How good are results after FUT surgery without using the drug propecia? (Photo)

The success of a hair transplant surgery is not dependent on taking Propecia. People take Propecia for existing non-transplanted hair.  Speak to your doctor about your options.

Thank you for your question. You are asking about FUT results without taking Propecia. You state you are 31-years-old, and a Norwood 6 which is fairly advanced hair loss, and you ask how many grafts you need for fullness. Additionally, you ask about the possible necessity for a second transplant, if you would you keep losing hair after transplantation, and if Toppik or hair fibers are problematic after surgery.

I can help you with these question as they are typical with what we deal in our practice every day. I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon practicing in Manhattan and Long Island for over 20 years. I perform hair transplant surgery and I am also the founder of TrichoStem™ Hair Regeneration Centers. We developed in our practice a method of using an injection to stop the progression of hair loss for both men and women with genetic pattern hair thinning, as well as reactivate hair and improve the appearance without surgery.

To begin with your question about what would happen in terms of the progression of your hair loss, I think it is self-explanatory. You are 31-years-old and you are already in Norwood 6, your hair looks fairly thin and it is inevitable you will continue to progress.



There is a general rule of thumb when we talk about hair loss incidents called the Rule of Decades: men in their 20s, 20% are affected by hair loss, men in the 30s, 30%. So when you think about your relative minority compared to your peers in terms of your relative advanced level of hair loss, you have an early onset and relative rapid progression. When it comes to transplantation surgery, we estimate the numbers of grafts, but in practice you are limited by the actual available grafts in the donor area. Typically, a younger man with advanced hair loss tends to not have a strong donor area where the hair tends to be relatively thin, which covers less scalp than a thick hair, and also relatively low density which means less hair available for transplant.



What I tell my patients before transplant is if we are going to do FUT or otherwise known as a strip method, I’m going to take out the widest strip I can, that still allows for good closure, and provide as many hairs as I can possibly get for a transplant. Invariably, people do need more than 1 transplant and we don’t want to put stress on the closure of this scalp in the donor area, and diminish or compromise the variability of hairs that can be used in the future.



As far as the progression, before doing a transplant, you want to do something to stop progression first.  If you can’t take or won’t take finasteride, where you are in good company. The vast majority of men who come into our practice and people come to us from all over the world for Hair Regeneration treatment will not take finasteride or can’t take finasteride because they had side-effects. For men like this, I would recommend Hair Regeneration to stop the progression of your hair thinning, reactivate hairs that are not growing which is part of the characteristics of male pattern hair loss, and allow thinning hairs to shed so thicker hairs will grow in.



Maximizing the quality, volume, and coverage of your existing hair are critical before considering transplantation. Once that is established, it is not unusual to consider  doing another injection. In people with advanced hair loss, we do a second injection around 15-18 months depending on how they look, and we finally feel like we’ve used every hair follicle we can to get the best result possible non-surgically, and more importantly stop the progression. When we look at our results even with just thinning hair, we have been able to get better coverage with a non-surgical treatment than we can than transplantation, particularly with men who have existing thinning hair. One of the harsh realities of hair transplantation is collateral loss of existing hair because of the trauma of making sites. When people say they’re getting 1500 grafts, 2000 grafts, they are getting 1500-2000 holes made in the scalp, where unfortunately existing hair will be lost. A certain percentage of native hair gets lost with hair transplant. The exception is someone who has smooth bald skin. What I’ve been able to help people with is take their existing thinning hairs and making it thicker to the point where they get better coverage. With their existing hairs, they don’t have to have surgical placement of hairs and they don’t have to lose existing hairs in compromise for transplantation. Collateral loss is understated in hair transplantation because unfortunately, it is the reality and the limitation. Before we developed Hair Regeneration, we accepted this as part of the reality as losing thinning hair in the transplant would go away eventually, and we were going to replace it with thicker, more permanent hair. Now with Hair Regeneration, we have a different perspective.



Learn more about your options and what your limitations are with hair transplant. Think stabilization before you think transplantation - it is critically important, otherwise you find yourself a little older and continuing to lose hair and your grafted hair will not look so good. We’ve seen many people like that and unfortunately their hair went away too fast for their grafts to make enough impact to enjoy the benefit of transplantation. It is the harsh reality of people who have thin hairs, early onset and rapid progression. Make your decision from an informed state of knowledge before you move forward with surgery. I hope that was helpful, I wish you the best of luck, and thank you for your question!

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The drug finasteride only adds to a hair transplants by (1) slowing hair loss and (2) preventing an acceleration of the hair loss that you have as genetic balding is a progressive process. If your Class 6 pattern is already declared and you don't expect any significant future hair loss, the need for this drug is far less than if you were early in the balding process. Finasteride can prevent the acceleration of the hair loss after a hair transplant for those who still have a lot of balding to happen.