Author: Dr. William Rassman

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A Week After Transplant, I See Small Hairs Falling Out With the Scabs

Hi, I had 500 grafts to the temples 12 days ago. I have been washing the recipient area almost every day, and gently dabbing the shampoo on and off but some scabs still formed. I began very gently running my fingers over them when dry (but certainly not pulling them) by about day 7 and noticed some easliy fell out but with small hairs attached. Is this my grafts coming out?

We all worry about losing hair grafts after the surgery and that is the basis of your question. It is an important question; so important that NHI did a major study on the subject and the best answer to this question is for you to read our article on this subject — Graft Anchoring in Hair Transplantation (PDF file).


2007-11-28 10:36:33A Week After Transplant, I See Small Hairs Falling Out With the Scabs

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A Specialist Recommended Scalp Reduction Surgery For My Small Bald Spot

Hello,

After having a bald spot on the left side of my head for 28 years, I’d like to do something about it. The bald spot is circular in shape and 2cm in diameter, about 7cm directly above my left ear. The hair fell out when I was 2 and the bald spot has remained the same size for as long as I can remember. I am able to cover it with hair surrounding it, but it does take an emotional toll on me as I see it every day and I have to be very careful every month when having my haircut. I saw a dermatologist about a year ago who told me it’s triangular alopecia. He was not able to locate any hair follicles under the skin, and told me the chance of regrowth is slim to none, especially as there has been no hair there for 28 years. He suggested we first try cortisone injections which did not work, and then referred me to a specialist. I went to see a specialist and he recommended scalp reduction surgery given the small area and lack of hair follicles.

I’ve done some reading on scalp reduction surgery, on your blog and others. The risks seem to be significant (stretchback, slot scaring, hair angled incorrectly, etc.) and it’s clear you’re not a proponent. I’ve also been unable to find any success stories/testimonials online. I’m going to ask the specialist to share more information (# of surgeries he’s done, before/after photos, # of surgeries I’ll need, risks, type of incision, etc.), but before doing so I’m hoping to get your advice.

Given the small area (2cm in diameter) and being able to cover with existing hair, do you think this is a case for a successful scalp reduction surgery? If not, are there any alternatives you’d suggest (e.g., Rogaine, hair transplant)? Both my dad and grandpa have full heads of hair, so I’m not really worry about the hair on the left side of my head receding back to the site of the bald spot.

Thanks for your help!

You are correct in that I am not a proponent of scalp reduction surgery. This is because over the years I have never seen it work well. I’ve written about this type of procedure before here.

A scalp reduction could be very tempting to the surgeon and the patient, because it makes logical sense — just take out the bald spot — but the best you would get is maybe 50% improvement. Or you might get considerable scarring from this, depending on the location.

There are other options, such as a hair transplant using the follicular unit extraction (FUE) technique into the small area you described. This is a more predictable result, particularly for the small area.

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A very personal story of a great man I worked with in Vietnam and in the United States

Dr. Nghi, a surgeon in South Vietnam worked with me as I volunteered to assist South Vietnamese Civilians and wounded soldiers while I was in Vietnam. He was fortunate to be evacuated and ended up in Camp Pendelton when I was able to connect with him in 1975. I sponsored him and his family of 8 others including his wife and two children, plus other relatives including his wife’s father and mother. He joined me in my Surgical practice in Vermont, working as a physician assistant while studying for his examinations to get a license to practice medicine in the United States. After 9 months, he took the examination and passed it on the first round. With some help by me, he went onto to Dartmouth in Hanover New Hampshire and studied Anesthesiology for 3 years. When he left Dartmouth, a special award was created for him to recognize outstanding service while he was there and was offered a faculty appointment. He decided not to take the appointment and moved to Pittsburgh where he has been practicing anesthesiology every since. He has been active in helping Vietnamese refugees resettle and has been invited to the white house twice to be recognized as an outstanding community contributor. His family now extends to more than 40, all highly successful and integrated into American life. He has four children, an OBGYN doctor, a PhD researcher, a district attorney and a pharmaceutical Vice President. He told me that America gave him and his entire family the opportunity to succeed through hard work. He loves America. Below is this presentation posted by the History Museum in Pittsburgh just this week to honor Dr. Nghi and his family.

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A Whole Lot of Eyebrow Transplant Questions

Dear Doctor:

I have thin patches in my eyebrows and want them treated, preferably by means of an eyebrow transplant. Dr Rassman is one of my three short-listed doctors and I have several questions, which I would be extremely grateful if they could be answered.

Many thanks in advance

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Questions re FUE/FUT, yield etc.
1. Does the doctor recommend FUE or FUT for the eyebrow and why?

