Very Red at 2 Months. Transplant disaster, health issue, or just #@$ luck??

[Ernie]

You think FUT would have been kinder to the skin?

 

??

 

Recipient incisions are recipient incisions, regardless. A different surgeon probably could have been kinder to the skin.

[mattj]

Ernie is right, the incisions from a FUT procedure would have been the same. The redness would have been no more or no less. We can't say for sure whether anything the surgeon did is responsible, though. Your physiology is most likely the main reason.

[Dr Blake Bloxham]

Red,

 

Still seeing the incision marks at 2 months isn't too out of the ordinary. The redness is extreme, but still seeing the healing incisions marks is not -- in my observations anyway.

 

Sounds like all the usual suspects -- and some unusual ones -- have been ruled out.

 

Ask the doctor if they trim their FUE grafts or not. Some clinics do not believe in trimming FUE grafts because they are generally thinner and always more fragile. However, there is usually excess tissue on the top 1/3rd of the graft -- because of the way you deliver FUE grafts -- and this can cause a prolonged, foreign body-like sort of reaction that I've seen prolong redness. So if FUT and FUE grafts are trimmed the same way, they won't react any differently in the scalp. If excess tissue that the body recognizes as foreign and is generally trimmed away with microscopic dissection is left, this can cause a prolonged reaction. Now, there are definitely those who purposely do not trim FUE grafts for the reasons I listed above. So this is in no way a swipe or suggestion that sometime was done wrong. But it could explain part of it.

 

As far as the treatments go, I'm not big on steroids in the recipient post-op. Nor do I think the laser would do anything. Obviously if your doctor recommends steroids and has experience with them, then I'd recommend following his/her instructions. I've had patients report positive things with witch hazel. But keep in mind that you clearly have sensitive skin, so putting stuff up there may cause new/different types of irritation.

 

So my recommendation may be the last you want to hear: wait another 1-2 months. Not fun, I know. But giving your body a little more time to cool itself off may be the best course of action.

 

Hope this helps.

 

Dr Bloxham

[gillenator]

There does appear to be a fair amount of inflammation. The recipient area is still under some level of trauma and only time and your body's immune system will heal this and subside the symptoms over time.

 

Even consider using some rich aloe vera cream and you would be amazed at how much it can potentially cool down the scalp and lighten up the redness.

 

It's too early to use steroidal creams but wonder of an oral one might be of some benefit. Talk to you doctor about that one or perhaps Dr. Blake can comment.

 

Also take lots of Vitamin C.

[JayBandana]

Thanks to everyone for the great posts. It's really helping me deal with this situation.

 

Fwiw, there's been no change in color, texture, or healing in the week since I posted the pictures. Actually, there's been very little change since week 2 or 3.

 

 

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Dr. Bloxham -

Thank you very much for your observations. I really value your experience and understanding.

 

It reassured me to hear that it's not uncommon to still see incision marks at 2 months post-op. It surprises me, actually, as it's rarely mentioned in doctor-written guides as being a possible effect. On forums, I've seen many guys complaining about the visible incision marks, but I thought that those patients were very rare. Good to know that it's much more common than I'd thought. And you didn't say directly, but by the way you write, I guess the incision marks in these cases gradually heal to become the normal smooth skin surface.... at least I hope so!

 

I checked out my donor area. It's hard to see the skin because of the hairs that have grown back, so I hadn't noticed anything unusual. But on close inspection, it seems that in the donor area there are at least a dozen little red areas at the FUE sites; there could be more which are hidden by the hairs. The red areas are maybe 1mm, irregularly-shaped blobs. Not raised, not scabbed. Just colored spots in a hue which varies within each blob from red to reddish-orange.

 

I understand your point that my skin is sensitive now, so I'll leave off any creams or gels for the time being. It's interesting that I've never before had sensitive skin: even in situations where people I'm living with have gotten allergies, rashes, and skin issues, I've never been affected. Makes me think that the reaction and healing of a patient's skin from HT surgery can't be predicted by just looking at his previous skin history or his skin type.

 

Another 1-2 months of waiting is tough. But I see your logic.

 

Thank you again, Dr. Bloxham, very much. You understand the topic well, both academically and from your own practice, so it's really useful to get your insight. I'll keep it updated here.

 

 

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Shera -

I'm interested about the Irish patient you mentioned. (He's different than the Irish patient mentioned by Dr. Lindsey, right?).

 

Would you have details about your Irish guy? I'd really be interested in 3 things:

a) What treatment - if any - did he do?

b) How was the timeline of his healing?

c) Pictures...?

 

Thanks!

 

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Biolizard -

Yeah, my skin definitely didn't respond well, to put it lightly haha!

 

You know, I checked out the pictures you've posted on this site of your HT progress. It's hard to say from the quality of your pictures, but based on what there is, you actually ended up with a pretty good result. I understand from your posts that you're not too happy with things, but I'd definitely be satisfied with the result you showed in your 10 month photo! Congrats!

 

I'd guess that by now it's even better, so cheer up, mate, :-). Make a new thread with your current result, post some pics that show it well, and I guarantee you'll get so much (deserved!) praise from guys on the forum that your only worry will be that your head will explode from your newly-inflated ego :-)

 

About the redness, I can see in your 5-week picture that you were red, although a lot less than me at 2 months lol! Can I ask: what treatments did you do? I saw that some posters chatted with you about V-beam laser, electrolysis, microneedling, concealer, lots more. What did you end up doing?

 

I'd love to know any details that could be helpful. Thanks, Bio :-)

 

 

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Gillenator -

Yeah, there's definitely still trauma. You concluded the same as Dr. Bloxham that only time and my body's immune system will heal it.

 

You mentioned about cases of redness like mine that you've "seen it before." I'm really curious about these cases.Would you be able to give any details about them like treatment, healing timeline and photos? That'd be really helpful!

 

Thanks, mate!

 

 

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Anyone else have similar stories?

I was prepared for a year of patience for the hair result, but definitely not ready for the disfiguring redness.

 

I've convinced myself it'll get better. Gotta keep hope up, right! And who knows, maybe the extracellular matrix of my skin will get some nice placebo healing action from it :-)

 

But it's tough to be living it in real-time, with no way to know if and when it will get better. If anyone reading this has any details of someone who went through something similar, it would really be useful if you could post details. Or if you're a lurker and not a poster, or if you just don't want to post your info on this thread, PM me through this forum or email me at [ jay2cr3 at posteo dot net]. I'd really appreciate any info that anyone might have: doctors with patient stories, patient advisors who might know guys who had similar issues, or guys who have personally gone through this...

 

I'll update this forum thread with any news. I'm seeing the dermatology clinic soon, so I'll post whatever I learn. As for pics, there's been no change in my redness since I started this thread a week ago, so no point in putting new pictures up. But when there's some change, I'll add it here so other guys can follow. I never wanted to have a bloody red bandana stitched around my forehead, but now that I'm in this position, I figure I can at least share all my info so all my fellow red-bandana mates who are lurking out there now and in the future can read this and see how it went for me.

