Scalp Pimples Weeks After Hair Transplants – Hair Loss Information – Balding Blog

I had 2200 grafts in the front. About 6 weeks later, I noticed pimples breaking out on my head. I went back to my doctor and he put me on an antibiotic which helped for a week and then when I went off the antibiotic, the pimples came back. What is happening to me? Will this kill off the transplants?

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After a hair transplant, spicules of hair are left behind after the grafts have shed. These spicules of hair can be like a foreign body and cause cystic reactions. This process is usually self-limiting and with warm soaks, will disappear over the next month or so. I believe that every person has these spicules in the recipient area, but only a limited number of patients have these type of reactions. The differential diagnosis is important here, namely distinguishing it from folliculitis, which can endanger the growth of the grafts.

You may have heard about MRSA (Methicillin-resistant Staphylococcus aureus), and if this should occur, a culture of these pimples are important to determine the correct treatment modality. There can be iatrogenic (doctor induced) causes where during the placing process the staff ‘piggyback’ one graft on top of another. This is often due to poor quality control processes and if the doctor sees this often, then the doctor may have a problem with his office staff. In less experienced hands, this is an iatrogenic problem so a good solid surgical team with good quality control systems in place will guarantee that this will not happen to you.

If properly treated, these sores will not cause hair loss. Sometimes local drainage with a needle is needed, but usually they will spontaneously drain on their own with frequent warm compresses.

Why Didn’t You Transplant 5000-6000 Grafts For a Norwood Class 6? – Balding Blog

In the piece dated October 19 “Goodbye Combover, Hello Hair!”, I am critical of your choice to limit the graft numbers. You should have performed 5000-6000 grafts in a Class 6 patient. Why didn’t you?

Here’s the post you’re referencing.

The number of grafts that were transplanted on this patient was the maximum safe amount that could be harvested, reflecting the density of this man’s hair in the donor area. If the grafts were cut down to single hair grafts, the number would have been more, but the amount of hair would have been the same. Some doctors would have cut the follicular units down to single hair grafts to make some more money out of the patient (since they charge by the graft). Not only will that not produce more hair, but it would be unethical to milk this patient’s pockets for more money. Cutting the grafts down would have yielded less hair in the long term, as all of the cut grafts may not grow as well.

With his fine hair character, this patient needs 5000-7000 grafts to get excellent coverage. On the day the initial blog post was published, I repeated the procedure and only got out 1706 more grafts — again, because that was what was safe (there are no results photos yet, as the procedure was just over a month ago). Each person is different, and while some people have enough scalp laxity to allow for a larger strip (with more hair), some people will only have enough for a smaller strip.

The photo on the left is before; the photo on the right is after one procedure of 2590 grafts. You should note that the transplants were artistically weighted to the frontal area to produce the best frame for his face and distributed to the back with a much lower density to reflect the limited number of grafts. Click the photos to enlarge.

 

More photos of this patient can be see at the original post –Goodbye Combover, Hello Hair!




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I Had 3 Procedures and Now I Want to Shave My Head – Hair Loss Information – Balding Blog

I have had 3 procedures over the past 9 years. My total transplant count was in the range of 5000 grafts. I have had very poor results in terms of density.

I am ready to shave my head and have seen photos showing what I should look like with ashaved head. I am happy with the look. I know that my donar scar will be visbible but I am ok with that. My question is regarding the liklihood that my recipient area will be detectable as having had grafts when shaved bald. I have no visible scarring there that I can see but am still concerned about this. Can you or anyone else offer some guidance/comfort so that I can proceed. This has been an enormous daily battle for me for many years. I have considered going to a hair transplant specialist and asking for some type of magnified examination of my recipient area, but other than than Im not sure how to know. I have hair up there but its too thin too really work with. Any feedback would be greatly appreciated.
Thanks

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I really cannot give you much assurance, since I haven’t seen your hair transplant or your scars. Some hair transplants may leave some degree of scarring in the recipient area that may be detectable when you shave your head. To be honest, the only way to tell is to go for it — but before you do this, you should sit down for a face-to-face with a doctor who is experienced in this type of problem and examine your options in detail, one on one. I would be pleased to do this with you and it is may even be worthwhile for you to come to Los Angeles where I will personally evaluate your situation. Considering all of the money you paid for what you describe as poor results, the cost of such a trip is nominal.

