Jotronic

What did both doctors tell you?

Finpecia has not increased the progression as that indicates that it is contributing to your hair loss. The only reason for your progression is that you have higher DHT levels than your current intake of Finpecia can handle, in a manner of speaking. You should first take measures to stop your hair loss rather than getting a hair transplant because that is only treating the symptom, not the cause. You should consider upping your intake frequency to daily, not every other day, as that is how the medication was intended to be taken and in my clinic we see a direct correlation of results to the amount of finasteride taken. In other words, the more you take, the better it works. By starting with a hair transplant now you are only setting yourself up for continual surgeries until your donor is depleted.

You may only be concerned with the front for now but you WILL be concerned with the back when, not if, it goes. That is why Propecia is important now, not later. Not to mention, the fact that if you let your loss continue then you won't have enough donor to return the back to it's current state regardless of how you feel about having additional surgeries. You mentioned you are having the temples done, what about the area behind the forelock? This area is thinning from what I see in the photos and in my opinion you'll need more than just 1100 grafts. I think you'd need at least 2000 to fill in all the gaps of the front, not just the temples.

Traction alopecia comes from years of sustained traction in one spot. Scalp laxity exercises only apply traction for very short periods of time in the grande scheme of things so you have nothing to worry about.

You should not limit yourself simply to Neograft clinics only. Neograft is nothing more than a tool and in my opinion is a poor one at that. Many Neograft clinics will have the same results posted on their websites as other Neograft clinics which means that there are not enough decent results by these clinics to show they do good work. One clinic has even used photos from the clinic I work for as their own thereby deceiving people like you trying to do their research. Avoid Neograft, stick with a clinic that has years of experience and more importantly, uses their own photos.

I don't think doctors outright lie about numbers. In the scenario you presented you are asking about whether or not free grafts are included in the advertised graft count? Most likely, yes. However, the bigger issue to be concerned about is the actual presentation. I see far too many clinics still using tricks to make a result look better than it does if you were face to face with the patient. This, in my opinion, is the big lie.

Understood, Goforit, but that's not my point. This patient would not be forced to shave by any clinic that normally requires it.

This is not really a good example of a patient that you didn't have to shave simply because there really wasn't much to shave to begin with. The recipient area is anterior to the region of higher native density but even this area is questionable. Shaved or not the hair of the vertex behind the recipient area would be used to cover the front in most similar cases. Do you have any non-shaved examples of diffused thinners with a megasession?

A proper scar revision will require cutting out all of the scar so that only healthy skin tissue meets healthy skin tissue when the wound is closed for the best healing. How this is done depends on the doctor performing the revision. Some doctors will follow the exact outline of the existing scar to purposely avoid getting viable grafts. However, this will always yield at least a few grafts. Other doctors will instead remove all of the scar tissue based on the laxity in the immediate vicinity as the revision progresses along the scar line, which will always result in some grafts being removed as well. This can vary to just a handful of grafts being 20 to 30 or up to 400 or so depending on the size and variations of the scar shape and direction. I hope this helps.

This patient flew in to Vancouver so that Dr. Hasson could give him the biggest cosmetic improvement possible in one procedure. He had lofty goals in that he wanted good density for his new hairline that was completely built from scratch, strong coverage for the mid-scalp and light coverage for the crown. He sent us these photos at 18 months post-op. 1795 Singles 3639 Doubles 454 Threes/ Fours Strip Size 30cm x 2cm

Hi CD. The scar is about 2mm which is good. Yeah, the high contrast is what you are seeing but also because it is lower density than what one may find on a Caucasian so you are seeing more scalp overall. I took these photos and unfortunately I didn't have anyone available to help me but I think that I'll start putting a ruler next to each scar shot that I take for reference. Thanks for your question!

Bumping this up since I was just talking about a similar case on a different patient. The subject is that of how some Asians have very coarse hair and how it is ideal for some cases. This patient is similar to the one I just posted by Dr. Wong in that he had excellent hair characteristics.This allowed Dr. Hasson to transplant the entire top of the scalp for incredible coverage and overall excellent density.

I particularly like this result because it shows the benefits of having such coarse strong hairs as found on many Asian patients. Dr. Wong was able to utilize the characteristics of the hairs to allow for maximum benefit with strategic placement.

