gillenator

I also took a peek back at your pre-op pics and although the lighting was not as bright, it does not appear that you have made as much of a visual gain in coverage as would have been expected for the 4,000 grafts at 10 months. What would be helpful is to know exactly where your grafts were placed. In other words, how many grafts were placed in the frontal third, mid-scalp, and crown. I do think you have made some gains in the frontal zone as your pre-op photos show little native hair. The hair shafts show considerable wave. Is it possible for you to put up a pic that is viewing you straight on, meaning with you looking straight forward? Lastly, your total graft distribution was made over a large surface area and that is part of why the gain in visual density does not appear strong in any of the three zones where grafts were placed. It would be interesting to know how many of the 4,000 grafts were placed in the frontal third.

Always amazed in how these threads turn into a stick of dynamite...:confused: Hair loss is a matter of perception and even stereotyping. I do think women have a more difficult time with it and are perceived as being less healthy when they experience visible signs of hair loss.

The individual response to this medication varies, and yes, shedding is one of them.

That's the tough thing about MPB. It is progressive over our lifetimes. We can at times experience periods of stabilization (from meds) but not in a permanent sense to where hair loss is completely stopped or reversed. And SMP as a stand alone treatment spells disaster for most individuals. SMP ink deflects light from the scalp more than anything else IMHO and why some level of hair shafts are needed to create any sense of aesthetic appeal.

Don't worry funky, most thyroid conditions are very treatable "if" that's your issue. You won't know until your blood tests come back. The important thing is that you are seeing your doctor...

funkygarzon, Thyroid conditions vary as well as other auto-immune disorders so the only real accurate way to find out is with a complete blood work-up. And yes, that means blood tests. It does not always imply a genetic disposition for thyroid issues. Unless we see actual clinical proof that decreasing androgens increases estrogen levels, it's very hard to confirm. Because DHT is a metabolite of testosterone.

What we must remember is that achieving original levels of density is not necessary to achieve the illusion of coverage. Successful HT surgery is not necessarily achieving optimal density levels but rather attaining a restored look. So the next question becomes, "Is that possible?" Yes, it is. Because what we forget is that our own terminal hair taken from the donor zone has the highest or optimal level of caliber. And caliber covers better than density itself. In fact, one could attribute the success of attaining visual coverage more to the degree of hair caliber, more than anything else. And we can also remember that achieving even 50% of native density is going to look or appear restored, even starting with a completely bald surface area. How many times do we see someone get around 50 FU per cm2, and they "appear" completely restored? Many times. It happened to me and after my third procedure, you would have never guess that I had any hair loss whatsoever. Having said all that, individuals with thin caliber or a lower than average degree of hair shaft diameter may need more grafts than those with outstanding hair quality.

You should have this looked at by your HT surgeon or a dermatologist because it may very well be folliculitis and not cobble stoning.

funkygarzon, Your puffy cheeks may very well be totally unrelated to taking low dose finasteride. You may have developed a thyroid condition or something else. The only way to know for sure is to have a complete blood work-up done to evaluate any other possibilities. Yes, there's a chance it could be related to taking the drug but unlikely as I have never heard of that side-effect. Are you by chance taking any supplements or any related to weight lifting such as creatine? BTW, switching to another form of low dose finasteride probably would not make any difference because they all have the same active ingredient but may come at varying strengths. Again, I strongly advise that you have blood work done.

Awesome photos Paulygon! What a nice transformation...you look like a completely different guy at 12 months and you also have good quality hair with a nice wave...

I see that you had 5500 beard grafts. How long ago was your FUE procedure and how well did the beard grafts grow?

You must have had all FUE with Dr. Umar?

