Redness pitting cobblestone after 3 transplants

[Redhead]

Hello! 

Ive had 3 transplants in total now and I really dont know what to do. The first one was an absolute butcher job by dr diep back in 2019. Im glad that its a bit better now. My biggest issue now is the cobblestone and the density. The cobblestone makes my skin uneaven and red. I also think that the hair in the front are to thick. 
 

My last transplant was with dr mwamba and im going back for a consultation soon. I dont know if he is going to remove some grafts or something else.

 

If it wasnt for the Redness and cobblestone (and a bit of density and finer hair) I would be happy. Ive lived with this now for a couple of years and i have been quit deppressed about this situation. Its somewhat better nowdays but its hard not to think about.

I hope u guys have a great start in 2023! 
Cheers!

[BaldReaper]

The density looks good to be honest but the redness is obvious from up-close. Did Dr Mwamba tell you that the cobblestone is related to the redness? How do you know it? 

[Redhead]

1 minute ago, BaldV said:

The density looks good to be honest but the redness is obvious from up-close. Did Dr Mwamba tell you that the cobblestone is related to the redness? How do you know it? 

Its better on the sides but its quit thin in the middle still. No, he dose not know why its red. Thats why im going back there. I just think it Can be due to the cobblestone. 

[HappyMan2021]

26 minutes ago, Redhead said:

My last transplant was with dr mwamba

im confused, was you last surgery with mwamba considered a repair or was it your run-of-the-mill implantation?

Mwamba is highly regarded as a repair surgeon, so it's strange to me that you can present to him with these botched issues and he did not address them in your last surgery. 

[Redhead]

33 minutes ago, HappyMan2021 said:

im confused, was you last surgery with mwamba considered a repair or was it your run-of-the-mill implantation?

Mwamba is highly regarded as a repair surgeon, so it's strange to me that you can present to him with these botched issues and he did not address them in your last surgery. 

We discussed it when I was there and we both tought that the best thing to do was to lower the hairline a bit to hide the old transplant. Its been 8.5 month since that transplant and im beginning to worry a bit. Thats why im going back there for a checkup. 
 

My experience with dr mwamba is good. So  i hope it will work out fine!

[Fue3361]

Hm, I’d say the density is solid.  Cobblestoning is quite hard to see as well.  I could see the redness making you uncomfortable though.

 

I think maybe your best bet is seeing a good dermatologist?  There are lasers that are designed just for correcting pigmentation issues.  This might be easy to deal with, but I’m just guessing here.

[Redhead]

3 hours ago, Fue3361 said:

Hm, I’d say the density is solid.  Cobblestoning is quite hard to see as well.  I could see the redness making you uncomfortable though.

 

I think maybe your best bet is seeing a good dermatologist?  There are lasers that are designed just for correcting pigmentation issues.  This might be easy to deal with, but I’m just guessing here.

I will wait and  see what dr Mwamba recommends. And then I’ll see if I can find a good dermatologist that have some experience with hair transplants or at least know what it is haha!

[Ajamilo]

I have also cobblestoning  and not sure what to do with it. Is it possible to get it removed?

[Fue3361]

1 hour ago, Ajamilo said:

I have also cobblestoning  and not sure what to do with it. Is it possible to get it removed?

I think I read somewhere a long time ago that if you continuously shave the area, you slowly file down the skin height back to normal height over the months.  But not sure if this is true or not.

[Fue3361]

2 hours ago, Redhead said:

I will wait and  see what dr Mwamba recommends. And then I’ll see if I can find a good dermatologist that have some experience with hair transplants or at least know what it is haha!

Even if they don't have much experience with hair transplants, they should have experience with bodyhair and facial hair, and how that effects skin pigmentation treatment.  I'd be shocked if they never ran into someone with pigmentation problems around the beard area.  So I doubt a HT would be a big factor when discussing treatment options.  

Just find someone that works with aesthetic problems.

[Redhead]

9 hours ago, Fue3361 said:

Even if they don't have much experience with hair transplants, they should have experience with bodyhair and facial hair, and how that effects skin pigmentation treatment.  I'd be shocked if they never ran into someone with pigmentation problems around the beard area.  So I doubt a HT would be a big factor when discussing treatment options.  

