My Hair Transplant Scar is 6mm Wide – Hair Loss Information – Balding Blog

Hi,
I had a hair transplant done 3 1/2 months ago. The hair seems to be growing in good but is blonde and fine whereas the rest of my hair is thick and dark, I am told it will thicken over time. But the main problem I think I have is that the scar along the bottom is about 6 mm wide. Along the sides up to my ears it is only 1 mm or less. The doctor told me I have good scalp laxity and it should not have stretched like it did, but I think it was because he took the hair too low on my head and in that area the skin stretches as I move my head up and down. It is like he took the hair from my neck and not my scalp. Another concern is that the hair is finer and lighter that far down on my neck and I am worried if it is even going to be permanent.

What do you think I can do to repair this scar? The doctor offered to “repair” the scar but wont it just stretch again? Have you heard about hair being harvested too low, or is this not a problem?

Thank you very much for your time.

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When donor hair is taken from the high neck (where it sounds like you are describing), it often scars. Some doctors mistakingly think that the neck hair is finer than the scalp hair and therefore intentionally take hair from the high neck. These often are flat scars that widen as you’ve described. From what you are saying about the rest of the scar, it is well healed without widening and this suggests that you do not have a problem with ‘stretch’. Removing these neck scars often leads to failure, so these may have to be transplanted to get the cover you need.

Hair Loss InformationContinued Thinning After a Hair Transplant – Hair Loss Information – Balding Blog

I’m thinking about a hair transplant procedure, but had some reservations about what happened if one continued to lose hair. The transplanted hair is supposed to permanent, so what happens to the rest of the hair on the crown if you get hair transplanted to the front hairline area? Does it stay and the rest of it go?

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Assuming you are a male, have genetic hair loss, and you are taking Propecia (finasteride), then the hair loss should stabilize so that as you add transplanted hair you are gaining, not losing hair. Hair loss is a progressive process, arrested by finasteride in most men. Hair transplants in the front will frame your face and finasteride for the crown should stabilize or reverse the hair loss. Get you scalp mapped out for miniaturization to be sure of the diagnosis and then you can get a transplant if that is part of your Master Plan.

Hair Loss InformationStandard of Care Consultation for Hair Transplantation – Hair Loss Information – Balding Blog

I just had my consultation at your office last week. I want to congratulate you with a professional way of managing your practice.

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This blog entry is a little lengthy, but it is important to retell this man’s tale as he told it to me. For the purposes of privacy, I’ll refer to him as Joe.

Joe had received three opinions from different doctors over the past few months. The one with me was the last of the consultations. After receiving the nice note from him, I asked him for a competitive analysis. Joe had planned to get multiple opinions over a three month period and he had already attended one of our open house events prior to seeing me privately.

He had some comments about our practice, some of which were not flattering. He criticized the quality of our video as tired and out of date (it is 14 years old) and our brochure was not nearly as fancy as the ones that he had seen elsewhere. He might not have been aggressive at pursuing us if it were not for the generally less than professional presentation of the other two practices. With the two previous groups he had met, both were front-ended with a professional salesman who went through well-scripted processes, each recommending what the salesmen thought Joe might need to address his balding problem. Both of these groups applied considerable pressure to get him to schedule a hair transplant. At one of the two clinics, the doctor came into the office, but spent very little time with him, only confirming what the salesman told Joe about his needs. When he left each of the two previous groups, he was somewhat impressed, but skeptical of their sales process. Later, he did some internet research and found considerable legal problems with one of the groups and many generally negative comments on internet chats. Both groups were eventually crossed off his list.

Our office was his third stop. He came by an open house event and met with many patients that had been through the same thing he was now facing. Three patients came in without notice and they showed results that he felt were normal looking. He was impressed with the openness of the patients attending the open house. He met two patients with the exact balding pattern that he had, both in their 40s and they had Joe’s hair and skin color as well.

Joe went into the operating room and talked to the outgoing fellow who was having the hair transplant that day. When we eventually met, he was impressed that I had committed a full hour to the interview. The night of the consultation he went to the internet and found that every claim that NHI had made on its website (reflecting their authority as a pioneer in the field) was easily validated. This was quite different than the claims made by the other groups which he felt were over-hyped in their representations. The very next day, he got an email from me with what he said “was an amazing and thorough summary” of the conversation we had on his visit the day before. I had included a full fee schedule for the quoted estimate of work. None of the other transplant office took the time to produce such a document, not even the doctor who performed surgery on his broken nose a few years ago.

