I Want a Hair Transplant, But I’m Prone to Forming Keloids – Hair Loss Information by Dr. William Rassman

i’m an 19 year old girl suffering from androgenetic alopecia. i’ve been losing much hair and tried everything(rogain 2%, hormone therapy) but didn’t see any major results. i’m considering of having FUE on my frontal hairline, the problem is, my skin is prone to forming keloids. I know that keloid will probably form on the donor area but is there any possibility at all that keloids will grow on my hairline??

Yes, you are at risk of forming keloids on your recipient area (frontal hairline), but the risk is low. In all of my years, I have never seen a keloid in the recipient area. At a medical meeting some years ago, we polled the audience of about 300 hair transplant doctors to ask them to raise their hands and tell us if anyone ever saw a keloid in the recipient area. No one raised their hands.

You must also consider that androgenic alopecia in a 19 year old female is very rare and make sure that you have the correct diagnosis along with realistic expectation of what you are trying to accomplish and the fullness that you are going to have from a transplant. In other words, you must weigh the risks versus the benefits and you absolutely need a diagnosis by a competent doctor.

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Recommended Age for Hair Transplant – Hair Loss Information by Dr. William Rassman

Hey Doc! I’m 22 With Norwood Class 3 (with some thinning in the crown) and I was wondering at what age do you recommend one does a transplant. I have noticed that most of the patient photos are from people older than 40. I really don’t want to wait that long. Do I have to? Thanks!!

I generally do not like to perform a hair transplant on someone whose pattern is not clearly evident based upon miniaturization studies when I map out the scalp and hair. Men under the age of 25 generally fall into that category, but clearly I have done hair transplants on men under 25 when there is frontal hairline loss or a clear pattern that has advanced such that the medications like Propecia and Rogaine will probably, in my opinion, not work. Everyone deserves a personal assessment. In other words, there’s no set age.

A good one-on-one examination and the building of a Master Plan with each patient is critical. It seems like you are too early for a hair transplant and should get good results in the crown with Propecia. Get your baseline mapped to you know where you are going and do it yearly.

Warning: It is quite unfortunate, but there are many unethical doctors who recommend hair transplants on young men who are easily swayed by the power of their MD and their fear of going bald. Although this is an important warning for men under 25, it also applies to all men considering hair transplantation. Be sure that the recommendations are in your best interests at all times, not in the interest of the doctor’s mortgage or fancy car payment.

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I Haven’t Seen Any Growth After Hair Transplant a Year Ago! – Hair Loss Information by Dr. William Rassman

Greetings from Indiana. I have written to the blog before, but have never had my question posted. I noticed on the site that you have stated before that if no hair is growing after a year after a transplant, that there is something wrong. I don’t have a typical pattern of baldness. My bald spot is at the front top of my head and is “T” shaped. I had a transplant in October of 2006, and I have not seen any growth. Is it possible that I have some sort of underlying medical condition? Did my transplant fail? I can send a photo if you would like. Any
help would be appreciated. Thanks.

Thank you for following BaldingBlog! We try to get to all the questions from hundreds of questions sent to us weekly, but it just doesn’t seem possible. A good number of the questions are the same or similar to those that have been asked before, so we put priority to the questions that have never been answered. You can always search to see if a question has been answered using the search field on the top right corner (opposite the logo) of every page of this site.

I cannot tell you why your hair transplant was not a success. First, I would want to know why you lost your hair. A “T” shaped hair loss is not in the normal genetic patterned hair loss (or your description is not clear enough). There are many diseases that cause hair loss and that can cause a hair transplant to fail — and there are also technical problems in the less experienced teams that perform the surgery. You need to follow up with your doctor to address your concerns and your doctor should be alarmed over the failure. Generally, it take 6 to 12 months for results of a hair transplant surgery to show. It can rarely take up to as long as 18 months.

Yes, by all means send me a photographs to the address on the Contact page (please reference this blog post when sending).

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Is a Hair Transplant Really Permanent? – Hair Loss Information by Dr. William Rassman

Hey doc, hows it going? I was reading some of the posts and was wondering if a hair transplant really is completely permanent? Or will that area bald again and another transplant of hair to the same area will be needed? Thanks.

Permanency of the transplanted hair depends upon the donor hair that is used. Since most men never lose the hair in the back of the head (the typical “donor area”), they will not lose the transplanted hairs that are used for transplanting from this area. However, if that donor hair is diseased (alopecia, for example) and a hair transplant is performed, that hair will still fall out, even in its new home elsewhere on your scalp.

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Shock Loss Producing Loss of Grafts from Previous Hair Transplants? – Hair Loss Information by Dr. William Rassman

Does shock loss occur in the grafts that were put into the head on prior occasions?

I have seen this occur on very infrequent occasions in men (probably less than a dozen cases). In each and every case, the older grafts regrew when the new hair transplants came in. So the good news is that it does grow back in 2-6 months, but the bad news is that the shock loss happens at all (risk is under 0.1% by my best guess).

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Scratching After Hair Transplant – Hair Loss Information by Dr. William Rassman

My question is regarding the itchy sensations and the followup scatching done after receiving transplants.

Will the possible infection to the scratched area cause the grafts to not grow

These types of questions should be addressed before and after surgery with the doctor you obviously trust and respect enough to perform a hair transplant procedure on you. Yes, you can scratch your head gently and the grafts will not get infected unless you do it constantly. The new grafts are sensitive to injury and if you irritate them with scratching, you can develop a folliculitis.

