Future Hair Doc

4 hours ago, whatthehair said:

I'm in a competitive program and don't want anything to possibly alter my state of mind. But I will seriously consider finasteride later on down the road. I'll be sure to discuss this with Konoir/Nadimi when I get a consultation with them. My hope is they come to a similar conclusion I have. Thanks for talking me out of Bosely, you guys convinced me to ditch Bosley just by their bad reputation.

The chances of side effects are a little less than 5% on oral finasteride. I would definitely consider taking oral finasteride. I know MANY patients who wish they had used oral finasteride much earlier. You're essentially fighting with one arm tied behind your back without finasteride/minoxidil. 

Oral finasteride will always be more effective than topical finasteride because oral finasteride is systemically absorbed while topical is locally absorbed (with much less systemic absorption). The chances of side effects on topical are basically nil, while the chances of side effects on oral will be a little less than 5%. I hope this helps. 

Are you in Chicago? You definitely need to consult with @Dr. Vladimir Panine. He's highly recommended on here and is an Elite Coalition member. He's board certified in dermatology and did his surgery training at Stanford and has been putting out amazing results for the past 25+ years. 

And yes, you should definitely be on oral finasteride and topical minoxidil. 

Please feel free to reach out anytime and keep the community posted.

I suggest the following:

Finasteride and minoxidil for about 1 year and save up money to go to a reputable clinic. You will likely require BHT from your beard and body and there are some great surgeons who specialize in this. Feel free to privately message me if you have any other questions, etc. 

For me, I believe it was around month 5 and the results were patchy. 

First, welcome to the forum. It's a great community we have here. Have you tried a topical solution of finasteride/minoxidil? I'll get to your other questions in a moment, but wanted to ask that beforehand. 

As @TorontoManposted, this is likely edema (fluid shifts between extravascular and intravascular spaces and to different parts of your body). Do you have noticeable swelling? Some people get edema and some don't. I remember my edema was pretty significant post FUT.

Great question. @Parsa Mohebi, MD has a medical device called a laxometer which is useful to measure scalp laxity. I think he made it over a decade ago.

Here's the link to it:

https://parsamohebi.com/videos/the-laxometer-ii-how-to-measure-scalp-laxity-and-elasticity-during-hair-transplant-procedures/

Eugenix consistently puts out amazing results. 

For a more comprehensive list of recommended surgeons in India, check here:

https://www.hairtransplantnetwork.com/Consult-a-Physician/surgeon-list/IND/India

It looks more that your hairline is maturing than MPB at this stage, based on the photos you shared. 

5 hours ago, bald-and-bearded said:

There was another thread on a similar topic about some topical product from India. I tagged Dr. Suhail on there. Is it necessary to have minoxidil mixed with Finasteride?

No, you don't need both in the same solution. It just makes it easier and more convenient though to have both 

7 hours ago, Melvin-Moderator said:

Yes please post it. I was going to, but didn’t since I thought it would come from you. In my opinion, you’d have to get it compounded out of the US. Perhaps, Europe or South America. 

Here is the fee schedule for different compositions of finasteride/minoxidil that I received from a very reputable US compounding pharmacy. As you can see, it's cost prohibitive to do this in the US. I'm looking at some reputable foreign compounding pharmacies to see if they have better pricing. Before I give these to my patients, I would obviously check to see if the composition is legit by working with a US based biochemistry group. 

I agree with your approach. Do a couple rounds of FUT and then FUE to maximize the number of grafts you can get. Of course, every situation is different. Would you kindly send pictures of the scar? I can't see it....which is great news!

Do you have older photos for comparison?

40 minutes ago, Jd98 said:

It’s called getfreshmans.com 

I thought the 0.05 twice a day was that standard?

Where is the product being made? Have you taken it to a compounding pharmacy or chemistry group to see if it's legit?

2 hours ago, bald-and-bearded said:

Good article @Melvin-Moderator.

Speaking of business opportunity, if it's too tiny for big pharma, I think this is something transplant surgeons should take interest in. If it means they have a greater adherence rate from their patients and therefore better results and potentially lesser real or nocebo side effects, then it would mean better business for surgeons. My doctor told me how frequently he has to refuse to operate on young patients who refuse to take oral Finasteride, so that is a business opportunity for sure.

