JayLDD

If you see an eaten away, non symmetrical frontal area with miniaturisation throughout and think it is a "non-balding" head no offense but you should reconsider whether you have enough experience with this to comment. Obviously not the most extreme balding in the world, but its very clearly occurring. Lack of finasteride and seemingly thinning crown towards a 3V pattern makes a transplant at this stage too risky. Potentially in a few years go for a full hairline reconstruction and crown work when both have opened up a bit more. If you can't achieve meaningful coverage you'll end up with visible holes behind the transplant.

Totally agree and think this is the most sensible rationalization I’ve seen.

He is obviously a capable surgeon but the ratio of positive/negative results and clear instances of low quality work are clearly telling. OP that post is a mess and overlong but at the end of the day the sentiment is sound. I would say the same about a variety of other doctors however.

I could give a more complex answer with specific standards, but to be frank his results look absolutely awful and even what he presents on his own website (which is presumably going to be his best work) shows a variety of what I would consider failed cases, unnatural results, extremely low densities and overall aesthetics that fail to match even mid level standards of top surgeons from this website as an example. If a doctors before/after photos look like they're from the 90s/2000s, are only from a single angle and aren't consistently HD you can almost with 100% certainty infer that they are a low quality doctor, of which Pak neatly fills the role. Compare his website, before/afters both website and patient and general densities with clinics here like Hasson/Wong or doctors like Freitas and Konior. Pak is not fit to shine their shoes. This might sound overly aggressive, but I firmly believe that hair transplants is an extremely difficult field and as a consumer there's a relatively small list of surgeons with a cost/results level to EVER be considered, Pak isn't at this level and only has a presence online due to his RS spamming.

Imo this is 1000-1200 grafts placed at best. 2700 hairs maybe, not 2700 grafts. For the area you covered for good density you needed in the range of 3500 grafts, you probably got about a third of that. This is going to be a required repair job, almost zero doubts. There's a zero percent change of good density. Would recommend much broader research in terms of future surgery if you go back, even if your budget is low this clinic was not at a reasonable standard.

If they become a chain and train other surgeons to operate at a variety of clinics with their standardised techniques it would realistically only be a positive thing for the broader industry. I would never recommend someone go to a chain, but even if they begin to operate a set of other clinics I assume you could also stick with Bansal and Sethi as you mention anyway. People still in general go to piss poor clinics and chains globally, maybe even a large majority. Don't like the chain? Don't go, reality is these separate clinics would likely do better work than average anyway and likely wouldn't be tailored towards people who spend heavy amounts of time on forums doing research for the cream of the crop, but rather servicing local demand with a brand name and standards higher than the typical Bosley or Advancedhair etc. Which again can only be positive.

In my personal opinion the temples assuming good growth should look natural, however I think almost certainly a large portion of grafts in those areas are wasted and a less is more approach here would have been better. I also think the temple point placement reflects a lower frontal hairline than you’ve received. Ultimately this could be fixed by lowering the hairline with a secondary procedure. I don’t think in any universe that the planning here is perfect or even justifiable, but I also think it’s likely you look better after this procedure than prior and would expect it can still look natural. Those with weak donors and existent but non prominent temples such as OP in my opinion should opt to avoid temple work altogether, too high risk and costly in terms of grafts for a good result and too low reward. A simple frontal hairline lowering here and more aggressively would almost certainly look better here, I’d bet my life on it.

I think its feasible you received 2500 *hairs* which potentially they are substituting for pricing reasons. Obviously a bottom tier clinic, not sure why you would ever go to Columbia for surgery, even with extreme budget concerns there are much better options in Turkey. The reality is you have one of the best FUT surgeons in the world Dr. Wong in Canada and the price of FUT in that case isn't even particularly high. If you end up needing a repair, consult with a clinic like Hasson and Wong that are doing serious work, if you end up with scarring issues they will also be able to aid in rectifying this competently.

I took 0.25mg daily and side effects slowly crept up after about two years before I got off it. So you can't place that much stock in the drug in the short term, that's the problem. The reduction curve of DHT doesn't change much from 0.25mg to 1mg, so even if just for the sake of cost savings its always best to quarter the pill. To be blunt, if you suffered side effects in the past I'd recommend you don't push it. As I mentioned no matter the dosing pattern or doseage itself the reduction in DHT will be similar, if your body can't tolerate 1mg I'd avoid it entirely. Don't push it when your body is clearly telling you to avoid it. In terms of graft numbers, basically *any* hairline procedure with good density is going to be at minimum 1500 grafts. Simply because it requires a lot of single hair grafts and the frontal hairline requires the highest density across the scalp. Any less and it will begin to look a little pluggy or unnatural as your current hair behind it is still quite youthful and dense. Its less about age and more about the possibilities you're setting up with the procedure and the potential risks it might create. A small hairline procedure (even 1000 grafts) is the riskiest procedure you can possibly do because it means you're going to create a dense, healthy hair barrier at the very front meanwhile everything behind it is miniaturising. A strip of hairline isn't going to give you coverage to cover up thinning hair, hence why ideally your first surgery should cover the entire frontal third, or at the very least you should be budgeting and planning for two surgeries over say a three to five year period. Its not a matter of 2000 grafts being aggressive and that you should consider say 1000-1500, its the TYPE of procedure for someone in your position that is young and hasn't tolerated finasteride well is high risk and keeps you on the hook for future surgery. What you want is to tackle the frontal third with 3-4000 grafts when you actually have significant losses at the point where you're a NW3+. Freitas certainly knows what he's doing but he's going to have an expectation that you have made an assessment of the risks and at the day he's not going to babysit you over those potential problems. At the end of the day problems arising that I've mentioned will have you on the hook for more surgery, and he isn't going to worry about this. I think the best thing you can do is wait a few years until you're clearly a NW3 and can fix the entire frontal third and in the meantime budget for multiple procedures, enough to pay for 6000 grafts with a surgeon like Freitas. I wouldn't bank on finasteride. Money and willingness to do multiple surgeries with back up plans are more important than anything here. In terms of another individual here saying that you might not have genuine hairloss, they have no idea what they're talking about, you should absolutely be preparing for significant losses over the next five years and at the very least be using something like a ketoconazole shampoo to inhibit that (in general circumstances I would also say finasteride, but because you didn't tolerate it previously I wouldn't lean in that direction). Why do I say that? Because you clearly have miniaturising hair in the frontal hairline and from what you've said the crown as well. Also the recommendation of visiting a dermatologists is pointless, for the most part they'll have no idea what they're talking about, from the photos and what you've said its clear you have male pattern baldness, you don't need a doctor to tell you this, nor for them to tell you about treatment.

If you'd done extensive research you'd know that surgery in your current position is a bad idea in terms of risk/reward, a 2000 graft procedure even with your current hair would be undeniably hyper aggressive and set you up immediately for future surgery in the short term. When you're not on finasteride that 2000 graft hairline (mainly temple rebuilding) will have bald spots nothing behind it within 2-3 years potentially. Filling in only small temple areas is NEVER going to result in a long term natural appearance without future surgery and should rarely be considered, at your age and without finasteride it should almost not be considered at all. If you were closer to 40 then its a different story but you're not. What you want is a situation where you can cover the entire frontal third including the centre, not just fill in recession. That way even if you have further loss of hair you'll be left with something natural that doesn't force you immediately into future surgery to not look like a freak. Think about through visualising how your hair is going to decay over time once you have the surgery, not to mention the potential for permanent shock loss around the area of implantation that would rapidly require you to be in the surgical chair within even a year. No one has strong temples and a decaying frontal tuft, and that's going to be a problem. I might sound overly harsh, but in particular the idea of levelling your temples with the centre tuft of remaining strong hairline is nonsensical at your age with your level of loss. You're going to be left with corners of the hairline with strong, transplanted androgen immune hair and a wispy centre that is pulling back, a recipe for disaster unless you're 100% willing to go back for future surgery within a year or two. I know the body dysmorphia effects hairloss can have at your age but to be very clear you would barely look to the average person like you have hairloss. There are plenty of people with naturally higher hairlines than you currently have and mature hairlines (which you're not all that far beyond) are common and will only become more common for your peers over the next five years. Its not "over" for you (yet) as some overly blackpilled individuals online might suggest. The idea to fill in only a small amount of temple recession when your central tuft is going to be miniaturising and potentially substantially within a few years without finasteride is idiotic, period. Wait until the point where you're a clear norwood 3-4 and can replace the entire frontal third. If you have rich parents who are going to pay for your current surgery with a high level surgeon like Freitas and then happily pay for a second surgery in a year or two if you further lose hair, then its still somewhat viable. But you should be absolutely aware of and willing to deal with a potentially necessary second surgery within a few years to keep a natural appearance. Also for the record I was still one of the youngest (if not the youngest that I'm aware of) patients to have FUE at my scale. I went more aggressive than almost anyone on this forum would advocate for at that age (and also had to get off finasteride) but the key was that I had back up plans for things like low yield or further losses mandating rapid future surgery. I also had more than enough in funds at the time to have even 3 surgeries within a five year period in the case I needed a repair. You've got to be willing to and have the money for multiple surgeries and potentially to go down the FUT route if you have a poor yield and require a repair when you're already on on finasteride. If your parents are loaded or you're a crypto baron then I'd probably just have surgery with Freitas in that case. Although even then risks should be seriously considered. If you're not in this position not only is it a gamble, you WILL be on the hook for future surgery due to an unnatural appearance.

