Late riser...please help!!

[sequel]

Hello everyone,

 

I am a 30+ guy and have been suffering hair loss for a very long time, thought I have lost majority of my hair in the last 9-10 years. In-fact, I had tell tale signs of hair loss as early as 16-17 years of age, but chose to do nothing about it then, a decision I greatly repent now having lost practically all my hair. As to why I started losing hair that early, I don't really know. My paternal side does suffer from hair loss and baldness, but no one in the family ever lost hair as early as me.

 

As of now, I would say I am somewhere between NW 6 and 7. I have never taken any medication for my hair loss, apart from trying applying a couple of bottles of Minidoxil couple of years back, which I abruptly stopped. I believe I am past the stage where medications and hair oil can help me, and hence HT is the way to go.

 

Considering my current hair condition, what would be the best way to proceed for me?

 

Please advice this fellow who really misses his hair:(

[Cant decide]

I personally do not think you are a candidate for surgery. However, it is hard to tell with your head shaved. I know you dont want to hear this but you do have a nicely shaped head and good skin color so a shaved head look for you would work quite well.

 

If you do really want your hair back, you may want to look into FUE to frame your face but still keep your hair tight and possible look into some SMP on top of that.

[gillenator]

It appears that you may some retro-alopecia going on which is hairloss from the nape area moving north into the donor zone (occipital zone). This means that it looks like you have DHT receptive follicles in your donor zone. The implication then is that you can potentially lose the transplanted hair if your were to have a HT procedure, meaning not a candidate for surgery.

 

If you must have a look "with some hair", I agree that a combination of SMP with very conservative framing goals might work for you. You are definitely in the Norwood class 7 stage but again I would not recommend surgical hair restoration for you.

 

You do have the right shape head for a buzzed/shaved look.

[sequel]

cant decide and gillenator, thankyou for taking the time to reply.

 

I am beginning to believe that HT might not be for me. I have written to couple of HT surgeons, and one of them has reverted with the same reply. Waiting for the others to reply, but the general opinion seems to be negative.

 

I have tried shaved head, but it looks really odd as I have a roundish face. I hail from India, and a bald looks seldom suits our personality

 

I didnt know abt SMP, thanks for the info. But I dont really know how its going to turn out. I fear it might look like a last ditch effort to get a look wid "very little hair" and might end up looking worse than my current self (though chances of that happening are slim..hehe). My goal is obviously to get my hair line when I was 10 years younger, (lol..), but I know thats not gonna happen.

 

It appears that you may some retro-alopecia going on which is hairloss from the nape area moving north into the donor zone (occipital zone). This means that it looks like you have DHT receptive follicles in your donor zone. The implication then is that you can potentially lose the transplanted hair if your were to have a HT procedure, meaning not a candidate for surgery.

 

Is there any way to slow down, stop or reverse the DHT effect. I certainly suffer from some abnormal hair loss, and I guess your diagnosis is correct. I saw my pictures from 2 years and 1 year back and I cant believe how much thinning and hair loss I have suffered in the last 2 years alone, guess DHT being the culprit.

 

I am not really enthusiastic about undergoing the FUE for framing and SMP, as I know the results would be far from I what I would like them to be, though I thank you both for the suggestions, and will certainly explore the option with the HT surgeons. Is there any other alternative to getting back some descent hair back on my head. Are there any non surgical alternatives worthwile looking at.

 

Also, what kind of medical treatment should I adopt to at-least do some kind of damage control, although I might be too late for that.

[chrisdav]

I agree with what has been said above by Gillenator and Cant Decide.

 

SMP is a possibility.

 

Would you consider wearing hair piece or wouldn't that appeal?

[gillenator]

Sequel,

 

You're very welcome my friend. Did you mean one of the doctors who responded to you also mentioned the "retro-alopecia"?

 

IMHO, the most important thing for you at this point in time would be to have the hair in your donor region microscopically analyzed for any changes to "hair shaft diameter" which is also commonly referred to as hair caliber.

 

Samples of your hair shafts can be analyzed over defined time intervals to see if in fact you are losing hair caliber. If decreases in hair caliber continue, then I would highly discourage you from pursuing hair transplant surgery.

 

Transplanting hair that is losing caliber is not a good thing to do for the obvious reasons. Chances are you would be very disappointed once the transplants started to diminish with time.

