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I had a hair transplant surgery since one month and week before (on the 20th of June), my hair is full of white crusts as shown in the photos, they exist everywhere in my hair. They are itchy and annoying. They increase with time. I wash my hair every day with a shampoo but don’t dry it to avoid hurting the grafts. I don’t know if this because of the residual of the shampoo or what. How to get rid of these white crusts please? They are very very annoying. I am afraid they affect the transplanted hair. I need your help please. I tried to contact the doctor did the surgery and didn’t reply. I am sorry for your disturbance.

This is residual crusting and requires a more vigorous hair washing with your fingers and a good shampoo. At this time you can’t harm the grafts so be aggressive.

What concerns me is the potential for change and any lack of planning for an outcome like this: https://baldingblog.com/need-master-plan-think-hair-transplants-photos/

I see such patients at all ages who developed balding that they didn’t expect. I always keep my eye on the donor supply, knowing that one should never use it up before the balding pattern completes, which may take many years. Young men in the early 20s don’t worry about getting older (like 30-50), but I see many 50 year old men who had hair transplants years before, and used up their donor supply yet continued to bald. Fortunately with tests like the HAIRCHECK test, I can often predict the long-term balding pattern when a man reaches 25 (not always) but I can always predict what their donor supply can provide for them for their lifetime. There are many things today that we couldn’t do years ago like Scalp Micropigmentation which can substitute for hair in certain circumstances (see: https://newhair.com/wp-content/uploads/2018/11/Combining_Follicular_Unit_Extraction_and_Scalp.98621.pdf). For these reasons, I focus on a Strategic Personalized Master Plan for each of my patients because even if they don’t worry about progressive balding, I am planning for it on their behalf.

How old are you? What have you done so for to treat your hair loss? The idea that you can get an estimate of how many grafts if you (1) are too young, (2) haven’t tried treatment without surgery, and (3) go forward without a Master Plan by a good doctor is crazy!

Like a question you answered from another emailer, I’ve also self-prescribed finasteride for the past few months. I went to a doctor a year ago, and he took a 30 second look at my hair and told me that I should consider Propecia. I’m 20 years old and hair loss is worrying me so much. I think I’m losing hair and want to be safe rather than sorry but I know I should get a professional opinion. Can I get a little more information about what would a doctor be able to evaluate me for?

When you visit us, we evaluate you as follows:

1. Analysis of your hair bulk with a special measuring instrument will focus on the top and crown of your head to determine if there is any early, sub-clinical balding present. One part of your scalp will be compared to other parts of the scalp (the donor area) to determine if you lost any meaningful amount of hair bulk or are in the process of losing hair. This test is highly accurate for determining the degree of hair loss you have to date.
2. Evaluation of hair for miniaturization is an important test, because hair loss in its earliest period will show decreased hair shaft thicknesses. This can be done throughout the scalp and is a good predictor for where you hair loss will stop, even though photos may indicate you’re at the end of your balding process.
3. Hair density evaluation is critical, because you must know the supply of good hair and establish a good baseline. Hair transplantation is a supply/demand process and you most know what you can expect over the years in front of you. You would not want to run out of donor hair or start too early, as you may continue to bald, leaving you freaky looking, as so many patients have found themselves in this situation when planning was not done properly. We are all different and are born with different hair densities. Add to that the ethnic hair densities found in different people (Caucasians are born with an average 100,000 hairs, Asians with an average 80,000 hairs and Africans with an average 60,000 hairs). Within each ethnic group, variations in the number of birth hairs vary considerably, so these measurements will give you guidance as to what can be accomplished and more important, what can not be accomplished. As an example, for an African who has a very advanced balding process, he would run out of hair before he could fill in the bald area so he needs to know this right up front, not find out about it after he starts the transplant process. The same issues reflect all ethnic variances.
4. Build a Master Plan for the present and the future, because hair loss is a progressive process. You must have a plan as to what you are going to do as you age and in the next 10-20 years, the progressive process should have slowed down substantially. The drug Propecia (finasteride) is generally safe and side effect free in 98% of people who take it. If you are really balding, there is no alternative way to hold on to your hair. Frankly, all of the other remedies out in the marketplace will not work as well as this drug, if they work at all.

They say you can get a transplant once you’ve stabilized your hairloss with Fin – but how reliable is it actually? I’m not sure how accurate this is, but I often read that Fin doesn’t really halt your hairloss, it slowns it down a lot but your hairline is still receding. And who’s to say that you get you a transplant and, 3 years later, Fin starts losing effectiveness and you end up looking even worse before? Do you just have to gamble on this, or am I missing something? Or is the transplant a commitment in the sense that you’ll eventually need more to “recorrect” everything?

What are you realistically getting in the long term with a hair transplant?

I have been doing hair transplants for 28 years and started the trend with small follicular units used for the hair transplants. Many of my patients from 28 years ago, come and visit me and a few came back for more hair transplants as they continued to lose hair. In good hands, hair transplants work and in 99% of people, the results are permanent. That is good and bad because if it is done well, you will look good, but it is done poorly, you will always look freaky.