Dr. Wipawan Vathananai

Hello TravelPlugs, After undergoing a hair transplant in Bangkok, there are still plenty of places you can explore, particularly department stores with air conditioning. Additionally, there are numerous cozy cafes where you can simply unwind. However, it's important to be mindful during the first few days post-transplant, as the grafts may not be fully secured to the recipient site yet. Most of my patients struggled a bit about having enough button shirts after a hair transplant but there are lots of places that you can get cheap button shirts here. You might want to buy some before the surgery. If you're considering a vacation after the procedure, I'd recommend waiting at least one week. In that case, heading north to destinations like Chiang Mai, Chiang Rai, Nan, or Maehongson might be preferable due to the cooler temperatures. You could opt for a retreat in a forest cottage or enjoy a stay at one of the many luxurious resorts. You can also go to the South but I guess you might have to stop yourself from going into the sea 😅 Regarding Thai massage, I suggest waiting at least three days after surgery before scheduling one and informing the masseuse that you'd prefer to avoid any head massage. Best, Dr.Wunny Hair Transplant & Dermatologist BHI Clinic, Bangkok, Thailand

Hello Cee, As a hair transplant and dermatologist, I understand your concern about preferring not to take oral finasteride after a hair transplant, and it's quite common among patients. Typically, I simply provide information about the advantages and disadvantages of not taking finasteride and allow patients to make their own decisions since it's their bodies. From my experience, lots of patients still have their hair even without oral finasteride after a hair transplant. Usually the transplanted hair stays, the non-transplanted ones are the ones that fall out. In your case, it would be better to keep the hairline conservative to preserve donor hair for future hair loss if your hair loss suddenly becomes active again. I've noticed that you have a significant amount of miniaturized hair on the crown. My preferred medication in such cases would be oral minoxidil at a dosage of 2.5 mg per day, taken consistently. This can be complemented with or without activated PRP injections, administered once a month for 3-4 months initially, followed by injections every 3 months thereafter. I offer PRP injections as an optional treatment because they can become expensive in the long term. While PRP is beneficial for maintenance, it's not typically effective for reversing hair miniaturization. Additionally, you might also consider topical finasteride. Furthermore, there are various products and supplements worth researching, and I have no conflicts of interest in recommending them. Some brands that have caught my attention include: - CRLab Havogen-5 patch along with their Anti-hair loss products (green line) - ISDIN Lambdapil - Iraltone (from Cantabria Lab), both AGA and AGA Plus formulations I always recommend the patients to do some blood tests in order to check correctable causes that might lead to hair loss, for example, vitamin D deficiency, iron deficiency, thyroid disorder, anemia, etc. Lastly, it's crucial to consider the desired hairstyle post-transplantation, as this significantly influences approach to patient management. I hope this help Best, Dr. Wunny Hair transplant surgeon & Dermatologist BHI Clinic, Bangkok, Thailand (https://www.bhiclinic.com/en/)

Extracting the donor area with FUE alone will decrease the donor area density to the point where it looks unnatural. FUT, on the other hand, preserves donor area density, allowing us to extract some grafts around the FUT with FUE. However, you will need to wear your hair at least 2 cm long to cover the linear scar, depending on your surgeon's technique during the FUT procedure. Everything has its advantages and disadvantages. Regarding scalp laxity, most people's scalps have enough laxity to be harvested by FUT if they have never undergone any scalp surgery. If you're not ready to proceed with FUT yet because you prefer to continue wearing short hairstyles, then consider doing some FUE from the scalp and beard hair (under the chin) area. After that, continue with medications and let's see if you're happy with the result.

Hello davidmcvicker, Your donor area appears to be in great condition in the photos. However, the hairline you've drawn seems a bit too aggressive 😅 For the frontal area, I suggest simply filling in the receding temples for now. It's advisable to preserve donor hair for potential future hair loss. Regarding medication, many people anticipate thicker and denser hair after taking oral finasteride, but typically it doesn't work that way due to its mechanism of action. Normally, testosterone is converted into dihydrotestosterone (DHT) by the enzyme called 5alpha-reductase. It's the DHT that causes hair miniaturization in male androgenetic alopecia (AGA). There are two types of the enzyme 5alpha-reductase: type 1 and type 2. Finasteride inhibits the function of type 2, whereas Dutasteride inhibits both types, resulting in a greater reduction in DHT levels. Primarily, AGA progression is slowed down by inhibiting hair miniaturization with either finasteride or dutasteride, but neither can significantly increase hair shaft thickness. Therefore, if you're expecting denser and thicker hair, you may not see significant changes. Essentially, these medications slow down AGA. It's worth noting that discontinuing finasteride might lead to increased hair loss. Considering your hair loss isn't particularly aggressive, you could either continue with finasteride or consider switching to dutasteride. Regarding graft estimation, I would roughly estimate around 1,000-1,500 grafts for the crown since you still have some existing hair there. I'd aim for a density of 15-20 grafts/cm2. For the frontal area (if it concerns you), approximately 1,200-1,500 grafts should suffice, aiming for 50 grafts/cm2. I recommend trying oral minoxidil at 2.5 mg/day on Mon-Wed-Fri, or daily if you can tolerate it, along with either finasteride or dutasteride for about a year before considering a hair transplant. I hope this helps. Best, Dr. Wipawan Vathananai (Dr.Wunny) Hair transplant surgeon and dermatologist BHI Clinic, Bangkok, Thailand

