gillenator

Just having HM done and seeing the proof are two different things altogethor. We continue to be promised with results but nothing material delivered. Hopefully we will see it in our lifetime, until then it's only talk like it has been for the past 50 years. I can't wait to be proved wrong!

Spursman, You want to be on finasteride for a year "to see how you respond" to the medication. That way you can get a better gauge on whether you can stabilize future loss or not. If you do not respond favorably to finasteride and your hairloss continues, you are in no position to start making decisions about sugery untill you can better ascertain how extensive your hairloss can be. By the age of 25, diffusion (loss of caliper) will be evident in the scalp even though you have not lost the hair yet. That provides the doctor the areas of your scalp that DHT is adversely affecting. I mean who knows, if one has the potential to hit Norwood class 7 someday, and does not respond to meds, would that individual even want to get started with HTs. Maybe, maybe not. It is understandable when young men begin to lose their hair, especially their hairline, and want that hairline back. But we are all getting older and a "mature" hairline is a more viable, realistic goal as eventually the youthful look will not compliment our age. Medications do not stop hairloss. They only buy us time at best. Hairloss is progressive in nature because it is a genetic trait. Finasteride is medicinally classified as a "specific hormone inhibitor" or what we commonly refer to as "blockers". There are no guarantees to their long term efficiencies.

Hi JC, I truly empathize with your situation. It sounds like you had a diffused thinning pattern before your procedure? I apologize for not knowing your exact background, but when you stated the high level of shockloss I am presuming that the natural hair that did not grow back was somewhat diffused. Every now and then I hear about this post-op effect from diffused patients and it is so difficult to predict pre-operatively, that is how much shockloss one will experience. In my clinical experience, shockloss can be graded on a "bell" curve. The very highest 20% of patients experience dramatic shockloss even when the number of recipient sites was low or reasonable. I have also witnessed diffused patients do larger sessions with very little shockloss, but they are on the other end of the curve and make up another 10% at the low end. That's why I am a proponent of a much more conservative approach with diffused thinning. The terminal hair from your procedure did grow in by now right? If I understand you correctly, much more of your natural hair was shocked out compared to the coverage you are now getting from the transplanted hair? What Norwood class are you in and do you have donor for future restoration? Terminal hair does not shock out as easy as natural hair and even if it does, terminal hair will grow back so eventually you start gaining coverage again. I hate to say this but it is a catch-up situation if you desire to get out of the hair sytems. I also wore hair systems for 11 years and ended up utilizing the Polyfuse method (glorified term for glue) with HCM. The glue on method will require far more servicing than your clip system. Your scalp will itch and you cannot remove the system unless you have clips. It drove me crazy especially after a shampoo when my scalp dried. The glue eventually breaks up due to the oils and salt our scalps release and then you have to get another service which means more money. The more active we are, the more we sweat, the more our scalps excreet. In the interim, possibly consider a high quality system that you can still anchor with clips. Get several opinions from a few more reputable HT surgeons for opinions. Try to get in and be examined in person. Try to determine what potential you have left for resolve. I wish you the very best JC.

Guys, I have e-mailed Dr. Arvind to post some pics and they are also available on his websites. You can also write to Dr. Triveni at his clinic as I do not maintain any of his clinical photos. I am not employed by Dr. Arvind so I am not involved in patient enrollments, etc. He is giving thought to doing some seminars in the US, and if so, I will be assisting him and Dr. Triveni with that.

Dr. Poswal has photos of donor area sealing results at his website and another forum.

Dear A B, The inhibition period of finasteride is approximately 90 days. That is when "most" men who ingest it notice any sexual side effects. Now if you did not notice sexual side effects in the first say six months, I would assume it is not Propecia. Most men who stay on the drug have their side effects dissipate in a very short period of time, usually in the first year. The advanced hair loss from weightlifting, specifically more muscle mass gained, especially in the thighs, more testosterone is released in the body. DHT is produced from testoterone so of those levels are increased, so is DHT in theory. I have not seen any corresponding studies to support this theory. You also mentioned heightened stress levels in your life and that can advance genetic alopecia. You do not need to respond to this next question publicly, but are you on any other meds? Any anti-depressents? Other meds can cause sexual side-effects as well so just thought I would ask. Lastly, wait on a HT procedure. You mentioned you have diffused thinning throughout the top of your scalp. You definitely want to consider family history of hairloss on both sides of your family. If your father, uncles, grandfathers, etc have gentic hairloss, observe their most advanced classes and consider this as your possible potential someday. If you do stay with Propecia or Proscar which is much cheaper once you cut the pills in four pieces, you may not sustain as much hairloss as was originally destined for you in your genetic profile. Use what works including minoxidil that was mentioned to you in the other posts. After you have exhausted all medicinal remedy, you will want to have your donor zones calculated for density and graft harvest potential. This will take an in-person evaluation from some of the top docs mentioned in previous posts. The bottom line is, have a better idea of where your hairloss is headed, know your donor limitations, and do what you can non-surgically speaking begore your consider actually having a HT procedure done. Best wishes to you and welcome to this community!

