Author: Dr. William Rassman

I have hesitation in prescribing finasteride in women who are pre-menopausal because of the risk of pregnancy which may be an unexpected or unplanned pregnancy. There is a direct relationship between this drug and sexual anatomies in the fetus

I’ve seen balding since I was 20, now 33M, NW V. I took intermittently min/fin for periods of no longer than 6 months, with noticeable results. Then skipped the treatments due to laziness. I now decided to go all-in for the very last time before I decide to get a hair transplant. I am doing religiously min, fin, biotin, zinc, saw palmetto and vitamin D daily; ketoconazole twice/three times a week; dermarolling 1.5 mm once a week. Do you think it will reverse?

At 33, the drugs rarely reverse a Class 5 pattern of balding.

I love doing Scalp Micropigmentation (SMP) because at times, the results are instantaneously amazing as it was today. Leave aside some mild pink color to the area of the scar that was just treated (it will be gone tomorrow), he was blown away by the disappearance of his scar from two hair transplant procedures in the past and the apparent fill-in of his crown with just the SMP pigments. Scarring like his is unusual and occurs in only a few patients who have stretchable skin (with high elastin collagen). He said his crown looked as good as if he has another hair transplant today with instant growth.

 

 

 

 

 

 

 

This is the result of a single hair transplant. His smile shows his satisfaction

 

To find out how many grafts you need for the crown, there are a few things you need to know first:

(1) Thickness of the hair – fine, medium, or coarse (the thicker the hair, the less the number of grafts you will need)

(2) Character of the hair (wavy is better than straight)

(3) Color contrast between your hair and skin (brown hair on light skin often means more grafts, while gray hair requires less hair)

(4) The crown is the place where the direction of the hair changes.

If you want the swirl, you need to discuss this with your doctor. Your balding area is similar to mine, and I had 2,700 grafts placed into it over the past 25 years. So, if I were to estimate a range of grafts for you, it would be between 2,000-3,000 grafts, modified by the above.

I would have expected more frontal density, as well, based upon your Class 3 pattern with a strong front forelock and 3,500 grafts. Actually I think that 3500 grafts were actually an excessive number of grafts for that area. You and your doctor established expectations when the surgery was done, so go back and review these expectations with your doctor. I would have expected more density but some of the grafts may not have grown causing the reduced density you are seeing.

It is difficult to tell if you have shock hair loss or over-harvesting of the donor area. Over-harvesting would be unlikely if your original donor density was normal as shown here (see: https://newhair.com/donor-area/). However, if your donor density was low, then 3000 grafts could have exceeded your maximum number of grafts that can be harvested. There is little you can do now but wait and see what you look like in 5 months or so.

Your donor area may be over-harvested reflecting that either the FUEs were taken too close to each other for the density of the area, the punch was too large or your donor area could not support the number of FUE grafts you received. It is possible that the donor area is undergoing vascular shock loss. If this is the case, it might grow back in 6 months or so. If the area that is shown reflects the height and extent of your FUE harvest, then your surgeon took it too high and too low. You might want to get a second opinion.

You were very fortunate to have a good strong forelock prior to your surgery which will give you a strong frontal hairline. These forelocks are great and if they last until the age of 35, they usually last your lifetime. Some of these forelocks have a different genetic code than the hair around them.