Category: Hair Transplantation

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3 Months After FUE, I Still Have This Yellow Substance On My Grafts and It’s Very Itchy – Hair Loss Information – Balding Blog

Hi Doctor,

I underwent a FUE treatment 3 months ago, around 2000 grafts. i’m 38 and always had a good skin quality. All went well, but i remarked “yellow shadows” over the recipient area very early. My GP said it was all ok.

At 2 months post op i remarked i lost small 1cm hair, trapped in balls of dry sebum. Also had red pimples with pus for one week and itchy. Went to a dermatologist, he gave me antibiotics and a sebiprox shampoo. I had to stop the use of the shampoo because it made me lose a lot of hair very quickly. I still take antibiotics for 15 days now. No more red pustules, BUT still losing some hair trapped in sebum balls and recipient area still red and itchy.

You cannot see with natural eyes, but if you use a looking glass you can see that almost every pore that is hosting small hair is bathed into a yellow substance. Sebum i guess. I fear this will prevent the hair from growing and make it fall.

What should i do? the surgeon who operated on me said it was a skin problem not a follicle problem and told me to see the dermatologist! I dont know what to do! Thank you for your advice. I see some hair growing from the transplant and i dont want to lose them.

As it is nice to see and not infected can we exclude the terrible folliculis decalvans ?

Best Regards.

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I don’t want to just brush your question off, but I don’t and I can’t diagnose medical conditions via the web. I think you should listen to your surgeon and make an appointment to see a dermatologist… or you could see another hair transplant surgeon or even your primary care doctor. This isn’t something I would want to guess about just based on a photo.

Some patients get infections and some have bad skin issues. You may or may not have both. Usually, within a few days, the evidence of a hair transplant in the recipient area is gone. Good washing techniques are critical to that process. At two months, you should be washing your hair, but not with too much pressure. Leave the shampoo on for around 5 minutes before you wash it off.

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If I Want Dense Packing, Is There Any Benefit to Several Surgeries vs One Large Surgery? – Hair Loss Information – Balding Blog

I had about 1200 grafts transplanted into my frontal third (an area i roughly estimate to be 10 square inches, which i figure the amount of hair transplanted to be about 20% of the original density).

My question regards dense packing. I’m looking to get 800 more grafts transplanted there, but the thing is i still have a considerable amount of native (miniaturized) hairs in the area. I realize I’m running the risk of damaging the native hairs but do I run as high of a risk involving the growth of the new grafts in two surgeries compared to one?

To sum all of that up, is there any benefit of having several surgeries instead of one large one in regards to the growth of grafts in dense packing?

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If you have significant miniaturization in an area that you’re looking to have transplanted, you do run the risk of surgical shock loss occurring that could wipe those hairs out. Finasteride may protect you from shock loss, but you should discuss this with your surgeon. You don’t want to end up having a hair restoration surgery that causes hair loss.

As for the transplanting question — I generally will perform the largest surgery reasonable to minimize the number of surgeries. Dense packing, something I originated in 1993, may not result in growth as well as traditional grafting spacing.

Although it has not been my experience, reports by doctors in our field with side-by-side comparisons on volunteer patient have shown a lesser growth rate when grafts are packed at greater than 60 grafts per square cm. This should also be discussed with your surgeon.

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How Can Redness Be Eliminated Following a Hair Transplant? – Hair Loss Information – Balding Blog

One thing I’ve read about online is that some people are suffering from long lasting redness in the donor area after a hair transplant. What should be done to eliminate the redness within a 2 week period before someone can go to work without being noticed he had HT?

I ask this question, because i tried your test for redness and my skin looks very sensitive.

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If your skin is prone to redness, then there really is no way around it (just like if you’re born with the gene for balding, you really can’t stop the balding… it will happen). Typically, most doctors give a small dose of cortico-steroid to minimize the redness.

Otherwise, if you’re not a Norwood 6 or 7 and have some existing hair near the transplant area, you can try growing that hair out a little prior to the procedure so that you can use styling techniques to cover any redness that may be otherwise visible.

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How Long Until There Are No Signs of Hair Transplant Surgery? – Hair Loss Information – Balding Blog

What do you tell prospective clients who say that they want hair restoration surgery, but it is absolutely imperative that all signs of the procedures, as well as the result, be undetectable? Let’s say for example that I was able to take 3 weeks off of work to have this done while I go on “vacation”; with what degree of certainty could you say that signs of the procedure, including scabbing, and what I’m more worried about being the “pinkish” scalp, would have subsided within a lets say 17 day period?

