Category: Hair Transplantation

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Itchy Scalp After Transplants – Hair Loss Information by Dr. William Rassman

I am a 53 year old male who was blessed, until November 2004, with a mostly full, but fine head of hair. At Halloween, I put hair coloring in my hair for a costume, did not wash it out until the following Monday morning (the color came out when I slept and I did think about the chemicals still being there – when I read the can later, it said not to use on fine hair – I was extremely mad at myself). Anyway, I had six weeks of an itchy scalp and some hair loss with it.

This past summer, I had another 8 week bout with itchiness and even more hair loss- I started using tea tree oil shampoo and creme rinse, and Jason’s thin-to-thick shampoo and rinse, as well as putting jojoba oil with tea tree oil into my scalp at night. I visited two Chicago area doctors who told me itchiness was part of the active balding time and nothing was wrong with my scalp. I visited them after this bout ended, with loss that I now wanted to do something about. I decided to go to female doctor at the end of October 2005. Everything went fine until a couple of months ago, four months after the transplants. I started to notice hair coming in, but then the itchiness/sensitivity started. I thought that was just irritation from the new hairs, but then I started to worry that maybe this was not the case. Anyway, the hairs placed deeper in the middle front and the majority of the right side transplants came in, but the front middle (new V) and the front left side mostly did not. I am very unhappy about this, and I just hate this feeling of itchiness /sensitivity that is only on the left side this time. (two months and running-getting better) I was / am taking propecia three times a week, as I had a lowered libido with daily use. (Dr. told me to go to 3x a week) I was not using Rogaine until a week ago, where I started to use Scalpmed, another minoxidal product.

Do I possibly have some stress loss of new hairs? Should I go back to using Propecia more often? I can accept the more frequent use until the hairs come in, if they still can. I was told by an assistant than it will take 18 months for the complete result.

I am in great need of some guidance. Thank you

If you have a good doctor, you should be discussing these things with that doctor. You asked about itchiness and was told that it is caused by male pattern balding. That is not the case as there is no evidence that the two are connected directly unless it is the result of sunburns or other things that dry your scalp skin. You had transplants about 7 months ago. I generally tell patients that 80% of the results will be in by the 8th month and 95% should be in within a year. If one side grows slower than the other, that is ok, but if one side does not grow and the other side grows out well, then the technical people placing (different technicians placing the grafts into the different sides of the transplanted area) may have caused a problem that killed off hair. Less skilled technicians may damage the grafts when moving them around or take longer to place them and in the process of placing the grafts, they just dry them out (just 10-15 seconds exposure of these grafts to the air can kill them). Wait out the full 8 months first before thinking of the worst.

Taking Propecia three times a week makes no sense to me, because it is completely out of your body in a day. Taking 1/2 tablet of Propecia each day has about 80% of the benefits of taking a full tablet if you have a libido problem. Rogaine (which is minoxidil, also contained in ScalpMed) can dry the skin and make it itch and that is not commenting on the other additives in each of the commercial products containing minoxidil. Propecia will have no effect on the new hairs, nor will the minoxidil impact the hairs from the donor area. I think that you need to sit down with your doctor and get answers from your doctor, real answers and not be talking to his technicians. This is what a doctor/patient relationship is about.

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My Father Had Awful Transplants from a Dermatologist – Hair Loss Information by Dr. William Rassman

I have been on finasteride for 7 years. I have pretty much maintained my same density over this period. A little more thinning in the front. I am now 36. My father had many transplants from a doctor who is a dermatologist. Not from a doctor that specializes in transplants. His transplants are awful. What should my expectations be if I wanted to get off the drug and try transplants? I am fair-skinned with wavy auburn hair, and my individual follicles are thick, but not dense.

First, the old plugs can easily be fixed today. Look at the following links for articles and examples of good repair work which can and should be offered to your father:

The second part is that taking the drug Propecia is a different decision to having transplants. They can be complementary (see: Hair Transplant and Propecia Combination Results). As for expectations about transplants for yourself, meet with your doctor and have him/her develop a Master Plan with you, so that you have your needs addressed before the procedure.

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A Transplant Doctor Told Me I Need Multiple Procedures – Hair Loss Information by Dr. William Rassman

I am not bald and have a thick head of hair. My only problem is my naturally deep temples which I want to fill in so that my hair line looks straight.

I was recently told by a hair doctor that only a certain number of grafts can be performed on the temples of my head in 1 session since the number of hair follicles in my hair which is very dense. He states it is impossible to graft too many or the follicles will compete for blood supply and the instrument’s pressure will cause adjacent grafts to pop out. The area I want to fix is rather small. However, he says I will probably need two transplants.

