gillenator

I know your experience with finasteride was not a good one however even if you adjust the frequency of ingestion to a 1/4 tablet every other day or every third day may ward off the sexual side-effects. Now because we are not licensed physicians, cannot give any medical advice yet I see many docs advocate this approach. In fact, I have heard of more docs initially starting their patients on an infrequent schedule as they introduce the med for the first time. Then, eventually the rate of ingestion can be slowly increased to find that acceptable balance. Am only mentioning this for two reasons. First, only low dose finasteride can effectively inhibit the DHT causing our hair loss. And second, because I have heard from enough guys who did cut back their ingestion and had no more sexual side-effects. Obviously the best thing to do is to consult your licensed physician who specializes in treating hair loss...

Spanker is absolutely correct. There would be a steady stream/trickle of oozing blood that runs down the scalp. The surface bleeding should have stopped by now. If it has not, then IMHO your blood is not coagulating properly. Are you consuming alcohol or working out? Too much activity?

Forgot to mention after I read your comments about trying to get your hairline as thick as Dermatch could potentially make it. Trust me, you don't want to do that. You have the type of MPB pattern that will decrease your overall density as you age. In other words, your entire scalp is probably going to get thinner verses large amounts of recessionary loss. The recessionary loss will follow the thinning eventually. So if you surgically get your hairline too dense and you end up with more progressive loss, and you will, your frontal zone may look odd when you get into your thirties and forties. Nothing, and I repeat "nothing" stops MPB in its tracks. It's progressive in its genetic nature. In addition you are using up so much limited donor, then where will your reserves come from in the future? So I wholeheartedly agree with 1978matt about approaching FUE more conservatively to begin with. You would be amazed at how much of a difference 1000-1200 grafts to your hairline would make because of your outstanding hair caliber. Then, as you get older, you will have some donor left to draw from...

You're welcome Justin. The reason your barbers think you have "thick" hair is because they are seeing way above average hair caliber and as I pointed out, hair caliber covers the scalp visually speaking far more than density itself. So the tendency is to think, "Wow, what a thick head of hair" and they think in terms of density until the scalp is buzzed down to a number 1 or shorter. That's when the spacing between the FUs are more readily noticed. I used to think that guys of African American descent had the thickest density but what I was seeing was the curl factor which covered more of the scalp surface. So really, density can be defined as the actual hair count within a defined surface area, or the number of FUs within the same surface area. But then you put up another photo and now your donor appears considerably thicker than the first photo. It's probably the difference in the lighting but as I said, a qualified surgeon will do an actual density calculation in your in person consultation. Then you will know for sure what your potential donor reserves are. A quick question. Are there any men on either side of your family history paternal or maternal that have reached Norwood class 5 or higher? Grandfathers, father, uncles, brothers, cousins?

It's something called hair shaft diameter (caliber) and IMHO the single most critical factor to be considered when determining graft counts and attaining the illusion of coverage...

Awesome! Best wishes to you Jimbo...

Graft survival depends in large part in the combined skill of your surgeon and the tech team. Transection (permanent damage) can occur with FUE if or when multiple hair bearing FUs are dissected into singles. Usually the techs do that part. Obviously transection can also occur during the extraction process especially to those docs who do not have extensive FUE experience with the yields and results to prove it. You probably already know that. In addition, it depends how the grafts are handled and prepared once they are harvested. The longer they are left out of body, the more potential for ischemia reperfusion of the graft tissue to take place. That's simply deteriation of the tissue over loss of oxygen (blood flow) to the tissue. And many docs use a cold fluid to store the grafts in a peach tree dish to prepare them for implantation.

Jimbo, You can also wear a bandana which will safeguard your new grafts. Just make sure it is not tightly tied. And hey, congrats on your upcoming procedure are you having FUE?

That's fine and glad you quit several years ago. It took me a diagnosis of terminal lung cancer five years ago and having my right lung removed to get me to quit...:eek: Wow, you must have some superb will power! Well my friend, I wish you the very best result and keep us in the loop...