I think everyone who posted their opinions on this thread made some good points. And it is true that those individuals who experienced a shed from the "initial use" of finasteride are the exception and not the rule. It's just so hard to put it in percentages because I usually hear from the guys who are experiencing the shed from starting Propecia immediately after surgery "for the very first time". The guys who do not have this problem are happy and go on with life. All that I am saying is that it does happen and probably more apt to those who have a more diffused thinning pattern, not as much to those with recessionary loss. And as I stated, those who have a larger mass of weakened diffused hair, have a higher potential risk of both shock loss and sheds. So I think it's important to get started on finasteride well ahead of the surgery date than to wait until the day after. Even the diffused patterned guys who choose to never get on finasteride still have a greater risk of shock loss than others, generally speaking. And although IMHO it does not make that much difference in waiting for the regrowth from their procedure to take place over the next 6-9 months, introducing all of the meds for the "first initial time" can be more risky that beneficial regarding "timely" regrowth. I am just of the opinion that waiting for our own bodies to regrow the grafts is best when the individual is considered a higher risk for sheds and shock loss. Yet getting on finasteride is the best clinically proven hair loss medication to date than anything else out there. So we are not advocating not using finasteride, it's simply more of a question as to when to start "if" you are in the higher risk category for shock and sheds. MPB is progressive in nature, and those of us who have it will have to deal with it for most of our lifetimes which is decades of time. And when the guys who do experience massive shedding after surgery and have stifled regrowth, many docs will inform them that it's undoubtedly related to starting Propecia and that it would have been better to have started it six or more months before the procedure. So there you have it. So really, it's in the consultation appointment that the doctor should IMHO prescribe Propecia and get the individual on finasteride as soon as possible. And ideally, their procedure date put off for at least six months "if" the individual has a very obvious diffused thinning pattern with a fair amount/mass of weak native hair. The problem is that we are impatient. We want to do the procedure once we find the right doctor and who wants to wait 6-9 months? Yet it makes the most sense to stabilize the hair loss as much as possible and get their bodies introduced to the hair loss meds before surgery. So in conclusion, yes, it's critical to get on low dose finasteride. But the timing of when to start it can be more complex that what it appears to those who have a higher risk of shock loss and sheds. None of us hold a crystal ball as to how we will respond to the meds and surgery so that's the tough part of the decision making process. This is where we sometimes must simply fall back on just common sense. I know if I had a large amount of weak diffused hair, that I am more susceptible to the things that can cause it to fall out. So I have to be careful that I am not introducing my native hair follicles to numerous things that can cause them to retreat into the resting phase especially during and immediately after the procedure. That's an opinion base on what I have observed over many years and many HT cases. They are not just premonitions and guesses otherwise there would be no point in talking about them. I have better things to do with my time...

hsrp10, It was more like these guys had very delayed periods of regrowth and shedding. I usually heard from them once they reached 6 months post-op or longer. And it always involved guys who started Propecia for "the very first time" immediately after their HT procedures. Again, not a lot of men, but enough to start noticing the similarities between them and the resulting phenomenon. Then, one day as I was reading the pharmacology data on Propecia, I noticed that the inhibition period was between 90 and 120 days. It's not unusual for hair follicles to enter the dormancy phase once the drug kicks in...:confused: So my conclusion was that these guys were experiencing a shed cycle when they should have been experiencing new growth from their grafts. Some even think that their procedure failed and get angry at their docs but I tell them to be patient and wait it out for at least 12 months. Surely you also must remember some of these guys who come on to the forums with their stories of delayed regrowth. And we all tell them to be patient and wait. This phenomenon also happens to guys who start finasteride for the first time and never even have HT surgery. They begin seeing their hair fall out approximately 60-90 days after starting the drug and freak out and quit taking it. I usually tell them that this is a good sign because the active inhibition of the DHT is inducing a shed cycle and if they are patient, the hair will cycle back into the growth stage and may even grow back thicker. But the younger they are, the less likely they will continue with Propecia or they reason that taking it less frequency will reduce the level of shedding. It won't. Once the hair follicles retreat into the resting phase, they will rest for 3-4 months before they re-enter their new growth phase. And for reasons unkown to me, some guys who had surgery had very delayed regrowth periods as long as 9 months post-op. Then out of nowhere, BAM, new growth emerges like wild fire! We also will read of a few guys who have a HT procedure, then initially start Propecia, minoxidil, Nioxin, Nizoral, large doses of MSM, biotin, etc, etc, all at the same time thinking they will all produce a super sized result. Some of them experience a massive shed cycle as a result an then cannot figure out why. IMHO, when there are numerous combined products and meds introduced to our hair follicles for the first time, they often retreat into the dormant phase which is defensive behavior. This has been my observation. So I often tell guys, just let your own body heal itself post-op. Allow time alone to do its thing. That's what our auto-immune systems are for. Time alone will work miracles and often produce the best optimal results. Then once the regrowth takes place and you want to add these hair loss meds and supplements, have at it. They obviously have their potential benefits but timing can be a huge factor especially right after surgery IMHO...

