First transplant 10 years ago, now again at age 34

In 2014 – was 24 years old in between a Norwood III and IV, and underwent a FUE 2700 grafts to mainly cover the front. Didn’t start fin as was apprehensive of the side effects but started minoxidil which I was also inconsistent with over the years. In more recent years (last 5-6 years have been taking Nourkrin man as a supplement and topical Min 5% foam very consistently)  In 2016 underwent SMP in London. 

The balding area grew as my native hair started falling, while the transplanted hair also got thinner. Used to manage a nice look with the help of hair fibres over the last many years which did wonders. Finally in Feb 2024 (age 34) decided to pull the plug on another HT. Consulted with 3-4 top surgeons and mostly their feedback was consistent with c 2500 grafts available from donor area and another 600-800 from the beard. The clinic I went with managed to extract 2700 from the scalp and 800 from the beard area over 2 days. Total c 3500 grafts. They reconstructed the hairline (one thin line ahead of the earlier transplant area) and temple area along with filling up the midscalp region and sparsely covering the back scalp (the crown was mostly left untouched given the large balding area).  I though you wanted to see the views on the work done in terms of look one day post implantation / distance between graft placement? I also realised my mistake of not starting fin (more mature now!) – hence have started 1mg a day and hopefully that along with min helps some regrowth along with the new HT to hopefully give a good result!  Your thought please?

When you start the hair transplant process before the age of 26, you are looking at more hair transplants because the native hair and your balding pattern may advance with age, as happened in your case. I am surprised that more hair from the hair transplant hasn’t lasted the past 10 years.  We see those on occasion; however, this is not that common.  Most of my hair transplant patients keep their transplanted hair for a very long time.  I have been doing hair transplants for the past 33 years, and some of the men I transplanted in 1992-3 have since visited me with hair on their heads. It is important to note that this man’s donor supply was significantly reduced. SMP is a good procedure, but as you can see from this man’s before picture, the SMP has faded and developed a blue tint. In addition, the individual dots from the SMP have spread out and are no longer little dots.  This is common with SMP.

The average man has about 5000-7000 grafts, provided their hair is not fine. If their hair is coarse and their density is at least average, the donor area can supply 8000, possibly more, grafts. Fine hair does not produce much bulk, so donor site depletion is common in fine-haired individuals especially with FUE.  For those reading this post, the message is to be sure to ask your surgeon to discuss your original donor density, hair mass, and total donor supply for your lifetime before undergoing a hair transplant. The distribution of the grafts was appropriate, with more density up front; however, considering the extent of the transplants I see, I wonder how this man’s donor supply will look in terms of over-harvesting.