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HT is not permanent EVEN if it was taken from the safe zone.


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Hey guys,

 

I am reading many threads lately that HT started to shed few years post OP. None of those patients are experiencing any donor miniaturizing.

 

Here's another thread I have seen:

Any doc can aim why does it happens when there is no health issue or donor miniaturizion?

Someone once told me if the grafts weren't implanted perfectly it could shed after few years. Idk if it makes sense.

My brother's girlfriend father done HT 10 years ago, he was Norwood 2 and the doc told him in 5-10 years they will thin and you will need a touch-up, well it did happen and now his transplanted area looks thinner. Her father has zero miniaturizion in his donor and never progressed over Norwood 2.

How many patients here actually done HT 15 years ago and still have their transplanted hairs?

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I think this can happen (I think of @Portugal25 among others), but I think it's the exception rather than the rule.  Even for me I've had thinning in my frontal third after my 3rd transplant in that area, but it really is hard to say how much of it was native or transplanted hair falling out. 

Dr. G: 1,000 grafts (FUT) 2008

Dr. Paul Shapiro: 2,348 grafts (FUT) 2009 ~ 1,999 grafts (FUT) 2011 ~ 300 grafts (Scar Reduction) 2013

Dr. Konior: 771 grafts (FUT) 2015 ~ 558 grafts (FUT) 2017 ~ 1,124 grafts (FUE) 2020

My Hair Transplant Journey with Shapiro Medical Group

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I would think it would be native hair thinning out. Transplanted hair may possibly thin if taken from the non safe zone. This would most likely occur if the transplant is performed by an inexperienced doctor. Another thing I can think of is if someone is not on meds and continues to lose native hair. Even when on meds based on my personal experience I feel that anything that increases testosterone which results in more conversion to DHT may not allow Finasteride to work as well as it did prior to this. My hair loss was stabilized in my 20s on meds and when I started lifting weights my hair loss seemed to excelerate. I then had my first HT and stayed on meds and everything was well for another decade. I then started lifting weights again and within a year I felt like all my native hair was being lost. I was not taking any steroids just lifting weights. This obviously is not an issue for anyone who is not sensitive to DHT but for people who are it is a real possibility that it excelerates hair loss. There have been studies which has shown that lifting nheavy weights increases testosterone. It may be short term for the few hours following the workout but in those few hours there is possibly more conversion happening to DHT. So imagine lifting heavy weights 4-5 days a week that much additional conversion happening. Not everyone's body converts at the same rate not is everyone have the same level of sensitivity to DHT but for some it can be an issue.

Some may disagree but for me personally I experienced this twice.

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I haven't seen this happen. In my experience, only the native hair that was susceptible to DHT in the first place would miniaturize or shed. That's why it's important to stay on meds like finasteride and minoxidil.

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My advice does not constitute a patient-physician relationship nor as medical advice and all medical questions/concerns should be addressed to your medical provider. 

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It is permanent, but it depends on the person. If you have donor thinning, then yea some of those hairs will thin. Some people have mild cases of DUPA. Only a miniaturization test would discover it. That’s why it’s important to get this done before having surgery.


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54 minutes ago, mxm56 said:

I just started Finasterid, will it benefit donor hair?

Yes!

Dr. G: 1,000 grafts (FUT) 2008

Dr. Paul Shapiro: 2,348 grafts (FUT) 2009 ~ 1,999 grafts (FUT) 2011 ~ 300 grafts (Scar Reduction) 2013

Dr. Konior: 771 grafts (FUT) 2015 ~ 558 grafts (FUT) 2017 ~ 1,124 grafts (FUE) 2020

My Hair Transplant Journey with Shapiro Medical Group

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It's possible - but I don't believe it's likely... "The exception and not the rule", as @aaron1234 pointed out above. 

