This man built a frontal hairline with 2300 grafts and 1600 grafts on his temple peaks.   He has since added another 2300 grafts to double up the density of his frontal area.  The goal here is to use a hair system behind the hair transplant to cover his Class 7 pattern of hair loss. Hair systems can often be detected, but with a transplanted hairline in front of the hair system, it will not be easily seen.  He, unfortunately, has fine hair.  That is why it will take a lot of grafts to create a thick frontal hairline.  If his hair was medium or, even better, coarse in character, he might have achieved his goals with far less grafting and with thicker-looking results.  Fine hair has limitations, especially compared to a hair system. The photo on the right shows a hair system behind his leading-edge transplant with his hair pulled back.  I have been involved in many such attempts; however, most of the men who started the process didn’t like the lower density of the transplant when compared to the hair system.  That can be overcome with more transplanted hair in the frontal 1 inch.

The arrows point to the sites where the skin or the scalp died off.  The second photo shows the scalp skin has sloughed off.  The cause of this is often too much epinephrine in the local anesthesia and site that are made too close for recipient area or even possibly too large a site creation.  This will cause a scarred area with no hair growth in it.  You need an experience surgeon and team to avoid this.  In my 32 years in practice with over 17,000 surgeries done by either me or my group, there has never been such a complication as shown here. 

Unfortunately, deforming or failed transplants take a big impact on people so such a story doesn’t sound outrageous.  I am aware of three men who committed suicide because of hair loss, so the emotional impact of hair loss can be very severe for many men.  Most men who get very emotional about their hair loss, get depression. In the days when the large plugs were put into bald men’s head, their hair transplants were deforming.  Prior to the early 1990s, these large deforming plugs had no cure short of a hair system,  a common solution for the time period between 1960-1990.  Hair systems is something that doesn’t work for everyone but if the deformities were soo bad, a few men were driven to suicide?  

Today, with the hair transplant technology commonly available, hair transplants that go wrong can be treated with a success rate of 100%.  Men who find themselves in this situation, should seek a modern hair transplant doctor to help manage the deformities and a good family doctor to manage the depression. The good news is that almost 100% of men with hair loss today can get their hair back.  Hair transplants are today’s miracle.  

See: https://www.hulldailymail.co.uk/news/uk-world-news/man-47-killed-himself-after-7724486

Alopecia areata is a devastating inherited autoimmune disease of the scalp.  It can be treat by many  dermatologists

Do you build up tolerance of finasteride/dutasteride over the years, or is it more your follicles have just become more sensitive?

I think that finasteride keeps its effectiveness; however, your genetics is a variable that could increase more hair loss, overwhelming the finasteride.  That is tied to your genetics.

There’s so much talk about finasteride, side effects, and the dreaded “pfs”. I feel that often people with negative experiences talk a lot more than people who have positive experiences. If you enjoy a product, you’re less likely to write a review, as opposed to someone with a bad experience. Just my theory on how feedback can be skewed towards the negative side. I’m 33 years old and have been on 1mg finasteride daily for 1 year. In this time I have experienced no side effects, and my hair loss has stabilized. I haven’t seen tremendous results, but results are there.

I recently got my testosterone levels checked and it came back as 830 ng/dL. Healthy levels for my age are 300-1,000. So I’m in a good spot, and may actually be considered on the high side of average. That’s all I have to say. Speak to your doctor if your considering it, do your own research, and I hope your hair grows back.

This story is more common than you might believe reading the various blogs, forums and posts that are ANTI finasteride.  In my practice, this is what I see most commonly.

Started fin 7 months ago, 1mg per day and my hair is currently the worst it’s ever been. I understand that finasteride doesn’t work the same for everyone, and not at all for some people, but at what point do I call it quits? Would a year with no stability be a good indicator that I’m a non responder ?

There are other medications worth trying including oral minoxidil. Also the use of microneedling may change what is happening to you as well.  It is important to recognize that finasteride almost always slows down or stops the hair loss, which is something you might not see.