mahhong

Was there any news or interesting information to come from this year's conference? I remember last year there seemed to be a lot of feedback from the conference but this year I've read nothing from anybody and was a bit confused!

I thought that at first but when you read the description some of the photos are less than 2 weeks out, and even the most recent ones (which look substantially better) are only a few months out. He has well over 5 or 6 months of good maturity yet - I think his results are actually going to be stellar! I also wondered about the MPB issue though; is he on preventative medication? And, if not, is the lack of MPB strongly suspected? Or has it simply been a case of the patient strongly desiring this number of grafts as a cosmetic improvement regardless of future risks?

I tried finasteride twice and unfortunately had side effects both times. The first time I was on it for about 8 weeks I think, and I reckon I did start seeing some slow down of hairloss. On balance though, if I could take it, I'd still be concerned about doing so over the long term. I don't by any means think finasteride is "poison" and I'm not against it (it seems to be great for many men!), but I do see the negative in taking it for the rest of your life. It's a financial commitment and it's something that absolutely has to be done. You can't have a break for too long a period of time and if you want to stop at any point (something I think a lot of young men will do at some point if they want kids, just to be on the safe side) then you have to say bye bye to the progress you've made. You can't just re-start again and get back to where you were. Many people take medications every day for their entire lives and manage just fine, so I don't think there's anything fundamentally wrong with it per se. But I do see permanent medication as a last resort and it is a struggle to truly justify the thought of having to take finasteride for what could end up being 40 or 50 years - just for hair. In addition, as much as it's ruled a safe drug and millions of men take it just fine, there are lots of reported anecdotal side effects and of course, no matter how safe it is, it is a case of artificially altering the balance of your hormones.. There's a good chance you never see any problems with it, but if at any point you get ED or impotence, whether it's fin related or not you'll be worried. In addition, with all the other hormonal changes going on in your lifetime, it just seems a little like riskiness to go taking the drug long-term to me. On a speculative note, I also think most men will, over perhaps years or decades, see the effectiveness of fin wear off. I honestly just can't believe that these men starting it as 22 or 23 will still have rock solid heads of hair at 42 or 43. They might have a hell of a lot more hair than the guy who isn't on fin, but I still think in the end if you want a good head of hair, you got to commit to several HTs in your lifetime, possibly more, to get it. And if you end up with fin keeping a few wispy hairs on your head, is it really worth it? These are just my personal opinions, and I'm not trying to put anybody off! But after I found I couldn't tolerate it I thought long and hard and just felt it was ultimately not worth it anyway - not over the course of my lifetime. What if I wanted kids and felt it best to stop? What if I couldn't afford it anymore? What if it plain just seemed to stop being as effective? What if I got ED or some other problem? Even if it wasn't fin related (it likely wouldn't be), I'd be worrying and probably mucking about with dosage and so forth. It doesn't seem to have much effect on the hairline either, so if you want to keep a decent head of hair that frames your face properly, HTs are still likely to become a consideration. Again, there's no doubt most men on fin will have more options with their hair, certainly in the short and probably mid-term - but over their lifetime? I still think you'll find by the time you're in your fifties or sixties (assuming you start it in your twenties or thirties), you're likely to see most of your hair gone. And people who talk about "not caring" at that age are probably not that age yet! It's an assumption to believe you won't care about your hair once you get old, and one I'd rather not make! And, ultimately, I realised I probably wouldn't be any happier, any less worried about my hair. There'd still be the hairline to worry about, there'd still be the slow erosion of my natural hair. There'd still be the daily mirror checks and research into the future of hair restoration. There'd probably still be serious consideration about HTs and concealers and all of that. I'm not on a total downer about fin (even though my post probably seems like it!), but since I can't take it anyway, when I thought about it pragmatically over the course of my lifetime, I think it'd be not worth it overall. No doubt it'd make things easier, certainly in the short term. I'd love to stop seeing my hair fall out and not worry about it so much and fin can potentially offer that. But it brings about a lot of other concerns and responsibilities with it and, as much as it's "just" popping a pill each day, it's really not that simple. It's a commitment and, truth be told, a commitment most men ultimately wouldn't really want to make unless they felt they had to. I didn't feel I had to ultimately and, even if I did, my side effects were bad enough to make that impossible. These are just my opinions, so take them as such! It's as much conjecture as reality, so if you're on fin or seriously considering it, just bear that in mind. I don't know much about the drug in the broad scheme of things, but my honest opinion is that I'm personally better off without it whether I can tolerate it or not.

I mean't more 17,000 (as an example) over several or more sessions. The only way Gho's technique is really of any use to the hairloss community is if it can offer the patient a greater number of grafts without compromising the donor yield. If all his patients are only going in for one or two sessions of 2-4,000 grafts, then he's really no different from the other leading hairloss surgeons out there, except that his reputation is not as established. As I say, for me it's black and white. If Gho can get more hair with less donor being used up, then I'm sure there will be a queue of people lining up at his door to get as many procedures as possible under their belt and as many grafts as they can. It's when I see these sorts of patients and, importantly, their results, that I will really start getting interested in Gho. Until that point all the talk and hearsay in the world won't mean anything.

Just to add some balance here, whilst I definitely believe finasteride is a very useful addition to the whole hair transplant thing and generally those on it will be better off, I wouldn't necessarily say a hair transplant without finasteride is always riskier. It's absolutely true that in most men finasteride halts and sometimes even reverses slightly the effects of hairloss - but the beneficial effects from man to man vary. Some report stellar results 10 or 15 years after starting finasteride whilst others claim after 5 or so years they're already seeing further hairloss. In short - finasteride is not an indefinite way to halt hairloss. It might slow it down, perhaps so much that even after 10 or 15 years you still haven't seen much extra loss, but it doesn't stop hairloss in its tracks. As a result, there's still a chance you could have a HT and 20 or 30 years after still have problems and either need more procedures or to live with what you have. So, in the short term (3-5 years) there's absolutely no doubt those on finasteride will probably have a better time of things but, in the longer term, less so. You're always likely to need further transplants at some point, and nobody can tell you how long finasteride will help you for - perhaps for decades, perhaps not even a decade. I only say this because I think the general consensus that goes around is that a HT without finasteride is pointless - but I don't think that's necessarily true if you understand the risks and have a solid master plan that you're able to stick to. It's almost definitely true you'd need several procedures to realise your goals without finasteride, and probably a hell of a lot sooner than the guy on finasteride. But I still reckon for those in their 20s and 30s now, whether you take finasteride or not, by 60-70 they're all going to pretty much have lost most of what used to be on their head (if they're genetically programmed to, that is). That's my 2 cents anyway. Some guys are unable or unwilling to take finasteride but I still think, with the right plan in mind and as long as the hairloss isn't too severe, there's potential benefit from going the HT route. You may need to modify or bring forward plans compared to those on finasteride, but in the long term for most say Norwood III-V patients, I reckon finasteride vs. non-finasteride patients will end up pretty much in the same place over the course of a few decades.

I concur, it's going to be a long time before we can just think about ditiching drugs and transplants and get straight in with the stem cell therapy. I have high hopes that within the next 5 years there may be one or two extra treatments on the market to help in the fight against hairloss, but that one-shot magic bullet isn't going to happen. As somebody else said; science is slow, it just doesn't work like that. Over the next 5-10 years I am confident we will see extra treatments come to life that will be able to improve and enhance what we can already do, but they will still have to work with what we currently have on offer. Hair transplants are not going to disappear overnight and I reckon you'll still need a transplant for the next 10, 20 or 30 years if you want to keep hair. You might be able to beef that transplant up with some extra therapy and perhaps get an extra 10-15% of bulk or something, but that's about the best we can hope for probably, at least within the next 5-10 years. There are no revolutions in science because things take time and have to go through such rigorous development and testing. The future is bright and the options on the horizon are better than ever, but think baby steps. We can already turn even a full Norwood VI case into a success these days in some patients, and I think the next modest goal is to make it possible for the majority of patients to be able to get good coverage and good density from say Norwood III-VI. But that still won't equal 100% density - we'll be lucky if it means only 50-60% density most likely. The "cure" is a long way off, but progress is happening all around us. I expect we'll see some interesting stuff turn up by 2016/17, but don't wait for it. Do something now and, if you're lucky, you'll be able to follow it up with something else in the next few years.

I don't think it's necessarily a case of Gho being a scam artist or not. I for one don't know enough about him to make any sort of judgement, but even giving him the benefit of the doubt as someone who truly believes he has a workable, advanced hair restoration treatment, only time and repeat results can truly give him a seal of excellence. I follow the general rule that if something is successful then it won't take long for it to catch on like wildfire. In the medical community there is often a lot of conspiratorial talk about treatments being kept "hidden" or doctors with miracle cures being suppressed and maligned, but it very rarely works out to be the case. Usually, those that find a better way of doing things will quickly be adopted into the mainstream, and those techniques become the standard of work for the future. It's like these people who put up websites saying "no need for propecia - here is a natural miracle cure!". They post up dozens of finely tuned concoctions full of herbs and natural substances claiming miracles can happen - and perhaps miracles really did happen for them. But the truth outs itself as the general public just doesn't have the success that individual claims to have had. If Gho's technique is legitimate, which I answer for one way or another, it won't be long until it takes off. Sneijder's work does look impressive BUT he's only had it done relatively recently, and it's nothing that couldn't have been achieved via FUE with a competent doctor. That doesn't mean it's not legitimate, but these are facts. The simple truth is whilst I've seen some nice work from Gho, and read a lot of interesting stuff about his technique, I've yet to see one single case that has truly blown me away - that has truly proven he's managed to make the issue of limited donor much less of a problem. Nobody has been able to point me to a case that has truly demonstrated how Gho is far and ahead of his peers. Everything I've seen has been the same 4-7000 grafts sort of work coming from many other leading doctors. Perhaps the technique is different and these guys have donor hair in spades left - but why aren't they queuing up to get another 7000 grafts put in? And then another 7000! If I went to Gho and he gave me 5000 grafts and I only lost 10 or 20% of my donor, I'd be scrambling back to him to get another 5000, and I'd be doing that until I had the sort of hair I could only dream about using previous techniques. Nobody seems to have done that - yet we're all on these forums screaming out for the opportunity every single day. Maybe in 2 or 3 years time we'll see increasing progress from Gho and increasing proof that his technique works and represents real progress in what we can achieve - but the results have to be there first. Gho might be legitimate, but I've not seen a case from him yet that makes me consider him over H+W, Feller or a dozen other leading surgeons. Now, if he posts up a guy that's had 17,000 grafts over 5 years in the next few months or years - and the work looks clean - I'd have to start considering. But even then, I'd want to see more than an isolated case. I'd want to see a whole page full of people who'd had more grafts anybody else can give them and still have donor left over before I consider Gho - and I think most pragmatic people would want the same. I really hope Gho is as good as he seems because that would be great. But it's only ever going to be results and lots of them that can prove that. All these articles and peer retractions and things might help turn some heads, but they don't equal proof of concept. We just, as usual, have to wait it out and see if the results back up the claims in the future.

Very interesting topic. I think what Gho is doing is interesting and perhaps even essential to progressing our treatment options for hairloss - whatever the results of his work may be in the long term. But, as always, patience and pragmatism are they key. Gho has not necessarily found the 'cure' and his procedure is still not thoroughly tested and proven. We're all excited about procedures like those Gho is claiming to use, but despite all the links to documents and reports and commentary, the only proof of a procedure's success is consistently good results and lots of them. There is no conspiracy as to why this sort of thing isn't yet mainstream - the boring truth is that it's just not verified as being consistently and reliably successful. It would all be our dream if something like Gho's technique does work and is reliable, but we won't know that for some time yet. There is no conspiracy when it comes to hairloss - the best and most cost-effective procedures will eventually become the gold standard. If Gho's procedure was watertight and extensively proven and understood, everybody would be very keen to get using it. But caution is key - proving something works beyond doubt takes time, patience and a degree of risk - and that is the time we're living in. So I think it's great that interest in Gho rising and we'll hopefully learn a lot more about his procedure and, importantly, the results they yield in the long term. But don't be too hasty to believe someone has found the answer to unlimited donor - it's a mouthwatering proposition, but you'll be caught short if you believe it too blindly.

This is indeed an interesting topic! I personally think very few procedures will ever truly be stand alone, if the patient's goals remain to keep a good head of hair. Although I am not "anti-medication" in any way, I do believe that the role of meds in hairloss is a lot more vague and uncertain than a lot of people give credit for. We now live in a world where many men are starting finasteride and minoxidil in their teens and early twenties in an attempt to stall balding. But the truly long-term efficacy of finasteride has not been fully verified and is, at best, very different amongst individuals anyway. There are some men who claim they've held on to the vast majority of their hair for 15-20+ years, and others who say after only 4-5 they are starting to "lose ground". It's my opinion that men starting finasteride at say 23 years old are going to still see pretty significant genetic loss at 45-50 years old and still very likely to want a good head of hair. In short, if you start to bald and want to get your hair back, transplant surgery is the only option that offers a permanent solution. And in my opinion, with the drugs not truly able to hold on to all your hair indefinitely and most men heading towards the middle or upper end of the Norwood scale, multiple surgeries will likely be needed to transplant at a density that constitutes "non-balding" across the vast majority of the balding area. Surgeons are in a difficult position; they must try their best to make every procedure "natural" but, at the same time, prepare for the very likely fact that further surgeries will be needed for reasons of either increased density or further loss. I think all patients should really be taught about the unpredictably of hairloss and that it is indeed a war of many battles. Some men may be lucky with a standalone procedure that lasts for several decades, but I don't think the man that gets 2000 grafts when he's 30 will still have the same head of hair at 50 or 55. I do think, at the end of the day, the patient can make their own decision and if they want to try a single procedure then that's their prerogative. But all patients should really be made to understand hairloss never really stops - with the current technology nobody on this earth can truly tell you "you are done losing hair". By the same token, nobody can truly tell you one procedure will cover you and meet your goals now and in 10, 20 or 30 years time. So all patients should be schooled that each procedure is theoretically one battle in the war. The battle may keep the peace for the rest of your life, but the next onslaught could just as easily be around the corner and one procedure may not be enough.

