Category: Hair Transplantation

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Washing Scalp After Transplant – Hair Loss Information – Balding Blog

I am day 4 post op right now. I have been pouring shampoo-filled water on my head followed by a round of conditioner. I am not touching my scalp at all except for gently massaging around the donor area a couple of times. At what point should i change how i wash. Can you please detail how to wash my hair when it is time to change what i am doing now? Also I still have pain in the donor area. Is this normal? How long will this last? Lastly, are there any post-op products that promote scabs to fall off and protect against infection? Thank you for taking the time to read this and for your reply.

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For starters, you should be asking your transplant surgeon these question. Of course, I will do the best I can to help and will expand upon your question to supply other bits of information that may help my general readership.

Washing your head after a hair transplant has been arbitrary among hair transplant surgeons for years. The dilemma is that there is a risk of grafts dislodging in the first few days after surgery if the grafts get manipulated. On the other hand, washing reduces the chance of scab formation which gives you acceleration of the healing and normalcy of your scalp. Fortunately, this issue was studied recently (see this PDF file — Graft anchoring in hair transplantation). This study showed that presence of scabbing after surgery extends the interval that grafts are at risk of being dislodged. The study emphasizes that preventing scab formation would shorten the high risk period during which new grafts may fall out. I recommend frequent, but gentle hair washing in the first few days following you operation without rubbing or scratching in the recipient area. Professional hair washing for the first days after surgery is advisable and I personally offer this service to all of my patients during this time. Some products have been claimed to reduce the scabbing and infection after surgery with no documented evidence to support them.

Fortunately, infection is not a common complication after a hair transplant in healthy individuals, thanks to good blood supply of the scalp skin. As a general rule the donor and recipient wounds are almost completely sealed in within a few hours and certainly by the next day after a hair transplant. External factors should not cause infection in these areas beyond this time. If you do not learn to wash with some vigor, then the evidence of a hair transplant in its healing phase may take weeks to disappear rather than a day or two (crusts that are not washed away in the first or second day tend to linger for weeks). The actual details of how to wash should be obtained from your doctor. After a week, if the scabs are still there, you can wash your hair and then leave the shampoo on for 10 minutes or so, gently massaging the scabs after the 10 minute waiting period.

Folliculitis (a cyst in the recipient area which may become infected) is the most common cause of post operative infection in people who do not pick on their transplanted site. For those that pick, the infection risk rises. There are a number of factors that contribute to these cystic ‘pimples’ that appear after 4-6 weeks. Some people believe that these are caused by remnants of hair left behind from the grafts or are foreign body reactions to the glands of the hairs which may survive below the skin after the hair is shed. These glands (which lie along the hair shaft about 3 mm down from the skin) almost certainly produce sebum (a waxy secretion) which can not exit the skin, because it needs a hair shaft to find its way out. These cysts are best treated with warm soaks and frequent shampoos to promote their external drainage. When a doctor employs staff without extensive experience or with poor eyesight, grafts are put in one on top of another (piggybacking), which buries the first graft. These buried grafts causes cysts that frequently get infected and at times require antibiotics or even surgical drainage.

Pain in the donor area could persist for the first 2 or 3 days after surgery. Soreness continues to subside within the first week, and rarely require pain medications after the first day. Mild numbness in the donor area may persist for a few weeks.

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A Year After My Hair Transplant, I Still Look as Thin as Before! – Hair Loss Information by Dr. William Rassman

Dr. Rassman. I’m 41 years old. I got a hair transplant done in April 2006. After the transplant i was vcery happy with the quantity of hair that i got transplanted. I know the doctor told me that i would loose my hair because of the body reacting to the surgery. Now it’s Jan 2007 and i find that the amount of hair that was transplanted is not as much regrown. Now that i’m approaching my one year period soon, why is it that the amount of hair that was planted as not all regrown back. I was expected a least twice of what i see. When i comb myself i still look like someone who is loosing is hair, and i hate it, especially when i go under a light or out in the sun. What is your suggestion to my situation.

Setting expectations is as much the ‘art’ of what I do as doing the surgery. That is why I have open house events every month, so that people who are going to have surgery can see and meet someone with a similar balding pattern and hair color. Then, and only then, will expectations be set properly. If you expected too much, then the error was on setting expectations. If the hair did not grow, then the question should be ‘what went wrong?’. You can always get a second opinion, but first, ask the doctor who did it and find out if your doctor’s expectations were met.

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I See Pitting Around Grafts After My Hair Transplant – Hair Loss Information by Dr. William Rassman

Hello,

I am 28 years old and had 700 grafts at the age of 23. Just over four months ago I went for a second procedure for 1450 grafts. I have noticed small pits where the grafts are when light shines down on my head. I am terribly regretful for starting this when I was young, just out of college and very emotional. why do I see pits? I went to a very reputable doctor. Is this normal when transplanting hair? My only hope is the new transplanted hair will mask the scarring.

Thanks

Just five years ago, few doctors were using Follicular Unit Transplantation (FUT). I might assume that the grafts that were used were relatively large, and those larger grafts tend to have more skin in the transplanted grafts that tend to form pits, cobblestoning and other changes in the recipient area. The techniques of FUT, which we defined in 1995, set the standard that had been slow to catch on. You should ask your doctor just what type of grafts he/she used. One way to tell is if your doctor used a microscope for the dissection, it showed that he/she probably was doing FUT. FUT does not pit as a rule.

You need to be evaluated by an expert in repairs who follows the rules outlined in our two classic articles on the subject Follicular Transplantation: Patient Evaluation and Surgical Planning? and The Aesthetics of Follicular Transplantation. The repair of a faulty transplant takes clear skills, so be sure that your doctor has those skills. Ask to see some of the patients that your doctor repaired to get one more step of confidence in your doctor’s skills.


