Hairs grow in groups of 1,2 3,4 and occasionally 5-6 hairs per group. These are called Follicular Units. Most doctors transplant Follicular Units and for simplicity call these units ‘grafts. When I do a hair transplant, regardless of the harvesting system (strip surgery or FUE), I charge by the graft. So depending upon your natural groupings of follicular units, the number of hair that I will transplant will vary with each individual. Some races have more hair than others. Caucasians have the highest hair densities but a fixed number of follicular units. The average number of hairs for a Caucasian is 2.3 hairs. For an Asian, on the other hand, the number of hairs per follicular unit are less than Caucasians, usually about 1.6 hairs/follicular unit. That means that the typical Asian, each hair group will have less hairs per graft so when they pay for a hair transplant based upon the number of grafts, they end up on the short-stick when compared with Caucasians. For this reason, a typical Asian might be better served having a strip surgery. Some doctors may confuse this issue by charging per hair just to earn more money. That does not do anyone any real service.
Any surgery can impact hair growth but usually hair transplants done previously are very stable and will not be impacted by any surgery. If however, you are balding at a rapid rate and have a hernia repair or any surgery, the stress of a surgery runs a small risk of accelerating hair loss that is rapidly being lost.
Many young men want to accelerate their beard growth and ask about it. It takes age (genetic triggers which occur in family lines) so if you want to find out when your beard will grow out, you need to find out when your father or grandfather started to grow their beard. Hormones should have kicked in nicely by the time a man reaches 18 but he must wait out his genetics as hormones alone are not responsible for the onset of beard grown. Beard transplants can be done when the young man is a bit older (over 25) if the beard has not grown in yet
For men, my concern is in the potential balding that may occur in your future as most balding starts in young men and is progressive so it advances with age until the mid-thirties or even later. If that happened to you (your risk) then you will have to get a hair transplant to cover it as the frontal area is the place where genetic balding starts in most men. If you are under 24, you may become a set-up for hairline recession so that if you lower the hairline with an advancement surgery, hair loss that will occur behind the scar. If you develop balding, it will require a hair transplant to keep up with the recession and the scar from the advancement will show. A hairline advancement procedure is not the best option for a male but a hair transplant lowering procedure allows you to follow the recession back if and when it should occur.
Many homeless men seem to have long hair and rarely shampoo, but we do accumulate dirt and air pollutants on our hair from living in the city. Shampooing daily or every other day keeps the hair clean. For me, I like a clean hair and scalp and would personally feel bad if I started to develop an odor in my hair, which is common in people who do not wash it.
The key to drying hair after a hair wash is to be gentle. Never rub it hard against the scalp because if there are miniaturized hairs, these will be easily pulled out. The use of a hair drier with long hair works if (1) you use a good conditioner to make the hair glide through brushes and comb and (2) use a low heat with the hair drier. Never pull on your hair when you have hair loss, even with a brush.
Finasteride attacks the cause of the hair loss by blocking the enzyme 5AR at the hair follicle level. Minoxidil produces hair in anyone who applies it topically, some time just fuzz, sometime some hair. The drug finasteride is a better and a more assured way to slow down or stop the hair loss.
This is an interesting question. I have had the opportunity to try to count all of the grafts that I put in. Even with good photography, it is difficult. I had a patient a while ago who paid me to count the 6100 grafts that he had done. I took 3 hours, with grids drawn on his head. I counted only 1900 grafts, nothing close to the 6100 grafts he claimed he got. If I was off on my counting, I don’t believe for a minute that I would have been off by ~4000 grafts in my count. This patient came back 8 months later and I counted the grafts that grew. Mu original estimate was close to what grew.
The internet has spread a great deal of information and misinformation about Propecia (finasteride) which is much over-blown. You need to put the decision in perspective. The risk of these sexual side effects are between 2-4% depending upon the sources you read. My son has been on this drug for 15 year and found an increased sexual drive, not a decreased sexual drive which his girlfriend appreciated very much. How often do you hear about an increased sexual drive? Answer: very, very rarely.
If you were one of the unlucky men to get the sexual side effect, 99+ % of these men find that the side effects go away within 2 weeks upon stopping the drug. Some very small percentage report long term sexual side effects; however these risks are very, very infrequent (less than 1% of the 2-4% people who get negative side effects that persists). Many of the people who reported these sexual side effects may have had sexual dysfunction (normally present in 30% of men 40, 40% of men 40, 50%+ in men over 50) so it is easy to blame this drug for sexual side effects when reduced sexual drive is unfortunately, a sign of aging in many men. Rarely do we see this in 19 year old men, however, you can have a placebo effect if you believe you will be one of them.
