gillenator

Yoshi, I think your frontal zone is going to look amazing!...

You're very welcome my friend. I took a peak at your 8 day post-op pics and your recipient area looks just fine, good healing has taken place. Most of your crusts are still there however and you should be ready to remove them. Once you clean up the area, it should look even better because if you use your fingertips to massage the recipient area, the crusts and the flakes should remove nicely. I also see several darker spots where it may have been the sites where you lost a couple of grafts? Hard to say from just photos. Regardless, you should have good regrowth and a nice end result. This will take time, up to 12 months. The best is yet to come...new regrowth and your new transformation. It will be exciting... Best wishes to you Mr6435 and again, congrats on your recent procedure...

thewalker431, Please allow me to first say thank you for sharing your case and photos with us. That's not an easy thing to do and yet at the same time please know that your transparency is helping many other guys who surf these online communities but do not participate for personal reasons. I must agree with some of the participants addressing your concerns that you owe it to yourself to first see how you respond to effective hair loss meds. Because if you do respond, that will help greatly in the battle against hair loss. But be careful starting any minoxidil based product above 5% strength because the initial use as well as prolonged use can potentially cause significant shedding. And obviously that would not be a good thing for any of us. I would even recommend initially starting with 2% and then work your way up to 5% because that can help reduce the initial shock of the medication. One thing that I have observed over the years is that the individuals with diffused thinning can be more susceptible to the initial shedding that both minoxidil and even low dose finasteride can induce. Now a couple of things. First off, I am kind of surprised that the issue of family history of MPB has not yet been brought up. This is a critical point. Take a closer look at any of them men who have hair loss in your family history. Even the females. Look at both the maternal as well as the paternal sides. If any of them show any type of diffused patterned hair loss, then you have a good barometer. Some may even have DUPA. That is Diffused Un-Patterned Alopecia. Only a in-person exam checking/evaluating for miniaturization "throughout your entire scalp" including the donor regions will tell the real story of where you are losing, and/or subject to future loss. It is impossible to make a formal diagnosis with photos. In fact, some of the docs may suggest taking several biopsies in case they are suspicious of any alopecia not related to MPB or in addition to MPB. But if you do have DUPA, with confirmed signs of miniaturization and diffusion in your donor areas, then you would at least know that your donor is unstable and really not suitable for transplantation. But only clinical confirmation will give you a true and full diagnosis of your condition before you start spending your hard earned money on something that may not last or be short lived. And if your donor is unstable, than you could also potentially have regrowth/yield issues which would defeat what you are trying to accomplish. Now I realize this gives you a lot to ponder, yet in the end you at least will have a much more accurate clinical confirmation of what you are dealing with. An that in itself can be priceless. Hopefully there will be some resolve in helping you achieve some of your goals. Sometimes we end up having to adjust those initial goals to parallel our resources with our limitations. However if you end up deciding that surgical hair restoration is not for you at least you will be making a well informed decision. I wish you the best in your journey my friend.

Glad to hear that your post-op redness has greatly dissipated and sounds par for the course. On average it usually takes several months for it to reduce. Now you can look forward to your regrowth...

Beard donor was being hyped in the hair loss communities not long ago and many individuals were stating they were having it done yet very few if any have come back to show any results. My premonition is that both the yield and aesthetic expectations were not very good and why it has to be approached as a last resort and always with a test session to see how any individual will respond. It's not that I am against using beard donor but only in special circumstances like scar repair and as a last resort. Beard donor appears unpredictable like other forms of BH.

Just though to touch bases with you and was wondering how things look presently. How do your grafts look?

Beard hair can have variable results both in terms of visual compatibility and yield. I would never recommend beard grafts in a high visual impact area like the hairline however your crown is probably the best area to use this type of donor as a last resort or mix. But I would approach using beard donor with a smaller session to see how it both looks and regrows before committing to any large numbers.

I agree, anytime you lose hair due to any scalp condition, it's time to see the dermatologist for a formal diagnosis and treatment. These conditions are normally covered under a basic health insurance plan.

If the crusts still remain after two weeks post-op, then they are ready to come off which will not hurt your grafts in any way. Many guys find it helpful to do this in the shower after lathering up your scalp and allowing the crusts to soften. Using the pads on your fingertips will dislodge them and then you can resume normal shampooing like you did before your procedure. Congrats on your recent procedure...

You also want to be careful as to not use any topical steroids so soon after a procedure. These include the ones sold over-the-counter like Mederma. If post-op redness lingers beyond six months or so, then you can talk to your surgeon about applying a topical to the area because they can potentially work wonders in proper timing.

Sorry to hear about your bump. I would take a closer look in the mirror to see if there is still bleeding and where it is coming from. Try spraying the area with saline spray to clear off any residual blood. When a graft is lost or pops out that soon after surgery, there is indeed a steady steam of blood that oozes from the site where the lost graft popped out. It may have closed enough by now or a scab formed to stop the bleeding. Hopefully you did not lose more than one graft.

