This study proposes 0.2% concentration as being nearly as effective as 5% minoxidil
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804833/
This astute 23-year-old male examined his donor area through a hand microscope purchased from Amazon after reading some advice I gave on Reddit. He was suspicious about having DUPA based on his view of his donor area, so he sent them on to me for an opinion. Both Dr. Bernstein and I believe that this is a case of DUPA. Note that the dark thick hairs are normal terminal hairs, while most of the other hairs have a smaller diameter, some are even thinner than the rest, and those hairs don’t have much color to them. These thin hairs are miniaturized. I can’t say how long they will survive in the donor area, but I suspect his progression will be slow. If he were to use it for a hair transplant by a doctor who is ignorant on what DUPA looks like, his hair transplant likely will fail, and the shock to the donor area could accelerate the disappearance of hair there (I am speculating). CLICK TO ENLARGE
This is an excellent photo showing that you have a very high donor density of about 2.7 hairs/follicular unit. The normal Caucasian person has a donor density of 2.2.
Some doctors are so orderly that they line up hair grafts like toy soldiers when they do a hair transplant. Sometimes these patterns show in the final result. Here are two photos 2 days (on the right) and 2 weeks (on the left) from the date of his hair transplant. He is rightfully concerned. Since I posted this photo, I was given new photos of him at 5 months growth. The hair that lined up at the time of the surgery, can be seen now when you look at him. He wants me to fix it, an easy fix as I have done thousands of these. I advised him to wait until he is 8 months out before undergoing a repair surgery with me.
Good morning, I came across your balding blog and think that it’s a great resource. Thank you for doing that. I see people ask you all sorts of questions and I wasn’t sure how to post on there and/or ask something anonymously so I figured I would email you. I had alopecia on my scalp into which I had roughly 3,200 FUE grafts transplanted into the scar to conceal it (not all at once but in smaller separate procedures). I uploaded a picture of about a centimeter or so of my donor area where grafts were extracted and was wondering if you can from the picture help me estimate roughly how many grafts I still have left in my donor in case I want future transplants. I counted 32 follicular units and 78 hairs so that comes out to an average of about 2.4 hairs per unit. I tried doing the math I saw you explain on one of your threads and here is what I got. The average donor area is 12,500 units X 2.4 hairs = 30,000 hairs. You need roughly 12,500 hairs remaining in the donor area to provide adequate coverage so 30,000-12,500= 17,500 movable hairs. 17,500 hairs ÷ 2.4 hairs per graft equals 7,291 available grafts that I could move. That would have meant that before I used those 3,200 grafts for the scaring alopecia that I would have had a total of 10,491 harvestable grafts in my donor. Is that even possible?
Your donor density is higher than average. What you didn’t take into account is your hair thickness, a very important factor in determining your harvestable donor area. Remember, that there are only 50,000 follicular units on the head of which 20-25% of them are in the donor area. If you are thinking that you take out more than half or 2/3rds of your donor area hairs, you will be in trouble if you have fine hair, which I believe is your situation.
How many grafts were removed totally? Answer 3200. Were these all follicular unit grafts? Yes? Subtract that number from 12,500 total donor supply and the remaining follicular units and you get 9,200 graft remaining. If your hair is fine, the actual number of grafts that are available will be significantly less than if your have a coarse hair. Medium is somewhere in the middle. You might still have a significant donor reserve based upon the hair thickness of the donor hair provided that you hair isn’t fine as I suspect it is. Does this help?
This patient had some small benefits in the bridge hair in the middle of his head, but most of the real benefits were in the crown, which clearly grew new hair. The frontal area did not respond to the microneeding, which is not unusual with long-term balding.
1) In a previous email, you stated that you’ve removed a strip of skin/scar from elsewhere on the scalp aside from the usual donor area and extracted grafts from it; we had been talking about the temporal region since I had a scar there with grafts placed into it. Strips that are removed from the temporal region, do they typically heal well with minimal scaring?2) If grafts from a second procedure were placed on top of grafts that have yet to surface from a previous procedure, what will happen?3) People with diffuse patterned alopecia, do they eventually lose all the hair in the areas that they are thinning and end up with a slick bald scalp? Or does the hair remain but just is thin?
1- Grafts placed into a scar often have a lower survival than grafts placed into normal skin
2- If a graft was placed exactly on top of the stem cell from a transplanted graft that had not grown yet, it will still grow as well as the original graft, possibly very close together
3- Diffuse patterns of balding may remain, thin further, or go completely bald based upon the cause of the balding process
Treating your badling with standard medications like finasteride and minoxidil and sticking to it get excellent results in many men without needing a hair transplant.
Any concern in SMP while on topical min fin? And what about a transplant with SMP on scalp?
Once the SMP is set (about 1 -2 weeks), the use of minoxidil is not a problem. if you had SMP and wanted a hair transplant, there should be no problem as any good surgeon should be able to work with SMP present.
Amazing, as this looks like full reversal of his recession.
Amazing that microneedling can regrow the hair in the crown in just 6 months. Congrats! The question we don’t know the answer to is, “What happens to the new hair when the microneedling stops?”
Amazing rapid growth. I suspect that you will see much more hair over the next few months.
If you develop hypertrichosis from minoxidil, stopping it will cause all of the minoxidil-grown hair to fall out. This may take a few weeks or even more than a month
If someone has a hair transplant procedure and 6-8 months later they have an additional transplant procedure, since it can take up to a year for all of the transplanted hairs to surface, what if in the 2nd procedure they place a graft in the same spot as a graft that has not grown yet from the 1st procedure?
Actually, by 8 months, 99% of the grafts that are growing have broken through the skin. Some telogen hairs may break through later on, but this is not a significant amount.
I am surprised that this man actually got some reasonable results from microneedling in what we refer to as Atrophic scalp, that is, a person’s scalp that hasn’t had hair for, in his case, 14 years. He used minoxidil and finasteride as well. This man got a response in just 3 months indicating that the stem cells are still viable.