Edited June 4, 2017 by JayBandana

[Bigforehead]

Hi All,

I have a pink scalp and slightly bumpy after 6 weeks and so i logged in for the first time and have been reading Jays story and comments. Are there some guys out there who have suffered similarly and can offer some light at the end of the tunnel?

[Spidey]

Hi All,

I have a pink scalp and slightly bumpy after 6 weeks and so i logged in for the first time and have been reading Jays story and comments. Are there some guys out there who have suffered similarly and can offer some light at the end of the tunnel?

 

Mine was light pink for the longest time and still is after showers and under florescent lights. It isn't noticeable with the grafts grown out but if I shaved it down you could probably tell. Under normal room lighting you can't really tell. After about three months you could only tell the light pink under florescent lighting. The crummy part is that almost two years in, I would have thought all discoloration would have resolved itself. I'm not sure if it will eventually or not. Texture wise I actually found that once all the hairs shed post op, the recipient area was smooth like the surrounding skin. Once the hairs started to come in, that's when I noticed the texture diff in the skin.

 

You will probably remain at least slightly pink until the hair grows out and you stop paying attention to the colour.

Edited June 14, 2017 by Spidey

[Bigforehead]

Thanks Spidey. Did you have a period of time in which you noticed bumps?

[Spidey]

I noticed texture change when the hairs started to sprout at about 3 months. Prior to that the area was more or less smooth. So I have a strong feeling If the hairs were plucked out or lasered away, it would likely leave a smoother area. I have started to massage my recipient area with quite a lot of pressure once a day in hopes it would help minimize any scar tissue that may be present. The pinkness is only present after a shower. A few mins after it fades to normal skin colour. But without shaving off the area there is really no way to tell what it really looks like.

[JayBandana]

2.5 months update

No change. Redness and texture still the same. Hasn't been any real change since the 2-week mark.

 

I've been talking to many doctors in a few different cities, including hair surgeons and different types of dermatologists. Still a few more to go.

 

I've also spoken/written with several men who've had post-HT healing problems. Stroke of genius to have put my email in an earlier post; quite a few lurkers out there who have their own redness issues contacted me. If you have any redness issues, email me at [ jay2cr3 at posteo dot net]. I read and respond to everything .

 

So with all my free time now thanks to my bloody red bandana, I've managed to gather lots of information, research and stories. I'll write it all up when I finish the consultations.

 

________________________

 

 

Hey Spidey-

 

Thanks for your comments in this thread.

 

I actually read all your posts months ago while I was deciding on my own transplant. I really appreciated your honest descriptions of everything you went through. Glad I get to thank you directly, it was really helpful! :-)

 

From your pictures, it looks like your redness was in better shape than mine at the 2.5-3 month stage. I'd love to have a situation at my 3-month mark where you can only see my pinkness under fluorescent lighting, as you write, but I think there's zero chance of that right now.

 

Your hair looks pretty thick/coarse, which I'd guess helps hide the pinkness you still have? I think in my case, because my hair is thin and blonde, it'll be less effective at hiding the redness, regardless of however much density eventually grows in.

 

But however you look at it, pinkness two years after surgery definitely isn't a good outcome. I feel for you!

[Spidey]

2.5 months update

No change. Redness and texture still the same. Hasn't been any real change since the 2-week mark.

 

I've been talking to many doctors in a few different cities, including hair surgeons and different types of dermatologists. Still a few more to go.

 

I've also spoken/written with several men who've had post-HT healing problems. Stroke of genius to have put my email in an earlier post; quite a few lurkers out there who have their own redness issues contacted me. If you have any redness issues, email me at [ jay2cr3 at posteo dot net]. I read and respond to everything .

 

So with all my free time now thanks to my bloody red bandana, I've managed to gather lots of information, research and stories. I'll write it all up when I finish the consultations.

 

________________________

 

 

Hey Spidey-

 

Thanks for your comments in this thread.

 

I actually read all your posts months ago while I was deciding on my own transplant. I really appreciated your honest descriptions of everything you went through. Glad I get to thank you directly, it was really helpful! :-)

 

From your pictures, it looks like your redness was in better shape than mine at the 2.5-3 month stage. I'd love to have a situation at my 3-month mark where you can only see my pinkness under fluorescent lighting, as you write, but I think there's zero chance of that right now.

 

Your hair looks pretty thick/coarse, which I'd guess helps hide the pinkness you still have? I think in my case, because my hair is thin and blonde, it'll be less effective at hiding the redness, regardless of however much density eventually grows in.

 

But however you look at it, pinkness two years after surgery definitely isn't a good outcome. I feel for you!

 

I am glad my posts were informative for you. I am not sure if the skin is pink under regular conditions or just gets pink easily from warm showers and or rubbing. If I look at it in the middle or the day it doesn't look pink. Even when you look at my 12 month pics you can't see any sign of pinkness. I think the lingering pinkness I have is just increased blood flow/capillaries that is a result or the recipient site creation and/or follicles. End of the day it isn't really a big deal. The only thing that concerns me is I don't plan on doing another procedure and am not sure what the skin will look like when I eventually shave or laser the hair away. I know scars can take up to two years to fully mature so I still have some hope that it will still get better. I have scars in other areas of my body that I got ten years ago that still slowly get better each year. The pinkness isn't as much or an issue as the potential texture diff, as I've read v beam laser does a pretty good job reducing redness. I won't really know how it will look until I remove the hair which I am not about to do until I really have to. The good thing is the rest of my native hair is still thick and I should be able to conceal the area when the day comes.

 

I am very happy with my ht results, but if I knew there was a potential that the recipient area would not heal 100%, then I don't think I would have ever done it as, my plan was to buzz my hair to a #1 and shave the transplanted hairs if my hairloss progressed.

 

As for your results, do you feel the area is tender or is it just the colour?

[JayBandana]

3 Month Update

It's just a bit before my 3 month point. There's been no change in the redness or in the texture of my recipient area since the 2-3 week mark.

 

There's a little growth of very fine, white hairs. Not much at all, but at just under 3 months post-op right now, it's fine and I'm not worried about the hair growth. My problem is the redness. It's now massively hurting my life and career. I wish I could just own the redness and laugh at anyone who makes an issue about it. But the reality is that my industry and my job aren't wonderful judgement-free safe zones; it's hugely competitive, everything contributes to reputation, and the stench from a redness disaster caused by hair transplant surgery would hurt me more than my current strategy of quitting and hiding out for months. Really horrible f$#% situation.

 

In this post, I want to 1) update about my situation, 2) report on what I've learned from consultations with many doctors and contact with other redness-sufferers, and 3) lay out the treatment options I've been presented. The focus is about my own case, obviously, but I hope that my experiences and the information I've found can be helpful for other patients who are suffering with redness post-op. I also think it can be useful as well as for people who are considering hair transplants and want information about potential problems that could arise.

 

 

Redness: research over last weeks

I've consulted many dermatologists (both clinic dermatologists and hospital specialists) and hair surgeons in several different cities over the last weeks. The short summary is that no one knows what's happening with my redness or why, and there are many different suggestions about what to do, many of which are mutually contradictory.

