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

[jolly]

5 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.

and that tribe of a Select few is growing by leaps and bound , mind you a few years back such issues were rarely surfacing , now its becoming much more . esp if you do not take propecia  as the sides almost overwhelm you as it did in my case , i too had a robust HT but it all tapered in 2 years and the thinning is ongoing with the donor being very stable .

[jolly]

7 minutes ago, Ron5566 said:

You are right.

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

he has always been on finasteride since his 1st HT till date , im talking of people who do not use that drug as the  sides are very serious .

[aaron1234]

35 minutes ago, Ron5566 said:

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

When I got my first 3 HT's I still had a lot of native hair remaining, so any loss I had since then would be very difficult to say whether it was the native or transplanted hair that thinned (maybe a little bit of both?).  My first strip was taken fairly high (as determined by Dr. Ron and Paul Shapiro) so if I did lose some transplanted hair it could be because of that.  But I also have some retrograde alopecia, so if I lost transplanted hair it could because of that as well.  Or maybe I didn't lose the transplanted hair at all and it was native... again, impossible to say with 100% certainty.  But yes, I've been on Fin for 14 years and it has definitely helped my situation.  

[deitel130]

8 hours ago, aaron1234 said:

When I got my first 3 HT's I still had a lot of native hair remaining, so any loss I had since then would be very difficult to say whether it was the native or transplanted hair that thinned (maybe a little bit of both?).  My first strip was taken fairly high (as determined by Dr. Ron and Paul Shapiro) so if I did lose some transplanted hair it could be because of that.  But I also have some retrograde alopecia, so if I lost transplanted hair it could because of that as well.  Or maybe I didn't lose the transplanted hair at all and it was native... again, impossible to say with 100% certainty.  But yes, I've been on Fin for 14 years and it has definitely helped my situation.  

@aaron1234 has Finasteride worked well for you for all 14 years. Have you experienced that after 10 years it was not working as well? 

[Chris32]

9 hours ago, jolly said:

and that tribe of a Select few is growing by leaps and bound , mind you a few years back such issues were rarely surfacing , now its becoming much more . esp if you do not take propecia  as the sides almost overwhelm you as it did in my case , i too had a robust HT but it all tapered in 2 years and the thinning is ongoing with the donor being very stable .

To have a HT thin after 2 years is not normal and definitely one of the more extreme cases. Even if the hairs from the safe zone were to obtain the characteristics of the DHT susceptible hair after the transplant as you say and therefore be prone to miniaturization, why would it happen in such a short period of time (2 years), if it didn't even occur that quickly with the DHT sensitive native hairs that were there in the first place? You're taking an extreme case and applying it as the rule.

[aaron1234]

@deitel130 Depends on how you define working well.  Did I experience more hair loss on Fin?  Yes, my sides and temple points have receded, but my lateral humps are still strong and my crown hasn't widened.  So any loss I did experience was not dramatic and I have Fin to thank for that.  The medication has been very resilient for me even after the 10 year mark.

Edited November 27, 2020 by aaron1234

[DenverBuff1989]

Its very common for docs to go outside of the small, classic, NW7 safe zone area. If a doctor predicts, say, you will never go beyond a NW3, then a NW3 safe zone is much larger area to work with. Obviously tho doctors are human and make mistakes, and obviously some HT docs just straight-up suck. So IMO its definitely possible for transplant hair to thin and/or die. 

I also imagine, throwing hairloss out of the equation entirely, an elderly man's safe zone hair is thinner and less aesthetic than a younger person's safe zone hair. So even with a god-tier HT, I imagine the transplant hair will go through the aging process just the same. 

[Richie888]

8 hours ago, Chris32 said:

To have a HT thin after 2 years is not normal and definitely one of the more extreme cases. Even if the hairs from the safe zone were to obtain the characteristics of the DHT susceptible hair after the transplant as you say and therefore be prone to miniaturization, why would it happen in such a short period of time (2 years), if it didn't even occur that quickly with the DHT sensitive native hairs that were there in the first place? You're taking an extreme case and applying it as the rule.

Very wise observation. No hair is guaranteed no matter what we think but accelerated hair loss in that time to me would point to underlying issues. 

[mcr7777]

I have also read stories about scarring alopecias like frontal fibrosing - which can be confused with MPB.     This is where the body's immune system attacks hairs - including implanted hairs (nothing to do with DHT).

