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I have a bad elevated, thick scar from my hair transplant incision. I was told by my doctor that this is a keloid scar. Can you explain this to me and what it means if I ever have another surgery?

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In medicine, we always talk about the differential diagnosis of a particular problem or disease. Scars come in many flavors and we are focusing upon healing wounds with this question. Some scars stretch, some get red for a short period of time, some hold their redness for weeks (even months), others get elevated and some form tumor type growths which grow from them – the keloid scar. Many people, even some doctors use the term keloid scars when they are not really understanding what a keloid is. The keloid has become famous from photos in the annals of National Geographic, showing people creating these grape like tumors by cutting into the ears and applying a chemical irritant which produces the keloids. When keloids are found naturally in wounds, they are most often found in the darker skinned races. Doctors have been polled reflecting the cumulative experience of tens of thousands of patients, and keloids are almost unheard of when we talk about scalp scars. When a keloid exists, it is a proliferative process in which the scar significantly exceeds the boundaries of the original wound and is significantly elevated and often globular. Hypertrophic scars can be elevated or simply a thick scar. Burn scars can also be hypertrophic, but rarely keloidal. The trunk and shoulders develop widened and hypertrophic scars quite commonly after mole removal, and this would not be a contraindication for elective surgery. I have done scalp surgery on people who are known keloid formers, but I have never seen one appear in the scalp from which the donor area is harvested.


I am the mother of an 19 year old son, who is now experiencing the effects of heritary male pattern baldness. My father was bald, and my son’s biological father is bald. In fact baldness on both sides of the family goes back for several generations. Poor kid; he is really distressed about this. I tried to explain to my son that just because he is loosing some hair on the frontal area does not mean that girls will not be interested in him. Of course he always says, “That is such a MOM answer!” My new husband and I live in Utah and our communication with my son is mostly over the phone to California where he lives attending college. We told him to go see a Pharmacist but I am sure they will just recommend some over-the-counter cream like Rogaine. Also he likes to work out and has been drinking these shakes to help him bulk up. Are those bad adding to premature baldness as well? What do you recommend? Should he contact is primary care physician? Should he see someone in the Santa Clara, CA area? Please help.

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Sometimes these ‘shakes’ have steroids in them and they can accelerate balding in people who use them. He needs to be seen by a specialist. I have an office in San Jose so ask him to make an appointment with me personally, and I will try to diagnose him and address the problem. The longer he waits to get to the root of the problem, the more hair he will lose. To set up a free consultation, please call 800-NEW-HAIR or fill out our online info request form and we’ll contact him to setup an appointment.


I visited NHI for a consultation about three years ago and was told that while I was a candidate for a procedure, my donor hair sites were limited. I guess they determined that the back of my head just didn’t have enough follicles to take care of my developing baldness in the front and on the top of the head. My question is this: I’m curious about the recent developments in cloning and gene therapy. How far are we away from these advances? I hope soon.

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Since you are in the Los Angeles area, please come back again and let’s talk. A re-examination may have value. With regard to cloning, I have had a number of questions on this subject, which I’ve answered in the Hair Cloning section of this blog.


As a former patient of NHI, I remember that it was desired/required to keep the hair length longer in the donor area in order to “cover” the post surgury scar/shaved area. Do the new procedures (scar minization) used for the donor area make this no longer necessary?

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Only about 5% of former patient developed noticeable scarring. Most of these scars are the result of the healing properties of the patient, although some are technique dependent. With new techniques recently developed over the past year or two, the risk of scarring in first time surgery patients has been reduced. We have notified all of our patients from over the years to contact us if they had scars that were noticeable or bothersome. New techniques can reduce these scars and there are a series of options now available to treat problematic scars. As you can see from my publishing your question in my blog, my goal has always been to focus my efforts on good patient follow-up and communication. I want 100% of my patients to be satisfied and I will work towards that end. Please contact me and make an appointment.


I am a 39 year-old man whose hair is moderately thinning. I have taken Propecia for about 5 years with excellent results but now it seems to have little to know results on the crown. The past two months hair has been falling out consistently. It has finally started to stall but now there are two very noticeable areas on the crown. I never really found minoxidil too helpful. What can I do?

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You need to have an examination to determine the extent of miniaturization in order to predict what will happen to you. You also need to quantify the donor supply, so that you will know if there is enough donor hair to meet your expected needs. Transplants work well, but before embarking on this path, you need to know what your future has in store for you.


