The value of finasteride and minoxidil in this young man of 21 shows with good fill out of his receded frontal corners.
A great response to finasteride alone. The reversal of the frontal hairline occurs more often in men under 25.
If most of the hair that falls out is noticeably thinner at the base than it is on the end, does this most likely mean that many of my follicles are miniaturizing or is this just the natural hair process and likely nothing to be too concerned about?
Yes, as hairs become more and more miniaturized, as they grow they become thinner and thinner so if and when they fall out, the base will be the thinnest part of the hair shaft
Is it a common side? It’s been a couple of days since I started taking finasteride, and my left side feels tense and slightly painful. Any similar experience?
If the testicle pain continues, go back and see your dctor as this drug is known to cause the problem in some men but also there are other condition that cause testicle pain in young men that requires an examination by your doctor.
The miniaturized hairs evident on the patient’s right side of the before picture show miniaturized hairs which are not clearly evident in the after picture. If it were not just a set of pictures sent to me, I would ask him if these miniaturized hairs grew before he went on finasteride. I suspect that they were stunted as most miniaturized hairs just don’t grow when they are at the end of their miniaturization cycle. I would like people to take the same view with the same lighting of their hairline so that the viewer can tell the difference.
First, thank you Doctor for your years of good advice offered through your site and elsewhere. I am light skinned, 65 and have been on Finesteride for 10 years, had a FUE procedure with an outstanding surgeon in Thailand 9 years ago, and found that I was among the 5% who never shed (perhaps due to blood pressure on the high side?). The untransplanted region in the rear of the crown seems to have thinned over time, but not profoundly and I have considered the procedure a success, until now. Recently I believe that the right side of my frontal hairline may be undergoing some sort of change, where a patch of maybe 15mm by 10mm seems to have hair that is both thinning and maybe only 80mm long. The symmetrical area on the opposite side of the hairline is unchanged the hair long and as full as transplants typically are (i.e., not especially, but cosmetically impressive). Apart from any comments you might care to make concerning the possible cause, could there be reason to believe that this situation could recur even after an second FUE? Thanks so much.
You should send me some photos. I saw a man recently (https://baldingblog.com/2017/
Yes, there is far more patchiness than I would expect to see. This was caused either by donor over-harvesting or vascular complications of the donor area which may reverse within 6 months of the surgery, so by that time you will know more. I also noticed that the grafts were harvested very high and also too low, probably outside the permanent zone. If you should develop any advanced balding, these grafts may not be permanent. The donor area is usually no more than 3 inches high (see here: https://baldingblog.com/2017/08/04/permanent-zone-hair-lasts-lifetime/). If the patchiness remains, then you might consider scalp micropigmentation, something we do all of the time, see website: https://scalpmicropigmentation.com/
This man sent many photos all showing tons of hair. The only one I included was an orderly view that compares favorably to the photo he took 3 years earlier. This man clearly enjoys his hair.
This 19 year old was taking minoxidil and finasteride for 4 months and had a great response which shows how easily young men respond to these drugs.
Can you imagine having to walk around like this. The doctor has no sense that there was a technique to wash off the crusts the day of and the day after the surgery. Within 3 days of surgery you should look perfectly normal and able to go out in public without detection. By the third day, you should be able to resume full activities, heavy exercises if you wish. The recipient area requires daily washes to keep the recipient area free of crusts. I generally recommend the use of a sponge and supply my patient with a surgical sponge to fill with soapy water and press on the recipient area daily. By repeating this daily, all crusts can be washed off without any fear of losing grafts. If any crust are present, use a Q tip and dip it into soapy water, and roll it on the crusts and that will lift them off without dislodging them, but never rub them, just roll the Q tip on the recipient crust. I like to see no evidence of any crusting in the recipient area and the crusts from the donor area gone in 3 days with daily washing. Below are two patients, this one with terrible crusting on the left and one of my patients on day 6 on the right placed side by side for comparison purposes. Both patient are 6 days after the transplant. Can you tell which patient is minet?
This patient had 4,500 FUE grafts and you can see in the photo the difference between the donor area, which is a bit too high, and the normal hair density on the neck side of the photo. The surgery depleted the donor hair significantly. This is caused by either (1) very fine hair or (2) a low original donor density (something that the doctor can measure in advance).
When I teach doctors how to do a hair transplant, I always discuss randomness for graft placement. The doctor generally fights his tendencies for orderliness and orderliness means alignment of the grafts in columns or rows, not normal as you can see. When the hair grows, it will show the orderliness when you look carefully at it. Also, note the picket fence hairline, which again is not normal. As this man already has hair, these issues may not bother him, but it bothers my aesthetic sense of things.
Another photo of a man who had FUE and as a result had an over-harvested donor area. The donor area that was harvested was larger than the permanent zone so some of the transplanted hairs will not be permanent and may fall out in time. This depleted donor area could be treated with scalp micropigmentation
This young man is an excellent finasteride responder and should continue on this drug for the rest of his life. If he stops it, he will lose all that he gained.
You have been using finasteride and minoxidil for only 45 days and these photos suggest that your hair is sensitive to finasteride and minoxidil. Your pattern of balding is a Norwood Class 3A with a huge forelock. The hair loss is around the forelock that is solid and not balding. You already show signs that it is reversing with the finasteride and minoxidil. Keep up the good work and make sure that you stay on it and let’s see what it looks like in 6 months from now.
