No Improvement After Two Hair Transplant Procedures – Hair Loss Information – Balding Blog

I am a 42 going into 43 years old. I have been losing my hair slowly but steady for a good 12 years now. Only about 5 years ago clear spots started to become more and more evident. I had 2 transplants. Both of them about 1300 grafs. The count of insertions was about 270 so I figure it must be in groups of 3 and 4 grafts. In the areas where I had the transplants done I dont see any improvement.IF any I see it getting more and more bald. I don’t know if is that I am just not holding the transplanted graffs. Is there such a possibility. My operating physician said that that was imposssible. That they will never come out. The first procedure was in October 2001 and 2 and 3 weeks after I had a lot of dry roots and hairs come off. I asked the Doctor that operated and he said that was normal. I was doubtful specially because of the roots being dry and out. Then last year I had another procedure. And I dont see any improvement from that either.I dont smoke , dont drink. I exercise, and I tried to eat healthy. I am contemplating a 3rd procedure but I am concern that I may not be holding it.

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It sounds to me like you are having confidence problems with your present doctor and certainly have not adequately communicated on the problem as you’ve presented it to me. Before you go at it a third time, get a second opinion. This is not something I can do over the internet, and since you indicated that you are on the east coast, I can recommend Dr. Robert Bernstein in New York and New Jersey at 866-576-2400 to get that second opinion from. If you are willing to make a trip out to California, I have offices in Los Angeles and San Jose and can be reached at 800-NEW-HAIR if you’d like to set up a free consultation.

Some of the things you are saying do not leave me comfortable. Clearly, that is your view as well. I would advise you to not rush into a third procedure if the other two did not work out. I find that we always get results and rarely have I heard of one of my patients have the issues that you’ve mentioned.

Is Shock Loss Permanent? – Hair Loss Information – Balding Blog

Dear Dr Rassman,
I am a 39-year-old male. I recently underwent a transplant procedure at Bosley in Boston. My class was a 3 vertex. I have been using Propecia for 4 years, and it has worked great! However, I still saw some daylight in the frontal region. Admittedly, 99% of friends and family would only say I had slightly receding hairline, and follicular enhancement surgery was ridiculous. My objective was to simply augment my existing hair and stay a head of the curve. With that said, I’m now learning of Telogen and “shock-loss”. Several web sites claim that the shock loss can be permanent, and I could wind up with thinner hair than I began with. I knew up front that trauma could case this to happen. Moreover, I could have waited several years before taking this step. I would be greatly disappointed to lean that this was futile and I could be worse off! My HTP counselor says, new evidence claims healthy non-miniaturizing adjacent follicles should, and will come back after a few cycles. Can you please expound on this topic.

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Hair transplant shock (shock loss) is often prevented in men of your age by Propecia, so you have done the right thing by taking it. The shock loss can be permanent if the hair that is lost was in the balding zone. When it occurs and impacts hairs in the balding area in men, the hair loss is often, but not always, permanent. This will only impact non-transplanted hair, so if you had transplanted hair that was lost (very, very rare) that hair always returns. For women who lose hair (with shock loss), the hair almost always comes back.

You need to wait it out. Chances are that it will not come back, but the newly transplanted hair may make enough of a difference to adequately address the area of loss on a worst case scenario.

Hair Loss InformationUsing Toppik to Conceal Transplants After Surgery – Hair Loss Information – Balding Blog

Hi Dr Rassman… I am thinking of getting a transplant from you as I have met you before. just wondering if you have to shave my reciepient area?? and is it possible to use toppik to conceal the transplanted area?? would using toppik damage new grafts survival rate?? thanks alot!!

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I know that some doctors require you to shave your transplanted area, but I have learned to work around the hair that is still present. Some of my patients who use Toppik can continue to use it, but I’d suggest that you hold off for a week or so after the transplant. I like all of the scabs (eschars) to be off prior to the use of Toppik to stop what is a potential irritant and foreign body reaction if it gets under the eschar. After a week, that should not be a problem. With our small wounds and good washing, everything should be pretty clean at a week post surgery with no scabs and small hairs coming from the grafts that look like a beard, which will just make the recipient area fuller. Adding Toppik, can only help fill it in more for create the illusion that you are trying to achieve.

