Category: Hair Loss Causes

When Can I Scrub My Hair After A Hair Transplant?

Scrubbing it tends to pull out hairs that are miniaturized or those near the end of their normal cycle. After a hair transplant, if there are no scabs present within a few days, the grafts are secure and will not come out with gentle washing. We wrote about this and published a hair pull study after hair transplants here:

Maybe I”m off but if technicians are doing most of the procedure I would think the rate of transection would be high. I don’t know what kind of training they’ve had. I assume just in house training. Obviously they’re needed considering the number of grafts but it’s a concern of mine.

In the United States and most of the world, only licensed physicians can perform hair transplant surgery. Doctors make incisions, harvest the grafts, harvest any FUE grafts, and they also make the hundreds or thousands of individual incision of where the hair follicles need to go. The technicians sort the grafts and individually insert the grafts into the pre-made incision sites that the doctors created. For strip surgery, the technicians also dissect the harvested grafts under the microscope into individual follicles. The technicians are trained to perform this highly specific task and the doctors oversee the process. For FUE, a doctor must be the person performing this step, but many doctors just can’s do this very well, so they use someone on their staff (not a doctor) to do the FUE extractions. This is frankly illegal, but as the State Medical Boards are not in the operating rooms, the doctors get away with it. On the other hand, some doctors who purchase an Artas® Robot, can use technicians to operate this machine. That seems to be accepted as legal, although the medical boards in most states have not ruled on this.

At our office, we do the FUE manually with instruments of out own design. Although we ‘invented’ the optical technology for the Artas® Robot, at $260,000 plus $1/graft, that would drive the prices too high for our patients, so we have continued to advance our manual technology which is faster and more efficient (in our hands) than any Artas® robotic surgery. We feel that the Artas® Robot and our manual technique are comparable in quality, but our manual technique is much faster and more efficient in our hands than what we have heard about the Artas® Robot.

Aside from the individual task of each team member, hair transplant surgery is a team effort. It takes a highly coordinated team to execute a successful surgery. That is why the reputation of the medical group or clinic is just as important than just the name of the doctor.

I’m 28 years old. I got a hair transplant done in November 2013. After the transplant, I lost some hair and seemed to be more hair loss in the first three months. Now that i’m approaching my one year period soon, why is it that the amount of hair that was planted has not grown? I was expected a least twice of what i see. When i comb myself i still look like someone who is losing 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 and ask them about their experience. It is possible that you lost a considerable amount of hair from the hair transplant surgery and the transplants actually grew but because of your shock hair loss, the net gains was zero (worst case). If you were on the drug Propecia (finasteride) it may have helped but that is hard to tell.

If the hair did not grow, then the question should be ‘what went wrong?’. Maybe it did grow but your expectation was unrealistic and the communication between you and your doctor may have been an issue. 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 and ask him/her to examine you for the results of the hair transplant.

Repeat From Archive

We have been getting a great number of questions about hairline hair loss. Basically the questions relate to the slow appearance of the mature male hairline. The pictures in this post show a young man in transition between his juvenile hairline and his mature hairline. Note that the corners are moving up and that there is some thinning of the leading edge of the hairline. What you see here is not balding, just maturing the hairline.

Please note that we do not generally diagnose hair line questions. However due to the increasing daily emails with photos of young men concerned about their hair line, we will soon be rolling out a new website where you can submit your photos and have others rate the hair loss. Stay tuned!

Hey doc, there is a new hair laser on the market. What do you think?

This space age design and the small case “i” in-front of the name does not add value. The FDA clearance means that it is safe. I really do not understand the FDA as effectiveness has not been proven in the one example mentioned in the article. I have not seen any definitive clinical research that proves that these lasers have any value at regrowing hair. Even the recent article in the Dermatology journal stated “further study is needed”.

What Is The Best Way To Diagnose Hair Loss?

