Post-Operative – Page 48

July 25, 2006

How Will a Patient Know if They Lose a Graft? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

How does a transplant patient know if they have lost/dislodged a graft? Will a lost or dislodged graft always be associated with bleeding and/or pain, or is it possible to lose grafts and be completely unaware. I think for many of your readers who have recently had transplants, it would be helpful/reduce the stress in the interim between grafts falling out and regrowing months later to know what may indicate a lost grafts versus the expected shedding that is supposed to happen. Thanks, as always, for your time and help.

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After the first day (the first few hours by the time you get home) your newly transplanted grafts will have set in and they should not dislodge. If you see something that looks like the pictures on this page, then it is a graft. It would be highly unlikely for these to come out after 3 days post surgery, unless you pick them out. To be a graft, all of the elements of the anatomy should be there.

Some people mistake the hair follicles that come out at about day 7-12 with hair and some surface skin (even with a bulb) as grafts. In a published paper we wrote, the grafts are clearly locked in place at the worst case 10 days after the transplant, or as soon as 3 days after the surgery, provided that all scabing is gone.

July 24, 2006

Hair Loss InformationWhat Procedures Has Dr Rassman Had? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I’m wondering if you could tell us a little about what you’ve personally gone through? I’ve managed to gather, based on reading about half of all your entries (i’m aiming to get through all of them!) that you’ve had a full transplant and that you’re currently on Propecia, but I was wondering if you could elaborte.

Cheers

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In the early 1990s I had three scalp reductions for balding in my crown. I realized after the third (about 8 months had passed) that I was worse off after the three surgeries than before I had them done. Worse off because:

my bald spot returned larger than before I started the first procedure
the skin was fragile, bleeding easily
the scar looked like a Mercedes emblem on my head

I was not angry with my doctor because he had done what others were doing, practicing a standard of medical care that was sub-standard. What angered me was a phone call I had made. I called the authority on this surgery, explained what happened to me and found out that it was a common outcome for many patients. I remember clearly that when I asked him one simple question: What was this outcome not published? His answer was: It would be bad for business. I was sickened. I had personally performed 8 of these surgeries myself, one of them on my first cousin. He was the only one who had the complications of scars and the emblem on his head. We joke about it today and he never loses the opportunity to be dramatic about the impact of the scar I gave him. I transplanted his crown three times to try to make amends, and although he now has great results, he still teases me over his suffering.

Like him, I had hair transplants performed into the scar in the back of my head. I no longer belong to Mercedes and am a free man with a good head of hair. My crown (1600 grafts later, see below) is still slightly thin, but few people notice it unless I call their attention to it. I use a comb-back and the hair in front of the thinning hair covers the bald spot reasonably well.

Click the photo to enlarge.

Because of the scalp reductions I had, it was not reasonable to replace the swirl in my crown so I accepted a change in hair positioning for each of the grafts to enhance the comb-back styling that I had gotten used to. I often do this in people who have a supply/demand mismatch, where the supply is short and demand is high. On some patients where there is no demand mismatch (like with Patient CL and Patient OR), we can replace the swirl.

July 20, 2006

Restarting Minoxidil Months After Transplant – Hair Loss Information by Dr. William Rassman

I had a transplant procedure (approximately 1600 grafts) 4 1/2 months ago mainly to the thinning crown of my head but some to reinforce the frontal hairline. The frontal grafts are beginning to show evidence of growth. The crown graft areas are causing some problems with redness and some sore spots that have been addressed elsewhere in this blog. The itchy red patches have made it impossible for me to continue using Minoxidil. As the patches eventually resolve am I likely to experience benefit from restarting Minoxidil even 5+ months post surgery? I am female and had one transplant 10+ years ago which was very effective at the time and from which I did not experience the same degree of problems with an itchy red scalp. It should be noted that I am 56 years old, with very fair skin and have had fine texture hair throughout my life. I was carefully evaluated prior to this procedure and determined to be a viable candidate for the procedure again. I did find a reputable transplant surgeon.

Thanks for your help.

If you have confidence in your tranplant surgeon, these are issues that the surgeon should address. You need to be examined to make sure there is no chronic infection (folliculitis) or other problems. It is always important to achieve a good patient to doctor relationship and these problems and concerns should be mentioned during your meeting.

With regard to restarting minoxidil, that is not a problem as long as the itching and active inflammation are gone.

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July 18, 2006

Is There a Pill to Prevent Shock Loss? – Hair Loss Information – Balding Blog

What is fallout/Shockloss? Is there a pill or something I can take after surgery to prevent it, or is it temporary and nothing to worry about?

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I just made a post related to this yesterday (see How Long Should I Take Propecia Before Transplant to Prevent Shock Loss?).

Shock loss occurs when the follicle becomes ‘insulted’ by swelling and inflammation, causing the hair to shed from the follicle. The follicle then enters a resting state and may never go back to an active state (if there is genetic balding in that particular follicle) or after a period of time it may go back to an active state and grow normally again. We suggest taking Propecia before the surgery to help minimize shock loss after hair transplantation because the hairs that are genetically impacted have the greatest risk of permanent loss from the shock of the hair transplant process. Propecia minimizes this risk.

