Possible to hide the donor scar 2 weeks after surgery?

[andy79]

Hi guys - I'm seriously considering an FUT in the new year with one of the top docs who don't require shaving the donor area. I was considering an FUE, but after a recent post, and your responses, I'm rethinking this.

 

My situation: The front third of my hair is thinning, as is my crown a little bit. I'm no expert, but I'm guessing 1500 - 2000 graft FUT would do the trick to add some thickness. I'm not trying to rebuild my hairline, just make what I have thicker. From what I've seen on this site, probably closer to 1700 ultra fine dense packed grafts would hold me over for a while.

 

Since I have to face clients weekly and can't go through an awkard phase (beyond the 14 - 18 day mark), concealing a potential HT is paramount.

 

I'm truly scared about the donor area. I comb my hair forward so, along with thickening agents, I'm pretty confident I can hide the scabs in the receptor area. So, if my donor area is 1 inch in length, will that be enough to hide the donor scar after 14 days? If it needs to be 2 - 3 inches, that will be tough for me. I don't like my hair that way so an honest answer would be greatly appreciated from those who have gone through this.

 

Does anyone have any good photos/links (to your HT or to others) that shows the concealing of the donor area 2 weeks post surgery? I can't seem to find any good ones. Am I dreaming here to think that I can hide an HT convincingly after only 2 weeks?

 

Thank you for your time guys,

 

Andy

[Jotronic]

I'm confused about your concerns. You are more concerned about the donor area post-op than the recipient area?

 

The donor area will not be less visible post -op if it is not shaved before strip removal. The strip removal takes out only the areas that have been shaved so once the donor area is closed the areas above and below the incision line are brought together. The only difference is that if the donor strip is not shaved you may experience permanent shock due to transection of the hairs near the incision line.

 

Also, has anyone explained the ugly duckling phase that patients go through? This is the phase where your hair looks worse for a couple of months before it looks better. This is due to not only the transplanted hair shocking out but also the native hair shocking out temporarily.

[andy79]

From reading various posts it seemed that there are doctors who are willing to not shave the donor/recipient areas.

 

So I was thinking, perhaps foolishly, that if I grew my hair long enough, I could hide a good amount of the HT work. I have come across the "ugly duckling" phase many times on this site. I was wondering if it's at all possible to skirt that...or at least lesson it...if you have a decent amount of coverage/length.

 

I'm also familiar with shock loss from both the transplanted and native hairs...again, thinking if your hair is long enough, perhaps you could hide a good amount of this.

 

Does that make sense? Or am I dreaming here...

[Jotronic]

Well, the debate about shaving the recipient area has waged for years. Our clinic was the first to push this issue about fifteen years ago. For years other clinics said it wasn't necessary. Now many of those clinics say shaving is better as well so there must something to it. If you don't shave then you have a higher chance of experiencing permanent shock loss. Shaving the recipient or not, temporary shock is unpredictable and nothing can be done to lessen the chance of it. The surrounding hair can be grown longer to help hide the work but what happens if that hair is shocked?

 

Regarding the shaving of the donor, I can't imagine what the benefit would be if the donor was not shaved. Like I said earlier, any area of the donor that is shaved is removed with the strip tissue anyway.

[andy79]

I see. Ok, the donor area would be shaved, yes. But I'm talking about the surrounding area that could be shocked. So I was asking if the rest of my head isn't shaved, could I hide the HT sufficiently enough to go back to a job where I have to face clients.

 

Thank you again for your time

[multiplier]

If you don't shave then you have a higher chance of experiencing permanent shock loss.

 

That is a very strong statement - where has that been documented as true?

[multiplier]

I wouldn't ordinarily bump a thread, but I would like to get jotronic's feedback on this.

 

I have never heard anyone claim outright that shaving prevents shock loss. If it does, that is a major factor to consider, as there are surgeons like True/Dorin and Shapiro who actually don't require shaving. So according to Jotronic, that would mean their patients experience permanent shock loss more often than others'. Is this verifiable?

[Jotronic]

Multiplier,

 

See, now you're pushing for a can of worms to be opened:) In all sincerity, you can use the search function to come up with several years of debates on this. It is not new.

 

Yes, shaving the recipient area will decrease and/or eliminate the chances of any amount (small or large) of permanent shock loss. Think about it. If someone with diffuse loss has a hair transplant and the recipient isn't shaved, how easy do you think it is to manipulate, tug, push, pull the hair 4000 times to find spaces for incisions? Now, how easy do you think it is to make 4000 incisions in between each hair when long? Now take those same 4000 incisions and try combing, pulling, pushing the hair another few thousand times, again, to place a graft. See where I'm going with this? The trauma of transection mixed in with the trauma of so much manipulation during surgery just does not add up for the most positive of environments. How can incisions be made that don't transect the native hairs if the existing angles and directions are being manipulated just for the purpose of finding a spot to make an incision?

 

Now imagine a recipient scalp shaved down to 2mm in length. All of the native hair stubble is sticking up at specific and true angles and directions with the open spaces clear as day. Wearing magnification makes the spaces even larger. Each incision can be made with a wide birth given to the surrounding hairs so that they are not damaged. The difference is night and day and if you were to see each approach in person you would see how this just makes more sense.

