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I am 33 years old andI have been on Finasteride since 2006 (I took a 10 month break in 2009) and have great success. In the last 10 months I have been losing ground though, my hair has started thinning a lot as the result of two massive sheds. I was wondering how you go about assessing whether an increase in dose is appropriate when Finasteride starts to lose  effectiveness? I have also been looking at rogaine foam as an option — but as I am constantly traveling for work pills are much easier to fit into my routine.

You can try to increase the finasteride does and see if that helps. I tend to look like the use of finasateride as a tug of war, the genes and the stresses on your life pulling on one side and the drug finasteride pulling on the other side. Maybe an increase in finasteride dose will weigh more on the pulling against the genes and stress side.


My forehead came down about 1cm with 1500 grafts. I am unhappy with the unnatural look and my skin is elevated and white. I would like to reduce my forehead surgically and reverse the transplant.

This is not an easy assessment without seeing, at the least, a photo. You said the hairline was only lowered about 1cm so I need to know what it looks like. Also your comments about the elevated grafts after growth and the white color of the skin is bothersome. If the entire area in front of your normal hairline is no more than 2.5 cm, then a hairline lowering procedure may be able to remove the entire transplanted area. You should see a surgeon that offers hairline advancement surgery and this could be a good solution for you.


I had 4400 grafts done and I am terribly scarred with cobblestonning of my skin and I have a heavily scarred recipient and donor area.  Can this be reversed?

Unfortunately, the answer here is no. Reversing 4400 grafts would be an enormous challenge and it would take far longer to try to reverse it than having it done in the first place.  Scalp Micropigmentation may be your only option but I would have to see you to understand the deformities you are asking about. We have performed Scalp MicroPigmentation in many people with similar problems as you have described and it works very well (see here:


The hairs were lined up like soldiers in a field performing a marching routine. The frontal hairline looks like a wood saw not a hairline.  Hairs are never lined up as they should be randomly placed. Your surgeon seems to have no artistic concept in copying nature’s hair loss growth pattern.

lined up soldiers


The donor area has been significantly impacted by the FUE suggesting that your original donor density was significantly less than what the number of FUE grafts could have supported. Your doctor should have measured your donor area density prior to doing FUE. The limits on FUE is related to your donor density otherwise it produces significant scarring as this photo shows.  If the donor area remains see-through, you should get Scalp Micropigmentation to fill=in the missing spaces.

donor site depletion 33


You have had unfortunate severe scarring from strip surgery. This is easily treatment with Scalp Micropigmentation ( it can be treated with balloon expanders above the wound. Both have their positive and negatives that you must learn about.

donor FUT scar severe


If you try filling in FUE scars with more hair transplants from thigh, body, neck,  you will be subject to the limitations of these donor sites.  The neck hair is not permanent hair, and all body hair below the neck has a short growth cycle and it which will grow, only half of the hairs will be growing at any one time. Filling in FUE scars can be very expensive and not very effective. SMP is the best option.


An FUE is treated just like a regular hair transplant with regard to the recipient area. Both the recipient area and the donor area has  wounds which require daily washing with soap and water. The key is to wash off the crusts before they appear.  Within 3 days of surgery, you can resume full activities, heavy exercises if you wish. I generally recommend the use of a sponge and supply my patient with a surgical sponge to fill with soapy water and press on the recipient area daily, never rub the area with the sponge. By repeating this daily, all crusts can be washed off without any fear of losing grafts. If any crust are present, use a Q tip and dip it into soapy water, and roll it on the crusts and that will lift them off without dislodging them, but never rub them, just roll the Q tip on the recipient crust. I like to see no evidence of any crusting in the recipient area and the crusts from the donor area gone in just a couple of days and daily washing properly guarantees this.

Since you did not follow the above routine, you now should leave a shampoo on your scalp for 15 minutes and do this twice a day. Gentle massage of the grafts as they will loosen and then the crusts will come off over a few days of this routine.

poor po care 

J Tissue Viability. 2018 Jan 4. pii: S0965-206X(17)30132-8. doi: 10.1016/j.jtv.2018.01.001. [Epub ahead of print]

Never too old to regenerate? Wound induced hair follicle neogenesis after secondary intention healing in a geriatric patient?

Wound healing is a natural process to restore the structure and function of injured or diseased tissues. Repair of a skin wound usually leads to a scar while regeneration implies fully recovery of function and structure of the damaged tissue. Adult skin wound usually heals with scar while fetal skin heals scarless. Hair regeneration in elderly scalp wound has never been observed. We reported an 80-year-old patient with a large wound on the scalp after excision of a basal cell carcinoma healed by secondary intention wound healing. The patient’s wound healed very well aesthetically. Interestingly, on approximate post wound day 180, a hair was observed to be growing towards the surface and eventually erupted in the center of the wound. The hair remained black at 42-month follow-up. This case demonstrated that neogenesis of hair is possible even in geriatric patient. To the best of our knowledge, this is the first report of hair regrow in human skin after wound healing.


Basal cell carcinoma; Hair follicle; Regeneration; Secondary intention healing


The history following the potential cure for balding is nicely put together here in the link supplied.

Two Decades of Quotes from Dr. George Cotsarelis


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