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. 

First, you’ll need the doctor to evaluate your donor area to rule out any disease that may be there. Assuming that you are over 25, the pattern looks like you are going to a Class 5A pattern. I would need to see your hair under trichoscopy to determine that, but it means that more balding is likely to occur on a limited basis in your upper crown areas. Good doctors routinely perform trichoscopy to rule out diseases of the donor area and the metrics that I am about to discuss.  It would be best to have metrics for your lifetime donor supply, including (1) donor density and (2) hair shaft thickness of the donor hairs. This will tell the surgeon what you will look like after the hair transplant, which will be shared with you. Then, a good surgeon will complete the examination by judging where your balding pattern will end up. Good planning is critical so you only expend some of your donor hair on a limited vision of where you are now. Balding is progressive, and you want to be sure that in the long term, you will always look normal and have enough hair left to follow the progressive nature of YOUR balding.

Some men have strong forelocks; when they start balding, as this man shows, you see the forelocks remain strong. The balding occurs around the forelock (A, B, C).  A man with a strong forelock often doesn’t look like they are balding because the forelock holds the frame to the face. When I transplant balding in a patient with the pattern shown below, I leave the forelock alone, realizing that sometimes, as this man grows older, he may lose the forelock, and then he will need it transplanted; however, in my experience, when men have strong forelocks to the age of 35, they are more prone to keep these forelock, regardless of the balding that may occur over time further back in the head.  These forelocks, I believe, have a genetic code different from the surrounding hair. 

21 y/o, been on fin for 3 months now and am seeing some new strands around the temples I think, but as the recession is already so big I wonder if it will be enough in my case. But topical min is ofc rather inconvenient (is it even sustainable long term..?), and oral min is not available where I live.

What do you think – is it worth giving fin alone a couple of more months or is it unrealistic to get this amount of regrowth with fin? After summer I will move to a new city so I definitely want to look better by then.

I have seen men who lost hair regain their hair on finasteride alone. They are usually under 24 years of age and they looked like they never were balding.

I unable to find 1Mg finasteride and there is only 5Mg available in my country .. what to do please help??

This is not uncommon. I advise people to cut the pill into 4 or 5 equal parts. Most people find that the pill will crumble so apportion the amount that you take. It is important to know that what counts is not the daily dosage but the weekly dosage divided into seven days.

 

 

 

When you bleed with microneedling, it shows you are at the correct depth. From a numbers perspective, I recommend a 1.25 mm depth. I particularly like the “Dr Pen” device because you can hold it over each area and deliver an effective injury to induce the healing cascade. Once per week is adequate; more frequent use is unnecessary. The photograph shows that you are using it where you want your hairline to return. I can see that clearly by the bleeding that shows in the photo.

 

I’m cautious of the microneedling + Minoxidil success stories here only because it might be the case that they were strong responders to Minoxidil irrespective of the microneedling. I’m more interested in those who added microneedling to the protocol after some time on Minoxidil/min+fin alone. Anyone with some post history or experiences?

Microneedling will work by itself without minoxidil.