Need Advice- Pics Included

[hairlosscpa]

Hi All,

 

To keep it short:

 

Plan: FUE only. Hairline and mid-scalp. Minor scar repair.

Age:27

Medication: None. Use to be on Propecia for 6 months, suffered sides. Waiting until after 30's and kids to go back on it.

Previous HT: 1704 grafts FUT with recommended surgeon in Oct 2012. Hairline and mid-scalp.

Current Location: Philadelphia, PA

 

I am considering a 2nd transplant. I consulted with the following Doctors:

 

Koray Erdogen: He will not take me right now and I should wait a few years and be on meds

 

Konior: 2000 grafts FUE, 500 for scar utilizing beard hair

 

Vories: 2,500 + 300 for the scar, utilizing all donor scalp hair (I asked his rep if I can instead bump the graft count to 3,000 in one trip over two days and that was not an issue)

 

I am considering Dr. Vories based on the fact that he has been providing some stellar results on this forum and is reasonably priced ($4/graft). With the graft count quoted above and traveling, he will be nearly $4k/$5k cheaper than Dr. Konior. However, Dr. Konior is just known as the best of the best and was more conservative. He asked for many donor pics before making his estimate whereas Vories did not really ask and agreed to 3,000 grafts right away.

 

I'm a little confused as to who to choose or if I should go for a transplant at all. I am very self conscious about my hairline and my concealer is becoming much more obvious and I feel as if people look at my hairline more when before no one seemed to second guess.

 

Pics are attached, your input is greatly appreciated. Thank you.

Edited May 1, 2015 by hairlosscpa

[gillenator]

hairlosscpa,

 

You would be very happy with Dr. Konior IMHO, and even if the graft price is slightly higher, the end result is what counts...

 

You definitely have a diffused thinning pattern so this is where a more conservative approach is of benefit to lower the trauma level, lower the shock, minimize transection, and thereby increasing the overall yield to get you to a more restored appearance.

 

With a diffused thinning pattern, additional follow-up procedures will be inevitable so again, approaching a more methodical restoration is more appropriate IMHO.

 

Have you considered a topical DHT blocker to avoid the side effects?

[Spanker]

Looks like you're trying to drop your hairline a little. I think that would be a mistake. You like like a diffused thinner. I think your best bet would be to implant yourself as if you were a nw6 and that means being very conservative with your grafts. You may even want to consider fue into the scar and diffusely implanting into a nw6 pattern with the intention of supplementing with a tight cut and smp? It's a hard call. Doing nothing may be an option as well. Maybe trying a shaved look and working on your scar. I don't think it's unreasonable to think you could end up slick bald in the next 10-15 years, especially without meds.

 

I do know Dr. K would do all he could to give you the most natural result available and Dr. Vories is turning out good work to since he dropped the neograft (just my opinion). I don't think you'd initially be going wrong with either one, but it's the long term you really have to consider. Talk with the docs and ask them to give you an example of what you may look like if you progressed to a nw6 with the donor they think you have available. This would mean getting an in person consult, which I personally think you need. I do think you have 3k grafts available, but I think your going to need 5k or more for a nice natural look in twenty years.

[gillenator]

hairlosscpa,

 

Forgot to add that your photo of your donor looks strong and of good quality...

[seeker2014]

Your situation sounds nearly identical to mine. Have you ever considered just filling the scar for now, shaving your hair short (which actually works quite well for someone with diffused loss), and waiting a few years to see how your hairloss progresses? Receiving any sort of transplant before 30 is somewhat of a risky proposition (from personal experience and looking at other cases) and this approach might benefit you in the long-run. It is easier for me to say this because I have reached the conclusion of only filling in my scar if I decide to undergo any other procedure(s). However, if you decide to proceed with the HT, either Konior or Vories would be an excellent choice (based on cases I have seen on this forum).

[Swooping]

No I wouldn't go for a hair transplant if I were you, at least for your mid-crown scalp area.

 

Why? You are a diffused thinner. Although you are clearly thinning you still have a pretty "ok" density. There are plenty of native hairs left on your head, they are just weak at the moment. If you go insert grafts around this area you have a high chance of losing these native hairs due to direct trauma or indirect through up regulation of factors like HSP.

 

I see many cases like you who go for a hair transplant and eventually it doesn't turn out to be cosmetically really that much different. Basically you have a high chance of sacrificing your (albeit a bit weak and thin) native hairs for implanted grafts. It's just not the smartest choice in my opinion.

 

If I were you I would hurry up with the kids and jump asap on finasteride + minoxidil . Minoxidil can do wonders too sometimes, have you considered that?

 

For your scar, you could fill that up indeed, or you could look into SMP in my opinion. Good luck!

[wazaam]

Have you considered a topical DHT blocker to avoid the side effects? __________________

Gillenator

Independent Patient Advocate

 

 

Gillenator,

What topical DHT blockers do you typically suggest?

[1978matt]

I'd leave the hairline where it is but maybe add 500 grafts to strengthen any weak areas.

 

Priority 1 would be to fill in the scar as it seems too visible even at short lengths. The short length looks good on you.

 

Any remaining grafts would go toward future-profiling the front 3rd/half so that you will always have some hair coverage even if native hair disappears.

 

Shame about the fin. You could try taking smaller amounts if you haven't tried already. It seems to work ok for me. No apparent hair loss for 3 years.

[KO]

I am blown away that Koray declined you for an HT.

