Clogged Pore or Dead Graft at 5 Months Post-Op? – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman,

I don’t believe this question has been addressed anywhere on your site. If I missed it, then my apologies.

I am a female who is 5 months post-op. In the past couple of days, I noticed 2 grafts “stuck” in my scalp in what had formed into a clogged pore. I could feel them when I ran my fingers through my scalp and it was obvious that they were just “there” – dead and not growing.

I gently forced them out and they came out easily. They certainly looked like the hairs I had transplanted. In other words, they were not “new” hair. Each graft had 3 hairs in it.

Is this normal or possible at 5 months post-op?

Was I wrong in pressing these things out of my scalp?

Thanks again, and God Bless you Dr. Rassman.

Some people do not shed the transplanted hairs and they are not the ones that grow. You are OK with what you did. Any hair that you remove will not damage what you have or any prospects of what you might get. Good luck. The new hair should be strong at the 8th month.


Eyebrow Transplant — Training the Hair – Hair Loss Information by Dr. William Rassman

Hi! I was wondering about eyebrow transplants. I have researched them as a possibility to do, but I have a question. Since the hairs come from the back of the head, I gather that the hairs that get transplanted to the brow don’t lie flat. I read that they have to be trained with gel. Do they eventually lie flat or do you have to plaster them with gel forever? How long does it take to train to lie flat?
Thanks for the info.

The natural angle for an eyebrow transplant is difficult to create artificially. Sometimes the strong hair that some people have will lift up when transplanted into the eyebrow and that compounds any slight increased angle of the transplanted eyebrow to the skin. Training the eyebrow may be important if that is a problem and for many women, the eyebrow can not be trained. For these women, waxing the eyebrow or using other cosmetic adjuncts will control the way the eyebrow lies. Some women have a natural tendency for bushier eyebrows anyway and for these women, cosmetic adjuncts are familiar territory. Most men like bushy eyebrows, so some lift helps achieve a masculine look. The more extreme examples are Albert Einstein — and even me. I would hope that my similiarity to Einstein goes beyond my eyebrows, though. Einstein’s eyebrows may not work well for some women.

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Scalp Laxity Exercises Before Hair Transplant Surgery? – Hair Loss Information by Dr. William Rassman

I have had several HT procedures. The latest was in March 06 and had HT’s placed on the frontal part of my scalp. They have not yet began growing. I know this because I can’t see any new hairs growing on my hairline. How long does it take for hair to grow after you have had three to four in that particular area? Can I do or take something to start making them grow? I looked on the Hasson and Wong website and they recommend doing Scalp Laxity exercises to give skin more flexibility prior to surgury. If you do these a few months after you have a HT in prep for another HT will this cause the scar to stretch? Will this improve blood flow to the scar for possible better HT’s into the scar in the future?
Thank you Dr.

Hair transplants always take up to 5 or 6 months to start growing. Previous hair transplants will not affect the start-up phase. Some doctors believe that minoxidil helps get the hair growing faster. I have tried minoxidil on one side of the head on a number of patients and did not see a difference in the rate of growth.

There is an exercise to increase the scalp laxity. It generally will take a month to get some gain from such exercises. Scalp exercises after the first 3-4 months of a previous surgery should not cause the scars to increase in size, nor will it increase the blood supply.

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Did Mel Gibson Have a Hair Transplant? – Hair Loss Information – Balding Blog

The value of posts such as this on the BaldingBlog are to show the difficulty in detecting modern hair transplants. In my day, when advertisements focused on blondes, the saying was, “Does she or doesn’t she? Only her hair dresser knows for sure.” This would be the case for people who have had hair transplants today. I might take that old ad and change it to ask, “Does he or doesn’t he have a hair transplant? Only his hair transplant surgeon would know for sure!

This article about Mel Gibson’s possible hair transplant is about 6 or 7 weeks old now, but it is nonetheless interesting (at least to me).

The photo caption states that the below photo on the left is Mel from 2 years ago, and the photo on the right is from today (or July, when the article was published).