Justin, Above all, getting on low dose finasteride was a wise decision IMHO. You have lots of native hair left and anything that you can do within reason to retain it is worthwhile. Now, a couple of things. You have outstanding hair quality. That simply means that it appears that you have outstanding hair shaft diameter to your hair shafts. The better degree of caliber, the better chances of achieving the "illusion of coverage". Density is important but not as important as hair caliber. Why? Because the primary goal of HT surgery is attaining the illusion, not achieving the virgin density levels that you once had there. What are your challenges? A couple. First, your donor density does appear to be on the low side. Even though it is cut down to a short length, it is evident IMHO. Only a closer physical exam and actual density eval will give you a more accurate idea of a range of harvestable grafts in your lifetime both in terms of FUHT or FUE. The other challenge is your wide color contrast of dark hair on a fairer complexion. I have the same as you. Light reflects moreso with dark hair and another reason why your scalp shows more between your hair shafts. How many grafts will it take? That really cannot be answered until you have your comprehensive in person consultation because the surgeon will work with you in drawing your hair line placement, and encouraging you to keep a mature placement and not juvenile. Once the proposed placement is drawn in, then your surgeon can give you a more accurate number. Another thought. IMHO, it does not appear that you will have advanced stages of hair loss, but what is the best barometer is your own family history and how advanced the men on either side have progressed. We all must remember that low dose finasteride is not efficient for the frontal zone where it appears that most of your loss is at this time. But where is it headed in the future? That's what you have to ask yourself and plan for. So again, once your donor density is calculated and you are provided with a estimate/range over your lifetime, the choice you make in how many grafts you will use and where they will go is critical. One last thing. If and I do mean "IF" you have an inkling that you will want to wear a buzzed hair style at any time in the future, "stay with FUE". And with a lower density donor zone, a strip scar would potentially stick out like a sore thumb. And trust me, you don't want that. It appears that you are in NYC? Simply do a search within this community and you will find several examples of good FUE work in NYC. Best wishes to you...

Not accusing you of anything but usually when someone states or asks about smoking post-op, it's their way of saying I'm a smoker. Regardless, the real issue of smoking post-op is that smoking promotes and can cause hypoxia which constricts the blood vessels that carry oxygen to your grafts. In other words, it can interfere with the healing process. I don't think for most individuals however that it is a real huge issue. I am a former smoker and resumed smoking the second I left the clinic to go home after all four of my procedures. It also depends how often or frequent the person is smoking. Some chain smoke which obviously would be ill-advised. Consuming a little bit of alcohol post-op usually will not impact the clotting of the blood to hold the grafts in place however the real danger is what Janna stated about mixing alcohol with pain narcotics. Not all HT patients use the narcotics post-op. Some use motrin, ibuprofen, and even extra strength Tylenol.

Your welcome my friend. I should have told you two other things. When I worked inside the clinic, I had the benefit of looking at multiple strip specimens in the OR under a scope. Amazing view! The thing that you never hear about is the irregularity of the pattern of FUs within the strip itself. In other words, the final count can be ambiguous depending on each individual. Yet some strips have a very definite pattern and spacing of their FUs, others do not. Ethnicity and other factors can vary one's FU patterns in the scalp. The other very critical factor that I should have mentioned is the "skill and competence" of the techs who do the microscopic dissection. Bottom line? Their competence varies and so do their individual experience. Good ethical docs seem to retain the best staffs. They compensate them well and they take pride in doing the best job possible. Then there are the greedy ones who do not treat their staffs very well at all. Because of this their turnover is high and they tend to employ sloppy and inexperienced techs who could care less about transecting those precious FUs. This is why I always tell patients to inform the doctor and surgical team upfront that you want your donor density calculated and charted, and that you want a total graft breakdown and count taken of what was implanted back into the scalp. Then at the end of the procedure, if the actual count is noticeably different from what the strip should yield, then that is a big red flag...:rolleyes: I mean could there have been a lot of transection going on while the strip was being dissected? Why the huge difference? Was the tech new who was dissecting the strip? :confused: Any patient will want to know which techs are dissecting the strip and how much experience they have. These questions can be asked in a respectful manner without offending the staff and best asked during the doctor consultation appointment and not the day of surgery. In other words, it is best advised to ascertain who will be on the actual team for "my procedure" and then they know you did your homework and that you expect nothing less than a professional competent team who is going to do surgery on you. Professionals appreciate the fact the patient is informed and only expects the best. Thank goodness you chose a good one...

