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My goal is to do the eyebrow transplant. I did some research and it said that it is difficult to separate the single hair from the multiple hair graft if your hair root is thick. So probably means big roots will be risky and causes the root to die and not grow in future.

My question is do i have to be concerned about the separating process of single hair or not because my hair root is quite big.

It has not been a problem in our hands. Careful microscopic dissection is critical to make sure that the area of the sebaceous glands are accurately dissected.

For those that aren’t familiar, follicular unit grafts used in transplantation contain 1, 2, 3, or 4 hairs each. With eyebrow transplants, these multi-hair grafts are split into single hairs. I generally like to find and use 1-hair grafts for the eyebrows.

Hello there Doctor Rassman!

My compliments on a great blog here. I’ve just had a FUE done for my hairline today. I have 2 simple Q’s -

1. Is Ibuprofen recommended after surgery? My surgeon has prescribed it twice a day for 5 days, but I read on the internet that it promotes bleeding?

2. On reaching home, I have been spraying the recipient area with saline solution every 30 mins as prescribed. I am seeing some drops of blood oozing out of the recipient area. Is this normal? I couldn’t spot any hairs in the blood so just concerned that none of the hair roots have fallen out due to this bleeding.

Thanks for your time and help

1. Ibuprofen in general can cause bleeding, but you need to understand and takes things into context. Believe what your doctor (a real live person you trusted to perform your surgery) over what you read on the Internet.

2. A little bit of bleeding should be normal since you just had your procedure done. It was surgery, after all. Many doctors have different post operative instructions, so if you are concerned you should contact your surgeon.

Hi Doc. I’ve had 2 hair transplants. Both over 2 years ago. One in Australia and one in North Carolina.

Today my new girlfriend mentioned to me that “where my hair is it looks red and sore”…. this is very disturbing as I have often thought the skin around my recipient area had a sort of raised redness about it. But I never thought anybody else would notice.

Before you say “see my doctor” I just want to know if you’re aware of this happening and whether or not there are any skin creams that might help my skin go back to normal. If not skin creams… is there anything you can do?

Redness can be an issue for some patients even years after surgery. I’ve seen this on occasion from old (bad) hair transplant days, but I rarely see this anymore. Maybe you have a skin problem, though it’s all a guessing game without an examination.

Hi Dr,

Thank you so much for this wonderful blog. I just recently got an HT with a very reputable clinic. My question concerns shedding of the grafts. I notice shedding began around the 9 day mark. Is this considered normal? Also, i had crusts on my head for approximately 9 days, and i noticed there were a couple of crusts that fell off with a hair in it. My question is, is it possible i lost a graft in one of these crusts. Or would there be some noticeable bleeding from the graft from being dislodged?

Thanks

At 9 days, I would expect that the grafts will grow out nicely. In a published article where we tried to identify when the grafts would be stable to grow out normally, we determined that stability occurs usually in a week or so. When the grafts fall out with the hairs in it after a week, they leave behind the stem cells in the recipient site. Don’t worry, it sounds like you will be fine.

Doctor,

Is Johnsons baby shampoo ok to use on newly transplanted hair?

Thank you

Always check with the doctor who performed your surgery. Basic information such as this should have been explained to you when you had surgery! I sometimes wonder who is doing these surgeries and why some patients kill blindly trust doctors with their medical care.

In general, baby shampoos should be fine on a new hair transplant. But as I don’t know anything about your surgery, you should always check with your surgeon.

Hi Dr Rassman,

Had a question about hair transplantation. In your professional experience in treating thousands of patients, would you say there is any hope for norwood 6’s?? I mean I know the limitations of supply and that everyones characteristics are different, but can a norwood 6 get any kind of decent coverage to get rid of the bald look. I ask because I fear thats where I am headed.

Have many norwood 6’s on my father side and have been loosing hair. At the moment I have arrested it with the help of finasteride (stopping around a norwood 3 and have not progressed in over a year), but as you keep stating, eventually your genes win, so I was just wondering what advice you give to people high up on the norwood scale, and if transplantation can do anything for them. thanks

We have transplanted many Norwood 6 pattern balding people. Some have excellent results, such as the one shown here (click the photos to enlarge):

You can read more about this patient here and here, but in case you don’t want to click, he had a single procedure of 2781 grafts. The results shown are after 9 months.