Hair Loss InformationSudden Hair Loss Years After Transplant – Hair Loss Information – Balding Blog

I have had 6 procedures. four smaller (elsewhere) and my last two (more substantial) with NHI. You performed my last procedure about 6 years ago. I started the restoration process early, so I never went through a noticeable hairloss phase. I have been on proscar for about 5 years and it halted my hairloss. Obviously, I still have a significant amount of hair. I normally kept my hair cut short, but recently I let it grow a bit longer and got a trendy razor cut hairstyle. I towel dry my hair and put a manipulator cream (bed head brand) to keep the style. I have never looked so good! Then one week before my next haircut I started to notice hairloss. From Oct. 13-Nov 12 I have lost all the hair behind and between my frontal-most grafts(about a half inch deep, from the front hairline and extending all the way across the front and into the corners. Is this normal? I’m beside myself. I have done everything through the years to combat my hairloss with unbelievable results and now this. It’s as if somebody just flipped a switch and Pow! Can proscar just stop working? I would appreciate any information(based on my brief description). I diligently keep track of my hair-the hairloss happened that quick. Also, I am now 41(a very young looking 41!!) I am on 3 medications. One is allegra D, the other is an acid reflux medication (both prescribed for allergies/cough) and finally, a cortiosteroid nose spray (nasonex). Can any of these be compromising the effects of the proscar? Thanks again.

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I am also alarmed. I will try to call you as I know you are not local to California. The corticosteroid nasal spray could cause this, if you are using it regularly and heavily. Loss of transplanted grafts after they have grown is very, very unusual. It could be caused by other medical conditions which you will have to get checked out. The Proscar should not be the problem.

As I think back about hair loss in transplanted grafts, they are rare. I have seen them in some men who have developed a type of senile alopecia where the donor area is thinning. If this was happening to you, your donor area should show signs of miniaturization and that would point to this diagnosis.

We need to talk and get you to a good doctor locally who can map out our scalp for miniaturization and attempt to clarify the cause for the hair loss.

Hair Loss InformationPimples in Transplanted Area – Hair Loss Information – Balding Blog

Dear Dr. Rassman

After going through your informative blog, i decided to publish my question seeking your good answer so others can benefit too. Am currently 8.5 weeks post HT surgery. Till now things seems to be fine except for one thing, infections from time to time that is, i get those deep pus filled pimples that develop right below the grafted area every now and then, which in part made me consider an oral anti-biotic called DURICEF. My question as follows, will my transplanted follicles survive in the presence of those so-called folliculitis? Is it advisable to leave the pimples un-touched when ever they form? Your Help is greatly appreciated

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Pimples in the recipient area are not uncommon in some people. When the transplant is done and the hair sheds, there are two things that could be left behind as the body works through the healing process. The first is that remnants of the actual hair shafts might stay buried under the skin. These would form a foreign body reaction and could manifest themselves with pimples. The more likely cause is the remnants of the sebaceous glands which survive and grow while the hair has not yet started to grow. These glands secrete sebum, which accumulate under the skin and cause pimples of varying sizes. They can be very annoying and become infected, on occasion. The best way to treat them is to have frequent soaks so that the skin softens and your pimples will work their way out with the sebum (or hair shafts). To stop infection (if they occur) a good bacteriostatic antibiotic usually works. I have my preferences, and your doctor will have his/hers.

After Care for Scar Revision – Hair Loss Information – Balding Blog

Everything seems very promising at this stage, two weeks after a scar revision procedure. I am wondering whether there is anything proactive that I can do to help minimize the presence of the new scar. (Besides avoiding exercise involving unexpected head-turning.) Such as:
– applying onion-based anti-scarring ointment; or
– not applying onion-based anti-scarring ointment;
– or using or not using some other topical thing.

Thanks for everything!

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I think that patience is a virtue and if the surgery was done well, that should suffice. Applications of any topical ointment may be pointless at this time. If hypertrophic scarring should occur, then you may need to take a look at it as it forms. Stretching of the scar will take time, as stretching usually starts to become evident at about 6 weeks. Keep in touch with your doctor if anything worries you.

Different Hair Characteristics in Transplanted Region – Balding Blog

I had my transplant at NHI 9 montys (2000 grafts to the front). My hair is growing very fast, and looks awesome, except that it is curly, and the rest of my hair is absolutely bone straight. I am growing my new “full” head of hair long and “surfery” looking, but it looks so different with a curly, puffy front, and then the rest is long, flowing and stick straight. Will the front ever be straight? What can be done? I use a hot flat iron every day to try and straighten it.. I know totally why people with curly hair hate humidity and rain…instant frizz. Help.

Hair transplants rarely radically change the character of the hair, but it can happen. In about half of the people when this change occurs, the hair will straighten a bit after going through a hair cycle. I remember one person who had a very radical curly change to his hair after the first surgery. I personally did not like it at all, but he loved it. When he came in for his second transplant, the same thing happened again. It remained very curly and he could not have been happier. Much to my surprise, it lasted through a hair cycle, possibly a bit less curly.

