Dr. Timothy Carman

Note this is a "generic" 1 mg finasteride tablet. Interesting, since there is an active patent on Merck's 1 mg tablet, "Propecia", and producing, distributing and selling of a 1mg finasteride formulation I believe is not legal. (This may be why it says for export only.)So you would need to be careful when it comes to the one mg finasteride "generics".

Also:

This is what some of the generic 5 mg tablets look like:

This is what Proscar looks like:

S777- From the description you give of the time frame of your hair loss, and especially the fact that your hair loss "has slowed down a lot since about 21 years old" leads me to believe that your experience was one of a normal maturation of your hairline which occurs in all males around the years you describe. That is a completely different entity not related to DHT-induced hair loss, or male pattern baldness. It's difficult to assess just how "uneven" your hairline actually is, as I don't believe you've uploaded a frontal view. Do your research (this is an excellent resource, the HTN), and, as it is a big investment, geographic location should not necessarily limit your decision, though I realize "down under" is a bit further away than most-(Having been on that flight from the U.S. and back, I know....). Hopefully you can get a frontal shot up so we can be of further help-

Interesting thread. The main concern I have with the removal of two strips as shown is the chance of necrosis (tissue death) in the portion between the two donor areas. This, in my opinion, is very very risky. That middle section's superficial vascular supply has now been limited to the lateral portions; i.e., there is compromise in the blood supply which may result in disastrous consequences-large tissue loss requiring serious reconstruction. This technique falls far outside basic principles of surgical practice, again, in my opinion. Dr. Madhu did point out he has some criteria for which most patients do not qualify, and I am curious as to what specifically would make a patient a candidate.

Great Discussion- As Bill points out, the pros and cons of using nape hair have been batted around for a while now. The point he brings up about the possible susceptibility of that hair to disappearance over time via DHT sensitivity carries a high probability. Another concern, not mentioned, is the scarring that may occur in that area: it is usually greater/more pronounced than in the "usual" area we take grafts from, and this is due to the nature of the "stuff" below the surface of the skin/hair in that area: muscle vs bone. The greater mobility of the tissue in this area produces greater scarring. Again, this would be minimized by using FUE to get your grafts out of the nape area, but believe me, scarring/absent hair in that area would be readily apparent, tipping off the casual observer that said person was a "transplantee", a bit of information most patients would like to keep to themselves. That said, using the available surgical methods along with an artistic eye, today's well trained/experienced hair transplant surgeon should be able to recreate a natural appearing, undetectably "man-made" hair line without resorting to the use of nape hairs. Personally, the hairline is one of my favorite and most satisfying areas to recreate- it really makes a huge difference whether or not one's face is "framed-in" by hair or not. Good question.

We have added 14 month Follow up Photos to this patients case. There are several views to show the use of ultra-fine follicular unit graftimg in the patients hairline to soften the previous look. As well, his scar revision was accomplished utilizing a modified tricophytic closure technique. Patient is a 26 YO who had a previous procedure done at another clinic who felt the hairline looked a little too much "like a transplant", and as well had concerns about the appearance of his donor scar. Our goal was to soften the hairline while revising the donor area. His scalp had less than average laxity, and along with the previous scar this lowered his available graft supply to about 1500 FU grafts.

As the closure in the case of the tissue expander would be under virtually no tension, this may mitigate the reformation of the scar. (Less likely.) Expanders can be used for scalp reduction, as I described in the case of a patient with extensive grafted skin to the scalp secondary to 3rd degree burns.

Turbo- I believe the poster ".." is referring to the use of a tissue expander (not "air" filled.) I used this technique extensively in the past in burn reconstruction, where large areas of injured scalp required excision. We can also use tissue expanders in other cases, such as hairline lowering procedures in women who have congenitally large foreheads. The procedure is quite successful, though it is very costly and time intensive, requiring visits twice weekly to the surgeon's office to slowly fill the balloon with saline over a period of 2-3 months. The principle is as follows: Using your situation as our example, an incision is made along the scar, and the scalp is separated from the underlying bone (skull) as far forward as the frontal hairline, a process known as undermining. The width of the undermining would be about 15-20 cm, about the width of your scar. After tunneling, a flat (deflated) surgical balloon is advanced so that it lies under the scalp that has normal hair (anteriorly, toward the front, not under the scar). A small port that attaches to the balloon via a tube is placed under the skin, usually just behind the ear. This is where the saline will be injected during the inflation process. The incision is sewn up, and the would allowed to heal. Successive filling of the balloon over 2-3 months leads to a very bizarre looking scenario due to stretching and expansion of the area under the normal hair bearing scalp. At the end of the filling period, the patient is brought back to the OR, and the balloon is removed. The result is a large area of uniformly expanded hair bearing scalp that can be pulled over the area where the scarring occurs. The scars are completely excised, and the normal hair to normal hair edges are approximated under no tension whatsoever. The results are immediate and dramatic. (You can imagine in the case of our burn patients.) Again, this is a costly and much more invasive procedure than a simple transplant scar excision as discussed above, but the results are very, very gratifying. I pass this on to you so that you and everyone are clear as to what I believe ".." was referring to.

fr33k- There are a good number of posts on the subject here already. Search the forum for some great discussions- In general, the scar can be excised as part of a subsequent procedure, or simply as the sole procedure (scar reduction). There are many factors which may influence what caused you to scar in the first place- age (younger = greater chance of scarring); placement (donor strips taken "too low" can result in inreased scarring); donor closures done under "too much" tension; an individual propensity to scar (despite the surgeons minimizing the effects of all the above)- and all these should be looked at in your case, as any contributing factors that can be avoided the second time would need to be identified- Also, if there are contraindications for excision, and FUE procedure with grafts placed into the scar would be another option (also an option without any contraindications). There are some very helpful folks here so look thru the forums- it's a great resource.

turbo- I would strongly recommend that you wait at least one year between procedures. This period is critical, IMO, to obtain laxity in the scalp as well as allow the postsurgical areas (donor especially) to fully heal. I would not recommend placing any grafts into that scar prior to one year, let alone at 6 months. Given your propensity for tissue reaction, I believe in your case that "haste WOULD make waste". Allow time for healing- that will be a critical factor in your progress, as far as I'm concerned.

