Diffuse thinners! Calling all doc's!

[dakota3]

Those of us w/ diffuse thinning often wonder is it worth having the procedure done considering the risk's of permanant shock loss and the chance of a 0 sum gain? what are the %'s of this type of thing happening? Obviously I would welcome all opinions and not just the doc's!

[Curious_George]

Originally posted by dakota3:

Those of us w/ diffuse thinning often wonder is it worth having the procedure done considering the risk's of permanant shock loss and the chance of a 0 sum gain? what are the %'s of this type of thing happening? Obviously I would welcome all opinions and not just the doc's!

 

Thanks for asking this. I asked this too and I'm hoping to see some professional opinions from the surgeons on this board.

[walkerg1973]

I'm a diffuse thinner and had a very pleasant experience with a doctor from this website. I had 2000 grafts done in a narrow strip from the front of my scalp to the back. Most of the grafts were placed near the front. It's been 10 months since the operation and I'm thrilled with the results. The doctor that did my operation shaves the recipient site. I'm also on finasteride , rogaine foam 2x/day and use the lasercomb 4x/week. If you have any questions email me at walkerg11@hotmail.com

[Bill - Seemiller]

dakota,

 

Great question.

 

In my opinion, diffuse hair thinners are some of the BEST hair transplant candidates simply because they are most likely "one and done" procedures assuming hair loss has been controlled with medication.

 

Keep in mind that the risk of permanent shock loss only exists for native hair that is currently in a weakened state due to hair miniaturization (or if the native hair follicles are transected, but this is rare in the hands of a qualified surgeon). This means that this hair would have eventually fallen out and leave you bald anyway. Temporary shock may occur due to scalp trauma but will return.

 

In my opinion, there is a very low risk of a diffuse hair thinning only acquiring a 0% gain. But the good news is, even if it does happen, at least susceptible hair has been replaced by permanent hair and subsequent surgeries can add density. After all, most patients go for multiple surgeries before they are complete anyway.

 

Best wishes,

 

Bill

[dakota3]

Thanks Bill!

 

In my opinion, diffuse hair thinners are some of the BEST hair transplant candidates simply because they are most likely "one and done" procedures assuming hair loss has been controlled with medication

 

Bill,

I was under the impression that after several years the effects of Propecia wore off and eventually I would lose it all anyway. So the 1 and done idea while sounding wonderful may not necessarily be true right?

[Curious_George]

Originally posted by Bill:

dakota,

 

Great question.

 

In my opinion, diffuse hair thinners are some of the BEST hair transplant candidates simply because they are most likely "one and done" procedures assuming hair loss has been controlled with medication.

 

Keep in mind that the risk of permanent shock loss only exists for native hair that is currently in a weakened state due to hair miniaturization (or if the native hair follicles are transected, but this is rare in the hands of a qualified surgeon). This means that this hair would have eventually fallen out and leave you bald anyway. Temporary shock may occur due to scalp trauma but will return.

 

In my opinion, there is a very low risk of a diffuse hair thinning only acquiring a 0% gain. But the good news is, even if it does happen, at least susceptible hair has been replaced by permanent hair and subsequent surgeries can add density. After all, most patients go for multiple surgeries before they are complete anyway.

 

Best wishes,

 

Bill

 

Bill: Thanks for your response.

 

Would you also be able to direct some surgeons to provide their professional medical opinion on this important question?

 

Thanks,

 

CG.

[whymewhy]

great question!

 

I am a diffuse thinner & have always been confused whether or not to go under the knife! The reason being shock loss. I dont want to end up looking worse than what I was before surgery.

 

Although I have decided to go with H&W I still am very confused whether to go ahead or not.

 

The problem is with the native hair. Unlike the normal MPB pattern I do have a lot of native hair which I don wanna lose due to surgery!

 

On the bright side as Bill said diffuse thinners make excellent candidates! going by what I have seen on this forum & my personal case I dont think my scalp would need tooo many grafts to make a significant cosmetic difference. Even lesser number of grafts placed fairly widely apart would give me very nice coverage ( assuming my native hair does stay after surgery). This hope makes me take the necessary steps towards scheduling my surgery but again! the killer called shockloss!

