LaserCap

Must have been very early when I replied to the original post.  Inadvertently started writing about SMP.  

Time will tell, very marginal results.  Not sure if this needs to be done at a specific interval, say once every three months and is it done under local? 

Nice article.  In most recent years I have seen some doctors achieve unbelievable density in just one procedure.  It is truly amazing.  When I began my career the general thought was that a separation was required in between grafts to allow for grafts survival.  They were, and still are, in the belief that grafts compete for blood supply.  So, if you think of graft paper, and draw a dot at the end of each square, that would be similar to what was being done.  Some do would do a random placing for more naturalness, but the separation would be there.  That's why most can not achieve density in a single procedure.  This is what a call a 1 dimensional drawing. But most recently I've noticed this changing.  I call it three dimensional.  Think of a 4 hair graft and placing a 3 hair graft right in front of it so that the hair shingles in such a way that it creates more density.  Now, how many grafts?  It depends on many factors that have already been outlined. Again, look at results before making any decisions. 

I was once offered a job with a company that offered this service exclusively.  I was impressed.  They were targeting patients that had little to no donor area that anted to have, at least, something that resembled hair and that would frame their face.  I think they accomplished that.  It is not a tattoo.  It is an ink that requires no anesthetic.  Since that time, and that has been about 5 years, I've met with a number of doctors that offer the service.  It lasts about 3 years and it helps to minimize the contrast of the color of the hair and the color of the scalp.  Thus, there can be many different applications.  A woman just wanting to minimize contrast behind the hairline, which is typically where they commonly tend to lose hair, an African American that likes to keep his hair short, or the Anglo individual that has no donor left and now wants to address the crown.  Where I think it does a nice job is in the donor area.  It can help camouflage wide scars in the donor if that's bothersome to the patient.

This technique does not help in any way to retain or grow hair or to heal anything. Think of Toppik but a bit more permanent.  

First suggestion is go to the dermatologist.  I am sure they can discuss a number of alternatives.  

Typically, after 7 days, you are asked to scrub the crusts off.  Whatever stub came with the graft, will start growing from day one. Whatever the length of the hair is, that will fall off as well.  It is not shedding.  Once the graft reincorporates into the blood supply, (3-4 months later), the transplanted hair will begin growing.

You need to get the crusts off!  Not doing so after X amount of time can result in an infection.  Get in the showing, let them soak, and scrub.

You can resume Rogaine 7 days post op.

I gather that you had some native hair to start with.  It would be difficult to tell which hair shed.  The difference between the hair in the front and top in comparison to that of the donor area is hair quality.  The best hair, with the most thickness, etc...will come from the donor.  Hair in front and top is typically a finer, and not as thick.  This can be easily seen under magnification.  I would encourage you to schedule an appointment with your doctor and ask him to scope the area and take photos.  Do the same 6 and 12 months post op.  This should give you a decent idea of what is happening.

PLEASE continue finasteride and, perhaps, add another modality to the mix.  

A couple of things I would like to add.......

This technique can be done in a number of ways as there are many systems available.  Some dry, some wet, ARTAS, etc. Typically it is not the doctor that does the harvesting.  Make sure to ask who specifically will be doing the work, and their qualifications.  

I am always concerned with ARTAS because it uses a punch greater than a .9mm.  This will always leave scarring in the back that looks like honeycomb.  Typically .7mm or less is ideal, it leaves an undetectable mark,  

Again, do your research.  Ask for photos of the work.  

Typically the best result for a beard transplant is to take the follicles from under the chin. It will be an exact match.  The question will be, based on what you've written, if there will be enough to accomplish your goals.  Dr. Arocha does tremendous work and has a great deal of experience with beards transplants.  I would take a number of photos and send them to him.  He is in Houston.  

