Checking in after 10 years and need some advice *Pictures included*

[brogain]

10 years on from my original hair loss story I thought it was time to check in with the forum which was so helpful when I first started researching hair loss in 2010. 

Quick recap

My hair: My dad is a Norwood 6 and lost the majority of his hair by the age of in his early 20's. I started to notice my temples receding in my mid 20's and started medication at 27.5 and have recently turned 38. 

Meds: I have been on the big three for almost 11 years with no side effect. I started out taking 1mg Finasteride before reducing to 0.5mg and using Minoxidil whenever I wash my hair which is usually every other day. 

My thoughts 10 years later

Looking back I feel the meds have made a real difference in combatting hair loss. Particularly in the early years where meds helped my hairline responded very well. My crown thickness remains strong with only some minor signs of thinning. The most noticeable area of hair loss for me is in the front with my hairline thinning gradually over the years. 

Where to next?

I intent to continue taking the meds to slow hair loss but realise at this point I am unlikely to make any significant gains in the hairline. Therefore I am starting to think for the first time about having transplant. I am currently taking a break from work so recently began thinking about this option and naturally have a lot research and questions ahead of me.

There are a couple of things I would love to know:

* Based on my ten years of hair loss, would I be a good candidate for a transplant?

* How many grafts would I require to restore my hairline back to what it was ten years ago?

* Is restoring my hairline back to its original shape and thickness a realistic expectation with a good surgeon?

Where I started (2011)

 

Where I am at (2021)

[TommyLucchese]

You're in great shape hair-wise for almost 40 if that's the extent of your loss. It's significant enough to justify a HT but without the considerations many have like being too young or having too big an area that needs work. 

From first viewing you look like a classic case of 2,000  / 2,500 grafts on the hairline and frontal third and looking 15 years younger.

[LaserCaps]

Seems your front even improved with the use of medical therapy when you started.  You then started playing with the meds and used less Fin.  Seems it's been a gradual process, but now your front is gone.  You may want to consider returning to the 1mg, add PRP and laser and consider a transplant.  PRP combined with laser therapy has shown reversal of the thinning and help with enhancement of the native hair.  That should keep what you have and perhaps even see some visual enhancement.  It is unlikely, however, that your front will improve greatly.  

In the old days, say 20 years ago - and still today - there are some doctors who are in the belief that a separation between grafts is required for survival of a graft.  So, you do a procedure and 9-12 mo later you do another and fill in the gaps.  Now-a-days, there are others who can achieve great density with a single procedure.  Not sure if it's graft placement, but the effect is unreal.  Visit Dr. Arocha's website and look at photos of results.  2500-3000 grafts may be possible.  (Always do as much as you can afford).

Seems you keep your hair rather long.  FUT would allow full use of the donor.  FUE would always be available in the future if needed.  The other thing that benefits you is the fact that you are anglo and have blond hair, (less contrast), which gives you the look of a fuller set of hair.  

Are you open to travel?

 

[TommyLucchese]

30 minutes ago, LaserCaps said:

Seems your front even improved with the use of medical therapy when you started.  You then started playing with the meds and used less Fin.  Seems it's been a gradual process, but now your front is gone.  You may want to consider returning to the 1mg, add PRP and laser and consider a transplant.  PRP combined with laser therapy has shown reversal of the thinning and help with enhancement of the native hair.  That should keep what you have and perhaps even see some visual enhancement.  It is unlikely, however, that your front will improve greatly.  

In the old days, say 20 years ago - and still today - there are some doctors who are in the belief that a separation between grafts is required for survival of a graft.  So, you do a procedure and 9-12 mo later you do another and fill in the gaps.  Now-a-days, there are others who can achieve great density with a single procedure.  Not sure if it's graft placement, but the effect is unreal.  Visit Dr. Arocha's website and look at photos of results.  2500-3000 grafts may be possible.  (Always do as much as you can afford).

Seems you keep your hair rather long.  FUT would allow full use of the donor.  FUE would always be available in the future if needed.  The other thing that benefits you is the fact that you are anglo and have blond hair, (less contrast), which gives you the look of a fuller set of hair.  

Are you open to travel?

 

Do you mention laser therapy and PRP in every thread? 

[LaserCaps]

3 minutes ago, TommyLucchese said:

Do you mention laser therapy and PRP in every thread? 

I do.  Propecia/Fin, Rogaine, PRP and Laser are the only modalities we typically refer to when discussing hair loss.  The subject of cloning comes up from time to time but I don't think it's going to happen in my lifetime.  

With so many millions of people living in this planet of ours, there are things out there that perhaps help.  If they do, go ahead and use them.  At least they'll make you feel better. I tend to stick with what is proven to have some success.  

