mahhong

Whilst I think it's better to be sensible and think alt9's advice to use a mask is sensible, I'm not so sure there's a definite immediate medium or long term danger to using fibre-based concealers, though I fully admit I am not a scientist or healthcare professional so do not know for certain. Dust-based disease from materials like asbestos are in large part due to the tiny, tiny nature of particles, much the same with silica dust. Concealer fibres are much bigger than this. It is a little concerning some of them contain silica, but the amounts are incredibly small. In the case of cotton fibre disease, that's mostly due to the bacterial and fungal elements to be found on the cotton itself. I don't doubt that there may be some small risk, in the same way there is risk from deodorants, hairsprays, common dust, clothing fibres, second hand smoke etc. and that's why I think alt9's idea of using masks is actually a decent one - it's cheap and simple, so why not? However I'm not so sure there would be a directly measurable link between hair fibre usage and lung disease, even after decades of use. Certainly there are no direct comparisons to commonly known dangerous materials like silica, asbestos, cotton etc. My feeling is pretty much all hair fibre particles would be fairly easily caught in the respiratory system and removed successfully - over decades of use that may add up to some exposure and damage to the lungs, but I'm not sure it would be much more than living in a busy city, or using hairspray every day.

I'm definitely interested to see how Brotzu's lotion pans out. The theory behind why it works is sound, but a great many things work at the theory stage and don't get much further. For me it comes down to the scientific and photo evidence to see if this really does work and, if so, how well. He's made some quite big claims but there hasn't been much in the way of tangible proof presented publicly yet. I've learnt not to get too excited about anything until the data is out there. Definitely one to follow, but I remain a little sceptical until we can see more hard evidence.

In fairness H&W are trying to develop a liposomal formula for their topical finasteride. Liposome formulations are not entirely new and do have scientific and clinical precedence. They have been particularly studied in diseases like cancer, where it would be much more desirable to have say a chemotherapy reach only the target tissue and be unable to spread too widely and cause toxicity to other parts of the body. The scalp is an excellent way to deliver medication, which when it comes to finasteride has been the problem. A standard topical formula is about as likely to lower serum DHT as an oral tablet, which negates the point of topical (and was the reason finasteride was eventually created as a pill, despite being researched as a topical). However in principle a finasteride formula that could be "anchored" to the scalp would vastly reduce the lowering of serum DHT whilst still successfully reducing DHT concentrations in the scalp and follicles. I think H&W are still having some teething troubles developing the topical but I do believe it could be an exciting new way of delivering finasteride with less side effects, but hopefully as effectively. To my knowledge it's used 2-3 times a week and a study the doctors did suggested that it lowered serum DHT to the "equivalent" of taking two finasteride tablets a month whilst still dramatically reducing scalp DHT - it's the equivalent of lowering serum DHT by only 1/17th or 1/18th that of oral finasteride, but hopefully retaining the local effects as potently. I hope this could be a real option in the next few months and years but I do think there are some hurdles to overcome. I don't think the clinic have quite perfected the formula yet (though they do have a formula available) and I think more studies and research is required to make sure it's really working, that it offers good efficacy and that it genuinely reduces the likelihood of side effects. Certainly the early signs are encouraging but I think we need to see how the next few months pan out and, it still must be remembered, side effects can and do potentially happy, even if seemingly much rarer. The science is proven though - drugs have been targeted by using an anchoring liposome formula for years now and better formulations are being developed all the time. It's not a perfect science, but it has made the delivery of some toxic medications much safer in some serious illnesses, particularly those with a clear target like cancer. If we can ultimately develop a finasteride that works pretty much exclusively at the scalp/follicle level with little-to-no reduction of circulating DHT and produce consistent results with that, I have no doubt it'll be a game changer - and it seems we're closing in on that goal.

