LaserCaps

Most patients get to experience some type of result 2 weeks after starting the medication.  Could be just as simple as "slowing down the loss." If that's the case, you could move forward with a procedure.  It really takes a good year to confirm what exactly the medication will do.  And, if it works, stay on it.  It does you no good to start and stop.  Just a waste of time, trouble and expense.

What if you're not a responder to the medication? What difference does it make if you postpone for a few months? Whatever it takes to confirm the medication is doing its thing is not a bad idea.  You may even want to combine this with other modalities.  The mechanism of action of each is totally different and there's synergy when combined.  

You have an advanced pattern and expanding.

One of the very basics in this industry is donor limitation.  There's typically not enough hair to allow for fullness in the front, top and back.  It's for this reason most ethical doctors will concentrate their efforts in the frontal area.  It's the area you see when looking at yourself.  It's also the area others see when they interact with you.  Having hair in the front will frame your face and provide additional coverage as you let it grow.  Now the crown.

Think of the crown as a circle.  You fill it with hair.  Because you've shown the propensity to lose, you'll continue losing.  You go on to lose all the hair around the island worth of hair.  You've now created a target.  Not a natural pattern.  It's for this reason retention of the native hair becomes imperative.  

Propecia and Rogaine are considered to be the best meds for retention in the crown.  The problem is that of expectations a year later.  Most patients get frustrated and stop when they see no visual change - not understanding - the meds are not intended for you to grow anything.  Rather, they're to keep you from losing more.  If a year later you look exactly the same, the meds did what they were intended to do.  Go ahead and research PRP and Laser.  These two can help reverse miniaturized hairs, which you seem to have a lot of. 

The crown is the weakest point we all share due to the whirl.  It's the point from which the hair stems.  That is, no hair is coming into the area.  Hair grows outwards from the point.  It would take many, many procedures and grafts to fill it.  Let me illustrate.

Grab a piece of paper and a pencil.  Draw a dot.  Draw an intersecting cross right on the dot.  Turn the paper ever so slightly and draw another cross.  Repeat until you tire.  How many crosses do you think it would take to fill in the circle?  This area is a sphere and can eat your entire donor.  Eventually I can hear you ask, "why did you put my entire donor in the crown when I now have nothing left for the front, and still look bald?"  Remember, it's the front everyone sees when they interact with you.

Getting on all modalities for a good year is not a bad idea.  Transplants pending outcome.

A couple of generalities which apply to the hair industry,

Donor limitation.  There's typically not enough hair available to allow for fullness in the front, top and back, particularly when dealing with an advanced pattern.  It's for this reason most ethical doctors will concentrate their efforts towards the front.  It's the area you see when looking at yourself.  It's also the area others see when they interact with you.  And, while this may not apply to you at this time, it's just something to keep in mind.  Why?

If you've lost, you'll continue losing.  Seems at this time your loss is minimal.  A lot of miniaturized hairs noted towards the frontal area.  The other thing that does not help you is the color contrast between the color of the hair and the scalp.  It makes it seem worse than what it truly is.

There are engineering principles that apply to hairline design.  Research the rule of thirds.  Since you've blocked your face, it is difficult to tell if lowering your hairline would be appropriate. Visit with a couple of surgeons and see what they recommend.  

Do you have family history of hair loss? It's imperative you get on some sort of regimen to help you halt the loss.  Propecia and Rogaine are considered to be the best meds for retention towards the crown.  The problem is that of expectations.  Most people get frustrated and stop a year later when they see no visual change.  The meds are not intended for you to grow anything.  They're to keep you from losing more.  If a year later you look the same, the meds did what they were intended to do.  Research PRP and Laser.  These two can help reverse miniaturized hair.  

Lastly, you're closer to 20 than you're to 85.  Everybody reminisces about the hairline they used to have.  Always consider being both age and pattern appropriate.  It would not be natural to be in a happy home, 85 years old with a hairline of a 20-year-old.  

15 hours ago, dm3431 said:

My background: I'm 25. My dad went bald gradually, starting with a bald spot at the crown and then receding hairline. My mom's side has very good hair genes; my grandfather had a mostly full head of hair until he passed away at 91 and my uncles have pretty thick hair as well in their 60s. My brother (in his 30s) does not have noticeably thinning hair either. 

