M36 | Dr. Bruno Pinto | 1716 grafts | 17 May 2022

[A Fue Good Men]

Wow this looks fantastic. Pinto is def in the top 5 worldwide with his work. There’s a reason he’s so popular on Spanish forums 

[Big Rome]

53 minutes ago, Harry Bosch said:

6 Month Update

Hey gang.

Attached some pics at 6 months.  Outdoor lighting, post-shower, damp hair *
 

(*hairline looks a lot better and homogenous when moist; dehydration- which is common with my wavy hair type - makes everything look more sparse)

Overall hard to complain.  My goals were aggressive, and in that sense it’s been a positive change but I’ve got a few weak points.  My thick hair type + loss pattern demanded a lot of density in the recipient area.  Cosmetically, it looks good and responds well to some mild, strategic fiber application (not pictured).

Downstream I will consider a touch-up.  I haven’t yet grown evenly everywhere, notably those two small gaps in my frontal forelock.  And I’m sure I’ll lose some thickness in the front to gradual MPB progression - my left side (stronger side, historically) does look like it’s become a bit more concave than a I prefer.  But these are small critiques, and not worth addressing for some time - hate to endure another shave/ugly duckling. Of course we all become hyper critical and greedy once we’ve taken the HT leap.

Speaking of shave, I know my case was unique with that peninsula of 200 grants that Dr. P implanted into a region affected (we think) by fibrosis.  I can’t really determine how that has grown or impacted the outcome, and I suppose I couldn’t know unless we shaved down again.

I do have a small smooth bump in each temporal region.  Initially we figured this was natural swelling from the dense pack, but Dr. P’s prediction that it will resolve in time has not proved true.  He did assure me it wouldn’t impact the final outcome.  Had anyone else experienced this long-term subtle inflammation (?) in the recipient?

Protocol

1.25mg Fin/day

5 mg Oral Min / day

Nizoral 1% 2-3x / week 

No topicals since the operation.  Had previously used topical Min for a decade, and RU for about a year.  Reluctant to return to the latter given its gray market status, anecdotal evidence,  and complete lack of safety information.

Interested in Pyralitamide.  I’m in that age pocket where TRT is a real option with much-needed physical benefits, but obviously hair safety is important to me. A legit, tested topical AA would be a great adjunct.  I did not respond well to oral Dut (in two limited samples) and hesitate to try the topical, endure a shed, and be able to confidently source it long-term.

Feedback welcome.

Pics below:
 

 

 

this is incredible with many months of growth to come! looks so natural!!! 🤩🤩

[Harry Bosch]

Pinto People:

@Bonek @Falconary @Iceee222 @JDEE0 @rambo man

[Harry Bosch]

Just now, Harry Bosch said:

Pinto People:

@Bonek @Falconary @Iceee222 @JDEE0 @rambo man

@therambler

[Iceee222]

13 hours ago, Big Rome said:

this is incredible with many months of growth to come! looks so natural!!! 🤩🤩

Looks incredible man congrats!!

 

[drawdownfx]

Looking really nice! Am so jealous of your already thick native hair!

Edited November 26, 2022 by drawdownfx

[Gramatik]

Really good result. Congrats. Do you have pre op pictures with long hair ?

[Harry Bosch]

23 minutes ago, Gramatik said:

Really good result. Congrats. Do you have pre op pictures with long hair ?

There are a few pre-op pics from clinic earlier in the thread.

I attached a few that I’d sent to various clinics during my assessment conversations.  I actually rebounded a bit from these images - at the time they were taken, I suspect my Fin pills had degraded through poor maintenance by me.  I was also less consistent with applying Min.  
 

Around the time of the first images (fall 2020) I started applying RU.  In January 2021, I stacked Oral Min on top of Fin, Topical Min, and RU.  Kept that protocol up until surgery and had some improvement.

[Harry Bosch]

2 hours ago, Iceee222 said:

Looks incredible man congrats!!

 

Certainly helps with styling, camouflaging, and coverage.  But very high maintenance and sensitive to dehydration!  One of the reasons I felt a procedure would really help cosmetically.  When hair was dry and unhealthy, it’s stand up and look like tumbleweed and really expose/exacerbate the appearance of recession vs. laying down flat for a combover style 

[Falconary]

I think it looks really great, as natural as it can get 🤩 You are also only 6 months in and should see more growth/thickness coming especially the coming 2 months. I had great thickness increase from month 6 to 8 even though I stopped minoxidil and fin at month 6. I also think the gaps is mostly something only you notice/care about, I didnt even think about before reading your text, but hey, any future "fixing" wont cost much and would be much easier to deal with. 

[Big Rome]

any update brother? @Harry Bosch

[Harry Bosch]

1 hour ago, Big Rome said:

any update brother? @Harry Bosch

Update at 7 Months.

