LaserCap

Typically hair starts coming in at 4 months. The shaft of the hair is very, very fine.  At about 6 months you can start seeing a slight difference.  At a year is when you can see a matured result.  But there are cases in which results do not mature until about 18 mo. post op.  So ,the first thing to consider is to wait.  But....

I would schedule periodic appointments with the clinic that did the work.  That way they can not say that you never followed up to any of your scheduled appointments.  The second thing I would do is to keep taking photos, say every 3 months so you and the clinic can keep a record of what's happening. 

Are you doing any type of medical therapy?

I've met with the doctor personally. Great. Great staff as well. He can help you with transplants as well as medical therapies - including laser therapy.

I've seen plenty of cases of patients stopping the meds after 10+ years of use only to see all they retained slowly leave the building.

I think there is a lot of misunderstanding out there with regards to what the medication is intended to do.  The confusion is further enhanced by the fact most do not understand hair loss.  Not only that, people want to see a visual change.  If it looks like you have more, the med is working.  If you see no visual change, the med is doing nothing.

The med is not intended to regrow anything. Nothing out there regrows hair except for a hair transplant.

5 hours ago, Superteeth said:

So it's really hard to take a picture of the entire scar because my hair is long, but from feeling along the scar I can see that it is only that wide above my left ear. It's slightly raised all the way around but thin in width everywhere else. Not sure why it stretched/went hypertrophic where it did. 

I do weightlifting, but I didn't go straight into it after the procedure, I waited the 10 days suggested by the surgeon and then started out at half the weight I had been doing for all exercises and slowly worked my way back up, so I'm not sure why the scar would stretch so much.

That said, I don't much care about the scar, not enough to keep me from getting another transplant. Would I prefer no scar? Of course. But I know that's not possible with me planning for a third (and final) FUT surgery. But my laxity after two strip procedures is surprisingly good. Now, I didn't talk to the surgeon about the scar, partially because I don't think it'll change anything. I specifically chose not to go back to that surgeon (despite good reviews on him) because my last consultation with him planning the third surgery he suggested that I needed 2,000-2,500 grafts to thicken my hairline and fill in my temples. 

I KNOW for a fact that I don't need that many grafts to do that. Taking into consideration my hair characteristics and the areas we were discussing (being as small as they are) I don't believe I need more than 1,500 grafts. He specifically said he was trying to achieve 60 grafts/cm2 in my hairline, which is odd since my Asian ancestry means my hair isn't super-dense as it is, so to create the illusion of density at 50% original density I don't need 60 grafts/cm2. I don't understand why he's suggesting I use my limited donor hair to do that. Not to mention that when I stated I "had a budget" (hence part of the reason I was keeping it at 1,500 grafts, not just because it was really all I needed) he stated his advisor would call me with price details worked out and then I wasn't contacted further. It's like if I wasn't getting a big enough procedure for him he didn't want to waste time on me. So I moved on.

Ahhhh.  If you do this again, AVOID weightlifting for at least 6 months post op.  The longer the better, particularly anything that stretches the neck.  Leg presses, push ups are OK.  

It is likely you will not be getting many grafts if the scar is wide throughout.  Just get a revision and give it time to heal and gain elasticity.  And please, NO weightlifting.

15 minutes ago, TheRealist said:

You don’t count, you have had surgery, how could it be possible to judge what you have held onto? 

Never had any transplants in the crown.  That's all meds.

can you photo the entire scar? Does it go all the way around to the other side? It'll be interesting to see if it is wide throughout.

What caused the scar to widen? Did you go to the gym and started exercising right after the procedure? What was your sleeping position post op?  A number of things could have caused this.

So, you've had one procedure and have plenty of give. Hmmm.  Let's talk about wound physiology.  

Much of what doctors do during a procedure is routine for them  If the doctor is good, most times the scars will heal just fine.  But that's it.  Everything else is up to you and would physiology.  You heal how you heal.  So, if you did not go to the gym and started a physical regimen, and slept sitting up and not creating unnecessary tension, then you have to thread lightly.  If it happened before, it is likely it will happen again. Is it worth a try? Speak with the doctor and discuss all possibilities.  If he stitches under and above, for example, this could help minimize the tension.  Also, an elliptical cut may help taper the ends.  If not a good idea, consider SMP.

How many grafts was the procedure?

Have you visited with the doctor since? What have they said?

On 5/14/2020 at 5:31 AM, Pangloss said:

My transplants were done over 20 years ago. Now my side fringe has receded a bit and frontal hair seems to have thinned a bit.

Do you risk existing transplanted hairs by planting new hairs among them in the hairline area? Might there be either temporary or permanent shock loss? Do you gain more than you might lose?

Can the surgeon be sure not to accidentally damage the existing follicles when he makes the new slits?

Thanks for any opinions.

The fact you had transplants 20 years ago, (and are still there), should tell you how sturdy they are.  (If permanent in the donor area, they'll be permanent wherever they're placed.  The follicle, for some reason, behaves as if it was still part of the donor).

