I am 26 years old and had a hair transplant last week and my surgeon recommended that I take Propecia to prevent shock loss. I am afraid to do this because I heard that I won’t get erections on this drug. Is this true?

The risks of ED with finasteride is 3-4% while the risks for young men in their 20s for shock loss after a hair transplant is probably 90%. You should have been on the drug before your surgery.  Now it is completely your call.

The scarring you have may be the result of a surgical wound that was closed too tight which is known to form scars like you have. This area can be transplanted filling in the hairline with a forward new hairline created with fine single hair grafts in front and this will hide the scar when done properly. Similar work can be done behind it. Here are some examples of hair transplants performed for female lowering procedures which does apply to you:  https://newhair.com/female-hairline-lowering/), scalp micropigmentation can hide the scars inside your hairline easily (https://scalpmicropigmentation.com/scar-covering/#!).

This appears to be a disease called Alopecia Areata or a scarring alopecia, both autoimmune diseases of the scalp.  See a dermatologist to get it biopsied and treated.

Yes, it is not unusual to thicken up the transplant with a second hair transplant, especially people with fine hair. Mechanically, there are limits to how close one can place grafts in a first surgery but on a second surgery, the surgeon goes between the previous grafts and this will double the density.  After the next surgery, you should look good.

You have a Class 3 Vertex pattern of hair loss which means that you are losing frontal hair and crown hair. At your age, I would suspect that if you lose more hair, it will not be very dramatic. You could try the drug finasteride (requires a doctor write a prescription for it) or you can transplant it. Transplants will work well for someone of your age and probably you will be stable so after a hair transplant you will just look like you never lost any hair

The recipient area requires daily washes to keep the recipient area free of crusts. I generally recommend the use of a sponge and supply my patient with a surgical sponge to fill with soapy water and press on the recipient area daily. By repeating this daily, all crusts can be washed off without any fear of losing grafts. If any crust are present, use a Q tip and dip it into soapy water, and roll it on the crusts and that will lift them off without dislodging them, but never rub them, just roll the Q tip on the recipient crust. I like to see no evidence of any crusting in the recipient area and the crusts from the donor area gone in 7-10 days with daily washing.  Now you should NOT pick off the crusts as they will slowly fall off on their own with daily shampooing. Leave the shampoo on your scalp for 10 minutes and then gently rub it with your finger tips once it is water logged. That will get the crusts off without risk to the grafts.

If you have cobblestonning it may be related to the amount of skin that you had on the recipient grafts. Also you will find that this skin will  be very sensitive to sun. I always trim off the skin when I transplant the beard or scalp so that I avoid cobblestonning and a significant skin disc which easily develops sun burn for the first year or two.

The photo on the left is before the surgery and the photo on the right is after the surgery.  The loss of hair reflects shock loss and it could have been prevented with the drug finasteride in 95% of young men who take this drug. This 25 year old male, lost most of his native hair from the transplant, something we see often in young men when they do not take finasteride

The permanent zone is measured from the base of the skull a distance up of approximlately 3 inches at most. If the donor area is larger than 3 inches on the sides or back, then this hair may eventually fall out in the years to come. You have gray hair suggesting that you are probably over 50, so that might make the risk of loss less, if your recession of the hair in the back has stopped. If it did not stop, then you may see the ‘white dots‘ associated with the FUE extraction once you lose the hair on the upper fringes.

 

Split ends on hair follicle shafts usually reflects damage from the use of blow dryers, hot irons and other tools that help you style your hair.