Paulygon

This is a great thread, and some great answers-- I too have been very concerned with this.. I am in a similar position as the original poster, hair loss since 16 and at 31 decided to go for the hair transplant. I got on the meds around the same week. As Jotronic mentioned, I had the "perfect storm" of results and and very happy -- but still have the burning questions posited above.... I am expecting that at some point (rationally or not), the meds will not be as effective as they were-- and this is causing me some anxiety... I am so happy with Future HT Doc's answer to #1, that the HT's stand the test of time At least I can really rely on that.. I do plan on going back to my doc for future work because I do expect that I will need that "maintenance" and I do strive for perfection, or as close to it as I can get.

A quick note- in 2012 I got the HT done, and gone on both Rogaine and Propecia.. To this day, I still have hair getting on my hands after every Rogaine application, and my shower drain still clogs every couple weeks with hairs. I live alone so I know the shower hairs are all my own... I feel like crap every time I see remnants of hair falling out onto my hands or in the shower drain... I don't know if it is falling out at a lesser rate than pre-2012.. but I'm sure that seeing this crap is at least partially causing my anxiety-- and there is no way to avoid seeing the darn hairs falling out... I've heard the adage that up to 100 hairs a day falling out is normal... but when you have as few hairs as I do, I don't think that 100 # is very accurate -- that number probably pertains to people without hair loss issues...

-I promised to create this thread in response to a great topic presented by "BeardedOne". - Although I have had excellent results in my HT procedure (see my Before/After pics) But I am suffering from nightmares (about every few weeks)- where I dream that my hair falls out at an alarming rate.. in my nightmares, I have quickly returned to my previous "bald" self or am in even worse shape hair-wise than before my procedure... I wake up from these nightmares, look at my hair in the mirror, and am surprised that I have so much hair on my scalp.. Is this common? Does the anxiety go away... do I need therapy? Or, is this nature telling me I am destined to go bald again? Is it because I have gone through an extreme change from bald to "not-bald" so quickly?

Just follow the post-op instructions-- why is it that hard?

this is awesome-- just hearing that you got a haircut that you couldn't have had since high school-- that feels excellent-- i've been there pretty recently and it there's nothing like it man.. i look forward to following your progress!

my hair stylist could not detect that I got a HT.. she is very skilled and only does men's haircuts... so that says something about the quality of my procedure and about the state of Hair Restoration these days if you go to a skilled surgeon. I concur that HT veterans could probably tell-- but that's ok with me!

to BeardedOne--- I actually DO get anxiety quite often- in the form of nightmares (that my hair is still falling out - at an accelerated rate)! (well, because, I'm pretty sure my hair IS STILL falling out-- I'm on the meds and with the surgical procedure somehow got my hair restored but I don't know if nature will catch up with me-- As Jotronic mentioned "Everything came together for Paulygon to create the perfect storm." So I don't know if its just a matter of time before that "perfect storm" goes away, and things go back to the way they were in 2012.. the nightmares are pretty bad and also seem to come every few weeks.. I wake up after the nightmare and then look in the mirror astonished that I actually do have a full head of hair. in a way those bad dreams motivate me to have an active dating life because they make me feel like time is running out... but still I wish I didn't have to deal with that horrible anxiety.. (this is an important topic that I may need to create a new thread about). btw, Jotronic, great analysis.. you're right about my hair characteristics - my hair is coarse and has a good "waviness" about it, which seems masks the "empty" areas. I also get pretty expensive haircuts ($45) make sure my hair stylist cuts my hair to strategic lengths- she has been doing a good job. I'm still impressed by your hair from when I saw it-- do you get anxiety as well? I've also been doing the Rogaine in the crown-- and from what I've heard, that is only effective for ~7 years.. maybe that's part of the cause for my anxiety.

crown got filled because of meds... hair in front appears thick due to hair economics formula that the doc uses in to give the illusion of density - you can read about that "formula" specifically on my blog post that Dr Mohebi answered: How to budget hair in hair transplantation – Hair Economy -> Hair Restoration Social Network - Hair Loss Patient Blogs I did not use concealer on that pic-- but I do think that my donor hair was high quality and perhaps lighting, hair style and other factors give the appearance of good density... however, I most social occasions, I do use Toppik (just not in the clinical pics I uploaded on my blog... however, in the "social" pic with the girl, maybe I do have Toppik, I don't remember)

