Julius

From what I gather after fue one can expect to buzz down to at least a #2 before scarring is visible what do others think? While with fut one can expect to buzz down to at least a #4 before scarring is visible what do others think? Of course there are individuals who can go lower or who must go higher but I am speaking about averages here.

I have thick dark hair and very pale skin what should people like us do?

Could I please see pictures? I have only seen a few do it

Unfortunately I cannot make it to Thailand but can Dr Pathomvanich do an online consultation? And how much would it cost? As I am really just after a prescription for oral minox j1j9j85 do you take a diuretic?

Facial swelling and excess body hair; I already have experienced mild facial bloating from the topical and apparently the oral is supposed to be worse for this. The other complication is getting a script for it here in OZ, I have asked two doctors for a prescription and both have refused. I am even thinking of seeing Dr Knudsen just to see if he will write me a script. Does anyone in Australia have a doctor who prescribes it to them for hair loss or would be willing to?

None I still have concerns about it

Apparently one 2.5mg per day is equivalent to 1ml of 5% minox twice daily http://www.hairlosstalk.com/interact/viewtopic.php?f=23&t=53548&start=0&st=0&sk=t&sd=a

Great work with the donor scar

Any updates from people on this?

Fantastic result, do you have any bird’s eye view photos of it now and how does it hold up in full sunlight? Congratulations!

Thank you Future HT Doc for all your work on behalf of this community. Dr Pathomvanich thank you very much for your reply it is very much appreciated and deserves to be applauded. Do you think the efficacy wears off overtime as with the topical? NotUrAvg said you use it yourself (even though you appear to be a lower Norwood), is that true? Cheers

Loniten Tablets come in 2.5 mg, 5 mg and 10mg. Check this out: http://www.medicines.org.uk/emc/document.aspx?documentid=1532 It would sure be nice if a Dr. could contribute here as there are serious safety concerns!

