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Mark Wolfer

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About Mark Wolfer

  • Rank
    Junior Member

Basic Information

  • Gender

Hair Loss Overview

  • Describe Your Hair Loss Pattern
    Thinning on Top only (Genetic Baldness)
  • Norwood Level if Known
    Norwood IV
  • What Best Describes Your Goals?
    Considering Surgical Hair Restoration

Hair Loss Treatments

  • Have you ever had a hair transplant?
  • Current Non-Surgical Treatment Regime
    Propecia (Finasteride)
    Generic Minoxidil 5% for Men
    Nizoral Shampoo

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  1. I buy the Costco (kirkland) minoxidil liquid (5%) and usually everything is fine. Recently I've noticed I get a lot more dryness and flakes. I notice that now I'm getting towards the end of the box of bottles and I'm wondering if it causes more flakes the closer you get to the expiry date on the bottle. Has anyone else noticed this? I'm using nirozal twice a week but still getting flakes.
  2. Is it fair to say though that doing an FUE first doesn't mean you can never do an FUT in the future? Just that your strip will be missing some grafts from the prior FUE?
  3. Thanks that's a lot of good info for me to consider.
  4. The advice that I've read here and on youtube is generally that I should do an FUT before doing an FUE and this conserves more donor grafts. How exactly does this conserve more grafts? Does FUE damage nearby surrounding hair during an extraction?
  5. What kinds of tests can one do? I'm wondering what information can be gathered that could help a surgeon make choices ahead of my 1st HT
  6. Disclaimer: I'm only about three months into my hair research journey so I'm not going to do well at making the arguments. However I can summarize what I've read: From Rob English's (perfecthairhealth.com) book: "Chronic inflammation is the gun. DHT and TGF-β1 are the triggers. Fibrosis and calcification are the consequences. Chronic inflammation likely causes the arrival of DHT and TGF-β1, which over time, causes fibrosis and calcification... a consequence of which is hair follicle miniaturization (i.e., pattern hair loss). " So then DHT and B1 possibly combine as an anti-inflammatory reaction. Now back to your question... when you move a follicle that has been in a part of the scalp that doesn't get inflamed, to a part that has become inflamed... then two things happen: 1. The healthy follicle may actually make the immediate recipient area of the scalp healthier by increasing blood flow (think of the healthy follicle as sucking more blood into the area). Especially if the follicle came across with more healthy connective tissue. 2. If the recipient remains inflamed it "resets the clock" on the transplanted follicles that will slowly over time be affected by the inflamation leading to fibrosis and calcification and eventual miniaturization. If it took 20 years for your original follicles to start giving up, it may take a similar amount of time for your transplanted follicles to do the same. Also it's fair to say that a lot of the early FUT transplants we saw brought in a lot of the surrounding connecting tissue along with the follicle which would fight off calcification and miniaturization longer. Nowadays with very precise FUE extracts basically bringing the follicle only into a new slit, that the hair may not last as long as the earlier FUT surgeries did.
  7. I've also met with both clinics reps for a first consultation. Both were good meetings so the decision remains a tough one.
  8. The botox is injected into muscles in donor areas at the back and sides and hair is regrowing on the scalp.
  9. So I was reading a book on hair loss and this study was referenced. https://journals.lww.com/plasreconsurg/fulltext/2010/11000/Treatment_of_Male_Pattern_Baldness_with_Botulinum.79.aspx Very small sample size but very interesting idea behind the study. Essentially it suggests that tension caused by the muscles around your scalp leads to restricted blood flow to the scalp and follicles, leading to male pattern balding. By injecting botox into the muscles that pull on the scalp, the tension is released and after a year of observation 75% of the ~50 men in the study had an 18% improvement in hair growth. And where this took me personally is to whether this is a reason to choose FUE over FUT because of the loss of scalp elasticity from the strip removal.
  10. This is the hairline drawing that Dr. Rahal suggested. Was a quick one just to get an idea. I think the forelock area could come down a wee bit from what's drawn here. I'd be okay with the temples curving in more along the current receded line on the left side of the pic. I'm lucky in that the temporal points haven't receded or thinned but my temples themselves are receded and my forelock is thin so quite a lot of density will need to be transplanted.
