https://www.ishrs-htforum.org/content/htfi/18/2/41.full.pdf
This article written by Dr. Parsa Mohebi and I, maybe worth reading for those of you who may doubt going forward with this type of hair restoration.
Great results. Congrats! The dermaroller probably was the most positive of the three things you used that reversed the hair loss. How long did it take you to get this result?
French student, 24, kills himself after getting a botched beard transplant ‘by an estate agent pretending to be a surgeon in Turkey’ | Daily Mail Online
Even older men in the 30-50 age range can respond to a combination of minoxidil and finasteride. You can see the gray hair just emerging.
So my hairline looks bad/weird is due to mild (but noticeable to me) thinning in the front plus a very straight appearance due to a scar (I previously had my hairline lowered due to hair loss). Because I’m female, it’s possible to cover this insecurity through styling, but I know I’d look way better with a nicer hairline. Plus, even when my hair is blown-out/styled I can see my scalp through my hair just in the very front, which ages me. (I’m not currently losing any hair btw, I just had an eating disorder at a young age that caused most of my hair to thin/fall out.)
So I think I’m just going to ask him to fill out the density, fill in the temporal peaks, cover the scar, and give me a natural-looking hairline. But is that too vague? I wonder if I should be more specific, i.e. providing reference photos of what I’m looking for… I’ve been looking at hairlines online lol and the most beautiful ones to me have lots of little irregularities, I mean I’ve seen some truly beautiful ones…but I also wonder if it’s best to keep it simple and stick close to what I’ve got. He quoted me 1000 grafts and touched up my eyebrows (one of my eyebrows looks like it got singed off, so I figured, why not do that too).
Any suggestions are very much appreciated. I’m hearing from other patients that it’s good to come in with a specific game plan of what you want, plus questions, as they are quite busy of late.
I have written a definitive article two times, defining what a female hairline should look like. Here are some interesting posts on my Baldingblog.com website that will show what you don’t want and what is normal: https://baldingblog.com/?p=54926&preview=true (don’t want these hairlines) and https://baldingblog.com/hairlines-for-men-and-women-photos/ (shows comparison between normal female shaped hairline and male hairline. Many surgeons, unfortunately, give women a male hairline. Here is a female hairline one day after the surgery: https://baldingblog.com/young-women-want-lower-hairlines-photo/ and here: https://baldingblog.com/customized-transplanted-female-hairline/
Female hairlines require a skilled, artistic, experienced surgeon. I have done many of them, enough to become an authority on the subject. In your situation, you have a significant recession, and you have lost your entire temple mounds. 1000 grafts probably will not work, but if you saw an experienced surgeon, you need to sit down with that surgeon and get a clear plan. If you have more questions, you can write to me at williamrassman33@gmail.com
Dr. Pascal Boudjema and I established a company in 2023, to build and market medical devices that would make hair transplantation more efficient, faster for the patient and more cost effective for the surgeon. This company is called Engraft Technologies, Inc. and it introduced, last week, the DUPLEX Implanter at the annual ISHRS meeting in Denver. This should decrease the surgical time and significantly improve graft implantation both in regard to the quality of the results (because it reduces human handling of the grafts which tends to damage grafts) and the speed of implantation. This should be good news for surgeons as well as the patient, the primary beneficiary of this technology. The product will not be commercially available until the summer of 2025 as it must be mass manufactured and pass the FDA requirements for a medical device. At the meeting, the DUPLEX implanter was used by over 100 surgeons (without grafts), learning how to use it in a matter of minutes. You can see a video showing the DUPLEX Implanter and how it works HERE
Appoligies for the video not working until this afternoon 10/26/24
The insane before/after results from Turkish clinics you see on TikTok are not at all representative of what most transplants look like. I’ve been looking around at reputable clinics in the US and most results aren’t even visually noticeable. The most visible ones are like a Norwood 2 to Norwood 1.75 transformation. I’m not at all knocking these surgeons, I’m saying that this is a realistic expectation for what a HT results should look like. Very mild and barely noticeable. Most of the fin/min results in this sub are more drastic. Not telling anyone to get or not get one. I’m just saying this bc I spent years on the fence about fin saying “oh well if I lose too much ground I’ll get a 5,000 graft procedure like this guy on instagram” but now realize that’s not really possible haha.