 

You could always try finasteride under a doctor's careful supervision, all along the way with comparing changes with hair shaft diameter to your donor. I do not believe Merck, the makers of Propecia, have done any clinical studies to the donor region in their trials. I am referring to changes to hair shaft diameter in the donor regions before and after taking low dose finasteride (Propecia). My understanding is that Merck is testing the mid scalp and post anterior regions (crown) for efficiency of their product Propecia. I stand to be corrected in case they are testing changes in terminal hair.

 

Other than that, there are no other FDA approved non-surgical treatments that I am aware of to improve or treat DHT receptive hair in the donor regions of the scalp. Minoxidil in my opinion does improve hair caliber but it is only temporary because minoxidil does not inhibit DHT like finasteride does. It does not address the main culprit behind MPB which again is DHT attaching to the hair follicles.

 

Some clinics may suggest laser treatments but IMHO, the jury is still out on laser therapy for genetic hairloss. In addition, it appears that the miniturization is more advanced in your donor region with the visual evidence of retro-alopecia going on.

 

The best suggestion? Get physically examined by a reputable doc in this community.

 

I wish you the very best my friend.

[sequel]

Would you consider wearing hair piece or wouldn't that appeal?

 

chrisdav, this does sound like the quickest and easiest way to resolve my hair issues. Quite literally the opposite of "Hair today..gone tomorrow".."Gone yesterday..hair today"..lol..but this is not my first preference. And mainly for two reasons..primarily coz of the social perview..of turning up wid hair all of a sudden amongst everyone who know me. I would certainly look much better, but it will be a socially awkward situation. I guess you would understand what I mean.

 

Secondly, of finding a hair piece i like. and also, as these have a certain life, I dnt want to end up running out of the hair piece after I exhaust its life, and not being able to get the same exact one again as I would need a continuous supply for the rest of my life. One can imagine what me turning up wid a new hairstyle every six months is gonna look like....

This said, I wld still not rule out the hair piece option, provided these concerns can be addressed.

 

If anybody here has some good reference of hair piece suppliers, please advise. Also, as I mentioned in my earlier post, I am from India, and I guess getting a good quality hair piece here is quite an uphill task. And considering the regular contact I would need with the supplier, I would prefer if he/she was easily approachable.

 

You're very welcome my friend. Did you mean one of the doctors who responded to you also mentioned the "retro-alopecia"?

 

gillenator, once again thank you for your detailed post. No, the one doctor who has reverted back yet did not mention "retro-alopecia", but just said, and i quote..

 

From the pictures it is appearing that your donor area is very limited and recipient area is very wide. Hence very limited area, that too in the frontal region can be developed, may not give you satisfactory result.Otherwise you are not appearing as a good candidate for hair transplantation.

 

I will have to explore the "Hair shaft diameter" analysis as recommended by you. It certainly would be devastating if I did undergo HT, and then started losing the transplanted hair. I am glad I started this topic here, as I am really learning a lot here. you guys are really well informed and knowledgeable..

 

About laser therapy, even I havnt read many positives abt it, and it does seem like a fancy gimmick to lighten you wallet. But again, I really wish that I am wrong as it would be for my own benefit.

 

I read about a shampoo called "NIZORAL", supposed to be a DHT inhibitor. Have you heard about this??

 

gillenator, I am impressed with the amount of knowledge you have about Finasteride, Minoxidil etc. I will ask the doctors about the recommended medical treatment. I will definitely discuss the same with the doctors on the first opportunity and will post my experiences here.

 

I have written to Dr. Radha and Dr. Pathomvanich and awaiting there replies as well. I have read only positives about these two doctors on the forum, and was hoping I could end up being one of their "Before-After" promotion pictures..hahaha!!..jokes apart, I believe these were the best recommended doctors here I can reach out to with comparative ease. I plan on calling up their clinics tomorrow as a polite reminder to my email and solicit their advise.

 

Please keep the suggestions coming, its helping a lot.

 

Thank for your best wishes buddy.

[sequel]

Anyone has any recommendations about where to get good hair system in India??

[gillenator]

Sequel,

 

You are very welcome my friend. Too bad you were not closer to me as I could potentially compare you hair shaft diameter for you over time of course.

 

Nizoral is a topical herbal product not a medication so it is not under the scrutiny or regulation of the FDA. If you look the product up online, you will see its claim to remove DHT from the sebum layer of the scalp. But since it is not a medication, there are no clinical trials to support that claim that I am aware of.

