Biceps

6 hours ago, LaserCap said:

2000-3000 grafts can make a huge difference - it all depends on the plan and the placement.  If you decide to put them throughout the entire pattern, you will enjoy a bit more density everywhere but will still look thin particularly if the hair is very dark. It will also depend on how much native hair you start out with.

But, if these are concentrated towards the front and you work up to the mid-scalp, not only will you have a much fuller look, you'll be pattern appropriate.

As far as being age appropriate, that will depend on hairline design.

Many factors go into this. I would encourage you to view photos of cases similar to your own.  Look for the type of density the doctor can achieve in a single procedure.  

Lastly, medical therapy.  Whatever native hair you have, it is making a difference.  Why not try to keep it and perhaps enhance it? Not only that...you need to prevent your pattern from expanding.

 

Hi LaserCap, appreciate your input. A few questions:

1) What do you mean by the front being "pattern appropriate"? Do you mean having a balding crown but full front is normal? I assumed receding hairline was more common.

2) I can't find many cases like mine perusing the transplant subforum  Do you know of any noteworthy ones? Looks like Melvin's is similar.

10 hours ago, Melvin-Moderator said:

I was a diffuse thinner, and I had about 5,300 grafts to look decent, but obviously need to style my hair perfectly, and I need concealer to look perfect. Also, my crown is very thin, you need to have realistic expectations before you agree to having surgery.

 

Wow Melvin, this gives me hope since your previous diffuse thinning looks like mine. I watched your Youtube video and have a few questions:

1) Why did you choose the midscalp for your first procedure? (1,800 grafts put in my midscalp in a diffuse pattern)

2) Your next procedure of 2,120 grafts were for your hairline. When did you do your crown, and how many grafts? Was that with Diep too?

10 hours ago, Wicky said:

3000 would make it to your crown area, will it be fully dense? no, but you should have a strong hairline and somewhat filled out mid scalp. may you post a pic of your donor? I would like to see for reference.

Attached are long, medium, and short:

Hi all,

I've been quoted within 2000 - 3000 grafts for many surgeons, but I have concerns about coverage for diffuse thinners. Going through the forums I haven't seen many examples of what this would look like on diffuse thinners, only receders.

I've had consultations with these surgeons:

IN PERSON: Diep (2,250 - 3,500), Pak/Rassman (2000 - 2500), Dauer (1500),  Abrahamian (2700 - 2800)

ONLINE: Vories (3000 grafts) , Konior (wants to see in person), H&W (rejected due to low donor density) , Rahal (rejected due to low donor density), Erdogan (rejected due to low donor density), Rosanelli (rejected due to low donor density)

Wondering if anyone has heard of these guys. All the big American SMP names seem to be in LA or NYC, no one in the Bay Area. 

https://scalpsociety.com/

Update after speaking with 3 doctors:

Rassman: Dr. Rassman asked me to take photos of my donor area using a microscope, based on these instructions: https://newhair.com/baldingblog/how-to-quantify-your-donor-area-hair-supply/ . During our call, he noted that I have "Thick donor hair, many triplets, and 20% better donor area than other Asians he's worked on". Will be meeting him in person to clarify, as this goes against what many other doctors have said...

Diep: Saw Dr. Diep again as I am local. I asked him about Rassman's comments, and he noted that while the back of my head is strong, my sides are weak (at least visually, I can confirm). He quoted 2000 - 2500 grafts FUE, but I have misgivings about this number being worth the surgery, given that other Diep FUE patients at that graft amount had frontal hairline recession rather than the large diffuse thinning I have:

Konior: Dr. Konior neither approved or rejected me, and I asked for an in person consultation. He has a $400 consultation fee which I find odd considering no other doctor has had such a fee. I don't know if its worth the $400 to see him, especially since I have to fly to Chicago.

Got in contact with Dr. Konior. He has a $400 in person consultation fee which seems extremely high to me.

On 2/3/2020 at 10:48 PM, giegnosiganoe said:

I also don't have the best donor (retrograde thinning and donor hair is a bit sparse..), and it seems like you're in NorCal as well. I'll be following your updates. I think you look good with the buzz btw. It's surprising how much more hair it looks like you have when it's cut that short. I'd try it out if I wasn't blessed with a cro-magnon skull 😛

On 2/4/2020 at 9:37 AM, gillenator said:

Sometimes less looks like more when buzzing down...I also think the buzz cut looks good on you Biceps but maybe try to wear it a tad bit more longer like a number 1 guide?

