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I am white female in my early 30’s. I had dreadlocks for 10 years and cut them off because of the same problem, the twisting and weight was too mich and caused permanent damaged.
I loved my hair it grew down my calves and to cut it was a hard decision. I cut them 7 years ago and the problem has not gotten better. Now i have thin hair and very little my hair line is higher and higher every year…it could maybe just make 1 lock. I lost hope. Traction alopecia seems not to have any cure coming up soon since they scalp hets scarred and the follicules are lost. I don’t know what to do, I wear wigs now without it I look 20 years older because of my hair loss. I loved my dreads and I hate to say they destroyed my hair.

Hair transplants are another alternative that you might look into. It requires a visit to a hair transplant doctor like me to determine if you are a candidate for this type of procedure.



This patient had an FUE megassession surgery.  When harvesting the FUE grafts, the surgeon must recognize the size of the donor area and limit the FUE extraction to the permanent zone as outlined in this FUE patient photo.  The doctor who did the surgery on the patient in the photo did not understand the limits of the donor area.

The permanent donor area for a hair transplant begins at the bottom of the skull bone, known as the Occipital Notch, and extends upward two and half inches.  This is the case for patients who will bald to a Class 7 pattern and sometimes to an advanced Class 6 pattern.  This two and a half inch zone extends horizontally to just in front of the ear level.  Hair was harvested for FUE from above and below this zone of permanent hair which in the long term will fall out by not standing the test of time.  The hair below the permanent zone is neck hair and not scalp hair and this hair does not last.


Why do doctors harvest hair beyond the permanent donor area as shown in the photo?


(1) Because the patient wants a high number of grafts.

(2) Because the doctor makes more money by charging more for the larger FUE session.

(3) Everyone thinks it is safe and the hair will last a lifetime – Dead Wrong!

A word a of caution: some doctors will push the number of grafts within the permanent zone so much that the permanent donor area becomes a new bald area.

Buyer beware: it is your responsibility to keep the doctor honest and to make sure the doctor does what is in your best interest.  This is why I shared this information with you.  Good luck.

bad donor


I am 19 year old girl..started using minoxidil when my hair started falling at tremendous rate…i used it for around 3 months and then stopped using it…again hair started falling….and I again switched to minoxidil. Now, I have been using it for around 3 months. I read many stories about “after quitting minoxidil effects” and it really freaked me out. If I stop using it…will I really lose all my hairs…? Pleasssse someone answer my question… Is there any teeny tiny possibility of growing them back…?
Pleassse do reply…

When you use minoxidil and it grows hair, the hair that it grows will require the minoxidil to be used every day or the hair will fall out. Minoxidil grown hair is dependent upon minoxidil so once you get it working for you, you must stay on it.


A little over a five years ago, I agreed to work with a company that supplied Laser Hats to us at no charge (valued at $3,000 each). I got 12 volunteers and sold them a Laser Hat for $500 with the caveat that they would come into our office every three months for photos.  At the time we did this, we did not have the HAIRCHECK instrument.  It would have been the perfect tool to measure if any value was achieved with the once-a-day use of the Laser Hat. There were clearly problems in the quality of the photos and the way the patients combed their hair. I for one will admit that I was less than fastidious about standardizing the quality of the photos. None of the dozen patient reported any significant benefit. Four of the 12 did not come back for photos but I did speak to each of them a year later.  They were incentivized to get their $500 back and to keep the Laser Hat if they came in four times in a year.

The patient below had pictures 18 months apart which are shown. These photos were less important than what the man told me, essentially he was disappointed that he did not see results to the experimental Laser Hat.  The upper row of photos are 18 months earlier than the lower row of photos.  You judge for yourself.  Is is worth $3,000 to purchase a Laser Hat?


before laser hatafter laaser hat


The first photo set is a woman who had her hairline lowered the day before these pictures was taken. Please note that the washing was so complete and the recipient sites so samll, that the recipient sites could barely be seen so I labeled the frontal view where a faint outline of the recipient sites show up.  The hairline was extensively lowered which is the case when we often perform this hairline lowering for traction alopecia in the African American population. From the side view, there is almost nothing to see.  Careful, small site recipient areas are critical to an undetectable transplant. For those who understand how difficult the African hair type is for a hair transplant (very kinky), the viewer should understand how beautiful these one day post-operative photos are.

The second woman is also one day after her surgery with a smaller distance for the hairline lowering surgery than the above patient. This was performed with an extensive restoration of her temple corners.  Many women lose their temple corners as they get older and a rounded frontal hairline (which is a typical female hairline) is critical to achieving a very feminine look for many women, unlike men, on the other hand, who have high corner, V-shaped hairlines.


African American Female HLL

saudi female hairline


“Drake, Lynn, et al. “The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia.” Journal of the American Academy of Dermatology 41.4 (1999): 550-554.”.

Can’t post a link because it’s behind a paywall my university has a subscription for. That study is published in a well respected journal and sees to be cited many times

“Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56.5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declinied significantly (P<.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1 and 5 mg finasteride treatment groups, respectively.”

The values are without error margins but I’m willing to bet that they might not even differ significantly.

I’m not sure why you claim that my post contains mis-information and then proceed to say the exact same thing.

It’s a competitive inhibitor, sure. But that just means that the affinity for finasteride to the enzyme is much larger than the affinity of testosterone to the enzyme. If it was reversible you wouldn’t see such a flat response and it also wouldn’t take 2 weeks for DHT to go back to baseline.

