LordBaldwin

Thanks, Melvin. I appreciate the feedback.

No problem, and thank you. Just out of curiosity, you don't think using the two DHT inhibitors together is a bit redundant? My impression was that dutasteride does the same thing as fin, but more effectively. You're really lucky not to have any sides and I'm glad to hear it. Yeah, I generally agree with you that the use of fin would've likely improved my result somewhat. Back when I did use it, it definitely helped "hold the line," and my hair only degraded very gradually back then as a result. Here's how I generally look at finasteride and other similar medications: 1) They do work, but not forever. I'd be taking them for years, but they'd only slow the inevitable deterioration (and I'd ultimately end up in the same place I would've been anyway about 10 years down the line). I suppose you could make a reasonable counterargument that a hair transplant is not all that different. However, a transplant has much more dramatic and noticeable results over a much shorter period of time, lasts for much longer (since you're using follicles from a DHT-resistant part of your scalp for the transplant), and the impacts to the body from the surgery are well understood (long term complications are basically not a factor). 2) We don't fully understand the long term safety of these medications, especially for people who do experience sides. I understand that Proscar has been prescribed for decades for enlarged prostates, but I'm really uncomfortable messing with my hormones over such long periods (especially given my side effects). 3) One has to consider the amount of money being spent to buy these medications continuously, for years. Given the diminishing effectiveness over time, the cost-to-benefit ratio shifts toward the wasteful end of the spectrum in the long term. 4) It's really hard to measure effectiveness of the drug unless you have an identical twin who's not using it, or unless you're one of the minority of lucky people who actually sees regrowth while taking fin (rather than merely a slowing of degradation). To be clear, I'm not necessarily advocating against other people here taking a DHT inhibitor -- each person has his own unique situation and obviously should make the choice for himself. From what I've seen, I think most people in this community use it.

I can answer this directly. I do not use finasteride, and have not used it since my procedure, because I had significant side effects when I used it years ago (between 2010 and 2014). I did use Minoxidil for a time...can't remember the specific time frame, offhand. I think it was for a few months starting around 6 months or so. That said, minoxidil has appeared to be pretty ineffective for me; I've never noticed a difference when using it.

Thanks! So, to answer your first question, the changes resulting from the procedure have made me feel a lot less insecure about my looks. I was a relatively late bloomer as a kid and thus didn't have a lot of time in my "prime," so to speak... so when I realized I was balding at 21 years old, I was pretty devastated and thought about it almost every day for years. I resented having my good looks, only recently obtained, suddenly stripped away from me again so abruptly. Every time I'd see myself in the bathroom mirror, or in a photo from vacation or with friends, the appearance of my hair would almost always cross my mind. With respect to dating, it's difficult to say because I met my girlfriend (whom I'm still dating) a couple of years before my procedure. During the period when I was still dating regularly (up until late 2015), the appearance of the hair hadn't degraded enough to really hurt my chances (it only started getting really bad in 2017). I haven't really asked for opinions from unbiased female sources since the surgery. That said, I know with certainty that I look better. My friends (who are mostly dudes) and my girlfriend have all commented on the improvement, as has my family. To be honest, most people don't make unsolicited comments about this kind of thing; most of them only said something when I asked them for their thoughts.

