It does appear that your donor area could be depleted. If your donor density wasn’t significantly above average, then it would not support the number of grafts you reported that you received.
My donor area is now balding, why and what can I do about it?
Your donor area was either over-harvested if you had an FUE or developed a scar from a strip surgery which, when it occurs, usually occurs in that location. You did not state if you had FUE grafts and if so, how many or if you had strip surgery. If it was FUE, the number of grafts for that area was too high. If it was a strip surgery, most likely the wound was closed too tight which will cause this type of hair loss.
We obviously see complications from both (a) too many FUE grafts for a given area of the scalp and (b) strip wounds that are too tightly closed. Most doctors and patients think that the donor area can stand almost any stress but in this post I suggested that stress (FUE or strip surgery) can cause hair loss by impacting the donor area blood supply. You should wait this out and in about six months after the procedure, the hair may return. Scalp MicroPigmentation is a good option for this problem if it needs to be treated.
See link below.
https://scalpmicropigmentation.com/scar-covering/
Donald Trump’s Bad Hair Day
UK’s Daily Mail has a new article up — A step-by-step guide to the gravity-defying Donald Trump combover — which includes some rather unflattering photos of The Donald’s infamous hair. And as everyone knows how bad his hair looks, that is really saying something!
The article hints that Mr. Trump’s combover is just hiding some balding, but I’d guess that he has had multiple poorly done hair transplants and is using this hairstyle to mask it as best he can. This is just rumor, though.
More on Donald Trump and his Propecia secret from NY Post
https://nypost.com/2018/05/01/trump-doc-says-presidents-men-raided-his-office-after-he-revealed-use-of-hair-growth-drug/
Donald Trump and Hair Transplants
What is the story on Donald Trump’s hair? He looks like he is trying to hide something?
As I understand it, Donald Trump was a victim of the old hair transplant process starting in the 1980s. The quality of the work most probably resulted in the pluggy look, and he possibly had scalp reductions (which were popular in those days). Between the two, he might have little donor hair left. There may be significant scarring as well if he had many procedures in the ‘old days’. He apparently found the solution to cover up his hair loss problem, with a creative hair styling that he is now well known for. He knows that his hair is the subject of much focus and with people who just love to talk or make their living hosting entertainment shows. That is the price of today’s celebrity.
What he has done is to exploit a ‘comb-forward’ style, maximizing what hair he has to cover what he wants to hide. Like the comb-over, it layers hair from one part of the scalp to another (comb-forward means that the hair is kept long and combed to the front). I call this the ‘Trump style comb-forward’ in my private office practice, because of his celebrity status. This style uses what many people with frontal balding exploit (see the Norwood Class 3 or 4 pattern balding). The less hair that is lost and the more hair that remains, the more effective is the result of styling to hide thinning or balding in the frontal area. When taken to extreme, whether it is the comb-over or the comb-forward, the appearance does not look good.
When any reasonable amount of hair is transplanted in the Class 3 or 4 balding pattern (those with natural Norwood Class frontal balding patterns), a comb-forward can work even better so restoring all of the missing density is not needed. Nobody ever knew that CBS News sports reporter Steve Hartman was balding and he perfected the combing to the front and side enough to hide his thinning hairline. This canopy comb-forward was very effective for him (a common combing style for many men), but he was slowly losing the battle to preserve his look. Many men tell me that they spend more and more time dealing with their hair, not only in the mornings, but throughout the day as well. One man who comes to mind told me that his comb was like his Mont-blanc pen, always needed wherever he went and he carried hair spray with him to touch up the styling in bathroom breaks that he had to take quite often. Steve’s hair, on the other hand, was very cooperative with a strong character that easily laid down the way he wanted it to. Rather than waiting too long and risking an unnatural appearance, Steve decided to take the bull by the horns and had one transplant procedure (see pictures). Steve went for natural fullness as he did not want to maintain any illusion at all, so we put as much hair as we could safely move in just one transplant session. The point between where Steve came from and a really bad comb-over (the kind that everyone sees on TV or at the airport), is a slow, insidious process — so slow in fact, that the person who is doing it never notices the advancing balding nor the progressive failure of the grooming style. I always wonder why family members do not comment on the failure of this styling process, but maybe they are just not saying anything early enough and now are embarrassed to say anything at all so late in the process.
