HT attacking hair on both fronts (hairline and vertex)?

[mikeyhwk]

I got an online consult done with many Drs and a couple have come back to me and said they do not like to do a HT that works the hairline and the vertex at the same time. While other Drs have said no problem, I'm lost as to which advice to go with. If the tops in the game were all saying the same thing the decision would be clear but the advice is split amongst them and my preference is to do it all at once. The advice from the drs who tell me to do one at a time is that if hair loss picks back up I may need those donors later so they advise doing the hairline and saving donors. The drs who have said it can be done in one pass say the loss in the vertex is minimal and itd take max 500 grafts to create density needed there so its not a huge demand on the donor supply and my hair loss is steady and given my age (turning 40) that I'm a good candidate to not have to wait. I am wanting to hear experiences from those that went either way and if they felt it was the right decision or the wrong decision. Has anyone had a HT at 40ish with hair that is mostly stable and found they started to lose a lot later in life around the transplant? If it is relevant, there is no major hair loss in my family outside my dad who is near 70 and a legit 3v with no meds and I am in the early stages of a 3v pattern on minox and just started finasteride a month ago.

 

TLDR...some drs say do crown and hairline same time, others say don't. Both sets include top surgeons Crown requires 500ish grafts. Hairline 2k. Hair loss stable, Any harm in doing both at once, better doing one at a time, pros cons to either?

Edited June 17, 2016 by mikeyhwk

[mikeyhwk]

bump,,.any thoughts

[gillenator]

Mikey,

 

Here's the deal. Obviously, you have MPB going on in the frontal zone, mid-scalp, and crown (vertex). Although you may at present have a good deal of hair left in the vertex area, that can change in the coming years. How much, no one can know for sure.

 

But the reality of it all is that MPB is a life long journey. It does not stop in its tracks. The rate of progressive loss can change somewhat but the progression over a lifetime is what some of the doctors are concerned with. Your vertex is obviously thinning and they know this will undoubtedly continue.

 

They must also see potential for continued loss in the frontal zone through the mid-scalp so they are wisely advising you to manage some donor reserves for future loss in this area.

 

You just started low dose finasteride so you still do not know how you are going to respond to it until you have been on it for at least 12 months without interruption.

 

If it were me, I would restore the frontal zone to start with and see how I respond to finasteride for the longer term. Because as there is more progressive loss in the front through the mid-scalp, I will want enough donor left to address it. Finasteride typically is not efficient in the frontal zone, only the vertex.

 

Now using 500 grafts in your vertex is not a big number, but remember, that's what you need right now. As you continue to lose in your crown, you will need to keep adding to it and sooner or later, you will run out of donor if you want to keep your front and mid-scalp restored as well.

[mikeyhwk]

thank you Gillenator, I appreciate the insight!

 

I guess my hang up is the small number of donors involved in the crown touch up. I realize progression of loss in that crown area is likely and this may be something I may need to address later and that there is potential for mid scalp loss, as yet there isn't but it is the way the progression moves so I should be thrifty with my donor usage but I weigh that against years of looking good while in my prime. I don't mean to discount my later years like they don't matter or my looks wont matter but I work a very image conscious industry, film industry and I'm single and successful, I don't see my dating pool getting better as I age so it's sort of a little bit of sacrificing later for now. If it were significant amount I would have an easier time dismissing the idea but it's tough to just let it go and be logical lol

[ontop]

Member is giving great advice,

I do really see your situation given your age & MPB but your only 40 & still have a long life in front of you.

Yep it sounds very convenient to just try & knock it out in 1 pass but the reality is a lot of HT guys, dont get done in just 1 pass even though the sexy commercials or shady sales reps make this out.

Be smart, mature over this, my advice & I'm not a Dr but give your Meds at least 12 months & see where your at then choose the Dr you feel comfortable with & have him/her work on your frontal zone, frame your face, once this is done you may not even think about your crown plus like the member has said you could be a good responder to Meds & buy yourself some good valuable time for any future loss you may have.

Just note....

This is not a sprint its a Marathon,. Keep some for Rainey day so to speak.

 

I wish you well.

[Mikey1970]

If you go with a top Dr and have the $$$, my research shows that BHT can be a viable option when head donor hair is expired. I believe that typically the crown responds well to chest, beard or in other words BHT.

