DHT...

[follically challenged]

To my limited knowledge, the hairs which fall out are the ones which are 'most sensitive to DHT'. Thus, by undergoing a transplant, taking the hairs from the back which are more DHT resistant are therefore less likely to be affected.

But i was just wondering, what if that isn't the case... what if certain parts of the scalp somehow create more DHT? Or certain areas of the scalp allow DHT to congeal more (for lack of a better word)? If so, maybe this would explain the reason that many HTs still fail down 10 years down line with the so-called 'DHT resistant' hairs leaving anyway....or perhaps it could explain why certain areas are affected by baldness in the first place...

Just a query anyway. Thanks!

[Future Hair Doc]

The hairs that are DHT susceptible HAVE receptors OR have MORE receptors for DHT itself than the hairs from the "safe zone." That explains why those hair follicles miniaturize/fall out.  

There isn't a localized area where there is more DHT, from what I've read. Rather, testosterone is the substrate that undergoes metabolism by 5-alpha reductase into DHT (the enzyme basically creates a double bond between the 4,5 carbon atoms on the leftmost ring and thus reduces the oxidative state of the carbon atoms). 

Also, there is no empirical evidence suggesting many HTs fail after 10 or so years. 

[Curious25]

If your hypothesis held any truth - then why would there be transplants that that continue to succeed '10 years down the line'.

Whilst acknowledging this query to be a common cause for concern for many prospective patients, the recurrence of these styles of threads are starting to become tedious to read. 

Would be very interested to see the 'many' post 10 year HT failures you refer to. 

[follically challenged]

On 1/7/2021 at 9:10 PM, Curious25 said:

why would there be transplants that that continue to succeed '10 years down the line'.

Haha, you're really asking that? If transplants were that sustainable, why are top-ups so often needed for a large number of patients?

I'm that sure some succeed down the line... of course I'm not saying this theory to be applicable to ALL, I'm merely wondering if it could be the case for some? Obviously each person's hair loss journey is different..

 Finally, if the '10 year mark' is so easy to attain, don't you not think more surgeons would be doing follow-up videos to show solid proof and put potential patients at ease?

You said it yourself... it's 'a common concern for many prospective patients'... so which HT surgeon in their right mind wouldn't jump at the opportunity to prove their work can truly last..? (And please don't suggest that it's simply because patients are 'too busy' or have 'moved on with their lives'... a 2 minute follow-up vid would be very little effort on their part if they had maintained solid results 10 years down the line...)

[Curious25]

17 minutes ago, follically challenged said:

Haha, you're really asking that? If transplants were that sustainable, why are top-ups so often needed for a large number of patients?

I'm that sure some succeed down the line... of course I'm not saying this theory to be applicable to ALL, I'm merely wondering if it could be the case for some? Obviously each person's hair loss journey is different..

 Finally, if the '10 year mark' is so easy to attain, don't you not think more surgeons would be doing follow-up videos to show solid proof and put potential patients at ease?
 

1) Because hair loss is progressive, and native hair continues to fall - hence the requirement for additional transplants.

2) Its either one or the other - there is no individual basis on this suggested theory of yours. DHT resistant hairs either exist, or they don't. What is individual, is the amount of DHT resistant hairs patients have - this is a variable factor.  

3) I agree that more long term patient follow ups would be useful. Thats not to say that there aren't any out there. 

[Al - Moderator]

2 hours ago, follically challenged said:

Finally, if the '10 year mark' is so easy to attain, don't you not think more surgeons would be doing follow-up videos to show solid proof and put potential patients at ease?

 

The patient has to actually go back to visit the Dr. 10 years later for the Dr. to be able to do a 10 year follow-up video. When the patient is happy with the results they don't have a reason to return.