After experiencing problems with the scar from the first FUHT procedure, you definitely do not want to do another FUHT and especially so soon after the first one. Scalp elasticity can only be tested with a physical exam. And IMHO, you still need to confirm why your scar came out the way it did from the first procedure.

Torn, Your situation looks like it has a lot of potential because most plugs are in much worse shape than yours. And it also looks like you healed very well with very little scarring. IMHO, there is enough space between the hair shafts to thin them out with FUE extractions however you want to make sure that the FUE surgeon of your choice is very experience with this type of repair. Magnification (Loupe) will enable the surgeon to minimize transection and the grafts should be singles and then placed between the others. IMHO, excising them out (cutting) can potentially show too much scarring when those large grafts can be thinned out by extraction methods. The work that you had done looks more like larger than normal mini-grafts verses plugs (open donor) and the commencement of your hairline should all be single hairs, not the doubles and triples, etc. That will make a huge impact in producing a more natural and aesthetically appealing hairline. It also appears that you have some stragglers, single hairs that are below your hair line. They look miss-angled and can be removed as well. Lastly, you can always have some fresh FUE single hair grafts taken from softer area donor areas which will also soften the commencement of your hairline and will make a huge visual difference. "Don't use beard hair on your hairline!" Beard hair is usually much coarser and can also grow out with a wave or even curl and you would have a much larger problem than you have right now. You don't want hair that is visually much coarser mixed into your hairline when you are trying to soften the look.

pinkfloyd30, The scar definitely looks wide and do you know what method of closure was done? It appears that your closure was on the superficial side. It's also possible that the strip was taken much too wide for the amount of laxity that you had at the time of the procedure. Just an observation. It's a good thing that you will be seeing Dr. Shapiro because he will be able to evaluate it and give you some solid advice. It's also possible that he may be able to revise it before doing any more strip excisions or he may feel that only FUE would be an option. Be careful with the SMP because you are very fair-skinned and sometimes SMP does not work well with wider scars and where there is a wide contrast with the complexion. Also be careful as to not do any activity that can put tension on the scar such as sit-ups or weight lifting. The scar could become even wider since it is not completely healed.

Forgot to ask, did you have two separate procedures then? One FUHT and one FUE? If so, how many days apart were your procedures. Or did you have both FUHT and FUE in the same procedure with the same doctor? If so, that's very unusual because usually it's one or the other. Hope you can get this all sorted out.

Unless your were completely bald, some of those fine hairs could be your native hair that was shocked out, and now growing back. You also want to ask your doctor/clinic how many grafts were done and the density level that your grafts were placed. In other words, did they place them at say 40 FU per cm2 or even possibly lower? They should also be able to tell you the breakdown of your grafts between how many singles, doubles, etc., and also the perimeter of the recipient area to again determine the grafted level of density.

MH, You should still have the crusts which are the tips of your grafts that show above the scalp line. These tips dry out and turn into crusts and appear grey or whitish in color. They can be removed between day 7-10 post-op and many guys find that removing them in the shower works best with slightly warm water and shampoo and then after waiting 10 minutes or so, begin to rub them off. Many of them will contain the graft hair stubbles when removed.

ModernHair, Congrats on your recent procedure and nice to read about your experience with ATP. It sounds like you had a PRP treatment which you stated as your spun up blood plasma. The ATP and PRP are of good benefit to you in the healing process and IMHO, will also promote an optimal yield. Eventually your grafts will cycle into dormancy however if a larger percent of them remain in the growing phase for now, it would not surprise me. But you do want your grafts to eventually shed because they will again cycle back into the growth phase and that will manifest into a nice end result. Happy growth to you...

