Berba11

I can't say for sure and I don't think anyone else can, but there may be a conflict between your newly transplanted hairs trying to grow and strengthen and the common side effect of a shedding phase with minoxidil. As others have suggested, I'd stop the minoxidil for now and stick to finasteride. Maybe look to switch to oral minoxidil moving forward. You've got a lot of stuff going on all at the same time (newly transplanted hairs coming through, them trying to mature, plus finasteride and topical minoxidil). Scaling back and simplifying your regimen for the time being might help figure out what's going on.

Honestly, this hurts my head a bit. This isn't planning. Planning would be to carefully inspect the scalp and pattern of hair loss. It would be to measure the entire scalp so that everyone knew an approximate number of lifetime grafts required to cover your scalp should you reach NW6 or 7 (given the diffuse hair loss in your 20's). It would be to measure you donor capacity to a reasonable degree of accuracy and it would be to proceed with surgery on the basis of a longer-term "worse case" view of your hair loss progression. The good news here is that most of the fun stuff tends to happen between month 6 and month 10, so I'd expect to see some improvement over the coming months. Whether that improvement is sufficient enough to get @shadow_godto where he wants to be is another matter. Regardless of the outcome, it's disappointing to read another case where the planning session was just a hairline drawn on and off we go...

Wear a hat as much as possible and cream up whenever it's not. Your grafts will be fine, but your scalp is still healing and will be vulnerable to sun exposure.

Any good surgeon will be able to do this. I really like Dr Mani's hairline work - he understands naturalness and you'll get the proper care and attention you deserve. Travel from Ireland to London should be cheap and obviously only a very quick flight over. Might be a good option to consider.

Welcome to the club 😅

I'd have to the say that the seemingly 'on the rise' prevalence of otherwise very good surgeons "doing their bit" and then sodding off for most or all of the surgery is a massive bugbear of mine and it's not really acceptable. Aside from potential risks of surgery already outlined here, a patient's results are likely to be worse rather than better with less doctor involvement/oversight, and if you're paying top dollar you should get a top dollar level of service and time with the surgeon at all stages of the process.

This.

I've seen his channel before. I have to say that looking at his new hairline results from his 12 month update, I actually preferred the height and design of his initial HT (albeit it lacked a bit of refinement as we often see from such clinics in Turkey). I find the Mwamba results lacks irregularities as well to be honest.

Personally I think they look really good and I'd be very happy. Just some extra density and a bit of refinement to the hairline to improve the poorer elements of Elithair's work and you'd be absolutely set. You could also have a few more soft singles grafts added along the entirety of your hairline without changing the shape too much, but rather just bringing things down towards the corners a smidge and creating some extra break-up and naturalness. Someone like Dr Mani or Dr Sever who have a very keen eye for subtle aesthetics might be options to consult with. Eugenix are proposing more of a U-shape (albeit, I get that it's just a line for illustration's sake), which to me seems too much of a sea-change from the current shape. Ultimately it's your head, but maybe a more subtle approach is worth considering.

How is everything @abrorkhasanov? Would be great to hear from you mate.

Personally I don't think you should fill in the temples, lower the hairline or touch the temple points. You have a nice, strong looking widows peak-esque hairline that will stand you in good stead into older age. Your face is framed quite perfectly and doesn't require any modifications to the hairline height or shape. What I maybe would do instead in your shoes is add a bit more density to the forelock, and have a few of those double grafts in the hairline punched out to soften and refine things a little further. Basically smaller, more subtle moves that will make a positive improvement without using many grafts or radically altering what you currently have (as there's no need). That should also help you stay closer to your budgetary considerations.

Avoid unless you can find proper patient reviews with detailed photos. Why would you need to travel internationally? You have great options in the US.

