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All Hair Transplantation related posts


If I have a restoration of the crown, will the swirl look right or will it look noticeably like a transplant?

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If the surgeon is experienced and properly recreates the whorl in your crown, it will not stand out as anything more than your naturally growing hair.

Just the other day, I went to my new eye doctor. We talked for a bit and when she asked me what I did for a living, I told her I performed hair transplant surgeries. She was suspicious, so I pointed to my crown and told her that those were hair transplants (see here). She said, “That’s hard to believe! I always thought that you can see them.” I couldn’t help but smile.

Tags: hair transplant, crown, hairloss, hair loss


If a patient gets hundreds of pustules (pimples) in the recipient area during the one to three month period following an FUT procedure, what is usually the reason for this? Is it due to bacterial infection of the grafts that occurred during the procedure? How does it bode for the eventual outcome of the transplant?


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There are many answers to this question. They include:

  1. The most common cause of pustules are left over remnants of the grafts that remain in the recipient wounds. The remnants include sebaceous glands which produce sebum below the skin. This sebum has no way out, because the hair follicle has not formed, so there are no pores. The result of this is that the sebum becomes infected. This should not produce hundreds of pustules over a month period. Warm soaks are the best way to draw out the pustules.
  2. For hundreds of pustules, one might assume that this is folliculitis caused by infection. It would look mean with lots of redness and erythema in the area. This would require antibiotics.
  3. A rare cause of this is an autoimmune disease called folliculitis decalvans. Unfortunately, I have had a few of these patients and the infections are hard to control. This condition usually lets up at about the time the hair follicles grow out, once the pores are established. I have had one patient in the past few years where the recipient area remained mean looking for a year.
  4. Infection introduced by poor techniques are uncommon, but I know of one medical group that has this as a common complication.

I have not seen a wipe-out of the hair grafts in #1. Some reduced growth may occur in #2. Reduced growth does occur in #3

Tags: hair transplant, hairloss, hair loss, pimples, pustules, infection


Hi Doctor Rassman:

I have a question about corrective surgery to repair Hair transplant scars and scalp reduction scars and lumps.

I had several hair transplants and a total of 7 scalp reductions back in the late 1980’s and early 1990’s from Dr. Martin Unger. With regards to the hair transplants, they were the typical 4 or 5 mm punch grafts I guess. The outcome was good but the donor area, which is covered pretty good by hair looks like a war zone if I were to shave my head or cut the hair anywhere shorter than a few cm’s on the sides and back.

I’d love to get FUE’s into the scar areas but I’m wondering how effective that would be in covering it up. I’m not interested in SMP cause if I do any corrective surgery, it is with the intention of wearing my hair very short and keeping it natural, using real hair.

With regards to the scalp reductions, as mentioned I had 7 of them. So I basically have hair up to the scalp reduction on both sides of the scar. I also have wavy hair so that helps to cover up the scar. But I would say the scar is about 5 or 6 inches long and maybe a quarter inch wide. Could that be filled up with FUE’s?

Another big problem after having 7 reductions is that at the crown / back of my head where the scar ends, there is a lump of excess skin left over from having the scalp excised seven times but excess skin build up behind the scar where the skin wasn’t cut out. It’s not a dog ear scar, just a lump, probably the size of quarter / half dollar and maybe 1cm high compared to the rest of the scalp, kinda like a mound. I’m sure you’ve seen that. It’s basically covered with moderate coating of hair but still visible if someone was looking at the back of my head from a close distance. God forbid if I let someone touch my hair. Even my wife and kids know NEVER to touch my hair. LOL!

So my question is, can that lump be excised or reduced in size?

Basically my intention is just to try to make my scalp, with very short hair, look as normal as possible. My hair, now if I keep it long looks like death. What I mean by that is it looks like it is on life support knowing that it should have fallen out decades ago but just as been kept growing by artificial means. LOL, hence I want to keep it short one or two cm long, shorter on the sides and back.

Back then I was young and naive and desperate and although I’m sure Dr. Unger had good intentions he never told me just to cut my hair short and move on. Now I’m using a shitload of treatment just to keep my hair for the sole purpose of not wanting to thin,especially on top so that the scalp reduction scar and is visible. Then I’d look like a freak. If I had no scars, hadn’t had any surgery, I’d just shave it cause hair to me now is not so important as it was back when I was 21 (I’m 49 now)

Just to show you how crazy my treatment is:
Proscar (5mg a day) Been on that since it first came out so going on 21 years.
Dutasteride (1 mg a day) been on that too since it first came out, maybe 8 years??
Minoxidil 5 and 15% daily
Nizoral shampoo


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While you may say your case is “crazy”, there are many men in your similar predicament. Dr. Pak and I have seen and treated many men in your similar situation with a combination of a hair transplant, scar reduction, and SMP.

