Posts from HT patients of 5+ years?

[leftygolfer71]

I dont see a lot posts from guys who had their HT 5 or more years ago?

 

I've read a lot of info online about guys seem to be unhappy after 5 years post HT??

I know a lot of that is because of not seeing a good Dr., but is it because of unhappiness?

[harin]

yes, would be interesting to see some comparison pics too!.

[Dr Blake Bloxham]

Lefty (and Harin),

 

Check this one out:

 

It's a patient of Dr Alexander who stopped by eight years after his hair transplant to say hi and give them an update:

 

Dr Alexander -- 8 year update

 

As you can probably tell, good planning -- and, of course, good technique -- can truly create results that "stand the test of time."

[win200]

More of this, please. Seeing great, immediate results is fine, but I think it's important for patients to see how transplants look over time, and what holds up and what doesn't. I know it's easier said than done given that people tend to vanish but it needs to be reinforced that when a 25 year old gets 3,000 grafts for a NW II, that's a LIFETIME decision.

[Dr Blake Bloxham]

Win,

 

Here are a few other pieces I -- and Dave -- have written about hair transplants "standing the test of time" over the years:

 

Do transplants stand the test of time -- Dr Rahal patient 5 years post-op

 

Photographic evidence that hair transplants "stand the test of time"

 

Dr Beehner discussing whether or not hair transplants stand the test of time

 

Another thread about the topic

 

We had a past patient stop by out of the blue the other day. He underwent hair transplant surgery with Dr Feller in the late 90s/early 2000s and wanted to discuss a family member he was going to send our way. We took a few pictures -- and maybe I can upload them Tuesday -- because the work really held up! He still looked great. The hair was a bit grayer now, but still looked thick and natural. We were hoping to compare it to his original "befores," but we figured out they were actually taken on real film -- and hadn't been scanned into this computer system. Crazy, huh?

[win200]

Awesome stuff, thanks! That Meshkin result is really incredible. I'm over three years out from my first procedure, and I really can't tell any difference. I might have lost a LITTLE more hair behind the grafts at the hairline, but who knows. When you stare at it everyday, you really lose the ability to see the differences over time. I think the one upside of being significantly bald (i.e., NW V+) is that there isn't much risk of the results deteriorating greatly over time.

 

Some docs have discussed the phenomenon of transplanted areas thinning over time due to miniaturization of the donor hair rather than the native hair. I've started paying a lot of attention to the safe zone in 40 year old and up guys, and thinning there is pretty typical. A NW V guy just doesn't have the same, dense safe zone of a NW II, so stands to reason that if you transplant when you're a II and you're headed to V territory, your transplanted grafts will thin, too. I don't think this is discussed enough.

[Al - Moderator]

Some docs have discussed the phenomenon of transplanted areas thinning over time due to miniaturization of the donor hair rather than the native hair. I've started paying a lot of attention to the safe zone in 40 year old and up guys, and thinning there is pretty typical. A NW V guy just doesn't have the same, dense safe zone of a NW II, so stands to reason that if you transplant when you're a II and you're headed to V territory, your transplanted grafts will thin, too. I don't think this is discussed enough.

 

It looks like you are beginning to realize that there is no safe zone. The "safe zone" phrase is a lie that every hair transplant DR must keep telling everyone or else people wouldn't get hair transplants. If there's no safe zone it blows up the whole idea of a hair transplant being permanent and lasting a lifetime.

 

Of course once you start to call them on that they then go into trying to convince you that it's called "senile alopecia" and only happens to men over 70, so you don't need to worry about it. Even the term they use (senile) is an attempt to make you think that you'll be so old by then it won't matter. But as you've been noticing, it happens to many men by the time they are in their 40's.

 

Many people on these forums will talk about ethical Drs, but every single one of the supposed ethical Drs will tell you there's a safe zone and that the transplanted hair won't fall out. How ethical can they be if they are saying this?

[secondtryuser]

Well my doctor told me to continue to use fin to prevent transplanted hairs thinning.

[HairJo]

My only guess is maybe they lost more hair and need another transplant or maybe 5 years makes a difference to your face too. Let's face it we all have to age and it is a good reason to not be happy even after you get your hair back then you focus on something else that doesn't look as good as it used too and it becomes a vicious cycle . But I do like the idea of a study and seeing pictures of guys years post op.