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My Transplant Doctor Suggested Rogaine to Prevent Shock Loss – Hair Loss Information by Dr. William Rassman

Dear Dr Rassman

Consulting a transplant doctor in my area , he suggested that shock loss can be prevented by using rogaine a few weeks before and after the transplant . In previous replies of yours i see that you recomend the use of propecia for shock loss prevention . So i am a bit confused . Propecia , Rogaine or both ?

Propecia is absolutely better for preventing shock loss. Adding minoxidil will not hurt.

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Will Taking Hydroxyzine Harm My Hair Transplant? – Hair Loss Information by Dr. William Rassman

(female) I had a hair transplant in January of this year for thinning from the front of my crown to the back of my crown…1500 grafts. I am now taking hydroxyzine for my anxiety disorder and wanted to make sure it would not harm my hair growth.

Thank you for your time

Hydroxyzine will not harm your hair transplant. Please consult with your hair transplant doctor or your psychiatrist if you have further concerns. You should never start or stop a medication without consulting your doctor. I am not your doctor.

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Scabs Won’t Go Away After Hair Transplant – Hair Loss Information by Dr. William Rassman

What can I do to speed up the process of the scabs falling off after surgery. Salt water? How much?, How often? Anything else I can do?

Scabbing was clearly allowed to build. They should have been kept down with good daily washing. I am assuming that you are more than 2 weeks out of surgery. You can put on shampoo and let it sit for 10 minutes, then wash it off and repeat it a couple of times. You can also add conditioner and leave it on the head for 10 minutes (after wetting it) and then wash it off. Gently rub them with your fingertips (not your fingernails). The scabs should come off.

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Hair Loss InformationThe Value of Experience in Hair Transplant and Prostate Surgery – Hair Loss Information – Balding Blog

Da Vinci RobotMy first cousin just had a diagnosis of prostate cancer. With my help, we explored his options. He is 67 years young and his father lived to 96, and many on both sides of his family lived into their 90s and 100s. This is important, because the decision on which treatment to take for the cancer depends upon your life expectancy. Many men over 70 are pointed to non-surgical treatments, because their life expectancy is in the 10 year range so the value of surgery over radiation (radioactive seeds) or “watchful waiting” is not clearly defined compared to the risks of surgery. You don’t want your surgeon to use actuarial tables alone in deciding whether surgery is right for you.

In my cousin’s case, we selected a radical prostatectomy with a new technique using the da Vinci robot directed surgery. The surgeon does surgery from another room, all through the use of telemetry and robotics. The surgeon most skilled in this technique is Mani Menon, MD, based at the Henry Ford Hospital in Detroit (my cousin flew from Washington DC for the surgery and will fly back out for the post surgery follow-up). Dr. Menon has personally done over 2,000 such surgeries and his complication rate is the lowest in the world. His extensive pioneering research and experience on nerve sparing techniques results in a lower incidence of complications, such as erectile dysfunction (ED), in particular, and incontinence. My cousin could have had the surgery done locally at much less cost with surgeons who had some experience (20 – 200 surgeries) with the robot. There is no substitute for experience. For more information on the da Vinci surgical robot, see DaVinciProstatectomy.com

He just had the prostate surgery yesterday and said it was easy with no pain. He thought that the entire process was first class. Of interest, his older brother had the same surgery with a local doctor just a few weeks before and did not have as smooth a course with the surgery. I don’t know and can not say that this is an apples to apples comparison, but my cousin thinks it is. He is now 24 hours from his surgery and is already walking around and being discharged from the hospital as I write this blog. Had finasteride been around for 20 years and had he taken it, it may have reduced his risk for developing prostate cancer (better than a slick surgery, of course).

What does this have to do with hair transplantation? Unfortunately, hair transplant surgery is fast becoming a commodity as more and more doctors enter the business and drop prices to lure patients into their practices. If you were my cousin, would you accept a discount from a local, less experienced surgeon rather than pay higher fees and endure travel expenses and associated inconveniences? Does it pay to travel to get the surgeons who are the leaders in the field? My cousin thought that some years ago when he traveled cross country to California to have his hair transplant surgeries done at NHI.

Here are some questions you should ask yourself when choosing your hair transplant surgeon:

  1. What are the complications that one can experience from doctors who do not have experienced teams performing this type of surgery?
  2. Do you really know what you are getting and what you are paying for?
  3. Are the graft counts accurate?
  4. Do the doctors maintain a high standard on quality control while performing these surgeries?
  5. How many surgeons have you met with that show the results of the ‘local’ doctor’s surgery? It is better than seeing some of their “failures” walking around the city.
  6. Do you have the discipline that my cousin had to ensure that the surgeon that you select will do the best job the first time around? Unlike prostate surgery you never see the patient’s incontinence or impotence, but on a poorly done hair transplant, you have to face it in the mirror every day and if it is bad enough, so will everyone else (and few will tell you what they see).

Case in point, I just met with a patient who had a terrible hair transplant. I asked him about the doctor who did it and he told me that the plastic surgeon who did the procedure was a relative of his and was willing to do the transplant at no cost to him. He thought he got the deal of a lifetime. This is a family connection that is now in trouble. Some plastic surgeons who do not have substantial training in hair transplantation and do not have an experienced team working with them, will fail at getting the results that are possible. There are no real bargains out there, and often, the old saying ‘that you get what you pay for’ is hard to learn.