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I am considering my second hair transplant as I have developed some baldness since the first procedure. My question is, can the old donor scar be made into a tricophytic scar during the second procedure?

Yes, the trichophytic closure can be done on the second or even third procedure to try to make the scar smaller. I haven’t written much about the trichophytic closure in recent months, but essentially it is a technique to minimize donor area scarring for those that have a hair transplant using the strip method. You can find photos here and here.

Snippet from the article:

One of the UK’s leading cosmetic surgeons is calling for age restrictions on hair transplant surgery, after seeing an alarming rise in the number of teenage boys wanting to go under the knife.

Dr Bessam Farjo, co-founder of The Farjo Medical Centre and past President of the International Society of Hair Restoration Surgery, has seen a 23 per cent increase in enquiries coming from men aged 20 years or under over the past 12 months. Some of the enquiries the centre has received have come from the parents of boys as young as 16-years-old.

Read the full article Plea For Age Limits On Hair Transplant Surgery

I’m glad Dr. Farjo is speaking out about this. I get quite a few emails from teens asking for surgical advice, but you must understand that hair transplantation should not be an option until you’re an adult. It’s not like getting a nose job, where once it’s done, it’s done. Hair loss is progressive.

I’ll give you an example: You know how you can see those old, ugly hair plugs on some men that had surgery many years ago? They likely didn’t see those plugs of doll’s hair at the time, but as the hair loss progressed around the plugs, those very plugs that were adding fullness to their hair eventually became the focal point of their scalp. Granted, today’s techniques are different in terms of appearance, but my point is that your hair loss will likely progress to some extent and you don’t want that touch-up work that you had at an early age be the only thing you have on your head as an adult. This is exactly why I mention the need for a Master Plan. Think long term!

Dear Dr.,

I really appreciate your taking the time with this web site and the questions I have sent in that you have answered. I am 29, about to turn 30, and have been on Propecia for about 6 months now, which I started when I saw noticable thinning in the crown/Vertex area. I’ve had good results thus far, some thickening and reversal in the crown area. I have a strong juvenile hairline and in some lighting look like I have a full head of hair - under very bright electric or sunlight my crown looks a bit patchy and there’s a line of thinning/scalp on the top. As I stated in an earlier post, I was turned away from the Aderan’s trial because they said I have too much hair.

My Question is, after I turn 30, what kind of restoration results could I get from an FUE procedure? I’m a bit confused, since you state that extensively bald people should have limited expectations, but that you are reluctant to transplant someone with thinning who wants fill-in work. There is also all the advice I read on the web saying to wait for better treatments down the line if you’re in the early stages of hairloss.

Thank you very much

I don’t know how much or what type of hair you have, so I couldn’t begin to give you any kind of remote guess as to what you can expect from a FUE procedure. You’re getting ahead of yourself.

Every rule has exceptions and to determine what you should do, first get examined by an honest doctor who cares more about you than his wallet, and if he says go for surgery… come to me for a second opinion (you indicated that you’re not too far from my San Jose office).

I would like to know whether it is possible to do hair transplants to someone who had radiation therapy for 6 weeks. The area is about the size of the palm of a hand. Balloon expander was suggested… but 6 months and 2 “operations” is too long and not worth the result…or is it?

Thanks for your advice.

Hair transplants may work in the radiated area, but that depends upon the status of the quality of the skin in the recipient area. I can not render an opinion without seeing you, but it seems like you got advice already from a doctor and an area as large as you report seems appropriate for a balloon expander at first blush.

When I transplant a patient’s hair into an area that received radiation, I often do a test transplant to be sure that the transplants take 100% and are strong and robust.

This is in response to My Hair Transplant Made My Skin Cobblestoned!

So, Selective removal of the grafts via FUE is not an option to reduce the cobble stoning? I too have this issue, and I only Have a few hundred grafts, not all of them are cobble stoning, maybe a total of 200 are cobblestone. I know FUE leaves a small scar, but would the removal of 2-300 grafts over my entire scalp really be that noticeable? Why do you say more hair transplantation is the only option?

Follicular unit extraction (FUE) is done with very small punches where a follicular unit is removed one at a time. Cobblestoning is a whitish scar with no hair in it. If you want these white scars punched out, then they will form new white scars, i.e. no gain. Removing the entire larger graft with the cobblestoned skin is the only real way to do this, and the scar that may be formed will probably be less detectable than the cobbled area. Depending upon the location of the cobblestoned area, camouflaging it with a hair transplant may be needed.

