My Transplanted Hair Never Grew, But Also Never Fell Out – Hair Loss Information by Dr. William Rassman

Hi,
I had a hair transplant about 7 months ago. What I noticed is that the transplanted hair which never shed has remained but I have yet to see any other growth. The hairline looks sparse and not what I was told that they would achieve, which is thickness. Can the transplants still develop or will I expect to see no more improvements.

Thank you

At 7 months after surgery, I would expect to see most of the growth. Wait a few more months and if there’s still nothing, then ask your doctor what went wrong (I am taking what you said at face value).

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Wearing a Hat After a Hair Transplant – Hair Loss Information by Dr. William Rassman

hello doc, I have to questions

i recently had a HT via FUE on thursday, today is tuesday so it has been 5 days so far. I have been wearing a hat and realized that it was breaking off a few transplanted grafts. When I look closely the stub of transplanted hair is still in my scalp but the rest of it has broken off. Do you think I killed my grafts this way?

Another Question. I washed my hair on friday night (next day after ht procedure) but then i read some where that I wasn’t suppose to wash it for 3 days. Could washing my grafts with a sponge and water next day after HT damage the grafts completely?

Thank you for your time

HatI suppose if you see stubs of hair follicles out of your body with bulbs on them, it could reflect grafts and if that’s the case, what you lost will never grow. I’m really not sure what you’re seeing. A tight hat can pull out grafts, though the grafts should’ve been secured by the 5 day mark. I don’t know enough about your surgery — like where you had your hair transplant or what was really done.

You can wash your hair 12 hours after the surgery. As always, I am happy to answer all questions, but sometimes questions like these bother me. Why are you not asking this to your doctor? Why haven’t you got instruction on how to wash your hair after a hair transplant? Special instructions should’ve been supplied to you for the washing technique.

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Experiencing Problems with Grafts Put Into a Scar – Hair Loss Information by Dr. William Rassman

Dear Dr Rassman,
I recently had about 420 grafts put into a scar that was about 10mm wide and 100mmlong. Some of the hairs that were implanted in there (this is from about 4 months ago) are still in there. They haven’t grown, and are just sitting there..they are bent as well, where the growth has stopped. What does this mean?

Also, I keep getting scabs in the scar tissue where the hair was implanted. Would this be because my body is trying to remove those hairs that have not shed(but not growing), and does hair that grows in scar tissue cause the scar to scab, when breaking through the scar? Also, I was told i’d have to wait 18-24 months before most of the growth. Do you agree with this?

thank you

First and foremost, I would go back to the doctor who performed your surgery for a recheck. He/she should be able to answer your questions more specifically as it relates to a procedure they were a part of and know more about your overall health.

On average, it takes 6 to 12 months for hair to grow. Hair growth in scar tissue tends to be slightly slower than in non-scarred tissue, and in general, it is thought that hairs transplanted into scars do not grow as well as hair transplanted to normal scalp/skin. There is no study to prove one way or the other if that is true, though. In a few cases where I transplanted a small number of grafts into a scar and counted them at full growth, 100% of what I put in grew.

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Hair Loss InformationDisasterous Hair Transplant Horror Stories! – Hair Loss Information – Balding Blog

Doll hairI saw two patients recently that are worthy of discussion here…

Patient #1:
He had a typical result from the hair transplant surgeries of the 70s, 80s and early 90s. He had hair transplant plugs in the early 90s which gave him a doll-like hairline in the frontal area. I have worked with him over a 10 year period with four surgeries to remove and thin out the 3 inch wide plugs, redistributing the hair from the plugs to other adjacent areas in an attempt to make them less detectable. He is about 80% closer to his goal over what he had when he first came to see me and now wears a crew cut, but he is still frustrated over the remaining plugs which still bother him when he looks into the mirror every morning. I will continue to work with him, thinning out more plugs until he is satisfied that he looks normal. He shared what it has been like over the past many years, as too much of his life focus revolved around his head and his freaky pluggy look. Fortunately he and I put together a Master Plan 10 years ago to get him back to a normal appearance, and even now, after a decade of my working on him, the process will continue.