I only hope there is agreement between reputed surgeons and an established protocol to administer and monitor such a topical product.

It's a LOT of work that goes into finding a trustworthy compounding pharmacy that can do this for a reasonable price. The other issue is you need to have a critical mass of patients who would want to buy this product in order for it to be fruitful for the surgeon to invest so much time/money into this endeavor. This isn't to mention the shipping/handling, storage costs, customer service issues, dealing with fraud from vendors and patients, etc.

 I am currently trying to find a trustworthy compounding pharmacy to do this. The compounding pharmacies in the US charge so much that it's not even worth it. I can give you the fee schedule that they sent me to give you guys an idea, if you're interested.

1 or 2 every few days if fine. Did your surgeon give you instructions on how to clean, after care instructions, etc?

4 hours ago, notsosure said:

Hey all. Long time lurker/reader. I think I created my account here about 10 years ago. I'm now 42 and it's finally time to take the plunge. After LOTS of research and lots of nerves, I finally scheduled FUE surgery with Dr. Konior. I've just hailed an Uber and it's 9 min away. I've never had an HT before. Never shaved my head before. And never even been to his office before. This is all very new and I'm not sure what exactly I'm getting myself into, but here we go!

I'll post updates throughout the process.

Here's to a very long day! 6:30am to 7:30pm ish...

Let's go!

It's normal to be nervous. Rest assured that you're in good hands. Chicago is a beautiful city. Hopefully you get a chance to explore Chicago as well.

Excellent explanation. Thank for doing this.

Have you consulted with any surgeons? Where are you located?

8 hours ago, bald-and-bearded said:

Many reputed doctors recommend its usage and claim that it is effective and yet has no side effects. But why is it not more popular? There are tons of patients who dread the idea of taking Finasteride pills and thus accept baldness while still being extremely bothered by it. Finasteride hesitancy is one of the biggest problems surgeons face when dealing with patients who will have advanced or unpredictable hair loss.

At this stage, we would have expected to have seen a few peer reviewed studies showing its efficacy and side effects profile and at least a few pharma companies manufacturing it at scale if there was a big market potential (which company would miss such a chance?)

The absence of big pharma (like Merck) manufacturing topical finasteride and the absence of well citer peer reviewed studies makes me think that the science behind it is not solid to even warrant a phase 1 trial.

What do you think?

There have been multiple studies showing it's efficacy (just Google it). 

The popularity of topical finasteride has been increasing...it's just hard to find a good source here in the US. My patients have had to buy it from India, China, etc. and they don't truly trust these sources (it could just be a guy putting water in a bottle and saying it's finasteride). 

I think the big pharma companies aren't getting in on it yet due to COVID. I'm gauging if there's enough interest for me to pursue creating a reliable source of topical finasteride/minoxidil to sell. 

I would suggest not doing this. It's too risky and you risk shock loss with the existing hairs. You've provided photos with the worst conditions (wet and direct light). I would protect what you have now with finasteride/minoxidil and see how it progresses. 

1 hour ago, Panamera13 said:

I took topical fin (https://www.minoxidilmax.com/maxogen-x-topical-finasteride-8-minoxidil-retinoic-acid) and had sides right away within 2 weeks and stopped. I had sides with topical fin also.

I just sent a request to fueclinic and for 100 bucks might give it a shot...

I’m curious, what were the side effects that you were getting and what was the concentration of the topical finasteride?

Yes, you should be on both minoxidil and finasteride for at least 6 months before contemplating a hair transplant (I would argue it should be for 1 year). You'll need to get a sense of how your hair loss progresses and how to plan for your surgery accordingly. Without minoxidil/finasteride, you're basically fighting hair loss with one arm tied behind your back.

2 hours ago, hakona said:

If one didn't have prp with the procedure, when is the right time to do prp afterwards, and how many treatments?

2 weeks post-op and 4 sessions in total spaced 3 months apart would be ideal.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064679/