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Hello, I've been flicking through many of these threads while conducting my research into the best approach for managing/correcting my receding hairline. I'm 25 and from the UK. I've been taking Finasteride for about 6 months but am unsure as to the results. I appear to be shedding hair still. Is this normal? I've had a few consultations already and have been advised that to restore my hairline I will require 2000 grafts in a transplant procedure. I have a good, thick, donor area and no loss on the crown. I would like to know whether it is advisable for me to opt for a transplant and, if so, who the best surgeons are in the UK? Please note, I am not willing to travel outside the UK. Any advice would be greatly received. (See pictures attached)
I am currently 33 (2012), and started to notice my hairline receding up the sides at the front when I was about 29. Like everyone who is visiting these websites, I started to follow closely the progress of my follicular retreat, and styled my hair to best mask it. The longer time went on, the harder this task became, and as well as continuing to recede up the sides, my hair immediately behind the front started thinning. This would ultimately have lead to a horsehoe-shaped hair-loss zone, and effectively have created a little hair-island tuft at the front, like a homage to Tintin! I weighed up the various options - I didn't want to spend money on treatments that only offered a small possiblity of working, or having only a small positive effect, so laser combs were not an option for me. I took some considerable time to decide to go on Finasteride - I don't like the idea of being on long-term medication, regardless of how low the chances of side-effects are, but I decided to start taking them in February this year (2012). Liquids or foams that you rub directly onto your scalp twice a day simply don't appeal to me (not at the moment anyway!) - the daily routine seems like a lot of hassle to adopt for the rest of your life! I decided at the beginning of the year that a hair transplant was the path I wished to take, and so began my research. I visited a couple of local clinics who offered free consultation. The first one said that they would not wish to proceed as there was still too much hair on my head, and really the minimum procedure they undertake is about 2,700 grafts. The second suggested around 1,700 grafts and asked me to have a look online to consider which surgeon of theirs I would like. Looking online, I noted that all surgeons were part-time hair-surgeons, with their main job being in the NHS. Whilst that meant one of them for example was practising plastic surgery every day, they were not doing hair-surgery 5 days a week. Also, no examples of their individual patient results were available to view, but rather the clinic's result as a group. As they have clinics in the UK, Spain and the U.S., this didn't tell me which, if any had been undertaken by the surgeon who I would potentially be letting loose on my noggin! At this point, I started to concentrate my search online and examined this website, as well as many others. This was a place that the surgeons who are connected with this site actually post their patients, allowing their work to be seen and scrutinised, and as far as I am aware, anyone can freely post, comment or ask questions about the op's. This instantly appealed to me far more than generic pictures with no follow up story. I don't know how many surgeons out there do hair surgery, but I would rather go with someone who's work is transparent and in my opinion appears unbiased. From this point, I got in contact with Spex. I explained that I had a window of opportunity between jobs to have my surgery done and was keen to move things along. I took loads of photos of my head (I've spent so much time staring at my hair over the past few years, that it was easy enough to do!), and passed them on. Spex forwarded them on to Dr. Feller and gave an assessment of whether I was an appropriate candidate and what level of replanting I would need (he reckoned between 2,000-2,500 grafts). Spex gave me links to examples of patients with a similar balding pattern and stage of retreat to mine, and shortly after I had a very informal conversation with him where my questions both general and personal (and there were a lot!) were patiently answered by Spex. Within a few emails, a date in February had been set for my op! Clearly, before I paid over any funds as a deposit, I checked over all of the operations and posts that Dr. Feller had made, and grew in confidence of his professionalism and ability. I can tell you that when the day of the op. arrived, I found that the man in person did not fall short of my expectations. I think this is as good a time as any to say that Spex really did make the path from from the UK to Little Neck was made as smooth as possible. His 'hair manual' which was (and still remains) a big help and comfort in the process is well worth a read! Day 1 - D-Day (or should that be T-Day?!) When I arrived at Dr. Feller's premises, I was as you might expect, somewhat nervous about the day's events which lay ahead! I don't think I could have been put more at ease however, or made to feel as confident that I was in a safe pair of hands (or multiple pairs of hands!) by Dr. Feller's attitude. He was personable, engaging, attentive and without any trace of arrogance, exuded a quiet confidence that relaxed me so much! Whilst he chatted freely during the pre-op stage, when the surgery began, I liked the fact that his full concentration was dedicated to the work being carried out - except for the apologies for the injections, and regular updates as to what was going on - which were once again reassuring! His