JayLDD

6 hours ago, BjornBorg said:

Koray Erdogan is the industry leader in Turkey. Yes, there are two or three examples around here that had subpar growth. But you'll never find a complete disaster with a botched donor or anyone looking like a freak. A couple of less successful cases will occur when you have more cases than anyone else on this forum.

A year or so ago there was a problem with Koray results getting a bit inconsistent since he was upgrading the number of patients he does a day. But I believe he has finetuned his operation and that the situation is under control as of late. Someone like @JayLDD, @Melvin-Moderator or @Yaz89 can correct me if I'm wrong on that last part.

In terms of any specific actions they’ve taken in regards to a drop in consistency I’m not aware although they do seem to have improved based on what I’ve seen on the international forum. At the same time, even during the period of most poor results here they still remained strong on the international forum for the most part.

It’s also an undeniable reality that statistically if they’re doing 3 times the amount of cases of many clinics here at the same success rate there will be 3 times the amount of poor results, and on top of that they were among the most exposed clinic on this forum in terms of patient posted cases which meant more visible bad results. People don’t want to be lectured on statistics or their inability to view results consistently across the board based on lighting, styling etc but it’s absolutely crucial to having a realistic understanding.

I would tentatively recommend them from what I’ve seen recently for someone of a higher Norwood that wants to do FUE. But at the same time I can’t deny they had a period that would have made me nervous. For someone that just requires smaller hairline work I’d probably look at Keser or HLC in Turkey also. In terms of my own results with ASMED after shaving down I’m pretty confident in saying that the percentage of cases I’ve seen more impressive than my own is minuscule and I don’t think I’d be better off having gone anywhere else.

On 10/23/2020 at 4:24 AM, servonoparecchicapelli said:

Couto and Freitas are booked until 2022. H&W and Konior are for people like Trump, Bezos etc.

HnW are affordable for the average American working in an area that requires a college degree. Particularly when looking at their FUT cost along with overall consistency and level of results they undeniably look like one of the best value clinics globally. 

In my opinion unless you're firmly part of the "1%" Konior should be avoided at those prices. That speaks nothing of his results which are clearly among the best globally, but chances are the money would be better spent elsewhere at those levels. He's raised prices to match his reputation and patient interest but at the $10+ a graft mark he's taking the piss when it comes to providing any sort of consideration to value. Good on him if he still provides great results but no one should pay those prices unless they can actually afford it. Most people are better off choosing a surgeon with prices where they have no issues going to for further procedures subsequent to more hairloss or desire a touchup.

The over emphasis on whether or not a company uses techs for extractions or implantations on this entire thread by the way is totally overstated. Certain clinics get attacked for it while others are consistently praised and it never gets brought up. Hasson/Wong use techs for extractions and I've virtually never seen it criticised, the consistent longer term results matter massively more than whether or not the doctor is doing all parts of the procedure. Same situation with Lorenzo or Dr. Villa. I don't need to pay a 3 star Michelin chef to kill and butcher a cow for me if its going to 10x the cost of a steak. 

I also saw a representative for Dr. Bhatti and I think also Dr. Maras recently on this forum attacking use of techs in FUE despite the fact that those two surgeons both utilize techs in extractions or implantations or both. It just comes across like vapid virtue signalling or people trying to convince themselves they made a good decision in paying more than the average person can afford for results they could have got with a cheaper surgeon that uses techs regardless.

The Criticisms of Keser and Freitas here seem unfounded. A few poor cases or an individual complaining about 1 or 2 multi-grafts in their hairline is a terrible way to judge overall results. In one instance on another forum a patient had a virtually flawless hairline, incredible density and yield with maybe 2-3 multis in the entire hairline (for which even I guarantee experienced members here would not notice in person) and after complaining they were accepted for free repair work by Keser. In regards to Freitas, there are significant numbers of consistent patient posted and clinic posted cases and he's undeniably doing some of the best FUE work in the world. Whether or not he started working at a cheap hairmill says absolutely nothing about his current standards which are clearly very high no matter who you compare him. Using the "he uses techs" argument is thoughtless and the "no patient posted cases"  just means you need to get better at using Google searches.

3 hours ago, BjornBorg said:

Are you happy with how the donor looks shaved down?

At this length there’s definitely a noticeable scarring although I expected that. Some lightings it seems to be worse than others, outdoors not particularly noticeable.

pretty much looks like I’d expect it to after 6000+ grafts 

I typically get a fade cut with scissors and it doesn’t show at all, I’m guessing it’s a bit over a week from buzzing to a zero before it starts to disappear.

