gillenator

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.

Hi Solid,

Yes indeed. I had a total of three HT procedures, all strip, with just over 4400 grafts to date. I was a Norwood 5 when I received my first HT in 1996, and prior to that, I wore hair systems for 11 years.

Robert,

Thanks bud and the same to you! I have learned alot reading your commetaries so keep em' coming.

I know you're kidding about the terminology thing! Take care my friend.

Hi WVHair,

Say it's great to hear you are doing your reseach! I too have found this site and forum to be very informative and helpful over the years. Very comprehensive.

Possibly over time you might keep us apprised of your questions and findings. I know the more you read, the more questions that come to one's mind.

There are plenty of folks here in the forum that can offer you informative and practical feedback both from a patient's point of view as well as clinical exposure and experience. Best wishes to you in your endeavors!

Thanks Robert,

From what I know the surgeon places a cup directly against the eyeball. The eyelids then hold the cup in place, and also hold the eye open. Think of it as an oversize contact lens with curvatures that hold the lid of the eye. The follicules extracted are sewn with a surgical needle #4 into the edge of the eyelid and situated between the natural hairs already there. I could be wrong on the needle size and I imagine that could vary depending on the thickness of the eyelid and the spacing between existing hairs.

The swelling post-operatively can be monumentous including black eyes. Obviously the patient would be in need of an attendant or other assistance to get around until the swelling subsided.

I believe the donor hair is chosen behind the ear or other area(s) to best parrallel the hair characteristics.

One drawback. The need to trim the eyelashes as they grow in the future. I suppose it can be learned with practice. It must be awefully hard to keep from blinking! Ultimately, it is still the private and personal decision of the "informed" patient. Thanks again.

Hey baldcasonova,

How are you doing these days? I agree but this patient mentioned to me that she's been wearing false eyelashes for years and is a hassle. I then mentioned to her that it's very possible that long term wear of the false ones may have contributed to her loss on the edges of her eyelids but she stated that she is asian and one of her sisters has the same sparcity since birth. So does her mother. She's been wearing false ones for so many years, she's very concerned that people who know her will be shocked not to see those thick eyelashes if she quits wearing them, namely her husband. I really feel for her man, I mean she was very emotional to tears about it. Still I had to warn her about the risks of surgical restoration including the swelling involved post-operatively.

Thank you everyone who has contributed and made recommendations! We will investigate this further now that we received some input.

I concur with the fact that more follicules placed in any recipient area may compete for nutrient and blood flow. Does this have a bearing on the maturity of each hair sheath? I have not seen any clinical studies released denoting any differences. Possibly some HT doctor(s)are evaluating this area.

That being said I have noticed on many patients including myself that after twelve months, the cylinder caliper tends to reach full maturity. In other words after twelve months the transplanted hairs appear "thicker" in diameter shaft. I believe that is the "magic" in gaining the appearance of coverage that patients see in the mirror twelve months or so post-op. This has been my observation over the years. Approximately fourteen months after my third procedure I was able to discontinue the use of Toppik completely. I have dark colored medium coarse hair so the caliper maturation definitely made a difference in visual coverage with less light reflecting off my scalp.

Patients with coarser hair and wider color contrasts owe it to themselves to await the "full" maturation process. Actually I encourage all HT patients to give adequate time before stepping back into the OR room. No sense to commit to more than what is needed to attain each and every patients' individual goals. How much appearance of density and coverage? That is a personal decision for each patient to make for themselves. Best wishes to all.

I used Toppik myself between procedures. I found the best results were to comb/brush your hair into place first. Then gently tap the fibers into the areas needed. If you do not mind a little hairspray, hold the spray bottle approximately twelve inches away from your head and lightly spray a mist and let it gently fall on the areas. The spray will help hold the fibers to your hair cylinders and very little of it will blow away. As Robert stated, you can wash the product out very easily with shampoos. I also found that first wetting or shampooing and then drying my hair in the morning made it easier to style before the Toppik was applied. Before long, you will be an expert at it!

You too notsohairy!

I received a call this afternoon from a female patient who has little to no eyelashes left on both eyelids. I have only dealt with this situation one time over the years and the results were not favorable. The HT surgeon involved with that case did emphasize to the patient that he had only performed this procedure several times, and he could not guarantee the outcome and actually attempted to discourage her from pursuing it, so presently she is not upset with the doctor but does have some regrets.

