mahhong

Looking good. It's hard to say if there has been any loss or not. Since much of your frontal third was entirely rebuilt, I don't think it has anything to do with the drugs and them working/not working. When you say the hair is weak, what do you mean? That it seems to come out easily? Perhaps the hair is still quite brittle and immature - it may become softer and easier to handle in time. The result still looks great though, and you easily have another 3-4 months until you can judge the result, and probably another 8-9 months before the transplanted hair has truly settled in. Congratulations!

manfue - You should be fine. After 6 weeks you should be largely healed and brief contact with hot water shouldn't be enough to cause permanent damage. As voxman says, it's only really prolonged contact with hot water enough to cause an actual serious burn that would likely be an issue. KiranJainn - I don't think the chlorine content in your shower should cause any real damage to your scalp, skin or hair, whether it's transplanted or non-transplanted. Hundreds of millions of people are having a shower daily, often multiple times a day, and there doesn't seem to be any real consequences.

Hi Bruce, That's certainly the only way to do it properly - either a hair transplant clinic or possibly a dermatologist (HT clinic would be better as this sort of thing is their bread and butter). There's a few clinics in the UK that I'm sure would be able to help (I myself will probably be looking to do the same thing in the UK soon). Farjo springs to mind as an obvious choice and is a recommended clinic on this site. There's also a few London based clinic that may be able to help. It's worth sending them (or their patient representatives, some of whom are on this site) a message and seeing what they say. It goes without saying that you won't be (or shouldn't be) under any obligation to book anything further with any clinic you visit.

This a good work! Nice use of a relatively small number of grafts in what looks like a deceptively large area. The result looks very natural.

I think Gillenator makes a great point and one I haven't seen discussed that much either. Although finasteride can and sometimes does stabilise miniaturising hair follicles on the top of the head, and can even help them to regrow stronger and thicker, there's still a fair chance that surgery to those areas will induce shock loss or at least that these follicles will likely be the first to "weaken" against finasteride and continue to miniaturise in a matter of months or years - not only are they compromised already but they're also clearly the areas of the head most susceptible to the effects of MPB. In my opinion the major benefit of finasteride, when it comes to its role in HT planning and management, is not so much keeping what you have in the heavily miniaturised areas (though it's great if you do), it's much more about slowing down the loss in the crown area and preventing the sides from dropping further. I don't know how true it is, but I've always thought it the case that each follicle has a certain amount of "resistance" to the effects of DHT. The follicles in the donor zone are the most resistant, and rarely succumb to the effects of DHT (they may over time miniaturise very slightly but remain largely healthy and functioning). The hair on the top of the head is usually the most susceptible to the effects of DHT in men, which is why of course most MPB sufferers lose their hairline, temples, crown and mid-scalp (in various different orders and patterns). The border between the susceptible and non-susceptible DHT areas are fairly murky and ambiguous. This is where finasteride is most useful - those areas that have a mild or moderate susceptibility to DHT are going to benefit the most from finasteride, in the sense that they're going to see the most cosmetic impact from the drug over the longest time. This is really where finasteride does its job - if you can massively slow down or even stop the effects of DHT in these moderately susceptible areas, you may be able to keep the fringes of miniaturisation fairly high and this, combined with a good HT or two, can create really cosmetically acceptable results. I've always presumed that, ultimately, the hair in the areas you're clearly balding is one day not going to be there. Finasteride may be able to save some of it for a time, perhaps even a decade or more, but I think already weakened follicles that are highly susceptible to DHT are always going to be the first go in the fullness of time. If you're 33 and diffuse thinning in say a NW5 pattern, and you get a HT around the miniaturised follicles, I can't imagine that in say 15 years time at least some of those follicles wouldn't have weakened further or died off even on finasteride, meaning less density and/or the need for another HT to compensate. But the only moderately susceptible areas may last for decades or more, perhaps even indefinitely, if DHT can be consistently lowered. That's going to enable you to make the most of your donor and maximise the chance of having a cosmetically beneficial HT plan.

