Post-Op Questions About Redness – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman,
Thank you for having this site and thank you for taking our questions.
I had hair replacement surgery a month ago. I received 2700 grafs. I still have redness on top of my head as well as an itching from time to time.
How long will the redness remain and how long for the itching to go away?
Also, is it okay to scratch my scalp in the area where the transplants were placed. I currently scratch with the tips of my fingers, very, very lightly? Is that okay?

Thank you.

Redness is generally minimal for most people. For those few individuals with a tendency to get red (having histamine positive skin), the redness may take weeks to completely go away. There are no straight rules. Topical steroids work to minimize redness or to treat it if it appears, but minimal use should be encouraged (speak with your doctor). Scratching vigorously is always a bad idea, because it tends to produce trauma to the delicate areas where the transplants were placed and increases your risks for infection at the hair follicle level. What you described sounds ok, as that is not scratching. Make sure your fingers are clean, that you do not pick your nose and then go to scratch your head, because the bacteria from the nose will seed the transplanted area for infection (don’t laugh, as this happens frequently).

Dreadlocks Causing Hair Loss in Woman? – Hair Loss Information by Dr. William Rassman

I have a dear friend, young, beautiful girl (caucasian) who has come to believe that her really long dreadlocks – which she has been growing for 7 years…is causing perhaps permanent bald spots on her scalp. She is really beside herself about it, and wondered what she could do to be sure, and if so – to cure the problem.

Dreadlocks can produce traction alopecia (hair loss from constant pulling). The best thing for her to do is to get rid of them and then wait for recovery of the hair. After 7 years, the hair loss may be permanent, but until the pulling stops, you will not know one way or the other. Recovery from traction alopecia may take up to a year.

Anything New with Alopecia? – Hair Loss Information by Dr. William Rassman

what’s new in the world of alopecia? I am a 34 year old woman and have had alopecia universalis (alost 100% hair loss) for 10 years. Should I get laser treatments? What about DPCP – is it even safe? What immune system enhancements could I do to boost hair regrowth? Or should I just be content to live without hair for the rest of my life?

Why does this happen? Is anyone doing research?

The last question is the easiest, as it is purely a genetic process now being mapped out by the science of genetics. When the research advances with a solution to the genetic defect, then you and many other people (even those without the complete loss of hair) may benefit.

For those of you interested in the subject of alopecia universalis, see: AlopeciaAreata.com or BaldingBlog – Alopecia Universalis

There is nothing now on the horizon though, sorry.

Any Advice for Woman with Telogen Effluvium? – Hair Loss Information by Dr. William Rassman

i have a form of telogin effluvium,with thinning on top of scalp!i’ve been to 2 medical doctors with no help in sight..my scalp itches and burns alots. for the past 5 mos. i’ve been wearing a hair system that is glued on to the edge of my outer hair..please advise!

If you have been fully evaluated by two medical doctors with blood work and carry a diagnosis of telogen effluvium, there is not much help I can offer other than assurance that it will take time for your hair to regrow, if it does regrow. The use of glued hair systems will definately make the problem worse. Hair transplantation is definitely not an option. Unfortunately there are no medications to treat telogen effluvium. With respect to your scalp itch and burn, the hair system may be impacting you more than you realize.

John Travolta’s Hair Piece? – WRassman,M.D. BaldingBlog

John Travolta’s Hair Piece?

I found a website that suggested that John Travolta had a hair system. Can you explain how this works for me? The site is Faded Youth

John TravoltaSome of the finer hair systems are created with a fine mesh material which then has hairs attached to the mesh, put together a hair at a time. At the hairline, a transparent plastic type material is used to match the skin tones and it is attached (glued) to the skin. For the mesh part behind the leading hairline edge, the hairs are layered so that the fine mesh does not show. The transition from front to back of the system must be meticulously put together.

