Your Questions

Q: Dr. Eppley, This is a strange question but is it possible to get donor grafts from the part of the head that isn’t considered a donor area? I know your average person has around 8K hair grafts available from the DONOR area, but if someone wanted to access the grafts from the other areas, would this be technically possible?  

Say there was a person that wanted a significant beard transplant and this person was much taller than the vast majority of people. They would prefer to take grafts from the non donor areas of their head because they are much taller than everyone around them, they would like to be able to conceal their scar or FUE procedure more effectively since very few people would see the top of their heads. They understand that FUT and FUE procedures nowadays can go undetected with good scar rejuvenation but still they would rather have the scars placed in a more undetectable area. They completely understand that non donor areas are labeled such because there is the risk that they will dissipate with progressive male hair pattern baldness and they are completely aware of this risk because they are already on balding medications such as finasteride and have no significant history of baldness in the family.

Would a situation like this be reason enough to oblige to their request of taking hairs from where they want:non donor area on top of head? or is there some physical reason why something like this may not be possible.

A: The simple answer to your question is that there is not a technical reason that the harvest site for hair transplants can not be taken from anywhere on the head. The reason the back of the head is used is two-fold; that is where most of the available hair is and it is hair that is theoretically programmed to last a lifetime for many men.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, can you elaborate on a question I have regarding the effects of Accutane on hair transplantations? I am on a pretty small prescription of Accutane right now that isnt going to end for a while. I’ m on around 30 to 40mg/week which s considered a very tiny dosage and considered “maintenance”. I actually get some medium depth Jessners chemical and Salicylic Acid peels while I’m on this medication and have had no true healing issues. 

I keep hearing that Accutane shouldn’t be taken for 6 months or more after a hair transplant because it can stifle healing but since I’m on such a small dosage would it even matter? I personally would be patient if my wounds did take slightly more time to heal. 

I do have other concerns though such as what other problems could arise? Would the expected graft retention outcome be less or is it just a matter of the wounds taking slightly longer to heal. The former would make me want to wait until my dosage is finished but I don’t mind if my grafts took longer to sprout as long or if my wound took slightly longer to heal, as long as the end outcome would be the same. Its the amount of grafts that I retain and the quality of them that is the most important to me and if Accutane does affect this then i would be fine with waiting. Thanks.

A: A hair follicle is an epithelial derived structure. Accutane impacts how epithelium regenerates and heals. Thus it is easy to see that Accutane can potentially adversely affect both the healing and potential take of FUE grafts. Whether a maintenance dose of Accutane would have any effect on hair transplantation at all is speculative. Healing from light chemical peels would suggest that it doesn’t. But given that every transplanted hair follicle is ‘valuable real estate’, why chance it? If you were my patient I would not let you do it whether you wanted to or not.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 26 year old female, I am very self conscious about my forehead and have been for years. I am so tired of feeling embarrassed and having to hide it and limiting what I can and cannot do for fear of it showing. I’ve been researching transplants to lower my hairline. I’ve ran into your website and was wondering if you do hair transplants to lower hair lines? If so a round about cost to have it done? I’m really hoping you can help me and I can get this done and feel 110% more confident with myself.

A: Lowering the hairline, as you may know, can be done by either scalp flap advancement or hair transplants. There are advantages and disadvantages with either approach and neither one is perfect. So let me review these with you. The advantages of hair transplants for lowering the hairline is that it does not create a fine line scar along the frontal hairline (although it will create a scar in the back of the head from the harvest site) and does not involve a true surgical procedure under general anesthesia. Its disadvantages is that it will take at least two hair transplant sessions and close to eight hours of procedure time to get the new hairline properly filled in and up to six to nine months to se the final result. A scalp advancement for hairline lowering creates an immediate hairline lowering in a fairly simple procedure under anesthesia. (like a reverse browlift) It disadvantages is the fine line scar along the frontal hairline and the possibility that some hair transplants may be needed along the scar line for better camouflage. (may or may not be needed)

When comparing these two, it is also important to look at the costs differences between the two. Two hair transplant sessions will definitely cost more than a surgical hairline lowering procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have contacted you in the past about questions I had regarding indentations I have on my skull, and about fixing them with a cranioplasty. You responded by telling me that I would require an open approach cranioplasty and the incision would be bilateral from ear to ear. Along with having a large indentations on my skull, I also am going bald. I am interested in getting a cranioplasty done by you and also am planning on getting a FUE hair restoration at some point.
My questions are:
1. If I was to get a FUE hair transplant/restoration would it be better to do it before or after the cranioplasty?
2. Would it make sense to do it after, so it mite be able to help cover the scar? or does it even matter?
3. Also can you diagnose what the name of the medical term/condition is that I have wrong with my skull by looking at the attached pictures I have here?

A: In answer to your questions, you would always want to do hair tranplantation AFTER a cranioplasty. This is because it would also give one the opportunity to place hair grafts along the scar should that be necessary. While this could always be done after, you would like to have that option during the initial FUE procedure. Usually that is not necessary but it is a theoretical option that you want to keep available given that bothi of these procedures are elective and can be done anytime in any order.

I believe what you have is a very incomplete form (microform expression) of bicoronal craniosynostosis. This is because you have deep indentations (like a constricting band) right along the exact location of the underlying original coronal suture locations.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, Hope you doing great and you might recall our discussion regarding my cranioplasty last year (I have attached the mail and picture for you to recall). As you mentioned, I have flattening as well as surface is NOT even on back of skull, and I have hair loss as well. Would you recommend that I have hair surgery (FUE or FUT) method first and then go for surgery with you or surgery with you first and then hair transplant? Your advice will help me plan my surgery.

A: It is always best to have the skull augmentation first and then the hair transplant. Much like building a house, you should put the frame up before you can build the roof. Since the cranioplasty must now be done through an open approach (the injectable material is no longer available), the hair transplants can be used to help further camouflage the scalp scar if necessary.

Dr. Barry Eppley

Indianapolis,Indiana

Q : I am interested in scar revision. I have had three hair restoration procedures and this has now left me with a very wide donor scar that is quite noticeable on the back of my head.

A: Hair restoration, also known as hair transplantation, is a true ‘robbing Peter to pay Paul’ type of surgery. Hair grafts are harvested in a horizontal excision pattern in the lower portion of the occipital scalp. (back of the head) The donor site is brought back together so that the scar, hopefully, is just a fine line that can not be easily found in the remaining scalp hair.

Harvesting scalp skin (and hair) is quite easy and the donor scar usually looks quite good since the scalp is very flexible and comes together without much tension. Since most hair transplants require more than one session to get the maximal hair density, this same donor site must be used consecutively. The scar will usually stay quite narrow even after the second time of graft harvesting but the scalp closure is definitely tighter.

The third scalp harvest, which is often not advised and even done, will likely run into a wider donor scar problem. One of the most important contributors to how all scars will eventually look is tension. The tighter the closure, the more likely the scar will end up being wide. Tension wins over time and it relieves itself through widening of what is an initially narrow-looking scar. Also contributing to the scar widening is the inavoidable horizontal orientation of the scar which is repeatedly pulled downward with neck flexion.

Wide occipital scalp scars can almost always be improved by excisional scar revision. Unlike the donor harvests, however, the skin is closed with the aid of significant tissue undermining at the galeal plane level. This helps reduce the tension on what would otherwise be a very tight skin closure. In addition, I have occasionally incorporated a geometric skin closure pattern with a running w-plasty series. The interdigitating limbs of skin closure are another method to change the tension lines on the skin closure.   

Dr. Barry Eppley