ASMED tend to approach cases to achieve some sense of "full coverage", a little bit thin in the crown but basically have patients after 2 surgeries walk out looking like they have a full head of hair. If they don't see this as possible, then you're setting yourself up for disappointment relative to other ASMED cases and from a marketing perspective they would want you walking around as an advertisement to their work. I would reiterate what others have said that its difficult to tell what is going on when you are shaven, however its clear there is thinning behind the temples and at the bottom of the donor, likely retrograde alopecia. I'd also say that even from these photos you're hardly the most difficult looking case in the world, I would consider Eugenix as someone else mentioned or FUT.

Personally would opt for ASMED from that list. Its quite clearly a very significant area that is uncovered. Upon shaving your head I think its obvious you've lost 75-80% of your hair. Optimally you should undergo a megasession at minimum 4k+ grafts or you're going to be going back for surgery within a year or two after continuously. Most of the other clinics are oriented towards smaller scale hairline work. In terms of being too cautious, well you've posted no photos of your donor and the photos are poor quality. If 8 other clinics are saying they'd operate, then perhaps HDC have enough work and aren't interested in a slightly harder case here.

You speak from experience but not understanding. "You have no idea who will be performing your extractions, what their credentials are, or how many hours they have working on tissue." You can say this about literally *any* clinic, this is just vapid word salad. Feel free to tell the qualifications and names of Bisanga's technicians for example. Problem is you can't because you have no idea. If a surgeon did the entire procedure themselves but can't produce consistently good or aesthetic results, I don't care less. The question is whether they have a system in place that produces consistent results and have the technical ability to produce an aesthetic, natural result. That is something that should be referenced to patient and clinic posted results, not "how many cases per day". Number of cases per day and use of techs is correlated to poor work because of Turkish hair mills for example, but it isn't a causal relationship. Various surgeons you mentioned clearly aren't at the level of Freitas. Bisanga I would consider, Konior is more than triple the price which compared to the prices OP mentioned doesn't seem particularly useful.

I'd focus less on who is doing extractions and how many surgeries a clinic is performing per day and more on who is consistently achieving the best results from those both clinic and patient posted. All three of these clinics do good work, but Freitas I would comfortably suggest does among the best hairlines in the world. Unless there are specific patient posted results that are poor that can be pointed to that show a lack of consistency its not logical to focus on concepts like "how many surgeries per day" that are removed from what is actually relevant, which are the results and success rate. I think its likely which ever clinic you choose your results will be of a high standard, not entirely sure of how the multiple doctor system of HLC works though which would make me direct more towards the other two options.

Just my opinion but Pekiner and Ferreira are significantly above the level of Bicer. For Turkish options I don't think anyone who can argue in good faith that Bicer does better or equivalent work to Pekiner or even ASMED for that matter.

