Category: Uncategorized

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Does a Hairline Shift When Closing a Strip Procedure?

Hi, doc. I’ve been researching hair-transplantation, and I have a question concerning F.U.T. (strip-harvesting): I understand, in this method, a strip is excised from the back of the scalp, the wound then closed. I wonder, then, is not the overall surface of the scalp reduced in this procedure? After two or three procedures, especially, (or even after one large session) — when, totally, a reasonably wide portion of the scalp has been removed, will not a patient’s hairline, in accordance, also be shifted?

That is, the front hairline would move back by the amount of scalp excised, or, more likely, the “rear hairline” (which ends at the back of the neck) must certainly be “moved upward.” At least, this is how I imagine it would be. Is my logic flawed? I’ve been trying to understand this in researching the procedure, but the point still evades me.

I understand a physician will take into consideration laxity of the scalp, so what I’m talking about might not be immediately noticed — I also hear doctors will try to cut out strips that are longer rather than wider, to reduce tension — but, ultimately (again, especially when a large number of grafts must be harvested), will not the hairlines (front and certainly rear) be affected? If not, why not? If so, is this effect permanent? The piece of scalp taken out can’t “regenerate,” can it (and, if it could, would it regenerate hair follicles, too)?

Sorry for this long question, but certainly I’d appreciate your taking the time to answer. Thank you very much.

P.S. Just one other question (a brief one): Can hair that’s already been transplanted to a new location be removed and successfully retransplanted in another area (e.g., back to front, then, later, if need be, north of that region)?

The hairline never shifts, but the scalp itself does stretch a little with each procedure so that the donor density reduces a bit. I’ve answered a similar question before.

Neither the front hairline nor the neck hair moves as a result of these excised areas. The only part of the scalp that is impacted is either the posterior scalp (which would be stretched) or in a small group of these patients, the redundancy of the scalp (scalp laxity) reduces. The scalp is attached to the galea and then to the skull. This keeps the movement from one area to another minimal, if at all. Scalp and follicles can’t regenerate.

As for your P.S. — Yes, we often move previously transplanted hair when the work is not good, but there are limitations to moving a great deal of transplanted hair. This is commonly done in repair procedures.

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Reader Doesn’t Think ACell Will Work

I don’t believe that A-Cell will work. Is there actually any proper evidence of this technology working anywhere? It seems to be just that guy with the finger which I am unsure whether has been exagerrated/fabricated. Other than this it feels like all hype.

Also, it seems like when you pluck these hairs, you have to take out so much of the hair that logically thinking I’m not even sure if they will grow back the same thickness (if at all). Now I know people will come back with how they wax their legs, chest, arms or even their head regularly and they always grow back, but I seriously doubt that when a normal person plucks/waxes, they are extracting the amount of tissue required to perform the A-Cell procedure.

In addition, Jerry Cooley states in his presentation on one slide: “you can see the thicker FUE grafts vs the thinner plucked hairs” – so this really isn’t what it is being hyped up to be?

This unfortunately to me feels like just another method of doing a standard hair transplant. Maybe it will infact become the common way as it appears to allow it to be done without any scaring at all, but right now it looks like you would actually be worse off using A-Cell method over current methods, as the hairs at the donor and recipient region will grow back thinner, that is if they grow back at all.

I don’t know of Dr Cooley’s reputation, but from watching his presentation this just doesn’t seem that impressive. The only way it might work is using beard hair that thinned out during the process and ended up like scalp hair, but even then if this worked perfectly is it really a cure? You can’t do whole units and can you control the direction?

Perhaps you are right, but in the spirit of scientific research we have to try. That is one reason why we are trying to conduct formal IRB approved clinical research. It will either prove or disprove the concept.

The hope is that the plucking approach will yield more hair than moving the hairs around with traditional transplantation. The fact is that not only us (NHI), but the entire hair transplant surgeon community needs to be able to replicate this technique to stand up to the test.


2010-12-10 09:08:40Reader Doesn’t Think ACell Will Work

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Does Body Hair Relate to MPB?

Hi Doc!

Does male body hair, like chest hair and/or back hair, have anything in common with MPB? In other words, have you ever seen a bald/balding person without this kind of male body hair? (assuming he is not shaved)

I also wonder if a maturing hairline should be as thick as a juvenile hairline, or if it is common that it is a little bit thinner at the very front of the hairline.

I would really appreciate your expertise on these matters.

It seems at times that the bald men have bodies covered in hair, somewhat like a gorilla, but it is simply not the case. There is no connection between body hair and the loss of head hair, except to state that those with lots of body hair probably have good testosterone production.

