Looking for advice on current sitution (age 26)

[Coligion]

I'm looking to get an outside perspective on my current hair situation. Comments and advice are appreciated.

 

First, some back-story...

 

I had a 1000 graft FUT procedure at the age of 22. Prior to the procedure, I had been on Finasteride for about 8 months. At the time, my concern was with my frontal third, where I noticed quite a bit of miniaturization and loss of density. I had issues with parts of my hairline as well, but opted to not touch any of that for fear of future recession.

 

Now, roughly 3.5 years later, I can honestly say I was not at all satisfied with how everything turned out. After the procedure, I suffered a great deal of shockloss in and around the area and, to top it off, my yield was very poor.

 

I remained on Finasteride for about 2 years after the procedure, but again, I saw no evident results--yes, I know it primarily effects the crown. I was also getting some side effects, so I've now been off the meds for about 1 year.

 

Fast forward to today, and I am now 26, which is still a young age for anyone thinking of FUT/FUE for the first time, let alone an additional procedure. Overall, I know my situation is no where near dire by any means, but my hair is still very sparse and open in that frontal third/tuft area. I constantly find myself thinking about doing another procedure to increase the density there, but my age, poor prior experience, and better judgment (not to mention costs ) keep me away. I'm afraid if I were to have anymore work in that area I would risk damaging what little hair that did grow from my initial procedure.

 

Anyway, I was, of course, very young on my first procedure, but I did my best to have the grafts placed in a long-term location. Unfortunately, the procedure did not pan out well for me, so future work has always been on my mind. I've thought about having a very small procedure to have this area strengthened, but as I've said before, I'm doubtful it's in my best interest long-term.

 

I've attached a video and several photos. In the video, I try to focus on where the density is blatantly lacking. One photo is taken with outside lighting, while the others are from a CFL light source. Appreciate any input provided, thanks.

 

http://s722.photobucket.com/albums/ww223/Coligion/Other/?action=view&current=6-11-12.mp4

[waitforanagen]

Wow, 22 1st HT.

 

I personally would be trying to predict what my baldness pattern is going be... if possible. Otherwise I think you would end up chasing your baldness and end up running out donor by 40.

 

Losing your hair in your 20's really sucks... I know I was looking at HT at 26 but I waited until my pattern was well known (stable). Unfortunately, I netted out at a NW6 - which I would have never thought at 26.

 

My advice is to wait as long as you can but since you already had a HT you may need to do something to keep from looking un-natural (i.e. not a progressing Norwood pattern). You don't want to end up at 40 with thick, dense, lush 1-2 inch hair line and then be bald all the way back into your crown..... with no donor to make it look "normal" - donor is finite.

 

But see an expert, well respected surgeon.... Be sure to see one that will have no problem in telling you walk away and wait.... (and be willing to accept that).

[Icecreamman]

See what a well respected doc has to say. As it stands, your hairloss right now is not bad, it seems a smaller fut or fue would thicken up the front. My loss was not too bad, I had a small procedure of 1300 grafts and it has made all the difference. Have you tried rogaine? What's the mpb history like in your family? Good luck in your journey

[Raphael84]

Coligion,

 

Good advice so far. Great video by the way, really shows where your at. Everybody agrees that the previous HT was in hindsight, a bad idea, but trying to remain positive, it could have been far worse and you could have wasted far more grafts. Your hair looks pretty awesome, but your concern is obvious. What is your family history of hairloss? At 26, you must plan cautiously and think of the future, and if you can hold out, that would definitely not be a bad thing in my opinion. However, like the other guys mentioned, go and see a recommended Doctor from here. Just to get a professional opinion. You may be surprised, and a Doctor may propose a small FUE procedure, that could minimize shockloss and really maintain your donor supply. This may not be the case, but could be an option. Just tread carefully and consider every step. You seem to have a good head on your shoulders, Im sure you'll make the right decision.

[Coligion]

waitforanagen, Icecreamman, Raphael84 thank you for the comments.