If I'm to guess my crown and midscalp is 20-25% of teenage density and the frontal third about 40% albeit with some micro areas of lower density. The donor maybe 30-40% feels like it has been taken but harder to tell. Currently not on any meds, only using keto shampoo. I have some level of worry about the transplanted hair thinning over say a 20-30 year period with no meds (however I think the chance it will become a problem is very low), in terms of my natives in the midscalp and crown thinning I think its viable to fill the entire area with an FUT.

With dry hair not much change. Maybe slightly less density throughout the entire scalp and visible heavy crown thinning when wet but when dry I look like a fullhead. Unlikely I'll need work done for another few years at least, still very slightly bugged by one side in the frontal third lacking in density (300-400 grafts maybe even) but things have held up well. Over time I only get more happy with my result. For the most part don't think about my hair in public and I know whenever I get it cut I'll get a variety of compliments from people who would never know I've had a transplant. At the time of my first procedure there were no patients I'm aware of as young as I was who had gone as aggressively as I did in terms of FUE and graft numbers. Ultimately the choice of approach and clinic couldn't have been better, by both some luck and some good decision making. Still thinking if I need a future procedure to finish the midscalp/crown and touch up frontal third will likely pursue FUT. Will either be Hasson/Wong or Konior assuming they're still around by the time I need more work done.

Bjorn's result is unbelievably good however he almost certainly benefits from having hair that has a significant waviness to it in terms of increasing the illusion of high density. In terms of raw density across a full (albeit narrow) NW5 there are no cases I have seen at the level of Aftermath's, including Bjorn's. In terms of pure aesthetics Bjorn's are a cut above (from my perspective at least) simply because the waviness gives it an edge in terms of how youthful and masculine it is likely to be perceived as. There's a uniqueness and flair that can't be achieved with donor hair of lesser thickness and waviness. Even without seeing OPs entire face the images here are enough to show that hair is often the only difference between someone appearing to aging well past their prime in the 6/10 range to having facial features of a male model. Whether or not facial features are perceived as attractive or balanced is heavily dependent on hair. For myself the experience was similar in which I went from below average beyond NW2 but comfortably above average as a NW1.

In my opinion the "you can't predict someone's final balding pattern especially at a young age" is baseless psuedo-science. Its a fragment of old world industry beliefs based in the 1990s and early 2000s-2010s where surgeons hadn't developed the craft to the point where they could appease younger patients or give them natural hairlines. The potential of the average donor wasn't as well known then as it is now. To talk about lack of ability to predict was merely an excuse to focus on more older and less demanding patients, which even when I first came to the forum were a much more significant portion of hair transplant candidates. You can't "guarantee" it of course, but if someone is diffusing in a NW5 pattern and has maintained thick lateral humps its unlikely they will turn into a NW6-7 by some force of magic. To avoid transplanting a youthful hairline because someone who has a *clear* current NW5 diffusion could potential hit NW6 at a 2-3% chance is madness in my opinion. You can't guarantee, but you can do an awful lot of accurate predicting. A surgeon can also visually check through various tools for miniaturisation in the donor outside the clear safe zone. Everything in life is a gamble of sorts, its the odds that matter. I also think people need to distinguish between senile alopecia and androgen based hairloss. Sure you see people in their late 50s+ who develop significant progression and diffusing across the scalp, but this is a world apart from someone who is in their 20s or 30s. Making a decision based on the short term of the next few years without risk management? Bad idea. Making decisions based on what is optimal for 15-20 years? Entirely different story, most people will be better off optimising their looks in their 20s-50s and and take at worst be left with a bald patch beyond this. The truth about donor areas is that with competent surgeons and overly large punches etc, people very, very rarely max out their potential graft numbers with either FUE or FUT, let alone both (which is a route very few take). Realistically, if someone is balding in a NW5 pattern and has a reasonable donor they can afford a lifetime approach of giving them an ultra NW1 hairline, assuming the surgeon is competent with donor management and the grafts grow. I personally would trust Hasson with this. Why do I trust the approach? Because I've seen 100x more people questioning the approach than people who are negatively effected by it. 40 grafts per sq cm or even less is a good baseline for *coverage* specifically, which behind the hairline will appear to reflect good density. The hairline and frontal third can generally benefit all the way up to natural density, albeit at 40-50 will still tend to look natural and full.