I have also wondered how many guys may have experienced a shed cycle from receiving stand alone PRP treatments...:rolleyes:

One other thing. I know some docs believe that being on finasteride prior to a HT procedure will reduce the level of shock loss, but I don't buy that theory. Why? Because shock loss is more attributable to the level of trauma in the scalp from the effects of the procedure. And we all respond differently to the trauma, some worse than others. And this is also why shock loss is really unpredictable. And the larger the procedure, the more recipient incisions that are made resulting in more trauma. Obviously the more volume of diffused existing native hair there is, the more susceptible that hair is to shock loss. Many docs are leery of doing large sessions on females that have large masses of weak native hair that is diffused. Shock loss is a real risk with those candidates.

The opinions on this topic vary widely. A fair number of docs will start their mature male HT patients on Propecia right after the procedure once they discover that their patient is not taking it and will potentially benefit from taking it. Yet every now and then we read about someone what is having poor regrowth and yet went to a reputable surgeon. Every time that I hear from a guy who is having poor regrowth or delayed growth, the first thing that I ask them is if they recently started Propecia for the first time or another form of low dose finasteride. It's amazing how many say yes. And further, many of them have started all sorts of other topical applications along with starting Propecia right after their procedures. Many of them are beginning to experience a shed cycle from the drug right when their regrowth is about to start. But they are the exception and not the rule so I imagine if a higher percent of these men were having issues with regrowth, their respective docs may tell them to wait until the procedure fully grows in. We rarely hear from guys who were already on low dose finasteride having regrowth issues. In fact, some docs want their patients to be on Propecia for at least 3-6 months before the procedure. They also want their patients to stop applying minoxidil at least two weeks before their procedure. So I have not heard of any studies of men who started finasteride right after a HT procedure as compared to men already on it but I think it would be interesting to do one.

Regrowth is going to vary between individuals but as was already mentioned, by 12 months post-op, most of the grafts should have broken the scalp surface. There is some variation in hair caliber maturation and it can take up to 18 months to fully manifest. The profound thing about hair shaft diameter is the more it thickens, the better visual coverage attained...

The best way to determine the suitability on of one's donor hair is to have it microscopically examined by a doctor who is experienced in comparing differentials in hair shaft diameter. This is how the doctor can determine exactly where miniaturization is occurring and where it is impeding. Hair diffusion can be seen by the naked eye but only once it is in the more advanced stages. Miniaturized hair is much more difficult to notice unless the hair shafts are compared under a scope. Can one's donor zone change with time? Yes, but not for all individuals. The best way to answer this for yourself is to observe and consider the older men in your family history that have MPB. Some men will begin to experience thinned out donor areas as they age. Other families do not. But some men can experience the more advanced classes of hair loss such as Norwood 5-6, yet their donor zones remain strong and dense. That's a good sign. Most Norwood 7s experience donor zone thinning with time from my own observations.

