This question, from a member of our hair loss social community and discussion forums, was answered by a staff physician from Coalition hair transplant clinic Shapiro Medical:

Accelerated hair loss vs. visual “turning point”. I think it’s an important distinction to keep in mind. By “visual turning point” I mean a point in one’s hair loss progression after which the loss of a given number of hairs makes a noticeably greater aesthetic difference than it did before. Put differently, a significant increase in the slope of an aesthetic effect (y) vs. hairs lost (x) curve. So if you’re all of a sudden looking frightfully thin in the frontal region, it may just be that you’re passing a turning point, instead of experiencing accelerated loss.

I am 6 months into finasteride and have been struggling to make sense of how much worse (to me at least) my hair has gotten over the past 2 months, considering the minimal shedding I have experienced over that time period. I believe this is the explanation and I’d be willing to bet finasteride users not grasping the distinction is a significant cause of “shed” anxiety.

baldheadI think that is an excellent observation on your part. This “turning point” as you call it is actually what happens. As many will tell you, one doesn’t start to notice their thinning hair until around 50% of the hair in that area is lost. Still, when you are getting close to the 50% mark, you may notice that some days you look thinner than others. You may style your hair differently one day or be in a bright light another and may look thinner. You have less flexibility with your styling. Hair loss continues though, and you may find it harder to have days where your hair doesn’t look thin.

The following response, posted on our Hair Loss Social Community and Discussion Forums was written by recommended hair restoration surgeon Dr. Tejinder Bhatti:

I’m consulting with a couple of hair restoration physicians in coming days to discuss a possible small hair transplant to correct perm shock loss incurred a year ago. This was caused by a tiny 30 graft procedure 2-3 inches away at the front of my hairline! Apart from this my hair loss had been stable for 10+ years and this was caused by hair greed on my part.

Any thoughts on risk/reward & how many grafts I might need? It is just in the left temporal area, the right side is pretty good. It is nerve wracking given my past experiences with shock loss but doing nothing with just keep grating away at me.

Dr-Bhatti-photoPermanent shock loss is an unfortunate side effect of hair restoration surgery that may not have been performed correctly. However, this is not the common denominator for permanent shock loss in the recipient area as there may have been some hairs miniaturized, to a small or great degree, that were traumatized by the procedure and reacted severely enough that they did not return.

I recently had a 2700 graft follicular unit extraction (FUE hair transplant with a renowned hair restoration physician. I’m on Propecia (finasteride) for 2.5 years (stabilized hair loss, slowed it down greatly. No noticeable regrowth) and after 1 year on finasteride I decided to try Rogaine (minoxidil).

I decided when I was booking the FUE last July I would not be going back on minoxidil afterwards as it was a massive pain to apply and results weren’t good enough. I tapered off the minoxidil very slowly over months (was using once/day for final 3 months then once every 2 days and so on until stopped completely 6 weeks before) hoping to avoid a big shed.

On the day of surgery my midscalp was looking decent (thinning slightly but had been before starting finasteride). I had head shaved for FUE and had hairline and temples filled in. Doctor looked at my midscalp and said it was too early to try to fill in. I told him about how I had been on minoxidil and how I tapered off it. Surgery was fine and went well.

I’m now 6 weeks post surgery and the native hair in my midscalp (no grafts put in here remember) has been really slow to grow back. Only about 40% of the hairs have actually grown while the rest has remained either at the shaved length or looks like they have shrunk and shed.

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Alan Feller:

I had an unpleasant experience with hair transplant. I’m looking to get the grafts removed from frontal hairline with least amount of scarring as possible. Most of the doctors I inquired from want to go with FUE. After doing yelp reviews, I became a little nervous and wanted to try to get as much feedback as possible. If you guys know any referrals who are good with graft removal please forward. Thanks in advance.

Dr_Feller_photoYou are correct to be nervous about using follicular unit extraction (FUE) for removing old grafts. It is not the right procedure for your repair. It is unreliable as the grafts tend to be brittle and break during the extraction processes. But you may not have to go that route yet.

If your hairline is not inappropriate in terms of shape or being too low you may just want to thicken around the old grafts. This may give you a more natural look and a thicker result, which is no doubt why you went in the first place. Plenty of hair transplant surgeons on this site do this kind of work. Of course Dr. Bloxham and I do it. Here’s a recent video example:

This question, from a member of our Hair Loss Social Community and Discussion Forums, was answered by recommended hair transplant surgeon Dr. Mike Vories:
Do you ever do many follicular unit extraction (FUE) grafts in to strip scars? And if so, do you find that they turn out well?

Dr_VorriesOver half of our hair transplant patients with previous strip excision surgery ask to place grafts into the strip scar. We have had modest success with this, but it is best to test the strip scar with about 100 or so grafts before using more hair (and more money) to concealing a scar that may or may not result in hair growth.

All scars are different, some with excellent blood supply, some with poor blood supply. Best to test it first. Hope this helps!

Dr. Mike Vories
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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The following response, posted on our Hair Loss Social Community and Discussion Forums was written by recommended hair restoration surgeon Dr. Tejinder Bhatti:

I have been facing hair loss for the past 8-9 years, but for the last 2-3 years the hair loss has turned really bad. I think that particularly because of my profession (IT Service), shifts take a toll on the body.

I have decided to go for a hair transplant within 3 months time. Currently I am on Propecia (finasteride (1mg), Follihair and proanagen topical solution to keep my existing hair intact.

