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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 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 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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After 3 Months of Propecia Use, I Can’t See My Scalp Under Harsh Lights Anymore!

Earlier this year I noticed my hair seemed thinner and a miniaturization exam revealed diffuse loss on the top of the scalp but not the sides or back. It was modest loss, only visible under harsh lights, but my hair definitely felt less dense.

Nearly three months later after consistent Propecia use, I could swear my hair feels thicker and I can’t see as much scalp in the mirror under harsh lights. Could this be a real effect or is it probably in my head? (No pun intended!)

This type of result seems like it might be too quick after just taking Propecia for 3 months, but I suppose it’s possible that you had a really great response, which we have seen in some men from time to time. It usually takes a few more months for most men to notice that much positive change, though. I’d keep taking the medication and keeping track of the gains.

Congratulations on the good fortune and better hair!

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After 13 Years on Propecia, Could I Be Developing a Facial Rash From It?

Hi, I am 43 year old and been taking propecia 1 mg per day and 5 % minoxidil. I have taken these for the last 13 years. The results have been amazing, probably a little less hair on top and sides now. As far as I am aware you didn’t/don’t think I have had any side effects. Well I have a slight none itchy rash above my upper lip. I have got very worried about using the propecia so I want to give this drug up. How would I scale down the drug and over what time period please. I have already halved the tablet each day. I do hope you can help, there is just so much worrying data on net saying about terrible side effects after finishing off propecia. Thanks in advance

The dosage of any medication has little to do with the allergic response. If you are allergic to it, cutting the finasteride pills in half will not solve your allergy issue. It’s possible that either Propecia or minoxidil could cause allergic reactions like you described, but you could and probably should see a good doctor for the discussion.

Stopping the pills or the minoxidil for a couple of weeks will have minimal impact on the hair, but will address the allergy issue if that is the cause.


2011-08-25 11:09:02After 13 Years on Propecia, Could I Be Developing a Facial Rash From It?

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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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African American Hair Expert

I’m an African American female and want to know which is better for my hair, pressing with a hot comb or using a non lye relaxer (like Precise). Also, I have hair loss and hair is very thin. I had a hair restoration in June 2005 by Bosley. Can you please recommend things I can do to improve my hair? Do you consider yourself an expert in dealing with African American hair?

I believe that I was the first person to place follicular units into an African American and started the trend that allowed for the use of small grafts in African hair types. As you may know, hair transplantation is a ‘peg in a hole’ surgery, but African hair is curly (like a cork screw) and therefore placing it into a round hole can be a difficult challenge to the inexperienced hair transplant surgeon. I guess that would make me an expert for transplants into African American hair types.

With regard to your other question, I am not an expert in the best ways to ‘relax’ hair, but I see problems with those individuals who have this done improperly. I am an expert in the complications of such treatments. I would have to examine you to make any recommendations.


2006-01-16 10:00:14African American Hair Expert

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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

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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)