staff were also friendly and comforting throughout the day - I only regretted that I wasn't able to thank them at the end! We started with a very relaxed chat in his office, discussing goals, which were mutually agreed upon - to retain my current hairline, fill in the sides to an appropriate level, and graft follicles in the front third area. 2,000 grafts were deemed to be required for this task. After some lovely lines were drawn on my head in marker pen, I was taken through to the surgery room to have my hair shaved! I was given a very stylish cut by a very nice lady and was left with the front third of my hair shaved off completely and the thin strip at the back shaved down to the appropriate length for transplant! I felt like I had just joined a new order based on the Franciscan Monks! The worst part of the entire op now followed - the round of injections - first at the donor site to harvest the 'seeds', and then before planting, the second set of injections into the front third of my head. I would describe this as a medium discomfort really - on a par with injections for dentistry or jabs for going abroad. Dr. Feller was thorough in ensuring all areas of interest were fully numbed in both cases - which I can say were fully realised as that was the last of the pain! In between the injections around the donor area and jabs at the transplant site, there was the removing of the donor strip. This was something I didn't really want to think about too much, but comforting words and reassurance were given throughout and this helped a lot! The donor area was extracted in three parts. Each time a strip was removed, I believe that part was cauterise, clamped and then stapled together. The only feeling was the tightness from the clamping and the noise of the stapling - it wasn't particularly scary, but did let me know what was being done. Oh, the radio in the background was tuned to a radio station playing some classic 80s tunes, which was a nice comfort! Once the donor strip had been removed for dissection, Dr. Feller numbed the front of my head and then set about making the slits for the grafts plantation! My next revelation may have you thinking that I am a bit of an oddball, which is probably fair enough, but here we go! I found the slit-making the most rewarding part of the surgery! For the past 18 months, on many occasions, I had found myself examining my cranial deforestation and imagining roughly how many grafts would be required to fill the bald parts at the side and restrengthen the front, imagining how good it would be for it to be done, and here I was finally, sitting in the chair of Dr. Feller's surgery, having those slits made. I didn't feel any pain per se, but I was aware of the action of the slit making, and roughly where they incisions were being placed, starting at the front and working back. Each one gave me a bizarre kind of satisfaction - knowing a new graft were shortly to be installed! It was done in three or four stages. First was to fill in the front & sides, and then the planting of the crops began. Then Dr. Feller came back for round 2, which took us back to probably about 90% of the extent of the transplant, then the last 10% of slits were made, and finally I think some reinforcement was made possibly at the sides. I assume that this is done to ensure the most important areas are covered first, and then when the exact number of follicles remaining are known, the last parts are dealt with. Dr. Feller was delighted that he was able to go further back than anticipated - all the way to where there was any evidence of decline in the local hair population, so this was all good news to me! Before the last 50 or so grafts were given their new home, I had a very tasty chicken mayo sandwich, a coke and a quick pit-stop. I avoided looking into the mirror and thought I would save that surprise until I got back to the sanctity of my hotel room! The donor area at the back of my head had a pad applied to it, although I was told there would be minimal oozing from it, and it was bandaged in place. I was given a complimentary cap (how funny I thought it would have been had it said "Caution - Re-planting in progress", but perhaps not that subtle!), and then one of the ladies from the surgery instructed me in the post op. events, including the staple-removal procedure! I was given a note too just to refresh my memory later on (which I was glad of!), and then went through to Dr. Feller's office for a wee post-op pep talk! We had a chat about the procedure, he went through the post-op instructions again and provided supplies in the form of antibiotic pills to eliminate the chance of infection, as well as some strong pain killers to take care of the first few days. I took these diligently, ahead of any potential pain, and indeed no pain was experienced as a result! I had a look in the mirror when I got back, and my head looked very similar to the countless photos I had seen of transplant patients who have posted online, which was quite reassuring in a way. The transplanted area was a general reddish colour, and a few of the graft sites had some blood or ooze coming from them. The first afternoon, I ventured out only for a burger down the road, which I promptly retreated to the hotel to consume! I felt quite conscious of myself - with a baseball cap and bandage visible below, but it's amazing how people can be oblivious as they are too caught up with their own business! After surgery, I was are advised to sleep with head and back supported by pillows, raising my head at a 45° angle, which is a little awkward, but to be honest, I was pretty tired from the day's events so got a fair amount of sleep. I was told that the first 24 hours are when the grafts take root and are really the only time they have