Hair Transplantation – Page 103

October 16, 2008

Chronic Pain in the Donor Area Since Hair Transplant 4 Years Ago – Hair Loss Information by Dr. William Rassman

My son had a hair transplant surgery in 2004. Since then he is suffering from chronic pain especially at the donor area, constant pulling, throbbing and tightness. Is there anything that can be done to relieve his misery? Thanks.

Pain for so long in the donor area can be a rare complication of a hair transplant surgery. It may also be that there is a small area where nerves have grown in a bundle and are irritating the area. Sometimes, larger nerves are cut and this can cause problems. If he gently taps the scar area and it induces a shock like pain, then the problem may reflect cut nerves.

This can be a complicated problem or a simple one, but this is not something I will treat over the Internet. With a case like this, you should have your son follow up with the hair transplant surgeon who did the procedure so that the area can be examined.

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October 15, 2008

Looking Younger After Hair Transplants (with Photos) – Balding Blog

My mother told me that she does not know what I have been doing but I looked younger and more vibrant than in years. Considering that I am about to turn 50, that comment made me take a real close look at myself when she said that and I realized today when you showed me my before pictures, how much I have changed. I remember always looking in the mirror to see what I could do to improve my look. but no more. Not only has my career done well, but I never think twice about my hair, that is until I see you.

The above is an email I received from a patient after he came in for a follow-up last week. He’s given me permission to share his results, which are after a total of 4184 grafts over two sessions. His before photos present a Norwood Class 5 pattern, and his medium fine, wavy hair helps with the after results.

Click the photos below to enlarge.

Before:

After 4184 grafts:

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October 14, 2008

Hair Loss InformationIf I Had Minimal Yield from FUE Procedures, Do I Have Alopecia Areata? – Hair Loss Information – Balding Blog

In the post linked — Hair Cloning and Hair Transplant Failures — you discuss “transplant failure”. Does this mean total failure or just poor yield? I am a male, late twenties that has been mapped for miniaturization and found to have Diffuse Patterned Alopecia.

Would minimal yield from two (2) FUE surgeries suggest to you that the patient is in fact actually suffering from diffuse alopecia areata? Or do you believe FUE is unpredictable? I realize you cannot make a personal diagnosis over the Internet, but I would like your initial thoughts to point me in the right direction because I am running out of donor hair and patience with two failed doctors.

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You’re right in that I cannot make a personal diagnosis over the Internet. You report Diffuse Patterned Alopecia which does not define what you have. I am assuming that you do not have the diffuse form of alopecia areata which is an autoimmune disease (very rare in young men) and if you had it, it would certainly kill off hair transplants if they were done. To make a diagnosis of alopecia areata, you would need several skin biopsies and an expert dermatopathologist to read the tissue when it was prepared. Have you gone through this? If not, this might be your next step before jumping to the conclusion that you had FUE failure for technical reasons.

I would love to see your results with a good photo or two, a set of slides from biopsies of your skin and then I can give you an opinion. What I meant in that post you referenced is a total or partial failure. Failures with FUE are often partial failures, where so many of the grafts were transected (having many amputated hairs) that the yield will be less than what has been transplanted.

In regard to follicular unit extraction (FUE), in my opinion, it is a procedure that is quite variable in the hands of doctors with different skill sets. Most of the failures with FUE, are probably related to the skill of the surgeon. I couldn’t tell you if you’re experiencing alopecia areata just based on the failure of FUE by your doctor. I recently wrote a new FUE guide that I hope you’ll read — Introduction to Follicular Unit Extraction Techniques.

October 14, 2008

How Do I Know I Got All the Grafts I Was Charged For? – Balding Blog

Dear Dr. Rassman,

Excellent blog. It’s great to be able to find straight forward information on hair loss which isn’t over hyped (like much hair info on the web) and isn’t afraid to point out pitfalls.

I’ve consulted with a Clinic who offer a technique which appears to be an advancement of FUE . They suggested I need one session and have 2,000 follicles transplanted on the day.

From looking at the photo of me today, aged 31, does it look like I need 2,000 transplanted? (I know a photo isn’t sufficient for you to diagnose and you could easily guess 15% too high or too low from looking at it) Also, how am I to know that I wasn’t charged for 2,000 while 1,500 are transplanted?

As I’ve found your blog useful I’m sure others have too and I’m more than happy for you to publish the photos attached.

Thanks in advance

Firstly, thanks for sending and allowing me to publish your photos. Even if I know the clinic you mention, it would be unprofessional of me to give a comment. The graft recommendation of 2000 grafts appears reasonable based upon the photos you sent and projecting the building of a mature hair line which is lower than the high exposed forelock the photo shows. Viewing the hairline proposed by the doctor would give me a better way to determine the appropriateness of the estimate.

