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I’m thinking about getting a strip method hair transplant and then just filling in the scar with FUE. Is that an option thats worth pursuing? I don’t want the line scar but I want every graft transplanted. I understand FUE has problems with transection or something.

I get this question quite a bit from patients who have already had the hair transplant strip surgery and then inquire about having a follicular unit extraction (FUE) procedure to follow it up. It makes little sense for the person that already has a strip scar (no matter how wide it is) to have an FUE into the donor harvest. If it’s just about treating the linear scar, better solutions would be a scar revision or Scalp MicroPigmentation (SMP). FUE grafts used in linear scars are generally wasteful and an expensive way to treat the scar with less than ideal results.

My complaints about the way the FUE technique is used are:

1. It’s generally more expensive than a scar revision for those with a troublesome linear scar.
2. The grafts do not come out of the sweet spot in the middle of the donor area (where the grafts are easily taken by a strip).
3. In my opinion, the overall survival of the FUE grafts are not as good as those harvested from a strip in most doctor’s hands (I do not believe that is a problem in our hands).

As the first to publish a paper on FUE (introducing it to the medical community), I can speak with authority on these issues. The ARTAS FUE robot has not really changed the process, except for leveling the playing field for those doctors not skilled in the extraction technique. The FUE technique, as done in most doctor’s hands without the robot, is not as good as the grafts produced by a strip surgery. If there was a formal study, I would expect that each doctor would show variable comparative results when comparing their FUE results with this strip results, making such a comparison between FUE and strip surgery essentially worthless.

Snippet from the article:

Starring in a film with Tom Cruise, can’t be good for any man’s ego. But it seems Simon Pegg gave his appearance a little helping hand by amended his receding hairline.

The Hot Fuzz star has been promoting Mission: Impossible - Ghost Protocol at various premieres this week, sporting a rather healthier head of head with a hairline that seems to have shifted a tad further forward.

Read the rest — Simon Pegg’s hairline appears to have shifted as he sports fuller head of hair

The article hints at a possible hair transplant for the actor, but I can’t find anything where Simon Pegg talks about surgery on his scalp. His hair does look thicker than before, but from the photos I’ve seen it appears he could just have some creative styling or products in use. What do you think?

I am 40 years old and noticed a drastic change in my hair texture and amount over the last two years. I have been about a NW2 with a strong frontal tuft that basically was quite curly and full. The top of my head was curly as well with a slight recession on the temples which seemed age appropriate. In the last two years that has changed in terms of width and density. It seems like looking back on pictures that my hair was darker and curlier only 1.5 to 2 years ago. Is this a common occurrence for MPB? I assumed it slowed down as we age but my case is reversed.

I have been stressed about it as well. The loss has been rather quick within the last two years at my age it seems that I had dodged the bullet for advanced NW patterns but looking at things now and I am certainly not as convinced. Should I start propecia and rogaine to restore the hairs that seem to have disappeared within a year? Family history is NW4-5 on dads side and moms side but later in life..what gives? thanks

Certainly, stressing out about losing hair could lead to further loss. Genetic balding, as we know it, develops in patterns. What you are describing doesn’t sound like patterned balding. I would want to do some testing on you to include bulk measurements of your scalp at different locations and miniaturization analysis to look for problems like diffuse unpatterned alopecia (DUPA), and even a pull test for telogen effluvium, etc. With a good examination and these tests in hand, I might venture a guess as to what is happening to you.

Dr. Rassman,

First off, Thank you for the excellent information you provide here on Balding Blog. I have been following your site for years now during college in Ohio, and I must say it has been my primary source of information in my research regarding hair loss. Now that I have moved to Los Angeles after graduating school I’ve had the opportunity to meet you in person, which was exciting for me after following your blog all this time!

Anyways, I am currently wondering how much more regrowth with Finasteride I can hope to see. I have been on the drug since August of 2010 and continue taking it today without fail. My results have been fairly typical. In this time I have seen some minor thickening / reverse miniaturization of my frontal hairline and my crown which had minimal thinning has went completely back to normal. This was indicated by you during my bulk analysis and miniaturization mapping exams.

I would like to add that I had the HairDX Finasteride Response test done in Ohio before starting the drug and my CAG score of 23 indicates I should only have a slight response to the drug, but I did start taking it at age 26 when my hair was only in the early stages of thinning. I know everyone is different but typically/statistically do you see much more regrowth in patients like me after 18 months of Finasteride use?

Secondly, what are the chances I would suffer shock loss at age 28 and having been on the drug well over a year if I had a transplant done to restore my frontal area. (You said I was an early Norwood 3 pattern).

Thanks for everything

I believe that improvement while taking finasteride has been reported for as long as 24 months.

Shock loss is often protected by finasteride… so as long as you stay on the medication, having a hair transplant should not produce shock loss.

Here’s a man in his early 30s that was tired of looking older than he actually is, with a Norwood 3A pattern. We restored his hairline in just one procedure of 2000 grafts, and with the hairline came the youthful appearance we’re all after. The after photos were taken at around 11 months after his hair transplant. Click the photos below to enlarge:

After (1 procedure of 2000 grafts):

Before:

This woman lost her eyebrows after multiple skin cancer surgeries. She had one procedure of 95 grafts into the eyebrow area. She told me that she cuts her new brows short every other day, and absolutely loves the results.

Click the photos below to enlarge.

Before on left / After on right:

Hello dr.Rasmman your site is really informative.Thank you for all this information.I have a question to ask.Is sebum rich in dht and testosterone? I mean if you don’t wash your hair and have an oily scalp,can this accelerate male pattern baldness allot sooner than it would normally start?

I’ve written about this before. And as I said then, most of the claims of sebum containing high concentrations of DHT (thus leading to hair loss) seem to be coming from companies that sell shampoos. These claims are just not supported by today’s science.

Taking finasteride does seem to reduce the amount of sebum, but the connection between sebum and hair loss (because it contains DHT) has no basis.

Hello,
I’ve been trying to find people who have been using Nanosal for a while to know the results but the only references all I can find are from 2005! Are there really minoxidil products out there that use nanosomes for delivery, is it any good? Thank you.

Most of what I can find online about NanoSal is from 2005-2006. If it was anything special, I am sure the medical community or the drug companies would have picked up on it by now.

So I’ll open it up to the readers — if you’ve used NanoSal, please feel free to post about it in the comments section.

This patient had 3 strip procedures, which yielded 7846 total grafts. His donor scar in the back of his head was revised with reasonably good results and a reduction in the width of the scar. You will find before and after photos of his hair transplant and the scar revision below.

Click the photos below to enlarge:

Scar revision (Before on left / After on right):

After (3 procedures totaling 7846 grafts):

Before:

Hello Dear Doc

For hair loss i am using minoxidil 5% solution on my scalp and my eyes burn. Eye burning and irritation is known side effect of minoxidil and i wonder if it might change eye color?

There is a medicine named larissa which may change iris color used for eye lashes.

Thanks for your support.

I am not familiar with Larissa, but perhaps you mean Latisse (bimatoprost ophthalmic solution), which has rare reports of permanent eye color changes in people with blue/green eyes. Latisse is used to grow eyelashes and it is presently being tested to grow hair.

There are no reports with minoxidil changing eye color, but if you’re experiencing burning eyes after using it on your scalp (a common side effect), you should consider discontinuing use if it becomes too bothersome.