Is it necessary to shave the transplanted area before surgery?

[Cant decide]

It seems that most pics I see of work done immediately after post op show the patient with the transplanted area completely shaved down. I am sure this is done so it is easier on the surgeon to plant the area but does this have to be done? I need to conceal my surgery as best I can post op and shaving the transplanted area would make it look very noticeable to say the least for quite some time.

 

Thanks

[Cant decide]

It seems that most pics I see of work done immediately after post op show the patient with the transplanted area completely shaved down. I am sure this is done so it is easier on the surgeon to plant the area but does this have to be done? I need to conceal my surgery as best I can post op and shaving the transplanted area would make it look very noticeable to say the least for quite some time.

 

Thanks

[New-me]

No, it is not necessary to shave the recipient area. Some top docs like H&W do, but I had an 1900 graft surgery done to my front third of the scalp without shaving the area- shaving the area just wasn't an option for me as I have a professional job that would not allow it.

[Jotronic]

The last thing people think of when they see our patients is that they had a hair transplant and we've worked on our share of professionals, including actors some of your may have heard of as well as CEO's and government officials. I have NEVER had anyone even a week post-op call me to say they were "found out".

 

Dr. Hasson wrote up a response to this same question a while back. Below is the post and the original thread.

 

http://hair-restoration-info.c...571041502#9571041502

 

"All,

 

I originally typed this post in response to Bezane and his question to Pat regarding recipient site shaving. I feel that this is a very important issue and deserved it's own thread.

 

Bezane,

 

The question you ask about shaving is a good one and one that I would like to address.

 

When you ask if it is necessary to shave the pre-existing hair before surgery- the answer is- "it depends".

 

Depends on what? It depends on the quality of the result that you are looking for. Some patients (and doctors) will be satisfied with a less than optimal result while others will want to achieve the very best result possible. For this long term gain a patient may have to endure some inconvenience including buzzing of the recipient area.

 

There are multiple technical factors that come into play during the creation of recipient sites and the subsequent graft placement. These include:

 

1.) When thinning areas are shaved down the "thinning process" takes on a different meaning. With the use of magnification it will be seen that some follicular bundles are absent (and there are wider spaces between remaining bundles) and that some bundles are significantly miniaturized. It will then be possible to place new recipient sites in the place of absent bundles and alongside miniaturized bundles to recreate the density. This can also be done in a uniform manner so that if the pre-existing hair eventually disappears, due to progression of hairloss, the transplant can still look reasonably natural. If the recipient site is not shaved the surgeon must part through the hair again and again looking for any empty spaces and trying to fill the spaces as best as possible. This is not really as exact a process but much more hit or miss.

 

2.) The hair exits the scalp at an exact angle. The only way to precisely match that angle is to buzz the recipient hair down (in a way similar to how ALL doctors need to shave the donor hair when taking out the donor strip).

 

3.) Transection of existing hair below the skin surface is possible if the incisions are not made exactly parallel to the surrounding bundles. We often see this as a "halo" type effect when performing repair procedures.

 

4.) When inserting grafts the technicians can easily identify the recipient sites and ensure that all sites are filled. This can be achieved with no trauma to the pre-existing hair.

 

5.) When hair is buzzed no manipulation of the pre-existing hair is required at all. When the hair is not shaved it needs to be combed through (hundreds of times) by the physician who makes the recipients sites and again by the technician who places the grafts into the sites. This repetitive trauma of combing through the hair again and again will result in "hair shock", a shedding of the existing hair. When this hair falls out in 2 to 3 weeks there will be a 2 to 3 month wait before it returns. Whereas if the hair were buzzed it would grow from day one 1 and keep growing. A number 3 buzz cut often will look good at 10 to 14 days post operatively and blend in with the recipient site well.

 

Bezane, all these factors are relatively unimportant if you are trying to place to 2 or 3 hundred grafts into recipient sites however if you wish to have the ultra refined type of result that Pat Hennessey advocates, the difference will be night and day.

 

I apologize if what I've said in any way contradicts what others have told you but I feel you should hear this from the doctors who basically developed the process you know as "ultra refined follicular grafting".

