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Posts posted by 4chanhrn
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18 hours ago, Al - Moderator said:
Bloxham tries to limit the width of the strip so there's not too much tension. A thinner strip will generally give you a lower chance of scar stretching. Hasson & Wong like to push the limits of how wide a strip they can get for higher NWs that could use more grafts.
Thank you. I asked Bloxham and got a similar response.
11 hours ago, Bucky O Hair said:BOOM!
The administrator has spoken, and he is in full alignment with Bucky O'Hair!
#neverstrip
15 hours ago, Melvin- Admin said:I would NOT recommend strip. If you’re going to do this, I would look at the big 3 Zarev, Sethi, Pittella. These are the surgeons doing large cases with the biggest Norwood 6 portfolios.
Keep in mind, this will not be a cheap endeavor.
#neverstrip seems to be the consensus and in an ideal world I should be going for a Zarev, Sethi or Pittella, but if one does not have the access to elite surgeons that have worked on NW6/7(I'm not sure you can even book Zarev. Sethi and Pittella would be like 1-1.5 yr wait away and expensive. $5/graft for 6000+grafts adds up quickly), then wouldn't FUE exhaust donor completely if I somehow progress to NW7 vs doing FUT first? That is really my concern. FUT leaves you with lot of grafts in the bank as an insurance policy+Verteportfin could end up giving more grafts down the line.
I've been tempted by someone like Nader, who's cheap and excellent(I think I can be persistent in contacting him). There are other good FUE surgeons as well. But worried about FUE not leaving enough in the bank for later. The scar doesn't bother me. What do you think? Here's a good large case Nader handled:
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5 minutes ago, Bucky O Hair said:
Was Bloxham's estimate of 7000 for the front/midscalp only? Not including the crown?
If he is excluding the crown from that estimate then I would have to say that is way too much, and will probably exhaust almost all (if not all) of your donor grafts.
I was in the same boat with you re: my crown in that I thought I would need at least 3500 grafts (or more)...and this is what the tech-heavy clinics were quoting me at. But I was surprised when the doctor-only clinics were quoting me at 2000 grafts. I thought that was way too low and couldn't possibly be true.
Bloxham said I'll need 2 FUT surgeries of 2500-3500 for full coverage front to back. He said he wants to start with 1 FUT aiming for "as much as possible".
He included crown in that estimate and I should still have enough grafts to do FUEs later after that if I really need those grafts/have more loss.
12 minutes ago, Bucky O Hair said:was in the same boat with you re: my crown in that I thought I would need at least 3500 grafts (or more)...and this is what the tech-heavy clinics were quoting me at. But I was surprised when the doctor-only clinics were quoting me at 2000 grafts. I thought that was way too low and couldn't possibly be true.
I decided to go with Dr Munib, and the jury is still out on my results (I'm not even 4 weeks postop on my crown) but the coverage looked great before it shed.
I'm beginning to really question the "low" transection rate that all of these clinics claim to make. There's no real way to confirm if a clinic has transected 5% or 20% of the grafts they take out (because you won't really be able to count each newly implanted graft to confirm this). You just have to take their word for it. In my case, if my crown results turn out to be as good as everyone else's here (with half the graft count) then I am convinced that most tech-heavy clinics are removing more than is needed and are just transecting tons of grafts along the way.
That's very interesting. I would love to see your results.
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15 minutes ago, LeonBlack said:
I drove for all of mine so not sure on that end. I would think fine to fly the day after procedure. Staples, you can get removed at home. PCP, urgent care, etc.
Got it, thanks!
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22 minutes ago, LeonBlack said:
2 nights. I stayed on Long Island near where his office was. Procedure Friday. Stayed Thursday and Friday night, drove home Saturday.
That's not too bad. How much longer do you think you'd need to fly and how did you get the staples removed?
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20 minutes ago, LeonBlack said:
Konior top notch….. but 35k/procedure
Yea, I know. He's pretty low down on my list(because of his price) and I'm not completely sure I can afford him but it doesn't hurt to ask.
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On 4/13/2024 at 6:26 PM, LeonBlack said:
I have seen a few 5K+ from HW on this forum. I don’t think I’ve ever seen over 4K from Bloxham here, or his YouTube videos. my strip goes from here to ear, actually a bit past the ears. Couldn’t be any longer. Only way is to take a wider strip. perhaps some patients have the scalp laxity for that and/or a they use a different closure technique to maintain a thin scar without too much tension leading to stretching. On my second FUT, he used internal sutures, in addition to the usual staples, to maintain a thin scar. That one was just under 3K.
