I have a Class 3 balding pattern (just corner loss) and I went to a hair transplant doctor who offered to perform 2000 grafts in the front to address the balding area.  It seemed to me that I was thinning outside of my frontal balding area. The doctor who offered me the surgery never looked at my hair under a microscope. I am a 24 year old male and I purchased a hand microscope as you suggested on Amazon. When I looked at my donor area, this is what I saw in different parts of the donor area.  How would you interpret the hand microscope pictures I have attached here?

This is clearly Diffuse Unpatterned Alpopecia (DUPA) which I originally wrote about in 1997 (see here: https://baldingblog.com/wp-content/uploads/pdf/mp-1997-evaluation.pdf). The view of your donor area shows very significant miniaturization of the donor area which means you are not a candidate for a hair transplant because it will fail. The hairs that get transplanted will look like these hairs and not have much bulk to them. The doctor who recommended 2000 grafts just wanted your money and probably never read about DUPA.  You seem too smart for that doctor. The drug finasteride sometimes helps.

You have a condition called Cobblestonning that is produced by the graft skin edge, located above the surface of your normal scalp, resulting in these “bumps”. There is little you can do about this other than get another hair transplant to overwhelm these graft sites, putting possibly more hair in front of them so that they can not be seen. Of course, your surgeon must be made aware of the problem to ensure that he places the grafts flat against the surrounding skin at the time of the next surgery.

Of course my answer would always be to go back to see your doctor. These red spots are suggestive of some type of inflammatory process or infection.

A failure of a hair transplant is most often a reflection of the techniques used. If I had a failure, I would perform the next surgery at no charge. Yes, by all means, go back to your doctor and ask about why it failed. Assuming that you do not have some dermatologic disease that caused the failure, your doctor should make things right with you financially.  Ask how he/she will make sure it does not happen again. Ask yourself if you trust that the doctor will get it right the second time.

The before pictures (above) and the after pictures (below) show the results of a women who requested to have her temple peaks restored which she started to lose 10 years earlier. She also wanted a slightly lower hairline that would not be perfectly balanced because she feared that a perfectly symmetrical hairline would look “man-made”. The hairline was drawn on the day of the surgery. The after picture below are shown nine months after the hairline was corrected.

The horizontal arrows show the temple peaks before and after the surgery.  The vertical arrows show the point to where the hairline was lowered. She had an unusual hairline for a female, as many of the women we see actually have thinning corners of the frontal hairline. This was not the case with this woman. A surgical hairline lowering procedure could not address the missing temple peaks which is what makes this hairline very feminine.

Hairline: customized transplanted with temple peaks (before and after photos)

We’d both be 19 if he was still here. We were pretty alike. Both were studying together. Life bummed him out but not that much. Then hair loss hit. He started losing hair all over his head. Every doctor just said it was aggressive hair loss. His worries become amplified ten fold. Everything bummed him out, he wouldn’t leave his house. I wake up one day to my mum telling me that he hanged himself in his room when everyone was away. Nobody talks about how hair loss made everything worse. I understand depression plays a huge factor but it would have never happened if hair loss treatments were not complete bull shit. Guess what though? Now i’m going through the same thing. Rapidly losing my hair and people are noticing it. My own parents won’t even look at me the same way. Can the industry get its act together? I want to live. Why can’t people understand how balding screws up your mind at a young age.

Hair loss can be treated and today, with modern technology, almost every person can get the hair that they are losing back when in the hands of an experienced, ethical and skilled doctor. There is no hopelessness with balding, not at all.  Yes, our industry may not focus well on people like you and your friend.  I, for one, have had too many young men in your situation and I spend a lot of time with each of them. Most of the time I am successful in bonding in a positive way to impact their depression; however, depression needs professional help. I had one young man commit suicide after being mutilated by a hair transplant doctor with the old plugs and many scalp reduction surgeries. I knew about him because his mother and I bonded over his management, but he lived far away and a phone connection was not enough. When his mother called me and told me the terrible news, I felt that maybe I should have flown out to see him or send him the money to come to visit me in LA, Hindsight does’t help.  Hair loss just adds to the depression that already exists in such young men and I keep seeing young men voice their depression about hair loss and relate it to hopelessness.

At one year after a hair transplant, I would expect to see at least 95% of the growth to styling length on your head. Go back and meet with your doctor and see what your doctor has to say. If you were my patient, I would want to know for sure that you don’t have some autoimmune disease and if you don’t then your doctor should make it right financially for you