Future Hair Doc

Your hair looks great buddy. I can definitely understand wanting a hair transplant though. Have you consulted with any surgeons? Where are you located?

Your hair loss looks stabilized on min and fin, I think a hair transplant in your case is fine. I thought you might have been under 30.

How old are you? I agree with the consensus that you should probably hold off on a transplant at this point.

I think 1.5k grafts sounds about right. Are you on any meds at the moment?

Great results. The density is amazing. Thanks for sharing.

No difference between the two. Also, are you on finasteride? You should be on it too.

I would recommend against quitting minoxidil

Looks like shock loss. Nothing to worry about. You're at a point now where many people worry and patience is hard to abide by. Keep us posted and best of luck.

So this topic has been brought up in various posts and there obviously will not be a consensus on this. How many hair transplants surgeries should a surgeon perform per day? I think a skilled surgeon should be able to do 2 surgeries per day and no more than that without sacrificing safety and outcomes. What are your thoughts and why?

I think 1 skilled surgeon can safely do 2 procedures a day. What are people's thoughts on this?

You'll be fine if you don't get too much sun exposure.

If you're worried that much about side effects, try a topical solution of finasteride and minoxidil in a liposomal delivery stem. You won't get side effects and will have good growth/stunt of loss. It all depends on the concentration of the solutes.

You can try topical finasteride. It's localized so you won't get the systemic side effects.

I highly recommend that you look into @Dr Blake Bloxham His results are amazing and he's highly recommended here too.

I've seen some of Dr. Bloxham's post-op patients and the scar heals so well that's it's barely discernable, even with short hair. Avoid vigorous exercise, smoking, drinking alcohol for 1 month and you'll heal up well. I've seen a patient resume heavy lifting at the gym like 1 week after an FUT procedure and he messed up his scar

That graft placement is so neat and refined. Dr. Bloxham is a great surgeon and a stand up guy. Keep us posted on your progress and thanks for the update.

Topical finasteride usually won't be as effective as oral finasteride since oral is systemic and topical is more localized and you have to depend on the diffusion of the topical solutions across various membranes to get into the target hair follicles. Topical finasteride is still effective and there are a lot of studies that demonstrate this. It'll all depend on the concentration of the finasteride and the delivery mechanism and how sensitive your hair follicles are to DHT. My advise is to start off with 1mg of oral finasteride and see how you react to that. As always, please feel free to reach out.

Yes, you're correct. STARTING dose is 1mg and you can titrate it UP to 5mg, which is the standard dose for BPH. I would only titrate it up if the patient doesn't respond well to 1mg and isn't having any side effects. For titration, the doses are usually 1mg starting, then 2.5mg, then 5mg. But you could modify that using pill cutters. I have not seen any studies that show that it loses efficacy with higher doses than 1mg. That doesn't make sense from a biochemistry standpoint since you're decreasing the conversion of testosterone to DHT by blocking 5-alpha reductase. Yes, you may have diminishing effects, but someone may still want a 30% increase in hair thickness/volume/etc and opt to increase their dose of finasteride given no side effects. Can you please send me those studies? Here is a study looking at efficacy of finasteride 5mg daily and it's efficacy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746222/

He is a fast grower indeed. The placement of the grafts is so clean and refined. His results look amazing. Awesome job @DrTBarghouthi and thanks for the update.

Great question. That's just the standard dose used and as everyone knows, finasteride is typically used for BPH and is given in 5mg doses. You can do 2.5mg as well in case you're having any side effects. I wouldn't use more than 5mg since it can cause orthostatic hypotension and syncope.

The rate of side effects with finasteride is about 5%...so 1 in 20 people on it will have side effects. The sexual side effects aren't permanent so once you cause taking finasteride, the sexual side effects will cease. I would try finasteride 5mg oral daily or every other day and see how you react. If you're having side effects even when taking it every other day, I would switch to a topical solution of both minoxidil and finasteride as multiple studies have shown that the topical solution of these medications are effective in treating hair loss without systemic side effects. I hope this helps. Please let me know if you have any other questions and keep us posted on your progress.