Patient #2:
This man has a far worse story. This young man (in his 30s) has had hair transplant work by many doctors over 10 years. Unlike patient #1, he never had a Master Plan and always sought out the best doctor who promised him a quick fix and he believed what the doctors told him. In the midst of the process, he even had a brow lift to raise a hairline that was too low, leaving him scarred in the hairline area. A series of transplants to fix the hair loss from the brow lift in the frontal area failed, compounding the problem further. The donor strips that were taken in the back of his head were all taken in different areas of the scalp and they all stretched and widened substantially. It seemed that the doctors just kept on removing donor hair from different areas to avoid the wide scars previous doctors created.

This man paid tens of thousands of dollars and each successive surgery seemed to leave him worse off. The recent transplants apparently did not work and he asked me if there was something wrong with his skin and recipient areas. I asked him if he called the doctors who did the failed procedures and he said he did call them over and over again, but they never returned his calls. Now he is massively scarred in the back of his head with at least three wide scars each measuring over 1/2+ inch in width. He received body hair transplants into the scar, but the difference was marginal. Each “fix” addressed one problem in isolation of the other problems, resulting (at times) with him being left worse off in the total scheme of things. I don’t know what he will do, but I suggested that he consider working with just one doctor, and building a Master Plan to deal with his problems. One option might be balloon expansion of his scalp to remove the scars in the back of his head by stretching the normal scalp in the crown of his head. The use of balloons to stretch the scalp will take at least 8 weeks of constant inflation of the balloon. If he wanted us to do it in California, he would either have to move to California for the period that the balloon expansion was being done or find a local doctor willing to do the incremental expansion of the balloon in his home town. We have done similar patients with outstanding results, but the commitment of time is substantial. What I gave him was a Master Plan to get him back to a manageable state. Anything short of such a radical approach will just victimized him again and again by some of the doctors who see $$$ in each successive procedure that they can offer him. Too much of his life is being centered around his scalp and the various poor choices he made.

Conclusion:
I often end with the statement: “Let the Buyer Beware,” which is so appropriate in this situation. Doctors are not immune to being scummy. I unfortunately see horror stories like this almost every week, and I post these as a way to educate you (the consumer) so that you can make informed decisions and avoid being taken advantage of.

How do I end a post like this positively? Well, today’s hair transplants in the hands of good and honest doctors are spectacular. At last night’s Open House event in our LA office, Steve Hartman (CBS Sports announcer and radio show host) who is himself a hair transplant patient, told me that not only was his procedure undetectable, but that he and many of the patients who were there looked like they never lost a hair on their head. Those horror stories I wrote about above rarely happen today. There are rotten applies in every barrel, but there are many really great doctors also in that barrel. You just have to do your research before you jump.

Could I Have Body Hair Transplants with a Strip Method? – Balding Blog

Dear Doc,

I have heard of body hair transplants and read that they are not a reliable form of surgery due to the body hairs being weakened during extraction. However, because the body hairs are being removed with a hole punch type of instrument that may damage them, could significantly better results be attained if the body hair grafts were removed via a strip method? Let’s say the patient did not mind have a scar on their thigh as long as the strip provided enough grafts for his needs. In my case, I am thinning in the crown and anticipate that I will require far more grafts than my donor supply. Thanks

Body hair transplantation is not a gold standard method to transplant hair to the scalp, because body hair looks and behaves different than scalp hair. Damage isn’t the problem — hair growth cycles are. Only about 50% of the body hair is in growth stage at any one time, so the hair-for-hair yield is 50% rather than 90% plus as with the scalp donor hair. In other words, you won’t see most of the hair at the same time… and the hair that you do see will look different from actual scalp hair. Body hair does not grow long and has a different texture than scalp hair. To directly answer your question, yes you may find a doctor willing to do it, but the above material is presented to try to get you to think through that decision.




