Hair Transplantation – Page 70

February 12, 2010

I Want a Hair Transplant, But Don’t Want Propecia Anymore – Hair Loss Information by Dr. William Rassman

I stopped taking propecia 6 months ago, after having taken it for 18 months. I believe the drug did stop my hairloss and I may have even gained some growth. I stopped taking the drug however, as I became very uneasy with it and the side effects. I am now using regain extra strength. My hairloss has returned and continued as expected. I am now seriously considering a transplant, but do not wish to go back on propecia. As my hairloss is very slow (over the passed 17 years), is it okay to undergo a transplant, but not use propecia?

Propecia is a great medication, but to a minority of patients the unwanted side effects may be an issues (as it is in your case).

You do not have to be on Propecia for a hair transplant surgery, but if you are under 30 years old and started to lose hair in the past 5-8 years, you run a risk of developing hair transplant shock with loss of hair from the transplant. I don’t know your age, but you mentioned losing hair for 17 years, so I’d assume you’re over 30. You still run the risk of shock loss, but it is less. Plus, without the medication the progressive nature of hair loss will cause your native hairs to continue falling out. As long as you know these facts, it is a decision you and your doctor need to make together.

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February 10, 2010

Why Do I Need to Sign a Disclaimer Before Hair Transplant Surgery? – Balding Blog

If Hair Transplant is so safe, why do clinics require patients to sign “disclaimer” before surgery? I was quite freaked out seeing the paper basically saying ‘Oh, BTW, you could die and it won’t be our fault’. Not the best thing you do right immediately after popping Valium and right before heading for the chair.

Gavel I agree disclaimers can be a bit daunting and scary when you read each and every line. While we live in a litigious society that necessitate us from signing disclaimers, it is also a way to give full disclosure of all risks involved.

Signing a full disclosure or a disclaimer after taking a Valium (while you are intoxicated) is probably unethical and against the law, but it is something that should be discussed with you before any surgery or any activity when you are in a clear state and of sober mind. In my practice I mail out full informed consent documents days before surgery so my patients can have a chance to read it in the comfort of their home. We also review the entire consent form on the day of surgery before any medications are given. There should be no hidden surprises. This is how it is (or how it should be) for all medical centers and hospitals.

By the way, yes, you can die from a hair transplant surgery. This happened just a few years back (see here). To be fair, there were special circumstances behind that death, as the transplant itself is a very safe outpatient procedure with patients fully awake during the surgery. Unless someone has a heart attack or a stroke during the surgery, a hair transplant in itself is not a life threatening procedure.

February 8, 2010

Pain in Donor Area a Week After FUE – Balding Blog

Hi Doctor,

I had a 1500 FUE session 7 days back. My donor and recipient sites has healed well. Everything looks normal. But since the 3rd day, I have been having a lot of pain in the donor area. Its a burning pain. For some reason it gets better at times and worse for no reason. The whole area, although well healed and looks normal from the outside, is sensitive to touch and a bit numb too. Is this normal? I talked to my doctor. He asked me to keep taking the pain killers and give it more time. Is this something to be worried about? Is it going to get better? How much time would it take? Can this be a nerve damage of some type? Is that a possibility? I would appreciate any info/help on this. I was told there is almost a zero chance of nerve damage in FUE.

Thanks.

Pain is subjective and it certainly is reasonable to have post-operative pain as many small nerve endings were traumatized. There is always some degree of nerve damage when you cut through the skin (that is why it hurts). The main issue could be major nerve damage that runs along the back side of your scalp. These are the greater occipital and lesser occipital nerves. My recommendation is to follow up with your doctor and have him/her examine you.

By the way, not all follicular unit extraction (FUE) is the same; each doctor can use a slightly different technique and different instruments. So I couldn’t say how slim your chances were of having a complication, because I don’t know how the procedure was done. You’re not alone though, as I had a similar question posed here.

February 5, 2010

Hair Loss InformationHair Transplant Failures and Survival Rates – Hair Loss Information – Balding Blog

An article written by Dr. Michael Beehner in the most recent issue of the Hair Transplant Forum (print newsletter published by the ISHRS) discussed survival of hairs in a hair transplant. He had done a study where he created five 1cm square boxes of grafts on a human volunteer just in front of the crown of the head. He separated grafts into each box focusing upon how the grafts were harvested and trimmed. One and two-hair grafts were studied. The tests followed the growth as long as 19 months. He showed that one-hair grafts which were trimmed very close and skeletonized had a 48% survival after 19 months. It was also shown in other publications, that grafts that are allowed to dry when out of the body also fail to grow. Grafts are out of the body when they are put into recipient sites, so the skill and experience of the staff clearly relates to the end results one expects to see.

