I’ve heard mixed things on this. Some doctors have said that it can cause micro-scarring and make the scalp not viable for a transplant. If that’s the case I might want to stop. Generally I do like 1mm dermastamp once weekly.
Microneedling done at a 1.25mgg depth doesn’t go deep enough to cause significant scarring. On average, the hair follicle goes down to a depth of between 5-7 mm, so the growth of the hair follicle in the dermis is unobstructed by any scarring.
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.
Hey all, I am soon going to start using topical minoxidil. The only brand (Linn Minoxidil) I could get a hold of somewhat easily where I live (the Netherlands) is a spray. The manual says to spray six times on the balding spot. But I am a norwood 3.5-4, and hence would like to spray both on my diffusing crown and receded temples. The manual however does not specify how to treat multiple areas, i.e do I just do three sprays on the temple and three sprays on the crown? Or do I have to use the spray on i.e the crown alone? Was wondering if anyone here has faced this issue/knows the answer.
First, you must be aware that only 40 % of men will respond to the topical minoxidil. On the other hand, the oral form is 100% effective because it is metabolized in the liver into its active form. I generally prefer to agree with the manufacturing instructions; however, with the topical minoxidil that I am familiar with, one good application a day works well. I recommend applying it after a hot shower on a damp scalp to increase absorption. If you do not get a good response to the topical, you may assume that you are one of the 60 % of men who do not respond to the topical form. If you are committed to going the minoxidil route, the oral form requires a prescription. I have seen wonderful results from oral minoxidil.
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 have a question regarding the mechanism of action behind androgenetic alopecia. I see some people saying that we lose hair as males with pattern hair loss because the scalp hairs are more sensitive to DHT in the area of balding (pattern). I also read that some people say that the conversion from test to DHT (via. 5AR) is greater in the scalp tissue than in other body parts. This begs the question: why would you ever need to block DHT in the whole body by using oral meds like fin and dut If the “problematic” test conversion happens in the scalp tissue, then topical dut/fin or a topical anti-androgen should be enough ? Anything I am missing something? Thank you!
Hair loss occurs in males because we carry the genes for hair loss, and our DHT hormones trigger hair loss. The genes are programmed to determine when hair loss starts, but most men get it before age 26. I have seen men develop hair loss as late as in their early 50s, but this is an exception to the rule. If we decided to cut off your testicles, I doubt that you would have hair loss, but that is an extreme approach to reduce the impact of DHT. Topical finasteride goes through the skin and into your body as it gets absorbed through the skin/scalp. You might as well take the oral finasteride. There is a type of liposomal topical finasteride where most of it stays in the scalp, but this is expensive and only covers part of the scalp. If you spread it around the scalp, it raises the cost considerably.
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.
I have been applying minox foam to my pubic hair for the past 3 months. My pubic hair was quite long to begin with, but now the hairs are over 4 inches long. Typically they would be only at 2-3 inches at the longest. I was doing this experiment to see if it would make sense to use pubic hair in a hair transplant and my research has lead me to believe minox is a valid solution to the length issue when using pubic hair for scalp hair transplant. I will continue to apply once a day, 1 ml for the foreseeable future (wife is not happy)
Pubic hair has been used for hair transplants in the past. The problem is its very curly nature and it may not match your hair characteristics.
I was quoted 3200 grafts- 2500 for hairline and 800 for crown and midscalp. Clinic told me it was a conservative estimate as I indicated I would still be on meds for another 5 months before doing the HT (been on fin / minox for the past 7 months). Do you think this is a fair estimate? I’m not hopeful of regrowing more hair from meds as progress from meds seems to be quite stagnant past the 5-month mark for me. Would appreciate your thoughts!
What is your age? If you are under 25, reconsider doing a hair transplant. It takes a year to see results from medications. 2500 grafts for the frontal hairline? As I can’t see your hairline, I would be just guessing that it seems high. The crown will likely reverse with finasteride and minoxidil, and certainly, if you add microneedling. You should get results in 9 months or less from this routine. You need to get a competent and hopefully honest surgeon and not blow your future on numbers that make no sense. You would likely lose all of the hair that is there now if there is any significant degree of miniaturization and if you don’t take finasteride.
You need your donor density and donor hair mass measured to find out if you are a suitable candidate and what you can expect. Make sure that you get numbers from your doctor as this is mathematically based. I have answered this question many times, so read many of my answers here: https://baldingblog.com/?s=how+many+grafts
There is a misconception that many patients and surgeons that they must replace the recipient area density in the balding area when having a hair transplant. Nothing could be further from the truth. Too many Reddit patients are wasting their donor supply by using too many grafts to cover Class 3 or 4 patterns of balding. Too many Reddit patients do not seek a Personalized Master Plan ((https://baldingblog.com/creating-a-personalized-master-plan-for-present-and-future-balding) with their surgeon before they embark on a hair transplant in Turkey or elsewhere. First, look at the analogy and the following numbers: Assuming a surgeon removed 12,500 grafts from the donor area in a Class 7 patterned patient. The average man has 50,000 follicular units (grafts) on his head (race in not dependent upon this number) of which 12,500 grafts reflect the donor area (12,500 grafts reflect 25% of the total follicular units). The total donor supply equals 25% of the total hair supply. This means that if the surgeons did only FUE and transplanted 12,500 grafts in the recipient area, there would be nothing left in the donor area. In such a surgery, the patient would likely become either bald in the donor area or heavily overharvested in the donor area if partial follicular units were excised rather than full FUe grafts. This patient would have a new problem: a bald donor area. His recipient area density would not exceed 30% of the original recipient donor density. With too many grafts removed from the donor area, there is no going back after this is done. Even transplanted numbers of 5000, 6000, or 7000 grafts reported by many Reddit patients reflect the maximum yield of their donor area if they have fine or possibly medium-weight hair. They may end up with a see-through donor area for their entire lives. Many of these Class 3, 4, or 5 balding patterns may leave very few grafts left in the donor area to address almost certain future balding because hair loss is ALWAYS progressive. When I review Reddit’s transplanted patient posts, I often see too many grafts for a particular balding pattern, reflecting poor planning and an impulse surgery decision in men who are often too young.
