zenmunk

Been on propecia for 13 years, 1mg every day. Missed a few days, but not many. Pretty much halted my hair loss since the beginning of the regimen. No observable sides except slightly watery semen. I've been pretty lucky so far (and I'm thankful for it), but who knows how long the meds will keep my hair loss in check? I am trying to decide if I should go forward with FUE (approximately 1300 grafts) to restore my hairline. Among my top considerations is what the propecia may be doing to my body in terms of non-observable side effects. Every six months since I started the meds I've gotten some blood tests done to monitor the health of my liver; so far, so good. However, I don't believe that's enough. Before I go forward with a HT I'd like to try and find out as much as I can. So, I'm planning on doing the following: 1. Getting a semen analysis done. 2. Getting a testicular ultrasound done. 3. Getting a full spectrum hormone analysis done (saliva & blood) 4. Getting a prostate exam done. If the results of those tests come back normal, then I will finish my HT research which involves one more in-person consultation with a HT doc and meeting as many of his FUE patients in-person as I can (with similar hair characteristics and hair loss to my own) to discuss their experiences and review their results. If all of that works out, only then will I move forward with the HT. If the results of the above tests indicate some kind of problem(s) which can be traced back to the propecia, then I will most likely discontinue the meds (unless there is a relatively safe way to address the problems without discontinuing them). If I stop the meds, I don't think I will go forward with the HT, and rather shave down, as I do not want to chase my hair loss with surgery after surgery for the rest of my life. Personal choice. HT is a serious matter on its own, but combining it with meds makes it much more so. The pros and cons must be carefully weighed. I'm in a good position to discover what, if anything, long-term propecia use has done to my body. I will keep this community informed. Everyone is different, but perhaps my results will be of some help to you all. Corvettester is absolutely right - the considerations are mind boggling.

