LaserCap

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.

Many factors are involved. FUT or FUE, who is doing the harvesting, the doctor or a tech? If FUT, once the segment is removed, it is then sectioned into groupings. If they are splitting, it will take longer. (More about splitting in a second). Then comes doing sites. To save time some doctors do it at the time the techs are prepping the grafts. Others wait unitl they have a count. The Clinical staff then starts placing. One, two, three techs. The number will make a difference. And if they are new, this will take more time as they don't have the experience and can only place a few. (More about this in a second) Lastly, are you a bleeder? Tumeric, aspirin, blood thinners.....all can have an effect. If the grafts are just popping out, this will also consume time. With regards to splitting. While there are different head sizes, I am guessing no one has more than 30 cm donor area from side to side. If the doctor takes a 9mm strip, which most conservative doctors do to avoid a wide scar, the number of grafts that can typically be harvested is 2400-3000. When I start hearing 5000 and outrageous numbers, it could mean that splitting happened. (Take a 4 hair graft and make it into 4) one hair grafts). Otherwise, how do you get that many? Perhaps other can share their opinion. Techs. If you ask most practices they will swear up and down that their staff has lots of experience and have been there for years. This is not always the case. It would be interesting to find out what all of you have experienced with this. One without experience can have a huge impact on results.

To avoid swelling, avoid being too active after a procedure. Sleep at a 45 degree position for the first 3 days. If you do get some adema, it typically happens 3 days after the procedure but it is very short lived. About 1 day. You can ice the area, (which does not help), but it will help you mentally feel better. I think that doing a procedure on a Thursday or a Friday helps tremendously. This way you can take advantage of the weekend. Sutures are then removed 10-14 days post op. I would keep the hair as long as possible to help you cover the suture line in the back. Lastly, and most will not tell you this. Avoid weight lifting, particularly anything involving the neck, for 6-12 months. There is so much movement in that area that it can cause scars to widen.

I agree. It seems it gets more controversial by the day. Add the internet to the mix.......What haven't I read....Propecia grows a third arm, etc. I now been on it for more than 20 years. Understanding that there is more testosterone under the medication, I take it thinking I am going to be better off. So I do think there is a mental aspect to this. If I give someone an m&m and tell then they are going to have a side effect, guess what?, they probably will. Have I seen side effect with the med? Sure. But I can count them with my hand and I've been in the industry for 20 years. I had the opportunity to assist the ISHRS in Las Vegas last year and more negative info came up on Propecia. Like it always happens, in the near future, another report will come out negating all that was reported previously. Does this deter me from taking the med? NO. I will continue using it for the rest of my life. I value all the retention I have experienced. My approach has always been...use it for 2 weeks. If you do not experience a side effect it is unlikely you ever will. And if you do get started, continue and don't stop. You are making a commitment to stay on the med. Say you use for 10 years. Always retained. You may have even enhanced some of the native hair. You stop. You will then lose all that you would have lost. So, it is in your best interest to stay on the medication if you decide to move forward with it. Cost...The best cost I've seen so far is $14 for a 3 month supply through Costco online. No insurance needed. This is a cash price. Many take the 5 mg pill and split. The issue I have with that is that the pill is difficult to quarter. And, not every day you may be getting the same percentage of the medication. If you have to...OK. Better than not doing anything. If you do decide on medical therapy, you might as well consider adding the others as there is syngergism when used simultaneously.

What technique to use will depend on you and the hair styling choices you consider once there is more hair. The way I see it, if you are doing transplants is because you want to let the hair grow. If that's the case, FUT. It is less expensive, the grafts are more robust. But, most important, is the fact that you have access to the entire donor area. You may be able to do more FUT procedures until you run out of elasticity. You can then move to FUE, (and can place grafts on the scar to help camouflage). You seem to have kept a decent bridge, Seems the forelock is intact but you are starting to thin in the area right behind it, based on the photo you posted. Make sure the doctors blends grafts through that area to avoid an unnatural looking pattern should you go on and lose the native hair. It is imperative you get on medical therapy, (Propecia, Rogaine, laser and PRP). Avoid transplants to the crown until you are happy in the front and middle. If you look at the way most patients lose their hair, with a pattern similar to your own, you will note that the crown is the weakest area. That's because it is spherical unlike the front and top where all the hair grows forward and shingles. Unfortunately you did not post photos of the back, (donor area). Not sure how far down you are dipping. \ Eventually, depending on the outcome, you could consider SMP.

Dr Gabel charges $5 for FUT and $7 for FUE.

