Mid-twenties - HT on the horizon - getting cold feet - HELP?!

[scalp bloom]

I've been scouring these forums in earnest over the past few weeks and cannot begin to convey how enriched I feel with the abundance of honesty and support from you wonderful folks.

 

So, as my appointment for my first HT is rapidly approaching (with a well regarded coalition surgeon), and I am feeling the onset of some natural anxieties, I've decided to take the plunge and post and see if anyone has any advice for me.

 

Basics: 25 yrs old - been thinning since high school, but it accelerated around 21 yrs. Finally got on propecia 2 years ago, and it has dramatically slowed the process, but not before I suffered some serious diffuse thinning all over the top of my dome. Everyone on my dad's side (uncles, grandfathers, etc) has eventually ended up somewhere between NW 6 & 7 (6.5?), and so I'm pretty certain I'm headed down that path (see photos).

 

I've been using Toppik for the past 2 years and I must admit, it is a wonderful product cosmetically, but I just can't do it anymore. I've become paranoid, and I can't deal with the time it takes me to make sure I've gotten everything *just* right. It's gotten to the point where I refuse to go to the beach in the summer with my friends because it will be so obvious in the sun and/or wash out in the ocean. That's not the kind of life I want to lead right now.

 

I made the decision to get an HT after seeing many doctors, and finally finding one who I believed was skillful, artful and honest enough to help me. Though he told me I am not the most *optimal* candidate, he does think that he can help me. I don't have optimal donor density (around 1.5-1.8) but my hairs are thick and black and I have good laxity. My doctor is shooting for a conservative 1800-2000 grafts (about a third to a fourth of my total potential), focused mainly on the frontal forelock region. The timing is perfect as well.

 

My trepidations are multi-fold. I know it will help me aesthetically in the short-term, especially with such a great doctor. And I know that I'll have to get *at least* one more surgery. But will it ever be enough? And will my first 1800 grafts even make a difference enough to warrant the scar? If we rule out money here, I am just weighing raw risk & benefit potential. Am I setting myself up for a lifetime of worry and regret for a couple of good years with a bit more hair? I just want my youthful look and confidence back so bad that I might be obscuring the long-term logic. I do know HTs are not perfect and that I will never have a full head of hair...

 

If I do go ahead with the HT, my goal is to stop using Toppik so I can start using Minoxidil, and keep using the Propecia. Is that enough to keep me clear of the NW 6.5 that has plagued my anscestry? Should I just wait it out until cloning or follice multiplication becomes mainstream?

 

I know these are a lot of questions, but I'm just ranting here. I don't want to shave my head. I know it's absurd to say, but it's just not a reflection of who I am. Any advice you guys can provide me would be of the utmost help to a guy that just can't figure out what's right and what's wrong any more. I've been dealing with this for too long and at too young an age. I just want to make a decision and move on, and if that means forgoing the HT and finding a way to face my fears, then maybe that's best. But i've convinced myself that having hair is better than not. So...

 

Help...?

[scalp bloom]

I've been scouring these forums in earnest over the past few weeks and cannot begin to convey how enriched I feel with the abundance of honesty and support from you wonderful folks.

 

So, as my appointment for my first HT is rapidly approaching (with a well regarded coalition surgeon), and I am feeling the onset of some natural anxieties, I've decided to take the plunge and post and see if anyone has any advice for me.

 

Basics: 25 yrs old - been thinning since high school, but it accelerated around 21 yrs. Finally got on propecia 2 years ago, and it has dramatically slowed the process, but not before I suffered some serious diffuse thinning all over the top of my dome. Everyone on my dad's side (uncles, grandfathers, etc) has eventually ended up somewhere between NW 6 & 7 (6.5?), and so I'm pretty certain I'm headed down that path (see photos).

 

I've been using Toppik for the past 2 years and I must admit, it is a wonderful product cosmetically, but I just can't do it anymore. I've become paranoid, and I can't deal with the time it takes me to make sure I've gotten everything *just* right. It's gotten to the point where I refuse to go to the beach in the summer with my friends because it will be so obvious in the sun and/or wash out in the ocean. That's not the kind of life I want to lead right now.