I really cannot advise you on your specific options without examining you in person. Repair cases like yours are unique with each person. BaldingBlog is more for general question and answers. If you would like a consultation please email me at or call my office to speak to me or Dr. Pak at (310) 553-9113. It would be best if you email photographs (held absolutely confidential) and include your phone number, and either Dr. Pak or I will call you.

Tags: hairloss, hair loss, scalp reduction, hair transplant


This comes from prominent New York hair transplant surgeon, Dr. Michael Beehner:

With FUE, it is easy to fracture the neck of the base of the follicle when the bulb is “naked” and then grasped for placement, while in microscopic dissection with a strip harvest, there is good fat around the base of the follicle and fracture of the hair follicle almost never occurs during placement. When all of the people placing the grafts have to grasp the naked follicle, I think this causes a kink on the end of the exposed follicle and may be accompanied by poor growth.

Quite frankly, I wish that, instead of our always talking to the patient about the choice between FUE and “strip” harvesting, I would rather talk about FUE vs. “microscopic dissection of grafts”, because this is where the biggest difference is between the two procedures. Also, the FUE often strips the end of the graft as it is being pulled out, leaving less tissue and fat on the end. With strip harvest and microscopic dissection, the doctor’s staff have total control on how that graft will be produced and we never see stripped grafts. Also, the fact that in a strip surgery, we are always taking the strip from the absolute richest center of the scalp where the best hairs are, this makes the choice difference for me a “no-brainer”.

I have no trouble convincing 95% of my patients who walk in seeking FUE to go with strip when I present the FUE problems to them this way. I explain all of these things and reassure them that many patients have almost undetectable strip scars.

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We wrote about Follicular Unit Extraction (FUE) vs Strip (FUT) nearly two years ago: FUE vs FUT — Which is Better?

When you look at a follicular unit, you will see all of the anatomical parts that are traditionally created from a strip harvesting technique. All of the critical anatomy is preserved as the grafts are dissected under a microscope from the strip harvest. Damage, providing that the grafts remain hydrated, is rare and growth is excellent.

When FUE’s are done, the follicular units are not-infrequently disrupted in some manner, and these grafts may not grow as well as a result of the disruption. This is shown in some grafts that we put aside for trimming when a patient had the type of collagen that resisted the extraction in the FUE process. This is viewed here. Once these second class grafts are trimmed, they must be grasped with a forceps at the bulb or just above the bulb, which can fracture the hair shaft (this is what Dr. Beehner was talking about above).

With good instrumentation and considerable experience, FUE can be done as successful as with a strip; however 100% of patients do not have a tissue anatomy that allows such a clean FUE. This was discussed in our pioneering article that introduced FUE to the medical profession.

Tags: follicular unit extraction, strip procedure, fue, hair transplant, grafts


I had a hair transplant about 3 1/2 months ago. I was curious if drinking espresso coffee could impact how well the hair transplant grows out. I get pretty zippy from a cup of starbucks espresso. I believe it has 150 milligrams of coffee. I drink atleast one per week. I also drink a cup of tea in the morning. That’s probably another 50 mg. Is this something that could hurt a hair transplant?

Another question I had was that I was taking 2 Vicodins per day for about 10 days after my hair transplant. I had not read the medication instructions because I had lost them. The doctor gave 25 tablets of the Vicodin so I presumed that I should take them all. Could this hurt the growth of the hair transplant?

Thanks for writing such an informative blog. If I had ran into this before my procedure I would have came to you for my transplant. My doctor was good but you are great. Perhaps I will come to you for a second procedure if it is needed.

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There is no problem with drinking coffee or taking Vicodin (hydrocodone/acetaminophen) following a hair transplant. Once the pain is gone, I generally tell patients to switch to Motrin or Advil (ibuprofen) for pain relief.

