**VIDEO** Working out after hair transplant? Feller and Bloxham, Great Neck, NY

[Dr Blake Bloxham]

One of the most common questions we're asked by hair transplant patients is:

 

"When can I go back to working out after hair transplant surgery?" "And, will exercising or lifting weights make my scar 'stretch'?"

 

So, when can patients go back to their regular exercise routine? Can weight lifting after an FUT ("strip" or "FUSS") really stretch the scar?

 

In the following video, we address these questions and also present the results of a patient (see his HD photos from the video below) who worked out heavily after his hair transplant:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[mav23100gunther]

Does anyone else find it awkward in the videos when one of Dr Blake or Dr Feller are talking to the camera and the other is just staring at the camera? - lol

[Melvin- Admin]

I don't know whats more amazing the fact that someone with the amount of hairloss he had would even bother getting a hair transplant, or the fact that he chose to get FUT and now has a scar for the rest of his life for a small amount of grafts.

[BadBeat]

Is that Tom Brady?

[Sethticles]

I don't know whats more amazing the fact that someone with the amount of hairloss he had would even bother getting a hair transplant, or the fact that he chose to get FUT and now has a scar for the rest of his life for a small amount of grafts.

 

 

i was thinking the same thing

[MAGNUMpi]

Very interesting Dr. Fellar and Dr. Bloxham. Thanks for debunking that old myth.

So basically collagen build-up, poor technique, and /or personal healing characteristics determine if a scar will be pencil thin or might stretch?

Does scalp laxity have any bearing on the outcome also?

How would a person determine if they scar well?

If you have had any scars stretch could you tell there might be a problem before the HT?

If this patient would have had 3600 grafts would the potential for stretching have gone up?

On a second procedure does the potential for stretching increase even in the hands of the best doctors?

Again, an interesting video. Thanks.

[Dr Blake Bloxham]

HTsoon and Seth,

 

The patient requested an FUT procedure. He did so, and I support his logic, for two reasons:

 

1) The size of the procedure.

 

The patient underwent a procedure of somewhere around 1,800 grafts. An FUE procedure of this size would have subjected the grafts to excessive damage during removal and significantly increased out of body time (which is even more damning for grafts with less supportive tissue -- IE FUE grafts). This is why most advocate "breaking up" large FUE sessions into a series of smaller sessions. This patient came from another country for the procedure and didn't want to break it up over multiple days.

 

2) Where the grafts were being placed.

 

I almost never recommend placing FUE grafts into the hairline. Why? It's the most visible region of the scalp, and I must be 100% confident of the growth and appearance of grafts in this region. FUE grafts are subject to lesser yields and have a greater tendency to grow "wiry" or "kinky," and I can't have patchy or unnatural growth in the front of the scalp.

[Dr Blake Bloxham]

Magnium,

 

Yes, it's really up to your body and how it was closed. Think about the way they do scalp tissue repairs on burn or accident victims. In order to get the tissue -- which is often scarred -- to stretch enough for repair, they have to implant balloon expansion devices under the skin and slowly inflate them (usually with saline fluid) over a series of month just to force the tissue to stretch!

 

There are some indications as to how people will heal. Previous scar healing, race, size of the wound, et cetera. However, I do feel like most people fall into what I call the "normal healer" category. When closed nicely, these people tend to heal as we would expect. There is always some degree of variability that is created by a patient's own natural physiology, but it usually falls right around where I'd expect.

 

If the strip taken was wider, then the potential for stretch could have been greater. In your example of 3,600 grafts, a wider strip would have likely been taken. We have pretty firm "cut offs" for width of the strip, and compensate by making it slightly longer. Long, thin incisions heal up nicely. Shorter, wider ones do not!

 

I think there is always slightly more potential for less cosmetically acceptable scarring after multiple surgeries. However, we do second strip procedure frequently, and I still think the scarring falls within the normal variation I described above.

 

Hope this helps! Glad you liked the video.

[Melvin- Admin]

HTsoon and Seth,

 

The patient requested an FUT procedure. He did so, and I support his logic, for two reasons:

 

1) The size of the procedure.

 

The patient underwent a procedure of somewhere around 1,800 grafts. An FUE procedure of this size would have subjected the grafts to excessive damage during removal and significantly increased out of body time (which is even more damning for grafts with less supportive tissue -- IE FUE grafts). This is why most advocate "breaking up" large FUE sessions into a series of smaller sessions. This patient came from another country for the procedure and didn't want to break it up over multiple days.

 

2) Where the grafts were being placed.

 

I almost never recommend placing FUE grafts into the hairline. Why? It's the most visible region of the scalp, and I must be 100% confident of the growth and appearance of grafts in this region. FUE grafts are subject to lesser yields and have a greater tendency to grow "wiry" or "kinky," and I can't have patchy or unnatural growth in the front of the scalp.