Where can I get it from in Thailand? And how do you plan on getting it once you run out? Will you take 2.5mg PO twice daily? By the way if you are on oral minoxidil many hair restoration surgeons like H&W will require you to go off it two months before surgery like the topical, however the hair gained by using it will all have fallen out within a month because it doesn’t stay in the system as long as the topical which lasts three months. I found this article on the net: LONITEN (ORAL MINOXIDIL) FOR HAIR LOSS Background: Loniten (pronounced Lon-ah-tin) is intended for patients with high blood pressure. Incidentally, it was also discovered that a very commonly reported side effects of Loniten is hair growth. Rogaine or topical minoxidil is a spinoff from Loniten and turned out to be a multi-million dollar success for Upjohn as a hair loss treatment. Recently, some have been experimenting with Loniten (oral minoxidil) to treat androgenetic alopecia. Upjohn listed "undesirable hair growth" as one of the side effects associated with Loniten. Specifically, 8 out of every 10 patients reported that body hair grew longer and darker while on Loniten. The hair growth usually starts within 3 - 6 weeks after beginning treatment. It is commonly reported that the hair growth tends to start on the forehead, temples, cheeks, and between the eyebrows. Subsequently, hair growth may be noticed on arms, legs and scalp. Some of HairSite readers also reported denser eyebrows and hair on the back while on treatment. Upjohn further added that the hair growth is not permanent. It will stop within 1 - 6 months after discontinuing the treatment. Publications from Upjohn explicitly stated that a diuretic "must be" taken in conjunction with Loniten in most cases. The rationale is that while Loniten lowers blood pressure, your body's defense mechanism will automatically return your blood pressure to the original elevated level. Your body accomplishes that by retaining water and salt so that there will be more fluid to pump throughout the body. So in order for Loniten to be safe to consume, it is necessary to use a diuretic medication to remove excess water and salt from your body. Spironolactone is a natural choice for most hair loss sufferers since not only is Spironolactone a diuretic, it is also a potent anti-androgen. More info about spironolatcone. These are some posts about oral spiro I found on another forum I thought may interest you: I take all 10 mg in the morning. I'm not sure if it would be more effective to divide it into day and night. I noticed thickening on 5 mg but 10 mg is a lot more effective. I have not noticed fluid retention but I do take spironolactone. However, I've had to drop back dow to 50 mg as gyno is a huge problem. I haven't had any chest pains or tachycardia. I attibute that to the beta blocker. I have had an increase in body hair. On the arms, back, hands, forehead, eyebrows, eye lashes, sideburns and scalp. Ive said it b4 and i will say it again ....Fin taken in conjunction with 5 mg of ORAL Minoxidil will turn your hair into CARPET..FISHING LINE ..whatever other metaphors you can come up with to describe how your hair shaft starts to look as thick as a tree trunk HOWEVER..the sides will positvely FLOOR YOU !!!! 5mg of oral minoxidil is not an especially high dose nor is it especially dangerous short term but i wouldn't take it over a long period, i.e. more than a year....people take 15mg orally for hairloss and these are the people i would say should reconsider...15mg orally is too dangerous...5mg every-other day for example certainly won't FLOOR you, but it's a little too risky over the long term...personally i used it and just shed a lot...a LOT...which freaked me out and i knocked it on the head...maybe i would've got some mega growth a couple of months later but i didnt want to find out...at that stage i still had a resonable NW2 and didnt want to keep going through big sheds at such an early stage in my treatment, so i persevered with topical minoxidil, hassle though it is I once ingested a dose of 500mg minoxidil by mistake...and woke up the next day close to death, with a face swollen to twice its normal size, i was absurdly pale and had difficulty walking out the house....i somehow drove to work but was immediately sent home...in other words, the stuff IS very dangerous and anyone thinking more is better with it is simply asking for trouble...my advise would be if you're set on trying it, then start off on 5mg every other day.....if nothing happens on that then maybe try 5mg a day for a while....if nothing happens on that or if the gains are minimal then forget it - if you grow an absolute shitload of hair from it then i guess the risk is your own to weigh up as to whether you want to continue on it long term to keep a thick head of hair...being aware all the time of course that at some point its effectiveness would wear off and you'd have to continue taking it just to maintain, or even go to a higher dose to gain back your initial growth from the 5mg....and therein lies the danger I found this on Dr Rassman’s (who is recommended here) balding blog: Is oral minoxidil (loniten) good for treating hair loss? No. Taken orally, minoxidil’s major impact will be a drop in blood pressure, not a treatment for hair loss. That is the reason it is placed on the scalp when used for hair loss. Minoxidil Tablets May 23 2006, 11:32 am PT | Posted in: Drugs In Australia, there’s a hair clinic that’s been supplying Minoxidil tablets once a day in their offerings to young hair loss sufferers for a long time now. Reports indicate that maybe 50% of them have astounding scalp hair growth with a few side effects, but this medication when administered orally in tablet form, is not approved for this purpose by the FDA. One reputable doctor does reports using the Minoxidil pill for severe psychological suffering in the young man and adding to it lotions containing finasteride and Rogaine. He warns of side effects and requires careful monitoring, which must be explained to the patient and the parents when minors are involved, and to use the medications only as a short term bridge for those young men with severe psychological dysfunction, until they can surround the dysfunctional state. There is caution suggested when side effects show up, because they can be life threatening. Of the ten or so young men reported by this doctor who received the pill in a 15 year period, one patient had excessive body hair and one developed occasional heart flutters. Stopping the medication stopped the heart flutters, but the excess body hair seemed to stay with the one patient that had it. Minoxidil was originally developed as an antihypertensive agent to treat high blood pressure. If this medication is given to people without high blood pressure, it could drop the blood pressure enough to produce more than a heart flutter — like a heart attack or stroke — in some individuals who have other underlying conditions that lie dormant. Just remember, Minoxidil taken orally is NOT approved as a hair loss treatment. It may drop your blood pressure dangerously low and may cause strokes and even death. I found this on Dr Bernstein’s (who is recommended here) blog: Q: Is Loniten good for treating hair loss? A: Loniten (oral minoxidil) is not useful for treating hair loss. The reason is that it stimulates hair growth all over the body (hypertrichosis) and has a number of serious side effects. Even when used to treat blood pressure, for which it is FDA approved, it is a medication reserved only for severe hypertension, used after at least three other types of blood pressure medications have been tried and are unsuccessful. In addition to increased body and facial hair growth, it can cause fluid retention and heart disease. When used topically (topical generic minoxidil or Rogaine) the medication generally does not cause any significant problems other than local skin irritation and occasionally increased facial hair (which can be real nuisance for women).

Everybody I have spoken to on oral minoxidil thinks it is far better than the topical, studies have even proven it! ‘According to Dr. Path, he thinks the low dose of oral minoxidil has much better results than topical minoxidil, with a low side effect profile. He stated that the dosage prescribed is low that systemic side effects are negligible’. I hope Dr Path (who is recommended on this forum) can tell us a bit more about it how he prescribes this drug. It sounds like he doesn’t recommend a diuretic with it. ‘I may have neglected to mention that the dosage prescribed to me was lower, maybe 1 or 2mg’ What dosage have you been prescribed 1mg or 2mg? And are you taking it twice daily? The study I saw found that best results were achieved when taken twice daily. I have personally always wanted to take oral minoxidil and everybody I know on it has said it leaves the topical for dead. However I have been warned off it because of the serious side effects associated with it, my GP would not even prescribe the lower dosage when I asked him. I think Dr Path (who is a great surgeon) has an obligation to this community and especially NotUrAvg to respond to this post!

