Month: January 2023

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My Transplant Doctor’s Post-Op Paperwork is Incredibly Stringent

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?

I 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?


2007-01-09 15:37:00My Transplant Doctor’s Post-Op Paperwork is Incredibly Stringent

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My Toddler Daughter Has Had a Large Bald Spot Since Birth

My 16 month old daughter has had a rather large bald spot since birth. It is about half of the back of her head. If you were to draw a line from the left ear to the right ear, the entire area below it only seems to grow very short, fine hair. Also, there are numerous tiny red spider veins in this area. I have no idea what this could be. Her hair is growing on the top and the sides of her head, although the hair on top is really short. I’ve had lots of people ask if they are bangs that I have cut. She prefers to sleep on her belly and I very rarely see her sleeping on her back. She is otherwise a very healthy vivacious little girl. She has another well visit in 2 months where I will address it with the pediatrician. She never mentioned any concern before, but it’s starting to worry me. Any help would be appreciated. Thanks.

Although you have an appointment with her pediatrician in a couple months, I would suggest that you bring her to a dermatologist with an interest in children’s hair loss. There is no urgency here, so take your time and find the best doctor. The American Academy of Dermatology site has a dermatologist search, and I’d start with those physicians that list “pediatric dermatology” as a specialty.

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My Tight Eyeglasses Caused Thinning on the Right Side of My Scalp

Hello,

from 2010 until September 2011 I was wearing eyeglasses that were too tight, and I suppose the tightly fitted frames lead to a pressure-induced alopecia at both lateral scalp sides, decreasing the blood flow passing through the external carotid artery. The right side of my scalp shows reduced hair density. Is this due to an ischemic process? How do I know if the alopecia is scarring and if this process is reversible? Up until now the hair hasn’t regrown. Thanks a lot

EyeglassesI suppose anything is possible. Perhaps you have traction alopecia, but I wouldn’t say it is from an ischemic process. If the problem has been ongoing, the hairs may not grow back. Only time will tell (about 1 year), but I suppose if it has been since late 2011, you would know by now.

Transplants work well if it does not grow back, and in fact, you would never know that they are transplants.

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My Testicles Hurt After 2 Days on Finasteride

Started Fin 2 days ago and now I’m at work sitting here with an annoying ache in my balls. It’s not painful, but a nuisance in terms of feeling. I’m an athletic guy and exercise daily. Is it smart to push through for another week and see if ache disappears or should I stop. I’m able to get hard and masturbate as of today and there was no pain in the process.

I recommend to stop taking the drug and see if it goes away. Then restart it in a few weeks and see if it happens again.


2019-11-06 15:42:19My Testicles Hurt After 2 Days on Finasteride

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My Teenage Son Has Alopecia and Wants Laser Hair Removal

My son, has had alopecia since age 13, when he turned 19 this year he started having laser treatments on his scalp to permantly remove the rest of his hair in order to look more uniformed and without patchiness. After 6 treatments already, the patchiness still exist, but permant damage was done in some areas. Is he now scarred for life @ age 20. Please help!!! He would like all of his hair removed nice and smooth skin, I wish he never would have had laser to begin with and had hoped for hair to regrow. Is regrowth ever possible now?

Regrowth of hair in the presence of active alopecia areata is likely not possible. I would need to evaluate him to understand the complex process and findings you are telling us about. Am I correct to assume that the lasers produced skin damage? Was it skin discoloration or is it real scarring? Is your son also balding from genetic causes? What was the last time he had a diagnosis for determing if the alopecia areata is active now? There are a number of doctors who specialize in the treatment of alopecia areata — has he seen any? It seems your son wants to be bald. There is nothing wrong with being bald (or shaving the head), but being scarred is a problem. Please send me photographs and if they are good quality, I can review the problem with you.

