Rough red skin / 6 months post operation

[turingmachine]

I've been lurking around these forums for years and finally had my operation just a little over six months ago FUE of ~2100 grafts front, I'm Norwood 2 to 2A. I want to focus the skin in the post rather than yield.

 

- The the skin has gotten better over the months, but it's still noticeably red. It's not bruised any more, no red spots or scars. Just redness. Is this normal at this point?

 

- The recipient area is very rough. Passing my fingers through the hair and pressing the skin softly, I can feel every hair as a very small bump. It creates a rough skin feeling. I do not feel the same passing through regular hair. I can see those "bumps" if I look very closely in the mirror. To be fair, these bumps are small enough it's hard to capture by a smartphone camera.

 

It still bothers me as does get highlighted in certain lighting, especially along with the redness. I asked my doctor about it, whether it's "cobblestone" and what can be done about it. They said it's not cobblestone and it should soften as time goes by. I know I should just wait, but I want to know there's a plan B in case it remains. I've read about "dermarolls" and "fraxel" to smooth the skin. Anyone else experienced similar skin issues and can advise?

 

Thanks!

Edited July 12, 2017 by turingmachine

[turingmachine]

Doing some more research I found just a few articles mentioning laser resurfacing (fraxel is one of the options) to fix the skin. Problem is I can't find a single case online that shows how such procedure would work on a recipient area of an HT patient. Could it be that there's generally little experience in fixing rough skin for HT patients?

[JayBandana]

The laser which dermatologists usually use for the redness from vascularization is a pulsed dye laser. There are several brands; the most common I've found used in clinics is the Vbeam laser made by Candela (https://syneron-candela.com/na/product/vbeam-perfecta). The idea is that the Vbeam laser is targeted to a very narrow wavelength which only targets the redness of the blood vessels and doesn't harm the skin or hair follicles. But there's lots of worry that the laser really can't really be so precise and will end up harming your HT result.

 

Fraxel is a different type of laser treatment which is promoted for general anti-aging improvement of the skin for things like fine wrinkles, pores, and uneven patches of skin tone.

 

The dermaroll you're talking about is also called microneedling or collagen induction therapy. You can buy a home version or you can have it done in dermatology clinics or some spas. It uses tiny needles to puncture the skin. Some clinics suggest this therapy for acne scar treatment.

 

Results from all these treatments vary a lot. Microneedling is probably the most controversial, but for all these treatments you can quickly find hundreds of (non-HT) stories online of both good results and of disasters.

 

For treating the redness and skin texture from hair transplant surgery, I've looked a lot for research, but I've found nothing. As far as I can tell, there's no data which is collected and maintained by doctors, and there's no organization which keeps a database of cases. So no one can give you any suggestions which are based on large data-sets. It will be all be anecdotal evidence like "I know a guy who knows a guy who did this...".

 

It's also a question whether your reaction to these treatments will be different than most people. Your redness and cobbestoning at 6 months post-op already shows that your skin is different. Wound healing is very complicated and no one can really tell you why your skin reacts like this. There are lots of concrete reasons which could be behind your redness - things like allergic reactions, for example - but in many cases no one has any idea why it happens. But whatever the reason, it's worth being careful because any treatment could actually end up making your skin worse. One idea is to test a very small patch of skin and see how you react.

 

I've written a thread on this forum about the extreme redness I have now after my hair surgery. I went to many doctors. I also have been emailing with a lot of guys who have redness for long periods (6 months, 9 months, and (sadly) permanent redness for 12+ months). Buried in that thread is a post here where I wrote in more detail about long-term redness and treatment options.

[turingmachine]

Jay, thank you for the detailed response, albeit rather depressing. I have a feeling treatment is out there, there's just little to no incentive for professionals in the field to talk about it or even deal with this. We need to keep the conversation going. Perhaps the best we can do right now is collect as much information even on "a guy who knows a guy" and hope for the best.

 

Sending you a private message now

 

Edit: Private messaging does't seem to work on these boards (shows up a blank page). Let me know if there's another way to get in touch

[turingmachine]

OK, in an effort to wake this thread up I captured some photos

 

It's pretty difficult to capture using a phone so I used my dslr. It's hard to notice the redness with these close ups. I did manage to capture the "cobblestone"-ish / rough skin I have in the recipient area. All of these photos were taken today, under two different lighting settings.

