My story: 2580 FUE, May 10, 2021 (Microscope diary beginning October 27, 2021)

[Lightmare]

Hello everyone!  31 year old newcomer here.  I am almost 6 months into my first hair transplant and recently found this site.  I've been balding (frontal half and crown) since 2014 and finally decided to do something about it!  My timeline is as such...

• 2014-2019: I did nothing about it.  baldness was progressing slowly and I didn't think much about it.
• 2019-2021: I started trying 2x a day topical Minoxidil, and a photo diary to track progress.  I had initial success but it oscillated after a while.  Too scared to try fin at this point.  I also noticed that at this 3 month mark I started getting massive (up to 4mm) dandruff flakes from the topical but witnessed reduced efficacy when switching to the foam...
• May 2021: I had enough and it was finally time to take the plunge.  I visited several doctors and picked one with solid credentials, and got the transplantation to re-make my hairline and fill in my entire scalp and a bit of my crown.  Also at the recommendation of my surgeon, I added 1mg of daily finasteride pills + 2x a week 2% Ketoconazole shampoo to help with massive flakes I get from topical minoxidil dandruff.

I had my transplantation this May and, though am starting the sharing process late, wanted to share the timeline with you all.  Interesting notes about my transplant:

• We focused most of the density on the hairline and frontal 3rd, with decreasing density gradually as you go up to the crown. 
• I had soreness for much longer than most.  Headaches into the 2nd week.
• My shedding period was very long, between 2 weeks and 2 months post transplant.
• The areas that were most bald pre-HT haven't yet witnessed much meaningful growth, but the areas with some native hairs have seen good growth.  Variation is high.

I started noticing real growth around 4 months, and 5 months was also decent growth.  However over the past 2 weeks I witnessed a massive shed, so I look worse than month 5 at the moment.   I do hope that is normal.  I am seeing my doctor in 2 weeks.  

The last few weeks have been tough on my mid scalp due to all the shedding.  The right side is also behind the left quite a bit but I hear this is ok at this stage.  Here is the crown:

I started wondering what's really going on with the balder patches at this point, and being a scientist by trade I wanted to document the rest of my HT journey (6-12+ months) under a handheld digital microscope.  I realize this is incredibly hard to find the same patch of hair every month but I will do my best as it will help me find whether hairs are growing and thin, or not growing at all in some areas.  I could not find any other microscope diaries... details of my microscope are

• Cheap, can find many of these on Amazon for ~$20-40 USD.
• Based on some rough metrology I took, the camera image area is approximately .11cm^2.  So the # of hairs/grafts you see need to be multiplied by 9 to calculate density in units of cm^2.  It looks like this first image has 8 FU, resulting in approximately 72FU /cm^2 total, and likely consists of combo transplant + native hairs.  However, there are areas immediately adjacent to this that have fewer, so I'd have to peg a rough, conservative average at 50 FU/cm^2.
• I will be tracking one of my most bald areas, where I expect fewest and most miniaturized hairs.  This is not the worst on my whole scalp but it is up there.

Anyway thanks for tuning in, looking forward to tracking this with you all.  Please let me know what you think of my progress so far, and whether the density looks all right.  It is still quite see-through in real lighting, and there has been a regression in some areas over the past month due to the shedding, I am wondering whether anybody saw regressions like this in their experience that got better afterward.  

 

Edited November 4, 2021 by Lightmare

[Britanium]

Look like you have good growth for this stage. Although that’s quite a large area to cover with approx 2.5k. You may need/want to add density in the future.

Can I ask who the Dr/Clinic was ? Thanks 🙏 

[Gatsby]

This is incredibly well documented. I would also be keen to now who your surgeon was. Thanks for sharing and I look forward in following your results.

[Lightmare]

Thanks JC71, I am seeing more results on here and do agree with you that the number is on the small side for such a large area.  The other clinic I visited offered 3000, but I didn't get good vibes from them.  