There is definitely something deeper going on here with hairmee. I responded to a thread recently about Body Dysmorphic Disorder. I think that reply may be appropriate here as well. I'm not suggesting that hairmee is suffering from BDD, but I think the overall message may be applicable. Perhaps he should take what he is feeling regarding his hair loss more seriously than he is... Negative perceptions of MPB are real, and both sexes have them. We've all probably experienced it in our own lives to some degree, but it's interesting to have our personal experiences supported with something a little more controlled. Hence, a study conducted by Thomas F. Cash called, "Losing Hair, Losing Points?: The Effects of Male Pattern Baldness on Social Impression Formation." The abstract states: "In the voluminous research on the psychology of physical appearance, the psychosocial effects of common male pattern baldness (MPB) have been largely neglected. The present experiment examined the influence of MPB on the initial social perceptions of men by both sexes. Eighteen pairs of photographic slides of balding and non-balding control men were matched on the actual age, race, and other physical attributes of the men. In a first-impressions context, 54 men and 54 women rated these stimulus persons on seven dimensions of social perception. MPB caused generally less favorable initial impressions, including lower ratings of physical attractiveness, judgments of less desirable personal and interpersonal characteristics, and misperceptions of age. The moderating effects of perceivers' sex and age and stimulus persons' age were examined, mostly without consequence. The baldness stereotype was substantially attenuated when physical attractiveness was statistically controlled." Granted, these are "initial impressions" we're talking about here. Clearly, if people make the effort to get to know a man with MPB, many will undoubtedly abandon the negative first impression as silly and superficial. However, no one can argue with the power of first impressions, and sometimes people just won't go beyond them. How we are perceived by others is important to most, but the degree to which it matters varies from person-to-person largely according to one's self-esteem. The more you value and respect yourself, the less affected you are by how others perceive you. However, self-esteem is tricky business. There are so many variables which influence it from cradle to grave. It takes a lot of effort to build and maintain self-esteem in the face of a myriad of forces which threaten to destroy it. Considering how difficult it is, I think it's admirable if anyone attempts to increase their self-esteem by visualizing that which they respect and admire most and working a little bit every day to instill those traits in themselves. However, a couple of questions are in order. Is what you're striving to achieve contributing something positive to your life and/or the lives of others? Is it constructive rather than destructive? What you value is yours. You don't have to justify it to anyone else, but you must justify it to yourself. Why do you really want to do it? Is the outcome truly worth the effort? 100% certainty is impossible, but if something keeps nagging at you, then it's not right, and you must address it in the healthiest way possible. That may involve some soul-searching which leads to a change of plans, and the new plan may be to do nothing at all. Unfortunately, people with BDD lack the ability to moderate their extreme insecurities with logical thinking. Their perceptions of themselves and the world around them are severely compromised. It's a very serious psychological condition. Their obsessions greatly reduce their quality of life and may even become life-threatening. Common symptoms of BDD include (from Wikipedia): Obsessive thoughts about (a) perceived appearance defect(s). Obsessive and compulsive behaviors related to (a) perceived appearance defect(s). Major depressive disorder symptoms. Delusional thoughts and beliefs related to (a) perceived appearance defect(s). Social and family withdrawal, social phobia, loneliness and self-imposed social isolation. Suicidal ideation. Anxiety; possible panic attacks. Chronic low self-esteem. Feeling self-conscious in social environments; thinking that others notice and mock their perceived defect(s). Strong feelings of shame. Avoidant personality: avoiding leaving the home, or only leaving the home at certain times, for example, at night. Dependent personality: dependence on others, such as a partner, friend or family. Inability to work or an inability to focus at work due to preoccupation with appearance. Decreased academic performance (problems maintaining grades, problems with school/college attendance). Problems initiating and maintaining relationships (both intimate relationships and friendships). Alcohol and/or drug abuse (often an attempt to self-medicate). Repetitive behavior (such as constantly (and heavily) applying make-up; regularly checking appearance in mirrors; see section below for more associated behavior). Seeing slightly varying image of self upon each instance of observing a mirror or reflective surface. Perfectionism (undergoing cosmetic surgery and behaviors such as excessive moisturizing and exercising with an aim to create an unattainable but ideal body and reduce anxiety). Note: any kind of body modification may change one's appearance. There are many types of body modification that do not include surgery/cosmetic surgery. Body modification (or related behavior) may seem compulsive, repetitive, or focused on one or more areas or features that the individual perceives to be defective. This excerpt is from an article called, "Psychology of Hair Loss" on hairtransplantguide.com: "Body dysmorphic disorder is an unusual psychological disorder that hair transplant surgeons see frequently. These patients are preoccupied with an imagined or slight cosmetic defect to the point that it becomes extremely distressing and may begin to impair day-to-day functioning. Patients may avoid friends, family, and work in some cases. The disorder can lead to depression and has been implicated in some suicides. These individuals will often have had visits with numerous physicians, frequently complaining of poor care. When surgical attempts are made to correct the perceived defect, the patient usually remains dissatisfied. They are more prone to sue and threaten violence. Typically no amount of talk or ‘common sense’ will dissuade these patients from believing they have a significant problem. It is as if they have a very limited form of psychosis (break with reality which is firmly believed despite evidence to the contrary). If the patient can be convinced that the perceived defect is all right, it is not unusual for them to then fixate on another physical flaw. Basically, this is a psychiatric disorder, not a surgical one. Convincing these patients to see a psychiatrist is problematic since they will frequently remain unconvinced that it is not a physical problem. These patients tend to make themselves miserable, and their successful treatment hinges on making the correct diagnosis." Obviously, if you exhibit the above symptoms, then you should not undergo any type of surgery, and seek help as soon as possible. If you have the capacity to think relatively clearly about the subject, then meditate on the fact that no amount or type of cosmetic surgery will solve all of your problems. The desire for cosmetic surgery is often a symptom of a deeper problem(s) which only a deeper solution(s) will truly be able to address. There is a place for HT, or any cosmetic surgery, but be realistic about what you think even an ideal cosmetic outcome will do for you in life.

Don't like taking it at all. I'd love to stop, but I don't, because the pros of taking it outweigh the cons so far. The recent info regarding fin and prostate cancer was alarming to say the least. Yeah, experts disagree about what the results actually mean, and the study used 5mg, not 1mg, but still not pleasant. I've gotten blood tests every 6 months for 13 yrs to monitor my liver for any abnormalities which may be attributable to the fin. So far, so good. Don't know what else I can do to gauge if the meds are hurting me. A recent full body scan (for something unrelated) turned up nothing as well, so knock on wood. However, just because the blood work and the scan hasn't uncovered anything doesn't mean there isn't a problem brewing. Bottom line is you never know what the long-term effects may be; it's a crap shoot. The thought of being a slave to meds for the rest of my life (for something that is not medically necessary) is one of things that's keeping me from getting a HT. I like having the option to discontinue use for any reason and not have to worry about my native hair falling out behind my transplanted hairline leaving an unnatural pattern. Even if I resolved to take the meds forever (or until a better option came along), what if they just stopped working? 13 years is a good chunk of time, but that doesn't guarantee another 13+ years. I'd love to restore my hairline, but I don't want to chase my hair loss for the rest of my life with surgery after surgery. The plan has been to get one FUE procedure and, if necessary, a 2nd to address poor growth areas and then stop. If the hair loss continues despite the meds, then just shave down. I wonder if that plan is feasible or if I'm just not being realistic... Any thoughts? All this just makes my head spin.