 

Edited January 9, 2021 by BeHappy

[Al - Moderator]

I still have hair growing from transplants done over 30 years ago. It has thinned out considerable, but this is because the donor area has thinned out and progressed past the strip scars. The transplanted hair has lasted exactly as long as the hair in the donor area lasted. Hair transplants have been being performed for over 50 years. It's not something new. It's been proven many years back from men who have had transplanted hair grow for 30, 40, or 50 years plus that transplanted hair continues to grow just as long as it would have if it was never transplanted.

 

There are two issues going on.

1. The myth of a safe zone or permanent zone. It doesn't exist. There is a zone that is safer and lasts much longer, but it is not totally safe as Drs want you to believe. Even the Brad Pitts of the world will have thinner donor areas as they get older.

2. This one is my own theory. I have no real research to back it up other than having been around hair transplants for over 30 years and seeing that this is a recent happening with FUE. The reason I believe that some transplants seem to be losing hair after a few years is because the punch sizes are getting too small to get the complete follicle or to get follicles with enough surrounding tissue to be viable long term. They are damaged grafts and don't grow well after a few cycles. This is not a problem of hair transplants in general. If you think about the recent issue of losing density over the past few years I believe they are all the same type of hair transplant. FUE with smaller then .9mm or .85mm punch sizes. Those .7mm and .8mm punch sizes sound great because they don't leave scarring, but they don't grow good hair either. They do at first, but with no tissue surrounding the follicle there isn't enough there for donor dominance to take effect and thus the weak, dyeing follicle surrounding it after it gets transplanted may actually be able to take over after a few growth cycles. I should draw some pictures to show what I mean.

 

 

[Melvin- Admin]

5 minutes ago, BeHappy said:

I still have hair growing from transplants done over 30 years ago. It has thinned out considerable, but this is because the donor area has thinned out and progressed past the strip scars. The transplanted hair has lasted exactly as long as the hair in the donor area lasted. Hair transplants have been being performed for over 50 years. It's not something new. It's been proven many years back from men who have had transplanted hair grow for 30, 40, or 50 years plus that transplanted hair continues to grow just as long as it would have if it was never transplanted.

 

There are two issues going on.

1. The myth of a safe zone or permanent zone. It doesn't exist. There is a zone that is safer and lasts much longer, but it is not totally safe as Drs want you to believe. Even the Brad Pitts of the world will have thinner donor areas as they get older.

2. This one is my own theory. I have no real research to back it up other than having been around hair transplants for over 30 years and seeing that this is a recent happening with FUE. The reason I believe that some transplants seem to be losing hair after a few years is because the punch sizes are getting too small to get the complete follicle or to get follicles with enough surrounding tissue to be viable long term. They are damaged grafts and don't grow well after a few cycles. This is not a problem of hair transplants in general. If you think about the recent issue of losing density over the past few years I believe they are all the same type of hair transplant. FUE with smaller then .9mm or .85mm punch sizes. Those .7mm and .8mm punch sizes sound great because they don't leave scarring, but they don't grow good hair either. They do at first, but with no tissue surrounding the follicle there isn't enough there for donor dominance to take effect and thus the weak, dyeing follicle surrounding it after it gets transplanted may actually be able to take over after a few growth cycles. I should draw some pictures to show what I mean.

 

 

This is the most sensible post on the subject. I spoke about this with Dr. Bisanga, I’ll post the video soon. He basically said the same thing. 

If you take a man with hair loss, and a man with no hair loss and examine their donor area at age 20, then again at age 80, they both will have less hair. 

We all experience involutional alopecia, which is basically aging hair loss. As we get older, our cells die out, and we no longer produce the same amount of hair as we did when we were younger. 

This whole hair transplants fail after 10 years is utter nonsense, spewed by guys who’ve never even had an HT. Will the hair transplant be as dense? Maybe, maybe not. But it won’t be like you never had an HT. 

