Mycroft

Yeah. He made a bad call at the outset but looking at the repair job you'd never know it.

Yes, I was talking about the dermarolling. At 2 mm it takes my scalp a few days to look and feel like it is back to normal, so I think at most I could try pushing it to twice a week, though even that might be too much. Even the frequency of PRP seems to vary wildly depending on the doctor you talk to. Some will say four times a year. Some say once a month. Dr. Arocha said refinements in the technique mean it is only necessary every 6-12 months depending on patient response. I've also seen people advocate for 3-4 treatments over the span of a few months to jumpstart with annual maintenance treatments thereafter. Again, that's why I'd encourage anyone considering PRP to do extensive research on a given doctor's results and consult with a few of them to see what they'd recommend for you. I'd also recommend checking in with your doctor every few months to see if their opinion has changed based on progress. I'm actually checking in a little later than I'd planned, but I've been a bit busy.

I thought this guy looked familiar and then I saw the comment about the YouTube videos. For anyone interested in the progress from the patient's perspective he's got documentation from before his first surgery in Turkey running through his repair and final results with H&W https://m.youtube.com/user/fitnesswithsteve

It's hardly conclusive, though not much about Dutasteride is other than it seems to be more effective than Finasteride for SOME patients. If you want the full article and not just the abstract, it's here. https://www.academia.edu/22488595/Combination_therapy_with_finasteride_and_low-dose_dutasteride_in_the_treatment_of_androgenetic_alopecia

The study was done with that protocol, yes. https://www.ncbi.nlm.nih.gov/pubmed/22686691/

There is some research showing that daily finasteride plus a tiny dose of dutasteride, like 1 mg PER WEEK is a viable course of action, particularly if you have noticed that you've started losing ground on Finasteride where it was once effective. Both daily is probably not beneficial.

I wouldn't recommend more than once, maybe twice a week tops if you are using 1.5 mm+ or you're probably not giving your scalp enough time to recover, which is important. It's the healing and not the wounding itself that is beneficial.

The only piece of advice I have for you here is to do a bit of research specifically on PRP results. The process is apparently not standardized across the board so not everyone does it the same way. Much like transplants, it's best to use a doctor who has some decent results in their portfolio so you know you're covered on that end of things. That doesn't guarantee you're a good responder, but you'll at least know it wasn't because the doctor didn't know what they were doing.

I started on Minoxidil three or four months prior to the PRP. I've been on Finasteride 1mg for three years. I started dermastamping with 1.5-2 mm needles once a week around the same time as the PRP. I have been using Nizoral 1% three times a week as well. Dr. Arocha indicated that Minoxidil, PRP, and LLLT had mechanisms that would enhance one another when used in conjunction. I haven't personally tried the LLLT yet but it's in consideration. If you're going to try PRP and add nothing else to the mix, try the dermastamping. There are a number of studies indicating that PRP is beneficial for wound regeneration and recovery in addition to hair growth. Microneedling creates superficial damage on the scalp to essentially prompt regeneration and repair functions in your body that can actually have positive effects on hair follicles (RE: hair growth). So, in theory, the dermastaming is regularly acting as a catalyst prompting the growth factors you received from PRP to do work rather than simply wait around to let your body regulate that on its own. From what I've read, LLLT may have similar, albeit lesser effects on wound regeneration, so a solid laser device MAY add to that effect. Again, I haven't tested that for myself yet.

