MisterBreakfast

A few thoughts...  Camera's jack up the contrast and usually in things like phones, they have poor dynamic range.  To compensate they jack the contrast and saturation up even more in software post processing. 

So, camera's will always be unfriendly, more so if you have dark colored hair on light colored skin.  This is why actors in movies use either post processing effects, hair fibers, or hair pieces, even when they aren't necessarily balding.

All this to say, while you can add density to a point, you'll probably never like the way your hair looks in photos, unless you're part of that like 5% of people that keep their 13 year old hair density. 

If you're happy with the way your hair looks in the mirror, or in real life, then I'd say leave well enough alone.  If you're an actor or other media presence, then maybe look into the hair techniques commonly used in that industry.  

Just going to note, I was one of the few that had side effects.  It took a few months to kick in, but it gave me extreme bloating in the stomach area.  It's listed as a very uncommon side effect. 

I actually had been on OM so long that I didn't even consider it as a possibility, that it could cause bloating, but sure enough.  I went to doctors, had ultrasounds bloodwork ect ect.  After exhausting all options, I dropped OM for 1 month, and all my problems went away.  I also lost about 8 lbs of what I presume must have been water weight. 

At this point I was just curious so I tried to start back up on OM, but sure as day, about a week later my symptoms started to come back.

Fortunately for me OM provided almost 0 benefit.  I'll just stick to Dutasteride, since that has made a night and day difference and I have no side effects from that.

TBH, your hair looks similar to mine, but maybe a little finer.  I think you gotta think about what kind of haircut you want in the future, and consider your age. 

Do you want to keep short sides? Then maybe you are looking at doing a *very* minimal FUE.  If you want longer sides- maybe you can do a FUT and get more.  Each one has big pros and cons, so I'd consider that.  Whatever you do I don't think you should get a large FUE.

Your donor will be almost impossible to evaluate at this length and without knowing your age. 

The best option is probably just go to a trustworth surgeon and get evaluated. 

The other, less good option is to grow your hair out and look for signs of retrograde or diffuse thinning.  

17 hours ago, mrmajified said:

Hi all,

Attached 14 day after surgery photos from 4 sides. Had my staples removed 9 hours ago. Really not sure why one photo went upside down cause it's normal on my PC.

 

 

Thanks for posting.  I'm looking at getting the same sized FUT from Wong later this year, so I'm following closely.

Hair restoration is both equal parts science, math, and artistry.  It's all about making something that looks natural enough to pass as such.

There are literally hundreds of considerations one should make when designing around naturalness.  I'll focus on 2 examples here.

1) You need to match density close enough with what you have.  If your parietal or lateral humps are 80 hairs per cm, then it would look rediculous to put 200 hairs per CM right next to things.  Human eyes are attracted to notice differences, it's the one thing they are super good at.  You'd be able to spot that something is wrong from across a room.

2) Your occipital hair is not the same as the hair that used to be on the top of your head.  There's probably a difference of about 10-20 micron, and since the amount surface area that your hair covers is a function of radius squared, that means that hair covers approximately 30-40% more light.  You don't need as much of it to have the same appearance.

There's so much more to talk about on this subject.  It's best to select a surgeon that know's what they are doing, because it really is a difficult matter to get right.

P.S. Another random thought is, that, perhaps because I'm getting closer to 40, it's simply not natural to see someone with no hair thinning.  I have maybe 1 or 2 friends with hair that looks like they are straight out of highschool, and honestly, they are in the minority.  Sure, it looks great, but honestly, it kinda sticks out in our crowd.  So I personally prefer transplants that have a mature hairline, and *slightly* thinned look, since that what's looks most natural in my opinion.

Kind of a hard question to answer.  It's kind of like asking "How many vehicles can fit in my garage?". Vehicles come in different shapes and sizes much like hair. So do garages.

It depends on the size of the follicles (width and depth), the recipient skin and thickness. I mean technically using the old punch technique they could transfer 100% of original density, but it looked very bad.

It's probably more worthwhile wondering how many grafts are needed for a good cosmetic result.

I don't think surgery can improve anything in this case.  You'll never match that native density, and even attempting would just be a waste of grafts you might need in the future.  

Looks like fine hair, but your donor looks above average. 

