Category: Post-Operative

Hi-
I’m in my early 20s and experiencing some pretty serious thinning across the top of my head. I’m curious what doctor(s) you’d recommend I see in the Chicago area. I heard about a place called the Chicago Hair Institute but I don’t know if it’s credible.

Also – I’ve been wondering why grafts don’t fall out after surgery. Would you expect to see a few of them fall out as the scabs come off?
Thanks!

The best way to find a doctor in your area is to check out the physician search on ISHRS.org. That may not tell you the best doctor, but it is a list that you can shop from. Remember to do your research before chosing a doctor.

After a hair transplant, some of the hair will grow and grow and grow to full length. If you are not careful, pulling off the scabs before they are ready could cause you to lose the grafts or the hair. Usually, the hair falls out only to regrow in about 2-5 months. Transplanted hair does not have the gene for hair loss so it grows for the entire lifetime in most people.

I had my HT surgery 1 week ago. My scalp is still pretty scabbed up. My concern is that when Im in the shower (or when i pick at my scalp), I continually see what looks to me like the implanted hair coming out with the scab. I understand that the hair would be lost following the surgery, but I thought that was when my scalped was healed, not during the healing phase. Am I overreacting or am I losing grafts?

Essentially, when the scabs are gone, the risk is over. That generally takes 5-10 days, depending upon the fastidious washing technique. We promote aggressive washing to reduce the risk period to 5 days and to get normal looking in that same period or time, or earlier. With regard to picking it, that is not an option so stop that ASAP, because it might cause you to pick out the grafts that are still attached to eschars and eventually you can get folliculitis (an infection of the hair follicle).

Hi Dr. Rassman,
I had a procedure of 1,600 grafts done on my front hairline just over 8 months ago. My situation was exactly like that of Steve Hartman’s, whose pictures are on the NHI website. The growth of my grafts didn’t really begin to show until about 2 months after the procedure. Now, after 8 months, the hairs have grown to length, but are very fine and thin in appearance. To compare, my transplanted area at 8 months looks like Steve Hartman’s photos at 5 months. It seems like everywhere I read, 8 months is roughly a good time to indicate how successful a transplant was. I realize that every situation is different, but I’m just wondering if (according to the averages) can I expect more density and fullness in the coming months? Am I just being impatient?

I’m very pleased with my results so far, I think I was just hoping to see a bigger difference sooner. Thanks for any help and I hope to see you the next time I’m in California!

At 8 months, the transplants usually show about 80-90% of the results, with more length coming in the following months. Steve Hartman‘s hair was an average thickness and your hair is very fine, so an apples to apples comparison may not be appropriate. You are asking if all of the hair has grown and the answer is effectively most have grown. You may need another transplant, which is not unusual for a person with very fine hair.

Dr. Rassman, thanks for starting the ‘Post-Operative’ section. It has been 5 weeks now since my FUE megasession. In the past 2 weeks, I have shed abt 30-40% of my transplanted hair…a condition I had been told is normal, does occur but am happy it has now stabilised. The only hair that I still lose now are those that come off with these thick crusts that form on my scalp every morning after I have applied Minoxidil the previous night. I have been using the 5% strength Minoxidil for abt 4 weeks. I now see redness on the scalp and the area around the red spots is sticky. I won’t call them pimples as another person writes in his message (pimples in transplanted area). But your inference in that post that ‘The more likely cause is the remnants of the sebaceous glands which survive and grow while the hair has not yet started to grow’ seems true to me.

I don’t know why there is this extra sebum production on those reddish areas and why it dries up to form a thick crust? By hit and trial, I found that instead of pealing of this crust if I just wash my head with a pH neutral or baby shampoo, there is much relief. What about your recommendation in that post about frequent soaks…do you mean something like applying a damp towel to the scalp? And could there be any relation between Minoxidil generated redness and sebum production? I don’t use Finasteride, so stopping Minoxidil is difficult for me though I am thinking of going in for reduced strength if this redness aggravates. Pls advise Dr. Rassman.

If you have lost the recently transplanted hair from the FUE, this is normal. The hair that remains may continue to grow. At 5 weeks, I would have expected that all of the crusts would be off. In my practice I get the crusts off in a week or less (often in the first few days with good washing daily). You should take them off in the shower with baby shampoo by gently rubbing them with your fingers.

Redness around a graft may be a sign of infection (folliculitis), so be sure to see your doctor relatively quickly as these may cause permanent loss of the transplanted follicle. Sometimes when crusts stay behind, bacteria will invade through the crusts into the skin and cause local inflamation. Soaks with a damp wash cloth placed on your head prior to shampoo will work for removing the crusts. Minoxidil is an irritant and it may cause increased sebum as your body responds to irritation. I can not advise you on Minoxidil and how to take it. Focus upon the red spots and the scabs that need to come off. That might solve all of the problems. If I were you, I would speak directly to your doctor about these problems and pay him a visit if it is possible, sooner rather than later.