Hal

I've always thought that must be a tough thing to experience-- having a full head of hair throughout most of your adult life and then in your late 40's/ early 50's to go seriously bald. I have known guys like that-- now maybe smugness is the wrong word to describe their attitude, but it's not far off. These are the guys who for decades have made cracks and jokes at their balding friends and family members-- all the while supremely confident that hair loss was not an issue for THEM. Hair loss was an issue that happened to the OTHER guy. It must shake their self confidence and world view right down to the bottom of their souls when it starts happening to them all of a sudden. We all know the other end of the spectrum-- the young guy who starts losing his hair in his early 20's (most common). You never seem to hear about this opposite end of the scale. Now I'm sure the young balding 20 something would gladly love to change places with the 50 something suddenly balding guy, hair wise. It's well known that the 20 something thinks with his peck&@ and can't conceive the concept of a sexual life beyond 30 years old. But still........ Hal

Tough to tell from the images-- some pretty bad lighting. At your age and from what I can see, you don't really have a lot of options. A transplant is totally out of the question. Not only is it not needed, it would be a foolish waste of money. Additionally, it would almost certainly lock you in to a cycle of procedures that you would regret. At this stage of the game, your only real option is meds. These have their own risks, and you must do your research and become informed before using them. That's it-- meds or watch and wait. Or both. But NO transplant. RUN, don't walk, from anyone who tries to convince you that a transplant now will "let you stay ahead of the game". JMHO. Hal

Hair-Loss Drug Propecia Linked to Depression - ABC News I'm personally against it, but to each his own-- as long as you understand the risks.

I agree with David-- you are way too young for a transplant. Meds are your only viable option at this point for keeping (and perhaps growing) the hair you have. Meds carry their own risk, so make sure you understand the consequences before starting any regime. I see posts from guys in your situation all the time. You have to learn to adjust your attitude. What I mean is that you must learn to be comfortable in your own skin. Right now you look in the mirror and are depressed by what you see. You hate your hairline, the way you look, and probably compare yourself to every guy you see or meet and wonder why you got the short end of the stick in the looks department. My friend, wait just a few short years. I can almost guarantee that 5 or 6 years from now you will still be looking in the mirror and still not be happy with what you see. You'll say, "God, if I only had the hair and look I had when I was 21, I wouldn't complain about anything...". That look you'll so fondly remember and wish for THEN is the one you have NOW. Do you see the point? And I'm not just talking about hairlines. There are other changes (weight, wrinkles, etc.) that will happen as you get older. I'm not preaching happy acceptance. Investigate your options and educate yourself. Improve your self physically and mentally as you seem to be doing. Ultimately though, you're going have to come to terms with yourself. There's no running away from you. Hal

This is a common problem and much depends on your hair, if you're shaving down, how much time you're taking off work, and if you can wear a hat. I work in an office. Wearing a baseball cap in an off hand manner was not an option. Fortunately, I had a built in excuse-- I am fair skinned and have had some actinic keratosis's removed from my arms (this is from sun damage). I told my boss that that I had to have a similar procedure on the scalp and that it would cause redness and might mean a crew cut. I asked if I could wear a hat post op for 6 weeks or so. I told him it was no big deal but might be a little raw to look at and everyone might be more comfortable if I wore the cap. This was more or less the truth. He agreed with no muss or fuss. I have thin hair so having sun damage on the scalp made sense. I did not have to shave down for my procedure (3700 grafts). I was also off work for 10 days post op. I prepared everyone with the cover story and when I came back, it was no big deal. A month later, I ditched the hat and went back to my old hair style while the hair grew in-- I was lucky in the fact that I had enough native hair to be able to part and comb over the HT. The scar was hidden by hair in the back. It's not easy an office environment, but it can be done. Make up a story about having a growth removed or something-- that explains the redness, the hair cut, and the need to wear a hat. I'm not advocating running some big con or encouraging lies, but on the other hand, this is your business, and you most likely can do your job in a professional manner while wearing a cap, so where's the harm? Hal

