JayLDD

4 hours ago, BLE123 said:

Your temple points are just stupidly good, makes me question why so many surgeons struggle with them.

There are other clinics that most would agree do slightly more aesthetic hairlines overall, but ASMED imo do the most natural and best temple point work in the world. Hasson/Wong also do very good temple work. Big graft numbers are definitely part of it though.

Tbh I'm not aware of a temple point result that is more impressive than Kraistoff's either. The side profile difference is insane. 

1 hour ago, caricatura said:

@UnbaldEagleAre you mostly upset due to the money, or the fact that you feel trapped into more and more procedures and no longer have the option of shaving?

@JayLDDI hope you're right about this--what you elaborated is my optimistic outlook on the situation. I guess I have gathered the above impression because of the number of threads on here of people getting multiple surgeries within 2-4 years just to be at the same place they were in before their first procedure. Hopefully, as you say, that's not the norm. If it is, I can't see how, after their donor runs out, they wouldn't be looking goofy in less than two decades. However, if, as you say, it just means easing the balding process so that you don't go from hair to bald/unsightly, but can distribute your hairs so that you age gracefully, I'm game. Not looking for perfection!

There are plenty of older guys in their late late forties and fifties (many of them in very recent posts here) who have had transplants to give themselves a hairline while leaving the majority of the crown bare or thin. You'll see the same often even for much younger guys but typically their desires are more aggressive and that inevitably means more procedures. You use the term goofy, whenever I see fully bald guys in their 20s and 30s typically the state of their looks is a disaster. Its incredibly unattractive, they've aged 5-10 years minimum and they look ridiculous.  If I see a large bald patch on a younger guy sure it can also look a little goofy, but goofy with a framed face is a hell of a lot better than being completely bald which is the central point I think your posts miss. You suggest that over time it may appear more goofy, the reality is the complete opposite. Over time imperfect density or a super thin crown with a conservative hairline is going to look better and more normal. For me I was close to a NW4 with heavy diffusing at 21 and desired a full head of hair NW1 so of course that meant I had to have multiple procedures. Part of the problem with transplants in my experience is that if it goes reasonably well your looks and overall wellbeing go up massively to the point it gives a sort of addictive compulsion to wanting more which is why so many people have multiple in a short time period. They don't HAVE to do it, but its hard not to want to.

And again, even if you do settle on one conservative but reasonably high graft number/broad coverage transplant in the medium term you're still certainly going to look better than a bald guy if the results turn out well.

"I guess I have gathered the above impression because of the number of threads on here of people getting multiple surgeries within 2-4 years just to be at the same place they were in before their first procedure."

Personally I actually don't recall seeing a literal example of this at all for people who go to competent surgeons that are doing appropriate graft numbers. Depends how much area is being covered however, if you're a NW2 for example and don't like the idea of multiple surgeries then you're better off waiting until you're a NW3-4 with a thinned crown and then doing a larger procedure. Without knowing what your exact situation is, its possible that you're better off waiting a bit until you lose more hair and then opting for a large megasession that will cover the majority of the entire long-term balding area. Although NW3A still means you probably have the option to permanently put yourself in a position better than being bald. Unbald Eagle above who mentions they sometimes regret ever having a procedure first went to a mediocre clinic for a tiny hairline procedure which is something you should absolutely consider. Just make sure this isn't a position you ever put yourself in.

Your point about donor running out and leaving the patient in a bad position just isn't realistic on the basis of anything you'll find on the forum. Sure some people have a procedure with a bad surgeon or simply are unlucky and get a bad result meaning they don't have enough to cover their entire scalp. But 90% of patients in the NW5-NW6 final pattern range can get close to full coverage in the long term if they utilise both FUE and FUE. The notion of people running out of donor is largely a myth, you'd be hard pressed to find patients who haven't had a botched procedure where they can't handle more procedures. Most people can smoothly hit 6k grafts long-term which gives them solid coverage across the entire scalp, and if they utilised FUT or even beard hair on top you go to numbers that 99% of patients can't be bothered with even if they could. It shouldn't be understated, the vast majority of patients never hit their overall potential for grafts because they don't need to.

Again, its very rare I see examples which emphasise your sinkhole theory as having any validity. If you demand a NW1 with perfect density then sure you might have a point but it doesn't sound like that's what you're after.