3 hours ago, Kraistoff said:

Is this when you shaved it down or something ? Why did you do that ?

My state is still technically in lockdown and has been for the last 3 months or so, hairdressers weren't allowed to open.  Ended up just buzzing it as the easiest option and was interested in how it would look.

19 minutes ago, JohnMelb1234 said:

Ok thank you. Re Knudsen, is this for both doctors in Melb and Sydney? And is this based on people you have seen or just what you see on websites?

the Instagram pics of Gro hair look great. 

i think it’s either Dr Vikram , gro hair, or just wait until international travel is back and I can go to where you went or Dr Bisanga in Belgium. 

 

Thanks again! 

I would consider photos I've seen from Gro clinic (although not specifically their insta) to be mediocre in general, many of their results they show on their website are downright poor. The issue is you can't choose off the basis of instagram pics because they're only picking their best and the photos are potentially touched up or taken in best possible circumstances. Patient posted results off forums like these are the majority of what you should go off. Similar situation with Knudsen's clinics. 

I haven't seen patients who have gone to Australian surgeons but that's part of the problem, there is very little documentation on forums like this which is a requirement of an informed decision on whether or not the clinic is competent. Yes they might have a few good results or enough to fill a website, but its statistically meaningless when they're only selecting good results.

Dr. Vikram seems much more talented than Knudsen who I would outright consider a bad doctor, although the fact he associates with Knudsen is enough to reject him, there isn't enough online evidence to justify picking him. 

Bisanga and ASMED are leagues above them regardless. In my opinion Australian hair transplant surgeons should be boycotted in general until standards are proven to have raised drastically. For the prices they charge the results should be world class and they aren't at this point.

5 minutes ago, JohnMelb1234 said:

Looks fantastic!  I'm keen to get a transplant in Australia during lockdown. Should I do this, and if so any tips where? Or, should I just wait until the international borders are open and go where you went? 
Thanks again

Would strongly recommend against it. I'm in your city city too (I assume) and Knudsen clinics in the eastern states do particularly poor work from what I see for the most part and he's probably the most highly regarded surgeon in the country.

It would be great to get it done during lockdown but unfortunately not optimal. The reality is that if you can afford Aussie prices you likely can afford surgeons that are at the top-end globally, which those in Australia are not.

2 hours ago, JohnMelb1234 said:

Hey, just reading this for the first time today. Looks great! How is your hair now? Thanks

1 hour ago, Melvin-Moderator said:

@JayLDD I constantly get reports of you being rude, and I've been asked by at least 3 members to ban you. Shape up and learn how to be civil or I will have to ban you. 

I'm not bathed in the holy waters of forum moderation as you are so maybe I'm missing something, but banning a highly knowledgeable and honest member for the sake of people like the above poster/s who clearly offered nothing but dishonesty, a lack of understanding or delusion which you know full well is the case as someone experienced yourself comes across horribly. Seems like a good way to traffic more bad information to people in an industry that's full enough with disinformation and people being taken advantage of.

If you think the fragile egos of people who whine to mommy that I'm rude are more important than people getting honest and accurate information then maybe you should indeed go ahead and ban me. Better to keep a merry bande of idiots around that are too afraid/stupid to even suggest that someone going to a Turkish hair mill with very suspect post-ops regarding graft numbers is likely going to get a bad result.

I don't expect much more from someone who babysits their own surgeon at the expense of multitudes of posters and locks threads that criticise them however.

3 minutes ago, JohnAC71 said:

No need to be rude! If he didn’t get the 5000 grafts he reported to have got that’s a shame.  
3500 upfront and 1500 in the crown isn’t exactly a push. 

I don't think bullshitting someone who went to a Turkish hairmill when you can see his post-op is incredibly sparse and appears nowhere near as dense as in other cases on the forum at those graft numbers is any better than being rude personally. 

The first rule for yourself and anyone else in regards to transplants is to use your own eyes and mind to process information rather than blindly accepting anything you're told. Even Blind Freddy can see that this is far too sparse for 5k grafts.

If all the grafts grow OP might have something positive to work with but its better to prepare them for what is likely rather than what would be the miracle outcome. And there aren't 5k grafts here.

2 minutes ago, JohnAC71 said:

No need to be rude! If he didn’t get the 5000 grafts he reported to have got that’s a shame.  
3500 upfront and 1500 in the crown isn’t exactly a push. 