At some point last year, it seems, my hair started thinning out considerably. I had a short buzz cut for a while so I didn't notice it, and when I grew it out again I still didn't really see anything drastically different. But I did notice that the texture started to feel a little different and that it kind of reminded me of other people whose hair is thinning. So I take a picture of the top of my head and notice that there are a bunch of random thin patches all over my head. I couldn't see them when combed, but I was really surprised. So I buzzed it off, thinking it might have been clumping/damage from overzealous use of gel (which I had been doing). But as the buzz cut grew in, I still noticed that it looked drastically thinner on top, and that I had a noticeable thin spot right behind my hairline. There was also strange thinning on the sides as well. 

I went to a dermatologist, who didn't really do a very thorough exam but confirmed there was thinning without specifying a cause. He gave me oral minoxidil (2.5 mg) and I've been taking it daily since the beginning of September. I know it takes 4-6 months for it to fully take effect, but I have not noticed any preliminary results at all yet after about 3 months. 

What could this be? Someone on Reddit says I'm a Norwood 6, but I don't have any recession in my hairline at all. I do not want to take finasteride because I've dealt with some of the side effects while taking another medication and would not want to even risk having them come back after all I went through. Should I consider a hair transplant? I am unable to afford one at the moment, but maybe I will have enough in the future. 

It's all been very discouraging for me.  

https://imgur.com/a/BOmQFOl Here are pictures for reference

Review the Norwood chart and look at a class 5a.  Color the entire figure.  This means you can have hair but, if you can see through and see the pattern underneath, it's likely where you'll be classified.  

You have hair throughout.  We typically refer to this as diffused thinning with lots of miniaturized hairs.

There are two types of loss. The type you can see, and they type you can't see.  What you do see in the brush, pillowcase, shower stall, is normal.  The follicle gets tired of producing hair and goes into a dormant period of 3-4 months.  The follicle then resumes growing. This will happen randomly to all the hair in your head.  100 hairs a day is considered normal.  Hair loss is different, you don't see it.

Start looking at the hair in your temporal areas.  Notice each strand and pay particular attention to the caliber.  Some thick and some not so much so.  Eventually the hair dissipates and disappears.  We refer to this as miniaturization.  Once gone, the hair will not return. 

Propecia and Rogaine are considered to be the best meds for retention in the crown.  The problem is that of expectations a year later when patients see not visual change. The meds are not intended for you to grow anything.  Rather, they're to keep you from losing more.  If a year later you look the same, the meds did what they were intended to do.  Research PRP and Laser.  These two can help reverse miniaturized hairs

Rogaine by itself is like using a band-aid.  It's a great adjunct when you combine other modalities as there's synergy and cross synergy.  I would encourage you to do all of them and stay on them.  A year later you can decide if the outcome is worth the time, trouble and expense.  I would hold off on the thought of transplants. 

The medication is systemic.  Put it on any one spot and it's working the whole head.  The medication is absorbed by the skin but has a universal effect throughout.  The only thing you're doing by putting it everywhere is just wasting the med.  

The purpose of the med is to help retain the native hair.  Grafts do not need the medication. They come from an area that seems to be resistant to DHT.  If the hair is permanent in the donor, it'll be permanent wherever it's placed.  

The head is very vascular.  Limited blood supply? I don't think so.  

Nothing regrows hair.  You can, however, retain and even enhanced miniaturized hair.  Once gone, however, the hair will not return.

You may want to consider all medical modalities.  The mechanism of action of each is totally different and there's synergy when combined.  That is, they work better together than separately. 

No doubt there's hair loss.  Seemed like a crown pattern initially but your second photos show diffused loss.  Are you dipping? Perhaps.  You keep your hair so short you can clearly see through the hair and see scalp.  Many doctors can get confused by this and could very well tell you you're experiencing global thinning.  My first suggestion, allow your hair to grow for 2 weeks and reassess.

You're very young and already experiencing an advanced pattern.  And, if you've lost, you'll continue losing.  When? Don't know.  Wish we had a hair crystal ball from time to time.

One of the basic concepts of hair restoration is donor limitation.  There's typically not enough hair available to allow for fullness in the front, top and back.  It's for this reason most ethical doctors will concentrate their efforts in the frontal area.  It's the area you see when looking at yourself, it's also the area others see when they interact with you.  Now the crow.

Think of the crown as a circle.  We fill it.  You go on to lose everything around the island worth of hair.  You've now created a target.  It's imperative you get on some sort of medical regimen to help you retain and perhaps enhance the native hair.  You seem to have a lot of miniaturized hairs.

Propecia, Rogaine, PRP and Laser are the modalities we refer to when dealing with this condition.  The mechanism of action of each is totally different and there's synergy when combined Get on them a give them a year.  It takes that long to confirm what exactly they'll accomplish.  Transplants pending outcome. 

