Hair Restoration Blog

Q:

I had a hair transplant in past and planning to have another one. Part of the scar from the first procedure is often visible on the right side of the back of my head even when my hair is pretty long. It’s just a small section, but during the second procedure would it be possible to minimize its visibility further by transplanting a small amount of hair into that area (not sure if this is safe or not if the grafts are being removed from a nearby area) or through other means?

Stretched Hair Transplant Scar

A:

In order to minimize the visibility, we will do a double-edge trichophytic closure on the donor scar. We generally have more flexibility with our trichophytic closure during the second procedure due to the fact that we now know how aggressive we should be in bringing hair into the scar. The second time around, we know how your body scars and can anticipate what kind of stretching will occur. Going further, in the future we can place hair into the scar if needed with filling the scar with FUE transplant or even use SMP (scalp micropigmentation), which will minimize the visibility of the scar by placing pigments in it. Everything discussed above will be addressed in the future if necessary.  Whether to use FUE or SMP to minimize the visibility of hair transplant scar is discussed in another blog post.

Q:

After the last procedure I started using Toppik to provide the illusion of greater density. After having the second procedure it will appear strange if I am not using it suddenly. I know I won’t be able to use it for the first two weeks, but will it be safe to use after that?

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A:

After the first week following your hair transplant procedure, your recipient and donor incisions are mostly healed. This means you can use any topical products, including Toppik, if you choose to.

For more information you can see our page about after a hair transplant and all Dos and Don’ts after a hair restoration procedure.

Q:

Dr. Mohebi,

We discussed a second procedure several months ago to increase density. I was told about 1500 grafts would be necessary. I’d like to get a better idea of what level of density I can expect. Is there a way to show me an example from another patient, or compare it to another area of my hair so I can set my expectations accurately?

Thanks,

 A:

Generally, one hair transplant creates about 35-40% density in the areas that we dense pack. Although the appearance of baldness is eliminated in most cases, the density you once had may not be able to be replicated. This is particularly important in regards to the front of your hairline where adding to the density can make the hair line look more solid. In the photo attached, you can see the frontal view of a patient before a hair transplant, ten months after the first procedure and ten months after the second procedure.

Q:

I started the hair medication finasteride. Will this help stop me losing more hair? I was concerned that if you restored my hairline would I need to do another surgery in years to come if my hair continues to thin and fade behind where the restoration was done? There are many stories on the internet of people that have had multiple surgeries (other doctors) and they are still not satisfied so I just wanted to take the opportunity to gather as much information and ask the appropriate corresponding questions so I can make the most educated decision.

A:

While reviewing your miniaturization study (the microscopic evaluation you had in our office), it indicated that you have some hair loss activity on the top areas of your scalp as well, but it is very minimal. If you continue using medication, your hair loss will range from none to very minimal in the next few years. One hair transplant procedure in combination with medical treatment with Propecia (finasteride) can maintain your look for many years to come.

Q:

What do you think about starting Minoxidil if you want to help speed up hair growth?

A:

There is no evidence that minoxidil (Rogaine) can improve the growth of transplanted hair after a hair restoration surgery.  However it could minimize the risk of shock loss which is losing hair when you are transplanting close to the areas that you are supposed to lose more hair in the future. Minoxidil should be started at day four after hair transplant surgery.  We most often prescribe finasteride for our patients to prevent shock loss;  adding minoxidil to finasteride may slightly add to the positive effect of finasteride.

Q:

What do you think about applying Emu oil or distilled witch hazel to the healing areas to help soothe and speed up healing process; (apply from seven/eight days post-op). Distilled witch hazel helps with redness?

A:

There is no evidence to show emu oil, witch hazel or other commercially available oils can help healing after hair transplantation.  Using the shampoo that we recommend and provide for use after hair transplant is the best thing you can do to minimize the scabs maintaining a proper environment for the hair grafts to grow.

Q:

Dr. Mohebi,

Reading thru a website about hair restoration and what is needed after a hair transplant. Resulted in a question; I wanted to see what you recommend here:

• Apply huge amounts of Aloe Vera gel to both donor and recipient area but not until five days after surgery (then twice a day minimum).

