BackFromTheBrink

On minoxidyl - have you considered oral rather than topical?

Looks very clean work. Did you discuss your expected outcome - is this a one and done procedure? It looks like they decreased density towards the back of your head but covered the entire area (with the exception of the thinning area in your lower vertex). It should frame your face and give an age appropriate level of density, with better but not complete coverage in the vertex?

Absolutely agree with that. What amazed me was how little attention people really pay to your head/hair. I was expecting lots of questions from people during the first few months and even more when it'd grown out. In reality, I only had one person (my mum!) who immediately noticed and a couple who suspected and openly asked whether I'd had work done afterwards.

There are certainly more grafts through a fut/FUE combo, or at least that was the traditional view, which the likes of pittella and Zarev seem to continually seek to disprove. I'd say most have far more than 4k donor capacity.

I don't agree. You're not long after surgery and your donor still has plenty of time to recover. There are plenty of examples of people with Norwood 5 who have 5k plus procedures without noticeable thinning of the donor.

It depends on the extent of your loss. My first procedure was fairly easy to spot for the first month or two due to shedding. My second (partial shave FUE), I'd say within 3 weeks you couldn't tell at all. I had work done to refine my hairline and add density to the midscalp and crown. Here's my head 3 weeks post:

I'm not sure about your maths there. 20% more would be 16.2cm2 = 97.2cm2.

I've not heard the recommendation about stopping exercise before. How does it increase bleeding? From my experience heart rate and blood pressure are raised directly after exercise but always back to baseline by the following morning.

Are you on meds? They may help reduce your transplant needs. As it is, I'd say 2 surgeries and 6-7k grafts in total.

I can absolutely relate to that. I opted for a partially shaved second surgery to avoid the head shave and ugly ducking phase. While id say it certainly helped, the first time I brushed my hair post surgery I saw chunks of hair on the brush from shock loss. Definitely not a good day! As you say, the first time it was a low risk situation so all growth was positive. Since this is the icing on the cake, someone stomping on it first is very taxing mentally! I'm about a month behind you and id say probably above baseline now, so looking forward to what's next.... Best of luck with your growth, I'm sure it'll be all worth it when your hair is longer, the shock loss has passed and you're seeing the density increase daily!

A fantastic result, congratulations. I'm not entirely sure what your pre op state was since the pictures have your hair pulled away from your face. Do you have any more candid shots? What Norwood level would you say you were?

Agreed. I think the concern was the unborn child being exposed to finesteride more directly and that exposure inhibiting normal development for male children.

From what I remember, there was a study in rats on much higher doses of finesteride which resulted in androgynous offspring. However, there hasn't been a case reported where the lower doses we take for hair loss have had a negative impact in humans. There have been many children conceived when taking the medication without issue. That said, I can completely understand people not wanting to take any risks in that regard. Psychologically, most parents would prefer to know they did everything they could to prevent any issues with their children, and would prefer to know that if they had a child suffering from a genetic disorder that it was not due to anything within their control.

I may be misremembering, but doesn't the OP suffer from traction alopecia? If that's the case, he may well never suffer from male pattern baldness. My advice would be to ask the clinic about their change in estimated graft count, and their planned density (raising their previous comment about the limitations of hair transplant density). If you're never going to lose hair, attempting to match native density as much as possible isn't a bad strategy. What you really want to know is their aimed density and their experience of achieving that in other patients. Hopefully they will be able to share some reference cases.

It is a cosmetic procedure, so there are relatively few quality standards other than specifying qualified personnel perform parts of the procedure. However, there's nothing that guarantees the experience or skill of a hair transplant surgeon. Have a read of the forum, and look for cases of relatively inexpensive surgery in the US. I can't think of any that ended well. A good surgeon in the US will be expensive. You can get the same quality of work done elsewhere in the world for less money - if you are prepared to travel. So affordable, local, quality - pick 2.

First time it was 7-10, second 4-5. That said, second time I didn't really have that many since it was a very refined surgery.

Were you able to get the name of the surgeon that would be performing the surgery? Do you have an indication from them of the number of grafts you have been quoted for? 2 patients a day is promising (in that it isn't a hair mill). Would the doctor do the planning and incisions? Any more contribution? Given its a new clinic, do the technicians have experience elsewhere?

Nape hairs are often lost with more advanced hair loss situations, so I'd also be concerned with surgery tomorrow using them. Similarly, if it seems you do with DUPA, the result would be compromised altogether. I have seen patches being shaven to assess donor hair, so I'm not surprised it took to that stage to fully assess you. He's clearly being ethical here and putting you first. I'd personally take his recommendations.

Now that's just asking for it - Good Luck ☺️ They seem to offer all kinds of aesthetic procedures. Usually most would recommend identifying a specialist hair clinic. Could I ask why you're considering them specifically, and details of how they perform surgery (the role of the doctor, how many patients per day etc).

I say that's an ideal density. Its not so dense that it'll require special treatment to ensure adequate blood flow in the scalp but is high enough to give a good margin of error and ensure a good result.

Generally I'd say in the region of 50 follicles per square centimetre in the hairline will give the appearance of a full head of hair. Some surgeons go higher, especially in the hairline. There has been people who got 70-80, but that's relatively unusual and extreme.

What's the total number of grafts you need for full coverage? Its a judgement call really, but if it were me; - I'd prefer 2 surgeries rather than one - if you ultimately don't have enough grafts for full coverage, a single surgery to frame your face (the surgery proposed for tomorrow) would be a good option. The question only your surgeon and you can answer is - will the current state of your donor affect the surgery (other than the available grafts) and are you mentally prepared if you don't get the density you require or cannot have a second surgery? Once you've had a procedure, your future options (shaving etc) are reduced.

I think it'd be useful for the community to hear if/how he plans to expand and reduce the waiting lists.

The very long winded explanation of lots of irrelevant information seems to get back to the original point you were arguing against. It's the receptors (or lack thereof) in the hair follicles that impact their succeptibility, not differing levels of DHT across the scalp.

You must have studied more biology than I did (and my Dr partner sat next to me). I thought DHT bound to the SHBG protein and the target organs have receptors which control whether or not they're 'consumed'. For receptive organs, constriction of veins control the amount of exposure. Vascularity is high in the scalp, with the veins not having significantly different diameters between the side, back and top of the head. Am I understanding the basics, and if so, what mechanism controls the amount of DHT that follicles are exposed to?