A scalp biopsy is a 20 minute procedure that allows Dr. Donovan to obtain several hairs in their natural 'non plucked' state as they exist beneath the skin. This specimen is a cylindrical core about 4 mm in diameter and will be sent off to the pathologist for further evaluation. The procedure is very safe and should not be a cause for worry. Some minor tenderness can occur for a few days in the area where the biopsy was taken. Dissolving stitches will be placed in the area - it takes approximately 6-8 weeks for the stitches to dissolve fully. A small scar will be present permanently in the area where the biopsy was taken.
Below you will find the following information:
PART 1: Educational Information about Scalp Biopsies
PART 2: Helpful Instructions and Tips for any patient of Dr. Donovan having a biopsy.
PART 3: Common Questions Patients Ask about Scalp Biopsies
1. If you normally use topical steroids in your scalp (clobetasol, betamethasone, fluocinonide, Clobex, Luxiq, etc), please refrain from using these one week prior to your biopsy. If you are not sure, please ask us.
2. Please take the time int he days and weeks leading up to your biopsy to review our consent form. You will be asked to sign this on the day of your procedure. Should you have any questions, please don't hesitate to ask us.
3. Please arrive on time for your biopsy. You may drive to your appointment and you may drive home. Expect to be at our centre for about 35-40 minutes in total.
4. If you normally use topical camouflaging fibers (Toppik, etc) or other camouflaging agents (DermMatch, Couvre, etc), please do NOT apply these product before coming to your biopsy. These MUST be washed out of your scalp prior to arrival at the centre. Please do not apply hairspray, gel or mousse prior to your procedure. These can be used the following morning.
We understand these camouflaging products may be important to you but they interfere with Dr Donovan's proper evaluation of your scalp and interfere with the biopsy procedure. Dr Donovan wants to obtain the most accurate and precise evaluation of your scalp - thank you for your understanding and cooperation. We regret to inform you that your biopsy may be cancelled and rescheduled if these products are in your scalp. Please choose to do your biopsy on a day of the week and time when this will be possible and convenient for you.
5. You will be instructed to wash your scalp well the following day and the day after (in the region where the biopsy was taken). You can wash and shampoo your entire scalp if you wish but it is critically important to wash the stitches where the biopsy was taken)
6. You may dye and colour your hair one week after the biopsy.
7. Product can be used on the scalp the very next day.
8. A follow up appointment via phone will be arranged 4 weeks after your appointment. The precise follow up time depends on the type of biopsy you are having and specifics to the type of hair loss condition. Dr. Donovan will advise you at the time of your appointment.
9. Although the stitches (sutures) are usually dissolvable ones - if they bother you in any way, they can be safely clipped out of the scalp after 14 days.
1. How do I know if I'll need a biopsy? Do all patients need a biopsy?
Most patients do not require a scalp biopsy. A biopsy is required in more complex situations where a patient may have two or more diagnoses possible - a biopsy is sometimes the only way to determine which diagnosis is correct.
2. Is it painful?
The scalp biopsy procedure is not a very painful one. There is some minor burning when the freezing medication is put into the scalp but that sensation lasts only 10 seconds. This is very similar to have a tooth frozen at the dentist. Afterwards most people have only a minor degree of discomfort. Dr. Donovan encourage patents to take a plain Tylenol 1 hour before and 4-5 hours after the procedure as this can help to reduce discomfort.
3. How long does a biopsy take?
The actual procedure takes 5 minutes but from start to finish most patients find that a biopsy takes about 20-25 minutes.
4. Will Dr. Donovan take one biopsy or two?
It depends on the clinical situation. In 50 % of patients, Dr. Donovan will take one sample. In the other 50 % of patients, two biopsy samples are taken. For patients with chronic telogen effluvium, generally two samples are taken given the improved ability to diagnose CTE confidently with two biopsies vs one.
5. Where on the scalp will Dr. Donovan take the biopsy from?
If a biopsy must be taken, the sample is always taken from the area of hair loss and usually from a site where the stitches and any small scar will be the most hidden. It is not possible to say exactly the site where a biopsy will be taken from until Dr. Donovan has evaluated a patient in person.
6. Where can I find a copy of your consent form?
7. Will others notice I have had it done?
There will be a small amount of redness just in the area where the biopsy was taken. If there is some hair in the area or nearby, generally the area can be covered. If the area is completely devoid of nearby hairs, the biopsy site may be slightly visible. Generally, Dr Donovan aims to take the biopsy from a site where the patient will be able to camouflage the area so that it is not noticeable to others.
8. How do I care for the biopsy area after the procedure?
Caring for the area is very easy. It is not complicated and one should not make it complicated. Simply wash the area the following day with soap for 10 seconds and rinse with water. Shampoo is also fine. Repeat the next day after that as well. That's it. For this first two days, use a non medicated shampoo. After 2 days, any shampoo can be used (including a medicated anti-dandruff shampoo such as Nizoral or Head & Shoulders). A scalp biopsy suture site can be properly cared for even in the most remote areas of the world. It is that easy and one should not place any limitations on their travel, lifestyle or work when having a biopsy.
9. How long do my stitches stay in the scalp?
Generally, dissolvable stitches are placed into the scalp. These dissolve in 6-8 weeks for most people. If they both a patient in any way, they can be clipped out in 14 days.
10. Does a scalp biopsy leave a scar?
Yes. All scalp biopsies leave a small scar. Dr. Donovan does everything possible to limit the appearance of the scar, including specific types of suturing, small thread sizes, and (if possible) biopsies from sites that are most likely to heal well.
11. Can I travel on an airplane the same day or next day?
Yes, there are no travel restrictions
12. When can I swim after a scalp biopsy?
Swimming is okay after 5 days, provided on knows well the cleanliness of the pool/body of water. Otherwise wait 10 days.
13. How long does it take to get results?
Results generally take 4-5 weeks.
14. Does Dr. Donovan perform the biopsy or does someone else?
Dr. Donovan performs the biopsy.
If you have any questions, please don't hesitate to let us know!