There is not much to say other than sit back and enjoy this
There is not much to say other than sit back and enjoy this
I have collected a series of photos from the internet of victims from overly aggressive surgeons who don’t understand the limits of performing FUE and have depleted the donor area on this patients (https://newhair.com/resources/#tab-id-4). These men may have addressed their balding on the front, top and crown of their head, but they traded it off for balding in the back of their head. Balding in the back of the head can only come from an overly aggressive surgery so anyone that looks at them knows that they had a hair transplant because balding in the back of the head is not anything found in nature. It is man-made.
At the bottom of this posting, there are two examples of views of the donor area under a hand microscope (these can be purchased on Amazon.com). The microscopic view on the picture above averages about 2 hairs per follicular unit. This number is close to the average Caucasian’s density with a total hair count reflecting 100,000 hairs on the head. The picture below shows follicular units that contain far more than 2 hairs each (a very high donor density). Without calculating it but eyeballing it, it appear that the number of hairs exceed 3 hairs for each follicular group or more than 150,000 hairs on the head. Let’s assume that there are 3 hairs per follicular unit for the simplicity of the calculations that follow.
The average human has 50,000 follicular units on his hair baring scalp, averaging 2 hairs each which calculates to 100,000 hairs on the head. If you look at the Class 7 balding pattern patient, the remaining hair is the only hair that we can legitimately call permanent hair. This reflects 20% of the hair baring surface on the scalp (excluding neck hair) i.e. in a typical Caucasian male, 20% of the 100,000 hairs are permanent hairs for transplantation, which is 20,000 hairs or 10,000 permanent Follicular Units (grafts).
That means that if 10,000 grafts were taken out of the Class 7 patterned area, the area would be completely bald. Therefore the obvious question is how many grafts of these 10,000 permanent hair Folliclar Units (grafts) can we move. The answer depends on a series of factors, but let’s say safely that 60% can be moved safely, or 6,000 grafts with the FUE technique. If your hair has an average thickness or is more coarse, then number of harvestable grafts can be higher so that the remaining follicular units (grafts) will be enough to make the donor area look normal. If the hair is fine, however, the number of extractions that are safe will drop below the 6,000 Follicular Units (grafts) that can be safely harvested. When you or your surgeon push these numbers higher, you take a risk of donor area depletion which produces a see-through donor area (i.e. balding in the donor area). This is the reason I am writing this post, to give you, the reader, the power to understand the logic in the decisions on how to estimate the maximum number of grafts that you can move before risking a see-through donor area.
One reality is that most people don’t bald to a Class 7 pattern (only 7% of the male population), but might stop at a Class 6 pattern of balding, so if your surgeon and you decide that you are willing to extend the donor area to the Class 6 pattern of balding, then the number of permanent hairs will increase to 30,000 hairs and the number of harvestable grafts will be much higher with harvestable grafts possibly at 9,000 Follicular Units (or grafts) leaving 6,000 remaining follicular units to cover the donor area (the size of the Class 6 pattern of remaining hair). The decision to increase the projected size of the donor area has its risks because no one will know for sure that they will never develop a Class 7 pattern. The consequences of this decision is (1) the extra 3,000 transplanted grafts will not live and will die where ever they were placed if you develop a Class 7 pattern of balding, and (2) the harvested area will show with FUE area as white scars above the remaining donor area and these scars will be visible to everyone. So this decision should not be taken lightly and it must be discussed with your doctor at the time of the FUE, or you may regret the decision sometime in your future.
In the microscopic view of the patient on the right who has a very high donor density, the harvestable hairs in the Class 7 area may have doubled because the look of the donor area reflects not the number of hairs that were removed, but rather the number of hairs (or follicular groups or grafts) left behind. To calculate the safe harvestable number of grafts, the key is to leave behind approximately 4000 Follicular units. With an average Follicular Unit density of 3, the donor area contains 30,000 hairs or 15,000 Follicular Units (grafts) so that to leave behind 6000 grafts, this patient can safely harvest 9000 Follicular Units (15,000 – 9,000 = 6,000).
