Curious25

Yes, this was one of the incompleted ones I had in mind. Shame.

DUPA is something different to diffused pattern hair loss, which OP mentions - DUPA is diffused UNPATTERNED alopecia, and relates to diffused loss found all over the scalp, including the donor. OP your hairline looks slightly receded on one side, which may also just have came with age, or maybe even always have appeared like that. It’s very hard from the photos you have provided to confirm whether or not you are diffusely losing hair - you really need an in person exam with a competent hair loss specialist, who can use a trichoscope to analyse your hair, and check for density disparities. RE. finasteride - totally get it, I was once in your camp too. All I can advise, is to study sad read as much scientific literature available, and listen/consult with dr’s with regards to it. If your hair loss as it is now is a concern, then this is going to be a very important component to help combat your problems. Also bear in mind. If you have only recently started on Minox, this may be what’s causing the large amount of shedding you see in the shower. I shed like a dog , and it looks like hundreds of hairs in the shower also, when in reality, if I was to count, it’s usually only 30-50. What I mean by this, is that it often times looks worse than what it is. And shedding a lot doesn’t mean you’re balding either. Anyway, you’re light years away from even thinking about a surgery. Go do some reading and learning, and weigh up the pro’s v con’s for your own situation, and what you want out of life.

Would love the link if you manage to come across it again!

If you have only just started taking it, and continue to pursue taking it - you should wait at least 12 months before scheduling a consultation, let alone a surgery. The state of play is likely to be different should you be a good responder, and could mean anything from not wasting unnecessary grafts to potentially not even requiring another surgery at all. The strategy the surgeon employs should also be tailored to whether you will be a consistent finasteride user, or not at all. Wait it it out, and be patient. It will be worth it.

I’ve never seen a completed patient posted result of Bisangas that has involved direct temple point restoration - I have also reached out to his reps several times and have had no luck in a response when enquiring for examples of temple point restoration work he has done. Perhaps he just doesn’t perform these types of surgeries, I don’t know.

It always confuses me when people seem to allude to blonde hair being somewhat more of a challenge? Blonde hair on a Caucasian male has a much, much lower contrast between skin tone and hair colour, which makes creating an illusion of density a far easier task. The trail of thought that all blonde haired people have fine hair is also one hell of a great myth - and OP is testimony to this, just look at his grown out donor. Hair characteristics hugely determine the expectations candidates can have, but providing all variables equal between a dark haired Caucasian male and a blonde haired Caucasian male -a surgeon would have a much easier task of creating a full looking transplant with the blonde haired patient, purely because of the reduced contrast between scalp and hair. Regardless , this is a very good result, and I hope OP continues to enjoy his new hairline. Congrats to patient and team.

I’ve read many times over now that lower doses with higher frequency are the best angles of approach when looking for an alternate regime to the recommended 1mg daily. Hair loss differs widely from person to person, therefore it doesn’t make sense that a uniform prescription of 1mg daily is required for every MPB sufferer. Trial and error - Start small and gradually increase.

Great improvement. Your donor looks plentiful, as does your beard - so I’m sure you will be able to bring yourself back to a pretty solid looking NW1 and remain like that for as long you wish, provided you keep up with your regime, and your HT grows in as we would expect! Any plans to touch the crown later down the line, or are you going to persevere with the meds to Strengthen it furthermore ?

Everything normal. My BP is usually always in range when I check it at home, the slightly elevated systolic reading at the clinic is nothing of concern, and can often times be different to your typical readings due to ‘white coat syndrome’ etc. The ECG reports normal rhythm and the ‘bradycardia’ just means a lower heart rate than average (avg in adults is 60-100) which is attributed to being in good physical condition. So to summarise - side effects sometimes associated with oral minoxidil (at higher doses) are; elevated heart rate lower blood pressure ECG abnormalities I’m please that the results from my medical didn’t portray any of these. I have previously read online, I think on Reddit, about people worried about an increase in eye pressure, something which I’d never heard mentioned before, but anyway, again according to my results I haven’t experienced. I have never taken topical so can’t compare. However I have enjoyed regrowth and thickening from oral - and have been unaffected negatively in anyway, as far as I’m aware. I will always advocate for anyone wanting to start on a medication, to speak first with a relevant doctor.