🤩🤩

Hello Shlenz, From the photos, it appears that you are experiencing aggressive hair loss from the front to the crown. I can see a significant amount of miniaturized hair. You mentioned taking minoxidil. May I inquire about the dosage you are currently taking? For management, I highly recommend oral medications such as dutasteride at 0.5 mg/day and oral minoxidil at 2.5-5 mg/day for at least 12 months to preserve your existing hair and slow down further hair loss. Additionally, it might be beneficial to consider some blood work to rule out anemia, thyroid disorders, vitamin D deficiency, and iron deficiency. Regarding hair transplant surgery, while you may not be the ideal candidate, there are still options available, particularly with a conservative hairline approach. If you opt for a single procedure with a high number of grafts, it would likely involve a combination of FUT & FUE and FUE techniques (aka COMBO). I also noticed that you have some amount of beard hair so thhe beard might be able to provide around 600-1,000 grafts from the photos. However, it is advisable to continue the medications for at least one year before undergoing a hair transplant, as this may reduce the number of grafts required. In summary; 1. Combo (FUT + FUE) 2. Beard-to-scalp FUE I don't usually recommend chest hair as a donor since the survival rate is not that good. Please note that this is only a rough estimation from the photos. Best, Dr. Wipawan Vathananai (Wunny) Hair transplant surgeon and Dermatologist BHI Clinic, Bangkok, Thailand

Hello Benjymu, Regarding your concern, I believe it would be beneficial for you to provide some photos so that we can assess whether the thinning area truly requires a hair transplant. If you're concerned about the visibility of the procedure, there's the option of non-shaven FUE, where the donor area doesn't need to be shaved, but it's suitable for cases requiring fewer than 2,200 grafts. Typically, the crown area may necessitate at least 1,500 grafts for optimal results, though this can vary depending on the size of the thinning area. Even with a traditional shaven FUE, six weeks should be sufficient for the hair to grow and provide coverage. Ideally, scheduling the surgery during the first two weeks of summer break would be convenient. It's important to note that the recipient area doesn't need to be shaved, whether it's non-shaven or shaven FUE. I hope this information helps. Best, Wipawan V. Hair Transplant Surgeon and Dermatologist BHI Clinic, Bangkok, Thailand

Hello Costantinos00, Regarding your concern, due to your young age, I believe it's preferable to initiate treatment with oral medications for a duration of 12 months initially to assess its efficacy. I would suggest transitioning to oral dutasteride at a dosage of 0.5 mg per day along with oral minoxidil at 2.5 mg per day. These medications not only help in preserving existing hair but may also reverse miniaturized hair follicles, potentially reducing the necessity for a significant number of grafts during a hair transplant procedure. Additionally, I recommend investigating other potential factors such as anemia, thyroid disorders, iron deficiency, and vitamin D deficiency etc. Your dietary habits also play a crucial role; it's important to note that a ketogenic diet may not be favorable for hair health, thus maintaining a balanced and nutritious diet is essential for hair nourishment. Regarding the surgical aspect, if you are determined to proceed with a hair transplant to restore the frontal hairline, I would estimate requiring approximately 1,500 to 2,000 grafts. It's advisable to maintain a conservative approach with the hairline, considering the possibility of needing additional transplants to address crown thinning in the future. I hope this is helpful.

Sometimes, there could be scarring alopecia which involves beard. Even though it's quite uncommon but if it really is scarring alopecia. Then a hair transplant cannot be performed. Only if it is a scar from trauma or external causes that the hair transplant can fix the issue.

You can try these products; - Ketoconazole shampoo - Tar shampoo - Selenium sulfide or Selenium disulfide shampoo - Clobetasol shampoo (severe cases) - Topical desoximethasone (moderate cases) For the shampoo, please use it every 2 days in the beginning and make sure you leave it on your SCALP for at least 5 minutes before rinsing it off. Normally, seborrheic dermatitis is caused by an imbalance of the yeast called Malassezia furfur and normal flora (bacteria) on your scalp. Basically, there's too much yeast. The shampoo will help keeping control of the organisms while the Clobetasol shampoo and topical desoximethasone will help decrease the inflammation during in the beginning of the treatment.

