https://clinicaltrials.gov/ct2/show/results/NCT01231607?show_locs=Y&sect=X430125&view=results#othr

Can you receive or do you recommend getting a hair transplant while on Accutane (isotretinoin)? My understanding is that the drug disrupts cell division and skin regeneration. Will this delay healing?

Yes, having a hair transplant while you are on Accutane it is not a good idea. You should wait a year without the drug ensure that the transplants will work and grow well.  There is no point in spending money and your donor hair if you are not going to have good results.

It is important for me to not only see some men who have had a full head of hair created by hair transplants, but to talk to them so that I can understand their decision process and what the experience was like. Looking at pictures is a sterile, non-personal process. 

The appearance of a thick head of hair is achievable with hair transplants. To manage people who have your needs, we have a series of men who regularly attend our monthly Open House events who have achieved this goal and can be met at my office.  We have been doing this for 27 years.  Spontaneous visits by many of my other patients repay their experience in such meeting by dropping into our monthly Open House events, unannounced.  We have an office in West Los Angeles and Irvine, California. We hold these events once a month in Los Angeles, and once every other month in Irvine.  In addition to meeting patients, you can see a surgery in process, speak with patients who are in the process of having it done, see a Scalp Micropigmentation procedure being done.

You have classic donor site depletion resulting from over-harvesting the grafts considering your donor density. The surgeon did not know what he/she was doing and clearly pushed your donor area well beyond what the blood supply could support and probably what your original density was. From what I see, this looks like you had too many grafts removed from your donor area.  The absolute number of grafts is relevant with regard to your original donor density, although few men’s donor area can support 5000 FUE grafts.  We perform Scalp Micropigmentation (https://scalpmicropigmentation.com/scar-covering/) on people like you but you will have to commit to keeping your hair shaved in the back for the rest of your life. The good news is that you will look normal after what must have been over a year of hell. Make sure that you do not have alopecia areata which could look like this? To make a diagnosis, you would need a biopsy.

Scarring from FUE is common. If it bothers you, the best treatment is Scalp Micropigmentation.  I don’t know how many grafts you received, but if it exceeded 3,500 FUE grafts, it is likely that you were over-harvested.  We have performed SMP on many people with all types of donor scars including for FUE, see here: https://scalpmicropigmentation.com/scar-covering/

The question of density by itself makes sense as the size of the balding area dictates the planning. However, density is only one of the considerations. Your donor density relates to the size of your balding area, so a skilled doctor needs to plan the reconstruction of these parameters as well as other factors such as hair thickness, the waviness of your hair, and the color contrast between your hair color and your skin color.