LaserCaps

This can vary by patient.  But there is always that "perfect" length where all the hair just seems to work together to provide the most density.  If too short, as others have noted, it just looks too bare.  If too long, it starts pulling away and makes areas look more see-through-Ish.  Work with your hairstylist to decipher.  SMP does come to mind.  This would help minimize the contrast and give the illusion of more density.

There are two types of loss.  The type you see and the type you don't see.  What you do see in the sink, 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.

Under a bright light look at the hair in the temporal areas.  Look at each strand.  Notice the caliber. Some thick and robust while others not so much so.  Some are so fine, it seems they're not growing at all.  Eventually the hair dissipates and disappears.  We refer to this as miniaturization.

Propecia and Rogaine are considered to be the best meds for retention in the crown.  The problem is "expectations." Most patients get frustrated about a year later when they see no visual change - not understanding - the meds are not intended for you to grow anything.  Rather, they are to keep you from losing more.  So, if a year later you look the same, the meds did what they were intended to do.  You may want to research PRP and Laser.  These can actually help reverse the thinning.

What clinics did you go to? Was your condition discussed at the time of the consultation?

Itchy scalp can mean a number of things.  Did you ever go to a dermatologist?

To identify the culprit and identify what exactly you're dealing with I would get a biopsy.  Short of that, it's anybody's guess.

It is important to recognize, if you've shown the propensity to lose, you will continue losing.  As Britalien has asked, what modalities are you taking/using to help you with retention of the native hair?

You have already used a good percentage of your donor, and you still look thin.  Get this identified before you waste any more donor.

Dr. Gabel is an experienced surgeon.  Meticulous in his work.  One of only a few doctors who can do long hair FUE in the Pacific Northwest.  

32 minutes ago, Alex94gasp said:

Can reverse some hair losse? Or fortified actually hair ?

No.  Fin and Min are considered to be the best meds for retention in the crown.  Unfortunately, most patients stop after a year when they see no visual change.  The meds help you retain. That is, if you look the same a year later, the meds did what they were intended to do.  Only a small percentage get to enhance hair.

Reversal of the thinning can be achieved with PRP/Laser.  Research these.

32 minutes ago, Alex94gasp said:

Can reverse some hair losse? Or fortified actually hair ?

Everything on top is at risk.  If you've shown the propensity to lose, you will continue losing.  I'm glad to hear you are doing a medical regimen to help you with retention.  Only a few percentages of people experience enhancement.  Regardless of what happens, pls do not stop. You may want to incorporate PRP/Laser. These can help reverse the thinning.  Research.

One of the basic concepts I like to discuss is donor limitation.  There is typically not enough hair available to allow for density in the front, mid-scalp and crown.  So, if there is a limitation, where do we want to put it, so it serves the patient well now and in the future? The front.  It is the area you see when you look at yourself.  It is also the area others see when they interact with you. Now the crown.

Think of the crown as a circle.  We fill it with hair.  You then go on to lose all the hair around the circle, you would look like a target.  It is for this reason retention of the hair becomes imperative.  This explanation is somewhat simplistic and there is more to it, but you get the gest.  So, when is the right time to do a crown?

Once you are happy with the front, and you can confirm the meds are working, you can then work the crown.  (Understanding you need to keep up all medical modalities). 

2 hours ago, SeanToman said:

Hi everyone, hope you are all doing well.

I was just wondering what the risks are of having a second transplant on the same recipient area as the first.

Can this cause damage to the originally transplanted follicles?

What other risks are involved?

Thanks.

Many surgeons are under the impression grafts compete for blood supply. They'll leave a separation in between the grafts and explain they are placing a foundation to which they can add grafts at a later time.  A year later you can return to do more.  It may even take an additional visit to achieve fullness.  This is also number dependent.  

It is typically recommended you wait at least 6 months before considering a 2nd transplant into the same area.  The doctor wants to be able to see where the first set of grafts were placed.

What medical therapy are you doing to help you with retention of the native hair?

You may want to research Fellowship trained doctors.  Some can achieve density in a single procedure.  

There are engineering principles that apply to most of us.  It is called the rule of thirds.  (Chin to nose, nose to eyebrow, eyebrow to hairline).  Tends to be 7 cm.

