Category: Post-Operative

If a patient gets hundreds of pustules (pimples) in the recipient area during the one to three month period following an FUT procedure, what is usually the reason for this? Is it due to bacterial infection of the grafts that occurred during the procedure? How does it bode for the eventual outcome of the transplant?

Thanks

There are many answers to this question. They include:

1. The most common cause of pustules are left over remnants of the grafts that remain in the recipient wounds. The remnants include sebaceous glands which produce sebum below the skin. This sebum has no way out, because the hair follicle has not formed, so there are no pores. The result of this is that the sebum becomes infected. This should not produce hundreds of pustules over a month period. Warm soaks are the best way to draw out the pustules.
2. For hundreds of pustules, one might assume that this is folliculitis caused by infection. It would look mean with lots of redness and erythema in the area. This would require antibiotics.
3. A rare cause of this is an autoimmune disease called folliculitis decalvans. Unfortunately, I have had a few of these patients and the infections are hard to control. This condition usually lets up at about the time the hair follicles grow out, once the pores are established. I have had one patient in the past few years where the recipient area remained mean looking for a year.
4. Infection introduced by poor techniques are uncommon, but I know of one medical group that has this as a common complication.

I have not seen a wipe-out of the hair grafts in #1. Some reduced growth may occur in #2. Reduced growth does occur in #3

I had a hair transplant about 3 1/2 months ago. I was curious if drinking espresso coffee could impact how well the hair transplant grows out. I get pretty zippy from a cup of starbucks espresso. I believe it has 150 milligrams of coffee. I drink atleast one per week. I also drink a cup of tea in the morning. That’s probably another 50 mg. Is this something that could hurt a hair transplant?

Another question I had was that I was taking 2 Vicodins per day for about 10 days after my hair transplant. I had not read the medication instructions because I had lost them. The doctor gave 25 tablets of the Vicodin so I presumed that I should take them all. Could this hurt the growth of the hair transplant?

Thanks for writing such an informative blog. If I had ran into this before my procedure I would have came to you for my transplant. My doctor was good but you are great. Perhaps I will come to you for a second procedure if it is needed.

There is no problem with drinking coffee or taking Vicodin (hydrocodone/acetaminophen) following a hair transplant. Once the pain is gone, I generally tell patients to switch to Motrin or Advil (ibuprofen) for pain relief.

Hello Doctor,

Is it possible for a hair transplant specialist or dermatologist to examine your scalp closely in order to detect if at least some of your hair has come from a fairly recent (1-1/2 years ago) transplant operation (strip, FUs), or is there no way to distinguish it from your native hair. I’ve had 2 procedures in 2 different locations of the scalp and was disappointed with the 2nd. one where I still had a fair amount of hair (20 – 30 FUs per sq. cm.), and would like to know if many (or any) of the grafts are successfully growing.

Thanks very much.

It’s possible that you may have some very slight skin pitting where the transplanted hair is, but if the surgery was done well and you healed well, it would be pretty hard to distinguish the difference.

I am a good example of a completely undetectable hair transplant patient. No one, even from close up with a comb in their hands, can detect my crown hair transplant. Few have ever detected my three donor wounds (all done at the exact same place), even with a comb in their hands. I am a typical example for the hair transplant process, but not the typical example of the donor scar in patients that have had more than 1 procedure.

I’m currently 9 months into my hair transplant, I’m certain the left side is thicker than the right side!

Is this normal?

It may depend on what your doctor did during the surgery. I would follow up with your surgeon.

If the growth is equal in numbers of hairs, you probably will see the two sides equalize over the next month or two. It’s important to note that once hair starts growing, it grows at about 1/2 inch per month.

What is your recommendation for using laser immediately post hair transplant surgery; either hair brush or professional low laser systems?

I don’t have a recommendation for you. Some doctors or medical clinics promote low-level laser therapy (LLLT) to increase hair growth, but we believe that it does not work. We haven’t seen the results to back up the claims. It’s one way for generating revenue for doctors with the power of the MD behind it.

i had a hair transplant about 3 months ago. is it normal to feel a sensation when you had goose bumps especially on your scalp (recipient area)? as if you could feel that the hairs are erected? i didnt feel this prior to my surgery at all. thank you doctor.

I’m not sure what you may be experiencing. If you have hair in a spot you never had hair prior to surgery, maybe you’re feeling your small nerves recovering from the surgery. Ask your doctor to examine you and give you a better assessment.

I had a transplant about 10 months ago. I can feel the stubbles since back then but it doesn’t seem to grow. It’s now 10 months later and it’s still the same. I had transplants before and almost very quickly, i would notice the thickening and darkening from the previous procedures.

This last procedure was my fifth and don’t seem to see a good result at 10 months. By this time my the transplanted hair should be maturing, correct? I now have about less than 3000 grafts done. Each procedure done in the past, the doctor could never extract enough donor. Perhaps it’s my donor area. Any thoughts?

At 10 months following your hair transplant, you should definitely see growth. Unless I am misreading your question, if you had five procedures that totaled under 3000 grafts, that is not today’s standard of care… however, I can not judge what your doctor was doing.

I’m not even sure what kind of surgery you had — strip or FUE. Plus, I don’t know if he was chasing your hair loss, if you were on finasteride, what your scalp laxity was, etc.

Have you talked to your surgeon about why there’s been no growth after 10 months? If you need a second opinion, you can either schedule a visit in my office or see another good doctor if I’m not local to you.

Hi Dr. Rassman,

I’m 4.5 months post-op and noticing some issues in the past 30 days. I’ve been seeing a lot of dry skin/flaky areas all around where my transplant was completed (dandruff like). These patches of dandruff tend fall off in the shower or when my hair is brushed and have hair attached inside them. Today, I noticed a new one formed and I dabbed at it with my finger and it came off! There was three hairs inside the piece of skin and my head begin to bleed where the hair came from. I thought this flaky skin was a sign of the new hair coming through, but why is hair coming out with them and I should surely not be bleeding? I went through the shedding phase the first month; it should not be happening again.

Clearly there is something wrong, but I do not know what is going on without an examination. In general, you should not have these issues. You may have an infection, you may not be keeping your hair clean, you may have a skin condition, etc. These are all wild guesses, though.

Please go see your surgeon. What you’re describing is not normal.