Hi Chamiga, As you say, shedding is normal with minoxidil and unfortunately sometimes a necessary process before the positive effects of the drug become noticeable. It's impossible to say how long it will last for or how severe it will be, although I would imagine total baldness is extremely unlikely. The hair becoming visibly thinner, however, may be a possibility. Rather than a wig, it may be possible to use concealers to cover up some of the hairloss in this phase, perhaps? They usually do a very convincing job when there is some hair but it has thinned, so they may work well to cover up the temporary hair loss. It's a less drastic measure than a wig. Or you may find the shed is not as severe as you first feared - I think a heightened sense of fear is to be expected, so you may find things don't get as bad as you thought they might. Or perhaps you can talk to a stylist that might be able to create a layered hairstyle that can cover much of your loss for the temporary shed (this might combine with concealer, too). The shedding is usually, in the longer term, a good sign though, so keep hold of that thought when going through this temporary distress!

Can't hurt to use it and there's some scientific and anecdotal evidence it helps hair grow faster, thicker and healthier. It might have some role in slowing or reversing hairloss but there's no serious evidence of that, and it's likely to be fairly minimal at best. As an added extra to a good regimen it might help.

Yeah more and more clinics are transitioning to FUE or at least offering it as a service. In fairness the transition was probably pretty slow because it just takes time and data to prove a technique really works consistently - you can't argue FUE was pretty hit and miss for a while, but I think a solid protocol has been developed over the last five years or so and it's now a very effective solution, even sometimes for large procedures. It's very unlikely we'll be seeing any hair multiplication/stem cell based therapies being offered any time soon. There's possibly more chance that novel therapy targeting some other aspect of the balding process may find a way to market in the next few years, so there may be another option or two, but like everything I think it'll take months and years for even approved products to really find their place and the data to accumulate on how well they work clinically and how they fit in and around established treatments. New topical finasteride solutions may make more of a show in the future. Jury is still very much out on how well it works and whether they offer a better chance of lowering the risk of side effects. There's a couple of new-ish surgical techniques like mFUE that are really in their infancy but these aren't really going to shake up the industry dramatically, just offer a few more options. Scalp micropigmentation offers another aesthetic option for adding the illusion of density and can look pretty good if used subtly and intelligently. I don't think anything major will change in the next 5 years. I think the best we can hope for is that one or two adjunct-style treatments may make it to market that could combine with or offer alternatives to finasteride and minoxidil and that may give patients more options or a higher chance of holding on to more hair for longer. It's all likely to be evolution instead of revolution. There's some interesting/exciting cellular based research going on but it's probably at least 10-20 years away from maturing into anything substantial, and that's being optimistic. Same with donor doubling - there's some hope it could work but it needs to be researched, trialled and then proven in the clinic consistently, with established protocols. You saw how long FUE took to become one of the standard practices, and it's just because diligent doctors want to take the time and effort to see data and find a real protocol that produces consistent results - there will always be pioneers and that's good, but moving from research to study to approval to clinical practice is a slow process and it takes time to establish new "gold standards". If a new treatment or technique "hit the shelves tomorrow" it'd probably be 3-5 years away from becoming standard clinical practice. That's just how things work.

Thanks for the detailed write-up Hayden and I very much hope this procedure turns out a success for you! Dr. Bhatti is a top FUE surgeon and it sounds like both you and he have come up with an achievable plan of action - I'm excited to see how this develops! n00b - Hopefully Hayden will be able to answer your question, but there's probably a very good reason. As Hayden has mentioned, he is relatively young with fairly extensive loss and maybe some concerns about his donor area too. In circumstances like that, it's far better to be cautious and plan a more conservative procedure and see how things go. Perhaps Dr. Bhatti wanted to see how the donor area looked after 2000 grafts and not risk too much thinning in that area. It's always possible to schedule further procedures if the capacity and desire is there, but it's nigh on impossible to fix mistakes related to overharvesting, so perhaps Dr. Bhatti had this in mind and thought it better to be safer than sorry.

