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

L

lightmare

member
Yeah, the more I see the more I fear it may be true. I just have to trust the process as the doc said I had wonderful and thick caliber donor hair. We will see.
 
L

lightmare

member
Agree on sticking with finasteride. It is heartening to know med based periodic sheds are also a thing. I faced the same periodic behavior with min alone and got through it, so I will not stop using it.

Thanks for the pointe on lipogaine, keen on getting rid of the dandruff because when it started last time I was only on minoxidil (pre HT) it aligned perfectly with the best result I got. The absorption ingredients appear similar but different to the Kirkland liquid and foam, with propelyne glycol in the regular (also in Kirkland liquid) and glycerin (vs butane for the Kirkland foam) in the sensitive scalp versions. Hopefully the lipogaine sensitive scalp will be easier on my scalp than the Kirkland foam, I may give it a try.
 
Kevboy

Kevboy

Valued member
If you do try Lipogaine let me know how it is as I might add it at some stage.
 
L

lightmare

member
Just got back from my doctor for the 6 month checkup. Overall, my doc is very happy with my progress so far, mentioning that growth is looking robust considering where I started and I already look a lot younger. After looking over my scalp (both with naked eye and microscope), doc found many new hairs starting to poke through, and many 2s/3s beginning to grow their extra hairs, so we're hopeful that more growth is coming. Additionally, thickening still has a ways to go. Donor area is doing great. After that I asked a ton of questions and got some good info.

  • Shedding starting month 5: we are not sure of the cause but doc doesn't think it's from delayed shock loss or med/fin shedding. Never had a patient have it this late in the game. Doc said most likely cause is seasonal shedding, which after going through my old minoxidil diary I did notice my hair 'peaked' in fullness early October '19 and '20, and bottomed out the following Januaries, to begin improving into the spring and summer. Hopefully, it is just seasonal.
    • Sees seasonal shedding in many of their patients.
    • Nonetheless, doc prescribed me some blood work to get done. Iron, Vitamins A/D, and thyroid.
    • Scalp looked healthy, no evidence of problems. Did not recommend me to go to a derm at this point.
  • Dandruff: I asked about oral minoxidil. Doc highly supported, has several patients on it seeing positive results and no sides, but could not prescribe due to impacts on blood pressure and monitoring it, suggests having my GP prescribe. Until then, recommends that I do one minoxidil per day instead of 2, with fin it is enough to get most of the benefits.
  • Graft density: I got 30 grafts/cm^2 on average, with lower densities on the crown and higher densities in the hairline. Doc tells me that, since I never had taken fin before, the goal of the first surgery was not a 'home run' but rather solid coverage, and seeing how my scalp takes the grafts and whether my native balding pattern holds or improves over the next year. Additionally, planting at this density apparently maximizes yield; going significantly more dense in a single surgery will increase overall density at the expense of yield due to limited blood supply. For cases like me that start meds after HT, doc tells me that a touch up procedure was common to really dial in the density and fill in the weak areas after stabilization. Even coverage was provided in case I progress either way to maintain my natural balding pattern.
    • Doc said I had very very good hair quality - lots of curl and thick caliber, so 30 grafts/cm^2 just might be enough for satisfaction too, possibly with some styling.
Overall, I am pretty happy with my meeting, and was reassured that things should improve. I have a shed that should eventually turn around, more sprouting and thickening coming. Cheers for the next 6 months!
 
Bigmac

Bigmac

Administrator
Staff member
I don’t think your hair looks any thinner at 6 months. If it were a seasonal shed, it will return. It’s good that the doctor is happy with the progress and that new grafts were visibly pushing through. At 6 months some patients are just seeing their first growth. You’ve had quite a bit so far, especially when looking at your pre op picture, the transplanted area was practically bald.
It will be interesting to hear what your blood results are.
Good luck with the oral minoxidil. Your blood tests and blood pressure will help your GP when making his recommendations.
I don’t agree with the doctors graft density statement. I believe you could have received more grafts that would have been sufficient to accomplish your goal with one surgery. Many doctors regularly do larger surgeries with great success. However, if you get optimal growth from this procedure and happy to accept you’ll need a second, then that’s what matters. I believe your doctor has been very cautious which it sounds like that’s his surgery protocols.
Hopefully, the meds work well for you.
All the best for the next 6 months of growth.
 
