Paul J. McAndrews, M.D.

Yes, you can transplant successfully into any area of scarring alopecia (surgical scars and disease-related scarring). However I would want the disease process that is causing the scarring alopecia to be quiescent for at least 2 years before transplanting. Sincerely, Paul J. McAndrews, M.D. Diplomate, American Board of Dermatology

Chris, I agree with Pat. Resist the temptation to get a hair transplant at your age. A hair transplant at your age may solve the "acute" problem, but long term may be a huge detriment to appearance. As hair transplant surgeons we only have a fixed amount of good genetic hair that we can transfer to the balding area. I consider myself a glorified farmer-- I have only "4 acres of seed", but I have potentially "10 acres of balding land" to cover-- as you can see it doesn't add up. Therefore I need 1) all the help I can get from the medical treatments for hair loss 2)to use your hair bank wisely (were I place the grafts today may not be the wisest area in the future for you and may not stand the test of time) 3)ensure the highest percent of grafts survive and grow. I think you need to maximize the medical treatments (Propecia and Rogaine) for hair loss for now and steer clear of the "snake-oil treatments". The medical treatments for hair loss are more effective the earlier you start treatment in the hair loss process (When is it best to use "tooth paste"? Before you have a lot of tooth decay. Similarly, the best time to medically treat hair loss is before you have an immense amount of "hair decay". Most patients do not go to a dentist and tell him "I am not going to brush my teeth, I just want you to fill in my cavities as I get 'tooth decay'". Similarly, you should be trying to prevent "hair decay" with medications before you consider hair transplants-- and you may need less hair transplants in the future. Sincerely, Paul J. McAndrews, M.D. Diplomate, American Board of Dermatology

Melanie, In the past, Men that were castrated (for various reason) after they were bald, did not regrow their hair. Therefore, the likelihood of full regrowth is low. However, you have been using Rogaine for only 8 months. You have not seen the full effects of Rogaine yet. Sincerely, Paul J. McAndrews, M.D. Diplomate, American Board of Dermatology

Shingles is caused by the same virus that caused your "chicken pox" when you were a child. Following your chicken pox outbreak, this virus never leaves your body, but resides in a nerve root (for you this was the trigeminal nerve- the most common nerve affected). This virus can reactivate later in life to cause herpes zoster (shingles). However it is almost unheard of to have a recurrence of shingles. In matter of fact, there has never been a "proved" case of recurrent herpes zoster. The recurrent cases that have been cultured turned out to be herpes simplex, not herpes zoster. Sincerely, Paul J. McAndrews, M.D. Diplomate, American Board of Dermatology

GNX- You either work for Dr. Woods or you have very little understanding of the "Limitations of hair transplants". The limitation to hair transplants is that there is a fixed amount of good genetic hair you can take from the back and sides of the scalp to transfer to the balding regions. Therefore as hair transplant surgeons we should do everything in our power to "ensure the highest percent of grafts survive and grow". The last thing you want a hair transplant surgeon to do is destroy this very limited "hair bank". When it comes to removing hair from the donor area (i.e.- hair bank), using any device {scalpel, multi-blade knife, punch excision or by Dr. Wood's punch technique} we remove this tissue blindly (i.e.- we cannot see what we have done until after we have removed the tissue). This is a huge problem since the only time we know if we transected and destroyed these hair follicles is after the damage is done (after we have removed this donor tissue). Therefore it is best to have as little surface area as possible exposed to any device removing tissue blindly. Once we have this tissue out, then we can dissect it into smaller grafts (follicular units) with full visualization of a stereoscopic microscope (which immensely decreases the transection of these very precious and limited good genetic hair follicles). Now let's review Dr. Wood's technique to remove the donor tissue. It's a modified version of the old, antiquated technique used in the 1960-1970's. Instead of punching out 4-5 mm plugs and letting this tissue granulate in (i.e.- heal on its own), his technique punches out 1mm plugs (or whatever fancy term he wants to give this cookie-cutting device he uses to remove the donor tissue) and lets it granulate in. This technique immensely increases the surface area of tissue being exposed to a blind excision technique. This technique permanently remove this good genetic hair from the "hair bank" and replaces it with a scar (albeit a very small scar that many times is hard to see), which ultimately decreases the density of the "hair bank". My problem with this technique is the immensely increased amount of surface area of tissue being exposed to a device that is removing the tissue blindly. This immensely increases the risk of transection (and destruction) of the hair follicles, which is the last thing we should be doing to the fixed and very limited "hair bank". As far as scarring is concern"???any time you remove tissue from the body you will get a scar, however some scars are much more unnoticeable than others are. Unfortunately, some people (taking away poor surgical technique) can form much scar tissue (i.e.-keloids or hypertrophic scars). I have seen some patient's that have developed horrendous keloids from just having their ears pierced with a needle. This is much less traumatic then having a 1mm punch removed from the scalp. So when you stated that a patient is not at risk of bad scarring following the "Wood's technique" is completely false. Both strip excision and the Wood's technique can lead to bad scarring, however with proper surgical technique this risk can be minimized (but again not removed). Sincerely, Paul J. McAndrews, M.D. Diplomate, American Board of Dermatology