seeker2014

Dr. Lindsey: Thanks for posting this case...this patient has experienced pretty impressive results considering it is only the 6 month mark. I had a few questions I was hoping you would be generous enough to answer: (1) Do you happen to know the guard number this patient shaves down to for the back?...it appears to be a 3 or 4 guard, but I was wondering if you could confirm this? (2) You mentioned the patient refused meds and comes from a line of class 6 guys. Hypothetically, if this patient lost a significant number of non-transplanted hairs 20 years down the road and, consequently, wanted to shave down to a 1 or 2 guard, what would be your recommendation? Specifically, do you think transplanting FUE grafts into the FUT scar would enable him to reach this goal and, if so, how many grafts do you estimate it would take? By the way, I have really enjoyed reviewing your FUE into scar tissue results...they have helped me with my research.

I completely agree with Spanker...I would recommend shaving it and possibly reevaluating your situation at 25 which, honestly, is probably still a bit too young for a hair transplant. At 22, my hairloss was very similar to yours except my crown was intact. I have now been spending the last half year researching different ways to further improve my FUT scar after undergoing a 2800 graft procedure. Don't jump into something too soon, especially 750 grafts with your current NW level. If you have not done so already, give the buzz cut a try...you might be surprised how effectively thinning hair is concealed when everything is at a uniform length. Best of luck!

Hi nervousguy: Your situation sounds very similar to mine (except I didn't have any work done in the crown). After evaluating my situation, this is what I think happened (and it could possibly apply to your case). I underwent a 2700 graft procedure and, initially, the results looked very satisfactory. However, considering I had pretty significant diffused thinning in the midscalp and front, the number of grafts I received were not sustainable over the LONG-TERM. In other words, the density achieved via 2700 grafts was right on the threshold of creating the illusion of density. Of course, despite being on finasteride and Propecia, hairloss still will continue its inexorable march (albeit, more slowly). So long story short, I don't think my surgeon really did an effective job of planning for the long-term...it was just a coincidence that 15 months out I experienced further hairloss. These are the two choices I faced: (1) Try to maintain the current density for as long as possible with the future expectation of keeping my hair as short as possible or (2) Reevaluate surgeons, go through multiple consultations, review posted results, and ultimately choose a surgeon who will help you achieve long-term goals which, more than likely, translates to multiple HTs. For me, I chose the former with the possible secondary goal of improving my FUT scar (which, fortunately, does not look too bad) via FUE. I reached the conclusion that if I went down the latter path, I will probably be chasing hairloss my entire life with limited (if any) success. I am by no means implying my decision has universal application since some people can achieve their expected results through HTs. However, considering you are losing ground relatively soon after a HT, I think you have to weigh your options more carefully and proceed with a decision that will be acceptable now and in the future. In terms of stress-induced hairloss, I don't invest too much weight into this factor. It is my understanding that if stress is the major cause of hairloss, it usually manifests as telogen effluvium characterized by unpatterned hairloss (including the donor area). Best of luck!

By the way, here is the thread I was referring to about FUT scar size and expected grade...look in the second paragraph: http://www.hairrestorationnetwork.com/eve/179389-dr-lindsey-discusses-dont-do-hairline-too-low-young-man.html Again, best of luck. My only other suggestion for research purposes is to stick to the results posted by top doctors. IMO, I have been very impressed with some of the FUE results as I am researching a possible FUE into FUT procedure to cut my hair shorter. Just make sure you are weighing all the possible advantages and disadvantages of both procedures relative to your individual goals.