I tend to agree with the others: without images its a little difficult to give a measured opinion. That said, I'm of the belief that you should have seen something by now. I've always felt strongly that by the 6 month mark you should be able to clearly tell where you're headed results wise. In my long experience reading and researching I've seen many posts such as yours. And its a very rare thing to have no growth at 8 months and suddenly experience a massive growth spurt in the last 4 months to the one year mark. I hate to say it, but if you're truly looking at no growth at 8.5 months, I would say you had a failed procedure for one reason or another. Your doctor saying "wait a full year"at this point is basically telling you to go away and get used to the idea that it didn't work. Hal

Hey Multiplier-- You're really in great and expert hands. As you may know, I'm a patient of Dr. Ron Shapiro and had a 3,700 graft procedure back in March. I am nothing but thrilled and satisfied with my results. From the images, we both have the same kind of hair and balding pattern. Really, don't sweat it. It should be a breeze. After wards, you'll wonder why you were so worried. 6 months from now, you'll be as happy as a clam watching your new hairline grow in-- and as a bonus, it will be right before spring when it really starts to come in so you can expect to enjoy the new hair next summer. As for the stress, changing jobs etc-- I feel for you there. Been through the same thing myself (changed job and moved, but still with same company). It's tough, but you can make it. Look forward to next spring and the new look. Hal

Joe, I'm not a doctor and don't know anything about the condition you describe, but it sounds like you're doing the correct thing: consulting your GP and HT doctors before the procedure. I am curious about one issue: during your initial consult, did you not bring this issue up to your HT doctor? what did he or she say? What concerns me about your write up is the potential for frequent tension headaches post procedure. The variables with regards to scalp tightness post procedure usually revolve around how wide the strip harvest is, how many grafts are harvested, what type of closure is used, and what type of scalp laxity the patient has. Some patients report feeling a tight scalp for several months after a procedure, some claim that the tightness never has gone away, and others (like myself) had no feeling of tightness at all post procedure. Your surgeon of course plays a big role in all this. I would not say your issue disqualifies you from a procedure, but I would think long and hard about it and find out as much as I could about potential problems. You seem to be doing that so you're on the right track. You may have to accept a lesser number of grafts from a smaller strip harvest in order not to close the donor area with too much tension. One other thing I have heard: although it sounds counter intuitive, its been said that a tighter closure under tension leaves a finer scar and less possibility for stretch back. However, as I said, there are a lot of variables and every patient is different. Your HT doctor can take you through your particulars and explain potential risks and issues. The bottom line for me in all this is that your issue is a pretty big red flag. I would weigh things very carefully before moving ahead. You could be setting yourself up for some serious post procedure health issues. The best course of action IMHO is exactly what you're doing: consult your doctors, ask questions, do your research, and make an informed decision about the risks. Hal

I had my HT with SMG and it was one of the easiest things in the world-- it was no worse than getting a root canal. The procedure, the first class treatment by Janna and the staff, the advice given by Matt, the expertise and skill of Dr. Ron-- you just can't get go any better, IMHO. And of course the results. I'm 5 months out now and couldn't be happier with results. Further, I still have a lot of growing to do, so those results will only get better Put it this way-- if you've ever looked in to having a HT procedure done, you've heard the sound advice: Do you research. Get educated. Learn enough so you understand the pro's and con's of the procedure, the risks, the benefits, and generally become knowledgeable enough to ask the right questions. Make an informed decision. The above is all solid, sound advice and should be taken to heart by every perspective HT patient. But here's the thing: even if you knew next to nothing about hair transplants and did no research, if you just walked in off the street to SMG and said "Ok, I'd like a HT" I'd think you'd be happy with your results. Certainly you'd be in the best possible hands and more than likely be thrilled with the results. Now obviously that's an extreme hypothetical scenario that would never happen, but you get the idea. SMG is that good. Dr. Ron is a very skilled surgeon whose expertise and sense of aesthetics is unmatched. More than that, he is a man who cares about his patients and their well being. He goes that extra step. How do I know this? well, because I'm his patient. I know first hand how he and his staff do things. I can't speak to the other Dr's or clinics on your list, but SMG is at the top of the list by almost any measure. With all the variables in a HT, you can't eliminate all risks. That standard is just not reachable. However, you can minimize it. SMG does that on a daily basis. And has done it thousands of times. Good luck with your search and future procedure. Hal

