Category: Post-Operative

i did a temple transplant a year ago, the left side hasn’t progressed at all. it is just light red, but no hairs. on the right side it has grew alot but it is still a bit red. how is it that i can’t see any progress at all on the left side?

You should speak with the doctor who did the surgery. At a year out, there should be full growth and no discoloration of the skin.

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Hi Dr. Rassman,

I had an all FOX procedure at your San Jose office in August and am anxiously waiting for my grafts to grow. I just found out I have a case of the shingles (2nd time — first was six years ago) and am worried that this might affect my results.

Is this something I need to be concerned about? The shingles are confined to a small area of my lower back. I’m 41 and in good health otherwise. I’d appreciate your feedback.

Shingles (otherwise known as herpes zoster) is a painful, blistering rash caused by the chickenpox (varicella) virus. You can only get shingles if you have previously had chickenpox. After having chickenpox, the virus lies dormant in the nerves, and shingles occurs when it is revitalized in one particular nerve to the skin, thus explaining the way it affects a clearly demarcated band of skin only (in your case, your lower back). Having shingles does not mean you have active chickenpox or are contagious.

With respect to shingles affecting your hair transplant, you should not be concerned. It should not affect your transplants or your hair growth.

Take care of your shingles, and I wish you well with the recovery.

i had 1200 graphs put in one week ago. after reading your blog, i wish i had done them with you. i was planning on another 1500 or so in my next procedure and i will come see you first for sure. so you will be seeing me about 12 weeks from now. unfortunately, today i was getting into my car and hit my head on inside part of my car door. ( again i am one week post op) i hit it relatively hard…when i reached to see if there was bleeding( i hit in the area of my recepient site) it was bleeding. I did not stop bleeding for about 35 minutes. Did i likely dislodge new transplanted graphs as well? The cut is about 2 inches long, not very wide not too deep. After one week am i likely to have dislodged graphs? i did not see any follicles, but you never know? your opinion?

It is difficult to answer your question without examining you in person (you’re in Los Angeles — we’re in Los Angeles). That being said, the hair grafts are generally considered permanent after the first couple of days. It is very, very difficult to dislodge a graft after they get set-up and I have seen people get lacerations of the scalp from accidents at about 1 week and when I examined them, all of the grafts were intact and in place (unless they were inside the laceration itself). If you did not see any grafts, you probably did not do any significant damage. However if you have a cut on your head, you will get an inevitable scar and hair may not grow on the scar.

If you do decide to make an appointment to have your injury looked at, please mention this blog entry to me (or to Dr. Pak, who is a contributing editor to this blog).

I had a HT from another surgeon about 4 years ago. The numbness area has still not gone away after 4 years. I was told it would take 3 months to a year. Is there still hope for my nerves to reconnect on their own? If not, is this correctible by surgery or any other methods?

Thanks.

Numbness after a year reflects some nerve damage. I would want to know where you are numb. There are nerves in the back of the head than can be damaged from surgery. They are the greater and lesser occipital nerves, temporal and third occipital nerve. The following image shows the major nerve distribution and it may correspond to the area where your sensation is impacted:

As you can see from the picture, these nerves specifically cover different areas of the scalp. If any of these nerves are injured, a sensory defect will reflect the nerve’s distribution. We are fortunate that these nerves overlap in most people, and if one is damaged, the other has a distribution that covers the damaged nerve. It sounds like your back-up system did not work.

After 4 years, the nerves usually are dead, so that surgery (which is very difficult anyway) will not work. If there is pain in these nerves, then there are things that can be done to alleviate the pain, but usually after 4 years, all pain should have gone away.

(image source: eMedicine)

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i had a procedure done at another clinic yesterday. they advised against washing the recepient (graph) sites for two days. essentially allowing scabs to heal and fall off two weeks later. I am in the public eye(professional speaker) and had to have a thorough celeaning today. So i di wash my scalp today against there written directions. i was able to see the removal of 75% of the one day old scabs and it looked like 8-10 graphs came out as well. I did not sit under the shower i used the cup pouring method and the gently rubbed the scabbs with my figertips..am i alright or did i maybe wash away my follicles unknowingly? again i saw about 8-10 in my scalp dislodged after the shower. did not look like many came out…no bleeding whatsoever by the way. your thoughts?

I always have the hair washed within the first day after surgery and offer that process in my office for our patients. The key to a fast recovery is to get the scabs washed off fast. The longer they stay in, the longer you must be gentle with the wash. In the hands of a professional wash, the wounds will be very clean by the very next day. We also wash it vigorously at the end of the procedure to get all of the crusts off quickly. Unfortunately, many doctors do not focus upon getting you looking spiffy in a day after the surgery.

This patient below came in one day after surgery and the pictures were taken immediately after he had his hair washed. The recipient area has an obvious pink hue against his white skin. His native hair was long enough (I told him not to cut his hair prior to the surgery) to cover the entire transplanted area when he combed it forward. White skin shows pink clearly and had his skin color been tan, the pink hue would not show much or at all. As you zoom into the picture, you can see the transplanted grafts and the hair contained in those grafts clearly without any crusts to increase the detection of the transplant in the bald scalp. People who have native hair with grafts transplanted between the hairs have automatic coverage from the native hair and the transplants can be completely hidden. Within a few days, the only evidence of a transplant will be the beard that appears in what is now the pink area. Click the photos to enlarge.

hello
i had the strip procedure done about 3 months ago with 1500 grafts. within the first two weeks many shafts fell out as is normal, however about 80% of them have not. i am unsure if this is normal and if these grafts will eventually begin to grow.

thank you for your help and this wonderfully informative website.

If the hair is still there but not growing, it just means that the shedding has not taken place. These hairs are dead, but new ones will arise in the next few months. Those dead hairs will eventually shed.

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IS there a correlation between how well transplanted hairs “took” at first, and the eventual yield?

The reason I ask is, I’m about 4+ months out from a 1,200 FUE session and I have seen little/no evidence of growth yet. But, I remember in the first couple weeks after my procedure, I felt and saw a whole lot of hairs as nubs, and they grew a little before falling out. If the hairs held at first, and even grew, can that be an assurance (or at least almost an assurance) that everything was done properly and they’re going to come back and grow for real? or is it still possible to end up with poor yield even if the hair looked real good at first?

At 4 months, I would not have expected much hair to be there. Between the 4-5 month, you should see hair growth and by the 7-8th month you should be in the combable hair stage. By the 12th month, expect over 95% of the grafts to have grown.

It is rare to have no graft growth if your surgery was performed by a doctor with an experienced team. A complete failure of the transplant in the hands of such a team is very rare. Those hairs that appear to grow in the first 2-3 weeks after the surgery (those short hairs that feel like a beard) are really just being shed and contrary to what you see, they are not growing. These hairs sometimes remain in the head and are not shed in the first month, but most times they do not grow either. Any residual hairs that look beard-like will almost all shed by the time the actual transplanted hair grows.

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