Category: Hair Transplantation

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Hair Stuck in Scabs After Hair Transplant – Hair Loss Information – Balding Blog

Hello,

I wanted to ask a question about scabs. I am 33 year old African American male and I had surgery done for 1000 grafts about 15 days ago. After the surgery, I was told not to wash them until the next day. I was told I was “poppy” which mean, I bled alot when the surgery was being performed. These forms little round beads of blood when I left, but I could see my hair transplants nicely.

When I washed my head, I was careful not to move them, so I just dabbed them and rinsed. Over the next week, these turned into scabs.

Now, my scabs are falling off when I take a shower, or when I lightly move them, with no bleeding. However, what I am noticing is there is hair stuck on them. I am so afraid that they are taking with them the hair follicles.

Is there a way I can find out instead of waiting 3 months. I still have some scabs remaining and it is exactly 2 weeks since I had surgery.

How can I be sure that my anchors are still in place.

Any ideas, thoughts appreciated.
Thank you

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Everyone experiences hair in the scabs when they come off. The key to good management is to get the scabs off immediately after the surgery. Now you should wait until the scabs come off with gentle shampooing of your hair. The hair you see in the scabs should not be the grafts, unless the grafts were not seated correctly on the time of the surgery. Talk to your surgeon about proper aftercare.

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Hair Loss InformationWhat is FOX Negative? – Hair Loss Information – Balding Blog

What does FOX negative mean?

Thanks.

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We coined the term “FOX” at New Hair Institute back in 2002 for FOllicular unit eXtraction. We thought FOX sounded better than FUE. We also published a paper on follicular unit extraction, describing how some patients are good FOX/FUE candidates and some are not.

I realize FUE is performed at many clinics without any pre-testing on all patients who want to have the surgery, however at NHI we pre-qualify potential patients with a FOX/FUE test to see if they are good candidates. A very small percentage of patients will have high transection rates with FUE and these are the FOX negative patients we are talking about.

We generally do not recommend FOX/FUE surgery if the transection rate is approaching 20% or more. If the patient is FOX negative, it is an inherent problem to the patient (not the doctor or clinic or machine). As we wrote about our experience with NeoGraft a week ago, the machine could not successfully harvest a known FOX negative patient.

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Hair Loss InformationHave You Tried NeoGraft Yet? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I read where your colleague, Dr. Bernstein, recently decided to add the NeoGraft Unit to his office’s hair restoration offering – see his blog for more information. I was wondering if you have had an opportunity to try the NeoGraft and whether or not they have managed to overcome trauma to the grafts from “drying” and mechanical effects (during extraction and implanting)? I have read your blog concerning your (and Dr. Pak) device (hydro) and was really hoping that they might take a page from your book on this technique.

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I did try NeoGraft on one of our known FOX negative patients and the results were not good, but comparable to what we would have gotten using our own techniques in such a patient. A quick aside, the FOX test means that we ran a small FUE test to see if they are candidates for a full FUE procedure… and FOX negative means we do not recommend the FUE procedure for them.

The NeoGraft system did what we would have expected it to do. I believe (without direct experience) that the ARTAS robot would have also produced damage with this FOX negative patient, but as most patients are not FOX negative, the test of the NeoGraft on this patient was not a fair representation of what it should do.

I have asked for a loan of a NeoGraft system to help me find a place in my practice for it. I know that Dr. Bernstein is getting an ARTAS system and I am sure that when he has a FOX negative patient, I will find out what his experience is with such a patient.

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Hair Loss InformationDo Doctors Track Transection Rates in Hair Transplant Surgery? – Hair Loss Information – Balding Blog

I was curious if you know if any doctors track the survivability of the grafts? I know that there is quite a bit of information on transection rates for different surgeons but was wondering if anyone monitors this metric? If they do – how might the survivability be determined outside of just counting the grafts in the recipient area a few weeks/months after the surgery? Thanks

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This is a great question. We track transection rates when we perform FUE surgeries. The transection can vary from 5% to 50%. I believe 5 to 10% is an acceptable number. If there is a high transection rate then we will abort or never recommend surgery. This is the reason why at NHI we always pre-test all potential FUE patients, but I realize other clinics and doctors may not do this.

The data for other clinics and doctors is not available or well published in studies. I believe mainly it is directly linked to business. No one would publish poor results or high transection rates, as it is not good for business. As unfortunate as it may be, the consumers and patients are left to do their own due diligence and trust their doctor, probably by contacting patients who had it done by that doctor. One way around this would be for patients to ask about seeing actual patients in person or seeing their own surgical records of how the grafts were tracked (if it is done at all). In theory, the transection rate should be documented on the day of surgery, but I realize not all doctors will keep this record (as it is not mandatory) and some may refuse to show it to their patients. I can say this because I have heard these issues come up in consultations with some patients that have had procedures done elsewhere previously.

I know of one doctor who promotes and reports 96% good FUE grafts (4% or less transection), yet I have see many of his patients and found a high degree of failures in those of his patients who came to me for a second opinion. This is a buyer beware business. Sometimes you can expose poor practices through reports by the chamber of commerce or the courts in the areas where the doctors practice. I’ve also been asked to post the names of doctors to be weary of, but if I were to speak up and identify those who may not be honest in their representation, I would become a target for slander. I have better things to do than take up residence in the court system.

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Hair Loss InformationI’m 23 Years Old and Want a Hair Transplant – Will I Regret It in 10 Years? – Hair Loss Information – Balding Blog

Hi,
I am a 23 year old male seriously considering a hair transplant. I am a norwood class 2 w/a naturally high hair line and diffuse thinning in the temples about an inch back and slight thinning in the front (minor). I have been on finasteride for 2 years and rogaine foam (on the hairline) for 2 years. I have a few uncles on my mom’s side who are norwood 5’s and some uncles on my dad’s side who are norwood 2’s and 3’s. My dad is a norwood 2a.

