Bernstein Medical - Center for Hair Restoration - After FUT Hair Transplant
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Q: I had a hair restoration procedure and the hair grew, but after one year the hair was kinky and dry. It has remained like this ever since.

From what I have read Dr Bernstein says this is uncommon but can happen. I understand there is no definitive explanation for this but I would like Dr Bernstein’s opinion on why this happens. My theory is that DHT is more prominent on the top of the head and is changing the structure of the transplanted hair. The hair is so dry and unmanageable it looks like I am wearing a wig. I await his response. — P.O., Greenwich, CT

A: Some dryness and texture changes can occur after a hair transplant and this usually self-corrects over 1-2 years during which time the transplanted hair gradually regains its original luster and texture. These changes are most likely due to the unavoidable trauma that takes place as follicles are removed from the scalp and placed into recipient sites. Excessive dryness can occur if the sebaceous glands had been stripped away from the graft. In FUT, this can be due to over dissection (i.e., grafts that are trimmed too much). In FUE, this can be due to loss or damage to the sebaceous glands in the extraction process. Persistent kinkiness may represent either damage to grafts from the procedure (improper handling, crush injury) or effects of scarring in the recipient area (usually from older procedures which used larger recipient sites) that distort the growth of follicles.

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Q: I have heard that shock loss can occur after a hair transplant. Do women experience less shock loss than men? — N.R. ~ Mineola, N.Y.

A: Actually, the risk of shock hair loss is usually greater in women than in men since women generally have a more diffuse pattern of thinning. This is because females often have more miniaturized hair, the hair that is most subject to post-op shedding.

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Q: Is it harmful if I do not rinse or wash my recipient area for 5 to 7 days after the hair transplant? — T.E., Yonkers, NY

A: The purpose of showering the day after the procedure is to remove scabs and dried blood. This will allow for quicker healing, less inflammation (redness), and a reduced incidence of infection. It will also shorten the time post-op where the procedure might be detectable. In our practice, patients are instructed to start showering and gently washing the recipient area the day after the surgery. The first day after surgery the patient will shower three times, and for the remainder of the week, showering will be twice daily. When showering, patients can clean the transplanted area with a special medicated shampoo that is gentle on grafts. The follicular unit grafts are made to fit snugly into the recipient sites and will not be dislodged in the shower, as long as the patient washes gently.

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Q: I am an MMA fighter and I want to get a hair transplant. How long do I have to be out of commission and which type of procedure should I have, FUE or FUT? — J.A., Columbus, OH

A: With any type of hair transplant it takes 10 days for the transplanted grafts to be permanently fixed in place. The difference between FUE and FUT is in the limitations of activity due to the donor area. With FUE one would need to abstain from MMA for the same 10 days it takes the recipient area to heal (the grappling component of Mixed Martial Arts is the most stressful on the scalp). With FUT, however, one would need at least three months for the linear donor scar to heal before one could resume contact sports like MMA.

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Q: I’ve heard that using Propecia and/or Rogaine is a good idea after having a hair transplant, but are they mandatory? — B.M., Short Hill, N.J.

A: Neither finasteride (brand name: Propecia) nor minoxidil (brand name: Rogaine) will have any effect on transplanted hair. That said, while you don’t need them to protect your transplanted hair, you will likely have original hair interspersed among your transplanted hair that will continue to thin and fall out over time. This vulnerable hair can be protected by finasteride which has been shown to reduce future hair loss significantly; additionally, you can add Rogaine for extra benefit.

However, with Propecia, you should only use it if you can commit to it long-term because it takes up to a full year to see any effect. With Rogaine, you should only use it if you can commit to using it continually and regularly – you should not stop and start it.

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Q: I have seen through forums that a hair transplant gives severe shock loss in the donor zone (especially behind ears) after the surgery. Doctors say it is temporary and can last about six months or more. Frankly, do you believe in this? Will the donor shocked hair recover? — M.D., Darien, C.T.

A: It depends if you are speaking about follicular unit hair transplantation using strip harvesting (FUT) or Follicular Unit Extraction (FUE). With FUT, it is extremely uncommon to have any shock hair loss in the donor area. This could occur if the hair transplant procedure was done improperly, i.e. the donor area was closed too tightly. In this case, some hair loss may be permanent. This is one of the reasons that very large hair transplant sessions are unwise. Shock hair loss in FUE is more common, but is generally not significant and should eventually recover completely.

