My natural hair is fine and wavy.  After the hair transplant, the frontal area is now thicker but it is clear there are two types of hair there. One is super curly.  Will this go away with time? Did my surgeon screw up? Will it happen for all subsequent transplants if I go that route?

The hair should mimic the hair from the back of the head in terms of thickness (not the frontal miniaturized hairs). The increased waviness is not an uncommon finding after a hair transplant. For those men who develop more wavy hair after the first hair transplant, the same is likely after a second hair transplant in my experience.   I don’t know why it happens.

For those of you who perform microneedling, you want to reach the area between the gland and the skin which is between 1 – 1.5 mm from the skin edge

A very nice restoration of the full hairline. It is still thin but I would hope that after one year of finasteride, it will be better

I want to help her and buy her a derma roller at the least but how do I have that conversation with her without destroying her self esteem

She should see a doctor. Female hair loss is very different than male hair loss as there are many common conditions and this could be a sign of some important change in her overall health or some disease of the hair and scalp more common in women then men.  Dermarolling is not the answer for most women unless they have genetic balding and female patterned hair loss.

J Eur Acad Dermatol Venereol

2022 Feb;36(2):286-294.

doi: 10.1111/jdv.17738. Epub 2021 Oct 25.

Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial

B M Piraccini 1, U Blume-Peytavi 2, F Scarci 3, J M Jansat 3, M Falqués 3, R Otero 3, M L Tamarit 3, J Galván 4, V Tebbs 5, E Massana 3, Topical Finasteride Study Group

Abstract

Background: Oral finasteride is a well-established treatment for men with androgenetic alopecia (AGA), but long-term therapy is not always acceptable to patients. A topical finasteride formulation has been developed to minimize systemic exposure by acting specifically on hair follicles.

Objectives: To evaluate the efficacy and safety of topical finasteride compared with placebo, and to analyse systemic exposure and overall benefit compared with oral finasteride.

Methods: This randomized, double-blind, double dummy, parallel-group, 24-week study was conducted in adult male outpatients with AGA at 45 sites in Europe. Efficacy and safety were evaluated. Finasteride, testosterone and dihydrotestosterone (DHT) concentrations were measured.

Results: Of 458 randomized patients, 323 completed the study and 446 were evaluated for safety. Change from baseline in target area hair count (TAHC) at week 24 (primary efficacy endpoint) was significantly greater with topical finasteride than placebo (adjusted mean change 20.2 vs. 6.7 hairs; P < 0.001), and numerically similar between topical and oral finasteride. Statistically significant differences favouring topical finasteride over placebo were observed for change from baseline in TAHC at week 12 and investigator-assessed change from baseline in patient hair growth/loss at week 24. Incidence and type of adverse events, and cause of discontinuation, did not differ meaningfully between topical finasteride and placebo. No serious adverse events were treatment related. As maximum plasma finasteride concentrations were >100 times lower, and reduction from baseline in mean serum DHT concentration was lower (34.5 vs. 55.6%), with topical vs. oral finasteride, there is less likelihood of systemic adverse reactions of a sexual nature related to a decrease in DHT with topical finasteride.

Conclusion: Topical finasteride significantly improves hair count compared to placebo and is well tolerated. Its effect is similar to that of oral finasteride, but with markedly lower systemic exposure and less impact on serum DHT concentrations.

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How effective is finasteride at stopping hair loss? I am 19 and have a receding hairline but thankful I caught it early. Started finasteride and just wondering if it can stop hair loss all together

Stopping hair loss with finasteride depends a great deal on your genetics. Finasteride can’t always stop your patterned hair loss if it is very aggressive.  There is a high probability that finasteride will either slow, stop or reverse the hair loss.  When it slows it down, it is hard to see because there is nothing to compare it to; however, if you are on finasteride for a long time and then stop it, “catch-up hair loss” will show that it was working. I wouldn’t advise someone to do this because there is no guarantee that the ‘catch-up hair loss’ can be fully reversed.

Great photo.  Good styling shows what happens when you probably have some reduced hair density and your comb your hair with good styling techniques. Styling is all important for those of you who are balding, especially in the early days of the balding process when the hair loss is just beginning.