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2 minutes ago, Henry said:

True, it would have to be a very skilled physician though, they are expensive or usually requires you to travel overseas. The diffused thinner would have a much harder time of looking for a skilled surgeon.

Let's say an average skilled physician operates on both people, i would argue the slick norwood 6 would have a better result, the diffused one might have permanent shock loss and at least 30 percent of grafts transplanted not growing, the diffused thinner might end up with exactly the same density or even less density.

 

 

Does implantation "technique" really matters along with skilled physician to avoid the permanent shock loss for diffused thinner? Like going with DHI and Not pre-made slits for diffused thinner as the slits are less wide?

Here is my confusion. I had an in-person consultation with Dr Couto few months back and he rejected my case saying I have DUPA by doing micro scopic evaluation. His Jr Doctor said atleast my frontal areas can be transplanted if not crown but Dr C said he wont operate due to DUPA and only medication is the option for me. I had an in person consultation with Dr Konior and Dr Sethi and they are good to operate on me  but they didn't do any microscopic evaluation of my donor and in their opinion DUPA is not a Blocker for HT. Other elite surgeons who saw my photos also they are ready to operate as long as I take medication. So can I ignore Dr C's assessment as every other elite doctor is ok to perform HT on me even though they didn't do microscopic evaluation? If a DUPA patient shouldn't get HT then why other doctors think I am a good candidate as opposed to Dr C's assessment?

Got it. So which is worse? Dupa or diffused thinner non dupa? Looks like dupa but wondering why surgeons operate on a dupa patient?

I was also rejected by 1 surgeon due to diffuse thinning. The reason was donor even though it looks good there is a thinning and no guarantee those grafts will survive along with shock loss on native hair. So overall cosmetic benefit will not be there so you might end up looking worse or just look how your are pre - HT. So for diffused thinners the recommendation is only meds but i am going with another surgeon.

I thought "stick and place" method is more time consuming and complex and its more suitable for "diffuse" thinners. Any idea?

On 7/7/2022 at 5:52 PM, Rahal Hair Transplant said:

Mario,

To be completely honest, based on the photos alone I don’t think you’re a good candidate for her transplant surgery.

You have a substantial amount of bald area to cover Norwood Class 5V borderline 6 based on the thinning in the lower crown region) and your donor area looks exceptionally thin. In fact, my initial concern is that you might have DUPA or Diffuse Unpatterned Alopecia.  If you do, your donor area is not safe due to the miniaturization which means that it may likely continue to thin or fall out even if transplanted to the recipient area.

Hair transplant surgery works on a principle known as donor dominance and thus, maintains its original properties even when moved.  That’s why DHT resistant hair such as hair on the sides and back the scalp doesn’t fall out even when transplanted to an area of the scalp where natural hair falls out. Thus, the opposite is also true.

Those with DUPA (which includes thinning/miniaturizing hair on the sides and back of the head) don’t make good hair transplant cabinets because miniaturizing hair moved to the recipient area Will maintain its original properties and course which means it will likely continue to thin out.

Now even if you don’t have DUPA, you have to consider the supply and demand principle of hair transplant surgery. Donor hair is already limited and with a shorter supply due to a low density donor, you simply won’t have enough to provide any real coverage or density to such a large balding area.  

A Norwood 5A/V Area would require approximately 22,000 follicular units (FUs) to re-create “true density“ which is essentially an approximate number based on how much natural hair one has in that area before any thinning begins.  In terms of density that’s typically on average anywhere between 60 to 80 FU/cm2 plus or minus.  To create an adequate illusion of density, one would require approximately 50% of that which would be approximately 11,000 FUs Which is typically anywhere between 30 to 40 Fu/cm2.

Bow keep in mind that hair is not evenly distributed and more density is typically added to the crucial areas like the hairline in the frontal region while the mid scalp and crown areas are typically provided with less density.   That’s why many cases such is yours can still look quite full with only moderate signs of thinning in the less crucial areas such as the crown with maybe only 7000 to 8000 FUs.

Long story short, depending on The actual size of your scalp and area to cover, hair coarseness/hair shaft diameter and hair color to scalp color contrast ratio, 7000 to 8000 FUs Could provide you with a pretty full looking and natural head of hair with only a mild appearance of thinning in the back of the midsection and crown areas.  

However, by looking at your photos alone, I really don’t think you have the donor hair for that and if you’re lucky, hey skills and experience surgeon might be able to extract half of that safely.  

That said, I think the best thing to do is to consult with a skilled and experienced surgeon will who will give you a completely honest assessment as to whether or not you’re a candidate. Anyone could take you on as a patient and perform hair transplant surgery on you.  But if you’re not a good candidate, you’ll be very disappointed with the results.

if you’d like to schedule a one on one information session with Dr. Rahal who will give you an honest assessment t if your case, please send me a PM and I can get this setup for you.