Hair Loss InformationA Week After Transplant, I See Small Hairs Falling Out With the Scabs – Hair Loss Information – Balding Blog

Hi, I had 500 grafts to the temples 12 days ago. I have been washing the recipient area almost every day, and gently dabbing the shampoo on and off but some scabs still formed. I began very gently running my fingers over them when dry (but certainly not pulling them) by about day 7 and noticed some easliy fell out but with small hairs attached. Is this my grafts coming out?

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We all worry about losing hair grafts after the surgery and that is the basis of your question. It is an important question; so important that NHI did a major study on the subject and the best answer to this question is for you to read our article on this subject — Graft Anchoring in Hair Transplantation (PDF file).

Hair Loss InformationMy Transplant Doctor Suspected an Infection After Surgery, Now I Have Dead Skin Areas – Hair Loss Information – Balding Blog

Hi, after recent hair transplant, I had severe swelling in my donor area and the Dr had to cut off a some of the sutures on the 7th day as he suspected an infection. Antibiotic ointment and medication has helped heal the donor area, but I am left with an area of dead skin, where there is no hair! This is on an area about 2cms wide and 5cms long, just on top of either ear. My Dr says that he can fix it by re-doing the scar in a few months or optionally by transplanting some hair in these areas, again after a few months. In your opinion, which is a better option? Your advise will be sincerely appreciated. Thanks and regards

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You describe an unfortunate, but a real and relatively rare complication with the surgery. I am not clear if what you refer to as “dead skin” is really “skin necrosis” or hair loss seen around the donor wound on the scalp that is not necrotic. Small areas are easy to treat, large areas can produce problems. You should bond with your doctor on what is going on and get comfort from him/her on the plan for you over the next month or two. I suspect all hair transplant doctors have had some scalp healing problems at one time or another. Assuming that the problem is minor and you have bonded with your doctor, the best advice I can give you is to be patient and let time work in your favor. While it may be an inconvenience, if this is just hair loss in the donor area and it is not too extensive, the hair you lost may come back after 6-10 months. If you really have a wide necrotic area, then clearly waiting without adequate physician management is not the correct course. Without seeing you I can not make a firm recommendation other than for you to connect with your doctor and follow his/her advice, or get another opinion if you can not or do not wish to continue the relationship with him/her. In discussions, you should ask about healing, timelines, a worst case scenario, etc..

Can Hair Transplantation Damage Surrounding Follicles? – Hair Loss Information – Balding Blog

Hello,

Great informative blog. I have a question about future density after transplanted hair. Does your thinning hair follicles around where transplanted hairs gets inserted die from having that area worked on? In other words, say you still have some hair left on you hairline or mid section and you use transplants to help fill that area. When you use Propecia or Rogaine to help thicken your original hair follicles does that hair get “damaged” from having transplanted hair around them?

Thank you for your time and keep up the great site you have.

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You raise a very important question. Yes, you can potentially damage the existing surrounding hairs with a hair transplant procedure. Thus, you must consider the risks versus the benefits of the surgery. Most of the time, hair transplantation near normal hair should not damage the normal hair, but if the surrounding hairs are weak (miniaturized) you may precipitate a “shock loss” phenomenon where you will experience loss due to the trauma of the surgery. Although drugs like Propecia work to minimize the shock loss risk, your doctor must not talk in generalities with you and should specifically address your risks. You must discuss this risk with your physician before a hair transplant surgery.

