LaserCap

All you are doing with SMP is minimizing the contrast between the color of the hair and the color of the scalp. I realize that most groups doing this service discuss/show before and after photos of someone completely shaved. I will tell you that women, particularly, will not shave their heads. They tend to thin out right behind the front. Unfortunately they tend to be global thinners and not very good candidates for transplatns. There are exceptions to this. With the comments you've made about how you look with a bit longer hair, I would give that a try and see how much of the donor you can cover. 2nd, adding other modalities to the mix might not be a good idea at this point.

Most in the industry want to wait on most young guys to have an idea what the pattern is going to be. I would wait until they are 18? Then visit with your PCP or a Doctor in a Hair restoration practice. It is likely they will be introduced to all medical therapies, (which, in my opinion), is the right thing to do. Either the meds will work or they won't. There are options either way. Right now, understanding how complicated hereditary conditions are, I would not worry about it.

SPEX, did you experience any side effects with Dutesteride?

A few things about your case. You are demarcating down on the donor area. It is likely that finateride is helping. Pls cotinue. I would consider adding Rogaine, Laser and PRP. These work in different ways and are thus, synergistic when used simultaneously. The second thing I would encourage you to do is to let your hair grow longer and then revisit with the doctor(s). I know of some that would not touch you at this particular time because you can see right through the native hair and see scalp. They may be under the impression that you are experiencing global thinning. You have a big pattern. 3000 placed diffusely through the front and top as you've drawn and discussed with others so far will give you a little bit more density but not "full" looking density. My suggestion would be to concentrate the 3000 grafts towards the front and just blend a bit to the middle area. (If youi look at the way advanced patterns lose hair, you'll notice that the majority keep the most density in the front, medium density in the middle and emptier in the back. You could consider SMP down the road for the crown or for the entire head depending on the outome). My last comment, and it's a combination of observation and the comments you've made. If you are planning on keeping the hair short, why consider transplants? Why not SMP? To me, doing transplants means that you care considering growing the hair out. So, perhaps start with SMP and see if you are satisfied. You can always add grafts depending on the outome of the medical therapy, (if you decide to take that route) which typicall takes a full year to truly assess results. If the meds give you great results, you may have other options at that point. If not too successful, the only thing you did was waste a year. With regards to Dutesteride, I learned early that they decided no to go through trials because their outcome was not any better than Propecia. Propecia is 1 mg while Dutesteride is 5 mg. While I undestand the concept of splitting the pill and all of that, why take the risk of potentially more side effects if it has been documented that the results are not any better. It seems, by the photo you have provided, that you are maintaining the hair in the perimeter because of the medication. Who put you on that? Did they take photos at the time to keep track? If so, go back to them and review the photos and see what has happened since then. This should give you an idea of how successful the medication has been for you.

You want to be careful the first few days post op. After 7 days you can typically return to normal activity. If it's been 4 weeks I would honestly don't worry about it. (Plus there is nothing you can do at this time so why worry about it). To feel better I would take photos of the area. Wait 6 months and take another set. Do the same at 12 months. If you notice an empty area, bring it up to the Doctor. Most doctors will guarantee the grafts. I am certain they will replace a non growing graft at no cost to you.

I've read all the posts with great interest given your pattern. You are still young. And, if you've shown the propensity to lose, you will continue losing. It seems, by the photo you took of the back, that you are still progressing, particularly the perimeter. It also seems as if you have a lot of miniaturized hair that has not left the buidling. I would encourage you to consider all medical modalities, (Propecia, Rogaine, laser and PRP) for a period of time. (Say a year). If you respond well, you may end up having more options. Considering your donor, which based on the photos you have provided seems very limited, be judicious with your grafts. Do not, I repeat....Do not place them diffusely throughout the whole pattern. I have some homework for you.....Go to the mall and start looking at people and how they typically lose hair. You will notice, in an advanced pattern, the majority tend to keep a forelock. The have a bit of density right behind the front, and are empty in the back. Mimicking mother nature will yield the most natural results. With regards to doctors that practice abroad.....regardless of country........and that also applies to doctors in the USA, the most recent trend is to attract patients by allowing a very low fee. This not only devalues the practice but it has an effect on everyone in the industry. This is augmented 12 months later when the results are less than satisfactory. My suggestion....Look at post of photos of results. Tons of them if you can. And save your money. When you are ready then move forward here or abroad.

