June 10th marks 6 months since my 1200 FUE graft HT on my temples (lowered hairline as well slightly). The transplant hair is growing in slowly but surely. Unfortunately, I have significant shock loss on my native hair surrounding the transplant hair. Much of this has not grown back yet. Specifically, I have shock loss in the front hairline area and behind my right temple where grafts were placed.

I met with my doc last month, and she boosted me from Fin to Dut to help with growth (I have no sides from either-yay!) She also remained steadfast that all my shock loss hair will grow back, it just takes time. However, part of me wonders if I should really believe her, if she thinks it will really grow back or if she is just saying that.

Finasteride is best taken before the hair transplant as it often prevents the loss of the native hair. Unfortunately, after you lose your native hair and then take finasteride, the effect is heavily muted. I always offer my patients finasteride before I do a hair transplant to avoid this problem. You should wait a full 8 months to see the results of the transplant and then reassess your situation.

You have to give it between 12-18 months to see if it will reverse. Add topical minoxidil along with microneedling and you have a better chance of reversal

The only way a hair transplant is normal looking after it is performed, is to transplant the natural growing groups that hair normally grows in, in their anatomical groups, i.e. the follicular Unit. The average Caucasian averages about 2.2 hairs per follicular unit and the typical human has approximately 50,000 of these follicular units on their entire scalp. So if the average hair count per follicular unit is 2.2 hairs/follicular unit, then the typical Caucasian man has approximately 110,000 hairs on their scalp. For the typical Asian, the follicular count remains at ~50,000 but the average hair count per follicular unit drops to 1.9 hairs/follicular unit for a total hair count of ~95,000 hairs. This is an average, but the range could be wide ranging from 75,000 hairs – 120,000 in any given population.

This is a picture of a 6 hair follicular unit (rare in most people) but worth showing because it shows new hairs in their growth phase. Notice that two of the hairs are shorter than the other four (marked with arrows). These are new anagen hairs growing into this follicular unit increasing the visual hair count by 1/3rd from 4 to 6 hairs. That means that possibly a few months before this follicular unit was excised, it probably had only 4 hairs that were visible. The two new anagen hairs arose from stem cells within the follicular unit. It is likely, that if we allowed this to grow (and were able to follow the hair count in this follicular unit over a year or so), the hair count may actually drop as some of these longer hairs (terminal hairs) may actually turn into their sleep phase (telogen).

These two photos show two different men responding to finasteride, 6 months on the left and 4 months on the right. This shows the value of this drug for many young men.

The issue at hand is not the blood levels achieved. A dose of 5mgs runs heart risks not worth taking for a healthy man. The point is at what level will the hair effect happen. The answer is a 2.5mgs daily, good results are seen and it is safe from severe cardiac side effects which is very rarely reported.

The average Indian has a lower density than a Caucasian of about 1.9 hairs/follicular unit (the Caucasian average is 2.2 hairs/follicular unit), so unless his hair is very coarse, his donor area is clearly depleted. He may find that he doesn’t have enough hair to cover the donor area. Additionally, this man’s FUE was taken outside the donor area. His entire remnant Class 6 pattern was harvested. If he develops a Class 7 pattern of balding, then he will lose more than half of the hairs transplanted.

The FUE procedure removes hair from the back of the head, so it can’t grow back. The amount of hair that can be removed is limited. If too much hair is removed, as in this person, the back of the head becomes thin and see-through as a result of the depleted donor area.

The number of FUEs that can be removed depends upon many factors. Most importantly, the original donor density must be measured by the surgeon before recommending FUE graft numbers. If too many grafts are removed from the donor area, balding in the back of the head (as shown here in this photo) occurs.

The initial problem, prior to a hair transplant, is that most patients want more hair moved, and surgeons are motivated by the money they receive for taking out more FUE grafts. So, without good planning, the donor area is often over-harvested, producing balding in the donor area (as shown in the photo below). I can state with almost 100% certainty that 5500 grafts would produce donor over-harvesting in 98% of the population because the original donor density in 98% of the population will not support this number of grafts (see here: https://newhair.com/donor-area/).

Female hair loss, unlike male hair loss, is rarely complete and most people believe that these hairs are still there, possibly cycling irregularly or poorly? When some new drug is discovered, we may find that the hairs that are not there, will appear.