Discussion: Balding men with fine hair
Can you help me?
The photos reveal what I would expect: a healthy donor area with no evidence of DUPA. There is a slightly better-than-average hair density; however, I suspect your hair is fine in thickness (I suspect in the range of between 25-35 microns (just a guess, but it should be measured with a micrometer) because I can see through the donor area to the scalp. The rest of the photos show widespread miniaturization (not shown microscopically), which should be treated with finasteride, or you will likely lose all of the miniaturized hairs after any hair transplant surgery. Finasteride will not only reverse some or many of your miniaturized hairs, but if or when you get a transplant, you will have the protection of finasteride, so you experience minimal shock loss. Men with fine hair and a large potential balding pattern will need at least two surgeries to address the pattern, as the hair bulk transplanted with one surgery may not be adequate. The higher-than-average donor density helps but is not enough to offset your fine hair thickness. Before considering hair transplantation, I would start you on finasteride and wait at least 9 months and then re-examine you. A transplant should not be a foregone conclusion for you.
When I transplant men like you with fine hair and an advanced balding pattern, I often discuss a good frontal reconstruction from the hairline to mid-head as a first step. One or two sessions might be indicated, followed by SMP, which makes for a fuller-looking frontal head of hair, especially in men with fine hair. I would delay the crown reconstruction after reassessing the donor area and after the frontal area is fully stable to the mid-head. I have performed surgeries like this frequently with excellent results, but men with fine hair often don’t have the expectations of someone with coarse hair because they only know fine hair, even as a teen. Men with fine hair may have to make compromises on their goals.
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