Dr Blake Bloxham

No problem! Sounds like you're all good. Happy growing!

Hi Jeff, You can find hairs like this a few days after the procedure. It could be from a follicle that was about to enter the telogen or "resting" phase regardless and the transplant pushed it into this sleep mode quicker, making the hair shed. Or it could have just been a hair shaft from some trimming during the procedure that stuck to the scalp. The general rule -- and I've found this to be true -- is that if you didn't bleed, you didn't lose a graft. When a graft is dislodged, you almost always experience a little trickle of blood from the specific spot where it was previously implanted. Most of the time, you can also see the graft itself. And these look more like little grains of rice than they do shedding hairs, so you would have probably noticed. If you didn't see this and you didn't see any bleeding, the hair that "shed" was probably harmless and caused by something else -- like the few scenarios I described above. Hope this helps! Congratulations on the procedure.

Is there a micron breakdown for that patient? The video claims his hair shaft diameter is "fine/medium," but his hair shafts look quite coarse and fat in the results combthrough. I'm wondering if they are considering his hair "fine/medium" with respect to the clinic's general patient population? Patients with Spanish/Latino/Hispanic heritage tend to have amazingly thick, coarse hairs. So it may be finer compared to average here, but I don't think many would consider his hair "fine" based on that combthrough.

Great footage. It really illustrates the difference between the two cases. Not only with respect to the thickness and resilience of the follicular units, but also the difference in their skin and how this can relate to deformation when scoring the grafts and difficultly of delivery. From the footage, it looks like one patient has pretty "stiff," rigid, inelastic skin, while the other has much more stretch and redundant tissue. This, in my opinion, plays a role in FUE ease as well. How was the scoring with the African American patient? I know the "J" or "C" shape of the follicular units in these patients frequently makes scoring without transection challenging.

Great explanation. Just to add a little more context -- without trying to start a "flame war" -- here is an official study done by Coalition surgeon Dr. Beehner (and presented by Coalition surgeon Dr. Wesley) published in the ISHRS journal a few months back: Clinical Investigation Comparing FUT and FUE yield I shared my thoughts in that thread previously, so I won't do it again here, but I think it's a pretty good assessment all around.

Love seeing these guys years down the road. I sometimes get asked during consultations what it looks like 5, 10, 15 years down the road, and it's great to have examples of hair transplants in "the long run."

Kalab, Instructions will vary. It is important to follow your own clinic's "to a T." However, I think most will probably be in the 10-14 day range. And this is likely when you'll feel like getting back into it as well. Some light exercising -- namely cardio -- is usually okay before then, but you do want to be careful building up sweat on the scalp. Especially post-FUE. Remember, you have thousands of little open, healing wound on top, sides, and back of your head. The last thing you want to do is build a very nice warn, sweaty environment for bacteria to thrive in, and risk any damage to the fragile follicles or infection in any of the wounds.

So here's how it works: Hair shafts are essentially sponges that soak up oil. Your scalp naturally secretes oil, and almost everything our hair comes into contact with deposits oil on the hair or on the scalp -- which is then "soaked up" by the hair shafts. When the hair shafts are enriched with oil, they look thicker, fatter, and heavier. As I'm sure you've noticed, if you go a few days without washing your hair, it definitely looks "greasy" from the oils, but it's also heavier, fatter, and harder to style because of this. If you were to look at your hair shafts under a microscope during this phase, they would look very swollen or full. When you wash your hair, you essentially wash these oils away with soap. Because the hair is no longer held down by the oil, it's lighter, easier to style or make stand up a bit, and it probably looks "puffier" all around. What conditioner does is basically replace the bad oils you washed away with good oils. This allows the hair shafts to "drink up" these oils and look full and heavier again. But because these are oils specially used for cosmetic purposes, they aren't the type that give you the "greasy" look like the natural build-up oils do. So your hair looks "puffier" without conditioner because it's likely clean and lacking the oils that make the hair shafts swollen and heavier. If you put conditioner on the scalp and leave it there for a bit, the shafts will soak up the oil, and boom!, the poofy look will subside. Kind of cool, right? And totally normal. Nothing wrong with your hair specifically.

I don't believe they would be "dead" either. Hairs, or follicles more specifically, don't really "die" in this manner. When follicles are weak or no longer function properly, they produce shorter and thinner hairs that shed easily and rapidly as they spend less time in the anagen (growth) phase and more time in the transition and telogen (resting) phase. If this was a transplanted follicle that decided to "die" at the 10 month mark, it would either slowly "die out" like a miniaturizing follicle, wherein it would produce smaller, weaker hairs that shed easily or it would have for some reason stopped functioning right as that hair was growing normally, which means that short, dark hair would easily break away or detach if you ran your fingers through it. And, frankly, I've never heard of that happening and it's not really how the follicles generally function.