I would like to do a corrective procedure. I have way too much hair on the frontal hairline and I am receding in the back. Presntly, I can comb over much hair to create a look of fullnes; however, I fear a wind storm or having my hair wet; the result is too much long strand hair which looks awful (when wet or during a wind storm) ; I am tired of “faking: my hair style; I would like a style that is easy to care for. allows me to get my hair wet and allows me not to wear as much hair spray. I realize that means that I will be bald in the back-so be it. If I had my choice, I would be bald all over whithout transplamt scars and dolls hair look.

Is it do-able-I have some donor hair left but not a lot.

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When working on the crown, there is a balance between donor supply, need and the worst case scenario for your hair loss. Often the donor supply is limited and you should have some reasonable assurance that your donor supply will not outlast your need as you continue to bald. It takes a real expert to make the most out of the least. A visit to a competent doctor with experience in corrective work will be invaluable. Be sure that the doctor will watch for your long term interests and not just transplant you today for how much money he/she can make now. When transplanting the crown, you must balance what might happen to you tomorrow. Can you send some pictures to me? It might help. My email address is on the Contact page. If you are in California or can easily come to California, please visit me.


why can’t someone use another person’s hair if the blood types match and he is willing to donate his or her hair for you

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Good question. When you think about hair you think of that stuff that grows on top of your head. Hair on the top of your head is dead as it exits the skin. The frozen Eskimos and ancient Egyptians in the tombs still had hair after thousands of years. Of course, it is dead. Now when I think about hair, I think of an organ. Each follicular unit of hair has blood vessels, glands, nerves, skin, and fat. It takes all of this plus a growth center and the right genes and nutrition to make hair grow. Since by definition hair is an organ, transplanting the hair from someone else is like transplanting a heart, kidney, lung, etc. These organs are rejected by a person unless the recipient is given drugs to suppress rejection. If you had a twin, then hair from that twin with the exact same genetic blueprint would give you a successful transplant. We did that exact process on identical twins and it worked wonderfully. The usual problem is that when one twin has balding, so does the other.


I and my daughter have severe bald spots. My other daughter has a bald spot also. Not as severe as ours. My daughter is devasted. I think she can be saved from what I am experiencing. I personally feel that there is something in our system. No other family members have this disorder. We have been unsuccessful in locating a doctor who is familiar with Black Hair care or disorders. Can you help us. I now wear a wig. My daughters do various things from sew-ins to wigs. If you provide address I will mail pictures. Thank you.

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If there are spots of hair loss in you and your daughters, you should start off by seeing a dermatologist. There are genetic conditions that fit the description of what you are talking about. Please see a good dermatologist.


Hi Doctor,
I am an avid weight lifter and exercise quite frequently. I heard that after surgery, I won’t be able to my normal routine physical activities for 3-4 months. Is this true? What type of weight lifting am I allowed to do in that period and for how long? Thanks.

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There are two types of surgical approaches in harvesting of donor hair. One is where the surgeon removes a strip of skin and then sutures back together (standard for today’s Follicular Unit Transplantation). I generally ask people who have strip harvesting to hold off on body presses, sit-ups and other such types of exercise that can strain neck muscles for a few weeks after the surgery. All types of aerobic exercises. otherwise, are ok.

The second type of surgery is Follicular Unit Extraction (FUE), where the follicular units are harvested one at a time. With this procedure, you can resume full exercise within a few days of the surgery with no limitations at all. The FUE surgery is more expensive than the strip surgery and the surgeon can not as easily move as much hair in a single surgery. This means that FUE requires more procedures.

Patients who had FUE surgery have not complained about pain, but those that have had strip surgery generally have some discomfort, mostly on the first night.


I am a hindu. I have to shave my head at various religious cerimonies. is there a way where I can get a scar free hair implantation? Having a scar is out of question

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Anyone who has a cut or break on the skin develops a scar. The proper question is, “Can the scar be seen in a routine social situation?” There is a surgery (developed and published by me in 2001) called Follicular Unit Extraction, or FUE for short — otherwise known as the FOX™ Procedure. With this procedure, individual follicular units of one, two or three hairs are removed with a 1mm punch. That leaves a scar measuring 1mm and a series of these are produced proportional to the number of such grafts that are removed. These scars close by ‘secondary intention’ which means that the skin from the sides of the wound, grow to the center as the center fills from below. The resultant scar can be seen in close-up detail on the FOX Megasession page at Near the bottom of that page, there are photos of scars shown at different levels of magnification and with the hair clipped and shaved.

For further information on FUE / FOX Procedure, please see our FOX Procedure page.


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