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I don’t mind shaving my head in future when hair loss develops, but not now. What I want to have is a hairline to frame my face even if I shave my head.

Is there any technique performed by any surgeon which does not leaves VISIBLE scarring on the back of your head? If I want my head shaved in future, what do you advice me?

I’ve thought of FUE + (ScalpMicroPigmentation on the tiny dots) when I finally shave my head. What do you think about it?

Not everyone will have very visible scarring, but any wound to the scalp will leave a scar to some degree. Just to what degree you will scar, I have no way to know.

The combination of follicular unit extraction (FUE) and Scalp Micropigmentation (SMP) does work… but with that said, you need to be evaluated by a real expert to know where you stand.

Hello,

I recently received a transplant of 2500 graphs. The day after the transplant I had sex and was wondering if the increase in blood pressure to the head may have dislodged any of my graphs.

There was no unusual bleeding nor was my transplant area touched.

As with all your first time hair transplantation-ees, I am concerned that I may have adversely impacted the recover process.

Comments?

I doubt that any problems were produced. I generally tell my patients if they must undergo sex right after a hair transplant, try to be a bit more passive in the process. Full active sex is safe after about 3 days.

Thank you for the time and effort you put into answering all of our questions. My question regards scarring. I have heard some people say that scar tissue forms where the hairs are implanted during a transplant, and that this can result in bumps or raised spots on the hairline. Is this true? If so, is it common? If not, why don’t scars form where the hairs are implanted? After all, a wound of sorts must be made to implant the hair, so how would do you prevent hundreds or thousands of scars from forming after a hair transplant?

With the technique we pioneered, we do two things that minimize recipient site scarring –

1. We make very small wounds in the skin, essentially slits that approximate the size of the grafts. These heal very fast.
2. When preparing the grafts for implantation, we cut off the skin disk at the skin level. To minimize the skin disk, we remove the top layer of the graft skin from the surface of the graft. This prevents the skin from surviving the transplant which could, in some individuals, produce the bump seen in recipient areas. The same process is done with grafts taken from strip surgery.

When doctors use grafts that have a larger surface area than what I described above, the bumps you referenced get more prominent. We have seen from the old days when plugs were done and the graft sizes ranged from 3-5 mm across, the skin always was deformed. Clearly the more skin that survives at the top of the graft, the more detectable will be the existence of the transplanted graft.

I was listening to the Joe Rogan podcast and was really surprised when he mentioned that he won’t shave his head because he had a transplant a few years ago and has a scar. I always wondered why he DIDN’T have a transplant when I would see him on TV but was kind of surprised that he says he had one. Do you think he was misinformed as to what his eventual loss would be?

Your guess is as good as mine. I do not know the circumstance of actor/comedian/host Joe Rogan’s hair loss or the treatment he had. It’s possible that he had the surgery many years ago and had continued hair loss, but I really don’t know.

Someone might mention to him that we can treat his scar with either a scar revision or Scalp MicroPigmentation (SMP).

IDOC.. let me see if I have this correct. Having a transplant in an area where there is still a fair amount of hair increases the odds of shock loss? if i want to get a head start and restore my hairline as its thinning but still have hair, the trauma from the surgery will most likely cause shock loss to the existing hair in that area. Is that right? So the best candidate is one who has little hair in the area to be transplanted?

Is anyone still testing A Cell therapy for hair restoration?

Thanks

Those who are at the highest risk for shock loss include:

1. Patients with noticeable hair loss that is active at the time of surgery
2. Patients that are younger than 30 years old
3. Patients that have significant miniaturization of hairs in the balding pattern.

When such patients are on finasteride, the risk for shock loss is reduced.

I know I sound like a broken record at times, but everyone is different and every individual case is unique. There is no universal answer to this question. Some wait until they are bald before they have hair transplant surgery. Some have surgery as they are balding (to maintain their existing look). Shock hair loss is always an issue, but not an overriding one after all the factors are considered… as long as you and your doctor are realistic about shock hair loss. Some overreact or misinterpret what shock hair loss really is, and make it out to be an overbearing issue. But this is a generalization. Please read this recent post on shock hair loss. We do take it seriously, but we also take it on a one-on-one basis. That is why we have a real doctor- patient examination and consultation before any surgery.

With respect to ACell, we have conducted the one year study for hair restoration, but it was a failure. As far as I know, no doctor has been able to reproduce the results claimed by Dr. Hitzig or Cooley on hair multiplication. That is probably why you are not reading about it in scientific journals or in the mainstream media as the next great breakthrough. I don’t know which doctors are still experimenting with it, though.

Can I use hair removal if I decide my transplants just aren’t looking right? I am just trying to figure out what my options are to undo the surgery.

I met with a patient a couple years ago who had frontal hair transplants at a clinic with results that did not meet his expectations. He responded by going through electrolysis and removing the grafts. He came to my office to figure out what to do with the linear scar.

