Lost!

[EmuSteve]

Hi all. This is my first post on this forum! =)

 

I've been slowly losing my hair for the past 8 years (I am 26, almost 27 now). I started on propecia about a year ago, but for some weird reason I'm allergic to rogaine (red, itchy scalp). My hair loss has always been a huge source of insecurity for me, so a few years ago I started doing research into HT's.

 

I've followed this site and forum for a long time now, an I feel like I almost know some of the regular posters. =) I'm incredibly cautious regarding this decision, and have a tendency to research it to death, but if I may I'd like to tap into the experience that many of the members of this forum have.

 

I've spoken with Jotronic over email and after lots and lots (and LOTS) of research have narrowed my choices down to Dr. Ron Shapiro and Dr. Hasson of H&W. Here's my dilemma though:

 

Jotronic sent me an online consult says that H&W (I believe it was Dr. Wong that viewed my photos) suggests a megasession of approximately 4000 grafts. However, other clinics I've received consulting from have suggested anywhere from 1500 to 3000 grafts. Is it accurate to say that H&W have a higher graft-to-hair count ratio? And if so, what are the benefits/drawbacks to this?

 

Also, I'm not crazy about having to have my head shaved before the HT. Is this really neccesary?

 

On a more general note, does anyone have any advice for someone my age in moving forward with this type of decision? I'm petrified that I will regret the choices I make today 10-20 years down the road. Is there anything any of you wish you had done differently?

 

Many, many thanks and loads of appreciation to you all for the posts you've made in the past and the advice you offer, and lots to Pat for setting up this community. I feel like one of the lucky ones who found it before I actually moved forward. =)

[EmuSteve]

Here's a top view:

[Salt-N-Peppa]

FWIW, in my opinion you will find that 4000 FU is far more accurate than 1500 plus. I would be curious of where your projected hair loss is going to end up....Norwood 4...5...???

The Doctors you have mentioned will be able to work with you on your concerns regarding future hair loss and the placement of transplanted hairs for a natural look.

Finally, depending upon where you want transplanted hairs to go ( crown only or sprinkled over your head) your Doctor may desire to shave down your hair for a better chance of avoiding cutting existing hair roots. There are numerous others on this site that have far more experience than I, so don't give my opinion more weight than it deserves. Cheers.

[Bill - Seemiller]

Hello EmuSteve and welcome. Glad you've been reading for awhile and finally decided to post. Research is good and it sounds like you've narrowed it down to two very awesome and talented doctors. Both Dr. Hasson and Dr. Shapiro do outstanding work and no matter who you go to, you will be in good hands.

 

Looks like you are starting around the same time I did...I'm 29 now and had my first HT at 27. The fact that you are on Finasteride is a good thing. I also had red and itchy scalp from minoxodil so I stopped that a long time ago. How has the Propecia been working for you? Hopefully it has at least slowed down or haulted your hairloss.

 

 

The number of grafts will depend on a few things. The two main factors would be your goals and how much donor hair you have. My advice to you since you obviously have good amount of loss in the crown is, don't get too low of a hairline...go relatively conservative. I'd say 4000 grafts is accurate and will make a huge difference. There has been some controversy regarding whether or not Hasson and Wong do Sub Follicular Unit Grafting, and even moreso about what that even means. Click below to read Pat's review of Hasson and Wong which discussed this in great detail:

 

http://www.regrowhair.com/hair-transplant-surgery/donor...-in-vancouver-canada

 

That being said, I went to Dr. Hasson for my third surgery simply because of the amazing results I've seen by patients who went to him over the years. I can't say this for all doctors, even others on the coalition, even though I've seen impressive results from other doctors, the consistency of the "wow" factor continued to come from Dr. Hasson (IMO), so I went to him for my third surgery. So to me, I was more focused on the end result before/after pics from patients then I was about the technique used, whether there was some sub follicular unit grafting or not. Perhaps JoTronic can shed more light here as to the accuracy of this.

 

So regarding the benefits/drawback to FU verses Sub FU (if that's really an issue) I think it's debatable. True Sub Follicular Unit Grafting would cost more than the same number of hairs in true follicular unit grafting, because the graft count would be higher in Sub FU...that would be a drawback to that approach. But as I frequently say, the proof is in the pudding regarding results.

 

If there is anything else we can help you with, please don't hesitate to ask. Dr. Hasson and/or Dr. Shapiro are excellent physicians and you'd be in great hands.

 

Bill

[EmuSteve]

Hey Bill, I really appreciate your comments man! You are one of the people I've read up on in the last few months. I feel our cases are similar somewhat, and I can relate easily to your story. =)

 

And regarding your comment, I read Pat's article (that's actually what got me wondering about the higher graft/hair count ratio), and given my position in life right now... recent college grad, etc... I'd rather not spend more than I have to (although cost, as important as that is, is secondary to the absolute best doctor I can find for my case. Money comes and goes, my hairline will be there forever).

