Tight Scalp, Scarring, and Multiple Strip Hair Transplants

Dear Dr. Rassman:

If someone has their donor scar from ear to ear but only one side (left, let’s say) is very tight, probably due to a thicker strip being taken from that side. If that person is considering one additional strip procedure with the best close possible, is it best for the entire previous strip to be excised, including the already very tight side? If so, can the excision on the tight side be very thin while being substantially wider on the less tight side?

Alternatively, can only part of the previous donor scar (on the right side in this case) be excised, such as the final 1/3 of the strip on the right side? What would be most desirable option and what would be an appropriate time to wait before doing the second procedure? The patient in the case intends to have the second strip procedure be the last one, using only FUE or FUE squared after that as needed if additional hair loss/thinning occurs with aging and needs to be taken care of.

Thank you in advance for your advice.

Best regards

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If the excision area is at least 6 months old, the laxity can be assessed. If the excision area is less than 6 months old, the laxity of the excision area will change the further in time you are away from the strip harvest. I never make an assessment of the donor area until at least 6 months have passed. As most second procedures are usually more than 8 months following the first one, this has rarely been a problem.

A second strip procedure puts a good burden on the surgeon to make judgments. If there is a large demand for more hair grafts at the second procedure, the degree of tightness will dictate what can be removed. I generally remove any scar along with hair if there is enough laxity and the width of the strip may vary depending upon the tightness of the scalp. Sometimes one side is tighter than the other so the strip width will be narrower on the tighter side.

The laxity issue seems to also vary with the individual. Most people will find that their scalp will return to its original laxity, but a small number of people will find that the scalp will become tighter with each successive procedure. In this later situation, the amount of scalp that can be removed will decrease with time. As the density also drops with each successive strip harvest, the combination does not bode well when both a tight scalp and a reduced donor density occurs in the same patient as measured 8 months following the first procedure. For those people with tight scalps, the FUE approach may be preferable to another strip harvest.

Tags: hair transplant, density, laxity, hairloss, hair loss, hair restoration, scarring

My Head Shape Has Changed and I’m Losing Hair

Hi Doc!

During my teenage years, I used to completely shave my head (0 mm) during the summers. I quickly changed my mind each time due to my flat head shape that bothered me.

At age 28, I’ve been experiencing a slow hair loss progression in a class 4A-pattern for some years, still fairly invisible to others I hope. This made me shave my head completely once again, revealing that the front of my head now didn’t look as flat as before. My hair loss almost exactly follows the frontal skull bone which clearly has turned into a more egg-like shape than before. The back of my head, where there is no apparent balding, remains the same however. The frontal bone seems “higher” than the back of my head and I can see and feel a distinct edge between front/back of my head.

Is it be normal for a head shape to change this obvious after 18-19 years of age and could it be the reason for my frontal balding? I would really like to here you opinion.

Also, have you seen shaved, non-balding people with an egg shaped head?

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EggThere is no connection between skull shape or changing skull shape, and hair loss. Hair loss is genetic and not influenced by the underlying bony skull. I’ve seen all kinds of head shapes over the years, but an obvious change in skull shape in the adult years is not something I’m familiar with.

Obvious changing of the skull shape usually occurs because of trauma or disease. There are diseases which can result in the skull expanding, though I’d expect you’d have vision issues or at least severe headaches. Or there’s this man that was left with a misshapen skull after a run-in with a stampeding bull. This isn’t my specialty, so I don’t mean to worry you… just speaking in complete generalities.

Tags: head shape, skull shape, hairloss, hair loss

Regrowing Eyebrows After Electrolysis?

An electrologist removed a lot of my eyebrows without my permission, leaving me with an ugly, too thin shape. It’s been 9 months since then and not enough hairs have grown back to improve the shape. Since she only treated the hairs once, do you have any idea how many of the follicles could still be alive, even if they’re damaged? And do you have any advice about things I could do to repair damaged but not destroyed follicles so that they could regrow hair?

I am a woman in my late 20s. I had naturally very thick and strong brows that I never had to fill in with makeup and still have very thick and strong head hair. Thank you for your help.