A follicle is a graft.  A follicular unit can have from 1-5 hairs.  

A slit is an aperture or recipient site. 

Yes, multiple grafts can be placed in a recipient site.  

You must have very poor density, or many 1 hair grafts that are not making much of an impact, particularly farther back into the pattern.  Try to get more info from the doctor and have them send you a report of what exactly was placed.  

1 minute ago, FixMyHair213 said:

Hair loss is known to be fast when your younger and slow down when youre older. do you know of anyone who lets say took finasteride for 20 years from the age of 20 to 40 then stopped then didnt recieve hair loss or recieved it minimally? Im currently an nw2.5-3 at 21 years old. ive been taken finasteride for 1 and a half years and have stabilized my hairloss but ideally I dont want to be on medication forever so im not sure what to do. 

I am aware of many patients through the years that stopped the med after years of use.  They wanted to "check" to see what would happen.  At the first sign of loss, they resumed taking the med.  Take me for example.  If I stop, I'll lose what I would have lost had I not been on the medication.  This does bring a good point.  Say you were not meant to lose anything in those many years, then nothing will happen.  Unfortunately, we do not have a hair crystal ball to give us that info. 

The medication is now available as a topical solution.  There's also Rogaine, PRP, Laser.  Perhaps adding some, if not all of these, to the mix would be a good idea.  They work in different ways and there's synergy when combined.  

21 minutes ago, PizzaWolf said:

You don't see any problems with this statement? No attempt to expand on it, or why this doctor you worked for hypothesized that Finasteride "would eventually lead to dementia"?

Unfortunately, I only saw him sparingly and never got the opportunity to discuss this with him.  If I had more info, I would have shared it with the group.  

But there is something else I would like to add.  It's not uncommon for patients to blame the medication for whatever they're experiencing at any one time.  Say, headaches, for example.  "Brain-fog is another. Likely coincidental.

6 minutes ago, FixMyHair213 said:

what sort of things can develop many years later? ive been taking it for a year and a half and have never had any side effects. 

I've been on the med for about 30 years and never experienced a side effect. It has always been my understanding there's more testosterone with the med.  So, I choose to think about it that way. I tend to think, if you believe you'll experience a side effect, you eventually will. 

Years ago, I worked for a doctor that wrote about this same subject for his doctoral degree.  He was under the impression that the use of the med would eventually lead to dementia.  We'll have to wait and see if this becomes true.

Year after year, it seems, more negativity comes up regarding the use of the medication.  Regardless, I plan on continue taking the med.  Can you imagine a consultant in the industry with no hair? No bueno.

10 hours ago, Diravu said:

I've been taking finasteride dailty for a year and 8 months now, I've started with 0.5mg daily, for 8 months, then increased it to 0.75m for another 8 months, and finally to 1mg daily about 3 months ago.

at around the year (more or less) I noticed (or at least what I thought) that my hair has gotten thicker, I thought fin was working and halted my hair loss, I remember that once even when I was at the barber, he had more volume to work with, he usually keeps my hair somewhat longer (because I'm diffused) and only goes as short as possible before all the diffused thinning shows, but I noticed that about after a year he started to go shorter with the haircut because there was more volume.

the problem is that in the last 3 months I've been losing hair like crazy, my scalp started to itch and be sore (comes and goes), which is something I also had before I started fin.

at this point currently it's like my hair is back to baseline, or even worse, from before I started fin.

it's like it simply stopped working, or perhaps it never worked at all and only slowed down the hair loss for a little bit but not enough.

is it common for fin to stop working that quickly? could this be just a temproary shed? although it's been going for 3 months now.

I don't know what to do.

This tends to get confusing from time to time.  There are two types of loss, the type you see and the type you don't.  What you do see in the shower, sink, brush is normal.  The follicle gets tired of producing hair and goes into a dormant period of about 3-4 months.  The hair then resumes growing. Hair loss is different, you don't see it.

Under a bright light start looking at each strand, particularly on your hairline.  Notice the caliber. Some thick, some finer.  Eventually the hair dissipates and disappears.  Once gone, the hair will not return.  That's hair loss.  

Fin/Min are considered to be the best meds for retention in the crown.  The problem is that of expectations.  A year later most patients become frustrated and stop when they see no visual change - not understanding - the meds are not intended for you to grow anything.  Rather, they're to keep you from losing more. So, if a year later you look the same, the meds did what they were intended to do.  Taking photos, as it's been suggested, is huge.  How else would you be able to tell if you're experiencing retention?  

