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Category Archive for Post-Operative

 

Styling After a Hair Transplant

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.

 

Does Closing a Strip Scar Cause the Crown to Be More Visible?

Does the crown stretch when closing a FUT scar?

Hi there - First off I would just like to thank you for providing this excellent resource. I just have two short questions related to FUT scars:

1) Firstly, I know you have answered this in the past with hairlines, however since the crown is within inches of the incision site above the prominent bone, does it slightly move/stretch downwards towards the incision site once the scar is closed?. For example… I have some thinning in my crown but im lucky in the fact that it doesnt dip low at the back so its not very visible unless looking from above my head. If I had a strip procedure would this thinning crown be more visible from the back because the skin has been pulled down to close the strip wound?

2) Secondly, I believe avoiding strenuous exercise is recommended for about a month after the procedure to avoid scar widening, but is general head tilting and looking downwards in the weeks after surgery ok in terms of putting stress on the scar?

I would be most grateful for any response you have for the above questions. Kind regards.

Strip scars placed in the true donor area in the back of the head should not impact the location or the size of the crown area. Strip surgery takes up laxity that is there at the time of the surgery. Bending your head should also not impact the crown area.

I have never been sure why we tell the patients not to lift heavy weights. If there is a pull from the muscles, it comes from the trapezius muscle, which inserts below the scar at the base of the skull. I still tell the patients not to lift heavy objects, but I am not certain there is any value to the advice.

 

Could a Traumatic Experience Cause My Transplanted Hair To Fall Out?

Have you ever had or known in your experience of a man having a hair transplant and everything was going wonderful for the first six or seven months and then a traumatic event reversing things? My age is 62 and I was doing well until I started having severe stomach pain at about 6 months after the procedure.

I guess I passed out and was taken to the hospital unconscious. I had to have a transfusion of a small amount of blood. I had a stomach aneurism and almost died. I had to have some metal clips placed in my stomach so I had to have general anesthetic. Could this event have caused me to lose a lot of my transplanted hair? I seem to be losing more all the time.

I’ve been taking iron pills because I’ve been told that I’m anemic. Is it possible that the implanted hair could be coming out due to this incident? If that is true do you think my transplanted hair will ever grow back again once I regain my full health again? I have asked my surgeon these questions but feel like I’m gettin the “run around”. My surgeon has recommended that i start taking propecia or rogaine. I did take propecia for at least a couple months before my surgery and about 5 months afterwards. I did have some sexual side effects with the drug so was told that I had taken it long enough.

It has been 10 months since my surgery and I am feeling like I went through all this and may not end up with all the hair I had after about 5 months after the HT. Could you give me your thoughts and feelings on my story because I read your column frequently and I do respect your opinion. I would be willing to have another HT if you think that would be the answer to this mess. I had 2400 implants the first time. Thanks for your opinion.

It sounds like you are lucky to be alive. We do know that stress can cause hair loss and I guess it could delay the growth of your new hair for 10-12 months, so all may not be lost.

Most people who lose hair after a traumatic event, will lose their non-transplanted native hair, but I have heard and have seen some patients lose their transplanted hair some 3-5 years after the transplant was done. We say that transplanted hair is permanent, but that is a general rule… and all rules can be broken.

Your hair growth is clearly delayed, so I would wait out another few months and see if the Rogaine helps. I am assuming that your transplant doctor knows what we/she is doing and generally gets good responses from the transplants he/she performs.

 

My Hair Transplant Looked Great at 5 Months, Not As Great at 8 Months Post-Operative

My question is regarding post operative transplant shedding. For a little background, I’m a 26 year old male on Propecia for 2 years and exactly 8 months out of a 2000 graft hair transplant all in the frontal part of the scalp. At 5 months, my results were excellent, a very dense, even result with a natural looking appearance and texture. Since that time, however, I have noticed an increased thinning in my hairline; leaving a more see-through appearance. This has been coupled with a more “pluggy” texture. Furthermore, at 6 months, I noticed an increase in shedding but it has slowed down in the last 6 weeks.

My 8 month result is still great but there’s a visible difference in the last three months. Is this merely a part of the natural process for some patients and can’t be judge too quickly in my first year growth? Any help would be greatly appreciated! Also, let me know if you need extra information to answer my question.

Why don’t you follow up with your doctor with these issues? A pluggy texture is not good. Thinning may be related to continued (normal) genetic hair loss that may have happened without surgery. Shock loss is generally seen in the first month or two after the surgery.

In general, results of a hair transplant surgery can be seen in as early as the 2nd month all the way up to 12 months. Most see results in about 6-8 months. I couldn’t tell you why your results looked better at 5 months than they do at 8 months, though.

 

How Long Until I Can Use a Sauna After a Hair Transplant?

Hi doctors,
How long after a hair transplant until I can use a steam room / sauna? And how about a tanning salon? Thanks

You should address any post operative questions with your doctor, as each doctor has their own recommendations. In general, most patients can resume normal activities in two to three weeks after a hair transplant surgery — including a sauna.

Tanning salons are not generally recommended for health benefits and high dose UV rays can potentially discolor skin during the healing process, which can take up to 6 months. This does not mean you have to keep out of the sun, just use a sun blocker.

 

After I Had a Scar Revision, the Area Is Very Itchy

I had 3 FUSS transplants over a decade. It left a wide scar. I had a scar revision. It resulted in a liner revision line. However after the scar revision, 5 years later, I have bouts where the scalp area is really itchy. It ceases in a day and then restful for awhile

1. What causes this?
2. What can one do?

thanks for the tip and your powerful website!

