White Scabs 3 Months Post-Procedure

Hello
I had a strip procedure done a little over 3 months ago and now Im starting to get a little worried. I have these white scabs in my donor and recipient area, and when these scabs come out, they carry with them 2-5 hairs. This does not seem normal…

At three months you should be completely normal. Most people have no scabs within a week or so. This may be a matter of your washing technique. I have seen men who do not wash their hair properly leaving the remnants of hair and scabs for weeks or months.

How Many FUE Grafts Actually Grew? (with Photos)

A man came to see me last week with a problem following his hair transplant at another clinic over a year ago. The surgeon told him that 6600 grafts were transplanted (in three sessions) using the follicular unit extraction (FUE) technique, which he guaranteed has a yield of over 90%. The patient wanted to know if his surgery actually reflected 6600 grafts, so at the patient’s request, we counted the actual grafts that grew. We divided up his head into 1cm square units and then counted the individual grafts inside those squares. The count yielded 2092 grafts of which approximately 50% had only one-hair and 50% had two-hairs, totaling approximately 3100 individual hairs. The hairs did not look very healthy, but the patient had fine hair in his donor area, so I suspect that the fullness reflected the low volume of each hair that survived.

I actually had the opportunity to measure his density before he decided to have his surgery with another doctor. His initial preoperative donor density measured 2.4 hairs per mm square. In my experience this type of donor density usually yielded about 15% one-hair grafts, 65% two-hair grafts, and the rest would be three-hair grafts. Estimating the hair count from the 6600 grafts he expected to grow, he should have had hair growth that would reflect (1) approximately 3960 hairs from three-hair grafts (20% of the 6600 grafts), (2) 8580 hairs from two-hair grafts (65% of the 6600 grafts) and (3) 990 single hairs (reflecting 15% from one-hair grafts)… for a total of 13,530 hairs that would have grown from a 100% successful harvest. Estimating an FUE yield of 90% (a reasonable estimate for FUE and his surgeon’s guarantee of that amount) from a projected successful hair count from the 6600 grafts, I would reduce that count to 12,204 hairs (90% of the 13,500 hairs estimated above). He should compare the actual hair count we obtained in the counting process of approximately 3100 hairs which reflects a loss of 9104 hairs. The hair count therefore reflected a substantial reduction in the hair yield of those grafts that grew when compared to what should have grown. When one would count the grafts that did not grow, the death rate of the hairs was almost three times what did grow.

Where did those missing hairs go? I suspect that they were killed at the time of the FUE either through drying of the grafts during placement, trauma from the technicians placing the grafts, or transection of the grafts (a common problem in those surgeons who really do not have mastery of the FUE technique).

Below left: Lines drawn to divide the area for the graft count; Below right: Sparse donor area. Click photos to enlarge:

 

This patient shows that he probably did have an attempted harvest of 6600 grafts, as his donor area is very sparse and very see through (which is very unusual for a person with his original density). The problem is, almost his entire donor supply was wiped out. He is no longer a hair transplant patient candidate for additional transplants, even if that surgeon agreed to do the surgery at no charge to that patient. Short of cloning hair, he has no real options… and as we all know, cloning isn’t close to being available.

I have made many posts discussing the false/misleading promotion of a surgeon’s skills with the FUE technique. The surgeon that did this terrible work has a worldwide reputation claiming expertise with FUE. Problems like this not only occur with the FUE technique, but in traditional strip harvesting where the surgeon does not get graft growth. Look through some of the past posts about this type of failure and you will see that this particular patient’s experience is unfortunately far from unique. Then to add to the current problems with inexperienced surgeons, there are new FUE systems/tools coming available that are promoted to allow any surgeon to perform this artistic procedure without any prior experience in the field. Things like this, combined with the false advertising and cut-throat pricing, has turned the hair transplant business into a frequent scam, where doctors promise the balding man a world of hair that can’t be delivered at the expense of many, many balding victims. I feel like I’m just repeating myself, but I really can’t say this enough — hair transplantation is a cosmetic procedure on your scalp! It is right there for everyone to see! If funds are tight, you might want to just hold off until you have the money to have the procedure done correctly by a competent, experienced surgeon… otherwise, you’re running the risk of major permanent problems in the future. This isn’t buying a car. You can’t turn around and sell it if you don’t like it. Hair transplantation is for life.

