404hairnotfound

I hope your get regorwth 404. It wouldn't make any sense if they were growing strong at 6 months then shed and didn't regrow. They're supposed to be safe-zone hair?

 

In terms of ceasing minox I would recommend people wean themselves off rather than stop it cold. ie. after 12 months of twice daily application, cut back to once a day for the next 2 months, then try every 2nd day for 2 months, then every 3rd day for 2 months, then etc etc.

Thanks Loags, I agree that weaning off is preferable to stopping cold turkey. I did wean to an extent, doing every other day application and then every third day. I only did this for about a month though, maybe it wasn't a gradual enough taper. Who knows.

I too just had a FUE for 2521 with Dr Rahal and was going to do the Rogaine for 1 year and then stop as per the guidelines and recommendations from Dr Rahals aftercare instructions in my folder I received after my transplant two weeks ago.

 

Do you guys think it will be okay after a year but not within 6 months because the hair typically is not strong enough to to stop only 6 months in but will be much stronger after a 12 month period due to being more mature?

 

This worries me as maybe I should not bother to use it if I am plan on stopping after a year. I don't want to be in the same boat after a year and lose all the hair I gained. I would be very angry after all the money I spent and effort to just go backwards

This is actually something that confused me after my surgery. Minoxidil is not something that you should start and stop after taking it for a significant amount of time; even simply switching brands from liquid to foam mid treatment has caused many people to encounter a shedding phase. This knowledge is common on hair loss support forums. Once your hair follicles adapt to a steady dose of minoxidil ceasing the application is a bad idea. I knew this going in and that is why I was confused about the recommendation to stop after 12 months. It is inevitable that hairs will be shed soon after. And if the stars align the right way the hair will continue to shed for 6 months or more, as in my case, although mine is a rarer scenario. If you are seeing good results while using minoxidil and not experiencing any significant side effects then I would not stop using it. Otherwise if you cannot see yourself committing to using it for the rest of your life (or as long as it is still doing its job) then I would not even start using it.

 

This certainly appears to be shedding of DHT sensitive hairs rather than the transplant hairs. If shed of transplant hairs occurred then you'd also see some shedding of the permanent native hairs resistant to DHT outside the recipient area shed as well because when apply minox these areas would've inadvertantly had minox on them as well. What I see is an even shed in all the area of the MPB area.

I can't say I agree completely, I think that the transplanted hairs have definitely shed in addition to the native hairs in the recipient area. I think the Before-After-Current pictures confirm this, as I had very little hair in the recipient area before the transplant. The hair that I did have there resembled vellus hair more so than terminal hair. The dramatic drop in density between month 6 and 12 indicates that a lot of the hairs that shed were transplanted hairs.

 

WOW, your 6 and 12 month photos are like night and day!! I hope you can achieve at least what you had at 6 months back, the density and blend with your native hair looked meticulous. Your post got me a little worried since I just had a procedure with Rahal less than a month ago! I too think he and his entire team are very professional. I had a good experience overall with the clinic, but also nervous about the final outcome, obviously. Anyway, glad to hear you had such an extensive conversation with Dr. Rahal and hopefully get you back on track to improve your result. I started Rogaine about 2 weeks post op as per the clinic's post op care. Your case certainly teaches me not to stop! Thanks and keep us updated on your progress.

Yes, certainly do not stop your minoxidil application. I have learned the hard way that meds should be an all-or-nothing endeavour, starting, stopping, and restarting is not a good idea. Best of luck with your recovery, I am sure you will be happy!

 

Also, for what it's worth eat healthy, rest well, consider green drinks. Not sure how much they will help, but certainly won't hurt. Good luck sir.

Thank you, I do exercise regularly and green smoothies are a staple in our household, certainly can't hurt.

Pleased you got to the bottom of it. That sure is quite a difference from 6-12.

 

I stopped minoxidil on the transplanted area around 6 or 7 months and did notice a slight shedding increase. Nothing as major as what you have experienced though.

 

I don't see why they wouldn't grow back over time since they should be DHT resistant.

Yeah, I am hoping that these DHT resistant hairs will come back strong, I guess we will see what happens in the next 6-9 months.