I've worked with a great number of surgeons these past 25 years. Some are brilliant with absolutely no bedside manners. Others would put grafts on a broomstick if they could with amazing bedside manners. Check results, naturalness and the density they typically achieve with one procedure. I noticed Dr. B Arocha is listed as one of the recommended doctors on the site. Hundreds of photos. If you go to the bottom of the page you will find interactive videos. I tend to think that most patients call the practice that is local to them. Please do lots of research before moving forward.

Costco on-line pharmacy. $14 for a 3 month supply. This is a cash price and no insurance. This is a 1mg. I never asked about the 5mg but it would be interesting to find out what they charge.

Very tedious work and a lot more expensive as you have to go in and around the native hair. Takes a long time and, opinion wise, it's just not worth it. if having the donor area shaved is an issue, take a vacation. When you return to work you can just say that you are trying a new hair style, (which is very becoming now-a-days. Not only will you pay less, things will go a lot smoother during the intervention.

From a consultant's perspective I'll give you my 5 cents. Propecia, Rogaine, laser and PRP are the only modalities approved/released by the FDA for retention and enhancement of native hair. There are a number of other things people swear by. What I tell them is, if they work for you, continue using them. Fortunately the mechanism of action of each of this is totally different and thus, there is synergism when used simultaneously. But, we are all human and we are all different. What may work for you may not work for someone else and vise-versa. With regards to Rogaine, many believe it is a blood pressure medication and there is truly no notion as to how it exactly works. Apparently patients using it initially were coming back with more hair during their post of visit. Honestly, this is the first time I hear of anyone having an ED issue from it. Something else I learned was that if you use it twice a day, you are getting 100% of the medication. If you use it once a day, you are getting 90%. Perhaps the medical community can voice their opinion and knowledge. I am aware of cases where the patient was told that by taking an m&m hey would have side effects. Guess what? Perhaps others can share their opinion. Lastly, the internet. How many patients I've heard say, "I read it on the internet," not even knowing who wrote the article. Many patients have eliminated medical therapy all together because of this and have gone on to lose the native hair. A couple of suggestions. I would visit with your PCP or Doctor at a hair restoration practice. Someone with experience. Perhaps the idea of doing this once a day and perhaps every other day would not be a bad idea. Additionally, I would discuss all other modalities available. The alternative is to do nothing and continue losing hair. Lastly, it would be nice if we could see your photos. Not sure if you have a full set of hair, if you have diffused thinning, or if the loss is only in the front. All of these things can have an effect on how the conversation goes from here.

You call around to find out the cost of a procedure....you get the price and hang up. Not exactly what you wanted to hear. Go on to the next one....Same outcome. You are finally told that the cost is $1 per graft and get all excited. Has this happened to you? It is sad what is happening in the hair transplant industry. Competition is fierce. Many, many practitioners are getting into the industry with no training, knowledge or experience. Ultimately the patient gets a bad outcome, the donor area is butchered, and the negativity spreads to the rest of the industry. Who do you trust? For the patient....Please do your research. Look at before and after photos. Results speak for themselves. For the doctors. If you don't know what you are doing....Get trained! There are a number of brilliant doctors out there that are willing to work with you like Dr. B. Arocha. Not only exceptional work but he can achieve density in a single procedure. Mind you,, this is all graft dependent. And like him, there are others that truly know what they're doing. Do your research! How many times have I heard "pioneer." The issue I've always had with this is the fact that if you've been doing it wrong for your entire career, you are still doing it wrong. Perhaps a refresher is not a bad idea. What is your opinion? Good luck with your search.

