Future Hair Doc

Amazing results. The Pt must be over the moon with his results

I've seen patients who have undergone FUT without a visible scar after some time and seen FUE patients with visible scars over time. It depends a lot on the skill of the surgeon and as LaserCap said, the size of the punch being used. Here's a great example of a basically scarless FUT done by @Dr Blake Bloxham, who is highly recommended on here:

Can someone please let me know how to put a signature on the bottom of the posts? I've tried, but haven't had any luck. Thanks!

Great looking results. The patient must be thrilled

I would recommend that you get off the oral finasteride and take topical finasteride. Don't take more doses than recommended

Sebum is naturally produced by sebaceous glands, which are part of the hair follicle. I don't think you have anything to worry about at this point. I know it's hard being patient, but hang in there. You should be seeing results in about 9 months

Research into the efficacy of topical finasteride is in its infancy. However, it appears that it is indeed efficacious and there are less side effects compared to oral finasteride. Please see the following study published in 2019 in the Journal of Drugs in Dermatology:

"Preliminary results regarding the application of topical FNS for the treatment of AGA are promising. Current data suggests that there may be a therapeutic potential for topical FNS in the treatment of AGA, while minimizing unwanted systemic side effects associated with oral use. Topical FNS appears to be non-inferior for hair regrowth when compared to systemic FNS. Combination therapies including topical FNS, as well as MNX or dutasteride, may be more effective than topical FNS alone. Topical FNS is not widely used despite its proven efficacy and lack of side effects, most likely due to the lack of evidence-based research."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609098/

Looks like shockloss to me. I know it's hard not to worry about this, but it's universally common

Phenomenal results 

Thanks for the informative video Melvin

On 10/24/2019 at 8:53 PM, LonelyGraft said:

Are you saying stress and elevated cortisol causes/accelerates  male pattern baldness or stress causes alopecia areata?

Great question. There are so many research papers on the questions you raised and a lot that we don't know

Stress itself can increase cortisol levels to such an extent as to damage hair follicles. It can induce hair follicles to regress into the catagen phase, inhibit the hair matrix (by damaging proteoglycans, etc.), and promote apoptosis (cellular death) of hair follicles. You need some cortisol in your body to function properly and our integumentary system (skin, which includes hair) has it's own HPA axis whereby it produces cortisol separate from the central pathway axis (hypothalamus, pituitary, and adrenal grands). 

I'd suggest the following studies for the topic you raised:

https://www.researchgate.net/publication/306293727_Stress_and_the_Hair_Growth_Cycle_Cortisol-Induced_Hair_Growth_Disruption

https://www.fasebj.org/doi/abs/10.1096/fj.04-1968fje

Alopecia areata is more of an autoimmune process whereby your body's cells (primarily lymphocytes) attack hair follicles through several mechanisms such as the lack of a protective factor normally conferred to our cells so that our immune system doesn't attack us. That's why steroids are used to help treat alopecia areata since steroids blunt the immune and inflammatory response

Male pattern baldness is more due to the effects of having DHT on the hair follicle. The follicles more susceptible to DHT tend to have a higher concentration of DHT receptors. 5-alpha reductase converts testosterone into DHT and that's where meds like finasteride come into play because they inhibit 5a-reductase, thereby lowering the concentration of DHT in our body. Here's a great paper on male pattern baldness:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174066/

I hope my reply makes sense. Please feel free to ask me more questions. There is SO much we don't know about hair and it's an exciting field to research.  

Thanks for sharing Melvin. Per the the article  you shared:

"Researchers say that it is likely due to stress and not enough downtime and work-life balance. 

Changes in hormone levels which occur during stress can negatively impact several areas on the body. Previous studies have revealed that stress can cause the immune system to attack the hair follicles on the scalp. This auto-immune condition is called alopecia areata. "

The primary stress hormone cortisol, has indeed been shown to cause hair loss. See:

https://www.ncbi.nlm.nih.gov/pubmed/27538002

I've seen this firsthand with many people who work stressful jobs or work long hours

Interesting study. The next step would be retrospective studies to determine the relationship between hair loss and air pollution. You can also do prospective studies as well. You'd basically have to compare hair density, etc. between populations that live with differing levels of air pollution. You'd also have to control for a lot of variables to prevent confounding. It seems intuitive though that air pollution would be toxic to hair follicles. Can anyone share the actual study? I can't find it.

I think it will work. Best of luck and let us know if you have any questions

48 minutes ago, stephennguyenspam said:

What questions should I ask the doctor during the consultation?

Here are good sites that list important questions to ask during the consultation:

https://www.hairtransplantnetwork.com/Consult-a-Physician/tips-on-hair-restoration-physicians.asp

https://fellermedical.com/howtopickhairtransplantclinic/

These are impressive results. I bet the patient is ecstatic 

I highly recommend Dr. Bloxham. He does both FUE and FUT. I'm not as familiar with Hasson and Wong. Dr. Bloxham's results are amazing and the FUT scar doesn't even show up at all often with Dr. Bloxham. Look at this thread:

I echo what Melvin has said

Amazing result! It doesn't even look there is a scar whatsoever. Dr. Bloxham is a magician

Finasteride doesn't regrow lost hair. It's used to maintain your current hair by inhibiting the conversion of testosterone to DHT. The hairs that are lost usually have a DHT receptor and are much more susceptible to male pattern baldness. I hope this helps. Please let us know if you have any other questions and best of luck mate

1 hour ago, Melvin-Moderator said:

I’m not sure how old he is, but I believe he’s well past retirement age. He was a pioneer in the early days, but I don’t know if he still practices.

Ahhhh, makes sense. I'm not sure if he still practices either. He's taught a lot of great hair transplant surgeons

Amazing result

I've heard great things about Dr. William Rassman. What's the general consensus on him?

I thought Dr. Alan Feller was recommended on here? I don't see him on the list. I've heard great things about him. 

Is Dr. Rahal the only recommended doctor in Toronto? It's a huge city, so I would have thought there'd be more great options

The beard looks great!