Speegs

5 hours ago, Legend007 said:

It’s illegal in California for a non- doctor or certified nurse to score the skin/extractions ..  that’s why diep has consistent results , since he does the extractions himself n charges $8-9 a graft ..  nothing wrong with trained techs doing the extractions , just less consistent results n not knowing which tech is working with u on that day.. but those are laws in most of the states.. 

That price has more to do with the regrettable reality that everything is expensive in California more so than the fact a surgeon performed it, the additional state-mandated regulatory burdens do likely make his overhead higher than clinics in other states.

That doesn't mean Diep isn't a good surgeon, it just means when it comes to a California location, you're paying for real estate in addition to a service, which skews the "you get what you pay for" metric that's usually a reliable generalization with cosmetic surgery.

I get generic finasteride through Walgreens without insurance for $6 bucks a month, they use the reputable generic made by Teva.

Always get generics from reputable pharmacies.

7 hours ago, bismarck said:

Just for kicks, how would you guys compare the top tier American docs for FUE (Rahal, Konior, H&W, Gabel, Diep etc) against the top tier Europeans  (Couto, Feriduni, de Freitas, Lorenzo, Feriduni, Bisanga, Erdogan etc)? For yield and to a lesser degree design.

Western medicine is going to mean nothing is too drastically different technique-wise between North America and Europe, but the doctors that do both FUE and FUT will have the leg up in experience and facilities on both continents.

I'd favor a doctor who can do both FUE and FUT for the sake of their own experience and the fact they will have the microscopes in-house to prep the grafts for optimal survival and placement.

Also, avoid any practice using a robot, the doc must extract personally.

Gabel, Konior, Hasson & Wong are the immediate names for that criteria.

29 minutes ago, Jack HT said:

It might be a good idea for me to see my own personal doctor and discuss it. I was originally prescribed it by a doctor from a large hairloss clinic in Australia who charge incredibly high prices and don’t really provide a lot of information. I will also look into that other medication as an alternative! 

Thank you all for the feedback

An educated dermatologist should suffice and be far more affordable.

11 minutes ago, pkipling said:

Justin Theroux is another great example of someone with a mature/dramatic hairline, and it's one of the most striking things about him... I'm often quite envious of his hair/hairline, and what the others have mentioned about the idea of embracing your own is very valuable advice. 

Agreed, a slight recession can be quite distinguished looking, even on a young man.

The hairline is young, need to let the hair mature a full year before we can assess the final cosmetic outcome.

It has the wiry look that recently sprouted hairs have before they settle down and tame.

That being said, it is possible a second pass to refine that hairline may be in order.

Minoxidil can be used with some effect for the crown mostly, and in tandem with finasteride may provide a one-two punch.

But truth be told, finasteride is the mightiest preventative treatment in the arsenal against hair loss.

1 hour ago, Jack HT said:

Thank you all for the feedback! Some of those styles really do suit the hairline.

As a said in my original post Melvin I originally started taking finesteride and minoxidil (7%) and saw palmetto when I was 20 but stopped the finesteride due to the side effects. Do you think it would be a good idea to continue that again?

I normally have a pretty dense/good head of hair usually, to be honest I think the hairline was having such a bad effect on my self esteem that I thought I’d see how I look bald. Turns out I have a very strange head shape.

It’s good to get some reassurance from people who have been in similar positions! So wondering guys at what point should I begin to realistically consider a HT? 

 

What side effects?

Without finasteride you'll realistically be chasing hair loss until you can lose no more hair.

Ethical doctors typically like to hold off until around 25 before operating on a patient, that gives a sense of genetic hair loss pattern and stabilization if on finasteride.

Which means hypothetically if you got back on finasteride for the next year you could be an excellent candidate to pursue a hair transplant.

No HT necessary, get on finasteride and keep an eye on things, but otherwise enjoy that lovely head of hair and your youth.

You need to observe your hair longer, if you can hold off to 24 or 25 to assess for surgery that will be best, that will give you a real indication about how stable your hair loss has become on finasteride and provide a very clear pattern of where your hair loss may be headed.

Take pics every four months or so.

Welcome, young man.

Pictures, please.

Let's get you on finasteride asap, you''re young and can possibly halt hair loss in its tracks with finasteride use, or at least mitigate it so that future surgery can be explored without dealing with total hair loss.

Please go to a general practitioner or dermatologist and get finasteride (brand name Propecia) as soon as you can.

A generic finasteride will save you money, so you should ask for that.

Just now, JeanLDD said:

I think anyone looking at the discussion would have a different view of who is being emotional and uncivil here but I'm happy not to respond to you.

I think most people here would be happy if you did not respond to them. 

4 minutes ago, JeanLDD said:

Again, you clearly didn't read what I wrote and decided to make something up. Having a "churlish" demeanor doesn't make me a troll when clearly on this argument I'm the one being discerning and pointing the facts on the matter, rather than resorting to fallacies and strawmans of what someone else is saying.  

