Sugar Goes to Ottawa - My 2822 FUE with Dr. Rahal

[SugarHighs]

I've also had a lot of itchiness in the recipient area. I am not sure what this is from, but probably I would assume dried minoxidil at the end of the day?

 

Instead of scratching this area, what I have done is gently shampoo it after getting it wet - but that also has the grafts shedding.

 

Does anyone else experience the feeling of itchiness after minoxidil dries, and then a subsequent shed of some grafts (not referring to native hair). ?

 

Thanks,

Sugar

[SugarHighs]

A couple more photos after a haircut. The missing density is more visible here.

[PupDaddy]

SugarHighs,

 

I must say, yours seems to be an unusual case. Notwithstanding that you have a beautiful head of hair as is, it does appear from your photos that some of the transplanted hair that was growing in at the 4.5 month mark has shed and gone dormant, and that some of your native hair behind the transplanted hair might have gone dormant as well. If one or both actually is happening (it is always difficult to judge from self-taken photos with different hair lengths, lighting, angles, hair product, etc.), I suppose the $64,000 questions are: (a) why, and (b) will this situation reverse itself?

 

Some conceivable causes:

 

1. delayed shock loss of native hair

 

2. insufficient blood supply to support all the densely packed grafts, causing no growth of some and a slow, diffuse die-off of others (can that happen?)

 

3. temporary shedding/resting of transplanted and/or native hair due to minoxidil

 

4. allergic or idiosyncratic response to minoxidil

 

I wonder whether Dr. Rahal might advise discontinuing minoxidil to rule in or rule out no's 3 or 4? If

no. 2 is happening, either alone or in combo with 3 or 4, I would think that a density touch-up session after a 12-month resting phase would do the trick (although I would want to ask Dr. Rahal whether scarring in the recipient area would pose a challenge), and if no. 1 is occurring, I would think that chances are good that the native hair will return in time.

 

Please do keep us posted about your efforts to solve this mystery. I am not at all surprised that Dr. Rahal has assured you he will take care of you. He will! It must be maddening not to have completely smooth sailing, but I have no doubt but that you will end up with everything you wanted from your ht. Hang in there!

 

 

 

 

 

Regarding no. 1, I would think that the native hairs would return on their own.

[Sean]

Sugar, I am following you & can see what you mean. Pupdaddy, you gave some very atriculate points. Whatever the case, Sugar needs the look he wants soon so he can enjoy life stress free. Maybe cruising in a nice convertible with no worries , whatever it may be. Sugar, lets see how it looks with the other camera as well. I got 11 month and then conclusion of 12 month to go for a similar procedure till my timeline ends. Best wishes and growth to you.

[Mickey85]

Another one, illustrating the right side, thinning going toward my original hairline. The photos make it look a little better than it looks in the mirror.

 

I do see why you are concerned. Good to know Dr. Rahal will take care of you should the problem not remedy itself, he is a stand up guy. I wish you all the best and hope this is just a temporary shed.

[SugarHighs]

SugarHighs,

 

I must say, yours seems to be an unusual case. Notwithstanding that you have a beautiful head of hair as is, it does appear from your photos that some of the transplanted hair that was growing in at the 4.5 month mark has shed and gone dormant, and that some of your native hair behind the transplanted hair might have gone dormant as well. If one or both actually is happening (it is always difficult to judge from self-taken photos with different hair lengths, lighting, angles, hair product, etc.), I suppose the $64,000 questions are: (a) why, and (b) will this situation reverse itself?

 

Some conceivable causes:

 

1. delayed shock loss of native hair

 

2. insufficient blood supply to support all the densely packed grafts, causing no growth of some and a slow, diffuse die-off of others (can that happen?)

 

3. temporary shedding/resting of transplanted and/or native hair due to minoxidil

 

4. allergic or idiosyncratic response to minoxidil

 

I wonder whether Dr. Rahal might advise discontinuing minoxidil to rule in or rule out no's 3 or 4? If

no. 2 is happening, either alone or in combo with 3 or 4, I would think that a density touch-up session after a 12-month resting phase would do the trick (although I would want to ask Dr. Rahal whether scarring in the recipient area would pose a challenge), and if no. 1 is occurring, I would think that chances are good that the native hair will return in time.

 

Please do keep us posted about your efforts to solve this mystery. I am not at all surprised that Dr. Rahal has assured you he will take care of you. He will! It must be maddening not to have completely smooth sailing, but I have no doubt but that you will end up with everything you wanted from your ht. Hang in there!

 

 

 

 

 

Regarding no. 1, I would think that the native hairs would return on their own.

 

Hey Pup,

 

Thanks for the reply, and you do make a good point there. I will check with Dr Rahal on Monday to see if I can dial down from minoxidil twice per day to once per day.

 

Previously, my patient adviser said I could do that, but I had only be doing so once in a while. I'm going to check if it's ok to go to once per day permanently. I am just a little worried that there may be minox-dependent hairs there.