 

 

May I ask why you are considering going on propecia after having kids? What side effects did you have? Why do you feel that they will dissipate in your 30s?

[hairlosscpa]

@gillenator - Is topical DHT available in the US? I thought it was only available in Canada. Or do you mean Nizoral? Currently I take vit D3, biotin and pumpkin seed oil supplements. I know they probably aren't helping but I doubt they're hurting so I just keep taking them. Thank you for advice, good to know that my donor hair can be possibly considered high quality.

 

@Spanker - To be honest, my head is shaped like an egg, there is no way I can rock the shaved look. The thought of being an NW6 is incredibly frightening (no offense to anyone) but I do like your advice over asking doctors how I would look as an nw6 with my future transplanted hairs. I sincerely appreciate the honest and straightforward advice.

 

@seeker2014 - Thanks for your advice. Would you or anyone else recommend using beard hair or scalp hair to fill in the scar?

 

@Swooping - Thank you for your advice.

 

@KO - Propecia worked wonders on me as I took it right before my first transplant in 2012 (as seen in my attached pics). I went from 1mg everyday to .5mg everyday to .5mg every other day in the span of a year. I kept having side effects such as foggy head where I couldn't focus as much and sexual side effects (which my wife noticed as well). I really wanted to stay on it but just couldn't handle the trade-offs. Regarding your questions on kids, I read a post from Dr. Lindsey a few years back saying that he personally would not take Propecia when trying to conceive because he would avoid all possibilities that would have even the slightest negative effect on the child. I know there are studies out there showing no correlation between Finasteride and birth defects but as a personal thing, coupled with the side effects, it just wasn't worth it if i plan on getting off it and losing all gains. I would rather start when there is nothing in my way. I'm thinking in my 30's I'll cut it down to .25mg every other day to hopefully avoid any sides. What are your thoughts on how I'm approaching this? Do you think it makes any sense?

 

Attached are my pre-HT and 6month post HT pics from 2012/2013 (while on Propecia). Thank you all for your advice.

Edited May 4, 2015 by hairlosscpa

[seeker2014]

It depends on your goals. If you want to proceed with another HT, then utilizing beard grafts would be an option to preserve scalp grafts. From what I have seen on this forum and others, beard grafts seem to respond well when transferred to scars. However, you do have to factor in the possibility of "visible" scarring with this procedure. From cases available on this forum, I have never seen visible scarring with beard grafting, but results can vary depending on the surgeon's skill and an individual's physiology to scar formation. In my case, if I elect another procedure(s) to fill in my scar, I am going to use scalp grafts.

 

Very interesting with the 6-months post-op combined with Propecia. Again, my experience is extremely similar. When I started with Propecia at 18, I had amazing growth, giving me good density until around 21. I then started to lose ground until receiving my HT at around 25. I had great results until 15 months post-op when I started to experience significant shedding. IMO, Swooping made an excellent observation. It seems to be somewhat common for a diffuse thinner to experience zero long-term gain in density from a HT due to the vulnerability of weakened native hair. I would say that I am nearly back to my pre-op state with slightly more hair in the front with crown loss (despite being on finasteride 1.25 mg daily and minoxidil). I am sharing this with you to emphasize the importance of proceeding with extreme caution...being relatively young and experiencing diffuse thinning is a dangerous combination, possibly leading to a futile chase for adequate density through multiple HTs.

[gillenator]

hairlosscpa,

 

Sorry to say that there really are not any specific topical DHT blockers that I recommend and the reason for this is because nearly 100% of them are supplement based, not medications where they are scrutinized and are required to support their claims with scientific clinical trials.

 

So they are really hit and miss for individuals who try them. Not trying to say that none of them have any efficiency, but if they did, we would be hearing about them much more.

 

One of the products for example is Hair Genesis which claims is very effective in treating thinning hair and states that it removes accumulated DHT sebum from the scalp and hair follicles along with adding DHT blockers. Does it work? Who knows, however they include testimonials from individuals but again, may not be supported with verifiable clinical trials. However, their oral soft gels do contain saw palmetto, prim rose oil, niacin, and many other additives so this product is loaded with lots of nature based supplements that may have a positive effect on some individuals.

 

Nioxin offers a Bionutrient Formulation which claims to remove excess sebum containing elevated levels of DHT. Does it have any efficiency with blocking or removing DHT? Who knows. Again, many of these products are supported by "independent studies" or "peer-reviewed" research studies that have questionable conflicts of interest in my honest opinion for the obvious reasons.

 

So when any individual does not want to take medications such as finasteride, dutasteride, etc., to avoid side-effects and other issues, the topicals along with oral supplements are limited in supply but may be worth a try...:rolleyes:

[mosd]

look into ru! Many had succes with it!

[hairlosscpa]

Decided to take the plunge and waiting on Dr. Vories and his reps to see if there is an opening on Sept. 18th (due a possible cancellation of another patient). 2500-3000 grafts FUE which includes 300 from beard to conceal a FUT scar made by a Coalition doctor back in 2012.

 

Crossing my fingers I get it and then booking my trip to Charleston!

[hairlosscpa]

Booked my procedure today with Dr. Vories on 9/18/15. 2800 grafts (300 utilizing beard hair to conceal a FUT scar).

 

For those who have gotten FUE, especially with Dr. Vories, any advice you can provide me? My only concern is looking like a mess about 10/11 days post-op when I may have to show my face to clients.

 

Thanks!

[hairlosscpa]

BTW pics can be found on the first post of this thread. Any advice will be appreciated, thanks!