A Few Questions

[CaptainO]

Hi, I'm a 29 year old male. I started noticing hair loss at 23. I began to take propecia and it stopped the hair loss and regrew all the hair. At 25 I started to see sexual side effects so I stopped taking the medicine at 27. I have been off propecia for 2 years solid now and have lost much of my hair in the front areas. My hair continues to fall out month by month.

 

My first question is should I wait to see how far the hair loss goes before doing the HT? Some tell me to do it before it gets too bad so its less noticable. But my fear is that when I do the surgery, the rest will fall out. I have a feeling I won't completely go bald because of the pattern of baldness thus far.

 

My second question is the doctor that I consulted with does the strip removal. He is a Newport Beach, CA doctor and has been doing hair restoration for over 20 years. I am curious about doing FUE. What does everyone think?

 

Thirdly, my first consulation was with the doctor in Nov of 08. Since then I have lost 30% more hair yet when I did my second consult, the doctor did not change the recommended amount of 1200 grafts. Should I bring up this fact of additional hair loss and possibly having more grafts done?

 

Man is this depressing. Thanks in advance.

[Al - Moderator]

It's hard to answer specifically to your case without pictures, but I'll do my best.

 

My first question is should I wait to see how far the hair loss goes before doing the HT?

 

It CAN be better to get it done while you still have some hair, so you can camouflage the work for the first few months while you're in the ugly stage and because sometimes it's hard to explain a big change in your hair appearance to some people if you were to wait until it's completely gone. However, depending on how much hair you still have and how fast it's falling out, you need to be aware that you may not get too much of a noticeable improvement over time as you continue to lose the native hair between the grafts. You'll then have to go for another session to keep up with the loss.

 

My second question is the doctor that I consulted with does the strip removal. He is a Newport Beach, CA doctor and has been doing hair restoration for over 20 years. I am curious about doing FUE. What does everyone think?

 

I prefer strip if you expect to continue losing hair and expect to require further work later. As far as the 20 years experience. I've found it should hold little to no weight when looking for a HT Dr. The reason is because there are some Drs in this industry who have been practicing for many years who have never updated their techniques and still offering outdated procedures and passing them off as state of the art. On the other hand, there are also a few Drs who have only been around a few years, but started out training with some of the best Drs and are doing high quality work. You just can't tell by the number of years in practice alone.

 

 

Thirdly, my first consulation was with the doctor in Nov of 08. Since then I have lost 30% more hair yet when I did my second consult, the doctor did not change the recommended amount of 1200 grafts. Should I bring up this fact of additional hair loss and possibly having more grafts done?

 

I'd ask him how many grafts he feels you would need in the thinning area if that entire area was completely bald since ultimately that's what you will possibly need eventually anyway. You'll get a better idea of what kind of costs you'll have to incur over the years that way.

[CaptainO]

I am currently a class 2, progressing towards a 2A. I don't see much hair loss in the sections past 2A so I'm hopeful it will not go further than that. I'm trying to attach a picture of what it looks like now. This is just coming back from a work out and my hair is 90% wet. It doesn't look this bad normally during the day when its dry.

[CaptainO]

side view

[CaptainO]

These two photos are about 1 foot away from a lamp with no cover on it, so very high light intensity.

[CaptainO]

heres one more but with less light. Still wet.

[CaptainO]

When I got my first consult back in Nov, the corner areas that have faded back were much much thicker. It was a mere slight thinning. Now it is very noticable people have told me I look much older. Man do I feel robbed of my youth.

[the B spot]

I would say 1200-1400 grafts is about right---you have some diffuse thinning, so you do not want to over transplant the area and lose the existing hair, you also do not want to set yourself up with a too dense hairline, only to lose further and look odd later on in life.

 

Your a candidate for FUE, I would recommend you do FUE first, but know right up front that you will need to do additional sessions as you continue to lose.

 

You have retained excellent temple points and have general thinning throughout the frontal region--you need to regain your look, using a MINIMUM # of grafts, but you need to keep some options open as you are not a responder to Propecia. That means you must be careful.

