So confused! Two consultations (Dr. True and Cohen), two different recommendations!

[Vinny1980]

Update 3 Doctors now please see last post.

 

I just first and foremost want to say that this site is awesome and I've learned so much from your posts on here so thanks for that. I'm 29 and use propecia and have been balding for the past 10 years. I'm finally ready to get a transplant although money is a bit tight but I'm ready. I then went to Dr. Cohen for a consultation and he drew the lines and recommended 1200 grafts, didn't really want to touch my sides of my head too much above my sideburns. He couldn't really show me any pictures of younger patients that he has done with my Norwood class 3V or anyone who had the front portion of the sides of their heads done either. Overall, I thought great he's honest and conservative. I'll have this surgery and then it will look natural and I won't have to have another one in a long time.

 

Then I went to Dr. True for a consultation and it was a great experience, he had some pictures of people similar to me who have a Norwood class 3V with some balding on the sides above my sideburns. He recommended 1800 grafts and it looked great, he even said they would but some grafts into my sides of my head above my sideburns and take care of that. He also said when you have this surgery I might have to get more work done in 2-5 years.

 

So now I'm confused, I really liked the line and the number of grafts that Dr. True recommended. But I'm worried that it's too aggressive and I'll have to come back in 2 yrs and get more work done due to its aggressiveness. But the lines were perfect, I would love to have hair where those lines were!

Dr. Cohen recommendation was less grafts and the hairline was much higher and not much grafting into the sides. It was conservative, but that's not such a bad thing. I would prefer not having to have the surgery again so soon or something that looks wierd in a year or two. But it also leads me to think is it conservative also because a lot of the people he does work on are older?

 

So I don't know what to do. Any thoughts??? 1200 or 1800 grafts?

Edited May 29, 2010 by Vinny1980
Updated and saw 3 docs now instead of just 2

[Blake Bloxham]

Vinny1980,

 

Welcome to the hair loss forums! Thank you for updating your social profile. You may also want to also consider fully utilizing this community by adding an album or creating a hair loss weblog.

 

I wanted to complement you on doing thorough research and consulting with multiple physicians before committing to a transplant procedure. These efforts will really help maximize your results, and I urge you to keep reviewing physicians, searching these forums, and analyzing cases presented by physicians recommended by the hair transplant network.

 

As you may know, Dr. Robert True is a member of the coalition of independent hair restoration physicians (click to read the coalition membership standards) and has a long record of providing excellent hair transplant results. You can review his membership page for more examples of his work. I think the fact that Dr. True was able to show you various, successful Norwood Class 3V restorations says quite a bit, and I would take this into consideration.

 

Additionally, Dr. Ivan Cohen is also recommended by the hair transplant network and has met the community's rigorous standards for recommendation.

 

I think both doctors perform ethical, refined hair transplantation, and you have made a good decision consulting with both clinics. As far as the graft estimate difference - this isn't too uncommon (on a reasonable level), and most likely has more to do with how each doctor designed your hypothetical restored hairline.

 

I think the best thing you can do is continue with your research on these forums. Use the search function to research both doctors, talk with members who have undergone transplant surgery with Dr True and Dr Cohen, review cases they have presented on the community, and take your time making an informed decision. Additionally, I would add some photographs so members can comment on the difference in graft issues, and maybe give you an idea of what is more appropriate (while keeping donor laxity and the need for subsequent procedures in mind).

 

I hope this helps! Please feel free to ask further questions, and keep us updated on your hair restoration journey. I applaud your research thus far!

 

Good luck.

Edited May 24, 2010 by Future_HT_Doc

[Vinny1980]

Thanks so much for the feedback. I have posted an album of my hair loss and I'll continue to do research. Any comments/recommendations/thoughts are much appreciated.

[Blake Bloxham]

Vinny1980,

 

Thank you for updating your profile with those photographs! It really helps analyze your situation.

 

After seeing the pictures, I can definitely see the issues regarding the temporal triangle (the area above the sideburns you were discussing). In many cases, restoring these areas (and surrounding areas) can really help "frame" the face, and enhance the overall result. However, many times, restoring these regions is a lesser priority when compared to density in the frontal hairline, or implanting grafts into a larger area (or multiple regions of the scalp). I think Dr. True's comments regarding additional work in 2-5 years may have referred to focusing on the frontal scalp and vertex during the first procedure, and improving the temple region during a second surgery (though that's just an assumption).

 

Having said that, I have a few additional questions:

 

1. Are you planning on restoring the vertex (crown)?

 

2. What are your goals and expectations? Would you simply like to restore density to the hairline? Fill in the frontal region and restore the vertex? Would you also like to enhance the facial framing with some temple work?

 

3. Is coming back for a second procedure in 2-5 years something that you would like to avoid, or are you okay with this idea?

 

Again, keep researching! You're doing a great job, and this work will pay off in the end. Please feel free to ask any additional questions, or send me a private message with any inquiries or concerns!

