Hair Transplantation – Page 109

July 30, 2008

Hair Loss InformationOver a Week After Surgery, My Donor Area Is Still Sore – Hair Loss Information – Balding Blog

Hi Dr Rassman
I had a procedure done, it’s now day 8 post surgery, and I get my staples out in 2 days. The donor area is still a little sore but not to bad. It’s mainly when I put pressure or sleep on back of my head, and some of the scabs are coming off now. I would like to get some exercise and go surfing.

Should I wait a little longer? Is it normal to feel a little sore in the donor area 8-10 days later? Is surfing 11 days post-op too strenuous, or could the ocean water cause infection? Of course I would take it easy and certainly wash my hair right after.

Thank you Dr. Rassman for your blog and reply

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Since you have staples, I’ll make a wild assumption that you had the strip method surgery, in which case the wound should not be soaked for easily 3-4 weeks after a surgery. If you had a surgery using the follicular unit extraction (FUE) technique, then you could probably go surfing. The wounds are not strong at 10 days, but at about 3-4 weeks, around 70% of the final healing strength will be present. I’d keep waiting.

July 30, 2008

Clarify About Folliculitis Decalvans and Hair Transplantation – Hair Loss Information by Dr. William Rassman

In your post here you say: “This is your worst case scenario. I have had 3 such cases over my years in practice.”

Can you clarify what you mean here? Are you recommending not getting cosmetic surgery if the disease is under control? Or, are you just saying that as a general warning of what could happen if one did get cosmetic surgery? Have you only had 3 cases of this disease to treat with a hair transplant?

My areas are I guess you could say small, but they feel like they are the size of a baseball on my head. Right now, only one area is really noticeable. How long should one wait, to consider the disease under control to have any type of cosmetic surgery? I have not had any activity in a few months now. Three doctors have recommended that because my areas are “small” a doctor may be able to just remove the scared area and fuse my scalp together. Is this a viable option?

If the areas are smaller, what are the typical prices for hair transplant?

The medical field is not clear about the cause of folliculitis decalvans. It is thought to be an autoimmune disease that presents like an infection of the hair follicles, but it does not respond to traditional treatment. The disease can be aggressive and destroy many hair follicles and badly scar the scalp. Hair transplants into this area may likely fail and may reactivate the disease (bad news when this happens). I always want to know if the benefits will significantly outweigh the risks.

The decision to have another surgery within less than a year from a previous episode may not be a good decision, but you and your doctor are in the best place to make that determination. I haven’t treated you, and I couldn’t make any recommendation without examining you at the very least. Our fees are listed here.

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July 29, 2008

Hair Loss InformationWhat’s This Fatty Hair Falling Out 5 Days After Hair Transplant? – Hair Loss Information – Balding Blog

Hi Doctor,

I had a HT 5 days back and have been shampooing twice a day since day one of the HT. This was advised by the doc anyway. I’m concern that I am having white stuff which look like the graft falling off. It has fatty end on one side and small black point on the other side. Am I losing the graft or just panicking. Thanks

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By your description it may be that you are losing some grafts. I would ask to see the doctor who performed your surgery and have that doctor address your concerns. Some people might lose a graft or two, but this has been unusual in our practice because we are obsessive about proper instructions for the patient.

July 29, 2008

Hair Loss InformationCan Skin and Fat Transplants Cure Hair Loss? – Hair Loss Information – Balding Blog

I think that the hair loss is not a problem of degenerating of the hair or a genetic predisposition of the hair to fall, but it can be a degeneration of the skin where the bald area apears. May be a transplant of the hyperderm from other part of the body to the bald area may help the regeretion of the skin and the hair . Or the injection of the fat from other part of the body taken by liposuction to the hyperdermis of bald area may have an efect.

Best regards

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The skin has nothing to do with hair loss, unless it is diseased. Transplanting skin would be human experimentation with no back-up clinical trials and skin transplants might very well kill the hair. Fat transplants also will do little to help grow hair.

July 28, 2008

How Deep Do You Make the Holes When Placing Hairs? – Hair Loss Information – Balding Blog

Thanks for the great site and the time you put into it. I have a couple questions. First of all, I watched the episode of John and Kate plus Eight and thought it was very informative.

I would like to ask that when you make the sites for the grafts, how deep do you go into the scalp? Second question, I receive finasteride from a doctor here in Canada. The pills are a capsule not a tablet. Do you have any knowledge of finasteride being sold in capsules? I’m just curious if i’m getting the real thing.

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I do not know about the capsule form of finasteride. There are many phony drugs on the market. Only Propecia, which has a distinct look (see photo at right), is guaranteed to contain 1mg of finasteride, because the drug company Merck controls the patent on it and no one else can legally manufacture and sell it in North America. The only way is to send it off to a laboratory for analysis.

With respect to how deep I make the incision (or holes) — they are about 5mm-6mm deep, which is about the length of the hair follicle. Some people (like Asians) have longer follicles than Caucasians. One of the most important jobs of the surgeon is to make sure that the incisions are uniform and deep enough to take the full follicular unit, as well as control the direction and the angle of the incisions. The hairs will grow in the direction that the incision was made. Sometimes when doctors do not make the correct angle, your hair may grow out in an improper direction making it difficult to manage and may be unnatural looking.

