Mycroft

The windy outside footage is a nice touch. We almost never see this from patients, but given how many hair loss sufferers talk about being uncomfortable with their thinning hair blowing around in the wind it's nice to see how a good result can change this.

Before you start thinking in hypothetical numbers you should get a doctor to do an in person evaluation of your donor. Without knowing that you don't even really know what your options are to start with.

Having said that, I'm going to reiterate that you should stay on Dutasteride at least 12 months before even considering another procedure.

3 hours ago, Melvin-Moderator said:

Personally,

I think its best to treat with medicine, the crown will expand no doubt. You don’t want to be chasing crown loss with hair transplants.

Since he's already had one transplant for the frontal/mid scalp I don't think it would be unreasonable for him to consider some light crown coverage as he's already addressed the front half of his head to some degree.

However, since he just started Dutasteride two months ago I agree that he should give it 12 months minimum to see if it gives him any additional improvements. He's already had 4700 grafts FUE moved and he doesn't mention what his remaining donor availability was estimated at.

@deluxe_247 did Dr. Cinik give you a ballpark idea of how much is left in your donor? If we are being honest the crown area looks pretty large and dense packing such a big area, especially after you've already had so many grafts moved, is likely not on the table. But maybe you have an exceptional donor area.

We don't see as much discussion about this clinic on these forums, but I like the results I've seen as well as the vibe of the doctors. I do understand that they are more selective about larger FUE cases so I'm very interested to see how yours turns out.

Normally I'd say 5,000 grafts for such a small area of the scalp is irresponsible, but if you've really got 9,000+ you should have plenty of grafts to cover the rest of the scalp if you start seeing loss elsewhere.

Looks like you had minimal shock loss despite the diffuse thinning throughout your scalp. You sound like you have realistic expectations and odds are you'll be happy with your result.

I was a little unclear from the original post, but are you back on Finasteride again?

I may be misremembering, but my recollection from the description of Doctor Wong's method was that he was still doing premade slits but utilizing pens for the implantation of the grafts in order to minimize graft handling. This doesn't sound like it's full blown DHI so much as simply implementing part of it.

Don't quote me on this though, because it's been a while since I've seen the video.

I would agree that any changes so far must be pretty minor, at least based on these photos. It's still pretty early though, so it's possible you may yet see some improvement. Keep us posted.

Great result. The shape and volume of the frontal third have improved immensely. Which areas did the patient have addressed in round two?

Any idea how much the hairline was lowered here? I'd guess around half an inch but it's not always easy to tell with the smaller cases like this.

Very nice result from Dr. Wong.

On 9/16/2020 at 6:55 PM, Melvin-Moderator said:

Personally, I don't subscribe to the idea that the donor thins. If that were true, hair transplants would be useless. I have noticed surgeons who say this usually perform FUE, and they usually do it on younger guys who still don't have a solid pattern. I have seen some of these doctors extract grafts high up near the crown, for some it may be okay, but for others those grafts could thin over time. There really isn't a one-size-fits-all with hair loss or hair transplantation. Now, i'm not saying theres something wrong with doing that, as long as the patient is aware those grafts may be vulnerable over time if they don't take fin. 

Personally, I have been to half a dozen surgeons, which have examined my donor with high-magnification. I do not have any miniaturization in my donor. My pattern hasn't changed at all in over 7 years. I am a Norwood 6 with a strong demarcation line of my pattern. 

I would say that I agree for the most part, but in a small group of patients I HAVE seen donor that is miniaturized and/or thinned out (DUPA folks are a good example of this). Anecdotally, the times I have seen this in DPA (not DUPA) patients were true NW7 cases with early onset progression and the last bit of donor thinned out over time. As far as I can tell from what you're describing that wouldn't be applicable to you, or most patients for that matter. A true NW7 seems pretty rare.

Having said that, our hair does tend to thin a bit (not miniaturize) as we age and that can be a factor in a transplant result down the line as well. 

On 9/12/2020 at 3:18 PM, HisHairness said:

Thanks all. @Melvin-Moderator I will provide a fulsome update this week with pics as I have just crossed the 8-month mark. Some continuous improvement on the crown, and I'd say very minor improvement upfront (e.g. I have some growth on the hairline itself, but not much behind).

 

This seems to fit with your previous trend as well. This is a weird inversion of what we generally see with patients worried that the crown is lagging, but I admit I question the advice to discontinue minoxidil and do think that might be contributing here. Looking at your photos I do see the slight improvement you mention, and while the density seems subpar the strength of the hairs seems greater than before, which almost implies to me that the loss of the Minoxidil enhanced hairs offset the cosmetic impact of the newly transplanted hair. The reason this doesn't seem to be as much of an issue in the crown is that it was pretty sparse regardless of medication.

Do you recall seeing appreciable improvement in that frontal and midscalp area after starting Minoxidil originally? Just curious as I try to wrap my head around this.

