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In an earlier entry, you were asked to talk about the ability to expand the lower donor scalp. Could you tell me more about why this is important.

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The ability to move hair from the permanent zone around the side and back of the head to areas where it may be needed are dependent upon two factors, which are:

  • the density of the hair in the donor area. The normal density measures 1250 hairs per square inch. The more the density, the more is the movable hair
  • the number of square inches of scalp that can be moved depends upon the looseness of the scalp (something we call Scalp Laxity). The more square inches we can safely move, the more hair we can transplant

The ability to move more square inches of scalp with a strip excision also depends on the ability of the surgical team to place them safely into the area of need. Of course, it is important that the need for hair reflects the size of the bald area. For small bald areas, either less hair is needed or more density is needed. The ability for an experienced and skillful surgical team to place the highest density into the recipient area safely is core to the results that one can expect after a hair transplant. This varies between doctors offices and that is why the wide offerings are promoted on the internet. Some physician teams promote 5000 grafts in a single session in a fairly bald person, while other state that a lesser number is the only safe number. The safe number varies with the skills of the surgical team and nothing else.


I have heard reports of using unusual wave lengths of light to stimulate hair growth for MPB. Is there any documented results on this work? Is there any application in stimulating growth in newly transplanted hair?

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I have been doing the Laser Light Therapy for the past 4 months with No positive results yet, if fact it seems to have made my hair loss worse. Do you have any data on this therapy?

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I have been bombarded with questions about Low Laser Light Therapy (LLLT) for hair growth stimulation since I started writing the BaldingBlog. The above are just two recent examples which reflect the wide variations in questions, one of which was already answered in a previous entry. To address these questions, I have prepared and will continue to prepare more updated information on the laser’s mechanisms of action and benefits as understood by the medical, scientific and commercial establishment. This summary should serve to supply an overview of the subject on LLLT. Until a well controlled FDA quality study is in our hands, we will not be able to judge with any degree of certainty whether or not the laser will become an important part of today’s hair loss treatment armamentarium. The wide enthusiasm for the technology in the United States today has been preceded in Europe for many years. I expect to review the European and American literature sometime in the next month or so.

Please read the new Low Laser Light Therapy page at for more information.

With regard to the second person’s question: the laser should not cause hair loss, so I would expect that this person is going through a rapid loss period that is coincidental to the laser treatment, or has some medical cause of hair loss that needs proper medical assessment. It is important to seek the help of a competent doctor when something like this occurs.


This 26 year old man received 2200 grafts into the frontal hairline. He came into my office today asking me if he should do any more transplants. He trusts me and felt that I would give him the correct advice.

His results are remarkably good and he is very pleased with the results. Like most young men, he feels he might be happier with more hair, but he is not at all dissatisfied with the fullness he sees when looking in the mirror. I told him that considering his age and his overall satisfaction with the results, that additional hair transplants should be postponed, and we should watch for more hair loss over the next 5-10 years. If his balding does not progress and his present stage of fullness is maintained by continuing Propecia (he has been taking it for the last three years), then he can increase the fullness with more grafts into the frontal triangle. If, however, his balding pattern should progress to a more advanced pattern, the additional donor hair may be best placed elsewhere on his head, for the best results.

This is a call that could go either way. If he felt that a fuller forelock area was his focus, then I would have no hesitation to fill in the rest of this frontal triangle. Clearly, I am in no rush to take his money and he is in no rush to get more hair, so for the moment, we have decided to wait out the unfolding nature of his future.

Photo on the left is the “before”, from a few years ago. The photo on the right is the “after”, taken today.


Thank you for this site. I’m certain it must be frustrating at times getting the same questions over and over (read the old posts people!!!!), but let me assure you that your time is not wasted. Many of us will certainly be coming to you in the future because of the site.

My question is as follows: If an individual starts taking propecia, then a few years later decides to get a transplant, will the transplant doctor still be able to predict the progression of hair loss in order to properly assess what needs to be done, or will the drug make this difficult (because the doctor won’t be able to see the ‘natural’ progression because (hopefully) the drug has effected the normal hair loss)?

i.e. I’m suggesting that the transplant doctor was not the one to suggest the drug years before, nor has access to any previous records.

