Compare your Consult with the Docs- thanks!

[TimeForAction]

Hello everyone,

 

First off I just wanted to thank all of the community that have inspired me to consider this transplant journey and to start this topic. I have a learned a lot from many of you, but still have a lot of learning to do, thus my first post to ensure my thinking process is correct.

 

 

Vital Statistics

-I am 40 yrs old diffuse thinner

-I live in Northeast United States about 3 hours from NYC

-My initial thought was FUE because I like to machine buzz my hair to a 1 on the sides/back.....even when I had much more hair on top. For the last 4 years due to hair loss, I have been forced to machine buzz to a 2 on top, to go along with the 1 on the sides/back- see attached pictures below.

 

 

Family history:

-Mother has some female hair loss and much of her family is bald/balding. Her brother and son(my cousin) are slick bald.

-Father is a NW3 but he is also almost 70 now, he has essentially had a lifetime of age appropriate thinning with no thinning noticeable until his late 40s and 50s.

 

 

Medications:

-I am currently only on Propecia 1mg daily, and it has done an excellent job at stabilizing my hair loss (for several years) and I plan to continue using it indefinitely.

-I also tried Dutasteride and RU, both causing me sides (erectile) that had me depressed, fortunately I am Ok with propecia.

-I have tried minoxidil liquid as well as Rogaine foam, but both have caused me scalp irritation and even then I stayed on them, but no significant effect, so I have since dropped it.

 

 

 

 

I have consulted with:

1. Dr. Carlos Wesley as I felt he offered the best FUE option in my region (Northeast US). He recommended 2500 FUE to the frontal zone only (See pictures below)

 

 

2. Dr. Rahal as my parents live in Ottawa! He quoted FUE 2500 frontal zone only, but at approximately 1cm higher hairline than Dr. Wesley.

 

 

I plan to consult with:

3. Dr. Konior (because his scars are excellent) for his opinion on FUT vs FUE, with the prerequisite that back/sides are machine buzzed to a 2 (MAX, preferable <2). Perhaps I should reconsult with Dr. Rahal re: his FUT scar and limitations on buzzing hair.

 

4. Dr. Erdogan....best FUE results I have seen IMO, and only person I am willing to go overseas for (although current unrest in Turkey makes me sad)

 

 

 

Goal:

TBH I rather enjoy keeping my hair short. Even when I had thicker hair, my gf used to tell me to cut my hair short. She was probably onto something. Therefore my intention with a HT is not to start having crazy hairstyles, rather just to keep a clean short haircut (and possibly even continue to machine buzz the sides and top), but I'd love to have a solid hairline to frame the face, along with some increased density in my anterior crown (not interested in full crown restoration as it would be impossible). I like Dr. Wesley's hairline although I wished it was about 0.5cm lower and I would have been lets do this- although he was not willing to address the anterior crown at this time. That is where the allure of Erdogan comes in, as I see many of his patients with frontal/hairline and some anterior crown work simultaneously in their first pass.

 

 

While the pictures below do not have concealer, I do currently buzz and use concealer and it makes a significant difference. Because of my goals/keeping my hair short, I am also considering HT with SMP.

 

 

Questons:

1. What do you guys think of a frontal FUE and SMP?

2. What do you guys think of FUT and buzzing hair ....someone like Konior (Rahal? others?) may be able to pull it off, or is it too risky a venture?

3. Do you think committing to a machine buzzed hairstyle on sides AND top allows one to go with a lower HT hairline?

3. What do you guys think of Erdogan's aggressive approaches? Does he tend to overharvest resulting in thinned donor (my biggest concern with ASMED, as I do value the aesthetics of a nice buzzed sides/back, just as much as the top)

4. Are there other minoxidil preparations out there that would be less irritating to my skin?

5. I am open to consider all possibilities, Other general thoughts/suggestions?

 

 

 

Responses are much appreciated!

[Dolph1969]

Your donor and hair characteristics look excellent I would not lower the hairline point at all. I think Rahal was correct when he quoted raising it a cm. I would consider rahal, as yours is mainly going to be the frontal 3rd and hairline. IMO Turkey is just too unstable at the moment, but again, it's your call. Good luck with whoever you go with.

[1978matt]

I'm biased but FUE with Konior as he manages the donor area better than anyone.