Just find someone that works with aesthetic problems.

Okay! I’ll see what Mwamba have to say first. 
 

Thank you for the tips!

[Matt3210]

22 hours ago, Ajamilo said:

I have also cobblestoning  and not sure what to do with it. Is it possible to get it removed?

I also have a problem with cobblestoning from Dr. Mwamba. I use a 1, 1.5mm dermaroller. It's getting a little better, but I doubt it'll go away completely. The only way to get rid of this may be to remove the misplaced grafts with FUE.

[Ajamilo]

5 hours ago, Matt3210 said:

I also have a problem with cobblestoning from Dr. Mwamba. I use a 1, 1.5mm dermaroller. It's getting a little better, but I doubt it'll go away completely. The only way to get rid of this may be to remove the misplaced grafts with FUE.

I have send u message

[Rahal Hair Transplant]

How long ago was your last hair transplant? If you guys looking at the photos, I agree with other members that say the density looks good, it’s just that there’s obviously some ongoing postoperative redness. Have you spoken to your physician about what this information could be from and what to do about it? If your third hair transplant wasn’t too long ago then this would explain it but if it was over a year ago for instance, you should not continually be experiencing. The redness unless you’re supposed to stop to the sun or there’s some other underlying stop condition.  

obviously pictures on always showcase reality 100% so if there’s something going on that we’re not seeing, you may wanna take some additional photos of the entire scalp.

As for the information/redness, I just suggest speaking to your physician to see if he suggests any topical applications that could help to reduce this. You may also want to consult a dermatologist to see if you have any other stop condition that could be causing this.

Best wishes,

Rahal Hair Transplant 

[Redhead]

On 1/4/2023 at 2:51 PM, Rahal Hair Transplant said:

How long ago was your last hair transplant? If you guys looking at the photos, I agree with other members that say the density looks good, it’s just that there’s obviously some ongoing postoperative redness. Have you spoken to your physician about what this information could be from and what to do about it? If your third hair transplant wasn’t too long ago then this would explain it but if it was over a year ago for instance, you should not continually be experiencing. The redness unless you’re supposed to stop to the sun or there’s some other underlying stop condition.  

obviously pictures on always showcase reality 100% so if there’s something going on that we’re not seeing, you may wanna take some additional photos of the entire scalp.

As for the information/redness, I just suggest speaking to your physician to see if he suggests any topical applications that could help to reduce this. You may also want to consult a dermatologist to see if you have any other stop condition that could be causing this.

Best wishes,

Rahal Hair Transplant 

I think this was taken 8 months in. I'm going back to Bryssel in a week so then we will see what mwamba says. And after that I will probably see If I can find a dermatologist.

[Redhead]

9 Months update (1 week before consultation with Dr. Mwamba).

I've taken pictures with some different lighting. I agree with u that the denisty is okay for the most part. What Im most concern about is the redness and that it does not look natural (at all in my honset opinion). I've also taken some pictures with downlighting so u really can see the pitting/cobblestone. And unfortunately it looks like I got more from the last transplant with dr mwamba. Maybe Im just having to high expectations, I dont know.

Please let me know what u guys think.

[Al - Moderator]

I think your best bet right now is to just wait it out for the next few months at least until you get past the 12 month mark. Lingering redness will usually mostly clear up on its own over time and cobblestoning. if it isn't too bad, will smooth out a bit over time as well. Certainly talk to Dr Mwamba to see what he says, but it could just be that you need a bit more healing time.

[Matt3210]

you are not the first person with this problem. cobblestoning is a complication of bad HT technique. You don't have exorbitant requirements and you shouldn't experience it. It is avoidable and most doctors manage it. Unfortunately, some doctors still don't care about these things.

[Redhead]

3 hours ago, BeHappy said:

I think your best bet right now is to just wait it out for the next few months at least until you get past the 12 month mark. Lingering redness will usually mostly clear up on its own over time and cobblestoning. if it isn't too bad, will smooth out a bit over time as well. Certainly talk to Dr Mwamba to see what he says, but it could just be that you need a bit more healing time.