 

I've read the forums long enough to know that you guys know what you are talking about. =) I guess the real question is: Given your experience, if you were in my position, what would you choose?

 

I'm not going to hold anyones opinion over their heads or anything, but I mean that genuinely... I respect a lot of the people on this forum for the insight they have shared and the experience that they have gone through. I can't think of anyone's opinion I'd rather have! =)

 

Thanks for your responses by the way. I appreciate it!

[EmuSteve]

Oh, and another thing I'd also like to just mention, because I haven't seen a lot of discussion regarding this topic:

 

What do some of you experienced posters think of any of the future treatments that may become available? And should these play a part in the decision making process for some of us younger guys?

 

I've seen a lot of stuff that says that follicular multiplication (hair cloning) will be a reality within the next decade. Does anyone put any stock in this? I've been following the news with Aderans (although the latest news on their page at http://www.aderansresearch.com/ is from August 2005), and others such as Intercytex, which I hear are already preforming the first human phase study (http://www.clonemyhair.com/dcforum/DCForumID1/486.html).

 

As always, comments and feedback is greatly appreciated. =)

[Bill - Seemiller]

Hello EmuSteve,

 

I'm glad my posts have been able to help you over the course of your research and hope that my direct responses will be close to as helpful =).

 

To answer the question who would I choose if I were in your shoes: I guess you could say I was in your shoes and chose 3 different docs. Though I will never knock Dr. Katz or Dr. True, both docs, though they do Follicular Unit Transplantation, are more on the conservative side (Dr. Katz even moreso than Dr. True). Both are qualified docs, however, my research and time spent here as brought me to Dr. Hasson. Don't take what I say here as trying to persuade you ONLY to see Dr. Hasson, however, I chose Dr. Hasson because out of all the research I've done, I've been impressed with his work the most. That's what it comes down to, to me...the countless amazing results I've seen by him over the years. So even though I've been impressed by other docs work, I've been impressed with Dr. Hasson the most. Now that is a personal opinion of course...but that's where I ended up...and if I had to start all over again, I would have gone to Dr. Hasson from the beginning. That's relatively bold of me to say considering I don't see any growth yet (of course not, I'm only 2 months post op tomorrow), but I'm feeling pretty confident based on everything I've seen by real patients posting on these forums over the years. Again, you must make up your own decision as to who to see...I have no direct experience with Dr. Shapiro, but I know he also produces amazing work. Comparing the two is like comparing great to great. Really what it comes down to, is you have to chose who you are most comfortable with, and who you feel will give you the BEST result that YOU are looking for.

 

Regarding cloning, I wouldn't hold my breath. I surely wouldn't put any stock in cloning happening in the next 10 years, however, that's one man's opinion. I've read some postings on the subject and it sounds exciting...but as far as I understand it's not exactly "right around the corner".

 

I hope this helps.

 

Bill

[bayscholar]

Hey Emusteve,

 

You have narrowed it down to Shapiro & Hasson....your major concern seems to be the future and if this is the right choice for you (now and then)....are you my long lost hairloss brother, sounds like you re-typed my blog....seriously your almost the same age as me and have a similar type of hair loss (aggressive for your age...I also can't use Rogaine as it make my scalp red and itchy). If you decide to go ahead with strip Ht you are choosing between two of the best doc's the world has to offer period same two docs I had ranked 1a and 1b....As for 3k vs 4k you should remember it is a very rare case that a person at your age would only need one pass or surgery (I am saying this from experience) so go into it knowing you will need two HT at least. First HT will lay the foundation and the second one will fine tune it up (you may get lucky and only need fue to fine tune your first)....so with that said I feel either 3 or 4k are good estimates 1.5k is usually a standard estimate from a doc the does a max of 1.5k hence that's what he recommends for you (I ran into the same thing and wondered how does one doc think 1.5k will do it and another says start with 4k and #2 will hopefully get 2-3k=7k plan)... you will in the end need much much more then 1.5k for a full restoration. Look I was in your shoes almost 5 months 2 the day, I asked myself.............

 

SELF-do you want to be bald and miserable as you are today for the rest of your life.... or do you care to gamble/chance(that you could end up worse in the future, if meds don't work or only work for 10years lets say) and get a megasession and hope it brings a solution(in the form of hair and lots of it, ).....move forward 5months-it has and I will never look back because of it (older members may disagree with my next line)...looking good from 30-45 with that chance of looking like an ass monkey from 45-60 if meds fail me and HT idustry does not advance in 15-20years....with how my hair is today I could give two shits, I am already planning #2 and just wish I could have told my self those first 2months after my HT....be easy brother its gonna grow like crazy.

