Is a HT a good idea if you been on fin for over 10 years?

[azakdan2682]

I am wondering about this. I really want to get a HT for my frontal third/hairline. but I worry about this as my crown has started to thin in the last couple years. No bald spots yet, but can tell it is thinning out. I have switched to Avodart in the last year as I had read that it is good to do if propecia seems to be losing effectivness. Well my NW3 hairline has remained approx them same, it is getting thinner as well. My concern is if I get a HT and it works great in the front, what if the hair surrounding continues to go? Aside from my hairline and crown areas everything else is thick. What do people do in the event that this occurs? They just keep getting new transplants or do they shave it all off and try to deal with the scarring?

[NEWHAIRPLEASE]

Well thats the million dollar question! Of course you could continue to lose hair, having made the switch to Avodart is probably a pretty good move as in thats probably about the best you can do to prevent other future loss.

First, getting with an experienced transplant surgeon would be great..there are obviously many qualified ones on this site! You could not have come to a better place for information. You and your surgeon will be able to line a plan up for you….but to answer your question, YES its possible you will have to have another surgery….

my case for example..

18 yo - 50 micrografts ( 1992 )

19 yo - 500 micrografts ( 1993 ) these two were mistakes by me but I was 18 and losing my hair in my crown,,,

38 yo - 4800 grafts ( 2012 ) Dr Rahal---and this is the best my hair has looked since I was 22.

 

Will I ever need another one? Its always possible….hope that helps..

[azakdan2682]

Well thats the million dollar question! Of course you could continue to lose hair, having made the switch to Avodart is probably a pretty good move as in thats probably about the best you can do to prevent other future loss.

First, getting with an experienced transplant surgeon would be great..there are obviously many qualified ones on this site! You could not have come to a better place for information. You and your surgeon will be able to line a plan up for you….but to answer your question, YES its possible you will have to have another surgery….

my case for example..

18 yo - 50 micrografts ( 1992 )

19 yo - 500 micrografts ( 1993 ) these two were mistakes by me but I was 18 and losing my hair in my crown,,,

38 yo - 4800 grafts ( 2012 ) Dr Rahal---and this is the best my hair has looked since I was 22.

 

Will I ever need another one? Its always possible….hope that helps..

 

 

 

 

 

Thanks, Dr Rahal is who I am looking at as well. I am looking at FUE, due to being in the military and would need to return to physical training within 3 weeks time frame. Aside from that, I still have rogaine to try out. Thanks for the input.

[MAGNUMpi]

Good question, and one that really everyone should consider. We all hope to live to a nice happy old age and not have a HT scars showing through. But what happens in 10-15 years if Fin stops really working?

I guess it would be best to be sure you have AMPLE donor supply because you might be needing that to cover things up in the future. That being said, I notice a lot of older men 60+ who have very thin donor area, basically if they are losing on top they are also eventually thinning out in the donor area also.

Something to consider because even as an older man you dont want to be looking strange with sprouts in front and nothing backing them up.

[mahhong]

I think something you have to remember is that finasteride/dutasteride rarely truly "halt" hairloss. For most men they slow down the rate of hairloss, sometimes significantly, so that for example the amount of hair you would lose over one year naturally may take 3 or 5 or even 10+ years with finasteride. This makes planning procedures and producing consistent, cosmetically acceptable results easier. The more aggressive your balding, the less likely finasteride is to slow the hairloss over time, but for some men that perhaps only have moderate balding, the drug can significantly slow hairloss, so that you might have in your 50s or 60s the hair you were going to have in your 30s or 40s.

 

The bottom line is, though, that for most men hairloss will still continue. It's unlikely that finasteride is losing its effectiveness, it's just that you're not blocking all the DHT and those hair follicles are still "under attack" somewhat because of that (we need DHT, so the drug only blocks about 70% of it). If you were to stop taking fin/dut, you'd likely notice a pretty significant loss of hair, so the drug is still probably working, it's just not a perfect solution.

 

The honest truth about surgical hair restoration is that, once you're on the boat, you're on the boat. Essentially all men, no matter how stable their hairloss seems, must commit to the idea that they may need more than one surgical procedure to meet their goals over time and that, ultimately, even on treatment, their hairloss may progress to the point that they cannot cover every cm2 of their balding with the available donor.

 

That's why most doctors will focus on building a decent density hairline and move back naturally into the midscalp, with much less focus on restoring the crown with any density. That way, if the day comes that you do age and continue to bald, you'll likely have a pretty good hairline and midscalp with a natural fade back towards a bald or thin crown - this will look natural and will likely happen fairly slowly over time. Of course, multiple surgeries down the road could continue to correct further loss - the idea with finasteride is that it will either limit the amount of surgeries you need or significantly extend the amount of time needed between surgeries, so that you may need 2 or 3 over 20 or 30 years instead of 5 or 6.