 

This is the one main reason that I believe you should look only at FUE initially---should you bald further you can opt to exhaust FUE or switch to strip.

 

Take Care,

Jason

[Bill - Seemiller]

Your a candidate for FUE, I would recommend you do FUE first, but know right up front that you will need to do additional sessions as you continue to lose.

 

I'm not inclined to agree with the above statement. Firstly, how do we know Captain O is a candidate for FUE? Usually it takes an experienced surgeon to evaluate whether or not he's a candidate for a hair transplant at all let alone has the scalp characteristics for FUE.

 

In my opinion, recommending FUE for patients who are certain to continue thinning seems potentially dangerous for a number of reasons.

 

Besides the cost being higher at most clinics for FUE, there's typically less total viable donor hair with FUE than with FUT strip. Also, not everyone is a candidate for the procedure and depending on the patient's scalp characteristics, it may take several procedures to extract and transplant the number of follicular units required to meet your immediate goals. Growth yield can be as optimal as with strip, but most leading clinics will tell you that strip surgery is much more consistent.

 

In my opinion, FUE is great for patients with minimal and stablized hair loss and/or for patients who are deathly afraid of a linear scar. But to go from FUE to strip defeats the whole purpose of doing FUE in the first place. Plus, to maximize the number of viable hairs using both procedures, it's typically better to do strip first followed by FUE later.

 

I'm not against FUE, but it's important to be aware of the possible pitfalls of the procedure as well as the benefits.

 

Strip surgery is not without potential pitfalls either. There are risks of scar stretching, it's considered more invasive (though this is debatable), healing time typically takes longer, etc.

 

In all hair transplant procedures, there are some risks of infection amongst other things, but these are typically minimal.

 

Best wishes,

 

Bill

[CaptainO]

here are two pictures right after coming out of the shower and the hair blow dried. Its 5% wet. 95% dry.

[CaptainO]

pic 2

[the B spot]

Hi Bill, I don't mind that you disagree, but I will list my thoughts on why I feel FUE is the proper method here.

 

He is a candidate because he has rather minimal loss.

 

He is a candidate because he will likely thin further and may not have the inclination, finances or time to do more sessions--thus retaining the ability to maintain a short buzz cut.

 

He is a candidate because he explained he suffered from sexual side effects of Propecia.

 

Additionally, even the most experienced surgeon will not have an idea of whether a patient is of the small % of patients whose skin type or splayed/curved grafts render a patient not a candidate for FUE--until he actually starts extracting grafts.

 

IF Capt.O must do a HT, then his best bet imho, is FUE--regardless if he did strip he would still be doing several smallish sessions. Because he cannot use meds, it would be a moderate risk to do a strip because we would have no idea how far his hairloss would progress.

 

Being that he is almost 30, and still retains excellent temple points, a decent hairline, high sides and is diffuse in the frontal 3rd, the likelihood of his reaching a NW6/7 is reduced somewhat--so doing a strip would effectively reduce his options for the future.

 

The argument that doing FUE first followed by strip reduces the efficacy of FUE is one I have made before and in certain instances, a solid approach. However, in certain patients, most notably those requiring 2000 grafts of less, there is no need to eliminate the option of stopping the HT cycle and walking away---

 

Finally, my comment that Capt.O is a FUE candidate is based on the factors listed above--and was not meant to be taken as definitive medical advice...obviously Capt.O needs to undergo a full consult before making a decision.

 

I hope this better clarifies my comments

 

Take Care,

Jason

[Bill - Seemiller]

Jason,

 

Thanks for your reply. I don't mind a healthy technical debate at all. In fact, dissenting opinions adds to the educational nature of our discussion forum. Adult readers of our discussion forum can then draw their own conclusions given all the information.

 

I disagree with some of your statements and I'll explain why.

 

You claim he's a good candidate for FUE because he has minimal loss. I'd agree with this except given that he's young and not taking Propecia, there's a good chance he's going to lose more hair. Thus, subsequent procedures would be needed whether he goes the FUE or strip route.