I think you make an interesting point - some people definitely seem more sensitive to medication in general. Perhaps it's an anxiety/placebo thing, perhaps some people genuinely have much more delicate bodies and find messing with that equilibrium even mildly causes side effects. I think you also make a good point about finasteride that puts a lot of people off - it's a lifelong drug. It's not something that's really worth taking for a year or even five or ten years (unless you are only looking for a temporary benefit, which is not the case for most men). The truth is it's a commitment for life, and I do sometimes worry that even if I didn't get side effects initially, how would I feel if I began to worry I was experiencing side effects 5 or 10+ years after starting the drug, perhaps after having a couple of hair transplants too? It's a sensitive subject. I'm not a finasteride-basher, it's easily the best drug we have for hairloss and you possibly walk past men every day who are on the drug and doing just fine mentally and sexually. I understand the concerns of some men who feel hesitant about a major commitment to the drug though, and I hope one day in the not too distant future we have a better alternative for hairloss.

Looks great! Much better than if he had gone with an aggressive, recession-less hairline to be honest. This simply looks like a 38 year old man with a great head of hair.

I agree this is definitely fixable. I think Spanker gave some honest but necessary advice - there are some realities you may have to face about what can be achieved, but everybody here agrees that one way or another you can solve this problem. I think we can all understand your desperation but don't lose hope. There are options including one or more repair surgeries, hair systems etc. Also have you seen a doctor about your inflammation/ridging? There may be ways to ease the pain, or this may not be entirely to do with your transplant, so I'd see what can be done there. This is a very distressing time for you but take heart that a lot of men have come on these forums with disappointing, sometimes even horrific procedures, and have found a way to repair these mistakes and move on to live very happy lives. A lot can be done, so I hope that you can consult with a few doctors and come up with a plan to rectify what has gone wrong and move on happily into the future.

I've often wondered about people like Schwarzenegger. Didn't seem to be balding at all in his 20s, 30s, 40s, maybe even 50s, though he must have been pretty high on the T/DHT. I guess it's just not as simple as that, and he still has a decent head of hair for someone his age. Roger Moore was always an interesting one too. I think it's fairly clear he was wearing concealer or maybe even some kind of system towards the tail end of the Bond era but I'm fairly sure he had a great head of hair right until well into his 40s and maybe even 50s. He's still not bald today but he has pretty diffuse loss in a sort of NW5/6 pattern. It's hard to read too much into celebrity hair though as between having a lot of money and copious access to stylists/experts it's difficult to tell if someone wasn't wearing systems or having all manner of concealers etc. added to their hair, so it's not very easy to gauge their level of loss or when it started. I've seen actors wearing wigs on top of systems for some films - Sylvester Stallone for 'Grudge Match' being one such occasion. It is an curious one, though, how MPB expresses itself from person to person. It seems it's not as simple a case as the level of DHT = the level of hairloss. Maybe there are more complicated factors that determine how and when hairloss expresses itself, even if DHT is one of the main underlying culprits?

Yeah, I'm not sure about this at all. There's not a single link to a scientific study or a proper explanation of what they're actually doing. There's a few research companies looking into this sort of research - broadly speaking using the bodies own cells to act as a kind of growth enhancer using various different techniques. But no way is it as simple as taking cells from the abdomen and injecting them into the scalp and, hey presto, you stop balding. The companies who have been researching this sort of stuff have had, at best, fairly average results. PRP is a similar kind of thing (if not the same thing...) and results have been variable. It's certainly no revolutionary way to stop hairloss. It's a potentially promising field but I'm highly sceptical about these claims. Particularly as there's no photos, no studies, not even any real attempt at an explanation. I'd at least want to see a lot of scientific evidence of efficacy and safety and, most importantly, some good quality photo studies before I even considered something like this.

