Lightmare

Awesome progress, following! I dunno if I’ve ever seen growth at 2 or 2.5 months but here we are. You’re going to win some kind of award or something.

Hoping to get some clarification, as I hear these terms a lot but don't really know what they mean. I am 6.5 months into my HT(and 5.5 months into finasteride) and have seen some decent growth early on, but it was very patchy and has basically paused since 5.5 months. Since then, I've been bombarded by a nasty shed that hasn't yet abated...the doctor thinks it's seasonal but that could be another topic in and of itself. My question is, can you tell a native hair from a transplanted hair if the area wasn't slick bald (but rather "visibly hairless") beforehand? Below are some real 1cm x 1cm close ups of my scalp in my worst (left, which was visibly hairless pre-op) and best (i.e. side donor, right) areas. The blue circled hairs are pretty clear that they are transplanted to me (as well as the longer ones of similar caliber), but what about all of these thinner hairs (e.g. ones circled in red)? Is it clear that they are all native miniaturized hairs or could some of them be transplanted grafts that are early on in their maturation phase? For reference I have been transplanted at an average density of ~30 grafts/cm^2, and counting the thicker hairs in the picture on the left yields ~20 grafts. Thank you!

Killer early results!

How did your transplants turn out?

Thanks Melvin, interesting, I hadn't heard of that phenomenon before. I looked it up, sounds like part of the HT process as explained by Eugenix. For other readers, anagen desynchronization marks the 'high water mark' of post op appearance as the hair growth phase randomizes after that. However that video says that anagen desynchronization happens after ~10 months post procedure, but I wonder if the point at which it happens varies from patient to patient as well? Would that be too early at only 6.5 months post HT? My transplanted region is shedding significantly since 5.5 months post op and I would hope that something like this isn't the cause since that would mean I've reached peak HT appearance only 5.5 months in...even if more hairs grew in after that it'd be pretty disappointing that it wouldn't look better than that .

I see, and that makes total sense. Asking because I saw an anecdote from the forums somewhere that mentioned they got increased shedding 1 month after a density SMP which they got after they had their HT. Though there are many causes to shedding so it can be hard to pinpoint the cause…so gotta take that with a grain of salt.

Nice. Did you notice any shock loss or increased shedding since you got it done?

Wonderful result. Was this permanent or temporary SMP? When is your next top op?

Any updates?

Very random question, but has anyone seen a hair like this before? Just found this 1” zombie on my countertop. It seems to have lost its color but it came back, like a boomerang or the Lost Son. What’s remarkable is how abrupt the transitions are. I am wondering if intermittent stress might cause this? Anyone know?

Hey everyone, Just got back from my doctor for the 6 month checkup. Overall, my doc is very happy with my progress so far, mentioning that growth is looking robust considering where I started and I already look a lot younger. After looking over my scalp (both with naked eye and microscope), doc found many new hairs starting to poke through, and many 2s/3s beginning to grow their extra hairs, so we're hopeful that more growth is coming. Additionally, thickening still has a ways to go. Donor area is doing great. After that I asked a ton of questions and got some good info. Shedding starting month 5: we are not sure of the cause but doc doesn't think it's from delayed shock loss or med/fin shedding. Never had a patient have it this late in the game. Doc said most likely cause is seasonal shedding, which after going through my old minoxidil diary I did notice my hair 'peaked' in fullness early October '19 and '20, and bottomed out the following Januaries, to begin improving into the spring and summer. Hopefully, it is just seasonal. Sees seasonal shedding in many of their patients. Nonetheless, doc prescribed me some blood work to get done. Iron, Vitamins A/D, and thyroid. Scalp looked healthy, no evidence of problems. Did not recommend me to go to a derm at this point. Dandruff: I asked about oral minoxidil. Doc highly supported, has several patients on it seeing positive results and no sides, but could not prescribe due to impacts on blood pressure and monitoring it, suggests having my GP prescribe. Until then, recommends that I do one minoxidil per day instead of 2, with fin it is enough to get most of the benefits. Graft density: I got 30 grafts/cm^2 on average, with lower densities on the crown and higher densities in the hairline. Doc tells me that, since I never had taken fin before, the goal of the first surgery was not a 'home run' but rather solid coverage, and seeing how my scalp takes the grafts and whether my native balding pattern holds or improves over the next year. Additionally, planting at this density apparently maximizes yield; going significantly more dense in a single surgery will increase overall density at the expense of yield due to limited blood supply. For cases like me that start meds after HT, doc tells me that a touch up procedure was common to really dial in the density and fill in the weak areas after stabilization. Even coverage was provided in case I progress either way to maintain my natural balding pattern. Doc said I had very very good hair quality - lots of curl and thick caliber, so 30 grafts/cm^2 just might be enough for satisfaction too, possibly with some styling. Overall, I am pretty happy with my meeting, and was reassured that things should improve. Thank you to those with your feedback on the graft count, it helped me mentally accept that a second procedure is likely needed. However I look forward to the 12 month mark to see how it improves. This is the 6 month photo, which is pretty similar to at 5.75 months in the first post, but enlarged. I could not find the microscope location so I switched locations to a spot closer to my hairline that I can visually see, so it will be much easier to track. You can see two well-grown grafts and another one just beginning to emerge on the upper left, alongside some thinner native hairs. I will update if I can find the original one later.

Thank you Bayern for the info. Did you have an initial shed when switching abruptly from topical to oral? If so when how long/bad was it?

@Sm90 what happened at the end? Did it grow back, in any capacity, or just got worse?

