mister_25

balumbalum, The photos seem to be in harsh light against a short haircut. I can't really give my opinion but a weaker donor usually has over 5000 grafts and I don't think yours looks as bad as others I have seen. Although the photos seem to indicate retrograde alopecia but that could be super harsh lighting. If you're that concerned get your hair checked out by a trusted and skilled trichologist. I would avoid Turkey/Istanbul altogether due to you being a High-Norwood case. If you can't afford the right doctor for your situation then I wouldn't get surgery at all. I've seen a significantly worse donor than yours and they claimed that they could get 8000 grafts out apparently (surgery didn't happen, it was on a in-person consultation/donor analysis by Dr Zarev who is known for mastering usage of donor area). As others have mentioned you need to be on Preventative medication to even be considered a candidate. Hair Transplants don't stop Hair Loss. Medication can. LookMaxx, He wasn't being racist, its a statement that has merit. Browse other forums and look at the doctors they recommend. ASMED is still recommended and their results have declined as of recent and I am seeing more failures and poor growth cases then I am successes. ASMED was considered one of the better clinics in Turkey. Until they moved into a more "hair mill" like structure and their quality dropped. Turkey has hundreds of Hair Transplant Clinics and only about two-three of them have merit on being consistent. Zarev and Eugenix routinely do High Norwood cases and have experience in managing donor areas to the absolute maximum. Its a skill that is required and needs to be refined. I sent in a consultation and was told that my donor is dense where it is strong. But factoring in the possibility of me having retrograde alopecia (which is common) my donor capacity is reduced and judging by the photos I can get 5500-6500 harvested. If that 5000 wasn't harvested in a correct extraction pattern my donor would like patchy/moth eaten in some areas. He's not lying first of all, and he isn't ignorant on the subject either. The example you clearly gave shows common hair transplant errors that make a hairline look artificial and not natural. The point of a hair transplant is to give you hair on your head and make it look like you never lost hair to begin with. By having a result like this you are asking for someone to stare at your hairline cause it looks artificial. Almost like his hairline is saying "Look guys I had a hair transplant! look at me!" Multis in the hairline is not natural. People will tell that something is up in your hairline and anyone that has a small inclination on hair transplants will know that they had a hair transplant. A lot of people on this forum, on other forums, etc. will definitely consider this a repair case on a second hair transplant. Turkey is known as "The place to go to get your hair back." which couldn't be further from the truth. The countries you listed don't have reputations for hair transplants to the general public. When I think "Cosmetic Procedure" I think of Thailand and Turkey. When I thought of "Hair Transplants" before I knew anything I thought "Turkey". Its a unfair comparison/perspective considering your way more likely to get botched in Turkey than other countries. There are so many hair mills to choose from. Hundreds maybe even thousands. No other country has more "hair clinics" than the amount that Istanbul alone has. Also the laws in Turkey heavily favor hair mills rather than the victims. Otherwise this practice would of died years ago. Although generally speaking your statement hold some truth. Every country has more bad clinics than good ones. People should be thinking that "BHR Clinic is the place to go to get my hair back, H&W is the place to go to get my hair back, Freitas is the surgeon I should go to get my hair back." Its not Belgium/Canada/Spain that is the best country for hair transplants. Its Belgium/Canada/Spain has some of the best choices of surgeons/clinics to get your hair back. No False Information was given. Out of the thousands of clinics/technicians and "surgeons" doing hair transplants in Turkey. Three of them are worth considering. FUECapilar, Bicer and Maybe HLC although some threads as of recent open up some questions on HLC. No one else is even a consideration. Other Turkish doctors that are recommended on this forum and others have been having more poorer/subpar/mediocre results on average compared to the successes of both Bicer and FUECapilar. Overall though as good as Bicer and FUECapilar are, I wouldn't call them "Elite". If your a higher Norwood like OP is, your better of going to a doctor with a track record that can create "more with less". This skill isn't found in Turkey, its found in the very bests hands, Any clinic can take out 5000 grafts, but that's pretty much borderline the average persons 70-85% whole donor. If some technician does it sloppily they can make a 5000 graft extraction look like a 15000 extraction.

