Disappointed with My Hair Transplant from 8 Months Ago

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).

Disasterous Hair Transplant Horror Stories!

I saw two patients recently that are worthy of discussion here…

Patient #1:
He had a typical result from the hair transplant surgeries of the 70s, 80s and early 90s. He had hair transplant plugs in the early 90s which gave him a doll-like hairline in the frontal area. I have worked with him over a 10 year period with four surgeries to remove and thin out the 3 inch wide plugs, redistributing the hair from the plugs to other adjacent areas in an attempt to make them less detectable. He is about 80% closer to his goal over what he had when he first came to see me and now wears a crew cut, but he is still frustrated over the remaining plugs which still bother him when he looks into the mirror every morning. I will continue to work with him, thinning out more plugs until he is satisfied that he looks normal. He shared what it has been like over the past many years, as too much of his life focus revolved around his head and his freaky pluggy look. Fortunately he and I put together a Master Plan 10 years ago to get him back to a normal appearance, and even now, after a decade of my working on him, the process will continue.

Patient #2:
This man has a far worse story. This young man (in his 30s) has had hair transplant work by many doctors over 10 years. Unlike patient #1, he never had a Master Plan and always sought out the best doctor who promised him a quick fix and he believed what the doctors told him. In the midst of the process, he even had a brow lift to raise a hairline that was too low, leaving him scarred in the hairline area. A series of transplants to fix the hair loss from the brow lift in the frontal area failed, compounding the problem further. The donor strips that were taken in the back of his head were all taken in different areas of the scalp and they all stretched and widened substantially. It seemed that the doctors just kept on removing donor hair from different areas to avoid the wide scars previous doctors created.

This man paid tens of thousands of dollars and each successive surgery seemed to leave him worse off. The recent transplants apparently did not work and he asked me if there was something wrong with his skin and recipient areas. I asked him if he called the doctors who did the failed procedures and he said he did call them over and over again, but they never returned his calls. Now he is massively scarred in the back of his head with at least three wide scars each measuring over 1/2+ inch in width. He received body hair transplants into the scar, but the difference was marginal. Each “fix” addressed one problem in isolation of the other problems, resulting (at times) with him being left worse off in the total scheme of things. I don’t know what he will do, but I suggested that he consider working with just one doctor, and building a Master Plan to deal with his problems. One option might be balloon expansion of his scalp to remove the scars in the back of his head by stretching the normal scalp in the crown of his head. The use of balloons to stretch the scalp will take at least 8 weeks of constant inflation of the balloon. If he wanted us to do it in California, he would either have to move to California for the period that the balloon expansion was being done or find a local doctor willing to do the incremental expansion of the balloon in his home town. We have done similar patients with outstanding results, but the commitment of time is substantial. What I gave him was a Master Plan to get him back to a manageable state. Anything short of such a radical approach will just victimized him again and again by some of the doctors who see $$$ in each successive procedure that they can offer him. Too much of his life is being centered around his scalp and the various poor choices he made.

Conclusion:
I often end with the statement: “Let the Buyer Beware,” which is so appropriate in this situation. Doctors are not immune to being scummy. I unfortunately see horror stories like this almost every week, and I post these as a way to educate you (the consumer) so that you can make informed decisions and avoid being taken advantage of.

How do I end a post like this positively? Well, today’s hair transplants in the hands of good and honest doctors are spectacular. At last night’s Open House event in our LA office, Steve Hartman (CBS Sports announcer and radio show host) who is himself a hair transplant patient, told me that not only was his procedure undetectable, but that he and many of the patients who were there looked like they never lost a hair on their head. Those horror stories I wrote about above rarely happen today. There are rotten applies in every barrel, but there are many really great doctors also in that barrel. You just have to do your research before you jump.

Disease appears after hair transplant (photo)

This man had a hair transplant a few weeks before these bald spots appeared on his head. More and more of them appeared. To make the diagnosis, a biopsy needs to be done. It is likely a scarring alopecia, but it could be a variety of scalp/hair diseases triggered by the hair transplant. I have seen men who never had alopecia areata, then get a hair transplant, and alopecia areata appears from days to weeks after the transplant. A surgeon must have a keen eye and perform a good trichoscopic examination on the head of all of his patients before the surgery. As a surgeon, I don’t like surprises, and I am sure that you, as a patient, wouldn’t like them either.

Discussion between two men on Reddit about finasteride

Below is the conversation I had with another reddit user in this post regarding finasteride. I would greatly appreciate your feedback regarding what he said. Is it true?


Me: I’m 7 months with no noticeable improvements. It may take up to 2 years for improvements, but we’ll see

Him: Thats not true the peak at 2 years mark , but thats only if u saw any improvment by 6 month mark

Me: At year 2, almost 20% more saw regrowth according to the FDA-supported study. So yeah…it may take 2 years to notice improvement. Never heard of the 6 month statement. How do you know that?

