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I had about 2,500 grafts transplanted approximately one year ago. The grafts grew in pretty well for about 7 or 8 months, then I exerienced some shedding. I know have less of the transplanted hair that I did 3 months ago. Funny thing is that it seems I also lost some of the hair from a prior transplant years ago. This is dissapointing and depressing. I believed that hair that had begun to grow would not fall out again, and I do not have an auto-immune disease. Any ideas? (I’ll try and get a follow-up with my surgeon. Thanks

If you had any original hair still left in the transplanted area, you could lose that hair and cause your problem. If all of the hair that is thinning is transplanted hair only, that is rare. We call the donor area hair “permanent hair,” but is it really permanent? In a very small percentage of the population, the donor hair can thin permanently. If that happened in your transplanted hair, the same would be apparent in the donor area, as both have the same source. I always measure the density of the donor area prior to a transplant so if this happened, I would have a measurement to compare to.

In a very small percentage of patients, hair that has been transplanted can be lost… and if that happens it will usually return. I do not understand the cause of this when it does occur, but I have seen it a few times and most of the time the hair came back. Please do have a follow-up with your surgeon and express your concerns.

Thank you for posting such useful information on this site. I want to ask some basic questions regarding post-op care that I haven’t seen posted (or maybe I’m not searching correctly either).

I recently had a 2500+ graft procedure just in case that matters for some of the questions posted:

1. Approximately how long after surgery should a patient expect to see bumps on their head? I am roughly 5-6 weeks out of my transplant, and I still see some pimple-like bumps on my scalp (sometimes even a random scab here or there that easily comes off after showering & soaking). I’m just curious to know how long it might take to see everything go away and return to normal.

2. There are still some areas from the incision that seem to be little tender, which I mostly notice when I apply shampoo in the shower. Is it normal to experience some form of (mild) tenderness around 6 weeks out of surgery? I believe you’ve posted before that around the first month, the incision is about 70-80% healed.

3. Have you ever heard of anyone experiencing slight swelling in the throat after starting Propecia? I started taking Propecia after my procedure, and noticed some minor swelling in my throat, but now it seems to have gone away. I also noticed I was more tired than normal, but that was probably due to causes unrelated to using Propecia or having the surgery (although I followed roughly the same sleeping pattern as I did pre-surgery). In either case, I was curious to know if you had heard of these types of effects from using Propecia.

Many thanks!

While it is a pleasure to educate on issues of balding and hair transplants, I don’t understand why a recent hair transplant patient will have such basic questions to ask when they have their own surgeon. Was this not explained in your post operative instructions? Is the doctor not available? Here is a link to some of the basic questions after a hair transplant procedure from my NHI website: Post-Op Course in Follicular Unit Transplantation

To answer your questions more specifically, some redness or bumps may be common or it may indicate an early infection or folliculitis. I would follow up with your doctor if this is of concern. Scabbing should be gone after 5-6 days unless you have not been washing your scalp well. Some areas on the donor site can be tender, but in the recipient area it can also suggest early infection, though I do not have any way to tell.

I have not heard of swelling in the throat after taking Propecia. Swelling in the throat after taking any medication is a very serious and possible life threatening side effect suggestive of a potentially dangerous allergy. You could have a possible allergy to an inactive ingredient in the Propecia, but I am just guessing. I would follow up with your doctor and stop taking any medication that causes swelling in the throat.

Is it possible say after 4 months of the procedure to damage the hair grafts if you are kinda compulsive and don’t really like to even show that you are losing hair as in my case i didn’t have to much hair loss in the first place but don’t like to show that i am losing any at all by styling the hair downwards. spending like 10-20 minutes doing so basically what I am saying is that if the hairs are inplanted after the immediate post op 1-3 months is ok to be less careful after this period and is there any adverse way to affect the growth. Also when is ok to buzz ones head after the FUE technique is performed.

thank you very much

Your hair transplant doctor should have told you this. Hair that was transplanted is considered permanent after a week or two.

Either you are an obsessive compulsive or have not been told the right information. You do not have to be so careful 4 months out from surgery. The point of the surgery is to have your own natural hair. Treat it as such.

Hey Dr. Rassman. Just a quick question that maybe you can help me with regarding my recent hair transplant. I also will be making an appointment to see my doctor. I had 1200 grafts done mostly in temple area 4 months ago. At around month three I first noticed some regrowth now a month later I have longer hairs in that area, which I expect to become fuller as I get closer to the year mark. However, hair has only grown along the front line of what was transplanted. So I have a thin line of hairs connecting the front of my hair line to the sides, yet have a large gap between that and my regular growing hair. My question is, is this normal? Can hair grafts first grow in the front and take more time to grow in behind it? Is it possible that only the hairs in the front “survived” and the others aren’t coming in? I know at four months it is still too early to tell, but I thought it was odd nonetheless. Thanks so much.

The most likely answer is that by the 8th month fully 80-90% of the hair should have grown or started to grow. I never draw conclusions at the 4th month and you are correct, some parts may grow faster than other parts of the scalp. Be patient and wait another 4 months or so to see the results.

I just had my first hair transplant and it says to not have sex for one week. Is masturbation ok the evening of or day after? or will it possibly cause some grafts to fall out?