You're very welcome my friend. When I first started working in the industry, I was employed by a large hair mill that got acquired by another hair mill several years ago. You have seen the type that do endless infomercials on late night TV. I witnessed so many horrific things that I ended up quitting and went to work for an independent. It was like night and day... You have the right approach, narrow down your search and definitely meet several who you have targeted. Honest and talented docs will have no problems in answering some of the issues that I brought up. In fact, many of them will introduce you to their staffs, give you a quick tour, and answer all of your concerns. It won't take long to get that good gut feeling that they have your best interests in mind and you will find that your decision will bring you confidence that you chose the right team... Best wishes to you in your journey! P.S. Don't forget to ask to use the patient designated bathroom!

$5,000 - Five thousand dollars?! Are you serious???...:eek: Honestly, this has to be one of the worst things that I have ever heard in this industry in over four decades...:confused: At least now you are thinking reality in using your hard earned money for grafts and not wishful thinking. If you live in the US, simply do a word search on FUE surgeons and start researching them. I want to encourage you to do this yourself because only by doing your homework will you develop a sense of what to ask, and to educate yourself on what the risks may be with FUE as compared to FUHT. There are a number of HT surgeons in North America who are becoming more skilled with FUE with the results to show it. Three to five years ago, there was only a few with proven yields but now things have progressed up to current day...

Well we have to recognize that there are absolutely no comprehensive empirical studies or clinical trials that confirm that PRP grows any hair. Same for ACELL for the reasons that I stated before. Neither product was developed for the purpose of growing hair, period. That's why I stated that using them as a stand alone treatment without surgery is a waste of money IMHO...:confused: And that's also why the FDA for example requires clinical trials and other means of substantiation for various products like these classified as medications. Pictures do not carry any weight IMHO when it comes to substantiating medications. Apart from showing surgical results, photos are so subjective and many times used more for marketing purposes than anything else. IMHO, you would potentially have better results by simply using 5% minoxidil for the purpose of regrowing hair... When there is that much hair loss within any zone, only transplants are going to give you any cosmetic improvement. That's scientific and not subjective or wishful thinking. I hope you are not offended by my direct and truthful remarks. I am sure you work hard for your money and why part with it when there is really no clinical merit to support "stand alone" or isolated treatments like these...:confused:

Well unless you have unlimited financial resources, that would be quite a challenge to do for the obvious reasons. Only an in-person exam and eval will provide the surgeon the clinical analysis of what they need to really know what your donor resources are and what the proposed graft count will be once they measure the surface area that you want restored. I have a question that you may not have thought of. How many of these docs took a preliminary medical history of you including all prior and current medical conditions and medications? If they did not, then for all they know you could have Lupus, cancer, etc, etc. And here you are going to fly all the way from your home country and they have no idea of who they are treating? See what I mean? This is an extremely important step "prior to any surgery" yet you would be shocked at how often this area is ignored. Further, an in-person visit would be ideal because the initial in-person visit and on site impression can and will potentially speak loudly of the clinic, staff, and even the doctor. I always recommend to patients that when they are on-site for their consultation appointment, ask the doctor if you can get a quick tour of the clinic including the OR rooms. Do they freak out at the request and appear to panic? Are the OR rooms kept clean and sanitized? Does everything appear to be kept in order or is the OR room a mess when not being used? You can also tell a lot about employee moral and the overall environment in general. Are the staff friendly and inviting and courteous? Or do they treat you as an invader of the clinic and unannounced to their shock and surprise when you ask for a quick tour. How does the staff interact with one another? How does the doctor interact with the staff? Ask to use the patient designated bathroom and take note if it looks dirty and unclean, or is it clean and obvious it is being cleaned routinely (daily). One might not think this is important or necessary but again it "speaks loudly" about the general "hygiene and cleanliness" of the place where a team is going to cut into your scalp. Does the admin staff seem out of place in the front office and/or do they seem to be in chaos? Do they appear that they like their duties or are they cumbersome or do they work together as a team with clear evidence in attitudes that they support each other and have some pride in what they are doing? I spent a fair amount of time working on the inside of clinics and it's many times these areas that make all of the difference in the world...

