PizzaWolf

@DUPAman I'm sure Eugenix can extract a small number of grafts from your scalp and recreate temple points, but do you really want them to if you don't have any safe hair in the traditional donor area?

You have to assume that any thinning hair on your scalp is going to continue to get worse without drug intervention, so you're taking a big risk that a transplant using any number of grafts--no matter how small--will leave you cosmetically worse off than when you started.

In your previous posts you discussed not having found a definitive resolution to your dermatitis and DUPA issues. It's frustrating, but I believe that those issues need to be fully resolved before getting a hair transplant.

1 minute ago, neverendingsearch said:

Thanks @PizzaWolf, I appreciate it.

Fun fact, Bernstein actually prescribed me 1.66mg of finasteride to "make up for the tolerance I've built", which I'm not sure is actually a thing. May go out and try to get a dutasteride Rx instead, and probably restart minoxidil. With that said, I'm scheduling for well into next year so I'll have time to plan interventions and figure out if my hair loss is accelerating any further.

I'm not sure if I believe in a tolerance to 5-AR inhibitors, but who knows, I'm definately no doctor.

I've done many blood tests on myself, including a pre-5AR DHT test. My natural DHT was something like 79 ng/dL, which was at the very top of the range, and my hair was getting obliterated fast. After taking .5mg a day of Fin for 1 year, my DHT tested at high 50 something ng/dL, and though my hair loss slowed, it was still progressing. I upped the Fin to a full 1mg per day, tested my DHT, and it was 42 ng/dL. At this level, my hair loss has stopped and some even regrew. It took quite a while, though.

I think the question is really: how sensetive is your hair to DHT, and how low are you willing to tank this hormone? Some say it's a trash hormone, others say a lack of it has ruined their lives.

Either way, good luck in whatever you decide. 

@neverendingsearch 

No, not susceptible to clinic marketing. I think you come across as susceptible to your own wishful thinking and what you would like to be true. 

You want a hair transplant to fix your hair loss and genetics--it simply can't do that. With the history you've described, even a great surgeon could leave you as a complete mess.

I don't like to recommend medications, but maybe consider moving to dutasteride or RU58841 if you're okay experimenting on yourself.

@Melvin- Moderator

It was patronizing. I should definately be more thoughtful of how I respond to fellow hairloss sufferers. We're all in the same boat. 

Apologies to @neverendingsearch

If you are determined to get a hair transplant, no one can stop you.

But the hard truth is that you are a lousy candidate for one. You have been losing hair since you were a teen, and have not been able to stabilize your hair loss even while using the most potent, established treatment available.

There will always be people willing to blow smoke up your ass and tell you what you want to hear, especially when there's money on the table. There's also many people in the transplant industry who love desperate, delusionally optimistic men. 

If my last, very tame, post offended you, I think you are going to be a prime target for the previously mentioned issues.

Good luck. 

@neverendingsearch I'm not trying to be your daddy. If you're determined to get a hair transplant--go for it. You seem to be well-researched and have arrived at some good surgeons. BUT if you're continuing to lose ground on finasteride, that's a very bad sign. From what you've described there has never been a point where your hair loss is actually stable.

As far as Bernstein, who cares. You'll always be able to find a HT surgeon that thinks you're a candidate.

@neverendingsearch You said: "Given that my hair loss has progressed considerably despite finasteride, I wonder whether my vertex is the next to go."

I think you're putting the cart before the horse in looking at all these hair transplant surgeons. You aren't a surgical candidate until your hair loss is stable. Anyone who tells you different does not have your best interests at heart.

@DrMunibAhmad  Are you opposed to doing multiple procedures on a single patient, as in one surgery for the front/mid and then addressing the crown in a second procedure at a later date?

It seems like all your results, at least the ones I've seen showcased by you, are all under 3000 grafts and don't have a follow-up procedure.

@washingtondc  It's pretty bad, especially since you've had a surgery and a touch-up with the same doctor. There was a woman who had a hair transplant with this doctor around the same time as you, and had exactly the same issues with density and naturalness. It doesn't appear that this doctor is able to dense pack, and obviously isn't telling his patients about the limitation. I think it's likely you're going to need a third procedure, hopefully with someone else. Sorry.

@Donditot I wouldn't give up until trying oral Minox combined with a topical anti-androgen. You have a lot of thinning hair covering your entire scalp. That hair could make an amazing recovery, possibly to the extent that you might not feel you need a hair transplant anymore. If after treating your hair with medication you are still interested in a hair transplant, you will be in a much better (and safer) position.

Good luck.

I edited my post because it did sound glib. You really should disregard anything this clinic told you and start fresh with your research, though. It's a money grab.

There's no direct photo of the back if your head, so it's difficult to gauge the exact state of your donor.

The "surgeon" is a physician's assistant. That should tell you all you need to know about this clinic.

I'm not a medical expert, so don't take this as gospel.

But your photos appear to show what might be a condition known as DUPA, a generalized thinning across the entire scalp, including your donor area.

Dr. Lorenzo in Spain is known to have successfully performed hair transplants on men with this condition, but I believe he was reliant on them taking oral Dutasteride for a lengthy period of time before agreeing to surgery.

Since you've had side effects from topical Minoxidil and oral Finasteride, have you considered flipping that around, i.e., taking oral Minoxidil and topical Finasteride? You may want to consider something stronger like topical Dutasteride to help mitigate the aggressiveness of DUPA.

There's also unapproved treatments like RU-58841 that may be worth looking into.

I believe the general consensus is that DUPA needs to be aggressively treated before attempting any surgical restoration, and even then it carries significant risk that many feel is too great in the longrun.