Medication is to stabilize your hair loss. If you get a hair transplant and fix everything on the front. But continue to bald behind it leaving this island of thick head its not going to be a ideal circumstance. A hair transplant doesn't stop hair loss. Medication does. I think that what Bisanga is telling you to do is a smart/reasonable approach. He's trying to get the most hair for your lifetime on the top of your head, and doing that requires you to sometimes wait and see what you can do on medication.

Surgeons skill/experience in that range. Couto gets a lot of a hype on this forum and others as this up and coming great but all the transplants I see are on Norwood 2-4s Rarely Norwood 5s. I haven't been able to find a Norwood 6 case of Couto. He has a excellent track record with people in that range and is able to make the transplanted hair of a Norwood 3 blend in almost seamlessly with the natural hair. When you are Norwood 6 you become a incredibly difficult case. Your crown becomes quite large and it actually dips into the donor area of someone with a Norwood 3/4 as a final pattern. This means you need to produce "more with less" or use alternate resources such as Beard/Body Hair. Experts in Beard/Body hair often are experts in higher Norwood's due to using beard/body hair is only really necessary in higher Norwood cases. Consider this, Transplanting into a Norwood 3 has a large amount of native hair, the difficulty would be to not damage native hair, so they avoid the native hair (which is probably quite dense and doesnt need a transplant in that area) and rebuild the corners at a density that's adequate enough to blend in well with the native. There is no concern really that the Donor Capabilities wont be able to match the recipient zone unless you had one of the worst cases of DUPA ever. Now consider this, a slick bald Norwood 5. You will need to rebuild from scratch a Hairline, Frontal Third, Midscalp and Crown and maybe even reinforce temple points depending on how far gone they are. Sure the difficulty of damaging native hair is not there due it being almost non existent. But you also need to produce "more with less". You won't be able to get 100grafts/cm2 everywhere unless you exhaust over 10000+ grafts. Even though 100grafts/cm2 isn't necessary you get my point. You want to enable the most success for your hair transplant cause Norwood 5s can get a good set of hair back, but they don't get any second chances like their lower Norwood counterparts. The difficulty is getting it right the first time and to rebuild a large area with available grafts. Now look at a Norwood 6 case. Always considered a high difficulty case and always the best results are seen at Eugenix, Zarev, Pitella, H&W, Bisanga and Mwamba and other elite doctors. Its because they've developed the experience in these high difficulty cases. Hair mills can create great results that we've seen, especially in lower Norwood's (2-4) but I've never seen a hair mill do a recovery like Zoomster or HugoX before. Its simply a experience and skill issue. The difficulty of Norwood 6s is that the donor can't possibly ever meet the demand of the top so you have to work with strong illusions where there are so many variables at play to create these strong illusions. Doctors that have the required skills of Norwood 6 understand this more than the doctors that mainly work on Norwood 2-4s. Its a completely different ball game. Norwood 2-4s have to "work with the native hair". Norwood 6-7s have to "rebuild from scratch with minimal resources to make it look like you never lost hair to begin with, or lost a minimal amount". Patient A can have a average of 80 grafts cm/2 in their donor zone, Patient B can have the exact same area and have 105 grafts cm/2 in their donor zone. Patient A + B have the exact same hair caliber and characteristics. Patient B can get more grafts out cause his donor is more dense. Not one patients donor is the same. There are many factors to consider that alter how much you can get out of a donor area. Retrograde Alopecia reduces your donor due to thinning above the ears and at the nape. DUPA is a whole other story. Donor density plays a factor but even so hair characteristics. Sometimes people with fine hair need double the amount of grafts for the same area as a patient with coarser hair. Some people have larger heads so if they get FUT their strip can be longer hence more grafts. People with larger heads also have more balding area, hence more grafts needed. There are many factors that determine a a good, poor, great, average donor. Not one donor is the same.

