splitting hairs

That may well be the case.  Nevertheless, I thought that it was a very informative video.  

Hi all,

I have seen a lot of questions on the forum about Dutasteride and how to introduce it if you are taking Finasteride ie should Dut be taken once a week with Fin on the other days?  

We have all seen a lot of surgeons, like Dr Freitas & Dr Lorenzo, prescribe such regimens.  I also had many of these same questions and found the below YouTube video to be very useful. 

Diabetes is not a contraindication to surgery.  In fact, it doesn't matter all that much because hair transplantation is done under a local anaesthetic, so it does not require the patient to be nil by mouth on the morning of surgery.  

It sounds as though a clinic has turned you down after finding out that you are diabetic?  It is not ethical for a clinic to keep your deposit if they are refusing surgery due to discovering something in your medical history.  

Provided that you completed all of the medical history paperwork honestly, then no clinic can keep your deposit for this reason. 

In response to your question, your HbA1C should be less than 7%, indicating that your diabetes is well controlled. 

Apologies, I should have been clearer.  There are a number of in vitro studies that show that collagen synthesis is reduced by minoxidil.  

This, coupled with the body of patient case reports, seems to suggest that it causes wrinkles under the eyes.  

https://pubmed.ncbi.nlm.nih.gov/32951485/

https://pubmed.ncbi.nlm.nih.gov/30481795/

https://pubmed.ncbi.nlm.nih.gov/2826267/

Hope this helps.

I hope so 🤞

Can't take anything for granted, though.

Thank you! 🤞

Oral minoxidil has been showing some very impressive results.  I am tempted to add it to my regimen, but my only concerns are the studies showing it decreases collagen production in the skin.  As a result, a lot of users have reported wrinkles - particularly around the eye area.  Any thoughts?  

Nice result so far! The meds have worked brilliantly for you! Did you notice any initial shedding when you started dutasteride?

31 minutes ago, shadowcast said:

Yeah I think this is like a Couto or Freitas influence or something. Makes me wish I opted for a straight hairline. I think your result will be great.

Yes, it seems that way.  Thanks.  

The advantage with FUE is that you can get small adjustments pretty easily.  So if you want to straighten your hairline, then most surgeons would be able to accommodate that. 

As you will probably be aware, a lot of surgeons are advising patients to take finasteride 5-6 days per week and Dutasteride on the other days. 

As others have said, I would suggest increasing your finasteride dose to 1mg daily first.  That way, you ensure that you are not experiencing side effects from the higher dose before escalating treatment.  

I would probably then consider adding in 1 or 2 doses of Dutasteride per week, and take finasteride 1mg on the other days.  

It's always better to escalate your regimen slowly.  That way you can monitor effectiveness and minimise side effects.

However, with that being said, I saw a patient posted result from Dr Freitas.  He advised this patient to take Finasteride 0.5mg x5 days per week and Dutasteride x2 days per week.  

2 minutes ago, shiba1985 said:

you have the type of hair, where most surgeons in the world should be able to hit a home run. 

 

Let's hope so! Thank you! 

As you will see, my thickness was 58 to 60 microns.  I also had a large number of 3 hair grafts.  

4 hours ago, shadowcast said:

Looks really good. Is Lorenzo changing his style a bit? Seems like a very straight hairline compared to his usual work.

Thank you.  Dr Lorenzo did say to me that because of my age and the fact that I've been stable on Finasteride for so long, we could be aggressive with the design.  So I opted to go aggressive.

However, I did notice on his youtube channel that some of his hairline designs are more youthful now.  But it depends on the patient.  

One month update:

so the ugly duckling phase begins.  As you can see from the pictures, the transplanted hair has grown a little in length and shedding has started.  I'm expecting the rest of the grafts to shed in the next week or so.  

The only other thing of note is that my native hair is growing very quickly.  This will hopefully mean that I can cover the transplanted area in a few weeks.  

Please let me know what you all think.  

Thanks

No, I paid the full amount the week before surgery.  They gave me 201 grafts free.  

It's growing in nicely!! You should be pretty happy in a few months! 

Are you getting any side effects after adding in the Dutasteride 3x a week? 

Hi All,

Please see my Day 11 pictures below.

All of the scabs have now come off.  

QAre you a diffuse thinner?  If you have DUPA (Diffuse UnPatterned Alopecia), then it means that the follicles in your donor area are also androgen sensitive.  

I have seen some of the Elite surgeons approach such patients cautiously, especially if you are young.  

However, the approach that I have seen is to put the patient on Finasteride/Dutasteride and see if the donor quality improves.  It generally does and the patient can then undergo a hair transplant, provided they know the importance of continuing meds.

Which clinic did you consult?

Hi @Smash, how are things going?

Did you get a touch up from Dr Lorenzo in the end?

I also wanted to thank you.  I recently got back from Madrid after having surgery with Dr Lorenzo (link to my thread is in my signature). Your write up was so useful as I went through the entire process!

It doesn't look too bad, to be honest.  You have to expect that your donor is going to look thinner once follicles have been removed.  

However, 5800 grafts is an absolutely massive number to remove in 1 session.  This would affect how your donor area recovers etc.  

1 minute ago, Yan bio said:

this is very important, and not mentioned enough I think. I've had my HT 4 months ago, and I have one area which was heavily bruised and crasted, and I'm not sure any follicles are going to sprout in it.

Yes, hair transplantation is a surgical procedure and like all surgery, it comes with risks.  

Dr Lorenzo presented at the World Fue Institute at couple of years ago about Haematomas and necrosis and how they can affect graft survival.  I have linked the video below:

17 minutes ago, Mike10 said:

I think youw were a very good candiate given your age, NW pattern, density and use of medication. It appears to me though that you have been losing some ground on Finansteride, so when you say you do not mean totally stable

Hi, I agree that I am a good candidate based on these things.

What makes you think I have been losing ground?  I have not posted any old photos to compare? 

In my opinion, I feel that my hair is more or less the same as it was when I started Finasteride.  Perhaps there has been a slight worsening of the hairline, but I don't know for sure.  

In 1 year, I am going to consider switching my meds to Propecia 1mg x6 days per week and Avodart 0.5mg x1 day per week.  This is more for my own piece of mind, so that I can safeguard my investment! 

A lot of surgeons are recommending the approach now and there has been a case report published, showing that a patient who was losing hair on Finasteride experienced regrowth when switching to the above regimen. 

27 minutes ago, civic said:

Very good work! He did all the implantation by himself on other patients as well ? 

Thank you.  Yes, he did the implantation for all the patients. 

I think that it's clear you have a very aggressive hair loss pattern.  I would switch to Dutasteride for 1 year and then look into a transplant.  

13 minutes ago, Melvin- Moderator said:

Very keen to see Dr. Lorenzos recent work. There’s been some complaints recently about him scaling up his practice. But I do believe he’s still one of the best in the world.

Thanks Melvin, I'll be sure to update!

I did read about this, but viewed his latest work on his YouTube channel and lots of patient posted cases on the Greek forums.

1 minute ago, Gramatik said:

Good luck and happy growing! I think the right temple design looks different than the left one. Can you also see it? Also can you tell us the cost of your hair transplant ? 

They are very slightly different.  But our natural temple points are not identical either.  Once they have grown in, I don't think it will be noticeable.  

Dr Lorenzo has a decreasing price scale of €6/graft for the first 1000, €4/graft for the second 1000, then €2.5/graft thereafter.  The pricing is regardless of the number of surgeries you have ie so if I go back in 5 years and get another 2000 grafts, the cost will be €2.5/graft - so €5000 euros.

Hope that makes sense.