Some people who get changes in hair characteristics, go to a slightly more wavy hair and this change is appreciated in almost every person because it produces ‘body’ for styling that they never had when their hair was very straight. This often reverses in a hair cycle (about 2-6 years), so these benefits may not last.

With regard to your situation, you need to see me personally so that I can review your change in hair character. In addition, unfortunately, you will have to learn to control the hair with relaxers that will allow you to gain better better control of styling. Blow drying and conditioners may help a great deal so that you may not have to use an iron. We should discuss this together. Call my office at 800-NEW-HAIR to schedule a visit.




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Balding Forum - Hair Loss Discussion

Hair Loss InformationPost-Operative Care and Scalp Flaking – Hair Loss Information – Balding Blog

Dr. Rassman, I think you are running a brilliant blog. After reading several posts, I am encouraged to share my own views and ask a question. I recently got a FUE megasession done in Europe and am pleased with the results, atleast till now (just 2 weeks post-op). While going through this website, I personally felt that it would be a great idea to start a new category called ‘Post-Operative Care’ since I am going through this phase myself and can feel the need to interact with others out there on the topic. Don’t worry, I don’t think it will scare away any prospective patients. It will only lend credibility to the transplant procedure.

On that note, I also have a question. I am using Minoxidil 5% to help with the growth of new hair. But my scalp in the recipient area shows considerable dryness / development of flakes when the scalp is dry. I was recommended to apply a hydrating lotion on the scalp. Would you agree with this advice and can you recommned a good hydrating cream /lotion meant for hair?

Thanks in advance.

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Thanks for your kind words and for the new category idea. I’ll add a Post-Operative category now.

The results of the FUE will take 5-8 months to show, so then and only then, will you know the value of what you had done. Minoxidil does cause dryness and flaking. Any non-alcoholic creams will work. Also, try a variety of hair conditioners as well. Take risks until you find the right one. Ask your hair dresser, as they may know the best that is available in your country.

Hair Loss InformationNo New Growth 10 Months After Transplant – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

About 3 months ago, I wrote to you concerning my situation at 7 months post-op. I had diffuse thinning in the frontal area and was a norwood 3 prior to surgery, and had 1700 grafts put in. At 7 months I was looking thinner than before my surgery, and could only find a few new hairs that were growing in, all very small (less than 1/2 inch).

Now, at 10 months these hairs (i can find only about 10) all seem to be the exact same size as they were at 7 months, and I have seen no new growth. This is very frustrating for me and I was wondering what your thoughts were. I took your advice and went to see one of your colleagues in San Jose, and he told me that I should wait until a year has passed to judge my results. But why do these hairs seem to be growing in so incredibly slowly if at all? If you could just mention what some of the possibilities may be I would greatly appreciate it.

Thanks for your time.

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To keep the blog readers up to speed, your original question (and my answer) can be found here: Transplant Failure To Grow.

You should see growth by this time. I would suggest that you make an appointment to see me personally. I will try to judge what has happened. Please try to get the preoperative pictures from your doctor so that I can make a judgment as to how much original hair was there at the time of the transplant. That will help a great deal because sometimes when people report these complaints, they lost much of their natural hair and the loss may cancel out the gain. Alternatively, the growth of the transplants can be estimated by someone experienced in this field.

Hair Loss InformationIs Propecia Mandatory After Hair Transplant? – Hair Loss Information – Balding Blog

Hi,
I have looked into hair transplants time and again but have been scared off by the horror stories of bad HTs. FUEs sound good to me. Where do I go to get evaluated? I am losing hair in my temple areas and am 36 years old. Also, do I have to be on Propecia? I was on it for a year, didn’t see any results in hair but did notice problems with sexual activity (i.e. hard to keep an erection) I like it a lot better without it. So, if I had a HT, would I have to be on propecia?

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You do not have to use Propecia after a hair transplant. However, by not using this drug you will not have any protection against the progressive nature of hair loss, assuming you are still losing hair and not totally bald. With regard to your sexual problems, almost 40% of men of your age have some difficulty maintaining an erection. One of the erectile dysfunction (ED) drugs can solve that. Taking Propecia for your hair and ED pills for your erection may give you both a better sex life and hair at the same time.

You indicated that you are based in Colorado. I would be happy to evaluate you for FUE, but my offices are in California. To find a FUE surgeon in your area, please visit ISHRS.org, but please note that there are not many of them out there that have the reputation and experience you may want.