Jack, The phenomenon you're describing with the conditioner is basically the reason conditioner was made in the first place and the mechanism behind how it works. I'll ask you this: why do you think this occurs? Why do you think the hair looks "puffy" before you use the conditioner? The answer is actually kind of interesting. I discuss it with patients during consultations from time-to-time.

Great scoring and delivery footage! This isn't easy to get. I've set up the video camera and filmed this aspect of FUE procedures on a few occasions now, only to be disappointed with the footage when I went to create a video. Definitely a good view. And this guy clearly is not an easy FUE-er. A lot of the times, I think the examples of scoring and delivering FUE videos posted online are the "best case scenarios." These are the guys who would be classified with excellent "FOX scores" according to the criteria outlined originally by Dr. Rassman and have grafts that seem to almost float up out of the scalp after scoring. This makes the delivery process of FUE grafts look effortless, but this is definitely the exception and not the norm. Most of the time it's a much more tenuous process like you showed in the video, and that aspect of the delivery definitely puts more stress and strain on the "roots."

Hi Alundra, I know we see a lot of big transformations around the 6 month mark or so online, but remember that the 6-7 month mark is still very early in the grand scheme of things. Still seeing more transparent hair around the 7 month mark isn't really out of the ordinary. Especially if you have lighter hair to begin with. And, of course, you may be a little slow/behind on the maturation scale in general. Altogether, I wouldn't be concerned at this point. It's difficult to state whether you're at "risk" of being a slow maturer, but what you describe really isn't out of the ordinary for 7 months. Hope this helps!

Hi Mods, I'm going to go against the grain a bit here! My guess is that it is a "late blooming" follicle and it will continue to grow and mature. Especially if you have 30 of them as you described above.

London, The pain you're describing in the donor area is something called "post-FUE neuralgia." Essentially, it's neuropathic or nerve pain in the donor area secondary to FUE extraction. Here's what happens: the traditional donor area is a network of superficial nerves and blood vessels. When you cut and remove tissue from this area, damage to the blood vessels and nerves occurs. When you remove a unified piece of tissue from a controlled area (IE a strip), the amount of damage, and the effects from this, is limited. This is why some people complain of temporary numbness in localized regions of the scalp or shock loss (from vascular/blood supply damage) temporarily occurring around the donor scar. However, the complaints are usually localized because the area of damage is localized. In FUE, the opposite approach is taken. Although each cut, piece of tissue removed, and tissue damaged is much smaller, it's spread out and occurs on a much bigger scale. This means that instead of caused localized damage to a few blood vessels or a few nerves, the damage occurs over a much larger area and dozens, hundreds, or thousands of small nerve endings are affected. In the cases of diffuse vascular damage, this can result in a big -- but temporary -- shock loss throughout the donor area and some localized areas of necrosis (skin death). In the case of diffuse nerve damage, this results in the very classic pain you're describing. Now, I share this not to scare you or to be critical of the FUE technique, but simply to let you know that this is a real thing that has been observed before. Frankly, I've never seen permanently in patients I've seen in person, but I have heard reports of it lingering online -- much like you describe here. I think seeing your GP is a great idea. You may want to relay to him that you've heard the pain you're experiencing may be neuropathic pain secondary to the thousands of small insults made to the peripheral nerves in the donor area. There are medications specifically to treat this type of pain -- as it does occur in other instances -- so this may be something your doctor brings up and discusses. I really hope this helps.

Noob, FUE into scalp scars tends to work in a certain scar type, and not so much into others. Scars that don't have as much thick, avascular (without blood suppy), tissue build-up tend to accept the FUE grafts a little better. If you have a flatter, pinker scar opposed to a more white, raised scar, you may be a candidate for FUE into the scar. Any pictures to share? I'll gladly take a look and tell you if I think it's a scar type that may be amenable to FUEs.

Vox and Dutchie, Thanks! Hope it was helpful. And glad to hear the "rock star" hair is coming back in, Vox!

Hi Mosd, That does look like a transplanted hair. If it was thinner, it may be a native follicle that is weak and doesn't spend enough time in the anagen (growth) phase to create a hair with any real length or a strong enough hair shaft that doesn't break. But because it does look like a transplant, my guess is that it's likely just behind schedule a bit. Probably a FU that is slow to wake up and start functioning normally. Did you ask your doctor what he thought?

10x, Have you had your scalp evaluated in person by a doctor? If not, this is the most important -- and first -- step. Like a few members have noted, your donor looks very questionable based on these images alone. It may not be adequate for a true hair transplant. Now, this doesn't mean you're out of options. I've personally performed FUE procedures on patients with low donor capacity because they wanted to combine it with scalp micropigmentation (SMP) all over the scalp (including the donor). Getting a little bit of hair spread throughout the top gives a more 3-D effect when combined with the SMP, and they were happy in the end. But it's important to realize that this was not a "dense pack" procedure at all; nor did we really try to define any area. But it may be an option if it's something you're interested in. But see a hair transplant doctor in person for an evaluation. Very important! Good luck.