I think the jury is still out on exactly the risks of taking finasteride in some men. I think what cannot be disputed is that most men take it and seem to get no side effects, or very few side effects, that discontinue upon cessation of the drug. There are literally millions of men using this drug daily and we do not have the numbers to suggest it's poison for most men. Not that this is exactly a scientific or statistical data, but many of the videos on that channel have been online for over 3 years and the most views any individual video has had is 1,224. The channel itself has 55 subscribers. None of this proves or disproves anything, but it's not like tens of thousands of men are flocking to the PFS Foundation. The website PROPECIAHELP, which to my knowledge is the most well known and active site of its kind, has 3,903 members at this moment. I remember visiting that site what must have been four or five years ago, so it's been around a while. Whilst I am willing to believe that some men have experienced persistent side effects related to finasteride and I myself have my own reservations about using the drug (particularly as it's a long-term medication), I do think that the number of men who experience serious, long-term effects they are convinced is due to finasteride are fairly small. I don't think there's any exact data but it's fairly reasonable to believe there's likely at least over 10 million men taking finasteride worldwide (there's over a million in America alone, and that's according to Merck's statistics, which only accounts for branded medication) so even if there were 100,000 men in the world with definitively diagnosed, long-term PFS that would still be only 1% of users. I don't think there's anything close to that many men claiming long-term PFS, and I would also be comfortable believing there's at least twice as many men taking finasteride than my estimate above. I do welcome the research into PFS and I do believe there are a small but genuine number of men who may experience this syndrome and be left debilitated by it - it would be unfair to dismiss their experiences and claims and there's no doubt we don't have a full working knowledge of exactly how DHT works and what lowering it through finasteride may mean for some men. The endocrine system is enormously complex and nothing is completely outside the realms of possibility. However, it's also the case that Ibuprofen kills or directly contributes to the death and injury of thousands of people a year. It's not a direct comparison, but it's a telling one. For complicated reasons nobody can quite determine, some people can have a bad reaction to NSAIDs (particularly after prolonged use) and end up with GI bleeding and death, or long-term damage. And that's an over the counter drug that is also, technically, elective (albeit it not for cosmetic purposes). I think balance and fact are important here. It is true that the exact way finasteride affects every individual isn't fully known, and it's also seemingly true that the side effects can be more prevalent and more serious than initial studies suggested - though it's also important to say that most of the evidence for that is anecdotal (i.e people reading and writing about their experiences on the drug) than scientific and statistical (most studies have found finasteride to be safe and well-tolerated, whatever you think of the veracity of them). However, it's also categorically true that millions of men take the drug and most would seem to live normal, healthy lives with an acceptable libido, erection and sense of mental wellbeing. It would be unfair to suggest otherwise.

I've seen a few results on here without medication that have looked good. Just search through the results posted by clinics forum and you'll usually be able to see if the patient is on finasteride or not. The problem is, most people and clinics will probably post up their 12 months results and that will be the last you see of that case. The real issue with not using finasteride is not necessarily the 12 month result (although shock loss and weakened hair loss could be an issue) - it's where you might be in 2 or 3 or 10 year's time. The biggest problems are continued erosion of the crown and the sides continuing to lower. I'm also reticent about using finasteride long-term and I've seen good results in patients that haven't used the drug. With long-term planning and realistic goals I think a HT without finasteride can be successful but you'll need to plan conservatively and make a serious commitment to continued procedures if it does come to that.

You can get grey Nanogen fibres (and other brands too). Although I've never done it, I'm led to believe you could simply use your natural hair colour fibres (say brown, for example) and then sprinkle in some grey as well and spread them across. Might not be perfect but it could help with the illusion of greying hair.

I agree, this is a great hairline design for a mature man. How SMP should be done!