 

This is not to say that massive amounts of failure due to not shaving is normal because it is not normal with a good clinic but you will also see good clinics that don't shave shy away from more diffuse cases where those that do shave are more likely to jump in head first. It is a matter of recipient site preparation.

 

What you will hear from some clinics is that shaving allows for larger sessions to be completed faster. This is very true, but the original reason for shaving is to allow for less or no transection of native hair, allow for recipient sites to be made parallel to the native hair as well as matching the angle. Dr. Wong and Dr. Hasson have been talking about this for years and it is one of the underlying tenets of the lateral slit technique.

[wb280]

I have to say i am with Jo on this. Although i agree that non shaving does not imply a bad result, but like Jo said, tugging the native hairs a couple thousand times does not sound like something i want to happen to me. Everyone does not want shaving, everyone does not want scar, but everyone wants a full head of hair, so what gives? For me, i understand the rationale of the doc and i am not taking any risk by disagreeing with the man who is holding the knife

 

Back to you Andy, yes some surgeons do not require shaving and i must stress, that does not mean 100% u will get more shock loss but logically, you are at a higher risk. Jo has explained it all. I have to reiterate that its not a definite 100% u will get higher shock loss

 

Also, i think u might be in for a surprise. Even though u r not shaving, i do not think u can cover your recipient area with concealers just 2 weeks after surgery. Scabbing is one thing, it takes time for the recipient to heal meaning it will not look like pre-op until maybe... at least 1 month... so if u assume that u can rest for 2 weeks and expect to look the same pre-op, i think u will be in for a rude awakening. just my two cents

[tarepanda]

concealing the donor and recipent area is 1 of my concern for HT... but now i felt that it is definitely not worth compromising the results of the HT just for the few mths of ugly ducklings.

 

wb280 has mentioned to me before... althought there is no documented proof that shaving/not shaving will/ will not compromise on the results, but i will not take the chance if its something that is within our control.

 

who will bother whether we had done any HT (other than ourselves) if our final results are good. non-balding ppl will forget abt ur HT after ur hair grows out. Balding ppl will ask for ur advice when they see u.

 

but to answer ur question... yes, u will be able to hide ur donor scar with 1 inch long of hair after 2 wks of surgery. Infant, u will be able to hide it immediately post ops.

Edited December 28, 2010 by tarepanda

[multiplier]

I appreciate your feedback, Jo. On paper your argument makes sense. I'm wondering if there are people who have done surgeries both shaved and unshaved and have noticed distinct differences in their level of shock loss. I have looked through the archives and seen the arguments, but your statement above seemed the most assured, which is why I wanted to hear some elaboration.

 

I'd also like to hear from reps from places like SMG and True/Dorin regarding Jo's feedback. Thanks!

[wb280]

panda, glad u understand where i m coming from. I mean, if the doc tells u he needs to shave, i think we should do what we can, within our means, to comply I am glad i did this and its like Benjamin Button all over for me, hair wise I wake up everyday feeling better and better

 

However, i dun agree that its easy to hide with concealers just 2 weeks after surgery. It still looks very raw and assuming there is no shock loss, it will simply not look the same as pre op. Maybe its just my experience but i defn did not look the same 2 weeks after surgery. Oh, and the shock loss thingy. Once it kicks in, god bless us mate

[multiplier]

Just FYI: I have contacted reps from both SMG and True/Dorin asking them to weigh in on what Jo said above regarding shaving and shock loss.

 

I don't do this to be a pest; I do it because I had diffuse thinning in 2000 when I got my first surgery and the procedure definitely caused permanent shock loss all over. This is precisely why I've been timid for a decade deciding whether to get a second procedure.

 

If there's reason to believe shaving will prevent significant loss, then this is a major factor for all of us in choosing a surgeon, no?

[Jotronic]

Multiplier,

 

I don't think you're being a pest. You're simply looking for answers and some modicum of reassurance about your potential decision to have another procedure. For this I could never blame you and applaud your diligence.

 

I bet the subject of shock never came up during your first surgery. Most clinics don't talk about it. I can't comment about your natural loss progressing and whether or not that was possible but the procedure could have had something to do with it for sure. This is one reason why we shave and while it allows us to go more safely in between existing hairs of higher native densities there is a limit to just how much hair we can go into without causing damage even if shaved. It is at that point that we simply tell the patient that they have too much hair to consider hair restoration at all and it is usually those guys that don't have much visible loss to begin with.

[aaron1234]

As for shaving the recipient area, I know SMG (or Dr. Paul Shapiro more specifically) didn't require me to shave but strongly encouraged me to do so. Of course, I wanted to make the procedure easier for them so I could achieve the best results possible.

 

As for covering the donor region post-op; You could keep the hair long and let it grow long in the back to cover the scar. Or you could shave down overall like I did and use dermmatch to cover the donor scar. This worked well for me for the first 2 months or so.

 

But definitely shave for the procedure. I had my first procedure with another doc and didn't shave the recipient region and it turned out like crap. Of course, it was a crappy doctor and probably would have turned out bad either way.