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EyebrowIf on target for the eyebrow hair you are treating, electrolysis can be effective in just one treatment. In other words, eyebrow hairs often do not regrow after having been killed off with electrolysis.

Eyebrow transplants using scalp hair work very well to solve your problem. As you indicated you’re in California, I have offices in Los Angeles and San Jose if you’d like a free consult with a physician to see what can be done about your eyebrows. If so, please call us at 800-NEW-HAIR to setup an appointment.

Tags: eyebrow, hair transplant, eyebrow transplant, electrolysis, hair loss

Could My Rogaine Use Have Swayed My Microscopic Scalp Exam?

I recently got my hair examined under the microscope to see if there were signs of thinning. The dermatologist informed me that everything looked fine. However, two months before I had noticed some thinning on the tip of my crown and I had used rogaine for two months around my head, crown and front too. Could the results of the test be because of rogaine, or if I had male pattern baldness, would the hairs show signs of that despite the use of rogaine?

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Rogaine (minoxidil) may have had an impact on the new hair that grew out, and the lower inch of growth is what I would expect in the 2 month timeframe you mentioned. I would cut a long hair and see if the lower half is different than the upper half. That might answer your question.

Tags: rogaine, minoxidil, hairloss, hair loss, hair growth

After Starting Propecia, I’m Thinning on the Back and Sides Too!

I started propecia about 7 months ago, I stopped it one time for a span of about 2 weeks and then restarted and have been consistently using it since. Prior to starting the medication I never saw any shed but my hair was thinning a lot which started when I was in High School. My hair is thin on top and maybe a bit thinner in the back as well. I have read about telogen effluvium and is it possible that propecia has sparked the onset of this? I shed from the sides and the back as well, it’s hard to know to what extent but I feel like the shed from the front and crown would be normal but why would a person shed from the non-affected MPB areas? Is this normal and why would it occur? I will send you pictures along with the post via email.

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First, thank you for allowing me to publish your photos. Click them to enlarge.


Thinning hair on the sides and back of the head is not typical from Propecia or from male pattern baldness. You have a somewhat unique problem, but without an examination I really can not draw any conclusions. I would want to perform a miniaturization study of your entire scalp, check the density in various parts, and perform a pull test for telogen effluvium, which I obviously can’t do over the internet.

Perhaps this unusual thinning is coincidental timing to the start of Propecia and there is some underlying medical condition. Diffuse unpatterned alopecia (DUPA) is something your physician may consider, as I don’t want to waste your time making guesses and ultimately problems like yours (which are a bit off our usual case) deserve the best that can be offered, which makes an examination with a good doctor critical.

Tags: propecia, finasteride, hairloss, hair loss

Female Mature Hairline?

Is there such a thing a female mature hairline ? It seems quite common for a woman in her mid-twenties/thirties to have a larger forehead than she did in her teens, like Britney Spears or Cameron Diaz seem to have for instance. Or is this just the effect of using hair extensions, harsh treatments and the like over a long period of time ?

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Britney Spears shaved headI do not believe that there is a maturing hairline for women, but some form of reshaping of the hairline may be seen.

In women who have had considerable plastic surgery, the corners of the frontal hairline often thin so significantly that I perform fill-in procedures for that area. Another possibility is as you suggested — traction alopecia can develop from the tight pulling caused by hair extensions, wigs, weaves, and similar.

Finally, some women are also just born with a higher hairline, and it’s possible that wearing wigs or professionally styled hair made it hard to notice in these celebrities’ younger years.

Tags: mature hairline, hairline, hairloss, hair loss, female hair loss, celebrity, actress

Cyberhair — Synthetic Hair Fibers

I went to this place to try cyberhair. They tied three artificial hairs to one of my own hairs and did this for a total of 100 hairs. After the procedure, there was pain in the area that they worked. A few hairs came out from the procedure. Is this legitimate?

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CyberhairCyberhair was developed by Aderans, a large maker of wigs and owner of hair transplant chains Bosley and Medical Hair Restoration (which has recently merged under the Bosley name). It’s just a type of synthetic hair fiber that is braided to your existing hair, a technique that has been around for many years.