I was curious so I did some research. Finasteride was taken off the WADA prohibited substance list (the International Tennis Federation use WADA's list) in 2008. It used to be that finasteride could mask other substances but improvements in doping technology means that's no longer the case, so it's no longer banned. Technically Andy Murray could have been taking it for a while, in that case. I wonder if he does? It's obviously proven safe but at the end of the day it is an anti-androgen and will somewhat alter your hormone balance - certainly there is no absolute guarantee that it wouldn't affect performance. Would a top-level athlete take that risk? It's possible, but in a sport where every conceivable legal advantage is sought out and so much effort is taken to improve and maintain performance, would there be too much concern about the use of the drug?

I don't have loads of experience in SMP so wouldn't like to say for definite, but my understanding that SMP looks best in two circumstances: 1) When you shave really short (down to very short stubble) and the SMP blends with that stubble to make it look denser and more even. 2) When you have thinning hair but still decent density (either you haven't balded much or you've had a HT which has restored some but not all density) and you're just looking to reduce the contrast between scalp and hair and, in doing so, make the hair look thicker. In this way SMP works a bit like concealer, just creating less visual contrast between scalp and hair. I don't know what a #2 guard would look like on you specifically but, yeah, long story short SMP doesn't usually work that well when your hair is short but not really really short. Usually it will just look like dots in and around your follicles, and there won't be enough to blend with, but too much to create the shaved look. I've seen a few men go for the "buzz" look with SMP and it doesn't always look bad (and is probably pretty convincing at a glance in some cases), but generally speaking it's not the best use of SMP. I think you either need to use it to create a very short shaved look, or have some density and length to your hair and use it as a camouflage and a sort of long-term concealer that doesn't wash out.

I agree that FUE would appear to suit your goals better than FUT. You do have great donor (by the looks of it) and still some decent hair in the balding area, so it's good you're tolerating finasteride as hopefully that will keep things stable. The balding area looks fairly substantial, in the sense that you look like you're probably ultimately heading towards a Norwood 5 or 6, so I do think caution is warranted when planning procedure(s). Particularly in designing the hairline and how you approach the crown. I know it's tempting to be ambitious and find a doctor who will give you what you want, but in the long run if your hairloss does continue you'd rather a more conservative hairline with enough donor to meet your goals, rather than a lower hairline and the concern about a black hole opening up in the crown or the miniaturized fringes of your hair. I think if you did want to address the front and the back, you would probably want to do that in two procedures with a bit of time between them to assess the situation. That would probably mean a frontal third pass first, and then once the "dust has settled" on that procedure after about 12 months or so, maybe seeing where your crown and mid-scalp is at and how best to address that. If you're stable on finasteride and fairly cautious, I don't see why you couldn't address the front and the back in a couple of passes, but maybe being fairly conservative in the crown so your donor doesn't get sucked up too much there. SMP could certainly help. If you can get decent density in the front and decent coverage in the back, SMP could help blend all that together, reduce the contrast between scalp and hair and make it look thicker and fuller. You'd have to plan that all out with your doctor and the SMP technician to see if you were a good candidate, but as you're diffuse thinning and look like you have good donor, I would imagine SMP combined with HT could be a real option. I don't have any experience with Erdogan and his harvesting, but I would stress the need to plan conservatively. With most advanced cases, the best strategy is to proceed slowly and, if you have any chance of full restoration, it's likely to be through careful planning execution over two or more procedures - where you have the time to really assess how things are going. If your aim is full restoration I'd imagine you'd need to be stable on medication (it sounds like you are), and then look at fixing the front third first, building a strong but moderately conservative hairline and mid-scalp, and then seeing how your donor looks and your hair looks with a view to a second (and maybe third) procedure if the capacity is there. It may mean you don't truly reach your goals straight away, but in the long run it's the best chance you have of getting a solid head of hair without compromising donor or overreaching with your goals. It sounds like you're a realist though, and you do look to have good characteristics and a stable enough platform to meet your goals, particularly if you're willing to do it pragmatically and step by step. Good luck!