Best wishes,

Rahal Hair Transplant 

 

Hello @Rahal Hair Transplant

I waited for 3 years to meet one of the elite doctor and I met that doctor recently and he gave exact reason as you described above. He told me that I have DUPA with Norwood 6 (close) and Surgery is totally out of question eventhough I am 45 age. In His opinion DUPA patients should never opt for surgery eventhough I am taking finasteride 1mg every day. I met few other elite doctors both inperson and online and they said I am a good candidate for HT. But this doctor explained the only way a DUPA patient can recover hair is thru Oral Minox plus Dutasteride. Even finasteride will not help. I am kind of very disappointed and almost gave hopes of HT because the doctor convinced me by showing the DUPA with microscopic exam. However I want a 2nd opinion because other elite doctors said i am a good candidate but they didnt do microscopic exam. Can you please let me know your opinion? DUPA patients Norwood 6 should never opt for surgery? Dr Bernstein in his youtube video also said the same.

15 hours ago, LaserCap said:

Some people would rather not take it.  I respect the decision, particularly when I see the patient doing other things to help himself.  What have you noticed so far?

@LaserCap I never started finasteride. i might be a good responder and will not get side affects but I dont see a point even to start on it when there are other alternatives. issue comes when doctor say he will not perform surgery if i am not going to try it for atleast 6 months. there are few top surgeons who can do HT without finasteride so my plan is to go with them and stick to alternatives like PRP and laser cap theropy.

@Melvin-Moderator yes i have conservative goals and looking for Only FUE/DHT. FUT and Finasteride is a big no for me although its a better choice suggested by some top tier surgeons. hence the questions.

Thanks for above pointers. I was advised by few surgeons to take finasteride before hair transplant as I have native hair left. So with lCPRO (dr arochas version of lllt) + PRP and rogaine daily is same as taking finasteride to some extent? I am not in favor to take propecia.

Please advise.

Hello - @DrPradeep @arika9ab 

what is your advice on starting finasteride 6 months prior to surgery and post surgery? I was never on it and sent my photos to few top surgeons who said I am not a good candidate for HT unless I start finasteride because i have DUPA (diffused unpatterned Alopecia). Please advise. Thanks

Perfect! Thanks

Hello!

Any chance of coming to states?

Thanks

Hi All! Although it took 2-3 months but I am done with Consult from all the doctors that we discussed about. Since list is exhaustive I will try to keep it short.

North America & Canada doctors - suggested FUT 3000-3500 grafts since crown area is large. FUE only NA doctors suggested 3500-4000 grafts with techs involved in 1 day procedure.

Spain & Turkey Doctors - Start on Finasteride for 6 months and reassess for FUE. 

Shapiro Medical (Dr Ron primary & Dr Joe basically 2 doctors will perform surgery) & Dr Gabel agreed to do 3000 grafts FUE in 2 days back to back and I believe these 2 doctors will meet the criteria which I am looking for. 

Dr Konior wait is 1 and half year and he agreed to do 2000 grafts FUE and wait for another 6 months for 2nd procedure.

Any comments on 2 days FUE Back to back whether it's a good idea as I don't see much discussion around that and also doctors which I selected please?

Thanks

Interesting. asmed said they will not perform HT on me for atleast another 6-8 months and they are suggesting to take Finasteride for 6 months and reassess the situation. 

4 hours ago, HARIRI said:

You mentioned top FUT surgeons in my opinions and not FUE. Are you looking towards a strip surgery?

 

Yeah. But based on what I read they are good fue surgeons too. I am trying to contact Dr Nader as well from Mexico but difficult to get their response quickly. Do you have anyone who can suggest?

6 hours ago, Shmiggy said:

Lorenzo usually took about 10 days or so to respond. He doesn’t have a North American rep so that makes it more difficult as he is replying personally.

Hope so. Its more than 10 days as of today.

I am seeing some good work by Dr Nader in some latest posts this year. Any comments on Dr Nader for FUE pls?

15 minutes ago, JeanLDD said:

I would definitely consider HnW along with Hattingen as optimal choices for your case in terms of the magnitude of cosmetic improvement they are capable of. Personally I would be focusing on FUT over FUE simply because longer term when you continue to lose your current hair you are unlikely to get full coverage out of solely FUE.  You also seem to have mild donor thinning, potentially some retrograde alopecia and an overall NW6 pattern.

 

Finasteride will probably help quite a bit too.

Yes I am finally starting on Finasteride! HnW is an option but they do use Techs for extractions it seems.

1 minute ago, Gasthoerer said:

They are very popular in a german forum "alopezie.de", but you need to sign to see patient reports. I guess there is sth on youtube too, but real patient reports are better. Hattingen was specialised in FUT for a long time and only added FUE to their repertoire some years ago, kind of like H&W. Also they are very conservative in their hairlines which for some guys might be negative, but for you case it is a plus. I do not know pricing etc. and for sure it is not turkey or india price range. But maybe cheaper than US?

Anyway, most clinics I see in this thread are good and I think you will make a proper choice. My recommendation: Visit several clinics in person and see whose plan sounds good. Recommendation for me were totally different in a live consulation compared to assessment via pics.

