Lightmare

Thanks everyone for your honest feedback. This is great! It seems that overall the density was too low, and the planning was on the ultra-conservative/hope fin would help side (it kinda did), but with the right styling this looks pretty good as-is. I agree with all of the above. I am probably not going to return to the same clinic as the density was too low and the price was higher than I'd like to pay again, I mostly wanted to get their assessment in terms of the success of the growth/yield. I am relieved to hear yield was good as I had some worries about scalp conditions midway through, but those have been all but answered. If / when I do another surgery it will be with a top clinic recommended on here (I keep seeing amazing results out of Eugenix and there are many others) to finish this off. The other thing I'd like some advice on is whether SMP to thicken up my scalp and crown is really a viable option for me at this point given where my hair is now. If anyone can offer some advice on this that'd be great. Thinking long term, it might help augment my results without burning through more donor hair, in case my hair loss speeds up somehow (though I plan to take oral fin/min forever). Additionally is hard to take a week+ off all of my household duties for a transplant+travel+recovery with a world class doctor (in addition to planning all the covid / blood work etc and spending more money) at this point. The ugly duckling phase also haunts me but I know I'll have to faced it again someday 😄). The timing of something like this is really crucial as I'm super busy with a 3 year old and both my spouse and I have demanding jobs. Last year I had a perfect opening and I took it to get this HT done, but it was with a local doctor so no need to do the international travel / planning. That was before I found this forum too - you guys all rock!! So I'd like to see if SMP would help my situation. If it won't help my situation, or if the cons outweigh to pros, I could live with what I have for a while and save up / plan for my next HT when I can take time off. I have seen a few folks on here ( @hairthere @EvoXOhio ) that have some experience in combining SMP + HT that I'd love to hear from given my situation, but any advice on that would be most most welcome.

I also met with my surgeon for my 12 month appointment! They told me that the surgery was a success given the number of grafts planted, a 9/10 result. Overall they were pleased with the growth, and told me that I could wait another 4 months to see the full results of the oral minoxidil upgrade before any more surgeries. They said the finasteride benefit is about 95% apparent by now (12 months of taking finasteride), so the only thing to really wait for is the oral minoxidil (started 2.5mg/day back in March). They believe I have another 2500-3000 grafts left before my donor starts to thin out. My doctor recommended a couple of options: A second surgery of ~1500 grafts focusing on the front through the midscalp, and extra density for the thinner areas, mostly leaving the crown alone. They mentioned this would really make the result 'pop' just as much as if not more than the first. Another highly recommended clinic here mentioned recommended that a second surgery would be 3000-3500 if I use beard hair for 500 of those (over a photo consultation) if I wanted full thickness pretty much everywhere. Another option is SMP for a density treatment. They believe I have the hair density needed everywhere except the crown for a pleasing visual thickening effect and recommended an SMP clinic they have sent clients to with good results after their HTs. If I wanted some extra grafts in the crown, a couple hundred could help fill it in and boost the SMP effect back there too. Given what my doctor said about my available grafts (less than I thought) and the economic uncertainty recently I admit the SMP option sounds appealing to see how my hair holds up over the next few years in case I need to reallocate the donor that I have left. But I will probably need another HT eventually. What do you guys think? I hope to thicken it up, allowing me to wear it a bit shorter with some more robustness to wind.

Here I am at the 12 month mark! It's been a roller coaster emotionally but I notice a big improvement from where I started.Here are some photos of me pre and post op, and now. The first set of photos has my hair parted to isolate the problem areas. The second set of photos is how I actually style my hair (assuming the wind doesn't mess it up). Here are some pictures with my hair up (the hairline was nonexistent before).

(see next page)

Hairman, have you tried topical DHT blockers? They are getting more popular now and the side effects are less common than the orals. Both topical finasteride and dutasteride are available now.

Yeah, most of the hairs I shed are right in the middle of being the thinnest vellus hairs and thick terminal hairs. I have been keeping a monthly photo log and keeping track of roughly how many I lose daily when washing/drying my hair. It's the shape that I'm wondering about - for hairs that were not cut, shed hairs seem to get thinner toward either end of the hair (both the bulb and the tip when it first pops out of the scalp). They are darkest/thickest in the middle. I'm wondering if the shape can give a hint in terms of responsiveness...if a healthy hair ought to be constant thickness before falling out then I'd be concerned that my finasteride is not working or wearing off. I checked my serum DHT after a few hours of taking a dose of this oral fin and it was sitting at the lower end of normal - not below normal like I would've hoped. Dividing it by .3 (since fin is supposed to reduce DHT by 70%) put me above the normal range. Unfortunately I didn't test before starting.