 

I made the decision to get an HT after seeing many doctors, and finally finding one who I believed was skillful, artful and honest enough to help me. Though he told me I am not the most *optimal* candidate, he does think that he can help me. I don't have optimal donor density (around 1.5-1.8) but my hairs are thick and black and I have good laxity. My doctor is shooting for a conservative 1800-2000 grafts (about a third to a fourth of my total potential), focused mainly on the frontal forelock region. The timing is perfect as well.

 

My trepidations are multi-fold. I know it will help me aesthetically in the short-term, especially with such a great doctor. And I know that I'll have to get *at least* one more surgery. But will it ever be enough? And will my first 1800 grafts even make a difference enough to warrant the scar? If we rule out money here, I am just weighing raw risk & benefit potential. Am I setting myself up for a lifetime of worry and regret for a couple of good years with a bit more hair? I just want my youthful look and confidence back so bad that I might be obscuring the long-term logic. I do know HTs are not perfect and that I will never have a full head of hair...

 

If I do go ahead with the HT, my goal is to stop using Toppik so I can start using Minoxidil, and keep using the Propecia. Is that enough to keep me clear of the NW 6.5 that has plagued my anscestry? Should I just wait it out until cloning or follice multiplication becomes mainstream?

 

I know these are a lot of questions, but I'm just ranting here. I don't want to shave my head. I know it's absurd to say, but it's just not a reflection of who I am. Any advice you guys can provide me would be of the utmost help to a guy that just can't figure out what's right and what's wrong any more. I've been dealing with this for too long and at too young an age. I just want to make a decision and move on, and if that means forgoing the HT and finding a way to face my fears, then maybe that's best. But i've convinced myself that having hair is better than not. So...

 

Help...?

[scalp bloom]

More Photos.

[scalp bloom]

One more.

[notgoing2gobald]

Scalpbloom,

man I feel for ya.

It sucks having hair loss and ESPECIALLY at such a young age.

I would normally be EXTREMELY passionate about my opinion and belt out:

GO FOR IT, NOW!!!!

But, my only hesitation is that within your post you stated many members in your family have reached NW6.5-7.

 

QUESTION:

***do you know what age (approximately) they reached this advanced stage?

 

I can completely identify with your fear of future excessive loss and revealing a scar/unnatural appearance.

Ultimately, it is a risk that no one can answer conclusively for you.

 

All I can say is what I would do if I were in your shoes...

I would go forward with the ht...

(i) you have meds which your family members (probably) didn't have at their disposal.

AT BEST--this will buy you more time before/if you reach a full blown NW7.

I've heard docs say that fin works for 10 years, then the MPB slowly begins to take it's course again.

So, say you were to naturally reach a NW7 at age 55, the meds could hold it off until past 65 because you would only begin to lose additional hair at 55.

 

(ii) 20-30+ years of BETTER hair would be worth the future risk for me personally.

sounds like you've done a lot of research so you are probably familiar with the following cases:

Jotronic, Bobman,...These guys were full fledged NW6+ and look at the cosmetic difference they now have!

they have had a nice head of hair on their head for years, without additional loss. Even IF they/you lose more hair later; for me the benefit of those years without a shiny head would be worth the risk of future loss at an elderly age.

 

(iii)...I don't mean this in a derogetory way,

BUT, your situation can only (even if temporary at best) improve. you have already lost a significant amount of hair; and as a result, your situation will only improve; notwithstanding the possible future risks...

 

I know you stated that you have below average density, but Im wondering if you went to a different/more agressive or competent doc, that they might be able to extract more grafts in your first session?

care to share who you had consults with?

[Guest josh - b]

Hi scalp bloom,

 

With your diffuse balding pattern i can see how toppik would make a dramatic cosmetic difference to u.

However, your hair loss seems to be very aggressive and it looks like you'll be a norwood 6 soon.

1800 fu will of course make a difference but you need a hell of a lot more.

