Hair Transplant for Diffuse Thinning? Please Advise

[ml75201]

I'm 44 with diffuse thinning and considering a hair transplant to thicken the frontal third and as a lower priority, perhaps add some to the crown. I would be fine maintaining my existing hairline - I don't want to lower it. I do want to blend a few pluggy spots on the hairline from an earlier 750 graft strip transplant I had in 2003. But I have lived with basically the same density and hairline since the 2003 transplant, when I started on finasteride, so I'm not desperate to do something. I only want to go forward if the risk of a bad outcome is minimal. Since I have an existing scar, I would do a strip procedure.

 

I worry about shock loss to the existing hair. I have consulted with both Arocha and Alexander and they seemed confident that they could work within the existing hair with little or no shockloss, and even without shaving the area. Arocha suggested 3000 grafts and Alexander 2500. But I have read shock loss stories that scare me, and I understand that different docs have different positions on shaving. Also, is 3000 an aggressive number of grafts for a 100 cm2 area in which there is significant (although diffuse) existing hair? Again, I'm not looking to build a new hairline.

 

I'd appreciate thoughts on shock loss risk - if there is a 10%+ chance of significant shock loss I don't want to go forward. Also, thoughts on shaving v. not?

 

I've attached pics. You can see that the amount of diffusion visible varies quite a bit with lighting.

[leindub]

Anybody shed some light on how risky shockloss is for diffuse thinners considering hair surgery?

[ArochaInfo]

Greeting gentlemen,

 

Increasing density in diffuse thinning patients is something we at Arocha Hair Restoration do often. Please take a look at:Forum By and for Hair Loss Patients - Search Results

[gillenator]

Here's the thing. Nobody, and I mean "nobody" can predict shockloss or how extensive it may be. The more advanced the degree of diffusion, the weaker that hair is, and ultimately can be lost to shockloss. If the diffused hair is highly diffused, chances are it won't grow back. Yet diffusion in itself does not mean the hair won't grow back in the event it is shocked. So hair that is in the "beginning stages" of diffusion typically will grow back. Based on ml75201's photos, I would conclude that the entire top of his scalp (including crown) is in an advanced stage of diffusion, and at risk of shockloss.

 

What is rarely mentioned to prospective patients who have advanced diffusion is what is the root cause of shockloss. It is mostly related to how the individual responds to the level of trauma from the surgery itself. Trauma to the scalp can be from anything as obvious as the recipient incisions but also medications including the fluids that are injected into the scalp like the anesthetic and even something as harmless as saline fluids.

 

The more recipient incisions there are, and even as important, the closer they are in proximity to each other, the higher level of trauma induced within that defined recipient area. Still, the trauma can spread to other areas of the scalp that do not involve recipient incisions.

 

The key again is how the individual responds to the trauma caused by the procedure. And again, no one can predict it. Sometimes guys tell me that Dr. John Doe stated there would be little to no shockloss. I tell them to insist that the doctor put that in writing with a full refund back if it occurs. Interesting how the doctor will not do that...:rolleyes:

 

I will say that over the years the instrumentation that create the recipient sites have improved and in some instances, the use of small blades have reduced the level of trauma. Still, we have to remember that we all respond to trauma differently.

 

In conclusion we have to realize that those of us who have advanced stages of thinning and diffused loss are going to lose that hair eventually, and in most cases, sooner than later. So if we must have hair, than we have to get started at some point in time. Some guys with advanced stages of diffused loss approach it in smaller sessions and spread out the level of grafted density to help reduce the trauma and then go back and add more density later. This approach does not "guarantee" a lower level of shockloss and why some guys just decide to go for a larger session. It's a personal decision that only the individual can make for themselves. What we do know is that smaller sessions can help lower the level of trauma.

 

As far as buzzing or shaving down the recipient zone, this can help reduce transection to the native hair within the recipient zone. Not all doctors require it but the more existing hair there is, the more important it becomes not to transect that hair because we all value any existing hair that provides us coverage.

[ml75201]

Gillenator, many thanks, very helpful! Would the fact that I have not seen much loss since I started propecia in 2003 make it more likely that hair would return if there is shock loss? In other words, if propecia has helped me hold onto hair until now, will it also help the hair through the surgery trauma?

[Td06]

Gillenator, many thanks, very helpful! Would the fact that I have not seen much loss since I started propecia in 2003 make it more likely that hair would return if there is shock loss? In other words, if propecia has helped me hold onto hair until now, will it also help the hair through the surgery trauma?

 

Propecia may help with the shock loss but i don't think its a guarantee. I'm just a bit over 13 months post op from my second procedure and both my donor and recipient area experienced loss at around one month post-op.

 

I've been on fin for more than 8 years if that helps.

[fortune11]

I was a diffuse thinner when I got my first HT in 2004 on hairline, and have had two more since , all in between existing hair . Shock loss for me meant acceleration of the demise of existing weak hair but the new thick hair that came in more than made up for it. The transition between native hair to transplanted hair was gradual enough that no one was any wiser in the interim (except those who knew about my procedures). for context, I was not on finasteride until began using it for the first time this year.

 

This also means that if you decide to go for another HT , you really cannot afford to have it fail as if you suffer shock loss as well , you will be worse off than before . That would personally bias me more towards an FUT procedure in the hands of a top notch surgeon.

[gillenator]

Gillenator, many thanks, very helpful! Would the fact that I have not seen much loss since I started propecia in 2003 make it more likely that hair would return if there is shock loss? In other words, if propecia has helped me hold onto hair until now, will it also help the hair through the surgery trauma?

 

You're welcome my friend. As you can see from Td06's experience, shockloss still occurred even after being on finasteride for a long time.

 

And I know of other guys who experienced the same. Although some docs are of the opinion that being on finasteride will help lower or prevent shockloss, my observation has been how the individual responds to the level of trauma induced from the surgery.

 

Finasteride is not efficient for the frontal zone but is good for the crown and sometimes the midscalp.

 

And it's really the hair that is not greatly diffused that tends to grow back, finasteride or not.

[Td06]

You're welcome my friend. As you can see from Td06's experience, shockloss still occurred even after being on finasteride for a long time.

 

And I know of other guys who experienced the same. Although some docs are of the opinion that being on finasteride will help lower or prevent shockloss, my observation has been how the individual responds to the level of trauma induced from the surgery.

 

Finasteride is not efficient for the frontal zone but is good for the crown and sometimes the midscalp.

 

And it's really the hair that is not greatly diffused that tends to grow back, finasteride or not.

 

I definitely experienced a lot more more pain with this second procedure when compared to the first.

[MichaelB]

Hey75201- assuming you are in Dallas as am I. Your story is similar to mine as I had FUT 20 years ago and want to make the front and sides more dense now, also on finesteride. I have met with Dr. Lam in Plano (do you know anything about him?) and talked to Arocha by phone and plan to have facetime meeting next week. I only need 1000-1200 grafts but wondered what you've done to this point and about shockloss. Only issue is inconvenience of traveling to Houston. Sam Lam is in Plano and I was very impressed with him and credentials, however after the only 3 reviews on here on him, and all very negative, am not so sure anymore.

Can i call you or you me? would love to compare situations.

Thanks so much.

Michael

214-675-7476