Great post Future_HT_Doc! Also, just to clarify, there have been tests performed with both plucking and autocloning, and I was referring to the pure plucking method. There has been very limited success with simply partially plucking a hair follicle from the donor area and grafting it back into the balding area (whilst the donor follicle also regrows), but the success rate has been far too low to be considered as any form of surgical procedure. Prior to ACell and other growth serums this partial plucking on the inner follicle was experimented with (though not in a large study to my knowledge) and it did produce some results, but those results were very inconsistent and could not warrant serious attention. Those results however led on to the current study of autocloning, which is what 'Future' is talking about. Results have still been mixed but they have been more consistent and we're still in the early stages, so there is hope that over the next few years greater progress can be made. I personally think there is huge potential in this field but, like Future, believe the key lies in perfecting the surgical technique and growth serum. Dr. Rassman hasn't had great success by the sounds of it, but his trial is relatively small and still unfinished. In addition there is a lot of discussion currently about the way to effectively use ACell and it would seem there are many techniques being tried out by a variety of doctors - only time will tell us if a consistently successful procedure can be developed. Cooley and Hitzig have reported with a lot more optimism on ACell and have been researching it for the longest period of time in the hair restoration community (that I know of). That doesn't automatically mean it will be a success, but it's encouraging that they seem to be learning more about ACell and hopefully improving its success in autocloning procedures. I hope the ISHRS conference will reveal some more interesting and hopeful information and believe that to be the case. Much of the next generation of surgical development is focused around some manner of autocloning by partially retaining a follicle during transplantation, and I believe it is not without reason that this looks to be developing into the next major area of surgical development. It could in theory offer the "cure" we've been searching for in its most optimistic form, but at very least should offer the chance for significantly increasing the donor available - making even the most serious cases of baldness treatable surgically. I hope within the next 3-5 years we see these early experiments develop into a coherent and successful surgical technique that allows a transplanted hair to grow without compromising the original donor follicle. That would be a gigantic leap forward and one that, on paper at least, seems plausible and possible.

Most doctors who have experimented with plucking have reported very limited success - certainly not enough consistent benefit to be worthwhile as a procedure. I think I read some doctors getting around 1 in 10 plucked hairs to grow, but that's very likely with statistically insignificant groups of people, or at least not enough data to make any sound judgement on. Some doctors are reporting more anecdotal success with ACell than Dr. Rassman has done, but we have to wait for the ends of the trials to really get a sense that anybody got them to work and, if so, how. Generally speaking though, it looks like if ACell is going to work effectively enough to be a common procedure there is still a lot of work to be done figuring out the best way to use it. So, I don't imagine plucking is in and of itself going to be useful anytime soon, but it is the basis of some interesting research - ACell being one example and Dr. Gho's work being another. The fact that some hair follicles on some people can seem to regenerate from plucking is interesting enough in itself to warrant research, but we're probably some way off from realising any benefits from that - if there are any to be had. It's good news at least that several doctors, some very reputable, are doing good research into the whole plucking/autocloning side of things, because it's certainly an area that needs to be explored whatever the outcome may be.

I agree with most of the other people here; no 'incident' would cause the hairloss you experienced. Your head and hair goes through a huge amount in your lifetime. Think of how many times you wash your hair, lie on a pillow and pull your hair, have it blown in the wind or submerged in water, run your hands through your hair, pull or have your hair pulled etc etc. Your photos show classic MPB and it's not uncommon to have it appear in the space of weeks or months in some cases. No specific incident would have causes such widespread hairloss in such a classic pattern other that your genetics. None of the incidents you have mentioned would have had any real effect in "helping" the hairloss along either - this was just the way your body was made and unfortunately that's that. It's common to try and link a negative phenomena with some sort of specific incident or personal blame - but this isn't your fault or the fault of anything else, so relax. This was always going to happen and nothing short of medication could or would have prevented it. The big question now is where you from this point. Relax and look at your options; you do have some. And don't blame and stress yourself over it. It'd take a gigantic amount of stress or trauma to eradicate your hair and a waterfall wouldn't do it.

If I'm honest with you I don't think anybody has noticed properly yet! I do use a concealer most of the time though; otherwise my crown is pretty thin and my hairline also. But it's not drastically obvious - I don't think anybody would look at me and call me "bald" (even without concealer" but it's pretty clear that I'm thinning now - certainly in the crown. That's particularly noticeable in strong light. One of the benefits (if you can call it that) about diffuse thinning is that it's probably less noticeable at first, because the "shape" of the hair remains and there's no obvious pattern to the loss - at least not in the early stages. In terms of how long it took me personally to notice my hairloss, it was fairly quick. Within two years it was pretty clear I was losing my hair and the bulk of the top of my head was noticeably less. But that doesn't mean anything in terms of your hairloss - you could bald faster than me, or you might not lose any more hair at all. Hairloss is unfortunately a game of complete chance and there are all types of ways to lose your hair; slowly, quickly, in a pattern or more diffusely etc. Regarding the thinning shears; it may be making a difference but it's hard to say. In honesty it'd more than likely some thinning of your hair, but keep in mind that doesn't always mean you're going bald.