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Could This Be Shock Loss Behind My FUE in the Hairline? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,

First I would like to take this opportunity to thank you for this great website.

I have two questions and i would be very greatful if you can answer them :

1. I had an FUE procedure done on the front area (frontal hair line)with approx. 1200 grafts before three months ago, the strange thing that i am experiancing is some hair loss in the area behind, which is in the mid-scalp area, is this shock loss? shedding period? or the normal genetic hair loss pattern? and how can i tell the difference between them?

2. If your answer to question no.1 is shock loss then can you tell me what is the solution for it? and is there any chance of hair regrowth for those that were lost? (By the way i have used propecia for 12 months before a few years ago but with no success and i experianced terrible testical pain)

Thank you and Best Regards.

If you were not on finasteride when you had your FUE procedure, it would almost be certain that you had shock loss. You should have worked this through with your doctor prior to having the surgery. I always assess the status of the hair behind the transplant recipient site and if it showed significant miniaturization, one could have predicted this outcome. I would need to see you and understand what the loss area shows now.

I would also have considered lower doses of finasteride, which may have allowed you to use the drug without the complication. One quarter of a pill finasteride (0.25mg) can be effective at minimizing hair loss from shock.


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My Hairline Was Transplanted Too Straight – Balding Blog

Hi Dr Rasman – many thanks for the very appreciated blog.

2 years ago I underwent an aggressive hairline FUE procedure – 3,000 grafts all in the hairline with temple closure.

I’ve recently started shaving my head and, despite the white-dotted donor area, I feel much better about myself. I’d love to continue shaving my head – the problem is the recipient area. My recipient hairs, though not particularly dense, are much thicker than the natural hair behind them and begin with a very sudden, ‘flat’ line. The texture of the skin is bumpy and *may* form a small ridge at the start of the hairline; it’s difficult to tell whether it’s scarring, or just hair follicles pushing up the skin.

If I were to remove the grafts, is there any hope of restoring a natural-looking, albeit bald area where my current transplanted hairline is? If so, what sort of treatments would you suggest?

Thanks again for the site

Oh wow! 3000 grafts to the hairline and temples does sound very aggressive, if not impossible from my personal experience. The bumpy skin texture you describe can be scarring from your surgery and if it is scarring there really is no treatment for it. I am not implying you had a bad surgery, but hair transplant surgery is not reversible. Hair transplant surgery is permanent and you need to have a good foundation and understanding of what you are getting yourself into, as well as the long term complication and issues (such as scarring and shaving) before you regret the decision.

There are doctors who do 3000 grafts routinely in a small area of the frontal line and I have seen the work. The hairlines I have seen are straight and many times I doubt that the patient actually got the 3000 grafts they paid for, which makes me question the integrity of the doctor. These hairlines can be repaired by creating a good transition zone in front of the harsh tight hairline, but that assumes that the hairline was not placed too low in the first place. Often in some of these patients the hairline is too low, making a good repair very difficult. Each case is different and I would love to see you either in consultation or good digital photographs of your frontal hairline.




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Surgeons and Multi-Blade Scalpels, Part 2 – Hair Loss Information by Dr. William Rassman

This is a follow-up to Should I Avoid Surgeons That Use a Multi-Blade Scalpel?

Your explanation makes perfect sense to me, but what does the “other side” say? Surely, a surgeon who would use a multi-blade knife (even an 8 blade) has some justification for its use. He would also have to have a reason ready to give to prospective patients to justify his selection if asked about it.

If I went to Doctor X who is using an 8 blade scalpel, for example, and said to him “Doctor, with all due respect, why are you using that? Doesn’t it cause unnecessary damage?” I don’t think he would say “well, I use it to save time.” I’m sure he would have a valid reason, if only in his mind, of why it’s really better. Do you know why their camp thinks the multi-blades are better and choose to use them besides “saving time?”