Some men with bad comb-overs deny their evolving look, putting a mental block on the unnatural appearance they evolved, and others just stop going out into the public arena. Hats and wigs solve the problem for some, a type of cover-up that does not work for everyone and I have seen a few take it to extreme levels, creating a bouffant style with hair that is one or two feet long and combed into a circlular pattern, layered hair by hair to mimic what the person thinks is normal.
I have been asked many times why the rich and famous who can afford the best doctors don’t just get the best surgical hair restoration money can buy. Ignorance is part of the answer. I believe that many men with the old deforming hair transplants find themselves in a difficult situation. They may not know that they were going down that road when the process initially started. When they found out, they may have come to the conclusion that it was too late to do something about it. With luck, men in this predicament may find some solution that they learn to live with when it works (comb overs, hats, wigs, scalp coloring agents, and the like) or they may find their way to a good hair transplant surgeon who can fix the problem.
With today’s modern Follicular Unit Transplant and Follicular Unit Extraction (FUE) techniques, some amazing work can be done. With FUE in particular, it is virtually for all practical purposes scar-less and the procedure is minimally invasive. Not everyone can be brought back to “normal” if too much of the hair has been squandered, or if scarring has gone too far. If Mr. Trump had old type plugs, he can have that hair redistributed so that the big bad plugs are no longer present. Any hair that is moved can be put to better esthetic use in other scalp locations under the guidance of an artistic hair restoration surgeon (see Dean’s Story for an example of this).
Had Mr. Trump been a patient of ours, I could never have written anything about him because patient privacy is central to the way doctors operate their business today. I hope that by writing this piece in answer to your question, I have not offended him in any way.
Doing Hair Transplant Surgery On A Teenager Is Not Good Standard Of Care
Source: NY Post: “Teenagers are fighting the “recession.”
The battle against baldness is sprouting to new heights as boys as young as 16 flock to surgeons for hair transplants, doctors and patients told The Post.
These young men have a high return rate for their hair when put on Propecia. Propecia is an elective medication and like all drugs, it has it’s side effects. The side effects are well publicized in the Internet balding forums and hotly debated. The reality is that Propecia works and the side effect only affects 1 to 2 % of men.
Doing a hair transplant commits a young man for a life time of hair transplants without giving him the opportunity to reverse or stabilize the hair loss. Doing surgery at an early stage can often accelerate the genetic balding in young men. The overall profession does not look kindly on hair transplant surgeries on teenagers. The only exception may be if the teenager is completely bald (Norwood 6/7) and understand the full implication and limitation of a hair transplant surgery.
2015-08-12 07:59:212015-09-05 23:02:02Doing Hair Transplant Surgery On A Teenager Is Not Good Standard Of Care
Dog is Losing Hair and Now I’m Itching Like Crazy!
I recently fostered a dog from our local animal shelter. The dog had hair loss on its front shoulder, elbow, and belly. I was told that the dog was loosing hair due to stress. After 7 days of being at my home with me and my cat- both of us began itching. The cat was having the same symptoms as the dog- lots of chewing, liking and biting.
My head is itching like crazy – I have tried lice shampoos and scalpacin and a scabbies cream Permethrin from head to toe. After a month and a half my hair has started falling out in large amounts. My cat was taken to a specialist in pet dermatology – she does not have ringworm, scabies, or fleas. she has gone on a special medication – which has lessened her symptoms but not gotten rid of them-and they had no definitive answers. Maybe we are passing something back and forth? But I cant imagine what this could be?
You need to take both of your animals to a vet and yourself to a doctor. Why would you try lice shampoos or scabies medicine without knowing you have lice or scabies? Those shampoos can do more damage than good if you don’t have lice or scabies. You need a good diagnosis before trying something blindly.
2008-10-29 09:33:362008-10-27 09:35:07Dog is Losing Hair and Now I’m Itching Like Crazy!
Doesn’t the Scalp Still Shine with SMP?
Hey Dr Rassman. i hope your day is treating you well. As i am a frequent reader of this ever informative blog of yours a few questions have sparked my interest over the last week. It is in regard to the new micro pigmentation service NHI is offering. Now in the past i have noticed you were quite the skeptic about this type of procedure. I recall reading a few comments made by yourself which made me think they were: wouldn’t the scalp still shine? The lack of a ”sandpaper feel due to there being no actual stubble on the scalp and hair is 3 dimensional a tattoo is not.