Some are misguided.  All we can do is try to educate.  I did add my two cents.  Hopefully it helps.

42 minutes ago, Ali took over said:

I agree with everything you said.

Very good info. 👍

Except for PPR and laser. They are crap and snake oils.  Never waste your time, money and energy on them. 

There are stronger and better alternatives such as Dutasteride, oral minoxidil, topical anti androgens etc... 

Other than that great post ! 

Thanks.  I see you've also fallen into the trap.  Most clinics do not know how to do PRP properly.  With regards to lasers, there are now knock offs of Knock offs.  It is no wonder most people see no difference with these treatments.  

A newbie! Refreshing.  Let's get you started the right way and with useful info.  The basics to keep in mind.

If you've shown the propensity to lose, you will continue losing.

The donor area is limited and finite.  Once gone it never returns.  There is typically not enough hair available to allow for full density in the front, mid-scalp and crown.  Thus, if there is a limitation, where do we want to put it so that it serves the patient now and in the future? The front.  It is the area you see when looking at yourself.  It is also the area others see when they interact with you.  How about the crown? You might ask.

The crown is a sphere. It can take many, many grafts.  You could actually put your entire donor in the crown and still look thin.  You then go on to lose the front.  You'll be asking "why did you put all the hair in the crown when I now have nothing for the front, and I still look bald" When is the right time to do the crown then? When you're happy with the front and confirm medications are working. What medications?

Propecia, Rogaine, PRP and Laser are the modalities we refer to when dealing with this condition.  They work in different ways and there is synergy when combined.  Propecia and Rogaine are considered the best meds for retention in the crown.  The problem is that of expectations.  Most people get frustrated and stop altogether a year later 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.  If a year later you look the same, the meds did what they were intended to do.  PRP and Laser can help reverse the thinning.

The sad thing about this industry, it is not regulated.  Any doctor can do this.  All they have to do is go to their local library, read about hair restoration, and be in business the very next day with zero experience.  There are only a handful of places offering a Fellowship in hair.  When in consultation, ask, "where did you learn how to do this?" Also, look at photos of results, particularly of cases similar to your own.  Pay attention to what the doctor can accomplish in a single procedure. 

There are many knowledgeable people in this forum.  Ask away. We are all here to help.

24 minutes ago, Geo said:

Thanks for your feedback. 
 

For the crown, I have been on finasteride and minoxidil for more than 10 years now; I don’t think it will improve any further, so, why not transplant it?

 

Thanks

Great question.  When is the right time to transplant the crown? When you're happy with the front and confirm the meds are helping you retain. Do you have photos of when you started this journey? If you're pattern has remained the same, or improved, you have half your answer.  I would wait until you are happy with the results in the front, including density.  You can then start transplanting the crown.  A "dusting" I call it.  Why?

The crown is the weakest point for everybody.  We all share the whirl.  It is a point from which the hair stems.  So, being thin is more than acceptable. 

It is important to always keep in mind, if you've shown the propensity to lose, you will continue losing.  Always keep a bank available just in case.

Can you post your photos? First thing we need to do is identify the pattern.  Look at the Norwood chart and look at a 5a.  Lightly cover the whole head with a pencil. This means a patient can have hair, but you can see the pattern when looking through the hair.  Pls confirm the NW3.  Do you have miniaturized hair? Or is it completely devoid of hair? It's all in the details.

Are you retaining or are you still losing hair despite the medications? Not clear. If you have experienced retention, you will continue enjoying the effect for as long as you stay on the medication.  So, please, don't stop.  You may want to add PRP and Laser to the mix.  These two can help reverse the thinning. 

I'll share my example with you.  Close to what you're experiencing.  

When my son was 18, I showed him photos of all my relatives.  My grandfather was bald, so was my dad.  I am following closely behind. I explained the hair loss process and suggested he gets on Fin.  Has been on it ever since. He is now 29 and is enjoying a full set of hair.  

A couple of things to consider about the system.  We cannot compete with the density of a system. 2nd. if you decide to stop the meds altogether, you could incorporate the system into the equation, but in reverse to what you're thinking.  I would do a small system for the crown.  If you do have enough donor, I would transplant the front. This will provide naturalness and help hide the system.  (That's if you can handle using a system).