Please note that I am taking the photos on the site you referenced at face value, and believe they are actual photos of John Travolta and not Photoshopped images. If these photos are his, unfortunately for John Travolta, an aggressive photographer caught this view of what appears to be a hair system. From any reasonable distance, a good hair system looks like a normal head of hair and I complement the folks that made this system. Such hair systems are very expensive and take considerable maintenance to keep them attached to the scalp and to keep them clean and odor free. Maintenance means that the person wearing them comes into a special facility (some get the experts to go to their home) to get them washed, repositioned and/or reattached as the hair under the system grows and the skin turns over from normal growth. The frequency of this maintenance process may be 3-4 times per month, on average. Monthly maintenance costs for good systems run upward of $250/month and the more affluent clients may pay substantially more for the better systems. The scalp below the mesh often grows some hair and the skin itself sheds as a normal part of the body’s replacement function. The scalp skin turnover rate runs about 14 days, which means that all of the skin of the scalp sheds and is replaced with new skin a couple of times per month. The old skin obviously has no where to go, so it accumulates under the mesh in flakes and eventually decays, developing a characteristic ‘musty’ odor associated with skin that is not washed away regularly. Even if the person can wash with the hair system in place, dead flakes of skin still build up and with added moisture, it becomes a culture broth for bacteria. When these systems are changed often and washed frequently, the person wearing them must have spare hair systems to wear. The good ones cost many thousands of dollars. Add to that the cost of weekly maintenance, and most people would be surprised to find that the cost of a hair transplant may be reached within a year or two in the hair system costs. Even for the normal run-in-the-mill hair systems, total costs (one or two hair systems plus maintenance) may exceed $3,000/year. In these photographs of Mr. Travolta, the edges of the hair system are marked with arrows and the mesh is circled in red, in case you can not see it. I’ve also lightened the photo so that you can see the problem a little clearer, though if you look at the source photos, you should be able to see the issues on their own. Click the photos below to enlarge.



The source photos are here and here.

These mesh systems produce traction alopecia, which means that they produce hair loss from the constant pull of the glues used to keep them attached to the skin that stop them from sliding around the scalp. These hair systems ‘hooks’ the wearer for years and like an addict, they become perpetual users because the traction alopecia makes it impossible to maintain any semblance of their image if they show any of the extensive balding patterns I have seen in my office practice. The replacement, as well as maintenance of these systems, are incorporated into the budget of the users, like rent on a good apartment. Alternatively, a good hair transplant can appear as good or better than a good hair system without the constant maintenance. Let’s face it, Travolta is Travolta because of his sexy, hairy look.

The need to maintain that sexy image is critical for celebrities like John Travolta. Can you imagine him playing a role that did not exploit the persona that this tight, sexy hairline creates? I can not. So the issue for most men in his circumstance is keeping this ageless appearance that their livelihood depends upon. The good news for hair systems is that they do not depend upon the hair supply, so what a person wants in terms of look and fullness is just a matter of money. Men like Elton John, Michael Jackson, Burt Reynolds and Frank Sinatra needed such systems, because the word on the street is that they did not have enough of their own, while others like Matthew McConaughey, assuming he has some hair system and existing hair loss (see previous blog entries) who has considerable amounts of normal hair behind the balding frontal 3 inches, have enough hair to get a hair transplant and join the world of free men, who let their hair hang loose with or without grooming.

For those people who use these hair systems there is a substantial overhead that is not evident when you look at the remarkable results that can be achieved. Hair Freedom is only a dream for hair system wearers. They have to worry about their hair, about the girlfriend who tries to run her fingers through it and having her fingernail get caught on the mesh, worry about odors and the importance that colognes and after-shave have taken in their life, they need to see the hair system specialist 3-4 times each month for adjustments and they must face the costs, those never ending costs, that recur over and over again.

The hair transplant process is in many ways the antithesis model for getting hair. The only overhead after the cost is the monthly trip to the barbershop. Wind, water, odor, women running their fingers through it, and the natural look of hair that will grow for a lifetime, delivers that Hair Freedom I had just mentioned. As I am a hair transplant doctor, I think that it is worthy to demonstrate what I am talking about by showing close-ups of the alternatives that I routinely perform in my office. The man on the left thought he wanted a Travolta look while the other two men had no such desire. Hairlines created by an artistic hair transplant surgeon are similar to what a good portrait painter would paint when creating ‘the look’ that his client wants to have. Click each photo to enlarge.




The entire hairlines of these three men are what is shown above. There is no original hair in these hairlines. Close-up views are a must for a side by side comparison to the Travolta photos above and for our readers to make their own judgments. We have men like these at our monthly open house events, because seeing is believing. I have many patients with sexy Travolta-style hairlines and each picture speaks for itself. Contrary to common belief, you can not tell a good hair transplant from a normal godly-produced head of hair in most circumstances.
Errors: https://baldingblog.com/wp-content/uploads/2019/03//photos/060317_travolta1.jpg is not accessible or supported filetype.https://baldingblog.com/wp-content/uploads/2019/03//photos/060317_travolta2.jpg is not accessible or supported filetype.https://baldingblog.com/wp-content/uploads/2019/03//photos/060317_patient1.jpg is not accessible or supported filetype.https://baldingblog.com/wp-content/uploads/2019/03//photos/060317_patient2.jpg is not accessible or supported filetype.https://baldingblog.com/wp-content/uploads/2019/03//photos/060317_patient3.jpg is not accessible or supported filetype.

Hair Shedding for Past 2 Months — Should I Get Transplants? – Hair Loss Information by Dr. William Rassman

I’m 33 and my hairline has been slowly receding over the last 10 years. By slowly, I mean very slowly. I never even gave it much thought until about a year ago. Within the last 2 months, my hair started shedding without any real reason. I went to my doctor to make sure there wasn’t any serious issue causing the hair loss and all my tests came out negative.

I don’t want to lose my hair and am now considering hair transplants. My question is: when should I get them? Do I need to wait until I’m bald?

First, I would ask if you have been losing hair for a long time and just noticed it. That would be evident if you already have one of the balding patterns (see Norwood Classes). If you are considering hair transplants because of one of these patterns, you should set an appointment with a hair transplant doctor for a formal consultation to map your hair loss for a href=”http://www.baldingblog.com/2006/02/07/hair-mapping-for-miniaturization/”>miniaturization to find out if you have male pattern balding. There may be other options that your doctor may recommend, such as taking a medication called Propecia (finasteride). You do not need to wait until you are bald to start this medication and if you have early hair loss, then this drug may reverse it. Not using Propecia would be similar to waiting for a heart attack before you start doing something about coronary artery disease. Perhaps not as drastic, but you get the idea. Then again, I am often surprised that hair loss can sometimes be a life and death matter to some people.

A hair transplant should not be your first option. Get a diagnosis first, determine if the hair loss is reversible with a drug like Propecia and then if the hair loss is cosmetically a problem and does not respond to Propecia or if the hair loss has gone too far, then and only then should a transplant be considered.

I Can’t Visit A Specialist — How Do I Know If I Am Balding? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman
It is not possible for me to visit a specialist to have my hair mapped for minaturization, but would like to know if I am balding. I am 32 years old and over the last 4 months have noticed about 20-30 hairs on my hands everytime I wash my hair (every other day), although there is rarely any hair on my pillow. This is something new to me and I would like to know if this hair loss is temporary. I have thick hair, and for this reason, about 1 year ago I had a hair cut to really make my hair actually thinner to achieve the style I wanted. Is is possible that the hairs that were not cut, have reached then end of there growth cycle and are falling out? I am asking this because most of the hairs on my hands after washing are the longest hairs on my head, namely the ones at the front. If so when can I expect this cycle to stop?

Also I notice a few red spots and dryness on my scalp. Can this be related to the hair loss?
Thanks for any help

I am sorry to say, but at 32 years old you should be able to find the means to visit a specialist if you are serious about wanting to do something for your hair loss. Are you unable or unwilling to take charge of your hair loss? I would want to know why you can not connect to a good doctor to help you. I recommend that you review some of the past entries on this blog to find the answers to your questions. We all lose 100-150 hairs per day so if you are counting hair on the pillow and in the comb, you may be over reacting. That is the start of an answer that has already been posted many times here on this site. After a year or so, your hair should have grown to styling length, but as you get older, the hair may develop a different hair characteristic secondary to thinning of the hair shafts, common also with aging. In answer to your last question, red spots can be a reflection of folliculitis, vascular skin irregularities, and many other conditions that go beyond the scalp. If there are really a problem, again, see a doctor.

FNS Follicle Nutrient Serum – Hair Loss Information by Dr. William Rassman

Hello Doctor,
I was reading an article on FNS Follicular Nutrient Serum. It was researched by a dermatologists, and I have not yet found anything bad about it. It claims to stimulate growth and grow thicker hair. Do you know anything about this product? please post your answer quickly (my time is running out).

I often receive questions from patients like you stating, “quickly.. my time is running out”. What does that mean? Is there a deadline? If so, how long do you have left? More importantly, what happens after your “time” runs out?

If you have been following this blog, I receive questions everyday regarding various hair growth / regrowth products. My answer has always been that it is a “buyer beware” market. Just because a doctor or a scientist endorses a product does not mean a product works. Likewise, the scientific evidence behind a product is subject to many interpretations and biases that may falsely lead the general public. Often times most products contain the same basic ingredient (minoxidil) packaged with a different name. It is not my role to be a pessimist, as it may seem, but a medical doctor that practices medicine with a scientific background. This does not mean your FNS Serum (or any other cream or serum) will not work. Even with its endorsements and “proofs” and “before and after” pictures, I suspect most of these creams, serums, potions, or lotions can never meet the strict FDA approval process that can guarantee its efficacy (see FDA approval process) . Otherwise I would love to market a six pack of beer as the new drug that enhances the sexual appeal of your date, but I do not think I can get an FDA approval even though I have personal proof and testimony from hundreds of ‘patients’. That was a joke, by the way.

In summary, we are all looking for a quick and easy fix to all our problems. Our time is always running out. You can try using the FNS Serum, but what happens if that does not work? Will your time be up? If you want a medical solution for your hair loss, you should see a qualified hair transplant doctor for a formal evaluation of your hair loss. But that is on your own “time”… before it runs out.

Wearing a Hair System While New Transplants Are Growing – Hair Loss Information by Dr. William Rassman

I have been wearing a hair system for almost 10 years and want to transition to a transplant, my concern is really with the transition..how to do this without letting the world know that I am infact wearing a system..or was wearing a system and am gettiong transplants.

Is there a way where I can keep wearing teh system, get transplants and as they start growing just crop the hair as short as aesthetically okay,a nd then just toss the system?

Please let me know I am a level 6 or so, have fairly realstic expectations about what hair transplant can do for me, but am simply confused about the transition period and thus have nto taken any steps.

Yes, many people in your situation continue to use the hair system. The systems must be switched to clips and great care needs to be taken not to allow the piece to irritate and rub the new hair. I generally recommend using a hat when you are not needing the hair system and taking off the system at night (easy to do with clips). Keeping your hair and scalp clean is important. I ask that you hold off using the hair system for the first week after the transplant, and recommend that if you really want to keep it covered, use a hat during this time.

20 Month Old With Possible Alopecia – Hair Loss Information by Dr. William Rassman

I have a 20 month old who I am suspecting may have alopecia. Can you recommend a physician in the Chicago area who sees children and specializes in alopecia? Thank you for your time.

Look to the ISHRS website for a hair specialist, or even the American Academy of Dermatology for a listing. Best for you to consult your pediatrician as there are many causes of balding in young children that he/she should be able to treat and if necessary, make an appropriate referral to a competent specialist in the field.