 

I've learned that redness following hair transplant surgery occurs more frequently than is typically portrayed. In general, I've found that dermatologists think that prolonged redness is much more likely than what is typically portrayed by hair transplant doctors. Every dermatologist I met has had patients with difficult wound redness from cosmetic surgery, and quite a few of them had patients with redness from hair surgery in particular. Dermatologists are much more likely than hair doctors to believe that redness must be treated; in general, they believe that redness which hasn't mostly faded after 4-8 weeks should be considered chronic and potentially permanent. In contrast, hair doctors are more likely to believe that waiting another 3 or 6 or 12 months is always better.

 

In addition to information from doctors, I've also been lucky to get information directly from several guys who have had redness issues following hair surgery. I included my email address in earlier posts in this thread, and quite a few lurkers contacted me with their stories. I spoke with guys who have redness that has already lasted for 3-9 months, and several others for whom the redness has become permanent at even 12-24 months post-op. It's heart-breaking to hear their stories (and very depressing to think that I might and probably will follow their path). It was funny - in a sad way - that these guys all had similar stories about the suggestions made by their hair doctors as the redness didn't fade in the months following the transplant surgery:

 

1) "Wait, it'll get better."

2) "Waiting didn't help? Try topical steroid then."

3) "Steroid didn't help? Then hope that new hair growth covers it."

4) "You can still see redness clearly through the hair? Well... that's life, must be your skin type, hmmm, can't help you, gotta go."

 

It's hard to estimate what percentage of patients have significant redness for 2 to 12 months and longer. In addition to the guys I emailed with, I also found many blog posts and comments on several forums from patients of many different doctors who suffered from redness for months. I understand it's hard to generalize from these patients because of the self-selection effect: people complaining on forums tend to be those with post-op problems, and those who have no issues just get on with their lives. But even if we can't estimate percentages, I'd say it's notable that just on an absolute basis, there are dozens of posts from guys with long-term redness issues. One poster on this forum's related area summarized it well:

 

Post-op redness is something very much played down and overlooked in the hair transplant industry. Consider my case: 3 months in, still with significant redness. And yet research would suggest having dark hair and fairly dark skin I should meet the criteria for redness to be minimal only after a short period.

 

Wound healing

Wound healing is a very, very complex topic and not well understood. If a wound doesn't follow the normal path of healing correctly in the first 4 weeks, then it is considered chronic... and modern medicine doesn't have great, one-size-fits-all solutions.

 

Lots of theories and research about the idea that many inflammatory diseases and pathological conditions (including cancer) disrupt the standard wound healing processes. Many similarities have been noted between atopic dermatitis and the chronic wound healing response such as that in long-lasting redness from a hair transplant.

 

Delayed wound healing can be directly caused by (literally) hundreds of different health and environmental issues, or can just be the result of (not very well understood) characteristics that are unique to the patient and make him/her heal slower or not completely.

 

Depending on the healing, the redness, bumpy texture, or slightly raised surface from delayed healing can and often does become a permanent part of the skin.

 

Lots of possible health issues could cause delayed wound healing following a surgery like hair transplant. Some are more common, some more rare. Here are a few:

 

• Diabetes. (High levels of blood glucose lead to problems with blood circulationa and the nerves, so wounds don't get all the blood needed for normal healing)
  
• Auto-immune disorders such as rheumatoid arthritis, lupus, etc. [Whilst the diseases are definitely bad for wound healing, there are conflicting ideas about whether the medicine for these diseases hurts or helps wound healing. On the one hand, it's reasonable to think that the main immunosuppresive drugs which are used would delay or prevent healing, but on the other hand, studies show that the medicine doesn't affect the healing process and aggressive drug treatment before any surgical wounds can actually be beneficial to the eventual healing process.]
  
• Collagen problems, for example Ehler Danloss syndrome: genetic defects in collagen and connective tissue synthesis and structure
  
• Koebner phenomenon: lesions develop at site of skin trauma, for example around surgical scars. Associated with psoriasis patients, but can also occur in people with eczema, systemic juvenile rheumatoid arthritis, lichen planus, warts and lots more skin issues.
  
• Ischemia (insufficient blood supply), edema (abnormal accumulation of fluid), hypoxia (insufficient oxygen in the tissue)
  
• Skin cancer
  
• Low HGH (human growth hormone)
  

 

Lots of outside influences can delay the wound healing, including:

• Infection from surgery
  
• Infection from bacteria
  
• Significant sun exposure
  
• Irritants from creams, shampoos, laundry materials, etc
  
• Allergies, among which some typical causes are: perfumes/fragrances, lanolin (used in skin creams), cetylsterol alcohol (used in skin creams), latex, and rosin (used in many printing applications, bandages, and sports/music where it's applied to bow strings, or to hands to improve grip).
  
• Medications affecting auto-immune system
  
• Steroids
  
• Cigarettes, drugs (delays healing, leads to higher rates of infection)
  
• Zinc deficiency
  
• Nutritional deficiencies (some studies show that lack of protein makes the wound healing process much longer)
  

The catch is that there are still many cases of delayed healing and long-term redness which are not caused by any of these issues, and no one has any idea why.

 

I've gone through all these possible reasons with doctors. I did thorough blood both tests before the operation as well as in the last weeks; all results were and still are good. I've had no sun exposure, swelling, pus, warmth, fever, or health issues. No one knows what has caused my redness.

 

All the people who emailed me also said that they checked through all these possibilities and came up with no explanation.

 

 

Disagreements about treatment

I've found as a patient that there is enormous disagreement between doctors about redness following hair transplant surgery. If you have redness and are trying to figure out what to do, these disagreements are very frustrating and make it hard to know what to believe, particularly as many of the views are completely contradictory.

 

Some of the reasons I saw behind the disagreements:

• Unknown medical issues. There are very big disagreements that develop when there isn't any well-understood diagnosis or treatment, and each doctor must form his/her own opinion. As a patient, you're limited in how well you can evaluate the science and you tend to judge instead by who you most like and trust, which isn't necessarily going to lead to the best treatment. I've found that how doctors approach a medical issue like this which has unknown cause and unknown solutions is affected by the human factors: personality, risk appetite, reputation, and confidence all play a huge role. In my interactions with doctors in the last weeks, I've seen lots of pride, boasting, and insults of others doctors.
  
• Different medical specialties. Dermatologists in general have very different views than hair surgeons. The split is exactly what you'd guess: hair surgeons in general are worried about the hair and recommend to do as little as absolutely necessary about the skin, whilst dermatologists are worried about the skin and emphasize that not treating it asap could lead to long-term permanent problems.
  
• Hammer and nail problem. Whatever tool the doctor has and frequently uses, s/he sees it as a good solution for whatever medical issue you have. If you have a hammer, then every problem looks like a nail. Especially noticeable amongst dermatologists.
  