You can check out My Hair Restoration Journal and the my pictures to at different stages Before / After Hair Restoration surgery (fyi- meds started around same time as transplant) Hair Restoration Journal for Paulygon - Surgery Day (Pre/Post OP)

Meds WERE also involved-- just look at my signature line before you accuse me of bullshitting you.. sorry if I "overshared" by posting a picture.

Last week, walking around the airport, to find my terminal for my flight from SFO to LAX.. my eyes naturally gaze towards beautiful women. I *don't see* mediocre women anymore. Midweek, in court, I make eye contact with the classy, good looking DA lady. She seems to like my confidence. This is a new me.. before, I wouldn't make eye contact with women-- was too shy. You don't know the value of hair until you lose it.. but once you can get it back, then you appreciate it. I have finally become active in dating and bought a hot ride. To any one considering a hair transplant.. don't delay... all my relatives tell me it was the best investment I ever made. You can't put a price on confidence.. and you shouldn't waste your youth. Here's a quote I found: "Enjoy the power and beauty of your youth. Oh, never mind. You will not understand the power and beauty of your youth until they've faded. But trust me, in 20 years, you'll look back at photos of yourself and recall in a way you can't grasp now how much possibility lay before you and how fabulous you really looked." Anyway, with my hair back... I'm back into the dating world and trying to make up for lost time! Wish me luck! (before addressing my hair issues I was a hermit sitting in my room behind a computer the whole time) -Paulygon

Hi All, I just tried the Hair Now app and found a hairstyle that I liked. I was able to successfully add that hairstyle to my bald (pre-transplant) pic. Check out the results.. I think this is a pretty useful app for people who want a preview of what they can expect from a hair transplant procedure. f you get more hairstyle on there. Dr Mohebi, I was your patient in Oct 2012 and and am very happy with the results... but I do not see my own AFTER pic on your app.. Do you plan on putting some more hairstyles on the app - I don't mind if you use my After Result also. (my initial plan was to add my own Post-Hair Transplant hairstyle onto my bald pic and see what it looks like, haha). Anyway, pretty good app and I'd love to check out future versions. Anyone have any thoughts on my uploaded Hair Now generated pic VS. pics of my actual results? Seems pretty close to what I have now (post-actual transplant).. though I still think my Actual hair is better.. Thanks Dr Mohebi for the good work! Paulygon

this is why i love these forums-- different viewpoints from experienced people... also, i agree, your scar is pretty small.. mine is of the curved-to-ear type that 'scar5' mentioned (2710 grafts from it). and i also think you have a ton of donor left.

Dude.. Relax! It's way too soon to be doubting the results of your HT procedure. You will drive yourself crazy if you analyze it everyday.. Just continue your life and let the hair grafts do their thing. You posed some interesting questions, nevertheless, that for a second got me curious and paranoid- as I am looking into getting some FUE work done to target/augment 1 or 2 areas on my scalp; and I am in the same region as you (Orange County / Los Angeles). I had a consult with my physician today and brought up the issues you pointed out. My HT surgeon is Parsa Mohebi and he has done a strip (FUT) procedure for me in the past. 1) My surgeon feels that 50% is way too low (based on his experience and skill level). That being said, I have seen sites on the next saying that for certain types of hair (ie. very curly, African American, as low as 50% is possible)- yours does not seem to fit that category. Maybe your physician was making sure to give you the worst possible outcome? In that case, I totally respect what he said. 2) Dr Mohebi also confirmed something from my experience post-transplant, which is that you (the patient) cannot guess the # of grafts the surgeon has implanted based on looking at the red scabs on your head after a transplant. Or for that matter, neither can we (the viewers who are looking at the pics you've uploaded). This is because not every transplanted graft has the scabs or dried blood on it. 3) Finally, and something I never thought of, is Dr Mohebi said that surgeons sometimes double up on grafts. For example, if the number of singles are more than what is needed for building a hairline, then they double them up to have more density. 4) Don't you need to get staples removed? Make sure to ask your dr if you have any concerns. Keep up updated. If your doctor was recommended on HTN, I'm sure you can be confident in his abilities. Did your doc's office ever get back to you - what did they say? Also, in case you are interested in further reading , David (TakingThePlunge) had written (in 2009) a nice article regarding that 50% survival rate for certain FUE cases: Is Graft Survival Lower with FUE Hair Transplants? | Hair Loss Q & A

