Author: Dr. William Rassman

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After 7 Scalp Reductions, Would I Have Donor Grafts Left?

Dr. Rassman, you won’t believe this. Maybe you will. I have had I guess 7 scalp reductions. Brandy did a lateral with that Y incision, but not a scalp lift, per se. Marzola, Stough, all did a couple of procedures. I saw my scalp under bright lights (the last thing one wants as that is very unforgiving) on a big screen last night and was shocked by the 1 inch by three inch or so bald thin area in the midline. Dr. Hitzig performed two large midline graft sessions around 1999 or 2000, fixing the scar but the density leaves something to be desired. I see you mentioned Dr. Frechet of Frechet extender fame I imagine in a response to a patient. Some sort of triple flap procedure. I have some donor left but can’t get over my lack of crown density despite a large number of grafts. I know Dr. Hitzig always grafted the midline before reducing a scalp. Do grafts just not grow after reductions, especially that many reductions? I could emply better styling but I wish I had followed the late C.P. Chamber’s advice and avoided reductions altogether. He knew what he was talking about. It sounds like there is no practical fix at any price.

Your case is complex. I have no idea what densities you have or the extent of your scar and wound defect. Most people who’ve had 7 scalp reductions are left with a slot deformity. I would like to see some good pictures of your scalp from the front, top, sides, and back. I am sure that you know that scalp reduction is no longer the standard of care today, because they do not work. I have seen men who had up to 16 scalp reduction surgeries and the last ones never really accomplished anything. I wonder about your 7th procedure and what you were trying to accomplish that the prior 6 have not.

It is best to be examined carefully by an expert and then see what your needs are. Patients should make a list of priorities and then try to work down the list. Patients who have had so many procedures never really get too far down that list, so be realistic.

For more information on scalp reductions, see:

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After 3 Months on Propecia, My Hair is Oily

I am a 24 year old male, and have experienced mild hair loss for the past 2 years or so, mostly in the temple region. However, the rate of hair loss has significantly increased in the last 8 or 9 months, and has expanded to the entire top of the head. The front is now very thin, and my scalp is plainly visible all over when the hair is wet. I began taking Propecia 3 months ago, and have not noticed any slowdown in the rate of hairloss. What I have noticed recently, is that my hair has become very oily (it has never been very oily before), and mild acne is beginning to form at the hairline.

So my two questions are:
1) Is the increased rate of hair loss, and sudden expanded hair loss region normal?
2) Is the oily hair and/or acne side effect of Propecia? Normal symptoms of hair loss? Or something else?

Thanks a lot for your great blog!

These are questions for your doctor. Remember, you’re asking about a prescription medication. You should pose questions about this sort of thing with your prescribing doctor.

In my experience, what you are reporting for the first three months with regard to seeing a benefit on Propecia is usual as it takes almost a year to see value. With regard to the oily nature that you are reporting, I have not seen this reported by my patients.

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African American Female Hairline lowering transplant (photo)

This could never be done with a hairline advancement surgery because only a hair transplant could have matched the original shape of the hairline she is known for. This woman is a successful model and continues that way.


2020-03-03 07:36:13African American Female Hairline lowering transplant (photo)

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After 10 Years on Propecia, I Finally Started Shedding

Dr, I have been taking Propecia for 10 years. If the drug would indeed stop working, what exactly would happen? Would I have some form of telogen shed? Or would the loss be gradual? The reason that I ask is because I am going through a severe shedding phase that began in September of 2008 and it continues until now. I have indeed ordered the “generic” drug from overseas the past couple of years. Could the overseas drugs be bogus and this is the reason I began shedding again?

There’s two possible problems — the generic you bought overseas could be fake, or your finasteride dosage could just be starting to finally lose the fight to your genes. I often talk about a tug of war of sorts, where Propecia works on one side of the rope and your genes work against it. The genetic side appears to be slowly winning. Talk to your doctor about increasing your dosage to 2mg daily and see if that helps.

Whatever you do, do not stop the drug! You’ve taken the medication successfully for 10 years now, and it hasn’t stopped working for you… but if it’s not due to fake overseas medication, then it’s not slowing the hair loss as well as it was before. Stopping it completely will likely result in a massive catch-up hair loss situation occurring.

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After 6 Months, I See No Change from Propecia

Hello,

I am 24 and have been taking Propecia for nearly 6 months now, but I have noticed little to no change in my hair loss. I have spoken to a doctor about getting a hair transplant but was told that I need to continue taking Propecia after the transplant in order to keep my existing hair, or else I will only have the transplanted hair on my head in the future. If the Propecia is not responding to me are there any options for the future in terms of keeping my hair?