• The business aspect. Almost all hair surgery and a good part of dermatology is paid for directly by the patient, and the business side is very noticeable in how doctors act. Of course, every doctor says - and believes - that s/he is unbiased and fair, but we're all just human: marketing, pricing, and profit affect what the doctor thinks, both consciously and unconsciously. I found many doctors who believe that certain treatments done at other practices are over-hyped, over-marketed, unsafe, ineffective, and just sales manipulation... but that their own treatments are legit, very reliable, fairly priced, and anyone who disagrees is inexperienced and lacks the skills to do it correctly.
  
• Relatively little patient data. I've been very surprised that in both dermatology and hair clinics, patient data isn't handled better so it can benefit everyone. Within clinics, few have much data recorded in useful form for statistical analysis. Between clinics, there's little exchange of information other than anecdotes, and as far as I've found from asking, there are no central databases which collect and analyze cross-clinic data. The only hard data are relatively infrequent randomized control trials. Otherwise, every doctor and clinic I came across is essentially an island operating on their own subjective assessment of patient experiences. It's impossible to know with any real precision what percentage of patients get redness, characteristics of patients who get it, how long it lasts, how red is red, what possible factors caused it, if/how it was treated, etc. Every doctor has an anecdote, or knows a guy who knows a guy... but there's no data. Unfortunately, many doctors extrapolate their anecdotal information and gut feelings into statistics. But the reality is there is no data. The lack of data and over-reliance on anecdotes further complicates diagnosis and treatment.
  
• Little incentive or desire to help patients who have complications. All the doctors I've met - including my own surgeon - seem to be good people who want to help. But at some point, their attention must be on the majority of patients with normal issues and they can't focus on the minority of patients who have complications. It's particularly acute because HT is a private pay business. It seems to also affect people other than doctors: I got emails from two guys who said that their semi-independent patient advocate/representative also stopped helping them when their redness lasted more than 2 months.
  

 

It also seems to me that hair doctors have a blind spot - conscious or not - about redness issues. An example: I consulted with two hair doctors (not connected to each other) who told me they had never had a patient with significant redness lasting longer than 2 months. But I have emails and photos from patients of those very same doctors which show extreme redness for 6 and 12 months. These patients communicated frequently with their doctors about their redness issue. I'm not an investigative journalist and I'm not trying to play gotcha-politics, so I didn't confront the doctors.

 

 

 

Treatment ideas

I've been proposed several treatment ideas by different dermatologists and hair surgeons I've consulted. Every proposal has been thoroughly attacked by at least two other doctors. So I thought the best way to present the ideas is to give the diagnosis and treatment suggested by the proposing doctor, and then the counter-arguments offered by opposing doctors.

 

#1. V-beam laser

Diagnosis: small dilated blood vessels near the surface of the skin ("broken capillaries"), i.e. a form of telangiectasias caused by the trauma of surgery. If you push with finger on the redness and release, the skin becomes white for a second and then returns to red. That brief whiteness happens because of these dilated blood vessels. It's also supposedly why I (and several guys who emailed me) have noticed that the redness is temporarily less following a warm shower, not more.

 

Treatment: pulsed dye laser ("V-beam"). Targets only the red wavelength of the capillaries, so the laser will reduce the redness but not hurt the (soon-to-arrive) growth of the transplanted follicles.

Counter-argument: The range of wavelengths of the V-beam laser cannot be made so narrow as to ONLY work on the blood vessels. The laser will probably hurt the hair follicles and harm my eventual transplant result.

 

Moreover, if you have significant redness after hair surgery, the last thing you want to do is aggravate the area by burning it with a laser.

 

Regarding effectiveness, dermatologists who work with V-beam laser thinks it would help the redness, although they differ about whether it will harm the hair follicles. On the other hand, hair surgeons almost unanimously think laser is bad in the recipient area; they're not sure if it would help the redness, but they very much advise not to laser on the recipient area only a few months after surgery. The cause of this difference in opinion seems pretty understandable: dermatologists with V-beam lasers think it's a good tool to solve many skin issues, dermatologists who don't use the laser have already decided it's not a good tool for skin issues, and hair surgeons are very cautious about doing anything which could hurt hair growth.

#2. PRP

Diagnosis: inflammation caused by the HT surgery.

 

Treatment: 100 little PRP injections throughout the red area as an anti-inflammatory to stimulate angiogenesis. In addition to promoting healing of the redness, it will help the eventual hair growth.

 

Counter-argument: PRP won't help much, while 100 injections into an already-red area would just irritate the skin more and cause even more redness.

 

#3. Strong topical cream

Diagnosis: inflammation similar to eczema.

 

Treatment A: a mid-level topical corticosteroid with potency around 100-150x hydrocortisone, perhaps mixed with an anti-bacterium. It's anti-inflammatory, immunosuppressive, vasoconstrictive. Doesn't affect the hair follicles. The idea is that it works in the same way as the corticosteroids which the body naturally produces to control inflammation. Try it 3-4 weeks. If it helps, great; if not, stop after a month and there's no danger of harm or long-term damage.

 

Counter-argument A: The vasco-constrictive properties of steroids is exactly what I don't want while my body is trying to heal itself now. And steroids have lots of bad side effects: red skin syndrome from withdrawal, thinning of the skin, and more. Everyone agrees that taking corticosteroids for too long and which are too powerful is very bad, but no one can definitely say where the limits are, as it varies by individual. But as a general rule, more and more research is showing harmful effects of steroids, so it's best to avoid them if not necessary.

 

Additionally, absorption of topical steroids is greatest at the skin of face compared to other body areas, so it's particularly important to be careful using them for HT scalp redness.

 

Treatment B: Try a drug affecting the immune response (calcineurin inhibitor) such as pimecrolimus or (less used) tacrolimus. It's anti-inflammatory in the same way as topical corticosteroids, but does not have the potential side effects of skin thinning or red skin.

 

Counter-argument B: Same problems as steroids regarding vasco-constriction. Plus, there's an as-yet unsettled question if pimecroimus and tacrolimus increase the risk of lymph node or skin cancer.

 

 

#4. Antibiotics

Diagnosis: possible infection.

 

Treatment: Antibiotic for full course of 10 days (e.g., doxycyycline). If redness hasn't faded after a few weeks, then skin punch biopsy to see if there is some form of infection. Assuming no infection, then use a topical steroid as described above in suggestion #3.

 

Counter-argument: If it were a rash which suddenly appeared for no known reason, biopsy and antibiotics might be indicated to understand and treat the cause. But in this case, the cause is clear: the trauma from hundreds of incisions made in each part of the forehead scalp. It's clearly more red in areas of greater incision density, less red in areas with less density. There's no signs at all of infection. A biopsy is not necessary, isn't worth the cost, and - given we now know how my skin reacts to wounds - there's no need to subject my recipient area to further surgical trauma, even if it's just one excision for the biopsy.

 

#5. Tough sh!t

Diagnosis: That's life. I'm blonde, light blue eyes, fair skin (stereotypical Scandinavian look). Redness can happen.

