Hair Restoration Blog

Q:

Permanent shock loss- in the front center mostly and also areas in the temples. Is it likely from your experience that hair like mine will survive?

A:

Although  could be seen in some patients for the first few months after surgery, taking finasteride will minimize or, in most cases, eliminate that risk in the majority of patients.  However, if you do experience shock loss, it won’t be for more than 2-3 months and after that time, your transplanted hair will begin to re-grow. It is by then that your hair should look much better than it did before.

Q:

I’m a 26 year old man and I am not completely bald yet.  Would doing the procedure right now add extra difficulties with the existing balding hairs or transplanted hair?  In other words, when my existing hair eventually fall out, would my hair look like they are thinning again?

A:

Transplanted hair is considered permanent and you won’t lose it.  However, you may need a touch up hair transplantation if you lose your existing hair in balding areas to maintain the maximum density for your hair line and other areas.

Q:

Hello I do mix martial arts and would like to know, how long will i be out from MMA (wrestling, jujitsu, muay thai, etc…) after strip surgery? also when can I return to regular cardio (running, rowing, sprinting,etc..) and weight lifting?  thank you. I have contacted other doctors too, but they all tell me different answers. the internet says to stay away from MMA at least for 3 months? some doctors tell me I can return to MMA after one month but in wrestling and jujitsu they are always grabbing and pulling down the back of the head in a very fast and hard manner.

A:

It has to do with the technique of hair transplantation.  If you are considering the conventional hair transplant surgery with a strip method, you should not perform any aggressive contact sports for the first month. After that first month, you can resume most of your activities, but you really need to be careful for the first 3 months and avoid some moves such as bending your head forcefully until your donor scar is fully healed, which is 3 months after  your hair transplant.

FUE (Follicular Unit Extraction) has different timelines after hair transplantation.  If receiving a FUE transplant you should be able to resume activities much quicker  because there is not a linear scar on the back of your head and you do not have to avoid bending your head for 3 months after hair transplant.  For more information, you can also read this other blog post in which I have answered another similar question from one of my patients (Physical Activity Limitations After Hair Transplant).

Q:

I am planning to have my hair transplantation with you soon and I have a few questions about the few days after hair transplantation.  I’ve been letting my hair grow so that I’ll be able to push it forward to cover the frontal work, but I’m concerned with how much swelling there might be, or if there’s a lot of shock loss, so that the hair I was going to use to conceal, fell out.
How many days is it again that the scabs usually persist? And how long would it be until I could get back into the gym or doing some other kind of exercise?

Also, I have been taking finasteride (1mg) and cutting the tablets into quarters. Is that correct? I haven’t kept up with the scalp massaging though. It was taking so long I was starting to wonder if was going to happen at all. But I could start doing that again now.

Thanks in advance, for your answers!

A:

These are great questions and I will be happy to answer them!

• Swelling
  Generally speaking, swelling after hair transplant surgery may occur 1-5 days following the procedure. It is usually moderate with certain exceptions which might be more noticeable and involve some area around the eyes as well. Not everyone experiences swelling, but I must always describe the worst case scenario: you may have an elevation (due to fluid) on your forehead which is alleviated by the medication we provide and elevating your head during the first few days after hair transplant.
• Bruising
  You may have some bruising or discoloration on the transplanted area, forehead, and occasionally around eyes which is even less likely, but necessary to mention. Wearing a baseball cap usually conceals your hair transplant for the following week. I’m sure your existing hair will do an adequate job as well (of course that is only for individuals who have some existing hair to cover the transplanted area).
• Shock loss
  The medication finasteride, or minoxidil in women, will help to lighten the shock loss (acceleration of the loss of native hair in balding area). Most of those shocked hairs usually go into a temporary resting phase and come back with your new transplanted hair.
• Scabbing
  The scabs are simply tiny crusts that dry up and flake off within a week.  They are hardly noticeable, and if you wear a cap no one can see anything.
• limitations in physical activities
  Exercise can be resumed two days following your surgery. Try to keep the blood pressure down (no squats, dead lifts, bent rows, etc) for the first four days after hair transplantation. If you can do some light machine work for a week, that would be best. Try to keep your head elevated/upright. You can do the treadmill or cycle, but just keep the intensity moderate. After 4 days post op, the grafts are pretty much locked in.

Rub your scalp before the hair transplantation. It helps! Your procedure size is rather small so scalp laxity will be a minor issue. However, do the scalp exercises! They are good for the delts also! And yes, you are correct in dividing the finasteride into 1/4′s!