A couple of things. First, not sure how your doctor arrived at your pre-op density numbers. It certainly sounds like your doc did it, however most docs do not clinically calculate it. And those who do oftentimes evaluate at just one point in the occipital zone through a densitometer, count the number of FUs within the 1cm viewed lens and chart the number. As I said before, the entire scalp has density variations throughout and that's just from birth. Obviously any HT surgery is also going to affect the density levels. I know of one surgeon that I trained under who evaluates six different points in the occipital zone before any procedure. He mostly did this in the advanced consultation appointment once the patient enrolls for the procedure. He would evaluate and call out the numbers to me and I charted them onto a diagram of the occipital zone that is permanently retained in every patients' chart. He then took an average between all six numbers to arrive at what he called generalized density equation. Before any HT surgery, he called it (VDL) virgin density level, and subsequent numbers: procedure 2 density level, GDL-P2, procedure 3, GDL-P3, etc. In other words, whatever numbers he evaluated in subsequent procedures he called GDL, generalized density level. With FUHT, this point of analysis was always within the proposed width of the strip all across the back of the scalp. He now only performs FUE so he does a more comprehensive analysis within the proposed zones where the extraction sites will be. He also calculates differences in hair shaft diameter to note any impeding miniaturization and tends to keep his extractions outside of those areas. Very scientific in his approach... The other thing that I did not comment on in my prior post is the area on either side of the strip scar. Although not always readily seen by the naked eye, there is usually at least 1mm of width in scalp tissue on both sides that cannot be harvested. There may be hair growing but due to the build-up of scar tissue, those grafts are not always usable in the next procedure. And there is really no way of knowing this until the strip specimen is out and passed to the surgical techs for microscopic dissection. Then the exact graft count is tallied and charted. Bottom line, some of them are not transplantable and will not survive. So the numbers are not as perfectly exact as we might think them to be. And some might jump to the opinion or conclusion that FUE is the only way to go to prevent collateral damage to FUs within the donor zone. Not true. Because the forces of torsion, traction, and compression from manual FUE can potentially also do collateral damage within the donor zones and make these neighboring FUs unable or ill-advisable to use. Trust me, I have seen enough horrible photos and in person observations of donor zones post-op both FUHT and FUE where FUs had collateral damage, especially from FUE extractions where the surgeon was learning manual FUE for the initial trial period, or from FUHT where the closing was poor and the patient ended up with a wider than expected strip scar. This is why when having either method FUHT or FUE, the skill of the surgeon is impeccably critical. And depending in how each and every individual heals, the level and volume of scar tissue formed in the healing process will vary. And I'm referring to the amount/level of scar tissue formed than can be seen on the outer epidermis layer as well as the underside layer of the scalp. These are just part of the implications in the aftermath of HT surgery. So really, I have tried to see surgical hair restoration as more of a viewpoint of having the overall donor to achieve my attainable life goals and appearance. And from your pics, I must say Can't Decide that you have some very nice results and I sincerely believe that you are going to be very happy when your second procedure fully matures my friend...

I agree that close examination of the scalp for miniaturization is the best way to determine which areas are in fact being impacted by DHT and to note how MPB is progressing. Diffusion is more readily seen by the naked eye, but miniaturization many times cannot.

britboy, Not trying to sabotage your goals and where you want grafts placed but from looking at your pics, the frontal zone is diffusing a great deal and any native hair in that frontal zone is going to be lost and probably sooner than you might think. So the impending issue for you is will you want your frontal zone and a decent hairline in the coming years since we are all viewed from the front? Your crown area is also going to progress with further loss and you could very well be left with an island of weak hair because you will never have enough grafts to gain any level of decent visual coverage. It's just too large of a surface area and will swallow up your limited donor. This is true for any of us who have that much crown loss. You may want to consider concentrating your limited available grafts for the frontal zone and then maybe consider beard grafts of FUE and also from the sides (rim) of your scalp to address the lateral humps as you progress over the coming years. Would just not want you to be regretful once your frontal zone goes but again it's your scalp and only you can make those decisions.

Absolutely that's a good number to harvest from... But the real more important question is, "What is the actual donor density to accommodate any upcoming subsequent procedures?" And that continues to be one of the dilemmas in that not many doctors will actually or scientifically calculate and determine the donor zone density in subsequent procedures. So if your density was 80 cm2 just before your second procedure, that's decent... In addition, the density can and will vary throughout the occipital zone where strips are taken. So the determination throughout that strip zone may be more of a hypothetical number and not actual. The positive factor is "if" there has been enough time for the scalp to regain a decent/adequate level of laxity, then more density can be realized. Not to it's original virgin level but enough for another successful harvest. I had four strips in my lifetime. The 3rd and 4th strips were taken ear-to-ear and culminating an average of roughly 2300 - 2500 grafts each strip excision... The third strip was roughly 1.4 cm wide and the fourth strip was approximately 2 cm wide so the doctor closed me with staples on my fourth procedure... And before I forget, I wish you great success and a superb yield...