As an aside, bald has been coming into style in recent years and has been more accepted by the “hip” young men of today. It should be clear to most people that the option to shave the head may be lost if you have a hair transplant procedure performed. Anyone with a good hair transplant that uses strip harvesting would have a noticable scar if the head was shaved, even if the scar was only 1mm width in size. This is also true even with the minimally invasive follicular unit extraction (FUE) technique where punctate scars (1mm in size) may be present. The presence of a Master Plan is critical in whatever you do.


2006-12-13 16:29:48My Teenage Son Has Alopecia and Wants Laser Hair Removal

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My Teenage Daughter Keeps Losing Eyebrow Hair While Sleeping

My 13 year old daughter annually starts complaining about the area over her right eye hurting. Within about 2-3 weeks the eyebrow hair will fall out while sleeping, or I just have to rub my finger over it and it comes off. This has happened 3 years in a row. Her pediatrician thought she may have used a razor the first time but now I KNOW thats not happening. I personally see it rub off at the root. What is happening?

It sounds like she might have a medical condition known as trichotillomania, which is a compulsion to pull hair out (which could also explain pain felt in the area). This can occur while your daughter is sleeping, and she is probably unaware that she’s doing it. If a doctor looks at it with magnification, he will see “Exclamation point” hairs and broken hairs at different levels in the eyebrow hair.

You could treat it by putting a head band around her head securing the eyebrows within it. Keep this for 3 months or so and see if the hair grows back. That would confirm the diagnosis. Often, a doctor can look at the eyebrows and see changes in the hair that point to this diagnosis.

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My Teen Daughter is Losing Hair — What Should She Do?

Is their a Dr.in the Sacramento area who specializes in hair loss. My 18 year old daughter has been experiencing hair loss for about a year. I took her to the Dr. last year and was told it was probably due to stress. Her blood work showed no abnormalities. She has another appointment soon. I am thinking it could be heredity. My father stated losing his hair at 18. I have Kaiser Insurance and I don’t think they are going to do a whole lot to figure out what is going on with her hair loss. What would be the next step? Should she be referred to a Dermatologist? If you could give some assistance, that would be appreciated, thanks.

Women’s hair loss is very different from men’s hair loss. Finding the source of the female thinning isn’t as simple as looking to the history of hair loss from the male side of the family. You should take a look at the female hair loss category of this site and read the many posts on the subject. A doctor who specializes in hair transplantation and has the intellectual capacity to analyze it may be able to help. Usually this is an elimination process for known causes.

I would be happy to give you an opinion, but you would have to fly to Los Angeles to see me. Or Dr. Pak goes to our San Jose office and may be a first start to the process of analysis. It’s not quite Sacramento, but it’s closer than Los Angeles. If not, you can try the physician search at ISHRS.org.

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My Surgery Was Years Ago and I Have Small Pimples With Each Transplanted Graft

Dear Dr,
I’m a man 38 years year old, writing from italy. I had an HT 2 years ago with about 2000 graft implanted FUT. I take 1 mg Propecia for 2 years.

This is my problem:
I have very small pimples (less than 1mm) on each graft implanted there are very visible i.e. under the sun light.they don’t hurt me and seems like the hair is pulling up the skin. I don’t have any of them on non tranplanted hair… I searched on this site but almost all of the discussions I found are on bumps or normal pimples or pitting or scars. the most valid explanation I found is that it is due to the graft that was implanted too deep in the scalp.If it is true, what can I do for improve the situation? Dermabrasion or laser? may I start trying some remedy for folliculitis or is completely useless?pls give me some good hope on what I can do,I’m really desperate. the doctor who make me the surgery (in Mumbay while I was in a long trip for job…)after the first telcon, don’t reply to my calls or mails…however I don’t trust him anymore! I contacted another Dr who said that the only solution maybe is to make another transplant to hide the thin pimples, but I leave this as the last solution and I won’t make another bad transplant. pls tell me if there is something I can do for making less visible these pimples.Thanks in advance. sorry for my bad english. Best Regards

If what you’re describing is a cobblestone appearance (and not actual pimples), then please see this post. Without seeing you, it would be impossible for me to tell you what the problem is caused from.