If he said he could’ve safely gotten me 5k+ on a single procedure, I would’ve paid and done it. Granted full coverage needs 6-8k+, so needs 2nd procedure either way for high Norwood. Larger was not advised for me.
That makes sense. I was always curious about discrepancy in numbers. I've asked it to Bloxham as well.
I know we've been spoilt by 10k graft transplants, but 4k was a big transplant just few years back.
Also can you tell me how long you had to spend in NYC? I'm guessing till the staples are removed? I'm wondering how much would the hotel costs come to.
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On 4/13/2024 at 6:00 PM, Bucky O Hair said:
Yea, my issue with H&W (when I had my consultation with them last year) was the high graft estimate. They always seem to give very high estimates.
Their estimate was double what I got quoted from Munib and Konior.
I'm not sure why this is the case, and (like you) I am trying to be efficient and maintain a long term plan (that doesn't involve exhausting my donor).
Don't you think I need atleast 4000-4500 for front/midscalp? Bloxham said in total would need 5000-7000 grafts with 2 procedures.
I'm going to consult with more doctors and see what their opinion is. Different opinions are always good.
On 4/13/2024 at 6:00 PM, Bucky O Hair said:Since you seem to want to stick to USA/Canada for your procedure, I would email Konior to see what he has to say. He communicates directly will all patients, so you'll get feedback from an actual doctor (and not a sales rep).
I'm open to other locations if the price/quality of surgeon is much better. Not strictly restricting myself to North America.
I'll contact Konior, thanks.
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3 hours ago, LeonBlack said:
Same as mine. Planned to do “as much as safely possible” on first. Ie max size strip while minimize stretching risk. Got ~3800. Wasn’t sure I’d ever want to do crown…. Til 6 months later when I saw how good front looked and accentuated my bald crown. Always very responsive via email with questions and concerns pre and post op.
Do you know why Bloxham's numbers(how much he can extract) from 1 session are much lower than H&Ws? I'm just curious.
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31 minutes ago, LeonBlack said:
Probably what I’d do if lived around there.
For me they are just 4 hr drive away. They are quoting me 4000-4500 grafts for first 1/2 to 3/4 scalp w/ FUT and it comes to 16.3-17.9k USD w/ taxes.
Bloxham wants to do 2500-3500 grafts for 14-16k USD(plus flight/hotel costs?) for as much as possible starting from the front. Plus another FUT procedure later down the line if required.
H&W is cheaper but I liked Bloxham's planning better. He was also very good answering questions and putting effort into the consultation. I'm looking for a long term plan to address my hair loss(especially because I'm not on a 5ARI) vs a 1 time procedure. I have a call with H&W consultant on Monday to ask questions but it would have been nice if I could talk to the doctor directly.
Currently for me both are viable options. I'm taking my time to decide who to go with. I'll be consulting with other doctors as well.
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18 hours ago, krusher7 said:
Hey @4chanhrn ... I was a NW 5/6 in a similar type scenario of hair loss like you. Do a mega session with Hasson & Wong in Vancouver. You won't regret it!
Thank you. Your results look really good. Currently consulting with H&W. I have a call planned with their consultant on Monday. Dr. Wong is world class surgeon. There's no doubt about it. I'm hoping they can help me more with long term planning and I wish I could talk to the doctor directly.
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23 minutes ago, LeonBlack said:
Sorry, but I’m not sure what his wait time is like. For my most recent, I specifically requested a date that was about six months out (working around my schedule and holidays) and it was open. I did not look into first available.
Got it, thanks.
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13 hours ago, LeonBlack said:
I do agree that would be the wise decision. Don’t intend to hijack this thread… But I acknowledge I have not made the optimal decision on that aspect. I used topical minoxidil for over a decade. definitely noticed I would lose more hair whenever I briefly stopped it. Hair loss nonetheless substantially progressed from Norwood 2 in my early 20s to I believe a 6 before my first hair transplant, as seen in my linked post. I tolerated finasteride somewhat, not perfectly, but not terrible. It was stopped for one to two years at a time, directly before/after having each one of my kids. Perhaps that was misguided, but it made my wife feel safer. Frankly, don’t know that I saw a difference on it, even when steadily taking it for a year or more. Perhaps I could’ve switched to dutasteride, or if more recently, added oral minoxidil.