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Lost All Pubic Hair After Radiation Therapy – Hair Loss Information by Dr. William Rassman

I lost all my pubic hair after cancer radiation therapy. I am hirsute guy with hairy chest, legs, arms. The blank spot now looks terrible and I’m embarrassed in the gym shower etc. Is there anything I can do?

Transplants should work well. Head hair may grow in curly, so it is worth a try. Underarm hair may also work, but the yield may be less due to the shorter growth cycle. Beard hair works very well. In older men, that would be my first choice. What is your age?

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My Transplant Doctor’s Post-Op Paperwork is Incredibly Stringent – Hair Loss Information by Dr. William Rassman

I recently went for a transplant and the post op paperwork I was given by my doctor seems incredibly stringent. Things like, laying straight up/at a 45 degree angle for a week, no aerobic exercise for 3 months, no weight lifting for 6, can’t be in contact with smoke/dust/pets for 4 weeks, etc.

I’ve read a lot of stuff on your site that actually coincides with things he’s said, but the post op instructions are quite different from what I could gather. Is he just being overly cautious to try preserving grafts?

To doI generally recommend no sex for 15 years, no walking more than 1/4 mile for 4 years… no, no… I’m just kidding.

I tell most of my patients the following:

  • They can lie flat
  • Can have full aerobic exercise in 1 week (even run a marathon if they want)
  • 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

Does that help?

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Covering Up a Hair Transplant Days After Surgery (with Photos) – Hair Loss Information – Balding Blog

This patient has black hair and white skin, so his short ‘beard’ shows at the hairline where he was transplanted just 3 days before these photos were taken (see photo to the left, below). He just combed his hair forward and to the side (as shown in the photo to the lower right) to camouflage his hair transplant. People who do not wash their transplants correctly, may scab more than those who do wash properly. When a patient has hair to use for cover, creativity in styling goes a long way to cover up transplants. Two days after this picture was taken, all of the ‘scabs’ shown in the below photos were gone. Please click to enlarge.

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Hair Loss InformationFUE vs Strip Harvesting for Transplants – Hair Loss Information – Balding Blog

I am considering doing an FUE, and later on need I recognize that I may want another transplant, won’t the FUE cause my donor availablity to be less as compared to having the strip transplant?

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I think that you must put the various surgeries that you may want into a Master Plan for your hair loss. If you are not going to be very bald, then an FUE solution is not an unreasonable one. The long term yields for an FUE may have to do with donor density, but for strip harvesting, I have exceeded 10,000 grafts over more than one surgery. With regard to your query, I do not believe that anyone really knows whether FUE will cause your donor availability to be less than that of the strip procedure, but I would personally doubt that FUE will yield more hair for transplantation than strip harvesting. There may be a role for combined FUE and strip at the end of the process.

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Hair Loss InformationScratch Test for Histamine-Positive Skin – Hair Loss Information – Balding Blog

What is the scratch test you mentioned in a previous post?

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I refer to the test as one used to discover a histamine positive skin type. The simple test is done by scratching the skin with a finger nail (for example) with moderate pressure, but not enough to cut into the skin. The skin will develop a red-streak within a minute surrounding the finger nail scratch. This, I believe, is local release of vasodilators at the skin edge. I have noted in my practice that people who react to the scratch with a red streak are the ones who tend to remain more pink after a hair transplant. When I transplant these patients, I will often use copper peptide dressing, which I have found gets the pink out sooner in these patients. I have had patients who were positive to the scratch test who were not treated after their first surgery and then when I did their surgery a second or third time, the addition of (1) copper peptide dressings after surgery and (2) the use of high dose steroids at surgery has helped minimize the pink discoloration over time. My view of copper peptide is not shared by many doctors, suggesting that what I observed have not been their observations and their experience.

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Hair Loss InformationRemoved My Hairline with Laser Removal, Now I Want to Cover the Scars – Hair Loss Information – Balding Blog

Hi Dr. Rassman…..I have a bit of a problem and I’d like your advice. I recieved two hair transplants in the 90’s and wound up with a low hairline. I’m 32 years old and a natural norwood 3/4. I just recently removed my hairline via laser hair removal. I’m now dealing with the underlying skin which is scarred. It’s not terrible but I’m very self conscious. I’ve decided on another hair transplant. I’d like to bring the hairline down to where it was to cover any scars. I’m thinking low density with good coverage. My doc estimates that I have about 4000 donor grafts left. Any feedback would be greatly appreciated.

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It is difficult without pictures or seeing you in person to render an opinion that has real value to you. You can excise the frontal scarred hairline (done frequently) and then have those grafts transplanted with a normal soft transition zone of 1, 2, and 3 hair units. As you are on the east coast, Dr. Robert Bernstein in NY might be worth visiting for a second opinion. If you make it out to California, I’d be happy to see you.

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Hair Loss InformationI Based My Hair Transplant Doctor Decision on Promotional Materials – Hair Loss Information – Balding Blog

i understand that you are under no obligation to answer my question, but i am a 27 year old male and just yesterday i had my first hair transplant of 1200 grafts. i went with [name removed], and made the huge mistake of basing my decision soley on their promotional material. now, everywhere i look says that theyre crooks and im going to wind up looking like a monster. could you provide any answers?

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Today’s transplant by that particular medical group is much better than their internet reputation indicates. Even the groups which do large scale promotion are now performing much better work. Wait it out and have hope and faith. Next time, follow through with the type of investigation I outline in The Truth About Cheap Hair Transplants. You generally get what you will see when you meet the doctor’s patients and you should see enough of their patients (face to face) to get the type of quality work you need.