gillenator, I haven't discussed my HT philosophy with any docs yet; I plan to, however. I wonder what the reactions will be... I expect that some will suggest that I shouldn't undergo an FUE procedure if I'm not prepared to chase the hair loss with additional surgeries for the rest of my life. Perhaps they'd be right. I'm still in the process of deciding, and corresponding with concerned people such as yourself on this site is quite helpful. It's good to get outside perspectives. Yeah, I suppose there really is no way to know how long the meds will continue to work. I made that question a separate topic, and no one has replied, probably for that very reason. Regardless, I think the odds are in our favor that they will continue working for us for quite a while since they've done such a good job so far, but it is a crap shoot. I do know where you're coming from and admire you for it.

Good topic. Thanks for posting. Negative perceptions of MPB are real, and both sexes have them. We've all probably experienced it in our own lives to some degree, but it's interesting to have our personal experiences supported with something a little more controlled. Hence, a study conducted by Thomas F. Cash called, "Losing Hair, Losing Points?: The Effects of Male Pattern Baldness on Social Impression Formation." The abstract states: "In the voluminous research on the psychology of physical appearance, the psychosocial effects of common male pattern baldness (MPB) have been largely neglected. The present experiment examined the influence of MPB on the initial social perceptions of men by both sexes. Eighteen pairs of photographic slides of balding and non-balding control men were matched on the actual age, race, and other physical attributes of the men. In a first-impressions context, 54 men and 54 women rated these stimulus persons on seven dimensions of social perception. MPB caused generally less favorable initial impressions, including lower ratings of physical attractiveness, judgments of less desirable personal and interpersonal characteristics, and misperceptions of age. The moderating effects of perceivers' sex and age and stimulus persons' age were examined, mostly without consequence. The baldness stereotype was substantially attenuated when physical attractiveness was statistically controlled." Granted, these are "initial impressions" we're talking about here. Clearly, if people make the effort to get to know a man with MPB, many will undoubtedly abandon the negative first impression as silly and superficial. However, no one can argue with the power of first impressions, and sometimes people just won't go beyond them. How we are perceived by others is important to most, but the degree to which it matters varies from person-to-person largely according to one's self-esteem. The more you value and respect yourself, the less affected you are by how others perceive you. However, self-esteem is tricky business. There are so many variables which influence it from cradle to grave. It takes a lot of effort to build and maintain self-esteem in the face of a myriad of forces which threaten to destroy it. Considering how difficult it is, I think it's admirable if anyone attempts to increase their self-esteem by visualizing that which they respect and admire most and working a little bit every day to instill those traits in themselves. However, a couple of questions are in order. Is what you're striving to achieve contributing something positive to your life and/or the lives of others? Is it constructive rather than destructive? What you value is yours. You don't have to justify it to anyone else, but you must justify it to yourself. Why do you really want to do it? Is the outcome truly worth the effort? 100% certainty is impossible, but if something keeps nagging at you, then it's not right, and you must address it in the healthiest way possible. That may involve some soul-searching which leads to a change of plans, and the new plan may be to do nothing at all. Unfortunately, people with BDD lack the ability to moderate their extreme insecurities with logical thinking. Their perceptions of themselves and the world around them are severely compromised. It's a very serious psychological condition. Their obsessions greatly reduce their quality of life and may even become life-threatening. Common symptoms of BDD include (from Wikipedia): Obsessive thoughts about (a) perceived appearance defect(s). Obsessive and compulsive behaviors related to (a) perceived appearance defect(s). Major depressive disorder symptoms. Delusional thoughts and beliefs related to (a) perceived appearance defect(s). Social and family withdrawal, social phobia, loneliness and self-imposed social isolation. Suicidal ideation. Anxiety; possible panic attacks. Chronic low self-esteem. Feeling self-conscious in social environments; thinking that others notice and mock their perceived defect(s). Strong feelings of shame. Avoidant personality: avoiding leaving the home, or only leaving the home at certain times, for example, at night. Dependent personality: dependence on others, such as a partner, friend or family. Inability to work or an inability to focus at work due to preoccupation with appearance. Decreased academic performance (problems maintaining grades, problems with school/college attendance). Problems initiating and maintaining relationships (both intimate relationships and friendships). Alcohol and/or drug abuse (often an attempt to self-medicate). Repetitive behavior (such as constantly (and heavily) applying make-up; regularly checking appearance in mirrors; see section below for more associated behavior). Seeing slightly varying image of self upon each instance of observing a mirror or reflective surface. Perfectionism (undergoing cosmetic surgery and behaviors such as excessive moisturizing and exercising with an aim to create an unattainable but ideal body and reduce anxiety). Note: any kind of body modification may change one's appearance. There are many types of body modification that do not include surgery/cosmetic surgery. Body modification (or related behavior) may seem compulsive, repetitive, or focused on one or more areas or features that the individual perceives to be defective. This excerpt is from an article called, "Psychology of Hair Loss" on hairtransplantguide.com: "Body dysmorphic disorder is an unusual psychological disorder that hair transplant surgeons see frequently. These patients are preoccupied with an imagined or slight cosmetic defect to the point that it becomes extremely distressing and may begin to impair day-to-day functioning. Patients may avoid friends, family, and work in some cases. The disorder can lead to depression and has been implicated in some suicides. These individuals will often have had visits with numerous physicians, frequently complaining of poor care. When surgical attempts are made to correct the perceived defect, the patient usually remains dissatisfied. They are more prone to sue and threaten violence. Typically no amount of talk or ‘common sense’ will dissuade these patients from believing they have a significant problem. It is as if they have a very limited form of psychosis (break with reality which is firmly believed despite evidence to the contrary). If the patient can be convinced that the perceived defect is all right, it is not unusual for them to then fixate on another physical flaw. Basically, this is a psychiatric disorder, not a surgical one. Convincing these patients to see a psychiatrist is problematic since they will frequently remain unconvinced that it is not a physical problem. These patients tend to make themselves miserable, and their successful treatment hinges on making the correct diagnosis." Obviously, if you exhibit the above symptoms, then you should not undergo any type of surgery, and seek help as soon as possible. If you have the capacity to think relatively clearly about the subject, then meditate on the fact that no amount or type of cosmetic surgery will solve all of your problems. The desire for cosmetic surgery is often a symptom of a deeper problem(s) which only a deeper solution(s) will truly be able to address. There is a place for HT, or any cosmetic surgery, but be realistic about what you think even an ideal cosmetic outcome will do for you in life.