These type of results occur in people with average or above average hair density, and medium or coarser hair thickness. Don’t lose hope.

Hello doctor

I see a lot of HT photos, a lot of the patients seem to have their hair up and raised back like they’ve been in the wind. Is that just the way they style it? If I was to have a HT I’d want my hair down towards my eyebrows..

Is every patient different?

Regards

Hair normally grows forward in the front (parallel to the ground when standing upright). As one moves back from the frontal edge, the angle starts to change with hair pointing a few degrees upward until it reaches the front of the crown, where the frontal pointing hairs are about 35 degrees to the ground. So you see, the hair when placed by the surgeon is never placed perpendicular to the horizon. At the crown, the hair changes direction in a circular pattern (swirl) and as you look further back, eventually the hair points down and away from the front.

What you see in our patient photos reflect each patient’s styling (or lack of it), not something we do. I always put the hair back in the direction it would have been had they never lost hair and depending where I am working on the scalp, the rules I discussed above are followed with every hair placed by me. Patients generally like to play games with their hair and although a few comb it forward, most do not. Some comb it to the side with a part on one side, others comb it back with some product that they apply to the hair. Some just let it stray, taking on the character of the hair itself. If the hair is curly, then the natural state will look less groomed than if it is straight or has a nice wave to it. If you want to comb it down to cover your forehead and point to your eyebrows, you can do that also.

Every patient is different and the results we get depend upon texture of the hair, density at the area we are looking at, thickness of the hair shafts, the degree of curliness (or lack of it with very straight hair). But the hair transplant you get will be your hair, and it will bring all of its characteristics that are present in the back of the head where the hair grafts are taken.

Hi Dr. Rassman,

Does smoking weed before a hair transplant affect the hair transplant in any way? When i say before, I’m referring to like a day or two before the procedure.

Thanks

I don’t have a clue. If you plan on being the test subject, you should discuss your plans with your surgeon.

Hey doc. I’m just wondering something. Since you’re willing to trial the laser hat technology would you also be willing to try out Dr Gho’s smaller 0.3m FUE punch.

I don’t really care about the supposed hair multiplication stuff that he claims but I am really interested in the size of his punch. And I am interested in the size of his punch because cosmetically speaking its really hard to see any white dot scaring on any of his patients.

Lots of people on various forums are showing really good photographic evidence of what I would simply call really really really refined FUE. The proof does seem to be out there and since I know for a fact you fight for the balding brothers would you be willing to try that out on willing patients? in the name of science and progressing FUE technology.

Cheers!!

I assume you mean a 0.3mm punch, not 0.3m.

I am open to any innovation, but I am also a realist. Have you actually gotten out your microcaliper and measured what a 0.3mm diameter punch really looks like? It is smaller than a hair follicle, and smaller than a hypodermic 30 Gauge needle (OD). See the needle gauge comparison list here.

I am looking into finding a doctor to discuss my plan of attack for hair loss, and i was wondering what is the ISHRS International society of Hair Restoration Surgery? Is finding a doctor off of that website reliable as finding one from the American hair loss association website?

The International Society of Hair Restoration Surgery (ISHRS) website lists doctors who are members of a learning society. The American Hair Loss Association (AHLA) is a similar site. You must understand that any doctor can be a member of these associations and societies as long as they pay a yearly membership fee. These societies do not have the power to enforce or regulate a doctor’s practice and skills, and the hair restoration/hair transplant field does not fall under the American Board of Medical Specialties (ABMS).

In the United States, there are 24 approved medical specialty boards that are overseen by ABMS, a not-for-profit organization. Certification by an ABMS member board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training at a medical institution after earning their medical degree, and has successfully passed a level of competence via written or practical or oral examinations.

Since hair transplant surgery is not a part of the ABMS, there can not be any physician that is board certified as a hair transplant surgeon. This is mainly because there is no formal training or credentialing in hair transplant surgery. You read that correctly — there is no board certification in hair transplant surgery! There is no standard curriculum. There is no oversight or direct review of the quality of the work being done. Unfortunately, there is no ABMS sanctioned facility to enroll and learn hair transplant surgery. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a private practice hair transplant surgeon. Even ABMS board certified plastic surgeons do not receive training in hair transplant surgery as part of their formal training.