Any thoughts as to how much effort one needs to put into laxity exercises before a 1st procedure? (or are you doing FUE?) I didn't do much of any scalp laxity exercises for the first HT.. and am wondering if I am going to regret that...

That's awesome.. you can always make more money in the future! but you can't buy more youth (ie. You'll only be 25 once)

How to budget hair in hair transplantation – Hair Economy Patient question to Dr Parsa Mohebi: When you implant grafts into the patient’s scalp, do you implant them uniform distances from each other (like in the agriculture photo above)? People have different hair styles that look optimal with their faces (or they’ve just become accustomed to some hairstyle that was popular when they were young and want to stick to that). Considering people have different hair design goals, shouldn’t the distance between grafts be customized to that individual’s goals? How do you determine the distance between grafts you implant into a patient’s scalp? In the photo below, let’s assume both subjects came from a Norwood 5A baseline (since that’s where I came from before you did my procedure). The man with the Mohawk (left) clearly needs more density in the middle and probably does not care much about the appearance of fullness outside the Mohawk region. In contrast, the man with the traditional hair cut (right) may be less adamant about requiring very high density in the middle, and may be a better candidate for “equi-distribution” (if that is a term) of grafts throughout the entire receptor region of the scalp. This can get complicated because Actual density is a function of: (a) distance between grafts; (b) # of hairs per graft. And then Perceived density, extends Actual density to include factors of: © strategic placements of multi-hair grafts (ie. each graft can contain anywhere from 1-5 hairs), (d) subject hair color and skin tone; and (e) thickness and waviness of hair. So, Doc, what are your thoughts? The reason I am asking is because i LOVE the result of your work on me. But, when I got a full head of hair again, my lifestyle was changing for the better, and I purchase a BMW convertible, which I need for my reviving social life. One problem is that when I drive with the top down in that sports car, an area in the middle of my scalp appears to be thinnish because of the overhead wind. (I know I don’t HAVE to have a nice convertible.. but I am going to take advantage of my newfound confidence, and I’m going to drive the car I want to drive. Check out Spencer Kobren’s great show about “Life After a Good Hair Transplant” http://blip.tv/file/6702253 ) Anyway, Dr. Mohebi, thanks for taking the time to read my question. I also have a favor to ask of you: I have a profile on Hair Transplant Network that I use to educate and interact with other hairloss sufferers. HTN voted me “Hair Transplant Patient of the Week” based on the impressive work you did on me. I’d like to share my URL with your readers so they can learn more about my hairloss story: http://www.hairtransplantnetwork.com/blog/home-page.asp?WebID=2597 Thanks & Respectfully, Paulygon Dr Mohebi's Answer: Great question. In fact, this is one of the first questions every hair transplant surgeon should ask before a hair transplant procedure. The answer to this is rather economic, because it has to do with supply and demand. Hair economy When I examine every new patient hair microscopically, I try to determine two main facts: <!--[if !supportLists]-->1. <!--[endif]-->The final stage of hair loss or the total surface area that needs to be covered <!--[if !supportLists]-->2. <!--[endif]-->The total value of their permanent hair Recipient factors It is important to know what the final stage of hair loss will be for a particular patient. Microscopic evaluation of hair can determine where you are heading in most cases even in early stages of hair loss. Family history of male patterned baldness can also help me make a better determination. For example, if you are heading for a class VI of hair loss (losing the entire hair from front and top), that means you will need adequate volume of hair to cover this large area. Donor factors Total value of permanent hair has to do with the qualities of donor hair described as follows: <!--[if !supportLists]-->1. <!--[endif]-->Density: The more hair per square millimeter you have in the permanent zone, the more reserve of permanent hair you have for transplantation. <!--[if !supportLists]-->2. <!--[endif]-->Thickness of donor hair: Thicker hair produces more volume after a hair transplant procedure. The important index to consider is the cross section of hair. If your hair diameter is twice as much as someone with fine hair, your final volume for the same number of hair will be four times more. So you can see that hair thickness is a crucial factor in the final result of a hair transplant. <!--[if !supportLists]-->3. <!--[endif]-->Waviness: Wavy or curly hair produces the appearance of more fullness. <!--[if !supportLists]-->4. <!--[endif]-->Color: The contrast of Hair color with skin tone is also important. Considering everything else is the same, transplanted hair in someone with only 20% hair density with blond hair on white skin will look a lot fuller than someone with black hair with white skin. Other factors to consider Besides donor and recipient factors, we have to take into consideration other factors that play an important role in the process of planning for hair restoration such as: <!--[if !supportLists]-->· <!--[endif]-->Patient styling preferences: People who always comb from front to back require a denser front that can help the back areas too. People who comb from left to right require more coverage and maximum number of hair on the left side as opposed to the right <!--[if !supportLists]-->· <!--[endif]-->Patient height: top coverage becomes more important for shorter patients while frontal hairline and back of the crown become more crucial for very tall people <!--[if !supportLists]-->· <!--[endif]-->Patient job: Sedentary jobs makes top coverage more important <!--[if !supportLists]-->· <!--[endif]-->Aging and other individual factors A good hair transplant surgeon plans the hair transplantation with consideration of the future pattern of hair loss. Focusing on restoring a juvenile hairline in a very young patient could result in a fake hairline when the person’s hair loss is matured in the future. So as you can see, planning for hair restoration is not always simple and should be done after a thorough examination of all the factors that play a role for each patient. Since the distribution of hair in transplanted areas is almost never even, the hair transplant surgeon should implant the hair grafts strategically to create the appearance of maximum fullness. To answer your question about whether you need more transplantation to fill the very front of the scalp; it depends on whether you have adequate donor hair that can address your future hair loss in the top and crown areas. Obviously, our priorities might change due to factors such as height, job, and personal styling preferences.