I

On 9/28/2020 at 3:56 PM, JohnAC71 said:

I don’t think you should be worried. 5000 grafts is going to make a big difference. But right now is the waiting game. Keep us updated on here every month. 
Are you on any meds to retain what hair you have already? 

You are a lost cause if you look at OPs photos and believe he genuinely received 5k grafts.

8 minutes ago, BeHappy said:

JayLDD,

Here is the one I was looking for. You can see from the hair that was transplanted years earlier that he wasn't a NW 7 at the time. It looks like he was maybe a NW 5, but his bald area greatly increased in size over time eventually making him a NW 7, but according to you it's not possible to be a NW 5 and then become a NW 7 later. Oh and look he still has hair on his sides and back. How can that be? It can't be true because you never saw this in real life. Maybe you just aren't looking. Here's a question for you. How many NW 7 men have you tracked their hair loss since when they were teenagers? Oh and look. This man was able to get more grafts even though it's not possible according you you because his hair would be too miniaturized.

 

 

 

 

 

 

 

I've clearly looked at signififcantly more cases than you have, the hair plug results you're posting don't prove your point. They give absolutely zero information about what I'm making very clear which is that these areas in the NW7 would have been thinning already at the point which he had lost hair in that smaller area on top.  Unless there are other underlying health conditions or a special kind of hairloss like DUPA.

If you have a NW6 pattern, you will have thinning in the NW6 area going deep back into the crown well before you hit NW6. Do you honestly think these cases prove that they went from a slick bald NW5 for to a NW7 magically? No, those areas would have thinned well in advance. Tests for miniaturisation and putting the hair under microscope are always possible.

Hairloss is progressive, but the final PATTERN stays the same. 

I'm sorry but your conclusions are totally off the mark. You may as well tell every patient on earth including those in their 30s don't get a hair transplant because you might hit NW7 and have no means of knowing even as a slick bald NW5 for example. Your conclusion has absolutely nothing to do with age either, if in your fantasy land NW5s all had a high or even likely chance of hitting NW6 in the future with no present signs of thinning no one could get a hair transplant. How would your conclusion make a difference even if someone was 45 and a slick bald NW5? They still might end up NW7 according to you.

6 hours ago, transplantedphil said:

18 hours ago, BeHappy said:

 

The first picture is 1989 in the chair ready for my first hair transplant. I don't have a picture from the side view, but you can clearly see my side hair goes very far up the sides of my head.

The next picture is 1998. You can see the side hair line has moved downward considerable and is now moving past the top scars. Also note that the top scar  was completely covered at one point with thick hair or else a strip would not have been taken from there.

The next picture is around 2014

 

 

 

 

 

 

 

 

 

- which admittedly can be a difficult thing to do. For those at a younger age the stakes are obviously higher as well, with predicting an outcome much more difficult.

Sound advice

Modern hair transplants didn't exist in the 1980s and even the notion of looking at the donor for miniaturisation almost certainly didn't occur, you simply can't make judgement off this. 

Your hairloss pattern appears to be occurring throughout the entire donor area, you are beyond even a NW7. If you went to a doctor today about this they likely call it diffuse loss as well as a NW7 pattern. For the record, this probably 1/500 at a minimum in terms of how rare it is and your result appears to be DUPA beyond just the typical NW scale. If you don't have a family history of NW7s its likely in the realm of 1/1000. I can't remember the last time I've seen it in the real world. Your chances of a poor yield as a 30 year old transplant patient are immensely higher.

The 1989 photo as aesthetic as it may be quite frankly doesn't give any real information about thinning in the back or sides. And I doubt the surgeon even bothered to run their finger through the donor to check for thinning during a period where hair transplants were largely a capitalistic immoral act of brutality even putting age aside.

Your case reflects a risk, but it doesn't reflect one at the level of normality and age isn't a major consideration here. Even if you had surgery in your 30s, it would have made absolutely no difference to your end result because you're clearly an edge case with thinning across the entire donor.

"Doesn't it make sense that some NW 7s were NW6 prior to being NW 7? Doesn't it make sense that NW 6 was previously a NW 5? Of course! This NW chart below is basically how my pattern progressed. From everything I've seen over the years I think the men who get crown loss early on are much more likely to go through the scale towards a NW 7 than those who only get frontal loss early on"

Literally all of this is either substantively untrue or broscience by the way. Zero evidence of the second point and on the first point if you are a NW7 pattern you will almost certainly thin in that area well before you hit NW5. 