[MAGNUMpi]

Good thread. My guess is that it totally depends on genetics and Finasteride usage and has everything to do with the individual. When will his hair around the HT thin out? When will his donor thin/etc.?

I do notice a lot of older men 50-60's with thin donor areas.

[Dr Blake Bloxham]

BeHappy,

 

Very important topic! Thank you for bringing this up.

 

The "safe donor area" (SDA) is actually a very controversial area -- no pun intended -- in the hair transplant surgery field. Let me provide a little context and explain how I believe doctors make surgical decisions with regard to the donor area and educate their patients about the permanency of their donor follicles:

 

The SDA was first essentially discovered by Dr Orentreich when he first described the theory behind 'donor dominance' and revolutionized hair transplant surgery in the 1950s. At this point in time, he didn't really define a 'safe donor region,' but he did note that follicles from this region were 'permanent' and seemingly unaffected by the androgenic alopecia (AGA) process when transplanted to the front of the scalp.

 

This is really what kicked off the 'plug' phase of hair transplant surgery. Initially, plug procedures were small. And these extractions were pretty safe with respect to safe donor. As time went on, however, they become larger and the idea of defining a safe donor became a more important reality -- in my opinion.

 

Before this could really become too big of an issue, however, strip harvesting (FUT) really took hold and defining the SDA wasn't that big of a deal. This is because there should really be a truly 'safe' harvest zone on nearly all patients. Even those with some retrograde nature to their hair loss or the 3% who, very unfortunately, will hit the dreaded NW VII at a reasonable age should still have at least a narrow strip of truly permanent follicles in the heart of the harvesting area. This is essentially where strips were taken, and everything was seemingly okay.

 

However, the follicular unit extraction (FUE) procedure began returning to prominence in the mid 90s onward and suddenly the SDA became a very important issue. It may not seem like it, but this is where it really became a 'hot topic' in the HT world. Most of what is published in hair restoration is released in the 'Forum International' journal through the ISHRS. There is a lot of good information in these journals, but it sometimes doesn't reach the online patient population. If you read these journals throughout this time period however, you'd find that there were actually A LOT of people looking into the SDA dilemma. One of whom was Dr Unger. He did a study in the late 90s or early 2000s (my dates could be slightly off here) to determine which regions of the scalp truly expressed DHT-resistant follicles and could be safely utilized for harvest. As expected, the region was the area utilized more frequently in strip procedures. So this put the issue to bed, right?

 

Well, no. You see, many FUE practitioners had begun to push the limits of donor harvesting and started experimenting with regions outside of the zone re-defined by Unger. This led to a whole new classification of: 'Safe Donor Area (SDA),' 'pretty SDA,' and 'not SDA.' I don't recall the exact terminology off the top of my head, but it was somewhere along these lines and you get the general picture. Obviously, this stirred up more controversy. However, this is basically where we are today: with strip harvesting and small non-strip harvesting procedures, you can pretty much stay within the true SDA (as defined by the studies). In larger non-strip (IE FUE) harvesting procedures, however, you'll likely start to creep into the 'pretty SDA' regions.

 

Now, what's important to realize is that harvesting in the pretty SDA regions isn't inherently wrong. BUT, this statement only holds true if the HT surgeon does a very thoroughly scalp examination, determines the safety of the pretty SDA region (which, I'll admit, is a bit of a scary task), and informs the patient of precisely where they are harvesting from and the potential fate of these follicles.

 

In this sense, some less DHT-resistant follicles may be transplanted. Is this right or wrong? I think it's tough to say. Like I said above, it really comes down to professional judgement and full disclosure.

 

What's more, all of above pertains to individuals with AGA. Other types of alopecia make this a very, very different discussion.

 

I think this is an important conversation to have with your HT doc. Especially if you have reason to believe you may experience thinning in the 'pretty SDA' areas I described above OR if you're planning a large non-strip harvest session. Hopefully this will help a few guys out.

 

And, BeHappy, I hope this didn't sound like I'm trying to skirt around any of the issues you mentioned. Obviously this is something to consider and thoroughly understand before 'taking the plunge!'

