Finally considering surgery after 12 years (long post)

[writehairline]

Hi there,

 

New member, first-time poster, longtime lurker on forums like this.

 

I'm 31 y/o, been slowly losing my hair since I was 19. I had shaven my head when I was 18, and as it grew back, I noticed something was off. Of course family and friends all assured me nothing was wrong, but no one knows the hair on someone's head like the person under it.

 

I went to a dermatologist, and sure enough, she said "don't listen to your family, you absolutely have male-pattern baldness." I was devastated, but thankfully was able to get on Propecia from an early age.

 

Fast-forward 12 years. I never regrew hair with Propecia, but I'm sure it slowed it down my hair loss. I had very slow loss for about 5-6 years, at which point I started incorporating Rogaine foam into my daily regimen.

 

The last 3 years though have seen even more accelerated loss, so I switched to Dutasteride. It's hard to say at this point if loss has stopped entirely, but even if I maintained what I have, my hair line is very weak and going out everyday is an entire process of Rogaine + blowdrying + hair product to create the illusion that I'm treading on very thin hair.

 

I don't know if it's my genetics or a result of the decade of Propecia, but I have both a receding hairline and very diffuse loss. On one hand the hairline makes it look like I might have more hair than I do, but I'm worried it also poses a challenge as surgery would mean not just strengthening/filling in my hairline, but also filling in the back and crown.

 

So here's where I'm at: I looked at doctors in Chicago, and have felt very "eh" about most of what I've seen, but kinda figured that's how it goes with transplants these days.

 

But as I read through forums, three doctors caught my attention (if their photos are accurate and testimonials aren't sponsored):

 

Dr. Konior in Chicagoland

Dr. Rahal in Toronto

Dr. Shapiro in Minneapolis

 

In an ideal world, here's what I'd get out of transplants:

* Stronger, lower hairline and temples

* Crown and vertex filled in

 

Here are my questions:

* What are people's opinions on results I could achieve if I'm looking at FUE? (I don't want a big scar strip in the back of my head)

* Given my age (31), where I'm at with thinning, and that I've been on Propecia all these years, would transplant be fighting a losing battle?

* Lots of doctors (whose photos I wasn't as impressed with) seem to advocate using Artas. What's the latest thinking on this, and is there any reason doctors still believe "feel of the hand" can out perform the benefits of a machine analysis?

* Outside of Konior, I'll have to travel for a consultation, follow up, etc. I make a decent living for a 31 year old, but I'm not rolling in money. How do people travel for these surgeries? Do they have to make multiple trips across the country (or world in some cases) to get FUE?

 

Anyway, sorry for the long post, but this is the closest I've ever come to making the plunge, and any and as much info as possible would be very appreciated.

 

You can see the progression of my hair below (shaved head at 20, hair at 24, unblowdryed at 30, blowdryed with product at 31) (un-blowdryed), and the kind of illusion I can create with it when blowdryed and with product.

 

Thanks so much!

[DavidAnderson]

Are you looking to fill in the hairline and crown? do you have any dry photos from above?

 

I personally wouldn't do anything to the hairline as it is already quite low and you are setting yourself up for a huge area to cover should the hairline continue to thin. It also look great front on currently. It might be appropriate to do something to the crown depending on your donor but I would try to see all the 3 docs you have mentioned in person as they have great reputations for a reason.

 

Start of with seeing Dr Konior as I understand he will give you some very honest advice. You are a diffuse thinner as you say and need to be careful about shock loss when placing hairs among all that native hair.

[Melvin- Admin]

* What are people's opinions on results I could achieve if I'm looking at FUE? (I don't want a big scar strip in the back of my head)

 

I had more hair loss than you currently have (we're the same age) and I've only had FUE, it can certainly be done, but will be very costly if you stay within the U.S.

 

* Lots of doctors (whose photos I wasn't as impressed with) seem to advocate using Artas. What's the latest thinking on this, and is there any reason doctors still believe "feel of the hand" can out perform the benefits of a machine analysis?