Him: Lol trust me the brother. I have no reason to let you down. If u got nothing by now. You are not gona get any after. I mean if you are stable be happy.

Me: The research contradicts you

Him: U clearly didnt understand

Me: Please explain then and where you got that info from. I want to learn

Him: There a huge missleading about the fda reaserch. They mention that the the peak of the result were on 2 years mark. But those ppl kept improving since day one up to 2 years. Its not like after 1 year the regrowth start to accure. After 1 hair cycle u should see some results if u respond with regrowth.

My opinion is:

  1. finasteride may reverse hair loss (rare)
  2. finasteride may slow hair loss down (common)
  3. finasteride may stop hair loss (common but you don’t know this unless you stop the drug)


2020-04-03 12:40:12Discussion between two men on Reddit about finasteride

Disappearing Neck Hair (photo)

Note that in this photo, the neck hair in this man has already started to disappear. This is a genetic trait that is different from general Male Patterned Genetic Balding. For this reason, I never transplant the neck hair into the recipient area because this hair, in some men, is not permanent hair. Note the transition between the neck hair and the scalp hair at are about the occipital notch (base of the skull).


2019-07-30 09:28:40Disappearing Neck Hair (photo)

Direction of Graft Growth

Hi Dr,

Can you explain how accurately a surgeon such as yourself can transplant grafts so that hairs grow in the same direction?

I have seen quite a few celebrity transplants where the hair still appears thin and the hair once grown out always looks messy because the direction of the grafts is not quite right.

How are you able to ensure that this doesn’t happen?

As someone with naturally fine and very straight hair then i imagine it would be essential that any transplant i had done should be performed by a top surgeon who is able to make sure that the angle of the transplanted graft is accurate. If i had thicker and naturally curly hair then i suppose this wouldn’t matter so much and is probably a part of the reason why those with curly make better candidates?

Thanks

Doctors have direct control of how the transplanted hair grows and how the transplanted hairs are distributed to give the most natural look. This is a very important point that most prospective patients do not take into account when searching for the right medical group for a hair transplant procedure.

You are correct in stating the fine straight hairs need careful attention to detail when undergoing a hair transplant procedure, but careful attention to detail is also a must for coarse hair, because each hair can have many times the bulk of a fine hair. A coarse hair put in the wrong direction will be more easily detected than a fine hair put in the wrong direction. Some surgeons, when placing the hairline, place the frontal hairs radially (like bicycle spokes). Is it possible that surgeons who do this do not understand the normal direction of the hair growth, just are ignorant of the facts? Sometimes I think so.

To be sure that these poor placement doesn’t happen to you, you have to do your own research and due diligence. There are many good doctors with great artistic skills. The best way to determine who these doctors are is to ask to meet some of their patients. My patients love showing off their results in the privacy of our office, so we set up circumstances once a month to allow this to happen. To me, this is just plain good medical education. This is why we have our monthly Open House events where anyone can come and see our former patients (up close) and speak with them face to face.


2012-09-05 10:30:14Direction of Graft Growth

Discouraged about hair loss and can’t get a date

It is discouraging. What’s interesting about human attraction and looks is, the most important factors are those you cannot change. Your height. Your hair. Your facial characteristics. Can’t get a date! Turns out being fit working out and being muscular doesn’t actually matter. Dressing nice matters but can’t compensate a lack of something genetically determined. I’m so bummed out how important the genetics code is to be successful in this area

Quality women often focus on what is inside your head not what is on top. Women who are superficial look for a package that may not be what they want when the wrapping is off.


2019-03-26 18:17:33Discouraged about hair loss and can’t get a date

Do alcohol based shampoos harm SMP?

I’m planning to get scalp micropigmentation SMP on my FUE scars soon. I currently use minoxidil foam which is essentially just minoxidil dissolved in pure ethanol. Does ethanol applied to the skin longterm cause significant fading or blurring of the SMP dots?

The use of alcohol based lotions should be avoided for only the first 3 days after the SMP is done. After that the wounds heal so that the alcohol can’t get to the pigment to have an impact on it. The skin is an effective barrier to protect the SMP from everything except direct long-term sun exposure


2021-05-25 11:16:07Do alcohol based shampoos harm SMP?

Do balding patterns stabilize as you get older

When you say hair loss has stabilized what do you mean? You were born with that pattern and won’t advance? Just want to clarify. Thank you Dr. Rassman

We generally believe that we inherit a balding pattern (assuming that you get the genes for hair loss about 50% of the male population) and that once you achieve that inherited pattern, you stabilize. I, for example, lost my crown hair and became stable even after a hair transplant without balding elsewhere


2020-08-31 08:50:17Do balding patterns stabilize as you get older