Dr. AP has presented the employment of hyper-acute angulation for those patients in the advanced classes of hairloss, Norwood 6 and 7. The whole concept of hyper-acute angulation is to bring the degree of angulation down to approximately 15 - 20 degrees off the scalp. Instead of the hair growing at 30 degrees off the scalp, the hairs almost lie flat and does not interfere with styling preferences. Since it is indeed the hair cylinders that provide coverage, the lower angulation provides a more enhanced illusion of coverage. There is less ultra-violet reflection off the scalp which is also helpful for those patients with a wider color contrast in the advanced classes. If the patient has pre-existing grafts in the recipient area at an angle of say 45 degrees, hyper-acute angulations are not recommended due to potential transection of the hair roots. It is critical that new recipient sites created mimic the angulation of the initial sites. With 30 degree angulation or even higher, the fully matured hair cylinders tend to produce an illusion of more volume "off the scalp" so to speak. As the degree of angulation is brought down, the eye tends to notice more coverage versus volume. For those patients with a virgin scalp, hyper-acute angulation can be followed in susequent procedures to attain the best illusion of coverage. And coarser hair will simply add to this benefit of coverage.

Dr. AP has presented the employment of hyper-acute angulation for those patients in the advanced classes of hairloss, Norwood 6 and 7. The whole concept of hyper-acute angulation is to bring the degree of angulation down to approximately 15 - 20 degrees off the scalp. Instead of the hair growing at 30 degrees off the scalp, the hairs almost lie flat and does not interfere with styling preferences. Since it is indeed the hair cylinders that provide coverage, the lower angulation provides a more enhanced illusion of coverage. There is less ultra-violet reflection off the scalp which is also helpful for those patients with a wider color contrast in the advanced classes. If the patient has pre-existing grafts in the recipient area at an angle of say 45 degrees, hyper-acute angulations are not recommended due to potential transection of the hair roots. It is critical that new recipient sites created mimic the angulation of the initial sites. With 30 degree angulation or even higher, the fully matured hair cylinders tend to produce an illusion of more volume "off the scalp" so to speak. As the degree of angulation is brought down, the eye tends to notice more coverage versus volume. For those patients with a virgin scalp, hyper-acute angulation can be followed in susequent procedures to attain the best illusion of coverage. And coarser hair will simply add to this benefit of coverage.

Sparky, Dr. Poswal may suggest electrofulguration for those plugs that are raised. It is very helpful in leveling raised skin edges in cobblestoning without any gross surgical intervention. In addition, the larger plugs (6-10 hairs) may need coring to remove sufficient scar material. Yes, excision of the larger plugs is the better way to go and then closing the site with monocryl #4 sutures which are absorbing and no need to have the sutures removed post-op. The smaller plugs can be thinned with Dr. Poswal's FUSE excisions to thin them out and re-implant the grafts excised. No suturing involved with the smaller plugs. Consider having terminal hair harvested by FUSE extractions from just above the ears and placed in the hairline area. You may also want to consider BH "if" you lack scalp donor. Either way, additional donor from the scalp or body can be harvested with FUSE and then placed ahead and between the thinned and/or removed plugs to fill in the areas that are needed. Hope this has been helpful to you and let us know how things are progressing in seeking some resolve for repair. Best wishes to you!

Hi Tara22, Welcome to the HTN forum! The very first thing to have done is a complete bloodwork evaluation. It is possible that your hairloss may be attributable to a condition that is not genetically related . The results of your bloodwork should determine the cause of your hairloss, but be sure you see a derm who is experienced in treating hairloss. The whole idea is to rule out the other possible causes. Is there any family history of hairloss either on your maternal or paternal side of the family? Did your mother, aunts, grandparents, etc have hairloss? What about siblings? Do you know if your loss is taking on a pattern such as the Ludwig pattern for females? You also mentioned some frontal recession, any female family members with this same pattern? I see you live in Virginia and I have an office in McLean if that is convenient to you at no charge. If you like, you can e-mail your photos to me as well. I can offer you my opinion based on my observations, but since I am not a doctor, it is only my observations, no diagnoses of course. I can also e-mail you a list of the various tests that are done that you can take to your derm for screening. If you have health insurance, the tests should be covered including your trip to the derm. If you have an HMO, you will need a referral from your PCP to cover the visit to the derm. Currently, only minoxidil is approved by the FDA for treating genetic hairloss in women. Best wishes to you.