 

I don't see any need for you to consider FUT. It does not fit your profile quite honestly. You have to go into FUT assuming grade 4 or grade 3 at best.

 

Hairline looks about right give or take a bit like Rahal suggests.

[n00b]

Your donor looks great. any idea how thick is your donor hair is?

[mahhong]

I agree that FUE would appear to suit your goals better than FUT.

 

You do have great donor (by the looks of it) and still some decent hair in the balding area, so it's good you're tolerating finasteride as hopefully that will keep things stable.

 

The balding area looks fairly substantial, in the sense that you look like you're probably ultimately heading towards a Norwood 5 or 6, so I do think caution is warranted when planning procedure(s). Particularly in designing the hairline and how you approach the crown. I know it's tempting to be ambitious and find a doctor who will give you what you want, but in the long run if your hairloss does continue you'd rather a more conservative hairline with enough donor to meet your goals, rather than a lower hairline and the concern about a black hole opening up in the crown or the miniaturized fringes of your hair.

 

I think if you did want to address the front and the back, you would probably want to do that in two procedures with a bit of time between them to assess the situation. That would probably mean a frontal third pass first, and then once the "dust has settled" on that procedure after about 12 months or so, maybe seeing where your crown and mid-scalp is at and how best to address that.

 

If you're stable on finasteride and fairly cautious, I don't see why you couldn't address the front and the back in a couple of passes, but maybe being fairly conservative in the crown so your donor doesn't get sucked up too much there.

 

SMP could certainly help. If you can get decent density in the front and decent coverage in the back, SMP could help blend all that together, reduce the contrast between scalp and hair and make it look thicker and fuller. You'd have to plan that all out with your doctor and the SMP technician to see if you were a good candidate, but as you're diffuse thinning and look like you have good donor, I would imagine SMP combined with HT could be a real option.

 

I don't have any experience with Erdogan and his harvesting, but I would stress the need to plan conservatively. With most advanced cases, the best strategy is to proceed slowly and, if you have any chance of full restoration, it's likely to be through careful planning execution over two or more procedures - where you have the time to really assess how things are going.

 

If your aim is full restoration I'd imagine you'd need to be stable on medication (it sounds like you are), and then look at fixing the front third first, building a strong but moderately conservative hairline and mid-scalp, and then seeing how your donor looks and your hair looks with a view to a second (and maybe third) procedure if the capacity is there. It may mean you don't truly reach your goals straight away, but in the long run it's the best chance you have of getting a solid head of hair without compromising donor or overreaching with your goals.

 

It sounds like you're a realist though, and you do look to have good characteristics and a stable enough platform to meet your goals, particularly if you're willing to do it pragmatically and step by step. Good luck!

[Spanker]

I agree FUE for you, but I don't think anyone can guarantee that you can shave to a 2. Especially in you eventually need more than 2500. It happens, but to guarantee would be setting you up for failure. If you would regret a HT I'd you had to go to a 3, I would reconsider.

[Stig]

You should also give Lorenzo a look. He is the best FUE surgeon out there. I would consider Lorenzo, Erdogan, Rahal, or Ferudini.

 

Listen to Rahal re the hairline. He is the hairline King after all.

[TimeForAction]

Your donor and hair characteristics look excellent I would not lower the hairline point at all. I think Rahal was correct when he quoted raising it a cm. I would consider rahal, as yours is mainly going to be the frontal 3rd and hairline. IMO Turkey is just too unstable at the moment, but again, it's your call. Good luck with whoever you go with.

 

 

Hi Dolph, thanks for taking the time to respond.

 

Yes, it is too bad about Turkey, such a shame. My parents are off on their first ever cruise this week as a retirement celebration, and the Istanbul stop was cancelled due to the unrest. They were pretty disappointed. I hope to visit someday. I was hoping to go for the HT this fall, so you are right it is just too unstable at this time in Turkey.

 

I was definitely a bit disappointed with Rahal's higher hairline than Wesley's but staying at my parents house in Ottawa while recovering would be very convenient. I think Rahal was quite busy that day during my consult. He didn't take much time with me, but my hair loss is very stable on propecia with no further loss, although I realize that is no guarantee for the future which is why Rahal went higher...

[TimeForAction]

I'm biased but FUE with Konior as he manages the donor area better than anyone.

 

I don't see any need for you to consider FUT. It does not fit your profile quite honestly. You have to go into FUT assuming grade 4 or grade 3 at best.

 

Hairline looks about right give or take a bit like Rahal suggests.

 

Hi Matt, this is very good information for me to read, especially coming from someone who has had FUT with Dr. Konior. This essentially seals the deal for me RE: FUE vs FUT. Thanks very much for responding.

 

I am wondering during your time with Dr. Konior, did you guys discuss FUE? I know there are many amazing FUT results from him, I am wondering about FUE though? Does he do a lot of them, and did you get to see any pics?

 

I think I will still consult with him regardless, since he is such an expert on HT surgery.

[TimeForAction]

Your donor looks great. any idea how thick is your donor hair is?

 

 

Hi n00b,

 

I was not expecting all these comments about my 'excellent' donor hair. I am pleasantly surprised, thank you.

 

These pics are taken at. Dr. Wesley's office, he just said I had average to perhaps a bit above average donor hair, but he certainly did not say anything about being excellent.

 

I was quite uninformed when I went for the consult, so I did not even consider to ask about donor hair specifics such as donor hair thickness/caliber, etc...obviously a rookie mistake, and before I discovered this forum.

[TimeForAction]

I agree that FUE would appear to suit your goals better than FUT.

 

You do have great donor (by the looks of it) and still some decent hair in the balding area, so it's good you're tolerating finasteride as hopefully that will keep things stable.

 

The balding area looks fairly substantial, in the sense that you look like you're probably ultimately heading towards a Norwood 5 or 6, so I do think caution is warranted when planning procedure(s). Particularly in designing the hairline and how you approach the crown. I know it's tempting to be ambitious and find a doctor who will give you what you want, but in the long run if your hairloss does continue you'd rather a more conservative hairline with enough donor to meet your goals, rather than a lower hairline and the concern about a black hole opening up in the crown or the miniaturized fringes of your hair.

 

I think if you did want to address the front and the back, you would probably want to do that in two procedures with a bit of time between them to assess the situation. That would probably mean a frontal third pass first, and then once the "dust has settled" on that procedure after about 12 months or so, maybe seeing where your crown and mid-scalp is at and how best to address that.

 

If you're stable on finasteride and fairly cautious, I don't see why you couldn't address the front and the back in a couple of passes, but maybe being fairly conservative in the crown so your donor doesn't get sucked up too much there.

 

SMP could certainly help. If you can get decent density in the front and decent coverage in the back, SMP could help blend all that together, reduce the contrast between scalp and hair and make it look thicker and fuller. You'd have to plan that all out with your doctor and the SMP technician to see if you were a good candidate, but as you're diffuse thinning and look like you have good donor, I would imagine SMP combined with HT could be a real option.

 

I don't have any experience with Erdogan and his harvesting, but I would stress the need to plan conservatively. With most advanced cases, the best strategy is to proceed slowly and, if you have any chance of full restoration, it's likely to be through careful planning execution over two or more procedures - where you have the time to really assess how things are going.

 

If your aim is full restoration I'd imagine you'd need to be stable on medication (it sounds like you are), and then look at fixing the front third first, building a strong but moderately conservative hairline and mid-scalp, and then seeing how your donor looks and your hair looks with a view to a second (and maybe third) procedure if the capacity is there. It may mean you don't truly reach your goals straight away, but in the long run it's the best chance you have of getting a solid head of hair without compromising donor or overreaching with your goals.

 

It sounds like you're a realist though, and you do look to have good characteristics and a stable enough platform to meet your goals, particularly if you're willing to do it pragmatically and step by step. Good luck!

 

 

Dear Mahhong,

 

Thank you for the time you have taken to give such a detailed and extremely informative post.

 

There is so much good information in your post that I can only respond by saying that I will read and reread your words many times before making any major decision, and digest everything you have written.

 

Wise words!....thanks again.

[TimeForAction]

I agree FUE for you, but I don't think anyone can guarantee that you can shave to a 2. Especially in you eventually need more than 2500. It happens, but to guarantee would be setting you up for failure. If you would regret a HT I'd you had to go to a 3, I would reconsider.

 

 

Hi Spanker

 

I always respect your opinions so Your post has certainly made me pause.