The real decision before you, of course, is the problem of progressive balding which this drug is very effective in treating in men of your age. It even reverses the hair loss in many men under 20. You are clearly in the drivers seat, so be careful about what you read and put everything you research into a proper perspective.
We are clearly more informed today that previous generations have been so today’s young people think that balding should not happen today when in our father’s time, it was just an accepted fact. In reality, Dr. Otar Norwood published his balding patterns in in early 1980s. What he said is that men bald in patterns and these patterns of genetic patterns that we inherit. The few balding men who have very advanced balding patterns (Class 7 patterns), usually, but not always, have them by the time they are 26 years old. Many of the less advanced patterns take years to occur. The reality is that each hair follicle has a ingrained number of hair cycles in its life time. If you have a 3 year hair scalp cycle for example, and you have an advanced Class 7 pattern of balding, the number of hair cycles that are ingrained in the hair follicles are about 7-8 cycles, at which time the hair follicles die out (called medically Apoptosis). Drugs like finasteride (Propecia), alter the length of these hair cycles and that is why they have become very popular.
Stress does add to the causative factors for hair loss. We see this in stressed college students and/or people who have romantic relationships that fall apart so managing stress is important to hold on to your hair. I do not believe that today, we see more balding than 30 or 100 years ago. Balding is genetic.
Dutasteride has been shown to be about 85% effective in blocking the enzyme 5-alpha reductase which is the active enzyme where DHT causes hair loss. Finasteride (Propecia) is about 70% effective. If you decide to take Dutasteride instead of Finasteride, don’t take the two together, no need. There are more side effects from Dutasteride than Finasteride. Initial shedding has been reported with both drugs but the shedding rarely lasts more than a few months and reverses the hair loss when it occurs. As hair takes time to grow out (1/2 inch per month), you don’t see the regrowth very quickly.
I have published a post on baldingblog in the past which shows that Saw Palmetto has poor responses for people with BPH (Prostate problems) here: https://baldingblog.com/2012/01/26/2006-study-says-saw-palmetto-does not improve-bph-symptoms/
Body builders are at the same risk for sexual side effects as the general population from the drug finasteride (Propecia) which is between 2-3%. They are at more risk for hair loss if they take anabolic steroids regardless of the use of Propecia (Finasteride)
It is a known fact that hair has cycles between telogen (rest) and anagen (growth). The growth cycle of scalp hair is different than body hair. Scalp hair grows for between 2-4 years on average and rests about 6 months on average. Body hair grows 6 months on average and rests 6 months on average. Younger people have longer scalp growth cycles than older people so they can grow their hair very long. When Propecia works at its best (completely arresting the hair loss from genetic hair loss, not common but more common in young people), their hair loss from telogen returns to its normal cycle. Calculate that the average Caucasian has 100,000 hairs on their head (Asians 80,000 hairs). If they have a 3 year growth cycle, then they will cycle about 100 hairs per day which will fall out (most never seen as they come out through the day in the wind or in a shower, etc..) and they will regrow through out the day at a rate of about 100 hairs per day. These new hairs get buried in the forest of hair on your head so you never see them.
If the hair grafts are taken exclusively from the donor area (permanent zone), they will ?have hair that is resistant to males hormones. The wreath of hair around the side and back of the head, is permanent on 99+% of men no matter what they have inherited from the ancestors, these hair will last their lifetime. Although this is the written rule, occasionally we see some patients that may lose their transplanted hair and if they do it may result from: (1) miniaturized hairs in the donor area (often called DUPA or Unpatterned Alopecia), aging of the donor area (seen in men over 50-70 years old a condition that unfortunately bares the name ‘senile’ alopecia, in many women whose hair around the side and back of the head is susceptible to female genetic balding and for other unknown causes we doctors call the ‘X’ face, which means we don’t know.
When strip surgery is performed and it strip incision is placed in the lower border of this permanent zone, these hairs will be lifetime hairs. If however, a doctor pushes the number of harvested grafts and extends outside of the permanent zone to push up revenue as they charge per grafts which are worth more to the doctor, these hairs may not be permanent.
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