gillenator

What I meant by starting minoxidil once daily is to slowly introduce the product into your scalp to try and minimize a significant shed in the area. Then after 10 - 12 days, you can try increasing the application to twice daily. The thing we all have to keep in mind is that we all respond differently to meds. Some guys experience significant shedding when applying minoxidil twice daily, others do not. Yet it's the initial use that can potentially be the most sensitive to the scalp. Only low dose finasteride still proves to be the most efficient medication for treating MPB. And it's the most efficient in the crown... And I also concur to wait on having any HT procedures. The risk of sustaining shock loss is too great for that volume of hair.

There is no clinical evidence to my knowledge that supports the notion that warts or moles, etc., have any negative impact on hair growth or be the source of any type of alopecia. Now your surgeon no doubt would be careful in working around them as not to implant any grafts in them. I have some moles in my scalp but never interfered with any of my grafts.

You have tremendous hair volume and yes there is a spot in your crown that appears to be early signs of MPB but with that large amount of hair volume, you will undoubtedly experience some shedding and the area could end up looking much thinner. Are you prepared for that experience? Because once you start minoxidil, you will be committed to using it every day or you stand to lose any gains. And you may want to consider only use a small amount once per day to start with in the first week of application. That can potentially reduce the effect of massive shedding compared to using it twice per day to start with. Minoxidil does not inhibit DHT so although it can invigorate some new growth and improve hair shaft diameter, it won't stop the DHT from causing future loss. And you may want to consider just buying one bottle of the foam to start with because if you purchase such a large amount of it up front and you don't like the effects of it, your stuck with a case of Rogaine sitting in your attic...:rolleyes:

NervousGuy, I took a peek at your hairline photo and there is new growth there albeit not as robust as you expected. But remember, at four months post-op the new growth is just starting. And your regrowth may not go as quickly as you want it to. You have to give your procedure one full year to even up to 15 months post-op in order to fairly judge the merits of your procedure. If you have grafts that have not shed by now, and they are not growing in length, then they are probably dead hair shafts and should be removed. You can use a tweezers and pull them out. If they come out with ease, then they are dead graft hair. Your crown probably appears thinner because of some shock loss in that area. Be patient my friend and things will happen but don't freak out in the meantime. Get your mind off it the best you can and allow time and patience to work...

Yeah, you could say that I am a real hair junkie... And yes with roughly 6900 grafts total, I am a happy camper. My crown is still a tad bit thin but was not as concerned with crown loss as much as the frontal zone where most of the grafts went. Lessons? I always encourage any individual considering HT surgery to do their research and homework before ever scheduling a procedure. We all must fully understand both the "benefits as well as the risks" of any procedure. And it is only through adequate research that any individual is going to determine their own candidacy for this type of cosmetic surgery and what type of questions to ask. Not everyone is a candidate for this and some can be marginal candidates at best. That's the first phase of homework. Once we understand the risks and benefits and also decide to move forward, then the journey of choosing the right surgeon becomes the challenge especially when there are many to choose from. Eventually, things come together and one's confidence to make that "informed decision" becomes apparent. But this is an elective decision including the choice of using proven hair loss meds. I never took any time off work except the day after in the first procedure and the last one in 2006. I was working inside the clinic for number 2 and 3 procedures so in those cases, I went back to work the following day. Most guys take at least a week off post-op however and many guys use vacation time or personal time off. agentHarley, Do you have challenges in getting time off your job? What do you do and how much time do you plan taking off?

agentHarley, Congrats on your second procedure and I know the feeling well as I had four separate procedures myself...