 

You say he's a good candidate because he will likely thin further and may not have the inclination, finances, or time to do more sessions. My argument would be patients who can't commit to the strong possibility of necessary subsequent procedures shouldn't undergo surgery at all. Why waste the money if he's only later going to shave his head? Why not shave his head now and get it over with?

 

You say he's a candidate because he's not taking Propecia due to sexual side effects. How does a young patient with minimal hair loss not taking medication to help stabilize his hair loss make him a candidate for hair translant surgery at all let alone FUE?

 

If we are looking at the patient's short term goals, I agree that FUE could probably help him. Of course, so can strip most likely for a reduced fee depending on the clinic he chooses.

 

But in the long term, knowing hair loss is unpredictable, he can't take Propecia, he's still young, and may not want to undergo subsequent sessions when they become necessary, I'd argue that the patient should not undergo a procedure at all, or at least awhile until he decides if he wants to commit to subsequent procedures as necessary.

 

Personally, though I respect your opinion, I think your advice is a bit too cavalier. In my opinion, the patient should decide first if he can commit mentally and financially to subsequent procedures as it becomes neccessary and recognize depending on the risk of future hair loss, realistic expectations must be developed as to what can and can't be accomplished with a finite donor hair supply.

 

All the Best,

 

Bill

[the B spot]

I agree that CaptO must fully commit to the idea of future loss, if you note, even in my 1st comment I mentioned future sessions, additionally I mentioned using a minimum # of grafts, and that he would have to be careful.

 

After your comments I further qualified my statements by stating "if he must" in bold print in my follow-up response adding the need to do a qualified physician consult.

 

I can certainly see your side of the debate, but I'm not sure how my comments could be construed as cavalier. The specific information he seeks will need to be determined as he moves forward.

 

I will re-read the thread and as always seek to get better at communicating my intentions. For now, I agree he should certainly take his time and explore all of his options, one of which is to not do a HT at all. Hopefully he can look at the information given from different perspectives and make a better, more informed choice.

 

Take Care,

Jason

[M1A1]

B Spot,

 

Just curious, do you have any pictures of your procedure?

 

Best,

[the B spot]

No--I do not--I will update my procedure at 12 months as I am hopeful it will have been my last.I may opt to do some minor touch-up in the temple region, but it will be negligible and just me taking advantage of Dr. Ron =)

 

Cheers,

Jason

[Bill - Seemiller]

Jason,

 

Understand that I'm not criticizing your opinion - only offering my perspective on the subject. It is my opinon that your advice may be a bit to cavalier - but it doesn't mean I'm saying you're dead wrong.

 

I just like to err on the side of caution and would prefer to see this prospective patient either make a solid commitment to a long term hair restoration plan or consider waiting or not getting a procedure at all. There are just too many question marks to advise this patient into a single procedure without further commitment to a need for subsequent ones to come, especially without finasteride.

 

And the bold "if he must" did not go unnoticed. I think with that, you're probably agreeing with what I'm saying but are suggesting what he should do if he insists on a single procedure. Of course, I'm not trying to put words in your mouth either. :-)

 

All the Best,

 

Bill

[CaptainO]

Now that I've read some other posts, does anyone think that I would have a lot of shockloss? The Dr. mentioned that if I went above 1200 grafts I might see it. but that was during our first consult, since then i've lost more hair.

[CuriousJungleGeorge]

Have you considered continuing medical therapy, if at lower dosage?

[CaptainO]

Not really, only because the side effects went so far that I didn't have any feeling in my sex drive left. I mean none. I think that was very tough to deal with. I've been off the meds for 2 years now and I'm only 60-70% of what I once was, and can only last about 10 minutes. I'm only 29, I hope I don't offend anyone, but that is something I didn't think I would be dealing with for at least another 20 years.

[CaptainO]

Oh and I read somewhere that it only effects 2% of the users, I truly feel this is a lie, because I knew several guys who took propecia, and all of them experienced ED at one point or another.