Gunner, Perhaps you can do an on-line consultation with a reputable HT surgeon. You can attach your pics. Derms vary quite a bit in expertise regarding hairloss. The derm you saw obviously does not do HT procedures and appears not very knowledgeable in the field. He may have been referring to the fact that finasteride and minoxidil have no efficiency in the front area of your scalp which is basically true. So once you start restoration in the front forelock including the hairline, you will be committed to future procedures as your hairloss continues in that area. What he did not mention to you is the fact that finasteride has remarkable stabilization effects in the bridge and crown areas. If you respond favorably to finasteride, more of your finite donor can be allocated to the frontal areas and then ideally maintain an all around appearance of coverage. Minoxidil may work some additional resolve for you as well but does not address the "cause" of genetic hairloss, DHT. Let us know how things turn out in your next consultation.

Spursman, Unfortunately I cannot think of anyone I would refer you to in the UK. Possibly consider North America or India. If not North America, there's Dr. Woods and Campbell in Australia but they do not do any strip. Dr. AP does both strip and FUSE/FUE in New Dehli. Prices? Dr. Woods is the highest and Dr. Poswal is one of the lowest, if not the lowest. Both do very good work so once you check their prices and their showcases, it is your decision ultimately. Yes, the transplanted hair grows! I had three seperate procedures and I get a haircut every 30 days or so. One of the fews things in life that has lasting value!

Could you just imagine if all the exposure was limited to the hair mills with their multi-million dollar advertising budgets? Driving their infomercials down our throats? And then compare the qualitative educational content between a forum like this compared to the marketing schemes of the big chains. Thank goodness this forum exists and the member doctors who support it, and their work.

Phl, I use Procyte's Tricomin Revitalizing shampoo as a second application which only takes a small dab of the product "after" I wash my hair the first time with a cheaper shampoo. The second wash really lathers up incredibly and a bottle has lasted me for well over a year. Let the suds sit on your head for approximately 5 minutes before the final rinse, that way the copper-peptide agent absorbs into the hair cylinders. It's a great product man! Nioxin is good too as Smoothy pointed out and I think Robert has recommended the extra-strength one also.

Elshugh, The Limmers have been around a long time and have heard lots of good things about their clinic. You are right on the threshold of lots of new growth. Just wait until you get to the 6-8 month mark!

YEP! Smoothy is the man no doubt! Have learned a great deal from him and respect his contributions. He's always there when you need him. I wonder if he's related to Robert? With all the talk of cloning, I wonder if it's possible to clone a few more Smoothys and Roberts! There's many others here too so HBT, would you like to volunteer for the first cloning procedure? Just kidding!

Robert, It is indeed your honesty, wisdom, genuineness, and concern for others (us) that makes you the best Forum Moderator we could possibly have. We all appreciate your dedication and the homework you do in this field and I know that is in addition to your classes in school. Thank you for your thoughts and input on this thread and yes we should be thankful for "any" improvements in the HT industry. I just get so frustrated with the mills and other unenthical doctors because there is never a week that goes by that I do not hear from someone in confidence regarding a butcher job they received. Then these mills often turn their backs on these folks when they are at their lowest emotional point. This still goes on current day. But like you, I am thankful for a forum like HTN, a place where honest objective advice is many times provided, and hopefully more patients will educate themselves "before" they step into the OR room. Take care my good friend and OH, before I forget, HAPPY THANKSGIVING to you and all our friends at HTN!

Thanks Robert, I appreciate your response and I do understand where you are coming from. In my viewpoint which is based on experience and observations, the good independents not only train their interns one-on-one, but administer a mentoring program quite unlike what the hair mills so-called training programs entail. Yes, obviously there is some level of teaching that may take place, but you would be amazed where alot of the chains emphasize assembly line production. So the focus too many times is on quantity over quality. Let's face it, money and profits are the bottom line to these hair mills and that's where their emphasis has always been and will always be. Their actions speak so much louder than their words or marketing schemes.

