gillenator

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!

Dear Eastcostht,

It sounds like normal shedding to me, especially if it's just a few hairs. This is normal behavior of a hair follicule following its anagen, telogen, catagen phases. Now if you were experiencing massive fallout, that probably would be an entirely different issue. My opinion based on the information you provided is that you are probably just fine. Keep us updated should anything change. Best wishes to you.

Hi Hairworthy,

I just wrote to Dr. Rose on your behalf to answer the question(s)you posed. You can also write him directly at paultrose@yahoo.com or wait for his post. Best wishes to you!

Dear Andy,

My word you have certainly been through alot! What courage and vision you have. When you have time, read up on FUE/FIT technology because it may be very possible to have those plugs "thinned out" by extracting some of the F/Us within the plugs and then having the extracted hair placed back into the recipient area. This way they may not have to be "cut" out or excised by scalpel. There is far less visible scarring in most cases especially when treating the hairline area. It is also possible to have your hairline raised with this type of technology. It is very possible that thinning or removal of the plugs will in itself not be enough to achieve your appearance goals as you probably will want more density (coverage) in the frontal area and top of your scalp. Be sure to consider this investment as well, the fact you will probably want more coverage. But I do not want to speak for you without knowing your secondary goals so I will respectfully not impose anything on you. This is your personal decision after you have done more research. When you are ready, definitely have the evaluations done in person with surgeons who specializes in repair and also proven FUE/FIT experience. Make contact with more than one doctor. In other words get more than one opinion.

You appear to be a Norwood class 5a however your crown is still bearing some natural hair which may be saved through a medication called Propecia (finasteride). Look up the benefits of finasteride as well as any potential side effects on the internet. You have probably heard of minoxidil which has been available in generic form (cheaper cost). Both products are approved by the FDA for treating MPB.

Possibly your hairloss in the crown are not as much of a concern to you. But if the crown loss is important to you, there are ways as I have mentioned to address that area as well.

I wish you the very best in seeking solutions and thank you for being an inspiration to all of us. Take care Andy!

Dear Headsup,

I too would like to welcome you to this forum. I just wanted to encourage you to be sure that your donor strip is prec-calculated by the HT surgeon you choose. Your entire donor area should be evaluated for F/U density so that just enough tissue is taken. Typically the surgeon utilizes a device commonly called a densometer which allows the doctor to examine one cm surface area of the scalp in the donor area. Some may utilize a video telescope or some other instrument. They then calculate donor density by counting the total number of hairs and also the total F/Us within that area. They divide the total number of F/Us into the total number of hairs to acheive the average number of hairs per graft that will be moved in the procedure and also allows them to calculate how wide and long the strip will be to harvest as close to the number of grafts you enrolled for. I have to believe most HT doctors calculate donor density in this day and age but insist on your HT doctor explaining his/her analysis and calculations to you "before" your procedure. Also be sure the laxity of your scalp is evaluated. A tighter scalp may imply that the strip would be taken leaner and possibly longer in the donor zone. If you have never had a HT before, this probably will not be an issue for you, but good doctors should evaluate this for you. Hope I am not getting off on a tangent here but the more precise the calculations are the better chance your strip will not be taken too wide and leave you with a corresponding wide scar. Best wishes Headsup!

Dear Taoofjord,

Wow! Lots of good questions and it sounds like your doing your homework so good for you. I will do my best to answer what I can for you and I am sure others will respond as well. Keep reading and researching as I would discourage you from trying to get a HT procedure done at present. I will explain this in your latter question. Please allow me to now respond to each question:

1) Most definitely genetic hairloss at a younger age carries the implication that you WILL lose more in the years to come. Bet on it. You must understand that androgenetic alopecia is in fact a genetic condition from your bloodlines and it sounds in your case to be from both the maternal as well as the paternal side of your family history. Genetic hairloss does not resolve itself on its own as you and I and other hairloss sufferers cannot dispose of our genetic make-up (profile). Think of it like a fingerprint or even your DNA profile.

2) You probably "are" following a similiar pattern as your family members including your half-brothers. Most men do in fact sustain hairloss in the temporal lobe areas in the various classifications of genetic hairloss. Look up the "Norwood" scale and you will no doubt see your pattern displayed. Now just because you do not yet see scalp in the crown, it does not mean that you are not diffusing (beginning stages of hairloss)there. The only way to know for sure is to have a competent HT surgeon examine all areas of your scalp to note any miniturazation (loss of caliper, diameter thickness)to confirm which areas are indeed affected and also to note where future loss can occur. The next time you are out in public, take particular note that ther are men with the similiar pattern of loss and they are not even related to you. There are seven classes depicting temporal and crown loss and another six for hairline recession on the Norwood scale.