Why Aren’t You Calling Dr Christiano’s New Research a Cure?

Hello dr
i am with you that the research is very early, but why did you say it is not a cure? if they can create hair then we will have unlimited supply, right?

You’re referring to — Dr Christiano’s Research Team Found That Upside Down Cells Produce New Hair

Everything is called a “cure” these days. This is still research. Don’t get me wrong — this is very exciting, but it was done in mice. It needs to be done in humans and proven both safe and effective before anyone should call it a cure. Lots of articles have come out calling this a cure, but article headlines are usually sensationalized.

How many grafts for a hair transplant? (photo)

From the picture, you have a Class 3 pattern of balding. Of course, I would want to examine you to see if there is balding behind the forelock you are showing, but assuming what I am seeing is all the balding you have, I would estimate something between 1500-2000 grafts depending upon your hair thickness (fine, medium or coarse) with finer hair requiring more grafts.


2020-08-08 09:46:16How many grafts for a hair transplant? (photo)

Why do doctors prescribe finasteride after a hair transplant?

Why do MDs suggest taking finasteride post transplant to keep the hairs? Just for keeping the non-transplanted hairs from falling out and having lower density? Nothing to do with the new hairs, right?

Finasteride after a hair transplant prevents the miniaturized hairs from falling out permanently. This is particularly important in men under 30 when their hair loss is most active.The new hairs in the recipient area do not need the finasteride to grow, just a good surgical team.

 


2021-01-04 14:43:03Why do doctors prescribe finasteride after a hair transplant?

How Much Does Bulk Analysis Cost?

Hi there,

I live in Canada, and unfortunately no one here provides miniaturization tests or hair bulk analysis. I understand Dr Rassman has offices in California and NY? Would it be possible to have these done if I came to one of his offices? Also, how much would I be looking at in terms of charge to have this done? I really have been trying any way I can to get a professional opinion with my hair, if I am over reacting or if there is something more going on. I would just like to know for sure, so I can determine my best plan of action, or if I need to be concerned at all. Any help would be much appreciated.

Thanks for your time.

We do this as part of a free consultation in appropriate young men. Our office is in Los Angeles, California. If you’d like to travel from Canada to see me or Dr. Pak, you can request a consultation via our website here. You might wish to send photos in advance of making any travel plans so that we can have an idea of what your loss is prior to your appointment.

If you decide to go to someone more local, just make sure that any doctor you see has the HairCheck instrument to measure your hair bulk.

Why Does Catch-Up Hair Loss Occur When Stopping Propecia?

Hey Doc.,

I have a question regarding the shedding after quitting propecia. Why is it that when one quits propecia the shedding occurs much more rapidly then the natural progression of hair loss? That is, why don’t we go through the same “minituarization” that normally occurs with hair loss?

You cannot escape genetic balding. Hair has a normal life expectancy (see this post) so when the Propecia is withdrawn, the apototic process kicks in. Medications such as Propecia slow this process down by preserving or strengthening the dying miniaturized hairs (the hairs that are genetically programmed to die and fall out). When you no longer take the medication, all the genetically predisposed hairs that should have fallen out naturally will no longer be supported by Propecia. As such, they will fall out. That is a simple way of thinking about catch-up hair loss. In other words, you didn’t stop the time line of genetic hair loss by taking Propecia.


2009-03-03 15:49:31Why Does Catch-Up Hair Loss Occur When Stopping Propecia?

How Should I Store Cut Finasteride Pills?

I know that with regard to cut up 5 mg finasteride pills, you recommend that pills are only cut up one at a time, to avoid excess hydration of the pill fragments with vapour in the air.

I have a question about the storage of the three pill fragments each time a pill is cut (assuming it is cut into quarters). Right now, I just leave the pill fragments inside the pill cutter, but would it be more effective to store them in an airtight container for three days? Or does it not make a considerable difference, given the short timeframe of storage?

Thanks.

It might not make that much of a difference if you’re cutting one pill at a time (which is what you should do), but I would err on the side of caution and store the fragments in an airtight pill bottle.


2013-02-16 17:38:17How Should I Store Cut Finasteride Pills?

Why Don’t You Reveal Who These Bad Doctors Are?

The following is a comment I received on the post from last week, How Many FUE Grafts Actually Grew?