[Geomarq]

Good info. but I don't believe #5 is necessarily correct. The description makes it sound like anyone who doesn't get a buzz will loose/shed their existing hair. I know three people for example that didn't experience this (HT w/ out the buzz cut) and I'm sure there are many, many more out there.

[Jotronic]

Geomarq,

 

I can appreciate your point however three cases do not prove nor disprove point #5. And in fact, we do not say that all patients will lose noticeable amounts of native hair due to shock much less will it be obliterated.

 

One must understand that point #5 is more relevant for those patients with a high degree of native hair but still have enough loss to warrant a filling of the gaps so to speak. Point #5 does not necessarily apply to those patients with a thin coverage of peach fuzz.

 

Many times when I post a patient result and the before photo shows a healthy amount of native hair I read many comments about how the patient will experience shock because of so much native hair being present. I remember a few comments of the placement being "reckless" within so much native hair. These people tend to not comment on the case again when the patient returns with zero appreciable loss and 100% improvement.

[HTHELP]

Originally posted by Jotronic:

The last thing people think of when they see our patients is that they had a hair transplant and we've worked on our share of professionals, including actors some of your may have heard of as well as CEO's and government officials. I have NEVER had anyone even a week post-op call me to say they were "found out".

 

 

 

I'm sure thats the case for some, and it obviously depends on what their hairloss/hair style was before surgery but if my CEO or any co-worker came into office 10 days post-op to with a shaved head (that didn't have one before)and scar going across the back of his head (i'm assuming that in this scenario the entire head was shaved to give a uniform look as the doctor mentioned) then I would say there is close to ZERO chance that people wouldn't suspect something. Based on what i've seen it next to impossive to to hide the surgery unless you have some extended time off OR you don't shave the recipient area (and even in the case of the latter its going to be a kind of difficult for most, especially if you are not a quick healer or experience shock loss). Actors can take months off at time if they want to, I for one don't have that luxury.

 

I'm not saying shaving down and concealing can't be done, but I would say people who were able to pull it off were either very lucky or had significant time to take off. (if not they were able to work from home/ wear a hat to work or something like that.)

 

Since a lot of us don't have this luxury and you want to also "hide" it I would say not shaving is the best option.

 

SMG, Cooley and Konior do not require shaving and are among the best in my opinion from what i've seen.

 

Overall H&W is certainly at the top of that list as well (as is Rahal and Feller if you want to go the shaved route though). I think the biggest benefit the shaved route (aside from the points that Dr. made above)is the ability to do a "mega" secession. From what i've read I think without shaving its basically limited to 2,500-3K grafts due to the extra time and risk of hurting existing hairs (Dr. Paul from SMG recently commented on this in great detail). So if your looking for the big time WOW factor with one of those 5K plus secessions then your more then likely have to shave, if not and you only need 2500 (or less grafts) then not shaving and going to one of those top docs will be viable (and im opinion) very good option as well. Personally the fear of not being able to conceal the surgery is a big factor in my decision on making the next step. Good luck.

[New-me]

I agree with HTHELP, H&W are amazingly good but when you look at weblogs of people at 10days out- I could not go to work like that so I opted for more sessions and not shaving the top of my head- but to each his own I guess. Some docs who don't require shaving do awesome work as well.

[Jotronic]

I can understand when people don't want to shave, do not think otherwise. Just understand that one of your mistaken assumptions is that patients shave their entire head after a surgery. Obviously this will make things more obvious because of the donor scar but most actually do not shave their entire head. Any barber worth their weight in razors can blend the back and sides to the top. It isn't perfect but it apparently works. If it didn't then patients would absolutely have to take an extended time away from work but the fact of the matter is that they do not. Most take a week, some less some more.

 

I'm not trying to make this seem any better than it is in reality either. I mean, if people had to take so much time off from work then we wouldn't have very much traffic through our office (which we do) and you'd be hearing a lot of patients complaining that we misrepresented the post-op period. You don't because we don't.

 

The original poster asked if it (shaving) had to be done. Of course it does not and I'm not saying it does. But Dr. Hasson made some compelling points that back up the practice of shaving. To further back this up there are several cases of shock where the hair was not shaved by doctors that say not shaving is actually better.

 

To each his own but people need to understand the pros and cons of each approach.