 

Still, there are some that would rather use a product like Nizoral verses taking a hairloss medication like Propecia. I also believe and stand to be corrected that Nizoral states there are no side-effects from using the topical application. I never saw or experienced any benefit from using it.

 

Nioxin is more of a scalp cleanser and invigorator. Some state they experience shedding from using it. Nioxin has no ingredients or hormone inhibitors to combat the effects of DHT. Nioxin is not classified as a mediciation and like Nizoral is not regulated by the FDA.

 

Only Propecia and Rogaine are under the FDA scrutiny. Avodart is regulated as well however Avodart was not a drug manufactured for the purpose of treating MPB. It is a prostrate drug just like Proscar however you may have read that some guys seek using Avodart if or when they do not respond to Propecia (finasteride).

[gillenator]

Off hand, I do not know of the top sources for hair systems in India. If your goal is to have complete coverage, then you make an excellent candidate for hair systems.

 

But stick with top end quality systems. Stay away from the big chains because they tend to be real aggressive in their sales tactics and they are at the top end of the price ranges that I have observed.

 

I wore hair systems for 11 years and always had a reserve or back-up system available. If you do choose to go with a hair system, you will always need more than one.

[sequel]

Hello friends,

 

Sorry for the hiatus. I was awaiting reply from Dr. Radha and Dr. Pat. I had to send another mail to Dr. Pat as the earlier one bounced back. And now I have replies from both.

 

According to Dr. Radha (she replies personally) she said I am a candidate for hair transplant, but she expects only about 2000 grafts from my donor area in view of the extensive hair loss. these would then be used to create a new hair line and used backwards till we run out of gratfs.

 

As per Dr. Pat's clinic, (reply from assistant), I would need about 3500 grafts, which would be used in a similar manner as Dr. Radha.

 

I am just gonna write to the two Doctors mentioning retro-alopecia and the availability of the donor grafts in view of the same. I guess I would have to exhaust all my donor supply in the first surgery itself as I have a very limited supply anyway. Also, will ask their opinion on the "hair shaft diameter" issue and the possibility of the transplanted hair shedding or loosing density because of the same.

 

In your opinion will 2000 grafts do any good to create a new hairline??

 

I shall post an update on getting a reply from the doctors.

 

Should I contact any more doctors for their opinions or should take a call based on the suggestions of Dr. Radha and Dr. Pat??

[sequel]

Send the email to Dr. Radha and Dr. Pat. This is what I wrote:

 

I guess I would like to get the best hairline and maximum hair in the current scenario. But I realize that only so much is possible. As you observed, my donor area is quite less. The hair in my donor area also has been thinning along with the remainder of the hair. I read about "Retro-Alopecia" and I believe I am suffering from that, that being the reason for loosing hair in my occipital zone and hence thinning of my hair in the donor region. Do you feel that could be the culprit?

 

Since my hair loss has not stopped yet, what would be its implication after the HT. I believe the hair loss will continue ever after the HT. I read somewhere about Hair shaft diameter and believe that it could be thinning in my case. Could this lead to me loosing the transplanted hair after the surgery.

 

Is it possible to extract more grafts from the donor area. Is using body hair an option? How will the donor area look after the HT. As you can see, i have very thin growth of hair around my donor area. How will the donor area scar be covered?

 

Do you feel that I would be able to undergo a follow up surgery later in time to provide more coverage? Do you feel that their will be donor supply left in my case after the first HT.

 

Is their any kind of medication I can undertake to halt/slow down/reverse my hair loss. Is their any exercise I can undertake to improve my scalp laxity.

 

Another question I have is about the procedure itself. I my case which procedure do you recommend, FUT or FUE. Also, how will the donor area scar look after the procedure. As you can see, my hair is quite thin around the donor area. Would this be sufficient to cover the donor area scar? And as my donor hair is thinning as well, would it continue to thin once transplanted or will they stop the loss/thinning once transplanted to the new region.

 

Anything else I should ask? Also, any comments on the queries/questions raised in the email are much appreciated.

[Raphael84]

Sequel,

 

Good email to both Doctors there, covering many major points. Hopefully some detailed replies will come back with answers and cover some of your points and questions. I really like your attitude in these posts, you have a very realistic outlook which is very important.

 

Its very normal, as bizarre as it sounds, for respected Doctors to recommend largely different graft amounts. Obviously with both taking their estimate from photos, neither can be 100% sure of the plan of action. 2k grafts would make "a difference" in my opinion, but obviously not as significant as 3.5k grafts. The big consideration, would be that with FUT the option to shave your hair down very short is eliminated. It will be good to hear both Drs response.