I have been to two hair transplant surgeons who both said I was a good canidiate because I have good donor hair and I’ve halted/slowed my hair loss with finasteride. The surgery would be a conservative approach to establish a mature hairline. I’m not trying to get my adolescent hairline back. They each recommended btw 800 and 1000 grafts via the strip technique.

I know I am young but what do you think? Will I regret this in 10-20 years? Is shock loss a major concern in my case?

Thanks.

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You need to find a great doctor that is known to be honest — not one that wants your money instead of giving you what you need. A good relationship with a doctor you trust will be critical to the decision making process. I cannot say the recommendation you got was good or bad, as I haven’t seen you. Some 23 year olds are excellent candidates, some are not. If you do go through the surgery, hopefully the Propecia will limit or prevent shock loss, but there’s no guarantee.

It seems you are having doubts and that raises a red flag for me. Unfortunately I cannot give you a diagnosis, recommendation, or prognosis here.

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Hair Loss InformationAfter Taking Propecia Daily for Years After My Transplant, I Think I’m Losing Hair Again – Hair Loss Information – Balding Blog

I have had two procedures in the past at Dr. Rassman’s NHI facility. The first about 8 years ago, the second about 6 years ago. I have used Propecia, or Finasteride as a substitute, religiously since before the first procedure.

About a year ago I started to notice substantial thinning in the areas that had become filled in from the procedures. I have assumed this to be loss of original hair. Is it common for Propecia/Finasteride to stop working at some point? Does substituting Finasteride have a negative effect?

Last, I have read that Propecia (Finasteride) dosage can be reduced from 1 mg a day to .2 mg per day with no negative effect, and that it may be possible to take the med every other day. True?

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Hair transplants are permanent and lifelong, but those remaining hairs you had in the balding areas (not the transplanted grafts) will continue to fall out. When you have surgery, we transplant the hairs in between any existing hair to blend it in so that if the existing hairs fall out years down the line, you will still have the transplanted hairs to keep things looking natural without an abrupt demarcation.

Propecia is just a brand name for the finasteride (in 1mg dose). There should be no difference between generic and brand name other than possibly the strength in dose of the active ingredient. It’s possible that there are different fillers. Propecia/finasteride does help hold on to the existing thinning hair as long as possible, but eventually your genetic predisposition catches up with you. This does not mean it just stopped working, but rather, you are getting older and your predestined hair loss fate is winning the battle.

The medication is about 70 to 80 percent as effective at half the dose of the recommended 1mg daily, so you can theoretically cut the pill in half (0.5mg) and still see some benefits. There have been some patients who have seen side effects, and cutting the dose in half has allowed them to experience good results without the side effects.

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Hair Loss InformationHair Transplant Results of Man with 2415 Grafts (with Photos) – Hair Loss Information – Balding Blog

This is a college professor who saw a new man in the mirror with this single hair transplant procedure of 2415 grafts. He has fine hair, which often takes more than one session for a completely full look. He told me that no one ever noticed the transition in his appearance, because the change was so slow.

Approximately 2/3rds of the transplants were placed in the first 6 inches of the hairline, which was moved forward, and some grafts were placed in the frontal part of the crown area.

Click photos to enlarge.

After (2415 grafts):

 

Before:

 

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Declining Propecia Benefits and Shock Loss – Hair Loss Information – Balding Blog

If you have been taking propecia for a number of years and you are seeing the benefits slowly decline, but you opt to get a hair transplant done anyways, wouldn’t that still kill the native hair beside the transplanted hair because of shock loss? because the benefits of propecia are declining.

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Maybe, but that is were your doctor’s expertise comes in. Your scenario is the worst case outcome, but our experience has shown that finasteride can reduce the risks of shock loss after a hair transplant. Shock loss would be a “worst case” if you do have surgery.

You will have to weigh the “risks versus the benefit” and the inevitability of where your pattern will end up. You will arrive at a point where the surgery will make a difference despite the worst case shock hair loss.

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My Transplanted Hair Grows Faster Than My Native Hair – Hair Loss Information – Balding Blog

I have had two transplants (1800 total grafts) over the past 2 1/2 years in the vertex (400 grafts) and front (1400). I have noticed that the transplanted hair grows significantly faster than the native hair (mostly in the crown/middle scalp). This increased rate of growth is probably 50% or more. I suppose this indicates that the grafts are growing well and are healthy, but has this effect been noticed in other patients?

Thank you.

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I have a hard time understanding how you can distinguish transplanted hair growth from non-transplanted hair growth, as 50% faster growth seems drastic. I have not had patients mention this type of phenomenon, as all hairs (transplanted and non-transplanted) should grow at the same rate if they are the same scalp hairs. If you had body hairs transplanted to your scalp it will grow at a different rate.

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Should I Worry About Shock Loss? – Hair Loss Information – Balding Blog

I want to have a hair transplant, but i read about the “Shock Loss” I read that i will have to wait 10 days post-op to be able to have a normal shower/to clean my hair normally. That 10 days it takes to the grafts to be held to the scalp. So in the first normal post-op if I have native hair besides to transplanted hair i will have shock loss because the native hair will not be normal clean, because the needles, because the perforations in the scalp.

My question is if i have a shock loss in normal hair, it will grow back again???? Do I have to be worry???

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Shock loss is unusual in men that are taking finasteride (Propecia) prior to the hair transplant, as it minimizes the risk. If you lose your normal hair, it may grow back, but likely it will be miniaturized.. A good doctor can ascertain this on an examination of your scalp.

I’ve written much about shock loss before, and some links to past posts can be found here, here, and here.