There is a subset of patients that seem to share the same experience. There are a few things to consider. Propecia/Rogaine/Laser/PRP are the only modalities approved/released by the FDA for retention and enhancement of the native hair. The mechanism of action of each of these is totally different and thus, are synergistic when used together. My first suggestion is to try all of them as indicated. Every year, it seems, more and more negative information regarding some of these modalities is published only to learn months later that some, if not all, was incorrect because of this or that. I find it laughable when patients say, "I read it on the internet." Who wrote it? Who knows. For some patients these may help slow down the loss. If you are still losing despite the meds, perhaps you are in that subset of patients that the meds just do not work. If that's the case - shave. I would NOT proceed with a transplant procedure. I would wait. Increasing the dosage of Propecia......not sure about that. The first thing that comes to mind is the fact that there are known side effects with the medication. By increasing the dosage, you are also increasing the percentage of side effects. I would consult with you PCP or a Doctor in a Hair Restoration practice before going that route.

Nice work, appropriate discussion. Hopefully the patient is doing some type of medical regimen to help him with retention and enhancement of the native hair.

I can understand, given the density you seem to have throughout your head, that you want to match that same density in the hairline and the area right behind it. You seem to be very thin in that area and, perhaps, adding other medical modalities to the mix, might not be a bad idea. Aside of the number of grafts you are considering, I would do some research on PRP at the time of the procedure. This will help reverse some of the thinning you are experiencing and may bring the grafts in sooner. Most of us have black hair and light scalp. That makes the see-through more apparent. I do agree with you that this should be the focal point and concentrate the grafts in that area. It is unlikely you will be shocking anything as there is little to nothing there. I think it is smart to consider FUT first because of the way you style your hair. You may be able to do that type procedure many times until you run out of elasticity. You could then go to FUE and really maximize the donor, if need be, (and could actually put grafts on to the scar to camouflage). Because the front is such a high impact area, (it is the first area people see when they interact with you), consider at least 2 good size procedures. How many you end up doing will depend on your density goals. You did say something about "repair." Are you thinking that the scar may become an issue down the road? How you scar has to do more with wound physiology and the Doctor typically has little to do with that. I am sure he will do all he can to keep it at a minimum. But, once you cut the skin, it will heal with a scar. if you re-excise down the road, you will replace it with a new one. If later you decide to do a second procedure, most will harvest from the same place to only leave you with one scar. If this ever becomes an issue you can then do some FUE.

Sure I disagree, up to a point based on the type of hair you seem to have. At the time of the consultation you can ask the Doctor what density you have in the donor area. The best way address the type of cut, when you go to the hair stylist ask him/her to cut it as short as possible without seeing the scar (in the area where the scar is). You can fade down from there. If you are in the military, OK, I agree. But the problem that most have with FUE is the fact that typically a .9mm or larger is used to do the extraction. This also leaves a scar, (not linear mind you). The scar is honeycomb looking. So, it does not leave a linear scar, but it does leave "something." This, eventually, will not allow you to shave to a zero as it will look like a barren area. The argument could then be, the Doctor can use a .7mm punch. That leaves something so minute that you can't see it. The problem is that the "instrument" for lack of a better description, is so small that the graft does not have much meat to it. An FUT graft is much more robust. It would be interesting to see what others have to say on the subject. You brought up the subject of hairline work. In the old days, (late 80's, early 90's), the thought was that the finer hair came from the nape. The problem is that it was so close to the neck, (a lot of movement), that scars widened. So then they started taking the hair from behind the ear. Since so many are now coming into the industry with little to no knowledge, that one hair follicular unit is being harvested from the middle of the back. That hair is much coarser that the "fine" hair you typically see in that area. My suggestion, view as many post op photos as you can. A practice that can only show you a handful of photos, in my opinion, is trouble. Doctors have to be proud of their work and show it.