The use of strip surgery, on the other hand, always keeps the excised donor hair at the lower side of the Class 7 permanent zone, so that if your surgeon and you decide to take more grafts, other than a possible scar that may occur from the strip surgery, the risk of placing non-permanent hairs with the surgery is very low and the risk of seeing an area of harvested grafts with no hair will not occur. Of course, the risk here is potential scarring. The use of “Scalp Micropigmentation” solves the problem for either a see-through donor area or a scar. Here are examples of what can go wrong if things are not done right: https://newhair.com/baldingblog/collection-victim-photos-internet-harvested-depleted-donor-areas/
Stephen Miller used too much Toppik in the front so that the back and sides of his head are a different color. He should have Scalp Micropigmentation (https://scalpmicropigmentation.com/bold-shaved-look/) done so that the effect would be uniform and not stand out (you can see it in the video below). The key to undetectable concealers is that the leading edge can not be sharply thick. A normal hairline has a transition zone between the forehead and the thicker hair behind it. Hair is very important to all men and the use of concealers show that the men who use them are take charge guys, wanting to look how they feel. I am not faulting Steven Miller at all by posting these Reddit photos and posts, just sharing my thoughts with my readers.
Some people cut their eyebrow hairs at the roots and it did not grow back. You will know in 6 months, which is the longest cycle I know of.
This is very patchy results. I think the grafts that were transplanted came in patchy which means that many did not grow. I would go back and speak with your surgeon. If you were my patient, I would make it “right.” A good examination is critical to going forward and in trying to understand this bizarre result.
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A Second Comment: WOW, I have been dealing with extreme hair loss for the last 3 years. I have a third of my hair. thyroid tests etc come back fine. Looked this up on a hunch. And see all these! I hope not too much of the hair loss is permanent but I am afraid that it is. Stopping nighttime benedryl immediately.
Doctors should take charge of the post operative care instructions by teaching patients how to wash their hair on the very next day after surgery. By not teaching the proper technique, patients (like the one in the photo) will have to hide either under a hat or at home for a month until the crusts come off.
I am having issues with finasteride and have been very depressed about it. I was wondering if you could answer some questions. Over the past two years, I’ve been taking finasteride and I would say that it worked moderately. I was still losing hair but the shedding was slowing down. I didn’t have too many sides but I had a bit of ED. My erections were weaker and I didn’t have morning wood. Suddenly, starting a few months back, it seems like I have lost tremendous ground. My shedding is very intense and I’m getting thinner by the day. I also got my morning wood back and it’s very intense. I talked to my dermatologist but she doesn’t know whats happening. Do you have any recommendations for dutasteride or any idea of what is happening? I would appreciate any help! I feel like I’ll be bald by the end of the year and I’m only 22, so this is absolutely killing me. Thanks!
I discuss often that a tug of war exists between the drug finasteride and the genetic balding process. Like any tug of war, the stronger side wins. If your genetic balding creates a stronger pull than the drug finasteride, you will lose hair. There is no solution for many people in this situation. Dutasteride is only slightly more effective, but it has sterility risks which may not be worth taking.
I tell most of my patients that they should use both medications when the area you are treating is small as in this man. Faster than normal response but I can’t tell which of the two medications caused the new hair that is clearly there.
Well you should never have had a transplant that young especially with this much hair loss. Any good doctor would never do this because the potential for you to keep going bald is too high. In other words, you only have 6000-7000 transplantable grafts total. You may not have grafts to cover future loss later. The sad fact is the best age for a hair transplant is in the 30s. Now you may be faced with shaving your head and if you have fut, you will have a scar. It’s possible you can have scar revision if it’s bad. You can also have what’s basically a hair tattoo where they take a shaved head and place tiny dots to simulate hair follicles as well as hide the scar. You have other options but not everyone has the correct head or hair for a transplant.
This man is right on!