 

I appreciate that guys. @gillenator the problem with wearing it longer is, the density difference between the sides and top become much more apparent at longer lengths. 

I could probably live with the buzz, though I'd want to add SMP.

So buzzed my head down to see what I would look like... not a fan. Gonna be awhile before I can use Toppik again haha. Still slowly getting evals from different docs. 

12 hours ago, nick1111 said:

I would seriously suggest to have in person consultation with DR Konior. I had the same exact problem when I sent my pictures to Dr Konior initially. But when I had in person consultation, things went better than I expected.  Finally, I had a surgery with 2500 grafts (approx).  Dr. Konior used  combination of small strip(FUT) and some FUE.

It got only possible when he checked my hair physically.

Recently, I had another consultation with doctor for a 2nd surgery  where he suggested me the plan to get combination of FUE scalp (very small number to define the base ) + Beard Hairs + some chest hairs. (Totaling around 1500-2000 grafts).

So in nutshell, don't loose hope as you still may have option to use body hairs and combining multiple ways(FUT+ FUE) to get desired quality grafts. I would strongly suggest to meet Dr. Konior.

Thank you for sharing. Dr. Konior recommended an in-person evaluation rather than just flat out rejecting me which was heartening. After looking at your weak donor area and your great results, I was also thinking - if Dr. Konior can do it why can't all these other doctors? Why do they choose to reject instead of requesting an in-person consultation? 

Wow big improvement. Thanks Nick for sharing on my thread, this is inspring.

Hi all, 

So I consulted with a few other doctors. 

Rassman

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Dr. Rassman said that my donor area could be fine because my donor area has coarse hair. He asked me to buy a magnifying lense, send him a picture, and reevaluate based on a blog post he wrote https://newhair.com/baldingblog/how-to-quantify-your-donor-area-hair-supply/

It appears Dr. Rassman is not doing procedures himself though, but delegating through Dr. Pak?

Rahal

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"Dr. Rahal reviewed your file and photos and he feels that is hair transplant is not the best option for you. With hair restoration, Dr. Rahal evaluates your donor supply (on the back & sides of your head) relative to your current & potential future hair loss. You have an advanced pattern of hair loss and many areas that require coverage. Your donor supply is very limited. Therefore, Dr. Rahal does not feel we can offer significant improvement with a procedure. Surgery is not the best option for you."
 

Vories

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Dr. Vories quoted me a 3000 FUE graft procedure, with 1500 grafts in the frontal forelock/hairline, and 1500 grafts to the vertex. I have concerns because:

1) The consult was done through webcam and the software was putting out what looked like 720p resolution. No pictures were asked to be provided.

2) I brought up the fact that multiple doctors have rejected me for a weak donor area but he did not say much besides that he was confident he could extract 3000 grafts from my donor.

So everyone, got H&W and Konior's responses to my pics and looks like there's no hope for me... not only am I in the percentage of men who have MPB, I am in the percentage of men who can't even have a HT. Feeling real down right now. Does anyone know of any threads where the poster is in my position? Just so I could get their perspectives on what to do.

H&W

Quote

The doctors have reviewed your photos and have determined you are unfortunately not a good candidate for a hair restoration procedure at this time. Your final pattern of loss is aggressive and your donor reserves are limited. It would not be in your best interest in their opinion to have a procedure. The amount of areas that could be covered with the present donor supply would not provide enough cosmetic benefit to warrant surgery. But perhaps just as important, as you lose more hair around any potential transplanted hair you will not have any donor hair left to improve your appearance should your pattern of loss become unnatural. Your best bet is likely to wait until such time technology has advanced enough to make you a viable candidate.

Konior

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Your photos are not suitable to provide an assessment of your donor area.  Based on your history of being rejected for surgery because of a weak donor area, I would recommend that you have an in-person evaluation in order to provide a meaningful recommendation as to your candidacy.  The photos of your thinning zone suggest that you will eventually evolve to a class 5 pattern at very least, and possibly to even a more advanced pattern.  Any graft supply limitation because of a weak donor area will definitely limit your options for restoration.  I would caution any restoration unless you have conservative goals for final coverage and density.