10 years apart and at only early 30s, you can't use this as an example as to why not to get hair transplants in your 20s. You can't sensibly suggest this isn't due to broader medical factors or a very specific type of diffuse hairloss. I don't think I've ever seen this in the real world.

8 hours ago, Billy0716 said:

I had one at 25. 2000 grafts FUE to the hairline. I’d tell you not to do it, but if you’re anything like me then you’ll probably ignore the advice. I’ve now completely lost hair in the crown area and have to wear fibers behind my hairline (32 now) See photo below ghat illustrates Further hair loss behind the implanted hair line.
 

I’m currently in the process of Consulting with Dr Muresanu at Hattingen hair who has examined me in person and advised that my donor area has been over harvested during my first procedure. The plan now is to remove some of the grafts in the hairline to make it more natural and place these more centrally to blend back into the bald crown. I will then buzz my hair down in a final attempt to look natural (albeit bald but with some framing of the face). 
 

Failing this I’ve seen great results at Men’s ink SMP, which I had never really considered before but I believe this may be my only option and the results on their pages look great at least. I’d say try buzzing your hair first. If you don’t like it jump on minoxidil for a few years (I never did Until now it’s too late) and then consider your options in a few more years. I would definitely recommend Hattingen if you’re looking for naturalness. My experience with them has been completely honest so far and they will be honest with your expectations.

 

In this case the mere fact that you've said after 2000 grafts your donor was overharvested tells me with almost certainty that the failure in result stems from the quality of the surgeon. If you went to Dr. Muresanu for your procedure to begin with either your donor would have been too poor to begin with and he likely would have turned you away, or you would probably have ended up with a good result. 

Your result is basically the Wayne Rooney result by the way, and he advertised it publicly and probably spent 20k pounds on it. Age really has nothing to do with it.

24 minutes ago, BeHappy said:

 

I'm in the same situation as the one posted. Why would you assume he had a rare underlying medical condition? I can tell you for myself I get a physical every year. At 53 years old I am not on any medication, I have normal blood pressure, normal cholesteral level, glucose under 100, everything else is in normal ranges except for biliruben which has always run a bit high, but was told last month at my physical that my kidneys are normal and my liver is functioning perfectly.

You also say it's very clear whether or not someone is a NW5 or 6 final pattern even in the early to mid stages. I can tell you this is not true at all. My pattern just continued to expand over the years. When I was 17 I only had a thin balding area down the center of my head and a thinning crown. The sides and back were very thick. The center area continued to widen for the next 35 years. You are totally wrong on this.

 

 

"When I was 17 I only had a thin balding area down the center of my head and a thinning crown. The sides and back were very thick. The center area continued to widen for the next 35 years. You are totally wrong on this."

A surgeon can test for miniaturisation in these areas regardless to remove a degree of risk. The idea you were thinning in a NW5 pattern and then miraculously started thinning in a NW6 for example is ridiculous, virtually never seen it and I've seen tens of thousands of cases. What you're describing sounds like a NW4 pattern moving to a NW5. The overall *pattern* of area that thins doesn't change in 99% of cases. The back and sides do thin with age but there's no patient in their 20s on earth you'll convince not to have a procedure arguing that it won't look great in 3 decades, and rightly so because its not a sensible argument. The case of moth eaten donors magically occurring two decades down the track are massively abnormal.

Feel free to post photos to prove otherwise. NO ONE thins in a NW5 pattern, then overnight starts thinning in the NW6 once they've already lost their hair in the NW5 area. People continue to thin with age but we are talking decades, not short term.  You also mention that you're in your 50s and in this position, the reality is you've aged and are no spring chicken. The patient mentioned above is in their THIRTIES. There's no universe in which they didn't have a very unique form of hairloss or underlying condition for this to occur.

Here is what this patient looked like after the surgeries.

This is now with the passing of time, only a decade after and in their early 30s:

And you're going to tell me that its not due to a health or external circumstances? Give me a fucking break, this is incredibly rare and if it happened as regularly as you suggest no one would get transplants. This forum wouldn't exist if this was common. 

I'll say it again as clearly as possible, the risk of this occurring is significantly lower than the risk of having poor growth. If you're worried about this occurring then you ought to be a lot more worried about a low yield.

9 hours ago, transplantedphil said:

@JayLDDhas had 2 but for some reason i cant link his threads. Admittedly id argue he was one of the few that made a well informed decision having researched thoroughly and has a larger than average donor. 

this guy just posted to the forum having started at 20.