Calling people who back their arguments with facts that you can verify (like looking at high graft count Lorenzo and Erdogan cases) trolls despite not bothering to verify them yourself seems somewhat hypocritical also.

Your pride gets you in trouble, you need to grow up quite a bit.

This is a platform for civil discussion not kneejerk emotive ranting, you have been given plenty of leash room for quite a while and it appears that has been counterproductive to letting you wise up.

You're no martyr for free speech, just an internet troll.

2 minutes ago, JeanLDD said:

It's an apples to oranges comparison, FUT and FUE are two different animals when it comes to risk because they are two fundamentally different processes. Its not an argument to just throw your hands up and say "all surgery has risk". 

And a hint, I only get enjoyment from instances where people complain about my "temper" or demeanor, typically it occurs when people figure out their argument is flimsy so have to reach for other methods to save face.

Not that in this case its a temper anyway, in general I think your posts are helpful and worthwhile so I have nothing against you, its just the tone I enjoy writing in if I'm arguing a point that doesn't seem to be getting across. I do think patients should consider and research both procedures. 

I don't have any desire to argue.

9 minutes ago, Ivery22 said:

Thanks for the response and detailed feedback.

 

Yes the HT route wouldn't be anything I'd be looking until at least being on Fin for 12 month minimum. I'm more than willing to combine SMP with a HT in the future. Harley Street clinic have actually said SMP could be something I could consider as soon as the end of the year as they believe they could create a natural looking result.

 

If I could achieve a result like the following I would be more than satisfied. Wouldn't really be looking to go any shorter than this:

 

 Do you think this is a good outcome and whether it is something I could achieve?

Regards

I am not an SMP expert, but I would err on the side of patience if a transplant is a genuine desire you want to explore.

I just want you to be able to maximize what you're working with without any regrets, I feel pre-mature SMP could be a possible hindrance to getting the best possible transplant.

Just my two cents, not gospel truth, just an educated opinion.

2 minutes ago, bismarck said:

I wasn't sure about this so I did a quick search through the forums. Lorenzo's higher count patients don't look half bad with buzz cuts.

I think we have trained our eyes spending so much time on these forums to look for the tell tale holes of prior FUE. But I don't think there's anyone that misses a strip.

 

Outside of hair transplant veterans, the general public doesn't fixate on your scars no matter how they came to pass.

If the average joe caught site of a pencil line scar on your head, which is unlikely, they'd just think you had a scar from something in life.

1 minute ago, JeanLDD said:

If you respond to someones comment, try to at least respond to something they said, rather than making something up that had nothing to do with the comment to make them look bad or pretend to yourself you won the argument.

It will not be invisible, but it will be less cosmetically significant than a strip scar, and 5% give or take going to top strip surgeons will not be able to buzz or have a cropped look period. That isn't the case for FUE without going into graft ranges 99% of patients never require or want.

Your churlish demeanor and bad temper won't validate your posts, you haven't learned that yet I see.

Surgery carries inherent risk to it, that's why you seek accomplished physicians to mitigate the chance of complications, but complications can arise from patient physiology regardless of a surgeon's skill, which is why scarring can occasionally happen even after expert care.

18 minutes ago, JeanLDD said:

I never said 6000 FUE grafts would be scarless or even close to that, difference is that that I've never seen a single FUE result from a top surgeon (and I've seen thousands, including hundreds over the 5000 total graft mark) where a person has donor scarring that renders any guard of buzzcut impossible, or with scarring visible past a month of growth, or permanent shock loss around the scar makes FUE difficult in future. I've seen plenty of awful scars from top FUT surgeons like Rahal and HnW with issues like these. It's the extent of the cosmetic risk.  No would suggest that FUE is scarless, but it doesn't carry the same risk of a butchered donor area that FUT does when comparing results by top surgeons. I might buzz down to a grade 2-3 in the next few months so will see how it looks after 6200 FUE grafts. Even 15 days after the second procedure scarring was barely noticeable, and thats without a decent amount of time to heal properly either. I've seen plenty of others at this graft level for whom its virtually undetectable even with a tight buzz. 

Understand your point for personal circumstances, however it isn't the norm that people require or want 7k grafts in the frontal third. In fact I've never seen anyone else do the same for a NW3A. As a generalisation most people don't demand or require that many grafts for their goals in an entire lifetime, nor do they quite frankly have the desire to go through 3 procedures and spend that much money on cosmetic surgery. Also the fact that your scar turned out well doesn't mean much for the 2-5% for whom it doesn't. I acknowledge that if you get the average scar from Konior, HnW etc you'd be better off than having gone FUE, but not everyone is lucky enough for average.  Also agree that use of microscopes in FUE is beneficial and a worthwhile selection criteria.

But ultimately saying its the "responsible" approach or only option for high norwoods  when there are a huge number of people getting FUE megassessions taking them from NW4-5 to what is visible as a full head of hair is delusional.  Of course people like in your circumstances might benefit from FUT, but you were lucky enough to not have bad scarring, and it isn't the norm (or even a 1%) that it takes 7k grafts for the frontal third result to satisfy them. 