 

Treatment: can't do anything. Will take 6 months to 1 year to heal. Bad luck. Buy lots of hats. As one well-known hair surgeon said to me, "Here's my best suggestion. What do you think about growing your hair longer and gelling it forward so that it can at least partially cover the red area for the next year or so?"

 

Counter-argument: At 3 months post-op - and 2.5 months of no change - the extreme redness is not going to get better on its own, no matter how many months or years I wait.

 

The "blonde, fair skin" argument doesn't hold water. Every dermatologist mentioned that most blonde, fair-skin people don't have wound redness. And many dark-haired, dark-skinned people do have redness. Maybe odds are slightly different based on some genetic variations, maybe not, but it doesn't matter in any event. If you are the unlucky person who has significant redness after 2 months, you might get lucky hoping and waiting, but odds are you have to do something to fix it. Talking about "skin type" is just a lot of hand-waving for a doctor to avoid dealing with a very complicated issue.

 

Moreover, the time to treat is now while it's still relatively fresh. As time goes on, it becomes an area of chronic, long-term wounds, and it will become much harder to treat. And there will be no hiding it: because of the combination of my blonde color, naturally thin hair, fair skin tone, and the density of a hair transplant, the redness will be visible even after all my hairs have grown in. So fix it now.

 

 

 

Photos

It hasn't changed since the 2-week point, but here's how things look now at just under 3 months:

 

 

 

 

 

Edited June 23, 2017 by JayBandana

[mrfivehead]

normal.

 

 

 

IT takes me six months before this pinkness goes away.

 

 

Have very fair skin.

 

 

At 4 months, and it still looks very pink.

[Shera]

Hi Jay,

 

Sounds like you've been busy, that's a great informative post.

 

Doctors in general do seem to be saying whatever is in their interests. In the case of HT doctors, it's very difficult to predict how a given patients skin will heal but generally it is proven in the vast majority of cases, it will heal in "time". This is probably why HT doctors just advise patients to wait, there is simply little they can do from their end, they have most likely been through the experience many times before with other patients where the "do nothing " approach came good in "time".

 

Now moving on to Dermatologists, it does appear they are horrified whenever a person willfully inflicts damage to their skin, indeed in the case of HT surgery, this horror is magnified tenfold. I suppose it goes against all they stand for.

 

Therefore an element of critique does tend to kick in and I've yet to read a case where a Dermatologist actually praised the work of any HT Surgery, it probably won't happen in my lifetime. Some patients will worry more than others about the outcome of their HT surgery. If a patient is a worrier then a trip to the dermatologist generally tends to escalate that worry factor tenfold. This in term causes unnecessary stress therefore in my opinion the patient is not at 100%, therefore it will affect progress and recovery. This can probably be applied to most surgeries.

 

I think in your case, your hair is growing out and will somewhat start to disguise the redness until it fades in time. I think you have accepted that your redness is destined to accompany you yet for a while.

 

Just a suggestion, but why don't you try massaging the area of redness in the evenings with a thin layer of Vaseline and leave it on overnight. I can't see it doing any harm and it may well help to heal the skin.

 

I advise my Dr Bhatti patients to apply baby oil to the scalp every morning for 6-12 months and leave it on during the day. I'm not sure whether you have been doing something similar. Just a suggestion for you to try, in my own experience I would say it definitely helped the healing process.

 

Also if you've had a decent cut or graze lately on any part of your body, can you recall how long the skin repaired itself and blended in with your natural colour, it may be an indicator of how long you will have to wait for the redness to clear.

 

Really sorry I can't be of more help, after reading your latest post, it looks like you have a hit a bit of a brick wall. There must be some skin product out there that will help you disguise it until your hair grows out and the redness hopefully fades. Try visiting a make-up counter, they might be able to provide a short term fix for you which will help you go about your daily duties without worrying about the red bandana.

 

All the best

 

Shera

Edited June 24, 2017 by Shera

[home1212]

it definitely looks like its subsiding, and when growth kicks in at 4-6 months it will be even less detectable, i truly understand and sympathize with your situation, but you'll get over this "hump" and I hope you'll be happier soon with your final result

[matt3480]

Agreed.....would not be worrying about what a dermatologist is saying. They deal with skin issues....not necessarily skin issues relating to trauma. I am 100% with what Shera said regarding them.

 

I would not go with steroids or lasers at this point....these definitely could affect your yield.

 

I'm sorry but any HT doctor who says they have never seen significant redness after 2 months is lying or doesn't know what the hell they are doing. Skin changes can take 1-2 years to finalize and heal (this is what Dr. K told me). I believe he told me he never had a patient (or maybe he had one), that had significant redness for more than a year.

 

You have blonde hair and very fair skin. You are going to have redness or pinkness longer than most. Might be 6 months minimum for you due to your skin type. Even when mine started to get better and was more pink....it would still get red after working out, etc. (blood vessels are working). Also, lighting affects it a lot....meaning it would look much redder in bright lighting. That's just the way it is. I can assure you mine went away 100% percent. I can't tell you when as the hair indeed started to cover it at some point....but I was still definitely pink then. Also, you are going to start getting pimples in the recipient area due to hair growing....that also is going to contribute to redness.

 

You, like me....had hair transplanted into an area that had no hair. The blood flow was much less in that area versus an area that has existing hair and an existing blood supply. Read online "This healing process is nourished by lots of tiny blood vessels that the body produces to (temporarily) provide an extra blood supply. This causes the area to appear red."

 

Think of a scar from trauma......it starts red....it gets pink, eventually it's light. It could take years. Same concept here....not that it will take years but that it takes time to heal. For what it's worth, I had NO redness or even pinkness on my second pass in that area. I believe it's because I had a good blood supply there at that point from the first transplant and it wasn't as much of a "shock" to that area (and I had my second pass only 8 months after my first) due to that.

 

I understand you might be apprehensive right now....but don't be.

 

Have you tried aloe vera like I suggested? As I said, that really kick started the healing for me. Aloe vera is common stuff and I was pretty shocked at how that helped so much.

[Bigforehead]

I had my HT 4/25 which I imagine is a month behind you. My doctor suggested I try 1% cortisone. I think it may have reduced my pinkness by a shade or more in the next day or 2, but not much beyond that. It definitely improved the scalp bumpiness that I had. My HT was done in Florida but I live in NY. Because I have been concerned with the redness,my doctor reached out to a colleague in NY who is willing to examine my scalp.I haven’t gone yet,but when I mentioned my doctor recommended cortisone he was wary and suggested I not use it more than once per day. I am a very slow healer in general am hoping that time does its thing and it continues to fade. More so I am hoping that if the pink remains, my new hair growth will hide it. I’m hoping the same for you. You deserve it. Although you are doing it for your benefit, your sharing of information which must have taken many, many hours is very generous. Good luck, I’ll be anxiously awaiting your posts

[JayBandana]

Thanks to everyone with the kind words of support. It's a pretty #$%$# horrible situation, so I really do appreciate.

