Steven Gabel, MD, FACS

Absolutely - but it is good to try to think of new ways of doing things to see if our techniques can be improved. Good discussion!!

The day after surgery, patients will have some residual blood and dried serous fluid that has accumulated on their scalp. I have my patients return the following day after surgery to have their scalp cleaned of these. It is well documented in the facial plastic literature that keeping wounds clean helps prevent infection and generally patients heal better. I have them do this for several days until all the dried serous fluid has been washed away and they are not accumulating more on their scalp. There is no magic formula for the number of days as it varies from one patient to the next - as I have stated, I instruct my patients to "keep it clean and don't touch" and they grow out great. I saw a patient back yesterday for his sutures to be removed and he followed the regimen as best he could and his scalp looked great, very little redness, and almost 100% of the crusts had been washed away. I have never suggested acetic adic (vinegar) to be added to the saline/water spray as I have not had experience with that for hair restoration. Yes, for facial chemical peels, we had all patients on day 1 through day 7 (or if needed) wash their face with vinegar/water solution as it has antimicrobial properties. Also, it is a common agent to use for patients who have outer ear infections to put them on Domboro, which is basically vinegar and water. Putting it on a freshly transplanted area - I'm not sure how the grafts would react and the saline rinses have been doing a great job.

I agree with Dr. Lindsey I did a transplant on a patient yesterday whom I was able to obtain 2500 grafts on a second session. His scalp was so tight on his first case that I was only able get 2150 grafts. I had recommended the scalp stretching exercises, but he did not do it for the first case. He had not the greatest density in the donor area is the reason for the low number; on the second session, he was very diligent about exercising his scalp and we got out 2500 grafts.

Glenn If you have made the decision to have FUE, Dr. Feller has consistently provided example after example of his FUE work; not only his immediate postoperative results, but most importantly, the long term grown out patients. Also, I agree that the punches that he developed are far superior to other "standard" punches. He put a considerable amount of time into the mechanical and engineering development of an instrument that extracts the follicles with the least amount of trauma then several other punches I have used. In fact, I have several FUE cases coming up and those are the only punches I use at this point. So the bottom line is: do your research: if you decide on Dr. Feller, your in great hands.

There are so many lotions and potions popping up at alarming rates to prey on peoples emotions. I've states this before: I want to see the data specifically on this product if it does enhance hair growth. There are multiple studies documented on the web site discussing the ingredients and their mechanism of actions: several are from the 1950s - 1960s and a few in 2002; however, looking scientifically at this, I did not see anything comparing this specific product with blinded studies to show any improvement or not. Until I see that, I'm skeptical. Thats the long answer. The short answer: if your looking for a topical, go with the one that has been tested and proven effective: topical minoxidil. In terms of Propecia, according to the product rep from Merck (the maker of Propecia), it is OK to continue on the medication while trying to conceive.

Do you have a link so we can look more closely at the ingredients of the product?

Geomarq May I ask how old you are? You will be disappointed with 1200-1500 grafts. If you want to cover the area well, at least 2500 or more.

Dr. Alexander - I agree with you that by using small slits that are custom made to fit the patient's graft size is optimal for several reasons including faster healing, less bleeding, and less trauma to the tissues. I also have my patients shower the following day after surgery - they do not let the shower directly hit the transplanted areas, but we have them rinse the area several times with water mixed with baby shampoo to clean the area off. We then have them come to the clinic on their first postoperative day to do a check of the transplanted area and donor site. Also, it is not about sterile saline, it is purely the action of the water cleaning debris from the scalp so the transplanted area is free of blood and blood products that can build up after surgery. This is most common on the first night, and quickly subsides after the first postoperative day. It is well documented in the plastic surgery literature and, as you are aware of, the general surgery literature, that clean wounds lead to decreased infection rates; in fact, this is why hospitals employ nurses that sole responsibility is wound care and teaching. During my head and neck surgical residency and plastic surgery fellowship operating on hundreds of patients, we would spend a considerable amount of time on wound care and wound care instruction. It was clearly documented that patients who followed the directions and kept their incision sites clean had much better outcomes then those who neglected their surgical site. And I agree with you: there is no one perfect solution; there are many ways to skin a cat and it is important to follow your physician's directions in the postoperative to achieve the best results.

My regimen is that I have them spray several times a day to keep any blood or residual serous fluid off of the scalp. Once the area stays clear of debris, then I have them cut it down to once or twice a day if needed. To prevent drying out of the scalp, I have read that people use many different substances from Vit E solutions, mineral oil, Aloe, etc. I have patients, on day 4, put either Vit E or mineral oil on their scalp to prevent the grafts from crusting up. With this regimen, when patients return for the sutures to be removed, their scalp looks great and a majority of the crusting has already resolved. Ringo: cost to the patient for the spray bottle: $0. I have to use the spray bottle during the case which is given to the patient at the end of the case. I agree that the use of Graftcyte is an unnecessary expense since that solution is around $75 - 100 ( don't have the exact figure as I don't recommend it as my patients have done well with excellent growth without it).

A don't fee there is any problem wearing a bandana. A bandana actually provides some "breathing room" for the grafts so you are not getting the grafts sweaty which may lead to a localized superficial folliculitis. I tell my patients: keep it clean and don't touch the recipient site and the grafts will grow just fine.