ScalpelThe only reason to use a multi-bladed knife above 2 blades relates to the time efficiency of the work, the need for less well-trained technicians, and the surgeons ability to do more grafts with less staff. The real expense however, is in the damage done to the hair and the hair that is lost. There are no patient benefits when using an 8 bladed knife (for example) over visual dissection of the scalp under a high-powered microscope.

One surgeon (about 15 years ago) presented a paper before the ISHRS which essentially was titled, “How to do 1500 grafts in under 10 minutes“. What I saw was akin to a sushi knife carving up the scalp with no respect for the hair. I asked myself if a ‘blender’ that I use to chop onions with would work as well? I would guess that the kill rate for hair exceeded 50% using this “method”. The surgeon was somehow content or fooled himself into believing that what he produced was quality grafts. I am afraid that the answer to your question is that there is no rational explanation for use of multi-bladed instruments unless there is some unique breakthrough.

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Did I Experience Shock Loss Months After My Hair Transplant? – Hair Loss Information by Dr. William Rassman

Hi Doctor,

thank you for the fantastic work you do helping people with their hairloss concerns.

I have had 3 surgeries (1500, 1500, 1000). The last being back in Febuary and the one before that about 11 months prior to the last. Anyway, Im on finasteride 1.25 mg daily, and i use regaine foam daily.

My question is that my hair was looking remarkably thick in the front and temples up until a month ago (2 months after my last surgery) . The last 1 month for some reason has led to some thinning in front….I may be crazy but it seems like Ive lost a decent amount of coverage/thickness. Im chalking this up to post surgical shock…but the hairs that are being lost are full length hairs. Is this normal 3 months post op ? My hair was looking really good!…and now…just “pretty good” ;) I hoping that my new transplanted hair plus my shock loss hair will grow and get me back to “great” status.

Also, im considering going on .5 mg avodart to replace the finasteride. Ive been on Fin for 7 years…and have recently felt that the results have been stagnated (also, do you recommend 0.5 mg Dut vs. Fin 2.5 mg?)

Thank you so much.

Maybe you are having shock loss… or maybe you are having ongoing natural genetic balding. Usually shock induced loss occurs in months 4-5. I don’t really know what is happening to you without an examination.

I generally discourage Avodart (dutasteride) at this point, because it has not yet been FDA approved for the treatment of hair loss (some doctors prescribe it for off-label use). In patients that are seeing Propecia not retain as much hair in the later years, doubling the dose of finasteride (1/2 of a 5mg pill, provided there are no side negative sexual effects) has been what I’ve recommended. Talk to your prescribing doctor about this. Keep in mind finasteride is not going to completely stop genetic balding.

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Did Writer Dean Koontz Have a Hair Transplant? – Hair Loss Information – Balding Blog

Hello Dr. Rassman! I am a big fan of horror writer Dean Koonz. According to his biography, he had a hair transplant because he was “tired of looking like G. Gordon Liddy.” His “before” picture is here and his “after” picture is here

I don’t know, I’m having trouble believing that those results are from a hair transplant. I’m thinking hairpiece but I thought I’d get an expert’s opinion. I see his picture on the book jacket every day and I can’t help but wonder!

Block Quote

Based on the photos you sent (which I’ve cropped and shown at right), author Dean Koontz’s hairstyle sure is shaped like a bad hairpiece… but that reflects personal taste and maybe it does the trick for him. I don’t know any details about his procedure so I couldn’t really guess as to what is actually going on there. Former Illinois state governor Rod Blagojevich has a similar look and I do not believe that he has a hairpiece.

In the years that I have been involved in hair treatment, I have seen everything imaginable with regard to what the consumer wants his look to be like. It is not unusual for balding men to have facial hair and when many of them get their hair back, the facial hair goes away. With regard to hair pieces, almost nothing shocks me anymore!