This is a very difficult question to answer without seeing just what you are concerned about. Please send me photos and I can be more pointed in my answer to you.

I just ran across a collection of photos on some celeb gossip site. I never realized Joel McHale from The Soup and Community had hair issues, but his hair looks good now. What do you think, did he have a hair transplant?

The change you see in the photo on the left (with an isolated forelock and hair loss around it) to the photo on the right (with a full frontal hairline) is often what I see when I do a hair transplant. I would think that he had a good transplant job done. Now it looks like a mature hairline as opposed to someone going through frontal hair loss. If I were the surgeon, I would have produced a slightly less concave shape bringing down the corners about another 1/4 inch.

Hi Dr Rassman
I had a hair transplant done 5 months ago by a board certified doctor with lots of experience. I recieved 1750 grafts (aprox 4300 hairs estimated). After 5 months it looks like maybe 43 new hairs have shown. The only difference between now and before the procedure, is that now I have a donor scar on the back of my head keeping me from shaving it all. I am very discouraged/upset by this.

In your experience, or to your knowledge, do some people not respond to hair transplants (the new hairs don’t ever grow)? If this is not reported as so, then does the length of time before ANY new hair shows ever take longer than 5 months? I realize it generally takes 9 months or so for the hair transplant to be fully realized, but I was told (and read) that by month 5 significant new growth should be visible. Your answers and info is much appreciated.

Thanks

Take a look at this patient and watch his hair grow over time. At 5 months after his single hair transplant procedure, he had some short hair growing… and by the 7th month it was styling length. Some people grow faster or slower (by about 2 months). Ask your doctor in another 2 months to judge if your hair growth met his expectations and match it to yours.

I’m worried that the combination of continued balding and my very fine hair will make it difficult to naturally and densely cover my scalp via transplant. In the case of having a fraternal twin, female family members, or maybe even friends with hair to spare, is it ever possible to retrieve grafts from a donor that is not the patient? Would grafts from a female donor be viable on a male MPB scalp? Thanks!

Unfortunately, transplanting hair from any person other than an identical twin will fail and get rejected. Hair is like any other organ transplant, which would require anti-rejection medication that could lead to further health complications. I’ve written about this process and the medication required before.

Hello Dr. Rassman,

As you seem to be the leader in your industry (in my opinion, at least), I assume many patients travel from afar to see you. Do you treat Canadian residents? I am in the eastern part of Canada, and while there seem to be some good surgeons in my area, I feel a visit to you is my best option. Any thoughts about this? Thank you.

Yes, I can treat any patient that sees me from any part of the world. We also offer a travel discount for surgical patients. Before we arrange that we should have a telephone consultation and that works best if you send me photos so I can see what your problem areas are. If you’d like to setup a phone consult, you can fill out this form so that someone on my staff can get back to you to schedule it and get those photos.

Here’s the info about the travel discount from our website:

“If you live more than 150 miles from the office where your surgery is performed, you are eligible to participate in our travel program. NHI will reimburse you for up to 5% of your net procedure cost for reasonable transportation expenses incurred while traveling to one of our facilities for a seminar, consultation or procedure. If you drive to one of our facilities, you can choose to be reimbursed for either mileage or gasoline expenses. If you fly to one of our offices, please note that frequent flyer miles are not reimbursable. NHI can only reimburse you for your flight-related out-of-pocket expenses. In all cases, please remember to provide receipts. In addition, you will receive one night’s stay at a pre-selected area hotel at our expense. This program is based on a minimum procedure fee of $3,000.00.“

This is a comment I received in response to this past Friday’s post, Hair Transplant 10 Months After One Procedure:

The results look great.

I do have a question though. I’ve often read that it’s frowned upon to transplant to the crown at a younger age because you might not have the hair to cover the front as you get balder (and who wants to be bald in the front and have hair in the crown?)

Was the crown covered because he has hair density similar to his father, or maybe he’s older than I think and not on pace for a Norwood VII?

The patient is in his early 40s and is a very special case. His density is very, very high (like his father and his brother), which means that he easily has a total of 10,000-14,000 graft capability. I could’ve easily taken out 5,000 grafts had the grafts been needed. He is in a good situation to stop doing hair transplants now and with the Propecia that he takes religiously he probably will not lose much more anytime soon. I don’t expect him to follow his father’s Norwood 7 pattern.

If the patient was to lose more hair between the frontal area and the crown (which was transplanted in this first procedure), he would have lots of reserve still left. It is important to note that very high hair density was critical in this decision process.