 

My family is extremely small, so my father is the only indicator I can look to. He's had several procedures over years, albeit much smaller graft counts than by today's standards, though I don't know the exact number. He's also been an avid user of Minoxidil for the better part of 15+ years. Without his procedures, my best guess is that he may have been somewhere around a Norwood 4. He'll be 70 this year, but his hair looks darn good for his age.

 

I've contacted a few offices and inquired about their stance on my current situation. I've also spoken to Scott Alexander in Phoenix about my concerns. It can be difficult to get people to look at my case objectively because I'm still young, but also because many offices don't like the idea of doing small procedures.

 

Everyday I find myself looking in the mirror wanting to find a way to fix this. However, I know I'm still not a good age to pursue further work. As I said before, my first procedure really left me disappointed, not only with graft yield, but my scar is sub-par, and I still have discomfort in my donor region after more than 3 years. It can be easy to look at yourself in the mirror and see what needs to be done, but when you've been through it all before--especially at my age--it's hard to logically go down that road again knowing how it turned out the first time.

[1978matt]

Tough call and probably not enough info to give an opinion on here. I'd try contacting a few docs who are good at repair cases. They would need to have a good look at your head to see how everything is haping up, how many grafts you have left in the bank etc..

 

You could try a shorter hairstyle and experiment with hair fibres.

 

I think it would be better to hang on as long as possible before a second procedure.

[gillenator]

Coligion,

 

Thank you for sharing your situation with us and putting up your pics. I got your PM and will try to give you my opinion and observations. Thanks for your kind words and do not worry about finding our pasts conversations because I do not need the prior dialogue to comment on your case.

 

First of all, not knowing anything about who did your procedure 3.5 years ago and also who cut your grafts leaves an important piece of the puzzle unanswered. Let me explain. Could transection have any factor in this? If you chose a doctor with a good reputation with proven results, then it could be more of how you respond to HT surgery, not his nor his staff competence.

 

I assume that you had more exisitng hair in the frontal third before your first procedure at the age of 22 right? At that point in time and after 8 months of using finasteride did you notice a dramatic slowdown of hairloss? If not, then IMHO, the timimg of that first procedure is in question, meaning, should not have had it done. I truly believe that all men especially at that young age should give finasteride one full year to fairly evaluate whether or not it was slowing down your hairloss.

 

You were IMHO more of a candidate for strictly a medicinal approach, no surgery yet. Why? Because as you expereinced post-op, there was far more risk of shockloss to the existing diffusing hair than any gains made with grafts. If the graft count would have been increased last time, you may have experienced even more shockloss. Every now and then I hear from a young man with very similiar profile as yours and then tell me that the doctor had a hard time finding a place to put all of the grafts. That's a big red flag. Not implying that it was the case for you but something to think about.

 

In addition, any young man losing hair in their late teens and early twenties is almost always an indiciation that they are headed for the more advanced classes of hairloss, Norwood 6 and 7. And because you have decided to stop finasteride, the rate of progression will resume its course.

 

I also agree with the other opinions given to wait it out because you still face an increased risk of shockloss being off the meds and also your past experience. You are diffusing much more than receding which also presents a higher risk of shockloss IMHO.

 

My suggestion is to first consider getting back on finasteride through the guidance of a repuatble doctor at a reduced rate of consumption like every other day, etc. NO SURGERY at this time. This reduced rate of ingestion may be the trick to combat the side-effects. But you must do this only under a doctor's supervision and guidance.

 

Next, try to not worry about your scar yet. You can potentially have it revised or have FUE added to it in the future when you are ready for the second procedure in the future.

 

You seem to have a little bit of more loss in the left side of your frontal third. You appear to be combing the hair left to right direction which shows the area of loss directly behind your left lobe, where you part your hair. It appears that you have trained your hair by combimg/brushing left to right. Try changing the direction to right to left. You may find that changing the direction will cover that spot better and then use some hairspray to hold it in place. I do this myself. There are hairsprays that are not as "sticky" so that you will not have to wash your hair every day.

 

I like that way you are keeping the length longer because you can hide the thinning areas better in the frontal third as well as hide the strip scar in the donor area.

