Category: Hair Transplantation

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Hair Loss InformationFixing Past Hair Transplant Mistakes (with Photos) – Hair Loss Information – Balding Blog

This is a patient who I just performed a corrective procedure on. There were many mistakes made here in the past with his other doctors and I wanted to share those problems with you. Knowledge is power, and I hope this will teach you what to look out for so you can prevent them from happening to you. So let’s jump right in…

The Problem

First, let’s take a look at the “Before” photos (click to enlarge):

 

  1. The patient had received around 3000 grafts total in three surgeries on the frontal hairline at another clinic.
  2. The hairline is harsh, without single hair grafts in front of the larger grafts. Plus, these were not follicular units, but the old type of minigrafts of 3-5 hairs each.
  3. The hairline was placed too low and too straight, creating an abnormal edge which made the transplants obvious to the patient.
  4. The surgeon made incisions in the scalp that were not kept in the same place, so the patient had two scars rather than one (see arrows in photo above). The second and third surgeries should have been performed at the same location as the first surgery. The location of the upper scar was too high as well, so transplanting into the upper scar made sense to me.

 

The Solution

Here are the “After” photos, taken just moments after the completion of his surgery (click to enlarge):

 

  1. I transplanted 1637 grafts total (1391 into the hairline and 246 into the upper scar in the donor area).
  2. I built a wide transition zone with only one-hair grafts to break up the leading edge of the hairline so that it would not look transplanted.
  3. I had to lower the hairline to get in front of the harsh hairline created by the other doctor. This brought the hairline almost back to its juvenile position, something that I rarely do, but was forced to in this situation.
  4. Those 246 grafts transplanted into the upper scar (see arrows in the photo above) should almost completely wipe out its visibility, so he’ll have one scar in the back of his head instead of two.

I find it amazing that this happened recently by a surgeon not far from my office who does a great number of such cases. If this patient had asked to meet some of that doctor’s patients, I am sure that this is the type of work he would’ve seen. People just don’t know or think to ask a doctor to meet with other patients ‘one-on-one’. There is no substitute for meeting patients directly and talking to them about their overall satisfaction. We offer an Open House every month to allow prospective patients the chance to meet up to a dozen of our patients who had surgery. A detectable hair transplant is not what you want and it is easy to see the quality of a doctor’s work by engaging with one-on-one patient interviews.

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Hair Loss InformationHair Transplants and Scar Tissue – Hair Loss Information – Balding Blog

I have some questions about hair transplant in skin with extensive scarring. I’ve tried looking for information on this online, but the vast majority of the information available is on transplantation into normal skin, and any information on scarring is generally limited to scarring as a result of the procedure itself. This seemed like a good place to ask.

A friend of mine was in a fire about 11 years ago and has had extensive skin grafts and reconstructive surgery. One of these procedures was an attempt to stretch the areas of his scalp that still grew hair to cover the areas that did not. However, the skin proved to be too thin to completely cover the hairless areas, and he was left with 2 areas of scalp with no or very sparse hair, each about 2″x3″. While he is comfortable with the grafts on his body, I know the hairless patches on his head really bother him. He has jokingly mentioned getting hair plugs in the past, but he doesn’t think his hair is thick enough to provide donor sites, and I think he worries that transplanting into thin or scarred skin would be impossible.

So, basically, my questions are, can living hair be transplanted into large areas of scar tissue? Can hair follicles be harvested without causing other noticeable thin spots, or can it be donated from another person with similarly textured and colored hair?

Thank you!

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Yes, hair can be implanted into scar tissue to provide a cosmetic benefit. We have done that on many occasions, but the status of the skin is critical in making the determination to go forward. Skin grafts, for example, with no thickness to them may not be able to tolerate hair grafts. Your friend’s issues are not unique and there are patients who have had hair transplant surgery to cover the bald areas from such tragedy. We have done many with neurosurgery scars and face lifts scars that easily support hair grafting, but each and every patient is very unique and can pose challenges.

