Is this advanced retrograde alopecia? Seems to have advanced really quickly (<6 months). Is a transplant an option to fill it out?

[archonlucien]

Hi all.

I've always had thinning in my temporal region (triangles above the ears), and the thinning started in 2018. However, after getting COVID 6 months ago, I was diagnosed with Telogen Effluvium 3 months ago by my dermatologist. Since then, I had noticeable thinning on the top of my head, as well as on the sides. But on closer examination, I noticed that my temporal peaks had actually miniaturized. Even worse, the area above my ears suddenly thinned over the last 2-3 weeks, to the point of looking like Retrograde Alopecia.

Here's what my hair looks like right now: https://imgur.com/a/dNy51CE [as you can see, I have some recession on the frontal hairline as well, but the sides are absolutely destroyed]

My dermatologist offhandedly remarked that it could be a nutrient deficiency, and gave me a vitamin supplement along with Redensyl, none of which seem to work. I feel like he's stringing me along, since he has prescribed costly supplements + serums (procapil and redensyl) for all 3 of my previous visits.

However, this effect seems less apparent when I crop my hair short (images here). I know a good haircut is an easy solution if this is indeed retrograde alopecia, but I still want to see if there's a long-term fix. I am getting married in mid-2023, so I was very tempted to get a transplant ASAP.

For reference, this was the state of my sides+back in July, before I got COVID: https://imgur.com/a/HgGPdkx

Experts, members of the community: Is a transplant possible or necessary? My donor area on the back of the scalp is thick and untouched by the (possible) retrograde alopecia. If so, do you know of any surgeons in Asia (preferably India) who can deal with this? I did contact one surgeon who did not evaluate my scalp, but mentioned that his clinic exclusively deals with FUE, as FUT is not preferred nowadays. 

[Henry]

I don't know much about COVID related hairloss but it looks like you're going through maybe a shedding phase? Also, do you always go to the same barber and get the same exact haircut? Maybe your hair was cut differently recently also so it grows differently. How old are you? A lot of people lose density in that side area of the hair but they tend to really not lose all of it. A transplant is definitely possible but where would your focus be? I don't see much thinning really. I would advise against lowering the hairline unless you're absolutely sure that you're not gonna lose all of that hair on top, or if you're taking finasteride or dutasteride. Also, if you think you doctor is stringing you along ( i feel like a lot of doctors do this, they recommend things that they know porbably won't work just to get some money out you, like recommending PRP for diffused hairloss) you should find another doctor. 

[archonlucien]

6 minutes ago, Henry said:

I don't know much about COVID related hairloss but it looks like you're going through maybe a shedding phase? Also, do you always go to the same barber and get the same exact haircut? Maybe your hair was cut differently recently also so it grows differently. How old are you? A lot of people lose density in that side area of the hair but they tend to really not lose all of it. A transplant is definitely possible but where would your focus be? I don't see much thinning really. I would advise against lowering the hairline unless you're absolutely sure that you're not gonna lose all of that hair on top, or if you're taking finasteride or dutasteride. Also, if you think you doctor is stringing you along ( i feel like a lot of doctors do this, they recommend things that they know porbably won't work just to get some money out you, like recommending PRP for diffused hairloss) you should find another doctor. 

Thank you for your response! I'll reply to each of your points below. I also have some questions about your comment, would be very grateful if you could answer them.

Shedding phase: Is this something that normally happens in the absence of any kind of alopecia? Also, the hair on my temporal points looks miniaturized. Is this a part of shedding, if it is indeed shedding?

Barber: Yes, it's the same barber.

Transplant: I'm hoping to fill out my temporal triangles at least, and then bank on Fin/Min for the area above my ears. On your point about lowering the hairline: Noted. Do you think it's fair to just fill the temples for now, and get a hairline restoration in future if necessary?

Yes, I will be finding a different doctor. It's sad, because I literally take 1 hour flights to see this doctor each time, since he's pretty renowned :]

 

[Henry]

5 minutes ago, archonlucien said:

Thank you for your response! I'll reply to each of your points below. I also have some questions about your comment, would be very grateful if you could answer them.

Shedding phase: Is this something that normally happens in the absence of any kind of alopecia? Also, the hair on my temporal points looks miniaturized. Is this a part of shedding, if it is indeed shedding?

Barber: Yes, it's the same barber.

Transplant: I'm hoping to fill out my temporal triangles at least, and then bank on Fin/Min for the area above my ears. On your point about lowering the hairline: Noted. Do you think it's fair to just fill the temples for now, and get a hairline restoration in future if necessary?

Yes, I will be finding a different doctor. It's sad, because I literally take 1 hour flights to see this doctor each time, since he's pretty renowned :]

 

Yes, even without anykind of alopecia you usually lose density in your hair. There are rare ones that maintain the same number of hairs up until their 60s but in general, you have less number of hairs when you were 30 compared to when you were 18, it's just part of aging. I haven't done much research about minitiurization in the sides though. You might want to look into that yourself, i have significantly thinner side, and sideburns now that I'm 30 compared to when I was 18 but when i let them all grow out, it's still thicker than what i have on top, and my balding isn't that aggressive, so there's that. 

