DrTBarghouthi

Thanks for the update. Great improvement my friend! 👍🏼👍🏼🙏🏻

Thank you for the mention. Please feel free to share some photos here or privately so we can have a better idea about your specific case. Thank you.

I personally deal with a company called Cesare Ragazzi based in Italy. They have a very high end hair system manufacturing facility and all their systems are custom made according to your area of loss.

It can be hard to ascertain what went on . It can be nerve injury related, or neuropathic pain. It can be related to the medication being injected in the first place too. You also said you had an injury in that spot too right? Could that be causing this pain after having the injury? Some injuries will cause such types of sharp pains a while after sustaining them. Please clarify a bit more the nature of the injury, treatment etc so we can hopefully come up with a good explanation.

Perfectly normal to shed and to have dandruff like material. I personally switch patients to ketoconazole shampoos 4 weeks after surgery twice a week. Just consult with your clinic to check if they are ok with that.

Yes that is very possible that suppression remains longer as half life of 5 weeks doesn’t mean that it completely goes out of the system. It can take much longer for any effects to go completely. However, I believe that from a safety point of view on transmission to embryos, the effects of Dutasteride on you have no relationship to the transmission to the baby. The changes in DHt levels or even semen analysis parameters doesn’t mean that the sperm itslef is gonna infiltrate the embryo with Dutasteride.

Please remember that with ANY pregnancy, there is always a 3-5% background risk of any genetic abnormalities- may god forbid. That’s why I tend to ask patients to stop as I really would not want anyone to partly blame themselves for anything (even though that risk exists without being on any meds in the first place).

There is no evidence suggesting the transfer of finasteride through the low concentrations in semen to be causing any effects. It is important for your partner not to handle the medication during the first trimester. The half life of dutasteride is few weeks so if you want to completely avoid any potential risk, I would stop 5-6 weeks before attempting and also during the first trimester. It is mostly unnecessary but if you want to deal with zero risk that’s probably what gives you peace of mind.

Thanks for the mention @J.A.C @general-etwan can you kindly share some beard photos too. I do think that beard will need to be utilised and probably from the beginning. It all depends on how much coverage you’re looking at though. But 6-7000 is what this requires ideally.

Many thanks for tagging. I do agree you have a good donor with some diffuse pattern of hair loss. In my opinion, you would definitely need to consider a good maintenance protocol in terms of medications and if an HT is considered, it has to be for the frontal and midscalp areas for now. I wouldn’t recommend adding into the crown at this stage.

Thanks. https://www.instagram.com/tv/CcnDqq4oKDS/?igshid=YmMyMTA2M2Y=

The main thing is to see if that area has more thinning hairs than the donor area above it for example. You could assess a difference in thickness between both areas and this will give you an indication that a process of thinning is going on. You can spot differences in hair thickness even if it is cut short on a microscopic camera.

Yes judging by findings on a scalp analysis, you can see obvious thinning similar to DHT affected areas in other parts of the scalp. Also looking at people who leave it on, you can see ongoing progression to complete loss of hair in those areas over the years. So yes it does certainly seem to be DHT mediated.

Will do. Should i copy a link? @Melvin- Moderator

Yes. Worth looking it up. Might well be the case. Not common but does exist.

I believe that thinning in the temporal triangles is not a feature of retrograde alopecia. Th temple points can regress as part of mphl or in some cases can be deficient congenitally or what is referred to as triangular alopecia.

Dear community, I am quite sure many forum users here have come across the term retrograde alopecia from various posts and discussions. This is a form of hereditary hair loss that affects areas in the donor above the ears and around the nape of the neck. While it is generally quite common to see, it is important to note that diagnosing on photos can be quite tricky because of the tendency to style the hair shorter around that area after a haircut for example. Many patients would have had a recent hair cut where the area around the nape has a faded cut or shave and that can lead to some confusion as to whether it is retrograde or not. It is therefore important to note that an in person microscopic evaluation is the gold standard so as to detect actual miniaturisation and thinning of the hairs there compared to actual donor hair.

Thanks @Mike24 That’s good to know. I think considering finasteride at least 3 times a week can also help you given your age. Certainly reasonable expectations will more likely help you achieve a satisfying outcome. Probably 3500 grafts is what is needed in your case I would say.

I guess it is important to know if you are on and medical treatment for hair or if you are at least willing to be on one? Makes it important to know what the best way forward is.

Thank for the mention @jacand glad to help anytime!

Great research and write up. Can you be kind enough to post more photos of your donor and the areas you are concerned about?

Thank you for your reply. I do prefer to over estimate what is needed in the crown. The reason being is that it usually takes more to fill than other areas due to the continuous change of direction that needs to be done when transplanting it. I also saw that there is some extension into the midscalp anteriorly and hence do not want to underestimate what might need to be done. It does seem that you might have some extension into the Midscalp resulting in a NW 5 pattern at some point. This ofcourse is only an educated guess. The reason i suggested a hair system is that I did sense that you wanted the coverage sooner than later. I totally understand that need. I also feel it helps you achieve this good dense look so that if you decide in your 40 s to go for a more conservative crown coverage, you will have the donor area for it and you might not look for a full density by then as you highlighted. Nonetheless, from experience, I know that even with a family and all, you would still care a lot about your hair. This is why donor preservation is important. If your crown is covered with a system and you develop MS thinning or frontal thinning in your 40s, you can simply do a very good coverage at that point. Always a good option to have. Yes some men tend to accelerate their loss once meds stop. I find that mostly with minoxidil more so than finasteride. Mainly due to the mechanism of actions of both. I can send you a name of some hair system companies. I am not sure I am allowed to disclose names publicly or only through DM. Maybe @Melvin- Moderatorcan let me know if allowed and I am happy to do so.

Thank you very much for your detailed thread. It really helps us in understanding more about the case. It seems to me that the crown area is something that is really bothering you and that the use of concealers is something that you’d wish to move away from. Nonetheless, you realize that donor maximization is important. I agree that the crown ranks lower in terms of priority- in fact you didn’t even realize the loss there in the first place. It’s a good thing you are on meds for now, but the fact that you may consider stopping them in the future is not reassuring- especially if a good amount of grafts will be used in the crown- which i estimate to be of at least 3000 going into the mid scalp area too. You also raised an important point about the importance of having it covered in these couple of years. I totally understand that but It’s important to know that you would still care about having decent hair well into your 40s and beyond. We see that all the time. If you really want my genuine opinion, I strongly believe that a good hair system might tick most of your goals. You would have fast results, great coverage, save your donor and would guarantee coverage even if meds were to stop in the future. At least your donor (which is fairly good imo) will be utilized to any future loss in that case and should be enough to restore any future thinning in the hairline, frontal or mid sections. Some of these systems are so well made that they are technically undetectable. They are well fixed to allow for a very active lifestyle, and would only require a once a month quick maintenance. They are great for crown cases and for cases similar to you in terms of expectations. I do apologize if this may be slightly different to what you’re looking for in terms of opinion, but I am honestly trying to guide you towards fulfilling your desired expectations yet addressing your concerns and fears about undergoing crown surgery at this stage- both of which are completely reasonable and justified.

I will have a look at your other thread and reply there instead.

I do believe that in your case (area, hair type etc) you would be looking at around 3500-4000 grafts and beard hair will most likely be needed. You may well go for a smaller number but the coverage area will have to be slightly smaller. I would highly recommend staying away from the crown considering your age and the fact you had previous surgery already. Best of luck in your research.