The itching issue is something that you need to address.  Go to the dermatologist to identify the culprit.  While it may be coincidental, it could very well be what's causing the shed. 

What other modalities are you doing other than Fin? The mechanism of action of each is totally different and there's synergy when combined.  Perhaps, if you're just doing Fin, getting on something else would be beneficial.

Best cost I've found is $26 for the whole year, (Costco on-line). 

The fact is most clinics do not know how to do PRP.  If you hear the word "sessions," run away in the opposite direction. This implies doing a few shots and have you return in the ensuing months to continue doing the same thing.  No results.  Research Fellowship trained surgeons with experience. Their approach is totally different.

13 minutes ago, Westview said:

Err, certified physician means he has a medical license I would think

If so, certified in what? You would assume it would be in hair restoration since it is this subject we're dealing with.  This does bring up a point.  Many times, you'll notice, "Triple board certified," etc. Do a bit of digging and you'll find it is in something else other than hair restoration.  I know of one. He is a physical therapist.  Why would anyone want a physical therapist to do their hair? 

It is the alcohol in it that's causing the dryness/flaking.  I gather you're placing it all over.  The med is systemic.  Just put it on one place, (you can change the place if you wish), and massage in.  The skin will absorb the med and have a universal effect throughout.  

The medication is now available in oral form.  Less labor intensive. 

There are two types of loss, the type you see and the type you don't.  What you do see in the sink, pillowcase, brush, is normal.  The follicle gets tired and goes into a dormant period of 3-4 months.  The hair then returns.  This will happen randomly to all the hair in your head, and not all at the same time.  100 hairs a day is normal.  This type of thinning does not preclude anyone from moving forward with a procedure.  Hair loss is different, you don't see it.

Under a bright light, look at the hair on your temporal areas.  Look at each strand and pay particular attention to the caliber. Some thick and some thinner.  Some are so fine; you can't hardly see them.  We refer to this process as miniaturization.  Eventually the hair dissipates and disappears.  Once gone, the hair does not return. That's hair loss.  If you're experiencing this, the typical recommendation is to get on a medical regimen to help you retain and perhaps enhance the native hair.  It's important to recognize, if you've shown the propensity to lose, you'll continue losing.  Is this the thinning you're referring to?

There is a lot of value to an in person evaluation with a doctor.  This is the time you can confirm if you are truly a candidate for hair restoration.   

2 hours ago, Rahal Hair Transplant said:

Mike10,

Honestly, it’s rare that someone who goes to a reputable and proven surgeon will obtain a poor result. It’s possible but not probable. However, when things go wrong, it could be due to one of several circumstances.  In most cases, poor results are due to surgical error but if a reputable surgeon was chosen, it’s more likely that there’s some kind of physiological factor that caused this.  But because this physiological factor is typically unknown, it’s referred to as the “X factor“.

This X-factor is rare and is hard to determine. Most people think that any sign of port growth is always related to surgical error but the rare physiological circumstance or X Factor can occur from time to time even in the hands of a skilled surgeon.  

It is true however that one technician being off their game could impact the result which is why it’s absolutely vital that the surgeon supervise and  oversee all aspects of the procedure, even if they themselves are not personally performing that part of it.  Because this X-factor should be exceptionally rare and if one particular clinic is experiencing poor growth more than on rare occurrence, then there might be a damaged cog in the wheel that needs repair or replacement.

I hope this helps.

Rahal Hair Transplant

I noticed on your signature, Certified physician.  Who gives this certification?  This is not a regulated industry.  

So much to this.  First, what's considered a poor result? Is it related to the scar? (If FUT). This, most times, can be attributed to the patient not reading the post op instructions, (which happens often). If the patient starts lifting weights immediately after the procedure, it is likely the scar will stretch.  It's important to realize this has a lot more to do with wound physiology than anything else.

If the issue is "too thin of a result," it's because either too few grafts were placed, or the graft number discussed was placed diffusely throughout the entire pattern. In this case, perhaps, the fault lies in both the doctor and the patient.  Was this not discussed during the initial consultation?

The initial consultation with a doctor is invaluable.  It's the time for the doctor to confirm candidacy and give a recommendation.  All sorts of things can happen here.  Say the patient forgets to tell the doctor that he's on blood thinners.  

Add to all of this all what's been happening with techs doing the work.  (Techs practicing medicine), a disaster waiting to happen.  

