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Everything seems very promising at this stage, two weeks after a scar revision procedure. I am wondering whether there is anything proactive that I can do to help minimize the presence of the new scar. (Besides avoiding exercise involving unexpected head-turning.) Such as:
- applying onion-based anti-scarring ointment; or
- not applying onion-based anti-scarring ointment;
- or using or not using some other topical thing.

Thanks for everything!

I think that patience is a virtue and if the surgery was done well, that should suffice. Applications of any topical ointment may be pointless at this time. If hypertrophic scarring should occur, then you may need to take a look at it as it forms. Stretching of the scar will take time, as stretching usually starts to become evident at about 6 weeks. Keep in touch with your doctor if anything worries you.

I had my transplant at NHI 9 montys (2000 grafts to the front). My hair is growing very fast, and looks awesome, except that it is curly, and the rest of my hair is absolutely bone straight. I am growing my new “full” head of hair long and “surfery” looking, but it looks so different with a curly, puffy front, and then the rest is long, flowing and stick straight. Will the front ever be straight? What can be done? I use a hot flat iron every day to try and straighten it.. I know totally why people with curly hair hate humidity and rain…instant frizz. Help.

Hair transplants rarely radically change the character of the hair, but it can happen. In about half of the people when this change occurs, the hair will straighten a bit after going through a hair cycle. I remember one person who had a very radical curly change to his hair after the first surgery. I personally did not like it at all, but he loved it. When he came in for his second transplant, the same thing happened again. It remained very curly and he could not have been happier. Much to my surprise, it lasted through a hair cycle, possibly a bit less curly.

Some people who get changes in hair characteristics, go to a slightly more wavy hair and this change is appreciated in almost every person because it produces ‘body’ for styling that they never had when their hair was very straight. This often reverses in a hair cycle (about 2-6 years), so these benefits may not last.

With regard to your situation, you need to see me personally so that I can review your change in hair character. In addition, unfortunately, you will have to learn to control the hair with relaxers that will allow you to gain better better control of styling. Blow drying and conditioners may help a great deal so that you may not have to use an iron. We should discuss this together. Call my office at 800-NEW-HAIR to schedule a visit.

Dr. Rassman, I think you are running a brilliant blog. After reading several posts, I am encouraged to share my own views and ask a question. I recently got a FUE megasession done in Europe and am pleased with the results, atleast till now (just 2 weeks post-op). While going through this website, I personally felt that it would be a great idea to start a new category called ‘Post-Operative Care’ since I am going through this phase myself and can feel the need to interact with others out there on the topic. Don’t worry, I don’t think it will scare away any prospective patients. It will only lend credibility to the transplant procedure.

On that note, I also have a question. I am using Minoxidil 5% to help with the growth of new hair. But my scalp in the recipient area shows considerable dryness / development of flakes when the scalp is dry. I was recommended to apply a hydrating lotion on the scalp. Would you agree with this advice and can you recommned a good hydrating cream /lotion meant for hair?

Thanks in advance.

Thanks for your kind words and for the new category idea. I’ll add a Post-Operative category now.

The results of the FUE will take 5-8 months to show, so then and only then, will you know the value of what you had done. Minoxidil does cause dryness and flaking. Any non-alcoholic creams will work. Also, try a variety of hair conditioners as well. Take risks until you find the right one. Ask your hair dresser, as they may know the best that is available in your country.

Hi Dr. Rassman,

About 3 months ago, I wrote to you concerning my situation at 7 months post-op. I had diffuse thinning in the frontal area and was a norwood 3 prior to surgery, and had 1700 grafts put in. At 7 months I was looking thinner than before my surgery, and could only find a few new hairs that were growing in, all very small (less than 1/2 inch).

Now, at 10 months these hairs (i can find only about 10) all seem to be the exact same size as they were at 7 months, and I have seen no new growth. This is very frustrating for me and I was wondering what your thoughts were. I took your advice and went to see one of your colleagues in San Jose, and he told me that I should wait until a year has passed to judge my results. But why do these hairs seem to be growing in so incredibly slowly if at all? If you could just mention what some of the possibilities may be I would greatly appreciate it.

Thanks for your time.

To keep the blog readers up to speed, your original question (and my answer) can be found here: Transplant Failure To Grow.

You should see growth by this time. I would suggest that you make an appointment to see me personally. I will try to judge what has happened. Please try to get the preoperative pictures from your doctor so that I can make a judgment as to how much original hair was there at the time of the transplant. That will help a great deal because sometimes when people report these complaints, they lost much of their natural hair and the loss may cancel out the gain. Alternatively, the growth of the transplants can be estimated by someone experienced in this field.