Everyone's welcomed to chime in, but I'd especially appreciate some insight from docs and HT vets with extensive knowledge/experience with propecia. I've been taking propecia almost every day for 13 years. I'll be 39 next month. For the most part it has halted my hair loss. I'm still a Norwood 2.5 - 3. If I wasn't seriously considering FUE to restore my hair line (~1300 grafts), then I'd just shave down if the propecia stopped working or if I decided to stop taking the meds for some other reason. I like having that option. However, once you get a HT, then you're pretty much committed to the meds for life if you want to give yourself the best chance of maintaining the native hair around the transplants. No one can predict the future, but we can hazard an educated guess. What do you think the odds are that propecia will continue to be effective long-term considering the long-term success I've already had with it, and why do you think so? Why might it not be effective in the future? Please try to support your opinion with as much science and/or specific experience as you can. Thanks.

Excellent reply, gillenator. Very educational. Thank you. My goals may be somewhat unique. As I've mentioned, I don't want to chase my hair loss for the rest of my life. If I get an FUE procedure to restore my hairline (and a 2nd to fill-in poor growth areas from the 1st, if necessary), then I plan on stopping there no matter what happens to my native hair. Since propecia has maintained my hair for 13 years, I'm rolling the dice that it will continue to do so for a long time. If the meds stop working, then I plan to shave down. That's why I've been very concerned about minimizing the appearance of scarring through the use of the smallest possible punches (but not so small they do damage) and the most spread out extraction pattern. I wouldn't mind at all if the doc extracts from the nape of my neck or other areas considered outside of the safe zone. In fact, I'd request it if it increases the odds of matching the native hair adjacent to the recipient sites and allows for the most spread out extraction pattern. If the meds stop working and my native hair goes bye-bye, then the more transplanted hairs that follow suit, the better. That would reduce the unnatural appearance of the transplanted hairs that remain at my hairline. Hell, if I could clone non-DHT resistant hairs and only use them to restore my hairline, I'd do it. By the way, what do you think the odds are that propecia will continue to work for me long into the future, considering the success I've had with it so far? Thanks.