I remember a billionaire I performed a hair transplant some years ago. He had an interpreter with him (came from Asia) and I jokingly told him not to have sex for 3 years. I remember laughing and I thought he understood it was a joking comment. Three months later, his interpreter called and told me that his boss told him ‘to hell with the transplant’, and he didn’t care if it ever grew, but could not handle the abstinence from sex for any more time. I realized how humor is very cultural and he revered my medical and surgical skills and took my joke as a directive, not as the humorous “masterpiece” that I intended. Obviously, it was a dumb joke that got lost in translation.

Anyway, I generally recommend passive sex for the first 1-2 nights, then go for it which ever way you feel up to it after. With regard to masturbation, wait a day to be safe.

Hello Doctor

After a hairline transplant some people get a facial swelling for a few days and some people don’t. My question is : Is a facial swelling a good sign, a bad sign or indifferent, regarding the future success of the operation and healthy grow of the transplants

Thank you

Facial swelling is just an annoyance after a hair transplant that occurs in random individuals. It is neither good or bad. You can always minimize swelling by sleeping at a more up-right angle (so that the fluid drains downward) and in our practice, we rarely see it because of the use of short term steroids during and after the surgery.

I am now two weeks post op from my forth HT. I have had great results the last three times with the same doctor. This time he did some temple work. It is now day 15 and both my temples are still red and I have a slight cobblestoning look. I know that cobblestoning in it’s true form was mainly due to large grafts, grafts too large for the incisions ect. I also understand that a this is what really sets aside a good transplant doctor from another. Is it normal for me to still have reddness and some slight elevation in the temple area after 2 weeks. I was told that while the graft area still should be red now the skin should have smoothed out to an even level by now and I should have no traces of elevation in the transplanted area. If this is true does this mean that I’m going to have a permanently detectable transplant in the temple area?

thanks

Cobblestoning, in my experience, does not occur in follicular unit transplantation. In some patients redness does last weeks or even months, but with those who have had prior transplants, the history of redness from previous transplants should tell you what you need to know. I am unwilling to give you treatment recommendations without examining you. Check with your doctor about your concerns as your recent experience seems different.

Hello. I recently got a hair transplant in Canada. I am a resident of the United States. I didn’t have severe loss, but my hairline has always bothered me. It was very unsymmetrical and missing temple points on an otherwise full head of hair. I had a procedure last week and the swelling has just subsided the last couple of days. Well, what the doctor drew in for my hairline is very different than what is now on my head. My temple points are extremely unsymmetrical now, more than before. When looking at me directly, one temple point can be seen and looks great, but the other one is further back the side of my face and can’t be seen from front view. One is lower than the other… The way it is now, is not what was drawn on my head prior to the surgery. The doctor took a picture of me before the transplant, but did not take a picture of me after the hairline was drawn or after the procedure.

My question is, how do I approach this situation.. Is it the doctors responsibility to fix this for me or am I bound to this agreement even though it was not what was discussed and agreed on prior to surgery? I have seen tons of pics on forums of people who have had temple work done, even from this doctor, and none of them look as unsymmetrical as mine. Should I have this fixed asap or wait till my results grow in and go have it fixed then… I mean, it is ridiculous how much I have paid and it was a fairly easy procedure from what I understand.

The good news is that you had a photograph taken before the surgery, hopefully outlining the hairline that was proposed. If the transplant was done in the last 5 days, it would be unlikely that you could undo the problem work. The best thing is to communicate with the doctor and address your concerns.

You trusted the doctor to perform your surgery after all. It is all about communication and having a trusting relationship. My answer may sound generic, but it is really as simple as that. Your doctor should be very concerned if the work is unbalanced. You can always get a second opinion. Keep taking good photos of your hairline and growth.

Dr. Rassman, I was reading a reply to a question suggesting that Rogaine Foam is not a problem 3 months after the surgery, but I wanted to know how soon after the surgery I can start using the foam as opposed to the ointment. My second question is I recently got a hair transplant, I am 22 years old male, after reading through your blogs I have come to conclude that I was a victim of transplant “fraud” which is a shame because I got mine from an institution that boasts itself in being a pioneer in the field. I started taking propecia 3 days after the surgery and still till today (20 days post op) my hair is falling off like no other. How long will this ’shock loss’ continue, it is really beginning to worry me because at the rate at which my hair is falling is unbelievable. I also read a post suggesting I can use a blow dryer on low heat after 10days but when I did I had so many hair fall off It was unreal. What would you suggest? is this normal? When can I start using a blow dryer without worrying about my hair falling at such a rapid pace.

thank you

It sounds like you need a second opinion. You can start using Rogaine Foam about 14 days after a hair transplant. Shock loss could be prevented in most situations with the drug Propecia started before the transplant is done. Shock loss will usually subside up to 4 months or so after it starts (hopefully much less). It sounds like you need a second opinion before you blame the surgical team that worked on you.

Good day,

When I had hair transplant, a couple days later I noticed there developed small (about size of pinhead) yellow “pimples” at base of transplanted hair. is this common ? could it be a dermatophyte infection or tinea and is it problematic ? Thank you !

At two days after your hair transplant, these pinhead pimples you are talking about may be the tops of the hair transplants. The skin shows in some surgeons hands if they do not trim the grafts closely. At just two days, I would doubt an infection, but certainly go back and ask your doctor to take a look at what you’ve described to me.