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Is there a difference between “internal sutures” and staples? Does one result in a less detectable scar?

Anything going through the skin produces a highway for bacteria to grow. Staples and sutures do just that, so bacteria can invade the body through the holes created by the needles, sutures, or threads, and through the use of stainless steel staples.

The final answers to your question relate to the opinions of doctors. I have waffled both ways in the many years of being a surgeon, and now I prefer staples over absorbable sutures. I don’t like leaving a foreign body like a suture in for very long and the absorbable suture is a foreign body. At least with staples or non-absorbable sutures, they can be removed by the surgeon when healing has occurred and wound strength builds enough to hold the wound edges together. At between 2-4 weeks, collagen production forms a lattice of ‘cable-like’ material that progressively gets laid down so that the wound will hold together. See Wikipedia for a better understanding of the various phases of wound healing. Some excellent videos covering wound healing can be found at Google Video.

I had a transplant done exactly 6 months ago. I was under the impression that between months 5 and 6 post-operation I would start to see the new grafts growing in. I have seen nothing, or very little. Does this mean it won’t grow in or something is wrong? I’m getting a little worried about it.

Why don’t you call your doctor who performed the surgery and ask for a follow up appointment? If I paid for something that didn’t turn out the way I thought it would, I’d contact the seller. Although you could apply that logic to buying a used car, this same principle goes for cosmetic surgery. If you were told one thing and it hasn’t happened, take charge and find out from the doctor!

Generally speaking, it takes on the average 4 months to see some growth, but it can take as long as 12 months. Everybody is different and not all surgeries are the same. You may be a late bloomer!

Hello Dr.

First of all thank you for having such an informative and helpful site. I wish other doctors would spend the time to have a site like this rather than having their sites full of promotional and marketing tricks. My questions is very simply.

I recently had ( 3 weeks ago ) a FUE procedure of 2600 fues to the zone 1 and zone 2. My question is… how soon can I start wearing a baseball cap/hat WITHOUT being extra careful with it. Meaning that the hat can touch the recipient area and also be a bit tight. My doctor say to wait a YEAR before I do this but it seems to be a bit too much. He said I can wear a hat after 30 days but making sure it is very loose and that it doesn’t touch the scalp. I find this very difficult to do given the locations where I received grafts.

I would like very much to know your opinion on this. Thank you!

Once the scabs are off, you can wear a hat or do anything that is reasonable. The donor area should be healed by this time. I’m not your doctor and I don’t know how your procedure was done, but that is the instructions I give my patients. You should double check with your surgeon, of course.

I had a hair transplant of 2010 grafts almost going on 5 months ago. My hair stylist tells me that the transplanted hair goes through a cycle and will fall out approx 3-4 months after the procedure then grows back in. Is this true? And why does it look really good in some light then in different light? When I go to work, the lights that are on there make me look like I had nothing done! I’ve been feeling very frustrated at this point.

Any hair (even non-transplanted hair) looks thinner under bright light or certain lighting conditions.

In general, transplanted hair falls out within the first month or so and new hairs start growing in 3 to 4 months later. I tell every patient to wait 7-8 months before judging the results. Patience is a virtue! I can’t tell you if your surgery was a success or not. You need to go back to your doctor and ask to see your before photos to compare for yourself. Also, ask your doctor his/her professional opinion on the matter. Whatever you decide to do, you will not know the results until 7-8 months after the transplant was done.

I have a very important question?

After my surgery, i started getting scabs (crust- normal), which lasted about 10- 12 days. After the 12th day, i decided to massage the scabs with oil. I did that for two days and further massaged it with my hands in the shower, used shampoo to wash it up. Now, i feel like i have made a mistake. massaging the scabs away? does it mean that my hair follicles are also damages and my hair transplant is a failure? I am scared and confused. please reply ASAP

We performed a study on grafts being secure after a hair transplant by pulling our grafts on successive days. We found that at 12 days, the grafts are secure. If you were gentle on the washing technique, usually the scabs that remain will loosen easily with soap and water. I don’t think you did anything to be concerned about.