It's a difficult one because SMP will only really work in one of two ways: 1.) Either you buzz right down to a zero guard (or even wet shave your head) and the SMP just creates the illusion of having a shaved head, with a hairline and density throughout the scalp. 2.) You have good coverage but perhaps the density is a little low in one or two areas (usually the crown) and you want to use the SMP to reduce the contrast between scalp and hair and create the illusion of more density. However, if you have very thin hair, but you try and grow it out and add SMP, usually it will look irregular. It will just look like dark dots on your scalp, and won't match up with the places that are more dense. For example if you have a decent hairline and mid-scalp, but no real crown hair, trying to use SMP won't really work for the long hair look, it won't blend well. That having been said, it might be worth getting in touch with some clinics and SMP places and getting their thoughts, as they will know best what could be achieved by combining the two. But usually SMP is good if you have very little hair and what to create the "shaved head" look, or you have fairly decent coverage and density and you're just looking to add a further illusion of density - but the middle ground between those two is harder to gauge.

The biggest factor is the likelihood of future loss, when it comes to doing small procedures to fix recession. If you're relatively young, with a history of advanced balding in your family, and you're showing miniaturization throughout the mid-scalp and/or crown, doing small fixes on the hairline is going to be a bad idea. There is a strong chance you will need future procedures to address continued hairloss and you'll need to use what might end up being a limited donor supply wisely - meaning being more conservative in the design of your hairline in order to have enough donor to address future problems. Even if you're on medication and stable, you'll still need to be cautious. If, however, you're a little older, and/or you have zero history of advanced hairloss in your family, and there's no obvious sign of miniaturization or further thinning and things seem stable, there is a possibility to be more aggressive and perhaps fix frontal recession and pack hair a little more densely where it has thinned. Most doctors will err on the side of caution, however, particularly if you're still in your twenties or early thirties. Pretty much the worst situation you could be in would be to have a nice, thick, straight hairline and then see your mid-scalp and crown continue to lose hair and expand, with hardly any donor left to deal with it. That would be a nightmare situation and, if a doctor agreed to it, medically negligent too. Best to be a little more conservative and reach those goals than ambitious and completely miss them.

SMP can really make a big impact; particularly in the crown and particularly where the contrast between hair and scalp is quite high. In that photo the crown is brushed forward and that, combined with the SMP, is creating the illusion of density so well. I really like the use of SMP and HTs though, when it's combined well in appropriate patients. It can make a decent density HT look full and really just help blend everything together.

Sounds like a good plan, Grigriman! It's definitely possible to have decent crown coverage, especially if you've been a bit more conservative upfront and have planned properly. Sounds like if you've had 3,000 FUE upfront and you're happy, you're going to have the donor to address the crown adequately when you decide to do so! The crown is also the area where concealers/SMP can help add an illusion of fullness and thickness most effectively (if you want to go down that route. You obviously need at least some native or transplanted hair to do that, but I'd say the crown is where you can "get away" with illusion the best - it's the hairline and mid-scalp where the illusion of density and having natural hair is most essential.

I think Dr. Lindsey is simply pointing out the realities. If you have extensive crown loss you're simply never going to have enough donor to cover the hairline, mid-scalp and crown with good density. So, with limited options, which option is best? A low-density, high coverage transplant right across the bald head? That's just going to give you a pretty see through, balding look. Focus density on the crown? You'll just look like you've balded at the front, and you won't really have a hairline to frame your face. It will likely look unnatural, or at best just like you're a NW3 or 4, which for most men would defeat the object of a HT. Far and away the most important element of your hair, from an aesthetic perspective, is your hairline. Yes, of course people see you crown, but people will spend the vast majority of time speaking to your face, seeing you from the front, where the hairline and mid-scalp will be most important. This will also make the most impact from the most angles. It's just a reality that for men with advanced balding they're never going to be able to get great density and great coverage throughout, and there's absolutely no doubt that, in that situation, you prioritise the front third of your head when it comes to a HT. If you're repulsed by the idea of having thin coverage in the crown, or no crown work but a frontal third transplant, then it's probably best you just forget the entire thing. But there are some realities that just can't be ignored and the supply/demand aspect of HTs are one of them.