A few things come to mind when reading this article.  First, if you've never been interested in hair, you will never hear about hair restoration.  I'll bet that there are millions out there that have no idea this is even possible.  Second, a lot of people are familiar with the old style plugs.  They even think that this is the technique being used today! Because of that, in my view, the whole industry suffers. Third, many patients believe they will achieve a full set of hair by doing transplants. As noted in the article, its all about the expectations.

To all consultants out there....Read, talk to your doctor, educate yourself. Become indispensable so that when you meet with a patient, you can guide him. Don't just sell the transplant for the sake of making a commission.  We are representatives of the company but also of the patient.  At the end of the day it is our responsibility. Take it upon yourself to be honest and ethical.  

Throughout my career I've worked for a number of doctors. Some unbelievable work and some not so good.  Some brilliant doctors with horrible bedside manners and others that would have patients eating out of their hands but would put grafts in a broomstick if they could.  One of the latest doctors I worked with was truly a nightmare.  When I reviewed notes in the system I noticed, without fail,  failed procedure, re-do.  Why? who knows.  This brings up a point, in addition to what has already been posted.

You could be the pioneer of hair restoration.  But, if you've been doing bad work for 30 years...guess what?

PLEASE do your research. Look at hundreds of photos and not just a handful.  Don't just call a practice and ask for the price....Go to the consultation and visit with the doctor.  Ask him to show you his work. FUT, FUE, ARTAS.Does he do PRP?  How does he do it? is he in favor of medical therapy?

Just like anything else, the hair transplant industry keeps evolving.  Things keep improving and if you are fortunate to find a good doctor, such as the ones listed on this site, you will attain a natural result. We are all limited by whatever donor we have.  Can the doctor meet our expectations?  Be realistic

Awesome work Doc! and nice set of photos.  This much density after only one procedure?

Nice.  I particularly like the staggered technique which adds to the naturalness of the work.  Unfortunately because of the angle of the photo, I am unable to see the temporal areas and if the doctor blunted the corners.  Peaks are common and appropriate with African Americans.  Doc, can you post photos of the corners for the review of our members?

The subject of shedding hair comes up frequently. To most in the industry, when discussing the subject, they'll be quick to point out that there are two types of loss.  The hair that you see in the shower, comb, etc.....this is normal.  Farther, they'll explain that 100 hairs a day is normal.  Simply, and in laymen terms, the follicle gets tired and needs a resting period.  After X amount of time, the hair will return.  And you will not shed all hair at one time.  It is random.  Some one day, some the next day, etc. To me this is shedding.

The second type of loss is the one you don't see.  Hair dissipates and miniaturized. Eventually it is hair you can hardly see and does not seem to grow.  Eventually this hair disappears.  This is hair loss.

Now. let's address the two questions you have,

Prior to the follicles being harvested from the donor area, the area is shaved,  This is for all types of transplant procedures.  Typically a small stubble is left and this is what is used to transport the graft to the recipient area. Days after the procedure tiny crusts will begin forming in each of the sites the doctor created during the procedure, (and where the grafts were placed).  7-8 days later, depending on the post op instructions the practice gives you, you will start washing the hair normally and some, if not all, of the crusts, will fall off.  By this time you may be able to see a bit of growth of the native hair that came with the graft.  The falling of the crusts/hair---sometimes patients feel this is shedding.  It's not.

3-4 months later, once the follicle has had the opportunity to reincorporate into the system, the grafts will begin growing.  At that point the grafted hair retains a memory and will continue acting as if it was still in the donor area.  Now, does this hair shed like it did at one point?  I believe so...but the hair returns.  I've never seen miniaturized hair int he donor area except for patients that become 7s. And even in this patients, they will typically keep a strong donor area in a small section in the back.  Unfortunately it is so little that not much can be accomplished in these cases.  Other patients that have issues with the donor are women.  They tend to be global thinners, meaning that they tend to lose hair all over, including the donor.  Medical conditions, such as a self immune system can also have an effect on patients.  

With regards to the second question,

When the graft is transplanted, it comes with the gland.  The gland does not know what to do and it blocks the hair.  It typically turns into a zit that you drain and clean.  Half dozen about 3 months post op is normal.  This just means that the hair its on its way.  The doctor can give you a cleanser to help minimize this.  

Nothing wrong with being young.  In the hair restoration world, however, it is somewhat of an issue.  Typically, at that age, there is little to no notion as to what the pattern is going to do.  Let me explain.  Say an 18 YO comes with a very juvenile hairline, (in the middle of his forehead).  The patient is freaking out about the slight recession he is experiencing in the corners, (maturing hairline). The doctor agrees to move forward with a procedure and fills in the corners.  10 years later he has two horns, (the two tufts of hair that the doctor placed years ago). The patient is now a class 5 with a well receded hairline. 

The best approach in this case is to educate the patient and explain the various options including all medical therapies.  The fact that he is young and just starting to lose, will help him.  Therapies can help with retention and enhancement of miniaturized hair. A yearly visit with the doctor is advisable to see what changes, if any, the patient has experienced.  And, while realize this is a long term decision, of course it is worth it.

Most agree that when you are born there are about 100,000 hairs in the head.  By the time you are a teenager, you lose about 1/2.  At that point the patient does not realize he has hair loss.  It is truly an optical illusion.  Say the patient has 7-8K hair follicles available in the donor.  You are asking this number to do the job of 50,000.  If your goal is to have a full set of hair, it is imperative you keep as much as you can of the native hair.  If losing hair is not important, shave.

What length hair are you keeping?  Perhaps grow it out, say 1 inch or more.  Then visit with a doctor and see what you are told. Despite the length, if you can still see through and see scalp, perhaps you are experiencing global thinning as others have indicated. 

Let's bring in hair quality, thin vs thick and everything in between.  What caliber hair do you have?  What color is it?  Just curious.

Lastly, medical therapy.  (Propecia, Rogaine, Laser and PRP).  Talk to your doctor about them.  See if he feels they would be of benefit to you. Try them for 1 year and, based on the benefit, you can decide if you should continue doing them.

Once done, and if it is DUPA, you may want to consider SMP with or without hair.  Not a bad option.

If the patient had realistic expectations, you met the expectations and the patient is happy....Nothing else to say.

The patient seems well demarcated in the back so doing grafts back there I guess it's OK.  Hopefully he is doing all kinds of medical therapy to help him with retention of the native hair.  

What size punch did you use? It would be nice if you could comb the hair up so we can show what the result of an Artas procedure is truly like.

Lastly, what percentage transection do you believe you experienced with this patient?

I'll give you my 2 cents regarding meds and research...I am certain others will be quick to correct me if something is incorrect.  

Since we are dealing with the population, tons of studies are done before the FDA gives its approval.  And, the company is to outline all possible side effects of the medication.  Have you seen daily commercials about different medications?  Some can even cause death.  

Proscar, the parent medication of Propecia, has been around for a long time.  Millions of people take the medication.  Side effects?  Of course.  Some more than others.  Some non at all.  We are all human, we are all different, and some things affect us more than others.  Genetics, our surroundings....probably many factors that have yet to be discovered.

During the ISHRS meeting in Las Vegas 2 years ago more negative news about Propecia came out.  And it seems that every year it's more of the same.  Months, maybe even years later, another report comes out refutiating the original findings.  And this goes around and around for years.  Eventually, as patients report side effects, trends allow for more education and research. 

I was helping a practice out in the East recently and had a lengthy conversation with the doctor about this same subject.  He had written a thesis on Propecia.  He is under the belief that the medication will eventually lead to dementia.  I guess we'll have to wait and see if this is the case.  For me, and I am not trying to be funny, I rather be crazy than having no hair.  