 

I have a feeling so much of HT discussion is focused on density nobody is talking about skin health. Surely it's more common than it appears. Would love to get more responses. Anyone had anything like this and it passed as time went by (as my ht dr suggests)? Anyone stuck with it?

Edited July 12, 2017 by turingmachine

[YouOnlyLiveOnce]

Sent you a PM

[turingmachine]

Sent you a PM

 

I know this sounds odd but my inbox shows up a 500 server error message:

 

http://www.hairrestorationnetwork.com/user_messages.php'>http://www.hairrestorationnetwork.com/user_messages.php

 

This page isn’t working

 

http://www.hairrestorationnetwork.com is currently unable to handle this request.

HTTP ERROR 500

[YouOnlyLiveOnce]

Ok, my question was more or less asking which Dr you went to. I took a guess based on what I'm seeing.

[turingmachine]

Ok, my question was more or less asking which Dr you went to. I took a guess based on what I'm seeing.

 

I'll gladly talk about it in PM once it works. Any way to fix the issue?

 

I found the following section, "Correction of Tenting" in the following book. Source

https://books.google.co.il/books?id=vd6ILG_cOjIC&lpg=PA264&dq=hair%20transplant%20tenting&pg=PA264#v=onepage&q=hair%20transplant%20tenting&f=false

 

They mention dermabrasion, laser resurfacing, electro-cautery (?) and steroids.

 

Edit: PM finally works, feel free to message me

Edited July 10, 2017 by turingmachine

[JayBandana]

Turing,

 

It seems you have a pretty good result so far at 6 months? And hopefully good progress still to come :-)

 

Btw, nice camera! ;-)

 

I think you've found what I and all the guys I've spoken to have realized: according to many HT people, your skin issues don't exist. Quite a few people - including hair surgeons - think that these long-term HT skin issues don't really happen. I'm at 3+ months now with huge redness still and clearly visible incision marks. I've talked with guys at 6-12+ months post-op who have very red and cobbled skin - much worse than yours - but their own own doctors don't recognize that there's even the potential for long-term skin problems from hair surgery.

 

Hair surgeons are focused on hair, so the skin issue doesn't get any attention. It's really a blind spot.

 

And to the extent that anyone acknowledges there's a long-term problem for some minority of patients, the answer from hair surgeons is almost always "wait a little longer."

 

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 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??

 

It'd be great if you really want to push the industry to recognize and deal better with the problem. You're right that there's little incentive to discuss the issue, let alone research treatments. It'd be great if they would gather data in order to understand the problems. The doctors I've spoken to have told me they don't know of any data. They also say that their estimates of the problem and its progression are based on their gut feelings (most doctors I've spoken to also invariably say that long-term redness and skin texture issues never happen in their clinics... the problem is always in some other clinic :eek:!).

 

So the data which exists is purely anecdotal and is very unreliable: for example, from the lurkers I've met from my thread I linked to earlier, I'd guess that at this point I have more case data about patients with extreme redness than most doctors, and from that I've found that the description and statistics about long-term HT-skin issues which doctors give based on their experience are often just factually wrong.

 

I've found examples of many cases that don't fit the usual hand-waving explanations from doctors and on forums. For example, 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 do and some don't. On the other hand, I've now found dozens of guys with dark skin and hair who have as much or even more redness and skin issues than I do, 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, despite what gets repeated in the HT world.

 

What's your background (from your link, are you Israeli?).

 

In addition to collecting data about the issue, if you really are keen to push people in the HT industry as you say, then I think it'd be great if they would organize and evaluate tests of different treatments. For example, it'd be very helpful to have small experiments of whether Vbeam laser harms hair follicles: test different settings, treatment variations, patient characteristics, etc. If some form of laser treatment could be shown to work well for redness and not affect hair, it'd be a very valuable add-on service which hair surgeons could offer to patients who have extreme redness around the 1-2 month mark.

 

About your redness:

It looks like your hair is covering some of the redness nicely now, but in the first picture, it's still visible as little red islands surrounding the front hairs. In the fourth picture, your skin in the recipient area is also noticeably different in tone than your natural skin.