[Future Hair Doc]

49 minutes ago, BeHappy said:

I still have hair growing from transplants done over 30 years ago. It has thinned out considerable, but this is because the donor area has thinned out and progressed past the strip scars. The transplanted hair has lasted exactly as long as the hair in the donor area lasted. Hair transplants have been being performed for over 50 years. It's not something new. It's been proven many years back from men who have had transplanted hair grow for 30, 40, or 50 years plus that transplanted hair continues to grow just as long as it would have if it was never transplanted.

 

There are two issues going on.

1. The myth of a safe zone or permanent zone. It doesn't exist. There is a zone that is safer and lasts much longer, but it is not totally safe as Drs want you to believe. Even the Brad Pitts of the world will have thinner donor areas as they get older.

2. This one is my own theory. I have no real research to back it up other than having been around hair transplants for over 30 years and seeing that this is a recent happening with FUE. The reason I believe that some transplants seem to be losing hair after a few years is because the punch sizes are getting too small to get the complete follicle or to get follicles with enough surrounding tissue to be viable long term. They are damaged grafts and don't grow well after a few cycles. This is not a problem of hair transplants in general. If you think about the recent issue of losing density over the past few years I believe they are all the same type of hair transplant. FUE with smaller then .9mm or .85mm punch sizes. Those .7mm and .8mm punch sizes sound great because they don't leave scarring, but they don't grow good hair either. They do at first, but with no tissue surrounding the follicle there isn't enough there for donor dominance to take effect and thus the weak, dyeing follicle surrounding it after it gets transplanted may actually be able to take over after a few growth cycles. I should draw some pictures to show what I mean.

 

 

I know exactly what you mean in your 2nd point. VERY astute observation. However, the graft should integrate itself into the surrounding recipient tissue and mitigate against this. The chance of transection does go up with smaller punch sizes though. 

Edited January 9, 2021 by Dr. Suhail Khokhar

[Captain Haddock]

This is very interesting. There seems to be a wide variety of opinions regarding this.

When we were marking the hairline during my surgery I was told by my surgeon that from her experience, even transplanted hairs last around 8-10 years and that they were NOT permanent. 

And what @BeHappy wrote about the punch size makes so much sense. 

Edited January 9, 2021 by Captain Haddock

[Captain Haddock]

1 minute ago, Dr. Suhail Khokhar said:

I know exactly what you mean in your 2nd point. VERY astute observation. However, the graft should integrate itself into the surrounding recipient tissue and mitigate against this. The chance of transection does go up with smaller punch sizes though. 

Excellent observations on this thread all round. I guess those with lower NWs could go for smaller punches and benefit from less scarring and transection rate. Higher NWs would absolutely need that surrounding tissue intact. 

[Future Hair Doc]

Of my cohort, every single person's hair transplant has lasted past 10 years. I received my transplant about 10 years and have had 2 FUTs and my hair is thicker and denser than it was back then (I'm also taking a topical solution of finasteride and minoxidil). 

[kramer79]

5 hours ago, BeHappy said:

I still have hair growing from transplants done over 30 years ago. It has thinned out considerable, but this is because the donor area has thinned out and progressed past the strip scars. The transplanted hair has lasted exactly as long as the hair in the donor area lasted. Hair transplants have been being performed for over 50 years. It's not something new. It's been proven many years back from men who have had transplanted hair grow for 30, 40, or 50 years plus that transplanted hair continues to grow just as long as it would have if it was never transplanted.

 

There are two issues going on.

1. The myth of a safe zone or permanent zone. It doesn't exist. There is a zone that is safer and lasts much longer, but it is not totally safe as Drs want you to believe. Even the Brad Pitts of the world will have thinner donor areas as they get older.

