Dear Dr Rassman,
I recently had about 420 grafts put into a scar that was about 10mm wide and 100mmlong. Some of the hairs that were implanted in there (this is from about 4 months ago) are still in there. They haven’t grown, and are just sitting there..they are bent as well, where the growth has stopped. What does this mean?

Also, I keep getting scabs in the scar tissue where the hair was implanted. Would this be because my body is trying to remove those hairs that have not shed(but not growing), and does hair that grows in scar tissue cause the scar to scab, when breaking through the scar? Also, I was told i’d have to wait 18-24 months before most of the growth. Do you agree with this?

thank you

First and foremost, I would go back to the doctor who performed your surgery for a recheck. He/she should be able to answer your questions more specifically as it relates to a procedure they were a part of and know more about your overall health.

On average, it takes 6 to 12 months for hair to grow. Hair growth in scar tissue tends to be slightly slower than in non-scarred tissue, and in general, it is thought that hairs transplanted into scars do not grow as well as hair transplanted to normal scalp/skin. There is no study to prove one way or the other if that is true, though. In a few cases where I transplanted a small number of grafts into a scar and counted them at full growth, 100% of what I put in grew.

Do you think that Dolph Lundgren has had a hair transplant? Does he have a norwood 2 hairline?

Thank you Dr!

I would guess that the answer is no on the hair transplant and yes on the Norwood Class 2. For starters, anyone in Hollywood with a transplant scar at the back of his head would likely never cut his hair that short (note the photo below on the left from late 2006). Even an FUE procedure would produce a small set of punctate scars. In addition, the density I can see appears normal, indicating that it is not a hair transplant… but pictures could be misleading.

Photo sources: Dolph at Rocky Balboa premiere (2006), Dolph (unknown year), Dolph in Rocky IV (1985)

Hey Dr. Rassman,

First off thanks for the great information and honest answers.

Are you following the process of Dr. Hitzig’s Acell experiment? He claims to have regrown hair in the donor area and multiplied hairs in recipient sites. The pictures he has provided to the public are not of great quality, but I figured you might be able to shed better light on his progress/procedure. Is there any way for you to contact him doctor to doctor and get specifics so we know if the results are legitimate?

I would always be skeptical when a doctor tries to prove a point with poor quality photographs. This is the digital age and good photography is common place even for a 3rd grader. Now I’m not going to say much more about the doctor, but I will point you to a thread on the Regrowth.com forum that might shed more light.

Wow…just wow…they really are making people believe this stuff can prevent hair loss and “help hair color retention”…

kronos.glow.com

I hope no one wastes money on this stuff.

I haven’t heard of Kronos, but with their “patent-pending t-sfere technology” how could you go wrong? The product looks to be another of the many volumizing shampoos on the market. Nothing special I can see, aside from the aforementioned “t-sfere”, whatever that is. My dictum, as to paraphrase your comments, is “let the buyer beware”!

I am having a hysterectomy July 31st and was instructed to stop taking my birth control pills which I did as of March. In the meantime, I ruptured both of my achilles tendons and had major surgery. I started losing my hair not too long after the surgery and thought the hair loss was due to the surgery. After reading some comments online, I realized that the hair loss is probably due to having stopped taking the pill. Now I’m concerned that with this major surgery and another coming up soon, I will continue to lose more and more hair. Is there anything I can do to stop the hair loss? I am terrified of going bald!

I doubt that you will become bald. Reactive hair loss after a major surgery is often cyclical and often will return if you are one of the unlucky people to experience. There is no way to prevent this in those that have experienced it in the past.

I saw two patients recently that are worthy of discussion here…

Patient #1:
He had a typical result from the hair transplant surgeries of the 70s, 80s and early 90s. He had hair transplant plugs in the early 90s which gave him a doll-like hairline in the frontal area. I have worked with him over a 10 year period with four surgeries to remove and thin out the 3 inch wide plugs, redistributing the hair from the plugs to other adjacent areas in an attempt to make them less detectable. He is about 80% closer to his goal over what he had when he first came to see me and now wears a crew cut, but he is still frustrated over the remaining plugs which still bother him when he looks into the mirror every morning. I will continue to work with him, thinning out more plugs until he is satisfied that he looks normal. He shared what it has been like over the past many years, as too much of his life focus revolved around his head and his freaky pluggy look. Fortunately he and I put together a Master Plan 10 years ago to get him back to a normal appearance, and even now, after a decade of my working on him, the process will continue.

Patient #2:
This man has a far worse story. This young man (in his 30s) has had hair transplant work by many doctors over 10 years. Unlike patient #1, he never had a Master Plan and always sought out the best doctor who promised him a quick fix and he believed what the doctors told him. In the midst of the process, he even had a brow lift to raise a hairline that was too low, leaving him scarred in the hairline area. A series of transplants to fix the hair loss from the brow lift in the frontal area failed, compounding the problem further. The donor strips that were taken in the back of his head were all taken in different areas of the scalp and they all stretched and widened substantially. It seemed that the doctors just kept on removing donor hair from different areas to avoid the wide scars previous doctors created.

