DrTBarghouthi

If they are scattered these can be removed and re implanted. Also adding density might disguise some of these and make it all hidden. 

Those irregularities are most likely grafts placed flushed with the skin so that when skin heals, it contracts and gets pushed in further. That’s only one assumption. Skin type and even incision technique can cause it. 
I think a proper repair is what’s needed. Removing unsightly ones and adding density. Part of what you see is due to it being “see-through” and that’s what makes any skin irregularities obvious. 

Yes it will be this month once we confirm the patients. 

Thanks @Melvin- Moderator

@Dickie Do you have immediate post surgery photos you can share? It may well be a skin type of thing or a graft placement technique. I’d like to see. 

Given your age and diffuse loss I would definitely consider oral finasteride and possibly Low level light home therapy. 

1 hour ago, BaldBobby said:

@DrTBarghouthi is it safe to use Ketoconazole shampoo shortly after a hair transplant?  

A month after I tend to start it. 

Yes I believe we are making good progress with the various aspects of the research and have overcome many of the "variables" involved. 

Please share some photos as it will make it easier to evaluate. Thanks. 

I believe this is mainly a travel agency licensing of some sort. I'M not entirely sure but I heard it is a some sort of tourism and travel agency licensing. 

I came across this and believe that a more conservative approach is needed. I would focus on your frontal and midscalp as they seem to be diffusely thinning. As for the crown, I think the area around your parietal humps is what stands out and would give you good coverage once filled- especially on profile views. I would leave the mid lower crown for now as this saves some grafts. Your full crown would need a good number especially if you consider how it goes towards your midscalp. I think 4000 grafts for these areas will do well. I have taken the liberty of drawing on your photo- apologies for that. As you can see. I suggest leaving the lower mid crown as a smaller circle for now. Other areas including the sides, midscalp and front are ok to address. 

2 hours ago, JimKan1 said:

I also came across this case from Dr Barghouthi

 

 

Yes I agree it depends really on the case and how much can be extracted to repair. The case @JimKan1referred to turned out very well actually. Here are some photos after the repair for anyone interested.

9 minutes ago, redacted said:

Thank you DrBarghouthi,

Yes the thinning is very evident. I am currently using Toppik as a concealer. 

I am very concerned about the side effects of DUT/FIN, but I am willing to opt for topical DUT for the time being. Do you have any experience on that drug?

What surprised me greatly is that my thinning is very aggressive even for the transplanted parts of the hair. Should I check-up with my doctor for my scalp?

A scalp examination would be good. In some cases even a small biopsy of where the transplant is can give some answers. We don’t have topical dut here but we use a lot of topical finasteride and with good results. I would definitely try either. 

Dear forum members,

This is the case of a 34 year old with a NW 4  MPHL. We commenced with adding density to the frontal zone. The crown area was experiencing some early thinning and was advised to commence on topical compounded finasteride to maintain it as he was not keen on taking  oral finasteride.   He underwent a total of 2040 FUE grafts 7 months ago (October 2021). Photos are showing the 7 month results. 

Surgical details: 

Total grafts 2040, 400 of which are single hairs for the hairline. 

Avg hairs/graft: 2.47

Comparison photos : 

I would honestly urge you to delay any further surgery. I think you should give medications a chance- whether oral or topical fin/dut.

You can elect to trial concealers or SMP and see how things go in this coming year before going ahead. I do think you continued to thin and 7000 grafts for severe loss in a NW 5 or more doesn’t always give the illusion of full coverage. Try to experiment with what might work for you in simple terms and leave surgery as a last option to top up.