(photo: DailyMail.co.uk)

Hair Loss InformationIf You Trash Your Competitors, You Will Get Dirt on Your Shirt – Hair Loss Information – Balding Blog

I read with disgust your piece the other day (Doctors, Crooks, or Con Men — How Do You Tell the Difference?) which attacked doctors in such a way that your readers will get an unfair view of the doctors who do good hair transplants and are honest and caring. There are many doctors with high integrity who try to get the best for their patients. Why don’t you promote them and talk about the wonderful things that we can do today, rather than dwell on the few rotton apples out there?

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From time to time, I just get overwhelmed by some issue and my frustration is shared with all of you. This is my blog, which is like a personal journal that I share with all of my readers. Sure, I answer hair loss questions that are written to me, but from time to time I also treat it as a place to express my thoughts and even vent my anger in hopefully some constructive way. The piece from the other day was clearly precipitated by one particular patient, but unfortunately, it was not such an unusual occurrence for me to see this problem come up. Of the four doctors who gave him opinions, two of them actually do good quality hair transplants that I have seen in my office, but the decisions they made when meeting this poor man were not necessarily driven by his agenda nor his welfare. I know, unfortunately, that many of the doctors in the hair transplant industry spend huge amounts of money promoting their hair transplant expertise. A 2 x 3.5 inch ad in the Los Angeles Times, for example, costs between $1300-2700 for each day it is run (depending on the day of the week and length of the contract), so when ads are run daily, the costs become staggering and the doctor is as much driven by his/her ability to support his ad budget and his staff salaries, as by his/her desire to be honorable and righteous. Does one agenda conflict with the other? I believe that they, unfortunately, do conflict.

To handle a high number of people responding to these ads, these doctors hire salesmen (often disguised as someone with medical expertise) who become physician extenders, often screening callers to find out who has enough money to afford a hair transplant. Salesmen earn commissions, and although commissions are illegal in California, the commissions in some form still are what drives the sales process. Every potential candidate is screened for his ability to pay the large fees, just as the prospective patient was quoted the other day. That patient had the money so I think that the blood hounds sensed it so the price incentives that were offered by one doctor had some sense of urgency to it. The process I just defined is sleazy and it is something that I have written about, much to my detriment in this heavily market-and-sales driven process. Unfortunately, this is not just a California problem, it is an industry-wide cosmetic surgery problem and some doctors from around the world fit well into the amoral mold I have defined here. But there are many good doctors out there as well, so shopping before you buy a hair transplant will probably lead you to a better choice than taking the first doctor you meet. Watch out for sales tactics that look like a used-car sales lot. Do not accept seeing anyone but the doctor who is going to do the work and never, ever accept anything that you are told unless the person is qualified to give you an opinion and can back up what the doctor tells you.

The doctor who wrote the above comment to me today does bring up some very important things. The surgery we can do today is almost miraculous and 6 of my family members who’ve had hair transplants think that I am God-like for how natural the work looks. I think that too many people have expectations of the deforming, pluggy, doll-look with corn rows, so it is a difficult road for today’s doctors to educate the public on today’s high quality reality. A hair transplant was not only good enough for my immediate family, but I also had it done. As I’ve shared before, I have performed surgery on the politicians, billionaires, CEOs of big businesses, celebrities, the Royalty of countries that my readers have read about, and a few probable mafia members from other countries who would not have allowed me to live had it not worked out and met their expectations. I am not the only doctor who can do this type of quality hair transplant, so please forgive me for yesterday’s and today’s diatribe. To complete my answer to the doctor who posed the comment to me, I must remind the doctors who are reading this blog that we have taken an oath to uphold our patients’ interests about our own. If our oath is not enough, most governments that license doctors require doctors to report any infraction in ethical behavior that we observe as a condition of licensure, something that even I do not adhere to, to the spirit and the letter of the law.

I remember in 1994, I spoke before hundreds of doctors attacking those whose ethics reflect the worst of the sleaze in the business. I openly called them ‘sleazy crooks’. I also remember that the audience stood up and applauded my comments because the large majority of doctors were also disgusted with those who dragged down this struggling new industry, making it particularly hard to break the monopoly that had been horded by a select few marketers. I felt good about my comments because I sensed that many of the doctors in the audience fully supported the victimized men we were focused upon helping. After many private congratulations in the hallway over my vocal position, one well known doctor waited on the sidelines. As the crowd that surrounded me thinned and dispersed, that well known doctor came over to me and said, “I did not like the way you talked about me.” He stomped off and I thought for a moment, remembering that I never named a name and the closest I came to identifying anyone was the label “ sleazy crook,” which seemed to have struck a sensitive cord with him. I think I remember saying, “If the shoe fits, its yours,” but I think that he walked away from me too fast to have heard my retort.