A lot of forum members submitted questions for Dr. Panine and I did a Q&A with him and asked the questions that members had. Here is the transcript: 1) What are your thoughts on the ideal age range to consider a hair transplant? There is really no idea age range, it depends more on the degree of hair loss and patient expectations. I never want to get too aggressive with young patients and create too juvenile of a hairline that will not look good as they get older. Also, older patients need to have no major health related issues. 2) What are your thoughts on sutures versus staples for closing wounds, especially in terms of scar appearance and infection risk? Sutures are preferable to stables because it minimize the risk of a wider scar. 3) With the success of FUE, do you think there's a place for FUT and if so, in what scenarios? With today’s results there is no difference between the success rate of a FUE or FUT procedure. The only difference is that with FUT procedures, there will be a linear scar. FUT procedures is performed for those patients who can't shave their donor reasons due to social or professional reasons. 4) Do you prefer finasteride or dutasteride? I prefer finasteride to dutasteride for his patients since it is FDA approved for hair loss. 5) Topical finasteride/dutasteride is coming to the US market soon (it's readily available in Europe and many Asian countries). What are your thoughts on the efficacy of oral versus topical? It will depend on the vehicle that it is formulated in. The closest to systemic administration would be using a liposomic vehicle. 6) What are the most common mistakes you see patients make in selecting a surgeon? Looking for price over quality

Mods, please move this topic if not in the right sub-forum. I have had the opportunity to visit many hair transplant clinics and am seldom impressed. However, I had the pleasure of visiting Dr. Vladimir Panine’s Chicago Hair Transplant Clinic (CHTC) in October and came away very excited. Dr. Panine is an Elite Coalition member and possibly the most accomplished hair transplant surgeon that I’ve come across. He is truly an artist when it comes to hair restoration. He completed 3 years of General Surgery residency (at Stanford University, no less) and finished a Dermatology residency and is Board Certified in Dermatology. Dr. Panine has been a hair transplant surgeon for about 30 years and has performed well over 4,000 hair transplant surgeries during his illustrious career. When I had the chance to visit Dr. Panine, I jumped at the opportunity. His academic and clinical accomplishments are stellar. CHTC is located on the 27th floor of the iconic John Hancock Center in the heart of the Magnificent Mile in downtown Chicago. His clinic overlooks the scenic Lake Michigan and famous Lake Shore Drive. I’ve visited many hair transplant clinics and CHTC is easily the most beautiful clinic I’ve visited. If I were a patient, I’d consider myself lucky to not only have Dr. Panine as my surgeon, but also being lucky enough to have such great views of Chicago and Lake Michigan. I was warmly greeted by Dr. Panine and Mr. Stuart Rosenberg, who is the clinic manager of CHTC. I visited CHTC on a Saturday and saw a post-op patient who had had an FUE procedure the day before on Friday. In my experience, most clinics are closed on weekends and I asked Dr. Panine why his clinic is open on weekends. He said, “Because I like to see my post-op patients the day after their procedure and periodically thereafter, even if it’s the weekend.” His dedication to his patients and passion for his craft are unparalleled. The patient had received about 2,300 grafts and the grafts were strategically and finely placed in the frontal part of his scalp to give the best results in terms of both density and contour. Dr. Panine creates the recipient site himself beforehand to minimize the time that grafts spend outside the patient’s body to maximize graft survival and everything is done by hand for perfection. He extracts grafts via a 0.7mm – 0.9mm punch using the Harris and Cole punches punch. Grafts are placed in chilled HypoThermasol and ATPV solutions, which has been shown to enhance graft survival. Dr. Panine’s techs have an average of 10 years of experience and they just assist during the procedure. Under Dr. Panine's supervision, the techs trim the grafts using Meiji microscopes and then Dr. Panine rechecks them before placing them. Dr. Panine extracts grafts with minimal transection, makes the surgical sites and places the grafts. While people appreciate the skillset, artistry, and knowledge of hair transplant surgeons; I firmly believe it is VERY important to have great technicians. In addition to a post-op consult, Dr. Panine saw a 36-year-old gentleman for a consult. The patient was concerned about his thinning hair and receding in the frontal and temple areas. This patient barely had any hair loss (I would have loved to have his hair) and Dr. Panine put him at ease and recommended a 3-month trial of oral finasteride. There was no rush or pressure placed on the patient whatsoever and Dr. Panine answered all of his questions comprehensively. I am thankful to Dr. Panine and his staff for allowing me to visit their clinic. Without a doubt, I would recommend Dr. Panine. He performs ultra-refined follicular unit transplantation and is extremely dedicated to his patients. He truly is an artist and it is no wonder why he is so well regarded in the field and has so many happy patients. Dr. Panine says that it makes his day making his patients happy and making them look more youthful. Here are some photos from my visit and photos that Dr. Panine and his staff kindly provided me to share. Check out the sweet views of Chicago and Lake Michigan from Dr. Panine's clinic:

The graft placement looks beautiful and the density is unreal. Please keep us updated

Absolutely stunning result. The gentleman looks SO much younger. Thank you for sharing.