Long overdue.

Roughly 10 months on 5mg daily compounded oral minoxidil (2.5mg AM & 2.5mg PM), after 6 weeks of 2.5mg daily. Last week had a full medical; - Seated BP 133/80 with a Pulse of 62. - ECG reported sinus bradycardia, with a pulse of 50. - Eye pressure reading Normal.

Can you post pics, if you feel comfortable ?

All depends on your susceptibility to hair loss - and by that, you can look at it as; Number of hair follicles on your scalp that are predisposed to miniaturisation from DHT x Quantity of DHT that is sufficient to cause miniaturisation (different follicles will have different levels of susceptibility) Then add in , the rate at which miniaturisation will occur at different parameters of systemic DHT and the levels to which 5AR inhibition medication has the capability of reducing your serum DHT down to. Then you also have senile alopecia to contend with. So simply put , I don’t think there is a one size fits all answer - it’s all subject to the individual in question. Like pretty much everything in medicine. As of now though, they are the best chance we have to prevent (prolong) androgenetic miniaturisation. 17 years on DUT? Quite the shift you’ve put in!

Second passes to increase density between existing hairs , for a high level m surgeon, should be a fairly standard and straight forward procedure to perform. An important factor is that the existing hairs are stabilised, however. I have personally seen more aesthetically pleasing and successful transplants, where two/three/four step strategies have taken place, and further density has been added into previous transplanted areas.

The former a very mediocre surgeon, and the latter, a plastic surgeon.

Your loss isn’t that bad relative to your age. Crown seems solid enough, and you have a diffused pattern of loss across your hairline and frontal third - a hair loss type which usually responds very well to meds. I would recommend; - Discussing oral minoxidil 5mg daily with a reputable doctor. - Using 2% Nizoral twice weekly - Sourcing a compounded topical finasteride from a reputable pharmacy, ideally associated with a reputable hair transplant surgeon. Other options, you could try a low dose of oral propecia such as 0.25mg on a 1 on 2 off schedule, and gradually build from there, given you feel ok. source a surgeon to perform 3 monthly dutasteride mesotherapy. Add in microneedling 1.5mm every 10 days. Good Luck.

It’s not a data driven fact rather it a logical perspective. I’m sure there are stats out there as to how many patient x’s exist, that I unfortunately don’t have to hand - nor is it something that I imagine would be too transparent of a figure to accurately assess, given it not being in any clinics interests to promote; however it is no industry secret that pretty much every major clinic provides patients with education and disclaimers in regards to the potential for a surgery not to yield as is intended for X, Y and Z reasons, prior to going under the knife. Combined with the number of patient cases you can find online, where yield hasn’t been of desired expectation. At the end of the day, it is down to the individuals risk vs. reward appetite, as are most decisions we make in life. There is no definitive right or wrong choice, as such. If you as an informed and educated patient are happy with your choice of Dr, and the agreed upon strategy, then all power to you. I don’t feel like it’s too alarming of a statement to make, that utilising a very large proportion of a finite resource in one go, is a riskier decision to make than utilising a lesser number of said source, given the unknowns that may occur, , , so I’m not sure where else the conversation can go from here?

DUT 0.1mg daily is more effective than proscar 5mg daily? Do you have a link to the study, would be interested to look at this. OP - why not just up your finasteride dosage? Going from 0.5mg daily fin to dutasteride is quite the step up, missing out quite a few tiers of progression that you could otherwise do to strengthen your regime.