any chance of being dislodged, but for safety, 3 days are given to ensure they are 100% attached and not going to accidentally come out. I was acutely aware of this and ultra careful with the hat for the first few days! Needless to say, no grafts were dislodged nor from the conversation I had with Dr. Feller, has any of his previous patients. Still, better to err on the side of caution - I paid for them, so I want them to remain on/in me! Day 2 I went down to the buffet breakfast and sat in a corner, still with the bandage visible just below my cap. I was once again surprised that no-one was staring at me! On the way back up to my room, I requested a late check-out, and after explaining to the receptionist that I had had head surgery, he was only too obliging to allow me to keep the room til two or half two, (can't remember which!) as the maids leave at 3pm. After returning to the room, I watched a wee bit of TV and then just after midday, removed the bandage. There was very little seepage on the pad from the donor area since the op., so that was a reassurance! I had a nice bath, and then vacated the hotel, venturing across the road for another burger! The only moment of panic was when I was crossing the road and a gust of wind made me feel like my cap was about to fly off, revealing to the stationary traffic my somewhat unusual haircut to the world! Luckily it didn't, and I enjoyed another tasty burger! I checked in online for the flight from the hotel and printed my boarding passes, able to arrange seats in an empty aisle at the back - much to my delight. I bought a fantastic neck pillow from the airport for $40 - which although expensive, was definitely worth the money over the cheaper options as it made the flight (and consequent nights' sleep) much easier, bearing in mind the staples at the donor site are uncomfortable to sleep on). The journey back was pretty good really - I was apprehensive about clearing security without having to remove my hat, but I think I got out of JFK without having to do this, and it was only in London Gatwick when I was asked twice (once on entry, and then again when I was boarding the plane up north) to remove my hat. Having read advice from the forum here, I was prepped for this. In both cases I had a quiet word with the security guy and told him that I had just had head surgery, I lifted my hat a little, and he was happy to let me through without any further scrutiny. Day 3 I arrived home, and was once again able to remove my hat in the confines of my house, which was a nice relief! My forehead at this stage was fairly swollen (which had been covered pretty well by the cap). Also, the central area just above the donor area had been a little numb since the surgery, but reading up this is perfectly normal after a transplant as lots of small nerve endings will have been cut and will re-establish themselves in time in the coming months. I had a nice bath in the evening and ran water gently over my scalp, which was lovely! The redness in the transplant site was a little less pronounced, and some of the crusts came off. Day 4 The swelling had progressed down my forehead a bit, and indeed the bridge of my nose was a little swollen as the fluid drains downward! I had a shower, and let the full force of the water hit both donor and transplant site, which was nice as it was getting itchy! More crusts came off, and it looked better afterwards. The transplanted area looked as if I had dried skin, but I decided it was best not to apply any moisturising lotion. Day 5 Most of the swelling in my forehead had gone, and in fact went out for dinner and a few beverages afterwards. Felt a lot more at ease with my cap now as it didn't need to be quite so loose. Made a saline solution by boiling water in a pot for a while, adding it to a plant sprayer and I think I added 8g of salt for 1L of water (check online to see what concentration is required to create saline). Seemed to do the trick and kept the grafted area moist, making it a lot less itchy! Should have used this several days earlier! Day 6 A lot of the redness in the transplanted area had died away, and things were looking considerably better. There was the odd graft hair which came off with or without a wee scab, but I had read that this would happen so was prepared! Day 14 Staple removal day! By now, there is no redness on the top of my forehead, and the grafts are regularly shedding - all to be expected! I go to my friend's house, who is a nurse and she promptly removes all 54 staples! With the exception of a half dozen that nip a bit, and maybe another dozen that are noticeable, they are all removed with not too much discomfort. A nice Scotch before and after definitely compensates! A wee bit of oozing from the staple holes, but my friend comments that the incision is healing very well and has knitted together very neatly indeed! Now I can lean the back of my head against a couch or pillow with a lot more ease, although still more comfortable using the awesome neck pillow, which has by now paid for itself many times over! Day 20 Finally got around to posting! I am considering how short to cut my hair next week to balance it out! Still trying not to keep looking in the mirror at the head stubble - especially as 90% of the new stuff will be gone in the next few weeks! Donor area is continuing to feel less lumpy and more comfortable when I'm resting it on the back of a couch or pillow! Just above the donor strip still feels a little numb in places, but once again this is all normal from what I have read and can take a few months, up to 6 months plus to fully return to normal. Contemplating whether inventing time machine will speed the process along or indeed will just catapult me forward in time with my hair at the same stage!