 

Surgeon selection is the most important thing! Going with the wrong Dr can cause a lot of damage & heartache. Pay the extra $$$ & go with the best...

[mikeyhwk]

thank you for your input ontop, I appreciate the straight talk from you and Gillenator.

[mikeyhwk]

If you go with a top Dr and have the $$$, my research shows that BHT can be a viable option when head donor hair is expired. I believe that typically the crown responds well to chest, beard or in other words BHT.

 

Surgeon selection is the most important thing! Going with the wrong Dr can cause a lot of damage & heartache. Pay the extra $$$ & go with the best...

 

I'll admit BHT has crossed my mind. I have a fair amount of beard and chest hair that I would be happy to part with as I just find it a nuisance. How good mine is as a donor I have no idea but assuming even a small percentage are usable I should be able to generate more than what I'd lose doing the crown now so that further makes me think go ahead now lol

 

I am definitely not trying to go the cheap route, I want to go with whose hairline work I like the most. I am leaning between Drs Rahal, Gabel, Mwamba, DeVroy and Bisanga, I will just let my in person consults decide between them as to who I feel the most comfortable with. I would've liked Dr Konior as well but his surgery schedule was insanely long and I don't have that patience.

[ontop]

Your welcome,

being your in Canada have you had a consultation with H&W? I guess you have right?

All the Doctors you mention is top of there game especially Dr K but he is mostly a FUT guy but I have seen some of his FUE he lately which is with him is excellent, so yep the long waiting list for him is certainly justified to say the least.

 

Not sure what surgery you prefer FUE or FUT both have there pro & cons something you had to think what could you look like in say 10/20 yrw from now.

 

I see you just started Meds while your giving that time to work, then carry on what your doing in your research.

I know you mention that this could be a ideal time for you being your inbetween employment & in the perfect world that would be ideal to make the most of your downtime, I do get that but try not to put to much pressure on yourself in the whole timing stuff, easy said than done right lol?

 

Like I said previous be smart & mature over your choices I see that you are anyways.

 

Obvious you read up on the meds & fully understand how the process works & what is the limited expectations involving these Meds, it can get kinda rough especially the first 6months but be patient with this stuff & if your unfortunately start to get sides go & speak to your doctor about this.

 

Anyways I wish you well for the future. Keep us posted!

[mikeyhwk]

I have had a consult with H&W, they have been my only in person consult so far. The feeling from them was that I did not need crown work yet, in the drs opinion I had enough coverage at this point that I should wait and see what the meds could do but he was not adverse to adding density in the crown just thought it was more of a luxury than a necessity at this stage. The Dr most opposed to doing the crown at the same time was Dr Rahal who feels I may venture down to norwood 5 territory eventually but I did not hear that from any other drs nor at my in person consult. That's what caused me such confusion as Dr Rahal is a top surgeon and if he sees that happening are the other drs not being straight with me or not mentioning it or is he just being overly cautious. Maybe I need to ask the Dr at H&W for his opinion on that since he saw it in person. I saw him first before Dr Rahals online consult otherwise I would have asked where he saw my progression leading. I ruled out H&W initially because of their speciality in fut but their fue work as of late has been excellent. I am 100% leaning fue, I wear my hair short so a long linear scar isn't an option.

 

haha yes, way easier said than done. The biggest hassle isn't even so much the timing tho that is an issue it is the shaving,I really don't want to shaving my head now, and 5 years down the road again. I know ufue is an option but for best results it is better to shave and Id rather do it right than risk results.

 

I wish I had started finasteride earlier, I started it ages ago but stopped as I got scared off by sides that I didn't even have, just the reading about them lol but now since a ht is on the horizon I thought it was best to start ahead of any procedure. I hope I don't face any sides but it is a wait and see. I have undergone a slight shed since starting but it is minor compared to my minox start shed.

 

I will try to be smart about this and will trust the experts and their advice and do appreciate all the talk here, you guys help me keep perspective and not get too ahead of myself. thank you for that!

[ontop]

Arrr your welcome buddy, thats what we all here to help each other in some sort of way.