I think something you have to remember is that finasteride/dutasteride rarely truly "halt" hairloss. For most men they slow down the rate of hairloss, sometimes significantly, so that for example the amount of hair you would lose over one year naturally may take 3 or 5 or even 10+ years with finasteride. This makes planning procedures and producing consistent, cosmetically acceptable results easier. The more aggressive your balding, the less likely finasteride is to slow the hairloss over time, but for some men that perhaps only have moderate balding, the drug can significantly slow hairloss, so that you might have in your 50s or 60s the hair you were going to have in your 30s or 40s. The bottom line is, though, that for most men hairloss will still continue. It's unlikely that finasteride is losing its effectiveness, it's just that you're not blocking all the DHT and those hair follicles are still "under attack" somewhat because of that (we need DHT, so the drug only blocks about 70% of it). If you were to stop taking fin/dut, you'd likely notice a pretty significant loss of hair, so the drug is still probably working, it's just not a perfect solution. The honest truth about surgical hair restoration is that, once you're on the boat, you're on the boat. Essentially all men, no matter how stable their hairloss seems, must commit to the idea that they may need more than one surgical procedure to meet their goals over time and that, ultimately, even on treatment, their hairloss may progress to the point that they cannot cover every cm2 of their balding with the available donor. That's why most doctors will focus on building a decent density hairline and move back naturally into the midscalp, with much less focus on restoring the crown with any density. That way, if the day comes that you do age and continue to bald, you'll likely have a pretty good hairline and midscalp with a natural fade back towards a bald or thin crown - this will look natural and will likely happen fairly slowly over time. Of course, multiple surgeries down the road could continue to correct further loss - the idea with finasteride is that it will either limit the amount of surgeries you need or significantly extend the amount of time needed between surgeries, so that you may need 2 or 3 over 20 or 30 years instead of 5 or 6. That's also why good doctors will be hesitant to chuck 5,000 grafts into 70cm2 of balding, particularly in younger men. Further loss is always possible, probably even likely in the fullness of time, so a good doctor will focus on rebuilding your hair with maybe 3,000 - 5,000 grafts and try to leave a couple of thousand in reserve for the "rainy day" fund, which is usually needed if the sides of your hair drop or the crown opens up significantly over time and you want to touch those up. Your position sounds like a tricky one; on the one hand it's a positive situation because it sounds like fin/dut is working and you still have a pretty significant amount of hair, which is great. The downside with that is surgical restoration becomes more tricky - you're probably wanting to use a few thousand grafts wisely to build and thicken up a mature hairline and thicken up the mid-scalp a little. The reality is, though, if you do this, you almost certainly need to commit at least to the possibility of more surgery down the line to address further loss - and you also need to plan conservatively and assume the areas that are thinning will one day be gone. Then, with a good doctor you can estimate how much donor you're likely to have in total, how much balding is theoretically possible, and come up with a plan that meets your goals without compromising the basic supply/demand issue common in restoration.

Lots of good advice here. It's somewhat debatable whether finasteride really helps with shock loss but a lot of doctors do feel it's beneficial (and most would recommend the drug anyway as part of your restoration). It's certainly beneficial at keeping your native hairs and slowing miniaturisation around the fringes of your hairloss though. You definitely don't need more than the 1/1.25mg dosage. I think the bottom line with finasteride is that, unfortunately, it's a drug for life (unless, as David says, something better comes along). It's only really going to be worth taking if you can commit to taking it long term, so you have to make a decision whether to get back on it and stay on it, or to commit to not using the drug and either making do or getting more surgical restoration/making do with what you have. If you weren't getting sides and were happy taking the drug then you might as well go back to it I would say. If you decide it's not for you, then you'll have to come up with a strategy that takes that into account.

Thanks for your input HTsoon (and congrats on a great procedure, by the way!). I agree that retrograde alopecia is fairly likely, however I'm also a bit concerned that the hair looks pretty thin further up too. However I know this could also be a combination of the hair angle, combing, lighting etc. in addition, I know the density here is often not quite as high as the back. I also suspect my hair is angled rather oddly in this area. All my life I've suffered terribly with hair that just won't "lie down" properly around the upper fringes of the back and sides - it's always sticking up and moving in weird directions! I do think this contributes a little. Anyway a little retrograde alopecia is in my family, so I have to accept there's a fair likelihood it could happen to me. I'm worried about DUPA, but to my knowledge that is not in my family history and is less likely (nothing is impossible though!). I'll hopefully be seeing an expert in 4-6 weeks. I'm also going to be seeing my GP to try and rule out any thyroid/vitamin/hormone issues. I do have some other symptoms that could be attributable to conditions that cause hairloss like hypothyroidism, iron deficiency etc, but often these symptoms are so vague and numerous almost anybody can find a reason to believe they might have them! A proper workup will hopefully help, followed by a good analysis by an expert. Thanks again for your reply!