Thank you!

I often write here about the importance of speaking with your doctor for a treatment plan, but I suppose even after talking to a doctor there are things that go missing. Your doctor should have explained to you (and maybe he/she did) that Propecia is not a cure for hair loss, but it should help hold onto the hair you currently have. Some patients respond better than others to Propecia, but that does not mean it isn’t working. It just means your hair loss predisposition is outweighing the limits of the drug.

Hair transplants may help, but you deal with your existing hair problem. This is the main reason you need to have a Master Plan. Hair transplantation is not a simple decision to take lightly. You need to plan for what your hair will look like in the future. With or without Propecia if you are destined to go completely bald (Norwood class 6 or 7) you need to plan for your surgery accordingly.

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After I Had a Scar Revision, the Area Is Very Itchy

I had 3 FUSS transplants over a decade. It left a wide scar. I had a scar revision. It resulted in a liner revision line. However after the scar revision, 5 years later, I have bouts where the scalp area is really itchy. It ceases in a day and then restful for awhile

1. What causes this?
2. What can one do?

thanks for the tip and your powerful website!

You can try an over the counter hydrocortisone treatment in small doses 3 times a week or once a day, whichever relives the itching. I can’t say a scar revision and scalp itch are related — at least, it’s not something I’ve heard of before. If it continues, I would see a dermatologist.

As an aside, we are no longer doing scar revisions, but rather offer Scalp Micropigmentation (SMP) as the treatment of choice for scars. Most people who have scar revisions still have significant scarring, and SMP literally wipes out the appearance of the scar.

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African American Female Hairline Loss

Hi I am a thirty year old African American Female. From my early childhood, I have been exposed to tight ponytails, braids, weaves and chemical services applied incorrectly. Surprisingly, I still have a head full of hair with the exception of my thinning hair line. My hair is currently chemical free and has been that way for over seven years. I normally wear wigs as a protective style. My hairline is still thin. Is surgery my only option?

Norwood 4AUnfortunately, there’s no medication that can restore a hairline and surgery might be the only option. Hair transplants for the frontal hairline work well, even in African Americans. Unfortunately, many African American women I’ve seen with traction alopecia have lost much of their frontal hair, even the hair that goes into the temple peaks on the side, creating a concave look similar to a Norwood Class 4A pattern (see image at right). The problem is that the larger the area, the more hair it takes to get a thick result.

African Americans usually are born with less hair than Caucasians (about 65% by hair count) so the supply is often more limited. In your case, if the hair loss is just in the frontal 1 1/2 inches, you may be able to get it back. A good examination is important, especially when made by someone who has considerable experience capable of giving you realistic expectations.

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After Hair Transplants, many doctors ignore patients’ questions – why?

Almost every day I get emails (because of my internet presence) from patients who had surgery and find their doctors don’t seem to answer their concerns and questions. Many of these men see an abrupt change in the doctor when compared to before their surgery. I guess it is like being sold a used car and the salesman is all over you, attentive to your every need, until…. that is, you purchase the car and have problems. As they already got your money they don’t to have to be responsive anymore.

Being a good doctor means taking care of the patient and all of his/her needs before, during and AFTER the hair transplant. I find, however, that I am stepping up to help those whose doctors just don’t seem to care about them after their surgery. This may be more of a problem as Medical Tourism is becoming very common (I get both types of post-surgery emails). If for example, you go to Turkey and have a surgical procedure, then go back to your home country, local doctors will have no interest in you and the doctors in Turkey (assuming that they were doctors – which is often not the case) certainly have no structure put together to help you in your home country.

My advice for anyone reading this post is to meet and speak with patients who had surgery with that ‘doctor’ you are considering before you make the decision to go with that doctor or that clinic. Their patients will always share with you what their experience was, so this way you hear it first hand and will avoid the problems if you listen to what you are told.


2019-12-12 11:51:46After Hair Transplants, many doctors ignore patients’ questions – why?

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African American Female with Bald Crown

I am an african American female 35 years old. My entire crown is bald. What do I do now? I’ve been using 2% minoxidil and it continues to fall out.

You need to be seen for close examination of your hair and scalp. A diagnosis should be made. You could have a variety of non-genetic hair conditions causing it. You might have genetic female balding limited to the crown as well. I need to know the miniaturization mapping results of your scalp and the pattern of your hair loss before making any diagnosis and treatment plan. You need a good doctor to take charge of your hair loss.


2007-03-09 10:32:36African American Female with Bald Crown