 

3 hours ago, gillenator said:

You need to know if your donor is stable regarding if it has hair that is DHT resistant or if it is DHT receptive.

If your donor is unstable, meaning DHT receptive, I would never recommend that you have HT surgery.

Your entire donor needs to have a microscopic examination to determine this.

I see. Would a dermatologist perform this? I've gone to two HT surgeon consultations and I don't believe they did anything like this (for the donor area).

19 hours ago, Abi28 said:

Stay on the medication for now, I would actually stop nizoral, personally I think it's overrated, it does more harm than good, your hair looks really dry and frizzy and that might be because of nizoral, also if you read the label on the shampoo one of the side effects listed is hair loss, I would stop nizoral for now, consult with a dermatologist, and maybe consult with a few more doctors and see what they say, maybe someone like Hasson & Wong, if you get rejected by other doctors then I would not consider a hair transplant for now, keep us updated and best of luck.

I'm mainly concerned that being on the Big 3 has not even halted my hair loss, let alone given me any gains.  

1 hour ago, 1978matt said:

Well he's not your average patient. He got a few bad surgeries in the 90s and was left with little choice but to get it repaired. 

The repairs were successful so why not maintain or improve it? He also works in the industry so may have had a couple for free as well. 

Whatever the case, it feels good to have hair. 

I see. Thank you for the context.

1 hour ago, 1978matt said:

Looks like you are based in California. I d suggest visiting a couple of other respected guys in that area like Carmen and Mohebi. 

Never met them myself but they seem like two of the more ethical guys out there. If your donor is suspect I'm sure they won't BS you. 

Thanks for the recs. I'm in NorCal but in SoCal often enough, I can make a visit to them.

23 minutes ago, Melvin-Moderator said:

This is total BS, @FUEblonde1985 @baldlivesmatter @bondi @m0dthispny @JBlonde @HairlessUser @E39 not to mention me. His resume speaks for itself. I recommended him to one of my best friends, and he is currently 4.5 months and is another homerun. There are only a handful of surgeons with as many stellar results on YouTube and the forum and he is one of them.

You may not like Dr. Diep, and that is fine, but don't make these nonsense claims. 

Hi Melvin, I also personally know people that have gone to Diep and don't doubt his skill. However it was concerning to me that after two rejections from Erdogan and Rosanelli, that Diep was willing to perform an operation on me. During the consultation when I pointed out that those two doctors said my donor area was too weak, he deflected my question with a negative statement about HT surgeons in Turkey. I did not push further at that point.

An observation: I read about this forum poster and his SEVEN HT surgeries. This is frightening to me because:

1. He is a handsome man and would pull off a buzzed/bald look easily
2. He is married and in his 40s - why is he still seeking more hair?
3. All the responders in the thread were encouraging of his seventh transplant

I mean no negativity to him with this observation. It's just making me think - do I really want to be taking Fin, applying Minox everyday, paying for HTs for the next 20 years? (I'm 26). 

I hate that I'm losing my hair, but I'm struggling on how much energy I want to devote into this... 

17 hours ago, Abi28 said:

It does look like you have some thinning in your donor, I would actually consult with a dermatologist and see what they tell you maybe you have DUPA? Erdogan is really good when it comes to donor management, so if he rejected you than thats something to think about, on the other hand I would not consider Diep he is not good with donor management.

Stay on the medication for now, I would actually stop nizoral, personally I think it's overrated, it does more harm than good, your hair looks really dry and frizzy and that might be because of nizoral, also if you read the label on the shampoo one of the side effects listed is hair loss, I would stop nizoral for now, consult with a dermatologist, and maybe consult with a few more doctors and see what they say, maybe someone like Hasson & Wong, if you get rejected by other doctors then I would not consider a hair transplant for now, keep us updated and best of luck.

I've been to a derm and they weren't really knowledgeable about hair loss - all they did was prescribe me Fin. Is there any MD besides HT surgeons and derms that could diagnose DUPA? 

13 hours ago, BjornBorg said:

Looks like you have a good headshape. And you have enough hair that it will look like you have some kind of hairline if you buzz it.

I know this is what noone on a hair restoration forum wants to read. But have you tried buzzing it all to a zero and growing a beard?