Some people's hair does thin naturally without ever turning into full blown MPB. I've seen quite a few men in their 20's, 30's and beyond who have a full head of hair but, being the full blown baldness analyst that I am, I can see a slight diffusion across the top of their scalp. My hairloss sort of started as yours did. I remember vividly standing in a hotel bathroom in Italy, brushing my teeth at the age of 25 and suddenly looking at my hairline and just noticing a tiny, tiny "gap" in the hairline and a sort of thinness, being able to see maybe a centimetre or two "into" my hair. Since then my balding has continued to be diffuse in nature; though it is most concentrated around the crown and hairlines corners. There is relatively aggressive baldness on all sides of my family though, so I never stood much of a chance! I agree it's difficult to say where you are. Your hairline looks strong but I do see what you mean regarding the slight diffuse quality to your scalp hair. The best thing to do is talk it over with a doctor (ideally one dedicated to hairloss) and maybe think about getting on the meds (providing what the doctor says). You still have good hair though, so don't fret too much at this stage. The other option is concealer (look into Toppik or Nanogen). Concealer would work fantastic on your hair and get rid of the slight see-through quality - but personally I don't think you need it. Unfortunately only time will really tell whether this is slight thinning or full MPB. As others have suggested, looking at the men in your family will also help in trying to figure out what's going on. Best of luck!

Just to clarify I'm not necessarily asking that the thread be closed; I was just concerned it was going to become a back and forth war of words with no extra substance being added to the debate. I certainly agree the thread should remain viewable even if it is locked. TEs review of his HT is perfectly valid and his opinions shouldn't be checked. He has the right to feel unhappy with his HT, whatever the facts surrounding the procedure are - as long as H+W have a similar right to reply to him at every occasion. I just felt that, in terms of making progress with TEs complaints, this particular thread had gone as far as it could and the only next step was private dialogue with H+W or another doctor. What this thread has done is seemingly opened a massive gulf between TE and H+W - a position that is unhealthy to both parties. In addition, much of the thread revolves around accusations extraneous to TEs results. When a thread turns to accusations of misconduct then facts and evidence really need to come to the forefront and, without them, there is a danger of serious repetition in the statements being made. Whilst I do agree TE has a total right to express his opinion freely, my personal worry is that it's much easier to make accusations than it is to defend against them. TEs accusations may be 100% honest and true, or they could be total lies - none of us know that except the parties involved. But it's very cheap to throw words around and we all know criticism and complaint can be browsed over by a casual reader and taken to heart. I have seen Dr. Feller become the victim of this 2 or 3 times on here. I'm not an advocate of defending the doctors unquestionably but sometimes I feel it's unfair they can do 1000+ procedures, one can go awry, and then suddenly there are whole threads devoted to "Is Dr. X losing his/her touch" etc. If TE has a genuine case, which it's clear he believes he does, then his next step is to really level with H+W and contact the clinic. That's where the substance of the matter can be worked out. I absolutely agree with freedom of speech on these forums, however, and certainly agree this thread should remain viewable, even if further replies are not allowed.

I'm not exactly sure what you're saying here. Do you have a specific reason why you think something is "going on" and H+W. I have been reading a few posts lately from individuals claiming similar things but I can't really tell where all this is coming from. There have been a smattering of dissatisfied customers yes, but in most cases I would say the clinic has managed to absolve themselves of direct blame in an honest and transparent way. No clinic is going to have a 100% success rate, but the number of unhappy customers coming from H+W is very slight and doesn't seem to be warranting this panic and concern. H+W still look to me like they're doing almost unanimously world class work. I think the problem is stemming from unrealistic expectations of what H+W are capable of. The words "megasessions" and "dense packing" have become synonymous with H+W, but now there seems this unrealistic expectation that everything coming out of their doors is going to be a 9000 graft masterpiece of flawless proportions. Even the unhappy patients have not had bad results. Disappointing somewhat, perhaps, but not bad. There will always be patients that wanted a better result, but that doesn't automatically assume a poor procedure. This is a difficult topic because any attempt to defend H+W is usually met with a barrage of criticism about how they're "beyond reproach" or "above judgement". I do not believe that to be the case and certainly do not believe it should be. But, at the same time, H+W have had such an exemplary record and seem so committed to offering a good service to their clients that when something goes even slightly awry their seems to descend a general mood of "unease" about them - like all of a sudden something is not right behind the scenes. I don't see any evidence of that whatsoever, and would hate to see a good business unfairly labelled as in crisis.

Thanks for clearing up the issue surrounding photos, Joe! The EXIF data doesn't lie! It's a shame that an amicable conclusion hasn't and now, it seems, can't be drawn up, as it's never a good situation for any doctor or patient to be in. That having been said, the thorough documentation that Joe has sustained on the issue comprised with the reputation and results would seem to vindicate them from a lot of the accusations that have been levelled. I would agree that the HD videos provided for a large majority of the patients on the H+W website would seem more than adequate "proof" of the veracity of success in certain procedures. Ultimately this is unfortunately turning from a thread about the results of a particular patient's procedures into a list of accusations and rebuttals - and all the while nothing is getting done about the heart of the matter. TE, whilst I think a lot of people are genuinely sorry for your feelings on the procedure's outcome, a lot of what you are saying is quite serious and needs to be backed up with facts if you can take it any further. It would seem Joe has kept a thorough paper and net trail of the whole situation and that's going to be hard to counter without solid evidence for the same of the claims you made. Whilst your transplants may not have been an overriding success it certainly wasn't a failure either. But your claims of technician negligence, false promises and doctored photos are, as Joe says. quite serious. This thread would seem to have run it's course unless more evidence can be provided regarding the claims made. As Bill also suggested, if you don't trust Dr. Wong and feel you need further work then it's probably best to consult with another doctor and get further opinions on the work itself and what can be done next. I hope this can all get resolved satisfactorily for everybody involved.

