Why can't I get a solid answer?

[leonilly]

I'm frustrated by the contradicting claims of HT docs, including those on this site. I am a 25 year old NW4/5. I tried propecia but it gave me sides and I stopped.

 

I spoke to Hasson Wong's rep and he told me that while they could get a good result, they would not do any work without me taking propecia.

 

Then I spoke to Dr. Lindsey who told me that taking propecia isn't required and he wouldn't want me to take it.

 

 

I've heard some people say 25 is wayyy too early for a transplant. Then I've heard others say that 25 is just fine as long as I'm willing to maybe get another one down the road.

 

 

Im struggling to make sense of it and I dont want to be taken advantage of by a doctor who is just trying to make a quick buck. At the same time, I want to not be bald anymore.

 

 

 

How do I sort this out?

[StaggerLee123]

Different docs have different standards and protocols. The concern with someone in their mid 20's who is not on Propecia is that your future hair loss is not predictable. You could have surgery and end up with a net loss of hair a year down the road. You could have permanent shock loss after surgery, your loss could accelerate on its own, etc...

 

Nothing is set in stone in this field. I would advise you to take the time to research who the leading Docs are and how they operate. If you really understand the risks involved in having surgery before your hair loss is stable, then I'd say go for it.

 

Another suggestion I would give is to shave your head and see how you look. You might like the look and decide surgery is not necessary, but once they operate on you be it FUT or FUE you can never shave it slick again without showing your scars. I would heed the advice given by Hasson & Wong very seriously.

[leonilly]

Yes, I have shaved my head. It does not look totally terrible. But I think its fair to say I felt like a 8.5/10 before balding. And I think about a 5 or 6 now.

 

 

I'm not obsessed with getting a full head of hair back. I just want my face framed and a decent coverage, even if not super dense.

 

 

The men in my family are generally NW6. I don't know any NW7's in my family.

[aWidowsPeek]

leonilly post some pics of your hair. It help in getting good advice.

[Sean]

You are right. Some docs dont care you take propecia and some do when working on you. If you are partially thinning, propecia can amp your result overall and can make your post op photos look better than without it. Even in areas where a doc has not worked on. Sometimes, such photos can confuse a prospective patient because you try to guage the quality of work but then get confused on what is transplant and what is native. Propecia and rogaine should not be a prerequisite for surgery unless you have definite early thinning in other areas where you are not going to have grafts placed. If the zone for loss is too great then surgery may not be the best option and a surgeon should turn away patients rather than take a persons money and give them false hopes.

[ontop]

Dr Lindsey proberly told you, he wouldn't force you to take propicia but in your 20s saying your a 4 or 5 on the NW scale & what you said about your family history, indicates to me you will loose more hair down the line, in other words chasing your tale.

its all about supply & demand that's why H&W was being honest with you to try & protect your investment for more hairloss your going to get.

 

At a young age its risky & especially being nw4/5 & not taking meds.

 

Have a one on one consultations with some of the Doctors on here, I mean at there clinic so they can sit you down & give you options on a "long term" plan.

[delancey]

Leonilly,

 

When I was your age, I used to hate hearing the advice that I am about to give you. If there is a problem, there needs to be a solution. This is especially true for anything that wears you down and makes you feel depressed. You can take my advice or you can leave it. I have no financial gain in any decision that you may make. I am just here to help you so that you make a smart decision that you will be able to live with when you're older.

 

 

I am going to go against the grain here and tell you not to do it (assuming average hair characteristics and donor density). You're only 25 years old and you've already developed a Norwood 4/5 hair loss pattern. You will most likely develop a Norwood 6 pattern in the future without Propecia (seeing as you have a family history of Norwood 6s). There is a website called Propeciahelp. Educate yourself and then determine if the possible side-effects are worth it to you. For if you are going to start the hair transplant journey as a young 25, you'll need every insurance policy that you can get.

 

In the end, I am not a fan of the average Norwood 6 getting a hair transplant. In fact, it can end up a total disaster even with the very best Doctor. Firstly, you'll need a significant number of grafts (unless you have favorable characteristics, and can ratchet down your expectations significantly). Are you willing to leave the crown bald at 25? Getting good density in the crown is challenging, especially on a Norwood 6. The crown can expand significantly and you won't have the grafts to fill it in at a high density.