haha., bunch of comedians we have here!

LOLLL - AND another thing to add to my list of hair woes!

Wait. Is this actually this possible? Can the individual hairs of a multi-hair graft be separated and moved to remote/separate locations of the scalp? I always thought they were like Siamese twins sharing the same organs and not separable without causing injury/death to the graft.

Stimulants probably do cause hair loss in the same mechanism of action as stress-induced hair loss.

Two of my favorites (before social events or dates) are: (1) Oribe Shampoo for Magnificent Volume (2) L’Oreal Professionnel Volume Expand Shampoo Review And I still use T-Gel or Nizoral 1-2x a week when I do not plan on going out.

Are you talking strictly FUE, or strip as well? When I got my strip out there was a team working to separate the grafts.

At ~$4 a graft I never would yank them out! But then again, don they say that for every gray hair you pull out 2 more grow in its place? That's like free hair multiplication right there--- save $$ on transplant haha.

I always appreciate your posts, and a small part of me agrees with you.. But in my case, I feel my results exceeded my Surgeon's (online published) Before/After photos. And if I based my goals solely on his (web-published) Before/After photos I don't think I would have obtained such a phenomenal result. I feel like I actively pushed the limits by bringing in those celeb photos and saying "Doc, let's get closer to this hair line [if possible].. well, if Colin Farrel is not possible.. then how about this Patrick Wilson look? is this possible?" I think it is the artistic side of my that took charge.. or perhaps, I'm overstating the role I had in my own hair transplant. Nonetheless, I believe we should all push the envelope and keep striving for improving what is possible in hair transplantation. We should utilize all the tools (and photos) at our disposal.. Hope for the best, prepare for the worst.. as is the case with any kind of riskful undertaking.