2. How does Dr Rassman avoid shock loss when implanting grafts amongst existing eyebrows?

3. How does he optimise yield of transplanted grafts?

4. What determines which follicles Dr Rassman selects for an eyebrow transplant?

5. What is unique about Dr Rassman’s approach for eyebrows as compared to similar leading transplant doctors?

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Questions re physical apperance of eyebrow

6. What is to prevent the hair turning grey later on, with age etc.?

7. How can you properly trim eyebrow hairs if they are growing horizontally?-with a simple nail scissor this would not be possible.

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Questions re preparation for operation:

8. How can you ensure the recipient area is in a healthy state to accept transplanted hairs? Should creams be used to ‘disinfect’ the area?

9. What factors would make an eyebrow transplant unsuitable for a patient?

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Side effects:

10 . Can having an eyebrow transplant affect the muscles around the brow, leading to future risk of a descending brow?

11. Is it risky operating on an eyebrow from the perspective of harming arteries etc. close to the eye? Can this harm the eyes? Have any patients experienced this?

12. In what percentage of cases, is the patient dissatisfied with his results?

13. Many of Dr Rassman’s patients travel from abroad and so can only avail themselves of an online transplant prior to the op. Upon closer inspection on the day or the day before the operation it may transpire that the patient is not a ‘good’ candidate for a transplant. Does the doctor in these cases advise against going through with a transplant? How many times this year, for example, has the doctor turned down a patient on the day or the day before an operation?

14. What controls does the doctor put in place to measure the performance of the various technicians?

15. Does the doctor, have a feedback system with a standard feedback form for post-op patients?

Now that is some due diligence! Below are the answers to your questions.

  1. Either FUE or FUT will be fine. The key is to prepare one-hair grafts and put them at the correct angle, lying flat so that they do not stick up.
  2. I have never seen shock loss of the existing eyebrow hair when doing an eyebrow hair transplant. The transplanted hair often fall out and then regrow in 3-5 months.
  3. There is no yield problem with experienced surgeons like me. I would expect close to 100% growth from the grafts.
  4. The doctor and team look for one-hair grafts and makes sure that they are trimmed correctly. If the grafts are taken by FUE, preferably one-hair grafts are removed, but it it is taken by strip surgery, then the team may have to reduce a two-hair graft into two one-hair grafts to keep the process delicate.
  5. I have a great deal of experience doing eyebrow transplants, as do a handful of other experienced hair transplant surgeons.
  6. Eyebrows will turn gray with age if those particular hairs are genetically programmed to turn gray, and other than dyeing them, the color is what nature gives you.
  7. I would advise you to get a good set of iris scissors to trim the eyebrows, as they do grow long. Twice or three times a week may be needed to keep them the length you desire.
  8. I suggest the use of Hibiclens soap for antibacterial application. As this is toxic to the eyes, it must be handled carefully with the eyes closed when applied.
  9. Unrealistic expectations.
  10. Not when done properly.
  11. No such problems have ever been seen in my patients.
  12. I do not remember any dissatisfied patient.
  13. About twice a year we turn down a patient who has flown in a long distance, mostly because of unrealistic expectations.
  14. Careful quality control is exercised in every case.
  15. All of my patients have full 24/7 access to me (or Dr. Pak). We encourage feedback such as this post.

For more information on eyebrow transplants see:

  1. Female Eyebrow Restoration After Cancer Surgery
  2. Eyebrow transplant – Patient BG
  3. Baldingblog search results – “eyebrow”

Do not hesitate to call my office @ 800-NEW-HAIR to setup a phone consultation with me if you’re not local.


2012-04-05 12:10:29A Whole Lot of Eyebrow Transplant Questions

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A View of New Rogaine Foam

A note from a blog reader:

I just tried the Rogaine Foam and found that it dries very fast and helps makes my styling easier. I don’t particularly like the lemon smell that they put to it, but the odor does go away in a few hours. I think that you need more of it than with the recommended dose that is used for regular Rogaine.

I thought this might be interesting for those that have used minoxidil in the past, but do not like the mess of the topical liquid. I have no experience with the foam, but if others out there have used it, please feel free to post your thoughts about this product.


2006-09-21 08:31:33A View of New Rogaine Foam

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A Week After Highlighting, I Have a Bald Spot!

(female) I had my hair highlighted approx 1 week ago, i thought everything was fine, but i now have a very sore bald patch at the top of my head,do you think this was caused by the hairdresser at all,i have had my hair done in this way many times ,but have never had anything like this happen before!

Thanks

PS, im really scared that all my hair is gona fall out!!!

