gillenator

Robert, For me, every function is going much slower than it was say a week or so ago. FYI. Thanks and I know you are working on it.

Hi Northface, I am very glad to hear there is no real hairloss in the donor areas, still you are young so yes by all means still get some in-person examinations. And yes it is possible to have your entire head examined to evaluate which areas are being affected. Now not all derms are experienced in genetic hairloss but you will find them on the internet by doing a search for derms with clinical depth in this field. Also when you contact HT surgeons, ask them specifically how much experience they have in treating hairloss patients with the ludwig pattern. Do not limit your research with one or the other, get several opinions. Then once you have your situation confirmed, you will have a much better understanding of how to proceed. And yes I would suggest FUE technology just in case you do have more dramatic thinning in the donor areas in the future since you are so young right now. Should that occur later in life, you would be able to buzz-cut your head. Keep us in the loop! Take care.

Hi Otto, Wow, from your foregoing comments maybe you should wait and really take some time and put some thought as to whether or not you want to move forward with another HT procedure. Your comment, "I would pay anything to reverse it" is indicative that you are not sure along with "I don't want to play catchup the rest of my life". Utimately with more strip the incision is going to get longer and potentially more noticable if you do shave your head compared to the scar that is there now. It is very probable that you may end up with as much hairloss as your father, then again maybe not. No one knows for sure. Yes you do have genetic profiles from your mother's side. Any hairloss on the maternal side? Also, you do have finasteride available to slow down the loss in your vertex and crown. If finasteride works efficiently for you, you won't have to chase this around as much as you might think. If you are not willing to consider finasteride or even minoxidil, would you shave your head if you lost as much as your father? Interesting question is it not? Well, if you are concerned that you may one day shave your head yet still want to do some level of hair restoration, stick with good FUE work as a very high percentage of FUE cases do not show "visible" scarring. I know you mentioned in a different thread that FUE was not attractive to you because of the increased cost but better you eventually get yourself restored with time than regretting a situation you "cannot" reverse. You can even consider having FUE done "in the scar" to camaflouge it one day. The outcome does vary. Best wishes!

Northface, Thanks for putting up your photo. I read one of your earlier posts on this thread denoting that you do in fact have the ludwig pattern of hairloss and so does your mother. Are you younger in age, say under 30? Also, do you have any maternal/paternal family members who are male gender with the same pattern of loss, ludwig? Older brothers, maternal uncles, etc? The reason I ask is because it appears that the photo is reflecting lots of light with your darker hair color and it does not appear to be greying. Unless you are coloring your hair, I am presuming that you are a younger man? The critical thing that stuck out in my mind is that you stated this thinning has invaded the sides and back of your scalp which implies your terminal hair typically used for transplatation is being affected. Have you been evaluated for androgenetic alopecia areata? Many female hairloss sufferers sustain this type of loss, and I have noticed approximately 3% of men with alopecia areata. If you are younger, under 30 years old, and do in fact get diagnosed with alopecia areata, I would strongly advise you to wait on doing any HT procedures for now. Why? I have seen too many times alopecia areata patients, both female and male lose substantially more hair both in the donor and recipient zones. Subsequently the multiple incisions from a HT procedure can shock terminal hair that "does not" always grow back. In fact their form of hairloss does not subside at all in most cases I have seen. I have witnessed some resolve with patients utilizing minoxidil but far and few between. Yes there are some exceptions but I hate to see patients chase their hairloss and never really get where they want to be. Along the way you can end up spending thousands of your hard earned money and possibly in the end regret you ever got started in the first place. This can be very difficult to accept if you do have alopecia areata however one should consider both the upside and downside. You really need to get in for an in-person examination by an experienced HT doctor and/or dermatologist experienced in diagnosing various forms of hairloss. Try to get at least three opinions. They can use video telescopic equipment or a simple densomoter to see how much of your entire scalp is being invaded. If other people have advised you that patients with the ludwig patterns of thinning or alopecia areata do not make good candidates for hair restoration, they are probably referring to the fact that your usable donor if any will not be enough to attain adequate coverage in a lifetime. If you are determined a candidate for hair restoration, be sure to consider your future needs since available donor and future affected areas of loss are at question. Then possibly do a "test" procedure to see if the surrounding donor hair shocks out a little or alot. DO NOT do a strip, only consider FUE if you are a HT candidate. My mother has the alopecia areata form of hairloss denoted by the ludwig pattern and she has been in hair systems for over 50 years now. I am so glad that she did not spend her hard earned money on HTs because ultimately she would have still ended up in hair systems. The technology was terrible in the 50's, 60's anyways. My point is to get "diagnosed properly" up front so you have a better understanding of your own situation "before" you start considering your complete options for resolve. Feel free to e-mail me or write me with your phone number if you want to discuss at length. In no way am I trying to sell you anything but I will offer you an open door as I know patients with these types of hairloss can have many questions. Either way I wish you the very best Northface.

