Mycroft

Improvement in the hairline is already evident even at 4 months. The PRP seems like it is speeding up that new growth a bit and the patient keeping his hair shorter helps the new sprouts blend with the natives.

I feel like ther are some lessons to learn from the original post. Not everyone is going to be this responsive to nonsurgical treatments, but it's probably not a bad idea to find out before you jump straight to surgical considerations if you're still in the earlier stages of loss.

8 hours ago, Shifty said:

Missed last month, will update fully in a cpl weeks. This is right now. Hairs still sprouting in the front, not sure about crown.

I hate treating the crown for exactly this reason. So hard to tell what's going on back there and even with the pen dermastamping is harder than it is in the front because I'm working blind.

Great results so far and very encouraging. I actually started on a more complex regimen (up from just taking  finest ride) around the same time as you did, so this thread helps me stay patient and keep perspective. Looks like you've had nice improvements not only in coverage but density and volume as well. Your hair has some nice bulk to it in this photo.

Looks very nice for only three months. I would say you're off to a great start.

To OP: if you have diffuse thinning it might be worth trying. I've seen some people reporting shock loss but I honestly have no idea how that would be happening unless they had an allergic reaction as above. The procedure itself is very non invasive and any trauma is pretty superficial. I actually noticed a big decrease in shedding almost immediately, and if you are having the work done by a reputable clinic I wouldn't consider shock loss a factor at all. I would find a clinic with PRP results you like and consult with the doc to see if they think it's a good option for you. My results were pretty darn good but there are many variables at work.

I've had it, with some pretty good results. I've got some photos floating around in a couple of threads here if you want a look. I'm seven months out and still seeing improvements although I would say the results were quickest and most dramatic between 3-6 months after. Right now I'm in more of a maturation phase. I also didn't opt to get a boost treatment although I've seen enough to suggest that could help around the six month mark or so. I did have Acell with mine which I am told extends the lifespan of results and means you don't have to go in for follow up treatments as frequently. In my case I was told every twelve months with an optional booster shot at six to help any areas I thought needed a kick in the pants.

Edit: Mine was done by Dr. Arocha and just like with transplants you want to investigate a doctor's results before choosing who to go with because it is not standardized AT ALL.

To look at this guy, I would never guess that he'd had any work done. Great job using his remaining native hair in the front to map out the restored hairline. 

Greater chance of existing effects, since you are increasing the absorption of the drug. You're basically upping the dose of the drug and therefore proportionally increasing possibility of incurring its side effects.

Oh, and it stings a bit when you apply directly afterwards. Shocker.

It's because applying it after the needling increases the absorption, which in turn increases the possibility of it going systemic (and you experiencing systemic side effects). Having said that, I haven't been getting any sides, so I don't worry about it at all and it's probably helping.

Okay, so it definitely looks like you have a naturally high hairline. As I mentioned, this is a thing some people just have naturally. I myself have a relatively high hairline and always have.

A couple of things:

1. I'm going to reiterate that you should start on medication NOW in advance any procedure because it will reduce the chance of shock loss, particularly for those weaker hairs in the front. If you get a transplant and lose those you'll end up having a weird thin spot in that area that you're probably not going to like. As others have mentioned, you  also appear to have some thinning in the crown but medication might be able to reverse that entirely.

2. A couple of people have asked this, but what kind of density are you hoping for/expecting?

3. Where exactly are you wanting to lower your hairline to? Are you able to show us in an image? 3,000 grafts may or may not be enough depending on your expectation (see above). 

4. What kind of estimate have you gotten, if any, about the strength of your donor zone? Have any of these doctors provided an estimated number of available grafts? This is important for you to know if you need more than one procedure, especially if the first one fails. On top of that, you say you won't care in your 30's and 40's, but if you care now and this has been bothering you a while I think you're going to end up being surprised once you hit 30. If your appearance matters to you now, it will probably continue to matter, and you'll be surprised how young you feel at 30. What's more, you've talked about dating a couple of times. What makes you think you won't still be dating in your 30's, or even later? It's entirely possible. 

That entire area in the front that is thinning/miniaturized could potentially be salvaged with medication, and that region alone would take quite a few grafts to fill in. If that area strengthened up you would have a normal, albeit high, hairline with zero grafts used.

As a final point, don't confuse your hairline being naturally high with male pattern baldness. You mentioned being born with a recessed hairline, but to recede it would have had to be further down your forehead. If it's always been high, that's not recession.

You've only included top down photos but from what I can see your hairline is not in a weird place at all. Some people just have high hairlines. I'm not trying to rip on you here, but I think your insecurity about your natural appearance is getting mixed up in your concern about male pattern baldness. Do you have front facing pictures?