 

Another week passed since my 3-month update and there's been no change in the redness. A few people asked if maybe it has improved and I don't notice. But no, I'm certain it hasn't changed. I standardized the lighting and photo situation of my pictures, and then to be completely positive, I analyze on the computer the actual tone of the redness on an absolute level as well as relative to the normal skin below the hairline.

 

So I'm certain that I'm not tricking myself one way or the other. I can say 100% for sure that there has been no change in redness from the 2-3 week point until the current 3-month mark.

 

I've learned about the cases of a lot of other people who have had redness. I left my email on the thread. A bunch of guys have written to me about their redness, lurkers who read here but for various reasons never post. Told me their stories, sent me pictures.

 

Thanks to that, I now have verified by photos at least 7 cases where the redness definitely did not heal after 12+ months. Imagine that, if in just the last few weeks there are 7 guys who wrote me, 7 guys who did not heal after 12+ months who read this thread in enough detail to make out my cryptic email address and jumped through all those hoops to share their story with me... imagine how many more there must be out there.

 

And that's just guys with extreme redness at 12+ months. A lot more have emailed me with cases that are right now in the 2-12 month range. Plus a few other guys who aren't really red at 12+ months, but have a noticeable pinkness and/or cobblestoning still one year post-op.

 

There's a lot of hope among redness-sufferers that the hair growth will mask the redness. I've found some problems with this. First, it takes a long time until the transplant result finally reaches completion at 9-12 months; before that, real redness is definitely still visible. But even at that point, it doesn't always work out so well. A hair transplant isn't that dense: scalp will show through at places, and when it's so red, it's very obvious. Also, for the front hairline, a lot of guys talk about the "outline effect" where the sharp border between the tone of the normal forehead skin and the tone of the redness is very noticeable underneath the transplanted hair and essentially outlines the newly-created hairline. I've seen pictures of it. Not a good look.

 

It's heart-breaking to hear their stories of how the redness has completely #%#'d up their lives, and now I'm learning for myself how it happens. It's not an ugly duckling thing. It's not a lingering pinkness that you whine about and feel yicky to have to hide with some make-up. It's a redness which can't be hidden, a permanent scar stretching across the head. You can see it in low light, you can see it from far away, you can see it in any situation.

 

It's crushing to have this extreme redness. I don't want to exaggerate: it's not life-threatening, it's not a true health issue for you or a loved one. I repeat to myself - and to all these guys who email me - that relative to real health issues, this redness is obviously of zero importance. But given that the whole thing started because of the desire which all of us hair transplant patients had to improve our cosmetic appearance... within that world, it's soul-crushing.

Edited July 2, 2017 by JayBandana

[rodfl]

Jay,

I am so sorry this is happening to you!! Shouldn't your Dr be the one that is researching, and trying to figure out what is going on? He himself said he has never seen anything like it before. i would think he would be willing to send you to a Dermatologist, or find something to relieve the redness. I mean he is the Dr. right? Amazes me how they just say "sorry" come back and see me in a few months.

 

Maybe you should take a look at HGH therapy. I have been taking HGH for about a month, and so far Ive seen amazing results including repair, and regeneration of old injuries.....Im not a DR, but I know how it has helped me.

Edited July 13, 2017 by rodfl

[pkipling]

Hey Jay. You have no reason to try and justify why this is so hard on you. True, it may not be as severe as what other people deal with, but that doesn't make your experience of this any less painful for you. I really hope that at the very least this resolves itself with time, especially as your hair starts to grow. I also hope that your surgeon can be of more assistance in helping you find a solution to this.

 

I wish I had an answer on how to fix this, but all I have to offer is support and compassion. I'll optimistically wait for an update where you tell us all how the redness is disappearing and on its way out. Fingers crossed.

[JayBandana]

4-month update:

 

Redness is still the same. No visible change since the 2-3 week mark.

 

Lots of little hairs have grown in. Nothing amazing yet, but it's early days still and the progress seems reasonable enough. More or less matches Dr. Bloxham's hair growth progress he outlined in a forum post. According to his estimates, at the 4-month point around 30% of hairs will have popped in and about 20% matured; right now my growth seems to be something like that.

 

The new hairs are mostly white, so it lightens up the underlying skin-redness a tiny bit. But it's a really tiny effect. The hairs are sparse and don't hide anything, and the contrast between my normal forehead skin and the huge zone of redness is still extremely visible in all lighting conditions. You can see the redness from very far away. You can see it at night. I can even see it now reflecting on the screen as I type this.

 

I was really hoping for some improvement by month 4. That seemed to be the final turning point for the difficult cases, based on the feedback here from Dr. Bloxham, Dr. Lindsey, and other posters, as well as what I've heard from guys who've emailed me who healed up. But at month 4, with absolutely no change in my redness since the 2-3 week mark, I'm really losing hope that this will clear on its own. It seems my redness is going to last much, much longer, and quite possibly become a huge zone of redness permanently etched on my forehead.

 

I look back at my initial posts 2 months ago. It's silly to say, but I can see how innocent I was then. I really thought that post-hair transplant skin redness would be a well-researched area, that there would be clear solutions based on studies and evidence. I thought that since there are thousands of hair transplant doctors, tens of thousands of hair transplant surgeries completed, and millions of forum posts, then whatever the issue is, the hair transplant world would have dealt with it before.

 

But in the last 2 months I've found that long-term skin redness is an issue which does not get much attention. Long-term redness because of hair transplant surgery can and does happen to many more patients than is commonly described. Skin healing is incredibly complicated, and it'd be very helpful to have real facts to reduce the number of patients who get redness and help the many hair patients who do end up with this skin problem. But I've found that there's no data and no evidence. Many - most - hair transplant surgeons simply don't recognize that the problem exists.

 

And whenever it is acknowledged, most of the explanations and treatment ideas, including from many doctors, are nothing more than vacuous hand-waving because there is no data for anyone to use to make evidence-based conclusions. It's crazy, but from the lurkers I've met from this thread, I'd guess that at this point I have more case data about patients with extreme long-term post-op redness than most doctors. Based on what I've learned from these guys, I've found that the description and statistics about long-term HT-skin issues which doctors give are often just factually wrong.

 

For instance, as I wrote in a separate thread, I've found examples of many cases that don't fit a common explanation about redness and skin tone which is given by many doctors and forum posters. You often hear that patients with blonde hair, fair skin, and blue eyes get redness, whilst patients with darker skin and hair don't. I'm blonde and fair skinned, so every hair doctor immediately tells me that my complexion is the explanation. But only a minority of fair-skinned patients get redness, and no one can explain why some blondes get long-term redness and some don't. On the other hand, I've now found dozens of guys with dark skin and hair who got as much or even more redness and skin issues than I did, including guys with family backgrounds from Europe and the Middle East, from South Asia (India, Pakistan), from East Asia (China, Korea) and from SE Asia (Phillipines). I've found that in some cases, the darker tone of hair and skin (and sometimes thicker hair) masks the redness slightly more than it does in the case of very pale-skinned guys like me, but otherwise, there seems to be no difference in the skin problem itself. So although I have no way of estimating percentages (there's that problem again of lack of data), I can confirm now that the skin issues are not limited mainly to fair-skinned patients; they can be a problem for everyone of every skin tone, despite what gets repeated in the HT world.