July 25, 2008

How Understanding Are Hair Transplant Doctors to Patients with Pre-Procedure Anxiety? – Hair Loss Information – Balding Blog

Hi, I had two HT’s done previously by FUE. I am one of these people that gets the ‘white coat syndrome’ just going to the doctors so going for a HT twice was very hard. I am a fit and healthy 38 with a good BMI and when they took my blood pressure i could feel myself get anxious both times which caused adrenalin to raise the heart rate and give a slightly higher B.P reading but once I got in the chair and had a valium I was relaxed and felt good and it was better than the dentist. the surgery went well and I had no bleeding. I will be needing another small procedure in the next 12-18 months with a different doctor and the worst part for me is the pre-procedure nerves that only last from the time I enter the clinic to getting in the chair. Have you seen this before in your patients ? and are HT doctors generally understanding of the healthy people like myself who have low risk of complications whos blood pressure is raised only before a procedure because of temporary anxiety and excitement, not a medical condition that requires treatment? I would appreciate your opinion on this. The actual surgery is the easy part for me. thanks for your time.

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Any doctor who is worth anything at all, must be compassionate and caring. I would stay away from doctors who are not that way. Most of my patients are anxious when they come in for the hair transplant and many will have elevated blood pressure when there is no history of high blood pressure. The rise in blood pressure is the result of anxiety and calming words and some good jokes go a long way to calm my patients down. Good drugs also work to accomplish the same effect.

July 24, 2008

I Overplucked My Eyebrows and Had Them Tattooed Back On, But Want a More Natural Look – Hair Loss Information – Balding Blog

I overplucked, then had to have them tattooed because they wouldn’t grow back. With the tattoing, of course, they didn’t regrow either. It’s been years and I would like a natural looking eyebrow, one that doesn’t fade and frames my face. What would you recommend?

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Hair transplants into the eyebrows is the answer and it works wonderfully. Here’s an example of a female patient that had eyebrow restoration — Patient BG. For more info about eyebrow transplants, here’s an article from a few months back that I was quoted in — Women who pluck too much turn to eyebrow transplants.

July 24, 2008

Taking Propecia a Few Weeks Before Surgery to Prevent Shock Loss – Hair Loss Information – Balding Blog

I have FUT surgery scheduled in late late July. I started taking propecia early July..so would have started about 3 weeks before surgery. Is this long enough before to help reduce chances of shock loss?

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The longer the better, but 3-4 weeks should cover you. Stay on the medications until all of the results are achieved and then consider staying on the drug for life. Talk with your doctor about this.

July 22, 2008

Does Dr Rassman Have MPB? – Hair Loss Information – Balding Blog

Dr. Rassman

If you were to judge from your own picture (the one shown on the website), would you say you have genetic hairloss? If so, to what degree?

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I had a bald crown measuring about 3 inches round. This is classified as a pure vertex balding pattern. I originally made a mistake and had scalp reductions in the early 90s, which left me scarred. Since that time, I have had hair transplants and the scars and balding spot is largely gone. My hairline is natural.

July 17, 2008

Using Couvre to Mask Linear Hair Transplant Scar (with Photos) – Balding Blog

Hello Dr,

First of all,,,a Fantastic/helpful blog. I am 50 years old. I visited 10 different hair transplant surgeons and decided to go with a doctor in Northern California. I think you hit the nail on the head, when you say ‘you have to feel RIGHT about the surgeon’. I did an FUT for 3000 grafts about 1 month ago, and everything has gone great. We just have to wait and see now as to what will be the outcome.

I wanted to contribute ’something’ to your blog,,,so I decided to send photos of my scar before and after application of a masking black lotion (COUVRE). It takes 1-2 minute, it will not come off with water and it is practically invisible from about 12″ away. The photos were taken by my wife. I keep my hair at 1/4″ length (I know I can go to #2 clippers and still mask it good). I send these photos for folks whom are worried about having the surgery and wanting to keep their hair short.

Now to my questions. I am on Propecia (4 months now) and Rogaine. I also have the laser comb, but I am hesitant to use it, fearing it might damage the ‘babe grafts’. What do you recommend to your patients regarding this scenario. I truly believe the comb works, not as much as the hype, but it DOES work (for me anyway). The question is, can it hurt the newly transplanted/asleep grafts

My second question is related to a comment my surgeon made prior to surgery. I asked, what percentage of the grafts are normally expected to survive. The reply was 113-120%!!!! It was explained by my surgeon that they do not believe in ‘dense packing’ of grafts in a CM2 and by inserting no more than 40 grafts (or was it 40 hairs?!), it insures the growth of all grafts + some regeneration of already dormant follicles!!! I found that pretty interesting, what is your opinion on this?!

Thanks again for all your great help on the blog, keep up the great work

Masking/concealing agents like Couvre can work “miracles”, as your photos demonstrate. There are two surgical solutions that also work well:

Follicular unit extraction (FUE) into the wound will put hair into the scar, or
A trichophytic closure could wipe out much of the wound if the laxity is good enough

The telogen count is about 10% of hairs, but as these telogen hairs grow back, others fall out so I would not expect more than 100%. I have read such studies and they are clearly flawed in their methodology. You can’t believe everything you hear or read. Nonetheless, thank you for contributing your photos and allowing me to publish them! The results after the Couvre look great. The photos are below; click to enlarge.