In general, transplanted hair is not as susceptible to shock loss as weaker native hair. What we don't know is the amount of native hair that was in the recipient zone compared to transplanted hair. Shock loss for the most part is related to the level of trauma from the surgery. It really comes down to how each individual's scalp responds. So can prior transplants shock? Yes, but again not as readily as the native hair. Most of what you lost in shock should grow back as long as your surgeon was careful and competent in making the new recipient sites.

PRP is over-hyped IMHO. It is not going to thicken up your hair in terms of density or any improvement in hair shaft diameter. It does nothing to inhibit DHT. And there is no clinical proof that PRP does improve hair mass. It's just ambiguous at best. PRP on the other hand is very instrumental in facilitating the healing process because of the enriched count in blood platelets. So if you are not having HT surgery, it is of no real benefit to you IMHO. PRP is derived from your own body and blood. The only risk is a possible shed cycle that it might induce but there is no real or consistent evidence of that either.

Thank goodness you were not offended and glad to see you keep your focus. I have also read through some of the other posts and there is always going to be a huge controversy with finasteride. It is a personal decision and if it's not for you, that's something you and only you can decide. I have been taking it since 1996 and have no problems whatsoever with it. But that's me. IMHO, the sides happen more frequently than what is reported by the manufacturer and I base that on my own observations. Every guy that I hear from is asked if he takes low dose finasteride and then I ask their permission to inquire about their use and how they responded. Overall, about 20% of the men responding stated real side effects. It was interesting to also discover how many were pre-determined they were having side effects when in fact, they were not. Some of them took it more than prescribed, some less. I found a fair number of young men under 25 years old who only took it if they happened to think of it during their busy schedules. Meds have to be ingested as prescribed or they will not work efficiently. Then I found several men who were taking the entire 5mg form of Proscar daily, a big no no. It was amazing to hear how many simply went on the internet to purchase their finasteride without ever consulting a doctor much less being formally diagnosed with MPB. Obviously anyone who experienced the worst of symptoms and side-effects will feel that it is poison but that simply is not true IMHO. We all respond differently to meds and I know an endless number of men who have and still have a good response to it and virtually have slowed their hair loss over the long term like myself. There is no question that I would have progressed to a Norwood 6 had I quit taking it and after having 6900 grafts in my life, the last thing I want is more surgery. So does that mean that I am a huge proponent of the drug? No. Because again, the guys who had a bad reaction to it are going to think it's the worse thing in the world of medications. And for them, that's a reality and none of us can deny that for their own reactions to the drug. And after all, who wants to take any meds? None of us. All that I am saying is that to date, there is no other hair loss medication that I am aware of and observed that stabilizes the progression of MPB like low dose finasteride does. So in the end, whatever you feel are "your" most viable options are going to be your choices. What works for one individual may or may not be right for you. I just want to encourage you to know as much information as possible to make the best informed decisions. Wishing you the best as you journey through all of this...

I was hoping that you would not take it that way. That was certainly not my intention. Sometimes the truth hurts however better that you know this before you end up regretting that you ever got started. Too many times I hear from guys that tell me, "If only someone was straight with me and told me the honest truth". They spend endless amounts of money only to end up with more and more hair loss as they get older and even lose their transplants. Just the other day a guy told me that he would have been better off bald with his savings than bald and broke...:confused: You seem like a good guy and listen, if your grafts were lost because your donor is not terminal hair, would you be angry that no one informed you? Honestly, sometimes I read threads like yours and it's much more tempting to play it safe an say nothing. Yet I know there are doctors out there that would bleed you financially knowing that you are not a good candidate for surgical restoration. They know fully well that the first procedure may initiate an aggressive loss pattern causing you to rush back in for more and more, as long as you are willing to spend the $. If you take the time and do the research about the type of loss that you have, then what I have conveyed will be obvious and make sense even though you may not want to hear it. So I truly apologize if I offended you and wish you the best in your journey.

IMHO, that would be Dr. Rahal...

Nice to hear that the regrowth is coming along...