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Looks amazing, are you planning on going for a second session for the crown?

Echo what Ccd99 said, some miniaturization is normal. I have it too but when the hair grows out it's quite thick. Grow out your donor for a few months and most likely it'll look normal.

Your result will look good to the vast majority of people who are not obsessed with hair. Can it be improved? Yes, but I wouldn't stress too much about it.

What's the general consensus on whether verteporfin could work for old scars? By excising them and creating a new wound.

@mustang got some SMP removed with the Picowave laser and I believe it did not damage the hair in that area. That's the one you want.

no but minoxidil should because it can lead to increased bleeding. stopping fin increases risk of shock loss.

That's amazing. I have SMP and my first transplant is 4 months from now and I'm planning on two. Not looking forward to dealing with the ugly duckling twice so the fact that you can buzz it after a month and basically avoid the ugly duckling is a gamechanger.

I'm in a similar situation, have SMP a little lower than I'd like and getting a procedure in a few months. Your hair looks amazing with a buzz, no one would think you have hair loss from the frontal view. Did you find that the SMP allowed you to "avoid" the ugly duckling phase? Saw another guy say that. 2000 grafts in the crown should help a lot and the SMP will increase the visual density even further.

Yeah I definitely oversimplified when I said he "simply" expands the donor area. At the end of the day doing a bit of extra detailed planning for this kind of procedure should be standard. I'd definitely be willing to pay a premium for it. If I recall correctly a lot of doctors don't like to go over 40-50% extraction of the donor. In the patient from the presentation, he had a total of 5600 + 4900 + 2700 = 13,200 FU outside the main occipital region. If we even conservatively took just 15 percent of those expanded zone grafts, that's an extra 2000 grafts, which can make all the difference. By taking a full 40 percent, that's an extra 5000 grafts.

Right, but my point is for higher norwoods, like a norwood 6 who has not progressed further or is on meds and responds well, it becomes necessary to be a little less conservative in order to get enough grafts for a good result.

This is from one of Zarev's presentations. He uses two thirds of the area of the head as the donor. Traditionally I believe the "donor" is what Zarev refers to as the occipital area (high and middle) which is ~140 cm^2 or 1/4 of the surface area of the scalp that contains hair. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371726/ This academic paper on the donor area says that about 75% of hair can be lost and only 25% is considered permanent donor hair: It's a massive discrepancy. The traditional donor has less than half the total grafts as Zarev's expanded donor area. This paper claims that 375 cm^2 could be lost which is an unrealistic or even impossible scenario, like Norwood 9. This patient in the presentation was NW6 and had 220 cm of area to cover. @mtb I believe your surface area to cover was similar? I don't doubt that Zarev has some improved techniques that allow him to also extract more. But a big part of what he does is simply expand the donor. Why are other doctors not doing this?

Agreed, I've found many doctors reluctant to take more hair from the donor even in high norwood cases. It makes no sense, the hair in my donor is of no use to me. I need as much of it as possible on the top of my head. It's a very conservative approach from doctors but if it's necessary to take hair from a larger possible area and the patient understand there is a possibility that the grafts may not last as long as "safer" grafts I don't see the problem. Also, patients who respond well to meds should not have to worry about this too much anyway. It's really unlikely if someone is on dutasteride that a significant amount of hair in their donor area even outside the traditional ultra conservative safe zone will thin. Or at least the total degree of miniaturization will be low and not a major issue long term. Also Zarev will extract 60% of the donor and in some cases even more. This makes a huge difference and is important for advanced patterns.

Looks like not too many grafts were placed in the crown, did the medication end up improving it by the After photos? It looks much better than the Before.

Haven't done an in person yet, but I definitely should. Would I be able to get a precise estimate of lifetime grafts from that?

Thanks for the advice. I'm just frustrated that I haven't seen much improvement from the meds. It's been over six months on 1.5 mg dutasteride which suppresses more scalp DHT than 0.5 mg. And I'm on oral and topical minoxidil for good measure. Part of me wants to just schedule for 6 months in advance and hope I see some improvement by then.

Yeah SMP honestly did help but it wasn't the "solution". With my diffuse thinning and SMP I can pull off a one guard which is way better than a zero or a wet shave. And I mean every time I have a conversation about hair loss people genuinely are surprised and think I have a normal head of hair that I choose to shave. So it's definitely much better than being bald. I can also grow out my hair and look good with a healthy amount of hair fibers but it's a PITA. SMP wasn't the solution though because I still think about my hair loss constantly and nothing compares to real hair. I still get depressed when I see old photos of me and wish I could go back. Thanks for the advice, yeah haven't had any issues with dut. I'm on 1.5 mg, might even go up to 2.5. Haven't seen a on of regrowth yet but hoping for more in the next 6+ months. Was thinking of doing Dr. Bansal, is Dr. Sethi significantly better and worth the extra cost/wait time?

Yeah because I'll need a lot of grafts for full coverage, I think beard hair is a must.

Just contacted Eugenix recently, they seem like a good fit for the case

Hair loss is stable. Haven't seen much regrowth yet though. Yeah, I don't plan on getting to NW1 at all. I'd be happy with a NW2.5 hairline and a slightly thinning crown that I can use fibers on. Hair loss has affected my life very negatively and after shaving my head for three years and being very depressed I need to do something about it.

31 M, have been losing hair since 22. I got SMP a few years ago but would like to get a transplant. I'm diffusing in a NW6/7 pattern. I've contacted a few surgeons and they've said I may not be able to get full coverage and density which I can understand. But they did say I could still do surgery. They also recommended FUE over FUT because my sides are weak. I started dutasteride and minoxidil six months ago. haven't seen much regrowth but it seems to have stabilized. How does my donor look and how should I go about this? I'm thinking do the frontal third first, ~2500 grafts, and then try to get 20-30 FU/cm in the remaining area. I also have some beard hair that I could use.

Yeah makes sense. I always wondered if Chemyo was a better option since many people also have good experiences with their SARMs.

Chemyo and Anageninc have pretty good reputations for RU

I'm not sure if Manual does dutasteride but I believe they do oral minoxidil. I recommend you first get the prescription via telehealth then visit your GP and explain that you're already taking the medication and they can give you a prescription for it which should be cheaper (not sure how the NHS works though, I'm in the states). That way they're more likely to prescribe it.

Crown is looking really solid, and you've still got plenty more growing to come.

I take 1 mg of dutasteride since my goal is not just maintenance but regrowth. No issues. You're already blocking so much serum DHT that it's unlikely that increasing the dose will cause issues.