It would seem this is really a matter to be dealt with privately now that both sides have given their version of the story. TE: It's a shame you were unhappy with your outcome and there is no doubt that I have seen better from similar patients, but of course on the flip side HTs are variable. I absolutely agree that H+W are not beyond reproach but not sure exactly how HTN can investigate. I don't know much about H+Ws practices but my bet would be that their surgical and support teams are second to none and, regardless of your outcome, I can't imagine finding any specific problems at their end would be the case. HTN should be with you on this though, if you really do believe there is a case to answer. I have seen good results from Dr. Wong for the most part, but I guess your opinions on his artistry are based on your own experiences and there's nothing more that can be said on that matter. Again, in regards to the differences of interpretation on consultations, promises and dialogue between yourself and H+W, this is something you can hopefully sort out with Joe and HTN. The facts lie somewhere between both parties and public opinion on this forum shouldn't be part of that I suppose. One thing I would still disagree with you on is the crown expansion, if I'm honest. Having reviewed all the photos from both parties I would say that your crown has remained relatively stable (give or take) and this "expansion" is the result of styling, minute changes in angle and a particular "tuft" of hair at the very top centre of your crown that can particularly deceive depending on the way it's brushed. I'm only going on the evidence in front of me but Joe is right; even if crown expansion does happen it's not a persistent fact of HTs. Many men have much more taken out of their donor and see no expansion. In addition; no matter how much you see your crown in photos and videos, it's not a part of your head you have personal access to from a visual perspective. You know how you feel and I don't imagine your opinion will change (and fair enough), but for my money there hasn't been any crown expansion and, if there have been any changes to the crown, it's likely a little more lost hair than some post-surgical phenomenon in my opinion. On a slightly different but related note that I do think has some merit; you raise an interesting point about the colour changes between "before" and "after" photos. Whilst I don't see how it could change the visual results of someone's HT, I would agree that having looked through the archive before/after threads started by Joe the before pictures nearly always seem somewhat paler and higher in contrast than the usually softer and warmer looking after pictures. Joe - is there any reason why this might be? I'm making no accusations but in the interests of fairness it's a point TE raised and one in which I see what he means. I know time and changes in equipment and all sorts of small changes can create differences, but looking at the skin tone the after photos nearly always seem a bit warmer and softer. Is there a logical explanation for this?

Sorry to hear about your negative experience at Hasson & Wong. To me it looks like the issue may primarily be one of yield - a factor that's difficult to pin down the problem with. On paper you had a good number of grafts transplanted and the photos post-op on both occasions looks like good, clean work. The results however are clearly not what you anticipated and you've pretty studiously documented them in some ways. I cannot see anything that Dr. Wong, or any other doctor, would have done differently (just based on the information you've provided). Poor yield is an unfortunate but real problem with some patients and your case looks to be one of those. I can't see another explanation. Perhaps the "B Team" did damage some grafts and I'm not in a position to know that, but it seems in my honest opinion unlikely they'd damage enough grafts to turn 6000+ transplanted grafts into the result you've had. Regarding the crown expansion I have to be honest and say I have mixed feelings about the veracity of this. On the one hand your photos do seem to show that the balding crown has expanded and they angle of your head/angle of the photograph do seem to be fairly uniform, lending some definite credence to your claim. On the other hand though the positioning of the hair is different in the photos, and the amount of time that has passed could have led to more natural loss. I know you say your rim of hair had been stable for years but in your "hat head" photo from your "2 Days" entry there looks to me some fairly clear miniaturization and general lack of density in the area that appears to be bald in the later crown photos. I am not trying to defend either Dr. Wong nor yourself here and I do not know the facts, so my opinion is based on observation alone. Crown expansion is not a well documented or reported phenomenon though and, even though your explanation makes sense, that does not make it true. I have seen many, many results without any documented crown expansion and fairly few with. In your case I can't come to a definite personal conclusion on what's going on, but it's definitely to your credit for documenting it as you have. Nevertheless your results are clearly not up to the standard you expected and some dialogue with Dr. Wong is merited. In addition your feedback on the whole experience has been consistently detailed and seemingly upfront and honest. But it seems to me this is ultimately a case of unfortunate circumstances rather than doctor error. I don't see any evidence of bad surgery or damaged grafts as such, and poor yield is sometimes a physiological condition rather than any sort of negligence. The fact that 2 hair transplants yielded sub-par results is, in my honest opinion, more suggestive of physiological attributes than doctor related ones, but I could of course be wrong. Ultimately though, this situation is never good and it's the patient that should be put first - especially one as thorough and upfront as yourself. Have you spoken to Joe or Dr. Wong about your dissatisfaction? They're clearly not in the game to make patients unhappy and will do their best to support you, I'm sure. As for the larger issue of whether there is or was some issue at H+W that led to the purported crop of bad results, this is something that HTN must decide what to do with I suppose. I have seen a few less than happy results from H+W, but I've seen many more satisfied customers on these forums, and of course it must be factored in that it seems HTs in general are becoming more and more popular and H+W in particular must be seeing increasingly larger numbers of patients, I would imagine. I personally don't believe anything is "going on" at H+W - but having no association or experience with the facility I'm in no place to comment on that with any authority. Once again, sorry to hear about your experience and hope you can find a solution you're happy with. If it's any consolation, based on the pictures you've uploaded your hair has improved drastically from before you had any surgery. I know you mention it looks less than realistic in real life, but the pictures at least do show an overall improvement. Hope you manage to find some resolve to this and thanks for being so thorough!

