Dr Lam's Hair Restoration Forum

Hey Doc

Quick question regarding a thin crown. I am 32 years old and have some thinning in the crown area....would describe the severity as moderate -- my frontal hairline is thick / not an issue. I have been on rogaine for 2 years now and have been on rogaine + propecia for approximately 6 months now. My crown has not experienced any noticeable incremental thinning in over 2.5 years (have pictures) and the addition of propecia seems to be sparking some modest regrowth.

So a few questions if you don't mind:

1) How long until I can judge the full results of adding propecia to my regime -- in other words is 6 months too early to judge how much (if any) regrowth will emerge
2) Do you perform FUE or only strip (if no FUE, why?)
3) Is it premature at my age and length of propecia use to even consider a HT
4) I would never have a HT in the frontal hairline...assuming my hair loss ever got to that point, I would shave it off....if that was the case, would the transplanted crown hairs lead to a cosmetically 'strange' appearance....

Thx so much Dr.

also one last question

assuming one has realistic expectations and would be happy with only a modest improvement in the appearance of a thin crown, would fue (say 300 to 500 grafts) in the hands of a skilled surgeon make sense...

..if the propecia and rogaine prevent any further hair loss then great....if hair loss precedes even with the propecia and rogaine, then one shaves his head and moves on with life (ha)......i don't want to have several procedures throughout my life / am scared of ever having work done in the front.....so am hoping propecia / rogaine hold down the fort and a small ht would lead to a bit more density...hope i'm clearly relaying my thoughts

1) How long until I can judge the full results of adding propecia to my regime -- in other words is 6 months too early to judge how much (if any) regrowth will emerge
GENERALLY, AT A YEAR. PROPECIA HAS FULL EXPRESSION BETWEEN 6 MONTHS TO A YEAR. REMEMBER ALSO THAT OVER 5 YEAR STUDIES PROPECIA AFTER REGROWING SOME VELLUS HAIRS STILL PERMITS ONGOING HAIR LOSS BUT COMPARED AGAINST THOSE WHO ARE NOT ON PROPECIA, THE AMOUNT OF HAIR LOSS IS SUBSTANTIALLY LESS SO IT CONTINUES TO WORK BUT IT JUST SLOWS DOWN HAIR LOSS NOT STOPS IT.

2) Do you perform FUE or only strip (if no FUE, why?)
I ONLY PERFORM FUE FOR SCAR REVISIONS BUT NOT FOR BIG PROCEDURES. THE REASONS ARE AS FOLLOWS:
WITH FUE, YOU CAN HARVEST 500 TO 1000 GRAFTS OVER 1 TO 2 DAYS OF WORK (VERY COSTLY BY THE WAY. ON AVERAGE 4 TIMES THE COST). THAT IS NOT EVEN CLOSE TO WHAT I NEED TO FINISH A CROWN OR MAJOR AREA OF THE HEAD. TO UNDERSTAND WHY THE CROWN TAKES MANY MORE GRAFTS THAN ANY OTHER PART OF THE HEAD, WATCH THIS VIDEO ON THE CROWN TALKING ABOUT THE BILLBOARD EFFECT:
http://www.hairtx.com/gallery2/v/videos/Video+Logs+VLogs/Hair+Growth+Hair+Loss+Hair+Restoration+in+the+Crown+Vertex+Region.html.
FUE ALSO DOES NOT ELIMINATE THE CHANCE FOR SHAVING THE HEAD BECAUSE BOTH THE AREAS THAT WERE TRANSPLANTED AND THE DONOR AREA CAN SHOW SMALL UNEVEN PITS OR CHANGES EVEN IN MY HANDS WHEN SHAVED DOWN. NOW, IT IS TRUE THAT RELATIVELY CLOSELY SHAVED HEAD COULD GET AWAY WITH FUE BUT NOT FULLY SHAVED DOWN. FUE IS SIMPLY PUT NOT RISK FREE AND THAT IS HOW IT IS SOLD AND IT MAKES NO SENSE FOR THE CROWN IN PARTICULAR.

HERE IS THE OTHER PROBLEM. I TEND NOT TO PERFORM CROWN PROCEDURES IN MEN UNDER 35 YEARS OF AGE FOR 2 REASONS: 1) I DO NOT KNOW HOW MANY MORE SESSIONS THEY WILL NEED TO COVER THEIR TRACKS AND THEY MAY RUN OUT OF HAIR TO DO SO. 2) THEY MAY HAVE AN UNNATURAL RESULT IF THE FRONT THINS DOWN OR EVEN AN UNAESTHETIC RESULT.

NOW THAT BEING SAID, I WOULD NEED TO SEE HOW BIG YOUR CROWN IS AND WHAT IS GOING ON. THERE ARE EXCEPTIONS BUT IT IS ON A CASE BY CASE SITUATION. FURTHER, THE CROWN IS ALWAYS BIGGER THAN YOU THINK. ALL YOU HAVE TO DO IS WET YOUR HAIR TO SHOW YOU THE AREAS THAT ARE IN THE PROCESS OF THINNING OUT.

3) Is it premature at my age and length of propecia use to even consider a HT
SEE ABOVE. I THINK YOU NEED AT LEAST A YEAR OF PROPECIA PLUS A CONSULTATION WITH AN ETHICAL SURGEON. AS I EXPRESSED IN THE ABOVE LIMITATIONS, YOU NEED TO BE SEEN BY A QUALIFIED HAIR TRANSPLANT SURGEON, PREFERABLY BOARD CERTIFIED IN HAIR RESTORATION.
4) I would never have a HT in the frontal hairline...assuming my hair loss ever got to that point, I would shave it off....if that was the case, would the transplanted crown hairs lead to a cosmetically 'strange' appearance...
IT COULD. SEE ABOVE.
thanks so much for asking!
best,
sml

Hi Dr.Lam,

I have had sever alopecia and thinning for over 10 years now in which I have completely gone bald. I recently started cortisone shots to improve on some of the hairloss which seems to work some buti am concerned about the bone density over time. I have gotten all my lab work done and nothing seems to be pinpointing to the problem but it may be hereditary. I would love to have a hair transplant seeming that i have tried everything to get faster results and being that i am 32 yr old and just wont peace from the embarrassment. What would you recommend, or suggest I do at this point?

hi,
thanks for the question. as you know, i love to do hair transplants but they have to be safe. here are my significant concerns with your situation regarding surgical intervention:
1. steroid injections tell me something is going wrong with your scalp. that means to me your dermatologist/doctor is thinking you have some kind of scarring condition that would preclude a hair transplant. you cannot put grafts into a scarring hair loss (if that is what you have) and have them survive. i hope i am understanding what is going on right.
2. at 32 if you are completely bald, i have two more concerns. first, i may never be able to close your whole head including crown because you may not have enough hair to do it. it might be better then for your look to shave it all off (sorry just trying to be correct here). also, you may run out of usable donor hair since you are young and will have further hair loss.

beyond the above comments, obviously, i have never seen or met you but they are general thoughts. it is always better to be safe than to be aggressive and dangerous when it comes to HT. hope that helps as a start.
best wishes,
sml

I think you are facing the problem of baldness...Why you don't try Generic Propecia ?.. I came across lot of positive results about it...Discuss with your doctor and start treatment as soon as possible...

hi,
thanks for the comment but i do not permit advise to be given on this forum. it is only for me to answer your questions.
best,
s.