LaserCap

The good news is the fact you're still enjoying a lot of native hair. The time to be on medication is now before you lose it. Once gone it never returns. The concern, as you know, is - your pattern is developing into something very advanced. You may be experiencing retrograde as well. Since we know this, let's move on to the meds. How do you know Rogaine stopped working? Why can't you tolerate Propecia? Be very specific. Patients have a tendency to think and be quite reactive to the fact, if they don't see a visual result, they are in the erroneous belief the medication is not working. The medication is not intended to regrow hair. Nothing regrows hair. The medication is intended to help keep the hair you have. To retain. So, if you look the same as you did a year ago, the medication did what it was supposed to do. From your excerpt I assume you did notice improvement. This might mean you experienced enhancement of the native hair. If so, you need to get back into whatever you were doing. There are two types of loss. Shedding is one of them. The follicle gets tired of producing and goes into a resting phase. in a matter of a weeks/months, the hair returns. So, if you see hair in the tub, sink, pillow - let it go, this is normal. The loss you don't see is what we're concerned about. The hair you don't see is happening as we speak. Go to the bathroom under a bright light and look at the hairline area- including the temporal areas, (corners). You'll note some strands are very thick and robust. Others are finer and you might find some that are so thin they're hardly contributing. This hair eventually disappears. That's hair loss. Propecia, Rogaine, Laser and PRP are the modalities we typically discuss when dealing with this condition. I have a few questions, Propecia, how were you taking it? Rogaine, how were you applying it and how many times a day. Do you own a laser? Have you discussed PRP with the doctor? With regards to SMP, great idea. Find an experienced group. The use of organic ink is important as this will be metabolized and will not turn into other colors like a tattoo does, (yellowish or blue-purple). This will help with the contrast you're experiencing, (Black hair, light scalp). Some of the doctors listed in this forum do the work). Do not despair, many in this forum can help you....Get well educated and be judicious with your grafts. More importantly, give serious consideration to meds for a good year before you do anything. You are truly at a stage where there are a number of options.

First, I tend to disagree with the assessment. In a class 7 you typically notice most of the hair gone with only a little strip of hair left int he donor. Based on the photos you've provided, you look very similar to a 5A pattern. You hair is rather short. It would be nice if you could let it grow a bit to "see" what's happening. There are two types of loss. The one you see and the one you don't. The one you see is referred to as shedding. The follicle gets tired of producing hair and it takes a vacation. That hair will typically return in the ensuing months. This will happen randomly throughout your head/life. Hair loss, however, refers to hair you don't see. Miniaturization of the shaft is what you need to look at. Eventually this hair will stop growing, will dissipate and eventually whither away. The second component to be aware of is the limitation of the donor area. There is typically not enough to allow for a full set of hair, particularly when dealing with an advanced pattern. It is imperative you keep as much of the native hair as you can. This is the main reason to consider medical therapy, (Propecia, Rogaine, Laser, PRP). (If you do meds and they work, stay on them. It does you no good to start/stop as you will resume losing hair). Let me give you an example.... Patient is 26YO. has a mature hairline with very recessed temporal areas. He's been using meds for 6 years and is retaining. Gets the corners done and stops meds. He loses all his hair and the only thing left are two horns worth of hair........I've seen it happen. Yes, you need to stay on the meds for as long as you want hair. The post op meds they are referring to is likely pain medication post procedure......They will typically include this and will be given to you at the end of the day. Transplant wise do as many grafts as you can afford and have them concentrated on the front and blend them to the area behind the front. Have the doctor continue working towards the back until he runs out of grafts. Do NOT place grafts in the crown area, allow meds to do their thing. Wait a year and reassess.

If the donor was unlimited, I would agree with you. Unfortunately this area is finite and quite limited. There is typically not enough donor in the area to allow for a full set of hair, particularly when dealing with an advanced pattern. So it is very important to keep as much as you can of the native hair. So you get on meds and they help you retain. You get a transplant and you look great. You get off the meds and you resume losing the native hair, (the transplants will remain). You will need to do procedures as you continue to lose - until eventually you have no more donor. Getting on and off meds is not a good idea. You are just wasting time and money. If they work stay on them. If you've shown the propensity to lose, you will continue losing. And once the hair is gone, it will never return. So if you are destined to be a class 7 and want to wait until you've lost everything, it will be too late for meds as they will do nothing at that time. Meds are only helpful when the hair has not left the building. If you experienced side effects with Propecia, you may want to add Rogaine and laser therapy. All modalities work in different ways and are thus synergistic. I would encourage you to do meds for a good year. Take photos. If you experience retention and maybe even enhancement, you may then consider other options.

Hit the front and middle, keep your current hairline and get on meds to help you retain the native hair you do have which is/will contribute to the overall density. (Propecia, Rogaine, Laser and PRP). 2400-3000 grafts with the majority concentrated in the frontal area and blending to the area right behind the front. Give it a year and reassess. You are doing a good job styling your hair. Most people will not notice. If they look at you from upstairs, different story. Right now you can add Toppik to the mix and will buy you some time. Getting on meds should be your first priority.