[PupDaddy]

Hi SugarHighs,

 

I might be inclined to get Dr. Rahal's okay to discontinue minoxidil completely for now. If you are having an allergic or idiosyncratic response to it (or to one of the inactive ingredients in the formula you're using), I don't know that assaulting your scalp and grafts with it once per day rather than twice per day would make a difference. I doubt that any of your grafts are minoxidil-dependent. So far as I know, Dr. Rahal and other ht docs who recommend minoxidil post ht do so only as a "boost" to stimulate the viable grafts to grow faster. It isn't the usual use for minoxidil, i.e., to re-awaken long dormant follicles that will thereafter require the drug if they are to continue their life cycle. If there was a risk of grafts transplanted from the donor area safe zone becoming dependent on minoxidil for continued viability, I doubt that ht docs would advise using minoxidil on them in the first place or advise discontinuing using minoxidil on them after one year. Same thing for previously viable hair adjacent to or surrounding the grafts.

 

Just my thoughts.

[SugarHighs]

Hi SugarHighs,

 

I might be inclined to get Dr. Rahal's okay to discontinue minoxidil completely for now. If you are having an allergic or idiosyncratic response to it (or to one of the inactive ingredients in the formula you're using), I don't know that assaulting your scalp and grafts with it once per day rather than twice per day would make a difference. I doubt that any of your grafts are minoxidil-dependent. So far as I know, Dr. Rahal and other ht docs who recommend minoxidil post ht do so only as a "boost" to stimulate the viable grafts to grow faster. It isn't the usual use for minoxidil, i.e., to re-awaken long dormant follicles that will thereafter require the drug if they are to continue their life cycle. If there was a risk of grafts transplanted from the donor area safe zone becoming dependent on minoxidil for continued viability, I doubt that ht docs would advise using minoxidil on them in the first place or advise discontinuing using minoxidil on them after one year. Same thing for previously viable hair adjacent to or surrounding the grafts.

 

Just my thoughts.

 

Thanks, Pup. I've posed the question to the patient advisers - minox twice, once, or discontinued. The thing is, I've used Kirkland Minox since two weeks post op, so it would be weird if it only became a problem for me in the last 3 months.

 

I agree that the hairs from the safe zone should not ever really become minox dependent, that would be strange.

[Spanker]

That is a good thing that the doctor promised to take care of you. I definitely see you concerns and it has gotten to where it looks "surgical" under heavy light be because your ht was pretty aggressive as far as the hairline. I wish you luck and hope good things for you. This is unusual for a Rahal result. Again. Good luck.

[HARIRI]

There is similarity in your case with Sean, Were 2800 grafts extracted and implanted in one day?

[SugarHighs]

There is similarity in your case with Sean, Were 2800 grafts extracted and implanted in one day?

 

Yes, but I wouldn't say that there is necessarily a correlation. We just don't know.

[SugarHighs]

What's weird is I have always associated itchiness with DHT attacking the follicle - but these follicles in front should be resistant to DHT as they came from the back/side.

[Janna]

It sounds like your skin is sensitive to Minox. You may want to stop using it for several weeks. I personally do not think it's worth it to apply Minox if you're skin is irritated by it.

[MAGNUMpi]

I had the same reaction to Minoxidil and had to stop using it a few years back.

[HARIRI]

Then just wait for L'Oreal Neogenic release on September, a topical alternative to Minoxidil.

 

Check the link below...

 

L

Edited August 9, 2012 by TakingThePlunge

[Sean]

What's weird is I have always associated itchiness with DHT attacking the follicle - but these follicles in front should be resistant to DHT as they came from the back/side.

 

Sugar, is it iching with the minox applied or does it occur hors later? The follicles should be resistant to DHT as they came from the back of the head.

 

Dr. Rahal explained the donor in this video from 8/8/2012.

 

Edited August 9, 2012 by Sean
added Dr. Rahal video from 8/8/2012 for educational use

[SugarHighs]

Sugar, is it iching with the minox applied or does it occur hors later? The follicles should be resistant to DHT as they came from the back of the head.

 

Hey Sean,

 

It occurs many hours later, usually at the end of the day when I'm taking my shower.

 

Did you experience anything similar with the Foam? Or any general itchiness in the reipient area?

[SugarHighs]

It sounds like your skin is sensitive to Minox. You may want to stop using it for several weeks. I personally do not think it's worth it to apply Minox if you're skin is irritated by it.

 

Thanks, Janna. It would be weird if I were allergic to minox, because I don't remember any problems in the first few months.

 

Perhaps I've developed an allergy?

 

In any case, my patient adviser recommended dialing down to one application per day. And also to try Rogain foam. I've been using Kirkland Minox, however I may try Lipogaine prior to the foam, because it's less itchy.

 

The plan is too wash my hair no more than 8-10 hours after the minox so as not to allow the situation to become itchy.