18.5 Months Post-Op: Final Update (Probably) Well, I've finally hit the 18-month mark (a little more, in fact) following my surgery and am ready to submit my final thoughts and photos. First, I'll list a few caveats to keep in mind when looking at these pictures: 1) I've been cutting my own hair for the last few months due to COVID quarantine, so the general appearance of my hair may or may not be all that flattering. 2) As stated in the beginning of the thread, my hair caliber is relatively fine (55 microns). 3) It's extremely hot and humid outside (about 95 degrees F), so sweaty, frizzy hair in the outdoor images was unavoidable. 4) Only the frontal portion of my head received transplants -- not the crown or mid-scalp. As a reminder, here are some images of what my head looked like before my transplant: Here are current images, with natural light, in a semi-outdoor (i.e., back patio) environment: Here are some images taken indoors, with natural light: Here are some images from outdoors: Here are pictures from indoors, with flash: Summary of Thoughts: Customer Support/Experience: My position concerning my overall experience with the clinic hasn't really changed since my procedure. I've been going about my life lately (to the extent that one can do so during quarantine) and thus haven't had many communications with the clinic in recent months, with the exception of sending in my 18 month images earlier today. I'm interested to hear what they have to say. Results: Shape/hairline: My face is now nicely framed and the size of my forehead no longer detracts from my overall appearance. In this respect, mission accomplished. Grade: 10/10 Donor Appearance/Scarring: The donor areas appear to have been harvested pretty effectively and efficiently. I can't see any visible scars and the density of the donor area is still good, though I probably would've harvested slightly fewer grafts from the parietal area of the scalp and more from the occipital region (the occipital area will likely need to be the source of most donor hair for any future operations). Grade: 9/10 Density: The density is...ok (i.e., within an acceptable range for the time being). The transplanted hair generally looks pretty good while indoors, under normal lighting conditions, etc., but seems somewhat less impressive when wet or under direct sunlight. This isn't all that surprising or unexpected, especially for a first attempt and with relatively fine hair like I have, but I think I'll likely need a touch-up of about 1000 grafts or so in the front, at some point in the future, in order to achieve the ideal level of density. Grade: 6.5/10 (I'm weighting this and donor appearance more heavily than the shape of the hairline, given that I had a lot of input on the hairline design; density and donor appearance are probably better reflections of workmanship in my case). Overall Score: ~8.1/10 Conclusions: I'm generally satisfied with my result -- as you can see from the images above, the changes from before surgery up until now have been dramatic and I no longer feel depressed and full of dread every time I look in the mirror. I've met my primary objective of setting back the clock on my hair to approximately 2014 (the last point at which the hair was aesthetically acceptable). The density of the transplanted area still seems a bit lackluster under certain conditions, but it's tolerable for the time being. In the next few years, I'm likely to get another transplant to fill in the crown and mid-scalp area (which had not been touched this last time around); when I do this, I'll likely ask the surgeon to reinforce the front a bit as well. ASMED had estimated that I'd need about 2000 more grafts to fill in the crown and mid-scalp. If I use another 1000 to touch up the frontal area, I should theoretically have about 2000 grafts left in "reserve," though I plan to get a few other opinions on this. As previously stated, I did have a positive experience during my visit to ASMED in December 2018. That said, I'm still going to consider multiple options when planning a follow-up surgery in the next few years, as the conditions of my life, the state of my hair, and my financial situation will likely change over time.

So I think I can speak for all of us here when I say we know how you feel. I started balding at 20 and it was f***ing terrible, so I totally get what you're going through. Hair loss is a slow, torturous, and emotionally exhausting experience that takes a massive toll on confidence as your appearance seems to erode before your eyes. I'm sorry to hear that you're going through this as well. Now, concerning what you mentioned above: - If you're not experiencing any negative side effects from finasteride, you may as well stay on it. If you stop, you'll definitely lose a lot of hair. For me, finasteride did slow the loss substantially, but I had to stop because of side effects; when I did end up stopping, I experienced significant catch-up loss. Now, I also think it's important to mention that finasteride will not work forever; as you indicated, it loses effectiveness to some extent over time, though the time span over which it holds the line varies from person to person. In the end, short of going nuclear (i.e., hair transplant), everyone ultimately loses this battle. - There's also really no downside to continuing your use of minoxidil (and ketoconazole shampoo if you weren't using it already). They're generally a lot less effective than finasteride, but they have very low side effect profiles. - Talking to hair loss surgeons is a very good idea, in my opinion. You can get a sense now of the level of work that would need to be done to restore your hair enough to make you feel more comfortable, and you can start saving money and weighing various factors that will likely play a role in your final decision (including logistics). I finally pulled the trigger on an FUE procedure at the end of 2018, after nearly 10 years of hair loss, and I don't regret it one bit. - Some people (and doctors) argue that one should wait until they're a bit older than you are (30+) before deciding to move forward with a hair transplant. For people with very early stage hair loss (like NW2), who don't yet know how their pattern will develop, I'd agree. However, if your hair loss is already sufficiently advanced and you think you know how it'll ultimately play out, you may as well get ahead of it now. One factor you should probably consider is the loss of quality of life in your youth... honestly, we really shouldn't have to worry about things like this in our 20s. We should be in our prime, enjoying the hell out of life. If you feel like hair loss is hindering your ability to do this, then waiting may not be in your best interest.