I'm not sure who your doc is but if cost isn't a major issue for you then why not consult h+w who specialise in large procedures where appropiate.

[flyby]

Hi Scalp,

 

It sounds like you're very certain that going with an all over buzz is not an option for you. I'm totally with you on that but I do sometimes wish I had tried it atleast once to have known how it actually looked on me prior to getting an HT.

 

You're definitely lucky to have some great options with the great doctors and new techniques. I'm not sure what your financial situation is or how many doctors you've consulted with to know your maximum amount of grafts which could be extracted based on your scalp laxity, but I do think that 1800 is too low. In my opinion for your first HT I think you should focus on the front half and plan for a conservative hairline. I would think that if possible you would want to do a minimum of 3000 for you first time around. With a second procedure you could then tackle the crown area and determine how much donor you have left to add additional density if possible. Based on looking at your pictures I do think that with the right Dr. and plan you will achieve some pretty nice results.

 

Best of luck to you and keep us posted. Take care!

[scalp bloom]

Thanks so much for great insight so far, folks! This truly is a fantastic forum. I wish I had stumbled upon it sooner! Keep the responses coming, please!

 

Just to touch on a few points posed by the great responses above:

 

I've seen 5 docs so far, spanning a pretty wide range from the most conservative of them all ("go home. shave your head. i won't touch you.") to Bosley ("you're a great candidate! is *NOW* good for you?"). The reason I've chosen this specific doctor is because of his reputation as an artist as far as aesthetics go, using the least possible donor hair for the greatest possible aesthetic impact, and his proficiency in ensuring the smallest possible donor scar using advanced plastic surgery techniques. He has been really open and honest with me, telling me I'm not the greatest candidate, but that I am still eligible and that he can help me if I've fully considered the risks. The results he's acheived on other young people is really encouraging. Thing is, I don't think I'd be going ahead with this HT if it weren't with this doctor. Am i putting too much faith in the human aspect of this procedure??

 

Also, as far as the conservative number of grafts proposed. Since I have limited donor supply and am still young, I think my doctor is pretty adamant about doing a lot with a little. But then again maybe it's an indication that my donor supply is just too low to go forward with a big HT the fist time around. See this great thread for more on this: http://hair-restoration-info.com/eve/forums/a/tpc/f/746...861/m/8481079903/p/2

 

Besides the purely human risk, I think I am also placing some additional bets. It seems that there is general consensus that within the next 5 yrs there will be a newer, greater treatment. Some people say it is the best time to be going bald because of all the wonderful treatments *on the horizon*. Whether it be something topical (neosil?) or a pill or even follicle multiplication for unlimited donor supply- I think I am basing my decision on the fact that current follicular unit HTs have reached their pinnacle of sophistication, and the next big thing is around the 5 year corner. Is this a risky bet to place?

 

Also, am I crazy to think that adding minoxidil post-HT to my propecia regimen will help me keep my native hair and even make it a bit thicker and healthier?

 

I've shaved my head 2 years ago, and looking back at photos I just hated it. With a big nose, big ears, and a bit of an awkward body shape, the only thing that keeps it all together is the dark tuft on the top of my head. But then, shaving my head is a small price to pay for years of regret and ugly HT remnants down the line. I'm just a bit scared.

 

Any more thoughts from folks who have been through something similar?? I'm desperate for any additional advice ASAP!

[hairthere]

I'm not sure 1800 grafts is going to do much for you. your nw pattern is clearly defined and pretty far advanced. if your few existing native hairs are lost to shockloss then they were likely destined to go soon anyway. if i were in your shoes and going for an ht i'd try and pull as many grafts as possible (4k+). the first docs i would consult would be h&W just because they seem to have a great track record for super high megasessions. that's not to say they can definitely get 4k grafts from you though. i'd also plan for 2 sessions concentrating on the front then the back in session 2. i just don't see the point in doing a half-assed ht with your level of balding....