I developed my hair restoration practice as I did when I practiced a more traditional ‘general surgery’. I’ve always believed that a medical practice should be classy and that means to me that the doctor should take every effort to provide what he would want to see if he or a member of his family were a patient — and that would include an honest, open communication. Unfortunately, too many medical groups who are now dominating the field of hair transplantation, have applied heavy sales tactics (which I believe is either immoral or unethical). The patient can easily become a victim if critical information is held back. As a case in point, throughout this blog, I discuss the need for assessments with mapping of the scalp hair for loss looking for miniaturization, and even with multiple articles written by me on this subject, the metrics in this field have not been incorporated into the standard of care. I would never transfuse a unit of blood without knowing the hemoglobin of a patient who was bleeding, nor would I use potentially toxic medications without understanding the working efficiency of the liver or kidneys, yet many hair transplant doctors seem to constantly offer extensive hair restoration surgery without measurements of the patients existing hair status or in giving the patient some help in predicting his future hair loss.

We need a standard of diagnosis for the consultation process and we need to exclude the salesmen who dominate the process and make recommendations that should be in the exclusive domain of the doctor. We need to incorporate such processes as mapping of the scalp for miniaturization, in order to give the patient a fighting chance in understanding what he is agreeing to when he undergoes a hair transplant. We need to provide educational material about what the patient may experience, including all of the risks (not sugar coated) associated with a transplant process. If we don’t do these things, then I will continue to speak out about our standard, hoping that the consumer will press those in this industry to discard shoddy sales tactics.

Hair Loss InformationOne Hair Transplant Changed His Image (with Photos) – Hair Loss Information – Balding Blog

This man wore a hat as often as he could. He has some pre-malignant skin changes on his bald scalp and the hat provided cover for it. His comb-over was as good as he could get for non-hat coverage and he didn’t like the way it looked. What did he do for a living? He is a make-up artist with a 30 year career working in many big budget movies and TV programs. Because of his career, he was self-conscious about his balding look and his comb-over. He knows almost every actor in Hollywood so he feels for those who are balding. Now, he proudly tells those people that he had a hair transplant, trying to help them find a similar solution (when appropriate). He received 1496 grafts in a single session just one year ago. Now, wanting to be slightly greedy, he will probably do it one more time to thicken the front so that in a bright light it will look thicker. His willingness to come forward and let me tell his story shows the character of a self-confident man.

Before:


After:


I Considered a Hair Transplant, But I Can’t Take Propecia – Hair Loss Information – Balding Blog

Hi Doc,

Thanks for such a wonderful site, it’s been very useful.

I’m 25 with thinning hair. I have taken propecia for couple of months but I have stopped it because of side effects. I have considered hair transplant but from what I read on your blog, you mentioned that it’ll be really bad to do hair transplant without taking propecia at the same time. So what are my options if I can’t take the drug, should I even consider transplant.

Thanks a lot.

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I don’t think I’ve ever stated that it was bad to have a hair transplant if you are not taking Propecia. If you can find a BaldingBlog entry where I did please let me know.

I often advise patients to take Propecia to prevent possible shock hair loss. However this is after a personal face-to-face consult on an individual basis and after I make an assessment of what the possible long term balding pattern might be. Everybody is different and there are many patients that have hair transplants without taking Propecia, but there is some risk of acceleration of the hair loss without it. The degree of miniaturization will be proportional to the risk of shock loss. There are some 25 year olds who do not have a great deal of miniaturization and they will be a lower risk for shock loss than a person with extensive miniaturization. Maybe a short term use of Propecia to protect yourself from shock loss would be worth trying. If you are considering a hair transplant you should see a good hair transplant doctor to have all your questions answered in person. Remember, there are some absolutes and if you have a hair loss pattern indicating extensive balding is probable, then you must be able to walk that line with your doctor so that you can keep you hair and understand the risks as well.

How Will a Patient Know if They Lose a Graft? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

How does a transplant patient know if they have lost/dislodged a graft? Will a lost or dislodged graft always be associated with bleeding and/or pain, or is it possible to lose grafts and be completely unaware. I think for many of your readers who have recently had transplants, it would be helpful/reduce the stress in the interim between grafts falling out and regrowing months later to know what may indicate a lost grafts versus the expected shedding that is supposed to happen. Thanks, as always, for your time and help.

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After the first day (the first few hours by the time you get home) your newly transplanted grafts will have set in and they should not dislodge. If you see something that looks like the pictures on this page, then it is a graft. It would be highly unlikely for these to come out after 3 days post surgery, unless you pick them out. To be a graft, all of the elements of the anatomy should be there.

Some people mistake the hair follicles that come out at about day 7-12 with hair and some surface skin (even with a bulb) as grafts. In a published paper we wrote, the grafts are clearly locked in place at the worst case 10 days after the transplant, or as soon as 3 days after the surgery, provided that all scabing is gone.