Otto, It sounds like the 500 grafts are going behind your hairline into the front forelock area? If so, you should get "some" visual benefit out of it. If the distribution is covering a larger surface area (including vertex), you may not gain as much appearance of added density. That's why it is important for the HT doctor to "measure" any recipient area, determine original density as well as the level of density you are seeking. Then an appropriate graft estimation is more likely to acheive what you are looking for. Let's say for example you have original density of 80 hairs per cm2. Your goal is to acheive the illusion of coverage without noticing scalp. You have approximately 20 hairs there at present. You will need at least another 20 hairs added to that area to acheive the result of coverage, ot half the original density. The more surface area the grafts are spread out, the less density there will be visually speaking. Just trying to save you any possible disappointment and then later concluding that you should have waited or did more than the 500 grafts. Food for thought.

Hey Corey, Thank goodness it was not serious and it could very well be a new and even possibly an ingrown hair coming through. Now the fun begins! New growth! Keep us in the loop and best wishes to you Corey.

Corey, Welcome to this forum! You stated you had a "strip fue" done? Usually one or the other is done. It is a matter of how the follicular units are harvested for implantation. Who was your HT surgeon?

Smoothy, You make a good point about "average" or "light" training. I think the HT docs should be a little more definitive in their post-op instructions so that a distinction is made. And you are absolutely right, people work out at entirely varying levels of intensity. Protect that investment!

I had a very nice chat over the Labor Day weekend with a good friend who is a tech in HT procedures. He sounded tired so I was glad to see he had a day off other than Sunday. He has been in the field for just over 7 years now and is greatly skilled in cutting and placing. Every now and then we hear some words of gratitude and thanksgiving for the surgical staffs of HT doctors and I think that is just great. Yes the good HT surgeons deserve their credit but so do the staffs that take pride in their work and help to make the aesthetic outcome successful. I mean I have worked on the inside before and I know how hard some of these individuals work "every day" and some of their own ideas and clinical contributions that often times go unnoticed. My friend has mentioned to me on occaision that he reads the forums simply to help him gain and appreciate the patient's perspectives and concerns since the patient is on the receiving end of the procedure. To me as a three time HT patient, that is most admirable! Please allow myself and all the recipients of good HT work formerly thank every PA, Nurse, Clinic Coordinator, and Surgical Tech out there who has made a significant contribution in the many, many procedures that have changed so many lives for the better. And let's certainly not forget those important administrative folks either. Although they may not be in the OR, they still are vital members to any successful team. After all, any team is as strong as its weakest link! Many thanks to all involved.