 

Really Dr. Bloxham, I understand what you say about the growth, I wouldn't want you to perform FUE on a hairline as you just started hair restoration and the learning curve is high for FUE, so that I completely understand, but the wiry and kinky portion is just flat out false, this occurs sometimes in patients regardless of FUE or FUT and it generally sorts itself out. I'm glad this patient had a successful hair transplant never the less and I'm sure you are going to get even better at hair transplanst blake.

 

Take a look at this video, a gentlemen who had FUE to his hairline by Dr. Nader in Mexico, this isn't even a clinic result, its just a normal guy doing vlogs on his on account.

 

Edited August 29, 2015 by Melvin-HTsoon
added some compliments = )

[Dr Blake Bloxham]

HTsooner,

 

This case was performed by Dr Feller, not me. He has 14ish years of experience doing FUE, so you are incorrect in this assumption.

 

And, again, you are mostly incorrect about the wiry/kinky issue as well.

 

Allow me to explain the phenomenon:

 

It can occur in both procedures. However, when it occurs in FUT, it happens because a mistake was made. It happens if the grafts were mishandled during implantation or if the incisions sites were too small for the grafts and compressive injury occurred during implantation. We've used the same technicians for 18 years, so this isn't an issue.

 

However, it can occur in FUE without ANY mistakes actually being made. The internal portion of the hair follicle (particularly the internal rooth sheath located superiorly to the bulb) determines much of the hair characteristics. Straight, curly, thick, fine; these are determined by that portion of the follicle. This portion of the follicle is also susceptible to damage and distortion during a hair transplant. If the internal portion is disturbed, the hairs will grow a bit "differently" for a while. This is one of the reasons why the hairs grow different during the first few months after a transplant. In FUE, however, compressive damage to this portion of the follicle can result in permanent distortion and damage. This means kinky or wiry growth that occurs after full maturation.

 

Hopefully this explanation makes sense. Since this thread isn't about FUE versus FUT, it will be my last comment on the subject. You are free to send me a private message or email if you would like to discuss further.

[CalvinJR]

I got two FUTs in the past. Left me with HUGE scar and poor growth. Don?t choose based on FUT or FUE. Choose based on doctors results ONLY and find cases similar to yours for comparison. Also the risk of stretching is real. I did heavy weightlifting shortly after FUT with trichophytic closure. I waited for the stings to come out - 14 days. Scar looked perfect after the first 1-2 month. Nice pencil line. Started stretching after a while. Now stretched 1 cm. Big risk.

[Dr Blake Bloxham]

Calvin,

 

I agree with doing your research and choosing the doctor who best suits your needs!

 

I'm curious about your scar stretch as well. Did it stretch after the first procedure and second? Or only the second? Also, what instructions did your clinic provide with respect to weight lifting after the procedure?

[Dr Blake Bloxham]

UPDATE:

 

Calvin,

 

I just had the opportunity to look at some scar photos your posted. Unfortunately, you are one of the people who I believe would have stretched regardless. This is rare, and it's actually one of the skin types we can pick up on before surgery -- and adjust accordingly.

 

Note how your scar stretched, but remained very flat? This isn't how scar tissue normally forms. Generally, it's very thick, raised, and avascular (without blood supply). Not thin, pink (adequate blood supply), and flat. This has a lot to do with your intrinsic skin "stretch" and natural collagen supply. The silver lining here, for lack of a better term, is that these type of scars respond better than virtually any for FUE repair. This may be something you could look into down the road -- as I see you recently had some FUE work done (and congratulations on that, by the way!).

[CalvinJR]

Blake: 1st FUT it stretched just as much as second. The second FUT was actually done as a FUT and scar revision. It was a VERY small FUT and he cut out the old FUT scar and made the line a bit longer (1st FUT maybe 8 cm long; 2nd FUT around 12 cm long) to take out more grafts for the front as well. Used TC for closure second time - not sure if that procedure was developed first time (2006). Scar stretched exactly the same again. Don?t remember what I was told about workout. Just to take it easy until stitches came out. I did deadlifts, squat etc. I have high laxity skin. You can see a picture of my scar in my thread.

[destorius]

 

2) Where the grafts were being placed.

 

I almost never recommend placing FUE grafts into the hairline. Why? It's the most visible region of the scalp, and I must be 100% confident of the growth and appearance of grafts in this region. FUE grafts are subject to lesser yields and have a greater tendency to grow "wiry" or "kinky," and I can't have patchy or unnatural growth in the front of the scalp.