Kevboy

Kevboy

Valued member
Your donor looks really full. Another transplant is inconvenient but you will probably get to where you want to be.
 
L

lightmare

member
Thanks Bigmac and Kevboy. I didn't plan on multiple surgeries at the start but have come to realize that many or most people need multiple surgeries / touch ups anyway, and conserving the donor area is important in the long run. Hopefully the doctor's conservative approach pays off in the end.

I noticed that the dandruff has reduced quite a lot over the last week, finally. I tried that Pura d'or gold label anti-thinning shampoo 4x a week and changed Ketoconazole 2% to 2x a week, while keeping 1x a day topical minoxidil (will also try a switch to lipogaine if I can't find someone to prescribe me oral over the next couple months) and 1mg finasteride daily. It's great to be mostly free of the minoxidandruff, thank you for that suggestion! The shedding is still elevated, have to stay patient on that.
 
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B

Boberto

Valued member
I haven't touched Minoxodil in 10 years but i remember it induced a massive shed and some of which never returned. I think the hair was on its way out and never came back. I found Minox useless personally and just irritated my scalp massively but understand some get benefit from it.
 
Bigmac

Bigmac

Administrator
Staff member
I’m pleased the shampoo has helped with the dandruff. It really is a good product. Hopefully, the shedding settles down soon. Keep us updated on the Lipogaine if you find a supplier.
All the best.
Bm.
 
L

lightmare

member
Hi everyone,

7 month update: Overall, not too much change from 6 months - but I think there've been ups and downs due to the shedding. Still quite patchy at this phase, though the balder patches coincide with my native balding. Those areas appear to have some thinner (hopefully transplanted) hairs there that will hopefully thicken, so hopefully coverage increases there soon. Some key points about what's happened over the past month:

  • The shedding has subsided a little bit, and I think is more or less keeping pace with the rate of regrowth, so I think it's a bit better than at 6.5 months. It is still elevated, though. If it is a seasonal shed, it should stop within a few weeks, according to my doctor.
  • My minoxidandruff has reduced since switching to the Pura d'or gold label shampoo recommended by Bigmac! However in the pictures below you can see flakes because this picture followed my ketoconazole shampoo day (2x/wk). It seems like my flaking increases after Ketoconazole 2%. If I cannot get an oral minoxidil prescription from my GP I will try Lipogaine from the main website. Should know in a couple of weeks.
  • Quite a few remaining post-op stubble still hasn't shed, but some of it is finally (very slowly...like 1-2 stubbles a day) starting to fall out in the shower. Does this mean new hair will replace it?
  • Hoping for more growth but given what my doctor said, it is starting to look like another transplant will be necessary. I am just trying to figure out where, given my situation (same doctor, different recommended doctors for second transplants etc). Also wonder if anyone has thoughts on SMP for the appearance of more density? I don't see it discussed much but saw images online.
Here are the photos. What do you guys think? Thanks in advance.
1639548036623.png

1639548082933.png
 
L

lightmare

member
8 month update. Happy New Year everyone. Overall my hair is not much different for the past 2 months. I have been pretty happy with most of the hairline growth now, but the right side of my hairline and frontal third, and the entire back part of the frontal half are very weak. The crown, however, appears to be thickening but that could largely be due to hair getting longer.