[Dr. William Lindsey]

Dr. Lindsey speaking with female 4 years out from HT McLean VA - Forum By and for Hair Loss Patients

 

This lady is approaching 5 years out. Now she was delighted UNTIL I pointed out that she's thinning a bit more...due to her female MPB progression. I suspect that many, but certainly not all, of the really unhappy guys at 5 years are guys who had significant progression of their MPB after their case...and perhaps their case was either small, or sprinkled around, or planned with a hairline too youthful for the future.

 

Dr. Lindsey McLean VA

[Dr Blake Bloxham]

Nice one, Dr L!

[Windjammer]

I would really like to see more discussion on why hair that is taken from the safe zone remains DHT-resistant after it has been transplanted to a DHT-receptive zone.

 

I know the average response to this is that hair taken from the donor zone is programmed to last you a lifetime...BUT whose to say this hair cannot become DHT-receptive over time from being placed into this susceptible region? What happens to safe grafts placed into a DHT-receptive zone after 5, 10, or 15 years of exposure to DHT? Is it still believed that safe, donor zone grafts will never become DHT-receptive, regardless or where they are placed on the scalp?

 

Also, I do understand the concept of donor zone thinning with age, and I am not referring to that in the above questions.

[gillenator]

The toughest thing to do is to predict one's future hair loss and how extensive it may become over time. Yes we have family history yet there are variations person to person.

 

One thing I have noticed over the past four decades is that one's so-called safe zone can change over time, meaning, the phenomenon of donor zone thinning. Yet this is not always associated with DHT related loss for everyone.

 

For example, an individual in their twenties can have their donor zone microscopically examined and the doctor may typically find little to no miniaturization confirming a broad safe zone. Yet once the same individual reaches their forties, there can be changes to their safe zone. Miniaturization shows up in areas where it did not before. So yes, IMHO, the so-called safe zone can reduce over time as the individual ages.

 

Does this happen to everyone? No. In fact, take the time over the next several weeks to observe men over the age of fifty and you will see that roughly 65% of them if not more have overall thinning to some degree. Yet there are some who never have any thinning whatsoever. I know of some men in their sixties who lost all color (pigmentation) but still have a strong head of hair both in terms of density and hair caliber.

 

We do know that DHT deposits in the scalp. Does the DHT enriched sebum move to the donor area (occipital zone) over time? Possibly.

 

Also, in my own case, my overall density is not what it was 30 years ago. My father never had MPB and he had the most dense head of hair without any recession to his hairline until he reached his mid-sixties. Although he retained his hairline, his overall density thinned out quite a bit and then in his seventies, considerably more.

 

I am keeping an eye on my older brother who is 62 and has the head of hair that my father had. However, my brother's hair has not thinned out at all and still looks like he did in his thirties.

 

I can clearly see that my past grafts (6900) have lost some degree of caliber over time but not much in terms of density.

 

Yet having my first procedure in 1996, I have to say that I have no regrets and am still thankful for having decent coverage at age 60. There is no doubt in my mind that I would have no hairline at all and would probably be a true Norwood 6 if not for the four HT procedures along with taking low dose finasteride for the past 19 years...

[HairJo]

I'm happy for you, you went through a lot but it paid off for you

[Coppal1]

It looks like you are beginning to realize that there is no safe zone. The "safe zone" phrase is a lie that every hair transplant DR must keep telling everyone or else people wouldn't get hair transplants. If there's no safe zone it blows up the whole idea of a hair transplant being permanent and lasting a lifetime.

 

Of course once you start to call them on that they then go into trying to convince you that it's called "senile alopecia" and only happens to men over 70, so you don't need to worry about it. Even the term they use (senile) is an attempt to make you think that you'll be so old by then it won't matter. But as you've been noticing, it happens to many men by the time they are in their 40's.

 

Many people on these forums will talk about ethical Drs, but every single one of the supposed ethical Drs will tell you there's a safe zone and that the transplanted hair won't fall out. How ethical can they be if they are saying this?