No Growth After 3rd Hair Transplant Done 7 Months Ago – Hair Loss Information by Dr. William Rassman

i had a transplant on april 9 from a very reputable clinic. i have absolutely no growth plus i have lost much more hair. i have been on propecia for 5 years. this is my 3rd transplant. is it possible there is a delay because it is my 3rd transplant. or is it possible i will get no growth at all since it has been 7 months already without any growth whatsoever. around the donor site there has been regrowth. just none in the transplanted areas.

You need to discuss this with your doctor and view the photographs carefully from 7 months earlier. I have had patients not see the hair grow out and when comparing to the before photos, their after photos showed remarkable growth! I suggest waiting for a full 9-10 months before drawing any conclusions on a failed hair transplant. With regard to hair loss, again, look at your before and after pictures and speak with your doctor. If you are still having a problem after meeting with your doctor and passing the 10 month mark, then seek a second opinion if your doctor has not given you a satisfactory answer to your concerns.

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Concerned About Redness After Hair Transplant – Hair Loss Information by Dr. William Rassman

I am a 30-year old male and one week ago, I had a FUE Hair Transplant along my front hairline. I am concerned that there may be lingering redness in this area which will make it obvious that I had a procedure performed to co-workers.

In addition to products such as Vitamin-E, Aloe Vera, etc. to reduce redness, what are your thoughts about using a self-tanning lotion along the top of the forehead/hairline to blend the redness in this area to my natural skin color (assuming I used the tanning lotion on the rest of my face as well and didn’t go overboard with it)?

Assuming I waited a couple of weeks after the surgery, would the tanning lotion in any way harm the future growth of these grafts or pose any other risks?

In those patients who have a tendency to become red (and hold on to the redness after a transplant), I treat them with a copper peptide treatment. This works to reduce the redness and shorten the ‘red’ time, but if not started immediately, it will not have value. The use of steroids are routine for my post-operative period and when they are started at surgery, they do reduce the redness.

As for the other products you asked about:

  • Tanning lotion — I do not believe that this will work
  • Vitamin E — this may have limited value when used topically
  • Aloe vera — this does not help manage the redness

These are really questions that your transplant doctor should be addressing. I can not offer you much real advice without knowing more about you, but I may be able to come to a solution if I saw you in person.

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Hair Loss InformationPoor Growth 6 Months After FUE Procedure – Hair Loss Information – Balding Blog

Dr. Rassman,

It has been a little over six (6) months since I have had FUE surgery. I had approximately 900 grafts done. My surgery was with a well respected doctor in the industry.

However, I have experienced poor growth thus far. My updated pictures that were recently sent to my physician showed lingering redness in the recipient and poor growth. My doctor responded that he was concerned about the lack of growth, and suggested that I have biopsy peformed if there is no improvement in the coming months.

Is this necessary and what can I expect a scalp biopsy to show as far as poor growth is concerned? It seems to me that not enough grafts were placed to begin with and that I may have experienced poor growth due possible transection of some of the grafts. Some areas are growing in better than others. What do you think?

Thanks

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I really cannot tell you what is to be expected and what is poor or good growth without examining you. Not being your doctor puts me at a great disadvantage. It seems you are in good communication with your physician and I would recommend that you follow up with that doctor. Sometimes the full growth may take as long at 12 months.

I believe that follicular unit extraction (FUE) has problems, even in the hands of good doctors experienced in that form of art. Notice that I said the “form of art”. I believe that FUE is a form of art in the way it is done. I have received many reports of failed FUEs and have spoken to doctors who are skilled in this ‘art form’ and they report hearing of many failures amongst the doctors procaiming to be experts in it. For example, I know of one doctor who is well known for FUE (he heavily promotes the practice expertise) and states that the speed for doing them exceeds an extraction rate of over 1000 grafts per hour. I would say, off hand, that this doctor’s failure rate must be huge. Not knowing your physician’s experience, I can not comment on your doctor, but you should be able to meet many of his/her patients to determine his/her success rate.

For more on FUE / FOX Procedure, please see: