UPDATE.
i just got an email back from Dr Bruno Ferreira. What do you guys think?
Initial Impressions
Your androgenetic alopecia is somewhat advanced. From your photos I can see that you have some frontal-temporal recession and miniaturization over the whole top of your head. You retain some hair in your forelock and midscalp areas, but coverage is poor. The crown area does not go too low or too wide, which is a good thing, but it’s still large. Temporal peaks look ok.
I’d consider you a Class 5 on the Norwood-Hamilton scale. Your hair itself appears to be of average thickness. Your occipital, parietal and temporal areas look good and there doesn’t seem to be reverse alopecia. So, from a macro aspect it looks like you have a good “donor area”.
At 38 years old, your alopecia is still active and I expect you to continue to lose hair for the next 10–15 years.
Medical Treatment
This is one of the first things we need to discuss. Your hair loss is still very unstable and will progress further left untreated. You’re currently not on any medical treatment and I’d recommend starting on 5-alfa reductase inhibitors in order to stabilize your hair loss and not let it progress. Not doing this has a high likelihood of your alopecia progressing, causing your hair to get thinner. By taking the medication you may also get some improvement to your current hair, which I would expect to happen. I need you to be at least 6 months with the medication before we advance for surgery.
Hair Transplant
A hair transplant is definitely your only option to reach your goals. We do have a rather large recipient area on hand, and I believe we would need two surgeries for a full recovery - one for the crown, one for the frontal third. The exact amount of grafts depends on a few variables: Where we place the hairline, how good your donor area is and how you respond to the medication. I estimate about 4500–5000grafts needed for your case.
We may feel the need to do a third, very minor procedure, as a touch up or spot improvement.
Prognosis
Your prognosis is good. Your alopecia is active, but we can stabilize it with medication. Your donor area seems to be of good quality and you have a circumscribed recipient area.
I expect a very good result.
Plan
Start Medical Treatment: Finasteride (or 1/4 pill Proscar®) p.o. 1mg per day
1st Surgery: TBA
Donor Area Recovery Period: 5 months
2nd Surgery: Upon analysis
Result: 10 months
Evaluate the need to further improve the result, do a touch-up, etc.
I really don’t want to wait 6 months
HLC replied again and I can do it end of July....