Are you considering FUT or FUE? Why? If you are fair complected? If you are, transplants may be more visible, or visible for a longer time. If you are tanned, this will tend to help. Typically, if you get too active after a procedure, you can experienc some adema. Gravity takes a hold of it and it goes down the face. I happens at about 3 days post op and lasts about a day. You can ice the area or massage down as it tends to drain towards the neck. So, relax for 7 days. Also, sleep at a 45 degree angle for the first few days. If your hair is lengthy, and you are doing FUT, most will not see the suture line in the back as the hair will fall down and cover. On the top, it will depend, again, on the length of hair you currently have. If long, you can comb it down to cover. If short, it will probably be a few weeks. Most groups will instruct the patient to wash the crusts 7 days post op. Depending on the color of the skin, as written above, the area may remain somehwat pinkish. This will eventually go away. With regards to pain, stay ahead of it. Don't wait until you are hurting to then take the meds. Talk to the Doctor. Most will also give you post op instructions in writing as to when you should take them. Lastly, wash as instructed. I've seen patients, despite the instructions given, go on for weeks without washing the crusts off. They feel they may damage the grafts. The grafts are under the skin. Most will agree that after 4-5 days you can not hurt them. But most are conservative in their approach and will suggest you wait 7 days. FUE is easier on patients as there is no segment removal. But to do this procedure, most will shave the donor area. Can you wear a cap at work? If not, just tell everyone what you are planning on doing. This typically takes care of that issue. Oh, if FUT, one more thing. Avoid weightlifting, (anything involving the neck), for 6-12 months post op. Because of the movement this can lead to scars widening. Hope this helps.

When I first started using Propecia I recall the Merck rep would come in, leave samples, etc. Learned a lot about the medication and truly believed, as I still do, that it can help most patients with retention of the native hair, particularly towards the back of the head. Takes a good year to see what it will do. When the patent expired, doctors started writing scripts for the 5mg pill and telling patients to get a pill splitter and take a 1/4. The pill, however, is difficult to 1/4 since it is small. The rep, to be able to continue selling the med, would say a number of things including, "when you cut into fourths, not all pieces are equal, so you may get more of the active ingredient one day and not so much the next." "The active component may be in one of the 4 sides and nothing on the other 3, that's why you should continue purchasing Propecia as a 1mg tablet." And all sorts of other comments...... Eventually all of that went away and the 1mg pill became availble...Best price that I've seen so far is $14 for a 3 month supply from Costo online. There are other names for the medication, like Finpecia, depending where they come from. I believe this comes from India? You can correct me if I am wrong. I am also aware that you can obtain it from Canadian pharmacies at a competitive cost. The problem, and many believe, that anything obtained abroad may not be equivalent to the one made in the States. Perhaps others can share their opinion on this. The internet then came into the picture. It is wonderful. Lots of info. Unfotunately there is also a lot of missinformation. How many times have I heard "I stopped the medication because I read on the internet about all possible side effects." I have visited with patients that never experienced side effects. Had been on the medication for 15 years. A year later they came with little to no native hair left. Said, "I stopped the meds because I read on the internet........" I asked him "who wrote it?" Did not have an answer. A shame. I recall going to national meetings early in my career. Every year, it seemed, we would hear concerning information regarding the medication. Years later a revision of the study would be issued. During the ISHRS convention in Las Vegas a couple of years ago, again, more concerning information regarding the medication came up.........I have now been on the med for about 20 years and will continue doing so. Do I care? NO. I was recently helping a doctor in a star-up and the same subject came up. His thesis was on Propecia and he is under the impression that in can lead to dementia...... Having said all that....Propecia, Rogaine, laser and PRP are the only modalities approved/released by the FDA for retention and enhancement of the native hair. The mechanism of aciton of each is totally different and thus, are synergistic when used simultaneously. They seem to help most, but there is a subset of patients that, despite the meds, they will go on and lose all their hair. Similarly, some will experience side effects. Most don't. So, talk to your PCP or a doctor in a hair restoration practice and get educated. If you do get started, keep a record. Did you experience a side effect? What was it? Talk to the doctor and decide if you should continue. Lastly, there are tons of products out there claimin a number of things. If you are using them and you feel they are helping, continue using them. Hope this helps.