Please let us know who this Dr. is. I know you do not want a reputation of badmouthing Drs. — but for the benfit of those of us who do not want this type of result, please mention it — it is not badmouthing, it is warning. At least the State where this Dr. practices. What good is a warning, if it isn’t linked to a culprit?

We maintain a policy to not slam specific doctors. I don’t want to open myself up to any legal action and honestly, I’d prefer to focus on revealing the scams some doctors pull and encouraging users to do their own research on any doctors they are considering.

We hold open house events each month where any patient can come in and say whatever he/she pleases in front of a very interested audience. I would challenge other doctors to have this same policy, which would obviate the problems that this patient had.


2010-03-30 14:01:18Why Don’t You Reveal Who These Bad Doctors Are?

How to Tell if You’ve Found the Right Hair Transplant Doctor

What is the difference between doctors and the various medical groups performing hair transplants. There appears to be a great deal of competition and as I go between groups, I get confused and overwhelmed.

If you were looking for a good family doctor or plastic surgeon, you would most likely use certain criteria for selecting one over the other. Fundamentally, you would look for a well credentialed, caring, competent doctor who you like and feel comfortable with. Be sure that the doctor values you as a patient by spending time with you and discussing your agenda freely. Ask yourself if the doctor listened to what you were saying or lectured you about his/her ideas. That doctor must be trustworthy to take on your welfare or your family’s welfare, and not only must you believe in his/her skills, but you should also like him/her as a person. Although the various family doctors and plastic surgeons use physician’s assistants or nurse practitioners to help them manage patient’s needs, the doctor is always ultimately the person in charge, the one whose skills you will eventually depend upon. As most doctors practice in groups, you should feel comfortable with the doctors who work with your doctor in the group that you selected, as sometimes your doctor may be on vacation or off-call when you need him/her the most.

You should expect that physician extenders should be educated as physician extenders (nurses or certified physician assistants, not salesmen). Hair transplantation differs from standard family practice and cosmetic surgery procedures in that there is a team approach to performing surgery. Doing refined follicular unit transplantation takes a team of 3-6 people working together for hours, so the doctor’s team is as important as the doctor is. An old cliché says that a chain is only as strong as its weakest link, so the skills of the doctor as one link of that chain can easily be offset by inexperienced technicians in the surgical team or sloppy processes that are not put together carefully and not focused on the many detailed nuances that produce quality hair transplants. You should feel confidence in the doctor and the team and you should feel ‘integrity’ and trust in soul of that doctor.

In my hair restoration practice, I add many elements to build confidence and establish trust. I have an open practice, where new, potential patients can meet completed hair transplanted patients one-on-one. This offers the opportunity for new patients to probe the process and see up front what they will be getting if we perform the surgery. I focus heavily on patient education, not only by providing copies of some of the important medical articles I have written, but also in spending time with each potential patient (doctor and patient in a private room without a salesman). Then after the visit, I provide a detailed letter summarizing what I learned about the patient’s objectives, and a written Master Plan for what I think will happen to that patient. Fees are openly discussed by the doctor and quotes for surgical fees are put into writing. By far, most of our patients do not have surgery and can be spared surgery with appropriate medications.

NHI is unique in that we have a fully accredited surgical center where all of our surgeries are performed, ensuring safety for patients to the highest national standard. Our surgical center is audited regularly for following hospital quality processes and procedure. Very few (if any) hair transplant facilities adhere to such rigorous standards. Why is that important? Well, it is the patient’s assurance that our sense of quality is judged against the best healthcare facilities in the nation. When you select a medical group for your hair transplant procedure, you should not only know the facility, the staff competence, and longevity of that staff, but also the history of the doctor. Has the doctor been disciplined before the medical board for infractions in any form of conduct? What does the public and his colleagues think about the doctor (available through internet sources)? What is the doctor’s malpractice record? Have you met or spoken to his/her former patients, and if so, what do they tell you about their research prior to taking on this doctor as their doctor-of-choice?

I always tell my patients (and have written on this blog many times before) that there is good news and bad news for the hair transplant patient — simply put, hair transplants are absolutely permanent. Getting it done right the first time is far easier that trying to fix what might not be fixable if it is done wrong. By following this selection process, finding a good doctor should not be difficult. There are many good doctors out there, just be careful not to end up in the wrong place.