Tags: hair transplant, surgery, caffeine, hydrocodone, vicodin, coffee, ibuprofen


Hello Doctor,

Is it possible for a hair transplant specialist or dermatologist to examine your scalp closely in order to detect if at least some of your hair has come from a fairly recent (1-1/2 years ago) transplant operation (strip, FUs), or is there no way to distinguish it from your native hair. I’ve had 2 procedures in 2 different locations of the scalp and was disappointed with the 2nd. one where I still had a fair amount of hair (20 – 30 FUs per sq. cm.), and would like to know if many (or any) of the grafts are successfully growing.

Thanks very much.

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It’s possible that you may have some very slight skin pitting where the transplanted hair is, but if the surgery was done well and you healed well, it would be pretty hard to distinguish the difference.

I am a good example of a completely undetectable hair transplant patient. No one, even from close up with a comb in their hands, can detect my crown hair transplant. Few have ever detected my three donor wounds (all done at the exact same place), even with a comb in their hands. I am a typical example for the hair transplant process, but not the typical example of the donor scar in patients that have had more than 1 procedure.

Tags: hair transplant, hair restoration


Hi Guys, great blog. With regards to hair transplantation, I understand that there will be a scarring of some type in the donor area. My question is, with regards to the recipient area, once the grafts have initially dropped out, are there scars in the recipient area where the grafts were placed?


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There is always scarring with any cut on the skin, but the visibility of the scarring depend on not only the surgeon’s skills, but also the individual.

The recipient area can usually appear red (in a fair group of people) for several weeks, but most patients will show no visible scarring in the recipient area after about 1 to 3 weeks.

Tags: hair transplant, hairloss, hair loss, scarring


Hi Doctor,

I have been reading your blog and it is really informative, Awesome job by you. Coming to my concern, I had my HT done back in India in January 23rd 2014 and I see dried pimples like thing from last couple of weeks and they don’t heal. I am attaching two pics of my scalp. Can you please look at them and tell me if any infection has happened or does it look normal. If you examine pic_2 attached, I see some fluid like thing at couple of places near the graft. As, I can’t see the doctor back in India now, I need your help.

Thank You Very Much

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Click the photos to enlarge:


It looks like you have crusting from the transplant (this is usually gone on our patients in a few days) and the crusting has caused an infection. You need to see a doctor and get this treated, even if it is not your transplant surgeon. You should wash your hair gently and get the crusts off, for as long as it takes to get a good wash.

Cleanliness is critical following a hair transplant surgery, and what I see is not a clean post-operative wound.

Tags: hair transplant, post-operative, infection


Have you ever encountered a situation where an FUT patient developed persistent redness in the recipient area after surgery that never went away? Have you ever encountered a situation where a patient developed Rosacea and/or Telangiectasia as a result of surgery which caused permanent discoloration of the scalp?

If this happens, what is generally the cause? And what is generally the ultimate outcome for these patients?

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No, I’m not familiar with this occurring. I have never encountered a situation where a patient developed permanent discoloration of the scalp, such as rosacea (facial redness) and/or telangiectasia (spider veins) as a result of surgery.

When redness occurs it usually reflects sensitive skin, but it always goes away. Redness rarely lasts longer than a few weeks in the worst of cases. The one exception that I can recall was a patient that had redness to some degree last around 6 weeks, but that was unusual.

Tags: redness, hair transplant, rosacea, telangiectasia, skin discoloration


I caught this on the news: Beard envy? Hipster trend sparks interest in facial hair transplants

I saw this article and knew that is what I wanted. My beard has never been very full and my mustache is almost non-existent. I am 28 years old and there has not been any significant thickening of my beard or mustache in the past 3 years. Should I go to a plastic surgeon for this?

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BeardHere’s a snippet from that article —

Hipster beards are no longer confined to the streets of Brooklyn, N.Y. — they have made their way into the mainstream as actors, politicians, athletes and other men are sporting their own scruff. That’s giving some follicularly challenged men enough serious beard envy to seek a facial hair transplant.

With the exception of the handful of dedicated plastic surgeons who manage to have a sizable hair practice, most facial hair transplant procedures would be right out of their depth. Most plastic surgeons tend to avoid such reconstructions, which are best performed by a hair transplant surgeon with experience.

In our practice, we have done mustaches, beards, sideburns, eyebrows, pubic hair, chest hair, hair into scars from brain surgery, etc. In other words, we specialize in hair transplants, and all parts of the body require similar technology and skills. See some of our other hair transplants here.

Tags: beard transplant, facial hair, beard, moustache, mustache, hairloss, hair loss, hair transplant, hipster


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