I know Dr. Alexander personally. Amazing individual, thorough and knowledgeable. Will guide you through the process both surgically and medically, (Propecia, Rogaine and Laser therapies). His staff has been with him for a very long time, very much a team concept. View before and after photos. It is about results after all.

The basics of a hair transplant involve the limitation of a donor area. It is finite and there is typically not enough there to allow for a full set of hair when dealing with an advanced pattern. You are young. You've shown the propensity to lose so the fact is - you will keep losing. Being on medical therapy is, perhaps, the best thing you can be doing at this time. Medical therapy, however, tends to be far more effective in the back area. So the basic approach of a doctor is to place more importance to the front, (which is the most prominent area. It is the area you see when looking at yourself. It is also the area others first look at during any interaction), and allow medications to maintain the back. When do you attack the back? When you're happy with the front. You have two things going on which don't help. The first is the color of your hair. Dark hair - light scalp, will always lead to more contrast. The second issue is the fact we all have a whirl. The hair grows away from the point Unlike the front and top. In the front the hair grows forward at an angle. In the top, (area behind the front), the hair also grows at an angle forward. So as the hair grows it shingles and it gives you the illusion of more density. From the photos you've shared with us, your crown looks just fine. Take photos every 6 months and keep records. Propecia, Rogaine, Laser and PRP are the modalities we typically refer to when dealing with this issue. The mechanism of action of each is different and thus there is synergism when used simultaneously. It typically takes a full year to see if you'll enjoy some enhancement. Do as many of these as you can.

So you go through a transplant procedure. The very next day crusts start to form. You start to pour shampoo and cup method. Within 3-4 days you see crusts all over, Some are small and some bigger. You can start noticing the shaft that came with the graft. At about the 5-7th day the crusts start falling off. You get in the shower and start massaging gently. Crusts finally come off but the hair never falls and starts growing. This just means you are ahead of everyone else by 3 months. Normally what happens, however - the hair also falls along with the crusts. 3-4 months later the hair start coming in. And, not all hair comes in at the same time. First it is vellus-like. Eventually, typically a year, the hair matures. Sometimes there can be improvement up to 18 months. If you do PRP, hair comes in sooner. I've seen a matured result at 3 months.

Nice work. The fact his hair is not black and seems to be on the finer side also helps him with naturalness. Med wise is he doing Propecia, Rogaine and LLL Laser therapy?

Yes sir, that's exactly what I'm telling you..........

Typically at 1 year post op. In some instances it can keep improving up to 18 months..

Awesome work....

If you put it away from the grafts - you can do it right away. If you want to put it right where you had the transplants, wait two weeks. Based on what I read, I think you only did transplants in the temples and eyebrows. So, if you did have grafts in the crown, you can go ahead and use Rogaine in that area. By doing so, it is working your whole head. Not sure if I am making sense.....

The medication is systemic. Regardless of where you put it, it is working the whole head. That is, there is no need to put it everywhere. You are just wasting the med. If you're going to notice any enhancement it will likely be in the crown and retention elsewhere.

I totally get it. There are patients against using the medication and I respect their point of view. No need to increase the amount of Rogaine...just keep doing a cap full of the foam once or twice a day - whatever your schedule permits. I would encourage you to add laser therapy to the mix. Maybe even PRP.

In the time I've been involved in this industry seldom, if ever, have I seen anyone benefit from "natural products," as you put it. Propecia, Rogaine, Laser and PRP are the only modalities proven to have an effect on hair loss. The mechanism of action of each is totally different and are thus synergistic when used simultaneously. So using any one or a combination thereof should yield some results. Here is the problem...... People in general want to see results. When they see no visual change a year later, they think the medication did nothing. The medication is not intended to regrow hair. There is nothing out there that regrows hair other than a hair transplant. The medication is intended for you to keep what you have. So, if you look the same today as what you did a year ago, the medication did what it was supposed to do. Sometimes there can be enhancement of the hair. That is, miniaturized hair, (thinner shafts) can thicken up. A small percentage of patients do experience this. And if you do, stay on the medication because it's working great. With regards to what Thisisnotatest33 outlined above, Rogaine has a tendency to work for about 7 years and then the effect declines. You are still retaining but not as effectively. When this happens, patients have a tendency to just forgo the medication. They then experience very aggressive and rapid loss. So, stay on the medication regardless of what you see or don't see. 2nd point, I've seen patients just stabilize and only notice normal shedding which I'm guessing its what happened. You will randomly shed hair throughout your life. The follicle gets tired and goes into a dormant stage. The hair eventually returns. (So if you SEE hair, don't worry about it, it will return). Unfortunately we do not see hair loss until it's too late. It is difficult to see miniaturization. Do you realize patients start noticing hair loss when they've lost 50% of their original hair? Crazy. With regards to Propecia, I'll share my own experience. Did my research....How it started, what others were experiencing, etc. I think of the medication as a potential benefit in a couple of fronts. First there is more testosterone under the medication. So you should be wanting more, not less. And while this is only temporary until the body figures out what's happening, it helps my mental/reasoning approach. Proscar, the parent medication, is taken by millions to address prostate issues. So, if it's going to help in that department as well...why not. So I think there is a mental aspect to this but it's all about the approach. If I was to give you a piece of chocolate and tell you, "this is an amazing piece of chocolate. It was magical powers but can give you permanent ED," what do you think it's going to happen? I've been on the medication for more than 20 years. Never experienced anything negative. I've kept my hair and to this day I get complimented often. More and more, and not just in this forum, I read all the negativity involving Propecia. Mind you, I am aware that some people do experience a side effect, (loss of interest when it comes to sex). And it seems the news keeps getting worse. Only to find a few months later, "after further research we've now found...."

