Category: Hair Transplantation

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Is This Necrosis After My Hair Transplant? – Hair Loss Information – Balding Blog

Dear Dr. Rassman
I’m a 54 years old male. I had a hair transplant operation on 30 June 2013 by FUT method followed by FIT method on 1st July to complete the transplantation. From the second day after operation I noticed that a big area in recipient part between crown and front of my head, the skin is so irritated (fig.1) and after 1 week it became completely black and was necrosed (fig.2).

Photos: Figure 1, Figure 2

I rang to my surgeon to consult on this issue. He said at your age this problem sometimes happens and I should wait until the skin being repaired and to speed up this procedure I should put warm towel on the necrosis area as well as making it oily by Vaseline to avoid dryness. I really don’t believe in the opinion of my doctor to relate this problem to my age, so I would highly appreciate if you let me know your opinion regarding the reason of this problem, is there any special treatment for such necrosis?

As the recovery procedure of the skin is so slow as shown in figs 3 and 4, I’m not sure that the transplanted follicles are not damaged. I thank you so much if receiving your valuable comments.

Photos: Figure 3, Figure 4

Sincerely yours

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I am not clear on your history as you note a FUT (as in strip surgery) and FIT (as in Follicular Isolation Technique). There are some doctors who combined FUT and FUE (called FIT by one particular surgeon).

In my 23 years in this industry, we have performed hair restoration surgery in over 15,000 patients (with as many as 8 doctors working for the New Hair Institute at one time), so my experience is in the thousands of patients we have treated at NHI. Although I have never personally seen this complication in any patient that I have treated, I have been aware of this complication in patients who have either consulted with me or I have heard about it through other doctors’ reports at medical meetings. This problem was more common in the 1993-1996 time frame, as doctors were increasing the number of grafts they were performing and not reducing the size of the punch or slit equipment. These doctors devascularized the scalp because their wound areas were too large. Based upon this, I have assumed that the blood supply was negatively impacted for this problem.

The central area of the scalp (where your problem is demonstrated) was the place where this complication has been seen. The least vascular area of the head is probably at that exact location. As you may know, balding produces an atrophic skin that is thin and not vascular with little infrastructure (fat) under the skin (where a normal scalp would be rich in blood supply, with many nerves per follicle, many hair follicles, considerable amounts of fat, etc..). The reason that the skin becomes atrophic in balding men is because the bald scalp does not need a rich blood supply, so the body withdraws the blood vessels in response to lack of demand. When a hair transplant is done, the demand of the new hair increases the blood supply and eventually the scalp is no longer atrophic and becomes rich in blood supply again.

I am certain that age is not an issue. My oldest patients have been in their 80’s and we routinely operate on men in their 60s and 70s. I have done surgery on diabetics and in these people, I have not seen vascular problems either, but I often do not ‘dense pack’ these diabetic people for fear of such a complication. I personally had a hair transplant last year (at the age of 70) with no issue. I had an atrophic scalp resulting from 3 scalp reductions done in 1991-1992 that left my skin very, very thin and atrophic, yet I suffered no vascular effects from the transplant into my atrophic skin.


Some doctors believe that there is a risk for people who smoke, so if you are an active smoker, then this could be a contributing factor. If your surgeon used instruments that were larger than 18 gauge needles, then this could be a contributing factor. I have also seen necrosis when the doctor accidentally switched the routine medications used for anesthesia from a benign medication to a toxic medication; however, yours does not appear drug induced, because the necrosis would have been more immediate than your earlier pictures showed.

My educated guess is that there was a blood supply issue to the top of the scalp where blood supply is reduced in atrophic skin (something that you probably had). How that happened is unclear.

The treatment for this type of problem could be a problem. Usually, small areas of necrosis shed the dead skin and the wounds heal from the sides; however, large areas of necrosis puts you at risk for damage to the skull, so an experienced surgeon who knows of such risks should be consulted.

Please note that what I have stated here is NOT to be taken as a second medical opinion, but just an informational view from a well informed and experienced hair restoration surgeon. To evolve this into a formal second opinion, I would have to personally see you and examine you. If you would like a second medical opinion, please find and see a physician in person.

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In the News – Beard Transplants Are Becoming More Popular – Hair Loss Information – Balding Blog

Snippet from the article:

The number of men opting for a ‘beard transplant’ has rocketed in the past year, according to experts.

Pogonophobia (the fear of beards) may be rife at the BBC, but statistics revealed today show that more and more men in the UK want a beard, just like Jeremy Paxman.