Yeah, you are probably right. I will come back with an update in a couple of weeks when I have spoken to mwamba and seen a dermatologist. 

[UnbaldEagle]

Hey @Redhead. It's been a while since I posted here. I just read your post and felt like I'd share my own experience with these issues. Know that there's hope and treatment options, but those are not called Aloe Vera, topical steroids or pretty much any ointment that your dermatologist might prescribe. Dermatologists who do not operate lasers can offer little help apart from telling you what's typically advised here: just wait a little bit more, it will fade. Even though from what I understood, it's been years in your case. The problem is, especially considering scar redness is that if it didn't fade in 7 months, it is pretty much a permanent condition. In some rare cases it would fade until 1 year, but it just stops improving after that. First of all, it is not your skin that is red per se, nor is it postoperative redness (i.e. erythema) as it was offered by someone above. That's a normal stage of wound healing, whilst having this amount of redness 9 months post op is simply not. As I said, when it comes to redness it's not really your skin that needs to be healed, but rather the capillaries which were ruptured by the thousands of incisions. So it's the broken capillaries that are causing the redness (they are not actually broken, but remain more dilated than before), hence it's a 3D problem rather than 2D. 

As far as treatment options are concerned, yes, dermatologists would sometimes prescribe a topical steroid, as they are anti-inflammatory, and some of the stronger ones, such as clobetasol propionate, are vasoconstrictive, so in theory they would constrict these dilated capillaries which are causing your redness. However the blood is still pulsing under pressure from the heart, so it would require long term use to see a noticeable reduction in redness, which is a problem because steroids would thin the skin, potentially leading to skin atrophy, which is irreversible and would make telangiectasia even more visible. So it's best to avoid topical steroids, or use them sparingly. I've tried a few myself and haven't seen any improvement. If you really want to try out any topical, there's tacrolimus which acts just like a steroid, but without causing any thin skinning, or silicone sheets, for which there are some studies showing they could reduce the appearance of hypertrophic scars, including redness and cobblestoning. The only problem is it's difficult to apply them on a hairy area. But of course do consult with a dermatologist, maybe they will tell you something new.

The gold standard for treating redness are lasers, which would also cause permanent hair loss, apart from one pulse dye laser called Vbeam. It is generally used to treat rosacea, but they're equally effective with other vascular issues. Vbeam targets dilated surface capillaries, causing them to shrink, or with purpuric settings (more Joules and different spotsize), causing them to effectively burst and disappear. The blood vessels feeding your follicles are much deeper and at a wave length of only 595 nm, Vbeam wouldn't reach them (the other pulse dye laser, Nd:YAG most likely would). I've had a total of 4 Vbeam treatments thus far and the redness is much better these days. I would say mine was comparable to yours at around the year mark. I didn't shave my hair for the first 3 treatments so it's possible that my hair has absorbed the energy from the laser and that's why my forth treatment, for which I shaved my hair, appeared to be more effective. I'm planning to do 2 more treatments and then hopefully move on with my life and try to forget I ever had this dreadful HT. 

Lastly, for the cobblestone appearance of your skin, there's microneedling, but again, that would require a few sessions. I would recommend going to a professional rather than buy the dermaroller or dermastamp and DIY. A forum member here, @harryforrealhad some great success in treating his own plucked chicken skin.

All the best and I hope you find a way. If it's any consolation, I think your hair looks great otherwise.

 

[Melvin- Admin]

Would you be willing to share updated pictures? 

[Parasol]

15 hours ago, UnbaldEagle said:

Hey @Redhead. It's been a while since I posted here. I just read your post and felt like I'd share my own experience with these issues. Know that there's hope and treatment options, but those are not called Aloe Vera, topical steroids or pretty much any ointment that your dermatologist might prescribe. Dermatologists who do not operate lasers can offer little help apart from telling you what's typically advised here: just wait a little bit more, it will fade. Even though from what I understood, it's been years in your case. The problem is, especially considering scar redness is that if it didn't fade in 7 months, it is pretty much a permanent condition. In some rare cases it would fade until 1 year, but it just stops improving after that. First of all, it is not your skin that is red per se, nor is it postoperative redness (i.e. erythema) as it was offered by someone above. That's a normal stage of wound healing, whilst having this amount of redness 9 months post op is simply not. As I said, when it comes to redness it's not really your skin that needs to be healed, but rather the capillaries which were ruptured by the thousands of incisions. So it's the broken capillaries that are causing the redness (they are not actually broken, but remain more dilated than before), hence it's a 3D problem rather than 2D. 