If your goal is a buzzed or cropped look and you have 6000 scars on the back of your head, that will not be invisible.

Follow your physician's post-op instructions closely and you'll be fine.

You have very advanced thinning, so let's see what that finasteride can achieve in a year's time before getting serious about a surgical restoration.

You only have so many grafts and re-establishing that frontal third will be crucial, whether or not you have the donor availability to tackle the graft intensive crown is another question that a professional will have to evaluate.

It is possible post hair transplantation that a strategic SMP could augment the appearance of density in parts of your scalp, but it would have to be done very thoughtfully because it would look off if done too broadly.

So basically, hold off on SMP until you're sure you want to attempt a surgical route or not.

And even then SMP would need to wait until your grafts grew in.

Basically, you're going to have to be very patient going forward to see the best results.

Keep us posted.

Are you content wearing a buzzed look indefinitely?

Your thinning is advanced to the point SMP would look a little off in my opinion if you didn't adopt a fully buzzed look.

27 minutes ago, JeanLDD said:

The idea of starting strip and then moving to FUE after running into laxity issues is a somewhat a moot point when I have seen only a minuscule % of posters go over the 6000 graft mark to begin with. Most people don't desire or require graft numbers and results that can only be achieved with strip. The vast majority are hitting their goals with numbers below this and aren't looking for perfection or coverage in every last gap, so if the worry of scarring and wearing the donor short is any issue to you, why start strip? Take a look for yourself how many people ever in their lives go above the range FUE can provide. Few and far between, even in hair transplant circles they are hard to find.

A lot of this debate is in the realm of theoretical when real world needs on this forum don't match up. Yes we can all understand that microscopic dissection of grafts is going to be more efficient than blind extraction, and that strip will for the most part cause a lower magnitude of scarring and allow maximum usage of the donor, but if 99% of people on a hair transplant forum aren't EVER requiring graft numbers above 6000 for the results they desire, its hard to see the who FUT appeals to. Even for those that are high norwood rarely do I see a NW6 demand full coverage at all costs that would necessitate FUT, they typically end up opting for conservative graft numbers and an approach that could have been easily achieved by FUE in terms of graft numbers.

The other big consideration is that ultimately FUT is a wildcard procedure in comparison to FUE. Yes you may be the 19/20 who goes to a top surgeon and have an FUT scar that is barely visible even with a tight buzzcut in which case it appears "gold standard" having also done minimal damage to the donor compared to FUE, but what about if you're the guy that ends up going to Rahal, HnW, Gabel etc and still ends up looking butchered with a scar that shows at a month of growth and odd looking angulation separating either side? You see it on a regular basis too. It's the more "responsible" method until you go to a top surgeon and still get awful scarring.

Those are the two big questions for choosing, do you need to do FUT to achieve your desired hairline, coverage and density? (for 99% of people on hair-transplant forums the answer is a flat, indisputable no, especially when surgeons like Lorenzo, Freitas and Erdogan FOR example do better work than the vast majority of FUT surgeons consistently) Secondly would you be prepared to have a scar on the lower end of acceptability that wouldn't allow for any sort of short hair cut? 

On top of all that Bismarcks question ought to be considered too. Unfortunately no good info on it.

12

Simply untrue.

There will be scarring from surgery, the idea that 6000 grafts of FUE will be scarless is ridiculous, and 6k scars are just as cosmetically impactful as one linear scar, potentially more so, despite the marketing as otherwise.

Also, FUE benefits greatly being done by a practice that also does FUT because the state-of-the-art microscopes are in-house to check and prepare the grafts meticulously, often FUE only practices don't invest in these microscopes and the result can be that grafts aren't given every possible advantage to survive and thrive.

I was a Norwood 3A, I have fine hair and fair skin requiring more grafts than generally proposed to create a cosmetically impactful density, in the ballpark of 7k in the frontal third.

All these grafts were harvested via FUT, going forward I'd probably require FUE, since I've done 3 FUT procedures, and my single linear scar is a non-issue, no barber or stylist has found it without prompting.

So have you tried finasteride yet?

Can help you keep from losing even more hair.

FUT is still the most responsible manner of maximizing grafts for the long term.

Reputable doctors that perform both FUT and FUE will often favor FUT for large cases, and gameplan long term to maximize grafts via FUT and then turn to FUE once FUT is no longer an option.

If you have significant hair loss, it is my opinion as well as the opinion of many distinguished physicians far more qualified than a patient educator such as myself, that FUT is how you begin your journey.

It simply has your long-term interests in mind better than FUE does.

FUE is for touch-ups, small to moderate cases, or if FUT simply is not physiologically possible because of past surgeries or a lack of natural scalp laxity.

It's why you should always go to a surgeon that can do both and has a track record of performing well with either, these are the physicians that have the nuanced approach to every case that you want from your doctor.