Hi 404hairnotfound,

 

I have to say, the comparison of your 6 months photos to your 12 month photos is striking. You looked like you were coming along well at 6 months, bordering on exceptionally well given your hair characteristics and relatively small number of grafts available for your frontal third restoration. I didn't know that stopping the post-transplant Minoxidil booster after 6 months could cause such a reversal of fortune. If I recall correctly, most ht docs who recommend Minoxidil to kick-start graft growth say to use it for 4-6 months. I am disappointed that you were advised to use it if what occurred was a known risk, especially in your particular circumstances.

 

I really hope that, with time, things will return at least to where they were at the 6 month mark.

Thanks PupDaddy, I hope so too. I have now read up about heavy and sustained post-minoxidil shedding occurring in some cases. Some people have reported shedding for one full year before their hair stabilized again.

Wow. This is definitely an unusual case. Looking at your pre ops pics it seems that you did not have that much hair there in the first place in the frontal third.

 

I honestly don't think you have had gained that much hair at the 6 month stage by minox alone. It seems like a lot of the transplanted hair may have come in but shed again. There are cases around where this has happened. Have you used minox before and have you noticed much growth with it?

 

Ive always been loathe to commit to minox. Id rather let the loss get to the max and then replace with transplanted hair from there. Hopefully another procedure can add density for you . Good luck,

Hey BaldingBogger, I have used minoxidil on a couple of occasions in the past and have had pretty good growth on it. This is the first time I have seen this kind of shedding after discontinuing it however.

I spoke with Dr. Rahal on the phone for an hour this morning and have updated my first post to reflect our conversation.

I have seen plenty of successful HTs of patients with hair colors other than brown / black. I do not believe hair pigmentation is a factor in whether a transplant is a success or failure.

In that vein, we really appreciate you putting your pictures up.

 

Be patient, I have faith that in the long run it will work out for you.

Thanks bismarck, I appreciate the words.

This is the 2nd subpar outcome from Rahal in as many weeks that come to my/our attention. Whats going on here??

I would wager to guess that it is more common than we realize. Many people are not as willing to share their poor results with the world, due to embarrassment, or because they are advised against advertising their result by their doctor, etc. People with great results are much more likely to share. my 2 cents.

Spanker, 2400 grafts was the amount originally quoted by Dr. Rahal. That was deemed enough to provide an acceptable amount of coverage/density for 44cm2. We ended up getting 2516. I feel that if all of the grafts had grown in I would have had acceptable coverage, but if we assume that only ~ 50-60% grew, that leaves me about 1000-1250 grafts short, which looks accurate. If the actual yield was 2500 grafts the result would look much better in my opinion.

 

Dr. Rahal advised to be conservative due to my donor area density and my hair texture (very fine). If I recall he mentioned I only have another ~ 3000 grafts remaining. 3500 in the frontal third would have depleted my donor too much, not leaving very much in the tank for mid scalp and crown work in the future.

 

I am going to be speaking with Dr. Rahal on the phone tomorrow morning and we will see what he has to say.

Yeah I'm hearing you on that question. I asked myself the same thing and had the crushing feeling that I must be one of "those" - you know, the ones doctors tell us don't have the "right physiology" for hair transplantation success. That's all bullshit designed to cover up a mistake possibly made by a member or members the team that handled your procedure. Maybe your grafts weren't placed deep enough into the incisions, maybe the grafts were handled badly, maybe . . .

Very good point - if the physiology was not right then why did some grafts grow out fine and not others?

Follically-Challenged, I am in the same boat as you and I am interested to hear how your case turned out. I hope you're doing better.

Thanks for the replies.

 

I will speak with Dr. Rahal personally and see what he has to say about this. Up to this point I have been corresponding with his patient care manager who has suggested to get back on minoxidil and wait longer.

 

You may be right 1978matt and 50% is more accurate, one of the reasons I posted was to get opinions on the yield. Thanks.

 

Just wanted to clarify that I am not trying to discredit Dr. Rahal; Dr. Rahal has had home run cases and unfortunately I am not one of them. Where the fault lies is difficult to determine but it's tough making the call to go back when your confidence has already been shaken.

Edit -

 

I spoke with Dr. Rahal for an hour on the phone and he has made a few things apparent to me that give a clearer picture of what is happening with my hair.

