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Yedela

Thinking of having 2nd FUT -- Advice requested

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Hi everyone,

 

I am a 40 year old woman experiencing a receding hairline in my temples; my hairloss is not the typical female-pattern hairloss (go figure), and it actually looks like a Norwood II -- not exactly the most attractive or feminine appearance for someone entering her forties. I had some thinning in my temples for about ten or fifteen years already but it wasn't until my mid-thirties when it really became obvious. I always liked to clip my hair up but around that time I stopped doing it as much because it would expose my temples. About two and a half years ago I went to my dermatologist and she conducted a scalp biopsy and sent it to a lab that determined I had androgenic allopecia. She also had me start a Rogaine regimen (I use 5% foam -- yeah I know it's not marketed for women but so what, it works for me) and prescribed Propecia (1mg daily) for me (again not marketed for women, but she strongly recommended it to me on account of my kind of allopecia). I had to go off the Propecia after 2 weeks because of side effects (I was getting daily splitting headaches), but after waiting a month I went back on it and the headaches never returned. So I have been on the Propecia ever since.

 

A few months later I had a 900-graft FUT procedure with a highly recommended surgeon; I notice he is also a Coalition member on this site. It went smoothly and the healing went well too, but there are some issues. On my left temples, most of the grafts have pitting and there are compacted follicles. Oddly enough this isn't so much a problem on my right side. Also the density is much better on my right side than on the left. I think though that might have something to do with the fact that the recession was worse on the left side, and there were more native hairs on the right side than the left. Also the Rogaine really worked well with the front hairline. I know some people say it doesn't work with the front hairline but that's not the case; I was growing hair even on my forehead where it dribbled down where hair never grew before. I think the Rogaine really helped the transplanted hairs blend in well. It would have been thin with the transplants alone, and I understood when I had the procedure that I may need a second transplant. I hoped I wouldn't have another one because it was really uncomfortable having a head wound, but with the Rogaine it looked reasonably thick so I thought I could get by with just one strip procedure.

 

Well then in June of last year I stopped the Rogaine, for various reasons. I feared it was giving me facial hair, it was a pain to travel with the foam (didn't fit in the TSA-required quart bag), and I guess I thought I didn't really need it anymore with the transplants; I underestimated how much the Rogaine hairs gave me density. Plus I didn't want to have to use it twice a day for the rest of my life. It wasn't a decision I thought through; it just kind of happened. Maybe in part due to laziness. Anyway it was a big mistake because then the native hairs started to shed, and in a larger area than the original receded regions. I noticed thinning in July, and then it looked really bad in August. And now in March, I've started the Rogaine again and I'm thinking again about getting that second transplant. I have also had some dandruff/skin flakiness in the temples in the past few weeks (which I've treated with ketoconazole), and I don't know if that contributed further to the appearance of bareness.

 

So now I have a lot of questions and things I'm thinking over. I hope I can get back some of the hairs I lost, but I realize I probably won't get what I had before. I have wondered if the Rogaine made hairs that wouldn't have otherwise been lost dependent on it, such that the area of loss is now bigger than it would have been without it (does that make sense?). I also wondered if this was a shed that would come back on its own but 9 months I don't think that's the case. But right now things are unacceptable, particularly on my left temples where things have always been worst. Now there is much visible scalp, the transplanted hairs are sparse with much space between them, and now they are sort of their own island separated from the rest of the hairline. So I am pretty sure I will need to get the second round of transplants.

 

The next question is...which surgeon? I could go back to the surgeon who did my first transplant (a Coalition member approved by this site) or try someone else. I have read that pitting is due to surgeon error -- is that true? If so, that would be one strike against this person. Also he was very expensive, around $8.50 per graft. I had a consultation with Dr. Pak in LA area and I was very impressed with him, and he charges only $5 a graft. That means with my budget I could have more grafts with someone who, from what I read, has a very good reputation. I would prefer to have just one more procedure to fill out my front hairline rather than needing two more. And I would like to use the smallest strip necessary for my surgery, as I would like to reserve as much donor material as possible for the future if god forbid things get worse. So I would also like to know if what you see in the pictures reflects what I should have received with 900 grafts. And if you all have any opinions on how many grafts I need to get good density, I would also be interested to know. I am open to other hair docs too. What I can't be open to is FUE; it's just not possible for someone with long hair. Oh yeah, and another question I have pertains to the timing of the procedure. I have had bouts of telogen effluvium in the past; it got really bad in 2007 and then improved and then I had a small bout of it last year and now I'm on the mend from that. If I have the procedure done at a time when I am experiencing this excessive shedding, that would result in a lot of wasted folicles, or not? So I am thinking I should schedule HT at a time when I am having minimal shedding (I have a good handle on this -- my dermatologist has gotten me in the habit of saving the shed hairs during each shower, so I can see when I am shedding a lot as opposed to when I am shedding only a little).