The problem with getting a HT under the age of 25 is that if it is noticeable it means your hairloss is likely aggressive and thus unpredictable. Ethical clinics cant reasonable predict what will happen in the future and guarantee you a long term result, so its neither in your best interest or good for a clinics reputation to proceed with surgery.

 

My hair has a waviness which really helps and my donor is definitely in the top 20%. My pattern is also a fairly conventional NW5 that doesn't extend down too far.

I have to assume that guy had a rarer underlying medical condition or form of hairloss, statistically the chance of being in that guys shoes is lower than the chance of going to Konior and getting bad results. 

In terms of stories of mistakes of people getting surgeries too young, I wouldn't consider this one of them. Without knowing for sure I think this is much closer to a "don't have a serious thyroid or 1/10000 fucked up health issue lurking before you have a transplant". I don't think its realistic to see this as a possibility for even 1% of people who have surgeries in their early 20s. After he final procedure he still had a great looking donor, now its a disaster. Totally out of bounds for typical hairloss cases.

Clinics can't reasonably predict what will happen with *anyone* in absolute, but its very clear whether or not someone is a NW5 or 6 final pattern even in the early to mid stages and for a NW5 they likely have enough lifetime grafts to start early in the process.

I've fixed the links in my profile now.

On 9/16/2020 at 3:01 PM, Kraistoff said:

Hello everybody,

 

so 2 years and 2 days after my first procedure of 4500 grafts, and as you who have been following would know, I have been invited back to the clinic.

 

I might start a new thread or continue this one, but I think the below photos speak for themselves. 
 

my hair shaft cross - sectional diameter is only 51 microns (average at best) and the contrast between skin and hair colour couldn’t be any higher. For those of you that know anything about hair transplantation these are two of the most important factors with regards to the illusion of density. I believe I was a challenging case given my characteristics. I do have the benefit of having wavy hair which curls as it wishes which help it look thicker. 

 

The Dr said my donor area was still perfect, but we agreed on 1500 grafts to be planted into the frontal third. The Dr raised concerns that finasteride didn’t seem to be working as effective as it should for me (perhaps I’ve built a tolerance) and suggested I give Dutaseride a go. Does anyone have any experience of this? 
 

my goals is to be able to cut my hair a little shorter than the usual 3/4 inches on top to maintain the illusion of density. 

It was a pleasure to meet the team again, and it was also a pleasure to meet Dr Patrick Mwamba who was visiting the clinic and was there during my incisions. 

 

I will try to not post as much for this procedure - perhaps once every few months . 
 

I do hope that I don’t suffer such an ugly duckling phase this time. I also hope that my transplanted Hair  from First operation doesn’t suffer shock loss. 

I know you mentioned once you would have preferred maybe more hair in those thin areas and not having done the temple points but in your side profile you literally went from 45 to 28.  Maybe you lost a bit of weight too and that helps.

12 minutes ago, Curious25 said:

I'm sorry to hear your experience with that, but glad all is well now. You make some very valid points regarding your outlook on all things hair loss tbh - and I enjoy conversing with people who are able to change their mind and avoid tunnel vision mentality in regards to anything in life, not just hair restoration.

RE. FUT first then FUE later, I myself too, had an FUE procedure, I quite frankly didn't want the risk of a scar gone wrong or the downtime, and I didn't buy into the whole FUT maximises graft numbers long term argument, because no one I spoke to could give me a good enough argument as to why you couldn't have FUT after an FUE procedure. I also liked the idea of eventual homogenous placement of hair across the scalp, as my back and sides have always been a lot denser than up top. Now I'm more read up and wise to hair restoration, I have come round to the idea somewhat of FUT, after seeing and hearing some great testimonials - but I'm finding it difficult to weigh up whether the shift in trend of clinics now favouring FUE is driven by consumer demand, or the additional money they can make . . probably a combination of both, although I do think techniques have come on leaps and bounds now, which under the right hands can provide graft survival rates akin to FUT. 