Thanks very much, gillenator. I appreciate the support and all of your advice. That's what makes a forum like this so valuable to hair loss sufferers, providing they take the time to delve into it and make connections with caring HT vets and docs who can help them make educated decisions. There are many wise people posting here with rather sad stories. They learned the hard way, and it would be foolish not to heed their collective advice.

That's reassuring, Corvettester. I look forward to your input going forward regarding how your transplanted hair grows in. Thanks, and good luck! HT vets and docs... please chime in here. It'll be helpful to get your perspective on this very important subject. Thanks.

Thanks for your theory, mars. OK, so we have three possible causes so far generally speaking (not necessarily specific to mars): 1. bad handling of grafts. 2. all the cells not active yet on the hair and it kinks on the weak points. 3. scarring in the recipient area. Any other opinions? Assuming the best scenario - great doc (great execution) & great physiology - I'd like to ask the questions again that I posted earlier in the thread with the hope that some HT vets and docs can chime in: - To what degree should we expect transplanted hair to resemble native hair when fully matured, and how long until maturity? - Is it realistic to expect it to be virtually indistinguishable, or must we accept that there will always be a difference between the two, even under the best of circumstances? - And, if so, what types of differences are considered "normal"? Thanks.

Point taken, mars. It would be interesting to see if others can confirm Dr. Feller's opinion via mars' recollection. Other learned theories are also welcomed. The more information we get about how transplanted hair grows in, the better. Thanks.

All good points, gillenator. I suppose those of us who have been able to maintain the caliber in our native hair via nature and/or meds are lucky indeed. Do you think the finer the hair is in the donor area, the more chance there is of achieving an undetectable or less detectable native-to-transplanted hair transition, especially when buzzed down?

Good advice. Unfortunately, I didn't know about Acell when I had my consultation with Dr. Feller, and he didn't volunteer any info. about it. I plan to schedule another consultation with him to ask a series of questions I've thought of since our last meeting, and I'll be sure to include asking about Acell. I'm in NYC, so it's convenient for me to do so. Hopefully he won't mind meeting with me again gratis. No offense taken. I'm aware of Dr. Shapiro's impeccable reputation regarding FUT, and he's been recommended numerous times in this forum for FUE as well, his relative inexperience with FUE notwithstanding. SMG's prices are also much more attractive. Having said that, I wouldn't even consider FUE with him or any surgeon unless I've corresponded with numerous patients about their experiences. I also insist on meeting as many patients in-person as I can. To be honest, I'm leaning toward Dr. Feller, because of his greater experience with FUE, but I like to keep my options open and research as much as possible.

Thanks for the well-wishes, southbeacharchi. Good luck to you as well. If mars' problem is the result of "bad handling of the grafts" as HARIRI implies may possibly be the case, then it may benefit all of us if we know who mars' surgeon is. Would you feel comfortable sharing that with us, mars? HARIRI, what did Dr. Rahal do to repair your "kinky wiry hair"? Thanks.

I understand why you haven't discussed it with your doc. However, it might be helpful to know what he/she thinks is causing the problem. That knowledge could benefit you if you get further FUE procedures done, and that info. may help others contemplating FUE.

That's very interesting, mars (and unfortunate, sorry to hear it). Normally, one would expect the opposite to occur. Have you discussed your situation with your doctor? Also, did you have FUT or FUE done?

Thanks for posting. This discussion and your pics are very helpful to anyone considering HT surgery. I second mars' question... I mean, assuming we've gone to a recommended "top doc," and our physiology cooperates for the most part, to what degree should we expect transplanted hair to resemble native hair when fully matured? Is it realistic to expect it to be virtually indistinguishable, or must we accept that there will always be a difference between the two, even under the best of circumstances? And, if so, what types of differences are considered "normal"? Thanks.

