Hair-here

With regard to fin- TBH I’m down to .25mg EOD and still having mild sides so I’m probably going to drop it altogether. I’m a NW 6/7 so prob not much was gained by it. My doc suggested waiting a year after the surgery to drop it though to not impact the surgery results but I feel like whatever I’m going to lose will be lost whether now or later. I figured dropping now would be better so he can see my “real” state without fin support but not sure if 2 months will be enough time to shed those fin-supported hairs.

I’m on fin and will start oral minoxidil on doctors recommendation after the surgery. I use nizoral twice a week. I’ve never really explored vitamins and supplements because it always seemed like so much variation in regimens without data to back any of it up- not to say it doesn’t work, just to know what does and doesn’t work. I’ve done a scalp biopsy after my first transplant didn’t yield well and there was no major issue. Any other suggestions for prepping myself in these last two months to get the best results? I’ll be likely using the last of my donor and a bunch of beard so it’s my last solid shot at this. Thanks for any suggestions.

Ooh but i realize I’m using some beard hair for donor too— it’s always hard to get sunscreen under a beard. Now I’m wondering. Would it make more sense to go 2 weeks before or 5 weeks after surgery?

Oh yeah- for sure full hat coverage the whole time! Just wondering how bad lots of exercise in heat and lots of sweating can be. I’m fully healthy and in good shape, the trip won’t be hard on me otherwise, just purely for hair.

Well I’m going back for another shot at it- I’ll go for my 2nd transplant in mid-July. It will be a large 2-day procedure. But i also promised my kids we’d finally do Disney World this summer vacation. It’ll be 5 hot sweaty long tiring days of walking miles in the Florida heat wearing a sweaty hat, maybe some chlorine from the pool. i feel like trying to get in at end of August seems crazy, just a little over a month after surgery. But the other option is going two weeks before surgery, leaving about a week between returning from Florida and first day of surgery. How bad of an idea is this?

Yeah I figured it might not make too much difference. Any idea how long it takes to lose any fin-supported hair? And about the shed when stopping- is that just fin supported hair?

I’m a NW 6/7 who’s now scheduled for my 2nd transplant after my first 3000 graft surgery 20 months ago didn’t yield great/didn’t cover enough with any substantial density. I have a July date with Dr Pitella for 10k grafts, half of that is beard hair. I’ve been slowly lowering my doses of fin since my last surgery 20 months ago to get rid of some sides but Im a point where I want to just quit it due to mild sexual sides. I’m down to .25mg every other day for past few months with no improvement on sides. So being a NW6/7 I don’t even know how much fin has done for me. I just added it after my last surgery because it was suggested my sides and back could drop even lower. So maybe it kept my back and sides from dropping but I can’t know that, I’m already pretty far gone. I may have just progressed as far as I was going to as I’m mid-40s. Ideally I would have quit fin a few months ago, to shed any fin-supported hair in advance and gone into this surgery with an accurate picture of my loss for the doc to work with. But I don’t think I’ll shed it all in 2 months. So the other option is to continue fin but then when I eventually stop like in a year after surgery, there may be spots which lose hair and are less dense because no hair was put there because the fin-supported hair was still there at time of surgery. Though he plans to approach my surgery as if I had no hair on top at all. My other question is whether it really is beneficial to be on oral minoxidil prior to the surgery? The doc recommended that and I’m game to give it a try after surgery if I do it now or before surgery if I delay surgery. I really don’t want to but I could delay the surgery a year if needed to wean myself off fin and also start oral minox. Dr Pitella said while delaying could make some sense and perhaps feel slightly safer, he doubts there will be much difference in the outcome but it’s up to me. I really like him and trust his opinion but this is my final shot at this due to a weak donor so I want to put some thought into it. I’m also feeling impatient to finally do something to improve my previous surgery and don’t want to wait an extra year unless it seems like it would be important to. I know there are lots of variables at play so there might be no clear answer but I figured I’d throw it out there to get some other opinions about quitting fin, adding oral min and if it’s worth delaying.

I’ve been on fin for almost two years. For almost all that time I’ve had some of the typical mild sexual side effects- lower libido, weaker erections, etc. Everything still works, but it’s still kind of annoying. I’m a NW 6/7 and had a transplant so the doc recommended taking it to protect the transplant and whatever further loss could occur- so I’m not protecting a full head of hair with fin by any means. I took 1mg of fin for a year then decreased to 1mg every other day for a few months and then have been doing 1mg/twice a week and .25mg every other day for a few months now. The decreased dosage doesn’t seem to have helped the sides go away. I think I’m at about the lowest dosage that could be effective and so I’m close to quitting. Has anyone else gone this route of lowered dosages without getting rid of side effects? What did you do?