Of interest, he noted that there was a significant increase in hair growth between the 14th and the 19th month of the study, reaffirming my own view that the transplant results get better over time. Doctors who create “chubby” grafts and leave the sebaceous gland with the grafts and a good fatty cover to the hair shafts, get growth in the 98% range at 19 months (up from 66% at 14 months), according to the study. Chubby grafts will also leave behind telogen hairs within the grafts that in some previous studies reported hair growth that exceeded 100%. There is a clear difference between the number of hairs that survive the transplant and the number of graft that are transplanted (as each graft can have more than one hair).

Lately, quite a number of our readers have written me about poor growth from their hair transplants and we’ve posted quite a few of those here. I have always directed these people back to their doctors and suggested that if they do not get the answers they want and need, they should get a second opinion. The main bit I hope you learn from this is that there’s really no substitute for a team consisting of a knowledgeable surgeon and an experienced, skilled staff. You don’t want to have your time, money, and available donor grafts wasted by a surgeon or his/her clinical team.

February 5, 2010

Using Toppik to Provide More Density After a Hair Transplant – Hair Loss Information by Dr. William Rassman

If you don’t have enough density to cover a full Norwood 6 with a transplant, what is your opinion of doing light coverage and then using Toppik and/or other concealers (for life) in order to give the appearance of more hair?

Toppik I’ve posted a couple cases about this. Those with very fine hair will have a harder time obtaining coverage, and the use of concealers with the transplants can work quite well. So yes, I absolutely think it’s a good idea if you want to use these camouflaging agents.

See these posts for some good examples:

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February 4, 2010

Scratching Out FUE Grafts a Month After Surgery? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I’ve had a hair transplant a month ago. Is it still possible for me to scratch my implanted FUE out?

Thank you

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I would usually say no, but I have seen some strange results and methods of hair transplants over the years. Not all FUE (follicular unit extraction) is the same and not all hair transplants are the same. If you are able to pull out a graft one month after surgery, then it was never going to grow anyways. Under most circumstances though, the graft has already taken hold by then.

February 2, 2010

No Growth 7 Months After from My Hair Transplant (with Photos) – Hair Loss Information – Balding Blog

Thanks for the informative site! I’ve searched for similar questions and answers, you’ve addressed delayed and no growth from transplants before, so hopefully this isn’t repeating too much from others. I’m 29 and had a hair transplant with a reputable IAHRS doctor seven months ago. 2400 grafts total were used, placed in the front 1/3 of my scalp to thicken my front and fill up my hairline.

It’s been seven months and the only growth that has occurred are a couple or so dozen hairs that didn’t shed during the two weeks following surgery. Those started growing further at about 3 months and are still growing, but it looks as though nothing else has even begun to pop through. The only possible explanation I can think of is concerning ridding my transplanted area of scabs post-op. 14 days after surgery, the scabs started to raise up and I went through with the balls of my fingers and gently rubbed them off, in some cases gently picked them a bit to rub them off (a few also peeled like dead sking does). There was no sign of trauma and with the scabs came the small hairs. So I shed about 90% or so of the hairs at 14 days. I discussed this with my doctor and he said there shouldn’t have been graft damage and any grafts coming out would’ve been followed by bleeding.

Is there any explanation(s) for this delayed or potentially little growth from my transplant? I’ve read articles about some transplants having delayed growth for up to a year due to different types of hair cycles. Could the rubbing and slight picking off of scabs after 14 days taken the grafts out or traumatized them to lay dormant longer? I’m sending before and after photos. Thanks!

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You sent a lot of photos, but unfortunately most of them were from a distance and poor quality, so they don’t help me see much. The two best photos are shown below (click to enlarge) — the left photo is from 1 day post, the right photo is from 7 months post surgery. There does not appear to be any growth and I would expect that something should have shown by now.

