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. 

19 hours ago, Fox243 said:

Tagging @BeHappy@Gatsbyand some others who are unhappy with their scars. Maybe you or you can tag others who would be happy to allow the Dr to try on your FUT scars if he determines that it’s safe? Since it’s been FDA approved, I don’t imagine any problem though. 

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. 

9 minutes ago, Fox243 said:

Tagging @BeHappy@Gatsbyand some others who are unhappy with their scars. Maybe you or you can tag others who would be happy to allow the Dr to try on your FUT scars if he determines that it’s safe? Since it’s been FDA approved, I don’t imagine any problem though. 

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. 

1 hour ago, HairRun said:

I think it's worth looking into just for the scar reduction possibilities alone. I feel a lot of people would be willing to drop a few extra Ks for the drug as long as the risk is low enough. 

3 hours ago, Fox243 said:

@DrTBarghouthiHi dr., just following up again. This would really be great for people who’s hair transplants don’t end up working out, and the clinic could simply advise them to shave. Would also help people who don’t want to take finasteride, as they could shave if too much loss of native hair occurs.

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. 

6 hours ago, TLewis said:

@DrTBarghouthi Hello, yes I've always had very fine hair and started thinning very quickly due to hair styling when I was in my teens, some of the hair grew back but overall it remained damaged.  The area on top of my head is the more recent area of thinning in the last couple of years due to a different hairstyle with a centre parting twist and this widened my parting without realising until I noticed thinning.  I basically can't do anything with my hair apart from wear it down.  I haven't tried any form of treatment as such apart from vitamins and some hair oils.  

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. 

1 hour ago, nycshearling said:

Yes, I was washing generally continuously//daily. I do think it’s a little odd timeline wise. Time will tell how this heals. 

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. 

4 hours ago, Melvin- Moderator said:

It’s strange your infection started at day 14 given that most grafts have anchored and healed by then. Did you wash the recipient at all during the 14 days? Maybe the dried blood got infected? That’s why it’s important to keep the recipient sites clean. After day 9 you should be using conditioner to soak and gently scrub away scabs. 

@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 🙏🏻 

2 hours ago, nycshearling said:

Thank you so much @DrTBarghouthi for taking the time to help. Could I run these questions by you? 

1. When infection occurs, is it always a guarantee that the grafts are lost in that area? My infection occurred post the 14 day mark, interestingly, so I am curious whether this absolutely means that no grafts will grow, given that they technically had been "secured" by then. I do see some hairs sprouting the area, so I haven't lose hope completely, but I am realistic that it won't grow from there as much as the other areas. 

2. At what point (month-wise) would you recommend following up to transplant more hairs in that area? My doctor mentioned, in passing, doing 6 months post-the initial HT if nothing seems to grow from there, but I am worried that this would be too soon and that we would not have a full idea of any hairs growing from the affected area. Any thoughts? 

Thanks for taking the time to comment.

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. 

1 hour ago, JC71 said:

Hi 👋 

I would say Dr Nadimi, Dr Bisanga spring to mind. I’m sure some other names will come back to me as doing good work with females. Oh yes @DrTBarghouthi(Vertex) is another ! 

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?

On 12/31/2021 at 11:13 AM, digi23 said:

As you said, you need to have patience and just wait it out.

I am using 99% aloe vera gel in my recipient area, not sure it does anything but I bought a large bottle so might just make use of it. I like the soothing effect from aloe vera, I think it also helps with itching.

Maybe @DrTBarghouthi can give you any insight what he thinks aswell.

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! 

7 hours ago, rr1992 said:

Hi @DrTBarghouthi

There are photos in my original posting. I am currently taking finasteride and have bee for the last 6 months. I plan on starting minoxidil as well but figure may as well wait until after my procedure (assuming it happens sooner rather than later that is)

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.