A:

You don’t need anything other than the shampoo that we gave you and proper techniques of washing that we instructed you for washing off the scabs.  If your scabs remain in place for more than one week after surgery, you can leave the shampoo on the scalp longer for over ten minutes to help remove all the scabs.  Aloe Vera Gel won’t hurt, but it does not replace proper washing.

Q:

Hello Dr. Mohebi,

I had a previous hair transplant which overall was not too bad. It was about ten years ago. I want to know what could be done with the scar at the back of my head. I do some on screen work and now I wear my hair shorter or would like to. Can the scar from my FUT be improved? Another showbiz friend said you are known to be excellent at this. Is there any hope of doing that?

Thanks, John

A:

Great question John!

Scar revision is one of the areas I really enjoy and have the honor of being able to help patients. Scarring like balding really negatively impacts people’s lives. It is rewarding to be able to help in this way. In our hair restoration practice we take extraordinary care to minimize the scar of an FUT hair transplant surgery. In fact I was able to develop and invention that is gaining widespread use in hair restoration. It is called the Laxometer. By allowing the surgeon to more accurately measure scalp laxity he or she is able to better plan the minimization to the best of ability of the donor wound.

Along with special wound closure techniques there are other ways in which modern hair transplant yields more natural, proven and permanent results by minimizing the scar.

1. Simple Scar Revision: This method can be used if the scalp scar is wide due to initial technical problem during wound closure.

2. Scar Revision and Trichophytic closure: This method allows hair to grow inside the scar and minimize the contrast between scar and surrounding areas of the scalp.

3. Hair transplantation inside the scar: In this method, we harvest hair from other areas of the scalp and transplant inside scar to blend in the scar: Some people may need more than one surgery, but the result is usually great. We can utilize FUE hair transplant procedure in this method. The primary benefit of FUE is that follicles are removed individually and can be then placed into the scar area. So new scarring does not occur during the revisioning.

4. Tattooing the scar: By tattooing stubble on scar the visibility of the scar can be significantly improved through the balancing of the color or reducing the contrast in color between the scar tissue and the surrounding scalp area.

Again the final method will be discussed during our consultation and patients may need a combination of these techniques to provide the best result.

Comment on Andrew Sullivan’s website:

… Another has a “warning to those men who are reading the posts exclaiming the positive impact of hair transplants”:

Like your reader who had a follicular transplant, one of my good friends also had this procedure when he was in his mid-20s; receiving rows and rows of transplanted hairs placed in neatly symmetrical patterns over the entire top of his head.  In the short run, this procedure, I’m sure, did much to help the self-esteem of a young man prematurely balding and panicked about his looks and the impact on his attractiveness to prospective mates.  The problem is that someone experiencing balding that severely in his early/mid-20s, is likely going to continue to bald.  Now, in his early 40s, my friend has the top of his obviously implanted head cut extremely short – making the unnatural pattern even more noticeable – because the balding has extended down creating a bare ring of head before the fringe of hair at his ear level.  The worst part of all of this: because of the horrible scarring created by the removal of the strip of hair from the back of his head to create the transplants, fully shaving  his head is no longer a reasonable option.  It’s an unfortunate example of having to live with a constant reminder of the vanity of youth.  He would have been better to just have left his hairline to nature.

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Dr. Mohebi’s Response:

I read the negative comment about hair transplants of one of the readers of Andrew Sullivan’s “THE DISH” blog.  As medical director of US Hair Restoration I could not stay silent because of the erroneous information disclosed in this reader’s response on your site.

The comparison of follicular unit transplantation which is the current gold standard of hair restoration surgery with old techniques that involved transplanting plugs of hair in rows is inaccurate.  Hair transplant surgery has come a long way in only the last 20 years, from plug surgery and mini-micro grafting to natural looking hair transplant surgery through follicular unit transplants. Modern hair transplant surgical procedures are technology advanced; a skilled surgeons procedure results are natural.  Most hair stylist cannot detect that their client has had a hair transplant. This has been proven true and our practice and colleagues.