 

Good luck and keep updated!

[sequel]

Raphael84, thank you for the support.

 

I am uploading my latest pictures. I understand that my previous pics were with very short crop, and hence probably made it a little difficult to properly access my condition. These new ones have been taken after growing them for 35 days, and maybe will offer a better reference.

 

In the opinion of our fellow members here, how many grafts do you think are required in my condition, considering:

1- Full Coverage

2- Frontal Coverage only

 

What is your estimate on my donor graft strength?

 

I have read a little about the pros n cons of FUE vs FUT here on the forum. As Raphael84 correctly pointed out, FUT would eliminate a buzzed look, but I guess I am ok wid that provided it gives me more successful grafts. Also, looks like Doctors are seldom advising FUE if the HT candidate is in of excess of NW5, in my case i am more like on the worse side of NW6, bordering NW7, or mayb alrdy there... Please correct me if I am wrong, but it looks like the success rate of FUT is higher than FUE. With my limited donor supply, I cant really take a chance with my limited precious hair (whose importance I realized a little late..very late..)..comments welcome.

 

I will definitely post an update on my correspondence with the doctors. In the meanwhile, please keep the advises coming.

[Raphael84]

Sequel,

 

My opinion, many members would say that from your photos, they feel that you are not an "ideal" candidate for a HT session. And I can understand why. However, if after an in person meet with one of your chosen Doctors, they feel that they can achieve 3.5k as you mentioned, or possibly more over a further session, if possible, then the visual difference in my opinion, would be pretty huge. A new hairline to frame the face and as you said, working back as far as possible.

 

You are obviously doing your research which is great. And I feel it is important to really understand and continue to be realistic regarding what can be achieved. Obviously, you like everybody, would love full coverage, and failing that, as much coverage as possible. This is something that you and your Doctor must really discuss, so that you fully understand the limitations of what can be achieved.

 

Also, I could be wrong so apologies if so, but I seem to remember reading that you are not currently on medications for hairloss. As you are genuinely researching the options available to you in improving your situation, then I would really consider starting up on them, at least in an effort to attempt to stop the loss continuing!

 

You are going to be just fine. Research Research Research!

[Cartesian]

Sequel,

 

I am not in medical profession, my advise is only on a personal perspective.

 

I had a hairline similar to you except that I had good donor area. I got around 2800 grafts and that had covered the frontal baldness. So in your situation, even if the donor area can cover the frontal zone, it would mask the baldness. If I were you, I would prefer two sessions rather than a single mega session so that I would get an opportunity to see how the first surgery went on and what donor area is left to go for second one.

 

I did not see Dr.Radha in person but based on the email interaction and the fellow mates write up, I feel she is a good doctor.

 

Good Luck.

[sequel]

Raphael84, I can understand if anyone thinks that i would not be an ideal candidate. I can see the effect of retro alopecia in my hair loss, and the thinning of hair in the donor area is definitely a big deal breaker. I had written to Dr. Madhu as well, and his clinics opinion was "I would not be a suitable candidate"(refer to my earlier post). All hope was lost until hearing some positives from Dr. Radha and Dr. Pat which made me believe that I still just might have a fighting chance. I am not getting my hopes too high though as these opinions are bases solely on my photos seen by the respective doctors, and the opinion after a personal interaction might be for better or worse.

 

I was discussing my considering HT with my family couple of minutes back, and we discussed if having a hair line restored but having a big bald spot just behind that was really a solution. I am 5'8", not a particularly tall person, and believe that though a new hair line would certainly improve my frontal look, it will still end up looking very weird and unnatural coz of the bald crown area. We discussed if instead of just getting a new hair line, it would make more sense to cover the entire head with whatever density we can achieve with the donor hair. I believe that a final decision on this would ultimately depend on my possibility of having a second/third HT session. However this was just a casual discussion, trying to figure out the best way to proceed. Opinions/suggestions are invited.

 

One particularly interesting point raised by my brother was whether he can act as a donor candidate for my HT. That's very generous of him. Touchwood, he is not affected by hair loss. I understand that the body has to accept transplanted hair. But what if the donor hair was to come from my family, what with the same genes and all. Could the body accept such a transplant. Food for thought. I am going to put this question to the doctors as well, and seek their opinion on the same. Also, what abt the possibility of using body hair for HT. I have read cases where this has been done, but is it recommended?