In the end, it is still a “buyer beware” market. You really need to do your research, meet with the doctor, and meet with patients from the clinic to judge the results — don’t just settle for seeing photos of results. Most important, you need to be comfortable with your ultimate decision to trust the doctor performing your surgery. Yes… its a hard process. Speaking with patients who have had the work done there before you came on the scene, will tell you much about the doctor. Speaking with the patient that has had the work done by that clinic should get you the inside scoop. I remember a clinic that offered potential clients a list of over 1,000 satisfied customers, but when I personally called the first 20 on the list, 100% of them told me of horror stories about their experiences with that clinic. The trust issue sometime is relatively easy to flush out from former patients.

If you trust the doctor, you shouldn’t have to worry if you indeed got the grafts you were promised. And yes, there are clinics that can deceive you on the number of grafts you received. We developed count sheets and for FUE we even recorded the amount of damage to the hairs in the follicular units, but damage from the FUE technique is now virtually eliminated with our new breakthrough (but we still keep a written track record of what we do every time, even with FUE². Ask the clinic you ultimately decide to have surgery with, to show you their count sheet paperwork, not only for your own surgery (as this is something you should have in your possession when you leave the surgery), but also in other patients (with the name blanked out so you can verify they actually even make count sheets and record their damaged grafts). If the clinic will not give it to you, or they do not exist, then I would probe the situation more.

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October 9, 2008

FUE with Longer Hair – Hair Loss Information by Dr. William Rassman

I am very interested in getting a HT using the latest FUE2 technique. I have a few questions regarding the technique. I know that performing FUE with longer hair takes more time than standard FUE. If I choose not to shave my hair, I wonder if the fee is higher and how many grafts can be transplanted in one session.

Thank you very much for your response.

The price per graft does not depend upon the amount of hair you allow me to shave. If you look at the photos below, you will see that there is a limited amount of hair that I can take. We might be able to get 500-700 grafts without heavily clipping the hair in the head if your densities are good. Much higher numbers of grafts can be extracted with more hair clipping.

Left: FUE grafts extracted; Right: Hair combed down to completely cover donor area

The fee for follicular unit extraction (FUE) is $8/graft for surgeries done by Dr. Pak in our Los Angeles office — and this is a special rate valid until November 30, 2008. This uses our new FUE² technique.

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October 8, 2008

Any Completely Scarless Transplant Techniques? – Balding Blog

Are there any hair transplant techniques available that allows you to completely shave your head? Or do all of them leave a visible scar of some kind? If they do, how closely cropped does the hair have to be to hide the scar?

The closest thing available is minimal punctate scars that are produced with follicular unit extraction (FUE). The smaller the punch, the less obvious is the scar, but the missing hair follicles become evident if the density is low. In individuals with high density, the use of a 0.7mm – 0.8mm punch will produce an almost scarless appearance, but if you shave your head, you might see it. The hair should be about 1/8th inch long to hide most FUE scars made with small punches.

October 8, 2008

I Have Less Hair Now After My Hair Transplant a Year Ago – Hair Loss Information by Dr. William Rassman

I had about 2,500 grafts transplanted approximately one year ago. The grafts grew in pretty well for about 7 or 8 months, then I exerienced some shedding. I know have less of the transplanted hair that I did 3 months ago. Funny thing is that it seems I also lost some of the hair from a prior transplant years ago. This is dissapointing and depressing. I believed that hair that had begun to grow would not fall out again, and I do not have an auto-immune disease. Any ideas? (I’ll try and get a follow-up with my surgeon. Thanks

If you had any original hair still left in the transplanted area, you could lose that hair and cause your problem. If all of the hair that is thinning is transplanted hair only, that is rare. We call the donor area hair “permanent hair,” but is it really permanent? In a very small percentage of the population, the donor hair can thin permanently. If that happened in your transplanted hair, the same would be apparent in the donor area, as both have the same source. I always measure the density of the donor area prior to a transplant so if this happened, I would have a measurement to compare to.

In a very small percentage of patients, hair that has been transplanted can be lost… and if that happens it will usually return. I do not understand the cause of this when it does occur, but I have seen it a few times and most of the time the hair came back. Please do have a follow-up with your surgeon and express your concerns.

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October 8, 2008

Political Talk — John McCain Could Use a Hair Transplant – Hair Loss Information by Dr. William Rassman

Hair transplants have come up a couple of times in the current US Presidential election. First, Senator Joe Biden’s plugs and subsequent repairs were the hot topic of political Internet gossip for a few days back in late August (Joe Biden’s Hair Transplant). Then, last night’s presidential debate had Senator John McCain, in a contorted logic, making reference to needing a hair transplant. Should we assume that this might be billed to Medicare healthcare reimbursements?

See the video, courtesy of Politico:

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October 7, 2008

Throat Swelling with Propecia Use – Hair Loss Information by Dr. William Rassman

Thank you for posting such useful information on this site. I want to ask some basic questions regarding post-op care that I haven’t seen posted (or maybe I’m not searching correctly either).

