Spaceman

Wait, most vital organ? is the cardiologist saying minoxidil affects your d1ck? Thought that was finasteride. 😉 Totally understand the concern about people taking serious health risks for vanity. At the same time, cosmetic surgeons operate every day on people taking risks for the sake of their vanity.

The active ingredient, ketoconazole helps in two ways. First, it is an anti fungal that will lower inflammation due to malasezzia overgrowth. Second, it can bind competitively to androgen receptors, meaning it can occupy a receptor that might otherwise be occupied with another androgen (with DHT, for example).

Its good to use dandruff shampoos on your scalp and face to help treat seborrheic dermatitis, however, you aren't helping things very much if right after the dandruff shampoo you slather on conditioner or moisturizer that then encourages the growth of malassezia. In that case you are simultaneously inhibiting and encouraging the growth of Malassezia. So SD may improve, but it will not go away completely, or it goes away but keeps coming back. I spent a couple decades like that. It turns out that nearly all (like > 90%) of skin and hair care products contain ingredients that are known to feed the malassezia yeast that causes seborrheic dermatitis. The problem ingredients include fatty acids with carbon chain lengths of 11-24. That includes almost all oils, polysorbates and esters. You need to avoid anything with olive oil, coconut oil, avacado oil, etc. And avoid anything with lauric acid, myristic acid, tridecylic acid, palmitic acid, stearic acid, oleic acid, and linoleic acid, etc. Unfortunately those ingredients are in most skin and haircare products! There are some products that don't have those ingredients and they will help because they will not throw gas on the fire. You really do need to check the label. I now use 100% malasezzia-safe products and that has made all the difference for me in controlling SD. I'm sharing them below in case anyone finds them useful. These products are all widely available, cost less than $15, and I have no financial interest in recommending any of them to you. I use Nizoral 1% on my face, ears, neck, and scalp once a week or so. This works very well, but in moderation. The other days I use a medicated baby shampoo called Happy Cappy. It is very mild and very effective. I use this Vanicream facial cleanser on my face. Again, mild but very effective. As a treatment for facial seborrheic dermatitis around nose folds, mustache, etc, I use MSM facial sulfur gel. Topical sulfur is a great treatment for SD. This gel uses MSM instead of elemental sulfur so the gel has no smell. The carrier is organic aloe and is very mild and very safe. Totally non-irritating. I use this daily on my face and neck. After that, I apply CeraVe cream again to face and neck.

Yes, absolutely. Ketoconazole, Selenium Sulfide, and Coal Tar are all irritants and I think overuse will do more harm than good. Irritated skin leads to itching and inflammation and that is known to contribute to hair loss. The dandruff shampoos all help to control seborrheic dermatitis but you shouldn't need to use them more than 2 times a week. If that is not enough to control the problem then you probably need to make other changes, e.g. the other shampoos you use, or the conditioners, or other hair products.

Wow! An amazing difference after 3 months! It certainly looks effective. I've read that topical dutasteride its supposed to be safer than oral (which gave me sides), and I'm tempted to try it but I still worry about safety. It has a 28 day elimination half-life so it builds up in your system over time. That also means it stays in your system long after you stop. Even if only a small amount of each dose of topical dutasteride goes systemic, with its long half-life, I'm worried it will build up over time to significant amounts. Too bad there are no studies (AFAIK) to answer that question. @Grzegorz641thank you for posting your results, and I hope you can report back over time to see how you are doing. I also encourage you to get hormone levels checked periodically just to be safe.

I had a similar hair loss pattern as you, and have a similar hair type. You could go with FUE or FUT honestly. FUT if you want to maximize scalp grafts and preserve donor density. FUE if you want to avoid the linear scar, wear hair at 0-2 guard, minimize healing time, and/or use body hair. I chose an FUT with H&W a few years back. It turned out very well, scar is totally undetectable at 3 guard, and I would do it again. Hair type matters with FUT because sometimes hair direction changes a bit at the scar. If you have very straight hair then the change of direction can look unnatural. But with a good surgeon and your hair characteristics that won't be a problem at all. My thread is here if you are interested.

@Superslim11 Given that 1) you don't care about your hairline and think the problem is your crown and 2) you seem to wear your hair very short, and 3) it doesn't sound like you have the funds for a multi-area HT from a top doctor, have you considered SMP to the crown? It would be much cheaper and not permanent. From your pictures you'd be a good candidate. Might give you more confidence and buy some time while you save for a quality HT. Just a thought.