As far as treatment options are concerned, yes, dermatologists would sometimes prescribe a topical steroid, as they are anti-inflammatory, and some of the stronger ones, such as clobetasol propionate, are vasoconstrictive, so in theory they would constrict these dilated capillaries which are causing your redness. However the blood is still pulsing under pressure from the heart, so it would require long term use to see a noticeable reduction in redness, which is a problem because steroids would thin the skin, potentially leading to skin atrophy, which is irreversible and would make telangiectasia even more visible. So it's best to avoid topical steroids, or use them sparingly. I've tried a few myself and haven't seen any improvement. If you really want to try out any topical, there's tacrolimus which acts just like a steroid, but without causing any thin skinning, or silicone sheets, for which there are some studies showing they could reduce the appearance of hypertrophic scars, including redness and cobblestoning. The only problem is it's difficult to apply them on a hairy area. But of course do consult with a dermatologist, maybe they will tell you something new.

The gold standard for treating redness are lasers, which would also cause permanent hair loss, apart from one pulse dye laser called Vbeam. It is generally used to treat rosacea, but they're equally effective with other vascular issues. Vbeam targets dilated surface capillaries, causing them to shrink, or with purpuric settings (more Joules and different spotsize), causing them to effectively burst and disappear. The blood vessels feeding your follicles are much deeper and at a wave length of only 595 nm, Vbeam wouldn't reach them (the other pulse dye laser, Nd:YAG most likely would). I've had a total of 4 Vbeam treatments thus far and the redness is much better these days. I would say mine was comparable to yours at around the year mark. I didn't shave my hair for the first 3 treatments so it's possible that my hair has absorbed the energy from the laser and that's why my forth treatment, for which I shaved my hair, appeared to be more effective. I'm planning to do 2 more treatments and then hopefully move on with my life and try to forget I ever had this dreadful HT. 

Lastly, for the cobblestone appearance of your skin, there's microneedling, but again, that would require a few sessions. I would recommend going to a professional rather than buy the dermaroller or dermastamp and DIY. A forum member here, @harryforrealhad some great success in treating his own plucked chicken skin.

All the best and I hope you find a way. If it's any consolation, I think your hair looks great otherwise.

 

Hi, my friend! I hope you are doing ok and that life is well. How are you?

[HairFunk]

Hows it looking now? Do you have any dry skins / dermatitis issues? I wonder if Aloe Vera or a Vit E cream would help ?

[Rafael Manelli]

I wish I had more helpful advice. Sorry for your surgery with Diep. Diep is a mess, there's a reason he was removed here recently. Mwamba may be able to help you more. The density looks good. I don't think it looks unnatural, but for the redness and cobblestoning which is apparent in some photos. Maybe you could file it down?

Maybe you could simply add more hair? I wish I had a foolproof solution. Best I can say is discuss with Mwamba. He's the expert.

Ps you have beautiful golden hair, looks great in those first pictures. Looks like great density too. 

And the cobblestoning is only visible in a few pictures. I doubt most people notice anything 

Edited February 3, 2023 by Rafael Manelli

[Matt3210]

1 hour ago, Rafael Manelli said:

I wish I had more helpful advice. Sorry for your surgery with Diep. Diep is a mess, there's a reason he was removed here recently. Mwamba may be able to help you more. The density looks good. I don't think it looks unnatural, but for the redness and cobblestoning which is apparent in some photos. Maybe you could file it down?

Maybe you could simply add more hair? I wish I had a foolproof solution. Best I can say is discuss with Mwamba. He's the expert.

Ps you have beautiful golden hair, looks great in those first pictures. Looks like great density too. 

And the cobblestoning is only visible in a few pictures. I doubt most people notice anything 

Dr.Mwamba have also problems with cobblestoning.