Although I would advocate taking the meds, I wouldn't say you "have" to use them to have an HT. Some men don't and get good results. The medication is no doubt fantastic at slowing down, halting and in some cases partially reversing hairloss - but they do not stop it in its tracks indefinitely. Finasteride works by lowering DHT in the body to around 30-40% of normal levels - but it does not remove DHT. Your hair is still getting slowly affected by the DHT in your body and that won't stop completely - ever. Finasteride has been shown to be effective in most men for at least 5 years and often more - there are some men who are still claiming it's working 15 or 20+ years from when they first started it. But most men will, within twenty years, say they can see their hair continue to lose ground. This will likely happen a lot slower than if you weren't on meds, but nevertheless it will still happen. I honestly believe that, if you're 24 now, by the time you're 55 you will still pretty much have lost most of the hair you were genetically determined to. You probably would have kept on to it through your 30s and maybe even your 40s, but you can't truly halt hairloss indefinitely. So whilst I broadly agree with the idea that you should get on meds, stabilise your loss and then consider a HT, I don't think this can be considered the end of the story. If you're looking to maintain a good head of hair for the rest of your life then the chances are by the time you're into your 50s, 95%+ of the hair on top of your head would be transplanted anyway. If you choose to get an HT then its a path you have to commit to. The idea that you can get a HT or two and leave the meds work their magic for the rest of your life is one I don't think holds much water. Chances are by the age of 50 or 60, if you haven't addressed the balding in your crown with a HT, then it will have happened anyway. Please don't feel I'm saying a HT without meds is normal or better than with meds (I'm not), I'm just saying that over the course of your life there's a strong chance the meds will ultimately lose ground, so that by the time you're in your 50s you'll have as much hair without the meds as the guy who took them. If you want to have an HT without meds you have to be prepared for multiple procedures and that the hairline/frontal third takes much more precedent over the crown/vertex. You also have to be prepared for the idea that, with current technology and knowledge, you'll never be able to get a lot of coverage on your crown if your hairloss progresses to a high-end NW6 or 7. If you can accept those facts though an HT without meds is probably possible - you just have to commit to multiple procedures and for your hair to be in a constant state of flux until the balding subsides and your DHT resistant hair is left - something that could take many years.

Hi Guys, Does anybody know if there are any hair restoration doctors or trichologists in the UK that can perform bulk analysis tests? I'm interested in trying to map my miniaturization but have not heard of anywhere in the UK that does it. I wondered if perhaps Farjo offered this service? Apart from their centre I don't really know of anybody else in the UK of much repute when it comes to hair restoration!

27 is not necessarily too young for a transplant but, as you rightly pointed out, there is a strong chance that your hairloss will continue to progress. Meds can help slow that down or halt it indefinitely, but over the course of years or decades your genes are likely to win the war and you'll lose the hair you're genetically programmed to lose. So the big question at 27 years old is really whether you will be happy with the results of your transplant and whether you're willing to commit to the idea that, further down the road, you may need another HT to keep the look you desire. It's not the age that's the issue, it's whether you understand the commitment and the pledge you make with yourself to start the battle and be dedicated to winning the war, metaphorically speaking! If you don't have the HT the only other option you have to keep your hair is medication (which it's likely you're already on). Medication can do a great job at maintaining your hair but it's less likely to give you great quanities of hair back and you're still likely to need an HT at some stage to get your hair back, If you've experienced enough loss at 27 to warrant needing an HT, and you're dedicated to keeping your hair, then it's perfectly acceptable to get the procedure done so long as a reputable doctor supports your decision and performs the surgery. The only other option really is to shave your head and abandon the hope of keeping hair for the time being! Hairloss is not a fair battle unfortunately, and some men experience a lot of loss even in their 20's. If you're Norwood IV now then only a HT can put you back into the NW3/2 frame - medication is very unlikely to achieve this alone. Usually the young patients are a mild NW3 and want to go back to a NW1, and that's usually when age becomes a factor. So ultimately it's about realistic goals and the position you're in now. I know men who have had HTs ages 23 and have ultimately made them a success. That's because their hairloss was dramatic but their goals realistic and their commitment strong. If that's how you feel about your hairloss, then 27 is fine to be having a HT.

