which he did with the precision of a rocket shop landing on the moon.

But I do have one regret… which I expressed to your staff openly: “Where were you guys 40 years ago when I first coulda used this?

Dr. Rassman’s comment: This man started his hair transplant process too many years ago. He is now in his 60s and shaved his head for the procedure. He will eventually allow his hair to grow on top of the SMP. This type of comment occurs almost every day in our office. Scalp MicroPigmentation is one of the most satisfying procedures we have ever offered.

This man lived under a hat and rarely went out for 14 years after he got the disease Alopecia Totalis. The Scalp Micropigmentation we did freed him up completely.