 

I have not/am not taking any medication for my hair loss. Call it ignorance/stupidity, I think its stupidity. Have read about Finasteride (Propecia, Proscar), Minoxidil (Rogaine, Mintop) and Nizoral/Nioxin shampoos. Are there any other medicines available for MPB. I would like to start a medication course asap, but under medical guidance. So awaiting some response from the doctors. What is the suggested way to take these/other medicines.

 

Cartesian, Dr. Radha has certainly made quite a name for herself, attracting HT candidates for world over. I have sought advise on the possibility of a second HT session, but that would depend primarily on my donor area strength. Lets see what they suggest. Fingers crossed.

[aaron1234]

Should I contact any more doctors for their opinions or should take a call based on the suggestions of Dr. Radha and Dr. Pat??

 

Yes, contact more doctors. One's that specialize in FUE. I'll be honest - up to 5K-7K grafts would not be enough for you and you probably don't even have half of that in your donor bank. But if you can stand a shaved look then a few thousand FUE grafts to the hairline combined with SMP is the only route I would consider (other than Body Hair Transplants which are a crapshoot). Talk to some of the FUE specialists in Europe (Bisanga, Lorenzo, Ferudini, and others). I personally don't think you are a candidate for a strip procedure. Gillenator is right - you definitely have retro-grade alopecia going on.

 

I'd just keep it shaved. Just say to hell with it. HT's are an uphill battle for NW5's... almost an impossible battle for NW7's.

 

If you absolutely need hair then start researching systems. But I wouldn't know where to look in India.

 

All the best.

[aaron1234]

I am 5'8", not a particularly tall person, and believe that though a new hair line would certainly improve my frontal look, it will still end up looking very weird and unnatural coz of the bald crown area.

 

You're exactly right. And if the hair in the frontal third does not have adequate native hair behind it will look extraordinarily thin and odd. Tread carefully - but if I were you I would drop the HT idea altogether. You're still in your 30's. One thing is certain - you will still lose more hair over the course of your life. The quality of your donor hair is already bad. I see diffuse patches throughout. Even if it grew in after a few months it might not last very long. Sorry dude, just want to spare you a big mistake.

[sequel]

Hi aaron1234,

 

I realize that my donor area strength is very poor, and might not yield even 3.5k grafts as you correctly pointed out. This would just about give me a new hairline, or a head full of well spaced hair, and these theories too need to be validated by a certified doctor.

 

I have tried shaved look many a times, but it dosnt really go well wid my face structure. I have a roundish face, and a shaved look makes me look like a boiled egg.... Neither does my family like me keeping a shaved head. Its also a religious issue back in India not to keep a shaved head (as per Indian tradition one shaves his head on the loss of an immediate family member). I am not married yet, and my family believes that having a shaved look does not help in finding a suitable partner. All this put together, the prime reason being the shaved look not suiting me, I guess I am not really keen on going the shaved way. I do tend to crop my hair real short at times, like with #2 or sometmes even #1 clipper, and definitely feel more comfortable that way. But I guess I really would like to get some hair now... SMP is again an option for a shaved look, but in that case I would probably rather just shave whatever I have and maintain in that way, instead of getting my head tattooed. I will discuss the SMP option with my family though and c what their opinion is. Also, I will bring it up in my next communication with the doctor.

 

I have completely dropped the idea of getting a hair system. I realized that its really maintenance heavy, involving recurring expense. Add to that the difficulty in getting a proper hair system in India. And most importantly, the constant realization that I am wearing a hair piece would make me really conscious all the time. Just not worth the trouble.

 

The quality of my donor hair bothers me too. I guess the best way to proceed would be to seek a personal appointment with one of the doctors I am corresponding with and seek their professional advise. My hair loss is a continuing process, that added with me suffering from retro alopecia (read only abt 3% ppl suffer from this- me being one), makes my case really weird. I am not getting my hopes really high about getting a hair transplant, but will take a final call after a little more research.

 

I just thought of one thing, lets say I underwent a HT, and the results are not what I expected, in that case I can still shave/keep a buzzed look like I would now. I guess it would look a little better than now neway, as the transplanted hair would give some definition to the head, isnt it, or I am completely wrong in thinking this. I would be minus lotsa money, but maybe its a risk worth taking. But I will have to stick to FUE procedure in this case as the FUT scar would rule out keeping a shaved/buzzed look, as pointed out by Raphael84.