It's always "five to seven years away" with these "breakthrough" treatments. What seems to happen is some news comes out about a new approach or method that seems promising. It's stated that studies are underway and human trials should be happening "in the near future". So it's the talk of the community for a few years and then the treatment or whatever it is doesn't pan out. But wait! here's another breaking news story about another method. And human trials should be starting soon... Eventually, something will work. However, don't look for a "cure". "Cure" implies a one time treatment and you're done. In the hair loss game, "treatment" is far more lucrative and profitable. Which means something you have to go back for and do repeatedly to maintain results. I agree that a lot of these new treatments on the horizon look promising. However, I think you're looking at a least seven or eight years before they are available, if that. Additionally, any new treatment is bound to be expensive. Tack on an additional few years before mainstream acceptance and pricing comes down to be affordable to the masses. So say 10 years. Maybe. That's why I agree with the other posters that you should investigate your options with current treatments. JMO. Hal

All, Thank you for the feedback and input. It's exciting to once again have a hairline. It's also a great feeling to know that hair is growing IN, instead of falling out forever. I will update at the 5 month mark. Good luck to all with your growing! Hal

Janna, Yes the time has flown by. I have the graft count/breakdown so not needed. Yes you did remove my sutures when you and the Doc were in my neck of the woods. Everything is going smoothly. I am eager of course for everything to grow out but really can't complain If Dr. Ron is going to be out this way again, I'd like to stop in and have him give me the once over. I will follow up with Matt on this. Thanks! Hal

I am now 4 months post op. In late March, 2011, I had a 3700 graft procedure with Dr. Ron Shapiro at the Shapiro Medical Group. I have to say that I am very pleased so far with the results. Post op healing has been a breeze. No itching, no feeling of tightness in the scalp, no ridging from the scar. No real redness 4 months post op. I am fair skinned so I was a little worried about this. The pictures below (3.5 months post op) show me right after a hot shower, so it does appear a little red. However, that's really from the shower, not the procedure. The scar is healing VERY well. It's very thin and I'll tell you, its getting hard to find. I still have a little bit of numbness at the top of my head, but that is resolving nicely as well. I don't even notice it unless I rub the top of my head. The hair is starting to come in. 4 weeks post op all hair from the grafts had fallen out as expected. Just short of 3 months post op it seemed like I had an explosion of hairs starting to pop up. I haven't had any big acne issues, either. I have had a few pimples that have resolved within two days of appearing, and have yet to have more than three at a time. These are new hairs coming in right below the surface. I started my hair transplant journey as basically a Norwood 6. I had no hair line at all and no hair (except a few dying strands) in the front third of my scalp. I am attaching pictures that show pre-op, 3 days post op, and 3.5 months post op. The images are nothing to write home about, but I do believe they tell the story. I am very glad I choose Dr. Ron and his team. Janna, Matt, and all the techs are the best in the industry in my view. And you really can't go wrong putting yourself in the hands of Dr. Ron. I think when I hit the 6 month mark I will be even more pleased if the current state of affairs is any indication. Currently, I am thinking about HT #2. That will be a second pass to put 1,500-2,000 grafts in the crown (Dr. Ron's estimate). My current thought is that will be 18 months post op, or Sept. 2012. However, based on where I was and where I'm headed, I think I could easily stick with the first pass. Happy Growing! Hal