Having pioneered the world’s first facial hair transplant in 1996, Dr Bessam Farjo, founder of The Farjo Hair Institute, has seen a six-fold year on year increase in the amount of men having surgery to boost their facial follicles over the last five years.

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Read the rest — Beard implants growing on us!

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Hair Loss InformationIf I Take Propecia After a Transplant, How Will I Know If My Hair Growth is From the Drug or the Surgery? – Hair Loss Information – Balding Blog

I just had my hair transplant. Going on Propecia in case of any shock loss. My question is how am I gonna know how much of my hair transplant is coming in thicker vs any hair I gain from taking Propecia both a year from now?? Thank you in advance

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Propecia is great to take to prevent shock loss, but it doesn’t necessarily guarantee regrowth of the hair you had previously. I would expect it to hold the remaining hair and protect from shock loss, though. The transplant growth will start coming in at 4-5 months and maximize after 8-12 months. That is the way you should see the difference from the impact of the transplant. Going on the drug before the transplant is what I recommend in most young men as a prevention for shock hair loss, and the additive effect of the drug with the transplant can only help if it brings back any hair.

If you do have regrowth from Propecia and your hair transplant grew in at the same time, I’m not sure how you would really know which hairs was which unless you had a visual examination of the hairs to see if they grew from a transplant site or not.

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Patient Results Follow-Up – Crown Restoration with 1870 Grafts (with Photos) – Hair Loss Information – Balding Blog

This is a follow-up of a patient we posted about a couple years ago. He recently came in for a visit and we took some updated photos of his crown now that more time has passed since his hair transplant.

He had a 3.5″ by 3.5″ very thin area in the crown, which was transplanted over 3 years ago with 1870 grafts. I measured his hair bulk as well and it showed that the transplanted area reflected 50% of the donor hair bulk. The results speak for themselves and I personally identified with him, as that was my status before my ~2400 grafts in my crown.

Click the photos below to enlarge.

After (1 procedure of 1870 grafts) on left // Before on right:

 

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Reader is Angry About Hair Loss Treatments – Hair Loss Information – Balding Blog

Please don’t call hair loss treatable. Why? Because it isn’t. For the vast majority of people, who don’t even bother seeking solutions because what’s available is so downright pathetic, it is a permanent scar.

Anyone with serious hair loss knows this, that other than some supposed miracle stem cell therapy in twenty years, there is nothing you or any doctor can do to truly repair the damage (I don’t mean moving three hairs from end of the scalp to the next.) Make a Norwood 7 a Norwood 1, and you can call it treatable, until then please be honest about the prospects. Aderans spent how much money and time trying to fix it and look where they are now? The prospects are dismal.

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You are obviously angry and my answer is not to assuage your anger. Hair loss is treatable. What you’re looking for is a cure, which doesn’t exist. Treatment options are available, though.

Your experience may not be uncommon, but that reflects poor research, not poor treatment. I am assuming that you are specifically referring to hair transplants. Go to our Full Face patient gallery and you’ll see examples of men that had their hair loss treated successfully with transplants. If you come to one of our Open House events (which are held every month), you can meet many of these patients in person.

Take a look at Patient ZU below and you will see a Norwood class 7 patient that turned into a person with a mature hairline from transplants with almost 10,000 grafts. Are you suggesting this man’s hair loss wasn’t treated?

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Hair Loss InformationWhen Are Transplanted Hairs Safe? – Hair Loss Information – Balding Blog

Hello doctor,

I had a hair transplant and I’m at month 3, I’m a little paranoid thinking about the weeks when I saw hairs falling out with the bulb on the hair shaft when I scratched my head..

That was around week 3, my question is, how long does it take until the hairs root?

Thank you this blog has been most helpful

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At 7-14 days, most hair transplants will not be affected by whatever you do. If all of the scabbing is gone, you are generally safe. If you tried to pluck one or even a few out after the scabs are gone, I doubt that it will impact the graft at the root, regardless of what you see.

So at week 3 or month 3, you’re fine.

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Can I Use Body Hair to Transplant Into My Temple Peaks? – Hair Loss Information – Balding Blog

Would using body hair be ideal to construct the temple peaks ? I had a hair transplant done, and my donor hair count was very low. So the doctor built a hair line which was 8 cm long. I want to go for a second session, and in that session I want do something about my broad forehead. The length needs to decrease both horizontally and vertically. Do you think it okay to use body hair only for the temple peaks. I understand the growth of the body hair differs, but it is ideal to use to decrease the horizontal length of my forehead ? I am also looking to decrease the hair line by a centimeter vertically.