[the B spot]

This is a tough one...Before I say anything, I want to say that either approach is fine....but your going to want a second HT almost immediately with 1200 grafts...the additional 600 grafts will define your temples a bit and just look better overall.

 

Now, my points of concern...your thinning in the crown. You need 1500-2000 grafts in the frontal zone/hairline/temple regions. If we take the information we do know and couple it with the information we do not know (how progressive your loss will be) it is best to explore options....I think Dr. True is 100% correct that you will need additional work in 2-5 years, so while I think a strip session is a viable option, I believe you should consider doing an FUE session first---build your hairline/temples, then wait to see how meds work on holding off the loss progression. A scar from a 1200-1800 graft session will likely not be very noticeable, so no real worries, but I like to remove the chance when people need 2500 grafts or less.

 

Obviously, this is my opinion, and I believe you need 1500-2000 grafts, but your crown worries me, which is why I think doing an FUE session first would be in your best interests...it gives you options for the future work you will need.

 

Take Care,

Jason

[Vinny1980]

Thanks for the opinions guys, I'm really learning a lot here:

 

Future_HT_Doc

1. Currently both docs said that they'd like to stay away from the crown portion. it's held up well with the propecia and I also just started using Rogaine on it recently.

 

2. Personally I like the facial framing idea you mentioned, the vertex for me hasn't really been something i've been focused on or a concern currently.

 

3. Ideally coming back for a second procedure in 5 years isn't a problem but the thought of going through this process again in 2 years isn't very appealing as I just would like to worry less about the way my hair is going to look in 2-5 years due to natural balding with age. I'm going to be 30 and just would hope that in 2 years or so that I won't regret getting the surgery or it's outcome.

 

 

And Jason thanks for your thoughts as well. I looked into FUE, but to be honest currently I'm still looking for employment so the FUE prices I've looked at appear to be just way too expensive. FUT really seems like the only procedure I have a chance of affording when the time is right.

 

I've scheduled two more consults with doctors recommended here on this website. So I'll post their feedback as well. But thanks again, your thoughts are much appreciated and gave me some more things to think about.

 

As currently I really want to understand what the outcomes of these options will be for me 1 year from now, 2 years, and 5 and 10 years from now on the way my hair will look and also the financial cost layouts expected in order to maintain this.

 

It's very kind of you guys to take the time out and offer your advice. Thanks again.

[Vinny1980]

Another interesting update, I went to see another HT doctor earlier this week and got a completely different opinion! I went to go see Dr. Bernstein as he comes highly recommended from this forum and from a few of my friends. I went to see him and it was an extremely quick consultation for 175 bucks, but he's well respected and I really wanted his opinion. He took a quick look at my head and said that my temporal baldness especially on the sides was a concern, but that I should NOT get a hair transplant. Two reasons:

1) He said that due to my balding on the sides it's hard to predict how much hair loss I will have in future years and that I could lose a considerable amount of hair.

2) He said that the side balding also is a concern due to the fact that the donor strip will get smaller with time.

 

He recommended that I up my Finasteride to about 1.5ish or 1/3 of a 5mg pill and to start using Rogaine solution not the foam everywhere not just on the vertex. I respect the fact that he told me not yet as it was honest, but WOW I wasn't expecting that. Now I have so much more to think about, not about who to do the procedure but also whether to have it done at all!

 

Now guys, all the doctors I've seen have been some of the best and come highly recommended. But seriously how confusing is that?

Doc 1=1800 grafts front and sides very progressive

Doc 2=1200 grafts front, more conservative no real sides

Doc 3= DON'T DO IT

 

Man, I realize that a major portion of this procedure is art and style not just straight forward mechanics, but these extremely divergent opinions on something that is so important emotionally and financially to me at this point in time is difficult to process.

[TC17]

Will you please post some pics of your hair so that we can get an idea of your situation? I am VERY curious to see your current level of loss and maybe an elaboration on Dr. Bernstein's reasoning for why you're not a candidate. I'm not quite sure where Dr. Bernstein's own hair loss is, but I do know that he has said publicly that the reason why he has not had a transplant is because he is not a good candidate for the surgery. I often wonder at what age that fact would have presented itself. After all, if you're not a good candidate at age 45, you wouldn't have been one at age 25.

 

Thanks in advance Vinny, and kudos to you for meeting with multiple doctors and doing your research. I suppose as bad as balding is, looking like a freak down the road would be even worse.

[TC17]

Whoops, I just saw that you in fact have an album posted, sorry!

 

I guess I can see where Dr. Bernstein says your temples are weak, but we see younger patients with MUCH more aggressive loss getting work done on this forum all the time. Now, that doesn't mean doing so is wise and that Dr. Bernstein is wrong in telling you that you're not a candidate, just an observation that it is done.

 

Personally, your hair loss is not at all bad. I have no idea what your family history is, how well the propecia has worked for you, and any other pertinent information about your hair loss, but I must say that I'm a bit surprised that Dr. Bernstein said no to you. I guess aggressive temple loss is worse than aggressive loss on the top of your head?