Ha! Thanks Spanker. How could I forget you:)? And thank you to Arochainfo, too.

This local patient came to see Dr. Wong in March 2013 to address the frontal zone and the mid-scalp. He wanted a hairline and more options for hair styles so that he could look more like his age of 34 rather than older than 34. Dr. Wong and his team transplanted 3359 grafts in one procedure with some grafts placed into the crown as well for the result you see below. 3359 Grafts 1405 Singles 1901 Doubles 53 Triples

Rootz, He had started losing his hair five years before the procedure and he had already been on Propecia for most of that time. I'm sure it helped to at least a small degree but it had little to no bearing on the final result from surgery as he had already been on it for quite some time. Win and Janna, thank you for your comments.

Not sure why but you posted twice in two threads with the same post so I'll respond in both threads as well. Olmert, Quote: Five years ago FUT was less mature as an industry. The best FUT docs were substantially better than the worst FUT docs and charged a substantial premium. Today, the technology is more mature, and the difference between the best and average FUT docs is less; so is the difference in their prices. Five years ago, in 2009, FUT was already nearly 20 years old so while it was less mature than it is today it was still twice as mature as FUE is today. If you think that there is less difference between the best FUT docs and the rest of the field you are sadly, sadly mistaken. 30% of our business, and I'm certain that of Shapiro(s), Rahal, Feller, Konior, etc, is repair from the same class of surgeons that have always cared more about your dollar than doing the best job they can. That is a fact and I see it all the time. Quote: FUE is also more mature, and just starting to become mainstream option and take over market share from FUT. No question it is growing but it is has a way to go before it overtakes FUT as the dominant form of hair restoration. Quote: So why did Hasson choose to develop his skill in the doomed field of FUT? Five and ten years ago, there were very good reasons for doctors like Hasson to develop expertise in FUT instead of FUE. FUT had more advantages over FUE (including better yield and much lower price) back then. I would wager that 5 years ago, Hasson was making more per hour than Dr. Umar. Dr. Umar, by opting to develop expertise in FUE, essentially took an immediate loss; the trade off was that as FUE matured, his product would make greater improvements than FUT would, and his profits would rise relative to Dr. Hasson's. This is exactly what is happening. Hasson is married to a diminishing industry and doomed to lower and lower the premium he charges over the average doctor. To be sure, Dr. Hasson might make more lifetime profits than Dr. Umar. This would be because Hasson got an early start. Perhaps Umar's advantage and superior profit today and tomorrow will not prove so great as to overcome his initial loss. Two reasons why this entire argument is moot. 1. Dr. Hasson started developing his skills almost 20 years ago, not five or ten. 2. You fail to understand that with FUE the profits are far higher especially when you are talking about an FUE doctor that routinely pushes several to tens of thousands of grafts (scalp and BHT) for roughly double the price of FUT. With our clinic each doctor has about 12 technicians most with close to ten years experience, some far more, and they all get paid very well to so they don't leave. With an average FUE clinic you need maybe two technicians and a receptionist. Double the cost per graft and 1/5 of the staff. Do the math. Quote: The premium Hasson charges over the typical doctor will go down and essentially be taken by the Dr. Umar's. What premium do you refer to? If a patient gets 4000 grafts the fee is 4.00 per graft. It used to be a bit lower but about 7 years ago the price went up and it's still a bargain.

Olmert, Five years ago, in 2009, FUT was already nearly 20 years old so while it was less mature than it is today it was still twice as mature as FUE is today. If you think that there is less difference between the best FUT docs and the rest of the field you are sadly, sadly mistaken. 30% of our business, and I'm certain that of Shapiro(s), Rahal, Feller, Konior, etc, is repair from the same class of surgeons that have always cared more about your dollar than doing the best job they can. That is a fact and I see it all the time. No question it is growing but it is has a way to go before it overtakes FUT as the dominant form of hair restoration. Two reasons why this entire argument is moot. 1. Dr. Hasson started developing his skills almost 20 years ago, not five or ten. 2. You fail to understand that with FUE the profits are far higher especially when you are talking about an FUE doctor that routinely pushes several to tens of thousands of grafts (scalp and BHT) for roughly double the price of FUT. With our clinic each doctor has about 12 technicians most with close to ten years experience, some far more, and they all get paid very well to so they don't leave. With an average FUE clinic you need maybe two technicians and a receptionist. Double the cost per graft and 1/5 of the staff. Do the math. What premium do you refer to? If a patient gets 4000 grafts the fee is 4.00 per graft. It used to be a bit lower but about 7 years ago the price went up and it's still a bargain.