Seborrheic dermatitis occurs often on the scalp, but can also happen on folds of nose, mustache, eyebrows, and even inside of ear lobes and the ear canal. Its thought to be caused by an overgrowth of malessezia yeast on your skin that feeds off of your sebum. The natural instinct to treat Seborrheic dermatitis is to add a dandruff shampoo that combats malassezia. Common ingredients would be ketoconazole, pyrithione zinc, selenium sulfide, or coal tar. They will help but its not enough. Many common ingredients in shampoo, conditioner, face wash, shaving cream, sunscreen, and moisturizers actually feed malessezia and will make your seborrheic dermatitis worse. So, In addition to adding a dandruff shampoo you need to stop using products that feed the yeast that causes seborrheic dermatitis if you want it to go away completely. There is a list of malassezia safe products here: https://simpleskincarescience.com/fungal-acne-products-malassezia-pityrosporum-folliculitis/. (I am not affiliated with that site). Best of luck.

Good luck on your HT journey @olmert. I wish you the best.

@olmert In the picture below, the skin is not being stretched, rather its being pinched to see how much laxity there is. Note that you can cut this pinched piece out without stretching the skin to close the wound. It is "extra" skin. That is what happens in FUT. The surface area of your scalp is a larger than the surface area the outer skull, or pericranium. If that was not the case you would not be able to move your head freely. In your example, if the surface area of the pericranium is 100 square inches then the scalp covering it must be 110 square inches or more for one to excise a strip of 10 square inches from the scalp. This extra 10 square inches of skin represents the laxity. Here’s another way of looking at it: say I have a shirt and I need to make a repair on it but I have no more fabric. If the shirt is baggy then I can undo the seams and trim off the extra fabric and then resew the seams to make the shirt more fitted without stretching the material. Then I can use the extra fabric I cut out to make a repair somewhere else on the shirt. But if the shirt is not baggy then it is not a candidate for this type of repair.

That’s just wrong. Let go of the stretching concept. FUT surgeons try to avoid excessive tension during closure to reduce the chance of stretched scars. Surgeons use the term elasticity to describe what you call stretching. And patients with high elasticity are poorer candidates for FUT because they are more likely to have wide scars. Good FUT candidates have laxity which is define by normal-to-high glidability and normal-to-low elasticity.

@yego I see the weakness on right side that you are talking about. You wear your hair long so it’s easy to camouflage. Still, if I had a HT to improve that part of the hairline I would not be satisfied with the result either. Maybe a small touch up on the right side, but only if you have a long term plan and are thinking ahead and can spare the grafts. How many grafts did you have in your first procedure? What was the yield? Did they mention how many you have in reserve? Can you share before/after pics from the first surgery? You are young so you need to manage your donor carefully as everyone says. If you do decide to go through with it and you are in Seattle and you want FUT then it does not make sense to take a 10 hour flight to Europe for a small FUT procedure when Hasson and Wong are a 2-3 hour drive north and only charge $5/$3 per graft for FUT. Or you can drive a couple hours south and see Gabel in the Portland, OR area who also does excellent FUT at reasonable prices. And if H&W or Gabel tell you to wait then you should listen!

FUT removes skin from the donor area and therefore reduces its size, but not FU density. I think where you are getting tripped up is that FUT relies on scalp laxity, or loose skin that can be easily moved up and down with your hand. FUT surgeons are removing some of the excess skin that most people (but not everyone) have in their donor area of their scalp. It’s not about taking a one inch strip from a 3 inch area and then stretching the remaining 2 inches of skin to cover the 3 inch area per your previous post. FUT is about taking out the lax inch of skin. You need to have an inch of play in your scalp to take an inch out. And if you don’t have that laxity then you will not be a candidate for FUT. That’s why FUT surgeons want patients to do laxity exercises ahead of surgery. FUT can remove 1000s of FUs without significantly reducing donor density though of course it does reduce the overall donor area by an amount equal to the area of the strip. No free lunch.

IMO, you’ve made great choices based on solid research and are likely to get a fantastic result. Thanks for taking the time to document and best of luck!

Yes, recipient looks fantastic but scars definitely not cool. Have you asked Hasson about them? Also, do you have any post-op pics of that area?