Hi,
I have looked into hair transplants time and again but have been scared off by the horror stories of bad HTs. FUEs sound good to me. Where do I go to get evaluated? I am losing hair in my temple areas and am 36 years old. Also, do I have to be on Propecia? I was on it for a year, didn’t see any results in hair but did notice problems with sexual activity (i.e. hard to keep an erection) I like it a lot better without it. So, if I had a HT, would I have to be on propecia?

You do not have to use Propecia after a hair transplant. However, by not using this drug you will not have any protection against the progressive nature of hair loss, assuming you are still losing hair and not totally bald. With regard to your sexual problems, almost 40% of men of your age have some difficulty maintaining an erection. One of the erectile dysfunction (ED) drugs can solve that. Taking Propecia for your hair and ED pills for your erection may give you both a better sex life and hair at the same time.

You indicated that you are based in Colorado. I would be happy to evaluate you for FUE, but my offices are in California. To find a FUE surgeon in your area, please visit ISHRS.org, but please note that there are not many of them out there that have the reputation and experience you may want.

I am planning to have a hair transplant, but I must return to work 2 weeks after. I am fair skinned, so I am very concerned about the appearance of my transplanted area. I do not want people coming up to me asking me what I did to my head, or in the alternative, looking intensely at my head like I was a freak.

Pictures are worth 1000+ words. These pictures were taken today at my office, of a fair-haired patient two weeks after surgery. You can see a blush of pink, or is it just a beard that accentuates a pink that normally one would not notice? He said that the only person who commented on this was a close friend, and the patient told him it was a sunburn. He said that no one looks at it and he is not self conscience about it at all. Click on the photos to enlarge.

Can I go swimming after a hair transplant? Scuba? Marathon?

I generally advise my patients differently depending upon what type of hair transplant they had. The recipient area usually heals within 4-10 days. If it is washed well, it will not scab and if there is not scabbing, then you can do any activity without losing your transplanted hair.

For those with the traditional strip method of harvesting, the donor area should not be stressed with exercises that strain the neck muscles for a period of at least 3 weeks. These people should not swim until around 2 days after their sutures come out. Prolonged soaking is not a good idea, so scuba is not something I would recommend in these people for a good 3 weeks. You can run a marathon 5-6 days after the hair transplant with this ‘strip’ approach, but not complete in Olympic weightlifting.

For those with Follicular Unit Extraction (FUE/FOX Procedure), other than the restrictions for the recipient area, you can do anything, including scuba, marathon and even Olympic weightlifting after 5 days.

Hello! I had a transplant at NHI with Dr. Mcclellan in February 2005 (2000 grafts). After the growth, and then fall out, I am starting to sprout What I have developed the past 3-4 weeks is a horribly itchy scalp that feels slightly greasy and is covered with a layer of sebum.

I have tried Nizoral and Head & Shoulders, but am afraid they will make my hair fall out, and dry/damage it. Is this a normal occurence after a transplant? I am itching so badly, that I am starting to shed.

You will have to experiment with different shampoos and conditioners, to find out what works for you. Remember, a hair transplant is a series of organ transplants and each and every one of the follicular units are full organ. It appears from your question that the glands of the new hair are producing excess sebum. Possibly twice daily shampoos during this period might help. You are nearing the 8 month post operative period, so please make an appointment with me so that I can see where you are, and maybe give you a more personalized suggestion.

I had a hair transplant 4 months ago and I lost hair in the months that followed. Is that unusual and will it return?

Shedding is not common after surgery on a patient who had a previous hair transplant nor on patients who are taking Propecia. In the days before Propecia was available, hair loss (shedding) following the first hair transplant was common in the younger men and less common in the men over 40. When the hair loss happened in the younger men, it frequently reflected what I might have guessed would have come out by itself in the next year or two. I only remember a small hand full of patients who lost some of their older hair transplants after a new procedure, but all of them (less than 1% risk) had the hair return at between 4-6 months. If it is the transplanted hair from a previous hair transplant, I am confident that it will all return.

I have had a hair transplant and I have numbness in both my front and back. How is this possible, how long will it last and will I become normal again as I love to have my scalp massaged.

Numbness does happen frequently after a hair transplant, both in the recepient and donor areas. Everytime a person gets a cut or a bruise, the area that is cut or bruised will develop swelling and numbness. The numbness will abate with time. The cutting and/or swelling of small nerve fibers are the cause of the numbness after a surgery, but in the scalp, there is a rich supply of redundant nerves so if one small nerve is cut, another picks up the function fairly fast. There should be no long-term numbness, but I have seen an occasional patient who had their major nerve cut in the back of the head. Even when this complication happens, the alternative pathways will frequently take over and that process may take weeks, months, or on rare occasions, up to two years to correct. Most experienced surgeons should be able to avoid this problem. In conclusion, many very small cutaneous nerves are often cut, but the sensation returns with time. Having had two hair transplants, I can tell you first hand that my scalp was normal within a couple of weeks and within a month of the transplant, I was able to enjoy a scalp massage.