The results of the tedious electrolysis was very good, but in our experience, electrolysis is very dependent upon the skill of the person doing it. The means the results from this process can vary considerably. The use of hair removal lasers also can be a problem particularly if the grafts are large since they leave an abnormal “foot print” in the skin once the hair is gone.

The following post is by UK-based physician Dr. Bessam Farjo:

Written by: Dr Bessam Farjo United Kingdom

I recently came across a poll on newbeauty.com, which reveals that one in four Americans would consider having surgery if it wasn’t so costly. With this in mind, it’s not surprising that people seek a lower cost option and consequently consider having surgery in a country where it’s cheaper. While the discounted price tag may be very appealing, there are some important things to bear in mind when it comes to having surgery abroad.

The same website outlines some of the dangers associated with medical tourism. It describes how it can be difficult to check if a foreign physician’s credentials are genuine, suggesting that the International Society for Aesthetic Plastic Surgery is a good place to start. It also flags up that you may not be covered by your travel insurance if something goes wrong in another country. Another issue concerns recovery, which can sometimes take longer than expected after surgery and there can also be a danger of clotting if travelling by plane.

Similar considerations apply to our own field of hair transplant surgery. The website of the International Society of Hair Restoration Surgery provides a list of members as a reference not necessarily recommending anyone in particular. It is down to the individual patient to do their due diligence whether online or in person.

There are clinics that try to take advantage of potential patients who consider surgery at home too. We’ve seen a growing number of men come to us after opting for surgery via an offer on a discount website such as Groupon or KGB deals. These ‘deals’ are usually limited to 1,000 grafts which is only around 2,000 - 2,500 hairs. To anyone with a significant amount of hair loss this would be nowhere near enough to provide a suitable result.

The small print in these offers often dictates that only one discount is available per person, meaning that anyone requiring further treatment would have to pay the full cost or more likely, above the odds.

There certainly are some serious dangers involved with having surgery both abroad and at home and I would strongly recommend considering these should patients be tempted by low-cost surgery options. As always, I must stress the importance of thorough planning and research when contemplating any type of surgery, make your decisions based on what’s right for you, not on the price it costs.

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Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

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Dr. William Rassman’s Comments:

I can speak to having surgery in the United States, Canada or Europe. The issue of recourse comes up. What recourse do you have if the doctor misrepresented himself (or herself)? Or if there is medical malpractice involved in the delivery of the surgery? Or if the “doctor” really isn’t a doctor?

I know the laws in California are made to protect the patient at all times, and California lawyers are waiting enthusiastically to represent those who are harmed. The legal recourse in many foreign countries may not be there, which means that if you become a victim of the surgeon, there is little you can do about it. This, to me, is a good reason to have the surgeries in the United States, Canada or European countries that have strict laws that control doctors’ licenses and the way they use their licenses.

Snippet from the article:

A new report highlights a novel way for doctors to replace thinning hairlines: transplanting leg hair.

The report, a study of two cases published in The Archives of Dermatology, describes a new procedure in which receding hairlines were restored by taking hair follicles from patients’ legs and grafting them to the head. Men’s leg hair had successfully been transplanted before to the back of the head, but these are believed to be the first documented cases of leg hair being used to restore the hairline.

Read the rest at the NY Times — A New Approach to Treating Hair Loss

The article is about Dr. Sanusi Umar’s amazing work as a pioneer in body hair transplants (BHT). He has privately reported procedures of 10,000 grafts in one sitting using body hair. These procedures are done through very long sessions at times, reported to run in the wee hours of the morning.

Body hair is not the same quality of head hair for use in hair transplants, so I don’t think that this technique will catch on. Although body hair seems to change and grow longer when placed into the head, its value is not equal to donor hair taken from the back and sides of the scalp.

I am 1 month post-op on my 3rd transplant. Just curious why I can’t see the tiny holes where the grafts were placed as compared to the first transplant. I recall this from my 2nd also. The scabs have healed. I look for the incisions but can’t see them. Is it because existing hairs make it hard to see or because the incisions have healed and the grafts are beneath the skin?

I can only guess. Maybe the surgeon used a smaller instrument making smaller holes, or maybe the holes are not there because there were no hairs transplanted on the area you are looking at. Could the holes have healed so that you can’t see them? That will depend on how long it has been since your surgery.

You should at least see some scabs, unless they were there and it have fallen out. It usually takes one to two weeks for scabs to heal and fall out. Then it takes another few weeks for the hairs to fall out, unless the transplanted hairs were shaved. The main point here is that I have no way to know for sure via email, and it is all a guessing game. The best person to ask is your surgeon.

Hi,
i had a hair transplant done 3 months ago. now i am seeing some thin hairs on the transplanted area. but when i apply shampoo or oil, the hairs are falling out. is this a problem?

Perhaps what you are seeing is the old transplanted hair shafts that never fell out. Maybe you are seeing your existing native hair falling out. Or maybe you mistook your bottle of shampoo for a bottle of hair remover. It could be that there are other unknown issues going on. Make an appointment and see your doctor. Have an open line of communication with your surgeon and see him/her for a follow-up to see how your transplanted hairs are doing.