That's true about taking fin for your native hair. If you take fin and have a good response and keep a lot of your native hair, or it grows back, you need to keep taking the drug to keep hold of that hair. Even if you didn't experience shock loss, that hair is still dependent on finasteride to halt or slow down the miniaturisation process. It's one of the unfortunate facts about fin - if it works for you and you regrow hair, you need to keep taking it. If you don't, you're going to lose what you've regrown.

I've never found a problem with sweating. I play badminton and go running with it on and it's never dripped down my head or anything like that.

Firstly, I know no definitive diagnosis can be made here and I will be visiting my GP and a hairloss expert when time and money allow - I'm just canvassing some general opinion in the meantime. To try and keep it to a minimum; I'm 33, currently not on any medication. I'm balding in a NW5 pattern and have been since about 2008; pretty extensive loss throughout the top of my head but crown isn't huge and sides fairly high, and they don't seem to have dropped much or opened out in the last 8 years. Still have some diffuse hair in the mid-scalp and just enough in the hairline/crown to get away with concealer, but it's becoming increasingly difficult! No doubt the hair up there is on its way out over time - hard to tell if the exact pattern is established but no obvious signs I'm rushing towards a NW6/7 after nearly a decade of loss. Anyway, I'm going to have to start thinking seriously about restoring my hair now. I should have done it a few years ago but, alas, we live and learn. I did try finasteride a few years ago but long story short, I seemed to get sides. However I'm thinking of starting Min/Lipogaine and have recently been using Nizoral, and of course hoping eventually for surgical restoration. Family hairloss that I know of; my father is probably a "NW5.5" (fairly high sides and diffuse hair on top, but pretty big crown loss) and he also appears to have some retrograde alopecia in the back/sides (hard to say as he buzzes but seems that way). Maternal grandfather was a full blown NW6/7 and in his old age had a very thin donor (but this was deep into his 70s/80s, it was possibly just that he had white hair and it was quite wispy at that point). Paternal grandfather is sort of a NW3V - has generally thinned a little on top and some mild crown/temple loss but still has a relatively full head of hair in the midscalp and hairline (apart from the recession). My hairloss pattern SEEMS to be following more my father/his father than my maternal grandfather, as he had fairly extensive, deep temple loss by 26/27 (I had barely started thinning then) and to my knowledge it went pretty quickly from there, but of course this doesn't guarantee anything for definite. That's my background! My question, though, is actually about DUPA. I've noticed on some incidental photos of me recently that my sides looked a little thin and I was pretty shocked when I took my own photos recently. There does appear to be a general thinning across the sides of my hair (not just retrograde either). The back of my head looks stronger to my eyes. I've posted photos to get your opinions and thoughts (these photos were taken in a fairly bright room with a window for lighting, but there is no strong sunlight or other powerful direct light source): Side (both sides are similar): Hair Restoration Social Network ? Community for and by Hair Loss Patients Back (note general crown loss - I also have a thin patch beneath the crown but to my knowledge my hair has always been this way, as I remember thinking it in my teens, and is partially due to combing - or lack of!): Hair Restoration Social Network ? Community for and by Hair Loss Patients Anyway to my eyes there would appear to be definite, non MPB thinning across the sides. I've become worried I'm a victim of DUPA but the back seems fairly strong, to my knowledge there isn't any history of it in my family (paternal grandfather possibly, but I think his donor region hair just went white and thinned with old age and therefore looked thin and wispy). Also, and I'm not sure how true this is, but I'm led to believe somewhat that DUPA is usually aggressive and shows fairly young? I can't recall noticing this problem except perhaps within the last year or two. I wonder if this is perhaps a problem other than DUPA, possibly thyroid or autoimmune? Again, I know I'll have to get that diagnosed properly (and will do so when I can and keep you updated), but just interested in hearing thoughts or other experiences. I notice my scalp has been feeling a bit itchy all over the last few weeks, possibly months, but hard to tell whether this is not just because I'm more aware of my hair and more sensitive to it? It's also been a bit inflamed recently but that might just be sunburn (I don't have the coverage I used to!). I would also say the last couple of years my eyebrows seem a bit paler and wispier - I still have them but I'm sure they were darker and fuller at one point. I don't take any long term medication or have any known medical issues and to my knowledge am fairly fit and healthy (diet and exercise not the best, but not overweight, in fact have deliberately lost 4 stone over the last 14 months). I would say I have mild to moderate stress with a combination of things, but nothing major - probably what most people experience between jobs and personal life (and hair loss!). I had blood work done about a year ago and it was fine - but I didn't have my thyroid checked, it was just a full blood count plus testosterone (which was low-normal). Anyway, just documenting my journey starting with this first road bump! I will get a proper diagnosis and see a hair specialist soon, just to rule other stuff out, but in the meantime I wanted to get some thoughts. DUPA is quite rare and I don't know of any obvious cases in our family, so a part of me wonders if other diseases or problems would be more likely. I obviously hope so, as if it is DUPA that doesn't really bode well!

