Do I need minoxidil after Hair Transplant?

[Ralph kaka]

Hi everyone,

I think my surgeon said I was a norwood 1.5-2.5. I had thinning in zone 1 and zone 2 but it doesn't seem like typical male pattern baldness, hence my upcoming questions. I just got a transplant of 3000 grafts to zones 1 and 2 to take care of a "see through scalp" effect that can't be seen in these pics, except for the last one.

I have attached my "pre" hair transplant photos. I am a 27 M-my dad had a full head of hair in his 50s. My mom's father was bald in his 60s/70s. My 23 and me genetics test analyzed my genes and said I didn't have a predisposition for male pattern baldness and 81% of people with my genes did not have massive hair thinning before 40. 

My clinic generally advices people to take topical minoxidil a week and a half after surgery ongoingly. How necessary is this do you think in my situation?

I really don't want any side effects and I think my hair loss was milder and that I probably won't progress to a norwood seven (if I am wrong please correct me). I had a thyroid problem, which I resolved without medication, and 2 bouts of covid that accelerated some hair loss. Pics attached. Ever since my thyroid problem, the hair never grew back, even though my thyroid levels have been normal for years.

Do you think I absolutely need to be on minoxidil long term? Any advice? This article here, helped me understand that minoxidil will just help me speed up the results of this hair transplant: Minoxidil After Hair Transplant | Beverly Hills Hair Restoration (beverlyhillshr.com)

I can wait a bit longer without meds, I do not need the result asap. 

Open to any expertise. @HappyMan2021 @Rahal Hair Transplant if you have any insight as well pls do share. Thank you everyone

[HappyMan2021]

For me personally rogaine/minoxidil is utterly useless. Plus its annoying and takes time to apply.

My unscientific opinion is that there is nothing Rogaine can do that Fin/Dut cant also do, and Fin/Dut are way more effective to boot. 

Also keep in mind that the effects of Rogaine (if there are any) only last as long as you are using it. It is only a "long-term" solution as long as you are applying it every day. 

[Ralph kaka]

@HappyMan2021 Given my situation based on how it looks do you think it is absolutely necessary to go on something like Fin/Dut? To me it doesn't seem like I am on the verge of progressing to norwood 7 and could hold off on meds for a few more years and re-assess. And I could perhaps be one of those people who gets to a NW 2/3 and it stabilizes. But idk how that works.

[MisterBreakfast]

3 hours ago, Ralph kaka said:

@HappyMan2021 Given my situation based on how it looks do you think it is absolutely necessary to go on something like Fin/Dut? To me it doesn't seem like I am on the verge of progressing to norwood 7 and could hold off on meds for a few more years and re-assess. And I could perhaps be one of those people who gets to a NW 2/3 and it stabilizes. But idk how that works.

If you think there is ever a time in the future you might want to take fin, then you need to talk to a doctor now and see if it's right for you... now.  Your future self will thank you.

 

Again talk to your doc about this, but essentially, once your hair is dead it is gone.  As one of the lucky few who has regrown some hair post loss, I can tell you it is nowhere near what it used to be.  I can only wish hair loss drugs had been available when I was younger.  

[Ralph kaka]

17 minutes ago, MisterBreakfast said:

If you think there is ever a time in the future you might want to take fin, then you need to talk to a doctor now and see if it's right for you... now.  Your future self will thank you.

 

Again talk to your doc about this, but essentially, once your hair is dead it is gone.  As one of the lucky few who has regrown some hair post loss, I can tell you it is nowhere near what it used to be.  I can only wish hair loss drugs had been available when I was younger.  

Hey @MisterBreakfast thanks for the insight. I honestly would never want to take it due to potential side effects, only if I have to. Is it possible to just stay at a norwood 1.5-2.5? I am curious your thoughts on the pics-is it male pattern baldness? 

This article seems to suggest that for people with mild hair loss it may not progress to a full norwood 7: Norwood Stage 2: Photos, Treatments, Results | Wimpole Clinic

[MisterBreakfast]

6 minutes ago, Ralph kaka said:

Hey @MisterBreakfast thanks for the insight. I honestly would never want to take it due to potential side effects, only if I have to. Is it possible to just stay at a norwood 1.5-2.5? I am curious your thoughts on the pics-is it male pattern baldness? 

This article seems to suggest that for people with mild hair loss it may not progress to a full norwood 7: Norwood Stage 2: Photos, Treatments, Results | Wimpole Clinic

It's a personal decision, and I'd advise talking to a dermatologist to get a true idea of what the side effects risks are, and for an official opinion.  

On a personal note, you look like I did before I turned into a Norwood 6.  You look to be a diffuse thinner possibly, which is already a challenge in and of itself.  If I were you I'd try to save as much of my hair as possible.  Listen, hair loss and patterns are not well understood, so we can't predict your future.  I will show you what diffuse thinning did to me, and I will let others chime in to see what they think:

[Gatsby]

5 hours ago, Ralph kaka said:

My 23 and me genetics test analyzed my genes and said I didn't have a predisposition for male pattern baldness and 81% of people with my genes did not have massive hair thinning before 40. 

I don't believe your doctor would be able to identify the gene/genes for baldness. Family history is a good indicator but it certainly is not definitive. Taking minoxidil after surgery is a good idea. I found switching from topical minoxidil to oral minoxidil made a huge difference to my hair thickness and beard thickness. Also have you considered finasteride to halt the progression of your hair loss? I wish you all the best!

[Ralph kaka]

Thank you @Gatsby and @MisterBreakfast! 

[gillenator]

Usually when the use of minoxidil post-op is recommended, the purpose is to jump start the regrowth of the grafts…minoxidil has been noted to improve hair shaft diameter, some are of the opinion that many of the hair follicles remain in the growth phase for  longer periods as well.

[Rahal Hair Transplant]

@Ralph kaka,

Medications like finasteride and minoxidil are good at helping men with hair loss maintain their existing natural hair.  Given your younger age and diffuse thinning, I can understand why your surgeon might suggest on going use Of these medication’s although, usually finasteride is the one that’s most suggested and useful. Do you understand however, that neither medication is required for your hair transplant to grow.  I say this because some surgeons/clinics recommend  minoxidil after surgery because it’s been stated that minoxidil may jumpstart early transplanted hair growth and even potentially illuminate the hair shedding. Between 4 to 6 weeks after surgery. That said, there is really no proof of this.

I would say this however. If you are going to use minoxidil, it should be an ongoing commitment and not just one that you commit to for a few months after surgery. Sometimes minoxidil will induce natural hair shedding which is usually a sign of the medication working. But if you stop during that period, that hair may not grow back.

As far as your hair loss pattern, it does actually seem pretty aggressive rather than mild as you suggest. Now, you’re only 27 and it doesn’t seem like you’ve lost that much hair yet but I do see signs of thinning all over the top of your scalp. While you may not progressed to a Norwood class seven necessarily, I see evidence that you may progress to a Norwood class 5A or even six which is on the higher side.   Now I am basing this strictly on the photos and information you presented so far and I am not a doctor. I am an educated patient who works for Dr. Rahal and I’ve been in the industry for over 15 years.  But the truth is, nobody can truly predict exactly how your hair loss will progress and we can only look at the evidence and make educated guesses. 

All that to say, I understand that you don’t want any side effects but finasteride may be something we want to consider long-term to hopefully prevent your hair loss from progressing too much further.  obviously, if you do experience side effects you can always stop taking the medication. But I do recommend speaking to your doctor about this and making an informed decision.

I hope this helps.

Rahal Hair Transplant

 

Edited May 1, 2023 by Rahal Hair Transplant