Lightmare

Hey @baalloss I am super sorry to hear about this and hope you can remedy the situation in the coming years. Scarring alopecias look very sinister and hard to diagnose visually based on what I have read. I come here for your help because I suspect I might have scarring alopecia. I am on my 8th month post HT looking worse than at month 5.5. The transplanted areas were growing on track, and pretty uniformly (one side wasn’t massively better than the other), until about 5.5 when I started shedding a lot (I was nearly bald in all the transplanted areas before). Now my result is patchier than before - the fall doesn’t appear to be uniform and one side is far worse than the other. There are a couple possibilities but one is that I have both scarring alopecia and MPB. I am weighing a biopsy but know those leave scars. My question to you is this: your 5 month results actually appear (of course variables like lighting, hair length etc can affect things) to look better than pre op, but then your 9 and 15 month results look possibly worse than 5 months. Did you get growth in the scarred areas at all, that then fell out later never to grow back? Or did those areas never grow at all and the difference was due to lighting or hair length etc? I know any hair follicle (transplanted or not) would not survive a scarring attack but my question is more whether a transplant into the scarred area would grow there once before getting killed off, or would just not grow at all. Thanks in advance, again very sorry for what happen to you and hope you can find a way out. I know it is possible to transplant into an inactive scar so there is hope. I also hope we can learn from your experience.

Looking great at 6 months!

Looking like another great result in the making from Eugenix! Who was your doctor?

Thanks 5Beta, what were your levels before adding in the supplements? Did you notice any improvement with your hair as a result?

I am starting to think that is a good idea. The dermatologist I saw couldn't identify any issues visually, so they didn't recommend doing one due to the scar they said it'd leave behind, but I know there are cases that are very hard to identify visually. It is very good to collect some thoughts from you all about this, because it looks more and more like a second procedure is in the cards and I don't want to do it if there's a risk for a scalp problem. My surgeon pointed out that this area was less densely planted than the hairline which is a fair point, but the difference is just so stark. Also they said they saw some stubbles in the problem area and said more growth should be coming, but IIRC those have remained the same length for many months - as long as I can remember. I am not tracking it rigorously though. Many of these are double and triple-hair stubbles too that are all the same length. I am beginning to wonder if they'll ever fall or grow out...occasionally a shorter hair falls and I hope it's one of the stubble hairs. I do hope my surgeon is right. Here is a zoom in of the problem area...lots of thinner hairs that haven't seemed to thicken much for at least a couple months when I first started taking close ups here. But a few hairs that are thicker. I really wish I could tell which ones were native and which are transplanted.

8 month update. Happy New Year everyone. Overall my hair is not much different for the past 2 months. I have been pretty happy with most of the hairline growth now, but the right side of my hairline and frontal third, and the entire back part of the frontal half are very weak. The crown, however, appears to be thickening but that could largely be due to hair getting longer. Some other notes: My hair is now long enough to mostly conceal my balding area with the right styling. Wind and water are still very harsh on me though. Got a prescription for Oral minoxidil (monitoring blood pressure)! Starting at 1.25mg/day (+topical 1x/day), bumping to 2.5mg/day after 6 weeks tolerated. Started taking 1000IU vitamin D daily at recommendation of doctor, as I had an insufficiency. Some good news, shedding has slowed down a fair bit. Shedding rate is now about 1/2 to 2/3 what it was a month or 2 ago when it peaked. Not as low as it was in the summer/early fall. Given that I looked like an early or normal grower early on in many parts, I am a bit worried about the uneven growth at this point, and I've read a lot about autoimmune disorders that can cause patchy loss for any type of hair (scarring alopecia, areata). Given how patchy my results are at this stage I am starting to worry whether I have some scalp disorder in addition to MPB, or if something went wrong during the surgery. What do you guys think about my very lopsided growth at this relatively late stage?