Your donor looks above average. You also seem to be a Norwood 4. If you haven't considered medication you should get one. Before becoming a Hair Transplant candidate you are going to need to stabilize your hairloss, to prevent progression into a higher Norwood. If you can do that for a year and see no further regression then you could be a candidate. You might even see some regrowth. You can use this year to build up a bit of money as well to go to a reputable doctor that would fit your case. As a Norwood 4, if you pick a excellent doctor/surgeon for your case and stabilize your hair loss. You could get appropriate density to get waves again.

The idea of healthy living having involvement in slowing/stopping hair loss is a myth. Sad reality is that people like me at 22 who are Norwood 5 are meant to be that way. I actually went bald rapidly around the time I started adding healthier habits myself, a shift in lifestyle for the positive. You can even debate that healthier people have higher DHT production which could lead to a increase of hairfall. People that take creatine get increased testosterone and increased testosterone means increased DHT which leads to further balding. Creatine is associated with Bodybuilding which is seen as a healthy outlet for men/women. Personally I don't really believe that healthy living equates to more hair fall myself although I've definitely seen people argue about that, always seen that as a ridiculous notion. Only way to stop MPB in its tracks is to simple either reach your final balding pattern, reduce your DHT to a large degree where it won't affect your hair as much or super slowly. Or 100-1000 years down the line when we can either cure baldness or just edit our DNA to our liking where we can having baldness as optional. Wishful thinking.

Limiting yourself to Geography and Budget is a sure way to really remove the potential clinics that could be most suitable for your case. For example I am from Australia. If I limited myself and said "I don't care how much I spend, but I want to do it in my home country" I would be setting myself for disaster due to Australia having zero good doctors/clinics The opposite is "I'm willing to go anywhere, but I don't want to spend more than a certain amount" then you are really cutting out a lot of good and reputable clinics. The best clinics/surgeons have a lot of demand, and for them to meet this demand they have to up their prices to filter out the ones that can and the ones that can't. When a Clinic/Surgeon extends their reach and says "I can do 10+ patients a day" the demand goes down, but the quality also drops. No reasonable doctor can manage over 10 patients a day and that fits hairmill territory. Hence the chances of things like donor damage, permanent shock loss, overharvesting, bad angles, multis in hairline is higher due to the doctor having less and less involvement in a surgery. Turkey in particular is a minefield. There are many clinics that will use false advertising, steal other clinics results and will do anything to close in a sale. Not close in a successful hair transplant. Bicer is one of the only good options in Turkey, but I don't think her skill range is Norwood 5. From my observations she works well in Norwood 2-4 range. HDC is a good clinic, but there are others that might suit your particular characteristics. Bisanga for example Is skilled in Norwood 5s and is known for working with blonde hair recently. Therefore he would be the most suitable for a Norwood 5 with Fine Blonde hair. In my opinion this "game" is all about finding the right clinic for your situation. You should do your own research on HDC. I was impressed by Dorons result on this forum as he was a high difficulty repair patient that has a suitable head of hair now. But I haven't seen too much on HDC otherwise so I didn't include them on my Norwood 5 recommendations. That's my personal observations, I can't recommend something when I am uncertain on what I am recommending (in this case, HDC). Keep in mind that no one is imposing a budget on you, its a more "how much do I want my hair back". You add more money to your budget and do your research you are increasing the chances of the surgery being a success (regarding you picking a good clinic/surgeon). Norwood 5 - Norwood 5As have a chance to get a strong set of hair on their head again, but they have to do it right from the beginning. Norwood 6s might need to accept a reality that they wont be able to get a full head of hair again if they have poor donor. But they can get something but only if they go to a specialist. This is why I would reccomend more elite clinics/surgeons. If you were a Norwood 2-3 you could go for "cheaper but still good" options because you would need less grafts, you don't want to compromise your donor for future baldness still. I personally believe that the higher Norwood you are, the higher difficulty the surgery becomes. More planning to get more out of your donor while still keeping it visually unchanged whilst getting the most out of less. If that makes any sense.