Okay, so again, please forgive inconsistencies in the images here. Working with what little I have. The "current" photos were snapped today. The hairline comparison is actually about the same. There is no concealer in my hair in any of these photos. Hair bare bones. This was somewhere around July. Hair is combed back with zero product. Notice the appearance of the hairline if you can. Top down from August. There is some leave in conditioner but otherwise nothing in my hair. Note thinness in the front and the temples. Those hairs were very short and scraggly to boot. The crown is not too visible here due to length and angle which I apologize for. Wouldn't start Minoxidil for a couple of weeks. August Hairline. Note the scraggly looking thinness in the hairline and temple areas. These are the "shaded" looking areas in the top down shot from above. Top down from today. Same room, under similar lighting. Not quite the exact spot. Leave in conditioner here as well. The hair stands up a bit because it's a tad shorter than it was in the August photos, but ironically August was much more carefully combed to be as flattering to the frontal loss as possible. One more top down with a slightly better angle in the harshest light I could manage to find. Note you can see some thinness in the crown. I want to note something interesting here, which is that the majority of my PRP injections were concentrated in the front. I did receive some into the crown, but we agreed that round one needed to emphasize the front of the scalp. Current hairline. You can see that a lot of the gaps in the hairline have filled in, the hairs have thickened and grown out a bit, and the temples are coming in as well. What you can't really see in this picture are all of the small vellus hairs growing just below this. I mention them because a lot of the "new" growth you see in the hairline here looked similar when it started. Some of these may actually grow out as well, and some of these other hairs may have some maturity to come. The best part of the comparison here can be seen with the difference in the temples/hairline since those photos are actually decent comparisons and it's also a place where non-surgical treatments tend to see "lesser" results. Hopefully this is helpful. I have a check-in with Dr. Arocha on April 8th to assess my progress and maybe get his thoughts on what the next move might be. I am inclined to think the crown might benefit from receiving some more targeted injections, but we will see what he thinks. If the clinic shares any of their before/after shots with me I'll see if I can get copies.

I figured someone would ask. My records in this regard aren't as good as I'd like because I've been through hell this last year, but I do have a few photos of varying quality I will try to get uploaded later. I apologize in advance for lack of quality/consistency between photos. I'll also try to take a couple today to illustrate the current progress.

Yes, he's advocated for it a few times. However, I wanted to defer incorporating it right at the outset for budgetary reasons and to give myself a chance to read up more on its interactions with PRP since I had previously dismissed lasers as hokum. I've seen enough to believe that it can have a modest benefit by itself, but I am told that some of the mechanisms compliment PRP very well and vice versa. I think with the inclusion of the dermastamping that might kick things up a notch. Lasercap had a money back guarantee for twelve months after purchase, and that's actually plenty of time to determine whether or not the lasers have had any benefit, so depending on how my check in with the doctor goes and when he feels I might warrant my next PRP treatment (he had indicated it could be 6-12 months at the outset and we are closing on six) it may be time to add that. I certainly think there is a strong lack of anecdotal patient accounts on the forums so if nothing else the experiment might benefit the community in that respect.

Well, you guys are in luck. Back in early November I received a PRP+Acell treatment from Dr. Arocha during hid visit to Dallas. That puts me around the five month mark. Some important things to note: I had started on Minoxidil about three months prior and was just exiting the crazy shedding phase. Hair was probably at an all time low for multiple reasons. I've been on Fin for three years. Around December or so I started working in dermastamping as well since my research indicated it was very synergistic with the mechanism of PRP along with the Minoxidil. I declined at that time to try LLLT as well. By three months I definitely noticed that I was no longer seeing my scalp in harsh light, even in the weakest areas. I also noticed that the quality of my hair in general seemed better and my shedding was reduced. Lastly, and perhaps most noticeable, is my hairline has crept down just shy of half an inch and has gradually filled in. It's not bulletproof by any means, but I continue to see new growth. Many of these new hairs are not as strong and thick as I would like, but there is still time yet for them to get there considering where they started. I've taken note that a number of the hairs shedding in the shower are miniaturized to the point of invisibility on one end and at the root have thickened considerably and almost look like they were dipped in ink. They're not all like this, but I've definitely seen enough to feel encouraged that some of my existing hair is being salvaged. A couple of additional notes: Dr. Around said his treatments needed a refresh every 12 months, maybe 6 depending on the situation. I need to schedule a check-in to see what his thoughts are on my current progress. Now, for those who are about to jump in and say I can't single out PRP as the cause of my success...you're right. Dr. Arocha was very candid that the PRP was just going to be one component of the treatment and I suspect that is true. I'm waiting until about twelve months post treatment to determine "final" results and see if I notice strengthening of the newer hair within that timeframe. If I didn't grow any additional hair and just saw some thickening in the existing regrowth, I think that could potentially add up to a substantial improvement. For me, that will help determine whether it was "worth it." Questions welcome.