I believe I’ve had some regression since my 6-month update.

Nothing tragic.  Perhaps it’s just some shedding and/or de-synchronization of growth cycles.  Hard to say.

I do think a I’ve lost some native hair surrounded the transplanted area.  My left side has historically been stronger but it looks worse, perhaps worse than pre-surgery.

Recall that I have had a post-surgical bump in the two recipient temple regions.  That, along with that fibrosis region (scarring alopecia?) has contributed to some ongoing anxiety.  Both my temporal regions, as well as my grey streak, present some weaker, wispier hairs that are don’t look healthy and are resistant to styling tricks.

Speaking of that fibrosis region, recently my hair has been lacking lift in that area.  Hard to support that combover wave I personally fancy.  Makes me wonder if I got any growth there - I guess we can’t be sure unless we shave down and assess that area.

Overall there are improvements.  There’s the temporal closure on the right side (which was the weaker side, pre-op).  The temple peaks are stronger, although I’d like the right side to be a bit less concave.

I’m comfortable with the fact that my current look is short of my surgical goals.  This was not unexpected.  My density behind the recession was unlikely to be matched with one operation.  Plus, the threat of continued loss and thinning threatens every patient.

At 6 months I was generally satisfied, but right now — when it comes to styling — there’s not a real material improvement vs. pre-op.  Again, perhaps it’s just a shed or a brief setback.  This was not the case one month ago. My hair is wavy and tends to stand up, which makes the hairline and loss pattern look bad.  That was the motivation for the temple closure.

I think there is foundation here for a successful refinement, and that was always a likelihood based on my hair characteristics.  I’m a bit discouraged by the regression on my left side, and certainly have ongoing anxiety about the two bumps and fibrosis.  The gaps in my frontal tuft still exist but are smaller.  We’ll see if the next five months offer some form of rebound and improvement.

As far as protocol, I’ve been loyal to 1.25mg/day Fin + 5mg/day Oral Min.  I abandoned topicals (RU and Rogaine) post-op, so that might be a factor in the result-to-date.  I plan to reintroduce Topical Rogaine alongside the medications, as it’s possible I grew some reliance to it after 10 years of use.  It’s possible I’m not a huge responder to Oral Min, and I certainly don’t have the associated sides such as excess body hair.

Pictures, both wet and dry, are attached.  Harsh bathroom lighting.

 

[Gatsby]

@Harry Bosch I certainly can't pick it. Your hair is looking excellent! 💯👌

[MazAB]

@Harry Bosch you might be correct on the switch from topical to oral minoxidil. I was very discouraged with the shed I had at 6 months when I added Dutasteride into the mix. I figured since Fin and Dut were similiar drugs in nature I'd be ok, but definitely not. By month 9 though, every was back to normal. Give it a couple of months more to stabilize, and in the meantime don't stress, enjoy your new hair! It looks incredible!

Edited December 21, 2022 by MazAB

[rambo man]

I think your hair looks great. 

i have been on the oral minoxidil for a year now and it does keep the hair in a good quality. 
 

you also have 5 months for the hair to thicken but honestly it’s looks great as your photos 

[Tiger2050]

The worst thing you can do at this point is re-introduce topical minoxidil back to your regimen, it will certainly cause another shed. Just stick it out with oral minoxidil, the hair you lost from stopping topical minoxidil will come back in the next few months. Speaking from experience, stopping topical minoxidil induced a shed that lasted several months and it took me a long time to recover on oral minoxidil but it all eventually came back. You have to be patient with hair loss meds, constantly changing medications will cause more shedding.

Edited December 24, 2022 by Tiger2050

[botchedguy95]

On 12/21/2022 at 12:58 AM, Harry Bosch said:

Update at 7 Months.

I believe I’ve had some regression since my 6-month update.

Nothing tragic.  Perhaps it’s just some shedding and/or de-synchronization of growth cycles.  Hard to say.

I do think a I’ve lost some native hair surrounded the transplanted area.  My left side has historically been stronger but it looks worse, perhaps worse than pre-surgery.

Recall that I have had a post-surgical bump in the two recipient temple regions.  That, along with that fibrosis region (scarring alopecia?) has contributed to some ongoing anxiety.  Both my temporal regions, as well as my grey streak, present some weaker, wispier hairs that are don’t look healthy and are resistant to styling tricks.

Speaking of that fibrosis region, recently my hair has been lacking lift in that area.  Hard to support that combover wave I personally fancy.  Makes me wonder if I got any growth there - I guess we can’t be sure unless we shave down and assess that area.

Overall there are improvements.  There’s the temporal closure on the right side (which was the weaker side, pre-op).  The temple peaks are stronger, although I’d like the right side to be a bit less concave.