I am not including budget/location in my assessments I'm just including what I've been impressed by in the NW5-6 range I will also mention that these high norwoods I would not skimp out and go on a budget. Maybe Norwood 5 if they are top budget options but even then if your a Norwood 5 that means that you have a large amount of thin/bald area to cover. Norwood 5 / Norwood 5A - H&W, Mwamba, Bisanga, Ferreira, Freitas, Nader, Eugenix I honestly believe that if you are Norwood 6 you have to eliminate concerns on budget/geography and go with a doctor that has a strong portfolio of that range. Norwood 6 - Zarev (need more cases, but still very impressed by those results) Sethi, Pitella HDC has done some impressive work on here as well.

Dermarollers can "break" the hairs when you use them. Dermapens are better and you wont have that issue nearly as much. Pretty much dermarollers wont affect your hair follicles but can accidently cut the hairs.

If you are inconsistent with minoxidil use, your hair will shed. I am speaking from experience here I had sloppy use of minoxidil but still applied it everyday and I went through very significant sheds. If you were inconsistent and not applying at all then you would probably undergo the same thing as me. I will provide photos once my phone is repaired cause I have some good examples if needed. I don't think your hair is much different comparing the previous thread and this threads photos. To be honest the photos you posted on November 1st look worse than the photos you posted today. It looks like your forelock strengthened. I circled in Blue where I think your hair improved based on these photos. In my opinion just judging by these photos, I would say your hair is improving rather than regressing. November 2021 Today I do not use topical DHT blockers myself. I just advised you that those options exist.

Fantastic Results as we expect from Bisanga.

This is what 81 Grafts looks like. I took this from @Fue3361s thread Not quite 100 grafts but 81 is still very high. His density in the hairline is incredible and I can't see any reason to make it any more dense. Even in the worst conditions I imagine his hair still looks incredible. Put some photos so people could help you. Different Cases will need different grafts. If you have finer hair you will need more grafts than coarser hair patients. If you have a smaller head than the area you need to cover will also shrink as well and higher Norwood's will need more grafts. There is a lot of variables in play that make things more challenging to determine. Usually a surgeon/clinic will estimate how many grafts you will need with photos but that number is subject to change when they actually get to examine your donor and your hair.

The hairline design looks well balanced and good. I think you will age well into to it if you dont continue to lose your hair behind it. I also agree that 3000 grafts for the area is covered is a huge risk for the future. Based on your current hair loss you have no certainty of what your final Norwood pattern is. You could be super incredibly lucky and are destined for a Norwood 3 and just hit it early unfortunately. Or you could be like a majority of people and end up somewhere around 5-7. 3000 grafts is getting close to about half your donor capacity without compromising it. The work looks clean and I'm sure the results are going to be great, its just whether you maintain this head of hair for decades to come. Also a large majority of Hair Transplants that fail are from surgical error. There can be many reasons to dictate a failure such as poor angles, multis in the hairline, coarser hairs in the front, cobblestoning, etc that are all from the surgeon's performance. Poor growth however can be attributed to either the patient or the surgeon. And usually when its on the patients behalf its not necessarily their fault. Usually its underlying scalp conditions, or even just your body has poor healing and most of the grafts wont take. Although this is pretty rare and most of the time avoidable because if you have something that gets in the way of hair transplants its usually something you would be aware of (dermatitis, scalp psoriasis) which you could get a handle on before the surgery and still get a good result. However there are cases where you might have a underlying scalp condition that is not as easily detectable and slips through the cracks on why you have poor growth. Once you get a poor growth case, I believe everyone should get a scalp biopsy to determine if it really was surgical error or something else. Also how long have you been on finasteride?