In today’s Follicular Unit Transplantation, hair follicles are divided into the natural groupings harvested from the patient’s donor area of scalp.  These grafts are transplanted in natural direction and distribution in the balding areas of the scalp.

Undergoing hair transplant at an early age as cited by your reader is no longer a problem.  Microscopic diagnostic methods assist a hair transplant surgeon in predicting the pattern of future hair loss in a young man.  Current state of the art diagnostic technique allows the surgeon to be able to design placement of hair grafts in a way that it looks normal at any age.  For example when I design someone’s hair line I pay less attention to where it was before and more to where it is going to be as a mature hairline in the future.  The result of a hair transplant that is done correctly should look good now and it should look good twenty years from now.

The newest methods of donor wound closure resolves the issues concerning scarring at the back of head.  One such method trichophytic closure allows hair to grow inside the scar and makes the hair transplant scar less visible.  Today, we also perform Follicular Unit Extraction (FUE) for the ones who cannot have any linear scar on the back of their head.  The FUE method is more labor intense and time consuming but it allows surgeon to remove follicular unit grafts one at a time.  After a FUE transplant the patient can keep his hair very short without being concerned about the visibility of scar of the donor area.

Finally I would like to clarify that with the knowledge we have today about balding and its adverse effects on men’s psycho-social lives, I don’t call hair transplant a vanity but a requisite that is available to us to make our lives better, just like many other advancements that are available to us in today’s world.

Parsa Mohebi, MD

Medical Director
Mohebi Medical and US Hair Restoration.com
Los Angeles, California

Q.

Dr Mohebi,

I hope you are well. As we get closer to my surgical date I have put together some questions for you.

I have been reading a lot on the hair restoration network and found this 1 individual called Megatron with a similar makeup to myself.

I have looked at his very detailed journal and find many similarities to myself. Because of this I have several concerns.

If you look through his journal you will notice that he has a similar hair type to myself. It appears he got acne throughout the donor and recipient area that looks horrible at about 2 months after hair transplant and continued for several months. I was very prone to acne as a child and as I mentioned in our consultation I have incredibly sensitive skin and very thin tissue. If I went to a spa and received a facial not only would my face become very red and inflamed but the benefit of the facial would not be realized for sometime due to the fact that I would most certainly get a breakout the following day. Seems like my skin does not like to be touched, squeezed etc. It also appears that he was treated for several infections around the 2 month mark as well which may have affected or increased his shock loss.

I am also concerned about the level of shock loss that he had. What are the common reasons for this and is there a way to minimize this other that the propecia you have already prescribed? It appears as if he lost a good portion of the density at about 2-3 months in the recipient area. I am not sure if I am ready to go through that even for the greater good. I understand that everyone is different and will react differently to the surgery. I have always been on the side of having the most and weirdest reactions to everything that messes with my bodies natural makeup!

When would you say that a return to normal sleeping patterns is likely?

I am not sure if this can be considered a random case of cold feet but I just wanted to get some additional reassurance from you prior to finalizing everything today

A:

It is great to hear from you. I will be answering your questions in the order you asked:

1.      What is generally seen a few months after a hair transplant procedure in some individuals is called folliculitis. This happens due to an accumulation of sebum, oily secretions, of the hair follicles.  They are not seen in every patient and do not generally have to do with having a history of acne in the past.

2.      Having sensitive skin may indicate more swelling and redness for the first few days after surgery, but this might be controllable with steroids that we already give to most patients.

3.      Shock loss is most often seen in the areas where you have significant miniaturization, which in your case we know exists based on our microscopic evaluation.  However, we recommend using finasteride after your hair transplant for a few months to minimize the shock loss.

4.      You may want to add minoxidil after hair transplant to the finasteride, to minimize the risk of shock loss even further.

5.      You can go back to your normal sleeping pattern after the 4th day after hair transplantation. Within the first four days you need to sleep in semi-sitting position, but there is no problem with putting pressure on the closed donor area.

In closing, be aware it is normal to have some level of anxiety before any type of procedure.  Please contact me if you have any other questions.