If you cherry pick the worst case scenarios such as patients who go to poor surgeons, have an abnormally poor donor, are close to NW7, or are unlucky enough to get a bad result with a good doctor, then your points make more sense. Otherwise they just aren't reflected by the vast majority of patients who go to elite surgeons.  In my opinion the biggest risk for hair transplants is getting a bad result despite going to a good surgeon. If that doesn't occur, virtually all of your fears are unfounded. If you're worried about a succession of short term chasing losses then your focus should be on choosing a surgeon like Hasson/Wong who are experienced in high graft numbers/broad coverage, can perform FUT and are at the highest level.

1 hour ago, caricatura said:

I’m 30 and a NW 3A with diffuse thinning. My dad is around 70 and basically completely bald, though that may have something to do with his overall poor health. In any case, I’m trying to justify getting a HT, but the more I research, the more I doubt myself, so any feedback would be welcome.

If HTs were a one-and-done procedure like rhinoplasty, I’d get one immediately, but I fear that, for most people, while they may work in the short-term (1 - 5 years), unless and even if you commit to Min., Fin., and at least two more surgeries down the line, you're condemning yourself to a very odd-looking head of hair (not to mention a scarred head) in the long-term (10 - 15 years+). That means that by the time I'm only 45, I may look worse than if I had just shaved or somehow styled it accordingly in-between those years. Of course, there's the possibility that my hair loss stabilizes after a transplant, especially with the help of forthcoming pharmaceutical treatments, but this seems like a big "if." It also seems that, understandably, many people such as myself go for the transplant out of short-sighted desperation, but may be even more unhappy in the long-run. Unfortunately, due to the relative recentness of successful hair transplant procedures, it's difficult to even ask around about such long-term satisfaction. Then again, maybe more people are satisfied than I think, and they just don't hang around these forums (I'm thinking of celebrities like Jeremy Piven, Elon Musk, and Matthew McConaughey who seem to have had great hair for at least a decade now).

Am I over-thinking this, or being too cynical about the long-term success of the procedure? Should I just "go for it" and live up my 30s?

Thank you!

"That means that by the time I'm only 45, I may look worse than if I had just shaved or somehow styled it accordingly in-between those years."

Most of your post is totally reasonable, this on the other hand is very likely to be false. For the vast majority of patients their process involves complete rebuilding of the hairline and frontal third, then moving front to back in order of importance. A bald crown, a thin midscalp and conservative hairline for example is a perfectly natural look that men in their 50s+ have. It also looks significantly better than being slick bald, having a framed face is absolutely crucial for most men with even remotely imperfect facial features, for me and most men that is 1-2 points on looks in itself. The difference for a lot of people of being ugly vs reasonably attractive/sexually desirable is having even a conservative hairline. If you get ONE procedure that's in the realm of 3500-5k grafts then you're going to be permanently in a massively better position than you would be shaving it. Look at cases with those graft numbers, there are 5k graft cases that basically take a NW5 to a full head of hair albeit with thin spots.

With that in mind, you can indeed rebuild a frontal third and create a hairline in a single procedure. With a single procedure conservative hairline and some even thin hair extending into the midscalp, you will ALWAYS look better than if you were slick bald, now and forever. Hairloss is indeed progressive, but this doesn't mean you need to achieve perfection with hair transplants. You can absolutely achieve results in a single procedure that last decades and give you 75% of perfection. If you want to cover every single spec of scalp as it becomes visible, and *never* have anyone know you're balding of course that's a different story and will likely require 2-3 procedures over time. There are also candidates at a NW5 level who basically get full coverage in a single procedure too, look at the massive amounts of megasessions from ASMED/Erdogan and Hasson/Wong for example.  Assuming that you absolutely need to have 3 procedures long for a result that is better than being bald is ultimately inaccurate,  multiple procedures are totally optional. 

Your post and the above quote also seems to imply or hint at the idea that if you're not on finasteride that your scalp is going to act as a sinkhole and that even with a procedure every 5 years you're going to end up bald. Truth is that's totally false. Even if hairloss is progressive those transplanted hairs are permanent and eventually you're going to virtually cover your entire scalp in 2-3 procedures. There is an endgame for hair transplants, and it doesn't have to be perfection. Over the years you will absolutely appreciate a conservative result from one or two procedures. 

If you have the money, choose a competent surgeon and use enough grafts then you absolutely should go for it. If you're willing to have a second procedure down the track then you're golden and likely to cover the majority of your balding scalp. The only things that realistically matter are your donor quality and final norwood pattern, how much money you have and how much research you've done to find a competent surgeon.