When you look around the world at all the men who are losing their hair, it's very rare to see men who lose hair from the "safe" zone, even men who have advanced hair loss and have nothing on top - and that's because those hairs typically aren't susceptible to MPB. Could someone be one of the rare guys whose "safe zone" isn't actually "safe"? Sure. But that's very unlikely, and chances are they'll have a genetic predisposition/history there that will give them reason enough to consider that possibility when choosing to get a HT

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Maybe a stupid question...  If DHT exists in the scalp, could it eventually attack initially healthy transplanted hairs, thus causing them to thin?

Dr. G: 1,000 grafts (FUT) 2008

Dr. Paul Shapiro: 2,348 grafts (FUT) 2009 ~ 1,999 grafts (FUT) 2011 ~ 300 grafts (Scar Reduction) 2013

Dr. Konior: 771 grafts (FUT) 2015 ~ 558 grafts (FUT) 2017 ~ 1,124 grafts (FUE) 2020

My Hair Transplant Journey with Shapiro Medical Group

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3 hours ago, aaron1234 said:

Maybe a stupid question...  If DHT exists in the scalp, could it eventually attack initially healthy transplanted hairs, thus causing them to thin?

DHT is not localized or stationary, its a hormone that circulates in your blood throughout the body. Finasteride can lower DHT by up to around 70%, Dutasteride can lower it even more by up into the 90s%, but there's no way to completely eliminate or escape it. Since the donor hair is the most genetically resistant to DHT, that's why it keeps hanging around while the rest of those wimps drop out.

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Very true!  So why are the "safe zone" hairs genetically resistant to DHT?  Is it simply that there is less DHT in that area? Do scientists even know why?  I'm starting to sound like a 3 year old, "Why? Why? Why?"

Dr. G: 1,000 grafts (FUT) 2008

Dr. Paul Shapiro: 2,348 grafts (FUT) 2009 ~ 1,999 grafts (FUT) 2011 ~ 300 grafts (Scar Reduction) 2013

Dr. Konior: 771 grafts (FUT) 2015 ~ 558 grafts (FUT) 2017 ~ 1,124 grafts (FUE) 2020

My Hair Transplant Journey with Shapiro Medical Group

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8 hours ago, aaron1234 said:

Very true!  So why are the "safe zone" hairs genetically resistant to DHT?  Is it simply that there is less DHT in that area? Do scientists even know why?  I'm starting to sound like a 3 year old, "Why? Why? Why?"

That's interesting.. maybe the DHT is not in the follicle but actually in the area?

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Since October my HT has got thicker, I've got loads of new hairs growing all over including in between my HT hairline and in the corners.

Unfortunately I made 2 changes at once so can't be sure the exact reason: I started dermarolling all over once a week, and switched to a topical fin/minox combo where I literally get it everywhere..including my donor area.

My point is - 8 years after a very successful HT that still looked good - you can still do things to make it even better.

I try not to think about 20 years' time if the meds stop working and it all turns to a disaster. But it's already been 15 years and there should be new and even better solutions out further down the line so fingers crossed.

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 2,000 grafts FUT Dr. Feller, July 27th 2012. 23 years old at the time. Excellent result. Need crown sorted eventually but concealer works well for now.

Propecia and minoxidil since 2010. Fine for 8 years - bad sides after switching to Aindeem in 2018.

Switched to topical fin/minox combo from Minoxidil Max in October 2020, along with dermarolling 1x a week.

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On 11/24/2020 at 6:38 AM, Ron5566 said:

Hey guys,

 

I am reading many threads lately that HT started to shed few years post OP. None of those patients are experiencing any donor miniaturizing.

 

Here's another thread I have seen:

Any doc can aim why does it happens when there is no health issue or donor miniaturizion?

Someone once told me if the grafts weren't implanted perfectly it could shed after few years. Idk if it makes sense.

My brother's girlfriend father done HT 10 years ago, he was Norwood 2 and the doc told him in 5-10 years they will thin and you will need a touch-up, well it did happen and now his transplanted area looks thinner. Her father has zero miniaturizion in his donor and never progressed over Norwood 2.

How many patients here actually done HT 15 years ago and still have their transplanted hairs?