Good point j1j9j85 brings up. Regardless if FUT or FUE, each puncture either in the donor or recipient area, is a wound after all. Bacteria crawls and now you're looking for trouble. Bring an animal in and now you may be dealing with other issues. Interesting. Allergies, rashes and all sorts of things also come into play..Again with open wounds I would try to keep them at bay. Lastly, bending over to feed, provide water, etc.....carrying, bend from the knees. All that being said, if you didn't bleed and the pet has been with you for a long time, doubtful it had an effect. Besides all these things are bound to happen 1-3 days post op. With each passing day the risk decreases.

Agree. The problem I find with this industry at its most basic form is the fact...if anyone does anything that results in a negative - everyone pays for it. I'm not sure why people overall generalize.

There was a story in the newspaper some years ago about a patient that traveled abroad...Had transplants, unsanitary tools, no experience...etc...Died on the table.

Standing on your head or using some apparatus to turn you upside down so blood flows in the direction of your head. Heard this throughout my career a number of times.

Retrograde is loss that happens from the bottom up in the donor area. Hair loss is like that. It can go years without manifesting itself. Keep an eye out for shedding and miniaturization of the hair. If the lady said so, it must be true......why then the concern?

Let it grow a few weeks and take the photo again..... You have dark hair and light scalp...the contrast does no help, particularly since your hair is rather short. I know of some doctors would get the idea you may be thinning in the area. To be absolutely sure, wait a few weeks. You also seem to be experiencing a bit of retrograde What hair loss pattern do you deem yourself to be? Family history? Are you doing any type of medical therapy to help you with retention? Have you met with a hair transplant professional? An evaluation with a knowledgeable doctor would help.....

Really? What doctors will not do your surgery if you don't take finasteride for at least 6 months? I would be hesitant to consider moving forward with any of them when it's evident they have no clue as to the reason why you should consider taking the medication. The reason why to do medical therapy is to help you retain the native hair. This is HUGE when you consider no one has enough donor hair available to allow for a full set of hair, particularly when dealing with an advanced pattern. And it takes a full year to see what exactly the medication will do. It is likely you would notice retention in a matter of weeks, but enhancement, if you're going to have any, does take a while. Let me go into a tangent for a sec..... You visit with one of these doctors, you listen to him and get on the med. You experience retention. You take the medication for the 6 months and do the procedure. You end up looking like Adonis with a beautiful set of hair. The day after the procedure you stop the medication and within a few months you go on to lose all the hair that you would have lot had you not taken the medication. And now you have two horns worth of hair, (transplants he just placed on the temporal areas). The worst thing about it is the fact, once the hair is lost, it never returns. Throughout my career I've helped thousands of people....Young, old and everyone in between. Consult and educate...Never have I met a doctor make the procedure conditional..."If you don't take Propecia I won't do the procedure," That's ludicrous. (And at the end of the day, how does the doctor know you are or not taking the med? What, believe everything you say? The suggestion has always been, at least with me, is to try the medication. And, if it works, stay on it. If it doesn't stop and research other alternatives other than transplants. It is important to recognize, if you've shown the propensity to lose, you will continue losing. When? No clue. If you're going to do Rogaine, Laser, PRP....Get to it and stay on them. Give them a year. Take plenty of photos. Getting on and off the medication is not the way to go.

You may be in the process of maturing your hairline. As far as the crown goes, everyone has a whirl and it's the weakest point we all seem to share. Given your family history I would encourage you to visit with a dermatologist or with a hair transplant professional. A couple of things to keep in mind. If you've lost, you'll keep losing. Based on what you're told during the consultation, I would encourage you to discuss medical therapy, (Propecia, Rogaine, Laser). The other thing to discuss is the fact you are only 17. If you've started losing so early, it is likely you may end up with an advanced pattern. Get on meds and wait to see what happens. Hopefully you'll notice retention which is what the meds are intended for.

Some people would rather not take it. I respect the decision, particularly when I see the patient doing other things to help himself. What have you noticed so far?

I think most guys dealing with hair loss compensate by growing facial hair. I am guessing, for those who get really depressed, weight does come into play because they can't stop eating. We all deal with stress in one way or another. But it is the stress that's contributing to the hair loss. It is not the culprit but can sure have an effect.