I am seeing a few shed hairs that look like they are gradually narrowing toward the hair bulb over the nearest ~1-2cm. I have been on finasteride (generic, from Ascend lab from Costco pharmacy) for a year now and am trying to figure out whether I am responding to it or whether I should switch pharmacies/suppliers or try a stronger 5AR blocker like dutasteride, but I had a HT at the same time so it is hard to tell. In the crown where I had very few hairs grafted I am not noticing a massive difference from last year, and am undergoing another shedding phase. My question is, do normal, healthy hairs (ones that are NOT miniaturizing due to DHT or other effects) shrink gradually during the last month or two of the anagen phase before they reach catagen, or is it a hard cutoff where the diameter stays the same throughout? I.e. should a healthy, or at least 'constant width' (i.e. not getting any thinner) hair look more like the upper or lower picture? Apologies for the bad drawing.

Hi StarTouch, month 4 is usually where the growth begins and fun starts - so to answer your question you definitely can't make any predictions this early in the game. In my opinion the growth looks good at this stage - your hairline is starting to frame your face, and you should expect more hairs to push through and thicken up in the coming months. You can refer to Dr. Bloxham's growth/maturation phase guide to see where you stand but at month 4 it's very very much early innings for you - a rule of thumb is that the postop month * 10 is the percentage of hairs that have penetrated - so for you, 40% of the hairs have penetrated the scalp. Maturation is usually 2 months behind - so the hairs that have popped are only 20% of their final thickness. Thickness / calibur is just as important as density itself, and the maturation phase usually takes 3-6 months to fully thicken. These are rough numbers but no matter how you slice it, you've got a lot of improvement coming, and won't be able to see your final density (pre-maturation) until month 9-10 or so.

So here I am at 11 months with a haircut as of a week ago. Though my hair is shorter now, I feel the crown has genuinely thinned out, and it feels like I'm going through another shedding phase back there. I only got ~400 grafts back there but I still feel a lot of stubble which I fear may be just dead grafts at this late stage. The front seems to be (?) holding up better against it. I was able to increase my oral minoxidil dose from 1.25 to 2.5mg a couple months ago but had to miss a week due to the increased prescription not being refilled in time by the pharmacy (I still use topical 1x a day too). So either that or a finasteride shed may be causing this. This time I am not as bothered as the one that started 6 months in but hope it stops soon.

Thanks fellas. It sounds like many of us have these and it's just part of fighting the good fight.

I wonder if anyone else has this issue where there are a few lone hairs (remnants of my original hairline) that somehow (completely) escaped the miniaturization process? They are a good centimeter under my transplanted hairline. I get that miniaturization doesn't affect all hairs at the same time in the same way but these are full thickness and way far down. I knew of these hairs before my HT but didn't think to ask my surgeon to punch them out for me. They don't bother me too much since I wear my hair down, but I would like to see if this is normal or concerning. Are they just the chosen ones?

The thing is telogen stage is more likely to happen in miniaturized hairs due to a fixed telogen length relative to a much shorter anagen length. So it’s natural that a larger fraction of the shorter, thinner native hairs will be in telogen. The thickness / caliber of the hairs matters more than the length. Are the sheds mostly thick and dark or thin? Was that side thinner pre op too?

https://www.google.com/amp/s/pagesix.com/2022/03/28/real-or-staged-oscars-2022-official-addresses-will-smith-slap/amp/

Really impressive results given the graft count and covered area at this early stage. The best may yet be to come, and it looks like you’ve gotten a big confidence boost from this. How big was your first operation, and was it also done with Dr Ma?

Thanks Steph for the feedback. My surgeon was Dr. Tania Pauls at Advanced Hair Restoration in Colorado. I was able to find 1-2 other cases of hers on here but those are dated and before she moved to Advanced Hair. The procedure, aftercare, and communication were top notch overall and she has been really responsive through email. I feel she took a more conservative approach on me compared to what other doctors may have done the first time around, but as long as the yield is good and I can conserve grafts for the future, I will be happy with how it turned out overall. Still feel like I need more, but happy overall since I have a lot of donor left.

10 months. Overall, the growth hasn't changed much since month 5, so I am assuming this is the final result, but I'm reasonab ly happy with the results, it is a big difference from before. When I style it right and when the wind and rain aren't problematic, I am fairly happy. But I need to keep my hair very long to hide the balder patches, and it's clear that I'll want more density. Looking for objective feedback from you guys, how well did this turn out for me given the 2500 grafts over this larger area?

Agree with what Rob said above and also hid mine completely. When asked about the short haircut I just said I wanted to try a new cut for the summer. Nobody asked twice and I don’t think people noticed. You can just tell your boss you are going for a week of vacation. You don’t need to wait til scabs are completely gone if you work remote - no need to keep camera off entirely for weeks on end. You can just dim the lighting, make your camera more upward and less top facing or change your work environment for a while, perhaps after the ugly duckling phase if you had your hairline lowered with no natives around it. You’ll look normal enough after a week that people won’t notice.