Hey Munchkinman, You're in a difficult spot, no doubt. From what you describe, your potential balding pattern (and that of your father's known balding pattern) match pretty closely to mine. I too have a lot of hair in the back of my head and high up on the sides. I had a receding hairline from about 18 or 19 years old. It hung on through my 20's, slowly getting worse until my early 30's, when I lost it. If I would have had my temples filled in, I would have ended up in a very bad way, chasing a dying hairline with multiple surgeries. That's one road you do NOT want to go down. Run as fast as you can from anyone who states otherwise, suggesting that you can "stay ahead of your hair loss..." That said, I understand your concern and the arguments for looking your best during an important time in your life-- young, independent adult hood. What I think is missing here is a consultation from a top flight Doc. It's great that you are doing research, gathering facts, listening to opinions from others who have been down the same road. However, you really need to be evaluated by a true professional, one who can examine your case and lay out your options and explain risks vs. potential benefits. I may be biased, but my first choice would be Dr. Ron Shapiro of the Shapiro Medical Group. If you're not a good candidate at the present time, he'll tell you. He's an honest man with a sterling reputation. There are others as well-- you don't have to dig too deep on these boards to find their names. Sure its an investment to get evaluated-- but one that is well worth it to get some vital questions answered. I can also tell you that many of us here have gone through exactly what you are experiencing right now. There are no easy answers or instant miracle cures. There are only treatment options that have upsides and downsides, potential gains and potential risks. All you can really do is become informed, get the facts, and make a call. And then live with that call. If it helps, I can also tell you that everything is relative. The hairline that you are so concerned about right now will most likely retreat a little further 5 or 6 years from now. So when you're 23 or so, you'll be going, "Man if I only had the hairline I had when I was 18, I'd be satisfied...". And when you're 30, you'll say the same thing about the hairline you had at 23. I guess my point here is that you should try to put things in proper context. Enjoy the here and now and try not to let the thought of future hair loss poison the present. Because I can assure you that in 15 or 20 years, your perspective be entirely different. That may be hard for a young man in your position to believe or even do, but the effort will pay dividends-- much like anything else in life. Good luck. Hal

My strip procedure was almost two months ago and things are progressing nicely. I've had no major problems and no major issues. I've gone back to my normal hairstyle. My grafts have fallen out and the follicles are now lying fallow, waiting to sprout in the next few months. About the only real issue I have is "hat head"-- right below the scar there is an indentation that makes it looks like I have been wearing a baseball cap for a few hours. This line follows the incision track from ear to ear, but is actually slightly below it. It is due I believe to the HT haircut in the donor area. From my research and input from the clinic, it should resolve in about 6 months or so. I was just wondering what kind of time line others have experienced with this issue. Thanks, Hal

It's my understanding that shedding when taking Propecia usually occurs at around the 3 month mark and can last from 4 to 6 weeks. If that happens, its usually considered that the drug is working for you. The advice is not to panic when this happens, as things should gradually improve with the final result being stronger, thicker hair about a year to 18 months in to treatment. Shock loss usually occurs 3 to 4 weeks after surgery, according to the research that I have done. It may be that in your case you won't experience any shock loss-- however, from what you describe in your post about your balding pattern and graft placement, it seems that it could be a very real possibility. Certainly it seems that diffuse thinners who have transplants inserted between existing hairs report shock loss far more often than other patients. It really depends on a wide variety of factors. You should ultimately be fine based on what you posted about going to a top flight doc and clinic. As for concealers, there are quite a few options. Personally, I have tried them all and find that Pro-Thik (a spray) works best for me. Others swear by sprinkle on fibers like Toppik. Still others prefer Derm. Match or Couvre. Each option has its drawbacks. For instance, to much spray product on your hair can make it look like straw and its sometimes hard to get a color match. Additionally, a spray simply gets EVERYWHERE, leaving a film on the bathroom floors, the counters, etc. I've learned its best to apply outdoors or in the garage if able. Depending on how your house is set up, that's less difficult than you might imagine. I would order a few of the most common options if I were you and experiment a bit after your healing period (about 10 days at least post op). In any event, I think you'll find that no matter what option your choose, concealers work best and are most effective if you have a core of hair to work with. Which very much sounds like your case. You would be surprised what a bit of concealer can accomplish with just a little hair. Just don't over do it. What looks fine in the light of the bathroom mirror can look not so great under harsh overhead lighting or the great outdoors. Be conservative at first if you decide to use. Hal

