Hello Everyone! This is my first post to AW. I was diagnosed with Alopecia Areata in 2006. I had 3 small to medium bald spots in the back of my head found by my hair dresser. I had recently started going to her to get my hair dyed and it was the 3rd time anyone had ever dyed my hair. I always did my own. Well Fast forward. One of the spots filled in from a size of a 50 cent piece to smaller than a than a dime after steriod treatments. Well after 4 years of the spots not changing and 4 years of comb overs I thought I would see if another round of steriod shots would help. I get horrible scalp atrophy with my steriod treatments . It wouldn't bother me but It is visible if I don't do a comb over and like all comb overs if my hair doesn't go a certain way you can see it throughout the day. So I changed derms because of location. I had been driving 300 miles to see my other derm. My new derm is suspicious of my my hair patches. She says 90 percent of AA returns on its on unless the AA is caused by a fungus or an infection or even a burn. Like a chemical burn. I haven't had any new spots only those and those haven't changed in 4 years. She suspects something killed my scalp. She mentioned either doing a punch biopsy or an excision. She said I may just excise that piece and sew the good scalp together and that would cosmetically fix my problem. Well I am 37 years old and I met my BFF when I was 6. She is a Dr in Pathology. She said the punch biopsy would definitely leave a scar and cause that section for sure not to grow back so she said would push for the excision but she said to do my research. What are your thoughts about just going to have the bald spots excised versus a punch biopsy. COULD THIS EXCISION GO BAD AND TRIGGER more hairloss? Other things to consider my BFF the doctor said if the punch biopsy showed my follicles were not damaged then I couldn't get an excision covered by my insurance because it would be considered cosmetic versus a diseased scalp. AGAIN what should I do?