[Dr. Michael Beehner]

The term, "diffuse thinner," can refer to two different types of patients.

One group - and the more common one referred to this way - is the man with homogenous thinning throughout the typical male pattern baldness area on top (horseshoe-shaped), in whom there is some degree of miniaturization going on with some of the follicles/hairs, allowing someone to see the scalp through the hair.

The second group are those who have the acronym diagnosis, D.U.P.A. - which stands for "diffuse unpatterned alopecia. These men, though usually much thinner on top, also have diffuse miniaturization throughout the donor area also. Many of these men present for transplantation in their 20's and it is difficult to tell them they are NOT candidates for hair transplantation. If you look around in a crowd of older men, you can spot some of these. They have hardly any hair on their head anywhere. It is a somewhat rare diagnosis fortunately. The reasons for not transplanting them are twofold: One, the "donor" hair is of uncertain quality and will not last that many years in all likelihood. Second, because the sides and back are thinnish, a donor scar would easily be seen and would draw attention to itself. Basically, a surgeon is raising false hopes and stealing the patient's money in such situations.

With the more commonly described "diffuse thinning" patient, in whom there is an equal degree of thinning throughout the top, the patient certainly should be told that he will eventually lose all the hair contained within that area, unless he is in his 50's or 60's at the time of examination. Even medication, such as finasteride and minoxidil, will not prevent it from eventually being lost. It may delay that day by 10 years though. If they are transplanted, the advantage for the patient is that the hairs that remain on top help serve as camouflage while the patient is recuperating and healing those first couple of weeks and makes the whole process more undetectable. It certainly is possible that some of those more vulnerable, miniaturized hairs will be "shocked" and possibly lost forever; but it's a minor point, since only 4-5 months later the new transplanted hair will be gradually growing and dominating the area on top.

I will try and attach a photo of a young DUPA patient, confirmed with 30x power magnification exam of the scalp showing a significant percentage of miniaturized hairs.

Mike Beehner, M.D.

[Dr. Michael Beehner]

Photo showing Diffuse Unpatterned Alopecia attached.

Mike Beehner, M.D.

[Bill - Seemiller]

Dr. Beehner,

 

Thank you for your medical insight on this topic. I wanted to get some of your additional input on this comment:

 

Even medication, such as finasteride and minoxidil, will not prevent it from eventually being lost. It may delay that day by 10 years though.

 

It is my understanding that Propecia and Rogaine may slow down hair loss, prevent further loss, strengthen existing hair, or in rarer cases stimulate some hair regrowth. Of course, it may not work hardly at all in some patients.

 

What are your thoughts on this?

 

Bill

[Dr. Michael Beehner]

Bill,

In reply to your question, I think it's probably unfair to at least finasteride to say "in rarer cases it stimulates some hair growth." My experience and that of most of my colleagues I talk with, is that a good half of the men we put on finasteride (Propecia or generic Proscar) experience some added hair growth, at least in the first 4-5 years. Minoxidil (Rogaine) works synergistically with finasteride and the results are better than with only finasteride for the single patient who chooses to use both. After 4-6 years, there is a slow gradual drop-off in hair mass in most patients with finasteride treatment. This period of potential hair growth seems to parallel the length of time of the normal anagen (growth) cycle of the hair follicle.

My point in including that in my comments on diffuse thinning was to make sure that someone with such a hair pattern didn't think there was a possibility he would just stay in that stage the rest of his life, as that is virtually never the case, medical treatment or no medical treatment. Our genetics inexoribly calls us home, so any planning that involves transplants has to take into consideration that there will be more future hair loss. The man with male pattern baldness who probably can say he's near the end of his hair loss is the male over 45 with a Norwood VI pattern of shiny baldness on top and a strong fringe border of hair. Even in these men, the vertex "scoop" in the back tends to sag a little lower over the years....and then there's "senile alopecia" which causes a mild gradual thinning as most men age.

Final thought: medical treatment is great, but it's not a miracle worker and doesn't prevent eventual balding down the road in life.

Mike Beehner, M.D.