The 3k grafts you mentioned? Triple that for an actually desireable outcome. 

You have extensive hair loss, so you would require thousands upon thousands of grafts for full coverage. Your last photo appears to show significant thinning into your donor from both the crown and nape side. You aren't on meds anymore, so even your current situation is likely not a final, stabilized one. Why put yourself through this process?

I say stop before you make a big mistake. You have a young son, and I'm presuming a full, complete life with people who care about you beyond your hair. Don't walk down a miserable path if you don't have to.

I've asked this question before. My best guess is that rows are easier to perform rather than attempting to mimic the more natural, irregular pattern that exists in nature.

Basically, it saves time and requires less surgical skill.

I personally don't see how anyone could say that rows are optimal, and it will be apparent that you've had a hair transplant if you opt to wear your hair shorter. I also don't think a surgeon who implants in rows can really be sure what length of hair will be required to camoflage their work. Is it a half inch of length? An inch? Not so great if you consider naturalness the most important aspect of a hair transplant.

19 minutes ago, DrMunibAhmad said:

I would go for the latter. Freitas is okay if you want to wear your hair long. But once you buzz cut it, the rows are evident imo. 

Do you think implanting grafts in rows can improve graft survival or the appearance of density?

Or is it just less refined surgical technique?

Do you want elevated DHT if you're taking Fin to prevent hairloss? If your dick is taking a vacation, then okay, but otherwise low DHT is really the point.

As far as your actual DHT numbers, they seem like they're rising and falling in tandem with the amount of testosterone you're using (higher on a cycle, lower on the cruise you've been on). 5AR inhibitors do their job very well, so it wouldn't be suprising for 3mg of Fin per week to significantly lower serum DHT levels.

Do you have any baseline DHT blood work, prior to using anything, for verification?

Last, throwing in other compounds that aromatize, like Deca, would also have a direct impact on your hormone numbers. Even non-aromatizing compounds, like oxandralone, for instance, could also have an impact through more convoluted mechanisms like androgen binding affinities and competition at the receptor site.

Basically, everything you're describing sounds like what should be happening under the circumstances.

3 hours ago, 15thaccount said:

See this is the thing , I think the  two main things that define define a good hair transplant .  That is graft survival and donor quality . extractions are fundamental and require good manual dexterity which trained Doctors tend to have over techs . The extraction process and the way they are handled is the main factor in them surviving . Look at bisanga, albeit I think kostis helps him now but he a doctor too who does all the extractions ,  never see one poor yield from him. Freitas who uses techs. I’ve seen poor yield on some Patients on the Spanish forum . Pinto, villa and Ferreira all do extractions and always produce high yield 

Dr. Ximena Villa does zero extractions. She does the implantation on two patients per day, her techs do all the extractions. The fact that you didn't know this speaks to how irrelevant this tech/doctor argument ultimately is in determining consistent results. Every single one of the doctors you've mentioned have produced poor yields, because ALL doctors occasionally do.

@De Freitas ClinicIt's a great result, but @jay80is right, it's at least five years old. Why post this, especially without an update on the patient?

12 minutes ago, LaserCaps said:

Years ago, I worked for a doctor that wrote about this same subject for his doctoral degree.  He was under the impression that the use of the med would eventually lead to dementia.  We'll have to wait and see if this becomes true.

You don't see any problems with this statement? No attempt to expand on it, or why this doctor you worked for hypothesized that Finasteride "would eventually lead to dementia"?

52 minutes ago, general-etwan said:

This is a position with some logical issues, because the truth is that even in the "Sethi" package, Sethi is only doing the design and slit making. The senior techs still do the extraction and implantation. So the idea that there is a wild difference in outcome with the highest package vs a lower one; it's just not an accurate idea. What you're really paying for in the highest two packages is for Sethi or Bansal to be there for a little bit of the time with you, when they would normally be doing more expansive business things in their lives. I think @Bandit90 would confirm that. Of course there is advantage to having one of those two world class doctors doing the design, but it's not always essential. I had Dr. Das, another senior doctor, do my design, and I don't believe there would have been any major differences if Sethi would have done it for me.

I was attempting to gauge someone else's position on Eugenix and the decision making going into which doctor, package, etc.

My personal opinion on Eugenix, or any surgeon that offers tiered packages, is that it's unethical. I wouldn't even consider going to them for surgery.

But to each their own. We all have to decide what risks are acceptable or not.

@HugoXDo you have any candid photos of yourself, just how it looks in a day to day setting/lighting?

How about I rephrase 

6 minutes ago, BaldingEagle1 said:

I would say im confidently happy with the package I chose. Looking forward to seeing your input in my own thread

I'll rephrase without the snark, and hopefully you'll do the same.

If you're basing your decision on data gathered through this forum, why didn't you go with the Dr. Sethi package? He's clearly demonstrated the most consistent results for high norwoods, at least on the HRN.

Have you observed different results somewhere else to influence your decision to go with Dr. Bansal? I'm asking this as a legitimate question, not as an attempt to argue.

@BaldingEagle1okey dokey. I just thought as a data guy you might've opted to go with the doctor responsible for most of Eugenix's high norwood showstoppers on this forum.

4 minutes ago, BaldingEagle1 said:

Im a numbers guy. I don't overreact based off of not even a handful of negative procedures my dude. Also, it's not that serious. You don't have to like them.

 

I was pointing out reason. 

You're a little more defensive than I would expect from a person claiming objectivity through data. From my viewpoint It comes across more as an attempt at self-reassurance.

Are you going with Eugenix's highest teir package, the one with Dr Sethi running your surgery?