My doctor's reasoning for 2580 is as follows:

• I never used finasteride before the operation and I had apparently lots of baby hairs that didn't completely die (just advanced miniaturization) when viewed under the microscope.  So it's possible the finasteride could strengthen some those miniaturized hairs back.
• Conserve donor hair for possible follow ups (but we hoped to avoid them if the finasteride works well).
• I was ok having some thinning evident in the crown but wanted the front to look good.
• Donor hair is very good with lots of 2s and 3s of large shaft diameters.  However I didn't ask specifically the breakdown or measured hair caliber yet...I will ask at the 6mo checkup.

So I am not sure how much of the growth is due to the HT versus the big 3 combo doing it's magic.  I do wonder though, how is 50 FU/cm^2 in terms of density, assuming they thicken up?  Through the same metrology, I estimated my donor region to be roughly 100+ FU/cm^2. 

The clinic I went to is Advanced Hair Restoration.  I think I'll ask the surgeon at the 6 month checkup whether they are comfortable with me sharing at this stage  

 

Edited November 4, 2021 by Lightmare

[Britanium]

I believe a second pass will be needed. Perfectly reasonable what the Dr was saying but it’s clear that 3k at least would be needed. 
Please keep us updated 🙏

[Melvin- Admin]

This is A+ documentation. I will say that it looks like you had some shock loss. It appears to be resolving now, but 5 months is still early.

[Lightmare]

Thanks everyone for the replies!  I really appreciate it, and I will for sure keep this updated!

Melvin, thank you very much for your input.  When I hear 'shock loss' I usually think about the initial shed between 2-6 weeks.  Is that what you're referring to for my recent (5 month) shed, or is it something else?  Is it normal at this stage?

Oh, and most of the hairs that shed over the past couple weeks are between 1-3cm long and are miniaturized hairs.  A few thicker hairs do fall but a vast majority are thin.  The hairs on the side/back of my head do not appear to be shedding more than usual.  

Edited November 4, 2021 by Lightmare

[Berba11]

20 minutes ago, Lightmare said:

Thanks everyone for the replies!  I really appreciate it, and I will for sure keep this updated!

Melvin, thank you very much for your input.  When I hear 'shock loss' I usually think about the initial shed between 2-6 weeks.  Is that what you're referring to for my recent (5 month) shed, or is it something else?  Is it normal at this stage?

Oh, and most of the hairs that shed over the past couple weeks are between 1-3cm long and are miniaturized hairs.  A few thicker hairs do fall but a vast majority are thin.  The hairs on the side/back of my head do not appear to be shedding more than usual.  

Melvin will be referring to shock loss in the sense that the implantation of new grafts close to native hairs can result in some of those native hairs "vanishing" for a while, often due to the trauma of the surgery and/or the added competition for blood flow that the newly transplanted grafts bring to a particular area of the scalp. Ultimately that's one of the core challenges with implanting grafts amongst native hair; there's only so many you can reasonably pack without risk of damaging native hairs (or worse; causing an infection), and it's totally normal to incur "shock loss" even when done excellently. Shock loss can last months and months in some cases.

It would be good to see a large close up of the post-op pics.

The hairline work looks nicely refined with the added micro-irregularities and I like the general shape of the hairline. Looks very natural. You maybe need a second pass of 1,000 grafts to really get that area looking a bit more dense and full, however. Time will tell!

[Lightmare]

That makes sense Berba11, thank you for your reply!  That would explain the shedding of some thick, mostly thin hair in the balder areas, and why I seem to have regressed by 1+ months in some areas.  Hopefully those native hairs come back soon and possibly stronger than before with the help of the finasteride. 

It was disheartening to see the shedding at this late stage when most sources do not mention it, but learning that it is a common side effect of mixing transplanting and native hair puts me at ease, as I wasn't slick bald anywhere before the procedure.