Lastly, where did the doctor learn to do this type of work? He might be considered to be a pioneer.  If he's been doing this the wrong way during his entire career, he will likely still be doing it the same way.

The almighty dollar at it again.  

Doctors with good reputation, ha! The sad thing about this industry, it's not regulated.  Any doctor can do this.  All they have to do is read up on hair restoration and they can be in business the next day with zero experience.  Do you realize, at least in the US, there are only 6 places that offer a Fellowship in hair?  I'd bet doctors coming into the industry don't even realize such a program exists. And now you have equipment manufacturers approaching doctors who have no clue about transplants.  "We'll sell you the equipment and send the techs.  All you have to do is stay in your office, read books, watch TV, we'll take care of everything." Techs practicing medicine.  Sad.  

It's standard practice for the doctor to be in charge of the surgical part of the procedure.  He will make the sites, for example, in the angle and direction matching the native hair.  The Clinical staff will then take the grafts and put them in.  They can only go in one way, the way the doctor made the aperture.  If you were to have the doctor do the placing, you'll be there for a week.  Sure the cost would be astronomical.  

Search for Fellowship trained doctors with plenty of experience.  Then look at photos of results, particularly those completed in a single procedure.  

First thing, congratulations! This is an important first step.  It's refreshing to see someone considering a medical regimen as soon as they realize they're losing hair, and not waiting until they do a procedure to get started.

Propecia, Rogaine, PRP and Laser are the modalities we refer to when dealing with this condition.  They work in different ways and there's synergy when combined.  It takes a full year to ascertain what they'll accomplish.  Get on them and stay on them. Take photos in the interim and reassess in 1 year.  You can then decide if the time, effort and expense are worth continuing.

Propecia and Rogaine are considered to be the best meds for retention in the crown.  The problem is that of expectations.  Most patients will get frustrated a year later and stop altogether when they see no visual change - not understanding - the meds are not intended for you to grow anything.  Rather, they are to help you with retention.  That is, if you look the same a year later, the meds did what they were intended to do.  Min by itself, I'm afraid, is like wearing a band-aid. You may want to research PRP and Laser.  These can help reverse the thinning.

The mechanism of action of all modalities is totally different and there is synergy when combined.  I would do all of them and give them a year.  It takes that long to confirm what exactly these will accomplish.  Take photos in the interim.  A year later you can decide if the outcome is worth the time, effort and expense.

29 minutes ago, jr1986 said:

At the age of 22 I noticed a lot of hair in the sink which caused a fair bit of panic, probably 50+. Read that it can be a leading indicator of short cycling hair and with a dad who was bald by 35 it was alarming. 

Over the years I noticed it again and again. Only by the age of 33 did I notice actual thinning of my hair. 

Do keep an eye out for poor quality, thin hairs being shed as I believe that can be and indicator of hair miniaturisation.

 

There are two types of loss.  The type you see and the type you don't.  What you do see in the sink, shower, brush, pillowcase is normal.  The follicle gets tired of producing hair and goes into a dormant period.  3-4 months later the hair returns.  This will happen randomly to all the hair in your head and not all at the same time.  100 hairs a day is considered normal.  Hair loss is different, you don't see it.

Under a bright light start looking at the hair in your temporal areas.  Notice each strand.  Pay particular attention to the caliber.  Some thick and robust while others very thin and wispy.  Eventually the hair dissipates and disappears.  We refer to this process as miniaturization. Once gone, it never returns.

Propecia, Rogaine, RPP and Laser are the modalities we typically refer to when dealing with this debilitating condition.  The mechanism of action of each is totally different and are synergistic when combined.  Get on them and stay on them as soon as you realize there is hair loss. (Which does bring up a question.  If there is family history of hair loss, but you are not experiencing any loss, should you just get on them as preventive medicine?) 

That's the difference when you choose a surgeon who does this correctly.  

This all means nothing.  You have to wait for the new hair to start growing in 3-4 months.  It will be vellus-like to start and it will take the ensuing 8 months to mature.  Eventually it will be the same caliber as the hair in the donor, from which it came.  Patience.

On 7/28/2022 at 4:59 PM, ArochaAngel4247 said:

This patient has a prior FUT procedure with a different doctor before coming to Dr. Arocha. The before images show his result after that FUT procedure. Dr. Arocha and the patient decided to do a 2300 graft FUE procedure to add density - and to conceal the unnatural looking result he received from his previous FUT procedure. He had a PRP treatment at the time of his procedure. These results are 1 year, 10 months out from his procedure with doc. 

Before:

After:

Before:

After:

Before:

After:

So natural!