On the bright side, even with your concerns I do think the current state of your hair still looks decent, so even if the growth ends up being poor you're certainly not going to look bizarre or worse off than before. I realize that may not be much comfort right now, but I think this is something that could sti be corrected to get you to where you want to be, whether it's at the same clinic or not.

7 hours ago, Montreal said:

thats a large number of grafts for is hairline

This guy had most of his frontal third reconstructed, minus that small bunch of persistent forelock. The graft count isn't out of line for the density this patient ended up with, especially since the hairline itself isn't crazy low.

2 hours ago, SethGecko said:

Frontal. I agree that results will vary from patient to patient.  My problem is with so called "doctors" like mcgrath that promote methods that have not been 100% tested and verified yet as a new cure for a hair loss that definitely works. He charges 5000$ for 5 cc's and the whole procedure takes only about 20 min. Not a bad business model, huh?

Totally get where you're coming from. I agree that regardless of the efficacies of a given treatment the industry has a tendency to overhype them, and I feel an ethical doctor is always going to make sure the patient understands the possibility that any surgical or non surgical option they may be looking at has the possibility of failure.

Thanks for sharing your experience with full candor.

7 hours ago, SethGecko said:

I had 5 cc injected by mcgrath 8 months ago in January and had 0 results from it. The whole experience with that doctor was kinda odd. The very first appointment with him felt more like a sales pitch, than the actual consultation with a doctor. He claims that he treated over 100 patients with exosomes, but doesn't show nearly as many before and after pictures. Oh well I gave it try and it didn't work.

Out of curiosity, what type of loss do you have? Diffuse thinning? Distinct pattern? How severe?

I imagine exosomes, like PRP, will have varying results depending on the patient's physiology. Some people respond very well and some people don't. It's unfortunate that there's no way to tell at the outset.

Thanks for sharing so many different "states" of the hair. I feel like patient posts have been a bit better about doing this lately and it helps people considering surgery have realistic expectations.

As a bit of a perfectionist myself I see where you might have concerns but I think you're in a much better headspace than your last update and that you will likely see some of that alleviated with hair maturation as you said.

Looking at your photos I actually suspect that the lack of maturity in some of the hairs is probably causing them to be a little less cooperative when you're styling, which probably feeds into your frustrations with certain spots looking weaker at times.

Having said all of this, I still think this is shaping up to be a great result, and even if you do end up wanting a second pass you'll be able to look good in the meantime. I promise nobody is doing a double-take looking at that hairline and that's exactly where you want to be.

The scar looks pretty good in this image. I think adding the extra FUE grafts for camouflage will probably look great. Looking forward to seeing it.

Wow, that is some quick growth. That's not just a significant number of sprouts but some decent length for noticeable cosmetic value. What a great start for this patient.

Thanks for sharing the post-op photos. How many grafts ended up being used for this FUE?

3 hours ago, ihategonigbald said:

So what is the view on topical Finasteride? Even topical Dutasteride? If you an get simiiar from topical I'd much rather go down that road.

 

 

I've seen some good topical Finasteride results. I've actually seen a couple of doctors argue that it may be MORE effective than the pill form assuming application that yields an equivalent dose.

I can certainly see spots where extraction looks to have occurred but I think it's important to note that I have seen a good chunk of transplant photos at this point and you are explicitly telling me you've had a transplant and to look for the marks. I think in general it appears more like your donor area just isn't all that dense naturally, which is probably the ideal outcome for FUE scars at this length.

Your hair caliber may not be very favorable but if your estimated donor and the design work here should more than make up for it. Honestly, even in harsher light with no concealer it is still looking solid at this stage. If the second surgery goes anywhere near as well you will be in great shape.

I appreciate that your videos show not only different lighting and "wetness" scenarios but that you do so with a high enough resolution to capture the details one might expect to see in real life. The regular updates are a very nice resource.

Very judicious graft placement on this one while maintaining a nice hairline design. Has he been on Finasteride for a while or was that a relatively recent addition?

5 hours ago, Melvin-Moderator said:

There’s been a potential cure for the past 20 years. Tsuji, allergan, none of these are even close IMO. 

Tsuji is probably the closest right now and from the sounds of it human clinical trials may be starting as early as this year.

Now, when I say "closest" what I mean is the closest to completing all of the hoops one has to jump through. Until human clinical trials are complete we don't really know if the efficacy of the treatment is all it's intended/hyped up to be. Moreover, even if it's able to regenerate 100% of your hair the initial projected cost is out of the price range for the vast majority of people at 200k plus.

Yeah, stop with the inconsistent drug dosing. "Sometimes I take one a day and sometimes two" is a big fluctuation in dosing that is likely causing extra unnecessary hormonal fluctuation. Pick a dose and stick to it.

Additionally, there are online services that will prescribe Dutasteride for hair loss. They're not as common as sites offering Finasteride but they do exist if you want to remove that X factor of not knowing if your stuff is legit.