Comments, Advice?

[Gish]

Hey guys, I have been researching/fighting hairloss for a number of years now. I believe my hairloss has all but halted and, although it is something I had read much about in the past, have only in the last year really considered getting a hair transplant.

 

 

 

Back Ground: I am a 22 year old male who first noticed hair loss near the middle of my senior year of high school. My hairline was already fairly "mature", as my friends often liked to point out, but when I noticed a bit of further recession I was off to the doctor hoping for answers. She informed me I was not going bald and that I had many years to go before I should start to worry. Although, at that point, I didn't know a whole lot about hair loss I had a strong, almost intuitive, sense that I was in fact going bald.

 

 

 

Fast forward a year or so to my first semester in college. Not sure exactly what happened, and I often speculate a fungal infection of some kind, but my hair started falling out quite rapidly while my scalp became unbearably itchy. I returned to my GP to whom I, once again, expressed cries for help at my thinning scalp. This time she agreed that, from what she could see, I had "classic MPB".

 

 

 

I had done quite a bit of research on the internet, pubmed, and hair loss forums and felt that I knew a bit about hair loss. I was 19 years of age and wanted to obtain from her a prescription for 5mg tablets of finasteride. She rejected my request, citing 'nasty' side effects as her rational, and instead told me too try a 5% minoxidil solution for 6 months to see how it would work. She referred me to a specialist in the area, Dr Jerry Shapiro, whom I was too see in 6 months.

 

 

 

I was disappointed as I had absolutely no interest in minoxidil. It in no way interferes with the balding process and my follicles continued to miniaturize during those 6 months. Time passed by eventually though (as it always does), and sure enough the doctor prescribed me proscar.

 

 

 

I am nearly 22 now, and have been on finasteride for 2 years. In that time my hair loss slowed dramatically, nearly to a complete halt. About half a year, maybe a bit more, ago I added a 5% topical spironolactone lotion applied along the hair line, as well as ~ 30 mg of RU58841 (in a 2/3rd IPA 1/3 PG solution) applied to the frontal portion of my scalp 5 times per week.

 

 

 

I feel that with my current regimen further hair loss will be either very slow, or so slow that it wont be of any cosmetic concern. I am currently about a norwood 2.5 with some thinning in the front fourth of my scalp.

 

 

 

The core of my regimen, and I believe the core of any serious person willing to take up arms in this fight, will/should always be that awesome little selective 5-Alpha Reductase type 2 azasteroid we all know as finasteride. The others I consider supplements due to their restrictive nature of application. RU is no slouch at all, arguably more effective then finasteride, and spiro is another good topical anti androgen.

 

 

 

I also use tricomin (if not simply for the fact I have 2 bottles of it), and nizoral 2% three time per week.

 

 

 

So...to recap

 

-1.25 mg of finasteride daily

 

-5% spironolactone along hairline 5 days per week

 

-30 mg of RU58841 applied to frontal third of scalp 5 times per week, and some weeks less

 

-tricomin once per day, applied to frontal third

 

-nizoral 2% 3 days/week

 

 

 

This sounds like a lot of products, but in reality is not that much of a hassle. The high alcohol content of the RU solution dries in a way much more favorable then the high PG solutions of minoxidil. The spiro is convenient for hair line application and the tricomin in water based.

 

 

Current Considerations: I have spent some time looking at peoples experience with hair transplants, reading about different doctors and different techniques. Not as much as I have about the science behind AGA process/treatments, but still a fair amount. My goals are modest. Fill in the temples a bit. Something very conservative.

 

 

 

Obviously I have some concerns though...

 

 

 

1) Age. I know that the age of 22 is considered young to have a hair transplant. And, if just by mean age, it would definitely be to the left of the bell. But, I am aware of the risks and the high possibility that further treatments may necessary.

 

 

 

2) Limited donor supply. With a limited donor supply the placement of graphs, in this case how much of the temples to fill in, will have to be planned in a way that gives consideration to possible further loss, if it happens.

 

 

 

3) Doctor. Perhaps the most important part! It is hard to judge, but I have gone mostly on reports of patient experience, a hand full of private forum conversations with former patients, and posted pictures and video of work by different doctors. My current considerations are H&W, Dr Rahal, and Dr. A Feller.