Can you replicate the same conditions like the ones you posted on June 27th? Your photos back in June looked really good. All things considered they were in the worst possible scenario of your hair spread apart, wet under very bright lights. And actually held up pretty well especially for 6 months results. I'm just a bit confused on such a difference between your hair taken in what can be considered all the worst conditions merged into one. And that in my opinion looks better than your hair just taken out in the sun? nonetheless you’ve made quite the improvements from your baseline, and there is still a hair maturing to come. Although you are right and I would be expecting more overall from 5.5k grafts. But still I would hold off any final reservations as I’ve seen recently how much maturing of the hairs can do.

There is Saw Palmetto which I take everyday with Finasteride. I haven't gotten any side effects with it. Its weaker than Finasteride/Dutasteride but its something additional you can take. There are a lot of topical anti-androgens and people get on these massive pharmaceuticals stacks for hair. Something that one of the people on this forum used to be knowledgeable about and praise a solution until they were banned.

In one of Melvins videos, he says that it sped up growth for his shock loss. If I can find it I’ll post it

This is where a massive misconception comes in, most clinics everywhere are poor quality. Turkey is known in the public eye for having high quality of work when in actuality its the most dangerous country to get a HT due to how risky it is and has the most hair mills out of all countries. Just because Spain has some good doctors doesn't mean that its "the place to go to get your hair back" its more like "this place has some of the best choices to go and get your hair back" Same applies to India, There are plenty of poor doctors in India, but India also has Eugenix which is one of the better options. They charge per graft, first you should consult with the doctors that you are interested in. Get cost per graft, and how many grafts you are going to need. Then convert to AUD if needed. Since you are a advanced case, you are going to need to spend more money. If they charge per graft, and you are a higher norwood you are going to need more grafts. More Balding = More Grafts. More Grafts = More Money I would say you are a Norwood 5 and you would probably need around 6500-8000 grafts if you maintain your existing hair and strengthen it with medication. You should get on Finasteride/Minoxidil if you haven't. You should share some photos of your donor to get a good idea of what we are looking at. For example do you have Retrograde Alopecia? Is your hair fine/medium/coarse? How much does your crown dip? Any signs of thinning into a further pattern? These will all factor in how many grafts you can get out of your donor, how many grafts you will need, etc. If you do FUE, you will probably need two-three procedures to get something really strong in your current state. If you do FUT and you go to someone that has mastered that craft like Hattingen. You could probably get away with one procedure. I think you would fair well at Bisanga in Belgium for your case. I can't answer your questions too accurately cause I have only one photo to go off. But based in this one photo you have good skin/hair colour contrast (this will help with your result) and you are currently around a Norwood 5. If you could provide a photo of your crown and your donor from the back + side (specifically so we can see above your ears) then we can tell what type of situation you are in.

I will also add to this once again and say that you are a Norwood 4. As a Norwood 4 its possible to get a very good result, something that would look good even in the worst conditions. However if you are getting a large procedure 3500 Grafts that is almost half of a decent donor area. You are also getting a FUT procedure which can scar significantly worse and by a doctor who recently has had pretty poor FUT donor management. I will also say that I do remember vaguely that Diep has fake accounts made under the guise of happy patients saying something on the lines of "yeah go get a procedure at Diep, changed my life for the better" copy-pasted on repeat. Also you do not want to get this done wrong, cause your crown might be showing signs of miniaturization and moving to a higher Norwood. Could just be the lighting but who knows. There are plenty of other US doctors that are significantly better than Diep. Konior, Panine, Cooley, Gabel, Bloxham, Nadimi etc. On a another negative thread on Diep recently, there was even a case of having freshly new technicians performing surgery on a patient. There was even a comment saying that the patients were washing the hair and placed the patients necks incorrectly cutting of blood-flow and making the patient pass out. If I were you, I would cancel and say goodbye to whatever deposit I placed. And search elsewhere.

I'm not a expert on this, but I do believe it looks like your going into a Norwood 4 visible pattern. You will likely develop into a Norwood 3 Vertex first due to the difference in your midscalp and crown. Then follow into a Norwood 4. If this is the case and your final pattern is Norwood 4. You should be fine and get something you are satisfied with if you choose the correct surgeons and harvest/implant appropriately.