I am in agreement with you about many things.  Leave the crown for last, make sure meds are working,.....etc.  The crown is the spherical area of the head.  If you draw a point and draw a cross intersecting the point, you will notice that every hair is doing its own thing.  Not working together as in the front and top where the hair all grows forward and shingles.  It would take many, many procedures to achieve any type of density.  Everyone by definition, has to be thin in that area.  Honestly, I would leave it alone. Talk to your doctor about adding another modality to the mix and give it a year.  

Thanks for writing the excerpt.  You've only hit the tip of the iceberg however, and we can surely elaborate on many of the points you make.  Unrealistic expectations, for example.  This typically happens with young guys that reminisce about the youthful hairline they once had.  The sad part is that many doctors will go ahead with the case just because the patient asked them to do so and because of the money involved.  Who to blame?  The patient or the doctor?  Perhaps both?  All of us have a responsibility to educate the patients properly.  We are a representative to the patient and to the company we work for. If after discussing all options the patient is adamant about moving forward, (he didn't listen to a damn thing you said), I would honestly send him away.  (The problem is that now he'll go and find someone that WILL do the work).  

Other examples of why not to move forward include medical conditions such as an auto-immune system.  How many times have we seen doctors move forward anyway?  Is this because the doctor feels bad for the patient and wants to "try" anyway?  Again, if the patient is educated properly and all options are discussed including possible outcomes, and the patient signs a waiver, I guess that's OK.  Sometimes it is worth the risk if the patient has realistic expectations.  

There are so many tangents.....but good to bring them out so patients are aware of the many pitfalls out there.  (At least we know that all participants in this forum are an educated bunch.  

Let's take your msg. one step at a time....

It typcally takes 12+ months to see the final result of the transplants.  That's the majority of cases.  There are cases where you can actually continue seeing improvement up to 18 months.  Be patient.  Unfortunately you did not post photos of the front, it is difficult to ascertain what results you had.  

It seems, from the photo, that you are thinning from the back to the front.  Do you know off hand how far back the doctor worked on your case?  Was it front and top?  Or just the front?

Medical therapies, (Propecia, Rogaine, Laser and PRP), it typically takes 12 months to see what they will do.  Here we need to be careful.  Most people expect.  And when they see no change, patients feel that the medications are not working.  The meds are not intended for you to grow anything. Rather, they are meant for you to keep what you have or the slow down the process. So the first suggestion is to also be patient.  Perhaps you should add some, if not all, of the other modalities to the mix.  They all work in different ways and are, thus, synergistic when used simultaneously.

Lastly, taking all these risks....What are you talking about?  All you read on the internet about possible side effects of Propecia? For patients that typically experience side effects, it tends to happen immediately.  If you never did, you never will.  I find it laughable how many patients that have been on Propecia for years, by the way, come in and say that they stopped because they read it on the internet.  (Who wrote it?), they have no clue.  The internet is a wonderful source of information but also of mis-information.  I've read that Propecia can grow a third arm! I've been on the medication for 20+ years and expect to continue taking it for the next 20. 

Could you be, coincidentally, experiencing normall shedding of the native hair?  Perhaps.  If you are noticing hair in the shower, the brush, etc....that's normal.  That hair typically returns.  Hair that is miniaturized and eventually dissappears is hair loss.  Again, be patient and keep taking photos.  

What does the Doctor say about what you are experiencing?  Perhaps he can examine you and give you more information.

I gather you did FUT? How many grafts?

After so many weeks you still have 1% scabs?  7 days post op you can wash your hair normally.  Whatever you have left, get in the shower, let them soak and scrub them off! The grafts are under the skin and you can not hurt them.

With regards to the gym......Typically you can resume normal activity 7-10 days post op.  Since you did FUE, there are no concerns of stretching scars, etc.  Go back to the gym all you want.

It seems you are getting early growth. Did you do PRP at the time of the procedure?

Lastly, what medical therapies are you doing?  Rogaine, Propecia, Laser, PRP?  You are young.  And, if you've shown the propensity to lose hair, you will continue doing so.  The donor area is finite and you will eventually run out.