12 hours ago, NOMORENORWOOD said:

Oh like a surgical cap? Also you can place sunscreen on the donor area or receptive to area 7 days after?

No, a baseball cap.  Yes, you can typically apply sunscreen 7 days post op. I would go ahead and confirm with your doctor.

17 minutes ago, arthurSam said:

Or do you think we can go to get a positive reward just to get some pleasure because we would like to have more hair, even if we are not depressed about that and we can live with our Norwood ?

For me this really does not apply.  Or does it?

My grandfather was bald, and I wanted to be just like him.  Never gave it any thought.  Didn't even know hair restoration existed.  I was confident enough.  Wore glasses, that didn't bother me either.  I was then introduced to the industry and was told, "how can you talk about hair restoration when you don't have any?" So, was this forced on me? No, but it became a necessity. I now have more hair than all my ancestors, combined.  Do I feel good about myself? Sure! More so when patients come for consult and say something about it.

This makes me think of a Cowboy I visited with years ago.  Macho! Great Cowboy hat, boots, etc. When he took of the hat, his demeanor changed.  He turned red, apparently ashamed of the way he looked.  Eventually he had his procedure. Did this have a huge impact on him? Sure!

Is age an issue? Sure, that's another matter.  I believe most young guys want to enjoy their youth and not look old.  How about women? They need their hair today! 

Most clinics will give you some type of relaxer prior to the procedure. It's almost as if you had a few drinks.  They prefer you do not drive that day.  As civic has stated, it is a good idea to return to the clinic the next day for your first wash.  Most people are concerned they may damage something.  The Clinical staff knows exactly what should be done.  You can go home right after that.  

I gather you took a bag with you.  If you get too active after the procedure, you'll swell at about the third day.  It will travel down your face and drain in the neck area.  It is short lived. Should last a day or two.  Lastly, it is likely the clinic will give you "things" to use post operatively.  Make sure to check in the bag otherwise they'll take them.

Oh, the cap.  You can wear a cap the day of the procedure.  Just have the staff show you how to put it on so the grafts don't catch.  You can wear a cap all you want.  After the 7th day, use sunscreen and a cap. If you burn the incisions, you can freckle permanently.

On 6/11/2022 at 10:55 AM, AnxiousBeginner said:

I'm at a point where I'm considering starting a hair loss treatment/regimen and I'm still worried about side-effects (especially ED/libido), cost, time applying creams and sticking to the regimen and inconveniences caused by side effects or oily hair with foam/topical in it all the time.

Do you ever regret starting the whole treatment/regimen process and wish you just adapted the bald look?

There is more testosterone under the med that without. Why people have side effects is beyond me.  But there are documented cases that do exist.  Why not try for 2 weeks and see what happens?  If you don't get any, you never will.  Without even trying, if you think you will get a side effect, it is likely you will.  So, IMO, your "mental approach" also has to be a positive one. Cost? This should not be an issue. Costo On-line charges $26 for the whole year. Rogaine, if doing it is too labor intensive for you, now comes in pill form. 

No, no regrets.  Can you imagine a consultant in the hair restoration industry with no hair? I've been at it now for over 30 years and have not missed a day of Propecia.  I also do Laser and Min in the mornings. You just need to make it a routine.

17 hours ago, Adier said:

@LaserCapsI have started with Finasteride and topical Minoxidil couple weeks ago. The HT industry seems to have conflicting opinions on PRP and laser though. I will consider prp may be. I have uploaded the donor area pic.

I think about the Old, Old West, when discussing PRP.  Every man for himself.  Since there is no regulatory agency, providers have not congregated to discuss the topic nor share ideas.  Moving forward with PRP in sessions does not work. It implies doing a syringe size worth of PRP, a few injections, and repeat in the ensuing months.  So, if you hear the word "sessions," run in the opposite direction.  There are far more effective ways of doing this.

Regarding Laser therapy, there are now knock-offs of knock-offs.  Some have duration of only a few minutes per day.  There were two studies done on this subject recently.  It was determined you can do 15 minutes every day or 30 minutes every other day for the most efficacy. 

