gillenator

Now that's the best self advice that I have heard in a long time...

Newbie, Just curious what you are spraying on your scalp at this point in time post-op?

I was also very challenged to PM this opinion to you yet something inside me said do a post reply because there are many guys in your situation who do not join these hair loss forums nor do they actively post. Yet I always end up hearing from them "after the fact" and again they are frustrated and broke. So to the guys who may be surfing this thread, I hope this has been helpful information before you pull the trigger so-to-speak...:rolleyes:

eternal, I got your PM and if you really want my opinion for whatever its worth, I agree a lot with Mickey's comments along with several others. May I politely add that you are destined IMHO for Norwood class 7. You are a diffused thinner and you will have a very challenging time in the coming years ahead of chasing this progressive loss with more and more surgery. Your crown alone will potentially demand roughly 60% of your available scalp donor and none of us know anything about your available grafts overall much less your donor density. If you pull down the density in the crown, then you can change those percentages. But remember, once you start crown restoration, you have to continue to add to the areas that continue to lose hair and pull downward including the lateral humps on both sides of your scalp. Otherwise there will be an island of hair with a large stripe of missing hair all around the back and sides. Something to seriously consider for the future. So I agree with others that are you best suited to leave your crown alone. Just your frontal and midscalp can consume all of your available scalp donor. You would need to go to BH to attain any sense of "overall" visual coverage because it also appears that your hair caliber is average. Plus you have a wide color to scalp contrast so that adds another challenge to the equation. Honestly? I would have challenged you to think real hard before ever starting on this transplant journey only because your candidacy is not ideal. And then having to resort to unproven BH and the added cost per graft of that? Surely this is not what you wanted to hear but it's an honest opinion. I have dealt with many guys in your situation over the past four decades and cannot even think of one who did not regret getting started when they are headed for the upper advanced classes of hair loss at such a young age. They end up frustrated and broke. That's the truth my friend. HT surgery at this point in time can also advance the rate of MPB so by the time you begin to make some visual gains, more loss occurs and they often wonder why they are not getting ahead. Low dose finasteride may have stabilized your crown and midscalp but that's gone now. So unless your goals are very conservative, and I do mean conservative, you may end up regretting this whole endeavor unless you feel you would be happy with a restored frontal zone and pretty much nothing behind it as you get older. I want to also challenge you to think about opting out for a high end hair system which can potentially provide you with front-to-back coverage and with a level of density that no amount of surgery can attain, considering your donor limitations. None of us want that option but it's a realistic one for individuals like yourself. You can also restore the frontal zone and wear a partial system behind it. That's also a viable option and I know some guys who are doing it and been doing it for years. Well again that's my opinion and just don't want to see anyone end up regretful and broke in the end. You owe it to yourself to do some deep realistic thinking about where you are headed with MPB and your limited resources both in terms of donor and financial.

Here's my two cents for whatever it's worth. Look, if you intend to wear a short hair style, "CHOOSE FUE". Even if you are not sure about the future of how short you will wear your hair, even if you have an inkling to buzz your hair, "CHOOSE FUE". Now myself, I chose to have four separate strip procedures. Why? Because I hate short hair styles and would never ever wear my hair short. I know that for a fact so my choices for FUHT docs were based on their high level of competency and artistry for FUHT work. But that's me and does not sound like that's you. In addition, at the time I had my FUHT procedures, FUE was not mastered by very many and the overall yields were still in question, and yield was and will always be one of my top objectives in any procedure. I also heal very well and my last FUHT was closed with staples because my laxity was borderline. My surgeon insisted on it so obviously I agreed. My last procedure was in 2006. Now hear we are 8 years later and there are more good docs doing FUE and doing it well including Drs. Robert Dorin and Bob True. Oh sure, everyone is entitled to their own opinions, but like others have said, it's the overall competency in either arena. There are bad FUHT docs and excellent ones. And there are bad FUE docs and excellent ones. Just do your homework thoroughly before making any decisions. Results are what count in the end! There are great FUE docs in both North America as well as Europe...

The problem with a bandage and/or wrap is that they often will stick to the grafts and risk the danger of losing some of the grafts when the bandage is removed. The bandage can also still rub the grafts or cause them to be mis-angled from the weight of the head. dd12, wish you the best result with your FUE into scar procedure and also a good result in the frontal zone...

