mcr7777

Pharmacies have to be very conservative and precise - it's unlikely to fall off a cliff in terms of potency - but how much probably depends on temperature and possibly other factors.

This presentation might be interesting....quite long but the first part talks about Type 1 vs Type 2 inhibition of DUT vs FIN (Fin only inhibits Type 2). I am only on week 1 of the .1% topical dut from FueClinic. I plan to use 1 ml/week. Very early days but my scalp itch stopped immediately when I applied it so it must be doing something.

Are you losing hairs from all over the head - or a specific area e.g. only the transplanted area?

Yes I agree with what you've said except that LPP can sometimes present at hairlines or diffuse thinning (there are variants called FAPD and Frontal Fibrosing)...this is why some people get caught out thinking they only have LPP - they assume LPP occurs only as bald spots on the midscalp or vertex - when it actually can occure in different places on the scalp.

Lichen planopilaris - most hair doctors in the know think it is way underdiagnosed, can mimic MPB - and can cause poor HT results. It usually but not always comes with symptoms of itching- sometimes burning or crawling too.

Do you have itching with hair loss? Your pattern looks similar to some cases of LPP (lichen planopilaris) I'd suggest seeing a hair specialist derm (not a HT surgeon) before going forward with any surgery to be certain.

Good you can suit a buzz cut well! Do you have any symptoms such as itching/burning on the scalp? These are typical of Lichen Planopilaris (LPP) - which can impact HT results.

I'm very sorry for your situation. It's very distressing I understand. I'd recommend seeing a dermatologist to rule out autoimmune like LPP. Make sure you find a derm that specialises in hair/alopecia. This is what I have - diagnosed after a HT. These conditions are common causes of poor HT results- and derms and HT clinics can't easily diagnose them in many cases.. Don't even think of another treatment before you get your scalp checked for LPP. My guess is LPP is the cause of many bad results on this forum - and many people don't realise as it's so difficult to get it diagnosed properly. Do you have any itching of the scalp?

Just curious....Have you lost overall density due to this process? If yes how much % would you estimate?

I'd strongly recommend finding a derm that is a hair specialist. They should examine your scalp with a dermoscopy/magnifiyer. This may help rule out e.g. autommune conditions. Don't bother with general derms - they are a waste of time when it comes to unusual hair conditions. e.g. LPP forums are filled with people who go years with incorrect diagnosis. Hopefully what you have is not serious - but it is very unusual so find a specialist hair derm doctor - even if it involves travelling. research to find one.

Do you have any itching/burning sensations in the area of hair loss? This is typical of LPP - but not always present. You might want to see a hair doctor specialising in unusual hair disorders. If you're going privately I can recommend a few in the UK in London and Manchester if you want to message me.

I'd recommend making sure you don't have lichen planopilaris....this can cause itching/tender/sore scalp. This should be in remission before any hair transplant...not saying you have it but it does cause itching sensations and is often misdiagnosed as seb derm. Have you seen a specialist hair derm?

That is good you're going to see a dermatologist. I'd suggest trying to find one specialising in hair disorders -as many general derms aren't very knowledgeable about hair conditions and lots of people get misdiagnosed. Hopefully it is nothing - but not something you want to get wrong.

LPP can make you shed transplanted hair - usually it tends to be around 2,3 or 4 years after the transplant when the new hairs start to grow as part of the normal hair cycle as LPP kills stems cells. Hence my raising it as something to consider. If you are not thinning, it may be nothing to worry about. However if it continues and if it starts to thin you may want to see a specialist hair dermatologist. HT doctors are often great HT surgeons - but often know very little about hair issues/disorders beyond basic MBP.

DO you know why your grafts fell out? I'd suggest understanding why first - if it is autoimmune e.g. LPP or another scarring alopecia - the same thing could happen again. Do you have burning/tenderness/crawling sensations at all on the scalp?

One thing I've learned by watching these boards for years now - is that it's important to establish what went wrong before going ahead with another HT. Do you have any itching/burning/crawling sensations on your scalp - either now or before the first HT? I'd be really careful to rule out an autoimmune condition first -or you could potentially end up in the same/worse situation after a 2nd HT.