That said, some shock hair loss in the recipient area is quite common with either hair restoration procedure (FUT or FUE). This is particularly the case if there is a lot of existing miniaturized hair (hair that is starting to thin) in the transplanted area.

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Q: How long are FUT and FUE visible after the procedures? — S.V., Weston, C.T.

A: The recipient area is visible after both procedures for up to 10 days. The donor area in FUT is generally not visible immediately after the procedure. In FUE, the donor area must be shaved, so that will be visible for up to two weeks (the time it takes for the hair to grow in).

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Gholamali Abbasi, MD, Sepideh Pojhan, MD, Susan Emami, MD. Tehran, Iran

SUMMARY of Dr. Abbasi’s Abstract from his presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia

Edema of the forehead and the peri-orbital area is observed frequently after a hair transplant. To prevent this edema the authors introduced a new method (Abassi’s solution) at the 12th Scientific Meeting of ISHRS in Vancouver, Canada. The present study tries to determine if Abbasi’s solution can have a negative effect on the growth of transplanted grafts following hair restoration surgery.

In this study, the authors examined the effects of Abbasi’s solution on hair growth one year after a hair restoration procedure.

Abbasi’s Solution
Normal saline, 100cc
Epinephrine 1/1000, 1cc
Triamcinolone acetate, 40 mg

In this study, the authors injected Abbasi’s solution into one side of the bald scalp and tumescent solution in the other side. 30 FU’s (2 hairs) were transplanted to each side. Photos were taken before, immediately after surgery, and 12 months after the hair transplant. In order to evaluate the hair growth, they compared the number of transplanted hairs with the number of hairs that actually grew after 12 months.

Results:

Preventative Methods % Edema Free
Oral Steroid 47.6
I.M. Steroid 65.7
Xylocaine/Steroid Mixture 70.0
Abbasi’s solution 97.4

Results showed that for hair transplant patients who received Abbasi’s solution, 97% had no edema during the period of 2-6 days after surgery. About 95% of the implanted hairs showed regrowth after 12 months.

The conclusion was that Abbasi’s solution not only can prevent post-operative edema following hair restoration procedures but also does not show any negative effect on the growth of the transplanted hairs.

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Q: What are your recommendations for wearing a hairpiece following a hair transplant? — P.K., Long Island City, Queens, NYC

A: First, some clarification. It is OK to wear a “hairpiece” (one that is attached to the hair with clips or to the scalp with tape) so that it can be removed each night, but NOT a “hair system” (that is woven to existing hair or glued to the scalp and must be removed by the salon).

Patients should wait a week before they resume wearing their hairpiece, although some patients use it as soon as two days later (but keep it on for very short periods of time).

After the first week, I don’t have any restrictions with regard to duration during the day, as long as the person removes the hairpiece at night and shampoos the scalp thoroughly at least once a day.

The hairpiece should be kept clean and it helps if the person has a spare. The piece should be attached with clips. A stiffening rod can be inserted along the front edge to keep it from lifting up. One should avoid using glue. Tape can be used in conjunction with clips only if the area of attachment of the tape is away from the implanted grafts.

Here are some resources for after your hair transplant:

After FUT Hair Transplant
After FUE Hair Transplant

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Q: I am taking a baby aspirin to prevent heart disease and I heard that I should stop this medication before my hair transplant. How long should I stop for? — G.A., Fort Lauderdale, FL

A: You should discontinue the aspirin 10 days prior to your hair restoration procedure.

Other NSAIDs (non-steroidal anti-inflammatory drugs) need only be stopped 3 days before the hair transplant.

Both aspirin and other NSAIDs can be resumed three days after surgery. ((Otley CC: Preoperative evaluation and management in dermatologic surgery. J Am Acad Dermatol 2006; 54:119-2))

Here are some resources for before your hair transplant:

Before FUT Hair Transplant
Before FUE Hair Transplant

Here are some resources for after your hair transplant:

After FUT Hair Transplant
After FUE Hair Transplant

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