Repair transplant - what are my options?

[redacted]

Dear all,

I have overcome 2 HTs and it seems that my bad fortune with hair continues. 

I started my HT journey in relatively young age of 26 and did another one at the of 28. According to my doctor 7000 grafts have been extracted from my scalp donor to my head. I feel that my hair transplant has not been quite successful. As you can see from my photos there are considerable see-through effect under certain lighting. Additionally, frontal forelock has an almost bald spot which magnifies the see through. After the 2nd hair transplant I was relatively happy with my result but after 1,5 year the frontal forelock has thinned drastically and I feel that even the transplanted hairs are falling or miniaturising. Could this be possible? 

I'll attach some photos under different lighting from the current situation, a picture from year ago picture under good lighting and the initial starting point. 

I consulted Dr. Bisanga for a repair surgery. According to him, he can only extract 800-1000 grafts to reframe the hairline. Fortunately, I have thick beard and chest hair which Dr. Bisanga estimates yield of 1500 each site, without noticeable difference After considerations, I want to solidify my hairline with 600-800 grafts. I do not want to hurt my donor area anymore. Secondly, I want to add density to the frontal forelock with 500 grafts by beard and chest hair. At a later point we can address the mid scalp. 

I do not use Finasteride since I am very concerned about the possible sexual side-effects. Additionally, if I am already at NW 5-6, lost my  natural hair and the remaining hair in my recipient area are transplanted, why would I try to preserve things which have already fallen?

I have tried Minoxidil, but it had effects to my heart rate and made me feel dizzy and nauseous.

Can anyone review my situation and provide their insights?

[Ajamilo]

Honestly with some concealer such as toppiks or another hairfiber you would have noo see trought and full of head. I would not recommend another HT since you already have usen 7000 grafts and are still under 30 years old. Take your time, use perhaps some smp to make it visually better and enjoy ur life

[ITA]

Also check your scalp before undergoing a third surgery, the fact that after a year and a half from the second, you have lost the transplants is not completely normal.  May I also ask you where did you perform the first two procedures?

[Britanium]

4 minutes ago, Egy said:

Also check your scalp before undergoing a third surgery, the fact that after a year and a half from the second, you have lost the transplants is not completely normal.  May I also ask you where did you perform the first two procedures?

Exactly this ☝️

[redacted]

1 hour ago, Ajamilo said:

Honestly with some concealer such as toppiks or another hairfiber you would have noo see trought and full of head. I would not recommend another HT since you already have usen 7000 grafts and are still under 30 years old. Take your time, use perhaps some smp to make it visually better and enjoy ur life

Thank you for your response. 

I get your point. SMP might be very practical for frontal forelock, which probably effects to the see through effect.

[asterix0]

Your transplanted hair can definitely thin if you are not on finasteride, it all depends how sensitive to DHT your follicles are.

I know finasteride is a personal decision, so I won't criticize you for not taking it, but you really needed to be on it to ensure your transplant(s) would be successful. 

[redacted]

14 minutes ago, asterix0 said:

Your transplanted hair can definitely thin if you are not on finasteride, it all depends how sensitive to DHT your follicles are.

I know finasteride is a personal decision, so I won't criticize you for not taking it, but you really needed to be on it to ensure your transplant(s) would be successful. 

Indeed, I am considering to try it out, but the side effects scares me...

Dr. Bisanga prescribed me topical dutasteride. Is it any better?

Edited May 21, 2022 by redacted
Adding information on topical dutasteride

[mafpe]

you'll have to try.

finasteride is by far gentler than dutasteride, why not try topical finasteride at lower dose first?

if the topical dut is on very low dose also, i guess that's just as good?

[asterix0]

1 hour ago, redacted said:

Indeed, I am considering to try it out, but the side effects scares me...

Dr. Bisanga prescribed me topical dutasteride. Is it any better?

I don't know, I take oral finasteride 1mg for 6 years already and haven't had any side effects.

Transitioning to either topical fin or dut is something I am curious to do in the future, just don't want to have a major shed. 

[redacted]

I'm just curious on whether anyone considers BHR as a viable filler to the frontal forelock and mid scalp and whether it is going to be sufficient to add density?