I hope that the doctor who posed his query to me here reflects those who supported my position in 1994 and would support this long winded commentary by me as well.

Hair Loss InformationPropecia and Shock Loss After Surgery – Hair Loss Information – Balding Blog

Dear Dr. Rassman,

Does a young man (mid twenties) who has been on Propecia for a few years run a high risk of permanent shock loss in the recipient area after an HT surgery? Also, will the HT speed up the normal balding process?

Thanks

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Usually, Propecia will protect a man against shock hair loss and acceleration of your hair loss, but alas that is a general rule and not everyone follows that rule. It is about 90+% predictable. Those at greatest risk for acceleration of hair loss are the young men who have very active miniaturization going on and are showing fast-track balding in process.

Can Shock Loss From My 2nd Surgery Hurt My 1st Surgery From 9 Months Earlier? – Hair Loss Information by Dr. William Rassman

I first had 2500 grafts transplanted in Oct of 2005. I thought this went well and my clinic ran a special [per graft price] if I did the next surgury in July, 2006. Exactly 9 months after my first surgery. I had 3000 grafts this time and it went OK. I started using minoxidal 2% five days after surgury per post op instructions. I feel like I had some shock loss about 3 to 4 weeks after surgury. Now I am at 7 weeks post op. My question is this: Since I was stage 6 baldness, Is it possible that new hair from my first surgury could get shocked out? Will it grow back? Also my post op instructions say that I can discontinue minoxidil after 6 weeks. What do you think about what I have told you? Thanks

You should direct these questions to you doctor. Shock hair loss for the second surgery 9 months after the first surgery is very, very unusual. I do not recommend minoxidil right after surgery unless you were on it prior to the surgery. Usually, shock hair loss reverses within 2-5 months after it happens.

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Hair Loss InformationDoctors, Crooks, or Con Men – How Do You Tell the Difference? – Hair Loss Information – Balding Blog

I just met a patient who, while doing comparative shopping, came to me as the fifth doctor on his shopping list. He was 46 years old and had some thinning in his crown. He lost the first inch of his hairline, but his hairline did not bother him and therefore was not his focus. He was fine with where the frontal hairline was. He was able to see through the crown for the first time in years. Below, is the spirit of what he told me his experiences were, I simulated quotes of a conversation to demonstrate what he described to me —

Doctor #1:
“You are going bald in the crown”, he was told. He was quoted a surgery cost of $12,000 for 1400 grafts.
“Will I lose any hair from the transplant?”, he asked.
“It happens sometimes,” the doctor answered, “but if it does happen, it will grow back”

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Doctor #2:
“I can fix it with 800 grafts for $3,000 and if you do that now, I will throw in another 100 free grafts”.

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Doctor #3:
The man had researched this doctor and found that there were reputation problems evident through industry-specific bulletin boards and in internet reference sites. He felt that the visit to this doctor reeked of sleaziness.

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Doctor #4:
On the visit, he met a patient in the crowded lobby. The patient (who already had surgery) warned him to stay away for his own good. When he visited the doctor, he was told that for $12,000, he could get 2000 grafts into the crown and it would make his crown appear full.

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Dr. Rassman (Doctor #5):
I mapped out his scalp for miniaturization and found that less than 50% of the crown hair was miniaturized (no other doctor did this). The frontal area had 80% miniaturization just behind the balding area, suggesting that his hair loss will continue in the frontal area. I told him that with only 50% miniaturization in the crown, a drug treatment would be the best approach, not surgery. When the hair is 50% miniaturized, there is usually reasonably good cover and surgery runs the risk of causing irreversible hair loss (which usually does not grow back in men). If this happened, it could make his crown more see through than it was now. I recommended against any surgery.

