Hello,

After having a bald spot on the left side of my head for 28 years, I’d like to do something about it. The bald spot is circular in shape and 2cm in diameter, about 7cm directly above my left ear. The hair fell out when I was 2 and the bald spot has remained the same size for as long as I can remember. I am able to cover it with hair surrounding it, but it does take an emotional toll on me as I see it every day and I have to be very careful every month when having my haircut.

I saw a dermatologist about a year ago who told me it’s triangular alopecia. He was not able to locate any hair follicles under the skin, and told me the chance of regrowth is slim to none, especially as there has been no hair there for 28 years. He suggested we first try cortisone injections which did not work, and then referred me to a specialist. I went to see a specialist and he recommended scalp reduction surgery given the small area and lack of hair follicles.

I’ve done some reading on scalp reduction surgery, on your blog and others. The risks seem to be significant (stretchback, slot scaring, hair angled incorrectly, etc.) and it’s clear you’re not a proponent. I’ve also been unable to find any success stories/testimonials online. I’m going to ask the specialist to share more information (# of surgeries he’s done, before/after photos, # of surgeries I’ll need, risks, type of incision, etc.), but before doing so I’m hoping to get your advice.

Given the small area (2cm in diameter) and being able to cover with existing hair, do you think this is a case for a successful scalp reduction surgery? If not, are there any alternatives you’d suggest (e.g., Rogaine, hair transplant)? Both my dad and grandpa have full heads of hair, so I’m not really worry about the hair on the left side of my head receding back to the site of the bald spot.

Thanks for your help!

Scalp reduction surgery, in my opinion, generally carries more risks than benefits. Small scars such as you describe do not do well with scalp reductions, as I have seen many patients for consultations over the years with failed scalp reduction / scar revision surgeries and difficult scars that result from the surgery.

Triangular alopecia is best treated with hair transplant surgery.

For a better assessment diagnosis and treatment options, please follow up with your doctor. Or if you are in the Los Angeles area, you can also visit me for a consultation.

Hello Doctor,

I know there have been various posts on this topic and please feel free to ignore the question given that you have already provided comments. Also, I wanted to thank you for the blog as it has really allowed my to expand my knowledge of hair loss and related topics which is greatly appreciated.

I had what I though was a thick head of hair on the top of my head and historically my worries over thinning was limited to a receding hair line. Recently I got a short hair cut (borderline buzz-cut) and seemed to notice that in certain house lights I can see some of my scalp. That being said other lighting I cannot see through at all including when I am outdoors. I am not sure if this is a function of how my hair is parting, the use of hair products which I read can ‘clump’ hair together giving a thinner look or whether there are legitimate concerns to be had.

My question(s) relate to the miniaturization process and the speed to which it can occur. I recall from a previous blog that hair will grow at a rate of about ½ inch per month and would it be possible to have ‘normal’ hair on the top-half of a follicle and a miniaturized bottom? Is the process of miniaturization more gradual or can you go from thicker to thin in a matter of a few weeks?

I can sympathize that people are different and will go through the process at different paces but I am looking for some general comments based on your experience. For further information, my hair tends to be quite straight and sticks up when short and could this growth pattern contribute to a thinning look i.e. sits in such a position that gives a thin look? I should note that I am 33, currently taking Propecia but nothing else in the way of medication.

Regards

I am not sure how fast miniaturization occurs. I would think it happens over weeks to months (not days). It is a gradual process. I do not know of any documented studies on how fast miniaturization occurs. Usually we follow patients on a yearly basis (not monthly).

If you would like to conduct your own research, you can buy a handheld video microscope and take pictures of a specific area over a period of time and document the results. We wrote a 3-part tutorial on doing this a few years ago — Mapping Your Own Scalp for Miniaturization.

in reference to a quote at the end of this article:

Link: Baldness cure could be for sale in just two years

I am concerned that in the next two years they will come up with a drug that will retain hair, and I (25 yo male) will be the last generation of bald people. The rest of my life it won’t be normal to be bald…. urgh? do any of these ‘on the horizon’ cures actually regrow hair???

I wrote about the possibility of the baldness cure being just a couple years away here.

You’re assuming a lot to suggest that it won’t be normal to be bald for the rest of your life, and even then, there are options like Scalp MicroPigmentation (SMP), hair transplantation, and even medication, to make it so that you don’t appear bald. I expect that we’re more than just two years away from the cure being a reality, but research is ongoing. And even if balding is somehow completely eradicated for future generations, there will still be millions of men around the world that have hair loss, so I wouldn’t get too worked up about it being abnormal.