 

That's also why good doctors will be hesitant to chuck 5,000 grafts into 70cm2 of balding, particularly in younger men. Further loss is always possible, probably even likely in the fullness of time, so a good doctor will focus on rebuilding your hair with maybe 3,000 - 5,000 grafts and try to leave a couple of thousand in reserve for the "rainy day" fund, which is usually needed if the sides of your hair drop or the crown opens up significantly over time and you want to touch those up.

 

Your position sounds like a tricky one; on the one hand it's a positive situation because it sounds like fin/dut is working and you still have a pretty significant amount of hair, which is great. The downside with that is surgical restoration becomes more tricky - you're probably wanting to use a few thousand grafts wisely to build and thicken up a mature hairline and thicken up the mid-scalp a little. The reality is, though, if you do this, you almost certainly need to commit at least to the possibility of more surgery down the line to address further loss - and you also need to plan conservatively and assume the areas that are thinning will one day be gone. Then, with a good doctor you can estimate how much donor you're likely to have in total, how much balding is theoretically possible, and come up with a plan that meets your goals without compromising the basic supply/demand issue common in restoration.

[DavidAnderson]

I think something you have to remember is that finasteride/dutasteride rarely truly "halt" hairloss. For most men they slow down the rate of hairloss, sometimes significantly, so that for example the amount of hair you would lose over one year naturally may take 3 or 5 or even 10+ years with finasteride. This makes planning procedures and producing consistent, cosmetically acceptable results easier. The more aggressive your balding, the less likely finasteride is to slow the hairloss over time, but for some men that perhaps only have moderate balding, the drug can significantly slow hairloss, so that you might have in your 50s or 60s the hair you were going to have in your 30s or 40s.

 

The bottom line is, though, that for most men hairloss will still continue. It's unlikely that finasteride is losing its effectiveness, it's just that you're not blocking all the DHT and those hair follicles are still "under attack" somewhat because of that (we need DHT, so the drug only blocks about 70% of it). If you were to stop taking fin/dut, you'd likely notice a pretty significant loss of hair, so the drug is still probably working, it's just not a perfect solution.

 

The honest truth about surgical hair restoration is that, once you're on the boat, you're on the boat. Essentially all men, no matter how stable their hairloss seems, must commit to the idea that they may need more than one surgical procedure to meet their goals over time and that, ultimately, even on treatment, their hairloss may progress to the point that they cannot cover every cm2 of their balding with the available donor.

 

That's why most doctors will focus on building a decent density hairline and move back naturally into the midscalp, with much less focus on restoring the crown with any density. That way, if the day comes that you do age and continue to bald, you'll likely have a pretty good hairline and midscalp with a natural fade back towards a bald or thin crown - this will look natural and will likely happen fairly slowly over time. Of course, multiple surgeries down the road could continue to correct further loss - the idea with finasteride is that it will either limit the amount of surgeries you need or significantly extend the amount of time needed between surgeries, so that you may need 2 or 3 over 20 or 30 years instead of 5 or 6.

 

That's also why good doctors will be hesitant to chuck 5,000 grafts into 70cm2 of balding, particularly in younger men. Further loss is always possible, probably even likely in the fullness of time, so a good doctor will focus on rebuilding your hair with maybe 3,000 - 5,000 grafts and try to leave a couple of thousand in reserve for the "rainy day" fund, which is usually needed if the sides of your hair drop or the crown opens up significantly over time and you want to touch those up.

 

Your position sounds like a tricky one; on the one hand it's a positive situation because it sounds like fin/dut is working and you still have a pretty significant amount of hair, which is great. The downside with that is surgical restoration becomes more tricky - you're probably wanting to use a few thousand grafts wisely to build and thicken up a mature hairline and thicken up the mid-scalp a little. The reality is, though, if you do this, you almost certainly need to commit at least to the possibility of more surgery down the line to address further loss - and you also need to plan conservatively and assume the areas that are thinning will one day be gone. Then, with a good doctor you can estimate how much donor you're likely to have in total, how much balding is theoretically possible, and come up with a plan that meets your goals without compromising the basic supply/demand issue common in restoration.

 

 

What an excellent post by Mahhong.

 

Correct planning for the future is so important, restoring a conservative hairline that looks natural in the future if the crown does continue to open up is the key. Not using up the vast majority of your donor in just the front to solve your issues now.