 

Hmmm....are you saying that even with FUE, I should be prepared to possibly only be able to buzz to a 3?

 

I always thought that the only real advantage of FUE is that it allows the patient to shave to a 2 or even 1 on he sides/back?

[TimeForAction]

You should also give Lorenzo a look. He is the best FUE surgeon out there. I would consider Lorenzo, Erdogan, Rahal, or Ferudini.

 

Listen to Rahal re the hairline. He is the hairline King after all.

 

 

Hello Stig,

 

I always value reading your posts, and in fact it was one of your posts that led me to discover Erdogan for the first time!

 

I had never considered going overseas until that, its too bad about the situation in Turkey right now. I am aware of Lorenzo, I guess I figured if I was going to go overseas, it would be for an equally excellent doctor such as Erdogan at a more affordable price than Lorenzo. Perhaps I will do an online consult with both.

[mav23100gunther]

Hi Dolph, thanks for taking the time to respond.

 

Yes, it is too bad about Turkey, such a shame. My parents are off on their first ever cruise this week as a retirement celebration, and the Istanbul stop was cancelled due to the unrest. They were pretty disappointed. I hope to visit someday. I was hoping to go for the HT this fall, so you are right it is just too unstable at this time in Turkey.

 

I was definitely a bit disappointed with Rahal's higher hairline than Wesley's but staying at my parents house in Ottawa while recovering would be very convenient. I think Rahal was quite busy that day during my consult. He didn't take much time with me, but my hair loss is very stable on propecia with no further loss, although I realize that is no guarantee for the future which is why Rahal went higher...

 

Hey buddy,

 

Interesting write-up that you found Rahal to be busy during the consultation. I had a very similar experience with him. Read my write-up below. I am sure he would go for a lower hairline if you really wanted. He does draw a hairline the day before the procedure, and leaves the marking on overnight so you can literally sleep on it. He will then give you an opportunity to change it on the day of surgery. I actually never liked his 1st couple of proposed hairlines, and he was very patient in revising them until the 3rd attempt when he nailed it. Interesting enough, looking back on pre-op pictures, I thought the best hairline he drew was during my initial consult with him (2 months before the actual survey). Unfortunately he wasn't able to replicate that one, but I was still very happy with the one we agreed on. You will also get way more attention from him the day before your surgery. He spent an hour with me drawing that hairline the day before compared with a very rushed 10 minute consult the initial consult that I did 2 months before the surgery. I would give him another look, as his hairline work is absolutely outstanding. Also remember that lowering hairlines eat up a lot of grafts. With FUE, you are definitely more limited in your lifetime donor supply of grafts. If you really want to lower your hairline, and need to address density over the rest of your head, you may want to reconsider FUT which provides a higher number of grafts over your lifetime, esp when you FUT until stripped out and then switch to FUE. Did you discuss that with Dr Rahal. I really cannot comment on Rahal's FUE, but agree you should consider the list provided by Stig. I would also add Dr Ron Shapiro and of course Konior, but Lorenzo and Erdogan are really the top FUE surgeons in my opinion. Erdogan may be more open to a lower hairline than Lorenzo though.

 

I really liked Dr Wesley, and he is a great guy, but I don't know he will be able to give you the same density into a lowered hairline that Rahal would. Very good surgeon nonetheless.

 

My write-up

http://www.hairrestorationnetwork.com/eve/181957-dr-rahal-2-245-graft-procedure-fut.html

[1978matt]

Hi Matt, this is very good information for me to read, especially coming from someone who has had FUT with Dr. Konior. This essentially seals the deal for me RE: FUE vs FUT. Thanks very much for responding.

 

I am wondering during your time with Dr. Konior, did you guys discuss FUE? I know there are many amazing FUT results from him, I am wondering about FUE though? Does he do a lot of them, and did you get to see any pics?

 

I think I will still consult with him regardless, since he is such an expert on HT surgery.

 

Yes a bit but you're best off contacting him yourself. He generally replies to emails within a few hours.

 

Have a look at the other Matt ' s thread: http://www.hairrestorationnetwork.com/eve/179036-2075-fue-graft-dr-konior.html

[wibbles180]

Just a little bit of information regards keeping your hair buzzed and thinking about future loss , with your dark skin tone you will almost certainly have white dot scarring in your donor and there is an obvious difference in the recipient between the transplanted and the native hair , I will attatch 2 pictures showing this .