[brogain]

59 minutes ago, TommyLucchese said:

You're in great shape hair-wise for almost 40 if that's the extent of your loss. It's significant enough to justify a HT but without the considerations many have like being too young or having too big an area that needs work. 

From first viewing you look like a classic case of 2,000  / 2,500 grafts on the hairline and frontal third and looking 15 years younger.

Thanks for your comment. 2-2.5 grafts is a great place for me to start my research. 

When I started out on my journey it was very much about saving my hair as I thought I was destined to be bald like my dad. But over the years I have come to realise it really is more about slowing down hair loss. I have only very recently given surgery consideration. 

[brogain]

41 minutes ago, LaserCaps said:

Seems your front even improved with the use of medical therapy when you started.  You then started playing with the meds and used less Fin.  Seems it's been a gradual process, but now your front is gone.  You may want to consider returning to the 1mg, add PRP and laser and consider a transplant.  PRP combined with laser therapy has shown reversal of the thinning and help with enhancement of the native hair.  That should keep what you have and perhaps even see some visual enhancement.  It is unlikely, however, that your front will improve greatly.  

In the old days, say 20 years ago - and still today - there are some doctors who are in the belief that a separation between grafts is required for survival of a graft.  So, you do a procedure and 9-12 mo later you do another and fill in the gaps.  Now-a-days, there are others who can achieve great density with a single procedure.  Not sure if it's graft placement, but the effect is unreal.  Visit Dr. Arocha's website and look at photos of results.  2500-3000 grafts may be possible.  (Always do as much as you can afford).

Seems you keep your hair rather long.  FUT would allow full use of the donor.  FUE would always be available in the future if needed.  The other thing that benefits you is the fact that you are anglo and have blond hair, (less contrast), which gives you the look of a fuller set of hair.  

Are you open to travel?

 

I certainly saw the biggest gains in the first couple of years of medication. I didn't see any dramatic changes reducing from 1mg to 0.5 but over the gradual process of 11 years the gains minimised just like the hairs. 

My preference is for FUE as my hair is very short at the back and would like to avoid a large scar. 

Based in the UK now (returned from Australia) but open to travel to Europe. 

[NYHAIR32]

Nice post and update. You maintained well considering the MPB in your family and the rather low Fin dosage. Like TommyLucchese noted, you're in decent shape. If you are looking for your hairline to be restored, an HT is probably the most logical way to go, but if you were looking to maintain, you may want to consider Dut. 

[Britanium]

Just now, brogain said:

I certainly saw the biggest gains in the first couple of years of medication. I didn't see any dramatic changes reducing from 1mg to 0.5 but over the gradual process of 11 years the gains minimised just like the hairs. 

My preference is for FUE as my hair is very short at the back and would like to avoid a large scar. 

Based in the UK now (returned from Australia) but open to travel to Europe. 

Some really good European names to consider are Dr Bisanga, Dr Freitas, Dr Pinto, Dr Lapunzula, Dr Ferreira, Dr Feriduni, Dr Lorenzo and Dr Villa. Just for example 🤩

[1978matt]

Your's is an easy case and I'd suggest 1000-1500 grafts, FUE.

Laser is just not worth it on an effort versus reward basis.  I don't see how it could work unless the user kept a buzz cut, otherwise the hair just blocks the laser.

[giegnosiganoe]

Damn, so your hairline thinned that much over the past 10 years while on fin? That's kinda worrying..

[JDEE0]

13 minutes ago, giegnosiganoe said:

Damn, so your hairline thinned that much over the past 10 years while on fin? That's kinda worrying..

By the looks of things, it seems to me that fin has kept his hair that was still strong and evidently largely unaffected by MPB back in the first photos (i.e. the bulk of his hair up top, right behind the hairline) in a very similar state 10 years down the line. This hair looks pretty much just as dense and healthy as it did back in 2011 to me. 

It is clear that the frontal hairline has thinned out nearly completely, but I think it needs to be taken into account just how miniaturised this area was 10 years ago in his original pictures. Look at the one from July 10th; you can see how see through the area that has now thinned out was back then, it provided some sort of illusion of an outline of hair, but it was extremely weak in reality and looked like it had miniaturised way, way past the 50 percent mark. It doesn't look like the present day thinning area has expanded much if at all beyond the area that was thinning back then; just that the hair that was still hanging on has since gone.

The fin definitely strengthened this area up somewhat as time went by, but ultimately, the damage was probably already done and this didn't last for too long/it wasn't able to fully recover as a result. Who knows though, maybe the OP just isn't really heavily predisposed to lose hair behind that original zone that he was losing in 10 years ago and that's why it hasn't progressed rather than the fin preventing things. I think probably a bit of both, but with that said, I would definitely bet things would be visibly more recessed without the meds, no question.