On 12/20/2020 at 4:45 AM, UnbaldEagle said:

I wonder how he can perform all these steps when having up to 8 surgeries a day. If he did all above mentioned on your surgery, that's great, happy for you, maybe you're the exception and not the rule. 

This is turning into Asmed apologetism here, so I'll stop, don't think it's fair to hijack OP's thread. 

 

Its you making false or entirely disingenuous claims and expecting not to be called out for it, that's the problem and it has nothing to do with apologism. Grow up, its not hard to avoid dishonesty. 

On 12/20/2020 at 4:41 AM, mustang said:

Go to Dr Mwamba or Dra Vila

Both are charging 2.50 euros per graft. Both top surgeons with world class results

Belgium and Spain.

Don't go to Turkey.

Dr Mwamba is nowhere near the level of even ASMED and the results on this forum prove that. Anyone who questions this including yourself ought to look. Dr. Villa is competent and does good work but they don't have a particularly long term track record and they don't engage in the process any more than Koray at ASMED does. 

There are certainly options in Spain and Belgium who do very good work, specifically Freitas, Lorenzo and Couto, and Feriduni and Bisanga. Your comments and those of Unbald Eagle however are clearly disingenuous and aren't based on facts.

On 10/27/2020 at 9:16 AM, Brad189 said:

Had an FUE procedure done with Dr Serdar Caglayan back in September.  2061 grafts were completed after an all day procedure.  Their whole staff were very friendly and welcoming. 

Overall, my experience was mostly positive.  Mainly using this as a blog to track my progress and see how things shape up over the coming year.  I'm currently taking finasteride and biotin and also use biotin shampoo.

Graft breakdown:

1 (181), 2 (688), 3 (828), 4 (207), 5 (101), 6 (56), total hairs 5710.  When I initially got the breakdown, I was a little surprised with the number of 4s, 5s, and 6s grafts because from what I read around here, most patients have 1-3 hairs per graft with some 4s.  I hope this doesn't result in a 'pluggy' look.  Additionally, I did get pitted depressions in the recipient area which can be viewed in the 1 month photo below.  I've read this can be the result when a larger # of hairs in a graft are transplanted.  Keeping my fingers crossed things are just early and still healing.  When I reached out to the clinic about this, I was instructed to apply iodine 3x a day for 3 days. 

Pre surgery: hair how it's normally styled (dry)

Pre surgery out of the shower, damp/wet

After Surgery:

 

 

About 2 weeks out, scabs mostly gone.  The hairs in the hairline go in a very straight side by side line.  Hoping this doesn't look unnatural when it grows in.  What are your thoughts on this as well as the angle of the hairs? 

 

1 Month shows a lot of shock loss.  I was ready for this but in addition to the transplanted hair, a lot of my native hairs from an earlier transplant are also gone.  Hopefully they come back if they weren't damaged by the current transplant.  The picture that shows the circling on my left area is the best picture i could get to show the pitting I mentioned earlier.  This occurs in many areas throughout the recipient area but is hard to capture.

Donor area after 1 month.  Looks pretty good in my opinion:

I'll keep this updated each month and answer any questions you may have! 

 

This is really, really, really low level work. I would brace for the worst and heavily research on forums like this for potential future surgeons if you require repair work. This surgeon is a nobody that shouldn't be in the industry within serious retraining to lift his standards. 

Best case scenario in my opinion is it will look very thin but natural. Worst case is a low growth rate with a pluggy appearance. At least your donor doesn't look terrible but I hope you have enough grafts to correct the situation. 

On 12/19/2020 at 7:32 AM, Guy73 said:

This guy on YouTube has had two procedures just to lower his hairline. Now this was his 12 month update from his second procedure. I believe when the light is above you and in front of you a true indication of where you stand on density. Usually in his videos you would think his hair is soo thick. But here you can clearly see the space between grafts. Not bad though. Any thoughts??

Sometimes when I look at hairloss Youtubers with 10k+ subs like this guy I get jealous of their success in the realm of hairloss information when I feel I’m personally vastly more knowledgeable, intelligent and helpful than they could ever be but I lack the platform and efforts to develop one. 

Then I see disasters like this and the envy stops, I immediately just feel bad for them and the vulnerable people who get advice from people like this. Even worse for him all of his multitudes of treatments seem to be failing. 
 

