I know that Biden had hair transplants in the old days with ‘plugs’ but got these repaired some years ago so he looks normal now. Trump I know had a Scalp Reduction (cutting out the bald spot in his crown) but I am not sure if he also had hair transplants. The scalp reduction left him with a scar down the middle of his head. I think that he wears a high end hair piece now.
When my hairline matured/progressed to NW2 in like 2015 the hairs around my hairline also became very thin and they still are today but with not a single sign of recession since. I literally have not lost any hair in 4-5 years but my hairline is thinned out.
Is this just a mature hairline/normal stuff? It seems really strange because it kinda looks significantly thinner at the front but as I said I haven’t lost hair in years. Thanks in advance.
Mature hairlines do not lead to balding in many men (easily 50% of the male population) who don’t have the balding genes; however, you can have balding present by detecting (1) a receding hairline that is more than a mature hairline, (2) thinning in the hairline, (3) balding elsewhere on your head. These are variations of genetic balding.
I have showed you two views of the same hair transplanted patient. Please note that the frontal hair grafts have 2 or more hairs each and the temple peaks are straight as if drawn on by a ruler. This is relatively fresh surgery but when it grows out, anyone will tell this is an abnormal hair transplant, poorly done. It was done in Turkey by someone who just didn’t understand what a hairline is supposed to look like. He got a bargain price, but when he looks in the mirror when it grows out, it may not be worth the bargain.
Hello from France Doctor. Firstly, I’d like to tell you that I appreciate your work ethic. I’ve been studying many topics since I start about AGA, hair transplant, medication etc, focusing on studies, facts, expertise and science, since I started suspecting a beginning of thinning. Your work was a great help and always a pleasure to read. I have a few questions mostly about medication, but here is my case. I’ve been diagnosed with aga today -what I suspected 4 month ago. It’s barely noticeable since I have very long hair (10 inches) and it’s the beginning, but I suspected it because I always paid a huge attention to my hair. There is : a 0.2 inch recession on temples, and subtle thinning / density loss on the top, especially on the mid scalp and following the hair-parting.
I plan to use the Liposomal Finasteride gel from Parati, already have a prescription after asking it from my doctor. I’ve read that you were also prescribing it to your patient. The doctor I consulted was really “expeditive” and unfortunately not really open to the dialogue. Here are the questions :
** – What would be the most efficient concentration for the gel ? ** I was about to order it at 0,1% because 1mL means 1mg, but i’ve also read some case using it at 1% or even 2,5%. I’m lost about this point since i will apply it all on the top and not only on a small zone, so quantity and concentration are important.
** – What is your opinion about the systemic absorption ? ** I know the liposomal formulation is made to avoid it as much as possible, I’ve read the absorption is “18 times less than oral finasteride” but I’m curious about precise serum/scalp DHT reduction. I couldn’t find studies about the liposomal formulation, only about that “P-3074” solution which uses a different vehicle.
– What is your opinion on the efficiency time of that gel ? Could it be efficient “forever”, considering its power on scalp DHT ? Can we count on it for like 10 years or more, like many oral finasteride user ? Would it be different for a diffuse pattern user ?
This is a lot of question, excuse me if it bothers you. I plan to do the things right, and will testify my case and experience with the gel in a few months.
Thanks a lot Doctor, and take care of you.
I generally recommend 0.1% Liposomal topical finasteride. In the past year, I have had two out of about 100 patient develop sexual side effects. If the gel works for you, you must stay on it for life otherwise you will lose all of the gains plus what you would have lost had you not taken it.
The pictures say it all!
We generally think that people who have developed advanced balding and the skin has become ‘atrophic’ which means very thin with no fat (almost tissue paper thin) for many years, that the hairs that were originally there are no longer alive. We believe that the stem cells that produced hairs have died off in these people. But if you are under 35, you may not be in this category. The presence of miniaturization is very hopeful with the right medication and possibly new medications on the horizon
Started taking fin around a week ago, and I feel like I’ve been getting really mad and annoyed very easily. Has anyone else experienced this?
If you think that the drug is causing this, try stopping it for two week and see if things go back to normal. There have been reports of changes in mental states in people taking this drug, although rare.
Some people have complained about cobblestonning or irregularities of the skin in the recipient area after a hair transplant. This is an example of a technique used frequently, where the doctor’s team left the grafts stick out of the skin. When it heals, sometimes the skin edge of the graft heals elevated from the surface of the scalp and this is what many patients complain about. See picture of patient 9 days after a hair transplant and you can see that the grafts are all sticking out of the scalp and it is not cosmetically pleasing. Also for comparison, take a look at one of our patients compared side by side also 9 days after surgery with dense packing of the grafts but as you can see from the photo on the right, the two patients are night and day for comparison. I am showing this because you should demand this type of post operative appearance because you have to be social and can’t look like a freak like the guy on the left.
This woman had a botched hairline from a hair transplant. Clearly the doctor did not understand that the female hairline shape is concave, so I put some marks on her forehead to show what might be a reasonable correction. Of course, the final design should be with the patient, one on one with the doctor. This is not even a good hairline for a man as it looks like Eddie Munster. Doctors who do this type of work, unfortunately, can’t be stopped other than by the patients who can take them to court for a lot of money and find a doctor like me willing to be an expert witness in any court action taken.
You have a surgeon, so your surgeon should address your problem. That has happened in my 16,000 surgeries over the past 29 years twice. Once I was able to retrieve the grafts from the car door, wash them and replace them and they grew just fine as it happened in front of my office. The second time, I replaced them at no charge to the patient. I always do the right thing for my patients, so should your surgeon.
In this published article, Creatine was taken by a Rugby player and his serum DHT levels went up. Although the article did not relate this to hair loss, we have seen men who take Creatine as a supplement and find that they notice more hair loss if they have the genes for balding present: https://pubmed.ncbi.nlm.nih.gov/19741313/.
Great response to minoxidil after just 5 months
From the picture, you have a Class 3 pattern of balding. Of course, I would want to examine you to see if there is balding behind the forelock you are showing, but assuming what I am seeing is all the balding you have, I would estimate something between 1500-2000 grafts depending upon your hair thickness (fine, medium or coarse) with finer hair requiring more grafts.
Although the front looks good, the back does not look as good as I expected. What do you recommend?
What you got now is about what you will get and no more. Usually all of the grafts have grown out in a year? If you want more density, you will probably have to meet with your surgeon again and ask for a second surgery for the crown or consider Scalp Micropigmentation (https://scalpmicropigmentation.com/gallery/thinning-hair/#!https://scalpmicropigmentation.com/wp-content/uploads/2016/04/scalp_micropigmentation-new_hair_institute-042-thinning_hair.jpg).
With these results in just 3 months, I suspect that in the next 6-12 months, you will get all of your hair back. These short hairs are the old terminal hairs returning. How often are your microneedling?