Unfortunately everyone is doing their own thing. A shame. You would think, for the benefit of all patients, that doctors would convene and share their experiences and come to a consensus as to what works and what doesn't. The ASHRAE convention was a week ago, Would have been a great opportunity for pitch in. In find a lot of practices starting to offer the service, often in combination with the use of laser therapy. Seems most stop alltogether when they see little to no change. The main issue, in the view of most, is that doctors are not drawing enough blood, and suggest the patient do injections, (often without an anesthetic), every month for X amount of time. Other factors include the addition of a matrix like A-cell. Some do and some don't. When done correctly, however, it can do two things. It can help reverse the thinning and, for those doing PRP at the time of the procedure, it can help achieve results sooner. One thing to keep in mind, if effective, it's something you have to continue doing to keep the effect. How often? Ask the physician when you meet with him. There is plenty of documented information on the internet regarding the subject. I am curious, are you doing any modalities to help you with retention of the native hair?

I have met with a number of patients that DID NOT LISTEN when post op instructions were given to them. They went to the gym as soon as they could. In every instance the scar widened. Mind you, these were FUT cases. I have heard this from many physicians. And, just to add, in the 80's, doctors felt that the finest hair for hairline work came from the nape. Very soon they found out that, since the area is so close to the neck, scars widened.

Staples? Where are you getting the surgery done? Staples are a thing of the past. Typically prolene is used..It is one long suture line with knots at the end. Cut the knot and pull. There are several other techniques being used and a number of products. Some even use dissolvable sutures. These are normally removed 10-14 days post op. I would encourage you to speak with the doctor and find out why he prefers to use staples. You can go to a local clinic but it is likely they will charge you. Try always to return to the practice that did the work. Typically 7 days after the procedure you can resume normal activity. I would, however, avoid weight lifting, particularly all exercises involving neck movement for 6-12 months. This has a tendency to stretch scars.

Most believe and go on to explain that you are born with 100,000 hair. By the time you are a teenager you've lost 1/2 and still do not realize that hair loss is involved. So let's say that 50,000 hairs represents a full set of hair. Would you agree that someone with decent donor can harvest 5-7000 grafts. With an average of 2.2 hair per graft you are talking about 15000 hair. So how does the doctor take 15000 hairs and place them in such a way that gives you the 'look" of a full set of hair, equivalent to the 50,000? Artistry, knowledge, experience. I think it is smart for patients to style their hair from one side to the other. The hair then shingles and gives you the illusion of a fuller set of hair. Typically, during a consultation with the doctor the dialogue of concentrating more grafts towards the part-line always comes up. That will always be the weakest point and, as the hair grows, it will allow for more density on the other side. The problem, by working asymetric, is the fact that if you decide to change your hairstyle now you will have more density on one side than on the other.

I've seen this done multiple times. It will not cover the scar completely but it will help to camouflage. SMP seems to work fairly well. The only issue is that this needs to be done every 3-4 years depending how quickly it is metabolized. Excising the scar is also an option, but this will leave another scar and no guarantees that the scar will be smaller. This is a function of wound healing. Agree with Melvin, there is also no guarantee what the outcome will be putting grafts into scar tissue. If the scar is within acceptable parameters, perhaps the best thing to do is to keep the hair just above the scar a bit longer so it drops down and covers. You can fade from there down.

Years ago I recall a doctor suggesting to a female to use Rogaine/laser therapy a couple of months prior to the procedure. It seemed to minimize shock loss. Not sure if this had anything to do with the fact that the patient did have minimal shock but the hair did return along with the transplanted hair. Eventually the patient kept on using medical therapiesl to help with retention so I can not report on what would have happened if she had stopped the med treatments alltogether.

Good subject...It can be taken in a number of directions. Let's go with price for a second. So you start by surfing the internet....Find a number of clinics close to you. You start calling to check who has the best price. You find them! $1 per graft. Go to consultation. You are so excited about getting something done that you don't listen to anything, do not review photos, don't ask questions. You just want to move forward with the best price ever. STOP Do yourself a favor. Get educated. Review photos. Look at the list of doctors provided here. There are brilliant doctors out there that truly know what they are doing. Discuss all non-invasive options. When? When you are educated. When you can take a few days off. Vacation time? Christmas? Makes no difference. Summer? Sure but be careful to burn each of the incisions as you will then freckle permanently. Use a blocker and a cap and you should be fine.