Ok interesting feedback. So maybe the yield wasn’t great but not quite as bad as thought? Maybe the bigger issue is density and it should have been concentrated in a smaller area, more focused on the front 1/4th instead of 1/3rd? In retrospect, I don’t think I had a good sense of what the end density would be like and for sure wasn’t expecting this. I think I trusted the doctor that surgery would bring me from slick bald to “naturally balding with hairline”. And I was OK with that, I knew 3000 grafts was never going to get me anything near a full head of hair. The balding dad with hairline look seemed better than bald horseshoe dad. I just wanted the results to look somewhat natural whatever they were. Buzzed it looks patchy. Any longer and it doesn’t really accomplish any real coverage and I look like the guy who has some odd scraps of hair left and should just shave his head already. Ive been buzzing the implanted area at 0 guard to keep it slightly longer and skin shaving the sides and it looks kind of OK for a couple days. And yes I do have a big head, so definitely some real estate to cover. Has anyone done anything like scalp biopsy or testing for this purpose? What exactly would they be looking for or testing for?

Based on my post-op photo, do you think if it had all grown it would have been decent? It seems like you rarely see photos of buzzed down transplants a couple years later since most guys wear it long to give more coverage, so it’s hard to know what actually survives from the original implanted density. Had I known about the high NW expert docs before my surgery, I probably would have gone with one of them because they could have gotten many more grafts which was what I really needed. But a few years ago when I was researching, I guess I just hadn’t read enough consistently good things about any of them to include them in my search. But researching now, they seem to be the commonly agreed 3 docs for a situation like mine.

To answer your question, I had no inkling that this was anything but a standard surgery- no unusual bleeding, no mention of anything from anyone that this was anything but standard. It was my first surgery, but everything about it seemed pretty normal. If it all grew in like in my after-surgery photo, I think I would have been happy enough since that’s basically the look I was expecting- a buzzed down frontal third with moderate density. We spoke at length about my expectations so this was not the doctor mis-estimating. 3000 grafts was the most any of the docs I consulted with were quoting me (due to my donor I assume) so I went in knowing 3000 grafts on an advanced NW wouldn’t go very far, but since I was buzzing it down anyway, my goals were realistic in just creating a hairline and gaining some frontal 1/3rd coverage to help connect the horseshoe.

My scalp seems pretty normal. I get a bump here and there from time to time but nothing frequent or bad. And I can keep an eye on it since I still buzz it weekly at 0 guard. i will look into a scalp biopsy and second opinions.

Yes I realize 3K grafts was never going to do the full job at all. However when I first got consults, that was the maximum grafts any of them quoted me. I got consults from 5 of the top docs recommended on this site (though not any of the 3 top advanced NW guys). So 3k was the most I was quoted and with lowered and realistic expectations I went with it. I actually think I would have been reasonably satisfied if the grafts grew. Again I was just looking for some hairline definition since I was going to keep buzzing it down. I probably still would have gone back for a second procedure at some point but most of those docs didn’t have high hopes for my donor as a NW 6/7. It was only now that I have gotten quotes from advanced NW docs that I am being told they can harvest up to 10k grafts from a weak donor and beard. And so that has given me new hope that I can get some real coverage.

I did get a bunch of decent sized whitehead type pimples in the first few months, nothing full on infected looking, but for sure some of these were in/near areas that look weak.

Sure, here it is- I had a few random hairs still hanging on but basically solidly bald.

I would be open to a doctor visit but what exactly are they looking or testing for? I’ve been to a dermatologist and he didn’t notice anything atypical about my hair or scalp that would explain poor growth. But also a dermatologist might not have a lot of experience with hair transplants.

Yes I didn’t plan to take up my old doctor on his repair offer. I was really just looking to cut my losses and go back to buzzing it, but then I saw some results from the big 3 high NW doctors and changed my mind. I don’t know them as repair docs but they sure seem to be good at advanced NWs like me. I’m willing to travel as far as needed. My only concern was whether there’s any way to know if there’s any indicator how second surgeries turn out after a poor yield on the first surgery. I don’t see cases like those posted much, especially for advanced NWs like me. In my mind though, even worst case another poor yield would still be a step better than where I am now and best case, the doc works his usual magic with a tough case.