Thanks @Gasthoerer

Yes I am not compromising on price per graft even though some of my friends are laughing at me with the doctors I chose and they feel its not worth it. However thanks to this forum I can see honest opinions of actual patients and reviews of the doctors. I am not going with Aggressive hair line(That's why I ruled out 1 canadian doctor , 1 Turkish doctor & all Indian doctors) and my goal is conservative/good hair line with decent coverage on Crown area. With that goals I believe I can go with FUE as well and have 2 procedures in 1-2 years to get maximum coverage. So far with these goals Dr Konior, Dr Baubac, Dr Wong, Dr Ron Shapiro & Dr Diep (yet to be consulted) met the criteria and with this list I have flexibility of going FUT 1st except for Dr Baubac. I am guessing I will end up choosing 1 doctor from the above list in a month or so. If my choice tends towards the doctor who does everything like extractions and incisions then my list becomes even smaller with Dr Konior & Dr Baubac but its looks like its not a deal breaker to lot of patients. 

1 hour ago, Sean said:

Yaar this going to be a long road.  I would try to remain on meds.  You have some native hairs in between.  If you are a candidate for FUE, make sure doctor has a good surgical protocol and extracts grafts if it is FUE.  Considering you may need over 5000 grafts, surgery should be done imo in 2-3 day period (if fue as it takes longer). Grafts left out of body for a long time after extraction may die, resulting in chances of lower yield.  This is a possibility.  FUT may be a safer option, but No one knows how that scar can heal.  No one knows if your surgery will be a success or if you will be a repair after all this.  Muje dek

sahi bola. Thanks. Your hair looks good now. Looks Dr Rahal did good job. I have appointment set with his advisor in 2 weeks. Do you know if Dr Rahal do online consultation or his techs?

10 hours ago, Gasthoerer said:

That is not true. There are still great clinics performing FUT in Europe. Just turkey is a FUT wasteland. Feriduni, Bisanga, Devroye and my favorite for your case Hattingen are all top notch FUT (and FUE clinics).

Thanks. I am first time hearing about Hattingen. Will check

10 hours ago, spex said:

is taking finasteride definitely not an option even if just intermittently ( every other day ) as you have diffuse thinning and without a comprehensive regime to help stabilise things I personally feel you might be setting your self up for a long rd ahead.

 

Regards

Spex

@spex

I will be starting on finasteride shortly as almost every doctor prescribed that to me. Am planning to take 1mg daily. 

14 hours ago, Regs said:

Check out Dr Cooley. I think he is one of the best! 

Sure. I am limiting the list to Max 3 members. Dr Konior, Dr Ron & Dr Lorenzo/H & W (If Dr lorenzo doesn't respond). But will check

13 hours ago, JeanLDD said:

Just based on those pics you do have a more extensive balding area than average and potentially some thinning in the donor. Agree that FUT is likely the better route, if you're going to touch both the hairline and crown in the first procedure I think minimum you're looking at 4000 grafts. Personally I think you would get the most cosmetic benefit out of a surgeon willing to do the highest graft numbers from your list. 

 

At the length your hair is currently I wouldn't worry too much about the linear scar. 

Only doctor from my list who does that is Dr Ron if I am going FUT1st and then FUE. He can do 3500-4000 grafts in 1 session. Another Doctor I am considering is Dr Hasson & Wong who does mega sessions for FUT & FUE.

@Bill - Managing Publisher

Yes I Uploaded them and deleted after few days. Uploaded few pics now. Please advise.

@JeanLDD

Uploaded few pictures.

I kind of liked your idea to go with another doctor 1st and for touch up with Dr Konior as his wait list is 14 months currently. Since this is going to my 1st HT I am kind of OK on the price per graft and looking for best surgeon. I just saw your procedure with Dr Erdogan and I did research on him as well. I kind of freaked out on his aggressive approach to be honest :). 5000 - 5500 grafts in 1 FUE session? It worked out for you because you got plenty of Donor hair. My case I don't have that much Donor Hair and will be around average or below average Donor(6000 grafts maximum maybe?) and that's why some of the NA top surgeons assessment makes sense to me. So what I am thinking is Get my 1st HT done with Dr Ron for 3000 FUE and get a decent coverage (frontal & crown) and 2nd Procedure with Dr Konior for about 1500 FUE for Good density and good hairline? The only problem with this approach is I need to shave the head twice in 12-15 months. Other than that I dont need to worry about Linear Scar etc., I still have consults pending with Dr Diep & Dr Rahal.

Work from Dr Konior looks very good frontal. Any reason why you went with FUT for 1st procedure? I know its your personal choice but I am also in similar situation like you were 5 years ago and I am getting prepared for my 1st HT procedure in next few months or a year and not able to decide to go with FUT or FUE as all top tier doctors in US suggesting to go FUT 1st and then FUE. Appreciate any inputs. Thaks