Is this true or is it just a way for him to make more money?

Without knowing the size of the area, the number of grafts, or the thickness of your hair it is hard for me to answer this question. Generally you can safely put 40-50 follicular units into a square cm (normal densities are 100 follicular units per square cm), but that depends upon various mechanical factors. The average person does not need to achieve normal densities to get adequate fullness. With a small balding area I would assume that your blood supply should be very good. Dense packing of the grafts was pioneered by me in 1993. I believe that there are situations where one doctor can put too many grafts too close so that growth might be impacted. Some doctors have extensive experience in dense packing and can do it safely, others have not built the skills and would prefer not to dense pack the grafts. Whatever the doctor is comfortable with is what is probably best in that particular situation. Never push the doctor to do more than his comfort level is. Plus, you always have the option to visit with a different doctor.

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Hair Coloring and Scar Visibility After Transplantation? – Hair Loss Information by Dr. William Rassman

Hi-
Over the past 3+ years, I’ve had 3 transplant surgeries and I’m tremendously happy with the results. Some years ago, I used to occasionally double process my hair blond (it’s dark brown naturally) and I liked the results. Is this still a possibiliy or is it to risky for my hair. Will it make the scars more visible? Needless to say, I wouldn’t want to damage my transplants in any way. Many thanks

Colored HairYour hair is your hair and a hair transplant, once done correctly, means you can dye it, cut it, perm it, spike it, etc. The beauty of a good hair transplant is that it is just like you never had lost your hair. As for the scars, I couldn’t tell you for sure, as there are a number of factors such as width/length of your scars (I am assuming you had strip procedures) and the length of your hair. However, I do not think the scar visibility will be an issue with processing your hair blonde, but the only way to know for sure is to try it once. Generally, the only time the scar has a chance of being seen is when the hair is cut way too short (like crew-cut length).

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I Don’t Like Having a Mature Hairline – Hair Loss Information by Dr. William Rassman

I am 23 and notice I have a mature hairline. its a 2 on the scale. I dont like my hairline though and would like to get the hair around my temples back. Is there any procedure that can fix this? If so please tell me

I have transplanted the juvenile hairline back in some men, but I do so only under certain conditions:

  1. There is no evidence of advanced balding either on examination or in the family line.
  2. I want to get to know the patient and he must be mature and able to understand the ‘worst case’ scenario that could happen (in your age the worst case thing is advanced balding).
  3. I look at the value of the various elements of hair quality, skin color, hair density, and overall donor supply characteristics and connect it with potential demand considerations.

I have clearly done this more than once, but in my present memory the only ones I have done under 25 years old were professional actors, television soap opera sexy men, or models whose livelihood depends upon that ‘youthful’ look.

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Another Patient Returns (with Photos) – Hair Loss Information – Balding Blog

I met with a patient who had one procedure of 1,541 grafts a little over a year ago. We sat down and reviewed his pictures together and he completely forgot that the man from a year ago ever existed. I share with you his wonderful results and I thank him for allowing me to show his face and post these photos. Click the photos to enlarge.

Before:



After:



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Hair Transplants or Propecia – Hair Loss Information – Balding Blog

I have been on Propecia for 6 years now and have decided to get off of it due to potential unknown long term side effects and even short term side effects that I seem to notice more as I age(Libido, minor Gyno, etc). My question is how long do you recommend I go before I consult for a potential hair transplant since it is difficult to say what my potential future loss will be right now since Propecia did have a positive effect on my loss and I would have almost certainly lost more. Im currently 30 years old and have probably a Norwood 3V and more of a Norwood 2ish in the Temporal/frontal region which hasnt changed to much since I started Propecia. Ideally I would love to get a transplant now to basically keep my existing hairline(which im ok with even though its receded a fair amount) and fill in some of my vertex while I can still conceal it with exising hair but Im worried about not being able to plan correctly since I wont be taking Propecia. Any advice will be most helpful.

Thanks

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You need to be evaulated. If you density is good and there is miminal miniaturization in the top (area between front and crown), then you may be a good candidate for hair transplants. At 30, your pattern should be evident when your scalp and hair gets mapped out for miniaturization. From that a Master Plan needs to be developed which will take into account your worst case hair loss scenario and then the supply/demand for hair transplants becomes a measurement to base a safe decision in the long term planning for any transplant process that you undergo. Stopping the Propecia is something that you should think carefully about, a lengthy discussion with your doctor to see how this decision may alter that long term plan I am talking about.

