Prior to knowing what is the number of grafts I would do, I would have to know 1) what is your donor density and the health of your donor area by trichoscopy, 2) what is your hair thickness of hairs in the donor area (fine, medium or coarse measures 30, 50, 70+ microns in thickness respectively). The thicker the hair, the less the grafts needed. Your hair loss pattern is unusual, but that entire central area runs the risk of loss unless you take some drug like finasteride to hold on to that hair. Before you jump into a hair transplant, I hope you share you age with me.

OK so I’ve done some researching and found articles stating that hair training aka infrequent washing can lead to hairloss or accelerate it. I believe it’s because of buildup of sebum on the scalp? I’m not too sure on how that works. This scares me because I hardly shampoo, mainly using conditioner to wash or just water to clean my hair but I at least try to shampoo once or twice a month. My hair when I shampoo feels very poopy and looks very unhealthy compared to when I don’t shampoo. But if it accelerates hairloss like some articles claim I’ll be more then glad to start shampooing more.

Many of my patients tell me that they see homeless men with full heads of hair who probably never wash or shampoo. That is true, so shampooing is not necessary. When vigorously performed, frequent shampooing may pull out the miniaturized hairs that are about to fall out. Aggressive brushing after shampooing will pull out miniaturized hairs relatively easily.

I started topical Finasteride 5 months ago (fin/min 0.15%/7%), and after 5 weeks I started to shed HEAVILY so it’s been almost 4 months of continuous shed. I don’t know what to do. I have been applying Minoxidil for almost 10 years and the initial shed was never as bad as this. Most of the sheds last 1 or 2 months I’m reading. I don’t know if I will be losing everything, or if i should try a higher topical dose (I also tried 0.25% topical before for 3 months), oral fin and then at what dose?

Topical finasteride goes systemic, but the amount is not in your control. If you use the oral, then you have better control. The hair loss response to the finasteride tells you that it is working, so be patient.

I believe that men who use the Dr. Pen device with 36 needles and a depth of 1.25mm have the best chance to reverse their hair loss.  The idea is to control the damage to the area where the stem cells reside that may trigger hair growth. I advise my patients to hold this reciprocating pen in a single spot for 10 seconds, then move it to the next spot where they want the hair to grow.  Let’s say that you have an area of 2 by 3 inches; that means that the pen is held in many positions until the entire targeted area has been covered by the pen.  This injury starts off a healing cascade with some bleeding, platelet aggregation, and the appearance of special defense cells called macrophages. Special proteins that stimulate new blood vessel formation pour into the wound and are followed by stem cell activation, which often triggers hair follicle growth. When this process is repeated weekly with a Dr. Pen device, I believe you get the best control of the healing cascade.

I’m 30M and considering getting a transplant. My case is a little unique though. My hair is actually very thick and curly. My hair loss is at the entire crown of my head and it’s due to physical trauma of the hair root from decades of pulling the hair out due to a disorder called trichotillomania rather than “natural” male-pattern baldness. So basically all the hair on the crown is very, very thin, in stark contrast with the rest of my hair. I’m very happy to be in remission from the disorder.

I’ve always wanted long hair, but my worry is whether the transplanted hair will still have a very noticible thickness/texture difference than the rest of my hair. At the consult I was told that once the hair is transplanted, it won’t grow back “as thick” as the rest of it, but they still think it will look fine.

Trichotillomania might return when you are stressed, putting you back in the same situation you are now.  The transplanted hair will always look like your donor hair, sometimes a little wavier.  Discuss medications you might take after the transplant to be assured that the condition does not return. A few of my favorite patients with this disease have ended up returning with the same balding that they had before I transplanted them. 

I have little doubt that the microneedling kicked in the growth, helped by minoxidil.

I am excited to see what it will look like at 6 months

If you read my 6/21/24 post, I discussed the number of grafts and its relationships with the size of the recipient area. Most average Caucasian men have about 7000-8000 grafts (plus or minus 20%) to take from the donor area for their lifetime. Asians and Africans have significantly less donor hair. Are you old enough to know your final balding pattern (over 26, at the least)? 4100 grafts should be more than enough to return your normal donor density to the area you transplanted. What worries me is that if you become significantly bald in your late 20s or early 30s, you will need more hair to take from the donor area. You might be unable to supply a balding Class 6 or 7 pattern, possibly resorting to beard hair if that happens. I believe that every person having a hair transplant needs a personalized Master Plan that considers their worst-case projected hair loss pattern, the value of their hair (fine, medium, or coarse), and the quantity of hair that can be harvested from the donor area (that is a number that is easily measured and calculated). With that plan in place, there are never surprises. If your surgical team did their job correctly, as I see it looks good, you would have more than enough hair for the balding you presented with.