 

Dermatologists say frontal fibrosing diagnosis is increasing rapidly.  It is mainly diagnosed in women but I have read experts think it may be undiagnosed in men due to it looking somehwhat like MPB. 

 

Wondering if some cases of losing transplanted hairs could be due to frontal fibrosing that hasn't been diagnosed?

 

 

[ITA]

I have read that many cases of FFA, (Frontal Fibrosing Alopecia), are often reported right after hair transplant surgery, and is basically, a special form of LPP (lichen planoplilaros)

“Frontal Fibrosing Alopecia is a progressive disease and without effective therapy in its stable form: therefore the interventions must be aimed at safeguarding vital hair, with classic therapies and regenerative therapies of the scalp (PRP, HC, PDRN in primis).”

Edited December 21, 2020 by Egy

[dobler]

Happened to me as well. And also to Wayne Roonie (you can look up for his photos after hair transplant, and now). Had 2900 grafts on frontal third back in 2016. Then follow up to fill crown in 2017 with another 2800 grafts (total 5700, Im NW6).

Results were great, I remember that in 2018 I had a thick full hair and I weren't even thinking about my hair loss anymore, thought I was done with this.

And then suddenly in 2019 (like end of 2019) I started thinning again in my frontal 3rd. 

Now I look almost as same as before the first HT. I don't know why is it.. Maybe FUE is just not as safe as you may think, as many grafts are taken from the nape, or from the thinning parts of the sides, which include hairs that were supposed to miniaturize anyway in the future. That may cause only part of FUE transplanted hairs to survive in the long term.

You can see the related post I had back then: 

 

Edited December 21, 2020 by dobler

[dobler]

On 11/26/2020 at 12:59 PM, 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 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 .

I agree.

In my opinion, the science still can't really explain the DHT and hair loss thing. It's all speculation. There are too many open questions about it.

Some have the horse shoe pattern, while other have just a high forehead, or temples receding. Are we sure that these types are all the same MPB? Maybe not? Maybe a NW3-4 and a NW6-7 are having a completely different hair loss issue, caused by completely different reasons? This sounds a very reasonable assumption, given that I personally became a NW6 without being a NW3 before.. It's just a totally different case.

How is it possible that some lose their hairs years after a successful hair transplant while others don't?

Maybe it's not about hairs that are DHT receptive, but it's the area of the scalp that triggers everything? If hairs would be the ones that are DHT receptive, I would expect it to be very random and diffuse, and not having the same pattern for almost every person!

So in bottom line, I think there are more unknown than known issues regarding hair loss.

Edited December 21, 2020 by dobler

[dobler]

On 11/26/2020 at 1:32 PM, Ron5566 said:

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.

 

 

Just makes it even more obvious, that it's not about the hairs themselves that are being "born" DHT sensitive. It's the zone on the scalp that for dome unknown reason makes them DHT sensitive. So if you take a hair and put it on the donor zone, it will survive forever (almost), while if you put it on the hairline, it will fall after 3-5-10-17 years (depends on some many unknown factors)

If the hairs on the "safe zone donor area" are starting to fall after implanted on the frontal third (while their twin sisters that stayed on the "donor zone" kept surviving), then ahm ahm... maybe the area is doing something to the hair! That could explain my case.

And in general - I think general MPB is false, not enough research were done. I think there are multiple MPB cases, caused by different factors, we just didn't research it enough till this point.

Edited December 21, 2020 by dobler

[mcr7777]

6 hours ago, dobler said:

Happened to me as well. And also to Wayne Roonie (you can look up for his photos after hair transplant, and now). Had 2900 grafts on frontal third back in 2016. Then follow up to fill crown in 2017 with another 2800 grafts (total 5700, Im NW6).

Results were great, I remember that in 2018 I had a thick full hair and I weren't even thinking about my hair loss anymore, thought I was done with this.

And then suddenly in 2019 (like end of 2019) I started thinning again in my frontal 3rd. 

Now I look almost as same as before the first HT. I don't know why is it.. Maybe FUE is just not as safe as you may think, as many grafts are taken from the nape, or from the thinning parts of the sides, which include hairs that were supposed to miniaturize anyway in the future. That may cause only part of FUE transplanted hairs to survive in the long term.

You can see the related post I had back then: 

 

Can't really see from your photos - but do you have any unusual pigmentation on your forehead (more pale and white at the top of your forehead towards your hairline)?  This is a classic sign of frontal fibrosing alopecia.  Also are your eyebrows thinner now than they were 5 or 7 years ago? Another classic sign. 