For shedding to happen, there has to be a lot of native hair around the area being transplanted.  This hair typically returns 3-4 months post procedure. 

Based on what you've written, it seems you are referring to what happens right after a procedure.  See below,

During the procedure the graft comes with stubble as the donor area was shaven or trimmed down depending on the technique, FUE or FUT.  This stubble is what is used to transport the graft to the recipient area.  In the ensuing days the crust forms but the initial hair, for lack of a better description, continues growing.  At about 7 days, depending on the post op instructions given, you are asked to wash off the crust.  At this point, typically, the initial hair will also drop.  (Many patients, at this point, feel they've lost the grafts).  Sometimes the hair will not drop and will continue growing.  This just means that you are ahead of everybody else 3-4 months.  It is then that the grafts have had the time to root and the new hair starts growing.  

I am surprised to hear that you were on blood thinners for both of your procedures.  Did you tell the doctor this prior to the procedure?  This would just make it more difficult for the clinical staff as there would be more bleeding, the grafts would just pop out, etc.  

Not sure about Manchester but I will tell you that in the States. you can expect to pay anywhere between $3.75 - $5.00 per graft for FUT and $6 - $9 for FUE.  That being said..........

Throughout my career I've helped a number of surgeons.  Recently I've noticed that most patients will call a practice, ask for pricing and, as soon as they get the info, they hang up.  Call the next practice.....and this continues until the patient hears what he wants to hear.  This eventually leads to the patient going with a physician that is giving away the work.  1.  This devalues his practice and 2, the entire industry suffers because the work is crap. It is important to remember that the bitterness of poor quality remains long after the sweetness of the low price is forgotten.

I truly appreciate the fact that you said "reputable surgeon."  Here you need to be careful.  There are recognizable names out there but the work is no good.  Like I often say, if you've been doing it wrong for 30 years, you will continue doing it wrong.

I would encourage you to look at results.  If the doctor is good, he will have hundreds of photos available.  Watch out for sites that have a handful of photos.  

There is an awesome list of doctors in this site that you can review.  Go to arochahairrestoration.com.  Here is a website with a good number of before and after photos.  Dr. Gabel in Oregon is another doctor you can research.

Good luck.

You seem to have a full set of hair.  The little recession that you have could just be part of the normal process of maturing your hairline.  I question the use of Finasteride as your loss is not in the back area.  I would look into the other modalities, perhaps laser therapy.  Talk to your doctor and see what he recommends.

Ease up on the use of gel.  This will cling the hair together and make it look as if yuo have more loss.  The contrast of dark hair and light scalp does not help any of us.

You also seem to be enjoying a very youthfull hairline. Doing transplants at this point would NOT be good.  Most of the patients I know would kill to have the hair you have.

Nice set of photos and of results.  Taking the follicles from under the chin is always the right thing to do, when possible.  

You seem to be losing hair from the back to the front, and from the front to the back.  It is just a matter of time if you are not on some type of medical regimen.  Glad you are on Propecia/Finasteride.  You may want to add Rogaine, PRP/Laser.  These work in different ways  and can be synergistic when used together.  That being said.....

The sooner you do it, the sooner you get to keep enjoying your youth.  The more you wait, the more challenging it will be later on.  Life always seems to get in the way.

Despite the length of your hair, you can still see scalp.  Are you experiencing global thinning?  Perhaps you were wearing a cap.  Let your hair grow another week and post the photos.  

My first suggestion is to start looking at before and after photos.  Tons of them.  If you see a website with a handful of them, move on to the next.  Doctors that are good and passionate about this business will have hundreds of photos posted.  Go to arochahairrestoration.com and look at that website.  This should give you a decent idea as to what you should be looking for.

Lastly, if you do decide to move forward, always start in the front.  Once you are happy, then tackle the back and make sure the meds are working.  It is normal to be thinner in the back since this is a spherical area unlike the front and top where the hair grows forward and shingles.