Transplanted hairs fall after transplant- will they grow back?

The transplanted hairs are attached to the hair root which we call follicle or graft commonly. The graft is of the size of the rice grain and when we transplant them in your skin a major part remains under the skin and a very small part remains projected outside the skin surface as shown in the figure. Immediately after and for first 24 to 48 hours there may be some oozing of blood from around the graft and if that blood is not washed away by spraying in the early period that may form a dry black brown scab which becomes hard ( as shown in the photo) and is difficult to remove for 10 to 20 days at times. 

Usually the skin heals in one week’s time. The overlying scab which is attached to the graft if tried to remove forcibly before 1o days the graft may be pulled out and that hair may not grow and more over there may be some bleeding from that site. It takes 10 days for the graft to be secure in the skin and even by removing scab it now does not come out and all that come out is the hair attached to the dry scab and some sticky white material under the scab. It does not bleed. The hair will grow from this graft. The majority of  transplanted hairs will first fall between 10 to 30 days time after transplant and they start growing form the already incorporated roots in 3-5 months time. This happens to every patient of hair transplant and this is not abonormal.

 

Following is from the :

“ Graft Anchoring in Hair Transplantation” A study published by
Robert M. Bernstein, MD,^* and William R. Rassman, MD
^*College of Physicians and Surgeons, Columbia University, New York, New York
Dermatol Surg 2006; 32: 198-204  
© 2006 The American Society for Dermatologic Surgery

For the first two days, pulling on a hair always resulted in a lost graft, but the chance of the graft being removed started to decrease by the third day. By the sixth day pulling on a hair would no longer dislodge the graft. Pulling on an adherent scab always resulted in a lost graft through day five. At nine days post-op, grafts were no longer at risk of being dislodged.

The presence of crusting extends the interval that grafts are at risk of being dislodged in the post-op period. If one can prevent crust formation by early and regular washing following a hair transplant, this would both shorten the time patients are at risk of losing their grafts and enable them to return to their normal hair care routines more quickly.

 

Hair cloning, Hair Multiplication (HM), Stem Cell Therapy, Genetic Engineering (Gene Therapy)

At the outset it is important to know that cloning as it sounds fascinating is not only clinicallybut even experimentally successful in human beings. There are mainly 2 companies Aderans of America ( Japanese  owned) and the UK based  Intercytex  are into these experiments and world is looking for any positive that comes out from their efforts. Although it appears form recent evidence that it may not be less that 10 years away before it ic available clinically. Following information is compiled to give idea about developing and related topics.

It was known to the scientists that the Embryonic stem cells have pluripotent characteristics i.e. they can develop in to any body tissue given proper environment.

There is a big ethical issue involved in the use of Embryonic Stem cells due to possible loss of life.

 The following experiment made it clear that even some adult tissues cells have Pluripotent characteristics they are called Adult Stem Cells. The significance of Adult stem cells is not having such a potential loss of life.

What is cloning?                                                                                                                                   

Cloning technically means the production of genetically identical organisms. The first clone of animal was Dolly, the famous Edinburgh sheep. Although technically not an exact replica of her mother (and therefore not a true clone), the revolutionary part of the experiment was that it overturned the long-held view that non-sex cells of an adult (somatic cells e.g. of liver, lungs. Brain, skin etc.) were differentiated to such a degree that they lost any potential to develop into a new adult organism or in other words other genes in the cell became permanently inactive. The other major challenge was to be able to initiate the multiplication of the genetically altered cell and then to provide the proper environment in which the growth of the new organism could take place. 

Transgender Induction of Follicles: (1999)

From the idea of producing genetically identical organism it was natural to come to the idea of genetically identical organ or for that sake hair follicle (which is no less than an organ with multiple tissues and complexity of an organ). Earliest successful work done in this field is that of Colon Jahoda of England. In their paper Transgender Induction of hair Follicles,  the researchers have shown that dermal sheath cells (essentially a  fibroblast-  an Adult stem cells) , found in the lower part of the human follicle, was isolated from one person ( a male) and then injected into the fore arm skin of genetically unrelated another person (a female) to promote the formation of new intact hair. The implanted cells interacted locally to stimulate the creation of full terminal (i.e. normal) hair follicles. Although this is not actually cloning the dermal sheath cells can potentially be multiplied in a Petri dish and then injected in great numbers to produce a full head of hair. The word potentially is highlighted, as this multiplication has not yet been accomplished. It seems, however, that this hair “induction” processes is the model most likely to work. It is well known that fibroblasts, unlike many other tissue cells, are relatively easy to culture. Theoretically, a patient's fibroblasts could be removed from the sheaths of just a few follicles and then cultured to produce thousands of follicles. These fibroblasts could then be injected back into the scalp to induce thousands of new hair follicles to grow. So far this important single study has not been reproduced.

Another interesting aspect of their experiment is that the donor cells came from a male but the recipient, who actually grew the hair, was a female. The importance of this is that donor cells can be transferred from one person to another without being rejected. Since repeat implantations did not provoke the typical rejection responses, even though the donor was of the opposite sex and had a significantly different genetic profile, this indicates that the dermal sheath cells have a special immune status and that the lower hair follicle is one of the bodies “immune privileged” sites.

Unlike, Follicular Unit Transplantation (FUT), in which an intact follicular units are planted into the scalp in the exact direction the surgeon wants the hair to grow, with cell implantation there is no guarantee that the induced hair will grow in the right direction or have the color, hair thickness or texture to look natural. However, it is not even certain that the induced follicles will actually grow long enough to produce cosmetically significant hair. And once that hair is shed in the normal hair cycle, there are no assurances that it will grow and cycle again. A major technical problem to cloning hair is that cells in culture (unlike the Cloning of the whole organism in the uterus - a proper environment) begin to de-differentiate as they multiply and revert to acting like fibroblasts again, rather than hair.

In another experiment (2009)

The study — conducted by Marwa Fawzi, a dermatologist at the University of Cairo Faculty of Medicine, and reported on Bloomberg.com — used stem cells from the scalps of eight children with alopecia areata to regenerate their own hair:
The Cairo researcher took small amounts of skin from the scalps of the children, isolated the hair follicle stem cells that stimulate hair production, and grew them in the lab, increasing the number of cells. After one month, she put the cells back into the scalps of the children, with numerous injections across the bald areas of their heads. Six months after the hair cloning treatment, an evaluation showed a 50% increase in hair in more than half of the subjects. Dr. Fawzi took new skin samples and examined the hair follicles themselves and could see that the injected stem cells had migrated into the follicles. There, the stem cells stimulated the follicles to transition from a dormant phase to a hair-generating phase.  (Posted on Bloomberg.com, July 10, 2009)

Adult skin can regenerate new hair follicles. -  2007

In the recent study published in Nature it is repored that in mice large skin wounds can regenerate new hair follicles.Report by Dr. George Cotsarelis, a dermatology professor at the University of Pennsylvania School of Medicine in Philadelphia underlines that in regenerating woulds skin undergoes processes similar to these during embryonic development which results in formation of new hair follicles. This process happens in wounds of adult animals. This fact shows that mammals and humans have better regenerative abilities than commonly believed.

These new findings could provide basis for developing new treatment strategy for male-pattern baldness and other types of hair loss. It is shown that hair follicles newly formed from wounds functioned normally, cycle through the normal stages of hair cycle. More importantly, hair fibers that they produce are indistinguishable from pre-existing hairs with one exception - lack of pigmentation.

Finding details:

In the reported experiments scientists produced relatively large wounds on the backs of adult mice. When wounds reached a certain size new hair follicles developed at the center of wounds. This developmental process closely resembled normal embryonic development of hair follicles.

It appears that as the part of this hair neogenesis non-hair skin stem cells were able to transform into hair cell types. It was shown that the stem cells that gave rise to de novo hair follicles were not stem cells usually associated with hair follicle development (i.e. bulge stem cells). Dr. Cotsarelis comments: "...They're actually coming from epidermal cells that don't normally make hair follicles. So they're somehow reprogrammed and told to make a follicle..."

Dr. Cotsarelis is affiliated with with Follica Inc., that has a license for the patent on this process of hair regeneration from wounds . He predicts that it will be more than 5 years before a baldness treatment will be available.

These experiments have shown that Inducer role of  Fibroblasts of Dermal Papilla, DP (and or Dermal Sheath Cell ,DSC) [DP cells (fibroblasts) can be grown and multiplied in culture so that a small number can produce enough hair follicles to cover an entire bald scalp.] to induce Hair Follicle formation esp. in presence of Pluripotent Progenitor Stem cells -Epithelial cells of Matrix keratinocytes.

 Methods of cloning:

While considerable work remains on turning hair cloning methods into a viable treatment for hair loss, there are four experimental techniques described in a 2008 paper in Hair Transplant Forum International — the primary medical journal in the field of hair transplantation — that shed some light on how cloning could become a viable treatment in hair restoration. * Teumer J. Strategies for follicular cell implantation. Hair Transplant Forum International 2008.

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1. Implant Dermal Papillae Cells Alone

• Implant DP cells into the dermis
• Cause the overlying skin cells (keratinocytes) to be transformed into hair follicles
• Referred to as “Follicular neo-genesis” since new hair is formed on previously bald scalp
•  

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2. Implant Cloned Dermal Papillae Cells Next to Miniaturized Follicles [ a model used by Intercytex for research-called Follicular cell regeneration]

• DP cells induce the keratinocytes of the miniaturized follicles to grow into terminal hairs
• Advantage: existing miniaturized follicles already have the proper structure and orientation to produce a natural look

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3. Implant Dermal Papillae Cells with Keratinocytes (“Proto-Hairs”)-[ A model followed by Aderans company of US- called follicular Neogenesis]

• Keratinocytes and DP cells are cultured together until partial hair formation takes place
• These culture-grown hairs (“proto-hairs”) are implanted in the skin
• Advantage: better hair direction because of the orientation of the proto-hair

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4. Implant Cells Using a Matrix

• DP cells alone or in combination with keratinocytes are placed in a matrix of collagen or synthetic materials
• Matrix acts like a scaffold to help cells organize to form a follicle and direct its growth

Problem is that the cultured cells (or Cloning) :

1. May lose their ability to differentiate into hair follicles with multiple passages

2. Hair direction may be uncontrolled. With mouse experiments, the hairs grow at all different directions instead of in the right direction.

3. Hair, may not be of a quality that is cosmetically acceptable and matches the patient existing hair.

4. And the hair may not grow in follicular units. Individual hairs will not give the fullness or natural look of follicular units.

5. Issue of safety: Are we sure that cultured cells may not turn into something else – such as malignancy cells with uncontrolled growth?

6. Finally, FDA approval would be required and this takes few years time

What is Hair Multiplication? (HM)

HM is a wider term that also includes other methods besides cloning. In hair multiplication, hairs are simply plucked from the scalp or beard and then implanted into the bald part of the scalp. The idea is that some germinative cells at the base of the hair follicle will be pulled out along with the hair. Once the hair is re-implanted, these cells would be able to regenerate a new follicle. In theory, microscopic examination of the plucked hair could help the doctor determine which hairs have the most stem cells attached and thus which are most likely to regrow. The procedure is called “hair multiplication” since the plucked follicles would regrow a new hair, potentially giving an unlimited supply.
In a modification of this procedure, the bulbs of the hair are separated from the shafts and then their cells (matrix keratinocytes and Mesodermal sheath or papilla cells) cultivated in vitro (outside the body). After the cells are multiplied, they are injected into the pores of local, dormant hair follicles in the balding area. The problem with either technique is that matrix keratinocytes (the plucked cells) are only transient amplifiers, and the stem cells around the bulge region of the follicle, the ones most important for hair growth, are not harvested in any significant numbers and can’t be readily activated to produce a hair. 