Hi kennex: I concur with the statements made above by KO. However, if you are absolutely determined to proceed with a HT, you have made an excellent point above...planning for contingencies. To start, regardless of the procedure you choose (FUT or FUE), there will be scarring. Saying that, it depends on how short you may want to shave your hair in the future, assuming the HT does not work or diminishes over time. I remember a recommended surgeon awhile back (I don't want to attach a name to this statement since my memory might not be serving me correctly) posted a breakdown of typical grades you can shave down to with a FUT scar...a vast majority of cases fell in the 3-4 guard range. However, even going to a top-rated FUT surgeon will not necessarily guarantee you these results. Individual physiology plays a tremendous role in scar healing so if you decide to proceed with FUT, keep this risk in mind. If you go to a top-rated FUE surgeon, I think a 1-2 guard would be relatively realistic assuming the surgeon is using a punch size in the 0.75-0.8 mm range. Long story short, if you want to plan to keep your hair shorter now or in the future, FUE may be the better option for you since visible scarring will be less prominent. To be transparent, I received a FUT procedure myself. Even though my scar falls into the average category, in retrospect it would have been to my benefit to leave options open. Hairloss is progressive and once you get to a certain NW level, there is a significant cosmetic appearance between a 4 and 1 guard in terms of perceived "neatness" (i.e. most people look better with shorter hair at higher NW levels). In terms of yield/grafts you can ultimately extract via FUE or FUT, I am not even going to proceed into that realm. There are many threads dedicated to that subject. I would recommend looking through results posted by patients to see the results of each respective procedure so you can make an informed decision. Best of luck!

Agree with the above statement. Considering you are a younger patient, I would research FUE options in order to minimize visible scarring. Granted, I am somewhat biased since I received a FUT procedure at the age of 25 from a coalition surgeon who promised I would be satisfied with the results...and, granted, I can conceal my scar reasonably well at short hair lengths after the results diminished a year and a half out. However, FUE can give you more options out just in case something does not go as expected, especially considering you have a family history of high NW levels. Also, have you tried to cut your hair short (at a 1 guard) just to see how it looks...I ask because it seems like you have retained a reasonable amount of front hair that would probably frame your face well with a buzzed cut.

I am confused as well. Why are you going in for a HT with the current state of your hair? Furthermore, considering you have already expended 1100 grafts + an unknown amount, you have to take into account potential future loss and the impact a lowered hairline might have on your future appearance. IMO, you don't need a HT.

No problem...as long as you stay within a couple guard lengths (i.e. a difference of 1/4 of an inch), no one should be able to detect the difference. Also it appears you have darker hair so DermMatch might also allow you to buzz down shorter (from my experience, the darker your hair, the better everything blends). If you were to consider the FUE grafting into scar route, it would probably require around 300-400 grafts to allow you to shave down to maybe a 2 or 3 guard without any blending considering you can almost buzz down to a 4 guard. Of course, transplanting hair into a scar can be somewhat unpredictable with yield, but I have seen some pretty impressive results. I am looking into this option at the moment, but I am not ready to proceed...I am a bit hesitant about undergoing any other procedure after my initial experience.

Hi Romeo09: I am sorry to hear your HT was not successful. From personal experience, I know how frustrating it can be when there is no definite reason why your HT ultimately did not produce the results you were expecting. Saying that, I believe you still have options. I know you mentioned the possibility of shaving down. From your pictures, it appears you have retained a strong hairline which might work in your benefit in terms of framing your face. Have you ever experimented with buzzing down your hair? With some creative blending, I have been able to conceal my scar reasonably well (i.e. I take everything down to a 2 guard with blending of a 3-4 guard around the scar). If your scar is a bit wider, you could always look into FUE grafting which has generated a significant cosmetic appearance for some patients. There are also some other options out there that you could consider if you are interested in just improving the scar as much as possible.

Hairloss (especially for diffuse thinners) does not always follow a predictable pattern/time frame. Typically, when you start losing your hair young, it is more aggressive in nature, but again this is not always the case. You can have intervals of intense thinning followed by years of relative calm. Saying that, whenever you suffer from diffuse thinning, it never hurts to undergo a comprehensive physical (assuming you have not had one recently) and/or see a dermatologist to get a definite diagnosis of androgenetic alopecia. Good luck!