Here are some close ups of my hair immediately post op.  The photo itself is slightly tilted, so the hairline is a bit more symmetric than it appears in this photo but not perfectly symmetric, which I kind of prefer, like you said it's a nice natural look

Edited November 5, 2021 by Lightmare

[Lightmare]

Also wanted to show a side by side of two photos from one of my worst areas compared to one from my best…both from same magnification.  It really highlights the importance of hair caliber!  The difference surprised me.  The denisty difference in FU/cm^2 is not massive (all of these photos suggest at least 70 locally) but the thickness difference is enormous.

I don’t know if it’s possible to disseminate early-stage growth of a HT vs native miniaturized hairs that I don’t know whether I’ll get back or not, but it’d be wonderful if a snapshot was possible.   I would love to hear some of your thoughts on this.  
 

Otherwise that is the goal of the microscope diary  . 

 

 

 

Edited November 6, 2021 by Lightmare

[Lightmare]

Hey everyone,

Just got back from my doctor for the 6 month checkup.  Overall, my doc is very happy with my progress so far, mentioning that growth is looking robust considering where I started and I already look a lot younger.  After looking over my scalp (both with naked eye and microscope), doc found many new hairs starting to poke through, and many 2s/3s beginning to grow their extra hairs, so we're hopeful that more growth is coming.  Additionally, thickening still has a ways to go.  Donor area is doing great.  After that I asked a ton of questions and got some good info.

• Shedding starting month 5: we are not sure of the cause but doc doesn't think it's from delayed shock loss or med/fin shedding.  Never had a patient have it this late in the game.  Doc said most likely cause is seasonal shedding, which after going through my old minoxidil diary I did notice  my hair 'peaked' in fullness early October '19 and '20, and bottomed out the following Januaries, to begin improving into the spring and summer.  Hopefully, it is just seasonal.  
  • Sees seasonal shedding in many of their patients.
  • Nonetheless, doc prescribed me some blood work to get done.  Iron, Vitamins A/D, and thyroid.
  • Scalp looked healthy, no evidence of problems.  Did not recommend me to go to a derm at this point.  
• Dandruff: I asked about oral minoxidil.  Doc highly supported, has several patients on it seeing positive results and no sides, but could not prescribe due to impacts on blood pressure and monitoring it, suggests having my GP prescribe.  Until then, recommends that I do one minoxidil per day instead of 2, with fin it is enough to get most of the benefits. 
• Graft density: I got 30 grafts/cm^2 on average, with lower densities on the crown and higher densities in the hairline.  Doc tells me that, since I never had taken fin before, the goal of the first surgery was not a 'home run' but rather solid coverage, and seeing how my scalp takes the grafts and whether my native balding pattern holds or improves over the next year.  Additionally, planting at this density apparently maximizes yield; going significantly more dense in a single surgery will increase overall density at the expense of yield due to limited blood supply.  For cases like me that start meds after HT, doc tells me that a touch up procedure was common to really dial in the density and fill in the weak areas after stabilization.  Even coverage was provided in case I progress either way to maintain my natural balding pattern. 
  • Doc said I had very very good hair quality - lots of curl and thick caliber, so 30 grafts/cm^2 just might be enough for satisfaction too, possibly with some styling.

Overall, I am pretty happy with my meeting, and was reassured that things should improve.  Thank you to those with your feedback on the graft count, it helped me mentally accept that a second procedure is likely needed.  However I look forward to the 12 month mark to see how it improves.  This is the 6 month photo, which is pretty similar to at 5.75 months in the first post, but enlarged.

  I could not find the microscope location so I switched locations to a spot closer to my hairline that I can visually see, so it will be much easier to track.  You can see two well-grown grafts and another one just beginning to emerge on the upper left, alongside some thinner native hairs.  I will update if I can find the original one later.