 

Dr Bloxham, let me first thank you for another clear and informative video. I am concerned by the above comment. Considering that yourself and Dr Feller only consider FUE for small cases (typically under 1000 grafts) then when would you do it if it wasn't for hairline work? Does Dr Feller also follow this mindset? I am not trying to turn this into another FUE vs FUT thread but as you mentioned this, I see it as fair game.

 

Thanks

 

James

[Sethticles]

Since this thread isn't about FUE versus FUT, it will be my last comment on the subject.

 

7 FUE slaggin off comments and you don't want to start a FUE vs FUT thread,

[MAGNUMpi]

Blake: 1st FUT it stretched just as much as second. The second FUT was actually done as a FUT and scar revision. It was a VERY small FUT and he cut out the old FUT scar and made the line a bit longer (1st FUT maybe 8 cm long; 2nd FUT around 12 cm long) to take out more grafts for the front as well. Used TC for closure second time - not sure if that procedure was developed first time (2006). Scar stretched exactly the same again. Don?t remember what I was told about workout. Just to take it easy until stitches came out. I did deadlifts, squat etc. I have high laxity skin. You can see a picture of my scar in my thread.

Blake, if what you say is accurate then CalivinJR had a bad doctor. Right?

His doctor should have noticed his skin condition and told him/suggested FUE.

 

What confuses me most is the amount of posters that have bad scars even from great doctors.

In your posts it sounds like stretched scars are a rare phenomenon that are controllable. Are they?

Also CalvinJR had good laxity. I, for instance, do not. My scalp feels pretty tight back there. Does good or bad laxity have any effect on a scar stretching?

 

If the strip taken was wider, then the potential for stretch could have been greater. In your example of 3,600 grafts, a wider strip would have likely been taken. We have pretty firm "cut offs" for width of the strip, and compensate by making it slightly longer. Long, thin incisions heal up nicely. Shorter, wider ones do not!

I think there is always slightly more potential for less cosmetically acceptable scarring after multiple surgeries. However, we do second strip procedure frequently, and I still think the scarring falls within the normal variation I described above.

Ok. Your patient has an amazing scar. Pencil thin. He must be very happy. But the reality for most people here they would need a lot more than 1800 grafts. A loose average would be about double that. So the same guy with 3600 grafts would have a thicker scar. Also as we all know almost everyone goes for a 2nd/3rd procedure. If the potential for scar stretching does go up with each procedure and the amount of grafts taken (bigger strip) make for more potential for the scar to stretch.

Again this guy must be happy but most people would have a MUCH higher chance of a stretched scar because of the reality of 2nd/3rd procedures/more grafts needed etc.

Im not at all disagreeing with what you said but there is still mystery around the "pencil thin scar" -VS- the stretched scar that we all read about so often.

Thanks again for being so transparent and relating so much good info.

Edited August 30, 2015 by MAGNUMpi

[FUE2014]

I will have to double check but I think in his video with a former poster who shall not be named, Dr Shapiro said one in four strip scars will stretch.

[CalvinJR]

My former doc said high laxity equals stretching in FUT closing.

[MAGNUMpi]

I will have to double check but I think in his video with a former poster who shall not be named, Dr Shapiro said one in four strip scars will stretch.

Dad gummit

 

My former doc said high laxity equals stretching in FUT closing.

Thanks CalvinJR. Strange, I thought a tighter scalp would be more at risk. Good to know.

[Dr Blake Bloxham]

Calvin,

 

That's very, very much consistent with my theory that you are one of these stretchers we can catch. I'm sorry you had to go through this! And I do hope your last procedure gives you the ability to pull off the look you're going for (I believe you underwent some hairline work and plan to wear a system in the back, correct?).

[Dr Blake Bloxham]

James/Des,

 

Thanks for the kind words! People seem to like the video format, so we'll keep making them! And let me apologize, in advance, for those who don't want to see our mugs that many times a month!

 

I agree that your comment is fair game and I'll absolutely address it. Unfortunately, Dr Feller feels the same way. And I wish it wasn't the case. But, it does make sense if you think about it: we, based on experience, studies, et cetera, believe that the quality and quantity of FUE growth is less reliable. The hairline is your money shot. Frankly, it's everything in HT surgery. I tell high NW guys daily that If I only recreated a solid hairline and re-framed your face, you essentially wouldn't look like a "bald guy" any longer. Obviously I don't actually recommend creating a floating hairline on these guys, but it's a good example of the power of the hairline. And this is why we need the powerhouse grafts here. I just can't risk missing pieces or unnatural growth up here.

 

So, where and how do we do it? Despite the controversy, we actually do quite a bit of FUE. It's done in small sessions and meticulously done with all manual scoring, manual delivery, and microscopic inspection before anything is implanted. Don't tell anyone either, because I don't want it to ruin my rep, but I actually really enjoy doing it too!