I understand what you mean now, after updating your original post. So using 3000 as a generic number on a slick NW6, you are wondering about the difference between focusing all these 3000 grafts on the front vs. focusing 2300 grafts at the front, and maybe 700 across mid scalp and crown? I imagine this entirely boils down to patient and Dr goals. Maybe, if a small head size, the dr would be concerned about transplanting all 3000 in just the front section, and wished to spread out the recipient area to help lessen the risk of overwhelming the blood supply demands - however in general, from a yield perspective, it shouldn’t really make a difference.

You’ve had incredible results , and have gone to a seemingly top of his game Dr - but the fact still Remains, a mega session, or any session over 3000 grafts for that matter, is still classed as a higher risk approach to take, purely for the fact of the matter that if you are indeed patient X, and the grafts don’t take - you have lost a huge chunk of a finite resource. The theory is the same , regardless of whether graft numbers are the same or different between the sessions - the emphasis is placed on being conservative with the graft number in the initial surgery.

One of the main advantages with a more conservative initial intervention, is for analysis of how the patient takes to surgery, and what his growth rate was. Aside from that, Surgeries with a smaller number of grafts leads for a higher likelihood of achieving a high graft survival rate, less chance of trauma and transection to the donor, and a better look at the landscape for surgery number 2/3/4 that provides much more accurate planning when it comes to graft numbers/graft groupings/hair types/ areas of allocation etc. You just need to take a look at the results of guys on here who have had 1 HT vs. multiple HT’s to see the difference in quality that is able to be achieved.

You do have options . . I’ll list a few in order of logic - but combining a few of them together would be your best option in terms of your hair. - Try lower dose oral finasteride, on a less frequent dosing schedule - Try topical finasteride - Try dutasteride mesotherapy - Use minoxidil, topical or oral (this doesn’t address the DHT issue but can help keep hair in the anagen phase for longer) - Micro needle (this doesn’t address the DHT issue but can stimulate hair growth) - Add Nizoral Shampoo - Change surgery strategy and opt for a Homogenous hair transplant combined with SMP to pull of a framed face short crop cut style - Wear a full or partial hair system - Embrace the shaven look - Get a HT and hope for the best Your donor density may be strong as hell for all we know at this stage, and you may not be genetically predisposed to have this area of scalp hair be affected by DHT, so you could be a lucky one ? No one has talked about your BHT availability either, which could also potentially be a game changer? It’s worth having a thorough assessment with a few docs anyway, and also take into consideration your family history’s hair loss.

I think a better analogy would be saying it’s like going to the gym whilst continuing to eat a bad a diet. You can’t out train a bad diet - similarly you can’t combat progressive balding without addressing the root cause. OP - if your genetic make up destines you to continue losing hair, then you are likely to experience further loss on top, which may or may not affect the results sustained from your HT, depending on what you deem to be satisfactory. Aggressive hair loss can also creep into traditional donor ‘safe zone’ areas, and miniaturise hair follicles found here, so again, if your genetic make up destines you for this, then your transplanted hairs may also thin or eventually be lost. There is no definitive answer unfortunately - just presumptions based on what we know and have already seen to occur.

Would be good to see some pics of your crown grown out/before you had your HT? Anyway, to answer your question Rogaine Minoxidil twice a day - Proven and effective medication in regrowing hair when there are miniaturised hairs present. 5mg daily Oral minoxidil is also an option you could look into. Finastiride 1mg once a day - Proven and effective medication in dramatically slowing down the miniaturisation process, and often times is able to regrow and thicken miniaturised hairs. Great when used in conjunction with minoxidil. An even more effective medication you may also wish to look into would be 0.5mg daily dutasteride. PRP treatment twice a month for 6 months - Waste of time and money. . Potentially an ok option to use immediately Post hair transplant surgery to improve recovery of the scalp from the plasma rich healing properties. Laser Therapy once a month for 6 months - Will do little to absolutely nothing. Derma Roller twice or 3 times a week - 1x every 10 days is the reportedly optimum frequency. 1.5mm needle.

Go 2%. Logical and beneficial adjunct to use in combination with other tools.