Sometimes transplanted hairs can take up to 12 months before it grows, but usually there is some growth by 7 months. You should see some results between 5-6 months post surgery. I would give it up to a few more months, but definitely follow up with your hair transplant surgeon. I really do not like the unusual zig-zag hairline the doctor placed, as evident in the 1 day post-procedure photo.

There are MANY factors that go into a successful hair transplant surgery. Each and every hair graft/follicle can easily dry up and die if not handled and transplanted by a professional medical team. That is why choosing the right doctor and the right medical group is very important. In other words, it is not like buying a car from a dealer who can get you the cheapest out the door price. Despite what the consumers may think, not all hair transplants are equal (even if they advertise the latest techniques).

January 27, 2010

Hair Loss InformationEstimating Graft Count for 2 Inches of Hair – Hair Loss Information – Balding Blog

Dear Dr. Rassman. I was wondering roughly how many grafts, single to double hairs, would be required to fill an area of 2 inches? I have straight medium weight, dirty blond hair.

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The average hair density is 1250 hairs per square inch (or 600 follicular units). So a 2 square inch area would contain about 2400 follicular units.

For the appearance of fullness, medium weight hair is certainly better than fine hair, and dirty blond hair with a white skin is better than black hair on white skin (less contrast is better). Take a look at the NHI Patient Photo Galleries, where there are well over 300 patients showcased with before and after photographs, and the number of grafts they received to obtain those results. Also, take a look at LA Sportscaster Steve Hartman‘s photos and see if the area you have roughly parallels his. His hair was medium weight, though he has black hair and white skin.

January 25, 2010

Hair Loss InformationHair Transplant Doctors That Charge By the Session vs By the Graft – Hair Loss Information – Balding Blog

Can you please translate this.

I always thought that most hair loss surgeons charged by the graft. However, I noticed the following on a certain surgeon’s website. The surgeon is very well known and highly respected, so I don’t believe he is playing a pricing game, but I have no idea of what is meant by “charging by the session and NOT by the graft.”

Also, how could charging by the graft be misleading, like the wording claims? Please explain what he is trying to say and clarify how you charge.

From a certain surgeon’s website: “At (name removed), we try to keep hair surgery affordable. We charge by the session, not by the graft or hair, which can be misleading and overly expensive.“

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Counting Most hair transplant clinics do charge by the graft. I think the surgeon who made the above statement clearly believes session charges are less misleading and have a greater value than graft charges. At one time, I entertained the idea of doing a session charge rather than a per graft charge, but I ran into a problem working through the details of the charging mechanism. For example, if a person had a session charge for 400-800 grafts and then another charge for 801-1200 grafts, would the person who paid for 801 grafts feel cheated when he knew that someone else paid a lesser price for 799 grafts? I think that a patient would want to know just what they are getting and per graft charges really reflect, in my opinion, the amount of work done and the value in transplanted hair to the outcome. Iin this example, there is almost no difference between a charge by the graft for 799 vs 801 grafts, compared with a big step up in pricing for a session charge.

Charging by the graft is like a lawyer charging by the hour. If the lawyer is honest in his hourly billing, the client actually pays for what he gets; likewise, if the surgeon actually delivers the grafts that he says he transplanted, the same question of honesty is raised by the patient who should ask, “How do I know what I purchased in number of grafts were actually delivered?”. Here’s a few posts about ethics in graft counting that may interest you:

January 25, 2010

Hair Loss InformationDoes Transplanted Crown Hair Grow Slower Than Other Scalp Areas? – Hair Loss Information – Balding Blog

Hello Dr. Rassman. I got a ht done just under 6 months ago and i’ve noticed that the crown has shown little to no growth while the top front half of my head has shown a significant amount of growth. Could it possibly be the crown is the last place that sees the new hair growth?? the difference between the front and crown is very drastic and looks as if no hair was even transplanted in the crown. Im on week 25 so should the new hair in the crown have grown by now or is still too early? also, i still have those little red dots on my crown area but nowhere else on my scalp.

thanks in advance

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Little red dots on your recipient area may reflect folliculitis and this can, on occasion, kill the transplants if not treated in a timely manner. You need to discuss this with your surgeon as he/she has a vested interest in your outcome.

I have often seen differences in the rate of growth from front to back or right to left. I would not worry a great deal if this is a rate dependent variable, unless you do not see the results you expect by the 8th month. I would expect some growth in most patients by now, but again, see your surgeon and discuss your concerns.