 

2 shave or not 2 shave what is best?....Well from what I had gathered from the internet + speaking with both doctors that must shave and those that don't....it depends on your level of loss and your age, some one who is 45 tends to have a much more defined pattern (NW level) then some one @ your age....it becomes even more important for you to give your doctor the best view he can possibly get...why jeopardize something so important for the ability to look normal faster (1week vs 2months)....you only get a few chances at this you want it done be as exact as possible.

 

Good luck hairloss brother, take your time and make sure you want to do this as you can't go back once you go strip (in my case to being bald as hell....no more )...its just the way it is.

[the B spot]

This is a great thread and it serves as a reminder of what this site stands for.

 

EMU, I concur with the others, that you are choosing between the 2 best clinics in the world at this point. Either clinic will exceed your expectations from a results standpoint.

 

At your age, with your pattern of loss, it is almost a given that the hair you have in the front/midscalp area will dissappear over the next 2-5 years. Your hair loss resembles my own, the only exception being my hairloss accelerated even earlier (NW5 by 25). You may be able to save some with meds, but it would probably be best to plan as if you will lose this hair, because you are so young.

 

Due to the fact that you have done virtual consults, you have to understand that these graft estimates are exactly that, estimates.

 

You may go to H&W/Shapiro and find that they can do 5500 grafts, OR, you may go there and find that your scalp is a bit tight, or your donor density is a bit low and you can only get 3200. Make your decision on a Doc based on your "feel" and your approach now and in the future.

 

That can happen at any clinic, regardless of them being the best in the world.

 

In your case I would proceed like this:

 

1. Shave the recipient area and only focus on the hairline/frontal zone/midscalp areas for your 1st HT. Given that you still have some hair in these zones a 3-4000 session will really create a major cosmetic difference in appearance. I would go with a conservative hairline for this HT.

 

2. Wait a 12-14 months and "see" how this looks and decide if you want to target the top of the crown, some of the crown, or you need to bolster the frontal zone/midscalp with additional grafts, because you may lose existing native hair and require additional grafts to get the density you want/need.

 

3. BE PATIENT!!! It usually takes 4000-5000 grafts with a mature hairline to redesign the hairline/frontal zone, with *some* coverage in the midscalp region. An additional 2500-3000 grafts will get you decent coverage in the crown. If you do the math that is 6500 to 8000 grafts. If you have 200 cm/2 of balding area AND 8000 available grafts you will be able to get a density of 40 fu's a sq cm.

 

IF your scalp laxity and donor characteristics enable you to achieve these numbers, the accepted practice is an average density of 55cm/2 in the frontal 100 cm and a density of 25 cm/2 on the remaining 100 cm/2 (crown) to give "thin" coverage, but still provide a really nice look.

 

Of course, this is where the skill of the Doc comes into play with graft distribution, angle and orientation in order to provide you with the ILLUSION of coverage in these this areas.

 

You individual physiological characteristics will determine exactly what is possible.

 

It is a very exciting time for those of us who can turn to Ron Shapiro, Jerry Wong or Victor Hasson and achieve a level of naturalness and density that is unrivaled by anything we have ever seen.

 

Regardless of which Doc you chose, you will be in great hands, period.

 

My only additional advice for you is to research density and get a better feel for 25 fu's cm/2 versus 55-60 fu's cm/2.

Also, understand the difference between 40 single fu's and 40 naturally occuring fu's (1's, 2's, 3's and 4's) Of course, you will have all singles in the hairline with some refined 2's in the transition zone.

 

I hope this helps!

 

Please let us know what you plan to do and why.

Also, it will be helpful for you to document your progress in a personal weblog for others to benefit from your experience.

 

Good Luck!!!!

[FacelessMan]

EmuSteve,

 

From what I have read, H&W and Shapiro are bot excellent...H&W's reputation is stellar, and they are one of the clinics that have made the "megasession" almost the norm. So, I would file away the 4000 quote they gave you as a viable option.

 

I myself had 4200g with Dr. Feller, who is superb, a "mentee" of the sadly recently departed and gifted Dr. Seager, and who is to megasessions what Guinness is to ale. He would have done 5000 with me with ease, had my scalp allowed that much donor strippage. He's also a sincere and compassionate physician, and will be straight with you about your goals.

 

From your photo, my completely amateur take is that with your level of loss and fine hair texture, 4000g or more sounds good...but it goes without saying, it your doctor's call...

 

Wishing you success! It seems that you've already targeted some great surgeons; I hope that you get all the feedback you need.

 

Benjamin

[FacelessMan]

Oh, and...