The three accepted non-surgical treatments for male pattern baldness are: (1) Rogaine (generic name: minoxidil) which has different potency ranges (from 2.5% all the way to I believe 15%); (2) Propecia (generic name: finasteride); and (3) and Nizoral (a shampoo which inhibits DHT). Each preventative treatment has its advantages and disadvantages which you will want to research in order to arrive at an informed decision. Depending on your hairloss pattern and expectations, a HT could be a viable option but of course there are potential risks just like any elective surgery. I have never heard of "man provillus" so I can't really comment on that option. Best of luck and use this forum to your advantage!

Hey destinyraymond: When you use the word "recent past", do you mean the physician thinks your hairloss is somehow connected with a traumatic event like major surgery (i.e. telogen effluvium)? Have you been diagnosed with male pattern baldness? If it is telogen effluvium, then the affected areas should eventually recover on their own over the next months.

Proceed with caution. I had a HT right around your age (I am currently 27 years old) and also was experiencing diffuse hair loss. 2 1/2 years post-op, I am basically back to square one (albeit with slightly more hair, but now have to conceal my scar with some creative blending which I can just luckily pull off). There are several factors working against you: (1) you have not stabilized your hair loss with preventative medications so it is nearly impossible to predict how and in exactly what pattern your hairloss is going to proceed, (2) you are a diffuse thinner, thereby making you more vulnerable to potential permanent shockloss, exacerbated by the fact you have not reinforced your potentially weak hair follicles (within the diffuse area) through any sort of preventative medication, (3) even with preventative medications, it is not a sure deal they will last forever as hairloss is progressive, (4) the crown can be a daunting area to fill (it has been referred to as the "black hole" since it can consume many grafts). IMO, I think your hair situation up front looks pretty solid and depending on how far away the wedding is (congratulations, by the way) you may just want to use a concealer for the mid-scalp which could make a significant cosmetic appearance. Then, in the meantime, you can conduct further research to determine if preventative medications and/or a HT are the right choices for you. My parting words--don't allow short-term goals dictate decisions with long-term implications. Best of luck!

Considering those factors, you still have some options available. If you wanted to pursue the FUE route, some doctors provide "shaveless" FUE procedures. They are not truly "shaveless" (they still shave donor/recipient areas), but the surgeon will keep the adjacent hairs longer to conceal any evidence of the surgery. This is only a viable option for smaller procedures (which obviously would apply to your situation). Here is a link to a thread that discusses shaveless FUE: http://www.hairrestorationnetwork.com/eve/179556-shaveless-fue-post2431633.html In terms of SMP, it can be hit and miss for scarred areas. Injecting ink into a compromised part of your skin can lead to unpredictable results such as individual "simulated follicles" spreading or color fading/changing long-term. Don't get me wrong, other people have made positive comments about their results, but I have not encountered many threads showing long-term results. It almost sounds like you are considering SMP to conceal the scar to receive additional FUE grafts. If this is the case, you might want to consider temporary SMP which typically lasts from 6 months-2 years. I have not encountered many cases of temporary SMP and I am not absolutely clear what makes the ink "temporary", but it is something you could further investigate.

Hi David88: If it is retrograde alopecia, I have never seen any pictures where it has progressed into the classic safe zone. It is also encouraging to hear that everything has been stable over a period of years and no thinning is evident when your hair is grown out. Again, to be on the safe side, you can always discuss it with your surgeon just to make sure you feel comfortable about proceeding. I wish you the best of luck!