I had a very nice chat over the Labor Day weekend with a good friend who is a tech in HT procedures. He sounded tired so I was glad to see he had a day off other than Sunday. He has been in the field for just over 7 years now and is greatly skilled in cutting and placing. Every now and then we hear some words of gratitude and thanksgiving for the surgical staffs of HT doctors and I think that is just great. Yes the good HT surgeons deserve their credit but so do the staffs that take pride in their work and help to make the aesthetic outcome successful. I mean I have worked on the inside before and I know how hard some of these individuals work "every day" and some of their own ideas and clinical contributions that often times go unnoticed. My friend has mentioned to me on occaision that he reads the forums simply to help him gain and appreciate the patient's perspectives and concerns since the patient is on the receiving end of the procedure. To me as a three time HT patient, that is most admirable! Please allow myself and all the recipients of good HT work formerly thank every PA, Nurse, Clinic Coordinator, and Surgical Tech out there who has made a significant contribution in the many, many procedures that have changed so many lives for the better. And let's certainly not forget those important administrative folks either. Although they may not be in the OR, they still are vital members to any successful team. After all, any team is as strong as its weakest link! Many thanks to all involved.

Arson, Do you feel that you do not have enough of your own donor reserves? I am not trying to tell you what to do my friend, but I would consider your own hair follicules first. My own father does not have genetic hairloss however he is 74 years old and his entire scalp is more thin throughout due to his aging follicules remaining in telogen (resting) phases for longer periods of time. Any of us would dread to see your scalp reject the follicules that did not originate from your own scalp. Best wishes to you.

w teflon, Robert provided you the correct technical term telogen affluvium. TA is considered as "dormant shedding" and would affect more than 10% of one's scalp. In a normal situation approximately 90% of the hair is in an anagen phase and 10% in telegon phase. We lose approximately 100 hairs from our bodies each day, not all necessarily from the scalp. If you are noticing more than 10% of your hair shedding (more than 100 hairs per day), then it's very possible you have this as Robert pointed out. In addition, please be advised that the early "onset" of androgenetic alopecia can produce this temporary TA condition as early as late teens to early 20's in men.

bdkiii, Good choice with Dr. Epstein in Miami and I am sure you will be enlightened.

I agree with you Scribe however the other comments about avoiding activities that would potentially place undue pressure or pull on the suture line should be taken seriously. Activity like sit-ups, chin tucks, head rotations, etc. The interior layer of scalp tissue (dermis) takes longer to heal and does not have the benefit of air circulation like the outside layer, epidermis. Glad to hear of your "positive" HT experience!

Forlife, The inhibition period of finasteride administered orally is approximately three months. It then serves as a specific hormone inhibitor manifesting full efficiency potential in 12-18 months. So you really will not be able to notice anything visually for at least three months. Best wishes to you.

w teflon, Yes there is such a condition as stress alopecia. Unmanaged stress in our lives that goes untreated typically for a year or longer can result in what appears as blotchy or patchy spots of hairloss throughout our scalp. Generally speaking, people who do not have androgenetic alopecia (genetic hairloss) experience this type of patchy loss, not necessarily their hairline. What occurs is the acute stress levels cause some hair follicules to transcend into the telogen (resting) phase. Once the stress is brought under management, the follicules cycle back into the anagen (growth) phase and the lost hair grows back and the barren patches fill back in. What about those of us who do indeed have androgenetic alopecia and suddenly a very stressful event goes unmanaged? The added stress can compound or "advance" what we were predisposed to lose ahead of its genetic timeclock. In those cases one can see the eroding of their hairline in much quicker time frames and other areas in their scalp as well. W Teflon, I want to encourage you to deal with your situation without getting too personal with you. Might your stress be related to your genetic hairloss? If so, there are lots of advice and encouragement we can offer you right here in this community. I believe I responded to one of your other posts earlier so I do remember you as a newcomer and want to welcome you to this forum, however at the same time I do respect your privacy regarding any personal issues. We are all here to help!

w teflon, Are you asking if it is expensive to see a dermatologist relative to your hairloss or some other issue?

