This patient had surgery yesterday. Other than the tape that is applied to his forehead to prevent swelling from working its way down, there is no evidence of the surgery from yesterday.  He had 1600 grafts from a combined strip and FUE surgery. He came in for his hair wash this morning which guaranteed that there was no crusting present anywhere to see. On the third day, he can remove the tape and go to work Monday morning.

 

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This second patient is 10 days after his surgery and there is a small beard present in the hairline that goes in front of his previous natural hairline which you can see; however, when looking at him from any reasonable distance, there as no evident hair transplant unless you had to look at it up close as this photo does. These hairs should fall out in the next week or so.

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I found this graph on the blog site. I am not sure of the source nor the accuracy, but it does somewhat address your question and explains much of what I know about the drug fnasteride.  When Merck did the initial clinical trials, they were trying to determine what the best and most effective dose of finastride (Porpecia) would be and then, of course, what they would recommend. They found that doses greater than 1 mg, on average, did not increase the value of the drug on hair loss. They also found that when half the dose was used, that the value was 80% as good as the full dose. Going down in dose as well to 0.25 mgs would have half of the value, so I think that this curve is somewhat correct. At least it does explain why some people can get an impact on a lower dose.  But Merck recommended 1 mg because it produced the best effect on MOST people.

finasteride inhibition curve

DHT levels have no value when you are considering taking finasteride for male genetic hair loss. Young men have good testosterone levels and therefore will have good DHT levels so measuring these levels does not change the treatment goals

Two patients one day after surgery. Neither patient has crusting and are clean as can be. They will not be detectable within a few days after the hair transplant. The first patient had 1800 grafts (FUE) in a completely bald area and the second patient has 2800 grafts (strip surgery) which is easily hidden by his residual hair.  I will continue to show post operative patients so that you, our readers who are afraid what they will look like, will see that they won’t look freaky.

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Genetic prediction of male pattern baldness.
Abstract
Male pattern baldness can have substantial psychosocial effects, and it has been phenotypically linked to adverse health outcomes such as prostate cancer and cardiovascular disease. We explored the genetic architecture of the trait using data from over 52,000 male participants of UK Biobank, aged 40-69 years. We identified over 250 independent genetic loci associated with severe hair loss (P<5×10-8). By splitting the cohort into a discovery sample of 40,000 and target sample of 12,000, we developed a prediction algorithm based entirely on common genetic variants that discriminated (AUC = 0.78, sensitivity = 0.74, specificity = 0.69, PPV = 59%, NPV = 82%) those with no hair loss from those with severe hair loss. The results of this study might help identify those at greatest risk of hair loss, and also potential genetic targets for intervention.
PMID: 28196072
Full paper is available in the open source journal PLoS Genetics:

Body hair transplants don’t have the staying power as you get older and drop your DHT levels as body hair is dependent upon DHT for growth. This also applies to beard hair as well. That is why some men who take DHT blockers like finasteride or dustasteride lose their body hair over time and some of them find that their beards are thinner as well.

Assuming that you are a male, short hair will bald at the same rate as long hair. Many men think that if they shave their head, the hair will come back stronger. That is a myth.

Loss of body hair occurs in patients on Propecia (finasteride) but not always. I suspect that the DHT block from the drug finaseride is not very effective on body hair in everyone and that is why different people see varying degrees of body hair loss.  It is not unusual to get a decrease in body hair and if you take it long enough, maybe you will see complete loss of your body body hair.

Humans lose hair asynchronously, which means we don’t shed with the seasons but rather have a fairly constant rate of shedding at about 100-150 hairs per day for the typical Caucasian.  Asians shed less because they have less hair than Caucasians by 20%.

When a man with genetic hair loss develops hair loss due to stress, they often find that it does not come back after the stress reverses. For men on the drug finasteride, the stress effects on the hair loss can be offset by the drug. For women, it is another story as their hair loss cycles in most women with stress related hair loss.

 

Many of my friends are asking me what I did to my head?

Unfortunately, SMP is an art form that takes a long time to learn, I have seen many such examples of SMP done by people who should not be doing it at all (sake a look at our website to see what it should look like here: https://scalpmicropigmentation.com. You can go to a dermatologist who has a Q-Switch laser and have these removed to get you back to normal. Then if you are willing to get it done right, visit us.

SMP amalgam Dsmp thinning done right

Two examples, one done wrong (above), done correctly (below – before and after example – click to enlarge)

Many such dietary supplements have steroids in them and these steroids can cause or accelerate the hair loss when a man has genetic propensity for balding.

Minoxidil is not effective to stimulate recipient area hair growth. I studied this on 50 patients with minoxidil on 1/3rd of the head and none on the other side. Both sides grew equally fast and well.  What is the best way to get good growth is to have an excellent surgeon and surgical team do your hair transplant. There is nothing that will stop a good hair transplant from growing.

I have been asked lately to show more pictures after the surgery so that prospective patients can understand what they may look like.  Each patient is different because of hair and skin color.  The lower the contrast, the less detectable it is, the grater the contrast the more detectable the ‘beard look’ of new hair is. The redness you see will be gone in a day or two. The tape was put there to prevent swelling from creeping down in the forehead into the eyes. Note there is no crusting and the recipient area looks clean because we wash it very carefully.  We don’t usually see the patients after the first day post-op to get daily pictures, but as the patients come in, I will try to update these photos.

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I have been asked lately to show more pictures after the surgery so that prospective patients can understand what they may look like.  Each patient is different because of hair and skin color.  The lower the contrast, the less detectable it is, the grater the contrast the more detectable the ‘beard look’ of new hair is. This patient is 9 days after his surgery. His skin color is olive but his hair is brown so what we are seeing is his brown hair in the recipient area against his olive skin color and an FUE donor area that is one day post-op. Note that there is no crusting present in the recipient area and the FUE wounds are almost undetectable at one day.

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