There is a lot of conjecture in this post, Olmert. Saying that eventually all FUE docs will get FUT level yield is making a blanket statement to the capabilities, not to mention the desire to do the best work, that I think simply doesn't exist. I mean, it doesn't exist across all FUT docs so why would it exist for all FUE docs? There will always be a few standouts in any field that are separated by results when compared to their peers. When you look at FUT there are only a few that stand out. Same with FUE and that will always be the case.

Bad hair transplant and LOTS of GLH, hair in a can:)

Did your clinic tell you this? Scalp laxity has nothing to do with the recipient area much less with the whether or not grafts pop out. Graft popping is usually due to excessive bleeding, grafts being stuffed into incisions that were too small, or attempts at placing at higher densities without knowing how to do it. Popping has nothing to do with graft survival either because when they pop out they can simply be slipped back in until they "take". If you had poor growth and you have a lot of popping during your procedure the damage could have been done at various levels of the procedure, starting with the dissection of the grafts, the size of the incision to the handling of the grafts by the technicians. I'm glad your second procedure grew better for you but I needed to clarify the issue.

I took a quick look at your profile and you classify yourself as a NW3. On average you would need between 2000 and 3000 grafts to give you a good result depending on final hairline placement. If you only got 1750 and this was your very first procedure then your scalp must have been either tight as a drum or your doctor doesn't know what he's doing. To be limited to so few grafts on a virgin scalp (when performing strip) is unheard of, to me at least. I'd take a second look at why this was the case. If it was only the lack of good laxity that kept your numbers so low then you should expect even fewer grafts, maybe 60% to 70% of the original number for your second procedure. Each subsequent procedure will give you fewer grafts due to the increase in tension with more tissue being removed. Scalp laxity exercises are the only way to counter this. Here is the original scalp laxity exercises video that I uploaded over 7 years ago... https://www.youtube.com/watch?v=gOQX_WyLosA And here is the newer version that I modified to help increase the comfort level while performing them... https://www.youtube.com/watch?v=f0yZ8CuiiGY Good luck.

So did Dr. Orentreich.

Paulygon, Wow, old thread:) I need to update my pics as it's been three and a half years since my last run in the chair with Dr. Wong. In fact, last month was my 12 year anniversary of being a patient of Dr. Wong and I just got a hair cut:) Maybe I'll take some shots this weekend. Thank you for your comments.

Thank you for your comment. Part of the reason for my result is because I don't try hair styles that are meant for those with more hair than I have. I can pull off many hair styles, certainly more now than when I was 25, but I stay within the boundaries set by my situation. Another reason is because of not only the sheer numbers of grafts that were placed but also how the grafts were placed. There was a strategy with each session and for that, Dr. Wong is a genius. These factors help to overcome the natural limitations of contrast between hair and scalp color and the fine nature of my hair. I must admit that the old work that was performed before Dr. Wong helps with the appearance of volume behind my hairline as it aids in "propping up" the newer work. Where did you get a measurement for scalp laxity? I think your expectations are realistic if only your hair loss is stabilized. If you are a NW5 now at 28 then there is a strong chance you'll hit a NW6 or worse in the future and that is where the danger lies. How long have you been on the reduced intake frequency? I would recommend against getting a prescription for .25mg or .5mg and I don't think you can get such dosages to begin with. A pill cutter, as far as I know, is the only way to get such low dosages but if you have not been taking the medication at your current intake frequency for long I'd say give it more time. This is how we recommend patient take finasteride if they have had the side effects and they have not dissipated with daily intake. If your current strategy does not work out for you after about two months then you may want to consider finding a source for topical finasteride. It is rare but you may find it somewhere. We have it compounded by a local pharmacy and it seems to be working well (as well as oral fin) with no side effects to date but you will have to have a prescription from us and that can only happen if you step foot in our office. Hopefully there are others out there that have a source that is easier to get. Again, your surgical expectations seem reasonable and attainable. Just do what you can to arrest your loss first else you risk regretting every having surgery to begin with.