gillenator

Hi Wantitback,

Yes losing a few grafts post-op is typical although none of us want to lose any of them. No one retains 100% of the grafts placed whether the patient realizes it or not.

What happens post-op is that we are told for the most part to wash our hair every day following the procedure. The grafts become soft again from the warm water so even gentle washing and rinsing can cause a graft to dislodge. The graft you noticed six days out was probably loose long before now and probably just rinsed out.

Many of us here are advocates of utilizing post-op wound care topical treatments like Graftcyte which advance the healing process and possibly you have been using something like this. Either way, you are now far enough out from surgery that you should not lose any more.

The best way to shampoo the recipient area post-op is to establish the shampoo lather on either the side of your scalp (rim hair), or other location of the body where there is lots of hair to create and establish suds. Then cup one hand and scoop the suds and then place the suds over the recipient area without scrubbing the area. Just pat the suds very gently onto the recipient area, no scrubbing. After the suds start melting away, apply a second scoop of suds and repeat. Then simply rinse off using a receptacle of some kind and gently pour the water over your scalp to rinse off. Use lukewarm water, not hot, not cold. "Do not allow the rinse directly from the shower head as the pressure can dislodge wet grafts in the first several days following surgery. Let your hair "air dry" and do not pat your head with a towel to dry off.

After 8-10 days post-op, the crusts are ready to come off and then and only then can you begin to get more aggressive in massaging the recipient area with your fingertips while shampooing. The crusts will come off and there should not be any other complications.

After the healing of the surface of your scalp (epidermis), you may begin to see some effects of shockloss. Hopefully it will be minimal and not very noticeable. Most of the hairs within the grafts will come out with the crusts and a smaller percentage will just take off and grow. In time, alll of the hair follicules that were transplanted will cycle through their phases and behave like they did before your procedure. Best wishes to you!

Jr1,

The surgeon featured was Dr. Allan Baumann based out of Boca Raton. FL. There have been other national programs that have featured him. He is also doing some FUE procedures although I do not think he has been doing FUE for very long. The examples I have seen of his work looked really good and I did have the opportunity to speak with him about a month ago. My impression is he is a leader in applying and making available all treatment options including the laser therapy. He is someone coming up in the ranks, and my guess is that we will be hearing more about him. I believe Pat knows of Dr. Baumann too and he does have a very comprehensive website.

Smoothy,

I believe the hair dryer was briefly utilized to minimize the "glare" of the scalp when the scalp was wet and being filmed. I saw this before during a live surgery workshop. I do not believe any damage was done because once the grafts are placed, the clotting process begins immediately and holds the grafts in place until healing of the dermis layer begins. Then the tranplanted follicules will re-establish their blood supply. I suppose too much drying could eventually dry out the top of the grafts but the follicules are imbedded into the soft tissue in the dermis layer. Keeping the epidermis in a moist environment for three days post-op is good as you suggested for the purpose of minimizing scar matter formation, but I believe the follicules themselves are not affected once placed and held by clotting. In other words that brief drying should not affect the yield. Personally, I do not think I would want a hair drier utilized during my procedure. I mean the tissue that remains above the scalpline will dry out soon enough and turn into crusts, but I think I would prefer them to do this after applying Graftcyte in the first week following the procedure.

Fabe,

Was the area of additional balding as you stated a "blothcy" or "patchy" spot? Or did you notice from a year ago that the "area" of balding widened into the coronet area? That area is the lowest point below the crown. It often distinguishes men between a class 6 and class 7 potential.

Nile,

Any reason why you would not consider FIT, FUSE/FUE extractions to thin the plugs? That way you can have those grafts extracted re-implanted in the recipient areas and gain some more coverage. Why have them destroyed? If you are going to pay to have your plugs thinned out, why not do it in a way that would bring you additional benefit? Just some food for thought.

Hi Neutronman,

Welcome to this forum! Alot of information provided here in this thread however I want to offer you a comment that you probably are already aware of and probably have heard from your doctors.

Long-term steroid use in any form is ill advised and can have grave consequences in the long run. I did note that you are a "professional" and so this may be hard for you to compromise at present, especially involving your occupation.

The production of testosterone really dips down in men reaching post 30's in age. It may not show up initially but as you get older, your body will need all that much more to maintain the muscle mass. I don't know how old you are nor how long you have been maintaining this regimen, but for whatever it's worth, at some point you will have to cease it or they will take their toll. Possibly you have plans to be a trainer in the coming years.

Please understand I am not trying to tell you how to live your life, it's just that I have seen some men very adversly affected by steroid use including terminal situations. Best wishes to you.

JacobS,

Did your doctor prescribe or provide you with a steroid known as Prednisone? This really can help with swelling along with the ice packs.

The effects of gravity also pull down the solutions that were injected into the scalp and usually noticed 2-3 days post-op and then lingers another 2-3 days until it subsides. Those are the averages and so don't worry, things should subside very soon. There was one individual in this forum who recently posted about some dramatic swelling, but it is the exception and not the rule.

Vocor,

Glad to hear of your research, the right decisions, and now the benefit. Keep on living brother, life can be good!

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.