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Hair Transplant and Propecia Combination Results (with Photos) – Hair Loss Information by Dr. William Rassman

This patient had a hair transplant a few years back with me, which filled in the front and top. He has been taking Propecia for the crown. The combination is awesome. In just ONE surgical session of 2,626 grafts, he now has a strong frame to his face and filled in much of the frontal hair. The back of his head gained just enough hairfrom the Propecia to take away the heavily see through look and all of his sensitivity to being the balding man we see in his before pictures. Photographs were taken from eyebrows up only. Click the photos to enlarge.

Before:

After:

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Hair Loss InformationHIV and Hair Transplants – Hair Loss Information – Balding Blog

I just had a patient who, in our routine testing, had a lab test that was HIV positive (he was very surprised). He is over 50, recently married and his wife of three years was tested for HIV prior to her marriage, but he was not. He and she came into the office quite calm. They had just returned from getting the news from their family doctor who wanted to repeat the test considering the patient’s history would not support a high risk status. When he came in, we spoke calmly about it and we ran tests from our lab on both the patient and his wife. Within 2 days, the tests from my office came back negative, as did his family doctor’s repeat test. What a hell he must have gone through!

I have dealt with many men who were HIV positive and who wanted a hair transplant. They knew that they were positive to the test, were already under treatments, and had good control of the disease. I took them on as patients just as I would anybody else. I routinely screen for HIV, although I am not hard on this rule. I have had 5 patients with positive tests when these men did not suspect that they were positive to the virus. The shock of my interviews with these patients is memorable and I spent a great deal of time working with them, arranging a repeat test, being sure that the tests are not false positives and advising them as any good, concerned human being would do. This was the first time (1 out of 6) that the test came back negative on re-running the tests. Four of the six patients eventually had hair transplants with me including the patient who tested a false positive this week.

I remember one patient who had advanced HIV, not controlled by medications very well. He was healthy enough to have a hair transplant and did after I worked through this decision with his doctor. I remember him well for two reasons: (1) He felt that he was going to die and wanted to meet his maker looking good with a full head of hair, (2) I accidentally cut my hand with the scalpel that I used on him. Yes, accidents can happen, and this was certainly one that I’ll never forget. Over the next six months, I tested myself for HIV monthly and have done so yearly, every time being negative (that was 10 years ago). I learned that the risk to a person who cuts his hand with a surgical knife that was previously exposed to HIV blood is less than 1% in contracting the disease, but had it been a needle with a drop of blood in it, the story would have been different. In fact, most healthcare workers who got HIV from a hospital accident got it through a needle that originally contained blood. About a year after the incident, this patient’s mother came by my office to inform me that her son had passed away. She smiled as she told me, ” He was happy in the last days of his life, and when he looked in the mirror, he liked the new look he got from the transplant.” She went on to tell me that her son wanted to lie in an open casket at his funeral and he wanted to have his own natural hair at that time. He wanted his friends to remember him that way. I realize that this story may seem a little morbid to some readers, but I wanted to share this very humbling experience where I helped someone achieve one of their final goals in life, even it the goals were outside the goals I normally see.

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

It’s been just over 8 weeks since you performed my 3000+ grafts hair transplant. I’m noticing some of the little guys are still falling out. There are no scabs, only small hairs that continue to tumble to their death into my bathroom sink. Am I not being aggresive enough when I shampoo, or do each of these little guys tumble to the ground on their own schedule?

I noticed a few grafts growing immediately from day 1, and these guys are actually pretty long already! Others, though, fell out early and are now pushing their way toward the light. I imagine the ones still shedding will subsequently start their growth later, and that’s probably why the 8-month total wait, huh?

Just wondering.

You are on schedule for your hairs to be doing what they are doing. It is not unusual to lose grafted hair as the old transplanted hairs shed. Sometimes the stubble of the transplanted hairs stay around for a few months, then they sooner or later fall out to their “death” (not really an appropriate statement, as they have been dead since a week after the transplant). The hairs from the transplant that did not grow immediately and fell out, do not reflect the hair growth center cells which are alive and getting prepared to start their anagen cycle. FYI, at the end of the cycle, a hair “bud” situated at the base of the “rest” root (phase 2) develops and will push out the hair in the involution to become a new hair as it ‘grows up’.

At this stage of your recovery, I would not worry much about aggressive shampooing, just do what you generally do and that should be fine. You must wait out the 8 month period to see 80-90% of your growth.

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