Thanks, Melvin. Appreciated. Truthfully, I can't even remember what it was like to have full density...it was so long ago. My goal going in was to dial back the clock at least 6 years (to the point before my forehead really began to expand) and reestablish proper framing of my face... this goal was achieved. I no longer feel that sense of panic when I look in the mirror, and that's really what I cared about most.

15 Months (+8 days) Here are my 15 month and 8 day photos. Apologies for the delay, but, to be honest, I wasn't sure if I was going to post again; I've been feeling pretty good about my results lately and didn't really want to jeopardize that by subjecting myself to possible negativity. That being said, I prefer to finish what I start and didn't want to leave people hanging. Also, I thought it was really important to show proof that slow and steady improvement, even past the 12 month mark, is plausible (this is how it has worked for me). I feel like I've seen some continued thickening, even now, at this late stage. While the result still isn't perfect (especially by the standards set in this forum), I feel like the clock has been dialed back about eight to ten years and I'm satisfied with that. I will most likely only make one more update at the 18 month mark to sum up any closing thoughts on my experience and results.

Thanks. Yeah, I think that's a good tip and plan to do these things; I'd actually been doing them prior to my procedure but hadn't been doing microneedling or nizoral since... But yeah, the baldness is fighting tooth and nail. This is like some WWII, Pacific Theater, fight to the last man sh*t on my scalp...

Here are some pics fresh out of the shower, wet and dry (I'm at about 12 months and 3 weeks). I'm generally happy with things at this point in the transplanted area, and I'm still seeing improvement. I think my biggest concern right now, however, is continued thinning of my native hair in the midscalp and crown -- these two areas had not been transplanted yet. I was hoping to squeeze in a few more years without having to do any more procedures, but unfortunately I may have to take further action in the near future.

12 Months Here are my 12 month photos; I used some styling spray.

I'm glad to hear that.

Thanks. Yeah, I actually think my progress isn't quite done yet. I've seen a bit more improvement in the front since my last update, and the area behind the hairline has filled in relatively nicely. There are more days now when I feel like it looks good (especially right after I get out of the shower and it dries). Also, the clinic told me, based on some pictures I sent them, that I should expect more thickening. It should be noted that that Hasson and Wong patient had 3462 grafts -- about 13% more than I had (3051), and in a smaller area.

You look great, dude. Just out of curiosity, do you think you've seen any improvement since the 12 month mark?

Thanks, Melvin. Much appreciated!

Thanks, bud. I kind of feel like it actually looks better in person than in pics...I'm not sure if it's because the camera increases contrast, or what. I was having a rough few weeks (for other reasons), which perhaps had negativity influenced my feelings about this. Yeah, when I look back at my pics from a year ago and remember how bad it was, I definitely feel relieved. There's no question that it's significantly better than it was then.

I was counting individual hairs, scaling up by 9 (because the highlighted area was only 1/9th of a square cm), and then dividing by the average number of hairs per graft (so, to answer your question, yes). I realize that some of these hairs are coming from the same follicles. Also, yes, I think it's possible that a follicle, after experiencing shock, will not sprout as many hairs initially as were originally there. However, I think odds are fairly good that they'd eventually come out if the follicle survived.

Thanks. I appreciate the positivity. I have to try not to let perfect become the enemy of the good.

Month 11 (approximately) Here are my month 11 images, give or take a few days. The forelock area has thickened up reasonably nicely, but I still have mixed feelings about the density at the very front of the hairline. As I've said, I'm going to let things go until 18 months and see where I am at that point. I may need a small touch-up in front to get where I want to be. I've been thinking about it a bit; given the fact that progress is so slow, it's very easy to forget where you came from prior to surgery, so you never really feel the full impact of the improvement the way you would if you suddenly woke up one morning with month 11 or 12 results. Things are far better for me now than they were a year ago, but I still feel the obnoxious call of hair greed. I want to look the way I did before any thinning started, even though that may not be a reasonable expectation.