Dermabrasion to the scalp causes visible scarring and only benefits the doctor’s pocket, not the patients who receive it. There are two types of lasers that can impact hair:

  1. Low level light laser therapy (also known as LLLT), which I feel does not work at all
  2. Higher powered lasers for hair removal, which do not work 100% on killing the hair

Neither offers much benefit to your situation. If you have bumps, some hair killed with the high powered lasers will just make what remains more visible and the laser itself can cause depigmentation (whitish areas) of the lasered skin. I would need to see you, but it is not an easy trip from Italy to my office in Los Angeles.

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My Surgeon Talked Me Into Having More Hair Transplants That I Probably Didn’t Need

I’ve had a total of 5 transplants. Two in the front (700 grafts each) and one on the crown (1000 grafts). These three surgeries together produced a beautiful result. I should have stopped there but I was under the illusion that another transplant (1.5 years later) would give me even thicker hair. The Doctor that did the transplants is a pioneer and very well known and respected. I’m not going to mention his name because you would automatically know who he is.

Nine months after the fourth transplant (600 grafts in the front) I did not see any additional density. Three years later I went in for a consult about the front again and he told me that I did not need the fourth transplant but he would be able to do a small one (500 grafts) at that time so I had it done. Six months later I did notice a difference and was pleased with the end result.

It has been six years since and I still have all of my hair. My question to you is: Why would he do a transplant when I didn’t need it? I look back and feel that the grafts were wasted and I was taken advantage of. Like I stated earlier this individual is a pioneer and respected. He certainly did not need the money. Even the nurses joked with me saying that I had “a lot of beautiful hair” hinting that I didn’t need to have the last transplant. What is your opinion on this?

I speak of the importance of ethics at medical meetings. Some doctors push for surgery even if the patient does not need it. This is commonly seen in young men who are too early in the balding process where drugs like Propecia (finasteride) suffice for the sole treatment, and 80% of women with thinning who are not candidates for surgery, yet the doctor recommends surgery on many of them who feel that they must do something about their thinning. For them, the surgical option is an easy sell, even if there is no value for surgery.

My job as a hair transplant surgeon is to always be a patient advocate, pushing those who do not need surgery away from the FUE punch or the surgical knife. It is always good business when I can create a trusted following of patients who believe in my ethics, especially when I steer them away from a surgical decision in examples as those discussed above (majority of women, young men). Many times it is harder to talk patients away from wanting surgery than it is to recommend surgery for an actual candidate. By that, I mean I have to spend more time with each such patient educating them on the ‘whys’ of my decision process.

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My Surgeon Said Some Grafts Can Be Dormant a Year After My Hair Transplant

A year after a successful transplant I can still feel some grafts on my head that never shed a year later.

Hello doctor, it is about 12 months since my FUT procedure of 2350 grafts. I and all concerned are very pleased with the results. As expected by this stage, almost all of the grafts are grown out and have matured for quite some time now. However, I find it strange that in one or two areas of my head I can still feel some of the short shaved implanted hairs that never shed or started to grow in the whole 12 month period. Now this number is very small, im talking maybe only 10 to 15 hairs over my entire scalp, most of which are in the hairline region.

I discussed this with the transplant surgeon at my 12 month review, and he told me that it was acceptable that even after 12 months there may still be very small number of grafts still in the dormant phase, and that these would eventually grow out in time.

I was just wondering if you had ever come across this before and if it was normal? Perhaps my growth is just a little slower than average as I noticed my real thickening happened around month 9/10 as opposed to the normal month 6 that one usually reads about. I also have been on finasteride for the past 5 years.

Thank you and I appreciate any response you may have for me on this.

Kind regards

You may also have the hair from the original transplant that just never shed and is just stuck in there (without shedding or growing). You can test this hypothesis by finding this “stubble” and gently tugging on it. If it slides right out, it may have been the original hair in the grafts from a year ago. Imagine a splinter stuck in your scalp. In this case, the splinter would be your inert hair.

Otherwise, your guess and your surgeon’s guess is as good as mine. I have no idea what you may actually be experiencing without an examination.