 

 

Another factor to consider is that you won't be able to wear your hair short again with a long and potentially wider strip scar going from one ear to another. The scar is permanent. Imagine being that guy with thin transplanted hair on top combed over, with a long strip scar permanently engrained in your head preventing you from shaving down. I wouldn't want to be this guy. But it happens. All to often. I've even seen it at a live consultation. In my opinion, shaving your head or maintaining a short buzz-cut is way more attractive.

 

 

Potential options in no particular order:

 

1. FUE procedure in Europe (costs are significantly lower). The scarring is more difficult to detect and when done properly, it will generally allow you to wear a shorter hairstyle. Once again, if you go the HT route, remember that it will leave scarring and that as a potential norwood 6, you will need to ratchet down your expectations (bald crown, perhaps?). If you go that route, Propecia is important in order to protect your hair transplant in the long term. Are you willing to take the gamble with side-effects? Many people don't get any. Some do. Check out Propecia help.

2. Shave your head and own your hair loss. This is not for everyone. I get it. But perhaps it's for you? And self-acceptance is seen as very attractive.

3. Hair system. Check out Northwestlace. Some of the results are incredible. And it gives you options down the line. You aren't scarred up. There isn't any permanent damage. There are many sites to choose from. This just happens to be one where the customers seem very satisfied.

 

https://www.youtube.com/watch?v=W-LK_ch13sY

 

Best of luck to you.

Edited July 3, 2016 by delancey

[Bill - Seemiller]

Leonilly,

 

You have already gotten some excellent advice but I wanted to chime in with my thoughts as well For starters, each physician has a unique philosophy on how to tackle hair restoration. Thus, while some may be willing to provide you with a hair transplant if you don't take Propecia, others may strongly advise against it. Some may also recommend a greater number of grafts than others. At the end of the day, there are benefits and limitations to surgery and there are advantages and disadvantages to each approach. While hair transplant surgery doesn't require the use of Propecia, it does nothing to stop future hair loss. Thus, just keep in mind that if you are still losing hair, you may likely need another hair transplant further down the road. Your hair transplant surgeon will need to be rather conservative with you and keep a good quantity of hair in reserve (in the donor area) for future work.

 

Best wishes,

 

Bill

[HairsGone]

While hair transplant surgery doesn't require the use of Propecia, it does nothing to stop future hair loss.

 

Bill, can you clarify this? I thought the whole point of Finasteride was to try and prevent further hair loss and in some cases to help regrow miniaturised hairs?

[chris39]

All the above answers are right , because there is no absolute correct answer .

 

As far as Propecia is concerned , that again depends on a number of factors . Some clinics will insist on this as it potentially going to give a better result form the HT alone - i.e. how much of the result was down to the HT and how much was down to the Propecia . It also depends on the level of hair loss and if it has stabilised .

 

Although I got a years supply of Proscar , I decided against taking this - primarily due to medical reasons , but also because I think my hair loss has stabilised ( hopefully ).

[Al - Moderator]

Bill, can you clarify this? I thought the whole point of Finasteride was to try and prevent further hair loss and in some cases to help regrow miniaturised hairs?

 

I think he meant "While hair transplant surgery doesn't require the use of Propecia, a hair transplant on it's own does nothing to stop future hair loss."

[leonilly]

Thanks for the answers so far to all. Here is an album of where I'm at. Imgur: The most awesome images on the Internet

 

I put a filter on a few of the pictures to highlight the thinning, because without the filter it just looks like normal hair. Luckily my hairs are fairly thick and there is a good color match. As mentioned, my father and uncles are NW6. No one progressed to NW7.

[DavidAnderson]

As others have suggested there is not definitive solid answer to give. It comes down to a number of factors and it is imperative that you understand the limitations of surgery should you decide to go ahead especially when not taking medication.

 

As you have tried the medication and had sides I can understand your reluctance to try it again. Is Dr Lindsay wrong for offering you surgery without it no I don't think he is provided that you fully understand the commitment you are getting yourself into.

 

From the photos it is clear you are going to be a 6 in the near future where that ends is uncertain. To have any idea you need to look at the males on both your Mothers and Fathers side to have any clue but even this is not totally reliable.

 

You need to understand the limitations of your donor and plan accordingly, to me that is giving you a 40-50 year old hairline. Most guys in their 20's are not happy with this which is why many clinics won't operate on patients so young without meds.