I do get H&W in there advice in leaving sleeping dogs lye so to speak but the real reason is not only to save your donor for a later date for what it seems from what I hear is that your crown thinning is to small to address at tbis time & not worth the risk as when planting new folicals can open up a can of worms with transection, blood supply blah, blah, again with a small area they proberly want to see you giving Meds a real go at least 1 full year.

saying that like I said, you on the other hand want to get this done with, off work theres a nice gap in your schedule all the ducks lline up for you, your in your 40s so your thinking yep I want it all done & be done right? Lol ....I get you, I really do buddy.

Look at it this way, you frame your face nicely, meds are doing okay say just keeping the wolfs from the door meaning the crown in the next 1 or 2 yrs haven't expanded then you may think later on down the line oh dam im glad I never touched that crown now, all good right?

Or you could just frame your face leave tbe crown, meds not keeping the wolfs from tb e door & a year or two crown has got somewhat bigger.

dam you say I wish I did the crown now....well heres the kicker, you can have a go because you never touched extra In your donor.

what im trying to say in a very long story LOL is you can add but you cant take away.

you still would have several options in the future, if only framing your face at this time.

Either way im still good given your age favors you to a degree.

 

Would you feel comfortable posting some pics? It may give us a better idea of where your at.

 

Have a good day

[gillenator]

You're welcome mikey and glad to be of some help.

 

You know it's kind of an interesting observation when various doctors have a variety of feedback. Some docs have an eye for various loss patterns and that may be why Dr. Rahal related his convictions about you headed towards a class 5 eventually. Maybe he sees the diffusion going on in your vertex and can tell where it is impeding but that can be hard to do without seeing you in person. Yet someone like Dr. Rahal has seen countless other men with the same loss pattern that you have.

 

One concern about grafting into an area that has a fair amount of hair volume but is also diffusing is that adding grafts can thicken up the area temporarily but it also can advance the rate of progressive loss as well compared to leaving it alone and using meds alone to stabilize it.

 

This again is a good reason to wait it out to see how low dose finasteride might affect your crown. If it improves, you may want to wait on adding any grafts there for now.

 

Just a thought...

[ontop]

I tend to agree with Gilllenator where some Dr has a eye in looking into what can become in several yrs from that particular one on one consultation which is far best to do than just looking at jpegs picture's. Which can give a Dr some sort of idea but nothing better than something personal meeting.

 

I also agree that dipping into the scalp is more risky, where hair is still active some hair on its way out nomatter what but giving meds a try for several yrs prior .may save, strengthen, thicken & some occasions even multiply to a ceratin degee if your lucky.

[mikeyhwk]

Damn I hate you guys talking logic and making me pause on adding to the crown

 

I'll include a few pictures of my crown all taken within a couple of days, dry and wet, the wet clearly shows plenty of loss the dry doesn't show as much. To me it seems like significant loss but the drs don't seem to agree.

 

Also since you guys clearly know HT's well, can you guys explain a little bit about blood supply to the recipient site. Ontop you mentioned it here and Mikeey mentioned it in another thread...where he said : "HT shed after a while is 100 % due to poor blood supply !" Can a good doctor make sure this isn't an issue, or is this strictly a wait and see after the transplants done?

[ontop]

To be honest & blunt yep you are thinning on the crown but being you just started meds I would definitely give that a fair shake because I think that could be turned around after 12 / 18 monthw on meds, ive seen this many times in guys like you.

take a look at Dr Bernstein website before & after pictures of some of the effects the meds has.

When going into the scalp where ther is still native hair its risky as this could effect the blood supply sometimes short term, sometimes long term, hense temporary shock loss or even permanent shock loss.

blood supply is different for each individual patient, when you inplant new hairs inbetween native hair there is a chance that you could open up a can of worms where the blood supply is getting more competition just like newly born puppies fighting to get at them nips some get more protein than other's, some become little runts & some even die unfortunately.

 

Im no Dr by the way but its just what I read up over the years, its just my prospective on the matter.

Somebody like micky or other's can describe / educate you better more than Im trying to wright now.

Also take a look at Dr feller & Blakes videos on the topic of blood supply, not sure where the link is but its on here somewhere.

hope that helps in some way.