Most of the strong non-surgical responses do seem to be diffuse thinners. My suspicion is that this is partly because that condition tends to be characterized by a large area of miniaturization rather than "true" baldness and it's generally agreed that miniaturization is easier to reverse than revitalizing dormant follicles on the edge of "death." I don't recall a large shed on Fin when I started but that was three years ago and I didn't even think or know to look for it at that time. I can tell you that I shed like crazy on Minoxidil for maybe the first three months of application and for a while my hair looked substantially worse. Most of the disaster stories I see of people not recovering from a shed are because they panic and discontinue a medication within a few months. General rule of thumb is wait 12-18 months to decide if the meds are working for you. The growth cycle of hair is a long and slow process.

I believe the clinic is actually local for me because I see their billboards all the time. Here you go. https://restorehair.com/results/urlacher/

There's no conclusive evidence that it does, and anecdotally I didn't notice much of a difference in hair fall after starting creatine. However, I have also been on Finasteride most of that time and that may have had some impact. My theory: if normal creatine dosages are linked to elevated DHT, creatine might accelerate your hair loss if DHT is the primary culprit behind your MPB. However, as we have established multiple times with DHT inhibitors, DHT is not necessarily the lone cause in many cases of MPB.

I am trying some non surgical options for diffuse thinning and miniaturization. I've been on Fin for a few years and after a consultation recently added Nizoral, Dermarolling, and PRP. A laser cap for LLLT was also offered and that's the one option I didn't commit to because I hadn't researched it enough. What I'm finding is: it does work, but as you said it isn't quite the way many would have you believe. The stats show that number of patients who see actual regrowth is small, although it seems to be much more effective preventing further loss. The ones who do show regrowth have results I would compare to milder Minoxidil responders. There are many reports of people reporting better quality of existing hair, which leads me to believe that it is most effective in a situation where a good amount of hair is still present but may be miniaturized. It was also stressed to me by the doctor that the LLLT was effective when used synergistically with these other methods rather than being amazingly effective itself. I am still considering biting the bullet. Lasercap, the prescribed device, has a twelve month guarantee that would allow me to get most of my money back if I didn't think it was effective. At this point I need to wait and see how the other methods perform without LLLT in the mix so I will be able to accurately make that judgment call.

What was the distribution of the graft placement? I don't have the most trained eye but I can see the marks for placement in the hairline and frontal zone. Any grafts in the crown or were those all non surgical results?

If you guys are interested in anecdotal evidence, I am actually going to be trying out PRP very soon in addition to a couple of other non-surgical options. I have been on finasteride for a few years, starter on Minoxidil two months ago, and will be trying out PRP treatments. I'd be happy to try to provide some details on my experience for whatever that's worth. Disclaimer: I have a lot of my native hair and am primarily suffering from early thinning and miniaturization. My understanding is PRP has the best chance of success in this kind of situation, particularly when combined with synergistic treatments like the ones mentioned above.

This was basically my understanding; that it may terminate dying hairs a bit prematurely but the healthy ones should grow back, which I assume is why I've seen some patients put on a finasteride and/or minoxidil regimen for a stretch prior to undergoing a transplant. I always figured in addition to the obvious need to stabilize natural loss that was a preventative measure to try to strengthen any native hair as much as possible to prevent shock loss.

Thanks for posting the post op pictures. I think the clarification on the frontal portion having thinned less visibly is helpful because in the initial photos it is hard to tell without wondering if I'm imagining it. Is the patient taking Finasteride?

Long time lurker. I'd be interested to hear some additional details on graft placement in this case as well. I was just looking at patients with a similar graft count with placements covering the bulk of the frontal area, and here that same amount seems to have been packed into the hairline alone. Was there a bit more thinning in the hairline than the pictures show? Or possibly it was lowered and I'm too inexperienced to be able to spot it?