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  1. #1
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    Nov 2009
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    Default Hair Transplant + Topical Finasteride

    Hi everyone,

    I have a question about the dreaded ugly duckling phase and the efficacy of topical finasteride.

    My story is this: I just turned 39. I was losing hair badly. I was a Norwood 5. From the side and from the front, you could tell I was thinning, but from the top, it just looked horrible. I finally took the plunge and booked an appointment for a hair transplant with Hasson & Wong. Surgery went just fine. It's been a month.

    I'm now watching all of those precious grafts, many of which continued to grow after being transplanted, rapidly shedding over the last couple of days. It's just heart-breaking to watch my scalp return to the way it was before. Actually, it looks worse now, because I have less hair on my head than I did before my surgery.

    I'm sure you've heard that H&W offer a topical finasteride, which you can only obtain with a prescription if you are one of their patients. (They are working on a new formula, which is apparently just as effective as the oral version and the current topical, but which, after being applied, appears 16 times less in the bloodstream than the oral version. But that will not be available for another month.)

    I was not on finasteride in any form prior to the surgery. After my surgery, I was given a prescription for the topical, but was told not to apply it for the first two months.

    I'm now wondering about a few things. I would appreciate feedback from the veteran members of the forum.

    1) Should I have gone on the oral prior to my surgery? Would it have made a difference to the ugly duckling phase?

    2) If I begin applying the topical after the second month, how long will it take before I start seeing the effects?

    3) I have read that the ugly ducking phase lasts 3 months. But what does this involve? Will the shock loss be noticeable during the first 3 months? Can it be covered by native hair before the first 3 months are over? My shock loss is looking pretty bad and it has me really worried. At what point will I return to my pre-op hair? 2 months 3 months?

    4) I'm a teacher, so I have the summer off. I had my procedure done in early July. I've been wearing H&W's black baseball cap whenever I go out in public. I'm dreading the beginning of September, because school will be starting and I will still be in the ugly duckling phase. What can I do when school starts? How effective, really, are Toppik and Nanogen when you have no hair on your head or shock loss areas? How bad will it be at the 2 month mark compared to the one month mark?

    5) Is it normal to be developing pimples in the crown 1 months post-surgery? My crown is by far the worst part. I have less hair on the crown than I did pre-surgery. It's just demoralizing when I look in the mirror.

    Sorry for all the questions, brothers. I'm just feeling the worst of it now. I could really use your support.

    Thank you.

  2. #2
    Member
    Join Date
    Apr 2015
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    Default

    I'm not a doctor so I can only give you my option based on my own HT and research.
    1. Yes but since you didn't you should go on the oral now. No most likely not.
    2. 4 months which is the same as if you don't apply the topical (my opinion).
    3. It lasts at least 3 months if not 4-5. Nothing to worry about. You can lose up to 90% or more of the grafts but they'll grow back eventually. You'll probably return to pre op at 3-4 months.
    4. If you can wear a hat when school starts then do it. by then you might have some stubble to attach Toppik to but I wouldn't think it would be worth the hassle.
    5. Yes, I had pimples all over the top and when one would clear up another one would develope. The crown grafts might be the last ones to grow in (after 8-9 months maybe).

    It's just hair. Congrats on your HT. Now it's time to forget about it as much as possible. There's nothing you can do to speed it up. Many doctors say they expect their patients to have nearly twice as much graft growth by month 12 as they had by month 6. I always try to remember that. Time feels like it's at a crawl right now but time flies. A year will go by quickly and you'll be thrilled with the results. Good luck.

  3. #3
    Member
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    Nov 2009
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    Winnipeg, MB
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    Default

    I can't exactly forget about it so long as I have severe visible shock loss. I'm scheduled to begin teaching in one month. I'm a professor. Unfortunately, wearing a baseball cap in the classroom goes against basic professorial attire. Jeans are okay, but a baseball cap would be considered unacceptable.

  4. #4
    Moderator JoeTillman's Avatar
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    Default

    1) Should I have gone on the oral prior to my surgery? Would it have made a difference to the ugly duckling phase?

    It may have as it could strenthen miniaturized hairs that are more susceptible to shock but at the same time it is an unquantifiable issue one way or the other and can only be answered from, at best, anectdotal evidence and experience.

    2) If I begin applying the topical after the second month, how long will it take before I start seeing the effects?

    Finasteride takes time for the results to manifest as visible improvements. Some patients see improvements six months after beginning their treatment, some see improvements 18 months after initial treatment begins, some only see a maintenance with no visible improvements or degradation.

    3) I have read that the ugly ducking phase lasts 3 months. But what does this involve? Will the shock loss be noticeable during the first 3 months? Can it be covered by native hair before the first 3 months are over? My shock loss is looking pretty bad and it has me really worried. At what point will I return to my pre-op hair? 2 months 3 months?

    Shock usually starts to kick in about one month and can take three months to return the patient to "par" or to the point that they looked before surgery before improvements above and beyond what they started with start to become evident. I've seen patients look "normal" at three months and I've seen some take five months. What needs to happen is the redness needs to subside, which is happening quickly at this point and any hairs that are returning will take one month to grow 1cm to 1 1/4cm (average).

    4) I'm a teacher, so I have the summer off. I had my procedure done in early July. I've been wearing H&W's black baseball cap whenever I go out in public. I'm dreading the beginning of September, because school will be starting and I will still be in the ugly duckling phase. What can I do when school starts? How effective, really, are Toppik and Nanogen when you have no hair on your head or shock loss areas? How bad will it be at the 2 month mark compared to the one month mark?

    It may be worse at two months but you'd be surprised what topical concealers can do and with how little hair they need to work well. Try Toppik and experiment with it now to get used to using it and to see how you like it.

    5) Is it normal to be developing pimples in the crown 1 months post-surgery? My crown is by far the worst part. I have less hair on the crown than I did pre-surgery. It's just demoralizing when I look in the mirror.

    Normal? Depends on how many you have. If you have a few, sure, kind of. This indicates early growth or it could indicate mild folliculitis. If you have a lot and the crown is red, inflamed and just "angry" looking you should head to your doctor and have it looked at. The last thing you want is a bad infection. The pimples may have to be drained/squeezed as well. It's not a big deal but give HW a call first then consider your next steps.
    Joe Tillman
    The original Hair Transplant Mentor

    Interested to know which doctors I recommend?
    See the full list at HairTransplantMentor.com/hair-transplant-doctors

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