Q:

Hi Dr. Mohebi,

First off I wanted to thank you for the job you did. You and your whole staff are just wonderful and I am very excited to see what will happen in the coming months.

I was looking online and saw that spraying a saline solution on the transplanted area is supposed to promote healing and help the scabs come off easier. I was wondering what was your opinion on that?

I am having some itchiness in the transplanted area. I’m guessing that’s normal. I can keep from scratching but was wondering if there was something I should do about it or will it subside on it’s own.

Thank you,

A:

I am glad you had a good experience with your procedure and our staff at US Hair Restoration during your hair transplant surgery.  Spraying Normal Saline solution to transplanted area is not necessary after a hair transplant surgery.  You need to wash off the scabs with tap water and the shampoo we have provided after your hair transplant.  The reason you need to wash transplanted area is to get rid of the scabbing that may harm the growth of transplanted grafts.

Itchiness for a few days to weeks after hair transplantation is normal in either transplanted or donor area of scalp.  Occasionally the itching after hair transplantation may become more uncomfortable and a prescription of a mild steroid might be required.  I will be in our Los Angeles Hair Transplant office for your follow up appointment. I will examine your transplanted and donor area and will address this issue.  However, please don’t wait till then and contact us if there is any questions or concerns before your next appointment.

In the mean time, have a great week and I look forward to seeing you next time.

Q:

Hi Dr. Mohebi,

I hope this email finds you well. I’m still waiting for a date to open up for me to come in, but in the meantime I was looking once again at the before and after photos on the site. I have a question regarding a couple of them.  In some patients in whom their after photos taken 8 months after the procedure, but it looks like his scalp is still rather red.  So I’m wondering for how many months could I have redness, scabbing or other telltale signs of the procedure?  Thanks very much for taking the time to answer my question!

Best wishes,

-

A:

The process of healing and hair growth is usually not complete before a solid 10 to 12 months after the hair transplant.  In fact, some people do not see their best result until month 18 after their hair transplant surgery.  Redness and inflammation of skin usually resolved after the first few weeks, however some patients may continue to have some remaining inflammation and slower disappearing, pinkish discoloration for months, yet they eventually resolve.

Q:

I had a hair transplant procedure a week ago and now I am having itching on transplanted area. The itching from the transplant is keeping me up at night.  I read on your blog this morning that an ointment might be available to alleviate that. If at all possible, I would like to have the name of the medication to use it. 
Thanks!
–

A:

Itching after a hair transplant surgery may happen as a result of an inflammatory reaction from the healing process.  This type of itching can be present after any type of wound healing.  Itching after hair transplant is generally very mild and most patients can tolerate this with no medications needed.  However, if itching is beyond comfort and is keeping you up at night, you can alleviate that with some medications. 

We recommend a mild topical steroid like hydrocortisone 1% that could be obtained from any pharmacy without a prescription.  If the itching does not improve after steroid use for a day or two, you need to be evaluated by your hair transplant surgeon.  Other medications might be needed based on the other conditions you may have, and your doctor needs to be involved with prescribing those.

The other factor that might increase the itchiness is dryness of scalp due to excessive washing. If this is the primary reason, you should limit your hair washing to once a day and not use cleansers in order to minimize dryness.  This may possibly be the primary change needed to minimize your itching.

Although the vast majority of men and women who undergo modern day surgical hair restoration are completely satisfied with the results, with the aesthetic and emotional benefits far exceeding their initial desires, it’s important to understand that there are limits to what hair transplantation can do. And for each patient, there are unique variables that play a major role in the outcome.

> Hair loss (androgenetic alopecia) is a progressive, ongoing genetic disorder that first manifests itself as thinning hair and ultimately results in hair loss, in those pre-determined hair follicles effected.

> You should never expect to retain the same hair density or the same hair line placement you had as a teenager, nor should you want to. Hairlines and overall hair density evolve as we age.

> You may have already lost up to 70% of your hair density before you’ve even realized your hair was thinning.

> Hair transplantation simply relocates natural hairs, it does not produce new hair.

> Hair transplantation does not stop affected native hair from thinning and future loss. The transplanted hairs are permanent, as they are genetically different from the thinning hairs, but hairs that are pre-disposed to thinning and loss will continue on that course.