Robert, For a business to state that they have a training program for new doctors implies nothing in itself. What exactly does a so-called training/internship program consist of? What exactly is it composed of? Unless you have specifics on anyone's so-called training program and know "how" or "if" it is administered it is meaningless. And I'm not referring to any specific organization, as this is apparent in many other industries. How many times have we heard from organizations about their training programs that may be laid out on paper but never transpire to the employees? Or better yet, they may only implement portions of the program, that which serves their financial interest. The true indication of a clinic who is genuine and true to what they propogate will be evidenced by forthcoming clinical findings, clinical contributions that are published to the community, and they will receive praise and confirmations from their peers and colleagues, and yes even criticism at times but there IS feedback. A good sign will be the societies and corresponding certification boards commending that clinic's training program and principles. How often do you see those words of praise to the hair mills? Better yet, how many docs come out of these hair mills with words of praise about their astute clinical training they received at the hair mills? Most of what I have observed are those docs who got their start/training in the mills are very quiet about it and do not disclose the fact they even worked there unless asked. And even then they seem very vague in their responses. So what is propogated to the new doctors and patients is not necessarily transpired in their clinics, the real world. That does not imply that any HT doctor who breaks away from the mills does not do good work, in fact the ones that I have seen leave the mills tend to have very good material reasons for doing so. Past sins?!

Nile, The excision of some FUs within the plugs combined with adding hair both from the body and scalp sounds like the most viable approach for you. I cannot speak for DHI however I am somewhat perplexed whenever I hear of these "extremely" high graft quotes. 90,000 grafts?! If the average graft carried 2 hairs, that's 180,000 hairs, and if the average was 1.5 hairs, that's still 135,000 hairs. The average head without hairloss numbers an average of about 100,000 hairs. Be careful of going for too much density because no one can replicate mother nature's density, and even if it could be done as some claim, it may start to look like a hair system. What about the yield from procedures that number that high? Some good points by Carl. Remember guys, it is not graft count in itself that is the determining factor of coverage. It is caliper more than anything. 2-3k grafts of coarse hair will cover much better than 2-3k of fine hair. Wave, color contrast, etc all play an important role in the illusion of coverage.

Congratulations Ron! Wow, what an incredible story! I have been supportive of Dr. True's work for years and believe me, you will be just as happy when the result matures. I have seen a fair amount of his work when he was partnered with Dr. Elliot when they had a clinic here in the greater Wash DC area. And FYI, I never heard of any complaints from his patients. Dr. True has been around a long time and his techs are experienced, dedicated folks so it was nice to read Dr. True's praise to his surgical staff. Keep the pics coming and hang in there cause "you're gonna like what you see comin soon!"

Nile, All three of my HT procedures had the donor taken from my scalp, all strip, one remaining scar. So it was my scalp donor that produced this wavy effect. Dr. Rose informed me that donor from that region (behind the head) can take on those types of characteristics especially when the hair grows longer. That reminded me of the days when I was a hippie in the 70's, and I had very long hair which did have a wave to it. I currently wear the length on top of my head at about three to four inches. I keep the back and sides to about one inch or so.

Big 1, Sorry to hear of your anguish but yes there is some hope. And by the way, you'll be able to take the weight back off right? Some patients tend to scar more than others. From getting to know you on this forum, I gather you have done alot of homework and chose a good HT doctor for the last procedure? It also is a little early to judge the total outcome of the second scar. Could not the surgeon from your most recent procedure do a scar revision? Did you lack scalp laxity or did the doctor feel a revision could have come out worse? Is the scar raised? Mederma is a very good product for scars, post-operatively speaking. Give the recent scar at least one year to heal. If there is still no improvement, consider FUSE,FIT,FUE technology to implant into the scar, but start with a "test" session. The composite of the scar material varies patient-to-patient and so does blood supply in the scar area. Regardless, I think there is room for improvement for you so keep us in the loop! Take care.

Low, Glad to see your feeling a little better and even with some humor. Laughter makes the best medicine as is said! Still, get in to see a derm experienced in treating hairloss for a clinical diagnoses or disposition. That is still in your best interest.

Hi there Ira, Welcome to the HTN forum! Before you make any decision to move forward, read all you can about FUSE/FUE/FIT technology so you are aware of your "complete" options. This research will also better equip you to know what basic questions to ask the doctors. Only a few of the doctors in this technology have done implants into scar material with documented success as was previewed in the above photo. How wide is your current scar? Do you have adequate scalp laxity? Many times the existing scar can be taken out with the new strip harvested so you only end up with one scar. But you must have adequate scalp laxity to accomodate this. Since you already have a linear scar, you may want to consider your next procedure with strip to move more hair "cheaper", providing you need alot more coverage. Then you can have implants into the final scar to camouflage it. Best wishes to you.