You can try an over the counter hydrocortisone treatment in small doses 3 times a week or once a day, whichever relives the itching. I can’t say a scar revision and scalp itch are related — at least, it’s not something I’ve heard of before. If it continues, I would see a dermatologist.

As an aside, we are no longer doing scar revisions, but rather offer Scalp Micropigmentation (SMP) as the treatment of choice for scars. Most people who have scar revisions still have significant scarring, and SMP literally wipes out the appearance of the scar.

 

Acne in the Recipient Area After a Hair Transplant

Would getting acne in the recipient area in the days and weeks post-op have any effect on the grafts? If so, for how long after? Thanks.

Sometimes hair transplant patients may experience folliculitis weeks to months after surgery, which looks like acne. It is generally advised to follow up with the surgeon and use warm towel compresses to address the area. Some doctors prescribe a short term oral antibiotic for it as well.

The cysts that form reflect the sebum production of the transplanted hair that can not exit the skin, because there is no pore present. It generally does not affect the grafts.

 

How Fast Do Transplanted Hairs Shed?

I am 2.5 weeks post-op, and already seem to be shedding transplanted hairs in the recipient area. This seems quick to me. Are transplanted hairs shed quicker if there is no or minimal crusting post-op ?

Transplanted hairs shed in 19 out of 20 patients and they usually start shedding at 10 days or so, unless the crusts remain (which will hold onto the hair inside the crusting). I prefer having no crusts, as these grafts are more secure in their recipient sites.

One patient out of 20 will grow out their hair without shedding the transplant hair (no dormant phase), and these remarkable patients have 2 inch long hairs at 4 months post-procedure… and great joy from beating the odds

 

Do I Have Cobblestoning In the Recipient Area 10 Weeks After FUE Surgery? (with Photos)

Hi Dr,

I had an FUE surgery performed around 10 weeks ago in Europe. However, my hair transplant Dr has not been very helpful in post-patient care. Because of my concerns, I have since become quite depressed and worried about the future success of the transplant.

So I now I hope you can assist me, being on the other side of the world, there are few people here available that could help (I am from Australia). Specifically, do you think I have cobblestoning in my recipient area? Or a nasty case of follicultis? I have sensitive skin and it has stayed pink since surgery, so I was hoping you could address some of my concerns through the attached images.

If so, what recommendations could you make to removing the redness and/or follicultus/red dots?

Also, are the little pits around the hairs normal that are trying to break out? Do these go away with time? There are some dark hairs breaking through and lots of light blonde ones too.

Thank you very much for your help. Feel free to use my pictures.

Thanks

 

If you have issues after a hair transplant surgery (or any surgery) you need to follow up with your doctor/surgeon. In your case, you traveled to another continent for your surgery, but you should be able to email some photos to your doctor and speak with him/her over the phone. It’s unfortunate that your doctor hasn’t been helpful to you after your procedure.

In general, redness and folliculitis can develop with any hair transplant surgery and sometimes it just needs a good physician follow-up. This may involve something as simple as warm compresses, to something like a course of antibiotics. The reddened areas can persist for a few months on rare occasions.

I suspect you may be overreacting, but to find out exactly what is going on, an examination by a doctor is your best bet. You can always get a second opinion (visit the physician search at ISHRS.org for other doctors in Australia).

 

5 Months After My Transplant, Nothing Has Grown In and Now I’m Losing Hair All Over!

Hi Dr. Rassman,

I find your blog to be incredibly informative and helpful to those with concerns after their hair transplants. I decided to undergo a transplant exactly 5 months ago as preventative maintenance. 1,700 grafts to fill-in the thinning top portion of my head. I still have hair on my head, but under direct light you could visibly see through to my scalp. I followed my doctor’s instructions and had no major issues after the surgery.

At 5 months, the incision scar is still pink and I have occasional pimples on the top of my head (with what seems to be a noticeable increase in grease on my head). Also, after the surgery I had shock fallout. But it seems that ever since my surgery for the last five months my shedding has been consistently increased. Not just from the top of my head, but all over (sides and back). I have yet to see any growth from the grafts. But I have noticed white streaks in my hair. I have pitch black hair, and there are now random strips of white developing throughout my hair (I had never had white hair before the surgery). Is it possible that the shock of surgery would cause some of my hairs to begin to turn white?

And I’m also concerned at this point that my grafts will not grow in and that I will continue to get thinner and thinner since my fallout has increased. Thank you for your input and advice.

In my practice, we never recommend a hair transplant surgery for “preventive maintenance”, mainly because most patients would not likely see much of a result as they continue to bald and run the risk of being worse off. There is also a good possibility that the surgically induced hair loss might make it look worse, something we call “shock loss”.

If you are really losing hair on the sides, maybe something else is going on like diffuse unpatterned alopecia (DUPA). Shock loss doesn’t usually cause hair to fall out from the back and sides of the head. White hair does appear with stress on some people, but I really do not understand the cause. It sounds like you need a good doctor to talk with and be examined by. Perhaps the surgeon that did your transplant would be a place to start.

In general it takes about 6 to 8 months before you can see results and I tell my patients that most people can see 80% of the impact from a hair transplant in 8 months. You should notice growth beginning about now and see improvement in the next 3 months. If you are young and had the transplant without taking the drug finasteride, and assuming that your preventive hair transplants were not really needed, then you will most likely not have as much hair as you did before the transplant (based upon what you are saying here). Hopefully though, over the next 3 months you’ll see some gains.