My question is, should I continue it up to my hair restoration surgery? And, also can you please suggest if doctors recommend medical hair loss treatments after the procedure performed to keep hair loss at bay? The consultant I went through suggested you won’t need any medicines in the future after the surgery is done as they are going to provide me with two platelet rich plasma (PRP) sessions after the 1st and 2nd month after surgery to support hair growth.

Dr-Bhatti-photoIf you wish to keep your existing hair then you must continue to take medication after the hair transplant. The surgery only fills the regions where balding has taken place.

If you do not take medication after the hair transplant the hair that is transplanted should grow fine (depending on the clinic you have chosen) but the native hair will continue to fall. This is a fact that is indisputable.

The following response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “Gillenator”.

I am headed to a hair loss level 3 on the Norwood Scale at this time, at 28, losing hair since around 18 or 19. I was wondering what people’s thoughts were regarding this. I am planning on my first hair transplant next year, at around 2.5-3k.

I don’t expect to look like the old me, obviously, but just having a reconstructed hairline at a safe distance would be fine. Even a somewhat receded look with some more density would be fine by me as I head into my 30s (maintaining something like the actor Patrick Wilson). Is this not conservative enough?

patrick-wilson__oPtWhen an individual begins to experience significant hair loss (MPB) in their late teens, they are usually headed for the advanced classes of baldness. But as long as you are well informed and work within your limitations and not set unrealistic hair restoration goals, then you should be able to experience improvement and be happy.

So, you have to work closely with a reputable, honest, and talented hair transplant surgeon considering not only the hair loss that you have to date, but your degree of balding in the coming years as well.

Supporting Hair Restoration Physicians: Dr. Glenn Charles, Boca Raton, FL – Dr. Jerry Cooley, Charlotte, NC – Dr. Jim Harris, Denver, CO – Dr. Robert True & Dr. Robert Dorin, New York, NY

This question, from a member of our hair loss social community and discussion forums, was answered by a staff physician from Coalition hair transplant clinic Feller Medical:

One of my big concerns about getting a hair transplant is how long would I have to stop playing football. I play 5 a side football once a week which doesn’t involve much heading but my biggest passion is 11 a side league football which is a big part of my life.

I know I would have to stop for a few months at least but just how many? I have thought about it and, no matter how hard I tried not to, there would be times when I would have to head the ball and I can imagine what damage heading a ball at full power would do to any transplant.

Anyone who has ever headed a match ball will know just how hard they are. I know this might sound trivial to some but for me it is a big factor in when I could get one. I suppose my question is when is the cut off point when the hair is totally locked in?

soccerGood question. Patients are often very curious about returning to sports and exercising after hair restoration surgery. Most of the questions about returning to weight lifting, jogging, etc are pretty straightforward. Yours is a bit more complicated. But I’ve been asked before.

The following response, posted on our Hair Loss Social Community and Discussion Forums was written by recommended hair restoration surgeon Dr. Tejinder Bhatti:

I talked to one hair transplant surgeon and he said if the transection rate during surgery is too high, he would stop the operation. This made me think that transecting a follicle during follicular unit extraction (FUE) kills the follicle, depleting that source of donor hair. Even before this conversation, I thought transecting a follicle also kills the follicle.

But, then talking to another doctor, he stated that during FUE extraction, if there is transection, the lower part of the follicle stays in tact and thus will grow back fully. Is this true?

Dr-Bhatti-photoThe issue of transection is easy to confuse, sometimes by design. Transection is by definition the cross cutting of a follicular unit in vivo. When you read studies about transection they usually are controlled in a manner that allows the top half to be transected or the bottom half will be transected, very neatly. In surgery, when a follicle is transected, it is not in a controlled manner bisecting the top half from the bottom half. It is in a slightly parallel, diagonal direction where some or all of the follicle will be destroyed.

If you are targeting a four hair follicular unit and transection occurs you will wind up with a follicular unit that will grow three hairs instead of four, or perhaps only one hair out of four. In inexperienced hands, especially those that shake and cannot control the process well, this will be a common occurrence along with very high rates of complete follicular destruction, thereby making the procedure a waste of time, money and of course valuable donor hair.

The following response to a question from a member of our Hair Loss Forum and Social Community, was written by forum member “hairthere” who is a scalp micropigmentation practitioner:
Do you think tricopigmentation could be improved in some way (aesthetically) or do you think there are certain downfalls? Or do you think it’s about as good as it can get?

After-150x150I never dreamed I would be doing scalp micropigmentation (SMP) as a career. I was just a regular forum member and hair loss sufferer like you. One day I was asked to be a model for Milena Lardi (thickening procedure) as she was visiting Dr. Alan Feller. Dr. William Lindsey was also present. I watched Milena perform SMP on a NW6 and observed as both hair transplant surgeons examined her work under magnification. They both agreed the work looked incredible and the dots were nearly indistinguishable from the real follicles. A year later I was on a plane to Milan.

I have many clients tell me people ask them if they are growing their hair out. These guys are slick bald! The key to realistic-looking SMP is the dot size (it needs to be tiny) as well as the hairline design. The equipment and pigments Milena has created really deliver on the dot size, and the design comes down to the artistic vision of the practitioner. I can tell you that Milena is always working to improve her products but from my clientele’s feedback I’d say it’s about as good as it can get. The other aspect with temporary SMP is that you have a built-in exit strategy which I think is quite important.

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