All that said… At the time of my first hair transplant, the only residual hair I really had was the miniaturized patch in the mid scalp.I asked my doctor his opinion. He did not think it was worth taking medicine for the rest of my life to preserve that small area that was already on its way out.
At this point, reasons I could think to take it would be preserving the lateral humps, and back of crown, just in case I was destined to go from a 6 to 7. Also, possibly prolonging the lifespan of my transplanted hairs. I have made the conscious, and perhaps unwise, decision to just let it ride, given all that. Several thousand scalp graphs left available via FUE, not even including my thick beard.
You're not hijacking the thread. It's a good discussion to have. I don't think you need finasteride. I feel it's a good thing for you to lost the hair more susceptible to DHT before you started your journey. I wish the same happened to me lol. Then I can start from a clean slate.
I feel planning for you was really well done so you don't need meds as much as others. I'm really impressed.
I've filled out Dr. Bloxham's consultation form looking at your case. Do you know what sort of wait time I would be looking at for Dr. Bloxham(or for other clinics)?
Also I started Pyrilutamide today.
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11 hours ago, Gatsby said:
Oh if your body can’t tolerate it then that’s different. 👍
I'm going to try pyrilutamide(from grey mkt) soon. Although phase 3 trials failed, it did have hair count above baseline after a year, just not a lot above placebo. AAs seem better for maintenance vs regrowth so it could be decent for maintenance with much better side effect profile. IMO this might work as well as topical fin. If you look at trials for oral fin, the hair count over baseline wasn't too impressive either.
Kintor's investor presentation heavily stresses on much better safety/side effect profile. Ofcourse you can't have 100% because AAs don't selectively target ARs on scalp, but I think this might be as good as we may get for a while. It's also non steroidal, which is better as far as side effect profile is concerned
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Just now, Gatsby said:
If you can tolerate Finasteride I would recommend taking it (I’m not a doctor). It will preserve your hair transplant and donor area. After all that money spent on surgery it’s a cheap investment.
I know. Have discussed it above. I've tried almost every variation and spoken to my derm, multiple doctors and their advice was not to take it because my body can't tolerate it. My body is very sensitive to 5AR blockers.
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1 minute ago, LeonBlack said:
re meds…. I am not. Used topical min for years and fin intermittently ( I know wasn’t optimal). Continued to progressively lose. Was so far gone pre HT that I didn’t see the point of indefinite meds.
Yea losing most of it pre HT I think is actually a blessing. I don't think NW6/7 needs meds if pros don't outweigh cons.
Low dose oral min may help you if youre comfortable taking it. It improved my hair a lot.
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4 minutes ago, LeonBlack said:
Example of a high Norwood with FUT x 2 for full coverage (me). Cost about 30k. Frontal half grown in, back half 3 months post op. Small FUE shortly after for temples. Plenty of donor in the tank if needed, ie I progress to NW 7.
I am super impressed by what Zarev/Pitella are doing, and acknowledge I have my biases….. but I think it’s still TBD if the FUE grafts taken from outside the conventional safe donor zone will stand the test of time.
Solid results and very solid long term plan. Planning for you was very well done.
I think we are very similar cases. I think it would be actually better to lose existing hair before surgery so that I can start from clean slate.
Are you on medication now? I remember coming across your post on reddit thread that I had posted.
I think I'm going to do a consultation with Bloxham and look at what he says. 2 FUTs might be the way to go.
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3 minutes ago, TakeAction said:
Yeah it's far from insignificant.
I think people are too afraid of the scar because most people are not high norwoods and don't need extra grafts so they don't benefit much from FUT. But for those of us who are higher norwoods and need 6k grafts or more, there's a massive benefit.
I personally don't mind trading a linear scar for 3k extra grafts. My donor is quite good in the occipital region but not so great on the sides, so it makes even more sense to use FUT to get all of those thicker grafts. Most people have stronger occipital hair than temporal, but for me it's a pretty significant difference. I probably need about 6k total and I might not be able to get that with FUE alone, but I probably can with FUT.
I actually met a guy last year at brunch who had a haircut that exposed his FUT scar. It didn't look bad, and I brought it up later and we talked about transplants. Pretty thin and honestly I wouldn't have thought much of it if I didn't know about transplants. It wasn't some disgusting frankenstein scar, and if he had let his hair grow another two weeks it would've been covered.
We can always talk about worst case scenarios i.e. "what if the scar stretches" --> then you grow your hair out longer. Everything comes with some risk. Not everyone has the luxury of being able to do just FUE and get the result we want. And some people say "just use beard hair" which I don't agree with. Scalp hair is far superior in terms of appearance for obvious reasons. Beard hair is something I'd only use when I've maxed out FUT and FUE.