However I was doing some thinking and this came to mind. If a patient were to come and request to have as many grafts that their doner supply would allow then have the tattooing procedure done in between those grafts and also had the scar camouflaged in the back of the scalp wouldn’t it be nearly impossible to tell the persons head of hair from a non balding person ? It would eliminate all of those issues i previously mentioned. Like for those individuals with high donor densities if someone had 10,000 grafts placed on their scalp then had the micro pigmentation procedure done i would think they would be able to get close to their juvenile hairline back and they would also be able to grow their hair out to probably a number 1 clipper with out it looking to odd. What are your thoughts on this ?
as I presently support the shaved head look but my hairloss is progressing i like the look i would just like more coverage. I have been on finasteride for 3 years when i first started it i was 20 and an early norwood three now my hair is really thin through out the top half of my scalp. I totally anticipate being completely bald by the time im 25 whether im on the medication or not.
Your scalp can shine with the oil that your scalp produces, so scalp micropigmentation (SMP) patients often use matting products available at cosmetic stores. There’s various brands of shine control lotions for the scalp, including HeadLube.
SMP has a use with some negatives and some positives. There is a natural symbiosis between hair transplants and SMP in some individuals. SMP is far less expensive than hair transplants, but you can not have it both ways (SMP in part with a limited hair transplant) unless the Master Plan takes into account what is happening to you now and later. There is a balance between SMP and hair transplants, but I can not give you an opinion over the internet.
It sounds like you need a Master Plan (I know I talk about that a lot), because you are changing with regard to your hair loss. Whatever you do, it should fit into the life plan; if you do go really bald, you’ll want to have a plan for what you’ll look like in the future if you make decisions about today’s problem. Come see me.
Why Doesn’t Propecia Work For Dupa or Female Pattern Balding?
In a previous question you said propecia doesn’t work for DUPA. Isn’t DUPA miniaturization of the follicle we see in Aga and FPB. I have seen that most cases of FPB also has some degree of thinning on the whole head, back and sides. I thought it had already been proven that dht caused miniaturization of the follicle. If not DHT then what are the other causes of hair miniaturizing? Actual miniaturization and not just hair falling out like TE or AA. Miniturization of anykind has been said to be the hallmark on diagnosing all AGA. Could it be that it does work at the same percentage as it does in mpb but because we see so much less cases of DUPA and by the time it shows you need to be at the point of 40-50% loss. Is it more a game of not being able to catch up after such loss.
I believe there are some misconceptions here I would like to clear up.
Male Pattern Balding is a genetic condition in men. In other words if a man was born with the gene(s) for MPB, he will have a hair loss in a certain predictable “pattern” (thus the term Male Pattern Balding). Scientist have found if a man has the gene for MPB, a hormone called dihydrotestosterone (DHT) is partially responsible for his hair loss. If a man does not have the MPB gene, DHT will not cause hair loss. Propecia is a drug that block the DHT action and it works in men who have the genes for MPB.
Propecia will not work for DUPA or Female Pattern Balding because hair loss is not a related to DHT and it is not related to the gene for male pattern balding. DUPA (Diffuse Un-Patterned Alopecia) is similar to generalized hair loss in women and as such is not impacted by the drug Propecia (finasteride).
Miniaturization is just a phenomenon seen in the hair loss process. You will see miniaturization in naturally shedding of hair in a non balding person in some of the hairs at the end of their normal cycle. A non balding person will have up to 20% of miniaturized hair (many of them actually vellus hairs that are small, very short hairs found in each follicular unit in all people). Hairs go through natural cyclex of growth and shedding (anagen, catagen, telogen). A person with MPB will likely have more than 20% of miniaturization in a specific pattern around his scalp. A person with DUPA will likely have much more than 20% of miniaturization all over the scalp in a non specific pattern (thus the term Diffuse Un-Patterned Alopecia).
Doesn’t 0.25mg of Finasteride Reduce DHT at the Same Rate as 1mg?
i have read the finasteride studies for alopecia. in the pre-clinical study, 0.25mg of finasteride was shown to reduce DHT at the same rate as 1mg. when the clinical studies were done, the dosage used was 1mg. less than that was never looked at with regard to actual clinical outcome. what is your opinion on extrapolating this info to clinically use 0.25mg per day? the purpose of this would be to get efficacy and reduce potential longer term complications. thanks.
I spoke with Dr. David Whiting, an expert on Propecia, some time ago and he informed me that finasteride 1mg and greater has equal value. A dose of 0.5mg is 80 percent as effective and a dose of 0.25 is less effective again. There is value at the lower dose, but if there are no side effects, taking less than the best optimal dose has no basis.
I’ve answered a similar question here — 0.2mg of Finasteride is Almost As Effective as 1mg?