Mycroft

Damn. That is one of the best surgical scars I've ever seen. Even such a short time after your procedure and having your hair so short it doesn't look very "angry" at all.

I've been doing foam in the mornings and a foam/liquid combo in the evenings. I actually find the liquid isn't much of an issue for my styling preferences as long as you massage it in like you're supposed to, but you've seen that I generally wear my hair up or back.

On 8/21/2019 at 10:23 PM, Melvin-Moderator said:

🤔 I would say hold off, I think your hair looks pretty good for 30. Can you show us a top down view? Perhaps were not seeing the severity.

"For 30" is always the swift emotional kick in the gut, isn't it?

Still, I mostly agree. To the original poster: I would echo what others have said and start medical treatments ASAP. Give those 12-18 months and reassess based on results.

If you have already tried meds and had bad side effects that might be a different story.

8 hours ago, LaserCap said:

I've heard from multiple sources it takes a good year to see what Propecia will do. I personally did visually confirm retention in a matter of weeks.  Enhancement did take time. Conversely, as you put it, I saw retention with Rogaine a bit sooner.  Never saw enhancement of the hair.  Thus, in my mind, I think - short term - Rogaine.  Long term - Propecia.  But......A combination of both would actually be best.

Ah, yes. I definitely agree with the idea that Minoxidil start to take effect more quickly. Finasteride definitely takes longer, and I've heard as little as twelve months to as much as eighteen to gauge initial results. I've even seen some of the better responders swear they'd continued to see gradual improvement as late as the three year mark. I would definitely agree that hedging your bets seems like the best option since neither medication is difficult to obtain.

Hard to tell in the images but the scalp seems a bit red. Is this accurate? Any scaling of the skin or itching?

The temple area looks very soft at the hairline. I wouldn't have guessed he had any work done at all.

1 hour ago, LaserCap said:

For years I've heard doctors tell women in particular, to get on Rogaine 3 months prior to a procedure to help avoid or to minimize shock loss.  Curiously, there was never any conversation about using it post procedure.  That being said....

Never heard of using finasteride to accomplish the same for guys. 

Now-a-days I do hear doctors tell patients, if they are doing Rogaine, to get off for a week prior to the procedure and resume 10 days later. This has nothing to do with shock loss but with the procedure.  If patients end up bleeding more, it can affect graft placement.  (Grafts will pop).

The main reason why to do the medical regimen should not be "shock loss." It should be to help you retain the native hair long term. And, if you're not willing to do it, get yourself a Laser.  This is external to you.  I would also talk to the doctor about doing PRP at the time of the procedure.  This will not only help bring in the results sooner, but can help reverse the miniaturization of hair that is dissipating and going away.

Really? I see the recommendation for Finasteride for that purpose all the time. The idea is that the medication may help to strengthen the miniaturized hairs that are already very weak and less likely to regrow after trauma. Conversely, I've actually never heard of starting Minoxidil to prevent shock loss but I suppose it makes sense with that same logic. 

11 hours ago, vanilia said:

can you get finasterid online or do i need to get it at my doctor?

There are online services that will offer you a prescription and a consult but in the U.S. you do need a prescription.

Don't stress the side effects without even trying the drug. You won't know if you have any issues with it unless you try. If you have side effects, stop taking it. Simple.

9 hours ago, Russ said:

Thank you for your reply. Does name brand matter or generic okay? Also did you start on 1mg right away? I’m just asking cause I was recommended to start on .5mg and then work my way up to 1. Just wanting to get your thoughts on it. That’s awesome if it can thicken one’s hair, my biggest worry has been that finasteride makes hairloss worse for some reason. I only have a thinning hairline and no bald spots but I guess my fear is that I’ll look worse after taking it than before(if that’s makes sense)

You might experience some initial shed as the drug starts to work, but that is typically part of the process. Thinner, fine hairs will shed and be replaced by thicker hair. Don't make the same mistake so many people do where they start on the drug, lose their cool when they start to shed, then freak out and quit before giving it a chance to work. Those people will just continue losing hair in the long run. I have a friend who had a more severely thinned version of your pattern and I told him to start fin and minox about a year ago. He sent me pictures the other day and has had a very nice improvement from drugs alone, but he stuck with it.

There's a lot of debate on name brand over generic. I personally use generic because the difference in cost is insane, but if you can afford the brand name that may be the slightly better option. Generics have the same active ingredient but slightly different formulations for inactive ingredients, so some people won't respond as well to certain formulations as they do to others. I would say this varies by individual. 

5 minutes ago, Russ said:

So it’s best to take/try finasteride before a procedure? Does it strengthen the native hair and that’ll help with shock loss? Also what would the best time be to take finasteride, upon waking or before bed? 