Super impressive result! Congratulations:)

After the donor strip is harvested, it and the grafts which are dissected from it are placed in what is called a "holding solution". This medium can be as simple as normal saline, or it can be made up of a number of ingredients whose purpose is to maintain the health of this living tissue. SMG, Feller and H&W all use saline, with one saying they are confident holding solutions offer little benefit over saline. However I remember another recommended surgeon on this forum saying that he uses a tissue holding solution which contained buffers, nutrients, and antioxidants which have been shown to reduce storage and ischemia-reperfusion injury. This is rather convincing and surely it sounds better than just saline in stopping the follicles being damaged or dehydrated, thus increasing the survival of grafts. Dr Cooley says “the bottom line is that for smaller cases and those lasting less than four to five hours, it may not matter”. In my opinion, using alternative holding solutions could give small but significant improvement in graft survival for cases lasting longer than five hours or greater than 2000 grafts. “In our clinic, we place the strip and 'slivers' in HypoThermosol at 4-10 degrees celsius. IMO, this provides the greatest protection for grafts outside the body. For dissected grafts waiting to be placed, we put the grafts in cell culture solution (DMEM with HEPES buffer) for protection at room temperature. This solution has glucose, amino acids, buffers to protect the tissue”. I would love doctors to say what they think is best saline or some other sort of tissue holding solution and if possible back it up with research. Other forum members please feel free to comment on what they think is better. Why are the top docs not using tissue holding solutions when I have heard about so much positive research on them improving follicle survival? Are they thinking of changing this in the future? Cheers

To be honest I am not impressed with the hair line. John I think you should shave it first to see if it suits you before you get micro pigmentation which I am not a fan of, personally I would rather bht instead of it.

Fantastic work, I particularly liked the hairline

Nice work very natural

I must admit Sparky that was impressive. However that was not fue solely from the head but included body and beard hair. Of concern is the use of nape hair as I have heard doctors on this forum says that it is not always permanent. Further I have heard other people on forums say that often the difference between head hair and body or beard hair is discernable. I think it’s a better strategy not to use body or beard hair to solely cover a specific area but rather disperse it amongst head hair to beef up density. I am not a fan of such an aggressive hairline and I could still discern where he had the grafts transplanted from the native hair at his Norwood level due to the disparity in density. Although I think it would be less obvious if that guy buzzed down to a #1. Any chance of seeing some picture of your scar now and the fue work you had done? I think a better option for those with significant loss is fut then bht into the scar or even a tattoo over it then buzzing down.

I have never seen an extensively bald man (NW 6 or 7) with ‘average’ characteristics achieve full coverage with fue as they would run into significant scaring or have a depleted donor requiring strip before it was accomplished. The ‘less is more’ thing sounds great but I haven’t seen much documentation, what makes it most dubious is that the doctors on this forum who are known for their transparency don’t seem to be taking this approach to fue much. I think if the ‘less is more’ look worked we would see more results of it from Feller and SMG etc, they would even probably recommend it to extensively bald men who want to shave down. A real problem with ‘less is more’ is the mismatch in density between the permanent zone and that where it has been transplanted or is thinning (believe me it is discernable to the naked eye)! It may however be a better contrast than that of strip with the same number of grafts (scar aside) because this permanent zone would have been thinned out more so it would match the density of the transplanted hair better. Of course buzzing down to a one will also help reduce the contrast.

Mate, I was not trying to bate an altercation, I just said I think he is a brilliant surgeon! I actually thought it was a good time to bring it up after reading your posts in Phil Mascallpen’s thread where you seem to write off a one pass approach and imply that dense packing was the ‘culprit’ for less yield. All I am hoping for is that the good Dr can explain why he said that to you in light of his research. Can you please try to explain what removing 2-3cm of skin does to the rest of the scalp? Good point Emperor about many having reduced yield in 2nd, 3rd etc procedures maybe this strengthens the case for a one pass approach, it would be great if a Dr could explain why this happens (if it does at all)? I once read something on minis and how when combined with fut that the transplant appears denser, although the study came to the conclusion that the same appearance of density could be created with futs alone.

It would be great if hair restoration surgeons could contribute by giving their personal views based on experience as to whether one dense packed session or two lower density sessions are better for overall survival. I would particularly like to hear from Dr Wong (who I think is a brilliant surgeon) so he can clarify what he said to Emperor.