But no one wants to talk about hair transplant long-term redness, no one studies it, and no one has any real solution. Long-term redness is a real blind spot in the hair transplant world.

 

Many of the guys I've emailed with have become very depressed because of their long-term redness issues. I now know of at least a dozen cases of guys who have extreme, very long-term redness and whose doctors have essentially ignored them. They - we! - are all guys who were unhappy about hair loss and chose surgery to improve our appearance. To then end up with a permanent and very visible red zone on your forehead is crushing. Most of these guys end up essentially hiding out from society because the redness is so disfiguring. The absence of any good solutions sucks away their hope, and the lack of support from their doctors leaves them very bitter. Many of them are told the same thing by their hair surgeons: "wait a little longer." If you've waited 3 months, then wait another 3 months. If you've waited 6 months, then wait 6 more. If it's been 12 months, then...

 

Waiting usually works well for hair but isn't always the best solution for skin problems. Wound healing is not well-understood and the best treatment isn't usually clear, so waiting might sometimes be a good option. And it's true that healing can take months and even years in some cases, so waiting could work if your body needs time to work through a slow healing process. But skin is not like hair: there's a good rationale for a wait-and-see strategy for hair because the telogen (resting) stage can last for months. In contrast, wound healing is a continuous process which gradually leads to healing not just deep underneath the skin, but also noticeable improvement in the skin surface as it moves through different phases of healing. So the obvious question which me and every guy who suffers from post-HT skin issues asks is:

If there's been no visible improvement in your skin for months, then what is suddenly going to happen to make it heal cleanly??

 

I now understand personally why guys who have long-term redness drop away. This redness is ugly, noticeable, and utterly life-changing: your work and social life are completely changed in a horrible way. But the hair transplant community barely acknowledges that the problem exists, and there's no data about it, no coordinated attempts to understand it, and no research about solutions.

 

This thread itself is a sign of how big the redness problem is. From what I can tell, it's the most-viewed thread started on this sub in 2017. Pretty impressive for a problem which supposedly doesn't even exist. And I know for sure that many, many people who aren't forum members have been reading this thread, because quite a few redness-suffering lurkers found my email address buried in one of my posts and have emailed me.

 

So I've realized that the best thing I can do is continue standing on my little hill here and scream out that there is a major problem in the hair transplant world which is not being sufficiently addressed. Hopefully two good things can come of it:

 

 

 

• If any doctors or researchers want to look into long-term redness, send me an email. Thanks to this thread, I'm now in touch with a lot of guys who have redness. A lot of them are extremely depressed and bitter and don't post publicly as I do, but if you're doing research, I'll do my best to convince them to give you their data and pictures.
  

 

 

 

• If you're a potential patient thinking of getting a hair transplant, consider what you would do if this long-term redness happens to you. Ask the doctors about potential redness. And run away from any doctor who tells you that long-term redness never happens to his patients, that it doesn't exist, that you have nothing to worry about. There is no good solution, so it's not like they could really offer you help if this does happen to you, but I think it's better to at least have a doctor who acknowledges that the problem exists.
  

 

[hairthere]

Hey JB,

Sorry to hear what you're experiencing. I've had several HTs and in my experience redness can sometimes linger up to 6-7 months. Most patients think of donor scarring being the main issue, but you've also created a good amount of recipient scarring and this can take awhile to heal, especially given your skin type.

 

From my research the best remedies are silicone patches. Mederma, a topical gel, works well, too (my wife used it successfully on a C-section scar). Also vitamin E oil, Aloe, and Emu oil can be used. I think the key with all of these products though is consistent use. So I wouldn't push the panic button just yet. Please keep us updated and continue to use this forum as a support system.

[JayBandana]

Thanks for the comment, HairThere. You've been a huge contributor to the hair transplant community in lots of ways - online and offline - and I read and benefitted from lots of your posts before getting my own transplant. Given your AheadInk experience, I think you'd have a unique perspective on redness and healing.

 

I've realized now that when I talk about recipient-area redness, most doctors, patients, and forum posters are instead thinking of what I'd call a "lingering pinkness". In this case, the extreme redness fades 1-3 weeks after surgery, leaving a pinkish zone that gradually and steadily heals to original skin tone. The healing might be quick within a few weeks, or it might take up to a few months. In my experience, most guys - and most doctors - are referring to this pinkness when they talk about redness.

 

But there's another class of patient. For them - us, actually, since I'm one of them now - the extreme redness fades a bit after surgery, but not much. After some time around the 1-3 week point, the redness stays fixed and doesn't change any longer.

 

Using myself as an example, here's a side-by-side comparison of my front at 7 weeks (on the left) and at 4 months (on the right).

 

Here's the comparison of my left temple over the same period:

 

And a close-up view of the left temple:

 

The change in hair between the pictures is obvious as some of the grafts have started to grow in a bit by the 4-month mark. But the redness is the same in all the pictures. During these last 2 months, there was no change in redness or the incision marks. In fact, there's been no change in my redness since the 2-week point.

 

Guys have now emailed me pictures of extreme redness which they've also been suffering post-op. Some are even more red than me. As for duration, I'm only at 4 months, but these guys are now up to 12 months and - sadly for some of them - much longer than 12 months even. The eventual hair growth from the transplant helps cover it somewhat, but for all these guys, I can unfortunately confirm that the redness is still clearly visible even after the full transplant result has been reached. The contrast between their normal skin and the redness is extreme, and that's what creates such a massive problem in their lives.

 

That's what I mean by extreme, long-term redness. It does happen. And waiting doesn't always cure it.

 

About your own post-op healing experience, hairthere, how was the redness progression? How did it fit in this context? Do you have pictures you could post?

 

Regarding "skin type" which you mention, I'm doubtful. I've found that skin type is one of the hand-waving explanations which doesn't seem to have a lot of evidence behind it and doesn't help in any event. Many doctors (and forum posters) quickly say that my blond/blue-eyed/fair-skin type is why I have an extreme redness which looks like will last at least very long-term and possibly permamently. But as I wrote in my previous post above:

 

 

• Most guys with fair skin don't get extreme long-term redness.
  
• Many guys with dark skin tone and/or dark hair do get extreme long-term redness.
  

 

Maybe there's a slightly higher percent of fair skin guys who get redness compared to darker skin guys. No one has any idea, because there is no data. But even if there is some truth to that, it's still not a real explanation. Let's say 10% of blondes get extreme redness, while 7% of darker haired guys do. You still don't know why those particular blondes and brunettes get redness and others don't, you don't know how to reduce the incidence of extreme redness, you don't know who clears up with no outside intervention and who ends up with long-term/permanent redness, and you don't know what treatments could help.

 

I'd think the goals for the hair transplant world regarding redness should be:

 

1. Prevent post-op redness as much as possible, particularly the extreme, long-term redness.
   
2. For redness which does occur, be able to offer evidence-based treatments which can help the skin with minimal risk of harming the transplanted hairs.
   