Propecia, Rogaine, laser therapy and PRP are the only modalities approved/relased by the FDA for retention and enhancement of the native hair. There are tons of other products that seem to appear out of no-where - and that claim to provide some type of benefit. Like I tell patients, if something works for you, continue using . The mechanism of action of each of these it totally different and there is synergism when used together. With regards to the "mint," and there are plenty out there, they give the sensation of cleanliness. Not sure if they are contributing in any way. If they do help, continue using. With regards to the finasteride, many believe that if you never had a side effect, you never will. Never heard of PFS. Understanding that there is more testosterone with the med, I kind of concetrate on that when I take it. Been at it for more than 20 years and never had an issue. I am aware of one doctor that did a thesis on the subject. He seems to think that eventually this can have an affect on the mental capacity of patients, memory loss, dementia, etc. Guess I'll wait until I am older to confirm this. Anyone else has an opinion?

Nice work Doctor! Hopefully he is on medical therapy including LaserCap. He has a lot of native hair which is contributing to the overall density.

Unknown loss is truly a moot point, surgeons can test for miniaturisation in these areas. Its not as if this is any different for someone in their 30s either, hairloss is progressive by nature, this risk doesn't magically change because you're a 20 year old NW3 rather than a 30 year old NW3. There's also absolutely no evidence that balding younger means you're more likely to hit a higher norwood pattern. No matter the age of balding, there is no evidence that your chance of being NW6 or NW7 is higher. Donor management beyond this is again unrelated to age, and donor miniaturisation tests are common and simple. The often rapid speed of loss is the only issue that doesn't also concern those in their 30s, so chasing losses can be a problem, which makes meds almost a very worthwhile first consideration like you say. I don't think anyone heading to NW5+ in their twenties that refuses to take finasteride is mature enough or in a good position for surgery. I am not sure what you are talking about. "Unknown loss? I have not written anything about that. Your second sentence, "surgeons can test for miniaturization?" That is incorrect. There is plenty of equipment out there that can help magnify any area and see where the miniaturized hair is. I am not sure if I understand what you are trying to say. Seldom have I seen 18 YO that are class 7's. I am sure they are out there. For those guys, depending on the level of matureness, the doctor could possibly help them. I think there is a huge difference between a 20 YO and a 30 YO. Perhaps the patterns are the same, I'll give you that.....but the consultation would be different for each, particuarly because for most young guys, a parent will tend to be present. You bring up the point of donor miniaturization tests multiple times. Do you know the name of them? This is the first time I hear of this. Most young guys, at least the ones I've met with, come with their parents and it is they that typically will pay for the service. This brings up a good point to discuss. Guys at this stage blame the parents for their condition and the parents want to be helpful.

There are doctors out there that will not touch a patient until they are in their 30's. I find this a bit ridiculous, but I understand the basic concept. I believe that the main reason why doctos prefer not to move forward with a procedure on someone in their late teens and early twenties is because (and there are many exceptions), the doctor is unable to tell the pattern in which the patient is thinning. Say an 18 YO shows up and he is maturing his hairline. The current hairline is in the middle of his forehead and you can see the corners starting to recede. After pleading with the doctor, the procedure is done and the corners are filled in. It becomes evident, 6 years later, that the patient is going to be a class 7. The patient experiences rapid thinning and the only thing that remains are two "horns" the doctor placed years ago. There are stories like this out there, plenty of them. That's not to say that the doctor can, perhaps, discuss medical therapy with that 18 year old. I think the best way to approach this is to have the parents involved and discuss all options and possible outcomes. Educate everyone involved so they can decide. In my view starting someone at 18 on preventive meds for a year, let's say, is appropriate. Depending on the outcome, the patient can then decide if it is worth it for them to continue treatment. For transplants....it all depends on so many factors.

"people never seem to reccomend products that are actually known to work." Propecia, Rogaine, Laser and PRP are the only modalities approved/released by the FDA for retention and enhancement of the native hair. That's it, no more., (for now). There are lots of products out there that people swear by. What I tell them is, if they work for you, continue using them. Perhaps this is because there is Rogaine in them? Could also be a combination of the other modalities mentioned above; who knows. The comment you make is actually the reason why I decided to join the group. I find the moderator and others are knowledgeable and are trying to guide you. There is a lot of misinformation out there and it is our duty, being part of the industry, to share our knowledge with you. Hopefully it will help you avoid some of the same mistakes many of us made when researching the same information.

The fact that you are HIV should not be an issue as long as you document it at the time of the consultation. You will probably be given a form to fill out when you first arrive at the clinic. This will be reviewed by everyone including the Doctor and clinical staff. That being said, I would encourage you to start reviewing before and after photos of the practices you are considering. Visit with ones that you feel show the most natural results and schedule appointments. Do your homework and then make a decision.