Based on my limited knowledge of shock loss, if this is shock loss I am surprised you got it in an area that wasn’t the donor or the recipient. I wonder why…blood supply competition? I am still learning about shock loss. At 3 months time timeframe sounds a bit similar to me, i.e. outside the “normal” window of 2 months. As it’s been 3 months since you saw it, that is right on schedule to see it coming back, I am glad to hear that and hope it completely recovers.

Thanks gilleanator - that is indeed pretty far after the operation. I'm curious if you know roughly what factor of improvement to expect, e.g. 2x, 5x or 10x increase in shaft diameter, that a given healthy transplanted hair will thicken up to relative to when it first popped from the scalp?

Sadman2021, great point that each hair has its own characteristics, I'd be curious to see if the variation in donor or recipient location plays a significant part in fraction of maximum hair caliber as a function of time from sprouting. I have heard that the crown grows 'slower' for a few reasons (blood flow is less, the whorl pattern requires greater density and angular variation thus making layering effects harder etc). Of course the "curve" could really be a family of curves, possibly one curve for each part of the donor and/or recipient region. But aggregate statistics or a single curve might also be good enough to get a ballpark estimate. It'd be interesting to see for sure.

Thanks so much for your reply Melvin! Those are really well made videos, and it's always encouraging to see slow growers that had awesome results, it does help out a lot. However my question is more about the quantitative/objective progression of hair caliber because aesthetics and macro pictures have too many uncontrolled variables (surgeon, graft yield, graft placement, hair type, hair caliber, hair color, scalp color, whether they're on meds / minoxidil, whether they had native hair in the region and how thick it was, etc), even before accounting for things like inconsistent hair length and lighting in the photo diaries and seasonal sheds. By just listing the fraction of the maximum surviving hair caliber/thickness as a function of time after sprouting, most or all of those variables might be controlled for (i.e. regardless of who did the transplant, the hair that survived should reach some max hair caliber eventually and this should be trackable with fiducials) and we could get a good idea of how much thickening is really left, especially behind the hairline.

Oops, double post

We've all seen the hair transplant timeline pictures and descriptions, and have read that new growth in months 3-6 after a hair transplant appears 'thin, wiry, or kinky'. Descriptions are nice but it would be nice to get quantitative on that. I have never actually seen studies or graphs on hair caliber as a function of time. Caliber is known to be similarly important as density to hide the scalp among hairs. Note, I am not talking about the number of new hairs 'popping' or sprouting through the scalp, or even about the final appearance timeline, which we can find pretty easily with a google search. It'd be wonderful to see something quantitative in the 'appearance' section ! I am talking about hair caliber / thickness as a function of time from when they sprouted. Basically I am looking for something like the below made up (by me) graph (it'd probably consist of a mean of hair calibers of many patients...I don't know if post HT differs in this way relative to native hair growth). It is likely buried in some medical literature somewhere, and I have done some searching with no findings on this, but I'd love if someone could post a pointer (graph or pictures would be best!) The boiled down version of the question I have is, do new HT growth start out as vellus hairs and turn terminal, or generally start out thicker than vellus but less than terminal, due to where they were in their cycle before transplantation? Also, how much % increase in shaft diameter can you expect from first 'popping' out of the scalp until final maturation? I am following my hair transplant growth with a microscope and don't want to get excited seeing a bunch of native vellus hairs on my scalp that are on their last legs and will likely die out. This piece by Dr. Bloxham was a really nice read on the subject but the pictures don't work for me unfortunately. And I think they were more showing patients' growth, not diagrams of what individual hairs look like up close. @Blake Bloxhamthank you for the work there any comments from you about this would be awesome! I think this type of knowledge would further equip anxious growers with extra assurance that things will turn out ok. Thanks!

Nice results so far. Appreciate you sharing it as I may be on the same path...I have huge dandruff flakes from the topical and foam. Did you take the topical solution or foam before this? If so, did you continue using the topical/foam after you started oral?

+1, how is this going for everyone?

Any updates @Pephair? Where did you get your 2.5mg oral minoxidil? @Spring15 also curious as to how things are going.

31yo NW4-5 (lots of miniaturized hair, very few slick bald areas pre-op) here. I am at 6 months post op and 5 months post finasteride, and had a nasty bout of shedding that started two weeks ago ( hasn't subsided yet, and left me worse than at month 5) that consisted of mostly miniaturized but some thick hairs too, only in the recipient/balding regions. Retrospectively, I wish I had started fin before HT, mostly to decouple what growth was from what source and to see how my body would react (sides, sheds, etc) to fin in isolation. Ruling causes out is always helpful for my sanity. Also to thicken up the thinner hairs before possible shock loss from the HT. I was told here that it is possibly shock loss, but I have read about periodic finasteride sheds too. I am keen to learn more about this too and am hoping to recover from it. Don't wanna hijack the thread, but it's always nice to hear anecdotes of folks who looked worse at month N post op than they did at N-1 or N-M, how it turned out / how you coped, because going backwards really sucks!

Not much about this out there specifically after a HT. Just trying to see whether there's any correlation of growth and sleeping position! Hopefully this is a good venue for the poll.

Also wanted to show a side by side of two photos from one of my worst areas compared to one from my best…both from same magnification. It really highlights the importance of hair caliber! The difference surprised me. The denisty difference in FU/cm^2 is not massive (all of these photos suggest at least 70 locally) but the thickness difference is enormous. I don’t know if it’s possible to disseminate early-stage growth of a HT vs native miniaturized hairs that I don’t know whether I’ll get back or not, but it’d be wonderful if a snapshot was possible. I would love to hear some of your thoughts on this. Otherwise that is the goal of the microscope diary .