July 17, 2006

5 Months After Procedure, Dry Skin in Transplanted Area – Hair Loss Information by Dr. William Rassman

Hello Doc,
First of all thanks for starting this section, it really helps many people who have queries about hair transplant. I have got a quick question as well. I have had hair transplant on 31 january 2006 (it’s been 5 months 15 days). The problem I have got is, I have got too much dandruff in the transplanted area only plus, skin on the transplanted area is also peeling, I can scratch the skin by my nails, I have used different shampoos and conditioners, but, it’s not working and peeling of skin is too much, I am worried, it would not affect the transplanted hair, whih are growing slowly.
Many thanks

A minority of patients complain of dry skin on the tranplanted area. The dry skin should not affect the tranplanted hair, though. A moisturizing cream or hair conditioner should take care of the problem. Periodically give yourself a good lanolin application (standard hand cream) and then wash it off with a conditioner for dry skin.

July 14, 2006

12 Days After Transplant And Hairs Haven’t Fallen Out Yet – Hair Loss Information by Dr. William Rassman

First – thanks for a wonderful blog!

It’s been 12 days since the transplant procedure and while almost none of the transplanted hair have fallen out yet, much of the transplanted fat tissue (I assume) is still clinging in small beads to the hair. Is this the “crusting” that many people write about? Any suggestions as to how to remove it – or is it just a matter of time before it comes off.

Also curious is that the small hairs have not fallen out yet… assume this is normal and just be patient and wait for them to fall out? Seems like the key to this whole process is to get on with your life and check your head in 8 months!

The crusting by this time can be removed by washing and then with the hair wet for a good 10 minutes, layer conditioner on the crusts and let it sit there about 10 minutes. Then, gently with your finger tips, rub these crusts — you should see them fall out. There is little danger in losing the grafts at this stage in time as long as you are gentle. The little hairs will generally fall out between 10-25 days after the surgery.

July 13, 2006

Rapid Growth in Frontal Area, Slow Growth in Crown After Transplant – Hair Loss Information by Dr. William Rassman

I had a 1565 follicular unit transplant 3.5 months ago and I seem to be experiancing a more rapid pace of growth on my frontal hairline compared to that of the growth on my crown. I am curious to know weather of not this is common and if the number of hairs within each follicular unit impacts the rate of growth? The doctor who operated on me put 3 and 4 hair follicular units on the crown and 1 and 2 hair units in the frontal region.

Almost every patient will experience varied rates of growth by where in the scalp you are looking. I have seen the crown exceed the frontal growth rates and visa versa. You must have patience. Generally you can expect newly transplanted hair to grow within 8 months. You seem to have a relatively early growth and I suspect the transplanted crown area to catchup.

July 10, 2006

I Want to Lift Weights 2 Weeks After Hair Transplant Surgery – Hair Loss Information by Dr. William Rassman

regards doctor, my question is i have had a my surgery 2 weeks ago and have my staples removed I am going to wait a month to lift heavy waits but I am still concerned that it might be too soon and will stretch the scar and if so how much will it stretch or bleed. Really worried about that. and will working out heavy affect my grafts?

Working out will not impact graft growth, just the risk of scarring in the harvested donor area (assuming you had strip harvesting). I tell my patients that they can run a marathon in 7 days, but hold off anything that works the trapezius muscle as it might potentially stretch the scar in the back of the head.

July 7, 2006

Dead Skin in Recipient Area After Transplant – Balding Blog

Hello Doc

I had my hair transplant done about 1 and 1/2 months ago. Couple days ago i went to see a car race. It was 98F and i was wearing a baseball cap. I stood in the sun for about 15 min and i was sweating badly coz of the heat. I went to mens room to cool off and sprinkel some cold water on my head. When i took my cap off i saw sweat dripping off my fore head and there were like white tiny things on my forehead (transplanted region). I wiped my fore head i didnt see any thing on the paper towel.I am little concerned, Were they roots of the new transplanted hair? Or just the skin.

Thanks very much for your advise.

You may have left some mild crusting still in the recipient area. When washing is not vigorous, the dead skin accumulates in the recipient area and needs to be washed off when shampooing. The sweat accomplishes the same thing. Don’t worry, be happy! The exciting times are yet to come as the hair grows in.

July 7, 2006

Donor Scar Healing After Transplant – Hair Loss Information by Dr. William Rassman

I had roughly 2600 grafts done 5 weeks ago. Although the donor scar has healed on the ends, the middle part of the scar right at the back of my head hasn’t healed and is a little weepy.

Is this normal? Typically I heal very well after injuries, etc.

Thank you.

If part of the scar is weepy (wet) then go back to your doctor. You could have an infection present. Wet wounds in a scar 5 weeks after any surgery is not normal.

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