2 hours ago, UnbaldEagle said:

I agree with @JohnAC71, HLC, Pekiner and maybe Hakan Doganay, I wouldn't go with anyone else in Turkey. But best to avoid Turkey altogether. 

The ones you mentioned, technically they are all hairmills, with Cinik there's a chance to get a decent result if you go with his premium package where he has more involvement. Erdogan's clinic operates on many people a day with techs only doing all the operation, no wonder I've seen a lot of poor results recently. Even on this forum there's some people who complain their hairline is littered with multis, etc. 

To suggest Doganay as an option but recommend against ASMED is mind numbingly absurd. It’s fine to think another clinic is better but when you say “techs doing all the operation” no you’re being totally disingenuous and jumping on a negativity bandwagon without knowing what you’re talking about.

On 12/14/2020 at 8:24 PM, Seniormido said:

May be they refused him as many of the top surgeons will advise you not to have a HT if you have severe hair loss at young age and not on Finasteride which is a good advice!

For a multi-millionaire soccer player who was only a Norwood 5 and close to THIRTY years old, you think he was turned down by surgeons of a caliber that could have basically given him a full head of hair and have results in their catalogue to emphasize that possibility? You think Konior or Couto would have turned down the marketing opportunity?  The chance is less than zero.

I know it’s a meme on the forum to pretend that it’s dangerous to operate on anyone under forty five, but even highly regarded and top-tier clinics like that of Hasson/Wong and Konior operate on men in their early twenties. Rooney like I mentioned was literally around thirty.

A few options IMO. Either the clinic contacted Rooney or his agent and they booked without research, his agent did a quick Google search for best UK clinics and fell for the marketing and booked without thinking (this being most likely I feel), or if I was being conspiratorial his agent took a fat check from the clinic as a commission and guided Rooney in like a sheep while they could advertise they’d done work on him as a means of marketing.

On 12/14/2020 at 9:15 PM, Seniormido said:

How 1000 grafts in 2 or 3 procedures !

Read what I wrote again, I didn’t say he’d only had 1000 grafts done, but rather he has roughly that or maybe even less currently on his head which implies that the clinic/s did a less than stellar job when it came to growth. There are photos across the years subsequent to all his transplants where he has no concealers and it’s clear he never had good growth. Someone suggested the grafts fell out over the years, there’s no evidence of that.

When I mentioned 1000 grafts it was in context to emphasizing that the clinics did a piss poor job when you look at his state without concealers. Someone argued the clinic isn’t that bad or implied that money should produce good results, it’s just not true. I’m still entirely confident Rooney could have got reasonable results at a good clinic.

12 hours ago, UnbaldEagle said:

Rooney had his HTs done at the Harley Street Hair Clinic, where Spex also had one of his and is a patient advisor for the clinic now. I wouldn't call them a poor clinic, however they are not quite there as the only 2 elites in the UK imo - Dr. Ball and Dr. Reddy and they are unreasonably expensive -  Rooney forked out £30,000 (!!!) there.

I agree with the rest though.. He was chasing a NW6 and while he once took finasteride, he surely stopped after having kids (4 if I recall correctly) and that must have made things only worse. 

To be honest, he's pretty much doomed hair wise, unless he'd consider BHT in the future as he seems to be having a lot of that.

On the other hand, to show you how most people have no idea what happens when you have a HT without being on meds or with aggressive MPB - I remember an article by The Sun years ago, something like "Rooney's hair is thinning again" and most comments were like "how is he still balding if he spent all that money on hair transplants". 

 

Spex had a hair transplant with them where virtually nothing grew or changed and it would have cost more than 10k USD.  I also wouldn't consider him a good source of information, the guy literally pushes trashy supplements for a buck that have no scientific basis for aiding hairloss.

Yes they are a poor clinic. And no Rooney was not "doomed", he's filthy rich and roughly only NW5. He literally has less than 1000 grafts on his head, there are photos from years back that show that even within a year of the transplant he had virtually no growth and relied on concealers. Look for yourself, the comment about "aggressive hairloss" and not being on meds is just plain dumb, it is a problem *purely* related to graft numbers and growth rates. Rooney has very thin hair but he could have got a B- result instead of a D- if he went to a competent clinic. 

Do you realistically think Rooney would be in this position if he'd gone to Hasson/Wong, Couto or Konior for example? 