I really cannot answer your question without seeing the patient in person or at least seeing a photograph. If your friend is considering options, I would have them make an appointment with a good hair transplant surgeon to discuss those options. (Also, “hair plugs” is a term used for the outdated procedures done in decades past. Current techniques can create an undetectable result without a pluggy look.)

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Hair Loss InformationCan I Get a Trichophytic Closure After My 2nd Hair Transplant? – Hair Loss Information – Balding Blog

I am considering my second hair transplant as I have developed some baldness since the first procedure. My question is, can the old donor scar be made into a tricophytic scar during the second procedure?

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Yes, the trichophytic closure can be done on the second or even third procedure to try to make the scar smaller. I haven’t written much about the trichophytic closure in recent months, but essentially it is a technique to minimize donor area scarring for those that have a hair transplant using the strip method. You can find photos here and here.

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Hair Loss InformationIn the News – Dr Farjo’s Plea for Age Limits on Hair Transplants – Hair Loss Information – Balding Blog

Snippet from the article:

One of the UK’s leading cosmetic surgeons is calling for age restrictions on hair transplant surgery, after seeing an alarming rise in the number of teenage boys wanting to go under the knife.

Dr Bessam Farjo, co-founder of The Farjo Medical Centre and past President of the International Society of Hair Restoration Surgery, has seen a 23 per cent increase in enquiries coming from men aged 20 years or under over the past 12 months. Some of the enquiries the centre has received have come from the parents of boys as young as 16-years-old.

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Read the full article Plea For Age Limits On Hair Transplant Surgery

I’m glad Dr. Farjo is speaking out about this. I get quite a few emails from teens asking for surgical advice, but you must understand that hair transplantation should not be an option until you’re an adult. It’s not like getting a nose job, where once it’s done, it’s done. Hair loss is progressive.

I’ll give you an example: You know how you can see those old, ugly hair plugs on some men that had surgery many years ago? They likely didn’t see those plugs of doll’s hair at the time, but as the hair loss progressed around the plugs, those very plugs that were adding fullness to their hair eventually became the focal point of their scalp. Granted, today’s techniques are different in terms of appearance, but my point is that your hair loss will likely progress to some extent and you don’t want that touch-up work that you had at an early age be the only thing you have on your head as an adult. This is exactly why I mention the need for a Master Plan. Think long term!

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Hair Loss InformationFUE for Early Stages of Hair Loss? – Hair Loss Information – Balding Blog

Dear Dr.,

I really appreciate your taking the time with this web site and the questions I have sent in that you have answered. I am 29, about to turn 30, and have been on Propecia for about 6 months now, which I started when I saw noticable thinning in the crown/Vertex area. I’ve had good results thus far, some thickening and reversal in the crown area. I have a strong juvenile hairline and in some lighting look like I have a full head of hair – under very bright electric or sunlight my crown looks a bit patchy and there’s a line of thinning/scalp on the top. As I stated in an earlier post, I was turned away from the Aderan’s trial because they said I have too much hair.

My Question is, after I turn 30, what kind of restoration results could I get from an FUE procedure? I’m a bit confused, since you state that extensively bald people should have limited expectations, but that you are reluctant to transplant someone with thinning who wants fill-in work. There is also all the advice I read on the web saying to wait for better treatments down the line if you’re in the early stages of hairloss.

Thank you very much

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I don’t know how much or what type of hair you have, so I couldn’t begin to give you any kind of remote guess as to what you can expect from a FUE procedure. You’re getting ahead of yourself.

Every rule has exceptions and to determine what you should do, first get examined by an honest doctor who cares more about you than his wallet, and if he says go for surgery… come to me for a second opinion (you indicated that you’re not too far from my San Jose office).

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Hair Transplant After Radiation Therapy – Hair Loss Information – Balding Blog

I would like to know whether it is possible to do hair transplants to someone who had radiation therapy for 6 weeks. The area is about the size of the palm of a hand. Balloon expander was suggested… but 6 months and 2 “operations” is too long and not worth the result…or is it?