On that note, would you consider that 400-600 grafts is sufficient for the hairline? Or if I fill the frontal forelock is it going to take-away the see through effect?

Edited May 21, 2022 by redacted

[asterix0]

25 minutes ago, redacted said:

I'm just curious on whether anyone considers BHR as a viable filler to the frontal forelock and mid scalp and whether it is going to be sufficient to add density?

On that note, would you consider that 400-600 grafts is sufficient for the hairline? Or if I fill the frontal forelock is it going to take-away the see through effect?

Yes, 400-600 grafts will be enough, but beard hair will not look natural in the front. 

Use it only to blend in the midscalp and crown, use your remaining donor for the front. 

But I strongly recommend you reconsider at least topical finasteride if you cannot take oral, but millions of men take oral without a problem.

[Rahal Hair Transplant]

Redacted,

Transplanred Hair is typically permanent or at least as permanent has a hair on the side and back of the scalp.  Therefore, it’s not very likely to lose transplanted hair unless hair was harvested/extracted outside of the universal safe zone or you are losing hair due to some other non-genetic reason.  Non-genetic hair loss can cause transplanted hair or other natural DHT resistant hair to thin or fall out.

Of course, there are unknown reasons why transplanted hair might fall out.  But for the most part, usually when a hair transplant patient loses more hair after they have undergone hair transplantation, it’s because male pattern baldness has progressed and they lost more natural hair.

Keep in mind also, that while 7500 grafts is a large number, assuming you lost more natural hair, you’re trying to essentially fill a Norwood class 5A bald area with solely transplanted hair.

When you do the math, you would technically require having approximately 22,000 follicular units placed in a Norwood class 5A area to obtain true density.  Half of that which is approximately 11,000 follicular units (assuming they are evenly distributed) and that would provide you with an adequate illusion of density.

So while 7500 is a large number of grafts, it’s still not quite enough to provide as much density as most people want. Of course, how the grafts are placed, the size of the hairs in microns, hair color to scalp color ratio, and other variables can aid the appearance of density.

As long as you have more donor hair in the tank, you can always go back for another procedure to get more density, refined the hairline and improve the overall appearance of your hair.

I hope this helps 

Rahal Hair Transplant 

 

Edited May 21, 2022 by Rahal Hair Transplant

[Melvin- Admin]

You haven’t even tried finasteride? I don’t understand this logic. I would strongly suggest trying the topical version. You’re not a repair, you simply continued to thin. You will be in the same exact situation again, unless you treat the root cause of your balding. 

[redacted]

54 minutes ago, Melvin- Moderator said:

You haven’t even tried finasteride? I don’t understand this logic. I would strongly suggest trying the topical version. You’re not a repair, you simply continued to thin. You will be in the same exact situation again, unless you treat the root cause of your balding. 

Thank you for your response Melvin!

I tried oral finasteride for couple of months before my first hair transplant, but I got some aching to my testicles for it. It could be placebo though. I was very concerned about that occurrence. 

I might try it out based on these instructions. However, I do not want to lose my sexual appetite or get ED. 

In the case of aforementioned things materialise, am I doomed if I cannot use Finasteride?

[Melvin- Admin]

13 minutes ago, redacted said:

Thank you for your response Melvin!

I tried oral finasteride for couple of months before my first hair transplant, but I got some aching to my testicles for it. It could be placebo though. I was very concerned about that occurrence. 

I might try it out based on these instructions. However, I do not want to lose my sexual appetite or get ED. 

In the case of aforementioned things materialise, am I doomed if I cannot use Finasteride?

Not doomed, but you will need to keep getting hair transplants as more hair thins. I would suggest getting on topical finasteride on a Monday, Wednesday, Friday split. Do not was your hair the day after each application. This is probably the safest protocol in my opinion. 

[redacted]

2 hours ago, asterix0 said:

Yes, 400-600 grafts will be enough, but beard hair will not look natural in the front. 

Use it only to blend in the midscalp and crown, use your remaining donor for the front. 

But I strongly recommend you reconsider at least topical finasteride if you cannot take oral, but millions of men take oral without a problem.

What if the BHR is done behind the hairline, how deep is a "safe zone" where it does not look unnatural?