RE. Finasteride - the lower dosing to reduce side effects is something I've never understood either - if the studies suggest that lower dosing still more or less reduces DHT levels by the same amount as a daily 1mg dose does, why would this miraculously reduce the chances of side effects, when its the reduction in DHT that causes these very side effects?! lol? Anyway - despite my strong views on it, I will never deliberately try and put people off, what I think is important is to advise every single guy to consult with doctors (and I mean urologists, endocrinologists etc, not HT doctors) read up and study, talk to users, talk to former users, consult with their partners/family, and then make an accurate and informed decision which is personal to you and only you can do that. There's too many idiots who jump on these boards and demand people to start a daily 1mg prescription of it the next morning as though its like sprinkling an extra bit of sugar on your weetabix, as there are too many idiots who will jump on these boards and tell people they'll never have an erection in their life again (which for the vast majority I also don't believe is true). 

Oh well, hopefully thread hasn't been hijacked too much and OP gets use out of these conversations in some shape or form, i think in particular with your case it will make for a decent case study to learn from and open up a bit of a pathway he could start to look at taking.

"if the studies suggest that lower dosing still more or less reduces DHT levels by the same amount as a daily 1mg dose does, why would this miraculously reduce the chances of side effects, when its the reduction in DHT that causes these very side effects?! lol?"

The problem is the system of variables which are effected by taking the drug are so diverse and understanding the effects of changing them individually are very difficult to test for, even if you could test for them the result might be different from person to person. It also might not simply be DHT reduction that causes side effects, or there might be a very specific level of reduction for which the average person has problems. You're right that its basically wishful thinking and I wouldn't deny its in the realm of broscience, but there's not a lot of legitimate information to actually draw conclusions from to begin with and the original studies are clearly farcical. Its not like Merck or other pharma companies don't have their share of causing massive harm to people off the basis of badly conducted trials.

It definitely still seems logical to take the absolute minimum doseage possible despite similar DHT reduction, its hard to tell exact benefits because I had multiple transplants but it seemed to grow back and strengthen my hair fairly drastically. It absolutely halted 100% of losses, maybe improved my hair and caused growth over baseline at 25% if I was to guess. And I totally agree with you about people having unjustified extreme reactions on both sides,  even in my own case I still probably benefited from a few years of improvement.

"and I didn't buy into the whole FUT maximises graft numbers long term argument, because no one I spoke to could give me a good enough argument as to why you couldn't have FUT after an FUE procedure."

I still haven't necessarily found this either,  it has some basic logic in terms of likely somewhat higher yields and probability of good yield going FUT first. Even a good FUE surgeon will likely have slightly lower yields and a material transection rate. If you do strip after FUE it will have to be a larger strip to have the same amount of grafts than if you'd gone that route to begin. If I have a procedure down the track I will almost definitely look into the FUT option however. I think I've lost the vast majority of my crown natives but if I lose the midscalp too it will probably be 2000 graftsish plus 1k to touchup the frontal third. I could probably go another 1k via FUE too so even 2k strip would be enough.

1 hour ago, Curious25 said:

Where do you stand on finasteride now? If i remember correctly, you were never keen on jumping on it in the first place, and when you did, took a very low dosage? Do you believe it to have had a cumulative affect on you?

I was mildly concerned with side effects to begin with but thought it was unlikely they would occur, I took 0.25mg the entire time. In terms of DHT reduction the result between 0.25mg and 1mg is very similar, although the exact effect on side effects is unknown so I was hoping it would drastically lower the chances. For the first year I had absolutely no sides, in the first month of useage my sex drive went up drastically and my lifts went up fairly drastically overnight, almost in a way that was steroidal. Things leveled out after that.  I can't remember the exact time span but after about 2 years I had minor issues with holding a boner in one experience and and maybe a month after that where it was clearly a problem. After getting off it took about 6 months to get roughly back to baseline. 

My unverified assumption off the basis with my experience in the first month and up to the point of 2 years (and I would have needed to test hormone levels to do so) is that to counter the reduction of DHT my testosterone production rocketed up in the first month, drifted down a bit subsequently and by 2 years or so was back to baseline. There isn't a huge amount of good information on side effects for fina over a long period of time. There's also plenty of other information on effects of finasteride on another of other variables and downstream effects that aren't well understood on top of this. If I had any specific reason to recommend against using the drug and doing so long term it would be how utterly terrible the lack of information on broader effects on the body are regarding a number of variables and how contradictory many studies appear, particularly older ones in comparison to newer.

Even in my experience with a NW5 pattern I think FUE was acceptable and ASMED did a great job, however because finasteride failed it drastically increased the overall risk factor. If my growth had been 30% worse for example I'd be in a very bad position, FUT with surgeons at the level of Hasson/Wong would have been safer in regards to yield even if it may have meant I needed to have my back and sides a little longer. Hair transplants are a permanent solution, finasteride is temporary and just seems to complicate things. It can however save you a lot of money in the short term.