Do you have any more information you can give, ykiska? Do you have any pre-op photos? Are you on medication? How long has it been since you had the op? It usually takes 9-12 months to see proper results and up to 18 months to really let the hair mature. I agree the results do not look great, but more information will help in knowing whether the result is sub-par or whether there could be more to come. Also, have you spoken to Dr. Doganay about this? Hopefully he will stand by his work and help if it transpires your procedure really has been sub-par.

I came across this video and just thought it was interesting. I've noticed Andy Murray has been going a little thin in the crown for a while but otherwise has a pretty good head of hair. This video, which I'm sure is from 2011, has made me think he's had a hair transplant though. What's particularly interesting is that the three players (they're good friends) tease each other about losing their hair and the interviewer (who is a tennis coach called Mark Petchey) talks fairly openly about the fact he's had a hair transplant. It's really only the first minute and a half or so. Anyway I'm fairly convinced he's had some work done in the front. So far as I know finasteride is a banned substance in the tennis world, so one must presume if he has had work it's without medication. It's hard to say but his hair looks quite different here to how it does these days, where it looks pretty full and thick apart from the crown and maybe a bit of recession - it could just be a better haircut though, what do you think? His father and grandfather both have fairly extensive loss, so it's in the family. Overall though, his hair seems to look better now than it did five years ago. If he has had a transplant, hopefully he hasn't been too aggressive!

Sorry to hear it didn't quite work out the first time! It is fairly normal for a hair transplant to show some scalp - particularly towards the crown and the crown itself. If you have fairly advanced balding (NW5 or 6) and get a HT the density is probably never going to be that high, particularly in the crown area. Concealers can really help there, if you're trying to go for the full look. SMP could also be useful in some circumstances. And of course future procedures if you have the donor and the goals are realistic. It's all to do with managing expectations and realities, I guess. It's never easy to know exactly how a result should turn out but it should be up to a doctor to manage a patient's expectations and make sure he or she can achieve their goals (and that their goals are realistic). The expectations of a 60 year old NW6 are likely to be quite different to a 30 year old NW3, but ultimately both must accept the limitations of any HT they can get and plan appropriately. I'd be quite happy continuing to use concealers if I got a HT or two and was still a little conscious about density. In an ideal world I'd love to get a HT that took my hair back up to "decent" and use concealers to make it look good again - I'm realistic about what HTs can achieve but I wouldn't be happy with a thin smattering of hair I needed to cake concealer over day in/day out.

The general consensus is always that a HT should stand on its own without needing any extra procedures or cosmetics to work. For example, if you're going to need 2 or 3 procedures to truly reach your goals (if you have advanced balding, for example), doctors will generally tend to do one procedures that focuses on perhaps the hairline and some of the mid-scalp, then a second procedure that focuses on the crown and maybe adds a bit of density to the first procedure, then maybe (if you have the donor) a third procedure that increases the overall density and addresses any refinements needed. Each one would work on its own though - the first procedure might address the frontal third or half to create an acceptably dense hairline and mid-scalp, the second to address the crown and complete coverage etc. What a doctor wouldn't likely do, for example, is do a first procedure that covers your entire balding head with just 15 or 20g/cm2, and then do a second pass that doubles that density. The reason for this is that the first procedure wouldn't be acceptable by itself. The first rule of medicine/surgery is "do no harm" and most hair transplant doctors will only do a procedure they know will likely look cosmetically acceptable first time around - rather than planning an irregular or sub-par procedure in the hope you'll come back for a second or third procedure. Basically, it's an extremely long way of saying a procedure should look at least half decent by itself. Using concealer to improve a HT's look is fine, but needing concealer to make a HT work isn't, and a good doctor probably wouldn't agree to do a really low density case that needed a lot of extra help to look half decent (unless he/she was sure the patient was crystal clear on the realities, perhaps). Plus, you do need decent density to make concealers work. I don't know what "density" my native hair is at now but I reckon it might average somewhere between the equivalent of 20-30g/cm2 (less at the hairline probably) and I'm probably just about getting away with concealer now - just. But if I ever got a transplant I'd likely be wanting at least 40-45g/cm2 at the hairline and maybe 30-40g/cm2 in the mid-scalp and crown to really make the concealer work properly. Also, there's scalp micropigmentation nowadays. I think a decent HT or two with SMP will achieve your goals more effectively than a HT and concealer. SMP sort of works like concealer, at least in the way it reduces the contrast between scalp and hair. You could in theory combine all three and possibly reap even greater results, though I don't know how that would look as I'm not sure I've ever seen it before.