2. This one is my own theory. I have no real research to back it up other than having been around hair transplants for over 30 years and seeing that this is a recent happening with FUE. The reason I believe that some transplants seem to be losing hair after a few years is because the punch sizes are getting too small to get the complete follicle or to get follicles with enough surrounding tissue to be viable long term. They are damaged grafts and don't grow well after a few cycles. This is not a problem of hair transplants in general. If you think about the recent issue of losing density over the past few years I believe they are all the same type of hair transplant. FUE with smaller then .9mm or .85mm punch sizes. Those .7mm and .8mm punch sizes sound great because they don't leave scarring, but they don't grow good hair either. They do at first, but with no tissue surrounding the follicle there isn't enough there for donor dominance to take effect and thus the weak, dyeing follicle surrounding it after it gets transplanted may actually be able to take over after a few growth cycles. I should draw some pictures to show what I mean.

 

 

When you say that your donor area thinned out and progressed past the strip scars; are you saying that the back has dropped significantly down where it has exposed your scar/s ? If i am interpreting this correctly, had FUE existed It would have been worse off today as you would have uniformly thinned through an already thinned out region due to the FUE extractions creating a massively moth-eaten looking effect.

Your second theory seems quite interesting

[Al - Moderator]

10 hours ago, kramer79 said:

When you say that your donor area thinned out and progressed past the strip scars; are you saying that the back has dropped significantly down where it has exposed your scar/s

 

Yes. Sides and back.

 

10 hours ago, kramer79 said:

If i am interpreting this correctly, had FUE existed It would have been worse off today as you would have uniformly thinned through an already thinned out region due to the FUE extractions creating a massively moth-eaten looking effect.

Correct (sort of). This is why I am still in favor of strip/FUT for a lot of cases.

When I went they made a new scar for each surgery, so I have multiple rows of scars. So the donor area used on me is more like an FUE area because it takes up a lot of space. I lost hair past the upper and lower scars. But what you are saying would be correct if compared to having a FUT strip the way it's done today where they keep using the same scar line. I would have been doing a bit better as far as keeping transplanted hair.

[follically challenged]

On 1/9/2021 at 4:33 PM, Curious25 said:

I agree that more long term patient follow ups would be useful. Thats not to say that there aren't any out there.

First of all, when i use the word 'fail' of course I mean that the result no longer looks great - not because of native hairs falling out, although that certainly would be a contributing factor to it looking less natural - but more about the quality of transplanted hair which has miniaturised or fell out. I think BeHappy mentioned a good point about graft punch...perhaps that could affect the transplanted hair quality down the line...

Though it's interesting that others have also commented on this thread here about the 10 year mark, so i don't think i'm being totally nonsensical in questioning the longevity...

But as you seem so confident in the 10 year mark, and as we can both agree how HT surgeons simply must advertise to stay afloat, as that's just part of business of course, and is the main reason we can find hundreds of HT results videos being uploaded each week from around the globe. And as established on this thread also, HTs have been happening for around 50 years....

So, of the thousands... hundreds of thousands of hair transplant results documented, to be seen on youtube right now, videos being made for marketing or simply a patient proudly displaying their good result, I challenge you to find me 10 videos marking a good 10 year result..... only 10....

It's OK, I'll wait..... 

[Curious25]

I agreed with you regarding the volume of 10+ year post HT videos being low.

When it comes to medicine - I stick to science and doctors' opinions on topics in their relevant field.

Which in this case doesn't support your proposed theory. I'm not saying that your theory is wrong, however I am saying I prefer to trust the thousands of doctors across the world who acknowledge DHT resistant hairs are DHT resistant wherever they are placed on the body. This is the reason the age old million dollar question of 'when is too young to transplant' is such a heavily debated topic - because the concern is that patients will be left with an unnatural hair loss pattern once the native hair continues to fall, and their transplanted hair remains. 

Genetic ageing is a separate issue - and can be likened to the ageing of other organs in our body, such as the skin. 

If your concerns are genuine, I suggest you consult with multiple doctors before choosing to go ahead with surgery, and ask this question to each of them. If you have deemed them to be worthy of your time and money to be consulting with them in the first place, I would assume you will trust their answers 😉 

Edited January 10, 2021 by Curious25

[ciaus]

2 hours ago, follically challenged said:

It's OK, I'll wait..... 