Genetic Engineering

In contrast to replicating whole organisms, in genetic engineering, one alters the DNA of a particular cell so that it can manufacture proteins to correct genetic defects or produce other beneficial changes in an organism. The initial step in genetic engineering is to isolate the gene that is responsible for the problem. The next step is to clone (multiply) the gene. The last step is to insert the gene inside the cell so that it can work to alter bodily function.
The focus of such work is to identify the defect that causes the problem we wish to fix and then to develop a drug, enzyme blocker, or another approach to address the problem. There are many baby steps taking us to that cure and Dr. Markus M Nothen of the University of Bonn in Germany identified an androgen receptor gene on the ‘X’ Chromosome which is contributed by the mother in setting a person up for balding. The androgen receptor gene helps govern the workings of male sex hormones (androgens), such as testosterone.

Though these hormones promote the growth of body and facial hair, on the scalp excess androgens may cause hair loss. Dr. Nothen believes that this is only one of possibly many genes that trigger the balding process

Some  websites about hair follicle cloning or which follow it closely are…
1. Aderans Research Institute: “dedicated to developing state-of-the-art cell engineering solutions for hair loss.”
2. Intercytex: It promotes “an autologous hair regeneration therapy, a suspension of human dermal papilla (DP) cells, for the treatment of male pattern baldness and female diffuse alopecia.” According to latest news the company has gone bust and has closed down the research operation in January 2010.
3.  Follica:  “Developing novel therapies for conditions and disorders of the hair follicle, the epicenter for the development and replenishment of human hair and skin.”
4.  Histogen:  It is marketing “a proprietary liquid formula created by the culturing of newborn fibroblasts in an embryonic-like environment and then harvesting the naturally secreted growth factors, anitoxidants and other synergistic bioproducts that are produced” that, it claims, may have “significant applications” as “an injectable for hair growth.”
5.  Luna Innovations:  It is use “nanomedicine” to stimulate new hair growth.
6.  Hair Science Institute:  Dr. Coen Gho’s clinic that claims a superior method for individual follicle transplantation.
7.  Phoenix Bio:  A Japanese biotech company that “propagates hair papillar cells which are the key element in hair growth and develops therapies that enable the implantation of these cells on patients thus regenerating the ability of the patient’s scalp to produce hair naturally.”
8.  Shisheido Research:  Another Japanese company that is doing research into hair multiplication technologies.
9.  Bernstein Medical Center for Hair Restoration:  An advanced hair transplantation clinic, the Bernstein Center also follows closely developments in hair cloning technologies and is a good source for a
“hands on” reality check on what is realistic at the moment.
10.Doctors of St Vincent’s Hospital in Melbourne and Melbourne University in Australia with the leadership of Professor Sinclair are also in to stem cell research according to latest report

 Curtersy: Doctorbersnstein's site

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Smoking, baldness and graying

smoking can reduce the blood supply to the scalp skin and thereby destroy the follicle or stem cells of the follicles by reducing the blood and hormone reaching to these follicles. This may lead to more and early hair loss and graying as well. Smoking not only speeds up hair loss but can also makes hair loss prevention medications ineffective. More over in the early post operative period after Hair Transplant surgery healing and hair growth of the transplanted hairs can be affected and smoking should be avoided for 10 months. There are 4000 poisonous chemicals in cigarette e.g. tar, nicotine, carbon Monoxide. Carbon monoxide reduces the oxygen carrying capacity of blood and Nicotine reduces the blood supply to skin by constricting the blood vessels.


For more detail visit my website http://www.goodbyehairloss.com - please contact me on info@goodbyehairloss.com

Can I use the wig for some time after transplant? I will quit once the hair grows.

