Curious25

You’re a good example of the paradoxical nature of this industry - You’re basically a perfect candidate for surgery - Mature age, good hair quality, minimal loss, on meds, etc. Yet peoples immediate reaction is to straight away harp on about the risk vs reward BS, and imply that no one would even notice the change cosmetically. You’re consulting with a very skilled surgeon, and you are taking the strongest 5AR inhibitor available - I think it’s pretty fair to acknowledge that the ‘risk’ in this instance is as low as it can possibly get. And when did we start doing hair transplants for other people ? It’s you who’s got the concerns that you have expressed, just as it will be most importantly you who will notice the new and improved hairline. Small hairline and temple point procedures can and do have dramatic impacts on people - people just get far too wrapped up in high Norwood transformations. Your hair is great as it is, I agree. Could it be even more great in the context of ironing out the concerns you have expressed? Absolutely.

I thought Eugenix ‘invented’ DHI

The DHT related itch has been anecdotally talked about for decades, and I personally believe there is substance behind it. Greasy hair from DHT related miniaturisation is also something else that I have read anecdotally many times before, and have also experienced - which reduced dramatically when I started on medication. I think using Nizoral 2x a week will certainly help with any sort of inflammation/potential itching - however given your substantial regime in play already, I would certainly consider revisiting a more specialist scalp dermatologist or trichologist, for further investigation.

Correct - if hair is stabilised by medication, permanent shock loss is pretty much a non issue, given surgical skill and execution is sound. In response to your dilemma between the DUPA assessment from Couto, yet the positive assessments from Sethi and Konior, I would explain to the latter two that another surgeon claimed to have found evidence of DUPA from a microscopic examination, and ask for them to do the same, so you can confidently count it out as not being an issue. It may well also be a possibility as was mentioned by Henry, that you are potentially a trickier than conventional case, and one Dr doesn’t have the desire to operate, whereas others might. All three are proven docs in the field.

Outstanding result.

I agree - but it’s important to remember what hair transplant surgery is - so between a diffuse NW6 with thin hairs like you mention, and a restored slick NW6 who has a better illusion of density because of the stronger and strategically placed hairs . . . Which one has more hairs on their head? The former , as their donor is untouched. So even if medication merely just stabilises these weak hairs as they are, once they get a restorative surgery from a skilled physician, given all variable factors equal for arguments sake, their illusion will ultimately be the superior one, because of the support these native hairs will additionally provide.

Unless you have an undiagnosed condition, that’s probably MPB in a NW7 pattern. The treatment protocol would be no different to how one would treat balding in other areas of the scalp due to MPB, 5AR inhibiting medication, in conjunction with the use of growth stimulants such as minoxidil. Whats the rest of your hair like ?

Give it up to 12 months with finasteride - the art of medication is to find the balance between using the lowest amount of a type of action, yet still benefit from the efficacy. What’s the point in dropping your DHT by 95% if you are able to maintain and potentially regrow by dropping it by 50-70%. Plus, you still want the heavier options in your locker should you need to play a trump card later on in life.

1. What is the best time to do a Hair Transplant ? Do We have to wait for hair loss ? A multitude of factors can be at play here, but in terms of a hair loss perspective, ‘when your hair loss has been stabilised’ is the ideal time. 2. Do we have to take Finasteride / other oral medicine that relate with hormones after doing Hair Transplant ? ( I have so many oral medicine allergy , I will avoid it if possible ) You don’t have to no, but if you are predisposed to lose further native hair due to androgenic alopecia, not using such medication will mean you will continue to bald in the non transplant areas, and possibly even the transplanted areas should your donor be susceptible. 3. Is it possible to do "Unshaven FUE" ? since when I was looking for references, all of the hair have to be shaved Yes 4. Can we use a cap/hoodie after Hair Transplant? Different clinics advise different post op instructions. I would recommend asking your potential surgeons this question whilst you are consulting with them. 5. Can we do Hair Transplant when our hair have already been colored, permed, or smoothing ? and how many days after Hair Transplant we can do those treatments ? Same answer as above, different clinics have different requirements - ask during consults. Usually hair should be in a natural state where possible. If you go for FUE, then either all, or a small part of your donor will need to be shaved down. You won’t be able to dye your newly transplanted grafts either until they have grown and entered into their mature phase, which to give a time frame depends on how fast a grower you would be. 6. About the Anesthesia in Hair Transplant process , is it does have any side effect beside swelling? I mean a headache or other things There are a whole host of potential side effects with the anaesthesia, headaches are more associated with when the anaesthesia wears off, and the head is recovering from the trauma - however OTC painkillers will help relieve this. 7. Is it possible for Donor Area to grow back ? The hairs grafted from your donor area will grow back in the area to which they are transplanted. They will not regrow from their initial sites in your donor region, and instead a scar will form. 8. How many graft you guys would think for my case? ( I know it's depend on, but I just want to know approximately how many graft is the best ) Assuming you are just looking at addressing your frontal loss that you have shown in your last photo, depending on the hairline design, it could be anywhere between 2000-4000 grafts. Keep researching, reading and learning as much as you can, you will thank yourself so much for it years down the line. All the best!