The initial intention and application of both ACELL and PRP treatments were for facilitating wound healing, certainly not growing hair. That still is the primary purpose of each treatment. What's happened since then was a buzz that started in these forums several years ago and suddenly everyone was talking about it (PRP) and wanting it done. Some docs were pushing PRP as a treatment for slowing down the progression of MPB, growing or stimulating new growth, yaddy, yaddy. There was and still is no clinical proof to substantiate those claims. IMHO, these treatments as stand alone isolated injections without any surgery involved is a complete waste of time and money...:confused: But and I do say "BUT", both treatments are indeed advantageous to those patients having HT surgery because again, anything that does have clinical proof of facilitating wound healing is a good thing. Both items have clinical substantiation for wound healing and so does the newly presented Liposomil ATP. Keep in mind that everyone is going to respond differently. ACELL primarily works to minimize scar tissue in the healing process along with a few other benefits. PRP is simply your own blood platelets injected back into an area that has a wound. Professional athletes have been doing this for years. And especially wounds that involve knees, shoulders, things like that. The platelet rich injections advance the rate of healing in many individuals. That's a quick synopsis of both treatments in layman terms. But to think it will grow any new hair is absurd IMHO. The theory is that PRP will bring resting (telogen phase) hair follicles into the growth (anagen phase) and POOF, new hair growth. Sounds believable right? You would IMHO have better results using minoxidil (5%) such as Rogaine Foam to stimulate new hair growth! Well that was the hype and yet not one patient who had these treatments has come forward with any testimonial of it growing new hair. Nor is there any clinical proof...:rolleyes: And as a result, PRP as a stand alone treatment without surgery has virtually died in forum dialogue...:confused:

One other thing that I forgot to mention. If the spot is noticeable enough to where it causes any eye drift, then just use a little make-up to camouflage/hide it when you are out in public. But once you get home, be sure to clean it off before applying a small dab of 5% foam to it. Dermatch is a good option because it colors the scalp very well. Even an eyebrow pencil with just a few dabs can disguise it as long as there is sufficient existing hair around the patch to do a tiny comb over. Use you fingertip pad to press the foam against the surface of the skin only where there is missing hair. My suggestion is to start with one application at nigh time before bed. If you still don't see any new growth after 30 days, try applying twice per day but certainly no more than that. IMHO, any more than that could potentially open up or spread the patch loss and then defeat the rejuvenated growth that you want. If this occurs then I would immediately stop the minoxidil to the confined patch area and continue to use the make-up/cosmetics until time itself passes and your follicles re-enter the growth phase on their own time table.

It is not unusual to see a tad bit slower regrowth time line because the transplanted follicles all behave intermittently when they come out of the resting phase. Some guys can take as long as 18 months to experience the full matured result, although it is more of an exception than the rule. Hang in there and I sincerely wish you more results in the months to come...

You know it is so warming to me to continue to see more and more guys doing their homework and being able to recognize when a doctor simply is willing to do anything that a patient asks without evaluating true density in the donor zone or even discussing future loss and then carefully planning over a lifetime with each and every patient. Kudos newbie33... Paulygon, did you ever see the episode on Cheers when Sam peels off his partial hair piece? He was conned by Carla the waitress into revealing any hidden secrets between them and off it came! That must have taken a lot of courage because not many people knew he was wearing a piece. Did you also notice on Becker that he had a fair level of density lowered in his partial to visually match his overall lower level of density throughout his scalp? He had both the color and density changed and if you see any current pics of him, it was lowered again. Had he not had the density lowered, the piece would have stuck out like a sore thumb...:confused:

What we must come to terms with is the scientific fact that we cannot completely stop the progression of genetic hair loss. The rate of progression can vary over our lifetimes but MPB never stops completely. We can only buy ourselves time with the current hair loss meds and low dose finasteride continues to prove the most efficient for the crown and mid-scalp. And yes some have longer terms of success than others and there is really no way of predicting how we will respond or for how long. But generally speaking, low dose finasteride is not efficient in the frontal third of our scalps and it is that area where we must plan surgical restoration prudently. And this is why I also agree with what thebossman stated. Take a long look at the men with MPB within our individual family history. That's where we are potentially headed in our lifetimes. The more advanced the classes of hair loss are, the more prudent planning one has to be considering the loss over a lifetime. Take a quick peak at the Norwood chart and you will inevitably find your pattern of loss and the various stages of progression.