[dakota3]

[Bill - Seemiller]

Dr. Beehner,

 

Thank you for your medical input and a nice balanced post.

 

The reason I said hair regrowth is more rare is because in the majority of cases I've heard, Propecia effectively slows down or stops hair loss and only a select few seem to experience any signs of visible hair regrowth. Their website also indicates is is much more common for it to stabilize hair loss than regrow hair.

 

Thanks again and your contributions are greatly appreciated!

 

Best wishes,

 

Bill

[Dr. Ricardo Mejia]

Keep in mind that the risk of permanent shock loss only exists for native hair that is currently in a weakened state due to hair miniaturization (or if the native hair follicles are transected, but this is rare in the hands of a qualified surgeon). This means that this hair would have eventually fallen out and leave you bald anyway. Temporary shock may occur due to scalp trauma but will return.

 

A few points I would like to clarify.

 

I do not believe there is "permanent" hair loss form transection of hair follicles in the scalp. There is Iatgrogenic or doctor induced hair loss when the hair shaft is cut below the scalp, and falls out, but it will regrow. This is not strictly due to poor placement. There are other factors involved. I am not aware of any studies that have proven permanent hair loss. You may recall our previous thread discussing this very issue. I would recommend readers review this carefully.

 

Transection risk with megasessions and shock loss

 

"shock loss" can have many definitions as I have explained in the thread above. Most patients view it as the apparent loss of hair density after a procedure in existing native hairs that results in a thinner look usually within three months after a transplant. In general, the hairs will regrow as I have explained in my other thread. For all hair transplant practices that shave the recipient site, you are getting 100% immediate shock loss. The hairs are gone visually! For all practical purposes, can not tell whether you really experienced true "shock loss" or not because the hairs are no longer there. Therefore it is a moot point in practices that shave the recipient site. MOst of my professional patients do not want that type experience, which is why I do not always do it, and work around the native hairs.

 

"shock loss" is a lay term for telogen effluvium which can be multifactorial and a result of the stress from surgery, antibiotics, postoperative illnesses, medications, weight loss diet etc. Therefore it is not strictly due to trauma or poor placement. This type of shock loss and Itrogenic shock loss can affect miniaturized and terminal hairs equally. I am not aware of any study that states Shock loss ONLY preferentially affects only the weak minituarized hair. It is probale and perhaps Dr. Beener has added insight from his years of research activity in this field. However, I see lots of patients with telogen effluvium and they are loosing good terminal hairs not just minituarized weak ones. I agree with Dr. Beener, It is true if a weak minituarized hair was on its last leg and was "shocked" out, it will not regrow.

 

WHen transplanting at higher densities within existing hairs and with shaven recipient sites, there is a higher risk of transection of the hair follicles, especially if you are using a multibladed handle which makes several recipient incisions sites at the same time and you are doing it fast. It is alot harder to try to align all the blades to be perfectly parallel to the hairs of varying densities, and the exit angle of the hair is not always the same under the epidermis. If you shave the recipient site very close with no superficial hair, you can not tell very well what the exit angle is and thus even harder or impossible to avoid native hairs with multibladed recipient site handles, especially in native hairs with pretty good density such as early diffuse thinners. I use a single bladed recipient handle to manuever within existing hairs to minimize the possibility of Iatrogenic trauma. Spex is right, it is unpredictable. The good news, dakota is "permanent" shock loss is a term that is used too loosely. Review the previous thread. We need to understand and define the multitude of factors involved and the defintions and type of shock loss one is referring to. In summary, the hairs will regrow even if doctor tansected without a permanent loss and even hairs lost due to the myriad of factors with telogen effluvium, with the exception of the minituarized hair on its last leg. There is a higher risk of transection in native hairs with higher density recipient sites and high dense packing sessions, yet they are not permanently damaged. Patients will get 100% shock loss when they shave the recipient site.

[Bill - Seemiller]

Dr. Mejia,

 

Thank you for your professional input on this thread.

 

I'm not quite sure however, that I agree on a few points.

