Need help planning course of action

[Rick055]

Hello all,

 

First of all, I am new here and must say it's a vibrant forum.

 

I was wondering if I could get your opinions.

 

I am 36 years old and have thinned in the crown. Nothing is completely bald, but without Toppik, it is certainly noticeable.

 

I have a pretty strong forelock with some thinning on either side thereof.

 

I would like to get enough grafts in the crown so that my thinning is not noticeable.

 

I was told by a hair restoration surgeon in Buffalo that I had enough donor hair to do two people's heads. I know he's exaggerating, but I take that to mean I have a very dense donor area, though I did not get any "numbers".

 

I know it is generally counseled against, but do you think I could start with my crown? How many grafts would it take for good coverage there?

 

I want to plan for the future and anticipate the thin areas on either side of my forelock to be history in time. The forelock looks pretty strong.

 

I am on minoxidil foam, nizoral, and won't consider propecia. I may use spironolactone.

 

I would love to post pictures, how do I do it?

[Rick055]

Hello all,

 

First of all, I am new here and must say it's a vibrant forum.

 

I was wondering if I could get your opinions.

 

I am 36 years old and have thinned in the crown. Nothing is completely bald, but without Toppik, it is certainly noticeable.

 

I have a pretty strong forelock with some thinning on either side thereof.

 

I would like to get enough grafts in the crown so that my thinning is not noticeable.

 

I was told by a hair restoration surgeon in Buffalo that I had enough donor hair to do two people's heads. I know he's exaggerating, but I take that to mean I have a very dense donor area, though I did not get any "numbers".

 

I know it is generally counseled against, but do you think I could start with my crown? How many grafts would it take for good coverage there?

 

I want to plan for the future and anticipate the thin areas on either side of my forelock to be history in time. The forelock looks pretty strong.

 

I am on minoxidil foam, nizoral, and won't consider propecia. I may use spironolactone.

 

I would love to post pictures, how do I do it?

[the B spot]

Hi Rick---Welcome!!!!

 

Without pics it is difficult, so what you do is click on reply and click on "add attachment" which is located in the lower left hand corner of the reply box. Once you do this, hit browse to go to My Pictures (or wherever you have your pics located)attach it and then type in a description of what you are showing (crown shot).

 

This is the easiest way to do it, IMO.

 

Anyway, most people will tell you the crown is a black hole for grafts, so I would not put more than 2000-2500, especially if you think you may experience further loss.

 

we would need to see some pics before anything substantive is recommended.

 

BTW, who did you do a consult with?

 

Take Care,

J

[Bill - Seemiller]

Rick,

 

Welcome to the forums.

 

I agree with B Spot...without pictures, it's surely difficult to give you a number.

 

Being that you are 36 years old with minimal loss, you likely are a good candidate for an HT, especially with a great number of donor grafts (as per your evaluation). I too would like to know who you consulted with.

 

Have you classified yourself on the norwood scale? Where are you on that?

 

The crown is surely a "black hole" for grafts, however, depending on how much loss you have there, you could certainly have some good improvement in that area.

 

Whether or not you start with the front or the crown is up to you. My advice is, if you are dissatisfied with the way the front looks, to start there since people see you from that angle the most...however, I see no harm in tackling the crown based on doctor recommendation.

 

I hope you will post some pictures for us.

 

Hope this helps,

 

Bill

[Rick055]

The doctor I consulted with was Dr. Joseph Neiman.

 

Two people I know had work done by him and I couldn't tell.

 

I will post pictures later today.

[Rick055]

Should I take pictures indoor or outdoor? Flash on or off?

[Bill - Seemiller]

Rick,

 

Pictures outdoor no flash are ideal. Take pictures from any angle that shows your hairloss.

 

Bill

[hairbank]

Rick055-

 

I was in a similar situation to you before any HT's but you likely have more hair in front than I did. B spot and Bill have given you some good input.............you may want to take a look at my hair loss blog for reference to my story along with indoor/outdoor pics. I received a little more than 3000 of my HT#2 grafts in my crown. It's still a little thin but if I have 2" in length or so it's pretty much covered.

 

I hope you can post some pics for us to see.

 

Peace...

[Rick055]

OK, here are the pictures.

 

One is flash and looks worse than it does in "real life", one is natural and looks closer to real life.

 

But the flash one might better clarify my pattern.