[richie48]

Hi scalp bloom

 

There is a guy called azza786,he had hair surgery with Dr Rahal , here is a link to his blog

http://www.hairtransplantnetwork.com/blog/home-page.asp?WebID=327

 

he was in a similar situation as yourself ,it may help you if you check it out .

 

I was worried also before my hair surgery however i justified it to myself on the basis I was confident in my research and choice of surgeon ,everything went fine and ,althought i'm only at 3.5 months I'm exactly were I should be in terms of progress ,so all is good .

 

I'm curious who the surgeon is who you have chosen , are you willing to disclose his name as it may help posters with experience of him to put your mind at rest ?

 

Good luck bud

richie

 

2100 crown grafts

Dr Feller

nov 2007

[nobuzz4me]

I agree with Hairthere.

 

Even though your pattern looks like your headinng nw6, your sides look prety good. Nw7 those sides drop and your sort of in a bad place then. A good doctor may be able o tell if you are having recession or minirazation of hairs there as well.

 

Also, very important! Go with a conservative hairline! You will have limied donor and you will want to fill the midscalp with some density and the crown if possible, that will look more natural than a low hairline and a big bald spot behind it. You have limied donor, use it wisely!

 

Good luck,

[hairthere]

I've been scouring these forums in earnest over the past few weeks and cannot begin to convey how enriched I feel with the abundance of honesty and support from you wonderful folks.

 

So, as my appointment for my first HT is rapidly approaching (with a well regarded coalition surgeon), and I am feeling the onset of some natural anxieties, I've decided to take the plunge and post and see if anyone has any advice for me.

 

weeks is not a lot of research time when it comes to hts either. don't jump into anything...

[scalp bloom]

I totally agree with you, hairthere. I only meant that I stumbled onto this forum a few weeks ago. But my research and thoughts about this have been going on for about 3 years when I consulted my first HT doctor. I have to admit though, I've learned a lot from this forum over the past few weeks. Sometimes I think that no matter how much I think about it, how much research I do, it's always going to feel like a jump. There are no guarantees, ever. At some point you just have to say, this is it.

 

Thanks again for the steady flow of comments, everyone. This is amazingly helpful. But I'm still undecided...Ha.

 

It sounds like the consensus is that people are unconvinced with the 1800 graft conservative approach. I will probably ask my doctor to shoot for a bit more, maybe 2200. But I'm not trying to totally re-create my hairline here, just trying to achieve some density in the forelock - mid scalp region to gain a few years on my appearance. I know I will still have a gap in my crown, and am thinking that I will still need to use toppik in that posterior region and/or go for extra HTs to help out there.

 

Any thoughts on the post-HT minoxidil question or the 5-year new treatment question?

 

THANK YOU EVERYONE.

[azza786]

azza

 

hi scalp boom...thanks for the pm...anyhow ye if i were you i would go ahead with the procedure i mean even though you are young, i would say you can probably pull of a impressive result given that you are 25 and that your donar characterisitcs look good.

 

i dont know if i missed this poin on your post but who is the doctor you are getting the work done by?

[hairthere]

scalpbloom,

is the conservative approach due to limited donor supply or limited funds? as you have recognized you not only need to reconstruct the hairline (which at 1800 grafts would be conservative)but fill in behind it. it looks like you'd need about 3k grafts to really accomplish that.

[Bill - Seemiller]

scalp bloom,

 

Welcome to our community forum. You've been given a lot of great input by many of our well respected forum members.

 

There are certainly many approaches to hair transplantation and certainly there are preferences.

 

If you have the right hair characteristics, 1800 grafts may be able to give you a nice start, at least at your current hair loss condition. Though it certainly depends on your hair restoration goals, I believe 1800 grafts will most likely leave you wanting more. See my first hair transplant surgery of 1600 grafts to see what I mean. Of course, my hair loss was more extensive and I don't have ideal hair characteristics. But if your donor density and laxity is not that great, the physician can only work within the boundaries of your donor characteristics.

 

Remember also that hair transplantation does nothing to stop the progression of genetic hair loss, so using a Propecia / Rogaine combination is certainly worth considering.