Rassman is an industry veteran but no longer at the same standard as the rest of the list. Jae Pak who I think trained under Rassman is similarly below par in my opinion, these are realself celebs in that they (or their marketing team) responds to ample questions on the website to get their names out but ultimately they aren't at the top of the industry. Not to say the rest of the list are bad surgeons, but the only options here I personally would happily pay money for are Konior, Hasson/Wong and Bloxham. The rest don't differentiate themselves from the pack in an impressive enough way for me to consider them or don't reach levels of what I would desire for consistency/aesthetics for the price. In terms of hairline aesthetics and density Hasson in particular is above the rest. Wong and Konior do some of the best crown work in the world, Konior being one of the best generalists simultaneously and who I'd choose if money wasn't a consideration. Bloxham and Nadimi at Konior's clinic are in a slightly lower bracket albeit both significantly cheaper than Konior and both doing consistently good work. Nadimi occasionally too conservative for my taste however. Wesley does good work but for the price I can't see a convincing reason not to choose Hasson/Wong if those are the main considerations.

From what I'm aware Freitas is a similar price to the average of other options mentioned. Repairs might be a different story however. Also I think his waiting list is lengthier than average. When I say lowering the hairline I don't mean in the sense of explicitly attempting to do this or anything significant, but rather placing a layer of singles at the front rather than extracting multigrafts. I would absolutely recommend against removing hair or raising the hairline. I've looked at at endless foreheads and your hairline already appears very high, not in an unnatural way but noticeably so. Removing grafts is a recipe for potentially killing donor hairs and lowering total yield and ending up with permanent scarring at the front of your head. The best case of action is placing singles in front of any doubles and poorly angled grafts in the hairline here, with overall density increases. "We will also need to rebuild those temple peaks." Also from the Ferreira response I dislike this. You absolutely don't have the rebuild the temple peaks, especially when your hairline is quite high. The lower the hairline the more forward the temple points to appear natural, in your case you currently have a highish hairline and non-recessed but small temple peaks. This is totally natural. Will agree that the corners (not the point itself) do look quite unnatural currently from the contrast in transplanted/native hair and its possible that 50-100 grafts might be better off removed here. But would tread cautiously. Reading the other referenced consults I feel quite confident that the approach offered in your original post is overly convoluted and the graft numbers don't make sense. Would also suggest that your crown should be left alone imo and you should tread very carefully when it comes to temple points. Even high-tier surgeons cannot work magic in this regard, the difference between donor hair and temple point hair often goes beyond what a surgeon is able to work with to create a natural appearance without very large graft numbers to cover the entire area rather than just extending the point as most do. Majority of clinics you mentioned are of a high standard, personally I'd consider those like Bisanga that are interested in making judgement in person and being cautious or those that have explicitly recommended a slight lowering of the hairline with density increases and no extraction of transplanted grafts. In terms of hairline aesthetics I feel Freitas is among the best in the world but I haven't seen his repair cases. As a side note, your current result is quite bad but its probably borderline passable for the average person looking at it.

I personally don't see how this requires 3000 grafts and have seen plenty of repair cases which are one and done. Fair enough to suggest that there is more uncertainty with a repair but stating that there is "minimum 2-3" procedures doesn't sound necessary to me. Depends on your donor, but imo I also wouldn't assume you'd need to remove any grafts to begin with, even a slight lowering of the hairline to place single hairs at the front wouldn't take the graft number up to 3000. Maybe just at the corners where the frontal hairline meets the sides which currently is quite unnatural. Depends very much on the donor but the mention of beard hair and a few hundred sounds more like a tactic to charge more than it does a necessity for your case. Would also forget temple points entirely for now, yours currently don't look that bad and certainly not unnatural with reference to the current hairlines height. Temple points are by far the hardest area to achieve naturalness in and its possible you might only end up with further problems to correct. I've seen cases of patients in a worse position than you are currently through 1500-2000 grafts in a single procedure looking almost perfect. Not that I think he isn't a competent surgeon, but I'd want a much broader variety of consults to make a decision off before I came to the conclusion that this was the optimal approach. In my opinion the repair is a 1 procedure job (if the procedure goes smoothly and with some luck on your side) and the temple points are a consideration for a future procedure beyond that because the reality is that currently they're not a huge problem.

