splitting hairs

Looks very good!! You look like you have no hair loss!

Dr Lorenzo did a hood presentation on necrosis. He had a oarient that had necrosis and the yield in the affected areas was lower. However, he did a touch up and debridement and the patient got good results.

Any updates?

It looks like it could be scarring. Best to speak to your surgeon. Also, I'd be concerned as to why you are losing transplanted hair? Did they take hair from outside the safe zone??

Dr Freitas is very well known on Spanish forums. He has lots of patient reviews there!

He absolutely should be recommended. Excellent hairline designs. I do have a question though. He seems to transplant at very high density at the hairline. Does this ever adversely affect yield or cause necrosis?

Hi, it's always best to get seen by a derm to get a diagnosis and a treatment. It looks like it's seborrheic dermatitis. Psoriasis has plaques and a lot of scaling. Have you tried an antifungal shampoo such as Nizoral? Having this condition doesn't exclude you from a transplant. Usually surgons get you to use a topical steroid for a week before a procedure. I have seen quite a few cases of patients with dermatitis by Dr Lorenzo.

There is no clinical evidence that any natural DHT blocking agent can help with Male pattern hair loss.

Ok so given your dry before pictures, I think it was absolutely the wrong choice to transplant 5000 grafts for you. I think it is poor planning from Dr Erdogan given your young age, the potential future hair loss and given that you are not taking finasteride. I would also say that it is unethical because the approach does not have your long term interests in mind. You should really have been asked to start low dose finasteride (1mg three times a week) to minimise side effects and halt your hair loss and then potentially a 2500 graft procedure to restore the hairline and temple points. Now however, I would consult a surgeon who will plan for your long term future such as Dr Lorenzo in spain. I suspect he would advise low dose finasteride for a year then suggest a small procedure to increase density at the front. One thing I would say about sexual side effects is that, sometimes the sexual side effects experienced can be due to psychologically expecting them. For example, when I first started finasteride 12 years ago I thought I was experiencing erection problems, but really I was just anxious because I was expecting them. It was the anxiety that was causing them. They went away after I realised this and I've never had a problem since. Good luck mate, I hope you manage to sort something out.

Hi, so I have had a look at your results and I have to say that I do not think it was appropriate for Dr Erdogan to transplant 5000 grafts for you. Do you have any top-down pics before your op with dry hair? From what I've seen of Dr Erdogan's work is that he transplants far too many grafts in young patients with a lot of native hair. This does not bode well for their future. Also, you need to get on Finasteride otherwise you are going to have significant further loss in the future without the donor reserve and will be left with an unnatural result hair loss pattern I feel that you have to be realistic with your goals now since most of your donor has been used. You may have some donor left but IT NEEDS TO BE MANAGED APPROPRIATELY!! You can maybe get a couple of small procedures of 600-800 grafts to thicken the hairline, but do not even consider lowering it given your age any remaining donor capacity. Good luck

Raker, do you know how long DR Vila's waiting list is? Good choice btw, I'm looking at her and Dr Lorenzo as well.

I have to say that I've been keeping an eye on DR Lorenzo's work for a number of years now and it is excellent. I saw a recent video his clinic posted on their vimeo page and he goes into all the meticulous details for planning the transplant and maximising donor. He also mentioned that 75% of their patients now get early growth by 5 months. He attributes this to a number of changesb they have made. Congratulations on your transplant!!

Wow!! Impressive result. The best in the business IMO.

I have SEB derm and have looked into this extensively. I have seen quite a few cases of good transplants from Dr Lorenzo in patients with scalp conditions. He documents it in the case summary on his vimeo channel. I have contacted him previously about how to manage the condition peri operatively and he said he prescribes clobex shampoo for a week pre op. I haven't had a procedure yet. But when I do decide to get one, it will be with him.

Hi Melvin, what I was trying to say is that the risk is theoretical, there is no evidence of finasteride in semen causing birth defects. But to be on the safe side, It's a good idea to use condoms after conception. Merck have not put a warning in the product leaflet about exposing your pregnant partner to finasteride through semen because there is no evidence of it causing problems. Here's a good link for more info: https://www.hairlosstalk.com/news/treatments/conceiving-baby-while-taking-propecia/

As a hospital pharmacist, I researched this extensively. I have now been on propecia for 10 years and have 2 boys. There is a theoretical risk that finasteride in semen could affect the development of a male foetus. However, the amounts are extremely small or even undetectable. Therefore, I decided to continue to take it during conception then use condoms as soon as we had a positive pregnancy test. From memory, the sexual organs are formed between week 8 and 15, so if you use condoms as soon as you confirm pregnancy it should be fine. However, this is a decision that only you can make. Best of luck.

What he said! Except I think he means SMP scalp micro pigmentation.

From my understanding, the risk of necrosis is small. However, it increases with dense packing as it can affect blood flow to an area. I believe smoking is also a risk factor.

Johnny, Baby shampoo is not sulfate free. You need to get a shampoo that is free of any kind of sulphate like sodium Laureth sulphate, sodium lauryl sulphate, ammonium lauryl sulphate, sodium myreth sulphate etc. Just look at the ingredients. I found that after switching to sulphate free, my hair was less oily in about two weeks or so, even with washing daily. I could even skip days without my hair looking greasy. Washing daily is considered normal, as long as you use a sulphate free shampoo, it's not overwashing.

Johnny, I also have very oily skin. I have noticed that switching to a sulphate free shampoo has helped to reduce the oiliness. Also, as a face wash try and avoid sulphates in face washes etc.

If you're interested in Greece, I would look at Dr Maras. His work is very good and he's also reasonably priced.

Hi Bill, I've been following this forum for years and Dr Lorenzo has always stood out as being one of the best FUE surgeons. I first heard of him when he came to the UK and was recommended here. I'm aware he doesn't want to be part of this community as he has plenty of patients in Spain already - hence his waiting list is 10months. For the last few years I've been following the Spanish forums and I have also seen very good results from Dr Ximena Vila, who has been working alongside Lorenzo since 2009. She is also very good and I've seen that her hairlines are more youthful than lorenzos. Her new website, which is still under construction is ximenavila.com Bill, do you think it would be worth approaching her for recommendation as she will be looking for clients? Just a thought.

I have seen cases on his youtube/vimeo channel without finasteride, but it depends on age and the stability of your hair loss.

From the cases I've seen, he does operate without finasteride, but only if hair loss is stable.

Hi, from the photos it looks as though you probably have thinning in the donor area. From the cases of Dr Lorenzo that I have seen, he normally recommends finasteride for 12 months, then reviews again. Usually there's improvement and then he operates. Just make sure whoever you go to does not do 5k FUE in a single procedure, as generally in order to maximise your donor, two smaller procedures are done to allow better recovery after each surgery.