 

If I still have the problem, I'll discontinue minox completely, but I'm kind of worried that I've got hair dependent on it now.

 

In retrospect, I wish I never had used it, or had only used once per day.

 

Since the follicles are DHT resistant, I would imagine they should grow back hairs once the irritation factors are removed?

 

Or can dried minox permanently damage a DHT resistant follicle? I would certain hope not - that would kind of be a pretty big flaw in a product designed to grow more hair.

[Sean]

Hey Sean,

 

It occurs many hours later, usually at the end of the day when I'm taking my shower.

 

Did you experience anything similar with the Foam? Or any general itchiness in the reipient area?

 

Hey bud, I did experience slight itch but i was assuming it could have been due to overdrying the area. It wasn't an itch that would be enough to be bothersome but as some folk reported in the past. But doesn't happen all the time and is temporary. Did you find out anything about it from the clinic or if you should continue it?

 

----

update: Sugar, disregard my last question. I wasn't able to see the post from your answer to Janna above due to Ipad issue. Thanks for the update.

Edited August 9, 2012 by Sean
Didn't see post #119, which, answered my question

[Mickey85]

The Minox itch dissipated when I switched to Lipogaine. It's not totally erradicated but much less noticeable now. Although the Rogaine foam makes the hair look thicker than Lipogaine.. Pros and cons.

[HARIRI]

Guys, I would stay away from the foam.. Liquid Minoxidil is better. Dr. Bernstien mentioned in his website:-

 

"Rogaine comes in a number of different forms. It comes in a 5% solution for men, a 2% solution for women and a 5% foam. The original formulation was the 5% solution for men, which has propylene glycol in it. The propylene glycol is what actually allows the medicine to penetrate into the scalp. That’s the best vehicle, the most effective way of getting the medication into the follicles. And that’s why it was originally designed that way. Many medications have propylene glycol as a base.

 

The problem with propylene glycol is that it is irritating to the scalp in some patients, and some patients actually can have an allergic reactions to it. Also, it is a little bit greasy. So because of that, for women, they put the minoxidil in an alcohol-based solution, so it’s going to be a little less effective, but less greasy.

 

Then, a number of years later they came out with men’s foam which has no propylene glycol in it. The problem with the foam is that, even though it is aesthetically a little bit nicer, it doesn’t really allow the medicine to penetrate quite as well into the scalp. Also, the foam is very hard to get on the scalp, especially if you have a lot of hair. It seems like the foam gets caught up in the hair, where with the liquid, you can separate the hair and get the liquid directly on the scalp.

 

What’s interesting is that although Rogaine has been prescribed in the packaging insert to be used twice a day, often people can get the same results if they put it on more liberally just once a day at night. So if you can put it on at night and use the propylene glycol based solution, the 5% men’s solution, then you can circumvent the cosmetic problems with it being greasy because you can wash it off in the morning. Most people take showers in the morning.

 

So what we advise most people to do is use the more effective 5% just once a day, at night, wash it out in the morning and then you’re done.

 

The other thing is we find that when people use the medication twice a day, it’s kind of a nuisance. They kind of just dab it on and you really want to get a good even coat of the entire areas that have the potential to be bald, not just the areas that are thinning a lot. Because the medications work, as you know, as a prevention just as much as regrowing hair back."

 

This is the link Which Is Better: Rogaine Foam Or Liquid? | Bernstein Medical - Center for Hair Restoration

[BobbyO]

Congrats! What was your total cost?

[SugarHighs]

The Minox itch dissipated when I switched to Lipogaine. It's not totally erradicated but much less noticeable now. Although the Rogaine foam makes the hair look thicker than Lipogaine.. Pros and cons.

 

Thanks, Mickey and Hariri. I used the foam once per day for a bit, and it relieved the itch, but it caused even more thinning out of my recipient area. I am using liquid minox now, once per day at night. This has alleviated the itch, but my recipient area is still very thin.

[SugarHighs]

I have very little growth in the recipient area, especially on the right side. I am going to meet with Dr Rahal in one week to see what the way forward is. I believe I will almost certainly require a hairline repair now.

 

I will post some photos next week, when I will have photos taken by Dr. Rahal (once they are available) and also by my brother.

 

The problem is the hairs at the new hairline have grown, but the areas above that (recipient areas) are now almost hairless. The lady who has cut my hair regularly for the last few years has even noticed it.

 

On some days it looks ok, but others I no longer even want to go outside in daylight, which is a problem I never had before the procedure. I won't yet say to avoid FUE - however I do want to get Dr. Rahal's opinion on what happened here, and also on a way forward.

[Spanker]

Did you have any miniaturization in your forelock area prior to surgery? Do you think the thinning is in the area that was implanted or in the area behind it.

 

Your forelock looked solid in your 6 week photos. Are u on fin? I have never seen someone thin that fast at your age before.