You may use hair piece after 15 days of transplant with some care when the wound have healed and then remove it once the transplanted hair grows. You must know that transplant will never give you as much density as the hair piece or wig can give and there for it is better that you get the hair piece trimmed to lighter density serially before you finally quit it . But still better method s shave the head completely during the transplant and maintained like that for 4-6 months and after that and let the transplants grow with other hair thereafter.

I read about the side effects ; should I stop Medications?

Every thing you read on internet may not be written in the right perspective. Minoxidiil may be very rarely a possible cause of hepatic ( liver) damage but when it is consumed orally and not when you apply it on the scalp. Same way Finasteride side effect is mainly reduced sexual libido ( a psychological manifestation) and not really impotency or sterility ( organic manifestations) more over this is very well studied to be experienced by only 1% of those who use it and majority of the time that is experienced in initial few weeks. Most important and interesting is the sexual symptoms are reversible on stopping the medication and it has been seen that many of those who have continued in spite of the experience of initial sexual symptoms had observed that the said side effect disappeared. By not taking this you lose a chance of falling in to 99% of those who do not have such side effect and have benefit of medication. for more ref to:

http://goodbyehairloss.blogspot.com/2010/01/medications-used-for-hair-loss.html

http://goodbyehairloss.blogspot.com/2010/01/hair-loss-medication-minoxidil.html

http://goodbyehairloss.blogspot.com/2010/01/hair-loss-and-medications-finasteride.html If you have been using this medications for long time and you already had benefit if improving your the thickness and length of your miniaturized hairs you may start rapidly losing those hairs which are supported by the medications if you suddenly stop the medications. Minoxidil is better used as 5% instead of 2% for more efficiency and use twice instead of oncee a day. In my experience Instead of plain Minoxidil as you have been using; use the combination with Reti-A which is more effective and have to be used once a day. check: http://goodbyehairloss.blogspot.com/2010/01/minoxidil-with-retin-or-minoxidil.html Finasteride is better than Minoxidil in effect when used alone but since both medications have different mechanism of action there is more benefit when used in combination.

Transplant of Hair from others or animal : is it possible?

Each follicular unit of hair has blood vessels, glands, nerves, skin, and fat. It takes all this plus a growth center and the right genes and nutrition to make hair grow. Since by definition hair is an organ, transplanting the hair from someone else is like transplanting a heart, kidney, lung, etc.

One may tend to think that a person (a Family, friend or well wisher) with same blood group if willing to donate hair to another person should be an easy solution for people with hair loss but it is not that easy a solution!

Generally hair transplantation from one person to another (called Allogenic or Homologous Transplant) who could be living person or a dead person (Cadaveric Transplant) carries the similar risks as organ (liver, heart, kidney) transplants.

Transplant from the animal fur to human head is called Heterogenous or Xeno Transplant. There is a

1. Risk of rejection and failure

2. Wastes money and effort of surgery

3. Lifelong use of anti-rejection medication that could lead to further health complications

4. Transmission of some diseases.

5.It involves surgery on the donor as well

6. There are medico legal aspects to it besides ethical issues: such as possibility of people selling their hair for money in future.

Such experiment has been done before without success (http://www.hairsite.com/hair-loss-articles/article308-person-to-person-hair-transplant.htm)

Hair from a newborn baby or identical twins (they have same Genetic Blue print) might be immune privileged (it seems to work for a heart transplant), but again, who would endorse such a donor? Incidence of transplant from one identical twin to another has worked in the past but the problem is that when one twin has balding, so does the other.

There are some research indicating that Anagen Bulb part of Human hair follicle is Immune Privileged (i.e. protected from Host Rejection)

http://www.nature.com/jidsp/journal/v8/n2/full/5640115a.html ). More research may open a new vista in this field in future.

Rosati et al. reported the case that the bone marrow transplant patients could undergo an allotransplant of hair from the same bone marrow donor. Jahoda et al. (http://www.nature.com/nature/journal/v402/n6757/full/402033a0.html)

Where is our Location?