Hey Multiplier, I agree with what has been stated above. I am looking for ways to possibly improve the appearance of my scar...I think yours looks pretty damn good. I am guessing you have your hair cut at a 2 guard. If you want to conceal it further, you could possibly try one of three things: (1) Currently, I cut my hair at a 2 guard, but around the scar I keep the hair slightly longer (around half an inch) and blend it. In your case, you could probably keep the adjacent hair at a 3 guard and completely conceal it all together. A vast majority of people cannot detect the difference between one eighth of an inch and any competent barber should be able to blend the hair; (2) Try another FUE procedure to further conceal the scar; (3) Add a small amount of DermMatch to the area. The challenging part is matching your hair color exactly, but once this is accomplished, the actual application is not too bad (I am currently experimenting with this option). You could always research other options such as Fraxel lasers and dermarollers (I have seen some successful results yielded through these options on another forum), but I don't think your case elicits either one unless you are going to shave completely down. IMO, I think your current hair length suits you.

I am by no means an expert, but I would be willing to bet you don't have DUPA. As the name indicates, DUPA manifests as unpatterned hairloss. After examining your pictures (especially the one grown out), I only notice some frontal recession. Most of the time, DUPA cases are extremely obvious (assuming it is not in the earliest stages) and hairloss advances rapidly. If you have ever known anyone with a severe thyroid problem, their hairloss could be categorized as DUPA as all hair (including the classic safe zone) thins evenly. I did notice your nape thinning which is PROBABLY one of two things: (1) the clippers just cut a little too deep into that area (have you noticed the thinning after multiple haircuts?) or (2) retrograde alopecia which specifically impacts nape and/or temple hair. If it is the latter, your donor area should still be safe. However, you could always ask your surgeon to reexamine your donor area just to make sure there is not any miniaturization OR delay the procedure just to confirm the thinning does not progress into your donor area.

From the pictures you just posted, it does appear you experienced some scar stretching. If you don't mind me asking, how many grafts was the 2011 procedure? Completely understand the work obligations, but I still think you have a few options available. Number one, would you be opposed to temporarily shaving your sides down to a shorter length for a FUE procedure? Considering you would probably need around 200 grafts (preferably over two procedures) your down time shouldn't be that long. If you could get a week (maybe two weeks) off from work, very few people, if any, would probably detect anything different (possibly some redness in the recipient site). Number two, you could always try another concealer for the scar if you are not satisfied with Toppik. I have heard some positive feedback for DermMatch and, considering how black your hair is, this might be a good solution. Concealers have proven a bit more difficult for me since I have a more varied hair color--strawberry blonde which can significantly change based on sun exposure. Number three, you could consider a scar revision, but honestly I have no idea if your scar width warrants this option (with my limited knowledge, I would lean towards "no"). Number four, you could consider SMP into the scar, but assuming you want to keep your hair at its current length, this probably would not be the optimal solution. Also, SMP into scarred regions can be unpredictable with ink blotting.

I think scar5 gave you some excellent advice. I am currently researching FUE into FUT and average yields are obviously below average when compared to a non-scarred area. Saying that, I have been pretty impressed by what some individuals have been able to achieve with so few little grafts. You have the advantage of the scar only being on only one side of your head and relatively thin (considering the average width is only 1-2 mm). To give you a better idea of the cosmetic appearance of the scar, it might not hurt to progressively shave the sides down (probably start with a 6 guard) just to determine when it becomes visible. My threshold is around a 3 guard which I would consider average (optimistically, slightly above average) for a FUT scar. From the dimensions you provided and the one picture you posted, I would estimate that 200 FUE grafts would do a reasonable job concealing the scar at around a 2 guard. Something else you might want to consider (assuming you want to cut the sides shorter) is blending the surrounding hair. When I go in for a haircut, I get everything buzzed with a 2 or 3 guard and then have the barber keep the hair adjacent to the scarred area a bit longer (scissor cut to probably around a 3/8 to 1/2 inch). It is very challenging for the human eye to detect the difference between a quarter of an inch so it gives the illusion of everything being at the same length while effectively covering the scar. If you do elect FUE, I would recommend at least 2 passes. The first pass should probably be around 100 grafts just to see how they respond and then a follow-up procedure to increase the density. If I decide to go down this path, I am going to use scalp hair since I have decided not to undergo any further procedures after my first one. However, you could use beard grafts if you plan to undergo further HTs. In terms of increasing the potential success of the FUE grafting, you can always look into fraxel lasers or dermarollers (a much less expensive option). According to other forums I participate in, both these options help reestablish blood flow to the scarred area, thereby increasing the chances of the grafts taking. I have not tried either one so can't personally vouch for their effectiveness. Sorry for somewhat rambling, but hopefully this helped!