I have mentioned false eyelashes as a more practical resolve but she asked me to check around and does not want to join in on any forums. Have any of you or do any of you know of a good surgeon who has/had good results with eyelash procedures? Thank you in advance.

I received a call this afternoon from a female patient who has little to no eyelashes left on both eyelids. I have only dealt with this situation one time over the years and the results were not favorable. The HT surgeon involved with that case did emphasize to the patient that he had only performed this procedure several times, and he could not guarantee the outcome and actually attempted to discourage her from pursuing it, so presently she is not upset with the doctor but does have some regrets.

I have mentioned false eyelashes as a more practical resolve but she asked me to check around and does not want to join in on any forums. Have any of you or do any of you know of a good surgeon who has/had good results with eyelash procedures? Thank you in advance.

Hey Robert,

I love to see posts like this too which make you grin ear-to-ear especially when you see how it changes peoples' lives for the better! Thanks for your support to all of us who visit this forum.

Hey Guys,

There's alot more growth coming your way! Thanks for the good reports and we will all look forward to hearing from both of you on your progress. Best wishes on your new growth!

Yes whether you elect to choose strip or fue, the scalp tissue will repair itself during the healing process and in that process formate some level of scar tissue. A real big issue for some patients is how visible is the scarring? I do understand that over-harvesting with fue/fit can potentially cause the donor area to appear less dense or even sparse, so there are some trade-offs. Or in the case(s) of previous open donor patients where possibly a strip excision would produce better aesthetic results rather than thin the donor area further with extractions.

Most virgin patients who pursue fue/fit technology want to prevent as much "visible" scarring as possible especially in the donor area (linear scar). Patients who desire the shortest hair styles namely a number one or two guide, have the greatest potential to do so by utilizing fue/fit technology. I have seen in person dozens of fue/fit patients immediately after the procedure, and as long as three years post-op. In most of the matured cases (roughly 90% or better), I could not tell where the extractions were taken by the naked eye. This then allows the patient to even potentially be able to shave their head one day if they elected to do so. I am sure there will always be a few exceptions to these cases. Patients then who desire to wear their hair extremely short could not do so without the strip scar showing. In addition, patients having the ludwig pattern of loss, the areas of future loss can impede into the donor area and that too can potentially show the linear scar. I am not implying that Northface has this type of loss but some do.

I also believe that there is potential to harvest more terminal hair with most patients in areas of the scalp that a strip harvest cannot without leaving visible scarring with a short hair style, namely above the ear(s). This too is an attractive benefit for younger men (twenty-five and older) to be able to one day cropt cut their hair in the event their hairloss becomes alot more dramatic with age.

Now do not get me wrong, I am not saying that either method of harvest is right or wrong, it really depends on each and every patients' goals including cost considerations. For me, I never intend to shave my head or wear shorter hair, so the strip method has worked very well for me. I may end up doing a fue/fit procedure one day but again I may do another strip, have not decided yet. It is a personal decision based on case situation as well as your goals.

Great idea for the pics as suggested. Best wishes to all!

Dear Northface,

Welcome to the hairloss community! Sure it is possible to have several FUE sessions with diffused thinning. My ecouragement to you is to start with "smaller sessions". This approach will help to minimize shock loss to the surrounding hair in the recipient area. Please note that I did not say "prevent" shock loss. Expect some level of it due to the trauma caused to the scalp. Some patients experience severe shock loss, others some, still others minimal. In addition the diffused hair you may lose as a result of this trauma may not come back.

HT doctors do hold to some varying philosophies regarding the types of recipient incisions they utilize, and even the instrumentation used to create the sites. You want your sites to be as least invasive as possible especially with a diffused thinning pattern. The fewer sites, the less potential trauma. Make sense?

Smaller sessions will also provide you the benefit of a more "gradual" appearance transition wich you also stated as a concern.

Do you know which hairloss classification you are in and where your hairloss is potentially headed (family history, etc)? Are you taking Propecia or some form of finasteride? Might you have the "ludwig" pattern of genetic hairloss not depicted on the Norwood scale?

Lastly, get evaluated for this type of diffused thinning with a proven HT surgeon who has done many cases in a diffused zone. Also ask the hairloss community for feedback from patients with diffused thinning and what their corresponding results have been in treating it. Best wishes to you Northface in your pursuit of seeking resolve!