I recently had a 2500+ graft procedure just in case that matters for some of the questions posted:

1. Approximately how long after surgery should a patient expect to see bumps on their head? I am roughly 5-6 weeks out of my transplant, and I still see some pimple-like bumps on my scalp (sometimes even a random scab here or there that easily comes off after showering & soaking). I’m just curious to know how long it might take to see everything go away and return to normal.

2. There are still some areas from the incision that seem to be little tender, which I mostly notice when I apply shampoo in the shower. Is it normal to experience some form of (mild) tenderness around 6 weeks out of surgery? I believe you’ve posted before that around the first month, the incision is about 70-80% healed.

3. Have you ever heard of anyone experiencing slight swelling in the throat after starting Propecia? I started taking Propecia after my procedure, and noticed some minor swelling in my throat, but now it seems to have gone away. I also noticed I was more tired than normal, but that was probably due to causes unrelated to using Propecia or having the surgery (although I followed roughly the same sleeping pattern as I did pre-surgery). In either case, I was curious to know if you had heard of these types of effects from using Propecia.

Many thanks!

While it is a pleasure to educate on issues of balding and hair transplants, I don’t understand why a recent hair transplant patient will have such basic questions to ask when they have their own surgeon. Was this not explained in your post operative instructions? Is the doctor not available? Here is a link to some of the basic questions after a hair transplant procedure from my NHI website: Post-Op Course in Follicular Unit Transplantation

To answer your questions more specifically, some redness or bumps may be common or it may indicate an early infection or folliculitis. I would follow up with your doctor if this is of concern. Scabbing should be gone after 5-6 days unless you have not been washing your scalp well. Some areas on the donor site can be tender, but in the recipient area it can also suggest early infection, though I do not have any way to tell.

I have not heard of swelling in the throat after taking Propecia. Swelling in the throat after taking any medication is a very serious and possible life threatening side effect suggestive of a potentially dangerous allergy. You could have a possible allergy to an inactive ingredient in the Propecia, but I am just guessing. I would follow up with your doctor and stop taking any medication that causes swelling in the throat.

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October 3, 2008

Hair Loss InformationFollicular Unit Extraction (FUE) Patient Guide – Hair Loss Information – Balding Blog

Dr. William Rassman I wanted to call your attention to yesterday’s announcement relating to follicular unit extraction (FUE). As the ‘inventors’ of the procedure, publishing the first authoritative article in the Journal of Dermatologic Surgery in 2002, I have taken a keen interest in the way this procedure is delivered throughout the world. Much of what I have been observing has been disturbing. Too many doctors with little experience, and skills that have not been refined, have entered the field with heavy marketing programs offering FUE. My experience, however, has shown that some patients are not good candidates for this procedure and damage to the harvested grafts can be substantial in most surgeon’s hands. The key here is graft yield and unfortunately, this is an assessment made either after the procedure is performed with careful surgical monitoring and record keeping (by recording hair damage within each graft), or 8 months after the procedure when the patient can judge the success or failure of the results on his or her head.

I realize there is a delicate balance between what we want and what we buy. Our progress in reinventing the FUE process is discussed here — new FUE breakthrough. I really hope everyone considering having an FUE surgery (or anyone just curious about how it works) will read our new guide to evaluating Follicular Unit Extraction Techniques.

So what prompted me to write a new FUE guide? A while ago, I had the opportunity to view a well known doctor extract approximately 20 FUE grafts under my direct observation. While he boasted that he had mastered the procedure, what I saw reflected far less than such mastery and the doctor obtained a significant transection/amputation rate of the hairs in the graft. That doctor is prominently offering FUE today.

The surgeon’s technical skills take years to acquire and perfect, and although there are now some very fine doctors who I believe have truly mastered the technique and can deliver a quality service, I believe that they are in the minority of those offering it. There is a substantial worldwide demand for this minimally invasive hair transplant (virtually painless during the post-operative period, the patient can return to full activities in a week including all types of exercises, and there is no linear scarring). The problem for the patient, however, is in selecting a doctor where the FUE technique does not produce a “follicular holocaust” causing a substantial loss of donor hair and a failure of the procedure. This insight seems to be hidden from most buyers, because prospective patients want to believe in the marketing hype that is prevalent on the Internet and they are sold the technique by professional marketing pitches. There is no way to determine in advance, the skills of the doctors offering to perform the surgery.

In our new FUE guide, we have defined a way for patients to examine the various doctors offering this procedure, giving them an idea of what questions to ask and what things to look for. There is no site to offer guidance in the doctor selection process so the consumer must arm himself with the knowledge and skills to make the proper judgments themselves. Hopefully, our writings will appropriately arm the readers interested in this technique.

Article link: Patient’s Guide to Follicular Unit Extraction