XT, Having performed many HTs now and consulted with many post-HT patients, I agree with the consensus here that there can be temporary aberrations, but I have not really seen anything "permanent." And by this, I mean anything still occurring when I see my patients at 12 months for follow-up, or when I consult with patients who have had HTs done elsewhere at sometime in the past. I do see a temporary "numbness" or "tingling" or "strange feelings to touch" in FUT patients. And I see diffuse, annoying "sharp" or "pinching" pains in FUE patients (and I have seen these last for a while), but both temporary.

HairOptions, Here's a thread discussing the differences between manual FUE and other types of FUE -- motorized, robotic, etc. http://www.hairrestorationnetwork.com/eve/182966-*video*-fue-clinics-avoid-dr-feller-dr-bloxham-great-neck-ny.html May be helpful!

J, Like others have stated, it will not affect the growth -- at face value, at least. But each clinic has their own rules as to when you can start using it after a transplant. Make sure you avoid it until they give you the "ok." From that point on, it shouldn't have any effect.

Louis, Concealers, like Toppik, can be great for many patients. I've seen a lot of individuals use them impressively. However, there are a few spots in the scalp where I personally don't think they work well and there is definitely a "tipping point" where you can see too much is being used. I think they work best in the further regions of the frontal scalp (a bit behind the hairline), the midscalp, and the upper portions of the vertex (crown). In the hairline, it can look artificial in some instances. I get this complaint from patients seeking hair transplantation for the frontal regions. This part of the scalp is very visible and it's tough to pull it off well here. The lower part of the vertex falls into the same category for the same reasons. As filler in the middle parts of the scalp? Can be great. However, there is a "tipping point" with concealers where too much is being used and it looks artificial. This is another common complaint I see in consults who relied upon concealers while their hair gradually thinned, and it eventually reached this point. The concealers have a bit of a "dull" appearance by nature. And when too much is used, it can create a flat, dull, almost dusty sort of look, and it may draw attention. And there are tricks to using it -- applicators, mixing shaker topicals with cream concealers, using the spray to give it a little shine and hold it all together. And these play a role on how well it stays on in certain instances like wind and rain. Hope this helps!

Mub, Are you using the liquid or the foam version? The liquid version, while some argue is more effective with respect to absorption, contains more alcohol and has a more drying and irritating effect on the scalp. This is sometimes interpreted as "itching." Switching to the foam, which has less alcohol, may be less irritating to the scalp. And I do believe Kirkland makes a foam version. If you are using the foam, it may be worthwhile to search for a brand that has less alcohol. There are some other ingredients that you may be sensitive to (and other brands may contain less of this), but I've found it's usually the alcohol that causes these issues. And do remember, that some people's scalps are very sensitive to minoxidil (the active ingredient) in general. So you may want to try a few different things and see if you can fix the problem by eliminating certain ingredients. If this doesn't help, you may be sensitive to minoxidil in general and it might not be the best solution for you. And if you can, discuss this with a doctor in person. A hair loss doctor would be ideal, but a generalist familiar with your medical history can evaluate and offer their recommendation as well. Good luck!

Hi AZ, Bunsen's response above really hits on a lot of what I was going to say. Nicely stated! And I think I answered a little bit of your question in the recent result thread we put up. But let me see if I can answer a bit further here: Yes, inflammation that some believe is related to the end stages of androgenic alopecia (male pattern hair loss) and the type of inflammation that causes some of the redness and swelling after a transplant are different for all intents and purposes here. I don't really think a little bit of swelling after the surgery is going to change the overall level of ongoing inflammation in your body or your scalp. So if you are concerned about ongoing inflammation causing hair loss, a transplant will not contribute to this and make it worse. Inflammation and how it relates to hair loss is a very interesting topic. I see more posts about this recently. Maybe I'll write something up about the theory and my thoughts. Hope this answered your question in the meantime!

AZ, Regarding the "redness and inflammation" post surgery ... No, I have never seen any correlation between this and the results. There are a number of reasons why this appearance occurs, how it may evolve, and how long it will last. As far as I'm concerned, however, it really won't play a significant role in the overall results. Some guys stay red for a long time or swell after surgery, and they seem to do as well as the guys who experience no swelling and have almost zero redness 2-3 days later. Now, following the post-operative instructions and how this can relate to the redness/swelling and the overall results is an entirely different topic. But the actual reaction of the redness and swelling doesn't have a bearing on the final result -- in my humble opinion.