Turbo; From the second photo it would appear that you have TWO scars, with hair present in between- is that accurate? This would present a more complicated issue than a simple revision, IMO. First, we need to try and deduce why the scarring is occurring in the first place. Another excision may simply reproduce the result. Also, as I said, that island of hair within (if thats what I'm seeing)really makes a multiple staged procedure all the more probable as a repair solution. FUE into the scars is another option.

IMO- Too young for surgery at this time- Get on finasteride, which should be quite well tolerated at your age, and go with that for now. Rogaine will work synergistically with finasteride (1 + 1 = 3....), so that would be of use as well.

johnboy- Actually, I have found that temporal point reconstruction, in general, is another one of those cases where "less is more". IMO, you don't want to aggressively recreate dense growth; only carefully place a minimal number of strategically placed grafts that suggest the presence of those important landmarks. This patient I recently posted actually is a good example of just that: http://hair-restoration-info.c...21087683/m/120101082 Note the subtlety of the restoration; actually only about 75 grafts or so per side- Hope this helps-

Competently done- 8 hrs- at least.

This 66 year old female came to us for revision of her facial hair line, which, as a result of multiple facelift procedures, had been moved posteriorly and superiorly, relative to it's naturally occurring presurgery position. Specifically, then, she had alopecia and scarring from those procedures which had resulted in: 1) Receded frontal and bitemporal hairline; 2) Elevation and recession of temporal points bilaterally; 3) Recession of bilateral sideburn areas. 4) Scarring/thinning in areas posterior to sideburn areas. As this was not a case of FPHL, she had an excellent donor supply. From a donor ellipse measuring 29 x 1.4 cm2 we utilized all FU grafts in the following distribution: 3458 Total; 1's = 1129; 2's=2166; 3's=163. There was acceptable closure tension using the tricophytic technique.

IMHO- Too young, HT not indicated based on your presenting history. Recommend medical management (finasteride, Rogaine) at this point.

jonesnyc- Welcome to the HTN- Yes- anything you can do to be proactive in slowing the progression of hair loss is a good idea. I would also recommend looking into taking finasteride, 1mg/day as well. It would be ideal to get photos of the degree of loss you have now, and compare that to photos taken on or before your transplant date, having been on both meds for that interval of time.

Thank you all- Your positive comments are greatly appreciated.

M1A1- Thank You- Our donor strip had a native density of about 60 FU/cm2, and measured 24 cm x 1.4 cm. Thanks for the reminder- I'll put that in the original history as well.

This pleasant 45 YO businesswoman presented to our office with classic female pattern hair loss. Typically, these cases can be a challenge for two reasons; 1.) In FPHL the donor area commonly has the same low density as the area which is to be transplanted. For this reason, the area to be transplanted is "targeted" to where the thinning shows the most- usually along the partline. 2.)The native hair in which the transplant will occur can be quite miniaturized, therefore rendering it more susceptible to permanent "shock" loss, which can work against our overall goal of increasing local hair mass. This patient had the benefit of a very lax donor which yielded more grafts than is usually the case. As you can see, the outcome is not a dramatic one, though there is an improvement from baseline. Total FU Grafts: 2098; 414 = 1's; 1639 = 2's; 45 = 3's. Our donor strip had a native density of about 60 FU/cm2, and measured 24 cm x 1.4 cm.

I thought this would be a good case to illustrate the use of hair restoration as a corrective procedure following facelift surgery in a female patient, something less encountered here on the forum. Pt is a 66 YO female with the following deficits: Preoperative Diagnosis: Alopecia and scarring secondary to previous surgical procedures (facelifts), which have resulted in: 1)Receded frontal and bitemporal hairline; 2)Elevation and recession of temporal points bilaterally; 3)Recession of bilateral sideburn areas. 4)Scarring/thinning in areas posterior to sideburn areas. Our goal therefore, is to create the frontal and temporal hairlines, as well as the bilateral temporal points, taking care to utilize a large number of single hair grafts to recreate a softer appearing hairline, especially important in the temporal point and sideburn areas. A total of 3458 grafts were used in the case as follows; 1's = 1129; 2's=2166; 3's=163.

33 yo male 2100 FU Grafts. After an in depth consultation discussing the ramifications of recreating a more aggressive hairline at his age, this gentleman elected to go with the hairline shown, understanding the concepts of limited donor supply and the progressive nature of MPB. There is a familial history of very "self limited" crown loss in males on his fathers side, the loss in the crown being limited to thining (not complete hair loss down to bare skin) in a 4 x 4 cm area, and he himself does show miniaturization in a area 5 x 5 cm in the crown. At 7 months post op he shows about 60% of his grafts in the growing phase, and is quite pleased with the results so far.

33 yo male 2100 FU Grafts. After an in depth consultation discussing the ramifications of recreating a more aggressive hairline at his age, this gentleman elected to go with the hairline shown, understanding the concepts of limited donor supply and the progressive nature of MPB. There is a familial history of very "self limited" crown loss in males on his fathers side, the loss in the crown being limited to thining (not complete hair loss down to bare skin) in a 4 x 4 cm area, and he himself does show miniaturization in a area 5 x 5 cm in the crown. At 7 months post op he shows about 60% of his grafts in the growing phase, and is quite pleased with the results so far.