If a patient plans to have multiple FUE procedures throughout his life, then your plan makes perfect sense to me. Thank you for that bit of insight. I've been quoted as needing approximately 1,300 grafts to restore my hairline. I prefer FUE. If necessary, I'd also be willing to have a follow-up FUE procedure to address the areas of poor growth from the first procedure. Assuming, after one or two procedures, my cosmetic goals are reached, I do not want to continue chasing my hair loss with surgery after surgery. I'll be 39 next month. I've been on Propecia religiously for 13 years, and for all intents and purposes it has stabilized my hair loss since I started the regimen. If the meds stop working for me, and I start losing the native hair around the transplants, my plan is to shave down and get on with my life. Therefore, I have a keen interest in minimizing the appearance of scarring as much as possible. Considering the above: - Do you think it's reasonable to request that a HT doc spread out the extractions as much as possible, utilizing the entire safe zone, and even venturing outside of the safe zone, all in an effort to spread out the scarring and avoid creating a clear, sharp-edged pattern of thinner hair in the occipital region of the scalp? - Obviously no one has a crystal ball, but is it reasonable to presume that, given my long-term success with the meds, I will continue to enjoy its benefits for many years to come? - Is my overall plan realistic, or should I seriously consider not getting a HT, because of my desire to not chase my hair loss with HT procedures for the rest of my life? Many thanks.

Well, I've narrowed down the choice of surgeons to two: Dr. Feller & Dr. Ron Shapiro. Matt from SMG told me that they use Acell. I'm not sure if Dr. Feller uses it - I couldn't find any info. to that effect on the forum, and he didn't mention it during our in-office consultation. Do you know if Dr. Feller uses Acell? Also, any general opinions on both doctors specifically regarding FUE? Thanks.

Thanks, Dr. Lindsey. Your comments are certainly helpful. I've also read that it's easier to extract from the back of the head (Dr. Bisanga noted that in one of his articles). Regarding it being less noticeable, I thought that spreading them out as much as possible, assuming you have the available donor area, reduces the appearance of scarring and "hairless" areas when the hair is buzzed to a #1 or less on the clippers. In other words, there's less chance that a well-defined pattern of thinner hair will be noticeable. I can understand if it's a large case, and you must condense the extractions, because of the limited available donor space, but I don't understand why it's necessary in smaller FUE cases. Is this position wrong? If so, please explain why. I look forward to your update. Thanks again.

Thanks for your input, Dr. Lindsey. I've noticed in various pics that doctors often restrict their FUE extractions to the back of the head even during relatively small procedures. The extraction points appear unnecessarily close together. In other words, there appears to be a lot of unused donor area. Can you give us some insight into why that's the case? I understand that the quality of the scalp tissue, and even the grafts themselves, can vary throughout the donor, and "cherry picking" may be necessary, but that still doesn't quite explain these types of condensed extraction patterns. In the following example, I'd like to know why the doc didn't extract from the sides of the head and perhaps a little lower as well: http://www.hairrestorationnetwork.com/eve/142984-fue-patient-1-year-post-op-also-**update**-2-year-post-ops-dr-feller-patient.html My understanding is spreading out the extractions as much as possible is the way to go in order to minimize the potential for scar coalescence and the appearance of hairless areas especially when buzzed to a #1 or less on the clippers.

Sean, Each extraction has to allow for FU’s to surround that point; you cannot punch two points adjacent to each other. In larger FUE cases it becomes more challenging for the doctor to not leave visible “hair less” areas as the extraction pattern becomes more confined. The pics of your donor are not close enough for me to see the extraction pattern in detail. However, it appears as if Dr. Rahal stayed well within the "safe zone" if that is one of your concerns. I think a key may be to buzz your donor, and surrounding native hair, down to a #1 or less on the clippers and try your best to notice if any obvious thinning patterns emerge. If the differences in density between the donor area and untouched native areas surrounding it are not noticeable or hardly noticeable, then you're good to go, especially considering 3,016 is no small number for FUE. But at the end of the day, what's done is done, and I wouldn't worry too much about it at this point. Stay positive, and concentrate on a successful overall outcome.

I'm a relative newbie, but according to my research an average donor can safely give approximately 4500 FUE with proper planning and execution. Regarding extraction patterns, I think you'd have to present pics of your post-operative donor (with extraction wounds still fresh) to learned members of the forum, including docs of course, to get some accurate opinions of your case. Do you feel that the FUs were extracted in a manner that minimizes obvious patterns especially when the hair is very short or buzzed?