Unfortunately I am not able to grow a full beard, only patches  

7 hours ago, Melvin-Moderator said:

^ Great advice I always think buzzing should be the first thing you do. Some guys really like it and it's the safest and cheapest option. I did it for a year and I hated it, but everyone is different.

I'll plan to take the plunge soon and just buzz it off. If I can accept it... then I can do SMP and close the door on this permanently.

7 hours ago, pre-screened said:

• May 2019 - Rejected by Erdogan for weak donor area.
• June 2019 - In person eval from Rosanelli (also rejected me for weak donor area).
• June 2019 - In person eval from Diep (estimated 2,000-5,000 hair grafts to cover the frontal area. The FUE prices are $16,500 for 2,000 grafts and $19,500 for 2,500 grafts. The FUT prices are $12,000 for 2,500 grafts and $20,000 for 4,500 grafts). He was not concerned with my weak donor area - which in itself is a bit concerning as two other HT surgeons had concerns.

 

Given the comments and cases I’ve seen recently on this forum..........why am I not surprised at Diep being happy to proceed where others wouldn’t..........

only thing I could add would be to try PRP with doctors who developed a protocol that works.....Dr Arocha seems to be one....perhaps big three + PRP could be final nudge needed to see regrowth.......if feedback is weak doner and meds arent stabilizing hair loss currently I would be hugely hestitant around doing anything HT related 

Thank you for your feedback. I've heard so much mixed feedback about Diep... during our in person consultation, I felt very rushed which did not instill me with confidence.

Hi all,

I'm a bit lost right now and could use some advice. I compared my pictures from Dec 2018 to Dec 2019 and I see worsening hair loss, doesn't seem like the Big 3 is doing anything. I'm also not a great candidate for a HT. 

• June 2018 - Started Minox and Nizoral.
• Aug 2018 - Started Fin.
• May 2019 - Rejected by Erdogan for weak donor area.
• June 2019 - In person eval from Rosanelli (also rejected me for weak donor area).
• June 2019 - In person eval from Diep (estimated 2,000-5,000 hair grafts to cover the frontal area. The FUE prices are $16,500 for 2,000 grafts and $19,500 for 2,500 grafts. The FUT prices are $12,000 for 2,500 grafts and $20,000 for 4,500 grafts). He was not concerned with my weak donor area - which in itself is a bit concerning as two other HT surgeons had concerns.

Seems like my options right now are:

1. What I'm currently doing - No HT, Big 3, Toppik.
2. Give up on HT but continue Big 3 - No HT, Big 3, Buzz + SMP.
3. Give up altogether - No HT, Quit Big 3, Buzz + SMP.
4. Hair System.
5. Continue exploring HT options.

HAIR LOSS (1 YEAR, 1st Pic is 2018, 2nd pic is 2019)

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Front (Dry). 1st Pic is 2018, 2nd pic is 2019

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Front (Wet) 1st Pic is 2018, 2nd pic is 2019

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Top (Dry) 1st Pic is 2018, 2nd pic is 2019

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Top (Wet) 1st Pic is 2018, 2nd pic is 2019

DONOR AREA

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Medium Length

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Short

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Buzzed

Due to my weak donor area, I've been recommended to due FUT to maximize the grafts. 

However, in the future if I decide to go buzzed/bald (if not satisfied with my hair) would this be a bad decision? There would be a possibility that not only would I take a loss on the financial cost of the HT, but I would also make my buzz look even worse with the scar.

On 5/17/2019 at 11:02 PM, Sean said:

I meant last resort in the sense to try meds first and see if you tolerate them.  Finasteride, nizoral, minoxidil combo after speaking with physician.  

Also get a blood test to determine if there is underlying issues for patchiness in donor.  Vitamin d deficiency?  Thyroid tsh levels? Etc.  Or is it something else- a dermatologist can help determine this.

it seems to be diffuse and hair type looks Asian.  This itself is very delicate hair type for FUE and may not withstand high speed motorized devices nor suction based devices for graft extractions.  Might I suggest to get few more online consults with docs that have dealt with this hair type- ex Dr Diep, Dr Wong, Etc to start.

aside from that, please realize you have varying degrees of hair in front that may be shocklossed permanently if you implant in between those fragile hairs.  