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When looking at Propecia induced hair growth or preservation, you can always see what area has been saved or regrown because the genetically impacted hair will have a high percentage of miniaturized hair easily seen under microscopic examination of the scalp. So do not fret, the ability to predict a master plan in a person over 30 is relatively easier to do than you may think. The ability to predict the final hair loss pattern is less with younger men, certainly those under 24 years old.


I want to get a hair transplant during the summer while I am off from school but if I am going to lose hair, I won’t do it. Is there a guarantee that I will not lose hair?

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I will assume that you are a student of college age (under 30) in answering this quesstion. If you are older, then shock hair loss is less of a risk. If you take Propecia, I have found that the likelihood of having reactive hair loss is significantly less likely. In the days before Propecia I used to see it all of the time in young men. For those who are on the drug before surgery, there appears to be a protective effect that stops the hair transplant shock loss that plagued the men prior to the introduction of the drug. There are few guarantees in medicine, but I do not remember any person in recent times that was on Propecia that had significant reactive hair loss.


Just learned that this month is Hair Loss Awareness Month, as determined by the American Academy of Dermatology. This is from the press release —

“Hair loss affects 80 million American men and women and while it isn’t life-threatening, it can cause emotional distress,” said Dr. Draelos. “Disease, genetic predisposition and even poor cosmetic grooming practices all cause hair loss. Even simple changes in your hair care routine can result in healthier hair.”

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You can read the entire press release here. So when is Hair Restoration Surgeon Month? :)


After reading your articles and Q&A, I decided that before doing anything I should check with some dermatologist. I search for doctors for hair disorder in my area through The American Academy of Dermatology website. I am just curious about how to check if the doctor is expert in this field? or is it safe to assume that the doctors suggested on the are expert in this area? I am just being cautious because once I went to a dermatologist and he just gave a glance to my hair and prescribed me propecia, and that was like one minute consultation. So I just want to make sure that I dont end up doing the same. Thanks for your time.

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There are many steps in the process of selecting a good hair doctor. You have done one. The ISHRS site has doctors who participate in the international hair society. These doctors do more hair work than most, but then again, that does not guarantee the best doctor. If it is a hair transplant you are looking for, go visit and interview the doctor and ask to see his/her patients. What you see is a good indication of what you are going to get.

In your situation, where the doctor didn’t provide you with a full consultation, that generally says to me that the doctor you got may not be a real expert, and although he may have done the right thing by prescribing Propecia, you still need to go through a better examination to be sure of the diagnosis. Typically, you should have a microscopic examination of your hair before the Propecia is started.


Thanks for showing photos of the guy a day out of surgery [note: Photos – Day After Hair Transplants ]. I don’t mean to be pushy, but can you show me some more patients, possibly a week or two after the surgery.

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I took some pictures of a patient who came in just 10 days after surgery. These photos show the small shaved hairs that were placed in the bald area (particularly noticeable if the skin is white and the hair is dark). These hairs will most likely be shed in the next week to month as the follicles enter the dormant phase. In 3-6 months, the new hairs will begin to grow as very fine hair. And by 8-10 months, the hair will be thick and groomable. You can find the entire best-estimate schedule in our Post-Op Course page.

This patient is a Norwood Class 6, and had one procedure of 2,705 follicular unit grafts. Please click the photos to enlarge.


Can you point me to information about the new surgical techniques you reference? I was under the impression FUE was the primary repair technique for widened donor scars.

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This is the response I wrote to another blog question…

We have developed a fascial closure of the donor wound. This has been successful in reducing the scars in the donor area. I imbricate the deep fascia holding it in place with a Vicryl suture (which lasts about 6 weeks). With the fascial closure, the tension on the skin in markedly reduced and most scars will heal with less stretching of the scar. This does not deal with the individual differences between the way we heal, but so far, the results of these repairs have been most impressive.


I thought since the steroids (cortisones) taken for colitis of the intestine is much different than anabolic steroids, that athletes take for strength it would not exacerbate or fasten MPB if someone is genetically predisposed to it. Doesn’t the 2 steroids vary significantly in terms of the ingredients that make up the steroid?

Also you referred to MPB gene, i thought there are multiple genes and just 1, can you correct this for me?

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All of the steroids are related in action, somewhat different in particular strengths and weaknesses, so they do vary. There is clearly overlap and there is no doubt that the steroids used for colitis will impact genetic hair loss. That is my point.

Yes, there are more than one gene that contribute to hair loss. Some estimates are above 100.


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