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This patient is in his mid-40s and wanted to address his hairline and fill in the rest of the scalp. We started him on finasteride and performed FUT of 3,933 grafts (7,275 hairs, 1.85 hairs/graft). He didn't return until 5 years later. Overall, he was very pleased but noted that he thought his hair looked thicker a couple years prior (ie 3 years after the procedure). I explained that the grafts were not thinning but that he was seeing the natural progression while on finasteride. I see this all the time, and unfortunately patients sometimes think this means the medicine has 'stopped working'. Referring to the chart, the 'average' patient who starts finasteride will see thickening for about 5 years and then will begin to decline below where they started, but they are always much better than if they had never taken it, the difference becoming greater with every year. Options at this point include: adding minoxidil (if they are not already using it), doing another transplant, and/or doing a PRP/ACell procedure to regain some of the thickening. It is important to have an understanding of this process to set realistic expectations and make a long term plan.
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