You can read the article in PDF format here — Graft Anchoring in Hair Transplantation

Dear Sir,
I had recently done a hairtransplant surgery and starting from day one i started spraying the grafted area with johnson baby oil at night before going to bed and washing my hair with johnson baby shampoo every other morning and evening.

Do you think that gohnson baby oil might cause a problem to the grafts if the grafts are washed regularily.

your quick response will be appreciated
Best Regards

I don’t know why you need this routine, but I can not find a problem with it, provided that the daily wash is done properly. I hope you received aftercare instructions from your doctor.

After 13 days post transplant, I developed lots of scabs on my head. I used a brush to help remove these scabs as it is said the scabs can damage the regrowth process. But using the brush removed much of the transplanted hair in one go along with the scabs. Was using a brush a mistake? Or would the hair roots not have been affected by the brush as it was on the 13th day?

Great work on the site, a real help.

Cheers

I do thank you for reading the site and I am more than happy to give you general information, but shouldn’t you be asking your post-surgical questions to the doctor who performed your surgery? Answering such specific and personal post-operative questions (simple as they may be) could be potentially misleading just by the fact that I do not know what was done in your particular case. I mean, developing scabs on 13th day (with no scabs prior) is very strange if I am reading your question literally!

Small scabbing (1 to 2mm size) on the transplanted recipient sides after a normal follicular unit hair transplant surgery is common, but very minimal. With daily hair washing it should resolve in a week or two. I am not sure how you brush your scabs away, but if the hair grafts are not locked in by that time, you run some risk of pulling them out with the scabs. I would ask your doctor and have it checked out to make sure it is healing properly. See our published article on the subject — Graft Anchoring in Hair Transplantation (PDF file).

Hey Dr. Rassman,

Appreciate all you do on the blog as well as answering my questions in the past. I had a less than desirable result from a HT procedure to say the least. Make a long story short, if I ever need to get one again, which I will since I have small gaps on my head still, I will be visiting your office before.

The grafts that did grow, which was on the low side, are coming in at all different angles and growing in different directions than both the other grafts and of my current hair. When I mentioned this to my doctor and the dissatisfaction of my results, he mentioned that it might be possible to change the angle of the grafts with a new tool? Is this possible to your knowledge? If not, is there anything I can do or this is just the way my grafts will grow forever? Also, do you ever have any open houses in the New York area?

Thanks so much.

It is unfortunate that your grafts were placed at poor angles and your results are questionable. Your story of a bad procedure result illustrates the fact that hair transplant is for LIFE and you should do your research of the doctors and see their work first hand before going ahead with the surgery.

There is no tool or technique that will change the direction of your hair. I suppose you can individually excise them one by one and try to re-implant them, but that could potentially cause more damage, trauma, scarring, and failure to grow. Plus why would you place more trust and risk a poor outcome from the same doctor who already put the hairs in the wrong angle? You are a brave man!

I don’t have offices on the east coast any more, but Dr. Bernstein does have open houses in his NY office.

Dr. Rassman,

I had 1600 grafts transplanted to my hairline, filling in about 1/2″ below its current level. It has been exactly one week and I am a bit worried about the left side. The center and right side look like they have solid coverage, but the left temple area looks sparse, with empty spaces. Is it possible that the grafts aren’t visible, or that they may have fallen out?

I certainly am not in a position to tell you what is going on, but the doctor who did your surgery should be the first place to go to find this out. I wish I could offer more, but I didn’t perform your surgery and I don’t know what was done in the operating room or how many grafts were placed in each area. You just had surgery a week ago, so definitely have an open line of communication with your surgeon to alleviate any of your concerns. There should be good photos of you immediately after the surgery so that you can see the coverage you got on your troublesome left side. Good luck.

I train regulary in full contact fighting sports. How long would I be out from training after a hair transplant???

If your surgery was done using the FUE technique, 7-10 days should be adequate (or until the scabs have gone away) before resuming your training. For a surgery done using the strip technique, I would wait 4-6 weeks.