[Cant decide]

If by shaving, some docs require a #3 buzz cut, that may be ok. However, many of the pics that I have seen have been shaved without a guard (to the skin). This is simply not an option and I can not imagine would be an option for most people. But, I could be wrong.

 

It sounds like you guys are saying that Dr. Feller requires the transplanted area to be shaved. Is this true? If thats the case, I may have a problem going through with it. Would he still require it if smaller sessions are done (3x500 grafts) for example?

[kaounis]

Hog-wash, weather you shave or not has to do with doctor comfort and technique. Imagine trying to do a 3500 or 4000 graph procedure at, lets say 4$ agraph, and paying for part of the air-fair. If the Dr. didn`t shave, he would be at it for maybe 20 hrs. Wouldn`t be very cost efective. Don`t get me wrong, I think H&W are the best of the best. But to be able to offer such a sevice at such a great cost, they have to comprimise somewhere. Doing large sessions will be more cost effective if the patient is shaved down than if he dosn`t. Nevermind what anybody else tells you, it`s still a business.

 

 

Just a thought from the peanut gallery...

[Cant decide]

I have been looking at more and more pics of not only post op strip procedures but also FUE. Honestly, I do not know how these patents are going out in public with the donor site shaved down this way as well as the transplanted area (Along with the redness, donot scar, etc).

 

Certainly, you can't wear a hat at all times. I just can't imagine that being a possibility for me or many people. Please tell me where I am going wrong here. Maybe I am just too darn self contious. I know more and more people out there are having this done but to be honest, I cannot recall one time that I actually saw a post op transplant patent walking around. Either they they wear hats at all times, stay indoors for 2 months (The later is a siilly premise of course) or maybe it is not as noticable as I think.

 

Thoghts?

[Jotronic]

Kaounis,

 

"Hog-wash, weather you shave or not has to do with doctor comfort and technique."

 

It isn't hogwash. It's the truth, but you are correct on the issue of time. Of course shaving makes the procedure go faster and more smoothly and of course this is a business. I never imply otherwise but it's a business built on doing the right thing as much as possible.

 

Can't,

 

"...maybe it is not as noticable as I think."

 

I truly believe this to be the case, to an extent. Of course you will look different but how different will be different enough to garner comments by others about hair surgery? If taken care of properly and if the procedure was truly "ultra-refined" then I argue that it looks much better than most people would suspect. Remember, we (you, I, others that research) would pic out a fresh transplant when we see one but I really don't think those that do not know about current technology would be able to pick one out.

 

I'll use my own recovery as an example. My scabs were gone five to six days after each of my three procedures with Dr. Wong.

 

Day 6. I have my staples still in of course but the top is looking pretty darn good.

 

 

 

Day 16. Forget about it! Shaved to a #2 and it looks NOTHING like a recent hair transplant.

 

 

 

 

 

Keep in mind too that these photos were taken SIX YEARS AGO! Nowadays the immediate post-op period, in my opinion, looks much better. In some of these photos you can still make out my old mini-graft work so if those old grafts weren't there it would look even more inconspicuous.

 

Bottom line is, you have to deal with your own comfort level of course, however just know that the immediate post-op period doesn't have to be THAT bad. You ask one hundred people on the street what they know about hair transplantation and you will get at or near 100% return answers of "plugs". That is what people think because that is all they hear about. Plug jobs are the comic relief situations in movies and TV. "Haha, look at the guy with the plugs". That is, in my opinion, why surgical hair restoration has the negative stigma that it currently has and why I consider it to be the "black sheep" of the cosmetic surgery industry.

 

Do what you are comfortable with, just understand why some clinics shave and others don't and what the realities may be for you should you decide to allow shaving. Good luck with whatever your decision may be.

[Cant decide]

Jotronic - Thanks so much. Your post was extremely helpful and I must say that your pics, even though they were taken 6 years ago, look great. I am amazed at how good the donor area and transplanted area look after only 6 days. Would you say that your case was the "Norm". I know we are all different but your case seems to be ideal. Again, can't believe that was six years ago!!