Thanks for requoting the same stuff you've quoted multiple times already over and over again. I didn't realise how much fun it would be to re-read it for the 5th time over! Let's get to the fatal flaw in what you're saying.. This statistic of patients destroying "20% to 30% of their grafts by choosing surgeons that perform motorised (not vacuum assisted) FUE" comes only as a claim from one single source: Dr Zarev. This is not, to my knowledge, in the published literature. Dr Zarev has not (again, to my knowledge), published any paper that validates this claim. It may be true, but as it stands you're simply taking it on faith and not peer-reviewed science. On that basis, you want every single IAHRS surgeon to be binned from the organisation if they continue to use methods that are tried, tested and effective? It simply doesn't follow. Nor have you actually addressed the key point I raised: Zarev and Trevellini are not themselves calling for every surgeon who does not share their methods to be canned from hair restoration organisations. I'm sure they'd agree that this would be a ludicrous suggestion. And that's totally fine - you do you. Dr Zarev's donor extractions are legendary for good reason (I even have a consultation with the man himself in October next year) and what he's doing clearly works very excellently. But the implication of what you're saying is that there's no merit to manual and motorized extraction. 1000's and 1000's of happy patients - including complicated repair patients and higher NW patients - are, unfortunately, a rather stark refutation of your position. Of course, if your argument had simply been that major hair restoration organisations should be at the forefront of innovation & development in the field then I would agree with you. Improved donor extractions, verteporfin and other developments shouldn't really be left to trailblazing individuals. Equally, Zarev isn't training other surgeons, and exactly what he's doing and how remains somewhat of a mystery. Until he opens his doors to other surgeons then progress in this area will be slower than it otherwise could be.

Surgery should always be the very last resort. The first resort should be the one that carries literally zero risk: done nothing/buzz everything off. You have a lot of hair left to keep and maybe improve (but at the very least, stabilise from future loss), so medical intervention makes a lot of sense. Turkey has the world's highest number of terrible, terrible HT clinics. There's somewhere between 500-1,000 HT clinics in Turkey, and maybe only a dozen pretty sound options. That's means you've got roughly a 1.8% chance of ending up a good clinic in Turkey... Do you like those odds? I don't! One of the reasons it might be best to wait in your case (beside giving the medical intervention time to kick in and be assessed) is that it also gives you a bit more time to save up some extra funds and give yourself a better chance of being able to go to a good clinic elsewhere. We have a few attractive options in the UK these days (in the past, not so much), and we have a lot of excellent options across Europe. There's also stronger budget options in India, Cyprus and Thailand than in Turkey. Probably around the NW5 mark, but I personally wouldn't get to hung up on the NW scale. You might find it useful to seek in-person consultations with some clinics in the UK, just for your own information and to get some eyes on your situation and some ideas and plans going forward. Dr Ball, Dr Mani and Dr Miln are three options that I would definitely consider for myself and would certainly have a consultation with at the very least before doing anything further.

Given that virtually no one is doing what Zarev is doing with donor areas, but many clinics are able to adequately transform their patient's hair loss troubles, this statement is plainly ludicrous. Is a technique like the one Zarev deploys better than the others? Maybe. That doesn't mean the other techniques are suddenly bad. Some of the best results we've ever seen pass through these forums are from motorized FUE extractions, and have left perfectly good donor areas at the same time.

The two are not in conflict with each other so there's no "perfect" dose, but most people would likely be on something like 0.5-1mg of finasteride daily (or every other day) and 2.5mg of oral minoxidil daily. You're not really going to know if they are working for you for a good 12 months, which leaves plenty of time to carry on researching clinics in the meantime. Why Turkey?

Sorry to hear you’re feeling this way. At the end of the day though, it’s just hair. Nothing really happens whether you have it or don’t. I think what you need to do right now is speak to a medical professional who can help with your depression and it sounds quite severe and needs to be addressed asap.

I don’t agree with jjalay’s assessment, which is far too certain of itself based on these slightly blurry pictures. You don’t have much hair loss given your age really, and look like you could easily get good coverage in the crown as well as a nice, age appropriate and conservative hairline reconstruction for a fairly modest “one and done” number of grafts ( upwards 4000 grafts sounds about right). I don’t think you’d need to use beard grafts for the crown at all and if you’re on finasteride & minoxidil as well then as I said, I think you could get an improvement that you’d be happy with in one go. Probably no need to consider FUT. If you were young and staring down the barrel of needing multiple surgeries over time to chase down future hairloss then FUT would be a fair consideration for life-time graft supply. But at 58, with a lot of hair on top still & taking finasteride, that seems largely redundant and FUE should serve you just fine (as it does for people with significantly worse hair loss than you have!). As long as you’re realistic about the density in the crown and opt for a nice, conservative hair line, 3-4K grafts from scalp donor alone should be absolutely fine. Also, I think your timelines for when you’d see results from a two-step surgical approach is off base. If you concentrated on the frontal third first, then a second pass into the midscalp & crown could be easily scheduled 6-12 months later (and you’d likely see improvements by the 6-8 month range. That means you could have two surgeries and see decent results from each before you’re 60 quite comfortably. You seem like a good candidate for a one shot pass but just wanted to point out that if you did want to de-risk matters over two surgeries, you’d see results much earlier than your 62nd birthday!!