I’ve been doing hair transplants since 1991 and founded the large follicular unit graft procedures through the 1990s, and in 2002, I was the doctor who pioneered FUE. I have done thousands of hair transplants (Strip and FUE), and the results were fantastic. As I published everything I did and met with many doctors, I realized quickly that too many hair doctors don’t get the nuances, so their growth rates could be better. There are, however, a large number of doctors who give you the growth in the transplant that you would expect. Your research should have taken you to the right sources. If you like, you can meet many of my patients to learn of their experiences. I used to hold monthly Open House events where 6-12 former patients would come to discuss their experience and show their results. For almost 3 decades of doing this, I have NEVER had a patient come in with underwhelming results to these Open House Events. They could have done this and wrecked my open house event for all attendees. It never happened! Transparency is the subject that we are talking about here. That is because I set realistic expectations for the patients at the onset and work out a Master Plan for each patient to help them
The insane before/after results from Turkish clinics you see on TikTok are not at all representative of what most transplants look like. I’ve been looking around at reputable clinics in the US and most results aren’t even visually noticeable. The most visible ones are like a Norwood 2 to Norwood 1.75 transformation. I’m not at all knocking these surgeons, I’m saying that this is a realistic expectation for what a HT results should look like. Very mild and barely noticeable. Most of the fin/min results in this sub are more drastic. Not telling anyone to get or not get one. I’m just saying this bc I spent years on the fence about fin saying “oh well if I lose too much ground I’ll get a 5,000 graft procedure like this guy on instagram” but now realize that’s not really possible haha.
I’ve been doing hair transplants since 1991 and founded the large number of follicular unit graft procedures, and in 2002, I was the doctor who pioneered FUE. I have done thousands of hair transplants (Strip and FUE), and the results were fantastic. I realized quickly, as I published everything I did and met with many doctors, that too many hair doctors don’t get the nuances, so their growth rates are underwhelming. There are, however, a large number of doctors who give you the growth in the transplant that you would expect. Your research did not take you to the right sources. You can meet many of my patients, if you like, to learn of their experiences. I used to hold monthly Open House events where 6-12 former patients would come to discuss their experience and show their results. For almost 3 decades of doing this, I have NEVER had a patient come in with underwhelming results. They could have done this and wrecked my open house event for all attendees. Never happened. Transparency is the subject that we are discussing here. That is because I set realistic expectations for the patients at the onset and work out a Master Plan for each patient to help them achieve their goals.
I have noticed that most of the hairs I shed are thicker at the ends and thinner towards the roots, is this normal?
Second email: Okay, thanks. I am currently on finasteride so is the fact that I am shedding these hairs a good sign?
First Answer: No, that shows that the new hairs are miniaturizing as they grow in. Remember, what emerges from the scalp is the new hair and the end of the hairs are the old part of the hair shafts.
Second Answer: Finasteride should reverse the hair measurements, meaning that any hairs that fall out influenced by the finasteride should get thicker at the scalp level when they regrow.
These drugs will give you even more hair in the next 6 months. Keep on your routine!
Currently, I microneedle every Sunday. The first week, I micro needle at a depth of 1.5mm, then the next three weeks at a depth of .8mm, and then I repeat. I use this schedule as my skin is more sensitive than most and it works well. However, I am a bit worried about the possibility of scarring my temples in the event that I get a hair transplant in the future. When I microneedle, I only do so until the skin becomes red, perhaps even slight bleeding (very very minimal). Will microneedling in general prevent a successful future hair transplant?
No. Microneedling needles that go down to a depth of no more than 1.5mm, will not impact a hair transplant with significant scarring.
Post-op wasn’t easy. I felt nauseous and tired for 5 or 6 days. Scalp is still painful
Your surgeon should have taught you how to wash off your crusts before they form. based on the photo, the crusts have coalesced together to create a type of hardcover, melding the grafts together. By keeping them a long time, they are unsightly and can increase your risk of infection and graft loss. You will have to wait a good 12=14 days before you try to get them off with shampoo left soaking on your head for 10 minutes each time you wash your hair. As the crusts start breaking apart, wash with your gentle fingertips.
Take a look at what my patients achieve immediately after surgery with proper hair-washing techniques. You can see a clear difference between poor washing and good washing here: https://baldingblog.com/wp-admin/post.php?post=20678&action=edit. This should motivate you to follow the instructions carefully and look forward to the positive results.
I’m on finasteride and topical minoxidil for 10 weeks, thoughts?
Nice early growth; however, you must give it more time. These new hairs are short, and if they grow out as expected, it will grow out at a rate of 1/2 inch per month.
But why doesn’t DHT attack our hair when we’re younger – what changes as you get older?
I don’t know why boys at puberty don’t lose hair, but I think that genetic hair for AGA has a number of hair cycles when it will not be impacted by DHT. For most young men, this age is around 17-19. We see, at times, significant balding in 19-25-year-old men. Most balding occurs in the 20s, but progression occurs for many in their 30s.
The female hairline is concave, while the male hairline is convex. Note a few problems with this hairline. 1- it is concave and rounded so that there are no temple peaks, something that 95% of men do not have, 2- the hair grafts at the hairline can be seen because there are many hairs in these leading-edge hairline grafts, and there is no transition layer producing a gradual evolution from the forehead to a thick hairline, 3- the hair density was low-balled for the frontal hairline. There are not enough grafts placed for adequate density (this is lucky for him if he wants them removed in a good repair process), and 4- single hair should have been placed on the leading edge of the frontal hairline. Fixing this can be a problem as the female-placed hairs would have to be removed with FUE, and the entire hairline would have to be reshaped into a normal convex male hairline. This is certainly not a bargain!