I feel it is extremely important for patients to keep their scalp clean after surgery. I provide patients with a spray bottle from the surgical procedure for two reasons: I want them to spray their scalp with the spray bottle to remove any blood or blood products that may have accumulated during the healing process as well as to keep the scalp clean. When blood and blood products accumulate on the grafts, a significant amount of crusting can occur which I do not think is healthy for the newly planted grafts. Once the blood products have stopped accumulating, I have them spray 1 to 2 times a day to keep the area clean. The second reason I provide the patients with the spray bottle is for sterility purposes: during the case, we use the spray bottles to clean the surface of the scalp clear of blood. The spray bottles are exposed to blood products. Any instrument or supply that comes into contact with the patient is either new or been autoclaved. If we can't put the bottles in the autoclave, which insures that our instruments are sterile (the bottles melt ??“we tried this), then we have to throw the bottle out anyway. Therefore, I give my patients the spray bottle that we used for the procedure and we use new spray bottles for each patient. This insures that there is no cross-contamination between patients.

Hairdoyle I ask my patients, if they are going to color their hair, to do it 1 - 2 weeks prior so all of the chemicals that may do any damage are long gone from the scalp.

lokingforsolution There is no magical answer to when patients can start dying their hair. The reason for this is that each patient heals at a different rate. I have some patients who come back 10 days after their surgery and their incision and recipient sites look like they have healed; I have others that need a little more time to heal. The instructions I give patients are to wait until the transplanted hairs have gone through their initial shock period ??“ usually four to six weeks. By that time, I know that the grafts are firmly in place and exchanging their blood supply. The problem with hair coloring and the dying process is that different hair stylists will use several chemical compounds to dye the hair and I don't want any risk of injury to the hair follicles with outside chemicals. My advice is always: be patient!! The same is true for wearing helmets. In the Northwest, this is skiing and snowboarding time (and this season we've had incredible snow at Mt Hood, Mt Bachelor, and Mt Rainier) and several of my patients are anxious to get back on the slopes with their helmets. Again, I ask them to be patient and wait 4 ??“ 6 weeks, at the earliest, so their hairs are firmly in place. I also tell them to ski/snowboard as much as possible before the transplant so they don't feel they are missing the entire ski season waiting for their hair transplant to heal. I hope this provides a little better insight into your question.

Cody Are you asking if the transplanted hair falls out immediately after surgery, or months later when the hair "re-enters" the normal hair cycle.

That is a great question of whether hair transplanted from one part of the scalp or body takes on the characteristics of the newly transplanted area. This is a fascinating subject, and in fact, at the last ISHRS meeting that I attended, there was some discussion about this topic. I do not remember the specifics, but some physicians did comments that they were seeing changes in the hair to reflect its new location. Now you may ask, well how can that be if the DNA is programmed already ??“ the answer is 'I don't know' but the body has ways of adapting. I have done many eyebrow and eyelash transplants and the scalp hairs that I transplant into those areas do seem to take on the characteristics of eyebrow and eyelashes after sometime. Again, I think this is a great question and hopefully more people will comment if they have seen this phenomenon.

It was definately a sad situation because he did not receive the results he was looking for in the previous transplants he received.

I had a patient who had 11 prior procedures (I did not do any of them) and wanted another session. Unfortunately, with the amount of scar tissue he had at both the donor site and the recipient sites, I advised him against any further work. Very nice gentleman in a difficult situation.

As with any medication, one must weigh the pros and cons of taking the medication. What is important is that the person taking the medication is well informed of the possible side effects they may encounter. I always discuss the potential sexual side effects with patients that I am going to put on finasteride. It must be noted that if one stops the medication, the side effects are usually transient. I have had a patient who thought the side effects lasted for a while after stopping the medication.

Sunny I'm glad you saw a dermatologist who evaluated your lab results. You asked in a previous thread if i obtain hormone levels on patients. It is very rare for me to ask for hormone levels for male patients - most of the time, when a male patients comes to see me, they would already have a diagnosis of some type of hormonal imbalance and they are aware of it - so no. For female hair loss, the incidence of hormonal imbalance is higher and i will draw labs on women if i feel it is indicated. If the labs then come back abnormal, i refer to an endocrinologist or their primary care physician to determine the next step.

This was advertised in a newspaper which I received in the mail today. This company is claiming results like this in 28 weeks. Unfortunately, people see this ad and think that the impossible is possible. Just more deceptive advertising.

This was advertised in a newspaper which I received in the mail today. This company is claiming results like this in 28 weeks. Unfortunately, people see this ad and think that the impossible is possible. Just more deceptive advertising.

Iron deficiency is a real cause of hair loss. I have seen several cases of iron deficiency as a causative factor for alopecia in women. When I see women for hair loss, one of the things I investigate, along with other blood tests, is their iron levels. For men, a blood work up is rare, however, if their history and examination are not consistent with androgenetic alopecia, then I will investigate further. A while back, I went to a lecture about hair loss by an expert dermatologist who specializes in alopecia (she was one of the original physicians in the phase trials for Propecia before it went to market) and she reports that even low iron levels contributes to hair loss. Women do have a higher degree of iron loss because of their monthly cycles, but I think you may want to have your physician work this up.

Weg I don't know why, but more people hit their head after transplants. During the day of the procedure when the patient takes a break, I always remind them not to hit their head. Sure enough, a few times a month, patients report that they hit their head. Most of the the time, they report hitting their head when getting in and out of the car. 16 days out from the transplant should be fine. By that time, the grafts have "seeded" and it is more difficult to dislodge the them.

Your welcome.

The bottom line is that you stopped using the tobacco products which is fantastic. I'm glad to hear that you did not use the products on the day of surgery or afterwards. I have had patients who, during lunch, went out for a smoke and I just shake my head. Anyway, I look forward to seeing your results. Keep us posted.