Anything that can improve survivorability and corresponding yield is worth it's weight in gold IMHO. So improved oxygenation to tissue, organs, etc can only help if done competently. I am sure with time, the differences will be documented with clinical substantiation and then presented at their respective workshops and conferences.

Once again Paulygon, you are giving good advice my friend!

Paulygon, Trust me my friend, you are giving him "sound advice"...

That's because MPB is indeed a genetic trait, not hormonal. There are various forms of alopecia yet MPB is genetically orientated. Again, it's very nice to read your comments about the progression being greatly slowed or even appears to have stabilized. But from four decades of researching this, MPB continues to show evidence that it is progressive in nature. Some progress faster than others so my wish for you is that you keep as much of your native hair as possible for as long as possible.

Very good news to know that it is that readily available.

Here's the deal. Continued strip excisions can be a roll of the dice. Some guys never regain enough laxity to continue on. Yes, although you may already have a strip scar now, that's no guarantee that the next one will come out the same. It also depends a great deal on your goals regarding how short you will want to wear your hair. Please allow me to use my own situation. I have had four separate strip procedures. Quite frankly, cost had a lot to do with it. I could not afford 7,000 total grafts by FUE which would have equated to $56,000.00 US. And on my last strip in 2006, my laxity was barely enough to accommodate that last strip excision, In fact, my surgeon used staples to close me against my desire but he did not want me to end up with a wider than desired scar. Neither did I. Yet I do not like a short or buzzed hairstyle and I will never wear my hair that short. But I always inform guys who do want to wear a short hair style to stay away from strip. Even if they cannot afford FUE, then wait till you can afford it. I am 59 years old and if I was 29, it's very possible that I would feel differently. Yet there is such a thing as bad FUE. I still hear from guys who had FUE from someone not competent with it or are just learning it. Most learn with larger punches which can do a lot of collateral damage with manual extractions. In fact, some of them have such damaged donor zones that they cannot have any more harvests whether strip or FUE. So if the individual elects to go with FUE, be very careful on picking the right surgeon. Moral of the story? Choose a good proven surgeon whether it's strip or FUE!...

And it can be very difficult to determine if and/or where the loss will infiltrate in the years ahead. Some only experience mild forms of it and others it continues on. This is very different from donor zone thinning or DPMPB. Recently I was at my three month follow-up with my PCP and she showed me her alopecia areata and I had no idea that she had this as she was wearing a variety of hair extensions and clips to hide it. Her hair length is long so I was somewhat surprised to learn how long she had been experiencing that type of alopecia. She was curious if I thought a topical steroid might stimulate some hair growth. I highly recommended that she see a dermatologist experienced in treating this type of disorder. Obviously I cannot give her any advice as a lay person. My guess is because she has no other symptoms that trouble her, she never took the time off to see a derm.

That's awesome news Shacked...

Are you trying after first softening them in the shower?

Thought it necessary to offer some clarification if you do not mind. What you may now be experiencing is not necessarily a shed cycle. You are probably experiencing some level of post-op shock loss. Shock loss and shedding are two completely different dilemmas. Please allow me to explain. On average, shock loss sets in roughly 3-4 weeks following surgery. It generally affects the areas closest to the recipient area and/or the donor area. The cause of shock loss is the overall trauma to the scalp from the surgery itself. In some cases, the effects of the trauma can cause other areas of the scalp to also lose hair. Shedding generally affects the entire scalp. it is more evident by the generalized shedding of the scalp with noticeable decreases in overall density. Shedding can occur on its own or as I have observed over the years, induced by the initial use of minoxidil and/or the initial use of finasteride. I continue to read posts about guys starting either hair loss medication either immediately before their procedure and right after. This practice can add further confusion to the hair follicles. Not only do they respond to the trauma but they are introduced to a medication that they have never been in contact with before. I recently heard from a guy from India who did both. He started low dose finasteride the week before his procedure and then he started applying minoxidil within 5 days of his surgery. He has such an extreme level of hair loss throughout his entire scalp and cannot figure out why. I always ask patients who contact me what exactly they did before and after surgery. Their answers are almost identical. Yet I cannot give him any medical advice or instruction because we are not doctors here. He told me his doctor started him on finasteride and also told him to start minoxidil three days post-op. Who am I to say different? But what I can clearly state is that I definitely have observed a direct correlation of what I just stated. It's the initial use that can potentially promote the shedding cycle. I also believe that the initial use of either immediately post-op can and potentially increase the level of shock loss in some individuals. And those with diffused thinning patterns can be even more susceptible for either. By the way, I should also state that I know of another man 28 years old who went to the same doctor and he is not on either medication however he only experienced a low level of shock loss and no shedding cycle. This is why I have become more of the opinion that if your doctor has formally given a diagnosis for MPB, it would serve well to start both medications well ahead of the procedure. Again, that's not medical advice, just my observations. Hope this has been of some help...

