Category: Post-Operative

I had a hair transplant 2 months ago. Should I be taking any medication to encourage growth or retain native hair? My surgeon said it was not necessary, but I an concerned about losing transplanted and native hair thanks

I do not think I can impart any more wisdom that what your surgeon has already told you. If the surgery went well, it should grow in 6 to 8 months. The native hairs may fall out as it depends on your genetic fate and if you were taking Propecia, you might be protected from the shock loss that occurs after a transplant. Just be patient and take good care of yourself.

This patient flew halfway around the world to come to us for a hair transplant in Los Angeles. He sent me this nice email after his surgery, and I wanted to share.

I am doing really well. The back of my head as well as the region where the grafts were placed is virtually pain free and surprisingly I feel really good. I did make it home ok, although the flight home was terrible due to the lack of consideration by the person who was sitting next to me (he was a New Yorker).

I wanted to say a big thanks to all you guys at NHI. I couldn’t believe how little pain there was and how easy the entire process was. You helped with every aspect of the process which was very much appreciated. Hopefully the hair grows well and I get great result. A big thanks again and i will be sure to visit the next time i am in town in late December early January.

It’s always good to hear from patients, and this is a testimonial to our staff and procedures.

I had a hair transplant 2 months ago and have now developed pimples where they put the grafts. The doctor prescribed an antibiotic, but never explained the cause of the problem.

If you look at the anatomy of the hair follicle, you will see that this is a complex structure that contains skin, a hair shaft with a bulb, dermal papillae, outer root sheath, dermal fat, arteries and veins, nerves, muscles that hook up to the hair that makes it erect when you are cold or stimulated… and with regard to your question, the sebaceous gland.

Above: Schematic drawing of a two hair graft with all elements of the anatomy labeled (on left). The photo on the right shows an actual mirror image of this schematic drawing. Note the similarity between the diagram and the photograph.

 

After a hair transplant, everything you see here disappears, and when the new hairs finally grow, these structures are rebuilt by the body to complete the newly growing hair organ. The sebaceous gland may not die and often survives after the hair transplant. When that happens, it is still a functioning gland — and what do glands do? They put out sebum. If the gland survives the initial transplant, it will still be functioning, pumping out the sebum that normally came out through the pore in the skin that the hair exited from.

With the pore gone (because there is not hair to maintain it open), the glands secreting sebum has no where to go. It will be attacked by the body as a foreign body, and in this attack, it may be walled off from the surrounding fat, forming a cyst. Most often these cysts contain sterile sebum, but this is very irritating stuff and the scalp often does not like it. If the walling off is successful, you may never know it ever happened and the body will remove the sebum as it would remove any foreign body, but sometimes it can not wall it off successfully and instead propels it out of the body, breaking through the skin on occasion (forming what we often refer to as a zit or pimple).

With proper warm soaks, the body is encouraged to get a cyst near the surface of the skin to expel it and then when it breaks through, it often appears yellow and thick (occasionally tinged with blood). If you saw me in the office, I would probably drain it with a needle under sterile conditions and if there were many of them, I might put you on an antibiotic. When we culture the ones that look “mean” to my medical eye, the culture is often done, but rarely do they show any bacteria when the culture reports are returned to us from the laboratory.

There are other causes of this condition to include: People who pick on the hair graft area and cause folliculitis (common), remnants of the hair shaft from the transplant (common), autoimmune reaction short term (probably common), autoimmune reaction long term (rare), etc…

If they persist, you should see the doctor who did your hair transplant and let that doctor determine what is causing it, and this is especially important if the problem continues.

What are my options after 2 failed procedures?

I had hair transplant surgery around 2007 using strip form back of head method, by what I thought was a credible Dr. from reviews online, experience level etc…Paid alot of money for hundreds of graft and got very little result. In fact only a few strands grew in at the hairline and temples grew in. None of the grafts in the crown area, where he said he really “packed them in” grew. He kept saying “you had beautiful grafts” and seemed dumbfounded as to why they didn’t grow.

After the salesperson tried to convince me that there was something wrong with me, the Dr. finally admitted that it was a failed procedure and agreed to do another one at no cost, This time saying he was going to try less grafts in that area hoping for better blood circulation. Well that also yielded very little growth. Although after about a year and half, filled in a little,but very little. Which shows me that there was no scalp biopsy necessary as they initially tried to say there was something wrong with me. I did get some growth. If there was a problem with my scalp, wouldn’t I have gotten 0 growth??