Lateral humps have dipped and therefore the balding scalp is quit wide. Whether you call it a strict NW7 or something between a 6 & 7 doesn't really matter at the end of the day.

You had 5523 scalp grafts taken from the back and sides of your head. It's entirely possible that 4 or 5 previously undetected grey hairs were extracted and re-implanted. Bear in mind also that softer single graft hairs will typically and most commonly be selected from areas of the scalp closer to the nape and above the ears (which tend to miniaturise and/or grey first). From your pre op photos, it's very clear that you have/had clusters of grey hair above the ears and in a couple of photos you can clearly see some stray grey hairs in the middle of your donor scalp at the back. No real mystery where they've come from.

Yes that's something I've considered, too. Better to have a surgery too young but in good hands with longer-term planning than to end up somewhere terrible just because that clinic were keen to pocket the money regardless of all the important considerations when dealing with a younger person.

Nice! When will it be broadcast?

1. As an emerging surgeon, I'd be interested to know what his thoughts are on the giga-session work we're seeing from the likes or Pittella and Zarev. 2. I'm noticing a lot more younger guys - 20, 21, 22 years old - passing through the forum somewhat desperate to get a HT. Be interesting to ask any of the surgeons you'll be speaking with on upcoming podcasts, including Dr Miln, what their/his position on this is. Do they feel the boom and accessibility of HT's (which naturally includes cheap options abroad) is starting to put younger guys at risk, who traditionally might not have been able to afford a HT or the stigma of getting one would have been enough of a deterrent until they were older? How are they handling enquiries from young guys? 3. Related I suppose to Q2, is Dr Miln doing repair work, and if so, of what nature? (hairline extractions, cover ups, donor/strip scar repairs etc).

It is an unusual hairline shape that isn't natural for men. Those sloping down bits on each side is indeed more of a female hairline shape. I can see from your original photo that those hairs are not only in the wrong place (because you're not a woman), but they've used thicker multi-graft hairs instead of soft single hairs to match your temple points, and the direction of those hairs is all wrong. Nothing will "expand" - that's total bollocks. Grafts will grow wherever they've been placed. Gaps will remain as gaps until otherwise filled in. In terms of a more immediate fix, you could look to have these bizarrely placed grafts removed and reimplanted into some of the more gappy areas. At the very least you'd have a natural male hairline shape and a bit extra density. If the rest of the transplanted hair continues to soften a bit it might be enough to get by on a small second pass for more density but this is where I would start personally.

The wiry, kinky hairs are normal for a while and to an extent. However, yours does look especially wiry. This can happen if the bulb of the graft has been damaged during extraction, or the incision sites are too deep, the grafts haven't been handled well in general etc. In short, this can happen when the work hasn't been carried out very well. Looking at the density issues and the angulation issues, I think it's fair to say that this simply wasn't a very well executed HT. The fact they took you on as a 19 year old is, to be frank, disgraceful. It would be useful to have more photos: pre-op, so we can see your starting point, immediate post op (so we can see the work), and a better range of angles and profiles of your current situation so we can better see the results and advise on how you might go about correcting things. In terms of getting it fixed (as far as one blurry photo goes)... Right now there's nothing you can do other than seek consultations with more reputable clinics. The issue you'll have is that if your HT has indeed been a botch job, then filling in the density and hoping to simply cover the existing HT might not work very well (and you'll be ploughing through more precious donor hair at a very, very young age). The other option is to look to have a load of grafts punched back out again to try and create more of a blank canvass. The problem here is that this usually requires two or three surgeries to resolve, and there's only a handful of surgeons who are expert at this - none of them come cheaply and that "crazy price" of £7-9K will likely be the very minimum. With love and respect, this kind of blasé attitude got you into a muddle to begin with, and throwing yet more grafts into an area with a load of bad grafts could backfire quite spectacularly. Firstly, you've already burnt 2,600 grafts away - that's a significant number of grafts by any measure, but especially at 19, and you've used those grafts in an attempt to reduce your forehead size rather to address any major hair loss it seems (from what you've said). Assuming you have the same issue on both temples as shown in your picture, you could easily be faced with throwing another 2,000 grafts at that whole area, leaving you almost 5,000 grafts out of pocket at 19/20 years old and without having actually addressed any hair loss. In 10 years time that could be a major issue. Secondly, if those grafts you've had placed already are beyond the pale and unlikely to improve due to poor work, then putting a load of good grafts in amongst them will still cause you issues in terms of managing the hair. The bad hairs might be blended in a bit more, but without some de-bulking of the bad grafts then you're probably going to have the same or similar issues to what you're facing now.