Propecia, Rogaine, PRP and laser are the only modalities approved/released by the FDA for retention and enhancement of the native hair. That being said, let's clarify that hair loss is. The hair you see in the comb, shower, brush, is normal. Most agree that 100 hairs a day is normal. Think that the follicle is tired of producing and takes a vacation. That hair typically returns. Hair loss has more to do with miniaturized hair that eventually seems not to grow any more and eventually disappears. Perhaps you are going through a shedding period? All these modalities work in different ways and are thus, synergistic. Most seem to be most effective towards the back. That is not to say, however, that they will not work for you. I would try them for 1 year and, based on the results, you can then decide if it's something you wish to continue. Lastly, please scope the area. If you are enjoying a fairly full set of hair and use a laser, for example, you will be sadly disappointed. Most modalities are used to help you retain and, perhaps, enhance the native hair. If you have a very thin hair, (under a full set of hair), you would not be able to tell if that one hair remained or improved.

Visit with a derm-pathologist. Find the reason. If the donor area is affected, this can all transfer to the top. Once the condition is not active, you can move forward. You seem to have diffused thinning throughout. Be judicious with your grafts when and if you move forward. You can never make a mistake by placing grafts towards the front. They will serve to frame your face. If you are going to be thinner, let it be in the crown. Because of the whirl we all have, being thin in that area is natural. You seem to have a lot of miniaturized hair. Medical therapies should be a priority if your goal is to keep as much hair as you can. And do it while you have it. Once gone, unlikely it will return.

How you approach the number of grafts and naturalness will depend on a number of factors. The first being what are your goals and expectations. Second is your age. Most young guys still reminisce about the hairline they used to have when they were 18. The problem with this is the fact that 18 is long gone and adulthood is coming. So the plan should be to create something that is going to look natural, age appropriate wise and pattern appropriate as well. Based on the photo you have provided, 1600 may add density to what you have. But if your plan to to bring down your corners the question then is, how much. And, if you are planning on matching the density you seem to have elsewhere, this could take multiple procedures. I am curious, given the length of your hair, why not FUT?

With regards to your comment, I tend to agree. The problem in my view is the fact that the entire medical community, (hair related), has not come together to discuss what and what does not work. I am aware of many out there doing PRP with little to no result. Others, however, are yielding great results. When you consider how most practices approach hair restoration, (the belief that grafts compete for blood supply and that a separation in between grafts is required for survival), the question becomes how many procedures will be needed to allow for a full set of hair. Without getting into patterns, patient expectation and all that is provided during a consultation, I think we can all agree that full density can not be accomplished in one procedure. When you start doing the math, purchasing a laser for $700-$1500, when appropriate, is a viable alternative.

Let' take it a step at a time. You are young. If you've shown the propensity to lose, you will continue losing. That's a fact. You have a great deal of native hair but it seems you have diffused thinning throughout. You are thinning into an advanced pattern. I would imagine your goal is to have as much hair as you can. It is imperative that you save all you can. Medical therapy should be your first consideration. Propecia, Rogaine, laser and PRP are the only modalities approved/released by the FDA for retention and enhancement of the native hair. Why not give these a chance and see what they do. Most believe it takes a full year to see what the meds are going to do. So you could wait a year and then do a transplant procedure. But that takes a whole other year to see the full result. This is the reason why many patients, provided they are educated correctly, will do a combination of medical therapy and transplants. Now, where to put the transplants? When you are interacting with others, that do you see? The front. Do some homework. Look at the way people lose hair. Particularly when they have an advanced pattern. Notice how most keep hair in the front.and they thin the crown. Mimic mother nature for the most natural result. Lastly, be judicious with your grafts. The donor is finite. 2500 grafts is not a lot of grafts but can have a very positive impact if concentrated in an area. Placing them diffusely throughout the entire pattern is not only a mistake, it is irresponsible.