Dr. Feller, May I ask why the extractions were not spread out more? There seems to be a lot of unused available donor area, i.e. below the extraction pattern pictured and on the sides of the head above the ears. Even though this is a small procedure, in theory, wouldn't spreading the extraction pattern over the largest area possible create the most optimal donor result? I realize that donor tissue quality may vary throughout the entire donor area, and that may limit where you can extract. What other factors limit a spread out extraction pattern? Thanks.

Firstly, thank you for your thoughtful reply, gillenator. Yes, I would prefer the transplants to fall out with the rest. I believe that would allow me to maintain the most natural look possible as my hairloss progresses. The alternative is being left with two patches of transplanted hair near the temple regions with bald or thinning areas surrounding them - not too attractive and not a natural balding pattern. However, I know that's not possible, because most, if not all, of the grafts will be extracted from the safe zone. That scenario will only be achieved when cloning is a viable option someday. So, back to present-day reality... My only HT options are chasing my hairloss for the rest of my life with multiple surgeries (which I'd rather not do) or getting one FUE procedure of around 1300 grafts to conservatively restore my hairline (and perhaps a follow-up procedure to touch-up areas where the first procedure fell short), and if my native hair falls out around the transplanted hair, just shave down. However, shaving becomes a problem if the scarring left in the donor area is unsightly. Therefore, I've been researching the best methods to reduce the appearance of obvious donor scarring and hairless patterns, especially when the hair is very short or shaved. I've found one article by Dr. Bisanga, and other info by one of his reps on another forum, regarding FUE and extraction patterns in particular to be quite educational. Dr. Bisanga emphasizes, "spread[ing] the extraction pattern over the largest area possible, try[ing] not to limit the surface area whenever possible." That's what I'd want my doc to do, including sides of the head and even venturing outside of the safe zone to get the best grafts and minimize donor problems. Actually, my dad still has a fairly decent amount of hair, perhaps a Norwood 3A with slight crown thinning, and he's 74. I didn't know my maternal or paternal grandfathers, but my maternal uncle is 60-ish, and he's probably a Norwood 3V with some diffuse thinning on top. So, all in all, I don't think Norwood 6 or 7 is in my future, but you never know. Yes, I've faithfully taken propecia almost every day for 13 years. It's pretty much frozen my hair loss with the exception of a very little bit of loss at the left side of my hairline over the years, but that hair was more diffuse when I started started taking the meds, so it's been fighting extra hard just to hang on. Currently, I'm around a Norwood 3, perhaps a little less (2.5?); it's hard to tell, because the Norwood scale charts vary. My crown is intact, and I have no diffuse thinning (other than my left hairline which would be addressed by a HT). I've been very fortunate with the meds so far, and 13 years is a long time, but who can say if/when they will stop working me; hence, I've been factoring that into my HT plans. I'm soon-to-be 39 y.o., by the way. All good points. I've consulted Dr. Feller in-person (I'm based in NYC). He feels I'm a good candidate for FUE. He quoted 1300 grafts being necessary to restore my hairline. He said he can never tell for sure if someone is a good candidate for FUE until he actually begins extracting. He added that if he discovered I wasn't a good candidate during surgery, he would stop the procedure. I find that approach quite ethical. Of course, I would insist that he use the smallest punches possible, and I'd make it known that I'd prefer that he take Dr. Bisanga's approach in my case and, "spread the extraction pattern over the largest area possible." I'd even sign something giving him permission to extract from outside of the safe zone if it would make for a more successful donor and recipient result. I have fine, straight hair, so extracting outside of the safe zone as well may increase the odds of matching hair shaft thickness at the hairline, and I don't have a problem with any of the transplanted hair falling out if the propecia stops working for me in the future. Having said that, I still haven't settled on a surgeon yet. I also had a phone consultation with Matt from SMG. I think the next step is to try and arrange in-person meetings with FUE patients of Dr. Feller and Dr. Ron Shapiro who share my hair characteristics and degree of hair loss. You can only get so much from photographs. Do you think robotic extractions are superior to manual? If so, why? Yes, I'm aware of the "mush" factor. That's a good point, because donor tissue quality may vary throughout the entire donor area. Exactly, aaron1234. I'd like the FUE extractions to go past and above the areas on the sides of the head as well as the back of the head. Like I was telling gillenator, I really appreciate the logic in Dr. Bisanga's approach regarding spreading out the extractions as much as possible. Of course, the ability to do that successfully depends not only on the doctor's skill, but the patient's physiology.