PSA: Use of Concealers And Possible Complications

[Jotronic]

On our recent trip to Rome Dr. Hasson met with a patient that had a procedure in Europe. As many patients do he used concealer on a regular basis to add fullness to his result.

 

The patient arrived in search of repair solutions and stated, as well as showed, that the growth rate was quite poor. While looking through his scalp we noticed many dark spots that resembled "blackheads". These areas turned out to be concentrations of concealer that had clogged the pores of the scalp and resulted in a persistent low-grade infection. This ocurred even though the patient stated that he washed his hair daily. It is believed that this stunted the growth of the grafts thus resulting in a poor result. This is not the first time we've seen this issue and while the evidence is still anectdotal it further reinforeces our view that concealer should not be used after a procedure. Note that when I mention "concealer" I am referring to make up style applications, not sprinkle applications such as Toppik.

 

The video below shows some of these dark areas of congested concealer being forced out of the skin. I recommend that if you have a good connection you should expand the video to full screen in at least 720p to see all the detail. Please forgive the focusing issues, I was getting used to my new camera.

 

http://www.youtube.com/watch?v=GGZBAci4hfU&hd=1

Edited February 27, 2011 by Jotronic

[hairthere]

Joe, It's saying the video is private...

[Jotronic]

Sorry, try it now.

[hairthere]

Nope, same issue...

[Jotronic]

Duh, I should "save" my changes, lol! Try it now.

[hairthere]

Joe, Did he have concealers on recently (before Dr. H examined him)? Also, those grafts look like they might be big... were they fus or minis and micros? Thanks!

[Atomic]

Joe,

How long after his HT did he begin using concealers?

Have you determined how long after a HT it is safe to use concealers like dermatch?

Thanks

[Tonycc]

I've never heard of that before. That's useful info to know for people about to go through with a HT

[Davis]

I agree, how long after the HT did he start to use them? I had waited a good month before using concealers...

[aaron1234]

This is probably why Dr. Paul told me to hold off on dermmatch until month 6. But now I use it everyday. This is certainly something that should be looked into more deeply.

[wb280]

Jo, u purposely mentioned that its the make up applications, not the sprinkle ones, like toppik or nanogen. I just need reaffirmation on this!

 

Can i safely say that u have not come across any cases where there was persistent low grade infection from sprinkle concealers like toppik and nanogen?

 

thanks!

[Jotronic]

I honestly do not know how long it was after his surgery that he was using the concealer but I *think* it was a few months post-op.

 

wb80,

 

This is makeup application like Dermatch. I don't think the sprinkle concealers are as much of an issue but with too much and irregular scalp washing this could probably still happen. In fact, I remember a patient that came to see us several years back that was a big Toppik user and he had the same issue. However, he literally caked it on, unnaturally so, and left it on for a week at a time. I am sure that you won't have this problem.

 

Hairthere,

 

This patient did still have some in his scalp and I believe he washed it out the day before.

[hairthere]

Perhaps he was not vigorous enough in washing his scalp? I must admit, this makes me a bit nervous as I depend on Dermatch, and was hoping to use it while awaiting growth from this last surgery....

[Mick from Farjo]

Joe,

 

This is an excellent post.We have seen this also where excessive use of products can affect growth and development of hair.I know of a patient who we told not to use concealers and his persistence in using excessive amounts is affecting growth.We are not talking about light use here but quite literally as you stated "caking it on".Our patient says he only started re using at 4 months but we have no way of knowing if this was the case.Also we warned of excessive use, which is something out of our control.

The scalp needs to be looked after at all times and the better this is, the greater the chance of an excellent outcome.

 

Mick

[Cam Simmons MD ABHRS]

Joe

 

Thanks for this post. It raises an important question about using concealers post-op. With respect, I would like to discuss your conclusions.

 

It may be hard to say with certainty that he had a low-grade infection. In the video, his scalp does not look particularly red and there are not a lot of pimples or pustules. Mostly what appeared on the end of the comb was a clump of pigment. The white spots on the end of the comb looked more like skin than pus. Plugged pores or comedones are not necessarily infected. With Dr. Hassan seeing the patient outside the office, he likely could not do swabs or a biopsy to confirm his suspicion that there was a low grade infection. Dr. Hassan, of course, can get a much better clinical impression in real life than we can from a video.

 

It is also hard to say with certainty that the concealer caused the poor growth. The clumps demonstrated were mostly at the bases of growing hairs. In fact they looked biggest where there were the biggest grafts. It may be that the pitting around the graft and the hairs in the graft caused it to be more difficult to clean the concealer with regular washing but that the concealer did not harm the transplanted hairs. It would be more concerning if the clumps of concealer were found in pits where grafts were transplanted but didn't grow. The patient noticed poorer than expected growth and the concealer may have played a role. However, there are many other factors that could have influenced the growth and the concealer might not have been a factor.

 

You have raised an important question because many patients rely on fibers or concealers to give them some camouflage while they are waiting for their hair to grow. I have not noticed ill effects on the end results but you don't look as hard for a relationship when you don't suspect it. I ask patients not to start using concealers or fibers until the scabs are all gone and they can wash their transplanted hair normally. I usually recommend fibers over concealers. This is just my recommendation and is not based on science. I will certainly look closer at the results of patients who choose to use concealers. It will also be worthwhile to see if there are already studies on the effects of concealers and fibers on hair growth.

 

If it hasn't been done already it could be useful to do a study where concealer is applied regularly to a small test area and not applied to a similar control area and to see if the growth is different. It is not easy to recruit patients for studies and it is time-consuming and expensive to do them. There is always a problem getting a large enough sample to make definitive conclusions.

 

I would be eager to hear about the experiences of forum members who have had hair transplants and used concealers post-operatively.

 

Thanks again for raising this question and posting the video. It is certainly worth considering.

[hairthere]

Dermatch's web site says the product does not block follicles and can be used safely post ht as long as there are no scabs present. I would like to know if they came to these conclusions via clinical studies.

[Cam Simmons MD ABHRS]

I have not found any clinical studies so far but have contacted the manufacturers to see if they have published studies.

 

Studies are not required for makeup, shampoos, conditioners, or stying agents the way they would be for medical treatment. Many recommendations for post-op care are based on experience and not on scientific evidence.