Our address: Dr. Bishan Mahadevia Dr. Mahadevia's Hair Transplant Clinic 3/A New Bhramakshatriya Society Nr. Pritamnagar Akhada Pritamnagar, Paldi Ahmedabad- 380006 Gujarat, India We are 14 Km or 45 to 60 minutes drive from Ahmedabad International Airport ( Known Sardar Vallabhbhai Airport) We are 12 Km or 25 to 30 minutes drive from Ahmedabad Kalupur Railway station

How to reach us:        If you are coming to India for the first time you need to take the visa from Indian Embassy in your country. Ahmedabad has some direct international connections from, Dubai, Sharjah, Singapore, New York, London. You can otherwise get the connection from Bombay (Mumbai) or Delhi.

For International flights: http://www.expedia.com/, http://www.globester.com/ ,  http://www.ezeego1.co.in/

www.cheapinternationalflights.net/airfares2_fs.html, http://www.airvalues.com/ ,

http://www.zoomtra.com/,

For domestic Flights: www.makemytrip.com, www.yatra.com, www.cleartrip.com, www.travelchacha.com, http://www.ixigo.com/, http://www.expedia.co.in/

Trains: www.makemytrip.com, www.yatra.com, www.cleartrip.com

Tourist Information:

Teperature43 - 23º C in summer and 36 - 15 ºC in winter

Average Rainfall 93.2 cm

Official Language Gujarati

Languages spoken Gujarati, Hindi, English

Ahmedabad:      http://www.ahmedabad.org.uk/tourist-attractions.html

Gujarat: http://www.gujarattourism.com  , http://www.tourismofgujarat.com/

India:    http://www.indiatouristspots.com/,  http://www.touristplacesinindia.com/ , http://www.toptouristplaces.com/

Visa:     check at              http://www.visatoindia.com/

Where to stay:                      

Hotels at walking distance: (N.B. Pick up and drop, on prior request can be arranged)

1. Hotel Chicago: Nr. V S Hospital, Ellis bridge Ashram Road, Ph: 079- 26578126, 26577225
Fax : 079- 26577226 http://www.hotelchicago.in (Rooms around 1500 -2500 per day)
email: chicago@icenet.net ( Sp. Note: This is closest to our clinic, reasonably priced, clean, comfortable, give good services, accepts credit cards, provide airport pick up and drop services.)

2. Hotel Maruti : Next to Hotel Chicago mentioned above (Rooms around 700- 1500 per day)
Ph: 079-26589871 Website: www.hotelmaruti.com

3. Hotel Apex: Phone: 079 26578101, 26579660 . (Room around 500 - 1000 per day). Sahjanand Trade Centre, Opp. Kothwala Flats, Ashram Road, Paldi.

4. Inder Residency: Opp. Gujarat College Ellisebridge, Tel: 079- 26560407
email: inder-residency@egujarat.net or inderad1@sancharnet.in web: www.inder-residency.com ( Higher price and facilities,)
5. Hotel Royal Plaza:
Hare Krishna Complex, Opp. Kothawala Flat, Pritamnagar, Ellisebridge, Ahmedababd-380006 Ph: 26576708, 26578235. Room rates from Rs. 600 to 1500
6. Hotel Dev Residensy:
7. Fortune Land Mark:  (about 4 Km from the clinic and rates and luxury facilities) http://www.fortunelandmark.com/  Address: Usmanpura Cross Roads,
Ashram Road, Ahmedabad - 380 013, INDIA. Phone+91 (79) 3988 4444 Fax +91 (79) 3001 4445 Email info@fortunelandmark.com
8. Taj Residency Ummed ( 5 star hotel near Air port ) http://www.tajhotels.com/Business/Taj%20Residency%20Ummed,AHMEDABAD/default.htm. Address Taj Residency Ummed
International Airport Circle, Hansol, Ahmedabad - 382 475,
Gujarat, India.
Phone:(91-79) 6666 1234 / 2286 9999
Fax:(91-79) 6666 4444
Email: residency.ahmedabad@tajhotels.com

 

Galeatomy what is it?