 

 

Edited November 16, 2021 by Lightmare

[Lightmare]

Hey everyone,

7 month update: Overall, not much change from 6 months - but I think there've been ups and downs due to the shedding.  Still quite patchy at this phase, though the balder patches coincide perfectly with my native balding.  Those areas have thinner transplanted growth that are starting to thicken, so hopefully coverage increases there soon.  Some key points about what's happened over the past month:

• The shedding has subsided a little bit, and I think is more or less keeping pace with the rate of regrowth, so I think it's a bit better than 6.5 months.  It is still elevated, though. If it is a seasonal shed, it should stop soon, according to my doctor.
• My minoxidandruff problem has been reduced (though you see a few flakes in the picture, overall it's a lot less than before) since switching to Pura d'or gold label shampoo.  Hoping to try oral min to get rid of it completely but looking for a prescription.
• Some remaining post-op stubble still hasn't shed, but some is finally starting to fall out in the shower.  Does this mean new hair will replace it?  🤞
• Starting to think about what's next.  Another HT around 12 months?  SMP for the appearance of more density?  A combination of SMP and then another HT?  Input appreciated!

Here are the photos.  Pictures are still with my hair parted to show only what's happening in the recipient areas.  

Microscope photo progress (I am not 100% sure this is the same spot but gave it my best shot - if so it seems there may be some thickening going on for one of these grafts).

 

 

Edited December 14, 2021 by Lightmare

[Lightmare]

Just got the results of my bloodwork back (took 1mg fin 3 hours before the test, and I take it daily).  4 fine and 2 potential red flags: 

- Vitamin D : LOW (bad)

- Vitamin A: low (but too high is bad for hair apparently)

- thyroid: normal

- ferritin: normal, and good enough

- Testosterone: 718 Ng/dL (normal = 250-827)

- DHT: 32 ng/dL (normal = 12-65), bad?

Apparently even with the full effects of finasteride (70% DHT reduction) I am smack dab in the normal range of DHT.  Either that means 1) I am a non or lesser responder to fin or 2) my DHT level is normally around 32/.3 = 107, which is way way above the normal range.  I wish I checked my levels before starting fin so I don’t know the baseline, I’d rather not do this but maybe it’d be interesting to stop taking fin for a week and do another test to make sure I am responding to it.  Going to ask my doc what they think after holidays.

 

Edited December 24, 2021 by Lightmare

[Lightmare]

8 month update. Happy New Year everyone.  Overall my hair is not much different for the past 2 months.  I have been pretty happy with most of the hairline growth now, but the right side of my hairline and frontal third, and the entire back part of the frontal half are very weak.  The crown, however, appears to be thickening but that could largely be due to hair getting longer.

Some other notes:

• My hair is now long enough to mostly conceal my balding area with the right styling.  Wind and water are still very harsh on me though.
• Got a prescription for Oral minoxidil (monitoring blood pressure)!  Starting at 1.25mg/day (+topical 1x/day), bumping to 2.5mg/day after 6 weeks tolerated.
• Started taking 1000IU vitamin D daily at recommendation of doctor, as I had an insufficiency.
• Some good news, shedding has slowed down a fair bit.  Shedding rate is now about 1/2 to 2/3 what it was a month or 2 ago when it peaked.  Not as low as it was in the summer/early fall.

Given that I looked like an early or normal grower early on in many parts, I am a bit worried about the uneven growth at this point, and I've read a lot about autoimmune disorders that can cause patchy loss for any type of hair (scarring alopecia, areata).  Given how patchy my results are at this stage I am starting to worry whether I have some scalp disorder in addition to MPB, or if something went wrong during the surgery.  What do you guys think about my very lopsided growth at this relatively late stage?  

 

Edited January 10, 2022 by Lightmare

[Melvin- Admin]

There hasn’t been much change. I think a scalp biopsy couldn’t hurt to rule out underlying conditions. That said, if it comes back clear, the issue could be due graft mishandling or poor extractions. Have you brought your concerns up to the clinic?