Finasteride does irreversibly inhibit any 5alpha-reductase it comes into contact with (see e.g. the Merck patent which is even called “Irreversible inhibition of human 5?-reductase ” ” In practice, the halflife of the enzyme-inhibitor complex is so long that the inhibition is for all intents irreversible, and release of the inhibitor probably occurs by death of the enzyme rather than turnover to regenerate catalytically competent enzyme.”) .

That’s as good as destroying the enzyme because it forms a strong bond with it that has a longer half-life than the enzyme itself. In other words, the enzyme will die long before it’s able to release finasteride.

The body replenishes 5AR constantly and that’s exactly why it takes >2 weeks for the DHT to go back to baseline.

Nice citations; however, the effectiveness of finasteride may be due to other factors such as the sensitivity of the receptors and the rate at which the enzyme is turned over in response to the blockade, etc..  Enzymes are always consumed in a chemical reaction and the human body just produces more of it. Skin levels may not be reflective of the type of response seen clinically. This is the practical side, because we see patient who do not respond to the drug regardless of the dose and then we see great responders.  I can’t address your mechanistic point very well and correlate the DHT levels, enzyme levels and clinical responses. You have clearly spent more time on this than I have; however, what I focus upon is clinical responses and side effects to the drug. With my focus, the pharmacology you reference does not produce a one-to-one clinical response with the values of DHT in the skin as you are referencing.

I like it when the consumer does research on what is happening to them and the treatment options. Sometimes what is read needs to be filtered by an expert so that is my role here in this reader’s posting which I am publishing at his request.


Hi I’m getting this horrible pain after FUE. I know its been some time please let me know how long does this pain last its been 4 Weeks now I am still with burning sensation and pressure pain all around my donor area and face

You should go back and speak with your doctor. Pain following an FUE might be the result of damage to the many small nerves around the scalp (there are thousands of them) so many are cut by either the FUE punch or the needles used to make the recipient area. The good news is that the pain you are reporting almost always goes away in week. A few people might see the pain a couple of months of so as it does take time for the nerves to heal.


You are most likely developing balding from genetic hair loss.  There are two wonderful drug for treating this problem, (1) finasteride which might reverse the loss if you are in your early 30s, and (2) Minoxidil plus taking the finasteride pill. You must see a doctor for the finasteride. Whatever you do, do not get a hair transplant until you are at least 25 years old.

21 with thinning crown


Thank you for the baldingblog. The answers you’ve give over the years are a very valuable resource for patients before, during and after hair transplants.

It’s now 9 weeks after my FUE. My recipient area is very red and incision marks are all visible. The color and texture of the recipient area improved until the 2 week mark, but since then it hasn’t changed in the last 7 weeks. I understand from your baldingblog that your patients have at most 6 to 8 weeks of redness (you wrote about it in separate posts in March and May, 2014). Unfortunately, my redness has lasted longer than that and shows no signs of improving any time soon. For what it’s worth, I’ve seen internet posts by guys who have had similar redness, so I imagine this is a topic of interest for quite a few men.

I’ve had no sun exposure, swelling, pus, warmth, fever, or health issues. I did thorough blood both tests before the operation as well as last week; all results were and still are good. There’s no hair growth yet obviously, but at 9 weeks, that’s normal. My HT surgeon said it’s the reddest he’s ever seen. He has no idea what’s going on. He said it doesn’t seem infected or to have any problems except that it’s still very, very red with incision marks still visible to the naked eye. He very honestly told me that he doesn’t know what to advise and suggested speaking to other doctors.  I’ve consulted several doctors, both hair surgeons and dermatologists. They all have very different ideas for diagnosis and treatment, as well as reasons why the other proposed treatments aren’t good. I’m confused by the different ideas and would like to ask your opinion about them:

Treatment #1.
Diagnosis: small dilated blood vessels near the surface of the skin (“broken capillaries”), i.e. a form of telangiectasias caused by the trauma of surgery. If you push with finger on the redness and release, the skin becomes white for a second and then returns to red. That brief whiteness happens because of these dilated blood vessels. Treatment: pulsed dye laser (“V-beam”). Targets only the red wavelength of the capillaries, so the laser will reduce the redness but not hurt the (soon-to-arrive) growth of the transplanted follicles.

Counter-argument: The range of wavelengths of the V-beam laser cannot be made so narrow as to ONLY work on the blood vessels. The laser will probably hurt the hair follicles and harm my eventual transplant result. (more…)


Are hair systems really unnoticeable? I am considering gluing the system on, is this the best way to apply ? What’s the best shampoo/ conditioner to use? Do you think that I should just rock the bald? (Devil’s advocate) Any tips/advice? I am planning on going scuba diving in September, will I be able to do this with the system in place ? For those that have used a system before, what was the first time after like? Has it ever came off at an inopportune time? How long do the pieces actually last? I’m hoping for it to last about a year, is this a reasonable expectation?

Hair systems or wigs are expensive over the long haul, running in the thousands of dollars forever. They are usually detectable and hard to keep in place unless they are heavily glued and with long term use they tend to develop an odor from your sweat. You can’t scuba dive or swim freely and you always look at people’s reaction trying to see if they can detect that you have a wig on. They do have challenges when you are with a woman who might want to grab you by your hair, not good. The average hair system last 2-3 years and then must be replaced.  The less expensive ones last a year or so before they fall apart. The advantage of a hair system is it almost looks like real hair but most people can tell it is a wig.

The Scalp MicroPigmentation alternative

Scalp MicroPigmentation gives you absolute freedom from your extreme balding and freedom to do whatever you want to do, swim, scuba, make-out with a lady as she grabs your head.


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