 

To reach those goals, there has to be research, data, tests, and analysis. A hair transplant surgery is similar in some ways to other skin trauma events, and much of the current wound-healing research could be applicable. But hair surgery is also very unique in many ways, such as the number of wounds, the size and depth of each wound, the proximity of the wounds to each other, etc, as well as the fact that there are hair grafts inserted into the wounds which hopefully will grow out. So it'd be very useful to gather cross-clinic, standardized data specifically about hair transplant surgeries and healing characteristics.

 

It'd be very helpful for current and future patients if you and others with influence in the community could help bring attention to this problem of long-term extreme redness after hair transplant surgery.

 

Wound healing is an incredibly complicated field that's not well understood, and no one expects miracles. But nothing will change and no progress will be made if the hair world continues to ignore the issue. I understand that many HT people - doctors, patient reps, forums, even many patients - have little incentive to deal with the issue or even acknowledge it exists, but long-term extreme redness is a real problem which will not solve itself or just disappear. The longer there is no active work on the problem, the more patients there will be who will suffer.

[mrfivehead]

The redness impacted me for a couple months, afterwards the pines lasts around 5-7 months before my skin matches native density.

 

It can be frustrating but your skin is healing from where you started from

 

 

 

 

Doctors should stop misleading people with this whole idea that post red inflammation is gone within a month. Absolute bullshit.

 

 

 

 

Most people with fair skin can expect a few months at minimum before the skin looks presentable.

 

 

In your case I would recommend make up. I used a 3 in 1 foundation for a few months post operation. Helps tremendously.

[JayBandana]

4.5 month update

 

The redness on my forehead is still as red and obvious as ever. There has been no improvement in the redness since 2-3 weeks after my hair transplant surgery.

 

Hair growth

In the recipient area on my forehead, many new hairs have grown in, tiny and white. And lots of the tiny, white hairs which had already popped in have now matured to become thicker, darker, and longer. It's not an amazing result so far, but it seems pretty normal at this stage: at 4.5 months, the hair growth in the recipient area is fine on all measures. I'll know better around the 8-month mark, but at least at this point, the hair transplant itself seems decent and doesn't seem to have any negative effects from the redness or be connected in any way to the redness.

 

Appearance of the redness

One effect I didn't expect: because of the maturing transplanted hairs, the redness actually looks worse now than it did a few weeks ago.

 

The tone of my skin redness hasn't changed at all, which I confirm all the time by measuring the redness on the computer both on an absolute basis and relative to my forehead skin which was not operated on.

 

But the redness is looking worse as the transplanted hairs mature and get darker. The hairs don't hide the redness; it's too sparse now, and realistically it'll never be dense enough to cover such extreme redness. Instead, the darkening hairs provide contrast to the redness, making the redness look dirtier and more gory.

 

Treatments and Life

I don't know what to do. Almost all the potential skin treatments involve some form or other of hurting the skin first in order to make it heal itself. But it's hard to know which if any of the potential treatments will work. And because of the transplant, it's a big risk to try any of them: I'm worried about starting any skin treatment while the transplant hairs are still just popping in and maturing. So I've had to accept that it's best to keep waiting and let my life to continue to be destroyed for the next few months.

 

I've considered HGH. The idea is that it might stimulate healing. The advantage compared to skin treatments is that it's an injection in the butt or abdomen, so no need to further aggravate the forehead skin or risk harming the incoming grafts. There's no hard evidence behind it, so it's a total shot in the dark, but I've found some positive anecdotal reports. We'll see.

 

I stopped work because there's no way I can do my job with this red bandana etched across my forehead. As I wrote earlier, of course all people should accept the redness and treat me the same as they would otherwise, but the world isn't perfect and the reality of my professional life is that redness from a hair transplant operation is a massive burden that can't be overcome.

 

As for social life... get serious. Show me any social scene where you can go normally with a huge red scar from one side of your head to the other and not have it become the only topic and negatively affect you. Imagine it like this: one week after a hair transplant, almost no guy wants to go out socially and show his face around. For most people, they get past that point after 4-8 weeks. But for hair transplant patients who have the extreme long-term redness, that need to hide continues month after month after month. So I'm shut out from most social scenes. At least I have been trying to do things where I can get away with wearing a cap.

 

I tell to myself and to all the guys I now correspond with that we shouldn't exaggerate how bad the redness is: it's not life-threatening, it's not a true health issue for us or a loved one. As I wrote before, relative to real health issues, this redness is obviously of zero importance. But given that the whole thing started because of the desire which all of us hair transplant patients had to improve our cosmetic appearance... within that world, it's soul-crushing.

 

Willful Blindness

I've seen more often now how the hair transplant industry is willfully blind to the problem of long-term, extreme redness in the recipient area.

 

I now know as a fact of several more patients who have had extreme long-term redness from hair transplant surgery, but their doctors say that redness does not exist and has never occurred in their clinics.

 

I also have now encountered a case where a patient has had redness for over a year. But the guy's doctor says that it's not red. I saw the same pictures of the guy as the doctor did. The redness is as obvious as his nose: if you can see one, you can see the other. The redness is very visible on the hairline edge outlining the hairline, and it's not very hidden even where the transplanted hairs are most dense. The poor guy is very upset about it, and rightly so: the truth is that it looks like a very large area of unhealthy skin. But the doctor doesn't see it and says it doesn't exist.

 

This is typical of what I've found. Many in the HT industry don't or won't see that long-term extreme redness exists. There is no data collected in the industry to use to analyze the problem or minimize its occurrence; moreover, there is no sense that there is even a need to analyze the issue. And there definitely is no push to test treatment alternatives.

 

To the extent that anyone acknowledges that long-term redness can happen, it's always claimed that it happens at some other clinic because that other clinic uses abc technique or doesn't use xyz procedure or just doesn't do things right in general. (I can't emphasize how much intra-industry criticism I've heard from top hair doctors in my redness journey in the last few months; it's like internecine warfare among them).

 

But despite the canard that redness only occurs in shady clinics in remote places using barbaric techniques, I now know of many guys (including myself) who had surgeries in well-known places with doctors who are considered top-tier on this forum and in the industry, yet who ended up with extreme, long-term redness.

 

Support

Big thanks to all the guys who've offered me their support. Message on this thread, PMs to me on this forum, and the dozens of emails I've gotten, both from people also suffering from redness as well as those who aren't but have ideas or just kind words.... to all of you, thank you very, very much.

 

I was prepared for up to 8 weeks post-op of hiding out, even 10 if necessary, and I was ready for 1 year of patience to see the final result. But I wasn't prepared at all for hair transplant surgery to destroy my life for 5 months... and most likely many more months to come. I'm trying my best to stay positive, I'm putting out as much info as I can here and in private emails in order to help out other guys and to raise awareness of the issue. But for me personally, it's rough. Really really rough. So thank you for the support, the kind words, and the suggestions: it's been a big help in getting through all this.

 

- Jay