 

I addition, if it were me, I would also employ a scalp covering product like Dermatch which will decrease the appearance of thinning because it prevents light from reflecting off of your scalp. I think it would work better than Toppik because the fibers in Toppik won't do much to keep light from reflection off of your scalp.

 

Lastly, at your young age, I would wait to see where your hairloss heads. Although your father appears to have less hairloss than you, I still think yours will be potentially more advanced that his. Only time will tell. But if finasteride works efficiently to keep your midscalp and crown intact or keeps hairloss at a minimum, you can use your limited donor in the frontal zone where you will definitely need it in the future.

 

BTW, we did not see any pics of your crown so I am not sure if that area is diffusing as well.

 

You still have lots of hair left. Hang onto it as long as possible employing the cosmetics. Why risk the exisitng coverage by shocking any more of it out?

 

One last thing. Stay away from scalp invigorators like Nioxin, etc. I would not recommend using minoxidil in the frontal section either. That could start a shed and that also would be like shockloss to the diffusing weaker hair.

 

That's my opinions and suggestions my friend. I truly hope it helps and try to not worry about it. A little thinning is not the end.

 

I wish you the best!

[Coligion]

Gillenator, thanks again for the detailed response. I sent another PM your way.

 

My procedure was performed by Dr. Keene in Arizona.

 

Here are some additional pictures that showcase my donor+scar, crown, and right-frontal third/tuft. Much like the the left-frontal third, my right side was also quite affected by shock loss, possible transection, and future thinning.

[Hairtechnician]

Dear Coligion,

 

Dr. Keene first evaluated you for hair loss on May 22nd, 2008, and at that time, recommended Finasteride therapy, not surgery. You then returned to the clinic in 8 months time, reporting that the medication had provided some stabilization, but that you were still unhappy with your density. In particular, her notes indicate that you were focused on various areas of the frontal scalp that you wished to address with hair transplant surgery. Dr. Keene noted that she cautioned you against this approach and explained to you that progressive hair loss would leave you with unsightly islands of grafted hairs if you opted to pursue that approach. On further discussion, Dr. Keene recounted in several areas of her notes, she explained that shock loss and progressive hair loss were significant risks to your request for surgery. Furthermore, she was aware that some young people become very focused on minor cosmetic imperfections which they perceive to be significant, and that correction can be very satisfying to them. You had also indicated to her your goal of establishing some permanent hair coverage to the frontal area, in light of your concerns about progressive hair loss based on your family history. Because of this, she agreed to proceed with a surgery that would guarantee the placement of permanent hairs in your frontal area, but in a very conservative number, and conservative area of coverage, in order to minimize shock loss. In this way she would assist you in preserving frontal hair coverage without depletion of your donor hair. Her operative note very specifically indicates that she did not place hairs in your hairline, and in fact that any grafts that were placed were several centimeters behind your existing hairline.

 

Our post operative instructions at that time recommended you be seen in follow up every 3 months for the first year. Our notes indicate that you came to the clinic for follow up at 2 months (too early to assess your growth), 4 1/2 months, and 5 months, at which point you did not return for further follow up. However, during this time, there was no evidence of significant telogen effluvium (shock loss) caused by your surgery. Shock loss happens within the first few weeks to months after surgery. Any hair loss you experienced in the intervening 3.5 years is likely due to progression of androgenetic alopecia, especially if you have not continued to use Finasteride. Dr. Keene would welcome the opportunity to review your current situation with you, and would suggest that if you are not still using medication, you consider resuming it, possibly at a lower dose, to re-stabilize your pattern, and possibly recruit any recent hairs that have been lost. Per Dr.Keene, you can also consider using minoxidil, because although the studies that were done for FDA approval were in the crown and vertex only, therefore the FDA will only allow the pharmaceutical companies to claim effectiveness in this area, she has many patients who have benefited from application of minoxidil to the frontal area, and the orignal impetus for the pharmeceutical companies to do the studes was the fact that oral minoxidil caused generalised hair growth in many people who were using it for blood pressure control. Please call our office at your earliest convenience to schedule an appointment.

Edited November 18, 2012 by hairtechnician