I have already written of this some years back on this forum , my take is that the donor safe hair when relocated to the recipient area acquires the character of the recipient area and is susceptible  to dht ... so in theory you have to be on propecia for life or else these HT will probably fall out ... i stopped finasteride due to sexual sides and depression and it took me a solid 1 year to feel normal again , but some unlucky guys never feel their old self gain and have permanent  sides .... so i better avoid that junk .

also many guys have recently reported this phenomenon that after 1 year of robust growth , the transplants thin out and fall ..... not all but the hair mass surely decreases.

so in a way HT are not as permanent as once thought .

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10 hours ago, TommyLucchese said:

Since October my HT has got thicker, I've got loads of new hairs growing all over including in between my HT hairline and in the corners.

Unfortunately I made 2 changes at once so can't be sure the exact reason: I started dermarolling all over once a week, and switched to a topical fin/minox combo where I literally get it everywhere..including my donor area.

My point is - 8 years after a very successful HT that still looked good - you can still do things to make it even better.

I try not to think about 20 years' time if the meds stop working and it all turns to a disaster. But it's already been 15 years and there should be new and even better solutions out further down the line so fingers crossed.

Woah nice to know! Does Topical Minx caused you any side effects? 

Many people say it lower your collagen which may cause you aging faster, not sure how often it happens.

Really happy it's working for you!

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On 11/24/2020 at 9:00 PM, aaron1234 said:

Very true!  So why are the "safe zone" hairs genetically resistant to DHT?  Is it simply that there is less DHT in that area? Do scientists even know why?  I'm starting to sound like a 3 year old, "Why? Why? Why?"

Hair follicles in the "safe zone" lack DHT receptors so they're not susceptible to the DHT unlike hair follicles that have DHT receptors and are thus less susceptible to the negative impact of DHT. 

Edited by Dr. Suhail Khokhar
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My advice does not constitute a patient-physician relationship nor as medical advice and all medical questions/concerns should be addressed to your medical provider. 

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8 hours ago, Dr. Suhail Khokhar said:

Hair follicles in the "safe zone" lack DHT receptors so they're not susceptible to the DHT unlike hair follicles that have DHT receptors and are thus susceptible to the negative impact of DHT. 

who has said that any doctor can safely predict  where a safe zone really is  ? its all assumption ..... and who says that the so called safe zone lacks dht ? have you ever heard of donor safe zone miniaturization?  and how do you explain why so many guys have started complaining that their transplants are falling out ? 

my take , and maybe im wrong , is that we had many more people opt for HT after the advent of fue as most guys resist the linear scar and many feel its barbaric ... so most cases of fue  are relatively new around 2012 onwards , so now many guys after a few good years suddenly see a gradual thinning of their transplants .... and mind you neither these guys are having any  donor miniaturization nor are their safe zones been trespassed ( no good doctor would do that ) , and also the theory of native hair fall out is not  true , as most guys were slick bald in that area before the HT , so they are sure its not native thinning , so the only cause an effect i think is the dht being strongly circulated in the mid frontal and crown that is eventually causing the fall out ( if you are not on propecia ) , so its utmost necessary that we get on some dht blocking tactic or else we will gradually loose many/ all  transplanted hair along with native thinning also , but the sides are too over whelming from propecia and i had to quit it after 5 months as i was having serious sides and depression , luckily it took me 1 year to feel normal again , but there are some who never recover and say their never feel like their old self even after quitting the medicine ,   hence many like me just have no option but to junk it .  

just my opinion  others surely can educate me , as im open to learning not debating .