Transplanting into the recipient area is not blindly removing as many grafts as possible and moving them into the recipient area. An experienced, well-trained hair transplant surgeon, with proper knowledge of both the original donor density and hair mass of the patient’s donor area, can make proper artistic and mathematical calculations to obtain good results with less than the original recipient area density achieved. I have done this thousands of times on very bald men, even those in patients with a Class 6 or 7 pattern of balding, and I have never removed a total of 12,500 grafts. I have had thousands of satisfied patients over my 33-year career. I suggest that many of you review Dr. Linkov’s interview with me, which covers much of the history of botched hair transplants, even on celebrities such as Frank Sinatra. Here is the podcast link: https://baldingblog.com/dr-gary-linkov-blog-features-william-rassman/
When I transplant a Class 4A pattern balding patient, I often try to get frontal densities in the 35-40% range for the first 1 inch of hairline; then, I reduce the density I create. If the man has a particular hairstyle they like (for example, combing their hair left to right with a part on the left side), I would place a disproportional number of grafts on the parted side to enhance his styling and achieve a fuller look and save donor hairs on the opposite side. For the very bald man, such discussions with their surgeon are critical, as their donor supply may only be able to supply the needed hair to achieve a full-looking head of hair, only, if proper planning is done in advance.
Yesterday, I met with a patient I had transplanted twice over 1 year, the last surgery just 8 months ago. He had a Class 6 balding pattern and a very poor donor supply, needing more hair to get to a full-looking head of hair than he had. To substitute for his lack of donor hair, I used beard hair for the top and mixed the beard hair with the hair I got out of his donor supply. The result was amazing. Such meetings make my day.
FYI: STATEMENT: 50% of recipient area density in a man with black hair and white skin is as good as 100% recipient area density. That observation is even more favorable as the skin becomes darker and the hair becomes lighter, or the hair and skin color match. HOW THIS WAS DETERMINED: This was demonstrated by Dr. Manny Marrit some years ago when he plucked out 50% of the hairs on one side of the head of a man with medium-weight hair, which was black, and his skin was white. No one could tell the plucked side from the Non-pucked side.)
This is truly an amazing response to finasteride. This rarely occurs in men over 28 but is more common in men under 25.
I recently turned 46, and I’ve been damn lucky with my hair. Around 5 years ago, I wanted to change my hairstyle to go more forward, rather than back. I was 41. I noticed that when styled more toward my forehead, my hair looked a little stringy. I initially thought it was just a bad haircut. Upon closer inspection, the individual hairs/follicles appeared to have gotten thinner at the front of my hairline. Probably further back as well, but I have enough coverage that it’s harder to notice. There has also been some recession of my hairline (maybe a quarter of an inch), although not much, and happening extremely slowly. It’s difficult to tell a significant difference in photos from 5 years ago to today. The top of my head/crown is still full; no bald spot at all, just the cowlick I’ve had since I was a kid. At 46, does this just sound like normal aging, or is there something to be concerned about?
The things to try would include (1) oral minoxidil, (2) oral finasteride, and (3) microneedling. If these don’t work, then at 46, a hair transplant is the best option, and it will work, provided that you get a competent doctor. Your hair loss is likely to have been present for more than 5 years. The combination of all three drugs should be tried first unless you decide on a hair transplant, which is no fuss and with a good doctor, and best of all, there is no uncertainty.
This is a great result, something I would expect in many men. This man used topical minoxidil and appears to be one of the 40% of men who respond to the topical minoxidil
I have been on oral minoxidil and been microneedling for a year or so, then I added finasteride just 3 months ago. What do you think?
I suspect if you continue with this routine, you will get the results you are hoping for. Finasteride works well in the crown, more than the frontal areas. Your frontal areas have filled in nicely and I would expect the crown to follow. Keep it up.
Should I get FUE or FUT?
That depends upon your donor densities and your donor hair mass. The higher these two are, the easier is the FUE choice. If your donor hair mass is low and the donor density is under average, the FUT may be a superior procedure. The problem is that today’s doctors are not trained in FUT, so they always recommend FUE. Find the right doctor to help you with that decision. I am always there to help, and I do both types of procedures.
How often do you see such dramatic improvements using oral min among your patients? Thanks
It occurs often. I only started prescribing it a four-five years ago, and I have been more than surprised with the results