[wibbles180]

Here's a picture of the donor scaring , my only other advise would to go conservative

[TimeForAction]

Hey buddy,

 

Interesting write-up that you found Rahal to be busy during the consultation. I had a very similar experience with him. Read my write-up below. I am sure he would go for a lower hairline if you really wanted. He does draw a hairline the day before the procedure, and leaves the marking on overnight so you can literally sleep on it. He will then give you an opportunity to change it on the day of surgery. I actually never liked his 1st couple of proposed hairlines, and he was very patient in revising them until the 3rd attempt when he nailed it. Interesting enough, looking back on pre-op pictures, I thought the best hairline he drew was during my initial consult with him (2 months before the actual survey). Unfortunately he wasn't able to replicate that one, but I was still very happy with the one we agreed on. You will also get way more attention from him the day before your surgery. He spent an hour with me drawing that hairline the day before compared with a very rushed 10 minute consult the initial consult that I did 2 months before the surgery. I would give him another look, as his hairline work is absolutely outstanding. Also remember that lowering hairlines eat up a lot of grafts. With FUE, you are definitely more limited in your lifetime donor supply of grafts. If you really want to lower your hairline, and need to address density over the rest of your head, you may want to reconsider FUT which provides a higher number of grafts over your lifetime, esp when you FUT until stripped out and then switch to FUE. Did you discuss that with Dr Rahal. I really cannot comment on Rahal's FUE, but agree you should consider the list provided by Stig. I would also add Dr Ron Shapiro and of course Konior, but Lorenzo and Erdogan are really the top FUE surgeons in my opinion. Erdogan may be more open to a lower hairline than Lorenzo though.

 

I really liked Dr Wesley, and he is a great guy, but I don't know he will be able to give you the same density into a lowered hairline that Rahal would. Very good surgeon nonetheless.

 

My write-up

http://www.hairrestorationnetwork.com/eve/181957-dr-rahal-2-245-graft-procedure-fut.html

 

 

 

Mav. A lot of what you say makes sense. I was surprised at how high Rahal's hairline was. Disappointed really, because it certainly would be VERY convenient, given that my parents live in Ottawa, and our family home is there.

 

 

But based on your post alone, I am going to get in touch with Rahal's clinic once more.

Thanks!

[TimeForAction]

Yes a bit but you're best off contacting him yourself. He generally replies to emails within a few hours.

 

Have a look at the other Matt ' s thread: http://www.hairrestorationnetwork.com/eve/179036-2075-fue-graft-dr-konior.html

 

 

 

Well you were right Matt, I sent him an email and he literally got back to be in the wee hours of the morning just a couple hours later.

 

He said he is booked out almost a year!! :eek:

 

I've just sent him photos though, and am anxiously awaiting his thoughts...

[TimeForAction]

Here's a picture of the donor scaring , my only other advise would to go conservative

 

 

Wibbles, thanks for posting these pics, very helpful. I guess I never really considered the dark skin tone factor.

 

 

That looks like a 0.5 buzz. I am thinking of a higher grade buzz. I used to do a 2 on the sides when I had more hair on top. What do you think about a grade 2?

 

Also, you are right the longer I think the more likely I am to go conservative. I think my thought of a lower hairline is out the window. I actually think the hairline drawn in the photos of my original post are quite good.

[matt3480]

I am the other Matt that UK Matt posted the thread of. I've had about 4,000 grafts taken via FUE from Dr. K. My stylist really takes me in tight on the sides and back (I would probably say about a 2 guard) and I don't feel it's noticeable, at all. He is definitely a master at managing the donor area and that's very important in a FUE case let alone on someone who has gotten multiple FUE surgeries.

 

I feel the donor got better over time in terms of appearance. A few months after my first surgery I wasn't confident I would be able to ever go that low but the skin was still healing. I've had 2 with Dr. K now (16 months out on my first and almost 9 months on my second) and I feel the donor looks normal (pre-op condition regarding the color, etc). Skin and scarring can take a year to 24 months to fully heal according to Dr. K. You simply wouldn't know I've had a transplant in either the donor or recipient at this point. I think that's the best compliment you can give a HT surgeon.