 

I hope this helps,

 

Bill

[beachair]

Go with your gut. If you don't feel confident and secure in proceeding, just wait until you do. The doctors will still be there, when you're ready.

"If you have to think twice whether something is right or wrong, it's probably wrong."

bb

[notgoing2gobald]

think I am also placing some additional bets. It seems that there is general consensus that within the next 5 yrs there will be a newer, greater treatment. Some people say it is the best time to be going bald because of all the wonderful treatments *on the horizon*

 

No offense, but honestly I don't understand why so many guys *especially* young guys, ALWAYS say this.

People have been saying this for YEARS. Millions, upon millions of dollars have been spent, top scientists have researched for years and

STILL no cure.

At BEST, we have a pill that SLOWS the entire process down.

At BEST, it will buy you 10+ years of hair withstanding DHT.

THEN---you will go bald.

EVEN STILL: many people cannot stay on the medication which AT BEST slows MPB down because of sexual side effects.

Even if a 'cure' comes along (which personally I don't think there will ever be a 'cure')

OR

if something better comes along, who knows what host of possible side effects that medication will present?

Meds always have *possible* side effects and you might be within that unlucky group.

 

As far as placing too much hope on minoxidil:

yeah, I would say you are.

It is the least effective of both types of approved DHT blockers;

only in a RARE few does it make a significant difference, usually when combined with fin.

 

HT:

I don't know who you have been consulting with,

but I do think it is somewhat alarming that

one/or some of the docs refused to operate on you.

 

Having said that, I would go to H&W for two reasons:

(i) they are known for getting the highest # of grafts per surgery.

-given your current loss, 1800 is not going to get you too far.

-why postpone the inevitable and do in 2/3 surgeries what you can do in a single?

(ii) they are VERY reputable.

-you mentioned a different doc refused to do a procedure on you, but you didn't state who precisely that doc was.

-I believe that H&W have a very reputable/reasonable opinion

AND if they think your not a good candidate they will tell you.

[thanatopsis_awry]

I would go for a larger session, no doubt about it; not that getting a HT is an obscenely arduous process, but it isn't a cakewalk when you take into account both the physical and emotional drain from start to finish.

 

With your extent of loss, and a pattern established, I think you (and the doc) can make an educated decision where you know what you are getting into, and the potential down the road that you could...possibly....and assuming no newer advancements....end up with an...."irregular" pattern of loss.

 

It becames a situation of risk-assesment where you take into account how you look and feel now, how you will look and feel if you don't get an HT, how you will look and feel with post-HT#1 w/ a megasession, a "commitment" to future sessions, and that you might/maybe/possibly end up with hairloss that exceeds your donor, in a sense....personally, I don't put that much stock into that argument...not to say that that potential outcome is desireable, or that you should start densepacking bold hairlines.

 

I'm curious which doctor refused you, and which doctor you currently are considering for the 1800.

[scalp bloom]

Thanks again all! This has been seriously enlightening.

 

notgoing2gobald, I totally identify with your skepticism. You're right, the road to a cure for baldness has been a single lane country road with a 25 mph speed limit and no destination in sight (with lots of obnoxious billboards!). But in terms of medical sophistication, just think of how much HTs have evolved just over the past 5-10 yrs. However, with the amount of money being poured into this industry, it's maddening to consider that we've had, at best, incremental and gradual advances to the actual non-surgical treatments. Everything that seems to be the *next big thing* inevitably suffers a tragic death somewhere along the way (remember curis and their hedgehog agonist?). I'm not even above calling out a blatant conspiracy against us created by the folks who are currently making tons of money off our insecurities. Sometimes, you just want to say- that's it! I'm not buying into this bullsh*t anymore! SO WHAT IF WE'RE BALDING?? But I know as well as anyone, suffering from MPB at such a young age, that it's really tough to face it. And so you can't begrudge me for holding out a tiny bit of hope that a better option will arise. I do agree though that placing a bet on this sort of big leap is naive.