Diffused thinning with the potential of losing it all.  Everything is at risk.  And, unfortunately, you have not submitted a photo of the back of your head.  I would encourage you to consider a medical regimen to help you with retention.  The good news, you seem to have a lot of miniaturized hairs which could actually thicken up. Propecia, Rogaine, PRP and Laser are the modalities we refer to when dealing with this condition.  They work in different ways and there seems to be synergy when combined.  Do them all for a good year and take photos in the interim.  A year later, based on the results, you can decide if the cost and time spent are worth it.  Transplants pending outcome.

It all depends on the doctor.  There are some that believe grafts compete for blood supply and feel the need to leave a separation in between the grafts.  They'll explain they are placing a foundation to which you can continue adding grafts in the future.  There are other doctors, however, that can create density in a single procedure.  Some doctors are truly brilliant and with a great deal of experience and techniques. Always review photos of results, particularly of cases similar to your own.  And, yes, look for results of 1 procedure and of multiple procedures (in the same area).

It will depend on the type of technique you choose.  If FUT, I would wait until the sutures are removed.  Some are self-absorbable - which take 10-14 days to dissolve.  If FUE, I would wait at least 7 days. Ask the clinic.  Some doctors are more conservative than others.

It varies per clinic.  Some doctors are more conservative than others.  Most believe you cannot hurt anything after 3 days.  But, out of caution, some will get you back to easy aerobics after 7 days.  Most will suggest 14 days for more extraneous exercise.  FUT, however, particularly when it comes to weightlifting, it is suggested you avoid exercises that affect the neck for 6 months.  This can stretch the wound margins and result in a wider scar.  Sweat, by the way, is fine.  It is exertion we are trying to avoid immediately post op.  

8 hours ago, mafpe said:

i understand the straight logic on the cost that you put on 3 procedure = triple the cost.

but the problem with density is that the more dense you pack it, the more grafts you are going to use. so to say doing 3 x 1000 grafts is just the same as doing 3000 grafts in total cost. the reason where they are "under the impression" that grafts compete for blood supply, is that very dense packing in one procedure give way to the posibility of lesser amount of grafts surviving, and possibly in the worst case, necrosis which is the worst most imagine. the only difference if the pricing is in graft, is the amount of time people need. booking, accommodation, and convalescence are all doubled or tripled, yes, but not the operation cost itself.

if the doctor is able to go for 80/cm2 safely, there is no need for double or triple the surgery. still, 1 cm will take 80 while if you make it 2 surgery of 40/cm each, both will take the same amount of grafts. that is unless you take an all inclusive package of any number of graft  = xxx $

No.  I am talking about 2 doctors doing exactly the same number.  One taking the approach of leaving a separation in between grafts to which you can add density in subsequent procedures and another doctor who's techniques are so advanced, that he can achieve density in a single procedure.  

The main reason why many doctors do not recommend working on someone very young is because the pattern may not have revealed itself.  If you start transplants too soon, it may force things.  Let me give you an example.  18 YO with a very youthful hairline is starting to mature the corners. He talks the doctor into adding grafts to the corners.  The patient is destined to lose everything.  He will eventually end up with a couple of horns in the middle of nowhere.  Unfortunately, we do not have a hair crystal ball that will give us this info.  Medical therapy is key.

Let me throw in my 5 cents. 

Have you noticed, most patients, after one procedure they tend to complain because of how thin it looks? So typically, multiple procedures are required to achieve density. Do you know why this happens? Most doctors are under the impression grafts compete for blood supply. They will explain they will be placing a foundation from which they can add grafts in future.  You return 12 months later, and you do it again.  Third procedure and you may have achieved fullness.  A few doctors, given technique, knowledge, experience and background, can achieve density in a single procedure.  Search for a Fellowship trained doctor and look at photos of results, particularly those similar to you. And, of course, in one visit. Why go into this way?

When you consider cost, consider how many times will you need to do this to accomplish what you set out to do.  If it's 3 procedures, $6X 3 = $18! What if you can accomplish the same in a single visit?! Cost can vary from clinic to clinic and from technique to technique. FUT seems to be in the $4.50 to $5 range while FUE in $6-$10 depending on a few variables.  My suggestion, once you've found the right clinic/doctor, is to make yourself available to the clinic.  They may work with you if a sooner slot becomes available.