Will 1000 1600 FU grafts be sufficient to lower my hairline and bring me to NW1? - Page 2 - BaldTruthTalk.com
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  1. #11
    IAHRS Recommended Hair Transplant Surgeon John P. Cole, MD's Avatar
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    Hair loss goes in plateaus. You stabilize and then you drop off the cliff typically. Then you land on another plateau, which you usually fall off of later on. DHT blockers do slow down the aging process. However, they do not work equally well in all individuals. Furthermore, DHT blockers alone are not the sole answer most likely. The hair loss process is quite complex. If DHT alone were the culprit, then all would respond with a full head of hair with dutasteride, which blocks most of the DHT. There are multiple pathways involved in the cell cycling process. Every cell has a limited number of cycles. Once a cell reaches the maximum number of cycles, stem cell populations are lost and the cell cannot replicate. In the hair follicle, there is an interaction between the secondary hair germ, which gives rise to the inner root sheath and the matrix, and the hair follicle stem cells of the bulge. BMP keeps the hair follilce in the resting, telogen phase. BMP suppression by noggin, produced by the secondary hair germ, causes the dermal papilla to turn off BMP expression and thus, upregulates Wnt/B-catenin from the bulge stem cells and induces the growing phase and gives rise to the outer root sheath. There are all kinds of BMP and WNT. Furthermore, there is Notch signaling is a downstream pathway can turn off anagen. Because cells have a limited number of cycles, the goal is to keep the hair follicle in anagen as long as possible. In androgenic alopecia, the percentage of follicles in the resting telogen phase is markedly increased. We want to keep these follicles in the active growing phase as long as possible so that they can have the longest possible life span. One does not want to start anti-aging medicine once you are old. You start when you are young. Once the stem cell niche is lost, there is no way to bring that follilce back at this time. This is why it is so important to attack hair loss from multiple pathways. DHT is only a single consideration. I have followed enough patients over 20 to 30 years to see what happens to them. They all lose hair, often to the point that hair restoration is no longer an option. In fact, it may prove to be a bad idea to begin with. For this reason, I am a very strong proponent of all newer modalities to improve the life span of the hair follicle. I am even more ardently supportive of maintaining the hair follicle as long as possible than I am of hair restoration surgery. Maintaining hair follicles is essential. Once you go beyond a NW 3V there is no hope you will ever get a full head of hair through transplantation using traditional methods alone. Thus, it is up to the individual patient to seek all potential modalities to maintain their hair as long as possible. I am hopeful that exosomes alone will be the single best option to effect this change in the life cycle alone. This is why I am offering exosome treatment in New York, among other locations at this time. I believe we will find that exosomes the key ingredient in all anti-aging modalities including PRP, CRP, amniotic membrane, and adipose stem cells (stromal vascular fraction). But time will tell. It could be that a combination of adipose stem cells and exosomes is the best treatment. What I can tell you is that amniotic membrane has a stronger influence on dermal papilla proliferation than PRP or CRP.

    Don't get too comfortable with a single treatment nor that you will never lose more hair.
    John Cole, MD
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  2. #12
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    Quote Originally Posted by John P. Cole, MD View Post
    Yes, he will. All men and all women begin to thin at age 35. The average safer donor area has 15,400 follicular units in your 20s. By your 70s, this number decreases to 13,200. There is a progressive decline each decade after one's 20s. In androgenic alopecia, you will eventually have progression. In some it is much worse than in others. It's all an aging process of the hair follicles and stem cells.
    If I use dutasteride every day and measure my DHT to make sure it is extremely low, why would I keep losing hair?

    Also, assuming within 10 years hair cloning will come true or better treatments I should be fine after 10 years or so, no? I mean, I have maintained this for good 5+ years and my hair was confirmed to gotten THICKER after dutasteride (by trichologist measurements).

    Don't get too comfortable with a single treatment nor that you will never lose more hair.
    Ok, but I will still have donor area left for another transplant 5, 10, 15 years down the line. 20 years down the line we should have hair cloning, no?

    My main importance is to maintain a youthful, strong hairline for rest of my life. If the area after hairline recedes it is way easier to camouflage.

  3. #13
    IAHRS Recommended Hair Transplant Surgeon John P. Cole, MD's Avatar
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    Every now and then, some guys do seem to maintain for a long, long time. However, usually, they don't. Plus, remember there are no long term trials on dutasteride. In the Propecia 10 year study, people gradually got worse but not as quickly as those not on medication. I hope it hangs in there for you.

    As a side note, I've heard we will have hair cloning in 5 years for the past 29 years. Still waiting. It isn't as easy as it seems with two different embryological stem cell lines.

    Good luck and be careful. I'll be cheering for you.
    John Cole, MD
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  4. #14
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    Quote Originally Posted by John P. Cole, MD View Post
    Every now and then, some guys do seem to maintain for a long, long time. However, usually, they don't. Plus, remember there are no long term trials on dutasteride. In the Propecia 10 year study, people gradually got worse but not as quickly as those not on medication. I hope it hangs in there for you.

    As a side note, I've heard we will have hair cloning in 5 years for the past 29 years. Still waiting. It isn't as easy as it seems with two different embryological stem cell lines.

    Good luck and be careful. I'll be cheering for you.
    Thank you! Really appreciate your input!

  5. #15
    IAHRS Recommended Hair Transplant Surgeon Amir Yazdan, MD's Avatar
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    Thank you for the detailed inquiry. Your native hair appears quite dense and as such would require a high-density transplant. A 1000-1500 graft estimate seems conservative in that regard. I would get a second formal analysis and opinion to compare graft estimates.

    Moreover, as Joe points out, the style and flow of your native hair may not harmonize with such a drastic hairline reduction (shown in those other mens photos). Go with what looks most natural and suitable for your face. Its often hard to picture a new hairline when its just drawn on your face. Not until the transplanted hair has fully grown and matured does it display the full aesthetic impact on how you look and its relation to your bone structure.
    Amir Yazdan, MD
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