How Many Follicles Required to Fill in This Scar? – Hair Loss Information – Balding Blog

Hi, I was just wondering about how many follicles would be needed to fill in an inch long and a few mm wide area of scalp?

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Tootsie PopHow many licks does it takes to finish a Tootsie Pop? In other words, I couldn’t tell you how many grafts would be required just by the simple question you asked. It depends on what you mean by a few millimeters — two, three, five?

It would also depend on:

  • the location of the scar
  • your hair shaft thickness and the scar thickness
  • the contrast of your hair color to your skin color to minimize the appearance of the contrast
  • the character of your hair (wavy, curley, straight)
  • the length of your hair (very short hair will require more densities than longer length hair)

Generally you can achieve a good cosmetic effect with about 20 to 40 follicular units per square centimeter, but that number does not reflect the local skin dynamics or how the surrounding hair may lay.

Hair Loss InformationWhat Procedures Has Dr Rassman Had? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I’m wondering if you could tell us a little about what you’ve personally gone through? I’ve managed to gather, based on reading about half of all your entries (i’m aiming to get through all of them!) that you’ve had a full transplant and that you’re currently on Propecia, but I was wondering if you could elaborte.

Cheers

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In the early 1990s I had three scalp reductions for balding in my crown. I realized after the third (about 8 months had passed) that I was worse off after the three surgeries than before I had them done. Worse off because:

  1. my bald spot returned larger than before I started the first procedure
  2. the skin was fragile, bleeding easily
  3. the scar looked like a Mercedes emblem on my head

I was not angry with my doctor because he had done what others were doing, practicing a standard of medical care that was sub-standard. What angered me was a phone call I had made. I called the authority on this surgery, explained what happened to me and found out that it was a common outcome for many patients. I remember clearly that when I asked him one simple question: What was this outcome not published? His answer was: It would be bad for business. I was sickened. I had personally performed 8 of these surgeries myself, one of them on my first cousin. He was the only one who had the complications of scars and the emblem on his head. We joke about it today and he never loses the opportunity to be dramatic about the impact of the scar I gave him. I transplanted his crown three times to try to make amends, and although he now has great results, he still teases me over his suffering.

Like him, I had hair transplants performed into the scar in the back of my head. I no longer belong to Mercedes and am a free man with a good head of hair. My crown (1600 grafts later, see below) is still slightly thin, but few people notice it unless I call their attention to it. I use a comb-back and the hair in front of the thinning hair covers the bald spot reasonably well.

 

Click the photo to enlarge.

Because of the scalp reductions I had, it was not reasonable to replace the swirl in my crown so I accepted a change in hair positioning for each of the grafts to enhance the comb-back styling that I had gotten used to. I often do this in people who have a supply/demand mismatch, where the supply is short and demand is high. On some patients where there is no demand mismatch (like with Patient CL and Patient OR), we can replace the swirl.

My Transplanted Hairline Was Too Low – Hair Loss Information – Balding Blog

im 22 and had 500 grafts done in my receding temples about 6 months ago. i experienced severe MPB at 18-19 and hairloss had been stable since then. the hairline was carefully marked by myself before the surgery so i cannot blame the doc, but now i feel it could have been 1/2 further up. the hair are very fine and not very dense, just as i wanted them on temples(not too dense, just enough to cover). in the future can these be moved 1.2 up??

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Not really. It is very difficult to move transplanted hair. I tell patients that transplanted hair is always permanent and that is why it should be done right the first time. If removal was to be attempted, it would have to be done with a Follicular Unit Extraction (FUE) technique. You can have a brow lift which will give you a higher hairline, moving the transplanted hair upwards, but that is fairly radical surgery for someone of your age.

I am disturbed that some doctor would transplant a 22 year old and that the hairline would be placed low. The fact that there were only 500 grafts also disturbs me, because it indicates that the balding is not severe. Were you on Propecia? If not, then there is clear malpractice here. You need an expert to assess your situation.

A hair transplant is for life. That is why I constantly emphasize the Master Plan in hair restoration. To achieve the maximum cosmetic benefit from hair restoration surgery, a personalized Master Plan should combine the best information available with a realistic assessment of what your future hair loss may be. It is an integral part of the patient-doctor relationship.

Grafts Growing in Scarred Tissue – Hair Loss Information – Balding Blog

Does a graft always have the potential of growing? Even in an area of scarred tissue? Or where a hair has been extracted?

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If the scar tissue is healthy scar, it will support follicular units. Healthy scar actually bleeds when cut. Scars often have a rich vascular network, but some skin grafts (split thickness grafts) and burn scars may not have enough vascular support for a hair transplant. A healthy graft will grow anywhere it is placed when the blood supply is adequate. For example, a follicular unit placed on the end of the nose will grow to pony tail length.