Newbie, Your update pics look great and noticed that the redness had dissipated. All good signs...

Newbi, Got your message and I agree with everyone that your recent post-op pics look very good. IMHO, John is absolutely correct regarding the redness and crusting. The itching is no doubt a result of the saline spraying and also a good sign of healing... IMHO, it is best to first dilute the shampoo with water at room temperature. Cold water will induce the epidermis to contract a little bit which won't hurt you but could add a little bit of shock to your underlying transplanted follicles. That's why I am more an advocate of "room temperature" mixture. If you use straight shampoo, it can at times be thick and not rinse away as clean as a diluted mix. IMHO, it makes no difference which direction that you pour the mixture. Now when the crusts start coming off, you are undoubtedly going to find that some of them will be stubborn. You should be 11 days post-op today so you should be fine considering you have been using saline spray for three days post-op and a normal healer. How will you know for sure that the crusts are ready for removal? You simply test some by gently rubbing them with the pad on your finger tip while in the shower and your scalp initially wet for 10 minutes or so. Any surface bleeding after removal can be a sign that you need to wait a few extra days or so. Use some diluted shampoo and pour that over the recipient area first however. This will work wonders in softening the crusts which are in fact dead graft tissue above the scalp line. Remember, scabs and crusts are two different things. Scabs are dried blood and crusts are dead tissue. Dead tissue is more hard in composite than scabs. If there is no bleeding, the crusts are ready IMHO. Relax, because most of the transplanted follicles will go dormant and the graft hair will shed. Your follicles will rest for approximately 3-4 months before a new growth cycle commences. That's the norm. Some go longer, some a tad bit shorter because they behave intermittently. This can be the hardest part for HT patients is waiting for the regrowth! But time alone works wonders. Best wishes to you and congrats on your recent procedure...

Good post and informative. Is not finpecia and fincar the European form of finasteride? That's what Euro and UK patients have told me. Finasteride only inhibits one type of DHT and DUT inhibits two types from what I have read. Yet a higher percent of guys who did not respond well to finasteride also did not respond successfully with DUT.

ohnoo, MPB is a 100% genetic disposition from the family genes. Yes there are other types of alopecia but it sounds from your description of your hairline receding that it is in fact MPB. Did the doctor you saw give you a formal diagnosis for MPB? If he did, the meds and anything else will never completely stop the recessionary loss. They simply buy us some time however MPB is progressive over our lifetimes which is a scientific fact. Some conditions like MPB are treatable, but everyone responds differently to anything we ingest whether androgens or meds. So my concern for you at such a young age is that once your hairline has HT surgery, it could potentially accelerate the loss because you are so young.

If you did not order the Viagra then that is really weird. Did they charge you for the Viagra or did they feel you would need it? They have no idea if you will have any sexual side-effects! I strongly encourage you to first consult with your doctor. Anyway, IMHO biotin can be used while taking finasteride and most docs want their patients to start low dose finasteride at least 90 days before any HT procedure. Did you mean 5mg Proscar? Propecia comes in 1mg tablets. This is also why you want to get advice from your doctor. Have you been formally diagnosed with MPB?

I have conversed with an endless amount of HT patients over the past four decades and there is no question IMHO, that there is a higher level of corresponding pain with FUHT than FUE. I say IMHO because I can only go by what FUE patients have told me since I only had FUHT myself. And the ones who had both techniques tell me that for the most part, there is no comparison that FUE is far more painless. It continues to be just one of the benefits and advantages of FUE.

Good points by David and some guys use MSM in conjunction with low dose finasteride and minoxidil. But only finasteride or dutasteride inhibits the dreadful DHT which is the source of the problem with MPB.

So Fincar is the European version of Proscar at the same strength...

Although not clinically substantiated, prolonged use of minoxidil can indeed improve hair caliber and also increase the volume of hair follicles into the growth phase. So some patients end up with more hair count (density) above the scalp line and a visual increase in hair shaft diameter. Both equate into improved visual coverage...