I am not a doctor so please don't take my answer as absolute truth, but I believe the doctor would have used 3185 grafts based on the information you have given. Grafts can contain anywhere from 1 through to 4 follicles, with 2 and 3 follicle grafts being the most common I think. But if a doctor said he used 1925 single hairs, then I would assume each of those hairs would be a follicular unit (a graft) all of their own. I do not know if this is definitely true, but I have always believed it to be the case. A "graft" is a follicular unit of between 1-4 hairs, so you cannot make a three-follicle graft into 3 individual grafts. So the number of grafts you had was the sum of your single and double hairs I believe. Did your doctor not give you a good idea of how many grafts he thought you had in your donor area? Doctors usually assess this and provide you with a good estimate. The 6000-8000 grafts you mention are indeed about average, but there are many people who fall both sides of this estimate.

I don't know much about hair pieces and systems but my honest opinion is that your hair piece looks great. I have to agree with what Corvettester said regarding a HT being a whole new can of worms. As you know it'll require taking a strip out of the back of your head to give you a little bit of hair in your hairline. It may well soften the transition between your hairline and hair piece, but I'm not sure the sacrifice would be worth the result. Your hair piece has a very dense look to it (I mean that in a positive way) and having a few inches of natural hair at a lower density (which it almost certainly would be) seems to me like it might look odd. Even if it does soften or help with the transition I don't think the net benefit will be worth the procedure, which would leave you permanently stuck with both the scar and the transplanted hair (save a repair). From the way you were speaking I thought I'd spot the hair piece a mile off if I'm honest but it looks fine to me. I know you say in ordinary situation it doesn't look quite as natural but I'm sure it still looks great! Although I can see how the HT might help your overall look, the cost and commitment seem to me too high just to improve slightly the overall look of your hair. In addition, as much as I'm sure you have no intention of shaving down your hair at the moment, if that does ever become an appealing option to you an FUT procedure would make it impossible (unless you'd be happy showing the scar). With your level of hairloss my advice would be to stay with what you have and wait out better options. Even if you do have 6000 grafts and you use them all the best you can hope for is a thin layer of coverage over your frontal and mid sections or a denser but much smaller rim of hair for your hairline and the hair system continuing to do 80-90% of the work. That having been said it's definitely worth continuing the consults! You may find an option that works great for you and the doctors you are talking to are the best at large sessions. But my feeling is, with such a dense and professional looking hair piece, the results you'd get from a transplant would not compare, and the hairline option doesn't offer as many benefits as it does cons. To balance this post out, however, your hair piece photos look great! I'm sure 99.9% of people see your hair as very natural and complimentary to your look and I reckon you can rest assured the hair piece is doing a great job of presenting you how you wish to be seen! Hope you find a solution you're comfortable with and best of luck with all the consults and decisions coming up!

This is an interesting and very important thread, and both sides have valid and valuable points to make. My experience of hairloss (looking at others and my own) is that, very broadly speaking, there are some men who bald more intensely and obviously than others, and it is in those men the safe zones can best be identified. For example, there are many men who appear (on the surface) to go slowly through the Norwood stages; receding at the hairline and crown slightly but in a very obvious way, almost like a "wave" of hairloss that grows over time. Jude Law is one common example of what I'm talking about; he's in his late 30's/early 40's and now has fairly significant loss throughout the frontal third into his vertex, but his balding pattern is not established in my opinion. He could be an NW7 by the time he's 60, or stop at an NW4 in 5 years time. When I look at my father's hairloss, however, his was much more widespread and diffuse. By the time he was in his late-20s his whole balding area was fairly well established and now, at the age of 52, although he's lost most of the hair in this "balding area", the 'limits' of his balding haven't really changed in 25 years. In my opinion it's clear to see, in certain types of men and balding patterns, where the DHT resistant zone begins and the clear margin between donor and balding areas. Usually these men seem to have more aggressive loss early on in their lives (20's/30's) and a more diffuse balding pattern (not diffuse in the DPA/DUPA sense of the word, but diffuse MPB). I could be totally wrong, but I would feel that, like my father, in the next 5-7 years my own balding pattern will be fairly clear to a good doctor. I'm not "receding" but losing hair in a pretty diffuse way, with the temples and crown most prominent in loss. I have a pretty strong feeling I'll be a NW6 within the next 20 years (unless I do something about it), but by the same token I also feel the limits of my hairloss will be much more firmly established in the next 3-5 years than men who recede in that "wave" like fashion. I think Dr. Hasson has seen enough heads to be able to make sound judgements on the donor safe zone for individuals, which I would ultimately suggest is different on each person. There may be a commonly held "safe zone" that applies to all men, but you only have to look at two or three dozen bald men to realize hairloss is a pretty individual condition, with no two heads really being the same. There are an awful lot of men who have more (or less) donor hair than the "average" safe zone criteria, and it's really up to the doctor to make a thorough examination of the individual and plan the route for surgery. My belief is that what Dr. Hasson is doing is actually realizing and quantifying more detail in the Norwood scale, and that there's no such thing as an outright NWI/II/III etc. Those guidelines remain true, but with modern microscopic examination techniques and good patient history it's likely Dr. Hasson can fathom with a good degree of certainty what's going to happen up there on your head in more detail than the blanket NW scale can ascertain.