 

 

 

As far as strip goes, I would usually shy away from this type of procedure due to the invasive nature of the donor site but I have judged that for such a small amount of graphs, with the right doctor, it can be acceptable.

 

 

 

I wouldn't settle for any thing less then trichophytic closure and use of the lateral slit technique for planting the graphs.

 

 

 

I was wondering if anyone thinks it would be possible to have graphs taken from a different area then the standard donor are above the nape.

 

 

 

For mega sessions the strip is usually removed along the safe zone starting somewhere near the back of the ear, traveling down the back of the head in a smiley face shape, and ending at the opposite ear. I wont need that many graphs and was wondering about the possibility of having the graphs removed from a small section near the back of the ear. i have never seen this done before.

 

 

 

I will attach some images of my current hair. One of them will be while my hair is wet.

 

 

 

Any comments, advice, suggestions, etc. will be greatly appreciated. These are 'no turning back' type of decision and the advice of those more knowledgeable about the topic then I will be of great value.

 

 

 

Thanks for reading.

Edited October 3, 2011 by Gish

[biscuit]

21 years old is very young to be considering HT surgery. If you're destined for NW6/7 then you will need to plan very carefully to create a look that you're happy with for the rest of your life.

 

Keep on your med routine and see what happens over the next 5-10 years. Hopefully the meds will prevent more loss.

[zenmunk]

I started noticing my hair loss around 26 years old; not as young as you, but young enough. So, I know the feeling. It sucks, but even more-so when you're young. You seem pretty well-informed regarding MPB and HT. That's a big advantage. You'll probably avoid many, if not all, of the pitfalls.

 

Your degree of hair loss looks similar to mine, perhaps a little less, but in the same ball park. My advice is if you can hold off on a HT for a few years, you should probably do that, and just continue your current regimen. You are still quite young, and your hair loss is fairly minimal. As you know, HT is something you cannot turn back from, and it can be quite expensive. You'll always have the option to do it later on. In my case, the propecia really helped for a long time and continues to do so. I'm only now considering my first HT, 13 years after starting the meds, and I'm almost 39.

 

Everyone's different, however, and if you feel like you must get a HT in the near future, then I'd suggest you avoid strip. I don't think your degree of hair loss warrants it. FUE is statistically less successful regarding yield, and you may have to go in for a second pass, but I think in your case (and mine btw) it's probably the better route to take at this time. Just make sure you go to a stellar FUE doc, and since you're considering Feller and Rahal, I think you'll be just fine.

 

I suggest you make sure the doc uses the most intelligent FUE extraction pattern possible. You want to minimize the appearance of white dot scarring and overall donor thinning. Spreading out the extractions as much as possible and using the smallest punches will go a long way toward achieving that objective. Be willing to shave down completely for the procedure (not just over the occipital area); do what you must to help the doc give you the best possible outcome.

 

You ask about taking grafts from outside of the standard donor area, aka the universal safe zone. Personally, I'm going to give my doc permission (and sign something if necessary) to do just that if it will increase the chances of a spread out extraction pattern. I'm not concerned with some of the hairs being non-DHT resistant, because if the meds fail me in the future, I'm not going to chase my hair loss with surgery after surgery for the rest of my life, but rather shave down, so some of the transplanted hairs falling out with the rest of my native hair would be a blessing in that case. But that's me. You must ask yourself what you are prepared to do long-term. That will dictate whether or not venturing outside of the safe zone is right for you. You'll work all of that out with your doc if/when the time comes, but I think a doc will probably try to accommodate you if you fully understand the risks and are willing to sign off on it.

 

Best of luck with your decisions moving forward.

[Gish]

Thanks guys.

 

I do plan on booking a consultation with H&W. I am very close to their office and I would like to get an idea of the number of graphs I would be looking at.

 

Considering what I have in mind I think the number may be quite low, just enough to lighten the angle of the temple recession.

[zenmunk]

It's wise to get H&W's input, but I don't think they do FUE, so keep that in mind moving forward.