8 hours ago, jolly said:

I do not think a celebrity star like rooney , for whom money does not matter , went to a cheap clinic , lets all admit that transplanted hair do not last forever in my opinion , if you are not on medication like the dreaded  finasteride or some other dht blocker ..... period ...... , donor hair is susceptible to dht in the recipient area as it appear to be quiet strong along the frontal hairline mid and crown , so no matter from where you take it , dht will attack it on the frontal zones unless you block it .

The hair that you think thinned out never existed, he's been using massive amounts of concealers since day one. He had ultra low graft numbers from a dogshit clinic that isn't equipped for anything other than marketing. The UK and Australia are the number one destinations for an incredibly expensive, incredibly poor quality hair transplant from doctors that haven't learned the depth of their craft. The hair didn't fall out, the hair was never implanted. 

No offense to sporting figures but most of them and their surrounding agents are meatheads outside of their own work, you often read about celebs and sporting figures booking out an entire clinic for themselves at those that clearly spend their entire budget on marketing. If they had any reasonable level of intelligence they'd do basic research and take their money to surgeons like Konior or Couto.

Disagree with waiting, OP has less than the equivalent of 1500 grafts across the whole head and the remaining hairs are largely cosmetically insignificant and heavily miniaturised judging from the top angle photo.  Those hairs are destined to fall out whether or not he waits and currently aren't providing enough to be overly concerned about. If he had sides with fin its not worth risking further issues with topical and minox on its own is objectively useless for more than a few years at maintaining hair without an effective DHT blocker.

OP imo you should likely consider FUT and go with a clinic that is skilled at large mega-sessions, 5000+ grafts. Hattingen in Europe and Hasson/Wong would be the first options I'd contact. The fact that you are aware of the limitations of your hairtype and aren't expecting a miraculous result suggests that you'll likely be satisfied as long as you max out safe levels of coverage in one procedure at a high-level clinic that is skilled in doing so. With a competent clinic if your yield is strong it isn't going to matter if shock loss occurs, which it may considering you're not on finasteride and the hairs already appear weak and mostly miniaturised.

5 hours ago, UnbaldEagle said:

I heard Keser is not using microscopes, if that's true, I believe what Clark.Ethan said is true, of course he ended up with a few multi grafts in his hairline. So that makes me think Keser is not quite an elite surgeon.

OP, I think you have a perfect hairline now, you should be very happy with it. I wouldn't touch it. 

He literally refused to post his own results after I prodded him five or six times. If someone is complaining about multi-grafts and complaining about a specific surgeon but unwilling to post photos their feelings are good as worthless to make any empirical judgement over. You believe what he said is true despite the fact that he refuses to post proof after asking for it 6 times? Unbelievably naïve but you do you bud.

I would absolutely advocate for microscopes, reality is however that they're a tool that isn't a necessity for top-tier results.  Its not a binary means of deciding whether a surgeon is top-tier, nor is it even the only means of avoiding multi-grafts in the hairline. I've seen many people who have gone to surgeons using microscopes that still have multis in the hairline. I've seen certain surgeons that don't use microscopes where its clearly not an issue that would cause the general public to notice anything unnatural in 99% of cases. 

To say Keser is not quite an "elite surgeon" begs the question of exactly who is. If you've looked at hundreds/thousands of results from across many of the top-tier surgeons, from looking at patient posted results its clear that there are virtually none getting consistently better results in terms of aesthetics and yield. Couldn't care less about hearsay or people complaining about multigraphs when they aren't even prepared to show photos of them. Who exactly is clearly a cut above? Couto, Freitas, Hasson/Wong, Konior are all examples of surgeons in this realm but even of this bunch I wouldn't decisively say they are a cut above, despite each excelling at different things. Again I totally advocate for microscopes but patient posted results speak at volumes above a surgeons tools or methodology.

In regards to OP, his hairline isn't perfect by any means but I totally agree its probably best not to touch it. 

17 minutes ago, plus said:

I don't know why everybody is so dismissive of him. See this thread of a NW7 patient

He is obviously not expecting Elvis Presley hair. For a lot of people having some hair on top that makes it seem like you are at an earlier stage of balding makes a big difference compared to being horse-shoe bald. Also he has beard hair.

The patient you bring up here probably isn’t a NW7 to begin with, the classifications are rough so it’s debatable but he’s closer to a NW6. The sides have dropped but not significantly. He also has extremely thick Indian hair.