I would love to get feedback on whether one dense packed session or two lower density sessions are better for overall survival? The case for a 1 pass procedure: Dr Tsilosani research: The first se­ries of observations were held on two volunteers in 2003.Two-hair FU grafts were transplanted in 1cm2of bald scalp. For the creation of recipient sites, Nokor needles were used. Our research showed that tripling the densi­ty from 15 (in control sections) to 45 FUs per cm2did not reduce survival and achieved a survival rate of 99% and 107%, respective­ly. Another study by Dr Tsilosani on two people, in the first one hun­dred FUs were insert­ed (70 two-hair and 30 one-hair grafts; 170 hair follicles in total) 156 out of 170 implanted hair fol­licles grew (survival rate of 92%). In the second 400 grafts were implanted into the recipient sites (200 two-hair and 200 one-hair grafts; 600 hair follicles in total) 574 out of 600 im­planted hair follicles grew (survival rate of 96%). However the recipient area was only 1cm2 in the first and 4cm2 in the second. Would it work over a larger area? Also Dr Wong and Dr Nakatsui apparently have shown growth of 126 out of 130 implanted follicles in coronal recipient sites in 1cm2 (survival rate 96.92%). In one study by them on examination of the most densely packed area (72 grafts/cm2) at 8 months post transplant revealed that the number of implanted grafts showing growth was 98.6% whereas the least densely transplanted area (23 grafts/cm2) revealed a growth rate of 95.6%. Reasons why this approach may be best are because it may stop shock loss to pre-transplanted hair and damage to donor region; the more times you go into the donor area to harvest hair the more scarring one will have. The same goes for the recipient area as well. Although what Emperor said caused me some concern: “In my case, after #1 I noticed that some areas in the hairline seemed to have less grafts growing than internally (behind the hairline), despite originally being planted at higher density. My conclusion was that the front of the hairline was dense packed and didn’t get the hoped for yield. Most of the grafts behind the hairline seem to have grown”. And I find it unusual in light of Dr Wong’s research that the Emperor could say: “More than one reputable doctor has stated that if they dense pack, they run the risk that nothing will grow. I know Dr. Wong said this to me when we talked about my plans for #1”. I do agree H&W have the results to support the case for a one pass approach but what is the best ultimately for survivability and thus results? I heard one doctor say there is, a 'sweet spot' for dense-packing a large number of grafts into a small area without risking complications. Unfortunately, there is no magical number that works for everyone. The perfect graft density varies with the unique tissue characteristics of the patient at hand and it is profoundly influenced by the technical intricacies of the operating surgeon. The case for a 2 pass procedure: Mayer’s study of hair counts at eight months showing that a combined survival rate of 97.5% for grafts placed at 10/cm2, 92.5% for those at 20/cm2, 72.5% for those at 30/cm2 and 78.1% for those at 40/cm2. Apparently Coalition member Dr. Ray Konior presented a case where a patient originally had 3000 grafts densely packed in the frontal third up to 100 FU/cm2. Considering natural hair density is typically around 80 FU/cm2, this hair transplant patient’s hair should have been so dense that nobody could see his scalp through his hair after his first surgery. Unfortunately, though 100 follicular units were packed per square cm, hair regrowth yield was significantly less leaving the appearance of hair loss and thinning hair. And I found this on SMG’s website: Placing grafts at densities up to 30-35 FU/CM2 will consistently produce survival rates of over 90 percent. Although successfully placing grafts at higher densities (40-50+ FU/CM2) is possible, studies show that as the transplanted density increases beyond 40, the potential for poor survival also increases. With appropriate patient selection and proper technique, this risk can be decreased but not eliminated. This approach overcomes the primary concern of the one pass approach which relates to the risk of compromising the local blood supply within the recipient area. Reduced circulation decreases oxygen delivery to the recipient area. Vascular disruption can ultimately decrease graft survival, and when taken to an extreme it can cause outright tissue damage. So transplanting hair at such a densities in a one pass approach compromises vascularity and increases the risk of necrosis and “shock loss” to existing hairs. A two pass approach also helps overcomes these dilemmas of the one pass approach: 1. Less than optimal growth 2. Potential for ridging (dermal fibrosis below the skin ??“ which is basically scar tissue resulting from the multiple recipient sites create in such a small area) 3. Permanent neovascularization (redness that won't go away ??“ resulting from capillary proliferation during the healing process) Also most doctors in theory seem to advocate a two pass approach Something of interest relating to all this is what Dr Feller has said “I've also notice that if a patient has a significant amount of bleeding during creation of recipient sites that the plan should be immediately changed to decrease the overall density”. And the four reasons outlined by Dr Tsilosani for the reduction of graft survival, (if it really occurs): 1. “Lateral pressure” on the implanted grafts in very small recipient sites 2. “Ultra fine” preparation of grafts, leading to the absence of tissue around follicles, or artificial splitting of FUs with the purpose of enabling the their implantation into smaller sites 3. Crush injury of grafts when assistants push them into small recipient sites. 4. Violation of blood circulation in the recipient site by excessive incision density

Phil your progress certainly parallels Fingers Crossed at the moment. At what density was the hair transplanted at? Good news is you both still have a long way to go yet. Emperor, if I had as many grafts as Phil in such a small area I would be rather perturbed to think that I would need a second pass.