  11. OP I suggest you continue puuting the minoxidil on your scalp, take up microneedling and take finasteride every two days for a while and see if sides are okay and move to once a day if possible. Don't waste your donor hair on a cheap surgery and don't let your existing hair fall out because of flakes and POSSIBLe side effects. I will be straight shooter with you ... don't so this surgery now you will probably regret it. Wait till you have that doctor salary money to do this properly
  12. What I've heard argued is that FUT first is a more reliable way of getting successful grafts from the donor area. More donor grafts don't survive in FUE and the FUE extractions ie the punches in the donor area can damage surrounding unharvested hair
  13. I've noticed that each clinic takes their own path with options and this was a recent change for Dr. Rahal's clinic. I spoke with both James and Dr. Rahal directly about it and he said with the graft success rate he's having with FUE, the demand for FUT was so low last year that the clinic was only doing it in specialized situations like male patients who had already done FUT before and were on a second surgery or female patients who didn't want to shave the back of their heads for FUE and obviously have longer hair and no chance of the strip scar being visible. For what it's worth I didn't feel like I was being pushed at all and I can understand a clinic choosing to specialize in a type of surgery based on changing demand from patients and innovations and improvements in FUE results.
  14. I had my meetings today with James from Hasson & Wong clinic, and Chris from Rahal Clinic (briefly met with Dr. Rahal too which was nice and unexpected). Both of the reps were great, thorough and informative. They both gave me a good sense of the clinic's approaches to surgeries and they both took my priorities into account and gave me a realistic idea of my options. Both clinics have done a good job choosing their reps! Now I need to start making decisions. Besides choosing a surgeon I also need to make the choice between FUT and FUE. Here's what I learned today: 1. My donor area is not terrific but also not bad. I have approx 6,000 to 7,000 available grafts 2. I have enough scalp elasticity for FUT 3. According to James I have retrograde allopecia above my ears. This was news to me and I've started reading up about it. I get my haircut every two weeks, in a fade style and always have very short back and sides so I am used to seeing a lot of scalp in this area and hadn't noticed what James was pointing out before. Interested to hear if others agree with this assessment, and what I can do about it (should I apply rogaine here? dermaroll the area?) 4. Hairs on the lower nape of the neck are not advised for FUE extraction because the lack of density makes the punch scars more obvious (makes sense but I have a lot of growth on my lower neck and have to shave there every few days so I was hoping to get these moved topside) Recommendation from Hasson & Wong An approx 4,000 graft FUT session to fill in the temples and bring my hairline down slightly and build through the mid scalp while leaving the crown untouched. This should leave ~1,500 or more grafts for a future surgery to fill in progressive loss of native hair in the front to mid scalp or if I've truly stabilized on my meds then to work on the crown. FUE is also available at a higher cost per graft but James advised FUT first to maximize future donor availability for a second surgery down the road. Recommendation from Rahal An approx 3,200 graft FUE session with similar objective as above, leaving the crown untouched. I learned today that since January of this year, Dr. Rahal is an FUE only clinic. The clinic also offers Scalp Micro Pigmentation (SMP) and Platelet Rich Plasma (PRP) which James recommended also. SMP at approx 4 months after the hair surgery to the crown and mid scalp to minimize the scalp contrast showing through the thinner areas. The SMP client before and after pics of patients looked really good. Four PRP sessions were recommended to help with scalp health while the transplanted hairs are taking hold. My thinking so far I don't want to make the FUT vs. FUE decision based on recovery time or the embarrassment of showing up to work with visible staples or scabs or scars in my donor area. It will only be a temporary phase and I can take two weeks off after the surgery for the worst of it either way. What I need to decide is whether I'm okay with the strip scar and the tighter scalp skin afterwards or if I'm willing to lose out on possible grafts through FUE but avoiding the scar and tighter scalp. I also have to pick a surgeon and if I decide on FUT then based on what I heard from Dr. Rahal today he's not an option for that. I'm going to take a few days to decide. Obviously money is a factor but I've been convinced by reading through the advice in these forums to put a high value on being happy with the result and thinking ahead for my previous donor area. I've attached the photos that Chris took today, my hair was a bit wetter than my first set of photos and gives a better idea of the areas that are thinnest.