Wow, that's very charitable of you. So all you do is throw out conjectures and expect other people to provide actual evidence.

Go ahead and bookmark this topic and check back in about 10 years.

[kramer79]

9 hours ago, BeHappy said:

 

Yes. Sides and back.

 

Correct (sort of). This is why I am still in favor of strip/FUT for a lot of cases.

When I went they made a new scar for each surgery, so I have multiple rows of scars. So the donor area used on me is more like an FUE area because it takes up a lot of space. I lost hair past the upper and lower scars. But what you are saying would be correct if compared to having a FUT strip the way it's done today where they keep using the same scar line. I would have been doing a bit better as far as keeping transplanted hair.

Without starting a FUT vs FUE debate, i believe this is a good example on how FUT is not going anywhere unless hair restoration reaches a new breakthrough (hair cloning etc) 

I don't believe that FUE alone can replace FUT as a viable and sensible approach to hair restoration while taking the future into account.

I see it in my own father who had great donor while losing the top but even his donor has thinned out relative to 10 years ago (60 vs 70 years old). Hypothetically, had he done a FUT when his donor was "healthier" it would still cover a FUT scar today but had he done FUE, his donor hair would look moth-eaten/depleted. I just believe FUT gives more mercy to the potential progression of hair-loss long term in case someone has to stop using FIN for any reason or any other unforeseen circumstance.

[Al - Moderator]

12 hours ago, follically challenged said:

So, of the thousands... hundreds of thousands of hair transplant results documented, to be seen on youtube right now, videos being made for marketing or simply a patient proudly displaying their good result, I challenge you to find me 10 videos marking a good 10 year result..... only 10....

 

Joe Tillman, Spencer Stevenson (Spex), Bill Seemiller are 3 that come to my mind who have had their hair transplants done over 10 years ago who were all once contributors to this forum and are still active in the hair transplant industry. There have been plenty of posters that come back here and post some years after having their hair transplants because they are looking to have more work done and say that they are happy with the first procedure they had years ago. There are also many of the hair transplant Drs who started in hair transplants after having a hair transplant themselves. Some of the older Drs transplants were done well over 20 years ago. You can also look at US President Elect Joe Biden. His hair transplant is over 40 years old with some touch ups over time to make it more realistic looking as it was originally very pluggy.

 

You're not going to find a whole lot of people on youtube talking about a hair transplant they had 10 or 20 or 30 years ago for several reasons.

1. Because if they are popular on youtube it's not for hair related topics (other than the people I mentioned earlier like Joe Tillman and Spex) because they had their hair transplant before youtube was a thing and probably none of their followers and viewers know they ever had a hair transplant. Why would they make a video about it and let that out there?

2. Guys on youtube who get a hair transplant generally make it into a series that can last an entire year showing you their before photos, the plan, who they consulted with, the immediate after photos and video, then weekly and monthly videos of how it's progressing and so on. Someone on youtube who happened to have a hair transplant 10 or 20 years ago would only be doing a one off video about how he just so happened to have a hair transplant 15 years ago. There's no reason to do it. There's no way to get followers or views from a one off video of some 15 year old transplant, so you're not going to find those.

3. Even if some guys who had hair transplants years ago wanted to tell the world about it there isn't much to show. Sure they can show a few old photos of what they used to look like, but it's very rare for anyone to have post op photos and certainly not video. It wasn't done in those days. My in office photos taken by the clinic were taken with a polaroid instant camera. Nobody had cell phones with cameras to take selfie photos when they went home. Besides back in the day a hair transplant was something you had to hide and be ashamed of letting anyone know you did it, so you wore a hat for a few months and made sure you were not in any pictures. It's a totally different thing now.

 

Edited January 11, 2021 by BeHappy

[follically challenged]

14 hours ago, BeHappy said:

You're not going to find a whole lot of people on youtube talking about a hair transplant they had 10 or 20 or 30 years ago for several reasons.

