DermMD

7 hours ago, stephcurry30 said:

Agreed. I will go back to Konior's office at 12-18 months and update the thread with high res photos. 

In my circled photo here there's lack of growth in this area. hope it turns around better. You cna clearly see how the hairline as drawn is relatively straight but in the photos is tapers backwards. seems like this small patch isn't growing for whatever reason. 

It is growing in exactly how it was placed (go look at your first week, it looks exactly like the grafts were placed). that marker is not exactly where the grafts were placed. You can see the micro-irregularities intentionally put in the hair line so you would not have a unnatural straight line. this a home run man, be happy. 

I prescribe accutane often. I have not in this situation (just has not come up), however, the most common association is telogen effluvium. There are studies analyzing this, with patients being on higher dosage of the medication, and for longer durations potentially contributing towards it. In my opinion, with treating thousands of patients  for acne with accutane, it is not a common occurrence. I would make sure though a patient in this setting was on medical therapy for hair loss. This is not medical advice to you, this is just how I would look at this situation. 

7 minutes ago, Recession1 said:

I 100% do. Dr Rassman who came up with DUPA did a microscopic evaluation and densiometer on me and I do have it. 

No one is going to change your mind, and your statement will not change mine. And as I said in the other post, go get a real report and post it, not some crumby test. 

11 minutes ago, Recession1 said:

It really has nothing to do with how thick the hair looks in the donor. You can have 20% miniturization and that classifies as Dupa and is hard to detect with the naked eye. I have Dupa and mine looks somewhat thick. I’m not saying OP has it im just saying you can’t go off of how it looks only. 

You do not have DUPA. end of story. 

I am a board certified dermatologist. I do not do hair transplants, but discuss them with patients often. I feel compelled to write a strong disagreement here with Dr. Rassman, and the assessment.  If you had true DUPA, it would show even with long hair. The photos attached of your hair being wet are still not consistent with DUPA. My assumption is your overt concern for DUPA, when your hair is the way it is swayed a statement from him. A concern for DUPA with your volume of hair is a giant red flag when doing cosmetic procedures, and personally would scream do not proceed, as any physician would not be able to meet your expectation. You have zero deficiencies in hair density of your crown, occipital, parietal, posterior vertex and temporal scalp, and no evidence of DUPA. This can not be magically hidden. And as a expert in dermoscopy (trichology is a component of this field), I would not anticipate the donor density having any true deficiencies as you're stating. Also, the test he instructed you to do is garbage. If you really want to have a true assessment, see a Board-Certified Dermatologist, or hair transplant surgeon using something like Fotofinder (no COI, just a good product for dermoscopy).  

https://www.fotofinder-systems.com/technology/hair-consultation/

Absolutely not. 

https://dpcj.org/index.php/dpc/article/view/1921/1599

Is this really well articulated in the literature? At 6 months the transplanted hair should be present at the recipient site, however, it might only minimally visible to the naked eye, but with loops, or trichoscopy it would be evident. therefore, a surgeon should be able to conduct another hair transplant at that time (regardless if its in the same area as the previous HT or a new area) as they would be able to place new follicles appropriately spaced from recently transplanted hair and native hair in the thinning region. I believe that the reason it is suggested to wait 9-12 months is to evaluate the hair transplant at full maturation, as opposed to the midpoint when results may not be fully appreciated. 

10 hours ago, Eli_Avdikian said:

However, on a side note, I don't buy that someone can keep their hair on Oral Minox alone without some form of 5AR inhibition

Correct. Board certified dermatologist here, agree. You need both. 

21 hours ago, mustang said:

It doesn't. Period.

What it does however is hide a very aggressive form of prostate cancer that might be non detectable because of Finasteride.

Correct. Simply put, once you start getting your PsA testing your primary needs to know you're on finasteride or dutasteride as it can decrease the value of this test (missing early changes). if they know this, they should essentially double the PsA number to put it more in line with possible changes seen not on the medication. 

18 hours ago, JoeD said:

Not necessarily an allergic reaction…. Everything, except rash, sounds like some of the lidocaine went intra-vascular (ie in a blood vessel, an artery) by accident.  I wonder if the IV med they gave you was steroids for allergy vs intra-lipid for lidocaine toxicity.  
 

In addition, even if this was a true allergic reaction, you can get allergy testing and determine which of the other local anesthetics you can use.  Most common are the “amides” (lidocaine, marcaine etc).  Esters are another type which may still be viable. 

See an allergist to have this tested (amide and ester anesthetics). it's unlikely you're allergic to both (I am a board-certified dermatologist), and this is how I would test a patient in this setting. just my two cents. 

On 11/7/2023 at 10:48 AM, Rahal Hair Transplant said:

@alexmillne,

Instead of answering your questions, I have to ask you… who told you that oral minoxidil is more effective than topical minoxidil? In my opinion, this is not true. Why? Because the actual mechanism behind minoxidil is unknown, however, minoxidil is said to stimulate hair regrowth upon contact. In fact, one of the side effects of minoxidil in women, for example is unwanted facial or body hair growth, if the minoxidil comes in contact with certain parts of the face or body. This is why people are told to wash their hands after applying minoxidil.

This shows that the minoxidil is affective when directly applied to the area where you want hair regrowth to occur.  Thus, if you take it orally, then you are assuming that the minoxidil will make its way through the bloodstream and find the particular areas you want to target and then stimulate regrowth there? If anything, taking minoxidil orally would potentially cause thicker hair regrowth in all areas of the body, face and scalp that is, assuming you take enough of it. But if you don’t take enough of it, it likely won’t do anything for any part of the scalp, face or body.

Personally, I feel that if topical minoxidil is working for you, don’t switch to oral minoxidil. The only reason why I think somebody should consider switching would be if they were experiencing side effects by taking it topically.

This, of course, is just my opinion, but I haven’t seen any actual research or evidence, suggesting that oral minoxidil is more effective or potent than topical minoxidil.

Best wishes,

Rahal Hair Transplant

So, this comment needs a little clarity. what is the most common side effect with topical minoxidil (link below)? Its not hypertrichosis (thats with oral minoxidil, see that study 27% compared to 4%). The common reason topical is d/c is it change to hair texture, pruritus and perceived lack of efficacy. I am a board-certified dermatologist, just trying to point out some facts.

cheers,

https://www.jaad.org/article/S0190-9622(19)32666-0/fulltext#:~:text=Premature discontinuation of treatment commonly,to be effective for FPHL.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10149432/

11 hours ago, consequence said:

I don't think its unreasonable to assume with how OP was at 6 mo things might not have ended up where he wanted them at a year.

Konior's FUEs are generally not as consistent as his FUTs, though he has had success with both. Extraction is something that can take decades to get right.

@sbguy01 if you ever come back, please update us as to where things ended up and if you went back for a second pass etc. I hope things turned out okay.

What makes you make this statement? can you provide references/rationale? The placement of grafts are the same regardless if its FUT or FUE (I am a board-certified dermatologist), so why would it be different?