1 hour ago, ItHasToLookNatural said:

What makes you say this now? You used to be the biggest FUE advocate on the forum. 

You’re right, partly on the basis of the fact that I had finasteride sides and it became clearer over time that the early studies on the drug and the FDA trials were farcical from what I saw elsewhere. I think if you assume that they’re legitimate and the sides are genuinely in the range of 1-3% then the majority of patients can achieve their long term goals with FUE and finasteride.

But as I said, I no longer am confident that those early studies are even remotely accurate in regards to side effects. So particularly for a younger patient that is probably going to lose a lot of hair and lose it quickly, I’d recommend or at least suggest the method that will maximize grafts long term. Before I would have said finasteride and FUE.

I do think the overall risk of severe damage to the donor is higher with FUT on average and scars stretching is a possibility but I at this point I’d take trade off of having longer short and sides for the sake of more hair on top. For the vast majority of cases they will have have significantly less scarring magnitude with FUT and be able to have their hair not that much longer than with FUE. 

It really comes down to trade offs with probabilities and what you make of them. Without finasteride in the equation FUT looks much more valid than otherwise. 

13 hours ago, transplantedphil said:

Some clinics will admittedly implant at half the density knowing full well the patient will be unsatisfied and will only HAVE to return for more surgery with them. My guess would be that's whats happened here.

Please take the advice of other members here and consider another clinic - with the suggestions of Bloxham, Konior and H&W by another member the obvious starting points. 

Can’t prove it, but I strongly suspect this is what happened.

On 9/12/2020 at 4:02 AM, JamesSterling said:

I'm sure it has been covered on this forum many times but which surgeon would you recommend if location and price is not an issue? For Norwood Grade IV, presumably around 4,000 to 4,500 grafts ideally using FUE (FUT doesn't look appealing). I have seen on this forum that Muresanu, Couto, Konior, Keser, Hasson and Lorenzo have been referred to as “super elites”. Is that all of the super elites in the world? What about Robert Bernstein in NYC? Who would you ultimately choose and why? (again ignoring price and location). 

I know they're no longer recommended here but realistically for FUE at this Norwood the only clinics getting anything close to full coverage via FUE are ASMED with Erdogan in Turkey as well as Lorenzo,arguably Couto although he tends to operate on patients without that level of loss and has at least 3 years on his waiting list. Bernstein is what I would consider to be part of an older, more conservative generation of surgeons that ultimately don't hold up to that present elite despite being important to the industries development.  

If you're a genuine NW6 your best bet would likely be to avoid FUE altogether and consider Hasson or Muresanu with FUT. Its simply the better procedure for high NWs. You mentioned Couto's price as being high, Konior is $12 USD per graft and despite being one of the best surgeons globally I can't see any universe in which its sensible for a NW6 to consider him unless they have unlimited or practically unlimted funds. If you can afford to go with Konior without giving up other material desires then I probably would however. 

My main recommendations would be Hasson/Wong and go FUT, if you go the FUE route then likely Erdogan or Lorenzo.

2 minutes ago, JayLDD said:

 

I'm going to be totally honest; avoid this surgeon and go elsewhere. Your donor looks terrible considering how many grafts you had. Why pay American prices for surgery if you're going to go to someone who is a nobody? The didn't implant enough grafts and left the state of your hair looking terrible and unnatural for at least a year. 

Its blatantly obvious from photos of your donor post-op and the design of the hairline that this is ultimately an amateur job. There are plenty of competent surgeons in the US, Bloxham and Konior for example, or Hasson in Canada are leagues above this. You should absolutely consult Hasson/Wong before you consider going back to this guy.

Its not normal for a surgeon to implant at half the density of what is natural, you're 6 months in and at this point likely have 75% of your growth at least. Its not a good result, its abnormal for the industry and even your donor looks poor.

 

This level of patchiness in my eyes isn't acceptable for that level of grafts. I've had 6000 and my scarring is nowhere near as bad, some of these are massive. You should find a competent surgeon that isn't going to ruin your donor completely before you even have a natural looking hairline. At this rate by 3000 grafts you won't have a hairline still and your donor will be fucked too.

People don't want to offend because hair transplants and hairloss in general is touchy, so often they're too cautious with pointing out faults on forums with someones procedure ultimately to the detriment of the poster. For the love of God, don't go back. Not only can you do significantly better elsewhere but you are potentially jeopardising your donor for future procedures.