I’m guessing you mean 0.5mg dutasteride? You could up the oral minoxidil to 5mg daily, which is the dosage that most dr’s want to get their patients up to. Daily 0.5mg dutasteride would also be an option, however if your serum DHT is really at rock bottom already, some people subscribe to the trail of thought that scalp testosterone can also cause follicle miniaturisation to those that are susceptible to androgens, albeit not at the same velocity as DHT. This is why some people seek to add in a topical anti androgen, such as RU or Breezula.

Crikey - where do you live!? I echo previous sentiments, focus the next 12 months starting on medication that you are comfortable with, see how you get on, and there’s nothing stopping you consulting with clinics in the mean time. Your balding is edging more towards the severe end relative to your age, therefore if you are able to, really try and come up with a good stabilisation regime to stand yourself in good stead for your eventual surgery/ies. All the best,

DUPA, because the patient doesn’t have a stable donor. Any good surgeon who can identify DUPA would be very reluctant to perform surgery, and it may only be a consideration if the patient is able to prove that it has stabilised from using medication for a sustained period of time.

If your donor is substantially thinning also, then this is DUPA - which is different to diffused thinning in a typical Norwood scale pattern. Totally different scenario.

Weird post, considering you’ve later contradicted yourself? A restored NW6 is effectively a diffuse thinner. Diffuse thinners can be perceived as more fortunate, as they tend to be more likely to experience regrowth as well as stabilisation on meds. There is also no reason as to why a stabilised diffuse thinner can’t expect to receive a good hair transplant result under the hands of a competent surgeon.

You’re more likely to run into headwinds if you delve into these wild scopes of opinions, anecdotes and precautions, as you have put it. Keep it simple and follow your clinics advice with everything - you’ve paid a lot of money at the end of the day, and placed your trust in their hands with providing you a good result, so be demanding of continuous follow up care, and go to them always for answers to these kinds of questions.

Why don’t you just speak to the doctor or clinic that performed your surgery?

I am confident the right medication will regrow your bridge and forelock to a near native density - well worth looking into, should you feel comfortable.

Solid uniform growth, and a very nice hairline design - Excellent result. RE the graft count; Aside from the patients’ fine hair calibre, and what I presume to have been hidden thinning behind the recessed hairline, Dr Bisanga is one of the Dr’s in the industry that aims to actively ‘transitionally transplant’, which helps blend the focus area of restoration into the native sections, as well as help the appearance of native areas that will inevitably become subject to further loss down the line.

@Rolandas is your man for this.

Stick with it if you’re able to do so, the two in combination are fantastic. Aside from the impressive growth you have seen on top, it’s the dramatic strengthening of your donor, in particular the lateral humps, that really stands out to me. Just goes to show how effective meds can be for regrowth when caught at the right time.

Impressive stuff ! Take note all those who believe hair loss meds don’t work on frontal hair loss, lol. Have you thought about adding in minoxidil ?

Just wear sunglasses and/or a covid mask. I empathise with being self conscious, but considering the time, effort and money you are investing into a procedure that uses a limited and finite resource, for the sake of risking dislodging any grafts or knocking a scab out of place and causing bleeding, it really isn’t worth it for the sake of appearances in front of an airport of strangers. Think about the long game.

Speak to your dr and follow their guidance. Personally, I would avoid putting anything on my head until at least the scabs have been removed.

There’s no universal answer because different people respond differently to different doses, due to a variety of other factors aside from just the individuals mechanical response, such as extent and rate of hairloss, history of medication, current adjacent medications etc. A few Dr’s have speculated there may be a correlation between body weight and the effective dose. From what I have seen over the last 2 years online, and from my own experience - 5mg daily for men, is the general consensus for optimum results.

Looks a great result, will look forward to the video. I’ve only just came back online now so I hadn’t seen Raphaels response.