That's a tough one and there's a few things to bear in mind. Firstly, you'd still need at least a semi-decent density to give the concealer something to cling on to. I don't know what that density would be exactly in terms of grafts per cm2, but it would probably be at least around 25-30g/cm2 to really be able to create the illusion of density (and higher ideally). I think concealers can do a great job of increasing the aesthetic look of HTs in terms of fullness, but I wouldn't like to plan an HT entirely around needing to use lots of concealer to make it work. Secondly, concealers work pretty well in the mid-scalp and crown, particularly the crown where they can really help to create the illusion of density and even out the look of your hair. They're not quite so effective on the hairline though. If your hairline is sparse and you're trying to pour lots of concealer into it it can clump up and rest on the scalp and just be very visible unless you're careful. This is where I'm beginning to notice a problem for myself - the mid-scalp and to a lesser extent the crown still look pretty solid with concealer, but the hairline has to be handled with care because mine has receded pretty badly and is very thin in the front cm2 or so. If you're receding or have a sparse hairline, concealer will not be able to create the look of hair where there isn't really any. But certainly concealers can really do a good job enhancing the visual quality of a decent HT, and they can make the slightly lower density HTs look fuller and reveal less scalp. I would still think you had to plan a HT to work by itself and just use concealers to add a bit of extra impressiveness though, rather than looking to get a low density HT you absolutely need to use concealer with. Otherwise every time it rains, every time someone or something touches your hair, every time you go to bed, you'll just be worried the illusion has been revealed. When I started using concealers it was great because they just made a decent head of hair look good, and if they washed out in the rain or someone ruffled my hair a bit or I forgot to put it in it wasn't a big deal. Now they're probably making a fairly poor head of hair look decent, and I'm more conscious of needing to use them and have them nearby. It's not a huge deal most of the time, but if I'd spent a lot of money on one or more HTs and was still really worried about how my hair looked every time it was windy or rainy or I rubbed my head against the back of a car seat or something, I'd feel disappointed. Ideally they're (almost quite literally) the icing on the cake - if you're absolutely reliant on them just to look half-decent even after a few HTs, those HTs were probably not worthwhile.

I haven't had a HT but have used concealers consistently for the last 4 or 5 years. Unfortunately my hairloss is getting to the point where the concealer is having diminishing returns! I'm going to have to consider a HT at some point in the near future. With that having been said, I don't think anybody has ever noticed I use concealer. You have to remember that most people have never heard of it or wouldn't be looking for it. As long as your hair looks fairly convincing at a glance it will probably fool most people. Less is definitely more. If you cake it on, well, it'll look like thick clumps in your hair (but I mean really cake it on). But it can do a great job if you have a decent amount of hair and you're just looking to enhance the illusion of density. It does limit your options in terms of things like a girl running her fingers through your hair or being able to get your head soaking wet and stuff like that. In some ways it is "fake" but all cosmetics is to some degree. Granted a HT is real hair, but it's still effectively an artificial construct. Like Jeff said, the main issue with concealers is getting overly reliant on them. If you continue to lose more hair you're likely to keep using more and more concealer until eventually you're just pouring fibres onto bald scalp and that can look pretty horrid - you do need some native or transplanted hair for it to work. I think I'm still just about getting away with it but in the not-too-distant future I'm either going to have to get a HT or shave down - I'm just about approaching that see-saw moment in the next year or two!