Hello, Based on the photos provided, I can observe perifollicular scales, scalp redness, and moderate hyperkeratosis (the white desquamation). My initial diagnosis would lean towards seborrheic dermatitis, judging solely from these images. However, to ensure an accurate diagnosis, a physical examination and microscopic examination should be conducted in conjunction. While there are no studies indicating whether seborrheic dermatitis affects graft survival in hair transplantation, it is not considered a contraindication. From my experience, I haven't encountered any issues with graft survival. However, if the donor hair carries seborrheic dermatitis, it's possible for the recipient site to develop the condition as well once the hair starts growing. Seborrheic dermatitis isn't a dangerous condition, but it's not entirely curable either. Its occurrence can be influenced by factors such as weather, stress, and scalp hygiene. Perhaps seeking a second opinion from another dermatologist would be beneficial in obtaining an accurate diagnosis. I hope this information proves helpful. Best, Wipawan Vathananai Hair transplant surgeon & Dermatologist BHI Clinic, Bangkok, Thailand

Hello ichigo, Regarding your concern about medication, I recommend switching to oral dutasteride 0.5 mg once daily and oral minoxidil 2.5 mg daily due to your youth and apparent acceleration in hair loss progression. Additionally, conducting blood tests to exclude other correctable causes such as anemia, thyroid disorder, and vitamin/mineral deficiency (ferritin, vitamin D) would be prudent. The reason I prefer a daily dosage of both dutasteride and oral minoxidil is that, at 39 years old, I typically aim to preserve existing hair before adjusting the dosage if side effects arise. As for shampoo, I'm uncertain if you can find ISDIN Lambdapil, but based on positive experiences from my patients, it's worth considering. Alternatively, you might be interested in other brands like DERCOS by Loreal (the red variant). Regarding your choice of surgeon, as a hair transplant surgeon, I believe it's best not to offer opinions on specific doctors. However, both Dr. Laorwong and Dr. Pathomvanich are esteemed in their field. I hope this help Best, Dr. Wunny Hair transplant surgeon and dermatologist BHI Clinic, Bangkok, Thailand

Hello Aykay7, Regarding your concern, 1. Three months are usually not enough to see the full effect of oral minoxidil. However, since you are not taking a low dose, I recommend seeing a doctor so they can help you adjust the dosage and identify the causes of weight gain. You might also need some blood tests to check electrolyte levels. 2. Topical minoxidil is a lot less effective compared to oral minoxidil, from my experience. However, if you really cannot tolerate the side effects of oral minoxidil, even with a low-dose regimen, you could switch to topical minoxidil. 3. The foam is quite sticky, and most of my patients don't like it because it makes their hair look greasy. 4. There are many brands of topical minoxidil with different solvents. You might have to try different brands to see what you like. 5. If you stop using minoxidil, either topical or oral, the hair will simply revert back to its natural state without the medication, which means it may become thinner and less dense. Please keep in mind that hair loss from AGA is not a life-threatening condition, and your overall health is more important. Best, Dr. Wunny Hair transplant surgeon and Dermatologist BHI Clinic, Bangkok, Thailand

Because topical minoxidil usually contains propylene glycol which is used as a solvent in minoxidil solution, that is the reason why some doctors recommend the patients to avoid using it. Propylene glycol can cause some irritation to the scalp in some people and it is advised to wait until the wound healing is complete before start using topical minoxidil. For oral minoxidil, it can be started right after the surgery. As a long term use, both topical and oral minoxidil are considered safe as treatment of androgenetic alopecia (AGA). Recently, the use of oral minoxidil has been getting more popular comparing to topical minoxidil because it is more convenient and the patients have better compliance. During the first 1-3 months after starting minoxidil, the hair will shed first because minoxidil drives the hair follicles to end the current cycle to initiate a new one with stronger and larger hair caliber. In order for the new hair to grow, the old ones need to say bye bye. There will be no spring, if there's no autumn The shedding phase makes lots of patients become anxious most of the time, it is advised to keep taking or applying minoxidil until it's at least 6 months. If the patient stops using it then the hair will just turn to the stage which it should be without medications. I hope this help Best, Wipawan Vathananai MD Hair transplant surgeon and dermatologist (BHI Clinic, Bangkok, Thailand)

If you were diagnosed with alopecia areata and topical steroid did not help, maybe you would like to consider seeking for a dermatologist who is specialized in hair diseases. The alternative treatment for alopecia areata is contact immunotherapy. However, you will need to see the doctor quite often during the first few months to adjust the concentration of the immunotherapy solution which I recommend that it is better to get treated in your local. Dutasteride injection or hair transplantation will not help treating alopecia areata.