There is often a shed when either minoxidil or finasteride is started. Other than the shed which tells you the drug will work on your head, there are no negative hair effects
Normal juvenile hairlines in young men like you, will evolve into a mature hairline so that the shape will change from a concave shape to a convex shape as your photo is showing.
If I have a more painful microneedling session, I seem to get quite a bit of baby hair growth pretty quick. I’ve even switched to doing a session every other week instead of weekly so I can go the extra mile. I use 1.5mm needle on Dr.Pen. Have you seen this? I was previously dermarolling but wasn’t seeing much. After going 1.5mm on the dermapen, the results picked up pace. I put Minox right after.
The science suggests that weekly is the best approach. Microneedling creates a wound, which starts a healing cascade; first comes the platelets, then the macrophages and other cells, and then, on the third day, the stem cells start activating. The stem cells we want to hit are located at the top of the hair follicle and maybe those that control hair cycling. That would explain why microneedling works. We are still determining if the hair will last the entire hair cycle (usually 2-3 years for a man in his 20s). If some maintenance program is not continued (like once a month), these hairs may go away as their predecessors did. This microneedling has arisen because young men are looking for solutions, and the medication profession hasn’t gotten the message yet. Since I speak with men almost everyone, I find that I learn more from my patients than I often teach them.
The before-and-after photos show his wonderful results. I performed his transplant just under two years ago. He recently sent me photos and said the front and crown were nicely filled in. Of course, he uses some styling to cover a reduced density in the crown and could easily fix this with more grafts or SMP in the crown. He told me he didn’t feel as old as he used to look and liked the man in the mirror every time he shaved. Surgical note: I always try to complete the frontal hairline in the first session. Then, with good styling, most men can handle a low density in the crown, especially when you are as tall as this patient is.
I’ve been reading scare mongering stuff online about how finasteride could harm your wife or a potential child if you were trying for one if they come into contact with finasteride which is worrying, can anyone share their opinion on this?
In the warnings originally published by Merck when they first came out with finasteride (today as well), they warned that women should not touch the pill because of the association between finasteride taken in women and fetal abnormalities (usually sexual identification issues), which were found in women who took the drug while they were pregnant. I have never been convinced that if a pregnant woman handled the drug (like giving you the pill to take), this drug could be significantly absorbed within a few seconds. Their legal team creates such statements to absolve them from any side effects.
Minoxidil has a different mechanism of action, so combining both is often better than one drug alone.
A good rule to remember for hair loss victims is that when it comes to hair transplant surgery and sushi, never be attracted by a bargain.
Graham Norton
Is it worth giving up minoxidil before a hair transplant to ensure all new hair isn’t minoxidil-dependent? I only want to have a transplant once in my life, I’d like to avoid going back in a few years once my min-dependent hair has faded.
Hair grown with minoxidil requires that you stay on it. I tell my hair transplant patients to stop the day before the hair transplant and restart one week later. This way, the benefits of minoxidil remain.
The answer to that reflects the presence of the enzyme sulfotransferase in significant quantities in the scalp. “the follicular sulfotransferase activity of 120 pattern hair loss patients visiting a dermatology outpatient clinic in India. Overall, 40.8% of patients with pattern hair loss had low levels of sulfotransferase. “Reference: https://pubmed.ncbi.nlm.nih.gov/30295395/
These photos show an excellent response to the combined treatment of finasteride and microneedling. There is little doubt that the microneedling added great value here. Many men may not respond to finasteride alone; however, adding microneeding weekly, as he did, worked well with finasteride. The change is dramatic. The diffuse thinning that you see, is likely a precursor to balding, so the microneedling seemed to keck start the stem cells that control the hair growth.
One of my former patients, still on finasteride and wanting a refill, sent me this photo of his present appearance. Blonde men do better, getting the appearance of fullness. The contrast in color between skin and hair is narrow, creating more fullness with less hair. Blonde hair also reflects light, adding to the cosmetic effect. Here is a picture of one of my patients, many years after his transplant. His original balding pattern went to mid-head.
This man started finasteride 1 year earlier, added minoxidil 6 months ago, and then recently added microneedling. You can see the new growth, and it looks good. Hopefully, it will restore his hairline. As this new growth reflects 1-2 months, it may have been the microneedling that stimulated it.
A 30-year-old man contacted me for surgery. As usual, I had him purchase a hand microscope and a micrometer. We went on Zoom, where he took control of his hand microscope. First, we used the micrometer. He measured his donor hairs (about 20 of them), and they ranged from 30 microns to 91 microns, averaging 50 microns. There was wide variation in the hair thickness of the donor area, which suggests DUPA. Then we went to the hand microscope, and he had some follicular groups with all miniaturized hairs, some with partial miniaturized hairs, and many normal groups. From what I saw, which was limited, I assumed that he had DUPA and eliminated the planned surgery for his immediate future. Of interest, he had met with 3 surgeons before contacting me; one was very well-known and respected. None of the three surgeons picked up on the DUPA diagnosis. All surgeons must examine their patients before surgery, looking for this disease, before they book the patient for a hair transplant.
THE IMPORTANT LESSON HERE IS TO MAKE SURE YOUR SURGEON DOES A MICROSCOPIC EXAMINATION OF YOUR DONOR AREA AND MEASURES YOUR HAIR THICKNESS WITH A MICROMETER. THESE TOOLS LET YOU KNOW (1) THE HEALTH OF YOUR DONOR AREA, (2) YOUR LIFETIME HAIR SUPPLY, (3) YOUR DONOR DENSITY, (4) YOUR HAIR MASS WHICH REFLECTS THE RESULTS YOU WILL GET FROM A HAIR TRANSPLANT.
This is a picture of this patient’s donor area (click to enlarge to full screen)
Hair transplants, plus minoxidil and finasteride, work wonders for him. Men like this person have a radical change in their looks, which changes their lives in many ways. First and foremost, they develop more pride in their appearance and better self-confidence. That brings changes in their social and work lives. They no longer feel ‘different’ than others.
About the 9 days, I put a bit pressure while doing the circular motion and there was no blood. Is this a safe time to have taken off the crusts?
9 days is safe, according to our article, which states: “Since crust formation only occurs in the 1-3 day post-op period, while there is still active exudate, vigorous irrigation during this period should be able to eliminate surface crusting while allowing the coagulum that formed around the graft, to hold it firmly in place. To this end, these authors are currently instructing patients to take very frequent showers, as often as every three hours the day following surgery. As anticipated, this one-day treatment seems to significantly decrease the crusting formed. Once patients pass through this “exudative” period, crusts no longer develop, and they are free to shampoo and shower as they normally do with low pressure on the shower head. Since there is no crusting, patients can theoretically resume their normal hair care activities such as shampooing, a light brushing with a large toothed brush, and styling by day 6 or, if one wants to be more cautious, at 11 days and I am still concerned about some patients whose entire recipient area is covered with a thick wall of crusts, I would add an additional 3 days before aggressively removing the crusts with good washing techniques is reasonable. I tell these patients to leave the shampoo on their scalp for 10 minutes to allow the crusts to get water-logged, then use their fingertips in a circular light motion. Keep doing this until all of the crusts are off. It might take quite a few washings.