 

People have been asking about the doctors I've been referring to. I'm really hesitant to call them out being that I haven't actually had this procedure yet and I'm still struggling with my decision. I can tell you that both the doctor that denied me and the doctor who I'm scheduled with are coalition surgeons who have fantastic reputations in this forum. Both are on the conservative side, but both do mega-sessions on optimal candidates. However, both, using their wisdom and expertise, do not think this is the way for me to go. And the ultra-conservative one didn't think an HT was the way for me to go. And you're right that is a bit alarming. And I know H+W are fantastic and their results are terrific. But being 25 I've got to side with the conservatives, and make the best of the current situation while making room for additional excessive hair loss in the future.

 

And so, I guess it's just up to me to figure this out. I thank you all for your expert advice, and if you have any more comments please feel free to post. I will let you know what happens in the next few days.

[thanatopsis_awry]

*edited*

 

Either way, whoever it is, they are coalition docs who I am sure have sound reasons; and I'm sure would stand by their decision publically.

 

Anyways, my only concern with: "But being 25 I've got to side with the conservatives, and make the best of the current situation while making room for additional excessive hair loss in the future"

 

Is that if you get 1800 grafts, while you might have "additional excessive hair loss in the future" (and take that for what it is truly worth), there is a good chance you will still feel that you *currently* have excessive hair loss and will just want/demand/need another procedure.

 

If you do have a good grasp of what the procedure and recovery will be like, and understand what 1800-2k grafts will mean to you then by all means err on the side of a "conservative" clinic.

[Bill - Seemiller]

I'll take a stab and say that the doc that denied you is w/ the rope in the library, and that the other doc is w/ the candlestick in the bathroom.

 

Than,

 

I know you are just adding humor to this thread, but this is how rumors get started.

 

Let's not speculate as to which physician made which decision.

 

Bill

[the B spot]

Scalp--- I think it is great your taking a gradual approach to your hairloss.

 

That may have swayed your doc into a conservative graft count, which there is nothing really wrong with, but.....

 

From your pics, 1800-2000 grafts will give a decent look, but your first thought after everything grows in will be, "Why didn't I do a little more, or go a little farther back?"

 

Your hair looks to be of decent caliber, and even if you have low density, the coverage should be excellent.

 

I would suggest you keep looking around--- I don't believe there is a real difference between doing 2000 or 3000-3500 grafts which is what I would recommend you do as a minimum for a person with your loss AND a virgin scalp.

 

There is really no reason not to--- your just going to be upset in 1-3 years after doing 2000 grafts that you didn't need more.

 

If you do a nice conservative hairline, you will be able to go back plenty far as your balding pattern is narrow.

 

Once you start hair transplants, you ARE going to need more--especially with your loss.

 

I suggest buzzing down to a #1 clip for a year or so, begin Propecia and minox, do more research, and re-evaluate.

 

Take Care,

Jason

[JoDirt]

Scalp,

the decision of being aggressive or conservative is up to you to decide.

take what members wrote here and present them to your doctor(s)to see what his opinion is.

HT is a lifetime committment, ppl on this forum can vouch that i have asked soo many questions,(mostly dumb questions, but im being forgiven) I think i moved up from being a newbie to a veteran member.

With that said, just take your time, I know you are eager to add hair to where its low, but dont jump the gun, i almost did and probably would have shot myself in the foot instead.

[TheEmperor]

Anyways, my only concern with: "But being 25 I've got to side with the conservatives, and make the best of the current situation while making room for additional excessive hair loss in the future"

 

 

Pardon my directness, but going with 1800 is not more conservative, it will just make your restoration take twice as long. You will need 3 procedures at a minimum at that rate, and 1800 will not make a significant cosmetic difference, so you will go through the whole inconvenience of the surgery (pain, cost, months wearing hat, time off work, etc) for a whole year and have very little to show for it.

 

If you can get 4000, they can give acceptable density to the front 2/3 and you can see how things go in the crown.

 

If you havent been able to get a mega session dr to agree to operate on you, that is another story.

Please reconsider goin with 1800.