GoForIt

To start with - pilofocus is a way of harvesting the graft from the other side - you will still get scars from where the instruments are inserted, just smaller and shorter. Hair style issues aside: 1. For strip, you need to not put stress on the area for a month to make sure the scar does not stretch. If you cannot take it easy for a month, then FUE. 2. Recovery for strip is longer. 3. Large FUE sessions push the envelope as to the safe donor area. If the harvesting is not done well you can end up with a moth eaten and patchy appearance of the donor. 4. Even though you can do larger strip sessions - the narrower the strip removed, the fewer issues with a stretched scar. 2 moderate sized sessions may be better than 1large sessions - though some surgeons are able to keep the scars narrow with large strip sessions. I think the bottom line is if you have never kept your hair very short, can take a few weeks and not put strain on the back of your neck, and are likely to need more than a few thousand grafts in your lifetime, and do not have an issue with scars stretching, the extra cost of FUE is not likely worth it. Like previously said, there are good physicians who do both, but far fewer physicians who do FUE well.

My thought is there is little to no chance that the company will go for the indication in the US. Finasteride is generic and has the approval. While the trials show dutasteride is somewhat better, it isn't a slam-dunk. If I were the CEO of the company making dutasteride, I would look closely at the experience with finasteride. The company didn't make much money off it for the MPB indication, and now has the headache of dealing with complaints about side-effects. A three month supply of generic finasteride (5mg tabs, cut into fourths) costs between $15-$30 depending on where you buy it. This is what dutasteride would have to deal with economically. As the CEO, I would not invest the millions (probably tens of millions of dollars) it would take to get FDA approval for that indication, but rely on the fact that patients would request it and physicians would prescribe it for the off-label indication. The company would also have no liability for any side effects if the drug were prescribed off-label. Long story short, there is no economic incentive for the company to do this. They've done some trials hinting it may be a little better than finasteride, the drug is on the market, and physicians can write a prescription for what ever indication they want.

Hi, To be honest, I think you have a pretty good hair of hair - you have a bit of recession in the front and perhaps a little thinning in the crown. I would strongly advise you to start finasteride and minoxodil. At worst you'll look probably have the same amount of hair in a few years (which would be as much or more than most 30 year-olds), but there is a good change (over 50%) that you'll grow some hair and/or thicken up the existing hair. If in a few years you want to tweak thinks with a hair transplant, you will be in great shape.

Hairline looks great. If it is transplanted too high and does not frame your face why bother with the HT? You have nothing to explain or justify to anyone but yourself. If it really worries you, go yo the gym and get fit and they will notice that instead . . . Or if you are fit put on 50lbs . Do not do the 50 lbs thing btw!

I was on minoxidil for a while before starting finasteride. For the first 3 months my hair thinned quite a bit - but no one said a thing, no one treated me differently. I do not think they noticed. Starting month 4 I thought my hair looked a little fuller /thicker and I started to get complements on my 'hair cut'. This continued to slowly improve uNtil month 6, and now my hair seems to be improving rapidly month to month ( at month 8 now). What is 3 months of thinning hair to years of better hair? One study of finasteride even showed men getting continued improvement over 10 years!

I briefly considered Leonard - but this post makes me glad it was only a fleeting thought. 5mg finasteride costs about $20 for a three month supply (cut in quarters). I get it from my PCP. Get on the train or fly to New York - see True & Dorin, Feller, Wesley, Bernstein, and there are a few others. I visited with Dr. Beehner and really liked him. He has been doing this for years and I think has a real talent for getting the most out of a limited number of grafts as well as anticipating future loss.

Bald heads just look bigger than heads with hair.

Don't mess with them. When the hair starts growing in a few months it will push out any unattached grafts. Have you called your doctor's office? Just wash your hair, style it, and try and ignore it for a few months! :rolleyes:

Yes, you can count hairs (or FU would be better). Pick an area of completely bald skin, put 4 dot tattoos at the corners with an area of 1cm, 2cm or whatever, and count the yield based on how many FU were placed. This is how the studies on finasteride and minoxodil were done - and there are a few studies out there on various techniques for hair transplants. There is so much hype in the FUT vs. FUE debate - but so little substance. Each physician I consulted with said that you can get great results with both procedures, but that the results for FUE were more variable. And then there is the motorized versus manual . . . . I know some physicians post excellent results here for FUE - but how many bad results not posted were there? This goes for FUT as well. We only see a snapshot of the physicians' results, the ones which came out the best. I wish we could see how consecutive patients do - and whether a physician has a 1% rate of bad growth vs. 10%. Come to think of it - it would be such a service to this community if the physician members here could audit each other regularly for consecutive patients. Based on the level of growth and the number of grafts transplanted they could rate the results as excellent, good, fair, or poor, and then the results be a part of their profile. Talk about a pipe dream!

I would walk away. If this were done at your initial consultation - fine - you could make a decision. It is probable ok, but I can feel your unease. There is a right and wrong way to do this. This is a really personal decision to trust someone to do a elective procedure on you. Listen to your gut. You could ask for another consultation with him present and see how you feel about it. At a few places I consulted they were training people, but I knew who would be doing the transplant.

I would have to disagree - I think there has been a real improvement. He now looks in his late twenties. I hope he is on meds.

I just wish there were less opinions on this and more facts. It wouldn't be too difficult to actually document the yields of different procedures. My sense is that FUE, especially manual, has more opportunity for poor yields than FUT, but that some surgeons are very skilled and overcome this by their techniques. In theory, I can see a robot making the recipient holes as a good thing - controlling the direction / depth precisely to restore a natural hair growth pattern. While many surgeons are excellent at this - looking at some of the cases here this is not universal. I think HT transplant patients should begin demanding that these techniques be rigorously investigated to demonstrate that they're equal, or better. While seeing results is important - how many cases aren't posted due to poor results for all the great cases posted here?

In NYC there are Bernstein, Feller, True, Dorin, and a bit north of NYC Beehner. There are a few more in NYC. Visit a few - and think about starting finasteride and minoxidil. All the convenience in the world is not worth a bad hair transplant. No one thinks a bald(ing) man is unusual. You might look better with a full head of hair, but you will look better bald than with a bad HT. Good luck.

Just noticed your profile - are you really a Norwood VII? If you are, you're going to have to be really careful who you see and what they say they can do for you.

Don't limit yourself by geography - go to the right physician. On the eastern seaboard from VA to NY there are world-class physicians. In the end, if you're going to spend thousands on a transplant, what is a few hundred dollars for a hotel room or a train/plane ticket, or even a couple hour drive home the next day?

Hi, Looking at your vertex it looks like you may be thinning there as well - but it is difficult to tell with the shorter hair. A HT is not something which should be done on such a limited budget. You can get a balance between quality and price - but with that budget it will likely be low quality. How long have you been on the finasteride? Perhaps see how things go for a year or two and when you are out if school and can (hopefully) afford more rethink the HT?

Reminds me how much of a boring life I lead. Sounds like a mess from the link!

I remember seeing this when I was researching hair transplant surgeons - an amazing result. I wish we knew what the graft survival was for varying sized procedures - even if it was only 80%, with 8000 grafts placed that would still be a 6400 graft procedure (and would look great). I really don't know what the balance between getting it done in one procedure versus seeing the results from the first procedure an planning the next session based on that. This is most definitely a home run. I think I'll be happy just to win the game .

You don't have to take medications after surgery. The goal is hair restoration - not necessarily through any one means. There are surgical and medical, and the combination. A good hair restoration surgeon will likely advise you to take finasteride if you can but will not necessarily plan the surgery around you taking it. Finasteride can stabilize hair loss, if not regrow some hair in the majority (>80% - 90%) of people taking it. Combined with a hair transplant, you would have the best chance of the 'fullest' head of hair. If your balding stops at a Norwood 3 - then it wouldn't matter. If you are a norwood 7, it wouldn't matter. But hair loss is usually progressive without medicine. With medication it may progress, but much slower. So - if you can't take finasteride, you can still have a hair transplant. The final result may not be as good (if your goal is a full head of hair) as if you took finasteride and you may need to go back for more surgeries as your hair loss progresses (with finasteride this may be the case too, but likely it would take longer to need another surgery). Just let the surgeon know that you're not taking it and can't take it so that you can plan what will give you the best cosmetic result.

It is really important to look at pictures from before and after. I have been on finasteride for 7 months now, went through the thinning and now have quite a bit of growth. I was a 3V when starting. My 'V' in front looks more pronounced - but I was having thinning on top and this has thickened up making the contrast between hair and no hair more dramatic. :rolleyes:. The crown is responding well - but apart from the V in front I had quite a bit of hair (though miniaturizing) when I started finasteride. I've seen this with HT too when people have only had the top done (not the crown), where the new hair on top accentuates the crown baldness, whereas when they had no hair on top, the crown was not so noticeable. Some objective pictures might help, but my experience is that it really improved areas I had hair making the contrast with the V in front greater.

Dr. Beehner talks about this on his website, and how he transplants hair if he's worried about this happening. Read about how he describes a forelock pattern for the transplant. It pretty much addresses what you're talk about - how to make a transplant look natural in this setting.

Hi, It's great to see how far you've come and how good your hair looks today! We see all these great results 1 year out - but not too much about how transplants stand the test of time. Your hair will look great in 10 years time I think as well. I have to laugh at all the people here who makes comments like HT aren't for people with advanced hair loss as they never look good. To be honest, you don't really look that much older (if at all) than you did in your preop photos (you didn't look old in those)! Congrats!

If you look on Dr. Mike Beehner's website (can find his website on here or googling), he has quite a thoughtful discussion of the issue when he talks about transplanting in a "forelock" pattern.

Sorry to hear about your hair loss - it's not easy at any age for some of us, and at 18 . . . The problem with a HT is that you are not going to get a thick head of hair. Given your level of hair loss, the best a HT would likely do is put a bit of hair on top and keep your crown bald. This is perfectly acceptable for a 40 year-old, but not an 18 year-old :cool:. If you haven't, and you feel ok with it, get on finasteride to preserve what you have and maybe grow a bit more. This may keep options open in the future. The shaved look looks good on you - to create the illusion of more hair you could consider temporary scalp pigmentation, and see what a few years brings. The beard looks good (frames your face well), and think about hitting the gym (adding to my list of things to do)!

My understanding is the Pilofocus device /technique is a way to reduce FUE scaring by creating a cavity under the skin and harvesting the grafts from below rather than from the surface. According to his website he is doing trials and applying to the FDA - so legit. There is no donor multiplication involved.