 

How visible is your redness from different angles and lighting? One issue I've noticed after having looked at lots of pictures of myself as well as all the guys who've sent me their pics is that close-ups underestimate the redness. I think this is because the HT redness is a large, clearly-defined zone rather than just a few small spots. On close-ups, the redness can look like a pink spot which seems to be not such a big deal, but when you back up and see the person from normal distance, the overall red area is very clear. Any difference in skin tone is really obvious when it's so large and precisely drawn; the human eye is really good at spotting this type of difference. And even when hair grows out and covers most of the redness, the edges of the redness create a red outline under the hairline which is very obvious - I'd guess that's happening in your case?

 

Do you have pics from the 2-4 month period? It'd be interesting to see how your redness was before the growth, maybe it could give some hints as to how it'll progress from now.

 

About the treatments you mention:

Most treatments for improving wound appearance are based on the idea of destroying the skin a bit in order to force (re-start) healing. But a lot of times, the treatments don't help at all, although no one knows if it's because of operator errors, setting issues, patient differences, or just overall being the wrong treatment for the problem. Additionally, these types of treatments definitely aren't risk-free: the skin damage from a treatment can and does cause lasting and sometimes permanent harm in some patients, making the skin redness and texture worse than when you started. That all applies for anyone dealing with any type of wound or scarring. In the case of hair surgery patients like us, we also have to worry about whether the treatment will hurt the hair follicles, and that's a gamble: I've found no reliable data to use as guidance on it.

 

Dermabrasion is a pretty old procedure where you're numbed and a doctor uses a brush or wheel to destroy the outer part of your skin. Every patient is very red for weeks or months afterwards whilst it heals. Since you've already seen that your skin becomes more red than most people's, I'd guess that in your case it would be red much longer than average after a dermabasion procedure. Personally, I'd stay away from it.

 

Dermatologists told me that dermabrasion isn't used so much anymore. The book you linked cites as reference for it a 2008 article from Japan, so maybe dermabrasion was more common at that place and time?

 

Microdermabrasion is not so rare. In microdermabrasion, the doctor shoots crystals onto your skin in order to exfoliate and remove the outer layer of skin cells. It's often used for melasma, the brown spots associated with female hormone surges (birth control pill, pregnancy, etc). Microdermabrasion is a lighter, less intense procedure than laser or chemical peeling, and has much less impact.

 

Electrocautery is a new idea for me. I haven't heard that suggestion either from doctors or from other patients. Just looking it up, it seems the idea is to burn the tissue in order to stimulate healing. Heat is passed through a resistant metal wire which is used as an electrode. This hot electrode is then placed directly onto the skin they want to treat, destroying that specific tissue. I'd think laser would be the same idea but more precise and less risky for your sensitive skin and valuable hair follicles. But I don't know. In my next round of dermatologist consultations, I'll ask. Let me know if you find anything.

 

Topical steroids or steroid injections is suggested often. I've heard of a few HT patients for whom it worked, but they were cases where they just had a very faint pinkness, so it's a question if the steroid really helped or if their skin was simply healing on its own anyway. I tried a fairly strong steroid myself, but there was no visible change for me. Several of the extreme-redness guys who wrote me have also tried steroids, but they also got no benefit. Who knows, maybe it's worth a try for you, but as I wrote to you earlier, it can have serious side-effects, so you don't want to continue more than a few weeks max.

 

 

About site logistics:

- I know what you mean that it seems like your thread - and this forum overall - is asleep. I used to think so too, but after posting my email in one thread, I got lots of messages from lurkers who read everything but never post on the forum, so I guess there's a large silent base out there reading this.

 

- A mod has to enable PMs for you so they'll work.

 

- If you want to contact me, you can email me if you'd like. My email is in this redness thread I linked to earlier.

[aWidowsPeek]

turingmachine your hair looks completely normal for 6 months quit worrying haha. All transplants look like that mega close up.

[turingmachine]

Jay, thank you for the huge response! Good research so far. To answer your questions:

- I'm a combo of european / middle eastern, kind of pale with dark brown hair. So hair density indeed helps covering up, but redness and tenting is visible up close. I also want to reserve the option to shave it all off- what if the skin remains this way?

- Different lighting changes how it looks completely, as seen in the photos attached in previous page. First two were taken in one room, other two in another. I found that in the dark the difference in skin tone is even easier to spot.

- Redness in my case is mostly highlighted around each hair, which highlights the small bumps.

- Attached to this post: 1. Another angle on my skin taken a few days ago 2. I found this photo taken at two months. I remember describing to my dr that it's far redder than this photo has captured. Btw, you can see no bumps are visible, these appeared only as the hair emerged.