The biggest problem in having artificial hair braided to your own is that in many cases it causes traction alopecia. This results in progressive hair loss from the constant tugging on the original existing hair.

Tags: cyberhair, aderans, hairloss, hair loss, artificial hair, weave, extensions, traction alopecia

Pea-Sized Bald Spot on Crown with Small Hairs in the Center

Hello there doctors

I was having my haircut when my hairdresser pointed out a bald spot just on the left of my crown, there is only one at this time, the size of a pea, its smooth, slightly raised and feels tough. She said it has about 10-15 hairs sprouting through and can see small holes where follicles are. I am 18 with a juvenile hairline and no signs of miniaturisation. 2 years a go my GP said i had a keratin horn near that location but he has since retired, could you shed some light on what the possibilities may be?

Thank you for your time

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Pea pod A pea-sized, slightly raised bald spot where 10 to 15 hairs are sprouting? I have no clue what it could be. If your physician has retired, I’d seek out another physician for an exam. Perhaps a dermatologist would be your best bet. Based on your description though, it does not sound like male pattern balding.

Tags: hairloss, hair loss, bald spot

Recoverup Hair Regeneration

Hi doc, there has been a company which has been on the minds of alot of people recently and for some reason no one like your self has mentioned anything up on it.

The company is “Recoverup”, please have a look at there website below and if you can find more up on this company I assure you alot of people will appreciate it.

Site: Recoverup.com

Also on hairsite.com someone got a very thorough reply, and it seemed pretty legimate, can you also please give us your thoughts on that.

Many Thanks.

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There does not seem to be meat on the bone with Recoverup. In other words, there’s nothing here of substance, though there are many outlandish hair growth claims. The site is filled with stock photos and their Video Gallery is just computer animation. If there was really a hair loss solution in that website, I’d suspect the world would be paying attention. Instead, they claim there’s guaranteed growth in 2 weeks time and offer nothing to back that up. I don’t know much about the company, but based on their website it sure looks like they’re offering slick marketing more than actual results.

As for that “pretty legitimate” response on HairSite, to me it sounds like a sales pitch. Here’s what they say about photos of patient results — “In terms of providing pictures, we have found many ‘hair restoration’ websites to have such pictures enhanced with photo editing software, etc and as such we didn’t consider to put up such pictures.

Uh huh. I’d have to assume that if this was truly a viable hair loss treatment option there would be photos made public, but instead they use the excuse that because some (unknown) hair restoration companies use Photoshopped images, they didn’t want to use any photos of results at all. So why would they use stock photos of pretty, hairy people on their site? Seems dishonest.

One last thought — I am a US-based physician and while I’m not aware of various legalities in other countries, it seems odd that a UK-based company (as Recoverup is) would only be doing this procedure in Taiwan and Malaysia. Are the laws a little more lax in those countries or is there another reason?

Tags: recoverup, hair regeneration, hairloss, hair loss, stem cell

In the News — Stem Cell Baldness Cure? Not Quite.

Snippet from the article:

Researchers working at the forefront of stem cell technology may also unexpectedly have come up with a cure for baldness.

They almost miraculously changed one cell type into a completely different one, but in the process ended up with skin cells complete with working hair follicles.

A treatment for baldness was not the goal when they started tinkering with cells from the thymus, a small but critical organ that helps run the body’s immune system to fight disease.

Rather, they wanted to see how stem cells from the thymus would perform if transplanted into growing skin as a way to help burns victims.

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Lab ratRead the full story at IrishTimes.com — Stem cell researchers may have found baldness cure

The title of the article might make for a good attention-grabbing headline, but it’s pretty misleading. This was an experiment on lab rats… and the hair lasted “as long as a year“. Granted, it is an interesting experiment, but I wouldn’t put too much hope into it.

Lots of research like this happens and ultimately doesn’t go much further. Could this be different and get a further look? Sure, but that remains to be seen. The researchers weren’t trying to grow hair, so I doubt they’re going to divert their attention to a completely new goal.

A similar article with further information can be found at ScienceDaily. Hat tip to the readers that sent me the link.

Tags: stem cell, balding, baldness, hairloss, hair loss, lab experiment, rats, thymus