Like I've said before I wouldn't do FUT if I were a NW3 or even a NW4. But FUT has it's place, especially for high norwoods.
Yes, I completely agree. I also feel people's opinions are skewed because people look at select cases where great surgeons have managed to overharvest(not sure if this is the right word) from unsafe donor and still managed to make it look great. But it is risky for many reasons. And very expensive because you need to pay for the best.
One underrated thing about FUT is that it reduces overall area of the scalp, while the actual overall density remains the same. If you do FUT, you can always goto a Zarev or Pitella later. That option is completely open to you. You could also just get more FUEs.
Scar is a complete non-factor for me, but I understand why people would be concerned about it. Before I knew what transplants were and if I had looked at Joe Rogan's scar, I wouldn't have known or cared at all.
I am open to using beard/body hair. FUT+beard/body hair+FUE w/ Verteporfin can potentially give huge no. of grafts vs just doing FUE today and probably much cheaper?
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46 minutes ago, TakeAction said:
Most surgeons won't take more than 50 percent of the donor, so that entire area would only have yielded 2500 grafts with FUE only. So the average patient can easily get another 2500 or more grafts by combining FUT and FUE.
This is also a good video I found.
If their calculation is right, then it's 40% more grafts for avg person from safe donor areaby doing FUT first? That's not insignificant.
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1 hour ago, Fox243 said:
I think your best shot is to go with Dr. Pittella and see what he says.
That's a good idea. I will consult with him as well. He's a great surgeon for sure. Not sure about price/location, but I can try to make it work if he's much better option.
58 minutes ago, Melvin- Admin said:Lack of morning erections is correlated to poor sleep. I don’t think you can claim dut causes nightmares. Correlation doesn’t equal causation. Poor sleep and insomnia can be correlated to stress, presumably from losing hair. Something that medication would help.
I don't want to beat a dead horse, but hormonal changes can cause sleep disturbances. From my understanding fin/dut can mess with HPA axis, which can lead to nightmares/sleep disturbances. Fin/dut can also affect neurosteroids.
It is possible that it was placebo, because placebo effect can be strong, but I have used 5AR blockers for more than a month and everytime I end up with prolonged similar effects. From people's posts on the forum, Xyon's topical dut still had significant effect on blood DHT levels. I am hopeful for Pyrilutamide, because their press notes say one of their primary markets is as a hair loss medication for people that can't tolerate 5AR inhibitors and safety trial data looks good.
Like I said I was closely monitored by my parents who are both MDs and their strong recommendation was to discontinue use of 5AR blockers. I also consult with a dermatologist who also told me not to take 5AR blockers because I can't tolerate them.
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15 minutes ago, Fox243 said:
I do not think it is worth the medication as a NW7, especially if your body doesn't tolerate it. There's not much more you can save and there is a risk-reward tradeoff -- meds aren't a "free" option. I instead think its more important to find a doctor who also uses beard hair and be conservative in your expectations (maybe a NW3).
I'm on oral minoxidil, which is supposedly a mild AR blocker. I'm going to try pyrilutamide. Also use saw palmetto tablets sometimes+keto/SP shampoo. So I'm not completely off medication. It would have been nice to use a 5AR inhibitor, but I can't seem to tolerate it.
Yes, I have super strong beard/body hair and I do not have high expectations. I can grow a beard like Bin Laden(maybe not the best person to compare to but you get the idea) and have body hair as thick as bear fur if I don't trim it down.
This is my hair 4 years back at 23 before starting minoxidil and after bit of TE. It's not a whole lot worse today(may actually be better), but it was better little later after TE improved and minoxidil worked for sure.
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Just now, Melvin- Admin said:
Sides after one application sounds like a nocebo. Xyon by design doesn’t penetrate immediately. It takes several applications without washing your hair before it could even get absorbed.
I left it on for a day without washing. Its hard for weird dreams/nightmares, sleep issues for few days after applications, complete lack of morning wood for 1.5 weeks to be nocebo, especially when I am normally opposite to this.
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23 minutes ago, mr_peanutbutter said:
Yea all good options..
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38 minutes ago, TakeAction said:
I have to disagree, the FUT could be the difference between getting good coverage and not. With FUT (plus FUE) he could get an extra 2000-3000 grafts from his donor.