As I said to Melvin, I feel that it might be worth of a shot. But I am very concerned.

[redacted]

11 minutes ago, Melvin- Moderator said:

Not doomed, but you will need to keep getting hair transplants as more hair thins. I would suggest getting on topical finasteride on a Monday, Wednesday, Friday split. Do not was your hair the day after each application. This is probably the safest protocol in my opinion. 

Hmm, what would be the suitable dosing?

[redacted]

1 hour ago, Rahal Hair Transplant said:

Redacted,

Transplanred Hair is typically permanent or at least as permanent has a hair on the side and back of the scalp.  Therefore, it’s not very likely to lose transplanted hair unless hair was harvested/extracted outside of the universal safe zone or you are losing hair due to some other non-genetic reason.  Non-genetic hair loss can cause transplanted hair or other natural DHT resistant hair to thin or fall out.

Of course, there are unknown reasons why transplanted hair might fall out.  But for the most part, usually when a hair transplant patient loses more hair after they have undergone hair transplantation, it’s because male pattern baldness has progressed and they lost more natural hair.

Keep in mind also, that while 7500 grafts is a large number, assuming you lost more natural hair, you’re trying to essentially fill a Norwood class 5A bald area with solely transplanted hair.

When you do the math, you would technically require having approximately 22,000 follicular units placed in a Norwood class 5A area to obtain true density.  Half of that which is approximately 11,000 follicular units (assuming they are evenly distributed) and that would provide you with an adequate illusion of density.

So while 7500 is a large number of grafts, it’s still not quite enough to provide as much density as most people want. Of course, how the grafts are placed, the size of the hairs in microns, hair color to scalp color ratio, and other variables can aid the appearance of density.

As long as you have more donor hair in the tank, you can always go back for another procedure to get more density, refined the hairline and improve the overall appearance of your hair.

I hope this helps 

Rahal Hair Transplant 

 

Thank you for your response Rahal,

What is your view on BHR in general? Especially using chest hair?

[RTC]

2 minutes ago, redacted said:

Hmm, what would be the suitable dosing?

Evidence has shown the lowest strength can work.

Aim for less than 0.1% for sure. I know FUEClinic do 0.025%. Less risk of going systemic like that

[redacted]

2 minutes ago, Aslitarcan sucks said:

Evidence has shown the lowest strength can work.

Aim for less than 0.1% for sure. I know FUEClinic do 0.025%. Less risk of going systemic like that

Thanks for your response Aslitarcan,

Interesting, do you have any verified spots where to get topical finasteride. Like said, I have the prescription for topical dutasteride, but apparently topical finasteride would be better.

[RTC]

I just read your comment that Dr Bisanga prescribed topical Dutasteride,that's great, why don't you try that for a while? What strength did he give you?

FUEClinic.com do finasteride with a low strength 0.025% so if you wanted you could try that, if and when I use finasteride topically I'll only use that strength or lower.

[redacted]

1 hour ago, Aslitarcan sucks said:

I just read your comment that Dr Bisanga prescribed topical Dutasteride,that's great, why don't you try that for a while? What strength did he give you?

FUEClinic.com do finasteride with a low strength 0.025% so if you wanted you could try that, if and when I use finasteride topically I'll only use that strength or lower.

Have I understood correctly that the topical dutasteride had some trait which does not have sufficient amount of (insert medical term), and hence it effects systemic but does not effect hair. Please, excuse my lack of knowledge on medical terms. 

[RTC]

51 minutes ago, redacted said:

Have I understood correctly that the topical dutasteride had some trait which does not have sufficient amount of (insert medical term), and hence it effects systemic but does not effect hair. Please, excuse my lack of knowledge on medical terms. 

I have not heard this at all sir

[HappyMan2021]

@redacted did you consult with Dr. Bisanga in person? Sounds like it was virtual but I could be mistaken. 

I thought all Bisanga consults for repair patients had to be done in person. 

[redacted]

1 minute ago, HappyMan2021 said:

@redacted did you consult with Dr. Bisanga in person? Sounds like it was virtual but I could be mistaken. 

I thought all Bisanga consults for repair patients had to be done in person. 

Hi Happyman!

I did consult him in person!

He seems to be a very pleasant man!