[Lightmare]

I am starting to think that is a good idea.  The dermatologist I saw couldn't identify any issues visually, so they didn't recommend doing one due to the scar they said it'd leave behind, but I know there are cases that are very hard to identify visually.  It is very good to collect some thoughts from you all about this, because it looks more and more like a second procedure is in the cards and I don't want to do it if there's a risk for a scalp problem.

My surgeon pointed out that this area was less densely planted than the hairline which is a fair point, but the difference is just so stark.  Also they said they saw some stubbles in the problem area and said more growth should be coming, but IIRC those have remained the same length for many months - as long as I can remember.  I am not tracking it rigorously though.  Many of these are double and triple-hair stubbles too that are all the same length.  I am beginning to wonder if they'll ever fall or grow out...occasionally a shorter hair falls and I hope it's one of the stubble hairs.  I do hope my surgeon is right.

Here is a zoom in of the problem area...lots of thinner hairs that haven't seemed to thicken much for at least a couple months when I first started taking close ups here.  But a few hairs that are thicker.  I really wish I could tell which ones were native and which are transplanted.

 

Edited January 11, 2022 by Lightmare

[A Fue Good Men]

5 hours ago, Lightmare said:

8 month update. Happy New Year everyone.  Overall my hair is not much different for the past 2 months.  I have been pretty happy with most of the hairline growth now, but the right side of my hairline and frontal third, and the entire back part of the frontal half are very weak.  The crown, however, appears to be thickening but that could largely be due to hair getting longer.

Some other notes:

• My hair is now long enough to mostly conceal my balding area with the right styling.  Wind and water are still very harsh on me though.
• Got a prescription for Oral minoxidil (monitoring blood pressure)!  Starting at 1.25mg/day (+topical 1x/day), bumping to 2.5mg/day after 6 weeks tolerated.
• Started taking 1000IU vitamin D daily at recommendation of doctor, as I had an insufficiency.
• Some good news, shedding has slowed down a fair bit.  Shedding rate is now about 1/2 to 2/3 what it was a month or 2 ago when it peaked.  Not as low as it was in the summer/early fall.

Given that I looked like an early or normal grower early on in many parts, I am a bit worried about the uneven growth at this point, and I've read a lot about autoimmune disorders that can cause patchy loss for any type of hair (scarring alopecia, areata).  Given how patchy my results are at this stage I am starting to worry whether I have some scalp disorder in addition to MPB, or if something went wrong during the surgery.  What do you guys think about my very lopsided growth at this relatively late stage?  

 

I’m not an expert but if your vit D levels are low, 1000 iu is a lighter dose in my experience. If I recall, I took 2k and had another 1k IU in my daily multivitamin and it moved up my levels by around 20 units. It takes a while to build up too. Keep in mind different people may metabolize vit d differently.

Edited January 11, 2022 by 5BetaReductase

[Lightmare]

Thanks 5Beta, what were your levels before adding in the supplements?  Did you notice any improvement with your hair as a result?

[Lightmare]

Here's my 9 month update.  What do you guys think?  It seems like shedding has reduced further, I am pretty much back to baseline level shedding before it increased 3-4 months ago.  Additionally, some more of the persistent stubble has fallen and new hair I believe may be replacing it soon... so hopefully I'll be in for some late stage growth.

 I've seen a couple of dermatologists and they say the transplanted hair has grown in very well, and can easily tell grafts apart from natives.  They both said that for 2500 grafts over a big area it looked good overall from what they've seen before with transplants, but admitted they weren't experts in HT.  No evidence of any scalp conditions, no abnormal gaps in transplanted or native hair and some grafts are still thickening up.   Good / healthy amount of scalp oil indicating sebaceous glands are largely intact.  Both did a pull test and looked at hairs under high magnification and came to the same conclusion.  Both literally told me they wouldn't have any idea on where to take a biopsy sample because the whole scalp looks perfectly healthy as can be, and the loss is uniform and like classic MPB. My surgeon says the results are still on track and nothing to be alarmed about. 