If within the US/Canada wouldn't even consider a clinic other than Hasson/Wong and FUT. Also for the record, at least on available photos I see a fairly clear NW5, not a NW6. High sides and the total area exposed in the crown is relatively small. The overall area exposed is narrow. Typically if someone has lost this much hair there would be a significantly more exposed crown if they were heading for NW6. People don't bald in the vast majority of cases from a NW5 to a NW6, they diffuse in a NW6 pattern visibly from the time they hit NW3-4. These are generalisations in terms of exact areas exposed or potential areas for further balding, but NW6 suggests a much worse picture than anything shown in these photos.

"yes it makes sense but I've been doing that already before I paid all that money and lost 3500 grafts for this operation. " In your before photo from the ASMED procedure its bordering on "hair plug" levels of unnaturalness, in the post it looks natural and like you have full head of hair, albeit thinning. In the real world, you aren't styling your hair by spreading it apart to make it look as bad as possible. To deduce what exactly should be done going forward and how many grafts a touchup might require it requires showing what it looks like when styled as normal, that is what actually matters as its what people will see. I understand the point about lighting differences, but again you haven't actually posted photos yourself from normal angles, normal household or outdoor lighting and from normal distances. What I'm trying to emphasise is that if things are as bad as you say and you've made clear you understand the importance of things like lighting in presentation, then you should be able to make a decent effort to actually show clearly that you have a bad result. Nothing you've shown here indicates something out of the norm I'd see on this very forum for that graft number for someone that isn't on finasteride and is thinning throughout their whole scalp. You had 3500 grafts to go from having an extremely unnatural presentation to a greatly improved presentation (at least on all the pics here) and 1000-1500 grafts would likely fill out the frontal third to the point it wouldn't be clear you're balding in that area. You can disagree or be disappointed that your yield was 90+% like everyone hopes for, but this is a normal, natural looking result for that level of balding and area. If you compare it to the average Freitas or Hasson case on this forum then sure it looks below par, compare it to the average general case on this forum and you'll see that your comments are overly negative. Again, you even mention in your initial post you initially thought it might have been a decent result and then changed your mind when comparing to someone else with a negative experience. If you take away anything from what I've said, try to make the hair look as I emphasised "normal" from normal photos, and post those (and view yourself this way) without the weird hair spreading that only function for self-fulfilling proof that your assumptions about it being a bad result were true. I'd take it up with the clinic that you don't think your yield is perfect and that you feel it would be right for them to offer a free touchup (assuming you'd be willing to do this) but that would require shaving the scalp down to judge what exactly the yield was like. I don't think the yield is as bad as you think.

Not for single sessions. They do have very impressive transformations across multiple surgeries but for one offs 3000-3500 seems to be their limit. Again, to the sentiment others are putting forth, the fact that people will defend Bicer or Pekiner over ASMED just tells me that unfortunately not everyone in this world is all that bright or willing to use basic senses like eyesight. Its just unfortunate regurgitating of broader forum sentiment rather than any kind of honest informative messaging based on reality. Yes I went to ASMED, perhaps not for some others here but for myself that meant researching thousands (tens?) of results from different clinics and hundreds from ASMED, not simply listening to the loudest, most mentally ill patients or the ones that repeatedly make fake accounts to tarnish reputation. 7/10s on average for Bicer? Time to head to the optometrist. For people to suggest Bicer and Pekiner over HLC, well to be completely real they're venturing into new, unfounded territories of stupidity. Me personally, if I needed say 2-3000 grafts I'd take a strong look at HLC, beyond those numbers I'd go with ASMED. Honestly, I'd also consider Dr. Freitas. At HLC prices I'd 100% opt for Freitas, although I still think HLC is a very good clinic with a long term track record.