Edited by jolly
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22 minutes ago, jolly said:

who has said that any doctor can safely predict  where a safe zone really is  ? its all assumption ..... and who says that the so called safe zone lacks dht ? have you ever heard of donor safe zone miniaturization?  and how do you explain why so many guys have started complaining that their transplants are falling out ? 

my take , and maybe im wrong , is that we had many more people opt for HT after the advent of fue as most guys resist the linear scar and many feel its barbaric ... so most cases of fue  are relatively new around 2012 onwards , so now many guys after a few good years suddenly see a gradual thinning of their transplants .... and mind you neither these guys are having any  donor miniaturization nor are their safe zones been trespassed ( no good doctor would do that ) , and also the theory of native hair fall out is not  true , as most guys were slick bald in that area before the HT , so they are sure its not native thinning , so the only cause an effect i think is the dht being strongly circulated in the mid frontal and crown that is eventually causing the fall out ( if you are not on propecia ) , so its utmost necessary that we get on some dht blocking tactic or else we will gradually loose many/ all  transplanted hair along with native thinning also , but the sides are too over whelming from propecia  hence many like me just have no option but to avoid it .  

just my opinion  others surely can educate me , as im open to learning not debating .

I wish more doctors would answer, so many patients are complaining that their transplanted hairs fall after 3-7 years (Seems when the hair cycle is over)Especially on other forum, the only reasons I can think of are :

 

1) Once you transfer healthy graft to unhealthy zone (like hairline), its starting to be sensetive to DHT.

2) After the cycle is over the graft won't have enough strength to re grow (What's why I read that oral Minoxidil helped some after their transplanted hair fall)

3) Some grafts were taken out of the safe zone, if you do dense packing, 50/cm2 and you lose 25% of your donor which is not noticeable in the back but going from 50-35 or so grafts I believe makes drastic change which makes believe that 50% are gone.

What I don't understand is how the surgeon of my brother's gf father told him that his results will remain for 5-10 years.

This guy did FUT, he never progressed after Norwood 2, now, 10 years later his transplanted hairs are much thinner (about 40% are gone). He has no donor miniaturizion (I checked him under microscope and actually just looking at his donor you can see that it's healthier than 10 years old kid.

 

I will try to reach this doctor, he's from Romania and I will ask him why did he tell him that the results will last 5 years only, what does he knows or telling that no body else does. Btw he did FUT.

 

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@Ron5566 - if any doctor is telling you they will do a HT which will only last for 5 years why would you even want to go there? The safe zone for everyone is different it depends on the norwood level. A nordwood 2s safe zone is far greater than a norwood 6.

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Just now, anker21 said:

@Ron5566 - if any doctor is telling you they will do a HT which will only last for 5 years why would you even want to go there? The safe zone for everyone is different it depends on the norwood level. A nordwood 2s safe zone is far greater than a norwood 6.

Not me, my brother's gf father 

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35 minutes ago, anker21 said:

He should have not even gone there. This is the first time i heard someone saying that a HT will last for 5 years.

The thing is, so many people are losing their transplanted hairs after 5-10 years. Maybe it's more common then we think.

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With miniaturization in the donor it's obvious to expect future thinning of the transplanted hairs.  What is not so clear is whether it's possible for HT's to thin over time even if the donor remains stable.  

3 hours ago, Ron5566 said:

The thing is, so many people are losing their transplanted hairs after 5-10 years. Maybe it's more common then we think.

I would replace "so many people" with "a select few".  It's all anecdotal at this point since we don't have a clinical study on the longevity of transplants to reference.

Dr. G: 1,000 grafts (FUT) 2008

Dr. Paul Shapiro: 2,348 grafts (FUT) 2009 ~ 1,999 grafts (FUT) 2011 ~ 300 grafts (Scar Reduction) 2013

Dr. Konior: 771 grafts (FUT) 2015 ~ 558 grafts (FUT) 2017 ~ 1,124 grafts (FUE) 2020

My Hair Transplant Journey with Shapiro Medical Group

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4 minutes ago, aaron1234 said:

With miniaturization in the donor it's obvious to expect future thinning of the transplanted hairs.  What is not so clear is whether it's possible for HT's to thin over time even if the donor remains stable.  

I would replace "so many people" with "a select few".  It's all anecdotal at this point since we don't have a clinical study on the longevity of transplants to reference.

You are right.

Aaron, I just looked at your signature and see you had HT in 2008, did the transplanted grafts remained? Thanks!

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