 

Definitly should try meds if you can for an entire year to see where you stand.

option 2 could be using toppik or temporary smp as filler.  

Consider surgery last as if you get something done and it doesn’t turn out ok, you have very limited donor.

the right docs may be able to help but i would take a conservative approach to this.

last thing i want is for you to be a repair patient.  I really hope you have all your goals answered.  It is tough, but I definitely do not want someone to go through what I an going through.  Best wishes

Hi Sean,

Thanks for the advice. I definitely had a blood test done already in Jan, found out I was both Vit D deficient and subclinically hypothyroid. Both those are resolved now due to Vit D supplementation and thyroid medication, but idk how much that was affecting my hair.

You are right, it is Asian hair. I am definitely worried about shock loss. 

FRONT VIEW

TOP VIEW

CROWN VIEW

23 hours ago, Vickykuril said:

Hi biceps,

This is my first comment on this forum and I’m following this forum almost every alternate day since 2 years.

Yes ur donor is weak but your sides seems decent and it is also very important for us to see ur recipient area/balding area so we know how much area needs to be addressed/covered.

Individuals with weak donor area should always start with FUT first period considering your Master Plan .Linear scaring can be treated with SMP (Scalp Micro Pigmentation) and u should never waste grafts for Scar revision.

Now for your first FUT HT u should choose a Dr who can take a wider strip from ur donor which covers ur sides which is decent so that maximum grafts are harvested. ( Dr haason is a master in this).Side hair is very precious as they have resistant from MPB and with FUE only few grafts can be extracted and there is transection also which damages surrounding grafts and weakens your donor.With strip entire tissue of your native hair is in your hands so that is maximum utilisation and harvest of available donor hair.

For your second FUT HT Dr can tell you whether or not its feasable cuz in your first HT most of the grafts will come from your side hairs above your ears which is in better shape.I think 2nd FUT is also viable since its always better then FUE for weaker donor areas.

3rd HT should be FUE from back very little whatever’s possible and sides mostly.

Beard HT is very good cuz hair quality is good and they have faster growth cycle then scalp hair. You can also go to an extent of extracting every beard graft!. Have a look at eugenix clinic India ( just a suggestion cuz I believe u have not done your research) 

Body hair transplant is also there and it works fine , hair quality is poor so it should be used in crown or you can fill in your donor area too! (Wink).

Genital hair transplant has also been performed and is in practice and I don’t need to explain hair quality! ( just for info).

Beard hair grafts are insanely good and body hair grafts are poor and should be used wisely. Beard hair transplant can be done along with scalp FUE so you don’t have to wait for a year and it decreases number of surgeries.

Every Norwood 5 or 6 needs three or four HTs in their lifetime for desired results

It all depends on your perspective and acceptance of realistic results. 

While writing I forgot two three very important things which I believe other members will say.

Finasteride, minoxidil, biotin tablets , prp, derma roller, laser therapy have different roles but its serves your hair...

I hope this helps

Hi Vickykuril,

Thanks for your detailed post! Why do you recommend FUT? Also I did not know that you could extract from the sides of the head? All the videos I see are from the back.

On 5/16/2019 at 10:20 AM, Lennney said:

Unless you're comfortable showing a FUT strip scar or the dotting of the FUE, you'll not want to ever buzz your sides. You'll either have to "change" your hairstyle post HT or accept your hair now as is. 

I'd get a second opinion on the donor, without mentioning someone said it was too thin. If another recommended doc says it's too thin, you'll have to figure something else out or go to a someone willing to work on you.

 

Also, the doc could have said your donor isn't sufficient for your wants. Is there a delta between what you expect and what can reasonably be done? If you don't want to change your hairstyle, it may come across that you also don't want to deviate from what's possible with your situation. 

Just something to think about.

Hi Lennney,

Thanks for your input. Regarding hairstyle - I have no qualms changing my hairstyle!

Regarding the delta - there was no discussion with Erdogan's patient coordinator in terms of my expectations vs theirs. They took my photos and video of me combing the donor area, and responded with a No. In the initial online intake form, I was very vague on my expectations - I really just want to fill out the top. I'm not expecting a miracle. I'll upload photos in my next post.