I’m comfortable with the fact that my current look is short of my surgical goals.  This was not unexpected.  My density behind the recession was unlikely to be matched with one operation.  Plus, the threat of continued loss and thinning threatens every patient.

At 6 months I was generally satisfied, but right now — when it comes to styling — there’s not a real material improvement vs. pre-op.  Again, perhaps it’s just a shed or a brief setback.  This was not the case one month ago. My hair is wavy and tends to stand up, which makes the hairline and loss pattern look bad.  That was the motivation for the temple closure.

I think there is foundation here for a successful refinement, and that was always a likelihood based on my hair characteristics.  I’m a bit discouraged by the regression on my left side, and certainly have ongoing anxiety about the two bumps and fibrosis.  The gaps in my frontal tuft still exist but are smaller.  We’ll see if the next five months offer some form of rebound and improvement.

As far as protocol, I’ve been loyal to 1.25mg/day Fin + 5mg/day Oral Min.  I abandoned topicals (RU and Rogaine) post-op, so that might be a factor in the result-to-date.  I plan to reintroduce Topical Rogaine alongside the medications, as it’s possible I grew some reliance to it after 10 years of use.  It’s possible I’m not a huge responder to Oral Min, and I certainly don’t have the associated sides such as excess body hair.

Pictures, both wet and dry, are attached.  Harsh bathroom lighting.

 

Wow.. one of the most natural looking transplants I've seen honestly mate

[Curious25]

Looks great for 7 months 

[Harry Bosch]

10 hours ago, Tiger2050 said:

The worst thing you can do at this point is re-introduce topical minoxidil back to your regimen, it will certainly cause another shed. Just stick it out with oral minoxidil, the hair you lost from stopping topical minoxidil will come back in the next few months. Speaking from experience, stopping topical minoxidil induced a shed that lasted several months and it took me a long time to recover on oral minoxidil but it all eventually came back. You have to be patient with hair loss meds, constantly changing medications will cause more shedding.

Curious for thoughts on this.

Fwiw.  The timeline.

I had been using Topical Min for 10+ years alongside Fin.

In January 2021 I started Oral Min and used it concurrently with Topical Min + Fin for 15 months up until my surgery (May 2022).

Post surgery I ditched the Topical Min but stayed on the Oral Min.

So I’ve really been taking Min all along.  I don’t think reintroducing Topical while staying with Oral, too, would create a significant shed?

I think there is something to the localized effect of Min when applying to weak spots.  Can’t say I’ve been a huge responder to Oral Min alone, and I’ve got a fairly large sample to determine that conclusion

[stephcurry30]

Looking good boyo! 

[Tiger2050]

3 hours ago, Harry Bosch said:

Curious for thoughts on this.

Fwiw.  The timeline.

I had been using Topical Min for 10+ years alongside Fin.

In January 2021 I started Oral Min and used it concurrently with Topical Min + Fin for 15 months up until my surgery (May 2022).

Post surgery I ditched the Topical Min but stayed on the Oral Min.

So I’ve really been taking Min all along.  I don’t think reintroducing Topical while staying with Oral, too, would create a significant shed?

I think there is something to the localized effect of Min when applying to weak spots.  Can’t say I’ve been a huge responder to Oral Min alone, and I’ve got a fairly large sample to determine that conclusion

Abruptly stopping topical minoxdil will cause a shed. Below is an article about transitioning from topical minoxidil to oral from Dr. Jeff Donovan who’s contributed to several studies on oral min for hair loss. In short, the transition is not that simple and you might’ve experienced a shed but probably didn’t notice because your hair was buzzed for surgery. I would give oral minoxdil a few more months and the transplant 12 months to fully develop before introducing any new medications. There is a study that compared the efficacy of oral min alone and oral min combined with topical min that determined combining topical and oral is not more effective.
 

https://donovanmedical.com/hair-blog/switching-topical-to-oral-minoxidil

https://donovanmedical.com/hair-blog/topical-oral-minoxidil

Edited December 25, 2022 by Tiger2050

[AB0274]

Looks amazing @Harry Bosch! Pinto is a star!

[Big Rome]

any update brother? @Harry Bosch 

[Harry Bosch]

On 2/22/2023 at 12:36 PM, Big Rome said:

any update brother? @Harry Bosch 

Yes, attached are pictures at 9.5 months.

MEDS

1.25 mg/day Fin

5 mg/day Oral Min

Topical Min 4-5x/week

Nizoral 1% 2-3x/week

 

PICTURES

Wet/damp hair immediately after shampoo + conditioner.

Presented in multiple states.  Messy, slicked back, and combed in both directions.

My hair and the overall cosmetic result look much stronger when hair is wet.  Weaker areas are exposed when hair is dry and dehydrated, which is common for my tumbleweed up top.

 

[stephcurry30]

wow 10/10. Amazing result!