This is a solid result. I wouldn't mind betting this man has at least 250cm2 of real estate to cover, maybe closer to 300cm2. No hair transplant in the world is going to cover all that with density. I think another few thousand to the crown will complete the transition and help smooth everything over. This man is virtually a NW7 with significant temporal recession too, so to go from that to full coverage is impressive. This is about as good as it gets for 3,800 grafts, and he looks pleased!

Kiran, I've used Nanogen for a few years (I haven't had a HT yet though). These products can be really good at producing a denser look to your hair. They work best when you have at least some density (so either you haven't lost a lot of hair or you've had a procedure or two). When I first started using Nanogen I had pretty good hair apart from some crown loss and general thinning and the Nanogen looked really natural and worked great. Now, I don't really have a lot of hair, and although the Nanogen is still providing coverage and making my hair look fuller, I have to work harder to make it look natural and the crown and hairline are becoming increasingly difficult to get right. That having been said, I really don't have much density up top now, I reckon it would average out less than 25g/cm2 compared to a transplant, probably less than 15g/cm2 in a few places. A transplant, even on a fairly bald head, will usually be able to give at least 30g/cm2 on average. As johnny2000 said, you should buy some and try it. You can buy the "locking spray" which helps the fibres stick to your hair and stay there, or you can just use normal hairspray (I don't know which works better but they're similar really). The fibres will stay in your head in general wind and a bit of light rain, but heavy rain will cause the fibres to clump up a bit or wash out. Again, when I had decent density this wasn't a big problem, but now it's more of an issue. Really and truly the product works best in the crown and mid-scalp to thicken up the look of your hair, it's not so great at the hairline, particularly if your hairline is sparse.

It's probably going to have some benefit, just not as much as taking it 5 or 7 days a week. If I remember rightly Propecia worked about the same at 0.2mg per day as it did about 1mg per day, so perhaps something more like 1978matt's routine might work better (a quarter of a pill 2-3 times a week) than a whole pill once a week. I don't think anybody really knows with absolute accuracy, to be honest. The 1mg/once daily regime was settled upon after scientific study as the most effective and easiest regime (taking one pill once a day is fairly straightforward). But some take it every other day, some once a week, three days on three days off etc. Bottom line is finding a dose you can tolerate without sides. The only issue is, the less you take Propecia the less likely it is to have an overall long-term effect. But even a little effect may mean your hairloss slows down and it might buy you some more time with your hair and make planning any procedures a bit easier.

Best of luck hkuser, we'll all be interested to see how your journey goes and wish you the best achieving your goals! A good HT result without finasteride is possible, I just think it takes a somewhat more conservative approach and a commitment to dealing with future loss and planning long-term. That's true of any HT anyway though.

