DrTBarghouthi

Yes some sort of medication is definitely worth it.

It does seem your loss is fairly limited to some frontal/ midscalp and crown areas. I would suggest some sort of maintenance. If finasteride is not within your plan, then maybe consider topical finasteride and oral or topical minoxidil. I believe your donor looks favourable and you can certainly do a limited HT especially in the front and Midscalp region.

Absolutely. There are several excellent surgeons in close proximity to you.

Thanks a lot. So yes probably 2500-3000 single and double hairs is what is needed. Usually this is achieved by extracting less follicles which helps preserve more of the donor. The photos I guess can be a bit deceiving in giving an exact number. Might need a bit less too.

You can commence it now no problem. Many are usually on it pre surgery and don’t necessarily need to stop it during surgery.

Can you kindly share more photos (both sides) so we can provide a better estimate?

Thanks for the mention doc and sorry to hear about your experience @DanielM Please get in touch or share your case here if we can be of any assistance.

Yes would probably need to. It might simply be the needling itself or might require a more pronounced injury site.

Thank you for your response. That is true indeed in that we wouldn’t know the full spectrum of its work on humans. Whether only on scarring, on scars with DHT insensitive follicles or whether it can actually induce regrowth of DHT sensitive hairs. With regards to any proposed protocol, we have to test each of these separately- with the most probable hypothesis taking precedence over the others in terms of order. It definitely would be something to consider testing on recipient areas if there proves to be good evidence of regrowth in scarred donor areas ofcourse. I guess with the way how this proposed testing is going, we have to minimise the risk taken by individuals. So in the first step, a suitable cohort would be people willing to undergo a Hair transplant or at least a limited extraction from the donor. In this way, if it works- great, but if it doesn’t then the risk is low. A separate cohort will be needed for only injecting in the recipient areas as we don’t want to overload anyone with the medication should this thing proceed.

Not stitching the wound would probably cause an increased load on the healing tissue and would heal with secondary intention- meaning the edges will heal without controlled approximation of wound edges as in the case of suturing. This leads to scarring that is not usually pleasant and also to a bigger surface area of scar tissue for the drug to work on. The problem is that if verteporfin doesn’t work, then you end up with a scar that doesn’t look good. I think that minimizing the area of scarring (suturing) or punching in FUE would give higher chances of the drug working because it is less of healing that needs to be done. Furthermore, it seems that any hair regeneration is based on the fact that it restores the tissue in the donor to what it was originally. So you go back to normal scalp and normal donor hairs. However, it doesn’t act on restoring hair that is undergoing progressive thinning as in male pattern hair loss if you know what i mean.

Yes I do understand and it could make good sense. I have to look closely to see if that could theoretically work because punching in an FUT scar doesn’t eliminate the whole scar tissue. It is important to prevent the scarring cascade from the beginning and that’s why a fresh wound is advised. However, this can also be looked at. Remember this is all still up for investigation and there could be numerous ways to go about it.

I agree. It seems that the most ideal time to inject the medication is at the time of excision whether FUE or FUT. So it technically should be injected at the time an FUT is sutures to allow for the stitched skin to heal via a different mechanism than what currently happens. Same applies to older scars- you need a freshly made incision- so the old scar needs to be removed and the new wound stitched and injected with Verteporfin.

Looking great my friend. Happy with how it looks so far. Remember it is still early days regardless. Please feel free to get in touch if you have any queries or concerns.

We are actually making progress with supplying and will be drawing up a protocol for use very soon. Hopefully things will progress in a positive way from here.

Thank you for sharing. It is honestly difficult for me to say exactly given the scabbing and the existence of hair in some of the transplanted areas. I would definitely encourage trying to gently spray and clean up some of the scabs according to any instructions you have. I’m not sure what day is it now since your surgery but I would like it to be cleaner. Best of luck. Only time will tell exactly how much was transplanted. I may have been able to give an estimate but the photos aren’t really clear to comment.