 

aWidowsPeek, thanks, I hope so mate. I realize there are far worse cases but if that's how a normal HT look like up close, then there's a huge issue with HT nobody's talking about. The skin is rough, not nearly as smooth compared to any other part of my scalp. It's kind of scaled with tenting. You can feel it and see it. I was definitely not prepared for this (and it's my fault). Can you describe your experience? How was your skin during / after?

[JayBandana]

Really great that you're posting here publicly and trying to raise awareness of the issue. A lot of guys end up very bitter and depressed after many months of no skin improvement after hair transplant surgery. It's really disheartening because doctors ignore them, tell them to wait and wait and wait and they still get no skin improvement. I can really empathize with these guys - I'm starting to go bat-sh!t mental and I'm at 4 months, I can't imagine how I'll be at 6+ months if I don't improve. But unfortunately, by going quiet from bitterness and not publicizing their problems, the skin issues these guys are suffering don't get as much attention as they should have. So respect to you for writing about this, Turing. I hope more guys jump on the forum and post their pics (I'm looking at all you lurkers who I know are reading this!!).

 

I know it's not a lot of consolation, Turing, but your skin is much better at 6-months than at least a dozen guys who've emailed me. And I imagine that in 2 months when I'm at my 6-month point I'll be worse than you as well.

 

The change in your skin from 2 months to 6 months is interesting. The redness at 2-months traces a fairly straight path (I assume it's the path of the hairline incisions your surgeon made). But in the 6 month pics (#1 and #111, especially) the redness seems to only be in circles around some of the grown hairs; in the areas where there are no hairs, it looks like it's faded to your natural skin tone. Is that just an artefact from the pics, or is that really what's happened?

 

How about the skin in your recipient area which is further back (towards the crown) from your hairline, can you see between the newly-grown hairs how is the redness there?

 

Your skin redness at 2 months isn't good, but it's not as bad as me or other long-term cases I've seen. Plus, you say (and it looks from your pics as well) that you didn't have any noticeable incision marks at 2-3 months? So is it that the newly growing hairs have caused the tenting and redness in the skin where they popped out?

[Spidey]

Jay, thank you for the huge response! Good research so far. To answer your questions:

- I'm a combo of european / middle eastern, kind of pale with dark brown hair. So hair density indeed helps covering up, but redness and tenting is visible up close. I also want to reserve the option to shave it all off- what if the skin remains this way?

- Different lighting changes how it looks completely, as seen in the photos attached in previous page. First two were taken in one room, other two in another. I found that in the dark the difference in skin tone is even easier to spot.

- Redness in my case is mostly highlighted around each hair, which highlights the small bumps.

- Attached to this post: 1. Another angle on my skin taken a few days ago 2. I found this photo taken at two months. I remember describing to my dr that it's far redder than this photo has captured. Btw, you can see no bumps are visible, these appeared only as the hair emerged.

 

aWidowsPeek, thanks, I hope so mate. I realize there are far worse cases but if that's how a normal HT look like up close, then there's a huge issue with HT nobody's talking about. The skin is rough, not nearly as smooth compared to any other part of my scalp. It's kind of scaled with tenting. You can feel it and see it. I was definitely not prepared for this (and it's my fault). Can you describe your experience? How was your skin during / after?

 

I too also have some of the "cobblestoning" that you have shown in your pictures but it depends on the lighting and angle where it can be seen, and only on a few hairs, not all. And like yourself, during the first few months when no hairs were sprouting, the skin texture had no bumps and was smooth as well. I think it has to do with the hairs growing out, and the thickness of the shaft that might be causing the skin to dimple out? As you can see it looks worse when you pull the hair against the natural direction as well...

 

I know in the future, if my hair loss progresses, I will not attempt to play catch up. I do plan to laser the transplanted hair away and hopefully what I see under is normal skin... If not, I plan to see if there are options like fraxel out there for me.

 

Redness: I am 2 years post op and after a hot shower my recipient area is still slightly pink.. I think it has some to do with my use of rogaine. I remember going off rogaine for a couple days and the recipient area looked a lot paler, but who knows.

 

At the end of the day, I had a small procedure, and although I am extremely happy with my results, I am not going to defy nature anymore as I have better things to worry about, and money to spend on...

[turingmachine]

Hi, to continue where this topic left off, I've now opened a new discussion for 18 months post op with a possible operation that might help: