Unusual Case of a Wound Healing That Produced Hair Where There Was None Before

https://www.ncbi.nlm.nih.gov/pubmed/29310861

J Tissue Viability. 2018 Jan 4. pii: S0965-206X(17)30132-8. doi: 10.1016/j.jtv.2018.01.001. [Epub ahead of print]

Never too old to regenerate? Wound induced hair follicle neogenesis after secondary intention healing in a geriatric patient?

Wound healing is a natural process to restore the structure and function of injured or diseased tissues. Repair of a skin wound usually leads to a scar while regeneration implies fully recovery of function and structure of the damaged tissue. Adult skin wound usually heals with scar while fetal skin heals scarless. Hair regeneration in elderly scalp wound has never been observed. We reported an 80-year-old patient with a large wound on the scalp after excision of a basal cell carcinoma healed by secondary intention wound healing. The patient’s wound healed very well aesthetically. Interestingly, on approximate post wound day 180, a hair was observed to be growing towards the surface and eventually erupted in the center of the wound. The hair remained black at 42-month follow-up. This case demonstrated that neogenesis of hair is possible even in geriatric patient. To the best of our knowledge, this is the first report of hair regrow in human skin after wound healing.

KEYWORDS:

Basal cell carcinoma; Hair follicle; Regeneration; Secondary intention healing


2018-06-21 09:54:53Unusual Case of a Wound Healing That Produced Hair Where There Was None Before

I Have an Unhealed Wound 3 Weeks After My Hair Transplant.

You have what appears to be one or more small areas of necrosis which, when healed, will produce a scar without hair growth. This is usually a failure of the surgeon’s technique for creating recipient sites.

 


2018-11-01 06:46:40I Have an Unhealed Wound 3 Weeks After My Hair Transplant.

Unhappy with SMP and FUE (from Reddit)

The pictures only show your over-harvested donor area. If I understand you correctly, you had the FUE with an over-harvested donor area to fix the SMP you had done. The only way to correct the over-harvested donor area is with SMP. Nothing is perfect, but our overall satisfaction for SMP is very high in our hands. You need SMP for your donor area because that is why people are looking at you.

I regret my micropigmentation + FUE transplant. (Pics) from tressless


2019-06-04 15:07:30Unhappy with SMP and FUE (from Reddit)

Unfortunately, Some Hair Transplant Doctors Are Crooks

Last week, I met with two patients who came to me with thinning hair. One was 19 and the other was 22. The 19 year old had very early miniaturization, evident by the measurements that were taken of his scalp, and I built a Master Plan for him and advised him to go on Propecia. The 22 year old had clear thinning in the frontal 2 inches of his hairline with 40-50% miniaturization and a thin type hair shaft. The thin hair shaft made his miniaturization look worse than if his hair had been more coarse.

Both of these young men went to these doctors before they came to see me (and no, I won’t name names). In my opinion, both patients should not have hair transplants at this time; certainly the 19 year old is not a candidate at all and probably will not be for years, and the 22 year old may become a candidate if the Propecia does not stop or reverse his hair loss to meet his goals. However, the 22 year old might be able to avoid a hair transplant if the Propecia works well for him. The lack of ethics of the two doctors who viewed both men and gave them both recommendations of 3000 grafts each reflect the ‘scum’ of the hair transplant industry. I know I’ve written on this topic a few times before, but it truly outrages me and demands this repetition. Performing surgery when it could be avoided with a simple daily medication shows that the doctors were chasing their patient’s pocketbooks, not pursuing their patients best interests. Fortunately, both patients liked my advice and will see me for a follow-up in a year or so. I am sure that they will get calls from these two doctors and/or their sales staffs and I strongly advised them to resist sales pressures to sell them what they do not need.

To make matters worse, in my normal examination I measured the hair density of the donor hair on these patients and found them both to be lower than average. That means that they might be limited as to what they can expect from a hair transplant when and if they balded. Both of the doctors that they met with just ran their hands over the patients’ scalp in the back of their heads and magically reported that they were unusually blessed with “lots of donor hair”. Neither of these doctors made a measurement of the donor density on either of these patients and as if by magic — *poof* — they had enough hair to meet the doctor’s income requirement. These scams are unfortunately common in this industry and I always warn patients that if the doctor does not precisely measure the donor density, they should run for the hills when told that their donor supply is good. Worst of all is the fact that if these men had undergone hair transplantation, their donor hair (which was limited in the first place) would be depleted, wasted, and worse yet, put in the wrong place. Over and over again I warn patients to do their diligence on the doctors they see and choose. This again, is a Buyer Beware market.


2007-10-12 16:08:16Unfortunately, Some Hair Transplant Doctors Are Crooks

Uneven recession with Folliculitis Decalvans

So I’ve been losing hair only only my left side of the hair line. And its gone pretty far back compared to the right. No sign of stopping. But one thing I learned was my scalp would hurt when I moved my hair and thats where I was losing hair. So where every it hurt, when I moved my hair, thats where it was thinning and I was losing hair. So why is that? and why am I still losing it.
Genetic balding is asymmetrical and it will eventually even up in time. If you dermatologist says it is folliculitis Decalvans, it requires your dermatologist attention. Never do a hair transplant with this condition.


2020-11-04 10:01:55Uneven recession with Folliculitis Decalvans

UNETHICAL Hair Transplant Surgery

HERE IS A LETTER I SENT TO A PATIENT: “You have had previous hair transplants done by Dr. XXX with 3400 grafts in the front of your head. You were very frightened about the prospect of being bald at that age of 23. Now you are 31 years old and started Propecia 4 months ago. You want to know the status of your balding situation.

Today’s we used the HAIRCHECK instrument on your head. Measurements indicated that you hair bulk in the frontal 3 inches of your scalp that exceeds the hair bulk of the donor area by 30%. Comparing the crown and the back of your head, the measurements were comparable.
This tells me two things:
  1. You are not presently balding
  2. Your hair transplant done years ago was done on a young man that probably was not balding but driven to have a hair transplant out of fear of balding. Frankly, you were taken advantage of for the money. I am ashamed that doctors in this field would take advantage of your youth and naivety.You agreed with me that in hindsight, you were driven by fear, not balding
The good news is that you should stop the Propecia and if you are ever concerned again about balding (which i believe will be unlikely for your future), please come back and let me retest you with the HAIRCHECK instrument.”
I wrote this to a patient and sent it off to be published because in the hair transplant community, this type of behavior is not unheard of, even today. Too many doctors practice this type of surgery, because for them, every patient has a ‘bucket’ of money that they can tap. Some of these doctors are predators, who think that it is easy to manipulate their patients, set them in a panic mode, so that they can push them to have a surgery, needed or not, often more than less. There is no such thing, in my opinion, as hair transplants that are done to prevent what hair loss might occur in the future by transplanting areas behind the balding pattern that needs transplants. So what doctors do far too often, is that if a person needs 1500 grafts, the doctor will recommend 3000 grafts (double the grafts and double the fee) and put these extra grafts into the normal, non-balding area. What makes it worse, these grafts into non-balding areas may kill normal hairs. Who could challenge these doctor, certainly not the patients who believe that doctors are not crooks but sort-of god like. Patients often don’t know any better, so they believe the doctor who tells them that they need 3000 grafts when in fact, only half of that is needed. Don’t get me wrong, when a patient needs 3000 or more grafts, I will do it. The overall warning here is LET THE BUYER BEWARE. Don’t trust your doctor if for any reason, you think that your doctor is not being honest with you. You can always get a second opinion and therefore protect yourself by shopping around. You will pay $$$, in the short term and valuable donor hair in the long term and unfortunately there is no going back, no recourse.

Unethical Hair Transplant Doctor Transplanting Hair On Patient Who Did Not Need The Surgery

This is a note I sent to a patient I saw today.

You have had previous hair transplants done by a Los Angeles doctor who has since lost his license. You received 3400 grafts in the front of your head. You were very frightened about the prospect of being bald at that age of 23. Now you are 31 years old and started Propecia 4 months ago. You want to know the status of your balding situation.

Today’s we used the HAIRCHECK instrument on your head. Measurements indicated that you hair bulk in the frontal 3 inches of your scalp exceeds the hair bulk of the donor area by 30%. Comparing the crown and the back of your head, the measurements were comparable.
This tells me two things:
  1. You are not presently balding
  2. Your hair transplant done years ago was done on a young man that probably was not balding but driven to have a hair transplant out of fear of balding. Frankly, you were taken advantage of for the money. I am ashamed that doctors in this field would take advantage of your youth and naivety.You agreed with me that in hindsight, you were driven by fear, not balding
The good news is that you should stop the Propecia and if you are ever concerned again about balding (which I believe will be unlikely for your future), please come back and let me retest you with the HAIRCHECK instrument.
As a side note: I would agree to (1) help him file a complaint with the medical board if the doctor was still licensed in California and (2) I would put him in touch with a lawyer to facilitate a malpractice action against the doctor and act as an expert witness on his behalf.

Undetectable Hair Transplant

Dear Dr. Rassman,
I will like to know if you can you tell that someone had a hair transplant by looking at it?

Hair grows naturally in units of 1, 2, and 3 hairs each. The frontal hairline always has single hairs and a transition zone of these single hairs starts at the forehead (more widely spaced) and they then get closer together as you look further back into the actual denser hair. Within ¼ of an inch, these single hairs get noticeably denser and then groups of 2 hairs start appearing. I say this because to make a hair transplant look like God’s work, God’s design must be copied. The single hair leading edge of a non-transplanted person is erratic and disorderly. It is not heavy, so the idea that there is a ‘line’ with a hairline is a misconception. The transition zone makes the hairline imperceptible. If the pattern is created by the transplant surgeon with enough hair to mimic the normal transition zone, an observer should not be able to see a hairline nor a hair transplant. At our open house events (which we hold every month at each office) the people are amazed that they can not pick out those who had hair transplants from those that did not.

So simply answered, in 95% of all cases, a hair transplant should not be detectable as a hair transplant if there is enough hair to address the needs of the patient. Look at this video of a completely transplanted frontal hairline worked with a comb. Please note that this patient has a high contrast black hair against a light skin color (the most demanding combination). If there is anything abnormal looking about a hair transplant, it will always show up in someone with black hair and light skin.