If white hairs are not many in the donor, it is usually possible to be more selective of the non white hairs to the best of our ability. However, if that black hair was to become white in the future, then it will become white in the recipient area later on. The donor area runs from one side of the ears to the other, including the back part of your scalp ofcourse. As for cloning, there seems to be some steady steps. One group in particular are allowed to “ store” follicles in a tissue lab for further research and development. This was a good milestone in that regard. However, it will be still few years mostly before anything materializes- provided everything goes at a good pace. I would add Ketoconazole (Nizoral) shampoo twice a week to be used. It is an anti dandruff shampoo, but it could have some role in reducing DHT levels in the scalp. Caffeine based shampoos can also be used other days as there is some weak evidence that these can also positively affect hair.

Many thanks. Yes it does seem that you will need some frontal/ midscalp and possibly some crown work. If crown is not a priority at this stage, then this can be kept for a delayed second stage. By looking at both sets of photos together, you’d probably be looking at around 4k grafts or thereabouts. This will be mainly for your frontal area and hairline as well as adding to your mid section. I would advise restarting finasteride at this stage too.

Thanks for the mention. Would you mind sharing some more photos Tony. Also what is your current age? You are indeed a NW 5/6 and finasteride is recommended considering you had no real side effects.

Great discussion indeed. Thanks for tagging @Melvin- Moderator The reality is donor hair to this day is limited, so whatever maximizes the potential of the donor area is valid. To maximize donor availability, one can certainly go for multiple strips and the FUE or even a combination in one go. One can also seek “non scalp” donor for such purposes too. The main thing is to always leave patients with future options and the potential to do more if they need it. A good strip will usually yield in the region of 2000 grafts on average. Now the problem is that most young patients prefer nowadays not to get the scar so early in life. However, if they are a high risk of developing NW6+ hair loss, it is important to leave some sort of security in their donor area. In such patients, we can start with FUE but leave a virgin strip of un-extracted area. This strip would not have any scars or punched out areas and “may” become an invaluable saving in the future, should they elect for a future strip in the future. Their desire to avoid strip scars now may well change in the future and they can settle for growing their hair longer to hide the strip scar. I do it on quite a number of people whom might have a limited donor and a potential for advanced loss/ or are currently advanced. I don’t feel FUT is outdated, just sometimes we have to work the other way around to what is conventionally done.

Thank you. The reason i wanted a side photo is to know whether the contrast is due to a stronger light effect. This would happen if a hairline is crossing the vertical plane of your forehead-which is not a right thing to do anyway. In all cases you don’t have that issue and your hairline is well placed imo. The reason for this possible discolouration is a density mismatch. I think with a touch up you should blend the two areas better.

Is it possible to have some side photos? I’d really like to see how far high the hairline was made and to understand the colour difference. Dr. Mwamba is a well respected surgeon ofcourse and I’m sure they went with a suitable plan for you. In my opinion, considering temple points were also done, you would’ve needed around 2000 grafts. Again, there may have been some limitations in donor etc. In all cases, I’d like to see some side photos to see what may be causing the difference in colour.

I agree. Donor is showing some red flags. Start your medical treatment and if possible switch to oral finasteride. Reassess after a while. In the meantime you can certainly shave your head. In my opinion the other valid option would be a limited transplant for the hairline area and a hair system in combination.

It would be nice to get better pics especially of your donor. In all cases good medical therapy is a must to slow down and further progression.

Thanks for sharing. It would be best to see some photos if possible. You can utilize SMP for FUE scars ofcourse. As for the repair, there are several options in terms of removal/ extraction or combining both.

Absolutely. I agree with all that was mentioned above. I personally wouldn’t mind a loose fitting cap or fishing hat few days after surgery. Normal hats by 7-10 days and almost normal activities after that. The only thing I prefer to delay for upto 3 weeks is swimming in chlorinated swimming pools, Sauna etc. Moreover, do not get your scalp sunburnt in the first few months- which you shouldn’t do even without a HT.