I am a 32 year old woman and got a hair transplant surgery a year ago. The front of hairline has always had fine baby hair compared to the rest of my hair. It doesn’t fall out, it is just fine. I got the surgery to make that hair look fuller. After my 6 month progress checkup there was no growth, after a year I don’t notice a difference and the before and after photos look the same. I asked my doctor about it and explained my dissatisfaction and he said that I don’t see a difference because the grafted hair is growing but my normal hair is falling out so I don’t see a difference. I think it is a bit strange that everything was the same, no notice of hair loss at the 6 month checkup and then all of the sudden the grafted hair grows my other hair falls out etc. It sounds like an excuse but when I confronted my doctor, he says, I’m the trained doctor and that’s what happened. I know my hair didn’t suddenly start falling out at accelerated speed in the last 6 months. How do approach this, there is no way to undo going through all of the procedure etc. How do I communicate this better to my doctor…because I think I should get a refund or something because it didn’t work. ~ Sima
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Investing time, energy and money into a hair transplant procedure and ending with an outcome that doesn’t meet your goals can be quite frustrating. But gauging results, after transplanting into areas with existing hair, can be difficult especially with the variable of shock loss. Read the Story

I had a hair transplant over 5 years ago and was fully aware that I would need 3 to 4 more hair transplant procedures to cover a bald head. I thought this was the direction I wanted to go. I have very thin hair, and realize I am not the best candidate for the procedure, so I’m not wanting to commit to putting an additional 3 scars on the back of my head. I wish I could just go back to super short hair/shaved close. Is there anything I can do with the scar on the back of my head? ~ Michael
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Thank you for your letter. Once you’ve had a strip surgery it is often very difficult to regain the ability to wear your hair shaved close as the scar may have a slightly different shade of skin coloring than the non-scarred skin and the linear scar, even when very thin, can draw the attention of an observer. There are, however, options to wear your hair short.

If your scar is a “normal” width, say 1-3 mm, you may be a candidate for a scar removal followed by a special method of wound closure whereby one of the skin edges is treated a certain way as to allow healing with hair actually growing through the scar. This method of treating the wound and suturing is called a “trichophytic closure.” Read the Story

What are the chances of having “shock loss” resulting from a hair transplant procedure?
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Thank you for your question. Personally, I have not seen any significant post-surgical hair loss for the last 4-5 years. The reasons are many. First and foremost is the creation of precise angles of the recipient sites, while fallowing the exact direction of hair growth. Secondly, the use of very small needles and cut to size blades, that minimize the size of the sites created, hence the extent of tissue and possible follicular injury if there is native hair remaining. Lastly, the use of finesteride diminishes the DHT by 70% hence protecting the native and transplanted hair from any post-surgical increase in circulating DHT. Lastly, the use of minoxidil 5% acts synergistically to further protect the native miniaturized hair and possibly stimulate the growth of the transplanted hair. Furthermore, the growth of the transplanted hair with its increased caliber is of greater contribution to the hair mass and volume than the native thinner caliber miniaturized hairs. I do recall one patient about 6 years ago that had some shock loss post-surgically. Read the Story

I am considering a hair transplant and would like to have the procedure and not be overly obvious about it. What are my options in hiding or concealing any redness after a week or so if it exists? I’m assuming I would follow all aftercare procedure recommendations. Thanks, Greg
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There are a number of factors that can make a hair transplant obvious in the post-op period. These include the redness that you are asking about, but also crusting and swelling.

Redness is easily camouflaged with ordinary make-up. At one week post-op, the grafts are pretty secure so that make-up can be applied and then gently washed off at the end of the day. Since the recipient wounds are well healed by one week, using make-up does not increase the risk of infection. At 10 days, the grafts are permanent and can not be dislodged, therefore, at this time the makeup can be removed without any special precautions.

Usually residual crusting presents more of a cosmetic problem than redness and, as you alluded to in your question, can be minimized with meticulous post-op care. Read the Story

I have already signed up to have a hair transplant at the end of July for 3500 follicular unit grafts and I began to wonder how do I know for sure that is the amount of grafts I will receive? Is each hair counted as it is placed in my head? ~ Hector
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Dear Hector,

Thank you for taking the time to write! This is an area that causes great confusion to patients, so let me try and clarify as best I can.

Hairs grow on your head in clumps of 1, 2 or 3 hairs (and sometimes even 4 or 5 but this is more rare). These clumps are a “follicular unit” and they are what is cut into “grafts” for your hair restoration procedure. (Yes, hair surgery is the only specialty where getting more “FUs” is a good thing!) Hair surgeons often use the terms “follicular unit” and “graft” interchangeably since, ideally, they are the same thing. However, this can lead to confusion for the patient.

