DrTBarghouthi

Very nice! Things look good so far my friend. 👍🏼👍🏼

You should definitely commence on medications for now and see how it progresses. You are starting to have diffuse loss which I think will improve on meds or at least stop it from further loss.

I do not believe that there will be any effect on the transplant from both the condition or the medication. However, it is advised that you inform your clinic in case they have any precautionary measures.

I would strongly advise you not to inject kenalog without any doctor’s involvement. Kenalog usually comes as a 40 mg/ml injection and should usually be dilutes down to around 5mg/ ml so as to reduce any skin atrophy. It should be injected in around 0.1 ml per cm to also avoid skin changes. It does have good evidence against keloid and hypertrophic scarring. I personally use kenalog in all my tumescent solutions in both donor and recipient areas to reduce swelling and also scarring so I do see the positive effects of it. However, please take under medical supervision.

Yes exactly. If it will be tried first it will be trialled on new scars. However, I read some role in old scars so that might be a possibility too. Again, this will need to be properly looked into before even attempting it as you know.

Yes assuming we can get some insight about the safe dosage in areas such as skin/ scalp. Remember this has been injected previously in tiny amounts in the retina, so I assume a bigger amount is needed in skin or to cover a donor.

Apologies for not getting back earlier. So yes this medication is FDA approved for some types of wet macular degeneration which is an age related retinal disease. This was the drug of choice to that condition years ago but has been abandoned with newer agents like Avastin etc. I spoke to some colleagues and it seems there is or has been recent delay or even shortage in production (possibly due to reduced demand?) I know it is hard to source here where I practice because ophthalmologist are no longer using it. It is around 1800 usd per vial but I’m not sure how much donor will this cover. I will try to source it and maybe get help from some of my ophthalmologist colleagues in preparing it and possibly testing it on some FUT scars as well as FUE scars hopefully. I just need to see what the requirements might be along with doing more reading about it (has been quite a busy period lately to do an extra reading unfortunately). Will keep you posted with how things go hopefully.

Hello. Normal saline from any pharmacy or if not possible, one glass of drinking water with one tablespoon of salt should be fine.

Thanks @Melvin- Moderator I dont think there is much concern here. I would really prefer you use some saline sprays every 1-2 hours and get it cleaned as much as possible as well as the daily wash. It looks like post operative fluids/ granulation tissue. Doesn’t seem infected or necrotic to me. Try this and keep us posted with how it goes.

Congratulations! I’m sure it was well deserved!

Hello, i hope you’re keeping well. That’s the stage that no one likes I know. Hopefully it will all be over soon. Everything else going well I hope.

Thank you for tagging. I can see where the concerns are but honestly it is not noticeable to most people as other experts mentioned here. I think a change of style will address your concerns quite well. The concern is mostly in the hairline region where the flaring took place, which i think is eventually repairable if you reach that stage later. I strongly recommend trying few styles to cover these areas and that might solve the issue for you.

Thank you for the answers. There seems to be an element of Andro genetic hair loss in your case. However, it is extremely important to prevent any further widening of the part and recession of the forehead before attempting surgery in my opinion. With female hair loss, density is very important and this can only be achieved with having very confined areas to transplant. I would seriously consider minoxidil foam 5% once daily for now and for at least 6 months. Keep a track of the progress and then consider a HT to fill areas that did not respond. The effect of minoxidil on thinning hairs can be quite impressive and this leads to smaller areas needing surgery.

Yes there are several reasons why it could get infected. The consequences of this can also vary and only time will tell. Let’s stay optimistic in all cases.

@Melvin- Moderatorcan you please send me the link to the video for the conditioner use. Can’t seem to find it when I search for it. Thanks 🙏🏻

Thank you sir. Yes considering that it was noted 14 days after, then there will be a good chance that growth can still occur. By 14 days, grafts have their own blood supply and so there is a good chance that all or some of them have survived. The infection may simply delay the growth or makes the dormant stage longer than in non infected areas. I would not recommend having another procedure before 12 months have passed at least. I have seen people with growth happening in such areas closer to the one year mark to the extent that even if growth wasn’t “full” the reduced density wouldn’t be too noticeable- and may not require having a procedure at all. I would wait if I were you.

Thanks for the mention @JC71 @TLewis Is this something that you noticed over the last few years or has there been fine hair in the area for a very long time? Have you been on minoxidil? Has there been any eyebrow loss at the same time?

Thanks for the mention and apologies for the delay. It is hard to pin point the real cause. Yes the growth in these areas is less and there has been some level of infection in the area on your post op photos. This “may” have been triggered by an element of reduced blood flow in these areas and an increased demand on the circulation with the new grafts in place. The scalp is rich in blood supply and this is the reason why infections are extremely rare. However, with dense packing, sometimes the blood circulation can be slightly compromised and this makes infections more likely. I do believe that this can be fixed eventually with adding more grafts in the area once all grafts grow out. It seems the clinic are responsive and willing to assist you in that too. You can wait until all potential grows happen and then this can be addressed.

Congratulations @Melvin- Moderator Looks great and happy growing! You were surely in good hands!

Thanks. Yes it seems that 2500- 3000 grafts is what you will need for the frontal zone/temple recessions. It is great you’re on finasteride already.

I’m not sure if you mentioned this before, but are you on any meds for maintenance? Please feel free to send us some good photos of the donor and area of concern to assist you further.

The donor in the last photo shows a better overall capacity. You do have some limitations in the lower central part and the crown seems to be dipping into the donor too. However, the sides seem good. Also it seems the density in the donor and the type of hair is good. You also seem to have a good beard.

It would certainly be great to assess the donor in person by someone local to you. You do seem to have loss in a NW6 pattern but the photos show some concerns in the donor area in terms of density and possible retrograde loss. Can you post some good donor photos please? You may need to be on finasteride to improve that too and protect yourself from ongoing loss.

Thanks for the mention. Yes you do seem like a NW4 to me based on photos. Donor does seem favourable and with a decent surface area. Is the crown something of concern to you? Would a low dose finasteride be something that you would consider?

Hi @louisianatransplant I read your thread with great interest and I do have few concerns. I am personally not familiar with your desired doctor, but I’m not here to discuss a specific doctor, but rather to discuss the decision to go ahead with surgery. I do believe that you should hold off for now. First of all, you are 24 and your pattern looks like it will be advancing further. I would suggest doing maintenance meds as much as you can and give yourself sometime before going ahead. You do wear a hair system and therefore you are practical enough about it. Therefore delaying a procedure for sometime would be ideal. I personally think 2800 is a small number for what you might need- although I am only basing that on photos. My main concern however is the fact that you wear a hair system. Hair systems give densities that can be unmatched by surgery at times. Therefore, replacing that with a transplant would technically mean multiple SUCCESSFUL procedures in most cases. The reason being, is that you will always have a mental image of the density of the hair system and any transplant not at par with that will be easily seen as unsatisfactory by yourself. I would consider all of this before going ahead with surgery.