The OP here also has very clear retrograde alopecia and potentially diffuse losses in the donor, either that or it’s naturally extremely thin. I’ve had 6k+ FUE grafts removed and my donor appears to have more density than his does. 

The only option I can think of worth pursuing is FUT to create density in the front and mid scalp with a conservative hairline, and finding someone who is experienced in hair systems to cover the crown.  I think I’ve seen it mentioned that Konior had been involved in this approach before.

7 hours ago, OliverAtom said:

Hair Clinics - YouTube Channels
So I see some say that having a YouTube channel is just a marketing vehicle to get patients? Da!!! And, what is posting results in this or other Forums? It is completely the same. Marketing.

Whatever we do in our lives in order that others, family, friends, coworkers can see and appreciate, that is Marketing! When we drive our BMW or Mercedes or Ford, we are Marketing ourselves having this status or the other ... nowadays, ALL is marketing because we are social beings and more than ever, we like to be appreciated, either at work or playing football with your friends on a Sunday morning... who doesnt want to be noticed? 

Now, how is it possible that nowadays, in this DIGITAL ERA, many hair clinics are NOT posting their video results on YouTube. I have been wondering about this for a long time and know that you have raised this marketing topic I wanted to share with you...

We have some doctors with the BEST results of the moment like Freitas, H&W, Couto, Eugenix, Lorenzo who are indeed uploading videos regularly... Why other clinics/doctors, do not publish videos of their results? Wouldnt you love to have a lot more results on video?

And again, I wonder... Hair Clinics not publish their results on YouTube ... could it be that those videos might "expose" their results too much and with therefore some clinics might lose some of their "status"? They could just use the concealer and, voila, perfect results!!! Let´s be seriuos. We all know, it´s not as easy to hide a "not so good hair transplant result" captured on video as it is on photos... Before-After photos are a lot easier to manipulate...

I have done a quick RESEARCH for Hair Transplant Clinic´s YouTube channels and FUExpert Clinic, led by Dr Juan Couto, is on way on TOP ... and the comparison with the rest, except from Freitas and Eugenix, it´s quite huge in terms of "FANS":

- Top 3 HAIR CLINICS YouTube Channels -

Dr Couto has 77 videos and 54.100 followers 
Dr Freitas has 76 videos and 47.300 followers
Eugenix Clinic has 435 videos and 22.200 followers

- Rest of Hair Clinics -

Dr Lorenzo has 877 videos and 13.900 followers
Dr Feller has 245 videos and 3.040 followers
Dr Lupanzula has 191 videos and 1.800 followers
Hasson & Wong has 218 videos and 1.800 followers
Dr Rahal has 74 videos and 1.200 followers
Dr Bernstein has 62 videos and 1190 followers
Hattingen Hair Clinic has 198 videos and 784 followers
Dr Arocha has 82 videos and 648 followers
Dr Bisanga has 112 videos and 328 followers
Dr Bruno Pinto has 20 videos and 453 followers
Dr Konior has 15 videos and 14 followers

Questions:
1. How could there be such a difference in followers from Couto and Freitas in comparison with the rest of the Hair Clinics?

2. How come some doctors are not uploading their cases on YouTube being videos the BEST option to show the true NATURALNESS of hair transplant results? 

3. Could Hair Clinics be avoiding posting videos on YouTube and Instagram cause it might jeopardize their status?

* Extra: Have you noticed Lorenzo 800 videos !!! That number is INSANE!

Well, I just wanted to share my thoughts with you and see what you might think...
Hope all of you are safe!
Best!

As a basic rule, the clear association here is that younger doctors + younger clinics are more interested in digital marketing. Not exactly a surprise. Various older surgeons have already established a reputation and therefore don't require the same level of marketing or are simply adverse to newer forms of technology, or don't want to invest in someone to manage this aspect of a business. As you say, many can't hold up to modern top Youtube surgeons so it doesn't make sense to contest against them.

I would also consider that younger surgeons who have learned their craft from the most modern set of data and information, utilise the newest tools/equipment and have better overall physical coordination than doctors in their 60s and 70s are likely to be better overall. Hasson/Wong and Konior here are the only examples where I'm fairly sure they're in their 70s but still managing to lead the industry which is no small feat. Certain older surgeons here like Arocha and Bernstein, as well as Lindsey come to mind where they are clearly competent and do good work but while the top end of the industry has blasted forward they largely haven't moved with them. As a newer surgeon, to compete and have your name recognized you ultimately need higher standards or better results.