One of the dernatologists noted that I looked more bald on the same side as before the operation, and that could have been due to slightly uneven levels of blood supply, which would also affect the transplanted hairs as well as just having less native hair to surround them.  When asked if a second transplant would be a good idea given my progress pictures and what they see they said 'No problem.  Your first transplant looks good, and I don't see any issues here.  But if you're still worried ask X (dermatologist in my area who also does HTs)'.   So I am thinking of possibly going there for a final opinion and getting one or several biopsies if they are not satisfied with my growth.

Edited February 15, 2022 by Lightmare

[Lightmare]

 I heard back from my surgeon today, and they are happy with my results for the 2580 grafts, given where I started.  I feel it’s improved a lot but I had to temper expectations after I learned more from this network.  But I want your opinions too!  What do you guys think if this was the final result for 2500 grafts placed over this big area?  Given that I was destined for a round 2 from the start.  How many more grafts do you think I'll need for a better, fuller and uniform appearance if it stays the same as now?  Does the ~1k estimate from earlier in the thread still hold or should I shoot for more?  I like my hairline and wish to keep it as is but want to wear it shorter, getting rid of the combover and try other styles.   I am almost satisfied with the crown if it continues to lag behind the front and respond to the meds.

My surgeon told me something interesting, that it is definitely possible to start seeing anagen desynchronization at this point, or even a bit earlier in some cases.  Most of my shed hairs at this stage are thicker now (but it has slowed down overall), so maybe that's it.  Given this possibility and the fact that it's stayed the same for 3 months now, I probably won't be improving much from here if at all.  I had some clues of desynchronization when I got a really strange looking hair come out (below) and Melvin pointed out that it could be related to desynchronization.  That was at month 6.  Given I saw first signs of growth at month 2.5 maybe it's possible.

 

 

 

Edited February 15, 2022 by Lightmare

[Lightmare]

10 months.  Overall, the growth hasn't changed much since month 5, so I am assuming this is the final result, but I'm reasonab ly happy with the results, it is a big difference from before.  When I style it right and when the wind and rain aren't problematic, I am fairly happy.  But I need to keep my hair very long to hide the balder patches, and it's clear that I'll want more density.

Looking for objective feedback from you guys, how well did this turn out for me given the 2500 grafts over this larger area?  

[stephcurry30]

great result given your baseline. Who was your surgeon? 

[Lightmare]

Thanks Steph for the feedback.  My surgeon was Dr. Tania Pauls at Advanced Hair Restoration in Colorado.  I was able to find 1-2 other cases of hers on here but those are dated and before she moved to Advanced Hair.  The procedure, aftercare, and communication were top notch overall and she has been really responsive through email. 

I feel she took a more conservative approach on me compared to what other doctors may have done the first time around, but as long as the yield is good and I can conserve grafts for the future, I will be happy with how it turned out overall.  Still feel like I need more, but happy overall since I have a lot of donor left.

Edited March 21, 2022 by Lightmare

[Lightmare]

So here I am at 11 months with a haircut as of a week ago.  Though my hair is shorter now, I feel the crown has genuinely thinned out, and it feels like I'm going through another shedding phase back there.  I only got ~400 grafts back there but I still feel a lot of stubble which I fear may be just dead grafts at this late stage.  The front seems to be (?) holding up better against it.

I was able to increase my oral minoxidil dose from 1.25 to 2.5mg a couple months ago but had to miss a week due to the increased prescription not being refilled in time by the pharmacy (I still use topical 1x a day too).  So either that or a finasteride shed may be causing this.  This time I am not as bothered as the one that started 6 months in but hope it stops soon.

  

Edited April 11, 2022 by Lightmare

[Lightmare]

(see next page)

 

 

 

 

 

Edited May 10, 2022 by Lightmare