Hey, sorry, I've been a bit distracted by other things lately. I'll try to post some pics this weekend.

Thank you. I'm not in stats, per se, but I do work in STEM. Anyways, no, I'm not counting hairs as grafts. I counted hairs per 1/9th square cm, then multiplied my 9 (since the box shown is 1/9th of a square cm), then I divided by my average hairs per graft (2.44 hairs/graft). The result is the average number of grafts per square cm.

10 Months I think I've seen substantial improvement in density over the last month. Note that I have puffy, fine-caliber hair and I'm not taking finasteride. Also, for perspective, I've included images (at the top) that show me before my procedure. Before Procedure: Current, indoor, with indirect natural light: Indoors with indirect natural light and flash: Outdoors with direct natural light:

Yup. If I'd been putting this information together entirely for others, I'd say I wasted my time, but honestly, my first goal was to put my own mind at ease. Better to do this, I think, than post on here constantly with no useful information, with my neuroticism and hand-wringing on full display.

So, some of the feedback I've gotten lately got me thinking... I wanted to see what my yield and growth really look like, in reality, and without bias, so I took (as you might expect) an analytical approach. I took 22 photos of the transplanted area of my scalp with a digital microscope and overlaid a box 1/9th of a square cm over each one (see Figures 1 through 22 below). I then counted the hairs with roots inside the box (mature hairs tagged with yellow dots at the hair bases and immature hairs tagged with orange dots). I tried to place the boxes where I could clearly see hair bases, so as not to count hairs from outside the sample areas. I entered these values into a model that scaled them up by 9, estimated total follicular units per square centimeter, and compared against my expected targets for this point in time (see Charts 1 and 2 below). I know this seems like a lot of work -- possibly too much -- but it felt like a better use of my time and energy than sitting around handwringing. Plus, to be honest, I kind of enjoy it. Anyways, Chart 1 below shows how far along I should be, in general, based on normal hair transplant growth timelines. It also shows how many follicular units and hairs should be in each square centimeter based on that information. Chart 2 compares where I actually am in each sample area to where I should be at this time, then projects forward into the future. It would appear that graft survival is probably not my issue. There are some areas that are weaker than others, but on average, there are about 46 follicular units per square centimeter. If there were no native hairs, but a 90% yield rate for transplanted hairs, I'd be expecting 45 follicular units per square centimeter. If I assume that all the hair is transplanted, rather than native, this means that I have a 90% current yield rate and will have a 92% final expected yield rate at the end of 12 months. I think 46 follicular units per square centimeter would normally be enough to provide a dense appearance. On the other hand, while the number of popped hairs seems to be on track, maturation appears to be where things are lagging a bit for me. At this point in time, if I were a normal grower, 78% of the popped transplanted hairs should have been mature. However, across all the sample areas, only 65% were mature, on average. Dr. Koray's coverage formula, if I remember correctly, is [follicular units]*[number of hairs per follicular unit]*[hair caliber]; you need a coverage value of at least 5 for the hair to appear dense. In order to estimate my coverage values, I assumed my immature hair was half the caliber of the mature hair. Currently, about half of my sample areas meet the threshold of 5, but the average coverage value for the entire area is 5.1, which is passable (but barely). However, when I factor in the extra months of growth I have ahead of me (both extra popping and maturation), at least four more of the sample areas should flip to exceed the coverage value threshold of 5, and my average coverage value increases to at least 5.75. Note that I'm assuming at least 50% of the "immature" hairs I counted are actually miniaturized native hairs which will not thicken and grow; if I assume that all of these small, fine hairs are immature transplanted hairs, I could end up seeing an average ultimate coverage value of 6.31 with my current yield of 92%. In short, I think I still have good reason to be optimistic, in spite of what some people on here may believe. Not everyone is done developing at 9-10 months (in fact, most people aren't). Since I appear to be a "slow maturer," or at least slower than normal, I'm going to wait until around 18 months to make a final judgment. That gives me another 8.1 months of maturation from today. Chart 1 Chart 2 Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Figure 22

It's based on a post by Doctor Bloxham. I'd have to dig it up, but it gives timing estimates for both pop rate and maturation rate. I used this to calculate percent coverage change over time.