3) Of the many products you are utilizing, Propecia is the medicinal product that in my estimation is doing the stabilization. Look up Propecia's pharmacology classification at Merck's website to gain all of the information of Proecia's benefits as well as their noted potential side-effects. It is also included in every dispention of the product in printed format. It should be attached to the bottle or inside the packaging material. Merck's controlled clinical trials claim efficiency in the mid-anterior scalp (vertex) and post-anterior scalp (crown). Both Propecia (finasteride) and Rogaine (minoxidil)do not claim retardation of genetic hairloss in the front forelock. I find it HIGHLY unusual that your doctor and I presume you are referring to your PCP, would recommend taking two tablets of Propecia per day for treating genetic hairloss. Again read the pharmacology classification, then bring it to your doctor and point out the facts of the medication. I am not trying to say I know more than any doctor as I am not one, but I hear this kind of thing EVERY day and then the patient calls me back and almost always the doctor agrees with the clinical findings. The active ingredient in Propecia is finasteride which has been clinically proven to block Type I DHT effectively in over ninety percent of men ingesting it for 12 months or longer at 1mg per day. Merck clearly states that taking more than the recommended dose will not provide you any advantages. The other products may aid you in cleansing your scalp and even invigorating it but I want to encorage you to deal with your high genetic disposition of producing a high level of DHT from testosterone, which is the genetic trait I spoke of earlier and most undoubtedly the cause of your hairloss.

4)Toppik is a great cosmetic way to help conceal your hairloss. The product consists of ground protein fibers that carry a negative charge to them. When applied carefully, the fibers "cling" to the hair cylinders making them appear fatter, and henceforth, WHAM, it looks like far more density right? The magic of Toppik is not that it is adding hairs but in fact making them appear fatter versus miniturized. Most experts in the field will inform you that caliper is the single most critical factor in coverage. It is extremely difficult to apply this product in the temporal zones unless you master the technique of "tapping".

5) Dutasteride claims to effectively block both Type I and Type II DHT which may give the advantage over Propecia in some cases. I have had patients mention that Propecia did not seem to work but saw much better results in Dutasteride. They were however the minority of my clinical experience. Dutasteride to my knowledge is still not approved by the FDA in treating genetic hairloss (MPB).

6) You need to see a dermatologist on this one, anything else is pure speculation.

7)You are who YOU and only YOU perceive yourself to be. I'm talking about the man inside you. Oh sure, I know, the occaisional glance at your hairline from others. We have all been through this and believe me Taoofjord, I know what it is like firsthand so I empathize with you my friend. But as long as you do not negatively react to their roaming eyes, they will know it does not shake the ground under you right? Do not let your buddies get to you if they start kidding you either. That's what they may want to see, to see if they can push your buttons. That's all.

8) Yes you can advance your genetic hairloss by pulling or twisting the hair cylinders. It's commonly called traction alopecia. Now you can wash it, groom it, and so forth, just don't apply tension or pull at your hair.

9)Here's the "big issue" that I said I would touch on at the end. DO NOT, and I mean DO NOT get a HT until you have at least waited until age 25. Why? You owe it to yourself to get a better gauge on how extensive your genetic hairloss is headed. Generally speaking, and there are exceptions, men who sustain genetic hairloss which is visible before age twenty usually is an indicator of extensive hairloss in the future. Now before you fall backwards, let me give you the good news. You are already ahead by being pro-active by starting Propecia, evaluating family history, and most of all, doing your research! I want to encourage you to consider your hair restoration planning based on your lifetime, not just what's missing today. You will need to adequately plan for future procedures and you will need future donor for that. The fundamental problem is that donor supplies are finite and yet genetic hairloss can be infinite. It's an issue of "supply and demand". Hopefully hair multliplication, scalp impregnation, follicule cloning, etc. will be in your lifetime, but do not bet the farm on it. The technology always seems to be another five years away. I have been hearing this for the past twenty-five years although I believe more strides have been made recently. I'm waiting for the proof in the pudding like everyone else. I would base your planning with the donor reserves you have from mother nature. In addition we do not know the long-term implications and efficiencies of finasteride, dutasteride, etc. These medications may "slow down" our genetic hairloss but they are not the cure. They are only buying us time. Again, at age 25, go to be examined by a reputable HT doctor. You can look up many in this forum's Coalition of doctors at hairsurgeons.com and/or ask many of us right here in this community or other communities. You will find consistency in feedback regarding the good ones. But utimately it will be your own choice based on your own criteria. That's why the more informed you are, the better equipped you will be to make the right decisions for Taoofjord. I truly hope this response has been helpful and I wish you the very best now and in the future. Take care!