I do get the feeling that you're generally likely to be able to hold onto any hair that was initially very healthy and non-miniaturised when starting finasteride, probably for decades (perhaps indefinitely as long as your genetics aren't particularly strong in these areas of the scalp) without any real change, in comparison to hairs that were miniaturised when starting and then recovered. I feel like these recovered follicles will pretty much always inevitably reverse at some point if they were so far gone like OP, whereas you have a decent chance the other way round.

It's kind of just a feeling though (and generally just a logical thought process that makes sense). The pictures from the Japanese 10 year study for example actually show the vast majority of patients recovering noticeably from diffused type loss, and being at least slightly above baseline visually at the 10 year mark, so it would suggest that OP has actually been unlucky to lose his hairline in the same time-frame going by that evidence.

At the same time, most people probably wouldn't even re-grow as much as OP did in the same situation, just maintain and probably continue to lose those already heavily miniaturised hairs on the hairline. I know I didn't, I only have temple loss in a barely NW3 pattern and after 2 years on fin, the rest of my hair is unchanged, but the areas in the temples that were all probably 90+ percent thinned have just continued to do so. 

[brogain]

 

2 hours ago, JDEE0 said:

By the looks of things, it seems to me that fin has kept his hair that was still strong and evidently largely unaffected by MPB back in the first photos (i.e. the bulk of his hair up top, right behind the hairline) in a very similar state 10 years down the line. This hair looks pretty much just as dense and healthy as it did back in 2011 to me. 

It is clear that the frontal hairline has thinned out nearly completely, but I think it needs to be taken into account just how miniaturised this area was 10 years ago in his original pictures. Look at the one from July 10th; you can see how see through the area that has now thinned out was back then, it provided some sort of illusion of an outline of hair, but it was extremely weak in reality and looked like it had miniaturised way, way past the 50 percent mark. It doesn't look like the present day thinning area has expanded much if at all beyond the area that was thinning back then; just that the hair that was still hanging on has since gone.

The fin definitely strengthened this area up somewhat as time went by, but ultimately, the damage was probably already done and this didn't last for too long/it wasn't able to fully recover as a result. Who knows though, maybe the OP just isn't really heavily predisposed to lose hair behind that original zone that he was losing in 10 years ago and that's why it hasn't progressed rather than the fin preventing things. I think probably a bit of both, but with that said, I would definitely bet things would be visibly more recessed without the meds, no question.

I do get the feeling that you're generally likely to be able to hold onto any hair that was initially very healthy and non-miniaturised when starting finasteride, probably for decades (perhaps indefinitely as long as your genetics aren't particularly strong in these areas of the scalp) without any real change, in comparison to hairs that were miniaturised when starting and then recovered. I feel like these recovered follicles will pretty much always inevitably reverse at some point if they were so far gone like OP, whereas you have a decent chance the other way round.

It's kind of just a feeling though (and generally just a logical thought process that makes sense). The pictures from the Japanese 10 year study for example actually show the vast majority of patients recovering noticeably from diffused type loss, and being at least slightly above baseline visually at the 10 year mark, so it would suggest that OP has actually been unlucky to lose his hairline in the same time-frame going by that evidence.

At the same time, most people probably wouldn't even re-grow as much as OP did in the same situation, just maintain and probably continue to lose those already heavily miniaturised hairs on the hairline. I know I didn't, I only have temple loss in a barely NW3 pattern and after 2 years on fin, the rest of my hair is unchanged, but the areas in the temples that were all probably 90+ percent thinned have just continued to do so. 

Some really good observations and thanks for your post. I think you are correct that by 2010 my hairline had weakened significantly with hairs miniaturising. I remember shaving my hairline around the 2010 picture which prompted me to start taking meds. My hairline certainly responded well to meds in the first few years and thickened up a fair bit in 2012. My loss became a bit more noticeable from 2018 onwards. I have thrown up a yearly comparison from 2006-2021 for anyone who is interested in seeing hair loss progression over 15 years. 

Behind the hairline remains thick and strong and has allowed me to style my hair without the loss being so obvious. Hopefully I can hold on to as much hair as I can for the next decade which is why I am thinking a transplant might be beneficial to recover my hairline. 
 

March 2012

 

March 2013

March 2014


March 2015

March 2016

March 2017

March 2018

March 2019

March 2020

Edited August 31, 2021 by brogain

[brogain]

3 hours ago, JohnAC71 said:

Some really good European names to consider are Dr Bisanga, Dr Freitas, Dr Pinto, Dr Lapunzula, Dr Ferreira, Dr Feriduni, Dr Lorenzo and Dr Villa. Just for example 🤩

Thank you good sir.

I will certainly be checking out those names.