Johnny, sorry the HT hasn't been quite what you'd hoped, but to be honest I started reading this thread on the last page and it took me a while to realise you'd only had work done on the hairline - because it looks very natural. Upon closer inspection I can see what you mean about some gaps in the hairline, but your hair looks good and you still have a few months for the hair to mature and soften and blend in. As others have said and I see you've accepted, you were never going to get your natural density back, which means the hair will always be slightly different where it's transplanted. That's the clearest to see in a short, shaved cut, where there is no shingling effect to create the illusion of density. You have great hair; perhaps not quite the result you were dreaming of, but this is not hair that should be causing anxiety or depression, or threatening your relationships. I know others have said similar things, but you need to be careful you don't let minor hairloss and disappointing procedure eat away at you (and I only say disappointing from your perspective - it looks great to me and it will to lots of others!). One of the issues with cosmetic procedures is that people who suffer from deeper anxieties and insecurities will often project these on to their physical selves and want to "fix" the cosmetic imperfections they have. That might mean hair transplants, teeth whitening, wrinkle removal, getting a six pack etc. There's nothing wrong with wanting to improve physically, but you need to make sure you are not consumed by that desire. Your hair is great and although I can understand your disappointment that the procedure hasn't quite worked out as you wanted, you need to make sure you don't focus on the minor imperfections at the expenses of what is a great head of hair. Otherwise you will descend into a vicious spiral. Perhaps another pass would meet your goals and it's certainly worth considering, but I'd also look into mindfulness and getting mentally stronger and more accepting too. Do not let your life become about fixing every little problem, or you will miss a lot of good things.

Hi Kiran, Welcome to the forums! Dr. Bhatti is a great surgeon so if you end up choosing him I'm sure you'll get a great result. A case of 5000+ grafts in one session is certainly possible, but bear in mind that the more grafts in a single procedure, the more trauma to the scalp and the more healing too. Ultimately, this is something to decide upon with your chosen surgeon. If Dr. Bhatti feels comfortable that 4,500 - 5,000 grafts are achievable in one session and you feel confident in him and happy with that plan, it is certainly possible. Regarding a second surgery, there are a few things to bear in mind. The first thing is that all hair transplantation is about demand and supply. You only have a limited number of follicles in your donor region that can be moved to the top of your head - usually this is about 6 - 7,000. Therefore, you have to plan how you use these follicles wisely. Most people can get about 6,000 grafts over two or more surgeries, and you can use body or beard hair to gain even more grafts, but you do not have an unlimited supply to put on top of your head - this is a particular consideration if you have a large amount of balding head and/or your balding is not stable. Usually a second procedure wouldn't be undertaken until at least 9-12 months after the first one. This is to both give your head a chance to heal and also to let the transplanted hair grow and mature, so that the surgeon can see the results of the first transplant and make better decisions about how to approach the second transplant. I believe it is in theory possible to have a second procedure sooner, particularly if that procedure concentrates on a different area of the scalp (say for example, the first procedure focusing on the frontal third, the second the crown) but all this must be decided upon with your surgeon and caution is needed. The main thing is to have realistic goals and a quality surgeon to help you achieve them. Dr. Bhatti is a recommended physician and a quality hair transplant surgeon, so you will be in good hands with him! However having a very densely packed scalp is often difficult, particularly if you have a lot of balding. That is not to say you cannot get great results, but because there is not unlimited donor hair, we must make choices and have a realistic plan and set of goals. I'm sure Dr. Bhatti has had a good look at your pictures and advised you accordingly. A transplant of 4,500 - 5,000 grafts should be able to get you a good result, with some grafts for a second procedure at some stage too. Best of luck!

You should definitely be happy - you look great! Hopefully it is just a case that the hairs are still brittle and perhaps it also has something to do with your hair care products too, though normal hair would probably be strong enough to withstand the average use of product and brushing. Like you say, I think you have to wait at least another 3-4 months before you can really judge how successful a procedure it has been - but so far it looks great!