What always comes to my mind when considering the true Norwood class 6 cases is one guy in particular when I was working inside the clinic back in the Spring of 2003. He wore a hair system (front-to-back) and was completely barren of any native hair whatsoever on the top of his scalp. The other men within his family never progressed past class 6. So initially, his future progression of loss was a concern because if he was headed for class 7, that would have made a huge difference in his total restoration plan and approach. Bottom line, he wanted coverage through his crown and to be rid of wearing any hair systems anymore. Although he was barren of any native hair on top, his lateral humps were strong and so was the coronet area of his crown. Imagine a bare scalp within the perimeters of a true class 6 and then having strong density all around that perimeter. He was examined for diffusion including evidence of miniaturization outside the zone of demarcation, and showed little to none. This was very rare and exceptional. His hair characteristics were outstanding. He had the upper end density all through the occipital zone and his hair was extremely course. Rarely have I seen such a high degree of coarseness and his strong red hair shafts felt like wire, literally. He also had a nice natural wave which was a very uniform wave. Nice red hair shafts contrasting a fair complexion. The surgeon that I was working for was one of the first and foremost recognized doctors beginning to perform FUE but FUE was just being introduced, not practiced to any large extent. FUE was hitting the forums like wildfire back then and this patient wanted to try it. So although this guy had a lot of questions about doing FUE, IMHO he had ultra-refined FUHT written all over him. His first procedure involved placing between 3700 - 3800 grafts re-building a mature placed hairline and through the midscalp with the density being transcended downward to roughly 35 - 40 FU per cm2. His second FUHT procedure involved another 3000 - 3200 grafts with approximately 1600 to the posterior (crown) and that was it. He was done because visually speaking, he felt he attained his goal. So he had approximately 6800 - 7000 grafts in total. He had superb regrowth and yield and appeared totally restored from every aspect and view. His coverage from front to back was outstanding and was one of the best and most successful cases I have observed since being in this field. So although this patient had a lot of good merits to start with, he was a true class 6 with no native hair to start with and ended up with complete visual coverage. Yet the thing we have to keep in mind is that very few patients have such outstanding donor density and hair caliber as well as a natural wave and fair color contrast. And the surgeon stated that he still had enough donor for any additional procedure(s) if he ever wanted or needed it in the future. Any future procedures would probably need to be FUE to tap the donor regions above the ears and through some parietal zones. So while I don't believe that this individual is a fair comparison for most class 6s, it certainly broadened my opinion in what a highly skilled surgeon can do with someone who has above average hair characteristics. In conclusion, it is certainly possible for a class 6 to achieve complete "visual" coverage with the right adequate resources along with a talented surgeon...

JT, Sorry to hear of the complications yet IMHO, things should improve for you over the next 3-4 months. You will never know if the area above and below the scar is shock until 3-6 months passes. If it is mostly shock loss, it should fill back in although there is always the chance that the area will lose some density. Scalp tissue is elastic but does have some limitations. The tension can vary along the scar because laxity varies throughout the zone. If the strip was pretty much the same width across the length, then yes there will be more tension in various places and that can be where the sores and seepage are. Some docs will use staples when laxity is on the tight side because they in most cases provide the most secure closures. I had staples on my last procedure. Obviously this is not a choice post-op. Also just want to encourage you to be careful from doing any activity that can potentially put tension of the scar including lifting, sit-ups, things like that. In about 6 months you should have a good idea on what the scar will look like in its final stage and I wish you a well healed thin scar.

IMHO, it would be beneficial to see a dermatologist for a diagnosis especially if the condition persists and Nizoral is not clearing it up. If you have health insurance, the office visit should be covered.

Torn, The same principle applies to the donor extractions as well as the recipient area, meaning avoiding transection. When the surgeon is extracting the FUs from the donor areas, he again needs to see the acute angles and the natural direction of the hair shafts as they protrude from the scalp. So not only is there an issue of transection of existing hair in the recipient area, there is the concern of transecting the grafts from the donor zone during the extraction process. Of my four procedures, only my fourth did my surgeon want to cut down the length of my recipient zone. He did not shave it, he merely cut the length down from 4 inches to approximately 1/2 inch. By my fourth procedure, I already had enough hair volume that he wanted to be extra careful which I appreciated. I did not like the idea, but I got a haircut afterward to shorten the overall length of my existing hair. We did not discuss this beforehand yet I should have known that it would be a possibility. So the more hair density to start with, better to taker a more safe approach. Before FUE, you never heard of doctors shaving down the recipient area. And with FUHT, they only shaved the dimensions of the proposed strip being excised. They actually wanted the hair length above and below the sutures to be long enough to hide the sutures. Experience is everything. And those docs who do not require shaving is usually because they are comfortable with their own level of skill and proficiency.

Once the graft is removed from the extraction site, it's not hard to tell what was extracted and what was not under magnification. If the transection occurs above the root and sebaceous gland, there's a good chance there will be regrowth.

Ryan, The reality may be that you are going to need to wear your hair length at least 1/2 inch or longer just like your previous update pic dated March 17th. Some would say that that you could potentially add density to the over-harvested area with beard grafts or other donor as a last stage effort. If it were me, I would leave it alone for now. Grow it longer and then take another look at it after one year.

Guys, Don't be fooled into thinking that if your strip scar looks healed after roughly 4-6 weeks post-op, the reality is, it's not. And it's clearly not safe for most individuals to do weight lifting before 8 weeks have passed. Let me explain. We can forget that all scalp tissue is made up of two significant layers. The outer layer (epidermis) and the inner layer (dermis). The epidermis is what we see from the outside and it can appear fully healed once the sutures and scabbing are gone. But the closure is still not fully healed because it's also the inner dermis layer that can stretch for up to 8-12 weeks post-op. The healing of this layer goes more slowly so stretching the area can still cause a wider than desired scar. Any activity that puts tension or causes pulling in that donor zone can still cause a wide scar. So it's wiser to side on the safer approach rather than regretting it.