I agree with the above. Fact is millions of men take Propecia and seem to do just fine. There are some who get side effects, and some who have claimed quite severe and persistent side effects (as your research has probably told you!). Nobody really knows exactly how Propecia will affect each individual or what the long-term effects might be. I think you just have to decide whether you want to give it a go and, if you find it causes any problems you're not comfortable with, like you say, you can always stop. There are men out there who have been on the drug for years, some 20 years or so, without apparent incident. It's a really tough one and I'm in the same boat as you. I'm deciding whether to try the drug again as I tried it briefly a few years ago and got what I felt were mild sexual side effects (they stopped when I stopped taking the drug). The truth is, though, I don't know whether these were more psychological than biological - I was aware of the possibility of side effects and this did cloud my judgement. I find it interesting from a strictly impartial perspective that the number of reported side effects have rocketed over the last few years, in line with the increased fear and online discussion associated with the drug - from a statistical perspective there is almost certainly a sort of placebo effect, where the increased discussion of the drug on forums such as these have made a lot more men scared about the drug and feeling very nervous when trying it. With that having been said, I would not dismiss the concerns entirely and it does appear that some people have been genuinely quite negatively effected by the drug, it would be unfair to dismiss everybody who has had a negative experience. It's a very tough decision. You are statistically unlikely to experience any side effects from the drug, that much is true. The possibility is there that you will, however, so it comes down to personal judgement. Not a particularly useful answer, I know, but unfortunately there really isn't a clearer one.

All great advice here. It's not so much you're getting contradicting claims, it's just a difference of medical opinion. Some doctors will perform operations that others won't, or feel comfortable making suggestions that others wouldn't. It's all to do with expectation, really. If you're genuinely going to be happy with decent coverage and a mature hairline, and you're fully understanding there may be limits on the density that can be achieved and the high likelihood for multiple procedures to keep up with continued loss (and a plan that errs on the side of caution knowing that), there is a possibility you could develop a modest but effective surgical plan to achieve your goals. As many have said, the main issue a youthful, dense appearance is unlikely to be realistic, and the big issue for many young men (<30) is they are either unhappy with their outcome, or they go in desperation to a doctor that fulfils their short-term goals at the risk of long-term problems (continued loss, not enough donor to meet demand, irregular hair etc.). Another potential option to research is SMP (scalp micropigmentation). This is used primarily on shaved heads (very shaved) and is a usually temporary tattoo that gives the illusion of a man with a full head of very short, shaved hair (apologies if I'm telling you something you already know). It can also be used to create the illusion of density in conjunction with hair transplants, but this is trickier and needs more planning. However it may give you a youthful looking hairline whilst retaining the shaved look (although you'd probably have to shave down shorter). The main thing is hair restoration is essentially a life commitment. You may need several procedures, you may need to have very modest goals, you may not be able to achieve all you want to achieve and the lack of stabilisation with Propecia throws even more uncertainty into the mix (especially because you're quite young and heading for the higher degree of hairloss). The main thing is you probably have to presume you're heading for quite an advanced degree of balding (particularly without medication), see what is realistic for what you can afford and the sorts of characteristics you have (donor density, hair type etc.) and then have a look at examples from doctors that are likely to be closest to yours. With this information you can then decide if your goals can be realistically met and search for a reputable doctor that understands your ambitions and shares your belief they can be met. The two of you can then execute the plan (if it's possible) and hopefully your results will match your ambitions. If that's likely to be impossible, however, then of course you need to be frank with yourself about whether it's worth embarking down the hair transplant path.