2 hours ago, Turkhair said:

6k is a lot of grafts, you should be looking at NW1 with that much and full coverage. Maybe even density among hairline. For comparison slick bald NW6 get 3500 for frontal density + coverage and another 2-3k for crown. You’re not NW6. 

FUT is a mistake. When you stop those drugs and you will one day - it will happen - that scar will look really bad all alone when the medicated hairs will fall off.

I will go with another clinic if I was you. FUT is so dated technique and the scars are hideous, it should never be an option. You can not go bald anymore or shave without looking like you had skull surgery. 
 

I have had FUE and nobody can tell I had thousands of grafts taken from me even when I shave bald. 

Interesting.  I was pretty sure I was Norwood 6, at least as a final pattern.  I feel like meds brought me back to a NW5.5 ish state.  Maybe a Ludwig 2 pattern?  What do you think I would be?

As for FUT, I'm just not that worried about the scar. I already have a fair number of scars from bike crashes and other things, so I know I typically heal very well. There are plenty of options to deal with it, if it stretches, and I've never been one for bald fades.  I'd also like to leave FUE as an option for the future for either repairs density or maybe the crown or touchups as I continue to age.

As for other things I'm happy to be as conservative as possible.  If Dr. Wong things less grafts are needed I'd be psyched to save them for a rainy day.  I've lived a fast and full life already. I was sure to already enjoy my 20's to the fullest and have no desire to appear as youthful as I did back then. 

I'm happy to have a mature/age appropriate higher hairline with even some thinning in the back. Something that will suit me in my 40's and 50s and beyond (hopefully). I really would just like to frame up my face in the front, as I do video calls, teaching and conferences quite often, where appearance from the front is important. Anything beyond that would put me over the moon.

4 hours ago, TorontoMan said:

Keep going on meds and delay your hair transplant. We may have positive results soon from HMI-115 and it would be worth knowing how effective it was in the first trial, in the meantime you are likely to continue to get some regrowth from dut and om given how its worked so far

54 minutes ago, Melvin- Moderator said:

^This you might want to add something else to your regiment, HMI-115, CosmeRNA, Pyrilutimide. I think you should see how much more growth you can get from meds before considering surgery. If you have a good deal of regrowth, you wont need to do FUT, which in my opinion, is risky. A large strip like that could definitely stretch. 

I'm interested in these, but to my knowledge, these new drugs follow the same mechanism of action of existing drugs like fin/dut.  Since I basically have knocked down my DHT levels to as close to 0 as possible, I don't think degrading my androgen receptors (AR) will do much.  

I will watch closely to new developments.  I'd be very curious if degrading the AR has any impact in users with little to no DHT.  I haven't seen any clinical studies to suggest that may be the case.  I suppose there is a small chance that it may prevent Test from binding to the AR, but that's speculation at this point.  I think test has low binding affinity to the AR already, however.  Will be interesting to see.

Currently I'm booked for December 2023.  I will consider pushing it out, but I have to weigh it against the risk of rescheduling out another 15 months or so for the waitlist.  

33 minutes ago, Big Rome said:

wow, the medication seems to have worked wonders, is that last pic your donor after the medication for a period of time? looks good not average! 

Last pic is after meds.  It certainly has thickened up!

Hi all,

I am currently scheduled for a transplant with H&W to do a 5000-6000 graft FUT procedure.  I have talked to Dr. Wong, and he says that he thinks I am a good candidate, and that even though I have an "average to slightly below average donor" he thinks he can safely extract a large strip and cover everything I'm interested in covering.  I have indicated I'd like to leave the crown whirl(s) as is, since dutasteride seems to bring it back.

My question to you is, do you think this would be enough?  My expectations are and illusion of density with a mature NW2.5 hairline up front, and in the back, a balding, or bald crown. Is 5000-6000 grafts enough? I'm suspecting I may need a follow up procedure, maybe FUE.  What do yall think?

Here is my history/progress on dutasteride and oral minoxidil. I'm 37. I have been on dutasteride for about 13 months so far. Oral minoxidil for 8 months.  I've come pretty far... starting here:

to here:

to here:

and here is my donor:

37 minutes ago, Turkhair said:

Mice do NOT have as complex and sophisticated immune systems like ours. 

 

 

 

I'm going to make a small correction.  Normal mice actually do, and they will fight off and kill most things.