I would advise that you document your journey with Diep here and also alert him that you will be recording and more. I've noticed that clinics will put their 100% when they are being documented on by video/forum updates. Hair mills like HOI get celebrities and they give them the best technician teams. Not insinuating that Diep is a hair mill just saying that when they are being monitored by video or their results are going to be in the public eye like a celebrity they will put their A game in their work.

On your next update, can you show what your hair looks like soaking wet and also something like towel-dried wet?

Hair mills are not advised in anyway. The chance of you coming out worse than what you came in as is still too high. And to be honest, their average results are usually subpar and have hints of donor damage. Freitas and Couto have impressed me on their Norwood 3 Norwood 3V results. I would advise looking there.

10k is still a rather low budget. Never limit yourself to budget and geography. Go with the doctor that fits your case.

1. Norwood 5as can get something relatively strong and dense looking. But it will take pretty a large amount of grafts, usually around 6500-9000. Captain calico and Rolandes are really good examples of Norwood 5 recoveries with 6500 grafts and 7000 respectively. don’t expect native density but you can get something that will hold up decently even in the worst conditions. Obviously there will be scalp showing in those cases but it should still look rather good if you got it done by a elite doctor with a successful result. I’m basing this without seeing your pictures. 2. It’s not a guarantee, but it’s possible. I think there is someone on this forum who got on medication at NW3 and avoided getting NW7 like the rest of their family. I usually like to give examples but I’m unsure who it was. In my case, I went from a Norwood 5, to a Norwood 4 or even debatably a Norwood 3 vertex. I've stabilized for over a year without any regression in my regrowth. I shed quite a lot and it will look worse temporarily but it always grows back in. The reason for my shedding is that I get slightly sloppy with my minoxidil application. 3. If you have fine hair, you will need more hairs/cm2 than someone with coarse hair. I would say density is more important in your donor, but coarse hair goes a long way in advanced Norwood’s. Additionally, if you are a advanced case. You can have your donor intentionally homogenously overharvested in extreme cases. But you would probably resort to beard hair. Their is a lot of hype around beard hair usage recently and I will say some of the results are incredibly impressive. But beard hair if done poorly can look super unnatural and actually look worse than being bald. First step, get on medication. You will need to stabilize your hair loss. You might be able to get regrowth. Take a look at my post on Finasteride. I went from. Norwood 5 to Norwood 4. You can get USB microscopes to examine your crown for miniaturization or it would be better if you got a excellent trichologist for that. After being on medication for a year and if you presumably stabilize, you should consult with a elite doctor for your case. Someone experienced in Norwood 5a but also has excellent donor management for upcoming Norwood 7s. Zarev is very skilled in high Norwood donor planning, Sethi as well. Bisanga/Mwamba/Ferreira/Hasson all have track records and skills for Norwood 5a. Other doctors that I think you should put on a research list is Pinto, Konior and Freitas

I am very impressed by your results here. I noticed that you were unable to remember how many grafts you had, are you able to ask your surgeon/clinic about the graft breakdown?

I haven’t seen this mentioned before on here, but I remember vaguely that when I was browsing reddit specifically r/tressless that dr Diep was called out for using bot accounts to promote his clinic under the guise of happy patients. Keep in mind that I learned about this before I learned which clinics were hair mills and which weren’t so it always left a negative impression of Diep on me. There are numerous cases of Diep implanting in rows now which have led to poor results. I feel like from what I’ve gathered is that he has lost passion of his work and is rushing along patients with minimal effort. This shows in his craftsmanship and is still charging top prices. I’ve also seen no word of a Diep representative to argue his case. And you would think by now given all these poor growth cases and negative opinions on his practice that he would come out and justify himself When will there be a discussion about this? In my opinion from reading others experience with him it’s looking like he is becoming the ASMED of the US. A skilled surgeon operating under a clinic that is producing questionable practices and more consistent poor results.