 

I hear you on the shaving thing; I felt a moment of squeamishness (if that's the word for it) about it, too, but for me, it was worth it -- if it made the placement easier, and reduced the risk of shockloss (of which I had none that I could identify), wearing a hat at times when I normally wouldn't was no big deal..

 

That said, I had the convenience of a) a job where no one cared about said hat and b) living in Virginia (near DC) where men seem to wear caps more often than I see them doing in, say, NYC, where I grew up. I was also wearing it during the summer, which is when men REALLY seem to wear them a lot here.

[Bill - Seemiller]

Great Thread!

 

B Spot...I almost didn't recognize you since you changed your avatar

 

Emu...some great comments from my friends above...hope it helps!

 

Bill

[the B spot]

Sorry Bill!!!!!

 

I guess it was time to change.

 

I thought I needed some cool guy avatar since I am going to have mucho hair in a few short weeks LOL!!!!!!

 

I thought the cigarette lent a dramatic effect........

 

[Bill - Seemiller]

LOL...yeah, maybe I should change mine. But I like my Matousi avatar...maybe I'll put a different one up. Besides, he's got rockin hair

 

Bill

[EmuSteve]

Wow. That is some great advice! =)

 

B-Spot, thanks for your post and advice (and everyone, for that matter). It really makes me feel more at ease knowing that intelligent people have gone before me and not regretted it. =)

 

I will certainly take your advice to heart, and I will most, most definitely let you guys know what I end up choosing, as well as keep a weblog to hopefully pass on what happens to me to those who come after.

 

If I may ask one more question... what exactly is financing like? I have a credit rating of somewhere around 680 - 700... is it true that I could finance this at 18 months with no interest?

 

I searched the forums on this alot, and found very few informative posts.

[EmuSteve]

Also, in case anyone was curious, this is the official recommendation from H&W (I believe Dr. Wong reviewed my photos). Jotronic was also great in answering all my questions (obviously, he went down the list one by one)! I am leaning towards H&W right now, and if I do, I look forward to meeting the guy! =)

 

 

 

Dear Stephen,

 

Thank you for the additional photo files. They were more easily opened than

the .rar. files. Dr. Wong has reviewed your case and feels that one large

megasession of at least 4000 (or more if we can) grafts will be necessary

for your case. Dr. Wong would like to rebuild your hairline in a mature but

strong fashion and add density across the top with the majority of what is

left. Dr. Wong may also wish to rebuild the sides of your hairline in the

temple point areas. The temple points are the triangular points on the sides

of your head that are behind your eyebrows. Adding grafts to these areas

will help to achieve a more balanced appearance with the final product.

 

To answer your direct questions:

 

1.) how do you go about

getting a prescription for this drug? I mentioned it to my dermotologist

(the one that gave me the prescription for Propecia), and he had never heard

of it. Is there a place online you can get it? (or Avodart?)

 

All he needs to do is look it up in his pharmacology book and he'll see

they're the same thing. It's not imperative though that you get it from him

but you do need to get it. If you wind up having surgery anytime in the next

few months then you can simply wait till you are with the doctor. As far as

online pharmacies go, I really don't know of any in particular and I'm

rather skittish about them anyway. You never really know what you are

getting. I do plan on researching this in depth at some point soon so I have

a place that I can recommend as I get this question a lot.

 

2.) How many grafts

should I expect to get a stellar result?

 

Well, while "stellar" is relative we would like to get about 4000 grafts if

we can. Your donor does not appear to be super thick but it appears to have

the amount of density and laxity required for such a session.

 

3.) How much does it typically cost per graft?....

 

That is answered below along with air fare and hotel points of interest.

 

4.) Would

you reccomend this precedure for someone my age? And if so, what precautions

should I take given my age?

 

Yes, I would, as long as expectations are not out of line. Don't expect a

teenage hairline. Don't expect density so high that you'll never see your

scalp. Understand that by having a session now you are potentially locking

yourself in for more down the road. We don't have a crystal ball but we do

know that you won't look like a circus act in the future because we loaded

up your hairline with 4000 grafts. They'll be distributed naturally and over

a larger area.

 

5.) Should I expect further hair loss if I continue

taking Propecia or Proscar?

 

Generally, no, but again there is no guarantee. I think at the very least

you can expect a dramatic slowing of your loss. Remember, it doesn't work

for the front of the scalp (we don't know why) but more for the mid section

on back into the crown. Also, your hair quality should improve all over your

scalp from it's use. I noticed this on myself.

[Bill - Seemiller]

Hey Steve,

 

Hasson and Wong is a great choice and JoTronic is a great guy. He is even more helpful and friendly in person and his hair looks just as amazing in person as it does in pictures.

 

Bill