It is really too early to assess your final results. I encourage all my patients to wait until the 12 month mark before getting too concerned. On the day of surgery, you can see every single graft that is placed based on the hair that comes out of those follicles. But those hairs are place-holders and will not grow. Once the stem cell at the base starts to give rise to a fresh hair, that new baby hair will push out the place-holder (usually around 3-4mos post op) and you will have a period of time where you may look like your preop self. All of those new hairs grow at their own pace and will emerge at differing times, leaving you wondering why your hair is now thinner. But in reality, hair cycles are SLOW and they also don't sync up with each other. An overall hair cycle (growth, stasis and shedding) can be anywhere from 3-7 years! Around the one year point, we expect that the majority of the grafts will have emerged, although some may still be very short. Rest assured that you need more time before you can truly evaluate the success.
Have you considered Scalp Micropigmentation? This may be a better option for you in the right hands. The option of transplant would not be ideal because the density needed to appear like uniform stubble would be fairly high, higher in my opinion that the density that would be needed in hair kept longer as the longer hair masks the thinner scalp. But with a great SMP artist they can achieve the appearance of stubble and it would be much less cost to you. Actors such as Vin Diesel and Jamie Foxx are great examples of what a skilled SMP can look like on the right candidate.
It is important to note that most medical therapies for alopecia are effective for a)reduction in shedding and b) partial reversal of miniaturization. So while it may reduce loss and improve the health of remaining hair/follicles, it does not REGROW hair once a follicle has failed and disappeared completely. There are no medical therapies that do that. In studies, there is very little clear data to show that zinc has an effect on hair loss to a degree that is statistically significant. And while there are studies that show low zinc levels in men with AGA, there is no known mechanism for it's contribution to balding and therefore may just be coincidental. Improving zinc levels MAY improve response to other medical treatments (finasteride, minoxidil, etc) but alone isn't known to be effective for reversing hair loss. I'm glad that you feel it's working for you but would encourage you to see a hair restoration specialist or dermatologist for consideration of other medical treatments to augement the zinc. Hope this helps.
Finasteride is effective in about 95% of patients. It takes a bit of time to see the effects as you may have noticed (no less than 6-12 months) and then the effect "peaks" around 24 month and stabilizes. Finasteride does NOT regrow lost follicles although you may have felt like it did for you. Instead what it does is a) keeps hair in the growth phase longer and b) encourages hair follicles that have miniaturized to cycle back toward thicker, more substantial "terminal" hairs. This second effect is why people think they regrew hair. In fact, those follicles were still there, they were just producing very small, pale hairs and when those hairs became more substantial and noticeable we think they are "new" . So at this point, the finasteride is probably still working perfectly fine but is just at it's peak effect and will keep your hair in it's current state for the foreseeable future, which is frankly, what we expect and the best result we can ask for. Any further "improvement" would need to be via FUE/FUT transplant most likely. On occasion, I see a patient for whom finasteride loses it's effectiveness after 15-20 years and sometimes switching them to dutasteride helps resolve this issue. But in those cases, it's an obvious re-initiation of hair LOSS. I hope this answers your question.
Each surgeon has their own preference. I personally prefer to wait at least 8 months for more complete ingrowth before working in the same area. This is primarily due to the fact that hair cycles are slow and I want to make sure that I am placing the new hair where it is truly needed. If your last transplant hasn't had time for complete ingrowth then I may be misinterpreting where your thinnest areas are based on current growth rather than waiting a few more months and seeing what additional growth occurs. So it's not really an issue of "trauma" per se but rather getting you the best result possible for your investment. I hope this answers your question.
