Roy Stoller, DO, FAOCO, FAAO

Hello:

  Large mega sessions are driven by a patient's desire to have "one and done" hair restoration surgery.  No one can predict future hair loss 100%.  Over harvesting of donor, limits the use of donor hair to address future loss and does not allow for corrections if necessary.  My training in facial plastic surgery taught me a respect for tissue and that surgery causes trauma to the body.  A 4,0000 graft FUE would potential mean 8,000 incisions and excisions. At 1mm each, that is a lot of trauma.  The percentage of grafts that survive would be lower than the survival rate of smaller FUE cases. In other words, more hair grafts will die with a mega session.

There is known adage: "You get what you pay for." It is important for a patient to view hair loss as any other disease process.  You need to follow up with your surgeon after surgery and develop a continued relationship of trust and guidance.  I believe that independent physicians dedicated to hair restoration medicine fit this model best. If cost becomes the main variable, you might end up with less in the long run.  Good luck.

Like any other organ in your body, the antigenic make up is pretty specific to person.  When another's antigen is introduced into some one else, antibodies attack these foreign antigens and rejection of the organ occurs.  A similar response is seen in allergy patients to environmental antigens.  The only way to combat this response in organ transfer is to take anti rejection medications which can have severe complications, even death.  

Interesting, when someone's own hair from another part of their body is transplanted to their scalp, over time we see change in the texture that is more similar to scalp hair.

When a medication is working well, without side effects, patients are encouraged to stay on them.  Not everyone responds to Minoxidil and some patients have difficulty applying it twice daily.  I would caution you that starting and stopping Minoxidil can cause prolonged and excessive shedding.  Although there are some alternatives, I would suggest you consider sticking with Minoxidil since you are having good results with out problems.  

With the use of Platelet Rich Plasma or PRP in my practice, I have seen patients' hair growth improve. There are no studies that have shown the addition of Acell or Adipose cells yield better results.  I think twice about adding an animal product made of porcine bladder to a serum that is injected into my patients' scalps with no proven benefit.  To obtain fat cells, aspiration similar to liposuction needs to be performed.  The addition of Acell and fat cells, without any proven benefit will just increase cost and possible complications.

Propecia works by lowering DHT (dihydrotestosterone) levels. This hormone is the culprit that in thinning and eventual hair loss seen in male pattern baldness.  Since hair cycles between a rest and active phase, Propecia will effect cycling time.  When hair is in the rest phase, telogen, hair is asleep and not growing.  I have seen patients cause a longer than usual sleep phase which results in shedding.  Patients need to make a commitment when starting Propecia to stay on it unless side effects ensue.  You could be less responsive to Propecia than before or the thinning you are experiencing could be secondary to increased shedding.  It would be a good idea for you to follow up with your physician.