 

My thoughts exactly, if you look at a lot of celebrities who have had HTs, and then "rebald" they were probably told it was a 'safe zone' and once its in, its permanent, look at Joe Rogan and Wayne rooney, I saw rooney at wimbledon 2014 and his hair was so thin you could see his whole scalp, and Joe Rogan, who has had 3 transplants is now completely bald

[secondtryuser]

My thoughts exactly, if you look at a lot of celebrities who have had HTs, and then "rebald" they were probably told it was a 'safe zone' and once its in, its permanent, look at Joe Rogan and Wayne rooney, I saw rooney at wimbledon 2014 and his hair was so thin you could see his whole scalp, and Joe Rogan, who has had 3 transplants is now completely bald

 

That's because Wayne Rooney stopped taking propecia due to him and his wife wanting kids. Had he stayed on it continuously he might have a different result.

[Swooping]

Yes deterioration of donor hair certainly happens. Everyone will suffer from a general hair diameter decrease as one gets older, including in the donor area.

 

Furthermore the hair follicles taken from the donor zone, even from the so called "safe donor zone" may succumb to miniaturization due to androgenetic alopecia.

 

Also unrelated to androgenetic alopecia we have senescent alopecia which is typically characterized by diffuse hairloss all over the scalp and can hit as early as 40-50 years old. This also hits the donor hair.

 

So the "safe donor zone" is a big fallacy.

[Petchski]

It's not a complete fallacy, it's just more complicated than that. Although you do notice some NW7's out there with really thin donors, where a strip scar would show through their hair even at an inch plus length, but they are a minority really.

 

As for Joe Rogan he decided to just let it go, and shaves bald despite the strip scar. Rooney uses lots of concealer, but sometimes doesn't bother, and the you can see his NW5 pattern through his hair. He's not a great HT candidiate without taking propecia.

 

Also if you think about it, as you get older everything deteriorates, so i don't see why donor hair would be any exception, although it's more towards the end of your life this seems to happen.

[Burlio]

Good thread, always love the big Fin debates many pros and cons to consider...

Anyway sorry to be corrective but in his defence Wayne Rooney, has never and will never be able to take Fin, not at least he's still a pro footballer.

Fin has properties which are able to mask other banned substances so all athletes who are governed by anti doping agencies are unable to take it. Google Austrailian footballer Stan Lazaridis who received a lengthy ban just by taking the anti hairloss drug. Must be the one thing that sucks about being a footballer!! Although I'm sure Rooneys 200k a week and his hot wife will soften the blow slightly ...

[Al - Moderator]

That's because Wayne Rooney stopped taking propecia due to him and his wife wanting kids. Had he stayed on it continuously he might have a different result.

 

 

That is the question though. Does the transplanted hair continue to grow after it is moved because it is programmed to grow no matter where it's placed? Or does it continue to grow ONLY because the patient is using drugs to help it keep growing? If you are required to use drugs to get continued growth, then the transplanted hair isn't safe.

 

From what you are saying, you seem to feel that you need to be on the drugs and it's not really going to grow on it's own.

[Sethticles]

In layman's term - you walk into a radioactive area with no protective suit on you'll get cooked.... same with transplanted hairs, subject them to DHT, guess what they get effected they "get cooked"

[Burlio]

The newly transplanted hairs will grow as long as it's extracted from a non DHT affected area or "safe zone" that's why it's so important to find a highly experienced and ethical surgeon in the first place who has the best possible opinion on where your safe zone will be not just now but in years to come. To give yourself the best chance of a successful HT you need to consider Fin otherwise what you thought is permanently transplanted hairs will fall out in years to come. But as your probably aware fin does come with a risk of side effects,I'm still experiencing them 12 years after coming off and believe me they are no joke. On the other side of the coin you have thousands of men who aren't affected by these sides and Fin is an absolute 'must' for them. All I can say is approach with caution maybe start by taking a little less than the recommended dosage and see how your body reacts. Sorry to be vague my friend but it's a bit of a roll of the dice whichever you decide. I wish you luck with your decision.

[newbie33]

The very simple answer is that hairs on the back and side - the 'safe zone' - tend to be resistant to DHT. But the older you get, the more these hairs also tend to thin out, through DHT's affect or for whatever other reason. So as I see it, the advantage of taking fin after a HT is primarily to maintain your native hair - so you don't get a nice bald ring around the transplanted hair in your lateral humps region.