Hi,

First of all I want to thank you for this informative blog. I have searched this wonderful blog and have found numerous postings relating scars and hair transplant. Here’s my case: I have what “they” call a coronal scar that runs from ear to ear. What I want is to completely cover the scar through a FUE procedure, but I want my scalp to be like how it first was, normal. My research has been conclusive and I first want to have a scar revision surgery to reduce the width of the scar, once that is done i want to follow some type of scar treatment to make the scar less obvious in color (seems like the scar gets pink/red after a scar revision surgery). Afterward get the FUE procedure and go from there. Is there any treatments that you would suggest?

I want the scar to be inconspicuous to the point to be able to cut the hair in the military/short hair style, because ultimatley i want to join the military as an officer.

Best Regards

Your plan is good, but it may not be realistic to have the scar completely hidden. Even if the hair in the scar is brought up to near normal density (which may take a few FUE procedures), there is often a color difference in the remaining scar, though of course it will be hidden with FUE grafts.

As you are local to my Los Angeles office, please arrange to see me so that I can ascertain a plan that matches yours. Any preparatory treatments can be assessed and recommended when you see me. You can call 800-NEW-HAIR (or 310-553-9113) to schedule a free consultation with myself or Dr Pak.

Dear Dr Rassman,

I searched the blog, but did not find answers to two specific questions.

1.)Is there a blood test one can have to determine the level of DHT in the body? What level of DHT would be considered above normal? If I want my DHT levels tested, what do I ask for? (I have an appointment with a dermatologist next month)

2.) Is Androgenic Alopecia the ONLY thing that causes miniaturization of the hair follicles? For example, could seborrheic dermatitis, or some other scalp or systemic illness, cause the follicles to shrink in a similar fashion?

Thanks so much for sharing your knowledge!
(male, 28)

The best way to get your DHT blood levels is to have your doctor send your blood to a lab that can do this test. Testosterone is broken down to DHT by an enzyme called 5-alpha-reductase type 2.

Miniaturization can be caused not only from genetic hair loss, but also it can be found in an unhealthy person and by certain medications you may be taking, such as tranquilizers. People who go through telogen effluvium can have miniaturization as well and the process can be reversed. More about miniaturization can be found here.

What if you need treatment for high blood pressure can using oral loniten help lower pb and also help a little with hair loss.

Thanks

You are very creative, but Loniten (oral minoxidil tablet) is not a reliable blood pressure medication and that is why it is not recommended for blood pressure management today. Topical minoxidil is more consistent in producing hair regrowth in the areas where it is applied, not everywhere on the body as Loniten did on occasion.

hello
is there a link between stress (psychological not physical) and hair loss? if yes, what is the mechanism of it?
thanks

There is clearly a link between hair loss and stress. We see it all of the time in people with hereditary hair loss. The hair loss can be brought on during the stress of the college student (for example) or during illness. I do not believe we understand the mechanism of it, though.

Hi Dr. Rassman. I’m 25 and have been following your site for a few years now since my hair started thinning at 22. I’ve been taking finasteride though and it’s kept it at bay…

I have a couple of questions for you if you please:

1) Any chance that FUE can become more affordable soon? Am I right in thinking that a FUE procedure of 2000 grafts would cost over $15,000 nowadays? Any chance it could drop to $10,000 soon?

2) This question is sort of related to the one above - Do you have any updates on the Restoration Robotics FUE procedures? All I know is that there are trials being carried out here. You mentioned before you had granted them use of your license… Have you enquired as to whether they’re seeing any success? Any chance the robotic technique will result in cheaper FUE procedures?

That’s all. I really hope you can answer these questions which have been on my mind (and many others I’m sure) for a while now.

Best Regards

Costs for follicular unit extraction (FUE) will follow a supply/demand formula. Although many physicians perform FUE procedures, the failure rate is very high, so buying 2000 FUE grafts may mean that you purchase the delivery of these grafts, but survival may not follow the delivery because of damage done at the time of extraction. There are many groups working on mechanisms to deliver quality FUE grafts that will not be damaged so that they grow. Many groups have devised better tools and have announced them at the various ISHRS conferences and elsewhere (Drs. Feller, Harris, Boudjema, Cole, and myself).

Restoration Robotics will require FDA clearance before their product can be released for commercial application. The other devices are what the FDA calls Class 1 devices, which do not require FDA approval. I’m not sure of their progress at the present time, nor do I know of any costs, though doctors will still likely set their own pricing. My guess (and I am not privy to any info, so this is entirely speculative) is that the equipment start-up costs will be substantial and like any other product or service, costs will come down at some point in the future when it becomes available to a wider market. How near of a future, I couldn’t tell you. One step at a time.

