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Mark Wolfer

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About Mark Wolfer

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Basic Information

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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. None of this has to do with DHT and donor dominance yet it affects hair growth on your scalp. So why would you dismiss factors like blood supply to the follicle and the negative affect of inflammation on the scalp for hair growth? I never said any of these factors are the primary reason for hair loss, but there is evidence that they matter.
  2. I'm no expert and I'm new to the forums and have only been researching for a couple of months. I am not pretending to understand all of the factors that lead to hair loss but I now know enough to be clear that the collective evidence around why we lose our hair still has a lot of unknowns and conjecture around it. And while our genetics is clearly part of the story, and DHT and enzyme reaction is part of the story, that's not answering all the questions. I've read and collected some interesting observations that point at MPB being more complicated than the prevailing theory. Firstly, inflammation, fibrosis and calcification and tighter skin across the scalp are associated with scalps that are experiencing male pattern baldness. So consider why minoxidil helps hairs grow back. There isn't a conclusive answer why but one strong possibility is that it helps with blood flow to the hair follicles because it’s a topical vasodilator (it improves blood flow). This improves the oxygen and nutrient supply to our hairs. What's clear though is minoxidil doesn't have anything to do with the genes, DHT action that finasteride does. Why does running dermarollers and microneedles across the scalp lead to hair regrowth? It can't possibly be affecting the DHT / 5 alpha reductaze enzymes. Why does PRP seem to cause hair regrowth when done "properly"? A study of patients who had botox injected into the muscles around the back and sides of their skulls showed significant hair regrowth. The botox "deadened" those muscles for months at a time which led to the skin at the top of the scalp being left looser because the muscles weren't flexing and causing the scalp to be pulled tighter. Note that the hairs that fall out and the follicles that stop working are all on the galea membrane that runs on the top of the skull. Conversely the hairs that overlay the muscles surrounding the scalp are in the donor areas and they don't fall out. Note the image that I pasted from the book called "Perfect Hair Health" by Robert English that shows how the areas of scalps that have the most tension are the areas where the hair tends to recede first. So tension and skin laxity seem to be a factor and they're associated with inflammation and calcification around the follicles, which can restrict blood flow to the follicle, and may signal DHT and 5 alpha reductaze to bind to the follicle to deal with the inflammation which area. Note that DHT is anti-inflammatory and it alone doesn't cause follicles to stop working, in fact serum DHT elsewhere in our body promotes hair growth. So why does donor dominance work so well? Why do the hairs transplanted from the donor area take hold in slick bald areas or survive long after the native hairs fall out? * Possibly because the follicles come across with healthy tissue that hasn't been affected by the years of tension, inflammation and calcification that exists in the recipient area. * It's possible that the newly transplanted follicle and tissue actually signals for surrounding tissue to regenerate * Even donor grafts can thin and follicles can die over time Read here for more explanation: https://perfecthairhealth.com/hair-transplants-debunk-scalp-tension-hair-loss/
  3. DHT and gene theory doesn't explain why the male pattern develops the way it does over time. However, scalp laxity and tension offers clues.
  4. @yesplease so the FUE procedure damages nearby follicles, or punched out grafts are lost more than a strip removed graft? Or both?
  5. Hi @H & W Doug I am trying to decide between FUE and FUT for my first surgery and I'm curious about your comment here. Are you saying that 2,000 possible donor grafts are now no longer available because FUE was chosen for this patient instead of FUT?
  6. In thinking through my long term plan I am trying to understand to what extent body hair and beard hairs can help me on a second or third surgery (still contemplating my first one and am hoping to pull the trigger soon). I am gathering that it's best to mix extracted body and beard hairs in with real scalp hairs so that it looks natural together, and that beard and body hairs should go into midscalp and crown, not on the hairline. As I'm sure the techniques for dealing with beard and body hair is slightly different to regular scalp FUE, I'm curious about which clinics have good reputations for this kind of specialized work. I live in Canada, but as I'm less concerned with the "artistry" side of the work for these gratfs, I'd consider Turkey, India etc. clinics especially if they work with beard and body hair more than North America clinics do (is this a thing?). Thanks for inputs and advice on this.
  7. 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.
  8. 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?
  9. Thanks that's a lot of good info for me to consider.
  10. 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?
  11. 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