[mikeyhwk]

To be honest & blunt yep you are thinning on the crown but being you just started meds I would definitely give that a fair shake because I think that could be turned around after 12 / 18 monthw on meds, ive seen this many times in guys like you.

take a look at Dr Bernstein website before & after pictures of some of the effects the meds has.

When going into the scalp where ther is still native hair its risky as this could effect the blood supply sometimes short term, sometimes long term, hense temporary shock loss or even permanent shock loss.

blood supply is different for each individual patient, when you inplant new hairs inbetween native hair there is a chance that you could open up a can of worms where the blood supply is getting more competition just like newly born puppies fighting to get at them nips some get more protein than other's, some become little runts & some even die unfortunately.

 

Im no Dr by the way but its just what I read up over the years, its just my prospective on the matter.

Somebody like micky or other's can describe / educate you better more than Im trying to wright now.

Also take a look at Dr feller & Blakes videos on the topic of blood supply, not sure where the link is but its on here somewhere.

hope that helps in some way.

 

It's not blunt, it's not news to me lol thats why it surprises me when the drs keep saying it's not a problem. I keep wondering what are they seeing that I am not cause it's clear to me. I am yet to get a single doc who said I would need more than 500 grafts either, when wet I feel like I got no coverage, dry different story I know that but still it seems like not much and others say don't do it not a problem its strong enough. I can understand the give meds time argument but the it's not bad enough to do right now argument, really?

 

I will take a look at Dr Bernsteins site and look up the vids.

[ontop]

What there probably saying its strong enough now but the future maybe a different story as you well know buddy.

The thing is that crown is very sensitive & once it cracks open it cracks open, spreads & being on meds for you anyways may tighten up that crown aslong you stay on your medications that is.

but lets flip over to the darker side a second, the meds do nothing for you, that happens also right? You go ahead & dip into that crown open up a can of worms meds are not doing anything all of a sudden your dealing with more losses than you was 2 yrs ago..you wont be a happy camper I guess.

you may of heard some Doctors mention the word the black hole right? Well they dont say that for a sound bite, they say it because they see patients day in day out.

 

The way I see your situation being in your 40s is that your stuck between a rock & hardplace, your definitely not wrong for going for all in one go....but what if them meds are doing nothing for you right now? You could be in a worse place on your crown.

 

I do agree that around 500 grafts seems a little conservative but until the doctor can evaluate your scalp, density blah, blah you never know you may find out that come 1 or 2 yrs that your crown has stabilized or even regrown, strengthen & you may think that the crown is a non issue which would be fantastic result for you right?

 

Your not wrong for thinking what you are, but just be cautious & be mindful of what could & sometimes happen especially tinkering with the crown for such a small number of grafts.

 

Just rrying to give you a outside prospective on your situation buddy, I support you whatever you decide.

[mikeyhwk]

And that is why I posted in the first place, the non biased opinion. It's hard sometimes to subtract what you want from what you need.

 

I'm surprised I never heard of the black hole before but I googled it and it does make sense. I guess I have a lot more consults to do and a lot more opinions I need to hear before I can come to a decision. Rahals opinion does carry a lot of weight with me but he still hasn't seen me live so I think it's for the best to meet with them in person and let them see what they're working with up close before weighing in. I have to slow my rush to get this done asap and on my timeline and just do it when I have enough data and the right doctor all lined up. I have a meeting with Dr Gabel next week for an in person so that will be my next step. I am starting to come around to the idea of not going full bore on the crown and letting the meds work but I will trust the drs to decide if there is any approach that is a safe and sensible to the crown or if its just best to let it be. As much as I am hating to admit that lol

Edited June 23, 2016 by mikeyhwk

[ontop]

Good call buddy,

let the pros take a look one on one & if your feeling the professional input, then go with what your guts tell you.

eitherway I think you be fine aslong you pick & trust a top Doctor.

have as many questions or concerns written down prior & a good HT doctor will educate you on the pros & cons of everything from A to Z .

keep us posted on your thread okay.

I wish you well buddy.

[gillenator]

mikeyhwk,

 

ontop is spot on. I have seen lots of cases over the past 4 decades of similar situations as yours. The challenge is that you do have a significant amount of native hair in your crown and it is at various stages of diffusion. And remember, the weakest hair will undoubtedly shock out and 500 grafts may not provide any visual gains when all is said and done from the procedure. In fact, it might look even thinner.