I don't know that I'd probably have this amount of hair loss. Derms I've seen post-HT say I have only minor minaturisation so think the LPP caused some of the loss. Most of HT that grew is still intact - it will be two years since HT next month. Although the disease is still active as I can feel it and have symptoms and I know it has attacked a few hairs as I can see on my digital microscope (you can buy one for 25/30 USD or EUR on Amazon if of interest) My mid scalp is a bit tender at times - but no noticeable hair loss to the naked eye. I think LPP meds are helping me maintain the hair I have. The thing with LPP is it can spread if left untreated - so it's important to catch it early before it spreads. Are you positive you don't have the issue you described of shedding and re-growing affecting other areas of your scalp? Is it only at the front hairline? or is that just the only noticeable spot possibly? Also do you have a photo of your loss beforehand - or a similar photo of what it looked like?

This was me right before the HT.

You should try and be sure the reason why your surgery wasn't sucessful. There are lots of examples of LPP and other conditions causing surgery failures - that aren't always obvious. The key thing with LPP and other scarring alopecias is to consider if you have typical symptoms e.g. burning/pain/tenderness/sore feeling sometimes feels like a crawling sensation during flares. These symptoms can come and go - can be quiet for weeks - and flare back up. Typical triggers for flares are stress, some people say diet. However some people have no/minimal LPP symptoms which makes it more tricky.

Not sure if you discovered your condition - but this does look like Lichen planopilaris (LPP) not psoriasis as Melvin noted. I believe scalp psoriasis does not normally cause permanent hair loss - unlike LPP.

Mine was 13 months after the HT. I had it before the HT I'm sure as I had burning/lots of itching when I started finasteride especially a few months before the HT - it caused a flare. I think about 75% grew in my case -but hard to say. LPP can sometimes cause hairs to fall sometimes a few years after the HT. In some cases, transplanted hair stays longer but it is considered high risk of failure vs MBP. Most HT doctors won't perform on someone with active LPP - but often it is not spotted (like in my case). I'm pretty convinced that many of the HT issues on these boards are LPP-related - but go undiagnosed. General dermatologists often misdiagnose LPP (the Facebook support group for LPP is littered with people who have multiple misdiagnosis before it's finally confirmed).

I have been reading more about what the 2nd HT doctor mentioned to you about seeing a dermatologist. It clearly looks like there is inflammation around the transplanted grafts. The 2nd doctor was absolutely correct saying you should see a dermatologist before another HT. I'd strongly recommend finding a doctor that specialises in hair conditions e.g. autoimmune alopecia. HT doctors often can't diagnose more unusual autoimmune alopecias like LPP, FFA and Alopecia Areata....you need to find a hair specialist derm - not a general one. The last thing you want to do is have the same thing happen again after a 2nd HT. It could potentially make things worse. You need to find out the reason for the sub-par result - and more importantly understand what those red marks are around the hairs and establish it's not an autoimmune condition. I was diagnosed with LPP (lichen planopiaris) after my first HT - and nearly went ahead with a 2nd. But thankfully now and getting treatment for the condition - which is autoimmune and different than MBP treatments.

I agree you should get a lower fade. It seems to high - low or mid fade would suit better.

It looks like you have bumps and redness around the transplanted hairs in this photo. Is that the case? Do you have itching/burning/tingling sensations?

If your transplanted hairs thin out it's often a sign of another type of alopecia (can sometimes exist alongisde MBP). There are scarring alopecis like lichen planopilaris that can kill transplanted hairs- or others like alopecia areata. And some other alopecias but lichen planopilaris and areata are the most common I beleive. It is not true that transplanted hairs last forever - that is only the case for androgenetic alopecia - and not other autoimmune alopecias that are sometimes misdiagnosed as MBP!!!! This is a big problem in the HT industry I believe - as I was misdiagnosed and only found out I Had LPP after a HT. I'm convinced many others that experience poor growth or whose transplants thin may have misdiagnosed LPP or other alopecias. Many simply don't want to investigate it/are unaware/don't have financial resources etc. If you have symptoms of burning/pain/lots of itchiness - you might want to see a dermatologist specialising in alopecia - suggest not to rely on a HT doctor or general derm as they are often clueless about other types of alopecia - and often misdiagnose for MBP.