Merck's controlled clinical trials utilized the use of rhesus monkeys to determine the "in utero" effects of finasteride exposure during the period of embryonic and fetal development, (gestation days 20-100). The rhesus monkey is considered a species more predictive of human development than rats or rabbits. Merck administered finasteride intravenously to pregnant monkeys at doses as high as 800 ng/day considered at least 750 times the highest estimated exposure of pregnant women to finasteride from semen of men taking 1 mg/day. The results were no abnormalities in male fetuses. To confirm the relevance of the rhesus monkey model for human fetal development, oral administration of a very high dose of finasteride (2mg/kg/day) was applied to pregnant monkeys. This is considered to be approximately "12 million" times the highest estimated exposure to finasteride from semen in men taking 1mg/day. This was the only example of oral administration provided by Merck and they did observe external genital abnormalities in male fetuses at that level of gestation. No finasteride related abnormalities were observed in female fetuses at any dose.

Dear Ams99, Anytime an incision or extraction (FUE) is made into tissue the body repairs itself and susequently formates scar tissue, something you probably already know. One of the foremost issues with FUE/FIT technology is will there be "noticable" scarring in the donor area. This is of particular importance to anyone desiring to wear a buzz cut in the future. Some folks (very fair complected) sometimes note a lingering redness although the surface area (epidermis) is completely healed. This can last up to 18 months to two years at times, and is the exception versus the rule. Also, in the summer months it is possible to note what may appear as faint spotted dots against a tanned scalp, depending on the contrast the surrounding tan creates. Why not do a test procedure of say fifty to one hundred grafts to monitor the outcome before you commit to the 500-800 grafts? Generally speaking you should be able to wear your hair cut to a number two or one guide. Remember, most folks viewing your shaved head from behind are not hairloss experts and will not scrutinize that area unless something obvious is showing. I would presume you are diligently doing your research on this technology and the corresponding doctors that are doing it. Best wishes to you!

From what I am aware of the active ingredients minoxidil and finasteride do not claim any efficiency in the front forelock areas including the hairline. In fact both products Rogaine and Propecia make this distinction in their labeling as well as their respective clinical studies. Both products have demonstrated some aide in reducing potential shock loss but nothing that I have heard or seen to be monumentous. In fact the results vary patient-to-patient. Some folks respond extremely favorable to minoxidil, some nothing. I have heard and seen excellent results with finasteride which is why I am a proponent of the medication. Still there is a small percent of men who do not respond to finasteride. My point, use what works best for Keneastcoast! We are only buying ourselves time anyways. People respond to medications differently and not just hairloss meds. ALL medications bear some side effect(s) and that proves the varied responses patients distinguish from each other. It sounds like you are experiencing diffused thinning and subsequent loss. There are usually one of two ways a diffused loss patient pursues. First choice is to approach their restoration in smaller procedures to minimize traumatic potential shock loss. The disseminating effect of DHT on one's hair follicules is not what causes shock loss, it is in fact the surrounding trauma caused by the recipient incisions. The more incisions that are made within a one squared centimeter surface area of thinning hair, the more shock loss that can occur to that thinning hair. That can be disaster to some. Any way you look at it, shock loss is unpredictable but you can take some measures to try and minimize it. The other choice is to "get it over with". In other words some diffused thinning patients conclude that the diffused vellus hairs are going away eventually so I may as well get as much coverage as I safely can. And yes, I concur with the fact that you will most likely have to replace your natural hair with more surgery as time goes forward. Use prudent life-time planning with your HT surgeon so you have adequate future donor reserves.

Hi Danger, Generally speaking, HT procedures have improved in reducing the size or invasion of the recipient sites made. In former days when micros and minis were used, the industry was concerned that possibly some might lose or possibly "pop" the grafts back out related to heavy exertion and/or heavy cardiovascular activity like weightlifting, running, etc. In fact alot of HT surgeons employed the use of pre-op coagulants like Vitamin K (Mephyton)to thicken the blood by the day of the procedure. My premonition is that some still utilize it. I would like to think that all of the HT surgeons are making their recipient sites as least invasive as possible. The other issue is the suture line if you elect to have a strip harvest. Sometimes one can re-open the area or cause subsequent bleeding between the sutures if too much pressure or exertion is applied too soon following the procedure. As remote a possibility as this may seem, it never hurts to be safe and wait a week before engaging in that type of activity. Considering what a HT costs, it never hurts to wait and it is good to see that you want to protect your investment. Best wishes Danger.