 

IMHO, it would make more sense to use concealers in the short term. That way, it would provide you the window period to see how you respond to low dose finasteride. Like ontop implied, worse case, you would not want to open up a can of worms if you can avoid it. I think Dr. Rahal also sees the various stages of diffusion within the vertex zone and why he responded the way he did. I tend to agree with him.

 

Worse case, if you do not respond well to low dose finasteride, you will undoubtedly continue to lose in your crown and you can always have another procedure to add hair in the future. That way the risk of shock is low and you will have a better idea of your loss potential there.

 

Another option would be to wear a partial system in the crown area and surgically restore the frontal zone. I have seen a number of guys in person wearing a partial crown piece and you cannot tell at all they are wearing it.

 

Just another option that would give you very nice coverage front to back...

[mikeyhwk]

So I went in and met Dr Hasson today. Really get a good vibe out of Dr Hasson, He also felt I could go to Norwood 5 if I continue losing but he thinks fin should halt my loss and regrow the loss in my crown so that I need not bother with the crown for at least 18 months while fin works then we'll reassess. He said I got over 10k donors and said it was a rockstar donor area. Felt doing the hairline was the way to go and thought he could get some serious density and fill in right behind the hairline as well without denting my donor supply. He said fue or fut were open and my skin laxity was excellent. Really upbeat after this consult and he all but clinched that he'll be my dr choice. He said hes very confident that we can get some great results and I'll have a full head of hair for a long time. Assuming fin doesn't turn on me at some point. He did recommend I stop minox immediately, said it will tighten skin, prematurely age me, possibly lead to worsened hair transplant result and isn't all that effective. The minox news was surprising but saves me a lifetime of minox. So thank you gil and ontop for your opinions, I will heed all your and the drs advice and go just hairline for the first surgery and let fin work its magic.

[ontop]

Your welcome buddy,

Kinda surprised what he said about Min though, it has worked for me & many others without any problems, strange comments.

okay well hes the doc & should know better & I agree working with the front first see what becomes in 12/ 18 months from your HT, you never know it may not be a issue by then.

 

So you havent booked yet I guess right? I would take a guess they have a waiting list of 2 3 months at least unless you put yourself down for a cancellation & slip In early of course this must synk in with your schedule also.

 

Good luck

Edited July 1, 2016 by ontop
edit

[mikeyhwk]

Your welcome buddy,

Kinda surprised what he said about Min though, it has worked for me & many others without any problems, strange comments.

okay well hes the doc & should know better & I agree working with the front first see what becomes in 12/ 18 months from your HT, you never know it may not be a issue by then.

 

So you havent booked yet I guess right? I would take a guess they have a waiting list of 2 3 months at least unless you put yourself down for a cancellation & slip In early of course this must synk in with your schedule also.

 

Good luck

 

I didn't book on the spot as I had to talk it over the woman first but Aug 22nd is first opening for fue and the one I'm going to take, after that it's like one opening per month till novemeber, If I wanted fut he could get me in end of July, 22nd and there are days scattered here and there over the next couple months, not a lot open but you can find a day for fut. Fue openings are scarce, they book up fast and eat up multiple days. He said my fut would be about 6 hrs while fue for the same grafts would be a 2 day surgery about 10ish hours per day. I didn't ask for the waiting list but I should, I know some docs offer a discount for that if you're able to go at a moments notice, hes 20 minutes from me so itd be easy enough to do.

 

I was shocked by the minox too but he is not a fan at all. He said it will tighten up the skin and make you a bleeder during surgery which can lead to lesser results. He said in his experience it doesn't do a whole lot, with that and the inflammation it caused to the scalp and with the new info about it prematurely aging users, it was best avoided. I hadn't gotten great results from it so it's no big loss to me just always heard it was a must.

[ontop]

Okay good,

well now it seems your getting a step closer to your chioce & I gather the Dr gave you the pro & cons of both surgeries so now its comi g down to the wire which one you will pick A or B ....both would would be fine In your case but it boils down to which one you would feel you could live with.

 

Okay well leave this in your hands buddy best wishes.