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I was personally frustrated with my colleagues in the hair transplant field, particularly for what appeared to be a lack of moral fiber in managing this man’s problem. I have always believed that doctors should put their own welfare behind the patient’s welfare. What the above cases clearly showed me was that the first four doctors were behaving like used car salesmen, selling this man the car driven by that little old school teacher who never abused it. I have no difficulty condemning the opinions of these other doctors and their behavior. Every one of the four wanted to take this man’s money and preyed upon his vanity.

Of interest, when he first started talking with me, he was at first baffled by the wide discrepancies between the recommendations and the pricing, but after receiving my explanation of the miniaturization assessment (something that none of the other doctors did on his examination), his confusion cleared up. His initial question to me was why was there such a wide descrepency between the estimates of work and price. That was not his focus after the consultation with me. In his case, good comparative shopping saved him from being victimized by doctors who behave like crooks and con men. They are still out there.

Again and again, I warn people, ‘Let the Buyer Beware!’

Born With Two Bald Spots – Hair Loss Information by Dr. William Rassman

I was born with two bald spots, one on the back of my head and on the left side of my head. Is there anything I could do to get them spots to grow back, and i forgot to mention that i am almost 20 yrs old.

Hair transplants work very nicely in congenital spots of baldness like yours.

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Old Plugs Now Showing – Hair Loss Information by Dr. William Rassman

I am 43 years old and had a procedure done 15 years ago involving mini grafts and micro grafts. Over the years it was fine and as I had a full head of hair and never really noticed the minis and micro grafts much.

Since last year I have lost some hair and the minis are now the transplants are more obvious to me. I have been very stressed, my wife left me and the hair started to fall out shortly after she left. I am not on propecia or rogaine or any other such drugs.

What can I do? With my hairline now looking pluggy and less and less hair to cover it, will a transplant help me? I am reluctant to have a transplant again as I am frightened that my pluggy look will be worse. Can I just remove these plugs and take on the bald look that I would have had normally?

Here’s my questions…

  1. Most of my grafts are middle size (about 1-2 mm in size). If I go with the FUE approach to thinning these grafts, how small are the holes created by FUE ?
  2. Are different sized instruments used ?
  3. What is the exact process ?
  4. How are these holes closed (sutures? ) and how long is the healing ?
  5. Do these holes upon closing leave a white spot like the pictures I have seen ?
  6. Some of my grafts are small 1-2 hairs but stand out (i think its the skin around is a little pushed in) ,doing this procedure will take care of the skin depression/irregularity ?
  7. What is the success of such procedures & What can I expect in terms of the look after this process ?
  8. I would like these grafts to be replanted on the top or in the scar area.
  9. Can you please tell me about this process and advise if what I am looking for is achievable ?

It is not unusual for people to see the older plugs when they lose hair. This is because many doctors would put plugs (in the old days) into places where hair existed as a prevention for hair loss or to cover a person’s eventual hair loss migration. This was and is today a terrible and immoral practice. I feel you have a series of options:

  • You can put back the hair that has hidden the plugs and go back in time, so to speak.
  • You can remove the plugs altogether. This will not bring you to look like the balding man you would have become, because the plugs tend to leave scarring and even removing them does not change the scarring.
  • You can remove the frontal plugs, thin out the plugs behind and redistribute the hair, and then transplant the entire frontal area.
  • You can lower the hairline very slightly and in doing this, you can add a deep transition zone which will bury the larger grafts that you have.

Now to answer your numbered questions…

  1. The diameter of the punch is 0.9mm.
  2. None smaller at this time
  3. Usually it is best to use a two step procedure — score the skin first, and then use a dull punch second to core out the targeted FUs.
  4. These are not sutures; too small. They are left open and close on their own.
  5. This is a risk. The small white patches are far less obvious than the plugs. The lesser of two evils.
  6. Yes, in most of them, provided that they are not the larger grafts that had hair killed off during the transplant. There is a condition called donuting where much of the central hair dies in the older type of grafts. The skin changes with this older technique frequently are larger than just where the hair are.
  7. For each group of hairs that are successfully removed, the success is good. Please note that I used the term successfully removed. Sometimes the scars that surround the plugs make it impossible to get them either out at all, or completely out. Every person is different, as is each scar.
  8. Always do this.
  9. It can be achieved, but without examining you and testing you with a FOX biopsy or trying it, one can not be 100% sure.

For an example of the procedure, please see Dean’s Story.

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