LAB mice on the other hand are either engineered or treated to have essentially no immune reactions.

That being said, transplanting hair from one to another is possible, but no one would do it ethically because you'd have to knock down your patients' immune system which puts them at a very high risk of death, especially these days.  Cosmetic surgeries are not quite considered worth the risk of death.

I teach older men how to dance, so I see a lot of them.  Trust me, not a single one of them has an intact donor and only 1 of them has had a hair transplant (that I can tell). Out of about 200 students or so I'd say that there are maybe 2 that have more than 60% density (age 55+).  

Similar story for post-menopausal women, although to a much lesser degree.

The game is to try to do as much as you can with what you have for as long as possible.  A good response to medication is a must in my book to give yourself a leg up in making your hair last. Or you can always shave your head.

3 hours ago, Cory said:

Indeed. If this doesn't look like a dense, healthy donor, I don't know what does.

But I'm not an expert..

I think you might not be commenting on the OP's hair.  A few different people posted follow up pics.  

It kinda looks like the transplant worked.  Maybe poor survival, but you can see the thicker hairs did take.  It looks like you lost ground on your native hair though (admittedly I am making a lot of assumptions).  Did the doctor prescribe you a DHT blocker?  If not you might have lost native hair

Looks like retrograde alopecia.  That looks like a 1 to 8 fade, so it's a little hard to tell but there is visible thinning on the bottom for sure. It might be easier if you grew everything out to the same length to tell.

For reference, here is my donor, without any retrograde alopecia:

This is cut to a #2 or #3

another before pic: 

Still alive : P

Dut has worked best in my crown(s).  Got both my whirls back.  Got a bunch of vellus hairs back and maybe ~ 1000 terminal hairs or so. 

It's always funny cause the crown is the thing I was perfectly happy losing.  Even now the hairs stick straight up in the air.  I think it's a common problem for us double cowlicks out there. 

In my estimate it looks like you might have a thousand grafts in that donor.  And you probably need about 6-8000 grafts depending on your head dimensions.  I'm afraid the math doesn't add up.

Sometimes, I feel like I'm in a similar boat, if it's any consolation.

Been on Dutasteride for about a year now, and I had my bloodwork done as part of a physical.  Liver looked perfect in my case.

6 minutes ago, Ralph kaka said:

Hey @MisterBreakfast thanks for the insight. I honestly would never want to take it due to potential side effects, only if I have to. Is it possible to just stay at a norwood 1.5-2.5? I am curious your thoughts on the pics-is it male pattern baldness? 

This article seems to suggest that for people with mild hair loss it may not progress to a full norwood 7: Norwood Stage 2: Photos, Treatments, Results | Wimpole Clinic

It's a personal decision, and I'd advise talking to a dermatologist to get a true idea of what the side effects risks are, and for an official opinion.  

On a personal note, you look like I did before I turned into a Norwood 6.  You look to be a diffuse thinner possibly, which is already a challenge in and of itself.  If I were you I'd try to save as much of my hair as possible.  Listen, hair loss and patterns are not well understood, so we can't predict your future.  I will show you what diffuse thinning did to me, and I will let others chime in to see what they think:

It is common to shed when starting finasteride. 

Usually the hair will grow back stronger in about 6 months.  Right now your genes are causing hairs are becoming vulnerable to DHT and dying (miniaturizing).  Finasteride blocks about 70% of DHT in the average person, so just think how much worse it might be if you were not taking the drug (not medical advice, talk to a doctor to confirm).

3 hours ago, Ralph kaka said:

@HappyMan2021 Given my situation based on how it looks do you think it is absolutely necessary to go on something like Fin/Dut? To me it doesn't seem like I am on the verge of progressing to norwood 7 and could hold off on meds for a few more years and re-assess. And I could perhaps be one of those people who gets to a NW 2/3 and it stabilizes. But idk how that works.

If you think there is ever a time in the future you might want to take fin, then you need to talk to a doctor now and see if it's right for you... now.  Your future self will thank you.

Again talk to your doc about this, but essentially, once your hair is dead it is gone.  As one of the lucky few who has regrown some hair post loss, I can tell you it is nowhere near what it used to be.  I can only wish hair loss drugs had been available when I was younger.