 

Most of the cases we do are on patients who had FUE before and are looking to add density to certain areas. Again, not a jab at the procedure, but the reality of what we see. Because of this, we invariably end up placing some in the frontal scalp from time-to-time. We also have patients who are coming back for another pseudo-planned small session and end up doing the same. However, we never really start off this way. Most of where we end up placing FUE grafts are in the areas behind the hairline -- as this is more camouflaged and where you need more density than anything else. But we also place in the midscalp, vertex/crown, et cetera.

 

Frankly, I do think I have an answer to this problem. But that's another thread for another time. Hahah. PM me if you'd like to discuss it further.

 

Hope this helped!

[Dr Blake Bloxham]

Seth,

 

Haha. Good point, my friend! I'll try to keep my ADD-esque posting to a minimum! Haha.

[fueBobby]

IMO he didnt need an hair transplant, maybe few years down the line. I think he was better of having FUE than FUT.

[Dr Blake Bloxham]

Magnium,

 

No, I don't think Calvin went to a bad doctor necessarily. I don't know anything about his strip surgeon, to be honest! I was merely commenting on the importance of doing your research. I always recommend this!

 

You bring up two important points that I do want to address. Frankly, I think one deserves its own thread and I may make it in the future. But I'll discuss it a bit here:

 

1) Are bad/stretched scars a rarity or a common occurrence?

 

Frankly, I really should bounce this question to my good pal Dr Lindsey. He's a facial plastic surgeon and scar healing is a bit of an obsession for him. The man even grades his own scars and openly reports the winners and less-than-winners to the community! Impressive.

 

Dr Lindsey does a very meticulous layered closure and stands by the fact that somewhere around 28 out of 30 of his incision sites heal up nice and thin. He says the other two stretch a bit and he's not as happy. But I don't think I've ever seen him share a big disaster case -- and he's the kind of guy who absolutely would share it. And the ones that don't heal the way he wants ("A" grade) are still very easily concealed with the "3 guard" level I tell all my patients.

 

We close with staples and I believe get the same ratio/effect. The worse stretching I've seen thus far has been a few millimeters, and it's still very easily concealed.

 

Do I think it's the 25% Dr Shapiro claims, or closer to the 2 or so cases out of 30 Dr Lindsey claims? I suppose it's going to vary all over the place, but I see similar results to Dr Lindsey's assessment. I think if you limit the width of the strip (which sometimes means not doing the 6,000 graft HUGE FUT cases, and I know this isn't as sexy or fun), and close it up nicely, I usually feel very confident with the way the patients heal and give them the same speech about "fade cuts and 3 guards."

 

I also think the disaster scars we see online have something in common, and it brings me to your next question:

 

2) What role does laxity play?

 

I really should make another thread about this, and it's actually something Dr Feller and I are experimenting with at the moment, but there are two types of "laxity" and each plays a role in closure (and it's different than what you'd assume):

 

There are two types of laxity: the intrinsic stretch or laxity in the skin, and the "give" in the scalp caused by how the entire scalp is attached to the deep layers and the bony skull itself. Both are going to affect how the scalp will stretch during and after closure. If the scalp is loosely attached to the deep layers, the skin is going to have a tendency to separate further from the wound. There is also the intrinsic stretch in the skin (which has more to do with the collagen we discussed above). This is different than the first type of laxity, but still allows for more natural stretching.

 

So imagine the following two scenarios: You remove a 1.5 cm (wide) strip from two patients. One has a scalp that is very loosely attached to the deeper tissues and, because of this, doesn't stay in place when the strip is removed and, instead, tends to creep away from the incision site. This same patient also has a lot of natural laxity or "stretch" in his skin. When we close this gentleman, we have two things working against us: 1) the scalp doesn't have firm deep attachments and will naturally drift away from our staples. and 2) the intrinsic qualities of the skin itself let this happen! This isn't going to scar well.

 

Now imagine patient two: he's locked down to the deep layers, and taking a strip from one portion isn't going to affect the areas around it because they are locked down. He also has hard, "non-stretchy" skin that won't allow for pull away from the staples either. This guy's closure is like stacking cinder blocks. He comes right together and doesn't move a millimeter!

 

Now, most people are somewhere in between and therefore the results are somewhere in between as well. The scar won't be an invisible seam like it will be on the second patient, but it also won't look like stretched silly putty like the first (and I don't mean to make light of this issue here). It will end up being a thin line across the back of the scalp. Maybe 1-2 mm if he has one quality a little worse than the other? So in this sense, I think my opinion may differ from the norm. But I do feel like an increase in both types of laxity leads to increased potential for scar stretching.

 

Does this make sense?