The maturing hairline is as thick as the juvenile hairline, as long as there is no genetic hair loss in the actual hairline (no miniaturization). Sometimes, the mature hairline is thinner (at least it seems that way to me as I look at my mature hairline), but that is just a feeling. No facts on that subject to back up my ‘feelings’.


2007-01-29 13:49:41Does Body Hair Relate to MPB?

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Recent Article Comparing Drug Results for Hair Loss

February 2, 2022

Relative Efficacy of Minoxidil and the 5-? Reductase Inhibitors in Androgenetic Alopecia Treatment of Male PatientsA Network Meta-analysis

Aditya K. Gupta, MD, PhD1,2; Maanasa Venkataraman, MSc1; Mesbah Talukder, PhD1; et alMary A. Bamimore, PhD1
Author Affiliations
JAMA Dermatol. Published online February 2, 2022. doi:10.1001/jamadermatol.2021.5743

Key PointsQuestion For male androgenetic alopecia, what is the relative efficacy of monotherapy with orally and topically administered minoxidil, dutasteride, and finasteride?

Findings In this network meta-analysis of 23 trials, the rank of efficacy across treatments and the relative efficacy for every possible pairwise comparison of treatments were determined for 4 end points (ie, change in total and terminal hair count after 24 and 48 weeks). The results of this meta-analysis indicate that 0.5 mg/d of oral dutasteride has the highest probability of being the most efficacious treatment, followed by these agents in decreasing order of efficacy: 5 mg/d of oral finasteride, 5 mg/d of oral minoxidil, 1 mg/d of oral finasteride, 5% topical minoxidil, 2% topical minoxidil, and 0.25 mg/d of oral minoxidil.

Meaning The findings of this meta-analysis contribute to the comparative effectiveness literature for AGA therapies with regard to the compared interventions.

Dr. Rassman’s Concern: Dutasteride has a half life of 5-6 weeks so daily dosing at 0.5mgs make little sense to me. Blood levels and other organ impact at this dose building up over time, have not been analyzed or published.

Dermatology News Wrote: Here are comments and an analysis of this article which our readers may find significant: https://www.mdedge.com/dermatology/article/251693/hair-nails/male-alopecia-agents-ranked-efficacy-meta-analysis

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Does Dying Gray Hair Lead to Faster Graying?

How true is it that when you color your grey hair, you will grow more grey hair faster than not coloring. I have been getting different answers from the web. I need your opinion. Thank you.

It’s not true at all.

Hair color is the result of pigmentation due to naturally occurring chemicals (primarily melanin). These chemicals are present at different levels, thus giving hair its distinctive color. The more melanin present, the darker the hair; the less melanin, the lighter the hair. Hair color changes as we age, going from their natural color to gray and then white. The color change occurs when melanin is no longer produced in the hair root and new hair grows without pigment. Coloring the hair has no effect on the rate of graying and on the deposition of melanin in the hair shaft — it just affects the hair above the skin.


2008-02-20 09:22:23Does Dying Gray Hair Lead to Faster Graying?

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Does Finasteride impact a man’s semen

What has been reported to me in addition to what I read are the following impacts on men’s semen: 1- change in consistency, 2- decreased volume, and 3- reduced sperm count.

Men wishing to have a baby should check their sperm count. If they find that they have a problem impregnating their partner they may consider stopping the drug with a risk of losing the hair you gained from it. I have seen some scattered reports that some men have seen such a radical reduction in sperm count that they would be considered sterile; however, stopping the drug supposedly increases the sperm count over time.

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Removing Scalp Reduction Scars?

I am 43. I had a scalp reduction at 24 along with 4 sessions of hair transplants. I was disappointed with results so I have been wearing a hairpiece the last 15 years. Now I wish to shave my head. Can the flaxel laser help with the scars on the back and top of my head? Or should I consider transplants in the scar areas or both options? I am a little leary to do transplants again. I appreciate any advice, don’t want to make any more mistakes.

In general, fixing a bad hair transplant or a bad scalp reduction surgery is very individualized and difficult. The results are often not perfect, so there must be a full understanding of expectations and what you are trying to achieve. There are always options for repairing your look, but you need to see a hair transplant doctor who specializes in these type of cases. It would be doing you a disservice to offer you specific advice for your case without seeing exactly what you’re talking about.

For the readers that aren’t familiar with a scalp reduction (see image at right), it was a procedure some doctors did that essentially just excised the bald spot. We’ve written before about how patients that underwent scalp reduction surgery often developed a “slot deformity”, where the hair from the sides grows away from the scar, causing an unnatural slot to appear.

Lasers will likely not achieve what you are looking for. Meet with a doctor in person that can advise you about what to expect the end result to look like. It might not be perfect, but I wouldn’t be able to outline your options until your repair area is examined.