We addressed this question before HERE

I personally believe that the HAIRCHECK instrument is a great instrument to put numbers (an objective measurement) to the balding process. When repeated yearly, you will know how your hair loss is standing up to treatment such as Propecia (finasteride) or just the normal progress balding men experience routinely. We perform HAIRCHECK measurements and MINIATURIZATION MEASUREMENTS (with a microscope) on most of our patients who are balding and those who go on the drugs so we can see gains or losses over time. The measurements are limited in certain cases when the hair is too short.

I am scared to death that I would have a hair transplant and everyone would know because it would be so obvious. What do people do to hide it? Do they live in a hat?

I could write a book about this subject. Many years ago when larger grafts were used, it was impossible to hide a hair transplant because the wounds were large (between 3 and 5 mm). Large wounds, are obvious and at the time that these were done (late 1980s and early 1990s) the typical patient had to use a hat (baseball hat most common). When I innovated the small 1mm grafts in the early 1990s (I started doing hair transplants in 1992), I focused on this problem. There are two parts to this problem. The first reflects the post surgical period of a few weeks. The small 1mm grafts healed rapidly and with good post-operative washing, the surgery could be undetectable within a few days. Swelling was also a problem immediately after a hair transplant, one we solved with the judicious use of corticosteroids which reduced the post-operative swelling plaguing our patients. In the early 1990s as the number of grafts in my practice rose into the thousands (2000, 3000, 4000 and 5000 grafts), careful focus on post-operative washing and the use of single large doses of steroids brought undetectability within a week or so. Most patients were able to go out into the public within a week, once we mastered the post-operative care.

The second concern was how did a man go from a completely bald look (Class 6 or 7 patient) to a hairy look. Here I have many stories and I will mention only a couple of them here. A Class 7 patient of Indian decent, let his beard grow out just before the hair transplant. To his and my surprise, his beard was white so everyone he knew laughed at his ‘Santa Clause’ appearance, but no one, observed his hair transplant or the change in his look from bald to hairy. He shaved off his beard and no longer paid attention to his hair. Like grass growing, you never see it grow. The second patient was a 55 year old male with a Class 5A pattern. His hair was prematurely white and his balding pattern was very obvious. His post operative care paid attention to his wounds and in a few days, his hair transplant was barely seen. He has rapid growth of the hair, an unusual rapid course. At Christmas, his daughter who knew her balding father, picked up the new hair on first meeting after a year of not seeing him. She said, dad, take off that silly wig. He told her that it was not a wig. Then she reached up to his hair and tried to pull off the wig. Of course, it did not come off because it was his own naturally growing hair. “Come-on Dad” she said, Yoy never had hair before. Where did it come from? He remained silent and then she said, Is that Rogaine that you used? He smile and acknowledged her comment. As a nurse, she followed, “that is the most amazing result of Rogaine I ever saw”. There was little else to say.

Even FUE procedure where you shave your head can be easily hidden in a few days

According to the Wall Street Journal (9/15/14) There was a 39% increase risk of developing aggressive prostate cancer when compared to non-balding men. This was the result of a questionnaire given to 39,000 men and fom this reason, the patients actually determined their balding pattern and their perception of the aggressiveness of the cancers. The conclusions expressed here should be evaluated with a more scientific clinical study; however because prostate cancer in the #1 leading cause of cancer in men, it may be worth taking note of this possible association. It seemed that the greatest risk may be with those men with frontal balding (what we call a Norwood Class 3V pattern) however, since this was done by self diagnosis, one can not be sure about the association. The American Cancer Society estimates that a man’s lifetime risk of developing prostate cancer is 15.3% and it carries a death risk of 2.7%. The article was written by Peter Loftus.

We reported a similar finding here
In another post on baldingblog, we wrote about a somewhat controversial article which contradicts the Wall Street Journal article is here

We have seen well documented associations between crown (vertex) balding and heart disease which we reported here

What is clear between the two subject article is that nothing is clear.

This is an Asian patient who wanted to enhance her eyebrows.
She was worried about how it may look after the surgery, especially going back to work!
She didn’t see many before after photos on-line of how it looked IMMEDIATELY AFTER SURGERY so she gave us permission to use her photos.
Hopefully it can help those considering an eyebrow hair transplant surgery.
We’ll keep you posted as the eyebrows start to grow out in the next coming months..