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This is a review of a patient who was happy with his hair transplant results but his linear hair transplant scar bothered him when he wore his hair short.
We kept his hair long (not shaved) and performed the SMP procedure under local anesthesia. The following results were immediately after the first session. He will need a follow up session for better blending.

At 17, taking Dutasteride puts you at risk of becoming sterile, since it is one of the known complications of this drug. Are you sure you want to do this? Dutasteride is not FDA cleared for hair loss.

Fin to Dut switch at 17 from tressless

This patient had visible FUE scars that he wanted to conceal. To accomplish this, we performed Scalp MicroPigmentation on the donor area with great results. FUE is a terrific procedure but it does form many very small scars for each follicular unit that is excised. When too many FUEs are performed the donor area becomes bald and looks more and more depleted. That was not the case in this patient. Click to enlarge.

Scalp MicroPigmentaiton used to conceal FUE scars

Doc, can you write a post detailing the effectiveness of dutasteride vs finasteride for hairline and general thinning if you ever get the chance?

These two drugs work in a similar manner. These drugs are competitive inhibitors to the enzyme 5 alpha reductase, critical to the functioning of DHT. Dutasteride is reported to be 85% effective while Finasteride is reported to be 70% as effective. That does not mean that dutasteride is a better drug, with know side effects that may be worse than finasteride like sterility. Finasteride is approved by the FDA for hair loss while finasteride is not.

My question is; does finasteride and dutasteride lost effectiveness over-time in the body? Like, say in decades, would my body become used to dutasteride and it will lose its effectiveness and hair loss will resume or can I preserve my hair forever (until I’m a senior, theoretically) just from taking 0.5 mg of dut everyday for the rest of my life?

Another question, will the hairs that grew back become thick like how they were before they fell out? Is there anything I can do to make them thicker or do I just have to keep taking the drug and wait longer?

It is not the blood levels of these drugs that are important, but the tissue fixation that occurs after taking the drug. The tissue fixation of finasteride is about 7-9 days while the tissue fixation of dutasteride is about 6 weeks. These drugs generally do not lose effectiveness but the balding pattern is tied to apoptosis (cell death) which these hairs undergo over time. These drugs slow the process down but will not prevent the outcome, which is inevitable.

In the early stages of use, when miniaturization is high and newly formed, the probability that these drugs will reverse the miniaturization process, making these hair stronger and less miniaturized, will be good.

An Email sent by patient from Turkey who stated that he had a red, hot scalp 2 months after his hair transplant. The presentation he was discussing sounds like an infection but he said he cold not go back to who ever did it. I told him that “You must go to a skilled doctor, any good doctor to make the diagnosis commence treatment?