Overall I consider my decision to be a poor one because now i cannot even shave my head or wear a low style because of this huge scar (even wider now from 2 procedures) on the back of my head.

So my question is a two part question. Is a future transplant out of the question for me or could it be that this Dr and staff blew it twice? It should be noted that I am of mixed race(black and white) 38 years old,(34 at time of procedures), with more of wave than a curl to my hair, not real kinky but thick and puffy and coarse when it grows long on back and sides. The Dr did say they had experience in afro american hair types and seemed very confident during consultation with my donor area and being able to handle my hair type

Any insight as to what might of went wrong? The balding area was pretty much completely bald so I am not seeing native area that has thinned out after surgery, but the area that never fully grew in after 2 procedures.

Also is it possible that 4-5 year later that some of those graft may still have ability to grow?? With the aid of a product like Nioxin??

Thanks in advance for your answers

That is one hell of a story! If that happened to one of my patients, I would want to get a biopsy of his scalp, looking for a disease like alopecia areata that would cause rejection of the hair grafts. Unfortunately, your story is far more common than our profession would care to admit. Doctors who lack competence often use salesmen to push hair transplants beyond their abilities to perform it well.

One of the reasons that I started BaldingBlog is to have a place to let people share their stories. Your situation is quite unfortunate. For those that are shopping around for a doctor, remember that it is critically important to have thorough research. I’ve written a “how to” guide of sorts for selecting your hair transplant doctor.

As for your options, I think you should see a doctor who specializes in fixing screw-ups. The grafts should be growing, and if there’s nothing there after 4 or 5 years, I wouldn’t expect them to suddenly appear. I would be happy to give you my opinion, but I would have to see you. I’m in Los Angeles… but as you are in the Northeastern United States, consider a visit to Dr. Robert Bernstein for an opinion. Best of luck to you.

Greetings doctor,

I am 23 years old and I had a HT just over 8 months ago. I started thinning about 4 years ago at my temples, Going bald at such a young age made me very self conscious so I just had to do something about it.

I got 1200 grafts transplanted into my right and left temple areas. over the next few months some but not all of the grafts began to shed and I also experienced some ‘shock loss’ which is all normal I know. some of the grafts however stayed in place and continued growing.

I’m on my 8 month now and some of the grafts that stayed in place and grown all this time started falling out!! which got me very worried. there are also some bald patches on my temples where grafts got transplanted that haven’t shown any sign that they are growing yet.

Should I be concerned about any of this? I mean at 8 months I should start seeing the majority of the hairs coming out right? the only reason I can think of for this is that the grafts are just simply taking longer than usual to come out. I don’t however have any explanation for the transplanted hairs falling out after 8 months..

Please can you let know so I can set my mind at ease..

Kind regards

I cannot say what is going on without examining you in person. How would you know if the hairs you are losing are the transplanted hairs or native hairs? Or maybe transplanted hairs (like regular non-balding hairs) are going through their natural hair cycle of shedding before regrowing. I really cannot say.

At 8 months, you should see growth of the transplanted hair. You should definitely make an appointment with your surgeon to discuss what is happening and get a more definitive answer.

Hello Doctor

Last year I underwent a hair transplant. Seven months have passed and I am very happy with results, the regrowth is quite fast. I have noticed one thing I’d like to ask about, though. The color and the texture of the transplanted hair differs from my native hair. The transplanted hair grows darker and it’s somewhat kink and curly.

Is a texture change something that happens in the early phase of regrowth after transplant? When should my hair return to its normal state? Is this something I should worry about?

Thank you

Changes in hair texture are somewhat common, though kinky hair occurs less frequently. Usually patients that experience a characteristic change see their straight hair get more of a wave in the transplanted hair. It’s possible that you’ll need to wait out a full hair cycle (2-4 years for the average male) to see if the kinky change disappears.

The transplanted hair should replicate the native hair in the donor area and most changes in color reported reflect a comparison with miniaturized hairs in the recipient area when compared to the transplanted hair in the recipient area. I do not believe that transplants themselves influence changes in hair color, other than maybe accelerated aging issues like early graying.

