I am in my late 20s and have been balding since 22. I started taking finasteride over a year ago, and while it reversed the balding a little bid (about 20% hair grew back in the bald spot), it’s been stuck at this level for a while. I am trying to figure out how many FUE grafts I will need if I am going to do a hair transplant surgery to cover this up, and whether I can get this done under $10k in the US/California. If not, I am debating making a trip to Turkey for a cheaper all inclusive surgery. I didn’t include a picture of the front, because my hair somehow hasn’t receded in the front.

Thanks in advance

You need a Master Plan to determine not only what you need now, but what is likely to happen to you in the near or long term future as hair loss is a progressive process. As you are in your late 20s, I could transplant the crown (depending upon your hair being fine, medium or coarse) the range of grafts would be between 1800-3000 (more for fine hair.

This patient clearly had an FUE in the past. I know this because I see the FUE scars (the missing areas) which I placed some arrow so that you can identify the scars from the older FUE this patient had. What I am seeing is that the surgeon, having already almost maxed out the FUE extractions from the permanent zone in the donor area, decided to move up outside of the permanent zone for more extractions. That means that if this man should develop a Full Class 7 pattern of balding, that he would then lose all of these new hairs. Also showed some arrow above the line I drew to show that this area was previously harvested as well. The circled area shows an FUE sites where the hair still is in the scalp as it is all over the newly harvested areas (the surgical team has not yet removed the FUE grafts). Now add to this that as he loses more hair in the donor zone where his FUEs were wrongly done, he will have terrible scars on the back of his head that everyone will see (scar-less surgery?).

I strongly believe that the FUE harvest should be restricted to the REAL permanent zone (below the line I drew) and not above the line because these guys don’t expect to lose the transplanted hair in the years to come (a real possibility).

Never (for a man) get a hair transplant before the age of 25 because the balding pattern does not declare itself until at least this age. You should build a Master Plan with a great doctor so that your hair transplant plans are carefully considered and reflect your specific short and long term needs.

Most of the topical finasteride sold today can get through the skin and its not the Liposomal preparation. if the drug gets through the skin into the body and you are known to get side effects with the pill, you will get it with the normal topical finasteride. With the Liposomal preparation; however, the measured maximal absorption for topical liposomal finasteride was reported to be rarely in excess of 18% of the total dose. I hope that language better explains what I know. But I would be happy to review articles you might have as I always keep an open mind. Last week I had a patient with the ethanol/ PG base solution and he had bad sexual side effects and that is why he came to me to get the Liposomal preparation.

A Liposomal preparation of a drug puts the active drug inside very tiny, fat-like particles. This allows more localization of the drug. Men who have measured their DHT levels found that with the topical liposomal finasteride preparations, their DHT levels did not change.

“I am almost 1 year since my hair transplant and I am very disappointed with the results”. I have heard this before. Setting proper expectation that are realistic is critical between the doctor and the patient. From what this patient told me in his email, he did not elaborate why he was disappointed so I would assume that either he did not get the growth of the transplants (reflecting some time of procedural error) or that his expectations were not realistic and his result may have been what the doctor promised but not what he expected. I always recommend that the patient return to the doctor who did the work and discuss the result, the expectations, etc… If there was a failure of the procedure to any significant degree, the doctor should be honorable and MAKE IT RIGHT to the patient’s satisfaction. I would do that if I were the doctor.

What is the long term perspective for someone who responds to common treatments like fin and min? Lets say a person starts these treatments at 30. Will they preserve their thickness into their 50s and 60s? Or they just delay the inevitable balding by 5-10 years?

I have been in the hair restoration field for 33 years and have seen it all. Men on Finasteride for life see a reduction of their end-stage bading pattern. Although the hair loss process continues, it is slowed down significantly with age. I have patients that have been on finasteride 25 years, and a few decided to stop it only to find significant hair loss occurs within 3 months of the date they stopped the drug. The same can be said with minoxidil or both in combination.

Do hairs like this stand a change with medication? Is a HT even a viable option to increase density?