1 hour ago, JacobN said:

Don’t worry, I didn’t get your answer wrong, I am happy for every opinion. I know exactly what you mean but for me the thing is: I am young NOW. I felt so depressed with the status pre operation so I felt I had to take this step. finasteride fortunately is working very good - I even recovered hair at the crown area and I thickens much more. Donor management has been made and they said that about 9000 grafts can be taken (good donor with mostly 3 hair grafts). So i have 5000 or so left. 💪🏼😌

You did the right thing, picked a very good clinic and the hairline is appropriately conservative. The redness is nothing to worry about nor unexpected with your skin tone, and things look pretty solid for 4 months. 

I'd recommend ignoring those who bring up age when they have no logical, or academically justified reason to differentiate someone your age with that level of loss and someone who is 30 when at the end of the day they're just thoughtlessly regurgitating a common opinion without a basis behind it. Whether or not you're 20 or 35 your final hairloss pattern is genetically predetermined and visible when you've lost as much hair as yourself.  If things grow well and currently it appears they will, I'm sure you'd be happier with a conservative hairline and midscalp in your early 20s while dealing with a thinner crown in the future than waiting till you're 30 to address the issue for arbitrary reasons.

In saying that, I doubt you'll manage a full 9k grafts via FUE, I'd put the number much closer to 7k before it starts to clearly show depletion. Donor hair naturally thins for all men over time also. Potentially you can do FUT beyond those numbers but I'd consider that if you want full coverage in the long run it will dent your ability to have super short hair in your donor area.

I've been consistently extremely impressed with Hattingen's megasession FUT work but their FUE work is typically on the more conservative side and hasn't struck me as top-tier. Pekiner has worked with Keser previously and although his results have overall impressed me I don't think he has the medium term track record or enough cases to choosing him over Keser. HLC does great work also. Personally I would choose Keser or HLC in terms of who produces the most aesthetic hairlines.

HLC has the most examples of cases in that graft count or slightly higher. I'm guessing you're roughly NW3 for which HLC probably would probably be my choice.

3 hours ago, BeHappy said:

Why do guys go for these super low hairlines that are never going to look good? People need to stop trying to get the hairline they had when they were 15 and get something that looks realistic. What's even worse though are that there are Drs out there doing this!

 

IMO the hairline isn’t too low, height isn’t the issue but rather the incredibly flat, circular shape that completely lacks natural irregularity, lingering light redness in the recipient that stands out more due to the shape and a lack of softness likely due to multigrafts.

Fifteen year olds have all sorts of different hairlines, high and low but the key is they look natural. This doesn’t look natural.

It sounds bad to say it but guys like this patient have mental illness as a result of insecurity in their hairloss that causes them to become totally blind to viewing their results from the perspective of the average person walking by.

14 hours ago, 1978matt said:

I'm not saying he wont need another HT at some point or will stop balding.  I would always tell someone to consider having to get 3 or 4 over a 20 year period.

You also have to be willing to accept bald or thin areas to stay thin either now or later in life, e.g. a thin crown.

If you cant accept that then I guess you're just not a ready for a HT.

Your comment is spot on and I'm not sure how its so hard to understand. What you are mentioning are not even "risks" as Mayhem seems to think, they are facts of life that are absolutely worth accepting for short term benefit and winding back time, which is ultimately what all transplants are doing.

14 hours ago, mayhem said:

I was being facetious.

You have absolutely no data to back up your claim. You've conducted no survey.

You have an 'impression' that does not even rise to the level of anecdote. 

Even if you did, the sample size is this forum. Hair loss affects most men to some degree, not just those who talk about it on THIS particular forum. 

Didn't think I needed to state the obvious.

 

You're erring on the side of optimism. IMHO, I think all doctors should be cautious. Especially when it comes to a finite resource like hair. 

 

I'm voicing my opinion on this case.

Just because someone disagrees with you does not make them a fear monger.

 

Completely irrelevant. 

Once again, I'm not looking at this from the perspective of what the patient wants.

I'm sure there are doctors out there who will provide the patient with whatever they desire even if it's not in their interests.

While Dr. Konior is one of the best HT surgeons around, I do not think this case was ethical. Dr. Konior's rationale was very weak too.  

I'm looking at this from the perspective of the doctor, who should be operating ethically. 