One patient from 2006 showed changes from blonde to brown which is a process of color change that many blond people go through as they age. My three sons (born with blonde hair) saw their hair change from blonde to brown by the time they got into their late teens. So what you’re describing is unusual unless it is in the aging genetics that you have triggered ahead of schedule.

Hello Dr. Rassman,

I’m 29 years old and had a transplant exactly one year ago in Thailand. I had roughly 1000 grafts transplanted to my hairline and temples using the FUE method. After waiting the full year, I’ve got to say I’m somewhat disappointed in the results.

I purchased a digital microscope after reading many of your blogs. I’ve taken a good look at the recipient area and it appears that 90% of my grafts are just single hairs, as if the follicular units were transected during the operation. I’ve also noticed many colorless, short, thin hairs in that area. Are these the remnants of my native hairs that have miniturized? Would you say I can expect any more development in the transplant? Or is 12 months pretty much it? If I was a norwood 2 at 27, how far would you guess my balding will progress? My crown looks thin to the naked eye, but I believe it’s because of the cowlick and that I’m a blonde and the light penetrates through. With the microscope, I see no miniturized hairs in the crown. Thank you for your time

If you have 2-hair grafts placed and only a single hair grew from each, that could mean one of three things:

1. Close to half of what grew in each follicular unit died from the process you had done. Or…
2. You are Asian and have typical Asian hair densities, which means that there are equal one and two-hair follicular units growing in your native hair. Or…
3. The doctors just divided the 2-hair grafts to make singles to increase the graft count.

Even if you are Asian, you should have 50% one-hair grafts and 50% two-hair grafts (on average). Strict quality control is critical for all of the hairs in the follicular units to grow and if you had all two hair grafts (typical of Caucasians) the growth of only one-hair grafts reflect some damage. You should also count the grafts, as well as the hairs. Was it a bargain deal? Take a look at our recent post about cheap hair transplants.

The doctor could have separated all the grafts into single hair grafts (if the doctor was not honest and tried to push up the graft count if he charges by the graft). In any event, 1000 two-hair grafts should have yielded 2000 hairs (in a Caucasian) and 1500 hairs (50% each of one and two hairs in each graft). That is the bottom line. I always measure the density of the patients prior to surgery so I know what I expect to achieve in the harvested grafts as well as how many hairs are transplanted, the count of each graft with regard to the number of hairs they contain. Some clinics charge per HAIR and not per graft, so look at how the billing was made. Maybe you were charged for 1000 hairs and not 1000 grafts (not uncommon to find).

Can you please tell me about the post-operative course I can expect after a strip and FUE surgery?

If you wash your hair twice a day starting the next day after surgery, most of the scabs and redness should be gone and you should be left with a 1/4 inch stubble of hair on the front after 2 weeks. I suppose if you are really looking at it you may be able to tell something was done. Cosmetically it should not be an issue. For those with transplants to the hairline or frontal area, if your exiting hair is long and you comb it forward to cover it, then it should not be noticeable.

Some patients with fair skin may get persistent redness for weeks after surgery. The redness will look like you have a slight sun burn. Most patients do not. Risk is higher in fair skinned individuals. As a rough rule of thumb test, to see if you may get the redness after surgery by scratching your forehead with your fingernail. Wait a few minutes to see if your scratch mark is bright red. If that happens, then your risk of redness after the transplant is higher than most people.

Some patients get forehead swelling on the 3rd day after surgery and it may last a couple of days, up to a week. For your social needs, 14 days should be no issue. Risk of swelling is about 1 in 30 and it is completely random. Once in a while some people get swelling so bad it may shut your eyes and cause bags under your eyes. We give corticosteroid to minimize the risk, but the risk is still there (although very small).

In general, most people return to their day-to-day activity in as early as 3 days. If your hair is long enough to cover the transplant, you can practically walk out of the clinic the same day and go to work the next day. (Or the same day if you’re Dr. Rassman who just had a hair transplant surgery (strip) to his crown) You can always use Toppik or a similar agent to cover any areas after the surgery.

If you are having a follicular unit extraction (FUE) procedure, the back of your scalp will be shaved. So in 2 weeks, the back of your scalp will have 2 weeks of hair growth over the FUE scars (about 1/4 inch length can be expected). At 2 weeks the FUE scabs may be detectable on close inspection, but should be cosmetically unnoticeable. Some people have the option to have FUE done without shaving the back of the head completely, but this will limit the number of grafts we can extract in a single session.