Thanks for your advice.

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Hair transplants may work in the radiated area, but that depends upon the status of the quality of the skin in the recipient area. I can not render an opinion without seeing you, but it seems like you got advice already from a doctor and an area as large as you report seems appropriate for a balloon expander at first blush.

When I transplant a patient’s hair into an area that received radiation, I often do a test transplant to be sure that the transplants take 100% and are strong and robust.

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Hair Loss InformationSelective Removal of Cobblestoned Grafts via FUE – Hair Loss Information – Balding Blog

This is in response to My Hair Transplant Made My Skin Cobblestoned!

So, Selective removal of the grafts via FUE is not an option to reduce the cobble stoning? I too have this issue, and I only Have a few hundred grafts, not all of them are cobble stoning, maybe a total of 200 are cobblestone. I know FUE leaves a small scar, but would the removal of 2-300 grafts over my entire scalp really be that noticeable? Why do you say more hair transplantation is the only option?

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Follicular unit extraction (FUE) is done with very small punches where a follicular unit is removed one at a time. Cobblestoning is a whitish scar with no hair in it. If you want these white scars punched out, then they will form new white scars, i.e. no gain. Removing the entire larger graft with the cobblestoned skin is the only real way to do this, and the scar that may be formed will probably be less detectable than the cobbled area. Depending upon the location of the cobblestoned area, camouflaging it with a hair transplant may be needed.

This is a very difficult question to answer without seeing just what you are concerned about. Please send me photos and I can be more pointed in my answer to you.

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Did Actor Joel McHale Have a Hair Transplant? – Hair Loss Information – Balding Blog

I just ran across a collection of photos on some celeb gossip site. I never realized Joel McHale from The Soup and Community had hair issues, but his hair looks good now. What do you think, did he have a hair transplant?

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Joel McHale

The change you see in the photo on the left (with an isolated forelock and hair loss around it) to the photo on the right (with a full frontal hairline) is often what I see when I do a hair transplant. I would think that he had a good transplant job done. Now it looks like a mature hairline as opposed to someone going through frontal hair loss. If I were the surgeon, I would have produced a slightly less concave shape bringing down the corners about another 1/4 inch.

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Hair Loss InformationI Can Only See 1% of My Grafts 5 Months After My Hair Transplant! – Hair Loss Information – Balding Blog

Hi Dr Rassman
I had a hair transplant done 5 months ago by a board certified doctor with lots of experience. I recieved 1750 grafts (aprox 4300 hairs estimated). After 5 months it looks like maybe 43 new hairs have shown. The only difference between now and before the procedure, is that now I have a donor scar on the back of my head keeping me from shaving it all. I am very discouraged/upset by this.

In your experience, or to your knowledge, do some people not respond to hair transplants (the new hairs don’t ever grow)? If this is not reported as so, then does the length of time before ANY new hair shows ever take longer than 5 months? I realize it generally takes 9 months or so for the hair transplant to be fully realized, but I was told (and read) that by month 5 significant new growth should be visible. Your answers and info is much appreciated.

Thanks

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Take a look at this patient and watch his hair grow over time. At 5 months after his single hair transplant procedure, he had some short hair growing… and by the 7th month it was styling length. Some people grow faster or slower (by about 2 months). Ask your doctor in another 2 months to judge if your hair growth met his expectations and match it to yours.

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Transplanting Hair Between Fraternal Twins? – Hair Loss Information by Dr. William Rassman

I’m worried that the combination of continued balding and my very fine hair will make it difficult to naturally and densely cover my scalp via transplant. In the case of having a fraternal twin, female family members, or maybe even friends with hair to spare, is it ever possible to retrieve grafts from a donor that is not the patient? Would grafts from a female donor be viable on a male MPB scalp? Thanks!

Unfortunately, transplanting hair from any person other than an identical twin will fail and get rejected. Hair is like any other organ transplant, which would require anti-rejection medication that could lead to further health complications. I’ve written about this process and the medication required before.

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