Edited December 30, 2010 by aaron1234

[wb280]

I agree. Shaving provides the techs and doctors a much clearer scalp to work on. I just cannot understand how come some just refuse to shave but insist on results? I mean, if the doc can promise then so be it and not shave. However, if he requires or strongly recommends shaving, it does not make sense to go against him. Its like, why not u ask him to wave a wand and not put incisions instead?????? maybe hair will just grow out enough said

[multiplier]

I bet the subject of shock never came up during your first surgery. Most clinics don't talk about it.

 

The rep's words were: "Oh, you could experience a bit of loss, but it's just hair you're going to lose anyway".

 

Yeah, but why would I want to lose them now at age 25 instead of 5-10 years from now? That should have been my response. But indeed, many hairs never returned. Which is why I'm so gun-shy for a second surgery.

 

However, if he requires or strongly recommends shaving, it does not make sense to go against him.

 

Sure, but the point is that I'm speaking with a doctor who is indifferent to the shaving. And that is what I'm trying to get enlightened on. Should I worry about this or just trust the doc?

[multiplier]

By the way, I have messaged both reps from True/Dorin and SMG asking them to please add their feedback to this thread. I hope they do.

[wb280]

Multiplier, if the doc is recommended by this forum and they show case examples of good results ( consistently ) then i reckon there is nothing to worry about though, correct me if i m wrong, most docs would prefer shaving. I reckon there must be some truth behind it, i mean, why would he want u to look like a freak for the 1st couple months for no good reason?

 

In fact, if u ask me, i will select a doc who requires shaving but thats just me

[Thehairupthere]

Some doctors require shaving, others do not. Those surgeons who do not require shaving simply give their patients the option of shaving or not because not all patients are willing to go through such a serious change in their appearance, but as it has been shown numerous times on this site that the results are of high quality even if the recipient area is not shaved. Shock loss can still occur even in shaved cases, for instance if a patient has transplants placed into thinning areas with miniaturized hair, those hairs are susceptible to shock due to the trauma that occurs to the scalp. This may be less noticeable in shaved cases as the hairs are very short and harder to notice if some are gone, but nonetheless it still occurs. Trying to avoid the ugly duckling stage or slightly thinner looking stage by shaving your head seems counterintuitive as you will be shaving your head, which is much more of a shock to your look then having a thinner appearance, along with having a large scar that won't be able to be hidden since you won't have any hair to hide it with (and that scar takes months to completely heal) but that is your choice. Many extremely skilled surgeons do this surgery without shaving because it is not necessary, but again if the patient is up for it, than there is no problem. If some surgeons feel more comfortable shaving that is their choice, but it is incorrect to state that the only way to go is to shave it all off, because it's unnecessary.

 

"If you ask me, I will select a doctor who requires shaving". Again all doctors would be willing to shave your head, it's just unnecessary, it is true that the doctor can see easier with a shaved head, but a skilled surgeon does not require that luxury and will still provide you with a spectacular result. You should base your decisions on the skill level and expertise of your surgeon, not on shaving or not shaving.

[wb280]

Maybe i wrote too fast but obviously u miscontrued my meaning. Nobody will choose a doctor specifically for the reason that he shaves, thats just mental. I would choose a good barber for that

 

What i am trying to say, is that if the surgeon u feel comfortable with, requires shaving, it makes no sense for the patient to insist otherwise. However, as per my previous posts, i have reiterated that non shaving does not equate to bad results but logically speaking, like what Jo has mentioned, tugging at the native hairs a couple thousand times just to make fine incisions are tough on the techs, day in and day out. I will not take the risk by not shaving.

[Janna]

Hi Multiplier,

 

Sorry for the late response. I've been out of the office majority of last two weeks and seen your pm today.

 

Joe is right that there are multiple threads covering this topic of shaving or not shaving but here's my 2 cents again since you asked...

 

I agree with what True and Dorin's rep posted above. It comes down to skill, experience, and comfort level of the surgeon and staff to work with long existing hairs. Long hairs do hinder the ability to see the whole field, therefore, the surgeries can take longer. At a certain point, there is now a risk for the grafts to be out of the body for a long period of time so it's imperative to complete surgery in a timely manner. This is the number 1 reason why big sessions cannot be done without shaving.

 

Until we started performing bigger sessions, we never shaved. Even now there are patients we don't shave. I don't recall shockloss being much of a concern. We require patients to shave if they're scheduling a session greater than 2500 grafts. Not every patient has the luxury to hide away under a hat for two months so if they are scheduling a relatively small session, we can work around the long existing hairs like we have done so many times in the past.

 

Does shaving decrease or eliminate shockloss? I've seen patients post their concerns online on various forums who went through shock loss even though they were shaved so I know it doesn't eliminate it. As T&D rep says, there are many skilled clinics who don't require shaving unless it's a mega session.

 

 

To address Andy's (this thread starter) concern -

Based on your session size, it's possible for donor and recipient area not to be shaved so that the work looks undetectible at two weeks post op.

[multiplier]

Thanks much, Janna. That makes sense.