Thank you for the mention. I personally think that we as medical providers have a limited role in the overall maintenance regimen of the patient. We can certainly advise using long term maintenance of any sort- minoxidil, finasteride, topical/ oral or any other form or combinations that could help with maintenance and delaying the progression. However, in reality, we can’t control the level of compliance or commitment. If someone is compliant before and shortly after a HT, then that doesn’t mean they will be forever. The main thing is to judge on a case by case basis to the best of our knowledge. Someone with a good track history of maintenance and well in their 30s and 40s with a moderate or limited loss and a great donor will be given a slightly different view from someone in their early 20s with a possible NW7 progression. As long as things are transparent between the provider and the patient and IF the expectations are fairly matched, then there could be a very high chance of offering something. We as doctors know the dynamics of ongoing native hair loss and all these factors play a role on who requires strict vs less strict maintenance. 

I don’t believe that topical is better than oral fin, but better than minoxidil alone. As long as some maintenance is done that’s the main thing. 

Thanks for sharing. You do have a good donor area. Things may progress in your crown but generally if you decide not to prevent your loss , then you will definitely need a top up in the future. Have you considered oral minoxidil or topical finasteride along with possibly low level light therapy? I think some sort of maintenance will definitely help you but in general you can get good results with a HT.  You will likely need 3500-4000 grafts for both areas. This can ofcourse be staged (delaying crown) or using only moderate amounts in the crown so as to keep donor for future use. As long as you have reasonable expectations and are sensible about what to expect and the risks of having low maintenance, then you should be ok. 

Please share som photos if possible.

On 5/5/2022 at 2:42 AM, simz7 said:

Honestly the reason for stopping topical minoxidil was that is was a pain to incorporate into a daily routine. the greasy consistency would leave residue on a lot of things and after that period I gave up on it. Maybe I should look into doing that again though, I was just a worried about the shedding period too though 😥

Do you, or anyone have thoughts on Oral Minoxidil? I’ve noticed a lot of hair regrowth startups using oral minoxidil instead of topical. @DrTBarghouthi

Tbh I have no idea what dutasteride is, I’ve been taking 1mg Finasteride everyday this whole time though, i’ll look into that too. Thanks!

@J.A.CYes that’s right, 6-7 sessions of PRP. I have up because it seemed to not being doing anything, maybe even making it worse somehow. 

 

I see very good results with oral minoxidil. We unfortunately don’t have it here but I ask my patients to get it from abroad usually. I also recently had a patient who gets 5mg minoxidil and 1 mg finasteride compounded orally in a capsule from Australia. 

Thank you guys 🙏🏻🙏🏻

It would be good to share some photos if possible to know more about what might be involved. As per @pkiplingscarring differs according tp punch sizes, type of skin etc. Technically it might also be difficult to predict what angle they were transplanted in since it is not naturally placed as in the donor area (which we are all naturally growing in a certain angle etc). 

It depends on your local and also clinic policies. If it is few weeks down the line, then you will most likely be negative by then. However, we see cases of Telogen effluvium post covid. Just be aware you may see some shedding in few months attributed to that, which may cause some delay in your perception of results. It may happen , doesn't have to be the case, just be aware of it. Good luck :))

Dear forum members,

This is the case of a 26 year old with a NW 4 -5 MPHL. Given his age, we agreed on adding density to the frontal zone and to maintain his original hairline or slightly higher. The crown area is to be staged at a future date once his full hairloss pattern is determined. He is currently on compounded finasteride with minoxidil and dermaroller. He underwent a total of 2306 FUE grafts 7 months ago. Photos are showing the 7 month results. 

Surgical details: 

Total grafts 2306

1's 678

2's1086

3's and 4's 542

Avg hairs/graft: 2.01

Photos: 

Before/ planning/ day of surgery

Before & After

Donor Area at 10 days and 7 months: 

Thank you for tagging @J.A.Cand @Future Hair Doc

@Afrocan you please share some photos so we can have a better understanding of your case? thanks

It all depends on the case. In some cases there might be donor limitations so the areas of priority are done first. In some cases there might be a worry that the crown might expand and that can look weird if transplanted and the the borders continue thinning. In other cases there might be extraction limits for each practice.