Hi Jacob, Welcome to this community as it appears that this is your first post... OK, let's see if your questions and concerns can be addressed. 1) Most of the grafts will shed within the 2-4 week post-op period. Will they all shed? No. Some of them will remain growing in the anagen stage however eventually, they all will commence their respective cycle behavior. The transplanted follicles behave intermittently this way and why it takes up to 12 months to fairly judge any result. There is no way to ascertain how many will remain in the growth phase but for most, a majority of the grafts will shed within the period stated. 2) No hair will regrow in a completely extracted site. The goal with FUE is to completely remove/extract the FU in it's entirety. Now, there are a few FUE doctors who have and continue to experiment with what is known as Donor Replacement Therapy (DRT). In simple terms, a small portion of the extracted follicle(s) are re-inserted back into the extraction site. The follicle then is supposed to regenerate and grow new hair shafts. The results to date have been poor at best IMHO. Neither finasteride nor minoxidil will be of any benefit in establishing any new growth in any completely extracted site(s). I assume you were referring to the donor zone where the FUs were taken and not the recipient area. Minoxidil does improve hair shaft diameter (hair caliber) in many individuals and it is possible to have one's donor area appear thicker, visually speaking without actually increasing hair density. 3) There are few and I do mean few cases where Propecia or any other form of low dose finasteride has regrown hair on a completely bald surface area. Regrowth is not typical in the more advanced classes of MPB. Minoxidil is more promising in that regard but again, not very favorable results in the advanced classes as denoted on the Norwood scale. 4) If your proposed 6000 - 8000 grafts are done within the same defined surface area, but split between two separate procedures, then you want to give the initial procedure no less than 10 months if your are a normal bloomer so-to-speak. You want to be sure that all of the first session of grafts have sprouted and are visible above the scalp line otherwise you risk the potential of transection. For most individuals, this will take at least 10 and even up to 12 months post-op. 5) That is only true by defining actual density count/placement, but visual density is a completely different thing because of the two factors of hair caliber and hair shaft length which the initial placement of the grafts does not show. In other words, improved hair caliber and hair length both add to the illusion of coverage of visual density. Visual density and actual density are two different things. It's great to see you doing your homework Jacob and wish you well on all of your decisions. You had some great questions and I hope this response will help others as well. Let me know if you need any further assistance and again, welcome to this community...

LT, Then you definitely want to stay with FUE. FUE extractions can harvest FUs where strip cannot and FUE does not require scalp elasticity like FUHT does. No two opinions will be the same but the point is to make sure you weigh the pros and cons of having any more work done. Then, if you do decide on FUE, choose the best proven FUE surgeon that you can find. Hope everything works out for you.

The newly grown hair shafts will tend to have a thicker degree of caliber and even the color of them can appear more pronounced. The entire procedure takes at least twelve full months to mature so you have lots coming.

LT, BTW, there have been several threads on this subject and try doing a word search on PRP within the larger online communities like this one.

LT, That's why I asked you about your intentions. There really is no clinical substantiation to support that PRP therapy is effective in curbing the effects of MPB or being successful in treating hair loss. Several years ago, PRP was introduced in HT repair procedures and did show some promise in some individuals. Then, it like exploded everywhere and was heavily marketed as the buzz in the hair loss communities and many guys embraced it. It has died down largely due to it not being appropriate for treating MPB. It's also very expensive. PRP was initially used and still is for treating athletic type of injuries, mainly in the joints like a knee or elbow. The doctor or specialist simply draws the individuals' own blood and it is then run through a centrifuge where the blood platelets are separated and condensed. The platelets (PRP) is then injected into the wound site and the rich platelets facilitate the healing process. It is very effective for most athletes and others who sustain wounds. So you can see how it was then introduced in HT repair surgery. But IMHO, save your hard earned money and instead use it on the clinically proven therapies and treatments...

One thing is for sure, any of the doctors mentioned are busy and most of them have reps that can assist you in the enrollment process. You can also go to their respective websites to get their contact info. Wish you the best in your journey my friend...

Trust me, when you see cases with those higher upward numbers, they are the exception and I am referring to those individuals that have upper end donor densities. Not everyone does. And obviously the best cases are the ones that get put up online. It is best to be physically examined with a microscopic instrument that can put your scalp on a monitor and show you your own donor density. You will see your own FUs and be able to calculate your density with the surgeon being considered. In addition, the doctor will be able to see the grade and quality of your hair shafts (caliber) which also is an important consideration. Taking 50% of one's donor FUs is not possible for every individual especially those with thin caliber. If the individual's scalp tissue is soft or on the mushy side, then the total available number or FUs also goes down because of the risk of collateral damage in the extraction process. If we were to pick an average number for the average individual, I would say a range of 5,000 to 8,000 would be more realistic.