 

What is odd about my case is that my results at 6 months were much better than my results at 12 months. At 6 months post op I was taking Minoxidil to speed up the growth of the transplant and I discontinued the medication shortly after the 6 month period due to side effects from the medication, mainly facial edema, under eye circles, and more prominent wrinkles.

 

The reason I did not mention my 6 month results was because I thought that they were irrelevant to my result at 12 months, as a hair growth accelerator such as Minoxidil will increase the diameter of the hair shafts and give an appearance of thicker hair. I figured that not taking the medication for 6 months would allow my hair to return to its baseline state and therefore provide an accurate representation of the state of the transplant at 12 months.

 

Dr. Rahal informed me that this is not the case, and that the result at 6 months is a better indicator that the transplant was a success than my current results at 12 months. It is very possible that by discontinuing the application of Minoxidil my hair has gone into a state of telogen effluvium that affects all the hairs on the scalp, both transplanted and native. I knew this would happen to a degree but I did not think that it would take longer than 6 months to recover from this. I consulted with Dr. Rahal before I discontinued the medication and was told that the transplants would still grow, albeit slower. In my case, discontinuation of the medication has caused a regression due to the heavy shedding brought on by TE.

 

Dr. Rahal says that my 6 month picture is indicative that the transplant was in fact successful, and that the situation now is due to other factors beyond his control. This gives me hope that once the TE stabilizes my transplanted hairs will grow back. However there are no guarantees that my native hairs will grow back, so the result may still look sub optimal.

 

The other issue he told me about is that my hair characteristics are not the most ideal for hair transplantation. Because of my very fine hair and poor donor density, Dr. Rahal said that I am one of those "on the fence" patients, where the result could go either way and it is impossible to predict the outcome. My hair caliber is very fine, and combining that with the relatively low number of 3's and zero 4's that were extracted, it is hard to create an illusion of density with very fine hair and mainly 1's and 2's. Going by this, Dr. Rahal said that he does not know if he would recommend that I have any more work in the future. He said that I could be a candidate for FUE possibly, but we will have to see how my hair stabilizes over the next several months. We talked about potentially doing FUE into my FUT scar so that I can shave my head if the loss gets too advanced to do anything more. He also recommended jumping on Propecia and going back on Minoxidil, but waiting until at least the 18 month mark to do so to give my situation a bit more time to stabilize first. I am not comfortable with the idea of taking medication but will give it consideration depending on how things are looking in another 6 months.

 

Dr. Rahal also clarified what I perceived to be shoddy technician work. He said that within his team there is a lead tech who gives ongoing direction to the other technicians throughout the surgery. He explained that although things may seem a certain way out of context, it is not an indicator that anything is out of the ordinary. What I perceived as a new tech was just the standard way the team operates, and not indicative of any sort of lack of ability or ineffectiveness. I believe that he is correct, and that during the stress of surgery my mind could pick up on things that are not indicative of the true nature, especially in an environment such as an operating room where the vocabulary or jargon is foreign to me.

 

I should also mention that both my good friend and I had the surgery done together. His surgery date was the day before mine and his result from roughly 2800 grafts was very successful. The team of technicians was the same for both of our surgeries.

 

Dr. Rahal said he would like to evaluate my hair in person after 18 months has elapsed and go from there. For now, I am adding my 6 month photos in order to paint a clearer picture. While I am still disappointed that my 12 month result is not up to par I can not say that this is the fault of Dr. Rahal or his team.

 

I will keep this thread updated with my 15 month and 18 month milestones to show how the hair progresses.

 

Before and after photos (added photos at 6 months)

 

Pre op:

 

imgur: the simple image sharer

imgur: the simple image sharer

 

1 day post op:

 

imgur: the simple image sharer

 

6 months post op:

 

http://imgur.com/SGCyYyN

http://imgur.com/PSVsIet

http://imgur.com/tXJkpeI

http://imgur.com/au9qvxt

http://imgur.com/JwBBlcQ

 

12 months post op:

 

imgur: the simple image sharer

imgur: the simple image sharer

imgur: the simple image sharer

 

**404 asked me to edit this post to include the 15 month pictures - Blake (moderator)**

http://i.imgur.com/Hfkz2hN.jpg

 

http://i.imgur.com/qg7DaMv.jpg

 

http://i.imgur.com/VIA2VvZ.jpg

 

Thanks for your opinions.