Author: Dr. William Rassman

Here are two photos which show two different patients who developed necrosis of the recipient area. These patients had their surgery in Turkey and will have to get wound care where they live. The area of necrosis will not grow hair. My clinic has performed over 16,000 hair transplant over 30 years with many doctors. We have never had a case of recipient area necrosis. I believe that these men had errors in their anesthetics that caused the problem. Turkey is no bargain when you don’t get a competent doctor doing your surgery. There are some very good doctors in Turkey and I doubt that the good doctors in Turkey get this complication.

These areas of necrosis for some technical problem induced by the surgeon usually heal with a large scar as shown here (before with necrosis on left, after healing on the right).

This is a patient that had a hair transplant by a non-physician and got necrosis of the recipient area where all of the hair will not grow there and it is heavily scarred as you can see.

 

I have about £2 to 3000 to spend and I thought it might be worth investing in a new head of hair. I’m 27 and rapidly losing hair. I’m comfortable with a shaved head but I actually would like the option of growing it out. Are there any clinics or websites that people recommend? I know going to Turkey is much cheaper but will that mean compromising on quality? Will I be able to shave my head in the interim period where my hair is going to be growing out? I actually applied to qunomedical but I was put off a bit with how much they whatsapped and called. I felt they were trying to pressure me when I just wanted the time to think about it as it’s quite a substantial investment.

I was thinking of getting a FUE hair transplant. I was hoping those that have been through it could give some advice on the following. Thanks for your help! How do you know/verify that the specialist delivered on the number of grafts that he charged you for?

How many hair follicles should be in a graft? What is an optimal number of hair transplant procedures done by the specialist? Some I called said they’ve done 50. What is a good baseline?

Does it matter if the specialist is board certified plastic surgeon?

I have spelled it out in great detail in two posts here: https://baldingblog.com/before-selecting-a-hair-transplant-doctor-do-your-homework/ just follow the link

This shows a needle puncture in the skin that is clearly present, after the needle exits the skin. For those people who get Scalp Micropigmentation, this is also present, just in the thousands. The hole usually fills in quickly from below, but when doing SMP, I always ask the patient not to shampoo or use alcohol in any manner for 3 days after getting SMP. If this rule is not followed, then the detergent will go through some of the holes and cause the tattoo ink to dissipate, making what was a “DOT” into a “Blob”

The chart below shows that the scalp hair has the longest growth cycle of any hair on the body. That makes it the best hair for hair transplant. Beard comes in as a close second, but may not last as long for a growth cycle. Chest and hair on your back are very poor with a growth cycle such that only 30% of the hairs will be growinh at any one time. This is important information for those of you who have run out of scalp hair, and need hair from other sources. It is not good news

There are two types of procedures for lowering a hairline. One is a surgical excision of the upper forehead, followed by the downward advancement of the hairline up to an inch from where it was prior to the surgery. To accomplish this, the entire scalp from the frontal hairline to the very back of the crown is lifted up and pulled forward. When this is done by an experienced surgeon, the hairline can often be advanced about 2/3rds – 1 inch, if there is enough looseness when this lifting process is done. This procedure is often completed in one surgical session; however, it may not address receded corners of the hairline if the corner recession is significant. A great advantage of this surgical approach is the immediate impact of the procedure on hairline location, with healing usually complete in a week or so. Sometimes, this procedure produces a scar in front of the hairline, and if this is the case, a hair transplant in front of the hairline can address the scar. If there is corner hair loss, or if you are a male, a hair transplant lowering surgery is better, because the risk of recession in men with genetic balding is very high. A recession will always reveal the scar from a hairline advancement surgery. The only disadvantage to the transplant is that it takes 6-8 months to fully grow out. For men, a hair transplant is a better procedure because the risk of hair loss is high, and hairline recession will show the scar from a hairline advancement surgery.

The second type of hairline lowering procedure is done through hair transplantation. The number of sessions varies by the thickness of the hair. For women with other than fine hair, they might do this in a single session. With fine hair, it often takes two sessions. The time to see the impact of a hairline lowering hair transplant procedure is 5-7 months after the surgery date, and if a second session is required, it will take another 5-7 month wait for full growth. See web references below for photos of this process on women we treated. When done properly, a transition zone is created that makes the frontal leading edge of the hairline soft – what I call a no-hairline hairline. See here: https://newhair.com/female-hairline-lowering/

https://www.oatext.com/Long-term-(10-year)-efficacy-of-finasteride-in-523-Japanese-men-with-androgenetic-alopecia.php

RESULTS: We evaluated the long-term (10-year) efficacy and safety of AGA treatment with 1 mg/day finasteride in a large study population (532 patients), as the first study of this kind in Japan, to our knowledge. A high objective efficacy was demonstrated by the MGPA, which revealed improvement and prevention of disease progression in 99.1% of the 532 Japanese men with AGA treated with 1 mg/day finasteride for 10 years.

SEXUAL FUNCTION: In the investigation in 40 years or older of Asians, the incidences of decreased libido and erectile dysfunction were 6.0–38.7% and 40.6–70.0%, respectively [29,23]. Overall, the adverse reactions were all mild, and the incidence was lower than the generic incidence of decreased libido and erectile dysfunction in Asians. As adverse reactions were recorded by patients in a subjective questionnaire, the result was thought to be slightly different from the correct number of adverse reactions in this study

Dr. Rassman’s Comment: The efficacy of long term finasteride treatment has been published many times. When compared side-by-side with men who did not take finasteride, the results show that men with genetic balding hold on to more hair over time than the non-finasteride counterparts. The issue of sexual dysfunction is briefly discussed and the comment that the sexual side effects of age parallel the sexual side effects while on the drug (just slightly less according to this study). There were no cases of Past-finasteride syndrome reported in this study, a significant point.

 

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I had a face lift in Aug. 2005. By his own admittance, the doctor has damaged nerves behind my ears and neck area. In addition, my healing has caused keloids, which he cleaned up once in April, but re-healed the same. I have had, and still am having a lot of hair loss.

Has the nerve damage caused less blood to flow to the scalp?

The damage has caused numbness, a sense of cold, and a sense of ‘strangling’ in my neck. I’m not sure if this can be re-paired?

The main question has to do with hair loss.

Thank you.

Your problems are clearly not simple and therefore I would require an examination of you with and would require more detail in your history. Keloids in the scalp are very, very rare. Nerve injuries should not impact blood flow to the scalp. Stick with your doctor if you believe that he/she is competent and has your best interests at heart.