You will most of them in Europe...

jeff1986, It always warms my heart whenever I see someone new doing thorough research and you bring up a number of vital issues regarding surgical hair restoration. If you take the time and use the same approach when choosing the right surgeon, someone highly reputable and recommended, then you should not experience the pitfalls that you outlined in your initial post. In fact, you can discuss each concern with any reputable surgeon and they should provide you a detailed response to each of them. Yes it is possible to experience some of the misfortunes when choosing someone incompetent yet at the same time, this industry has come along way over the years and today, there are many competent and reputable surgeons to choose from...

Are you considering a PRP for treating MPB?

Sounds perfectly normal...

The post-op redness can also be related to a corresponding lower level of collagen. There are some topical steroidal creams that can help with the redness however the surface must be completely healed before applying it and generally used when the post-op redness lingers for several months or more. Another idea is to simply use a cosmetic tan product which is a make-up to give the appearance of a facial tan. I know of several guys who used it for weeks on end and were quite please with how effective it hid the post-op redness. There are high end quality of facial make-up products where you can actually blend the appropriate level of skin tone to match your own. One is a granule type based make-up and not a cream. I just cannot remember the brand name of it but most women will know what it is. Kind of pricey though.

The hair that continues to grow is supported by follicles that have not retreated into the resting (telogen) phase. For the most part, grafts shed 2-3 weeks post-op almost entirely related to the trauma of the procedure. In days of old, when the instruments used to create the recipient sites were much more invasive, nearly all of the grafts shed. As the instruments continue to be refined, we see a higher percent of the grafts continue to remain and grow. There is nothing wrong nor detrimental about this. It's the lower level of trauma experienced overall in the recipient area. And simply put, all hair follicles behave in a cyclical intermittent manner including the transplanted ones. This is a good thing because if the transplanted grafts all shed at the same time and then cycled into the growth phase concurrently, we would undoubtedly experience subsequent periods of pronounced visual thinning and density. There would be periods where out hair would appear thick and then periods of low density. This is why we can never fairly judge the merits of any HT procedure without giving it at least 12 to 15 months post-op. Then at least all of the hair follicles have adequate time to move into resting, shedding, and growth and to attain at least several inches of length in the hair shafts. And also why I never support adding new grafts "within the same surface area" within twelve months, nine moths at the earliest. There could be some late blooming hair that has not yet broken the surface area of the scalp and the risk is the potential transection of that late blooming hair.

Patrick, due to the residuals of finasteride having a long shelf life, the frequency is not a big issue IMHO. The main idea is consuming an average of 1 mg daily to attain the level of efficiency for treating MPB and established by Merck's clinical trials when the drug was approved by the FDA. I basically switched to EOD because the generic form is difficult to cut into four equal pieces. I purchase the generic form of it which has an odd shape to the pill. The name brand Proscar tablet is easier to dissect but much more expensive. And the kicker is that I have two brothers who are just one year apart in age and neither of them got MPB, just me...:rolleyes:

The pain can be slightly higher due to the increased level of blood flow to the scalp as we are in a lying down position. The ibuprofen definitely will help with inflammatory pain...

Just for Men, Beard and Moustache does not have harsh chemicals. But it does not last long, maybe 5 days.

Yes it's possible however unlikely especially if the surgeon uses the least of invasive instruments, like blades for example, to create the coronal incisions. Some docs may choose to use needles to create recipient incisions. Some use a combination of both instruments depending on the variance of graft sizes. The key is that the size of the corresponding recipient incisions accommodate the peripheral sizes of the grafts that are placed within them. If the incision site is too large, there can potentially be some pitting at the base of the implanted graft when it heals. Sometimes that can be slightly noticeable. And of course if you are a good healer, that makes a difference as well...

Patrick, I used to take 1.25 mg of Proscar daily but now I take the same dosage "every other day" and still maintain good efficiency. Did not experience a shed either, knock on wood... I started low dose finasteride in 1996 and been on it ever since. My maternal grandfather and uncle were both a full blown Norwood 6 and I truly believe I would have reached that had I not started finasteride.

Possibly start a new cable show called "Beard Dynasty", get dressed in cammies, and who knows? This could potentially evolve into something big!... Just kidding. I think many of us can be the biggest critic of our own looks which is absolutely normal. Beauty is in the eye of the beholder as they say...