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Uneven/patchy growth after nearly 5 months post-FUE (detailed picture timeline)

L

lightmare

member
I am almost 5 months post-FUE (2500 grafts). Though overall I definitely have seen a difference, it is very (I could call it extremely) uneven growth, with the areas that were most bald pre-HT still not showing any kind of results (I can't even see/feel hairs there, there are 3-4mm diameter zones with no visible hairs), while areas that were better-off pre-HT are now noticeably thicker than before. I was also a late/long shedder, with shock loss happening between weeks 3 (most bald areas pre-HT) and 8 (least bald areas pre-HT).

Here is my timeline (longer-hair pics with hair parted down the sides):

1633045581116.png

I think overall it looks pretty good, but it is definitely uneven, and these are taken with dry hair. After applying minoxidil, the original bald spots are revealed:
1633045688144.png


Again, the (pre-HT) bald spots are not showing significant signs of hair growth, even when dry. There are several 3-4mm areas with no visible/touchable hair. I have read about alopecia areata but am hoping that is not the case, and know that progressively spreads (vs my balder patches have been that way for the last 2 years). I know

Another thing is that I just began using finasteride (first time) 1mo post op. I have been using liquid minoxidil for 2 years and re-started it 1mo post-op at the suggestion of my doc.

So I am also wondering whether the growth I'm seeing is from the introduction of finasteride + reintroduction of minoxidil, or could it be new hairs from the HT? Especially given my late shed...but the real question is whether this extreme (i.e. lots of growth in some areas with zero in others) un-evenness would be normal at this stage if only considering the HT. I know final results can't be visible for 12 months...6 months is where growth really starts etc etc but this is making me very anxious.

Any feedback / comments appreciated. Thank you!
 
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F

Foody

member
I have found out through research more than a dozen conditions are the reason for sub-optimal growth. Some conditions lay dormant, activating after surgery, and that is why the growth is affected. Seeing a Dermatologist could put you at ease if you think something is not right.
 
Bigmac

Bigmac

Administrator
Staff member
The new growth you’re seeing is most likely transplanted grafts. The medications could be helping accelerate the growth or they may have caused early shedding, it’s difficult to know. 5 months could be the start of your growth, not everyone sees an improvement at this timeline.The next 2 months should provide a better indication of growth. Uneven patchy growth can happen due to the various growth cycles the transplanted grafts are going through.
You had a large area to cover with most of the grafts placed in the frontal third and a light dusting going towards the crown. Were you planning on a second surgery to address the crown? With some luck you’ll be a good responder to the meds, strengthen your existing native hair and regrow miniaturised hair.
What does your doctor think of your progress to date?
 
L

lightmare

member
Thanks for your replies! I believe a positive, persistent response to min+fin was my doctor's hope to help the crown too, but we wanted to prioritize the front to make sure it is thicker (they said it should look natural afterward). I showed them that I had a positive response to minoxidil in the past (3 months after starting it in 2019 gave me the optimal result), but the optimal results did not last and oscillated between ~50-80% of my best result for the next couple years before doing the HT. By this I mean that 0% is baseline pre-minoxidil hair growth and 100% is my best growth that I observed while solely on minoxidil. However there was no finasteride during this period, so if I added that, maybe the crown would look close enough to full... They were shooting for about 2500 grafts and completed a bit over 2500 by the end of the day. It was approaching as many as they felt comfortable doing in a day while preserving graft health while out of my scalp.

Regarding my progress, my doctor seemed happy at the 4 month mark. Once I hit 5 full months I'll give another update. However I did not bring up the patchiness at the last check-in as I read that was normal at 4 months...but now near 5 the discrepancy between the good and bad areas has increased a lot, with still no growth in the bad areas, so I am starting to wonder.
 
Bigmac

Bigmac

Administrator
Staff member
The fluctuation between the results/positive response you’ve had is usually down to heavy or lighter shedding. I’m only using Finasteride, some months my hair is noticeably thinner than the previous month and then it recovers. The percentages you’re achieving are still good, maintaining what we have is very important.
If your crown does respond well, that’s a great achievement that saves precious donor hair.