2 minutes ago, lebaneseguy said:

I've done my research about it, and I'm young. I care for my sexual ability and other health issues to be stable. I'm trying to eliminate a problem, not suppress it and create others.. 

If you've done your research you also know that only a small percentage of people are experiencing any side effects. The only way to know if you're one of them is to try it. If you experience side effects, you stop taking the drug. You CANNOT undo a surgery. Ruling medication out without even trying because of some stuff you read on the internet is silly.

You have a great deal of hair that could potentially recover and thicken up with medical treatment, but as far as I can tell you haven't tried any of that yet. Most credible physicians are going to ask you about that right off the bat, especially at your age. On top of that, if you're not taking any medication a transplant won't help you in the long run because you might end up losing the hair behind it.

Why are you afraid of Finasteride? Have you already tried it?

The new photo illustrates my suspicion pretty well. Lots of general thinning back there that was concealed either by the patient's hairstyle choice, angle of the original photos, or both. Thanks for sharing.

One thought I did have: since Dr. Arocha seems to work almost exclusively with a no shave approach it might be helpful to snap a post op photo or two where possible. A couple of his patients have been sharing their progress on the forums and the redness in the post ops usually helps give an idea of where grafts were placed. It's a unique challenge with no shave work when a patient has more diffuse thinning rather than an obvious pattern.

Always nice to see these cases of subtle transplantation into existing hair.

I'm using the derminator 2 at 2 mm once a week. In conjunction with my other treatments it seems to be working well for me (PRP, Minoxidil, and Fin). I also hear good things about the Dr. Pen devices.

The reason I am using 2 mm is simply because I'm of the theory that the device itself is actually not going to penetrate quite as deeply as advertised, and I want to make sure I am getting deep enough to give extra stimulation to follicles that have been dormant for a while. 

The pen hurts much less than the stamp or the roller. I use a new set of pins every week and that minimizes the discomfort quite a bit. The blunter your needles the worse it will feel.

Worst case you can start with a 0.5 setting and increase by 0.25 every week or so to build up to it. I apply minoxidil right after needling, though I do clean my scalp of any trace blood that may have come out first.

Most of the studies linking significant hair growth to micro needling utilized a 1.5 mm needle. Consequently, most laymen I've seen trying it out at home are emulating that.

Wow, that's a stark transformation for just over 2,000 grafts. Very impressive.

10 hours ago, CosmoKramer said:

In all honesty, 1,800 grafts seems a lot just for what looks to be a slim area, and the after pictures are of no help in showing true results due to the hair styled forward. I would have expected better.

I feel the graft count may actually be justified based on the patient's goals and consultations I've had thus far with a few clinics. It's a bit hard to tell what the final outcome is though because as mentioned the hairline itself is not really visible in the after pictures. The only area we can see is part of the corners just above the temple.

Looks great, and very natural based on the pictures. I'll bet most people you run into have no clue you had any work done.

Firstly, your hair is still better than it was in the original photos and it's important to keep that perspective. You could be experiencing synchronized shedding, and you're certainly around the right time frame for it. 

Are you still using the minoxidil? How long ago did you start/stop that?

Looks to me like the front half was pretty thin in the before pictures with that tuft around the forelock hanging on a bit better than the rest of the hair. 

That thin area behind the forelock looks like it has largely been filled, and the forelock seems like it has a bit more density/fullness as well. Curious about the graft placement breakdown for the two procedures.

I have used a roller, a stamp, and a pen which is basically a motorized stamp. While I believe they are all effective, I think the pen is the superior option.

1. If you're rolling or stamping it is hard to be consistent with your pressure. A pen takes that and a decent chunk of the physical labor out of the equation.

2. Stamping, with a pen or a regular dermastamp, is less likely to snag and pull out existing hair compared to a roller. Other than accidentally pulling out some hairs, this also makes it more frustrating to go over your scalp in areas with more hair.

3. Theoretically the stamp may be performing the same micro wounding with less risk of tearing, which can cause damage to the tissue and hurt your follicles. This is highly variable on the individual and their technique, but I would rather be safe than sorry.

And for what it is worth I think my pen hurts way less than the roller did and takes me about half as much time.

I agree that the transition from front to back is very well handled. Great cosmetic improvement while the patient weighs his options on any possible work further back on his scalp.

Looks like the PRP and meds have done a nice job boosting the mid scalp and crown. Hairline work is pretty impressive given the small number of grafts and the severity of the thinning in the before picture.

So at the moment it looks like the scar is not going to be too bad, although I'm not an expert. Still very fresh but it doesn't look terribly large and even the shock loss isn't too bad. Barring some major change I'd say it looks like it will heal nicely.