 

Firstly, I don't like your definition of shock loss. I see shock loss as a type of telogen effluvium that has been caused directly as a result of surgical trauma, hence the term "shock". Shaving of the head is not "shock" loss because no trauma was involved. These hairs will start to grow immediately as opposed to those hairs that are shocked.

 

From what I understand, these shocked hairs are forced into catagen (resting) and will begin to regrow around the same time as the transplanted hair starts to resurface. There is a difference in appearance of these hairs when they regrow, as transplanted hair typically starts to grow as thin and colorless while shocked hair grows normally once its back in anagen.

 

Therefore to suggest that there is 100% shock on recipient sites that have been shaved is based solely on your definition of shock loss - which seems to go against the way it's typically used.

 

I am also not convinced that "permanent" shock loss can't occur from transection of the hair follicle. I think if any follicle is damaged enough, it will not grow back. On the flip side, it is probably pretty tough to kill the follicle with ultra refined tools and would require a "direct hit" in a particular location that would prevent it from regrowing.

 

I'd be interested to hear other physician input on the above.

 

I think this topic makes for great discussion. Thanks for adding your professional input.

 

Best wishes,

 

Bill

 

I have also heard many physii

[Curious_George]

Originally posted by Mike Beehner, M.D.:

Bill,

In reply to your question, I think it's probably unfair to at least finasteride to say "in rarer cases it stimulates some hair growth." My experience and that of most of my colleagues I talk with, is that a good half of the men we put on finasteride (Propecia or generic Proscar) experience some added hair growth, at least in the first 4-5 years. Minoxidil (Rogaine) works synergistically with finasteride and the results are better than with only finasteride for the single patient who chooses to use both.

 

Hi Dr. Beehner,

 

While on the topic of Propecia and while we have your attention; does Propecia induce body hair growth in anyway?

 

Thanks.

[Dr. Ricardo Mejia]

shock loss discussion moved to a new thread.

[Al - Moderator]

Originally posted by Mike Beehner, M.D.:

The reasons for not transplanting them are twofold: One, the "donor" hair is of uncertain quality and will not last that many years in all likelihood. Second, because the sides and back are thinnish, a donor scar would easily be seen and would draw attention to itself. Basically, a surgeon is raising false hopes and stealing the patient's money in such situations.

 

Yes. Finally someone is understanding MY problem. My hair on the sides looks very similar to the picture shown. Unfortunately I did have a series of hair transplants years ago. The hair on the sides was very thin then too and spreading towards the back. Today I have thin wispy miniaturized hair everywhere including the transplanted hair on top which is also falling out (although I've been keeping it there with Proscar over the years). The scars on the sides are easily visible no matter how long I try to grow my hair because the hair around the scars is not enough to cover them. How do you repair something like this?

[Dr. Michael Beehner]

BeHappy,

From what you say, you very well may be one of these DUPA patients (Diffuse Unpatterned Alopecia). There are a couple of ways to approach your scar problem. First of all, if the scar is wider than usual (3mm or more wide), and providing you have good laxity left, I would first do a scar excision, which could get it down to 1mm or so. Then, assuming it still showed through the thinning hair, I would use FUE grafts into the scar. These FUE donor sites would be undetectable, even with a DUPA donor hair type.

If you did not have the laxity to do an excision, then I would simply go right to using FUE into the scar. I find this sometimes has to be done a couple of times to get good camouflage of the scar.

Mike Beehner, M.D.

[Al - Moderator]

Thank you for your answers. Each individual scar is not bad. They are all very thin scars. The problem is I have many of them. I'd say 7 or 8 rows from ear to ear. It's hard to give an exact number because they are all haphazard and done in sections that were connected to each other. For example I'd have a procedure that made a scar on the left side. Then in a later procedure they would make a scar in the back that sort of added onto the first one. They just kept making new scars each time. I had 25 procedures total, so my entire donor area is scars with very little hair between them to cover them. The additional hair loss pattern over the years has made all of my existing hair very thin (individual hair thickness). Also the additional loss over the years has gone past the upper scars, so the transplanted hair on top has also been thinning and falling out.

 

My uncle has almost no hair at all on the sides of his head and my pattern is the same which is why I had a HT in the first place, so I wouldn't end up being bald like that.