As is the nature with the internet, I have read posts with wildly different interpretations, and have also seen very different outcomes in the online photo-blogs I’ve looked at. I have no doubt you must receive hundreds upon hundreds of questions, so thanks so much for what you do for so many of us in this frustrating predicament; any help with my question would be greatly appreciated.

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Every patient is different, but in general the scabs and the redness (if there is any) goes away anywhere between a few days to around 2 weeks. On the other hand, the short hairs from the transplant look like a newly grown beard, and in a woman that might make it detectable if she does not style her hair to cover it; however, these short hair will all fall out in about 3 weeks, so by that point there should be no trace of a transplant. The hairs that fall out will reappear somewhere between 3-6 months and then start growing at about 1/2 inch per month.

Most people have no signs of the surgery between 3-4 weeks afterward; however, on rare occasions there have been some patients that will hold redness in the recipient area for up to 8 weeks. With a simple scratch test (where you scratch your forehead with your fingernail with some moderate pressure), the skin might produce a red mark in the scratched area within a few minutes of doing this. That indicates a positive scratch test, and those with the positive scratch test will often hold the pinkness of the recipient sites for a few weeks.

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Hair Loss InformationCan I Have Hair Transplanted from the Crown to Make a Juvenile Hairline? – Hair Loss Information – Balding Blog

Dear doctor,

So far I have read that transplanting back a juvenile hairline (from a mature, assuming the person is not balding) is a bad idea due to the risk that the patient may suffer from balding in the future, leaving a permanent transplanted section at the front, which would look ridiculous.

Could this not be avoided by transplanting hairs from the top of the head (rather than from the ‘permanent’ zone of the back/sides) to the front, so if that person does end up balding, those follicles will be equally affected by the DHT, and so will not remain permanent? What’s more, those transplanted follicles could therefore be treated by minoxidil and propecia if need be?

On the other hand, if the person doesn’t bald, they will retain the lower hairline. It seems like a win-win situation. I only ask because I think my hairline is maturing (it remains to be seen if it will become balding) and I want to maintain a straighter hairline because it looked much better on me and had better styling options.

Many thanks

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Yes, you can technically take hair from the crown and put it in the hairline… but if you harvest from the crown, then you’ll have a potentially bald-looking crown. I wouldn’t recommend this being done.

For example, let’s say your genetics might just have crown loss in your future, in that case you would’ve had an unnecessary surgical procedure if those transplanted hairs start falling out with the rest of your crown hair. You must remember that Propecia doesn’t protect you from hair loss forever, as your genetics will eventually win out at some point down the road.

I think you need to understand the importance of a Master Plan, where the doctor and the patient plan out a specific plan on how to address the evolving balding process. If you plan it right, you don’t have to worry about the “ridiculous” look of a partial job.

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Would You Use Body Hair if There Was No Donor Supply Left? – Hair Loss Information – Balding Blog

If you have no donor supply left would it be possible to use body hair to help with density. I understand your positions on BHT having read your posts on the topic, however is that something you would ever consider?

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There are few indications for body hair transplants (BHT). From what I have seen, the results are quite variable. It might be a waste of your money doing it, especially if it did not meet your objectives. I occasionally refer patients who are committed to body hair, but I do not do them myself.

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Do You Perform Touch-Up Transplants to the Hairline? – Hair Loss Information – Balding Blog

If a younger patient (late 20s) wanted to ‘touch up’ their hairline to make it more symmetrical with a small transplant e.g 10cm surface area…approximately what density should this be at if you were to consider that the patient has fine hair and wants to be cautious with regard to future loss?

I’ve seen some surgeons using ‘dense packing’ produce great looking results, but i know these can be risky as future loss can leave a bad result…but would it be ok to transplant at a lower density in this case? And do you ever perform ‘touch ups’ to the hairline of a younger patient if they’re not on medication?

Also, are lower densities (i assume 25-30 per square cm?) going to give a very poor looking result for someone with fine hair?

Thanks

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Each case is different, so you will need a diagnosis first to see if you are balding. Some young men get freaked out about a mature hairline (which is not balding), so it’s very important that you get a diagnosis before you can plan for surgery to address any cosmetic issues to the frontal hairline.

If someone wants a very full hairline (original non-balding density), for most people that would likely require more than one surgery, regardless of how densely packed the hair can get. If your hair was medium-coarse or thicker, you might get a reasonably full look in one session.

If it sounds too good to be true, it usually is. You should want to create a Master Plan with your surgeon to account for any future loss that might occur. Remember, you’re talking about a surgery to your scalp (particularly at the hairline, right in front of everyone that you interact with in person). You should want to make sure that if you do have hair loss progression, the results from any earlier surgery will remain natural in appearance.