Yes. It will strengthen native hair and reduce the risk of shock loss. Many surgeons recommend starting on it at least twelve months before any surgery. The Finasteride might also thicken your hair and help fill in those areas on top of your head where the hair is thinning but not gone.

I take mine in the morning. Just do whatever is easier for you.

Well, firstly six months isn't really a great enough timeline to see results on Minoxidil. Second, if you're not on Finasteride or a similar DHT blocker you're making a big mistake. You're increasing the risk of shock loss, almost guaranteeing more future loss, and ignoring an option that might make you reconsider having a transplant at all.

Yes, any side effects should stop when you stop taking the drug.

Good call. I actually think the comparison between the video and the still is a great contrast. I hardly gave the scalp appearance in poor conditions a second thought on video because it was only evident for half a second, unlike the image which was obviously capturing that least flattering instant.

First of all, get on Finasteride now for the reasons everyone has mentioned. Additionally, if you respond well enough to the medication you might decide you don't need a transplant at all. Given your type of loss it is entirely possible that medication alone could yield a more than acceptable level of recovery.

New frame is definitely starting to take shape, particularly in the corners. Not bad at all for four months.

Scar doesn't look too rough on the right. I think your shock loss theory is a good one though because the hair below the scar looks like it doesn't fill in until a bit lower. I think it's entirely possible that it's just lagging behind a bit. Thanks for the close shots.

Glad we were able to get clearer images of the hairline work, because that looks great. Truly no indication that he had a procedure at all, and the result blends in perfectly with the native hair.

Just now, Melvin-Moderator said:

Correct no concealers in that picture. I’m standing in the same place too facing the sun.

Thanks for clarifying. I think seeing some scalp in harsh sunlight is no big deal especially since concealer legitimately will help with that if someone is super insecure. Your hairline is great and you've got enough coverage that everything is very workable with a bit of effort, and if we're not doing this for appearance what ARE we doing it for? Nobody is going to walk up to you and count the number of hairs per cm on your scalp.

That after image doesn't have concealers, correct? 

I have always had hair trending towards medium/fine, so my hair always looked terrible wet even before I started experiencing any hair loss. For me, my concern has always been whether I can make it look good consistently. I knew I had a problem when it took forever to style my hair in a way that would make me comfortable, and when it seemed harder and harder to make that happen I really started to worry.

A slight top down angle might help to say for sure, but I agree with Melvin. Your hairline appears mature but doesn't seem like it has any real thinning in it, at least not that I can see.

Funny how much a clean and "solid" hairline seems to impact appearance. As you noted, the patient has quite a bit of hair everywhere else, but that eroded look right at the front kept drawing my gaze. Very different story in the after images.

Were the previous two FUTs also performed at your clinic, or elsewhere?

Very nice work.

It's possible, but from what you said that could already have started before you got on any treatments at all. Tough to say, although the light definitely isn't flattering. The frontal area right behind your recipient, for example, looks thinner in the second image from the bottom than it does in the last picture. Best recommendation I'd have here is to periodically check in with a hair specialist and have them do regular evaluations and comparisons to track any progression.

16 hours ago, Melvin-Moderator said:

Might be interesting, but it all depends on the price and longevity. If it lasts 10 years its worth a couple grand, if you have to keep getting it done every year it’s not.

Well, that may also depend on the efficacy and the patient's degree of loss. If you were a diffuse thinner with a high Norwood pattern but getting this treatment annually kept you looking like you had a full head of hair, that would be worth considering. Grafts are limited and a transplant might never be able to get you to the same level you'd be at if you regularly shelled out that cash.

16 minutes ago, Melvin-Moderator said:

I believe the thought is the younger the cells the healthier and longer they’ll live. Essentially, they’re rejuvenating hair not necessarily cloning.

Yeah, this sounds like it's not dissimilar to the logic behind PRP, although in this case it seems like they're actually trying to replicate and inject new cells to create the results. I can definitely see potential in the treatment depending on how often it has to be done and what it costs. If younger cells drastically increase treatment longevity the expense of freezing might be worth it.

This makes slightly more sense in terms of the youthfulness of the cells, although I still wonder why healthy donor hair wouldn't be just as viable as a source of the cells.

Perhaps the implication is the younger cells would likely contain a higher concentration and thus be more effective per treatment?

ThusThis might be the largest case I've seen from your clinic, and it looks terrific. Obviously the patient is styling his hair to maximize the effect of his result, but being able to have that kind of coverage and fullness compared to his starting point is impressive.

I'd also like to say the hairline looks very natural despite the strict graft limitations. It doesn't seem pluggy at all in these photos and not so high as to limit the benefits as a facial frame. Great example of what someone with a more aggressive potential hairloss pattern can expect. 

Had the patient been utilizing any medication prior to the first procedure? It isn't as important now since he doesn't have much native hair left, but I was curious whether he'd done anything previously to slow his rate of hair loss.