Good question. I guess you can generalize it to “can you do an HT during a bout of telogen effluvium “. Would be great to hear a good answer on it. We know that Covid hair loss is essentially telogen effluvium so the hairs should grow back within a few months of the loss. However the timing of it with an HT does seem suboptimal. Maybe it depends on whether doctors can see the telogen remnant areas (under microscopic magnification they look like tiny low contrast yellow holes, so much harder to see than healthy hair stubs) when doing the operation so they don’t add in follicles to where there are already healthy but hiding hairs, or affect where they take donors from like you said? The good news is that TE usually happens due to a fever or bad illness, so if your symptoms are mild maybe you’ll he less likely to get it?

Congratulations Melvin on your surgery! It looks like it's going to turn out amazing, but when you said you were going to get a final transplant I was thinking it'd be a few hundred grafts as a touch up somewhere I couldn't see on online photos, not a few thousand. I always thought your hair was pretty much perfect, but now it really will be a year from now. The rounding out of the hairline + temple peaks look like it should make for a nice difference as well. Looking forward to following your progress. Also, what a time you've had - honeymoon, flight to India, 3 days of intense surgery while staying in an epic Farmhouse, Dubai, and back. Phew! Seems like a good time to rest and grow.

Thanks Kirkland for sharing. I used topical min for 3 years and had initially fantastic regrowth in the crown and good regrowth in the frontal 3rd, but most of it was lost slowly until last year when I had my HT and started taking fin. Additionally, after about 3 months on the topical min I got horrible minoxidandruff flakes that have stayed with me ever since (both topical and foam). 10 days ago I finally got a prescription for Oral Minoxidil. Currently I am combining the 1.25mg half-pill with once a day Lipogaine (skin reacts better to that) at night. So far no sides, and my doctor plans to increase the dose to 2.5mg if I tolerate after a month or so. At this point I'll hope to ditch the topical min and be free of the dandruff curse for good. I've been using a blood monitor at the recommendation of my doctor and so far so good.

@kirklandhave you noticed any improvements in your scalp hair?

If you look at the density of the little pores (non hair bearing ones, the ones underneath your hairline) on that last photo it is very close to the density of the hairs that have already grown out. More starting to emerge and thicken too. Looks awesome for just 4 months! I’d be elated with that as my final result, but then again I am less than half your density.

Just got the results of my bloodwork back (took 1mg fin 3 hours before the test, and I take it daily). 4 fine and 2 potential red flags: - Vitamin D : LOW (bad) - Vitamin A: low (but too high is bad for hair apparently) - thyroid: normal - ferritin: normal, and good enough - Testosterone: 718 Ng/dL (normal = 250-827) - DHT: 32 ng/dL (normal = 12-65), bad? Apparently even with the full effects of finasteride (70% DHT reduction) I am smack dab in the normal range of DHT. Either that means 1) I am a non or lesser responder to fin or 2) my DHT level is normally around 32/.3 = 107, which is way way above the normal range. I wish I checked my levels before starting fin so I don’t know the baseline, I’d rather not do this but maybe it’d be interesting to stop taking fin for a week and do another test to make sure I am responding to it. Going to ask my doc what they think after holidays.

Just wanted to pop in and say wonderful question, thank you for asking it, I just hope that the folks that ghost are still on the forums and the results won't only consist of the rest of us that are just left guessing. The cliffhangers are frustrating sometimes as you see someone following a similar journey as yourself and they suddenly stop posting. Especially so if you're anxious about the current state you're in. It's like watching a great movie that gets cut off at the rising action.

Looking for a good Dermatologist that specializes in hair loss to take a look at me. Any recommendations for the Bay Area, CA area? Trichologist recommendations also appreciated. Specifically I am looking for someone who can help test me to ensure I only have MPB, and rule out things like scarring alopecias, areatas, etc that might be lurking underneath.

Did your stubble ever grow @vancouverguy66 @Betterhair? I’m at 7 months with lots of stubble that hasn’t grown.

Any updates from either of you guys @Egon. @Maballack? I am 7 months with lots of non growing multi graft stubble still there. Same thing.