I can't really advice you to have a hair transplant now since from what I'm seeing based on your picture, i don't see any problem areas. Having a hair transplant with a lot of hairs in between is tricky. You'd have to find a really great doc for that. 

This is just my advice and by no means should you consider everything I'm saying as absolute truth. I hope you can find other knowledgeable opinions as well.

[Gatsby]

I would be speaking with your dermatologist to find out if this is Covid related. I have no doubt that dermatologists would be aware if patients have Covid related hair loss and how it presents. By no means would I say that you should have surgery. It's just my opinion but I would be considering oral minoxidil and/or finasteride at this early stage (which may even resolve). All the best!

[HairEnthusiast101]

Looks like retrograde. Hopefully it stops there

Edited December 23, 2022 by JoDimaggio22

[Marlo]

Certainly looks like retrograde which I have myself. Would be odd if the onset was as quick as you've described, however. 

Really doesn't make much sense to transplant into the retrograde area. Save your donor hair for the top. 

[HairEnthusiast101]

23 minutes ago, Marlo said:

Certainly looks like retrograde which I have myself. Would be odd if the onset was as quick as you've described, however. 

Really doesn't make much sense to transplant into the retrograde area. Save your donor hair for the top. 

Does retrograde just always look thin throughout life or overtime go bald?

[A Fue Good Men]

Telogen effluvium can kickstart, and in some cases speed up male pattern baldness. Your case is quite interesting because you seem to have those thinner areas although the rest of your hair looks pretty good on top. Do any of your male relatives have similar thin spots in the donor? How has their hair overall held up? Generally, strong thinning of the donor zones can possibly indicate higher norwood levels of loss down the line, but there might be exceptions. You never mentioned your age either.

 

I would hold off any plans for surgery until you get thoroughly examined by a professional that’s familiar with this kind of issue.

[archonlucien]

10 hours ago, Marlo said:

Certainly looks like retrograde which I have myself. Would be odd if the onset was as quick as you've described, however. 

Really doesn't make much sense to transplant into the retrograde area. Save your donor hair for the top. 

Got any pictures up on your profile by any chance? If so, just want to see if it's similar.

Also, what are you planning to do about your RA? What's the progress and how are you managing/planning to manage it?

[archonlucien]

8 minutes ago, 5BetaReductase said:

Telogen effluvium can kickstart, and in some cases speed up male pattern baldness. Your case is quite interesting because you seem to have those thinner areas although the rest of your hair looks pretty good on top. Do any of your male relatives have similar thin spots in the donor? How has their hair overall held up? Generally, strong thinning of the donor zones can possibly indicate higher norwood levels of loss down the line, but there might be exceptions. You never mentioned your age either.

 

I would hold off any plans for surgery until you get thoroughly examined by a professional that’s familiar with this kind of issue.

 

I'm 27.

It's strange because the onset of TE was very sudden. My hair went from being dense and rough to being flat and bounce-less in a matter of days. The density is still good (worse than before though) up top, a nice combover can mask it well. If I comb it wrong and am under white light, my scalp shows through.

My father still has solid sides, mild thinning in his left temporal triangle but the rest is fine. His hairline receded only 3 years ago and he's 63. His male relatives have great hair. My mother's mother's brothers are all bald, but they're the only members of the family with MPB (all NW6+)

Also about the donor zones - had a popular HT surgeon examine these pictures (not in person though). He said my donor zone is intact and the sides thinning can be fixed with medication, although the temporal triangles could be better off with a transplant ~1800 FUE grafts. But I'm not 100% convinced by his words since he has incentive to reassure me that my donor area is safe. he's still asked for a testosterone level test before he can pronounce me worthy of a transplant.

 

[A Fue Good Men]

4 minutes ago, archonlucien said:

 

I'm 27.

It's strange because the onset of TE was very sudden. My hair went from being dense and rough to being flat and bounce-less in a matter of days. The density is still good (worse than before though) up top, a nice combover can mask it well. If I comb it wrong and am under white light, my scalp shows through.

My father still has solid sides, mild thinning in his left temporal triangle but the rest is fine. His hairline receded only 3 years ago and he's 63. His male relatives have great hair. My mother's mother's brothers are all bald, but they're the only members of the family with MPB (all NW6+)

Also about the donor zones - had a popular HT surgeon examine these pictures (not in person though). He said my donor zone is intact and the sides thinning can be fixed with medication, although the temporal triangles could be better off with a transplant ~1800 FUE grafts. But I'm not 100% convinced by his words since he has incentive to reassure me that my donor area is safe. he's still asked for a testosterone level test before he can pronounce me worthy of a transplant.

 

I’d get more opinions, in person if possible. I’d be a bit weary of restoring the temple points as it may create a scenario with thicker/denser areas in your temple points and less density behind which won’t look natural. Temple points are extremely difficult to get right