Thanks for the response...any future updates would be very much appreciated.

By the way, are you satisfied with your FUE into FUT scar results? I am possibly looking down this avenue...

Hi densedream: I want to preface this by saying I have never received any work in the crown area. However, reviewing other cases on this forum, 5200 grafts does seem like a lot for one area. Conversely, as you mentioned and others have stated in other threads, the crown does have that infamous moniker of the "black hole" so maybe other members have received the same number of grafts for the crown area and this truly is the average. It would be interesting to hear other members' experiences (sorry I couldn't be more help). For what it's worth, I think your current hair looks excellent. Best of luck with everything.

I decided to look at the Pura d'or shampoo again and some of the ingredients are intriguing...specifically, the saw palmetto extract and biotin. I have no idea at what concentrations these components are present in the shampoo or their true effectiveness in preventing hairloss. I suspect some people might have a negative reaction due to the argan oil which can exacerbate dry skin for some individuals. As a FYI, the "item is under review by Amazon" and is "currently only available through independent dealers". There can be many reasons for the "item under review" label including inadequate inventory, the shipment process, or how the item is described, but just wanted to relay the information to you.

Hi Wylie: I am using a similar product at the moment--an organic shampoo (by baby mee) which contains aloe and chamomile infused with honey--after getting into cycling more (and having to endure the occasional dry helmet head). I have enjoyed the product so far as it has eliminated my previous dryness. Unfortunately, I have not experienced any hair growth over the month I have been using it. Today, I also picked up a product by Hair and Shoulders called "instant relief scalp soother" (which contains tea tree oil and peppermint and is a leave in product) since it was on sale. I reviewed some of the online customer reviews and it seems to be hit and miss with its effectiveness--some customers claim it only provided them with 10 minutes of relief while others have labeled it a "miraculous" cure for healthy scalp/hair. As I have yet to use it, I can't personally vouch for it one way or the other. However, I have encountered a few threads where people have referenced the hair growing capabilities of "tea tree oil", but, like you, I find these claims dubious at best. As a side note, I was initially going to purchase the Pura d'or shampoo, but was turned off by some customer reviews which cited the dry hair. I have pretty sensitive skin so when my scalp gets dry, it can almost feel like an infinite loop to find an exit. Hope this helps!

It depends on your goals. If you want to proceed with another HT, then utilizing beard grafts would be an option to preserve scalp grafts. From what I have seen on this forum and others, beard grafts seem to respond well when transferred to scars. However, you do have to factor in the possibility of "visible" scarring with this procedure. From cases available on this forum, I have never seen visible scarring with beard grafting, but results can vary depending on the surgeon's skill and an individual's physiology to scar formation. In my case, if I elect another procedure(s) to fill in my scar, I am going to use scalp grafts. Very interesting with the 6-months post-op combined with Propecia. Again, my experience is extremely similar. When I started with Propecia at 18, I had amazing growth, giving me good density until around 21. I then started to lose ground until receiving my HT at around 25. I had great results until 15 months post-op when I started to experience significant shedding. IMO, Swooping made an excellent observation. It seems to be somewhat common for a diffuse thinner to experience zero long-term gain in density from a HT due to the vulnerability of weakened native hair. I would say that I am nearly back to my pre-op state with slightly more hair in the front with crown loss (despite being on finasteride 1.25 mg daily and minoxidil). I am sharing this with you to emphasize the importance of proceeding with extreme caution...being relatively young and experiencing diffuse thinning is a dangerous combination, possibly leading to a futile chase for adequate density through multiple HTs.