 

Let me know.

[Rick055]

here's another (can you do more than one per?)

[Rick055]

And the front.

 

I can post more pics if you need them.

[Rick055]

Here's one outside, but I think the flash was still on. (I'm not a digital camera guy!!)

[Bill - Seemiller]

Rick,

 

Critical question: have you lost any hair recently or have you been pretty set with that pattern for awhile? My primary concern for you is whether or not you will have more loss.

 

The important thing here, especially if you are considering an HT, is to get your hairloss under control. This is why finasteride is recommended highly. Just curious...why won't you consider finasteride?

 

You are in relatively good shape concerning the amount of hair you have left, however, it is obvious that you have some thinning all over the top of your head, with the primary loss in the crown. Your pattern of loss does suggest that more loss MAY be in the future...however, at 36 years of age, perhaps you won't lose too much more. But hairloss is unpredictable. So really how you answer the first question in this post may be critical as to whether or not you should press forward with an HT.

 

As we've said above...the crown typically requires a LOT of grafts in order to achieve any sort of density in that area.

 

If you do NOT lose anymore hair, I'm certain that about 4000+ grafts would give you pretty decent results. Personally, if I were in your shoes, I'd target the crown and move forward since your hairline and front seem to be in pretty good shape. Then maybe touch up the hairline slightly with some of the grafts toward the left and right (leaving the middle alone).

 

I'd be curious what a doctor has to say about your situation. As I said, my main concern for you is whether or not you will lose more hair.

 

Hope this helps.

 

Bill

[Rick055]

Thanks for the reply, Bill.

 

My concern with finasteride has to do with testicular cancer. I don't know if you've ever heard of "The Pill Book", it is a $6.00 book sold in some drugstores (I got mine at CVS) with drug profiles/side effects/interactions, etc...

 

Years ago, (1999-ish), there was a warning for finasteride that said there was an increased risk of testicular cancer in bold letters. It has since been removed, but it scared the hell out of me, especially considering I had a congenital anamoly which predisposes me to that risk.

 

I was actually on it once (and even now have a prescription for the 5 mg) and had good results with it. I'm just scared to use it and so I have 6 proscar tabs cut into quarters sitting in a pill cutter in my med cabinet, patiently waiting

 

I was also worried about pregnancy risk (my wife's, not mine .

 

Any thoughts?

 

Also, what pattern do you think I am?

 

Maybe I should just do a highly androgenic steroid cycle, and see how the hair fairs...too much confusion.

[Rick055]

Bill,

 

Sorry, forgot about the first question.

 

The short answer is that my front region has been pretty stable - although I've had diffuse thinning on either side of my forelock over the past few years), but the crown has thinned more over the past few years.

 

As an aside, I began losing hair in my mid twenties, went on rogaine, which worked wonders (Dr. Lee's + retin-a, not generic) and then for some weird reasons, went off everything for about four years.

 

I have been on Rogaine foam for the past 6 months and I'm noticing some improvement.

 

Maybe I should just try the finasteride.

[Bill - Seemiller]

Rick,

 

I look forward to your answer to my critical question

 

Critical question: have you lost any hair recently or have you been pretty set with that pattern for awhile? My primary concern for you is whether or not you will have more loss.

 

 

Regarding testicular cancer...I have not heard about this regarding finasteride...it's surely not listed on Merck's site. I wonder why it was there and then removed...sounds fishy...but I venture to say that out of ALL the people using finasteride, that if it was a side effect or increased the risk that SOMEBODY would have reported it.

 

There have also been other posts regarding worriments of taking finasteride while trying to conceive or while she is pregnant. I think I originally posed that question as well. The general consensus, including from Hasson and Wong, there is no problem taking the medication while trying to conceive or while your wife is pregnant.

 

I've also attached a photos of the norwood scale so you can determine where you fall on it.

 

Bill

[Bill - Seemiller]

Rick,

 

I personally would not advice an HT for you until you get your hairloss more under control, especially since you continue to lose hair in that area. The thinning even in the mid/frontal region suggests future loss there as well.

 

I would talk to your doctor about your concerns about finasteride and see what he/she says. When in doubt, consult a doctor .

 

But your best course of action would be to try the meds to slow down or stop your loss first. Otherwise, surgery could cause the dying hairs to go into permanent shock.

 

Bill