During an intervention, the doctor is working with magnification and can clearly work in and around the older work, (and around the native hair as well). He may inadvertently give you a hair cut as the instrument he's using is very sharp).  Seems like shock loss but it isn't.  And, if for some unknown reason there is shock loss of the native hair, that hair will typically return 3-4 month later - along with the newly transplanted hair.

Have a conversation with the doctor prior to the procedure and voice your concerns.  Ask if a full panel is necessary prior to the procedure, particularly if there's been a change in your medical condition. (A self immune system could have an effect, for example).

Lastly, and to ease your concerns, have the doctor scope the area.  You'll be able to confirm there is typically a lot of space in between follicles.

It typically takes a few weeks to confirm retention.  It takes a full year to see if you'll experience enhancement.  Rather than speculating, just give it a full year.  Take photos every 3-4 months and you'll have your answer.

There are a couple of points which are important to keep in mind.  All hair in your head will fall at different intervals throughout your life.  (The follicle gets tired of producing hair and it will take a vacation.  After a resting period, the hair will return.  This is normal shedding). Hair loss is different.

When the caliber of the hair becomes thinner and thinner - until eventually disappears - we call this miniaturization.  That's true hair loss.

Seems you are on the right track...

Your hair is just a bit too short and would encourage you to let it grow and re-post.

The word "patchy" is tricky, for a lack of a better word - in the world of hair restoration.  Patchy typically means a bare area with small "islands" of hair throughout and it's typically caused by a self immune system.  Yours does not look like that.  It almost seems as if you are dipping in the donor which means there is a pattern and it may be progressing.  My first inclination is to ask you if you are doing any type of medical therapy to help with retention and enhancement of the native hair. So, are you doing anything?

Have you visited with a doctor or a dermatologist?  If not, I would encourage you to do so.  Depending on where the eczema is, if you ever have a hair transplant, it can "travel" along with the transplanted hair. (My son suffers from the same condition and I know how hard it is to get it under control).

Thanks for the photos. At least a 5 but progressing fast.  Get on medical therapy and give it a year. Take photos every 4 months just to keep track.  You have a lot of native hair and, if you can not only keep it but also experience some enhancement, it will guide you to make a decision. At this time I would NOT move forward with a transplant procedure.

First, take a better set of photos.  Some are out of focus, others are so dark it is difficult to ascertain.  

2nd, allow your hair to grow a bit - which should not be difficult - with all that's going on.

The third issue has to do with your hair color.  Black hair - light scalp, allows for the greatest contrast and makes things look worse than they're truly are.  (An agent like Toppik and even SMP could help you minimize the issue).

It is difficult to see if you're experiencing shedding or loss.  Take photos of your entire head  but have someone do them for you.

Are you doing any medical therapy to help you with retention?

You mentioned stress.  Are you stressed about something? While stress is not the cause, it can prompt the loss sooner. 

20 hours ago, HTHope said:

Are you on anything else @LaserCap?

LaserCap

Like Damifino, I started using Propecia in 1999. Never experienced side effects other than hair retention.  I honestly believe I would not have what I have today had it not been for both, the combination of transplants and medical therapy. My belief and approach has never wavered.  There is more testosterone with the meds than without so I''ll perform better.  

My grandfather and other family members are class 20. I've remained a 5 but with hair.

It will depend.  If you are fair-skinned, it will take a bit longer because of the contrast.  Even after 3 months I've seen it linger.  Most patients, however, 4-6 weeks post op.  One thing to remember, you can put some foundation after 10 days or just let it be.  

10-14 days post op, for the sake of being ultra conservative, you can do whatever you want.  No restrictions.  Not sure what you mean by recovery...by that time you've recovered.  Will it help with the "timing" of the grafts? I don't think so.  It is typically at 3-4 months when the grafted hair begins to grow....

13 hours ago, LonelyGraft said:

Wrong!

 

scientists at Merck knew damn well that finasteride helped with propecia as well as male pattern baldness. They sent their doctors and scientists to the Dominican Republic to study a group of men know as “psuedohermaphrodites” who had a 5ar deficiency. The scientists noted these men had virtually no mpb and no prostate issues while remaining otherwise healthy. They developed finasteride to mimick these people’s hormonal profile as best possible.

 

they released proscar first in 1992 and juiced the profits for a good 6-7 years while the fda studies for propecia were process. Hair loss treatment was not an accidental outcome of treating prostate issues with finasteride

"Finasteride helped with Propecia".....you seem to be well informed.

Let's look at this from a historical perspective.  Proscar, the parent medication, is used to help with prostate issues.  Patients were returning back to their doctors with more hair.  So, Merck started doing tests and found, out of the 5mg tab, 1 mg would allow for the retention of native hair.  So, Finasteride as a 1 mg tab came into the market.  Once the patent expired, Merck suggested quartering the 5mg tab.  Cost wise this is great - the issue however, since the tab is not pre-scored, some days you get more of the medication and some less.  (Back then we also discussed side effects, less than 1%. By taking the 5mg tab, you are now running the risk of experiencing the side effect by 5.  Recently, however, this number seems to be increasing and many of the members here can jump in and give you their opinion on the subject).