Looking nice and thick at this stage. Awesome! Looking good now with a hairline that matches your awesome temple peaks.

Any updates @WhatsHairGotToDoWithIt?

I heard back from my surgeon today, and they are happy with my results for the 2580 grafts, given where I started. I feel it’s improved a lot but I had to temper expectations after I learned more from this network. But I want your opinions too! What do you guys think if this was the final result for 2500 grafts placed over this big area? Given that I was destined for a round 2 from the start. How many more grafts do you think I'll need for a better, fuller and uniform appearance if it stays the same as now? Does the ~1k estimate from earlier in the thread still hold or should I shoot for more? I like my hairline and wish to keep it as is but want to wear it shorter, getting rid of the combover and try other styles. I am almost satisfied with the crown if it continues to lag behind the front and respond to the meds. My surgeon told me something interesting, that it is definitely possible to start seeing anagen desynchronization at this point, or even a bit earlier in some cases. Most of my shed hairs at this stage are thicker now (but it has slowed down overall), so maybe that's it. Given this possibility and the fact that it's stayed the same for 3 months now, I probably won't be improving much from here if at all. I had some clues of desynchronization when I got a really strange looking hair come out (below) and Melvin pointed out that it could be related to desynchronization. That was at month 6. Given I saw first signs of growth at month 2.5 maybe it's possible.

My right side is worse. Another theory that I've seen is that sleeping position could cause asymmetrical blood circulation and hence speed/strength of hair growth. Since we are sleeping almost a third of the day it could make sense. I am a side sleeper (usually on my left) and my right has always been thinner than my left. That was the case pre HT too, but also it appears like fewer grafts have grown or are in earlier stages of their growth cycles, trying to keep native hair aside.

Here's my 9 month update. What do you guys think? It seems like shedding has reduced further, I am pretty much back to baseline level shedding before it increased 3-4 months ago. Additionally, some more of the persistent stubble has fallen and new hair I believe may be replacing it soon... so hopefully I'll be in for some late stage growth. I've seen a couple of dermatologists and they say the transplanted hair has grown in very well, and can easily tell grafts apart from natives. They both said that for 2500 grafts over a big area it looked good overall from what they've seen before with transplants, but admitted they weren't experts in HT. No evidence of any scalp conditions, no abnormal gaps in transplanted or native hair and some grafts are still thickening up. Good / healthy amount of scalp oil indicating sebaceous glands are largely intact. Both did a pull test and looked at hairs under high magnification and came to the same conclusion. Both literally told me they wouldn't have any idea on where to take a biopsy sample because the whole scalp looks perfectly healthy as can be, and the loss is uniform and like classic MPB. My surgeon says the results are still on track and nothing to be alarmed about. One of the dernatologists noted that I looked more bald on the same side as before the operation, and that could have been due to slightly uneven levels of blood supply, which would also affect the transplanted hairs as well as just having less native hair to surround them. When asked if a second transplant would be a good idea given my progress pictures and what they see they said 'No problem. Your first transplant looks good, and I don't see any issues here. But if you're still worried ask X (dermatologist in my area who also does HTs)'. So I am thinking of possibly going there for a final opinion and getting one or several biopsies if they are not satisfied with my growth.

Thanks Melvin, for the video. Since you did a lot of flying after your most recent HT, do you have any tips on sleeping on an airplane taken within the first 7 days post op? Or just dealing with a long flight afterward?

Super interesting thread, and indeed if it were to work I wonder why not just put it directly on the bald areas in the first place. It indeed sounds hyped but I like your phrasing the question as a 'would you please take a closer look' type of question. I believe for any type of advancement it is good to raise overall awareness. However if I had to take a guess I'd think the first folks that'd offer this type of option 'off the menu' to informed patients wouldn't necessarily be world class surgeons. Why? Because they have a reputation they want to keep clean and already have plenty of patients coming to them to help them with their hair. It could definitely be risky and cause backlash in the advent of unforeseen side effects even with the right legal protections in place. That said, hearing their opinions on it is really helpful as people look up to these surgeons for their leadership. I'd guess that it'd be offered by some upstart surgeons/clinics that want to differentiate themselves that have yet to get the years of successful results under their belts. Sort of like a startup idea. Analogously, I am curious as to the first HT surgeon that started pairing HT with PRP, exosomes etc. These would also likely be the type of surgeons that'd take the lead on this, and some important people to ask these questions to.

Thanks Gillenator for the input. I am trying to keep calm but my results seem to look more and more patchy as time goes on. Hopefully I am turning a corner soon. @Egy thanks for the reply. I am sorry to hear about that. Did you ever find out why your transplanted hair fell out and didn’t return? Did you do any biopsy or anything?