 

 

Here was my point:

"You present this as if he is moving towards an armageddon scenario, the clock moving tick tock until doomsday. Have a 30 second think about the likely outcomes here and what the worst case scenario is. The worst case scenario is still going to look perfectly natural and suit this patient while they're younger. Stop fear mongering and think about what you're actually saying and whether it makes any sense, because it doesn't. Even if he loses more hair that isn't the end of the world and it won't look unnatural. "

Here is your response:

"Completely irrelevant. 

Once again, I'm not looking at this from the perspective of what the patient wants."

Its quite literally the *only* thing that is relevant. You are fear mongering about a scenario you clearly haven't even considered.

You are arguing for the sake of arguing at this point. Its obvious you haven't giving basic thought to the fact that if the patient ended up with a thin crown and midscalp and a stronger frontal third in the long term that is perfectly natural, its also the worst case scenario. When you say that you're not looking at this from the perspective of what the patient wants you've lost all credibility. When someone is as thoughtless as yourself you are the LAST person who has a perspective relevant to this patient or any other. The patients short and long term desires are the only thing that matters, and with a surgeon like Konior who is clearly world class they have a track record to show they can attain them to the best degree which its possible.

When you say you're looking at this from the perspective of the doctor you are  delusional if you think you know better than both the patient and Dr. Konior. End of story.

37 minutes ago, mayhem said:

Hair loss is unpredictable. 

However if someone has advanced hair loss when they're young, then it's not a good sign. We can't predict when they will go bald or whether they will go bald at all. 

But no one would look at this patient pre-op and bet confidently they'd have no further loss until 40. 

 

Can you support this statistic with some evidence please? Can you say whether this statistic, if valid, generalizes to the rest of the male population outside the forum?

Age isn't the issue in and of itself. TIME is the issue.

If you have an advanced pattern at a young age, then you have much more TIME to keep potentially losing more hair as you get older and older. 

 

Right, and balding in the crown with a strong hairline is a totally natural hairline pattern. Having a youthful hairline is incredibly important to people in their twenties, this patient is likely to have still 4-5000 FUE grafts left and the option of FUT and BHT beyond that. That is quite frankly highly likely to be enough to get full coverage across his entire head as a NW5 if he exhausts all surgical options. Even if it was the case that he could not cover the entire top of his scalp, he will absolutely be able to cover the vast majority of it even if he ends at a higher NW. Worst case scenario is he is left with a strong frontal third and some thinner areas in the midscalp and crown, which again is a completely natural situation for men in their 40s and 50s. 

You present this as if he is moving towards an armageddon scenario, the clock moving tick tock until doomsday. Have a 30 second think about the likely outcomes here and what the worst case scenario is. The worst case scenario is still going to look perfectly natural and suit this patient while they're younger. Stop fear mongering and think about what you're actually saying and whether it makes any sense, because it doesn't. Even if he loses more hair that isn't the end of the world and it won't look unnatural. 

I'm not going to babysit you with statistics when what I said was totally uncontroversial. Most men go for hair transplants prior to being completely bald. Your subsequent sentence has absolutely nothing to do with anything being discussed in terms of relevancy. 

You're right time IS the issue, and this patient has bought substantially more of it in the years it matters most. Even if he progressively loses significantly more hair he will be in a good position going forward and the worst case situation is a bald crown and a strong frontal third. Do you think the patient is going to cry about that when they're 45 years old? No, they're not.

Just now, mayhem said:

Hi Matt, yes I did. 

Dr. Konior's rationale seems bizarre. He acknowledges that an ethical doctor would consider the patient's family history, current hair loss, age, regime, etc. 

Yet, if one were to do all those things - how could he justify giving this 28 year old with advanced hair loss a juvenile hairline?

Hair loss can strike at any age and it is unpredictable. Dr. Konior cannot predict this young man's hair loss.

As others have said, you can always lower the hairline - but if you start off by giving a patient a NW1 or juvenile, then you take away any consideration for further loss. 

I wonder how much donor this person has left. 

 

Do you think that when someone hits 30 that their hairloss magically stops, becomes completely predictable and controllable?

Your argument makes no sense. 90% of patients on this forum have progressive hairloss and aren't completely bald yet. You could say the same to them, age has absolutely nothing to do with it.

14 hours ago, HTHope said:

Looks good for 6k grafts. What length clipper guard is the donor in this pic?

This is about 6 days of growth after buzzing it at a zero guard.  Probably roughly a 1 guard. 

MAGA