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D3A59D74-990C-4793-A099-00CB2255D45E.jpeg



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Some other notes:

  • My hair is now long enough to mostly conceal my balding area with the right styling. Wind and water are still very harsh on me though.
  • Got a prescription for Oral minoxidil (monitoring blood pressure)! Starting at 1.25mg/day (+Lipogaine1x/day), bumping to 2.5mg/day after 6 weeks tolerated. I am ordering my Lipogaine from the main website, and it is easier on my scalp then Kirkland.
  • Started taking 1000IU vitamin D daily at recommendation of doctor, as I had an insufficiency.
  • Some good news, shedding has slowed down a fair bit. Shedding rate is now about 1/2 to 2/3 what it was a month or 2 ago when it peaked. Not as low as it was in the summer/early fall.
Given I looked like an early/normal grower in many areas at first, I am a bit worried about the uneven growth at this point, and I've read a lot about autoimmune disorders that can cause patchy loss for any type of hair (scarring alopecia, areata). Given how patchy my results are at this stage I am starting to worry whether I have some scalp disorder in addition to MPB, or if something went wrong during the surgery. What do you guys think about my very lopsided growth at this relatively late stage?
 
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Bigmac

Bigmac

Administrator
Staff member
Happy New Year to you too.
I`ve added your pre op picture to your post to make it easier to evaluate your progress.
Your crown has improved from month 6 to 8. It is definitely fuller. Your hair is longer but you’re not doing a combover which makes it easy to see the progress. I think it will improve further, especially with your new hair loss regimen. It’s good that the Lipogaine is better for your scalp. The added vitamin D will help your immune system too. If you do have an underlying issue, there’s a chance it will help out also.

At 8 months you still have time for more growth. I’d expect more but you only had 2500 grafts with some of them being used in the crown and the front was quite a large area to cover. You probably could have done with more grafts in this area. I don’t think you have an underlying issue but you never know. There does not seem to be any obvious redness and you’ve not reported excessive itching/soreness. I’d wait it out until 12 months, have your doctor check the growth and confirm what the density is. This will give you an indication of how many grafts have grown. If the numbers are well below average, then you can start to look into the reasons you mention for low yield.

Without going through the whole thread again I don`t recall if I asked you if the clinic provided a graft breakdown for the area covered. How many in the frontal 3rd, then mid section through to the crown. It’s possible they placed around 1800 in the frontal 3rd which was nearly bald, therefor, coverage will decent but the density will probably be lacking when compared to your native hair which is still quite thick.

Finally, the lopsided growth still has time to even out. 12 months should determine this.
 
L

lightmare

member
Thanks Bigmac again for your thorough comments!

You're spot on - it was 2000 grafts for the frontal half, and 500 for the rear half and crown. I have uploaded a higher resolution post op photo, and a close up of the problem area currently. I really wish I could tell whether all the problem area's thin hairs are transplanted or native, but it has looked similar to this for the last couple months without much change.

h0w__-NkqNt-iNfs0H2kWNa3rRk3FCy1f9YVOt0GHXP0etGrsD4N__Z6KXNCLUQWOsk83wg3laiI-YsHAzBp8bR4moe7MF9C7YiSC4bgXeHGsEDWYo9eWyuKneTUg6Oly-nKr8IaLV8

1nAi3ya2vlquqzWouEDqrgFuJXisiF5M5U9mAq1pweKQXh7XHTSUqgyxVx4OEOK-JEgjbGOK753KxV7bhDJifpmzjydzryyvw9lY0h2kojCD8r9aDyVGaSsUY6S56FGUSpOyyV1ZPS20


1641957479464.png




My doctor told me they planted an average of ~30 grafts/cm^2 for the frontal third, with a bit less than that when averaging over the frontal half, and a bit more than that just at the hairline. You are correct, no real itchiness or redness, so that is reassuring to hear your thoughts on it.
 