> If warranted, in addition to hair transplant surgery to replace lost hairs, your physician may recommend finasteride or minoxidil in an effort to stabilize existing thinning hairs.

> Since beauty is in the eye of the beholder, and hair loss is progressive, somewhere down the road, you may elect a second hair transplant procedure to help you achieve your hair restoration goals.

Here are some factors that directly impact surgical results and should be considered when setting realistic expectations:

1) The ratio of supply (donor hair) and demand (area of hair thinning and loss). In essence, the more significant the hair loss and/or the larger area of scalp affected by hair loss, the more donor hair required. Hair density following one surgical procedure will be based on limits to donor hair extraction.

2) The caliber (diameter) of each hair shaft. Thicker hair will provide greater coverage and volume than fine hair.

3) The body of hair. Curly or wavy hair tends to create greater coverage than straight hair, resulting in greater hair density.

4) The contrast between the scalp and the hair. Hair density, or at least the perception of greater hair density, increases as the contrast (or visibility) of the scalp through the hair diminishes. For patients with dark hair and a light scalp, this contrast is greater, giving the appearance of thinner hair, or less hair density.

5) The density of the donor area. The donor area is the source of the hairs utilized in surgical hair transplantation. The greater the natural donor hair density (hairs per square millimeter), the more available donor hairs for possible future procedures.

6) Scalp elasticity. Mega-session and giga-session hair transplant procedures are becoming more common. For a surgeon to safely perform a procedure of this size (4,000 to 5,000 grafts or more), there has to be a need for it, the donor area has to have sufficient density, AND the scalp has to have enough elasticity to accommodate the donor removal, allowing the surgeon to close the area safely, leaving nothing more than an undetectable scar.

7) Future thinning and loss. Unless a patient is a Class 7, having lost most of the hairs in the affected area, it’s important to anticipate future, continued loss and recession. A secondary procedure and/or the use of finasteride or minoxidil may be recommended to achieve the hair restoration objective.

It’s important to review all available information, to make an informed decision. And when considering hair transplant surgery, or any surgery for that matter, it’s good to remember that the most critical decision is the surgeon himself… his training, his artistry, his skill, his compassion, his surgical techniques, his results.

If you are looking for answers to hair loss and are considering hair transplant surgery, we encourage you to visit a good hair transplant surgeon. In the right hands, you too can experience the life-changing benefit of hair transplantation, exceeding all of your expectations.

Q:

Dr. Mohebi, I have already made an appointment for hair transplant surgery on Wed April 20th per your recommendations and paid the deposit. If you don’t mind I have a quick question.

Do you think it’s realistic for me to see patients on Monday following my procedure? I have clinic that day and OR the next (will need to wear surgical cap), is this okay in the week following?

A:

Because we will be transplanting a large number of hairs in the frontal area of your scalp, we expect significant swelling until day 4-5 after surgery.  Occasionally patients may experience swelling until day 6-7, but your surgical cap use is okay and should easily cover it.

In addition, some patients occassionally get swelling and bruising around their eyes (which may be difficult to cover). Probability of bruising/swelling around the eyes is minimal but its possibility should still be notated.

Q:

I had a hair transplant back on October 31, 2009. I started getting red boils along my transplanted area (suspected to be folliculitis) in January and I have been taking Accutane for the last complete month.

My question to you is, why did it happen? Was it due to infected surgical equipment used in the surgery? I was advised to get such a heavy drug which has effected the overall tone of my face somewhat like getting severe dryness. Lastly, sir what do u think there are few patches in the infected area who are now like bald patches. Do you have any suggestions or medicine for the future?

A:

Pimple-like scalp lesions that develop after hair transplant surgery are typically folliculitis.

Folliculitis can typically be seen after hair transplant surgery in both the implanted and donor wound areas in the few weeks to month after hair transplant.

The development mechanism of folliculitis is similar to acnea.  It is usually due to blockage in the exit pores of the sebaceous gland (skin oil glands).  Following obstruction of those pores that can occur after hair transplant surgery, sebum (skin oil) cannot be emptied to the skin surface and instead begins accumulating underneath the skin surface.  The result is red or white head-like pimples.

Recovery is generally spontaneous. Although, if too many of these lesions develop, or if there was any sign of secondary infection (i.e.- redness or swelling around the area), the lesions may need to be drained by your physician and the patient may occasionally be recommended to use antibiotics.

Thanks to the generous vascular supply of scalp skin, the infection of scalp skin after hair transplant surgery is extremely rare.