I’m not saying there was no growth- for sure I have more hair than before. Probably my biggest issue is the patchiness. Had it been thin but consistent I would have just looked thinning and balding maybe more normally. But the patchiness is what makes it look much worse.

I obviously chose not to name the doctor. I honestly just don’t think this was their fault at all and I wouldn’t want to give them any negative press. They were very responsive throughout the process and even afterwards with suggestions and advice. And everything looked good when surgery was done. I think this is just the reality of any surgery, results aren’t guaranteed and everyone’s body reacts differently. To be fair, the doctor did offer a free follow up procedure which seemed very generous but I was just unsure that the amount of grafts suggested would be significant enough. i was planning to just go back to buzzing my head and forget about any more surgery but seeing some of the high NW docs like Pitella, Zarev, and Eugenix I’m now reconsidering. Even though I keep my hair short and have buzzed/shaved it usually, I have an objectively bad head shape for shaving and really think it would look better with some hair. My intention with posting was to hopefully hear from some people who had poor yield transplants who went back for another surgery and what their results were. I’m just trying to figure out if it’s worth giving surgery another shot.

It’s been about 20 months since my hair transplant. 3000 grafts with one of the top frequently recommended docs. Well over $10k spent. And it just didn’t yield well. It’s patchy and just not what I expected at all. I don’t get it. I know there’s no guarantees in surgery but it just really sucks to go through all that for such a disappointing result. My surgery seemed to go smooth. I didn’t bump my head. I stayed 4 days after just for careful head washes by the staff. I made it past the initial 14 days and thought my grafts were in for good and the wait began. i probably am the kind of case where I should have skipped surgery- a NW 6/7 in my 40s who wasn’t on any meds or any hair regimen at all really. But I was very realistic though with my expectations and went in knowing 3000 grafts would give me back a hairline and some density in my front third only and leave a bald crown. I just wanted to keep buzzing my hair and the new hair would erase the dreaded horseshoe even if I was still left with a donut. I thought any new hair would be better- balding is still better than bald, right? Us advanced NWs have a different view of hair. I just wanted to see a hairline again even if a mature pushed back one. I gave Finasteride another shot after my surgery, even though my previous attempt 15 years earlier (when I still had a nice head of hair) gave me some mild but unpleasant side effects. I just don’t know what went wrong. My doctor had no explanation either but fully agreed it did not turn out well. My mind has gone to a number of things but none seem likely: Did the large whitehead pimples in the months after surgery hurt my growth? My donor isn’t looking so great either. I like to keep it buzzed down and had always planned to do that even after surgery. Probably SMP would have been suggested for my situation but I really wanted some real hair. I was totally ok to keep looking like your average balding (but not bald) mature Dad, I just don’t get why it failed. It’s frustrating. I’ve recently consulted with the top advanced NW docs and plan to give it another shot though. To those who have had poor yields, any idea why? My pics show 18 months after surgery and a week after surgery. No pic but before surgery, I was pretty slick bald on top.

The more I read, some people suggest the extra oiliness could be coming from shampooing too often. Cleaning the natural oils off can cause the scalp to dry out and make more oil creating an overly oily condition. I currently shampoo daily even though Im a NW 6/7 so I’m basically just shampooing my bare scalp.

Yes I always shampoo daily, though I have a very short buzzed hair style and basically a NW 6/7 pattern of loss. i have been using the nizoral usually once per week and then a basic shampoo the rest of the time.

I actually do rotate shampoos as well but it’s hasn’t really helped. Maybe this isn’t a known issue?

I followed my surgeons directions after the surgery. Im just surprised it didn’t go away over a year after surgery. Id like to listen to the dermatologist I saw but I just am not confident they are familiar with hair transplants and worry daily nizoral would be too harsh on my scalp and head, especially as I have a 2nd surgery planned in a few months.

I have had an oily scalp for almost 2 years after my transplant. I did also start fin right after my transplant so not sure if that could cause an oily scalp. Is this common? And anyone have any solution? I only know it’s noticeably oilier because my transplant didn’t go well so I continue to buzz my hair very short and I can feel how oily it is. I went to a dermatologist who said to use nizoral every day. The derm was not a hair “expert” and I had heard that nizoral daily is not recommended. Any thoughts on the topic? Thanks