Here is the problem; if a two-hair graft is cut into individual hairs, it can be implanted as TWO single hair grafts – even though originally it was supposed to be one single graft with two hairs! You see how easy it is to double the number of “grafts,” you just need to cut apart each hair in the “follicular unit”, even if it existed in a clump in its natural state. Read the Story

I have been reading about “long hair” hair transplant procedures where you can have the ability to see the basic outcome of the hair transplant the very day you have the surgery done. Is there a downside to having this done or will the outcome remain the same?
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I have never embraced the concept of “long hair” surgical transplantation. There are simply too many disadvantages with this method that far outweigh the single advantage of being able to see long hair in the grafts immediately upon completion of the procedure. The list of disadvantages includes, but is not necessarily limited to, the following:

1) Many patients who undergo large graft sessions will need to have the recipient site shaved to facilitate accurate graft placement. Long hair grafts make no sense in this case since they will not give an accurate idea of the final result with the recipient site having been shaved in the first place.

2) Working with long hair grafts will dramatically prolong a procedure. Long hair grafts slow virtually every component of the procedure, i.e. – the donor strip harvest, the microscopic graft dissection, and the graft insertion. Read the Story

Why credible and trusted websites may be displaying ads for bad products and services.

By now, people are becoming increasingly aware that there are many untrustworthy websites on the Internet, like the ones that will try to sell you snake oil remedies for hair loss. Scams and spam are rampant online but there are sites out there that you can trust.

Or can you?

Often, a trustworthy website will show ads for products or websites that are not trustworthy at all. This means that when conducting research and buying products on the Internet, hair loss sufferers need to be vigilant about every link they click.

How it happens

Many websites use advertising programs to generate revenue. The advertising programs are provided to website publishers by advertising affiliate networks. These networks perform two significant duties. First, they sell ad campaigns to companies, websites, and independent professionals who want to market their businesses online. Second, they provide affiliate advertising to website publishers.

When website publishers sign up with affiliate networks, they enter topics or keywords that are relevant to the content on their own sites. The affiliate networks then provide a bit of code that is inserted into the publisher’s website. This code is automated to generate the ads that you see on many sites.

No control over ad displays

The problem with this model is that the publishers have little control over which ads appear on their sites other than to specify rather broad categories and topics. A credible website that focuses on hair loss will naturally enter “hair loss” as an advertising keyword. However, the ads that appear may very likely link to gimmicky websites that are pitching products or services that are either dangerous or simply do not work.

Be wary

The best way to protect yourself is to understand that whenever you click on a link, you may be exiting the site you’re visiting and heading into new territory. This should be obvious as the second site will probably look a lot different from the first. For each new site you visit, be wary of the site’s credibility. Always practice safe, smart web surfing and always look for the American Hair Loss Association certification seal before you even consider buying any product or service to treat your hair loss.

Spencer Kobren
Founder, American Hair Loss Association
Founder and Director of Consumer/Patient Affairs, International Alliance of Hair Restoration Surgeons (IAHRS.ORG)

This question was originally answered by Dr. Bradley Wolf on April 8, 2008. Below are Dr. Alan Feller’s comments for this same question.

To date, all FUE is essentially the same. That is, the follicular bundle is first targeted. Then the doctor scores around it with a punch or punch like tool. Then a forcepts is used to grab and pull the graft free of the lower layers of tissue that anchor it in. In theory, that would be it and all would be well. However, reality places certain limitations and obstacles in our way.

No matter which “form” of technique used, the current day FUE practitioner must subject his FUE grafts to THREE major detrimental forces:
1: Torsion (twisting)
2. Compression (Squeezing)
3. Traction (pulling)

If not for these three destructive forces, FUE would have replaced strip surgery as the mainstream method of surgical hair restoration in 2002. Read the Story

I know that during surgery the doctor removes a strip of hair from the donor area, but lately I have found a lot of doctors and clinics offering a different technique that does not require this to be done. I believe it is called FUE, and the advantage would be avoiding a scar in the donor area. What can you tell me about these 2 different techniques? Best regards, Ezequiel
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Dear Ezequiel,

For the first 30 years of hair transplantation hair was removed with large pencil-eraser size punches, with each one removing around 20 hairs. Then around 1990, the Personna company came out with a surgical blade finally sharp enough to cut narrow strips of hair-bearing scalp out, so that very small grafts could be cut under the microscope from them. Read the Story

I am 28 years old and had a hair transplant procedure of 1800 grafts two years ago. The transplant isn’t really horrible or anything, but it just Isn’t as natural as I hoped it would be. What I really want to do is just have the grafts removed, shave my head and move on with my life. Can this be done? And if so, will my head look relatively normal after?
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If you are convinced that you really just want to shave your head, my guess is that there is a pretty good chance you could make your head look relatively normal. Let’s start with the recipient area. The first thing you should probably do is to closely shave a small area of transplanted grafts to make sure that you don’t have any scars there that would bother you if there were no hair to hide it. If your hair is dark and coarse, you might even choose to pluck a small area of grafts or to use a small amount of chemical hair remover designed for beard hair to really get an idea of what your scalp would look like bald. Assuming you are comfortable with the look and you want to proceed with graft removal, I would suggest laser hair removal. This may require 3 or 4 sessions and occasionally touchup sessions every couple of years, but the advantage is that it is relatively quick and it does not scar. You should understand, however, that it may not work well for blond hair. Read the Story