Of course nobody wants a linear scar. I would never advise anyone below a NW4 on meds to do FUT, the benefit just isn't there. But in order to maximize the donor in these high norwood cases, especially someone who's not on a 5AR inhibitor, FUT + FUE is the best way to get enough grafts. Those several thousand grafts are the difference between covering the crown and leaving it bare.
So it's either start with FUT, do several procedures and probably get good coverage over a lifetime or do FUE only, not get enough coverage over time and then have to shave.
That's my thinking. I also think Verteporfin+FUE would likely work out for better donor management. The trials are very promising. FUT now gives me the option to use Verteporfin for FUE later when it's better studied.
I'm OK with a bare/bareish crown. Looking for front/mid coverage. I don't have high expectations because of my level of loss+not using 5AR inhibitors. Also I don't think I would care as much in 40s/50s.
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1 hour ago, Melvin- Admin said:
How often did you apply the Xyon?
Got sides after single application. Tried 2 applications 3 days apart for sides to fully kick in. Sides went away after around 1.5 weeks of discontinuation. This is consistent with other 5AR blockers I have tried(topical/oral fin). Topical fin microdosing sides came in after few weeks. I stayed on it for a month hoping it would improve and had complete limp dick.
I am very sensitive to 5AR blockers. My parents are medical doctors and their recommendation was not to use 5AR blockers when my body does not like it. Every body can react completely different to medication. What works for you may be poison for you. It sucks but you can't do anything. Oral Min is complete opposite for me. It feels like it gives me so much energy and has improved my cardio.
Maybe Pyrilutamide can help. I'm waiting for it to arrive in mail.
1 hour ago, Bucky O Hair said:Personally, I would advise against an FUT procedure. You have many more decades of life, and you will experience further loss. You may want to one day buzz your head (when you're in your 40s or 50s) and you'll regret the linear scar on the back of your head.
I'm completely fine with the scar. Like you said it's a personal decision to make. I want to maximize grafts and I do not mind the scar at all. Even if I at all need to buzz it down, I don't think I would mind it, especially in 40s/50s.
1 hour ago, Bucky O Hair said:I get that money may be tight, but you cannot cheap out on a hair transplant especially with this level of loss.
Don't get a procedure if you cannot afford one, and do not get a procedure if you're not willing to travel a few hours for a good one. If I were you, I would reach out to Dr. Zarev for your level of loss, and do what I could to save up money in the meantime (while you are on the waiting list).
I'm not trying to cheap out, but I do not have unlimited money and would like things to be cost efficient. There are excellent surgeons(on HRN recommended list/recommended by patients) that are very good, but still not prohibitively expensive. I'm thinking I may have to get a little expensive large FUT, because there aren't a lot of good FUT surgeons(and most of them are in North America). I've listed the ones I'm considering above. And then I can get cheaper FUEs down the line. Laorwong, Nader, Pekiner, Keser, Eugenix(I often travel to India so would be easy to get done) are all good enough options for FUE without breaking the bank. There are many surgeons that charge much more, but are subpar in quality.
As for travel, it's a similar story. H&W is 4 hours drive for me. Hattigen would be a long flight+like a week worth of trip+arranging visas well ahead of time. Visas for Schengen countries can be super hard to get sometimes(depending on your passport). It adds inertia to the whole process. I can do it, but if costs, quality of surgeon aren't that much better, it is harder to justify.
Dr. Zarev is very good, there is no doubt about it. For me, his costs and availability make it a non-option.
Need advice - Suggest plan and which doctor to consult with (NW5/6)
in Hair Restoration Questions and Answers
Posted · Edited by 4chanhrn
That's a good idea. Waiting for a reply from Hattingen.
I was watching your podcast with Hattingen. Dr. Muresanu says the jury on FUE(especially for high NWs) is still out because you need to harvest from outside traditional safe donor area and FUEs are a relatively new procedure so we haven't seen how the patients would age with them, especially if donor starts to thin. I guess this would be even more of an issue with people not on fin and young. People getting these large FUEs seem to be either on fin or much older(and have stabilized pattern/donor for long time) or both.
I'm thinking 1 strip+FUEs with beard/graft after that.
Hair loss can progress beyond initial pattern. Your hair loss will just end up naturally how you will lose hair. If you don't plan for it correctly or take that into account then your HT can look weird later. Fin can put the breaks on or help you keep hair that you started with.
During consultation I got told that most likely I'm NW6. Although there are some areas of weakness, if I was a NW7, I would have been there by now so should be planning like a NW6.