Unfortunately, your three points are moot, based on the explanation I already gave: "HT surgeons simply must advertise to stay afloat"

1. Nothing would be better for the HT surgeons (not necessarily the patients) than to show the longevity of a patient's HT that has lasted 10 years, and no, it wouldn't be too difficult to get them in for a follow-up video or even a video recorded from the comfort of the patients' own home. If they're willing to do a follow-up after 12 months, I'm sure they would be after 10 years.. it would be the very least they could do to show their gratitude towards such a great surgeon and having their life changed for the better, right?

2. As for patients...you mentioned a year series? Hmmm, not quite true either. YouTubers will make content as long as they enjoy doing it and as long as people continue to watch it thus creating ad revenue from it... hence one of the main reasons behind most YouTubers' content... they don't automatically stop at 1 year...

3. If its anonymity you're giving as a reason...again, it simply doesn't hold up. It's so easy now to blur the eyes, face, etc making patients unrecognisable, focusing purely on the results.

I started this thread merely curious about the DHT effects, curious as to if the hairs were different or merely the areas of scalp... It seems that i am most likely wrong on that, and it is a case of certain hairs being less susceptible to DHT... I'm happy to accept that..

But for whatever reason, I still find it hard to accept that most HTs will last the 10 year mark. Sure, some will! But your examples of patients happy with their first results aren't that great... Joe Tilman has had, what... 10 HTs now? lol, Spex probably the same amount almost.... so that doesn't really support your argument that they last so well...otherwise surely 2 or 3 or even 4 HTs would have done it..?

[follically challenged]

On 1/10/2021 at 8:48 PM, ciaus said:

conjectures and expect other people to provide actual evidence.

errr, yeah...i was asking a question, dude
...isn't this forum supposed to be used to discuss all things hairloss related...?

[Richie888]

4 hours ago, follically challenged said:

Unfortunately, your three points are moot, based on the explanation I already gave: "HT surgeons simply must advertise to stay afloat"

1. Nothing would be better for the HT surgeons (not necessarily the patients) than to show the longevity of a patient's HT that has lasted 10 years, and no, it wouldn't be too difficult to get them in for a follow-up video or even a video recorded from the comfort of the patients' own home. If they're willing to do a follow-up after 12 months, I'm sure they would be after 10 years.. it would be the very least they could do to show their gratitude towards such a great surgeon and having their life changed for the better, right?

2. As for patients...you mentioned a year series? Hmmm, not quite true either. YouTubers will make content as long as they enjoy doing it and as long as people continue to watch it thus creating ad revenue from it... hence one of the main reasons behind most YouTubers' content... they don't automatically stop at 1 year...

3. If its anonymity you're giving as a reason...again, it simply doesn't hold up. It's so easy now to blur the eyes, face, etc making patients unrecognisable, focusing purely on the results.

I started this thread merely curious about the DHT effects, curious as to if the hairs were different or merely the areas of scalp... It seems that i am most likely wrong on that, and it is a case of certain hairs being less susceptible to DHT... I'm happy to accept that..

But for whatever reason, I still find it hard to accept that most HTs will last the 10 year mark. Sure, some will! But your examples of patients happy with their first results aren't that great... Joe Tilman has had, what... 10 HTs now? lol, Spex probably the same amount almost.... so that doesn't really support your argument that they last so well...otherwise surely 2 or 3 or even 4 HTs would have done it..?

My brother has had his transplant for well over 10 years(since he was 23). That's without meds or much hair care overall.  In his own words he has no time to make 'poncy' videos or blogs.  He done it for his own gain and didn't really want to shout about it. 

On the flip side if the clinic wanted to contact him he's changed his number about 25 times since and about as many email addresses. Prob not the norm for all patients but it's not as black and white as going through a little black book and getting hold of all previous patients with ease, and getting them to take the time to document their progress. 

[TommyLucchese]

Here's my new thread with pics 9 years after my FUT with Dr Feller...