Note: The image is of a violin-playing robot developed by Toyota. It won’t do hair transplants, but it might play you a song.

Dr. Rassman,

I know that this question is probably answered in many FAQs, but I’ve been watching your blog for two years straight and do not recall seeing it:

What happens to the surrounding skin when you cut out the donor area? I’m particularly concerned with knowing exactly which areas of skin are going to get “stretched” to make up for the missing skin. For example, does my face get tighter? Does my neck feel tighter? Does the skin regenerate to compensate? Can this lead to minor sagging/stretch marks in areas behind the head? More importantly, can it shift parts of your face slightly out of line?

This is a great question, one that I am asked when I do consultations. Your face doesn’t get tight, your neck isn’t stiff. You don’t even get tighter buns. The stretch that occurs is so uniform that most of the time there’s nothing that can be detected. Some people who have good laxity will notice a slight decrease in the looseness of their scalp.

I only wished that my own strip excision would’ve produced even a small face lift, but the answer is that there is really no shift of anything. I dream of doing a hair transplant and giving a person a facelift, which would allow me to increase my fees and offer more value, but alas this does not happen.

I had a hair transplant about seven months ago. It was performed April 5 2009. I had been cutting my hair all this time because I am in the military. but started to grow it out the last two weeks. but it still looks funny. What I mean by that is when it grows it doesn’t match the rest of the hair. the back hair is more full, and the front looks like stitches. Is this normal after seven months? How long do I have to let it grow to make it match the rest of my hair?

I do not know about your hair transplants or how the procedure was performed. I do not know what your expectations were or if you were given realistic expectations. So I really cannot comment on what you are experiencing. Keep in mind that not all hair transplant procedures are the same. The doctor and the team you chose can either produce great results or substandard results, depending upon their experience and skills. It is not like shopping for a car.

The best advice is to follow up with your doctor. Sometimes it can take a full year for 95% of the growth to be evident. At 7 months, I would expect 60-80% growth.

Can hair be lost because of change in location/water?

I can not imagine that either the geographic location where you reside or the water you drink will cause hair loss, unless you are stressed or there is something in the water. Though I’d expect if there was contamination in the water, your neighbors would have similar hair loss. Stress from a recent move can possibly cause hair loss.

I am a female, 36 years old with long Naturally curly hair. In the last 2 years have seen a dramatic decrease in hair. This runs in my family. After seeing the dermatologist to try to prevent any further loss it was recommended to me to use once a day mens Rogaine foam. Having long hair I am finding it very difficult to apply and am unsure what area to apply it to. I am worried I am wasting product on having it soak into my hair and not my scalp. Yet I want to make a valid effort to do this as its important to me to at least keep the hair I still have.

I should also point out that my hair “expands” so to speak when dry. Frizzy. I do see why some try to apply after a shower as that is when you can get to the scalp easier. Thanks for your time and i hope you can give me some insight.

Many people who use Rogaine in one form (such as the foam) may try it in another form (liquid). There may not be an easy, practical answer to your problem, but you can try the minoxidil liquid and see if that is easier for you to use. These medications are a waste in the hair, as their only value is on the scalp itself.

I can only afford to have my bald patches of my hairline transplanted (FUE) so no other areas of hair will be near. Will the shock loss only affect the donor follicles? or does all of your head hair fall out?

While price/cost is a factor for any cosmetic surgery, it should not dictate the surgery itself. Having cosmetic surgery is not like shopping for the cheapest loaf of bread, laundry detergent, or shoes.

When shock loss occurs, it may be the result of the anesthesia given to numb the head for the transplant and may cover a large area of the scalp, not just the area where the grafts are placed. The mechanical impact of the transplant may not be the cause of shock hair loss. You also have to look at the big picture. We call this the Master Plan. Surgery must be placed along your hair loss timeline and it will be progressive. In other words, you can’t just transplant hair to the small bald patches and expect that to solve your problem, as the balding process is regional. What if you lose more hair around the transplant and behind it as your balding continues? A good doctor should give you insight on your worst case scenario and plan for such consequences. After all, you don’t want to have small patches of transplanted hair scattered around your bald scalp in the years down the line “IF” you were to go bald.

To answer your question in further detail, shock loss is a concern… and while it may not happen, it is a risk. I have addressed your question with the assumption that you have genetic male pattern baldness and not just a patch of bald scalp (which is very rare in genetic balding). Either way, you need a Master Plan created with a doctor (not just me on the Internet) who is willing to look at your hair loss problem as a long term process.

For the follicular unit extraction (FUE), you need to understand it does not work to fill in the scalp balding areas like a patchwork quilt. Do not let the cost of FUE be the primary reason in your decision making process as to what to do and where to put the hair. It is better to be bald than be disfigured with a half-ass surgery.