[HTHELP]

Hey Joe, pics are great indeed! Quick questio, in these pics had the grafts that were just implanted shed already? If not I can see it being a problem trying to explain to co-workers how you can go from having a buzz cut with coverage to a buzz cut with no coverage a couple of weeks later. Also if you don't shave your head already and all of sudden sport a shaved look then I think for the most part people are going to wonder what happend. Maybe not suspect a transplant to begin with but down the road they may put two and two together no? Like I said I think it's "possilble" to conceal by shaving but would imagine it would be MUCH easier to conceal had you not especially if your using a concealer to hide the thinning that you currently have and to hide any of the "pinkness" that occurs after the surgery. I just personally find it hard to believe that people wouldn't suspect something, the fact that someone might no say something to them at work is meangless to me. I had a co-worker who got a bunch of plastic surgery done to her face (facelift, lips etc). Everyone noticed, but did anyone say anything to her? No. Someone actually asked the group if they think it was okay to say something because they wanted to tell her that she looked great, but they decided against it. I think for the most part people just don't want to "go there", but rest assured people talk and i'm sure know something is up when someone's appearance changes like that. Anyhow I guess it's just a difference of opinion on this one. Regardless your result was clearly fantastic.

[Dewayne]

I agree with Joe and Dr. Hassan 100%, but I also agree with one of the other docs in saying that he believed the benefits of shaving often times didn't overcome the inconvenience to the patient.

 

In my drunken state, about 15 minutes after Dr. Cooley gave me the valium, I offered to let him shave my head if it made the transplant better. He said there wasn't a need, and I'm glad he did because I'm like many of you and had to get back to work quick; and didn't want to explain a transplant.

 

But, Joe's got a strong case and I believe I probably could've taken off a couple of weeks and nobody would've noticed - except for the large holes from the old plug removal.

[AMR1]

From personal experience I have been through 3 HT's now in past 14 years and i have NEVER shaved or buzz cut my hair, I do belive that it made no difference to the HT at all.

 

This is my personal opion

[Dr. Mohammad Humayun Mohma]

I do differ from the opinion that my esteem colleagues hold with respect to the shaving of the head, or for that matter trimming of the head. I would try to put up with what I believe in, or people who are from my school of thought.

 

 

Quote:

1.) When thinning areas are shaved down the "thinning process" takes on a different meaning. With the use of magnification it will be seen that some follicular bundles are absent (and there are wider spaces between remaining bundles) and that some bundles are significantly miniaturized. It will then be possible to place new recipient sites in the place of absent bundles and alongside miniaturized bundles to recreate the density. This can also be done in a uniform manner so that if the pre-existing hair eventually disappears, due to progression of hairloss, the transplant can still look reasonably natural. If the recipient site is not shaved the surgeon must part through the hair again and again looking for any empty spaces and trying to fill the spaces as best as possible. This is not really as exact a process but much more hit or miss.

Answer:

By not shaving the head, all the surgeon is doing is putting more effort to find the space through the existing hairs but the process of recreating density is same, we still look for the space and while having longer hair it is technically easy to look for the miniaturized hairs and the terminal ones, so you can actually see the space and you can do it as natural as you want. It takes a bit longer and if you trim or shave its probably more time or effort for the surgeon. One reason for doing this is convenience to surgeon but it should not affect the outcome. It's not a hit or miss. Actually by shaving the head the patient see the real thinning and hence when he hair grow the change is huge so he is more happy but the result should not be effected at all.

 

Quote:

2.) The hair exits the scalp at an exact angle. The only way to precisely match that angle is to buzz the recipient hair down (in a way similar to how ALL doctors need to shave the donor hair when taking out the donor strip).

Answer:

YES it does exist at an angle. trimming is not the only way to precisely match , actually if you want to precisely match the angle you should be careful and just see the base of the hair and will know the angle. Doctors trim the hair in the donor area is mainly for ease. Doctors who do long hair transplant don't even trim the hair in the donor area. They still get a great result.

 

Quote:

3.) Transection of existing hair below the skin surface is possible if the incisions are not made exactly parallel to the surrounding bundles. We often see this as a "halo" type effect when performing repair procedures.

Answer:

That is very true but trimming does not make any difference in the transaction of follicles. It's the carelessness of the surgeon. A doctor of H&W repute will do exactly same whether if the trimming is done or not (My believe).

 

Quote:

 

4.) When inserting grafts the technicians can easily identify the recipient sites and ensure that all sites are filled. This can be achieved with no trauma to the pre-existing hair.