 

Of course you can create something lower now and make you happy short term but what about the future? What if your sides drop and the hairline becomes disconnected, what if the sides recede and the front is top heavy.

 

One thing is certain that more surgery will be required but it depends how much donor you have to chase this loss and whether you have enough for more than a light dusting of hair in the crown. There are many factors to take into consideration. I would suggest you visit some Doctors in person for assessments and get some more opinions. All the best.

[leonilly]

David, thanks for the reply. Very very helpful.

 

I don't mind a high hairline, I just don't want to be bald. What are the hair characteristics that would make a successful hair transplant for a NW6?

[Stig]

Bill, can you clarify this? I thought the whole point of Finasteride was to try and prevent further hair loss and in some cases to help regrow miniaturised hairs?

 

He is talking abut surgery alone (without taking Propecia) ... does nothing to prevent future hair loss.

[DavidAnderson]

Leonilly,

 

Happy to help.

 

A NW6 ideally is going to have some miniaturized hair already in the area that can be saved. This will make a big difference on what the final result will look like if you can keep this hair.

 

Your sides where the permanent hair is currently appear to be quite high this is a very good thing as of course it means there is less area needed to be covered.

 

The down side to this is of course that they sides have a real risk of dropping leaving the transplanted hair disconnected.

 

Good donor density above 75-80 in the donor per cm2 and at least a medium to medium-coarse hair caliber. Lower contrast between hair and scalp so not black hair and pale skin. A wave or slight curl is better than straight hair.

 

If considering FUT then above average scalp laxity which is the movement of skin at the sides and back of your scalp. The more movement means the surgeon can take a wider piece of tissue containing more grafts.

 

A small head! yes less donor supply but less grafts needed as a result, less grafts the lower the cost.

 

And finally realistic expectations.

[mahhong]

All great advice here. It's not so much you're getting contradicting claims, it's just a difference of medical opinion. Some doctors will perform operations that others won't, or feel comfortable making suggestions that others wouldn't.

 

It's all to do with expectation, really. If you're genuinely going to be happy with decent coverage and a mature hairline, and you're fully understanding there may be limits on the density that can be achieved and the high likelihood for multiple procedures to keep up with continued loss (and a plan that errs on the side of caution knowing that), there is a possibility you could develop a modest but effective surgical plan to achieve your goals.

 

As many have said, the main issue a youthful, dense appearance is unlikely to be realistic, and the big issue for many young men (<30) is they are either unhappy with their outcome, or they go in desperation to a doctor that fulfils their short-term goals at the risk of long-term problems (continued loss, not enough donor to meet demand, irregular hair etc.).

 

Another potential option to research is SMP (scalp micropigmentation). This is used primarily on shaved heads (very shaved) and is a usually temporary tattoo that gives the illusion of a man with a full head of very short, shaved hair (apologies if I'm telling you something you already know). It can also be used to create the illusion of density in conjunction with hair transplants, but this is trickier and needs more planning. However it may give you a youthful looking hairline whilst retaining the shaved look (although you'd probably have to shave down shorter).

 

The main thing is hair restoration is essentially a life commitment. You may need several procedures, you may need to have very modest goals, you may not be able to achieve all you want to achieve and the lack of stabilisation with Propecia throws even more uncertainty into the mix (especially because you're quite young and heading for the higher degree of hairloss).

 

The main thing is you probably have to presume you're heading for quite an advanced degree of balding (particularly without medication), see what is realistic for what you can afford and the sorts of characteristics you have (donor density, hair type etc.) and then have a look at examples from doctors that are likely to be closest to yours. With this information you can then decide if your goals can be realistically met and search for a reputable doctor that understands your ambitions and shares your belief they can be met. The two of you can then execute the plan (if it's possible) and hopefully your results will match your ambitions. If that's likely to be impossible, however, then of course you need to be frank with yourself about whether it's worth embarking down the hair transplant path.

[ontop]

Mahhong..

Excellent advice there buddy....well done!

[leonilly]

Thanks for the great advice Mahhong . Yes I have modest goals. I'm current a NW4/5 . I'd be happy to even get back to an NW3.

 

But based on the general consensus, I think Im going to rock the shaved head for a couple more years before deciding what to do.