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Scalp hair is the best source for transplanting to the temple area. It should be noted that the temple area is a very difficult area for hair transplant doctors to get “right”. It is an artistic and technical skill to make temple transplants look natural, as the surgeon must fully understand the direction of the hair that is placed there. Hair transplantation in general is an artistic and technical skill, but the temple area takes even more attention to detail, as I have seen many failed and marginal attempts at creating them.

I personally do not endorse using body hair for restoring the temples, especially since it is such a delicate area to get right. The only rare exception may be if you have very kinky/curly scalp hair and your body hair can match the kinky texture, AND you do not have sufficient scalp hair to accomplish your goals. Straight hair can stand out and will be less forgiving.

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Hair Loss InformationAugust Is National Hair Loss Awareness Month – Hair Loss Information – Balding Blog

This August marks the 13th year for National Hair Loss Awareness Month, which was established by the American Academy of Dermatology (AAD) to raise awareness about this treatable condition that affects an estimated 60 million men and 40 million women in America.

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The above snippet is from a press release I was sent, and I want to elaborate about how this is a treatable condition.

For those of you who look into the mirror every morning and see the signs of hair loss, you should know that there are many options available for you to slow, stop, or reverse hair loss without surgery by using medications such as finasteride (for men) and minoxidil (for men and women). Additionally, there other modalities that can make your hair look thicker without surgery, such as Scalp MicroPigmentation (SMP). Of course, there is also hair transplant surgery, an example of which can be found here.

Granted, many readers of this site are knowledgeable about the treatment options available, but just in case some of you weren’t familiar with them, I hope the above was helpful.

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Can Marijuana Ruin Hair Transplant Growth? – Balding Blog

will smoking marijuana just once affect a hair transplant ? I was wondering if it would ruin the hair growth?

No, not that I know of.




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Balding Forum - Hair Loss Discussion

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Hair Loss InformationHair Transplant Expectations – Hope vs Reality – Hair Loss Information – Balding Blog

Here’s a story about a patient that has had four total hair transplant procedures — procedure #1 and #2 in 1995-1996 with us totaling 3286 hair grafts, procedure #3 with another doctor a couple of years ago of 1000 grafts, and finally procedure #4 (to fix procedure #3). This gentleman continued to lose hair after his first two procedures in the mid-1990s, and although he did not like what was happening to him, he was reluctant to have another procedure.

That is, until he saw an advertisement for hair transplants at $2/graft. At that price, he decided that one more surgery would solve his problem. Unfortunately, this cheap procedure produced a harsh, detectably grafted hairline which made him never really satisfied with the final results. He came back to us to correct this harsh hairline to some degree about a year ago with one of our standard hairline repairs, but he still did not like his look and the larger grafts from procedure #3 still showed.

We are all torn between what we hope to achieve and what we really end up achieving, and progressive hair loss during the treatment phase does not help the problem. This particular patient had unrealistic expectations and that is why he went to another doctor who, based upon promises, sold him a procedure that just made him angry with himself for falling for a sales pitch. As planned, after the repair of the frontal hairline that we performed a year ago, he came in for Scalp MicroPigmentation (SMP) about a month ago and told me that he is now euphoric with the results (today was the last SMP procedure).

“Why didn’t you offer me this 15 years ago,” he asked. I told him that it was not available until three years ago. “Innovation moves at its own pace, driven by problems that need solutions,” I told him. This innovation took time and the right circumstances to find its place in our treatment regimen. He continued to discuss the personal toll that he experienced with his hair loss and his recent dependency on surgery to fix something that he did not like. “It was not pleasant, but now things are different,” he continued. And he can put the entire hair loss experience and the toll it took on his self confidence behind him. It was rewarding to hear this from him, so I decided to share it with our readers.

Many people can not achieve their goals of a perfect end look because they either:

  1. don’t have enough hair to cover the balding area
  2. their balding pattern is advanced and the supply/demand equation for hair does not math out, or
  3. they continue to lose hair without a Master Plan that took into account the progressive nature of the hair loss.

Scalp MicroPigmentation bridges the gap for many people who fall into the above categories. Doctors want to believe that given enough money, every person that they treat can get a full head of hair; however, nothing can be further than the truth.

I continue to write this blog because it is an important part of our practice, educating patients and bringing them to understanding what is happening to them. At the last ISHRS physicians meeting, I was told many times that the doctors in this industry read my blog and that it has become a resource for them when dealing with their patients. That just adds to our (editors) satisfaction in knowing that this blog is a good community service.