On 5/16/2019 at 10:21 AM, MarshallUK said:

Hi biceps,

I was also rejected by Asmeds for my donor but have seen a lot of results from them using people with donors alot worse than mine so can only put in down to me not being on finestride at the time. However I consulted 3 doctors in person who had no issues with my donor so definitely do a face to face consultation. 

Thank you MarshallUK. Where did you end up having your HT?

19 hours ago, Sean said:

If you are rejected, that is assurance as high number of extractions are done vs recipient coverage area in some clinics.  

I would hold off for a bit and get multiple consults with other surgeons who use less grafts vs the recipient coverage area and get higher yield.  

No doubt, surgery should be a last resort.  Best of luck!

Thank you Sean. In what sense do you mean surgery should be a last resort?

18 hours ago, Melvin-Moderator said:

If you live in California, consult with Dr. Diep in Los Gatos, Dr. Rosanelli in San Francisco. They should be reasonable driving distance from you. 

Thank you Melvin. I will check them out. They are very close to me. In your opinion, is their skill level on par with surgeons I hear about all the time? (H&W, Erdogan, Rahal, etc) I have no issues financially, I just want the best I can get.

11 hours ago, elduterino said:

Whatever you decide do not go for FUT 

Not worth the scar 

I had 2 Fue and a total of 3700 grafts 

The growth yield has been very Good and the donor looks like nothing happened at all to my eyes 

In fact you can extract more grafts from Fue than Fut since you don't need to have long hair to cover the scar 

 

Which surgeon did you go to, elduterino?

10 hours ago, Dr Blake Bloxham said:

Biceps, 

I think the advice to seek doctors who perform both FUT and FUE is wise. Sometimes patients are good candidates for one and not the other. And many times patients with "weaker" donors are much better served with FUT. 

I pretty much perform a large FUT procedure daily and have a pretty good eye for evaluating donors via pictures. If those images were sent to me, I too would be a little be concerned and want to evaluate closely in person before recommending anything. However, FUT might not be the right answer here either. Melvin's advice to see, in-person, a few doctors who perform both is spot on. 

How much do you need up top? The "right" answer in the end may be conservative FUE and augmenting with something like SMP. 

Hi Dr. Bloxham,

Thank you for taking the time to respond. I'll be uploading pics of my hair loss in the next post. I have a few questions for you, but they are pretty basic as I don't know much about these procedures (and anyone can jump in to answer!)

1) What makes FUT better for weak donors?

2) Are the gaps in my donor area due to retrograde alopecia / DUPA, or is it just weak donor area?

13 hours ago, CosmoKramer said:

I’d say Dr Erdogan is right, your donor doesn’t look optimal enough for an Ht and would probably look bad after if you did get an ht to be honest.

Do you mean the recipient area will look bad due to weak grafts, or do you mean the donor area will look bad?

11 hours ago, elduterino said:

not a problems if you use hair meds 

Are you on anything? 

I have been using finasteride 1mg since last year. Are you saying it will help with the donor area?

4 hours ago, Melvin-Moderator said:

Where do you live? Have you consulted with a doctor in person?

California, USA. I have not, but looks like you guys are recommending I should. I will definitely talk to someone in person. I am in Northern California but I can visit doctors in LA too (I'm assuming the HT surgeons in LA are better?)

1 hour ago, DrTBarghouthi said:

It's a tough call at times to base the decision on photos. I think in such cases a live consultation is the best, where the donor area can be properly examined and also the areas of hairloss and then an appropriate plan can be drawn. 

Thank you, I will look for a live consultation in my area. 

56 minutes ago, harry_potter1 said:

I think you should also consider FUT clinic and see if they think otherwise 

I'm not very familiar with HTs. Are FUTs better for weak donor areas? My normal haircut is buzzed down sides and back so I'm concerned about the scar being shown.

From Erdogan:

"After analyzing your photos Dr Koray Erdoğan found that your DONOR AREA is not strong and thick as it should be for the hair transplantation. Therefore Dr Koray Erdoğan came to the conclusion that your Donor area has a low capacity for the procedure of hair transplantation."

Anyone heard of this type of rejection? Since Erdogan is so well respected, does this mean that most other surgeons share his opinion? Pics of my donor area below:

Long

Long (combed upwards)

Short (you can see my donor area has "gaps"?)

Buzzed (this is my default look)

FRONT VIEW

TOP VIEW

CROWN VIEW