Category: Hair Transplantation

doctor my question to u is regarding direction.while transplanting grafts into the balding areas of the scalp how do u determine the direction in which it will grow, the depth or angle? the hair is trimmed so short before a surgery is there a sureshot way to determine the direction of hair will grow after a transplant??

The direction the hair will grow in is determined by the surgeon as he/she puts in the recipient sites. The direction and angle of the instrument in making the ‘hole’ is the direction that the hair will grow in. Almost 100% of the hairs between the parts point forward. At the part, the hair changes angle and the surgeon’s skills here are most important. I have seen far too many patients have a ‘radial’ direction to the hair where the hair is directed more like the spokes of a bicycle wheel. For those patients with straight hair, any faulty placement of the hair direction will be magnified.

Take a look at an article I co-authored back in 2002, The Art of Repair in Surgical Hair Restoration. In the images shown in this article, you can see some of the wrong directions and how to do the work correctly. Particularly, take a look at figure 3 from the article which shows the wrong direction (below for convenience) and the right direction in a schematic form:

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I had hair transplants a month ago. My hair looks like it is caked with crud. When can I wash my hair?

A month following the surgery you may wash your hair as you normally would. You should have started to wash it after the surgery, but the ‘crud’ you are talking about reflects scabs from the surgery and skin that normally sheds. To wash it clean, apply shampoo and leave it on for 5-10 minutes, then gently with your fingers, rub off the built up ‘crud’. Repeat it until it is clean and then all you must do is wait for the new hair to grow in.

Haemorrhage, vascular and nerve damage is a risk of strip excision?? can we see some of these implications in patients? what are the chances of this to happen?

I can reflect on these from only experience in my practice:

1. Bleeding after surgery — I sometimes see some wound ooze beyond a day after a surgery (I would guess 1 in 300 patients). I handle this with a simple pressure dressing over the donor wound. Bleeding is never a problem beyond a day in the recipient area.
2. Bleeding significantly during a surgery (by “significantly”, I mean enough to impact blood pressure – more than a few ounces of blood) — Risk for this is close to zero. Every patient bleeds during the surgery as the scalp is very vascular (might lose a few ounces of blood), but it should not be meaningful bleeding that risks anything. Bleeding may be a problem if a patient is on anticoagulants, Aspirin, or if they might have a clotting/bleeding disorder that stops blood from coagulating (this last one should be known by taking a good history from a patient for hemophilia).
3. Vascular damage — There is no risk of direct vascular damage in a normal person unless the patient has had many scalp reduction procedures or many hair transplant procedures, or the surgeon does not have experience in doing this type of surgery.
4. Nerve damage — There are two types of nerve damage that may follow a hair transplant. The fine cutaneous nerves are cut in almost everyone both in the recipient area and the donor area. This might leave some numbness above the wound and this usually disappears in days or weeks. The second type of nerve injury occurs when and if the surgeon accidentally cut a major nerve (’greater or lesser’ occipital nerves). This is a surgical error in technique when it occurs. In my practice, I have never seen it in a surgery I have done, but I have seen this injury in patients who came to me from other doctors who may not have been skilled surgeons in the first place.

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Hi Dr. R!

Captain Forehead here. I’m one week post-op. Staples are good so far. Not too much discomfort.

Wow, there is SO much different info online about what you can and can’t do after surgery. I found this elsewhere on baldingblog.com, a very helpful guide.

Patients…

* Can lie flat
* Can have full aerobic exercise in 1 week (even run a marathon if they want)
* Should limit weightlifting greater than 25 lbs for 4 weeks and keep the back straight
* No sit-ups or pull-ups for 4 weeks
* May play with pets in 1 day (but no licking the transplants by your dog until the crusts are off – it had to be said)
* Smoke and dust in the environment are not a problem unless you are not clean
* Passive sex is ok for the first 2 nights, then everything after is a go

It’s just weird ’cause sometimes I feel more tension while yawning than I do after the pushup I just tried, of course while keeping my head totally back!

I guess I’m just writing to say, I wish I knew for sure how “zombie-like” I have to remain after surgery and how much of my history of widened scars is due to junky genetics.

Thoughts?

P.S. See ya at the Open House in L.A. this Saturday!

You don’t have to be a zombie after a hair transplant surgery. The precautions are so that it protects and minimized the donor area scarring and most of the rules are to protect the people who are not generally careful and do unsafe things. I am generally open to shortening all of the time lines with more careful people. To simply think about it, the more tension you put (sit-ups, etc), the more there is a risk of widened scarring when your neck muscles are pulled. You will know that if you put your hand on the back of the neck and see how much pull you get from what you are doing.