Hair Restoration Blog

Q:

Hi Dr Mohebi,

I had some questions, more of a concerns that I’m hoping you could clear up for me. Forgive me if I may sound like I worry too much or jumping the gun.  For the last several days, I’ve notice pain in the crown area and directly above my forehead in the hair line.  Upon inspection, I’ve notices red raised bumps sporatically  over those previously mention areas.  Some have even burst and bleed while I’m  shampooing.  They appear to me to be folliculitis, and I was wondering if I need to be on antibiotics? Will this hinder hair growth in a timely manner?  Again, I apologize for worrying too much.  Thank you for your time and patience.

Sincerely,

A:

What you are describing here is probably folliculitis.  Folliculitis is normal and may be seen a few days or even months after a hair transplant surgery.  The folliculitis skin lesions look very much like pimples and they usually dissolve within a few days from their occurrence.  Folliculitis does not affect the growth of transplanted hair grafts and it does not need antibiotics unless the lesions do not get better spontaneously or in presence of cellulitis or skin redness and swelling because of infection (this is extremely rare in scalp).  In most cases folliculitis does not need any special treatment.  The lesions usually get open by themselves without any instrumentation.  If they persist more than a week or two or if they bother you due to their numbers or location, you need to see a hair transplant doctor so they can be opened and drained.

I just found this article on transplantation of artificial hair.  Artificial or synthetic hair for the treatment of male pattern baldness or androgenetic alopecia has been tried in many countries, but has been unsuccessful at getting FDA approval in America for a variety of problems that it had.  The result of the study published in Journal of Cosmetic Dermatology is very limited in terms of the number of participants and transplanted hair but it is worthy of mentioning in our hair restoration blog.

The article discusses the problems of the artificial hair implantation such as poor quality fiber, untrained operators, and inadequate techniques.  However, the paper aims to establish safety and efficacy of a new artificial copolyamide fiber implantation in male patterned baldness or androgenetic alopecia.

In the study, ten healthy adults with androgenetic alopecia who had failed prior conventional therapies such as medical or surgical hair restoration were implanted with copolyamide fiber and were followed for a minimum of 3 years. Implantation consisted of 100 test fibers followed by subsequent sessions of up to 500 fibers every 4-6 weeks to achieve a density of 20-40 fibers per cm(2).

The techniques of implantation and follow-ups maintained a strict adherence to schedule.  In this study 10,000 fibers were implanted with a mean of 1000 fibers per patient. With the exception of one patient, implantation was found to be safe, aesthetically pleasing, and psychologically rewarding to its recipients. Sebum deposition and temporary pitting at entry point of most fibers were universal. Recurrent mild folliculitis occurred in 30% of patients.

The other complications such as facial swelling, cellulitis, and severe scarring were not seen in this study. Between 15-20% of all transplanted fibers fell every year and maintenance of the procedure was shown to be necessary.  In conclusion, the choice of fiber implantation technique and mandatory follow-up were deemed to be some of the important contributory factors towards positive results.  Hair restoration with artificial hair might become more popular in the future for patients who lack good quality donor hair with extensive baldness.  However, other studies on a larger number of patients need to be done before it can really prove to be safe for practical use.

Picture taken During a Hair Transplant -- when transplantation of single hair grafts for hairline are almost completed

Hello Doctor how are you?

Thanks for giving me my pics.  I cant wait to start my blog. I attached some post op pics. Dr.Mohebi just a quick question, what is that white stuff during my post op?just curious since my brother brought it up when i showed him the pics.i was looking around the net to see other post op pictures,i wanted to find out what it was,but i didnt seem to see it on other patients.

thanks Dr.Mohebi.

A:

Hi there,

The white part of the grafts that you can see is the top part of the graft that is above the skin level.  As you know, a hair transplant does not implant hair but an entire organ.  This includes the collagen band around a follicular unit, microscopic muscle, small supporting vessels and a small portion of epithelium (superficial layer of skin) within each graft.  The white portion on the picture is the skin part or epithelium.  During hair transplant surgery, the goal is NOT to bury the grafts.  Buried grafts may folliculitis, sebaceous cysts and/or dimpling of the skin.  Here at US Hair Restoration, in order to prevent those complications, we make sure to keep the grafts slightly elevated from the skin surface.  Obviously the white part that you can see will dry up and fall off after a few days after a hair transplant surgery but this little mechanism alone can certainly prevent many problems that are seen by buried grafts.

Have a great weekend,

Best,
Parsa Mohebi, MD