 

I am also worried that the Propecia is not doing me any good, as I still seem to be losing hair. I know it doesn't work for everyone. But there is no chance I'm giving that up.

 

Okay, so let me share some pictures of my ongoing hair situation. Let me start with pictures of my hairline from over a decade ago. The quality isn't that good because they were taken with film, but you can see some thinning on my left temple:

 

hairdecadeago2.jpg

 

hairdecadeago3a.jpg

 

And this is how it looked about a year before I had the transplants...you can see the thinning quite clearly.

 

hair1yrpre.jpg

 

hair1yrpre2.jpg

 

And this is how it looked when I went to my dermatologist for the skin biopsy (yuck :():

 

hair2mospre.jpg

 

And here are the same areas the day after receiving the transplants:

 

hairnxtday2.jpg

 

hairnxtday1.jpg

 

This is at the 7 week mark:

 

hair7weeks2.jpg

 

Notice the hair going down my forehead! Rogaine really does work on the front hairline (at least it does for me).

 

Okay here I am at the two month mark, and notice the pitting, about the same as it is now:

 

hair2mos.jpg

 

Okay then when the hair grew in, I was pretty satisfied with it, and didn't take any really good closeup pictures. But this is how I looked last March, a year ago:

 

hairmarch.jpg

 

As you can see, the hairline looks smooth, natural, and full. Lots and lots of Rogaine hairs. Here is a closeup of my left temple:

 

hairmarch2.jpg

 

Then after ending the Rogaine, the shedding started. I noticed it was looking thinner by July (bear in mind that my fringe is hanging down in this photo as opposed to me holding it up):

 

hairjuly2.jpg

 

And it was looking dreadful by August (I know this is a crappy quality picture):

 

hairaugust.jpg

 

And this is how it looks now (I know it looks unhealthy but bear in mind that it is uncombed and some hairs are sticking up due to Rogaine foam):

 

hairnow2.jpg

 

hairnow.jpg

 

Anyway, I hope that gives you all some good info to start with. I look forward to reading your comments. :)

Edited by Yedela

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I've started my sister on regaine foam for her crown. Not sure if a woman is ever meant to use Propecia though! You should stay well clear.

I went with my sister to have her hairline done. Dr Hasson operated on her. Nice early growth by month 3. Will have to go back for the crown.

You can consider using Biotin & MSM

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Since you are in California, you should see Dr. Carman or Dr. Reed at La Jolla Hair Restoration. Both surgeons are Coalition members. In fact Dr. Reed is a past recipient of the Platinum Follicle Award, the highest awarded to HT surgeons.


Finasteride 1.25 mg. daily

Avodart 0.5 mg. daily

Spironolactone 50 mg twice daily

5 mg. oral Minoxidil twice daily

Biotin 1000 mcg daily

Multi Vitamin daily

 

Damn, with all the stuff you put in your hair are you like a negative NW1? :D

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Wow, $8.50 for FUT? That's more than most charge for FUE.

 

The FUT work looks pretty effective, though, and you were fortunate to get the added boost with the Rogaine. Women can use Rogaine - it's only propecia that is meant for men. I hope that the doctor who prescribed it knows what they are doing. Perhaps it might be worth seeking a second opinion on that... (?)

 

It's tough to really tell what changes have occured by looking at the photos as, despite being clear, they do differ a lot in angle and in how the hair is brushed. If you've noticed that areas have thinned then they probably have. This might be due to hairs becoming dependent on the Rogaine, but it could just be a continuation of the same hairloss that drove you to begin treatment in the first place. I wouldn't expect hairs that weren't grown due to the Rogaine to be dependent on it, but that can't be ruled out.

 

Regarding the telogen effluvium: it's probably wise to coordinate surgery with your hair being at it's fullest - for the reason you stated as well as to ensure that by having surgery you won't be damaging follicles that can still produce healthy hairs.


I am a patient and representative of Dr Rahal.

 

My FUE Procedure With Dr Rahal - Awesome Hairline Result

 

I can be contacted for advice: matt@rahalhairline.com

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A lot of physicians will prescribe Finasteride to women as long as they aren't albe to have any more children. That is where the risk lies. The women must also have AGA for the Finasteride to be effective.


Finasteride 1.25 mg. daily

Avodart 0.5 mg. daily

Spironolactone 50 mg twice daily

5 mg. oral Minoxidil twice daily

Biotin 1000 mcg daily

Multi Vitamin daily

 

Damn, with all the stuff you put in your hair are you like a negative NW1? :D

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The work done doesn't look very impressive. I would definitely look at a different doc. Keep doing research and you will find the right one. I don't believe the you will lose more that you would have lost anyway by stopping rogaine.


I am an online representative for Dr. Raymond Konior who is an elite member of the Coalition of Independent Hair Restoration Physicians.

View Dr. Konior's Website

View Spanker's Website

I am not a medical professional and my opinions should not be taken as medical advice.

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