As I mentioned earlier, the growth can be uneven, certain parts growing more than others or one side way ahead of the other. Providing every care was taken during surgery, no underlying conditions, you should be ok.
There are patients who have zero growth at 4 months. Try not to overthink things and try to relax about it.
 
I

Ian888

member
I am almost 5 months post-FUE (2500 grafts). Though overall I definitely have seen a difference, it is very (I could call it extremely) uneven growth, with the areas that were most bald pre-HT still not showing any kind of results (I can't even see/feel hairs there, there are 3-4mm diameter zones with no visible hairs), while areas that were better-off pre-HT are now noticeably thicker than before. I was also a late/long shedder, with shock loss happening between weeks 3 (most bald areas pre-HT) and 8 (least bald areas pre-HT).

Here is my timeline (longer-hair pics with hair parted down the sides):

View attachment 26686
I think overall it looks pretty good, but it is definitely uneven, and these are taken with dry hair. After applying minoxidil, the original bald spots are revealed:
View attachment 26687

Again, the (pre-HT) bald spots are not showing significant signs of hair growth, even when dry. There are several 3-4mm areas with no visible/touchable hair. I have read about alopecia areata but am hoping that is not the case, and know that progressively spreads (vs my balder patches have been that way for the last 2 years). I know

Another thing is that I just began using finasteride (first time) 1mo post op. I have been using liquid minoxidil for 2 years and re-started it 1mo post-op at the suggestion of my doc.

So I am also wondering whether the growth I'm seeing is from the introduction of finasteride + reintroduction of minoxidil, or could it be new hairs from the HT? Especially given my late shed...but the real question is whether this extreme (i.e. lots of growth in some areas with zero in others) un-evenness would be normal at this stage if only considering the HT. I know final results can't be visible for 12 months...6 months is where growth really starts etc etc but this is making me very anxious.

Any feedback / comments appreciated. Thank you!

Hi @lightmare your growth post HT seems pretty normal and what’s expected. With time most people find the unevenness resolves and the slower bits catch up. From what I can see from Dr Bernstein website most people shed over first 3 to 5 months and then growth spurts from 6 to 12 months and then a bit of hair maturing after that. Good luck with your journey.
 
L

lightmare

member
Thanks Ian and Bigmac for your replies. That does put me at ease a bit.

All of my baldest patches are further up scalp from the hairline. My hairline seems to have seen the most growth so far, with my rightmost part looking better than it has in years but still with improvements I'd like to see. I have read somewhere that hairlines and temples typically grow in faster than the top of the scalp and the crown, so if that is true then I am following that pretty closely. However I have seen examples of nearly totally bald patients that had all of the hair grow pretty uniformly, which is what you'd expect of a truly random process (i.e. follicles are plucked at random parts of their growth cycles)...so it appears as though the time dependence is sometimes but not always the case. I have to try not to overthink it at this stage, it is so easy to worry.

5 month pictures to come in a couple of days.
 
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L

lightmare

member
Here’s a 5 month photo. There is some difference vs 4 months but not as great as the difference between 3-4. What do you think?

Since yesterday I’ve been noticing (in addition to the 10ish typical thin, longer hairs) a few very very dark, thick, short hairs come out in the shower. They seem to have been approximately the length of the hairs right after my surgical buzz cut. I haven’t seen that happen for about 2-3 months. Could those have been stuck grafts that did not grow or shed? Would the follicle underneath be safe if that’s true?

Going to schedule 6 month checkup with surgeon soon.

C10D0DD3-BD2F-4E16-A7AB-1BD013B5EAFB.jpeg
 
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Bigmac

Bigmac

Administrator
Staff member
They could well be stalled hairs. Sometimes they will grow for a short time, then shed but the hair shaft remains stuck in the scalp. It’s nothing to worry about. The new hair once growing should push them out but igs best to remove them. falling out while shampooing is ideal. At 5 months it looks as though your area is beginning to thicken up with the new growth coming through.
 
L

lightmare

member
Thanks Bigmac. I think I feel some new, prickly hairs coming through on the right side which has been coming in slower than the left. The top / worst balding spots are still pretty bare, but hopefully this is a sign of growth to come for both the right and top areas.
 
Bigmac

Bigmac

Administrator
Staff member
It’s exciting feeling the hairs coming through. Hopefully, you get a good burst of growth in the next few months.
 
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