I know, I know.

And even if there was more clarity, most of us want our hair now. It is nice to see the research taking place, the more we know, the more we understand, and ultimately more resolve. Thanks for the info.

Dear Danger, Wow, I really empathize with you. Robert really hit home with some very insightful, helpful reflections and suggestions that I am sure any of us hairloss sufferers can relate with. Danger, I wanted to ask you a few questions about your comments. You stated that no one on either side of your family history has hairloss. This promted me to ask you if your noted hairloss is recessionary (hairline, temporal lobe areas)? Or, might this loss appear patchy or blotchy including areas in the donor zone? The reason I ask is there is an absolute difference in androgenetic alopecia (MPB) and stress alopecia. I have on rare occaison observed patients who had no history of genetic hairloss with the blotchy form of loss and instead of considering a HT (not that your are considering one), we referred these folks to their PCP for evaluation of potential "other" causes of loss. Your primary doctor can make referrals to dermatologists, etc. I am only mentioning this because lets say that your loss is totally stress related, the good news is that it is resolvable and the hair should by all means grow back. Still others I have met with did indeed have genetic hairloss with family history supporting it. It's just that they are going through a very stressful time in their lives and sometimes that can "advance" one's genetic hairloss ahead of its timeclock. In other words, let's presume you have genetic alopecia and the stress in your life is under good management. Will you continue to lose hair? Probably so, but possibly not at the advanced rate that both factors combined can do, that is both the genetic profile and the stress compounding it togethor. Possibly see a HT doctor(s)for their opinion and subsequent diagnoses. I want to wish you the very best Danger and there are many folks on this forum that can provide some insight because we have been there too. Take care!

Eastcoast, I want to first say I am happy for you in that you stated that your hair now looks natural, especially considering your comments about Dr. Gallagher. I appreciate your questioning the graft "range" I posted in response to Solid's questions. Please keep in mind that these are only estimations based on any patient's "appearance" goals. You implied that the "only" way a HT looks natural is if "all" the HT hairs are as close to 1mm as possible regardless of thickness, caliper, etc. And you are certainly entitled to that opinion. There are many patients including myself that would politely differ with your opinion. Why? Our goals vary. I do not know your age but after visiting well over 9,000 patients in my life time, some patients especially those over 40 years old may not want the level of density you spoke of. Generally speaking, we lose density with aging. Hairlines can move back with aging not attributed to MPB. In addition, the graft ranges I provided encompassed those who would desire a higher hairline including the temporal lobe areas. As you may have experienced yourself, the HT doctor typically will draw in the proposed recipient areas with a marker, but it is up to each and every patient to decide how much or how little they want. Density in itself is not what attributes to a "natural" look, it is only part of the puzzle, important as it is. Even "partial restoration" can have a natural appearance if angulation is good, hairlines are not too low, etc. I have seen enough patients who were able to achieve great densities but their hairlines looked totally unnatural. As I had mentioned in my other post, Dr. Shapiro started my hairline but it was not complete relative to my budget. That hairline was "perfectly" natural in its appearance and not even one person knew I had sustained a HT! The result was like reverse balding, but it was natural. The fundamental problem we face when we comment about others is we tend to view them from our own perspectives. I am as guilty of this as anyone else at times. What we think is right for others may not be anything even remotely close to what the "patient" desires. Lastly, it is always ambiguous to provide estimated ranges for "any" hairloss class "until" the patient has stated his/her goals. How can one imply what is right for someone when too many of the facts are missing such as age, race, contrast, and the hair charatersitics I mentioned. Early in my career I had observed many patients who have the tight curl characteristics and I always had presumed these folks had mamouth densities. After closer observation of their scalp inlcuding donor areas, I found that many had natural F/Us that were rather spacious, more than 1mm apart from each other. But due to the spiralling of their hair cylinders, more surface area was covered compared to those with fine, thin straight hair. I appreciate your comments and again congratulate you on your own progress. Take care.