SCALP has 5 layers (S: Skin C: Cutaneous Tissue A: Apponurosis (Galea) L: Loose Areolar Tissue P: Pericranium) According to one theory it was believed that 3rd Layer Galea or Apponurosis which is a a tough sheet like layer under the skin tightens over the blood vessels passing through it to the skin and does not allow enough blood to pass through it to the skin. This leads to hair loss. Well this theory is never been proven. Galeatomy as a procedure is there for many years now and not new; is deviced with the hope that by cutting this constricting layer blood vessels will carry more blood to the skin and will therefore control the hair loss. This theory was never been proven and those who have performed this surgery in the past have never substantiated this belief. This procedure which I have no personal experience of has never been supported by even international association like ISHRS where hair loss specialists from around the world are active. It is also important to note that most of the scalp blood supply come from front and back of the head and not from the underneath the Galea and those vessels above the Galea and they do not have to cross the Galea. There are few surgeons in Belgium who rpomote this but have perhaps never presented their results in ISHRS.

Does FUE have less hair in the same number of grafts than that by strip method?

well there is view like that because in FUE some of the grafts (about 8-10%) can have partial extraction of the grafts due to the nature of the procedure this may extract less number of hairs. As against the in FUE we have a freedom of choosing follicles with 3-4 hairs unlike the strip method therefore total number of hairs extrcted at time may be same or even more than the same number of grafts by strip method as in strip we do not have any choice but to harvest whatever is available in the strip area.

Flakiness due to Minoxidil liquid- Is Foam better?

Propylene Glycol is often the cause for this dryness, irritation, itchiness and flakiness. Daily thorough shampoo wash and application of say Johnson’s baby oil at nighttime on alternate days on the scalp is usually beneficial. Conditioner for the dry scalp or hair can be used. Foam based preparation has no PG (Propylene Glycol) For more details check: here

Hair Transplant in Young age

The hair loss started in young age is usually due to strong genes and at times is very rapid and if you go for early hair transplant you may lose more of non transplanted hair in near future and that can make you unhappy very soon. We cannot predict your future hair loss and its extent and time. If you begin surgery when you are young, you may find your hair loss exceeds your donor capacity. Since the hair loss is recent the desire to look as it was just a few months ago is intense and it is prcticlly not possible with transplant because can not achieve the normal density.

Most medical treatments such as Minoxidil, Propecia, Avodart, etc. do not grow a significant amount of hair in most individuals. What they do often though, is slow or even stop hair loss. This is very important to you. You are buying time until we have a better solution and perhaps limiting the amount of hair restoration you will require over the course of you lifetime. This may ultimately save you money and preserve you coverage for a longer period of time. You may also slow your hair loss until such time that you become more comfortable with your degree of hair loss.

Well having said that it is equally true that having hair loss at young age also creates great mental stress because that is the age when everyone wants the best of the looks.

On the other hand if you have a good donor area and also the awareness about possible hair loss and reasonable expectation out of HT and can control the hair loss medically transplant can give you happiness although you do have possibility of hair loss and further transplant in near future. If you do consider surgery at a young age, I recommend FUE. This is the only true stand alone procedure. In other words, you can elect to shave your head down and still appear natural because you will not have a linear strip scar in your donor region. Hair Line placed in a conservative fashion in a younger male.

Minoxidill Liquid application

As for the Minoxidil with Retin-A 1ml is the dose.The best time is in the morning after bath on dry scalp. so that the effect lasts for 24 hours till the next hair wash. Do not apply on hair from the top but use it on the skin. Look skywards and allow drops to fall on the hair line area in the front the liquid will roll over to the back on the skin till the crown rather than hair. That way your hairs may not remain sticky. One of my patients taught me this.