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What Density Would Make Brown, Straight, Fine Hair Appear Full? – Hair Loss Information – Balding Blog

In a caucasian male with brown, straight, fine hair…what sorts of transplant density would start to appear ‘full’? Is it possible to get a thickness so that the hairs can stand up or will they always ‘fall down’ because of the lack of surrounding hair?

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There is no magic number for density. Hair transplantation is about using a limited number of hairs to make your overall scalp hair appear fuller. The density varies from location to location to achieve this look.

For example, if we put a density of 10 hairs per square centimeter all over the entire bald area on a Norwood 6 patient, it will look very sparse with no significant cosmetic improvement. If you put 100 hairs in a square centimeter on the same patient you will quickly run out of hairs and will only be able to cover a small / partial area on the bald head. But if you vary the density from 50 hairs to 10 hairs and focus with the higher density in the front AND combine it with hair styling, you can achieve a full appearance.

Thus, the overall result of a hair transplant is not only about the density. It involves hair texture (thicker and curlier is better), hair color contrast against the skin (low contrast such as black hair on dark skin is better), and hair styling (longer hair, wavier hair is better than a straight buzz cut).

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Gluing Hair Grafts in Place – A Little Bit of History – Hair Loss Information – Balding Blog

I met with one of my earliest transplant patients who had surgery in 1992 when I was just in practice for about 6 months. We performed 400 grafts on this patient and he reminded me of the troubles I had in using the glue to hold the grafts in place. At first I had to think about what he was talking about… and then I remembered the painful process of placing a large number of grafts close together.

In those early days, just 80 grafts was considered a big session. 400 grafts was a huge surgery and putting grafts close together caused them to pop out, so I came up with the use of a medical quality methyl methacrylate (a form of super glue) to hold the grafts in place. The problems I encountered was that the glue was stringy and I had to be able to limit the glue to one corner of the graft, holding it to the skin. I had to put the methyl methacrylate into an insulin syringe and then express it through a very tiny needle to produce a micro-drop.

I had to work out just how to do many grafts at one time to stop the popping before this “glue” bonded into the insulin syringe. The glue problem was never solved to my satisfaction, but eventually I developed a very sensitive touch so that when I placed the grafts and kept a steady hand, I did not disturb the adjacent grafts. Eventually I mastered this technique and taught it to my staff. Now the world does it that way.

The patient compared the procedure we did recently to the one I did to him in 1992 and we both has a good laugh. This most recent procedure was his third and the grafts that I placed in 1992 worked very well for him over the past 22 years.

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I’ve Been Taking Finasteride for Years, So What Should My Next Step Be? – Hair Loss Information – Balding Blog

Cheers doctor. I live in the UK and there is not much information regarding hair loss as there is in America. I have been steadily going bald for the past 14 years and have been on proscar for some time. My doctor was reluctant to put me on proscar but finally gave in, bless him. Anyways, fast forward to now, I am 32 years old and have been seeing an increase in my hair loss in my temple area, hairline, and behind it. It is not that noticeable yet because nobody has really commented on the loss but I know in certain lighting it is very apparent and when I style my hair in different ways it is apparent.

What are the stages I should be taking at this point?
A. Continue with the medication or not take it anymore because I am losing hair regardless
B. Wait for my hair loss to continue until I have a more prominent bald spot and then go for a procedure
C. Go for a procedure now and try and stay on top of my balding
D. Get those micro dot tattoos on my thinning area
E. Do nothing and hope for the best

I always wondered about people who stay on top of their balding but the problem is when they start losing the hair behind their implants or their donor hair runs out, that is what is sort of preventing me from doing anything. Your comments and feedback would really be appreciated. Cheers.

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There is no substitute for a good doctor to help you in this process. If you are really losing hair, then stopping Proscar (finasteride) could be a disaster that would lead to “catch-up” hair loss. I assume the Proscar you’re taking is cut into 4 or 5 pieces, and not the full table, which would be too much medication for treating hair loss.

You don’t need to necessarily wait for more prominent balding before you plan for surgery, but as hair loss is progressive, your pattern would need to be determined so that any surgery accounts for potential future balding. Having Scalp MicroPigmentation (SMP) is also a possibility, depending on the hairstyle you plan on having. I can’t really answer your questions without pictures at a minimum.

So really, your next step should be to sit down with a good doctor (you are fortunate to have both Drs. Bessam and Nilofer Farjo in the UK) and build a Master Plan with them.