Personally, I feel that in the not too distant future Merck is going to be forced to revise their conclusions on the side effects of the drug. The official position is that less than 2% of men suffer side effects and of those that do, stopping the drug will reverse the effects. It seems clear that this is not the case-- more and more people including patients, doctors, and researchers are coming forward with direct and anecdotal evidence that the % of people suffering sides is a lot higher. Additionally, its now emerging that some individuals who suffer sides continue to do so even after stopping the drug. In effect, the sides are permanent for a small minority. Finally, there is real doubt about the safety of long term usage of this drug. I'm talking 15+ years. No one knows. So in the not-so-distant future, I see a possible recall. Or at the very least, a drastic revision of the warning label. It may very well turn out to be that in the future, some guys who have been on the drug for 10+ years may rue the day they ever heard of Propecia. That will most likely happen when the FDA finally releases the bad news about long term effects and the consequences there of. To each his own, but to me, its really a matter of common sense. Do you really think you can play around with your hormones and body chemistry by inhibiting a vital natural process for 15+ years with no consequences down the road? Hal

Shock loss can happen in the donor area and in areas where transplanted hair is in close proximity to existing hair. Usually, shock loss is temporary, but as been mentioned, it can be permanent if the hair that falls out was on its last legs. Another form of permanent shock loss relates to transection. This can happen in two ways-- one is where the transplanted hair follicle has been damaged due to poor harvest methods and/or handling. The second form of transection applies to existing follicles that have been damaged during the surgery-- this can happen when placing implanted hair between existing hair. However, with a good surgeon and a well trained staff, transection damage should be low. I hate to say it, but you are at greater risk for some type of shock loss because of what you describe in your post. First, you sound like a diffuse thinner. You state you had grafts placed in between existing hair. That's very likely to cause some sort of shock loss. Second, you state that you just started meds in the form of propecia. Propecia, if it works, can cause shedding. What happens is that some existing hair sheds, goes in to a resting phase, and then hopefully grows back thicker. It usually takes several cycles (about a year to 18 months) to see full results. I can't read the future, but I have seen guys in your situation before. I don't mean to alarm you, but you most likely are going to have a lot less hair than what you started with prior to the transplant-- at least in the short term. The recently transplanted hair should shed and the follicles will go in to a resting phase in the next three weeks or so. Because of the placement of new hair, you may have some sort of shock loss that will kick in around the 1 month mark. Because you you just started taking propecia, you can expect some shedding of hair about the three month mark-- right when some of your newly transplanted hair starts to begin growing again. It's a rough ride. A year from now everything should be ok if you had a good transplant and if the meds kick in for you. But short term? sorry. Most likely a lot less hair than what you started with. Personally, I'm not a fan of starting meds in conjunction with a transplant. I feel you should start either a year before or year after. Meds just muddy the waters and make it hard to tell what's going on in the tough period right after a HT-- is is shock loss? shedding? is it permanent? the list of questions go on. Besides, is it really wise to start playing with your body's chemistry right after the surgery when your scalp is trying to heal? The time to take propecia was about 12 months ago or longer-- that's when it would have done the most good for your recent HT. JMO. Hal

Tanning? are you kidding me? who does that anymore except for 16 year old girls? If you're determined to take care of yourself and want to look your best, then tanning is really a bad move. You might as well light up a smoke while you're at it. JMO, Hal

Hey Smartguy, I know how you feel about the long wait. I guess I'm luckier than most as I can still create my pre-op hairstyle-- this covers the grafts so I basically look like I've had nothing done. My donor is healing up nicely and the soreness has mostly gone away. I just had my first post op haircut this past weekend. The back was cut pretty short but you really can't tell. All in all, it been very little pain, very little stress. It will be three weeks tomorrow and my grafts are still hanging in there. Scabs are gone. I expect the hair in the grafts to start shedding anytime now. No sign of shock loss in the donor area or anywhere else but that's still a possibility for another few weeks I guess. I'm still very glad I had it done. Dr. Shapiro did an excellent job and I feel that I've done all I can to maximize a great result. As Tom Petty might say "The Wayyyyyyaaayyyting is the hardest part...". I still can't get over looking in the mirror and seeing the new hairline and frontal core. After 20 years or not having it, it's great to see it back. I guess these things are relative. I may be a Norwood III or so when this grows in. To some, that's not a great victory. To me it is. I will post pictures when I reach the one month point. I was going to do a big write up of the entire experience but It's all been done and said before. Glad to hear that you're doing ok yourself. By the end of the summer you should be seeing some great results. And come next Christmas? Well, you won't mind so much stepping up and posing for the camera for the family pictures, right? Hal