[Spanker]

Really, you should transplan like you are an advanced norwood if you see these signs. If it were me and it bothered me I would transplant the frontal 3rd and leave the crown alone, keeping the majority of grafts for the frontal hal . What you are talking about really is a master plan. If you have a good one that you and your doc are confident in, then I say yes, go for it. But it is something you need to be fairly confident in and that will comfort you over the years as your hair continues to thin because you have a plan for what is nex .

[MAGNUMpi]

I think something you have to remember is that finasteride/dutasteride rarely truly "halt" hairloss. For most men they slow down the rate of hairloss, sometimes significantly, so that for example the amount of hair you would lose over one year naturally may take 3 or 5 or even 10+ years with finasteride. This makes planning procedures and producing consistent, cosmetically acceptable results easier. The more aggressive your balding, the less likely finasteride is to slow the hairloss over time, but for some men that perhaps only have moderate balding, the drug can significantly slow hairloss, so that you might have in your 50s or 60s the hair you were going to have in your 30s or 40s.

 

The bottom line is, though, that for most men hairloss will still continue. It's unlikely that finasteride is losing its effectiveness, it's just that you're not blocking all the DHT and those hair follicles are still "under attack" somewhat because of that (we need DHT, so the drug only blocks about 70% of it). If you were to stop taking fin/dut, you'd likely notice a pretty significant loss of hair, so the drug is still probably working, it's just not a perfect solution.

 

The honest truth about surgical hair restoration is that, once you're on the boat, you're on the boat. Essentially all men, no matter how stable their hairloss seems, must commit to the idea that they may need more than one surgical procedure to meet their goals over time and that, ultimately, even on treatment, their hairloss may progress to the point that they cannot cover every cm2 of their balding with the available donor.

 

That's why most doctors will focus on building a decent density hairline and move back naturally into the midscalp, with much less focus on restoring the crown with any density. That way, if the day comes that you do age and continue to bald, you'll likely have a pretty good hairline and midscalp with a natural fade back towards a bald or thin crown - this will look natural and will likely happen fairly slowly over time. Of course, multiple surgeries down the road could continue to correct further loss - the idea with finasteride is that it will either limit the amount of surgeries you need or significantly extend the amount of time needed between surgeries, so that you may need 2 or 3 over 20 or 30 years instead of 5 or 6.

 

That's also why good doctors will be hesitant to chuck 5,000 grafts into 70cm2 of balding, particularly in younger men. Further loss is always possible, probably even likely in the fullness of time, so a good doctor will focus on rebuilding your hair with maybe 3,000 - 5,000 grafts and try to leave a couple of thousand in reserve for the "rainy day" fund, which is usually needed if the sides of your hair drop or the crown opens up significantly over time and you want to touch those up.

 

Your position sounds like a tricky one; on the one hand it's a positive situation because it sounds like fin/dut is working and you still have a pretty significant amount of hair, which is great. The downside with that is surgical restoration becomes more tricky - you're probably wanting to use a few thousand grafts wisely to build and thicken up a mature hairline and thicken up the mid-scalp a little. The reality is, though, if you do this, you almost certainly need to commit at least to the possibility of more surgery down the line to address further loss - and you also need to plan conservatively and assume the areas that are thinning will one day be gone. Then, with a good doctor you can estimate how much donor you're likely to have in total, how much balding is theoretically possible, and come up with a plan that meets your goals without compromising the basic supply/demand issue common in restoration.

Well said.

[ArochaHair]

I agree, a very good post but I disagree with the idea that finasteride does not actually stop hair loss for some patients because of the countless cases where thickening has occurred, sometimes even to the point of being a dramatic 180 degree turn around. It is wise to never assume this will be the case but sometimes it really is.

[azakdan2682]

Well my biggest concern is scarring and us why I am choosing FUE. I just want to have the option of shaving my head if it goes down that way in the future, if a transplant gave me good coverage for another 10-15 years, I say it would be worth it, ESP if I can enjoy a great hairline and a mostly full head of hair for some time, as I have not had that since a very young age. I have noticed that people bald weird regardless and have seen guys that have a perfect hairline, but bald from the back to the front, which is what I would imagine what it would look like if hair continued to bald in non transplanted areas. I think that yes, dut is currently working for me in slowing down balding to a crawl, I guess I'm more afraid of hitting a dramatic loss if it just starts to stop working and then having nothing but implanted hair while I'm still in my 30s. I tried the bald thing for a bit and I hated it, if I liked it, I would probably be ok, I had girls into me still, but I couldn't get over what I saw in the mirror.

Edited July 30, 2016 by azakdan2682