HAIR TRANSPLANT FORUM

I have had most of my plugs and miniplugs removed from my hairline.

Yet I still have pronounced ridging in the hairline.

I have had some doctors suggest kenalog shots for the ridging. I am currently undergoing some shots every 3 weeks with my doctor but with no change. (I also tried a couple years ago with a doctor but kind of gave up).

I know he is trying to be very conservative with the volume and concentration of the kenalog as to not cause permanent hair loss, which I respect him for.

But its like a Catch-22, unless the volume and/or concentration gets bumped up, it won't reduce the ridging.

The thing that concerns me, is that I haven't really read on any forum boards of any patients who have had their ridging permanently removed by kenalog injections.

So I guess I am asking if it has worked before for patients and if its worth me continuing with the injections?

Has it worked for others before?

There is no question that you can reduce ridging with Kenalog injections. You have to recognize what causes ridging. it is due to the volume that is added with grafts. Usually it only occurs with grafts that contain multiple follicular units and a great deal of fat. such grafts usually occur with mini-grafts. i have only seen it occur once with follicular units; that was from a physician who generally recommends very high densities and lateral slits with each procedure. apparently, he also adds a good deal of fat with his grafts because his procedure caused the patient to have ridging. We don't see it with our CIT procedure because we don't have any fat on our grafts. when you place the grafts containing fat and multiple hairs, the added volume has only one direction it can go...up. that is why the scalp lifts up in the grafted area.

the way to treat ridging is to either remove the mini-grafts and redistribute them as smaller grafts or to inject with steroids such as kenalog. i usually recomend you begin with 10 mg per cc and increase gradually. you can go up to 20 mg per cc, but start with the lower dose first.

Kenalog works by causing fat atrophy in the subcutaneous fat space. this loss of volume will allow the larger grafts to sit down closer to the scalp.

you must be a little concerned about causing irregular atrophy. you could wind up with certain areas that are lower than other areas. you can always treat this with fillers if necessary.

one should also be concerned about causing hair loss in the grafts with kenalog. this can occur.

if the lower dosage does not work, just increase the concentration gradually and you should get some affect. of course if you have very little subcutaneous fat, there is not going to be much volume that you can loose in that space. if that is the case, you will need to look at de-bulking your grafts. very trim individuals with low body fat percentages might find kenalog injections work less affectively than those with more body fat.

Thanks Dr. Cole for your response.

I have read this reasoning for the ridging before. As you state, grafts that are placed that have not been closely trimmed of the extra tissue fat will cause the ridging.

It really makes me depressed and feel like what a distarous result I got and what a bad doctor I had when I read how this never happens anymore.

I just don't understand, how a doctor who is going to see this ridging due to placing these types of grafts, just keeps doing the same thing over and over again to other patients in not trimming the excess tissue from the grafts.

I am guessing the answer is greed and $ (cost benefit of just getting patients done as quickly as possible in order to work on another victim while minimizing employee costs of hiring extra techs)???

The doctor I had, Dr Thomas in Chicago, I have heard just about caused ridging to all of his patients that he did hairlline work to. He started my hairline work in '97, which to me, was late enough in the game that this should have had never had happened.

I also understand firsthand, the hairloss that can result due to incompentent use of kenalog injections.

I went to a Dr. Pomerantz subsequent to Thomas. He told me besides fixing and improving the bad work I had previously done, he could fix some of my ridging especially on the right side of the hairline where the ridging was more pronounced.

He never told me how he would do it, I was just like great, I'd love to get rid of the ridging.

So without informing me that he was giving me kenalog injections during the transplant procedure, Dr Pomerantz juiced me up with what must of been huge amounts of kenalog on the right side of the hairline.

So much that in ONE procedure all of the ridging on the right side went down.

Which at the time, right after the procedure I thought was great, but then I noticied the huge amounts of hair loss that took place in the area where the ridging was reduced.

But of course, he never informed me of what he was doing. I went back and asked about the huge hair loss in the area and he still never informed me that he had given me kenalog injections (and obviously at a extremely high concentration and/or dosage) and told me it would all grow back, which of course it did not. And just said I need another procedure (which of course I wasn't about to do with him).

In additon all of the ridging just came back anyway - since from what I understand the area needs to be monitored to see signs of the ridging starting to reform in which subsequent injections are required.

(By this time you might remember or figure out which patient of yours I am.)

I guess my apprehension with the shots, is that I just haven't read any kenalog success stories from patients on any hairloss/hairtransplant forums.