This man paid tens of thousands of dollars and each successive surgery seemed to leave him worse off. The recent transplants apparently did not work and he asked me if there was something wrong with his skin and recipient areas. I asked him if he called the doctors who did the failed procedures and he said he did call them over and over again, but they never returned his calls. Now he is massively scarred in the back of his head with at least three wide scars each measuring over 1/2+ inch in width. He received body hair transplants into the scar, but the difference was marginal. Each “fix” addressed one problem in isolation of the other problems, resulting (at times) with him being left worse off in the total scheme of things. I don’t know what he will do, but I suggested that he consider working with just one doctor, and building a Master Plan to deal with his problems. One option might be balloon expansion of his scalp to remove the scars in the back of his head by stretching the normal scalp in the crown of his head. The use of balloons to stretch the scalp will take at least 8 weeks of constant inflation of the balloon. If he wanted us to do it in California, he would either have to move to California for the period that the balloon expansion was being done or find a local doctor willing to do the incremental expansion of the balloon in his home town. We have done similar patients with outstanding results, but the commitment of time is substantial. What I gave him was a Master Plan to get him back to a manageable state. Anything short of such a radical approach will just victimized him again and again by some of the doctors who see $$$ in each successive procedure that they can offer him. Too much of his life is being centered around his scalp and the various poor choices he made.

Conclusion:
I often end with the statement: “Let the Buyer Beware,” which is so appropriate in this situation. Doctors are not immune to being scummy. I unfortunately see horror stories like this almost every week, and I post these as a way to educate you (the consumer) so that you can make informed decisions and avoid being taken advantage of.

How do I end a post like this positively? Well, today’s hair transplants in the hands of good and honest doctors are spectacular. At last night’s Open House event in our LA office, Steve Hartman (CBS Sports announcer and radio show host) who is himself a hair transplant patient, told me that not only was his procedure undetectable, but that he and many of the patients who were there looked like they never lost a hair on their head. Those horror stories I wrote about above rarely happen today. There are rotten applies in every barrel, but there are many really great doctors also in that barrel. You just have to do your research before you jump.

Dear Dr. Rassman,

First I would like to take this opportunity to thank you for this great website.

I have two questions and i would be very greatful if you can answer them :

1. I had an FUE procedure done on the front area (frontal hair line)with approx. 1200 grafts before three months ago, the strange thing that i am experiancing is some hair loss in the area behind, which is in the mid-scalp area, is this shock loss? shedding period? or the normal genetic hair loss pattern? and how can i tell the difference between them?

2. If your answer to question no.1 is shock loss then can you tell me what is the solution for it? and is there any chance of hair regrowth for those that were lost? (By the way i have used propecia for 12 months before a few years ago but with no success and i experianced terrible testical pain)

Thank you and Best Regards.

If you were not on finasteride when you had your FUE procedure, it would almost be certain that you had shock loss. You should have worked this through with your doctor prior to having the surgery. I always assess the status of the hair behind the transplant recipient site and if it showed significant miniaturization, one could have predicted this outcome. I would need to see you and understand what the loss area shows now.

I would also have considered lower doses of finasteride, which may have allowed you to use the drug without the complication. One quarter of a pill finasteride (0.25mg) can be effective at minimizing hair loss from shock.

Doctor, you mentioned in one of your recent posts that you supply one bottle of Progaine Shampoo to your patients after the surgery. I use Progaine a lot but can only find the Progaine Volumizing Shampoo available. The other Progaine products do not seem to be available at this time over the internet or in stores. Do you know why only one Progaine product is available at this time? When would the other products under the brand name be available again? If you could provide any information, it would be appreciated very much!

Progaine is just a volumizing shampoo like any other volumizing shampoo. It does not grow hair. There were other formulations, but I believe they’ve been discontinued. I just did a quick search online and you’re right –only the volumizing shampoo seems to still be for sale.

But… um… I must’ve had a temporary memory lapse when I said that Progaine was what I give to patients after their hair transplant surgery. I used to provide Progaine, but for years now I’ve provided GraftCyte shampoo (which contains copper peptide to promote better healing). You can find more info about that here. Sorry for the confusion!

Dear Doc,

I have heard of body hair transplants and read that they are not a reliable form of surgery due to the body hairs being weakened during extraction. However, because the body hairs are being removed with a hole punch type of instrument that may damage them, could significantly better results be attained if the body hair grafts were removed via a strip method? Let’s say the patient did not mind have a scar on their thigh as long as the strip provided enough grafts for his needs. In my case, I am thinning in the crown and anticipate that I will require far more grafts than my donor supply. Thanks

Body hair transplantation is not a gold standard method to transplant hair to the scalp, because body hair looks and behaves different than scalp hair. Damage isn’t the problem — hair growth cycles are. Only about 50% of the body hair is in growth stage at any one time, so the hair-for-hair yield is 50% rather than 90% plus as with the scalp donor hair. In other words, you won’t see most of the hair at the same time… and the hair that you do see will look different from actual scalp hair. Body hair does not grow long and has a different texture than scalp hair. To directly answer your question, yes you may find a doctor willing to do it, but the above material is presented to try to get you to think through that decision.

Dear Dr. Rassman. What does it take to be a good hair transplant surgeon, besides a medical diploma?

I could write a book on this subject (and actually, I did write two books). Simply put, the characteristics of a good doctor will always put the patient’s interests above his own and works relentlessly for the welfare of his patients without regard to money or time. The good transplant doctor will have an artistic skill as it applies to the field of hair restoration.