I'd definitely recommend getting a biopsy before considering any future transplants.

 

 

[mcr7777]

9 hours ago, Egy said:

I have read that many cases of FFA, (Frontal Fibrosing Alopecia), are often reported right after hair transplant surgery, and is basically, a special form of LPP (lichen planoplilaros)

“Frontal Fibrosing Alopecia is a progressive disease and without effective therapy in its stable form: therefore the interventions must be aimed at safeguarding vital hair, with classic therapies and regenerative therapies of the scalp (PRP, HC, PDRN in primis).”

Yes I've heard this too. I'm actually wondering if people often get hair transplants without realising they have frontal fibrosing alopecia.  And the disease then starts working away at their hairline again.  They just don't realise they have it until afterwards - it might explain some of the cases of losing grafts after 15 months or two years.

 

[dobler]

12 minutes ago, mcr7777 said:

Can't really see from your photos - but do you have any unusual pigmentation on your forehead (more pale and white at the top of your forehead towards your hairline)?  This is a classic sign of frontal fibrosing alopecia.  Also are your eyebrows thinner now than they were 5 or 7 years ago? Another classic sign. 

I'd definitely recommend getting a biopsy before considering any future transplants.

 

 

Hmmm no, for both of your questions.

[ITA]

11 minutes ago, mcr7777 said:

Yes I've heard this too. I'm actually wondering if people often get hair transplants without realising they have frontal fibrosing alopecia.  And the disease then starts working away at their hairline again.  They just don't realise they have it until afterwards - it might explain some of the cases of losing grafts after 15 months or two years.

In fact, it would be enough for surgeons to request a scalp examination from patients before undergoing the procedure, but they would lose too much money, because many would not have the transplant.

[asterix0]

I think it is pretty simple. If they were truly permanent, why has there not been a scientific study proving it?

But let's assume you can't necessarily prove it that way. Well, why can't a clinic outright state that it is permanent? Before you sign on the dotted line to agree to a transplant, why can't the documentation state "the hairs transplanted from the "safe" zone region will be permanent for the duration of the patient's life", with a further disclaimer defining what the safe zone is, on an individual basis and more generally?

I think it is because clinics themselves do not know if it is permanent or not. They know for some patients it is, for some it isn't, perhaps due to how sensitive their hairs are to androgens and how poor the blood flow / fibrosis is on the top of the head due to calcification and other DHT-based causes. 

They would lose business if they admitted this, so it isn't in their best interest. So many clinics skirt this grey area of language about hair transplant permanence. 

 

[mcr7777]

3 hours ago, dobler said:

Hmmm no, for both of your questions.

Ah ok - it might not be frontal fibrosing alopecia in your case but could be any number of other things. Might be worth consulting with a dermatologist hair specialist/considering a biopsy to rule out other conditions.

 

[mcr7777]

3 hours ago, Egy said:

In fact, it would be enough for surgeons to request a scalp examination from patients before undergoing the procedure, but they would lose too much money, because many would not have the transplant.

Yes - I agree - I am concerned myself about having frontal fibrosing/lichen planopilaris - already nearly a year into my transplant and waiting to have a biopsy now.  Wish I'd known about these conditions before and had one before my transplant so I could have had more peace of mind.

I think some HT doctors aren't very aware of frontal fibrosing (FFA) and how much it can look like normal MPB - and certainly general public don't seem to be very aware of it.

[caricatura]

I think that, if there is not one already, there should be a thread posting photos of people's (from this forum, not celebrities) HTs that are at least 2 years on, ideally 5+ years (without countless HTs inbetween). I am considering a HT myself, and the question of permanence is a no-brainer. This kind of problem scares me--but then I think of people like Jeremy Piven who seem to have had an FUT at least a decade ago and still are okay.

[asterix0]

48 minutes ago, caricatura said:

I think that, if there is not one already, there should be a thread posting photos of people's (from this forum, not celebrities) HTs that are at least 2 years on, ideally 5+ years (without countless HTs inbetween). I am considering a HT myself, and the question of permanence is a no-brainer. This kind of problem scares me--but then I think of people like Jeremy Piven who seem to have had an FUT at least a decade ago and still are okay.

We don't know if he's on finasteride or not.

[caricatura]

2 hours ago, asterix0 said:

We don't know if he's on finasteride or not.

True--same with Elon Musk, Matthew McConaughey, and others. Which is precisely why I think such a thread with ordinary people (detailing one's regimen) would be beneficial.