 

 

 

 

 

 

 

On 9/11/2020 at 1:26 PM, Dangrowthfactor said:

The 6 Month Mark has arrived. Today Sept. 10th is the start of month 6.

still on minox 5% foam, and finasteride 

Still have to set up follow up appointment with Dr Magdelin. 
 

we spoke on the phone, going to talk about touch up procedure to double or potentially triple the density. He was very clear that we restored a fraction of original density. He’s been very consistent and straightforward through the entire process. 
 

If I am heading in the direction where of the 1400 I have maximum yield of grafts that’s great. Will def need another procedure to fill in density. 
 

the light, makes a difference in appearance. If it’s wet or dry makes a difference in appearance.

 

Combed or Not is seen below. Both wet hair. Bright light. 
 

 

 

I'm going to be totally honest; avoid this surgeon and go elsewhere. Your donor looks terrible considering how many grafts you had. Why pay American prices for surgery if you're going to go to someone who is a nobody? The didn't implant enough grafts and left the state of your hair looking terrible and unnatural for at least a year. 

Its blatantly obvious from photos of your donor post-op and the design of the hairline that this is ultimately an amateur job. There are plenty of competent surgeons in the US, Bloxham and Konior for example, or Hasson in Canada are leagues above this. You should absolutely consult Hasson/Wong before you consider going back to this guy.

Its not normal for a surgeon to implant at half the density of what is natural, you're 6 months in and at this point likely have 75% of your growth at least. Its not a good result, its abnormal for the industry and even your donor looks poor.

This level of patchiness in my eyes isn't acceptable for that level of grafts. I've had 6000 and my scarring is nowhere near as bad, some of these are massive. You should find a competent surgeon that isn't going to ruin your donor completely before you even have a natural looking hairline. At this rate by 3000 grafts you won't have a hairline still and your donor will be fucked too.

People don't want to offend because hair transplants and hairloss in general is touchy, so often they're too cautious with pointing out faults on forums with someones procedure ultimately to the detriment of the poster. For the love of God, don't go back. Not only can you do significantly better elsewhere, but you are potentially jeopardising your donor for future procedures.

I had my first transplant at 22 and it was absolutely the right decision.  I ended up having to get off finasteride due to side effects but even that has not changed my considerations for the most part. The benefits massively outweigh the risks with a high-level surgeon.  For someone in their early twenties I would likely recommend FUT to maximise graft numbers and suggest to anyone in that position to accept the scarring, for the vast majority a clinic like Hasson and Wong will leave you able to leave your back and sides relatively short regardless. ASMED for myself was a great choice although I'm less convinced over time that FUE is the safest choice.

Curious gave what is basically a really intelligent comment overall.  I think its often slightly overstated how conservative one needs to be however. By the time you are NW3 your overall balding pattern is typically very apparent. If it is a NW5 depending on donor quality there is a good chance even if you went completely bald that you have the capacity to basically create a youthful hairline with a thinner crown that is overall the appearance of a full head of hair. FUT is likely the better option in terms of maximising donor however. 

The main questions I would ask are do you have the money do afford multiple surgeries, including potential top-ups over the decade and beyond, and especially what you will do if the procedures don't turn out the way you hope. How will you cope in regards to future actions, emotionally and financially. Honestly, I think the biggest questions are whether or not you are a NW5 or a NW6 pattern, the quality of your donor, your finances and choice of surgeon. 

Does it make sense to wait until I'm 25? I believe that adding these 3k grafts would provide me with a better look for at least 5-10 years and in that time if I see further hair thinning / recession then I can go for different treatments such as PRP. 

In regards to this, PRP is in my opinion largely unproven as a serious means of combating hairloss. I would personally avoid surgeons that push PRP as a treatment.  I would also say as MUST you should post photos of your current situation and say who the surgeons are that you've been to to get a second opinion. There are plenty of posters here that are quite frankly more knowledgeable about optimal strategies and the top surgeons than a lot of doctors are. If your hairline is almost completely gone 3000 grafts is a fairly standard and common amount to rebuild it but serious work in both the crown and hairline would likely be closer to 5000.

If you're worried about finasteride sides, I would say avoid it and focus on transplants. Finasteride might save you a lot of money in the short term however.

23 hours ago, BjornBorg said:

Did you mean physiological? And if not, care to elaborate on how psychological factors would play a part here?

I think you know what I meant