Not that I'm saying anything here, but two minutes research on the net or in these forums would tell you everything you need to know. It's a hairpiece. An expensive hairpiece. Go to their website, though, and you will never hear that mentioned. Not even close. "Strand By Strand" or "Liquid Skin Optic" or "Invisible Skin Membrane" whatever the company chooses to call it-- these are all marketing gimmicks for gluing a rug to your head. It's not a rug or hairpiece-- we don't want to use those terms-- we are just adding hair in to your own-- now doesn't that sound great? So, it's a hairpiece. Glued to your head. And its very expensive. Not just the initial outlay, but also the mait. and upkeep. And it's also smoke and mirrors and marketing hype. Because you can get the same thing for a fraction of the cost on your own with a little research and education. That is, if you decide to go this route. Ultimately though, it's my belief that wearing a rug is just trading one set of concerns about your hair for another. Hal

The short answer is yes, wait it out. The longer answer is that you're too young, too uneducated, and have way too much hair at present to be thinking about a HT. Meds are about your only option right now-- and if they work for you, your hair is probably going to look worse before it get better. I'm not endorsing meds, only saying that right now, its about the only card you have to play. Hal

The crown is considered a "black hole" by surgeons and patients alike because of its ability to suck up available grafts in an attempt to provide decent coverage. You only have so many donor grafts available and the conventional wisdom is to use these wisely-- that is, to place them where they will have the best cosmetic value. That of course is in the front-- the hairline and the core. You want to frame the face. Naturally, everyone's hair situation is different. But the general consensus is that you do the crown last (if at all). You're a good case in point-- you're worried about the crown but you state you are now losing the hairline. I'd think long and hard before doing anything with the crown and depleting my donor supply until I knew how the hairline and frontal core were going to resolve. Hal

Hey Multiplier, We we taking about this in another thread, but I have to say I'm with the others that say you would benefit from a 4,000 graft (give or take) procedure. I look it at your situation like this: Your crown doesn't look to bad and you've indicated that you would most likely leave it alone for now-- I think that's a wise choice. So if you put the 4,000 grafts in the hairline and towards the back (hairline, core, and top of the head) I don't see how you could go wrong as long as long you had a top flight surgeon. Consider: Those 4,000 grafts would give you a nice appearance of hair. Obviously, the density is going to be a factor-- but it should provide you with a nice, reconstructed hairline and a stable pattern once everything grew in. Now your existing hair in the target areas is going to be a bonus, adding density. But even if you suffer shock loss from hell and have problems growing it back, the 4,000 grafts will still be there and I think that will give you a better appearance and more style choices (and less worry) than your current situation. So personally I think you're in good shape and will benefit from the procedure. It's sort of a win-win in my view. A good bet as these things go. You will have to shave down and it will most likely be a long first 6 months or so, but I'm sure you can tough it out for the results that you'll be getting. Just my 2 cents. Hal

Smartguy, Dr. Shapiro did not ask me to apply Rogaine-- following post op instructions was stressed with the graftcyte, etc.-- but no meds. I decided not to do meds-- and with my level of hair loss meds, etc. could do very little. Everyone accepted that point of view. I'm now almost to day 6 but I haven't seen any scabs. I've been using baby shampoo and the "pat down" method as explained in the post op instructions. No grafts have popped out or anything and I've washed the hair everyday gently rising with a cup of cool water. My donor is a little sore of course. But swelling has been minimal and there has not been any real pain. I've haven't taken any of the pain pills that were given me. I've been sleeping *slightly elevated*-- meaning a doubled pillow and a neck pillow flat on my back. It keeps the pressure off the donor and the grafts untouched. Sleeping with no issues. Having no hairline for almost 20 years, its still a shock to see the reconstructed hairline in the mirror. I am going to be sorry to see it go in to a resting phase. It's been mentioned before, but psychologically, it rocks. For the first time in decades I can look forward to hair growing IN, coming back, instead of leaving forever. How's that for turning the tables? It's like "up yours, DHT... you've had your turn..." When did your scabs start to form? Hal