Bigmac

Bigmac

Administrator
Staff member
I’m now thinking it’s just a numbers game. Not enough grafts planted to give you the density required. There is the possibility the last few remaining hairs you had in the frontal 3rd have miniaturised but even so, there weren’t too many there so the difference would be minimal.
I`d say you still could see further improvements but it won’t be enough to meet your expectations. You’re going to require a 2nd surgery to add density. This is providing your doctor is satisfied the yield has been good, therefor, ruling out underlying conditions.
I think your crown is responding to your hair loss regimen considering only 500 grafts were placed.
For now, stick with the regimen, try not to stress out and see what happens at a 12 month evaluation by your doctor.
I also think cutting your hair shorter, styling the hairline upwards could make it blend in more and provide a better aesthetic look. A little bit of hair fibers would also help if you wanted a full head of hair appearance.
 
L

lightmare

member
Yeah, I would agree that a second surgery is definitely in the cards. My doctor also admitted it, and only after I started coming on the forums did I realize how few grafts 2500 was for such a big area.

I don't wear my hair like that, it is just parted to isolate the efficacy of the transplant and highlight the weak areas. Luckily my hair has grown long enough now that, with the right cut and styling, I can almost completely hide the thinner frontal third, so hopefully waiting out the final months will be less stressful. When it was shorter the thin frontal third was very badly exposed and obvious. But that is where I want to get - to wear my hair shorter and not be at the mercy of tough lighting, wind and water.
 
Bigmac

Bigmac

Administrator
Staff member
Hopefully by 12 months you have achieved a graft survival and growth ratio in the high 90`s. How is your donor looking now? From what I can see from your pictures it looks good. Maybe have a couple more consultations at 12 months to see what other doctors suggest for a second surgery.
It’s good that you can style your hair to conceal the thinner parts. Have you tried using a concealer? If not, I think you’ll be pleasantly surprised how well they work.
 
Bigmac

Bigmac

Administrator
Staff member
Hi Lightmare, for reference purposes take a look at Joes thread. He had a similar loss pattern but had 3500 grafts placed in the frontal area and a small splatter in the crown. 3500 grafts
 
L

lightmare

member
My donor feels so thick that keeping it at the same length as I keep the top is a bit much - I need to cut it more often. I'll attach pictures pre and post op. Right now it doesn't feel much if any different than pre-surgery. However my doctor says I have some retrograde alopecia on the back so that somewhat limits the donor zone. We are hoping that oral fin and min can stop the upward creep.

7jpRH9Nd9dsOPu-UPiBWRdd4fmYaLhmjquAH7zMUyDKJPIgjTuNcVezRy9RVyluXR0PpxaRbqLKf14eXOK0FW8wKvWvMQRheAawHe-lGShA6vwj-12Z_1rSlZktYu-pnI7LjAO5Pb6s1
1642136160129.png

eOcGy317jUX5l_ArTLHvnyWEbwtnHR76fcCTaU1VNUfMr1fxCiQq94jirG729iourDl1-e9kkHWYORk5yFFjIRGFQCTyvVSjs0lDWpv9qiAFAfIJf7x8EwZx1IgHKf8oCjhE10o2Q_0H
1642136340712.png

And here is how I style my hair now vs at 6 months after a too-short haircut (I usually don't monitor progress that way).
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The clinic that did my transplant was Advanced Hair Restoration. I haven't found any other patients on here or elsewhere that used them but they had an impressive array of results and experience, gave me good vibes and have treated me well, A+ care before during and after. The Dr. is very responsive and the team felt well synchronized during the procedure, but I will hold off on passing judgment until my results are final, especially if there ends up being an underlying scalp issue that I find out about. I am just keeping my fingers crossed for some late stage growth...
 
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L

lightmare

member
Thanks for that reference Bigmac, indeed it looks quite similar. I look forward to following his progress and seeing how the +1000 grafts over what I have serve him. Almost identical frontal balding but his area seems to stop pretty abruptly on the back half whereas mine keeps thinning a bit further back and almost meets the crown. I have seen impressive work out of Dr. Ferreira.

Oh yeah, I tried Dermmatch - I know you recommended that one and I do like the added boost it gave to my density! However it conflicts with my routine - I really like morning showers and two a day is usually too much for me. I have some with me for special occasions but usually keep it in the cupboard.
 
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