This patient had grade 3 baldness with a receding hairline and temples. The donor was good. The patient always had a broad forehead, so we mutually agreed to keep the hairline high.

We can’t go for a lower hairline at a young age because that can lead to overconsumption of grafts. We must accept the fact that male pattern baldness is progressive and we need to preserve the donor for future usage. Whenever we design hairline, we keep following factors in mind:-

• -The age of patient
• -Pattern of hair loss
• Family history
• -Previous treatment history
• -Patient’s expectations
• -Structure of face

Both the options were possible in his case, FUT & FUE. After a thorough discussion, the patient opted for 2000 grafts by FUT.

The surgery was done using trichophytic closure technique, so in the after results if you see the donor area, there is no scarring visible. A lot of people are worried about the scarring of FUT, which is a propagated myth.

Moreover it is important to understand the fact that, had we done an FUE surgery for him, the same 2000 grafts would have given him more hair & more density.

It is because of the fact that we can cherry pick multi-hair grafts in case of FUE. The grafts in FUE don’t have fat tissue, as compared to the grafts of FUT which are bulkier. So, it is easy to place more grafts in a smaller space in case of FUE, which gives more density.

The patient was not put on finasteride, he was prescribed 2-3 times/ week application of 5% minoxidil. Adding finasteride would have further improved the result by improving the thickness of miniaturised hair and would have given a more aesthetic look to the hairline as it grows a lot of softer hair in the hairline.

All the hair grown by finasteride is credited to the hair transplant surgeon & hair transplant surgeons happily take the credit for the work which finasteride is doing. This not only misleads a patient but other people also who are interested in transplant. They overestimate the results by that particular clinic and expect the same for them.

Finasteride works on five aspects of hair transplant:

1. Area coverage: Improves hair even in those areas where no hair is implanted as miniaturised hair gets thicker.
2. Density: Improves miniaturised hair in transplanted zone as well adding a great deal to the density.
3. Hairline Aesthetics: improving the thickness of miniaturised hair in the zone & would have given a more aesthetic look to the hairline as it grows a lot of softer hair in the hairline.
4. Thickness of donor hair: is also improved significantly with finasteride & it is more obvious in thin donor zones right at the top or the bottom of donor area. It may create a false impression in the mind of a patient who may think that the donor area is still looking good even after extraction & actually it is almost gone or very much thinned out.

5. Thickness of transplanted hair: It is important to note that even the transplanted hair becomes thicker when finasteride is given at high dosage. The effect of medicine on the thickness of transplanted hair is directly proportional to the dose of medicine. This again may create a false image of a wonderful hair transplant result, which actually might be very ordinary.

People who are happily giving testimonials to the clinics, don’t even know that these results are not going to stay long & premature use of the resources like donor and finasteride can hit their long term prospects badly.

Finasteride can have issues of dependence & tolerance as well. Patients who once start taking it, can’t stop & if stopped, it leads to severe rebound hair loss. Even if somebody keeps taking the medicine, finasteride may stop working on his hair after one point of time because of tolerance. There can be issues of potential side effects like erectile dysfunction, loss of libido or gynaecomastia.