Finasteride is now available as 1mg.  

Caution....The issue I've always had with patients is the fact we are all very visual.  A visual improvement typically means we grew more hair.  Less hair, we lost.  This is not so.

There are two types of loss.  The type you see and the type you don't.  Hair you see on the floor, tub, sink and pillow case is normal. The follicle goes into a resting phase and sheds the hair.  After a dormant/resting period the hair will return.  This will happen to every hair on your head at different intervals. Hair loss is different. 

For patients experiencing loss, the easiest way to understand hair loss is to inspect their front hairline, particularly the temporal areas, (corners).  You'll note some very robust hair and others just a bit finer.  Some are so thin you can hardly see them.  This miniaturization process continues until the hair dissipates and withers away.  Once gone, the hair will not return. 

To complicate matters, since there is no more patents, the medication is readily available in the US and abroad. Unfortunately we just don't know how much of the active medication is being used.  I have seen cases where there was non and it had a huge effect on the patient. So I think staying consistent and purchasing from a reliable source plays into this.

Lastly, there are patients the medication will do nothing for.  If after a number of weeks you are still losing hair, get off of it because it is not working.

With millions and millions of people in this Earth, it is likely you'll come across different results, different types of side effects...Just too many variables at play..keep an open mind. The global idea however is, if it works for you, it will work for as long as you take the medication. And, if you did not experience a side effect, you never will.  The reverse is also true. Visit with your doctor, discuss and decide if it is for you.  This is a long term med.  Getting on and off is just a waste of time and money.  Advise from someone that's been on the med for 30+ years, (that's me). 

It seems the grafts were placed diffusely throughout instead of concentrating them.  You just need a lot more to cover the trees on the forest.  The first thing I would do is have a couple of consultations, particularly to check your elasticity. If you are like a Shar Pei, then all they have to do is re-excise the original scar and transplant whatever number of grafts they're able to harvest.  Given the scar you have, I doubt they'll get much.  The goal, as this time, is to help reduce the scar you have.  This will ultimately allow you to harvest more grafts.

If you elasticity, FUE.  Concentrate the grafts in the most prominent position...the front.  I would then consider SMP and allow your hair to grow a little more to help camouflage the scar.

I'm sorry you're going through this.

What part of the Country are you in?

Some years ago I was told they contain Rogaine and thus the claim.

What exactly are you trying to accomplish? Have you done a recent consultation with a doctor to estimate the number of grafts you'll need?

Where do you live? Apparently you do not mind traveling.

I'm guessing you took the same approach on your first procedure and that gave you less than optimal results.  Why do you thing this time is going to be different?  I would rather you look at photos of cases similar to your own and then choose the doctor.  You can always call them and discuss your situation.  If you are flexible with your schedule, they may help you with the cost.

It's always been my opinion, moving forward based on cost alone is never a good thing.

I'll share my approach with you given I've been on the medication for more than 20 years.  It's always been my understanding there is more testosterone under the medication than without.  So I actually think I am going to perform better. I've experienced retention.  I would not have the hair I have had it not been for the med.

34 minutes ago, Melvin-Moderator said:

I went to a surgeon who wasn't very good, he pretty much gave me a hairline that started in my midscalp. The results didn't look good, and left a lot to be desired. The next procedure with Dr. Diep, is when I saw an enormous change in my appearance. I did my crown in 2016, but I also reinforced the midscalp. I had about 600-700 grafts in the crown and that was also Diep. The crown is bare, and I use concealer to make it look good, for full transparency here is what my crown looks like without concealer, and obviously the density is an illusion. You can see the true density when I part it down the middle. I want to give you realistic expectations. If you think hair transplants are gonna solve all your problems they won't. 

 

Go to the mall, whenever it is OK to do so.....look at people and their patterns.  Very quickly you are going to find that most people with similar patterns tend to keep hair on the very front, thinner in the mid scalp and a lot less hair in the crown.  In addition, when interacting with others, it is the front they see.  So, by concentrating a bit more density in the front, you are accomplishing a number of things but still remain pattern appropriate.

2000-3000 grafts can make a huge difference - it all depends on the plan and the placement.  If you decide to put them throughout the entire pattern, you will enjoy a bit more density everywhere but will still look thin particularly if the hair is very dark. It will also depend on how much native hair you start out with.

But, if these are concentrated towards the front and you work up to the mid-scalp, not only will you have a much fuller look, you'll be pattern appropriate.

As far as being age appropriate, that will depend on hairline design.

Many factors go into this. I would encourage you to view photos of cases similar to your own.  Look for the type of density the doctor can achieve in a single procedure.  

Lastly, medical therapy.  Whatever native hair you have, it is making a difference.  Why not try to keep it and perhaps enhance it? Not only that...you need to prevent your pattern from expanding.

You are being a bit too gingerly.  Put more effort into it.  After 15 days you will not hurt anything.  Let it soak in warm water for a while and scrub away with the tips of your fingers.  If nothing works go to the clinic, they can do it for you.

Work, walk, read, sleep and watch the news from time to time.