Answer:

The insertion can be easily done with trim hair but yes a bit of more care is needed in case of longer hair. But longer hair is certainly not a cause of trauma to pre-existing hairs.

 

Quote:

5.) When hair is buzzed no manipulation of the pre-existing hair is required at all. When the hair is not shaved it needs to be combed through (hundreds of times) by the physician who makes the recipients sites and again by the technician who places the grafts into the sites. This repetitive trauma of combing through the hair again and again will result in "hair shock", a shedding of the existing hair. When this hair falls out in 2 to 3 weeks there will be a 2 to 3 month wait before it returns. Whereas if the hair were buzzed it would grow from day one 1 and keep growing. A number 3 buzz cut often will look good at 10 to 14 days post operatively and blend in with the recipient site well.

Answer:

True the buzzed hair does not need any manipulation (combing). But the combing does not cause any trauma, and Shock loss is not due to combing at all. It's the surgical trauma inflammation that is responsible for shock loss. You do not see the shock loss in trimmed or shaved hair cause you do not see the hair falling (psychological Advantage), cause the hair are so small. We all know that the planted hair tend to grow for first few days and then they fall of, it does not depend on the length of pre-excisting hairs. It is because of what we call 'cold ischemia' the longer the hair stay out of body the more chance of that hair to go into telogen and catagen phase commonly called resting and shedding phase.

 

 

I am an adovocate of there is no right or wrong way of doing a surgery. The basic aim is to give a natural looking undetectable hair transplant. How you do it is not really important to some extant but what you give the end result is what matters.

 

YOU can point out so many so called 'ultra refine follicular unit' hair transplant surgery that looks as bit of unnatural looking surgery.

 

HAIR TRANSPLANT is 30% science and 70% art. Two pupils from same class one becomes non entity the other Leonardo devinci or Michael Angelo.

 

In the end, go and meet the Doctor, see his results, judge it, discuss it and if you are confident on the doctor get it done. Things can happen to the world top most surgeon as well.

 

The results are no doubt exceptional of Dr Wong, but the cause of less trauma nd less obvious results on 5th or 6th post op day is the size of the blade. They routinely make 0.7 to 0.9 mm. SO the smaller th site the quicker the healing and less trauma and therefore less shock loss.

 

Not the length of excisting hairs

[dontwantbald]

Hello Doctor Mohmand, is the Lasercomb a proven treatment in the regrowth of hair?

 

How long must it be used to see any definitive results?

 

Thank You in advance

[Dr. Mohammad Humayun Mohma]

I think there is no proper study that has either validated or negated the effect of the laser comb.

Clinics and people are doing clinical studies and trying to perfect the science but I think it has a limited effect and using it by itself would be not advised. In other words it cant on its own bring you the looks back, but it do have a clinical effect in slowing down the hair loss.

The works needs a lot of time and study.......I think its in infancy stage....whether it will survive or die its own death depends on the final outcome. There are advocates and some serious opponents to its use.

 

Just sit back relax and if you can spend a couple of 100 US$ without problem, buy one and use it judiciously and see for yourself.

 

Dont expect miracles and if you more than type IV then forget it, mainly for thinning out people.

[Bill - Seemiller]

In my opinion, I believe there is a time when shaving is necessary, and almost critical. However, these cases are reserved for transplanting hair in between and around an abundant supply of natural hair.

 

Because paralel (sagital) incisions make sliding in between and around existing natural hair easier, surgeons who regularly use sagital rather than perpendicular (coronal / lateral) incisions may be able to get away without shaving.

 

Some physicians will religiously shave because they believe it provides an optimal working environment and promotes better hair growth yield while minimizing shock loss. Others won't shave and believe they can produce results on-par with surgeons who do shave. Surgeons who don't shave the recpient area when transplanting hair in between or around existing natural hair typically take a longer time to complete the surgery, but believe it does not negatively impact hair growth yield or facilitate shock loss.

 

I've written on this topic several times and thought I'd post a few links to additional articles that may provide some additional insight on this topic:

 

Why do some hair transplant physicians shave the top of the head?

 

Shaving the Recipient Area for a Hair Transplant

 

Is Shaving My Head Necessary for Hair Transplant Surgery?

 

Best wishes,

 

Bill