Hey everyone, 7 month update: Overall, not much change from 6 months - but I think there've been ups and downs due to the shedding. Still quite patchy at this phase, though the balder patches coincide perfectly with my native balding. Those areas have thinner transplanted growth that are starting to thicken, so hopefully coverage increases there soon. Some key points about what's happened over the past month: The shedding has subsided a little bit, and I think is more or less keeping pace with the rate of regrowth, so I think it's a bit better than 6.5 months. It is still elevated, though. If it is a seasonal shed, it should stop soon, according to my doctor. My minoxidandruff problem has been reduced (though you see a few flakes in the picture, overall it's a lot less than before) since switching to Pura d'or gold label shampoo. Hoping to try oral min to get rid of it completely but looking for a prescription. Some remaining post-op stubble still hasn't shed, but some is finally starting to fall out in the shower. Does this mean new hair will replace it? 🤞 Starting to think about what's next. Another HT around 12 months? SMP for the appearance of more density? A combination of SMP and then another HT? Input appreciated! Here are the photos. Pictures are still with my hair parted to show only what's happening in the recipient areas. Microscope photo progress (I am not 100% sure this is the same spot but gave it my best shot - if so it seems there may be some thickening going on for one of these grafts).

Consider also that at any given time you should see 10-15% of hairs that look miniaturized. That is the normal telogen hair ratio. In the fall that ratio can increase, leading to seasonal sheds for some people. To tell for sure you’d need to see a doc like JC mentioned.

Thank you @gillenator for the advice. I agree, unfortunately my 7 months ago self did not consider this or know about this forum . I am a case of what you mentioned, started finasteride a few weeks after my HT at the recommendation of my doctor. Initially I was too scared to take it due to the sides, fortunately I didn't get any. If I could have a do-over, I'd have gotten on the finasteride 6-12 months before the transplant to see whether it thickened anything up, and to better assess impacts of the fin vs the transplant independently instead of doing these at the same time. Conflated effects are so frustrating! Appearing to go backwards from month to month is very upsetting, and identifying the root cause of the shed can be hard. But it is good to hear that the new growth should resume after any med based shedding stops...I am hoping for some 'catch up growth' in the later months after my bout of shedding ceases. It sounds like long term the results will be the same, but with more bumps in the road if you start therapies right after the procedure.

Same for the crown:

Here was my situation pre op, at 5.5 months, and now (6.5 months).

Thanks everyone for your input. I started taking finasteride for the first time 1 month after the HT and haven’t stopped. Also on min 1x/day and ketoconazole 2% 2x / week. Right after I started finasteride my normal shedding stopped almost completely. For the past month or so it’s picked up and is higher than it was before starting finasteride. I can’t tell if it’s native or transplanted hairs shedding. Also I have heard that fin can cause multiple rounds of synchronous shedding, even up to 2 years after you start taking it as the shed hairs make way for bigger healthier ones. Is that true? My doctor thinks it’s seasonal shedding. She is having me see a dermatologist and get blood work done. I really hope it’s just temporary… If it was anagen desynchronization only 6 months after the HT i’d be ultra upset, as that would mean I already reached the best I’ll see at 5.5 months!

Sorry to resurrect but @Timhow did this turn out?

Did you fellas’ hair ever return from the sheds? @Egy. @CreamyLogan . Going thru shedding month 6 myself.

Everyone goes through the ugly duckling phase and expects it. But what about folks who do well in the beginning, clear the initial 1-8 week shedding phase, start growing on schedule (3-4 months), but hit a 'bump in the road' or a 'big shed' halfway down the line (months 5-8) that makes them lose some of their progress since starting their HT journey? I'm going through this now (at month 6.5 and looking worse than 5.5 due to a shed) and it is very unsettling. I have been looking high and low for examples but almost everybody seems to get monotonically better, or at least stays the same month to month to month, between months 5-12 after a HT. Very few seem to go backwards anytime after month 5, and if they do, I have never seen it improve after that. I am looking for folks that do improve after they temporarily get worse, specifically after only starting to get worse in the middle months 5-10. I am not talking about folks who look worse at month 3 than at pre-op as a result of initial shock loss. I know temporarily losing progress is theoretically possible due to a mid-game shed, which could happen for many reasons, but would love to see some examples. Of course, hoping that lighting and hair dryness etc are kept regularly consistent throughout the photo diaries. Any examples on the forums would be great!