Ouch! Chemical burns from dyes start off just like you’re describing. You may want to see a dermatologist to find out if the burn did indeed go deep enough into the skin to cause the problem.


2008-09-23 14:38:45A Week After Highlighting, I Have a Bald Spot!

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A Special Letter from an NHI Patient

I just received this email from a patient of mine and thought I’d share it with you, as it brought a smile to my face. Periodically, I want to share the joys of this uniquely wonderful medical practice with my blog audience as I am getting terrific feedback for many of you.

Good afternoon, Dr. Rassman. I thought this might be of help to your new transplant patients and those considering a procedure. I have been a happy client of NHI since 1999. Your organization actually turned me away prior to that until you thought I would receive sufficient benefit.

In September of 2004 you yourself did a whopping 1400 or so in the crown area (your organization did 1200 grafts prior) . Now this is the reason I am writing to you (in addition to just finding this blog business on your website): your prospective patients, especially the younger guys, need to know that balding is a long process. Although they may awake to the process all at once with the “bell in the brain” event, it is likely that the process has been in place for sometime and will likely continue. In my case technology and my finances came together and I was able to get ahead so that I never had a bald spot period in my life and managed to keep the “shine through” months to a minimum. To this day it is a hoot to tell new friends or business aqaintances that I’ve had transplants and would have a spectacular bald spot had I not chosen NHI. None, and I repeat none, believe me. Even when I show them evidence of the donor scar most assume I am pulling their leg. Now, for the second reason for writing after reading a number of your blogs. Last week one and a half years after I started the process, I was lolling in the tub and discovered a veritable thicket of new stumps in the thinest area of my swirl. I made a mental genuflection to LA and hollered to the wife: blog the good doctor and tell him that, as in the previous two sessions, his theory of waves of hair growth continues to be proven.

Sorry about the length of email but continue to reassure your younger patients with confidence that it takes time to grow. My only regret continues to be that in never having gone bald I never got to qualify for your “before and after” photos. However, my dream may yet come true. At the advanced age of 57 my front hairline is going. You may see me back in LA or San Jose for splotch in the front. Please let me know if you are running any “forelock specials” and be prepared to guarantee me a minimum half-page pic in your next updated booklet and I’m there. Remember, there are many other hair docs who would benefit greatly from claiming your good work and artistry for their own were I to rent out to them my forehead and crown as an advert. Perhaps I should hold out for a 3/4 page or maybe an inside back cover. Thank you again for your time and attention to my skull. My wife sends her regards and hints that she needs another free shopping day so she’s hoping the front falls out. I’ll remind you that it was an inappropriate comment you made during my last session that all the other wives who drive their husbands get five free hours at the mall with the husband’s credit card. Through sessions one and two I had had her convinced her it was sufficient reward for her to share my salad at mid-surgery point.


2006-02-20 17:48:21A Special Letter from an NHI Patient

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A Year After My Hair Transplant, I Still Look as Thin as Before!

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.


2007-01-10 07:27:39A Year After My Hair Transplant, I Still Look as Thin as Before!

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About a Decade After My Hair Transplant, It is Falling Out

I had a transplant procedure about 12 years ago done by a great physician and personal friend, the late Jim Arnold. During the past couple of years I have had more dramatic hairloss including the loss of my new hairline. I thought that transplants lasted forever. Would I be fighting a losing battle to go ahead with another procedure?

I have seen what you described before, but there could be many reasons why you have this happening. I don’t know much about you (I’m limited to your single email) and I need to learn more. When we say that hair transplants that come from the fringe area around the head are permanent, we mean that in 99% of patients. The hair in this fringe area will stay the lifetime of the person, but we do know that there are general diseases that are seen (such as DUPA) which can appear at any age.

I would want to understand what is happening to your donor area now and an examination with a high powered video microscope will allow me to evaluate that donor area. What you are seeing in the grafts may very well be in the donor area as well. Without an examination, I can not tell you what to look for. Please call my office at 800-639-4247 and set up an appointment. As you likely know, I acquired Dr. Arnold’s practice and see many of his patients. He was a wonderful man and a wonderful doctor, loved by his peers and his patients as well.


2009-08-19 17:40:19About a Decade After My Hair Transplant, It is Falling Out

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Abdominal Pain And Hair Loss

Hello Dr Rassmann,this blog is great.
Sir suppose a person has genetic hairloss for around last 3 years. If he also has abdominal pain for around last 6 months, so is it possible that his abdominal pain can increase/accelerate his genetic hairloss but without causing acute/chronic telogen effluvium?

stomach

I am not sure how you can make a correlation between abdominal pain and hair loss. Abdominal pain is not related to genetic hair loss or any other type of hair loss from my experience.