Dr. Glenn Charles

Trying Finasteride and Nizoral shampoo a few times a week is a reasonable plan to start out with. You should give it at least 6-9 months before re-evaluating. You can alway make changes to your regimen or consider hair restoration surgery in the future if necessary. Prevention is the key. Gently messaging the scalp while shampooing is the correct way to wash. Just use common sense and don't pull to hard on fragile hairs that are in areas of the scalp that are already thinning.

I agree that 5000 grafts is a very large case. I hope you are intending on keeping your hair much longer because you will most likely have some scarring that may be noticable with a very short hair syle. Make sure you are aware of all the details and have realistic expectations. You never want to be in a position where you are saying to yourself I wish I would have never had the surgery or I should have left my hair the way it was.

Here is a patient in his late thirties wanting to restore his frontal hairline.

In my experience shock loss in the donor area is not that common, but certainly does happen in some isolated cases. I think it is a little more common in females than in male patients. Thankfully, when it does occur the hair usually returns to its normal pre transplanted density in due time.

Shaving the recipient area should not be necessary in your case. It is very important when transplanting the temporal triangles that the angles and directions of the existing hairs be copied exactly when making the recipient sites. This would be more difficult if all the hairs in the area where shaved.

Good question. It depends on what type of procedure is being performed and how the physician has instructed his technicians to handle this situation. In my clinic I instruct the staff to discard only those follicles that have clearly been damaged, which is generally very few, and place all follicle that appear to be intact. Often follicles that are thought to be not worthy of placing into the recipient sites will still generate hairs. Follicles are very resilient.

I am not sure if financing companies here nin the US will approve a patient that is not planning on having their surgical procedure by a doctor not licensed in the US. Probably not. I have had a few patients from over seas that did get finacing in the country they where from for a surgical procedure performed in the US. Maybe you could try and establish a line of credit with a bank that knows you, and you can do what ever you want with the money.

I agree that the temporal peaks/triangles are often critical to establishing a natural hairline. Sometimes patients do not have any real recession in the temporal areas and do not require any work done in those areas when having other hairline work done. However, if a patient does have recession in the temporal areas and hairline work id done where the temporal areas are not addressed it actually can make the situation more noticable. So to answer your question all patients who have hair loss in the hairline area and are considering hair transplantation should be evaluated for temporal recession and this should be included in the surgical hair restoration plan.

Here is a 28 year old male patient wanting to restore his hairline by filling in his corners. There are three pre op photos, one immediately post op and three one year post op.

You can call the office of Dr. Kenneth Siporin. He is located in Southern California. They will be able to give you very good recommendations for hair stylists with experience cutting hair in patients who have had hair transplantation.

The hair restoration physician can always try to salvage the grafts from within a scar. However, the growth rate is much less predictable. I have had some cases with a high percentage of success when transplanting grafts taken from scar tissue and others with a much lower yield. I agree with Dr. Lindsey that the type of scar really makes a big difference.

I have never really seen Rogaine lower a patients hairline. In most cases the only way to do that is with a transplant. In fact, even if you used Rogaine 4 times per day ( twice the recommeded dosage ) I would not expect any change in the height of your hairline.

Most of my FUE cases are completely healed in the donor area after 4-5 days and in the recipient area 7-8 days. How many days post-op it takes before a transplant in not noticable depends on the healing properties of the patient and how much hair they have prior to the procedure.

I would say that 6-12 months is an adaquate amount of time for the Dutasteride to do its job. Every patient has a different time frame when they will reach the maximum results from a particular medication. I agree with your plan to continue the Dutasteride after you have the procedure.

The only patients that I have seen with post-op redness lasting for more than 1-2 weeks are those with very fair skin. I try to warn patients with this skin type to expect prolonged redness. Some choose to get a little sun tan prior to the procedure to have the transplanted area blend in a little better with the forehead. I never recommend sun exposure without sun screen.

My guess is that if you took a survey of the average strip width from many reputable clinics the avereage would be between 1-1.5 cm. However, with the newer suturing tecniques such as two layer and Trichophytic closures it is allowing the doctors to take wider strips and still close the wound with minimal tension.

Patients should be evaluated for miniturized hairs and DUPA ( Diffuse Unpatterened Alopecia ), These situations can make patients not good candidates for hair transplantation. Many physicians address these issues while evaluating the patient and do not bother mentioning them because they do not apply in their case.

Are you taking any meds in an attempt to slow down or stop future hair loss? Where were your previous grafts placed? Can you post a photo of the vertex/crown area that you are considering having additional work done? Often if patients already have had a strip procedure the physician will not recommend FUE. However, it really still depends on the quality/density of the patients donor hair.

I agree and thought that the open technique referred to a method of carefully removing the donor strip. There are other names for this type of donor harvesting. I also use a very slow and calculated method for removing the donor strip that takes a long time, but have not given it a special name.

Hair washing once a day is adaquate. If you are using the medicated shampoos you may want to consider alternating with some sulfate free shampoo so you do not over medicate your scalp.

If proper angle and direction made with precise incisions are used during the procedure there should not be a problem where the transplanted hairs are sticking straight up. I have had many patients over the years with a similar problem that was improved with some additional grafting in the problem areas that helps to weight down the misdirected hairs.

It is almost impossible to determine what percentage of the patients original density would be necessary to give the illusion of full density. However, in my experience in patients with your hair characteristics need between 40-60 follicular units per sq. cm. to give the appearence of full density.

Patients have been telling me that a little dab of foam Rogaine or a touch of hair spray just prior to putting the Toppik works wonders. Just something to consider. Hang in there it really usually takes between 12-14 months to get the full results of the procedure.

Information about your hair characteristics including hair color, hair diameter/caliper and curly/wavy or straight would help to answer your question. Do you have any hair loss behind the hairline? Are you looking for thickness/density like you had as a teenager? Remember optical density is not the same as actual density.

Very nice results Dr. Paul Shapiro. This patients new hairline is natural and should still look appropriate as the patients ages. Two layer closures are often a good idea in patients who have had prior procedures. It does reduce the tension at the wound margins which can often be the cause of wider scars.