 

I personally don't subscribe to the idea that one method is better than the other, manual, motorized, artas, they are all just tools, if in the right hands they can all deliver good results. I think the general consensus is that manual is better, IMO I think it depends on the surgeon and what they are comfortable with, I honestly believe you could get good results with either tool it just depends on how good the surgeon is at using the specific tool.

 

* Outside of Konior, I'll have to travel for a consultation, follow up, etc. I make a decent living for a 31 year old, but I'm not rolling in money. How do people travel for these surgeries? Do they have to make multiple trips across the country (or world in some cases) to get FUE?

 

Most set up skype consultations with the doctors and travel once to have their procedure. I think if you're only interested in FUE and you have a budget, your best option is to seek out treatment in Europe, particularly Belgium and Spain, you can look at Dr. Lupunzula, Dr. Feriduni, Dr. Bisanga, Dr. Lorenzo, Dr. Cuoto. All of which will be cheaper than Dr. Konoir.

 

With that said, I don't think you'll find a more respected surgeon than Dr. Konoir. Given that you already live in Chicago, I think it would be worth it to spend a little extra money and save yourself the hassle of having to travel. I stayed fairly local for my procedures, I live in the LA area and traveled 5 hours away to the SF bay area to have my procedure. Could I have saved some money traveling abroad? sure but then there is a convenience factor to consider, if you can achieve good results conveniently close why not, of course this is just my thinking.

 

I also agree with David, don't lower your hairiline, you are still losing hair even on Dutasteride, that means you are highly sensitive to DHT, I think its clear you will be a future Norwood 6 eventually even with the meds, plan your surgeries carefully and plan for the future, you want to look good at 41, 51, 61 etc.

[writehairline]

@David, I'd really love to strengthen the hairline (when sunlight is shining on it, you can see straight through the the scalp all over the top of my head, and you can easily shove a pinky finger through parts of my hairline without even touching another hair), fill in the crown, and not "lower" the hairline but not have the pizza-slice shape I have right now, have something a little straighter/with temples filled in.

 

See attached for a photo from today. But as I mentioned, this is with product, blowdryed, lots of magic I put into looking that full. If my hair was buzzed you'd be able to see much more clearly how thin it is.

 

@HT thanks for the info! How do you determine if someone's going to be a Norwood 6? What's your opinion on where I'm at now?

[Melvin- Admin]

You already did what you have to do to determine whether you will be a norwood 6, you wet your hair and took a picture under the light. You have what is described as diffuse loss, this means that you're not really receding you are miniaturizing all over,

 

I have the same exact hair loss pattern you can see in my profile, the difference is I can't tolerate Finasteride much less Dutasteride so the balding process was quick. When you have diffuse loss it is difficult to accurately gauge your pattern because it is not classified on the Norwood scale.

 

I thought for a long time I was a Norwood III V until shaved my head and realized I could see a horse shoe pattern, when you see the horse shoe pattern of hair that is miniaturizing that is an indication of whats to come. I know this may be difficult to hear, but it's the truth, even with meds the hair on top will eventually go, now I'm not saying it's going to happen anytime soon, it can take decades, but it will happen.

 

You have to plan accordingly, assume that hair is already lost, that's why it is so important not to lower the hairline or bring in the temples to much, because when you're 50 you may not have enough donor to make up for the rest. When you're 50 having a mature hairline with good density will look better than having a really youthful hairline with everything behind it thin. You have to also consider that eventually even your transplanted hair will thin, why? well that's because you still have a lot of native hair that will eventually be lost, so the transplanted hairline would appear thinning again. You would be setting yourself up for additional surgeries using up a lot of finite grafts for one small area.

 

In closing, I don't think you should do anything, you're not necessarily a kid anymore let's face it we're over 30, the need for a low juvenile hairline is not really necessary, you can easily get away with using a small amount of toppik in the crown and look like you have a full head of hair, remember hair transplants are only "Illusions" they do not match original density hair for hair, you already have the illusion of a full head of hair so why get any work done. Wait until you no longer have the illusion of a full head of hair to get work done.

[gillenator]

writehairline,

 

Let me first commend you on being a "longtime lurker" in these online communities and for educating yourself in this field of hair restoration.

 

A couple of things. You're still young but not too young for the procedure. What I mean by "still young" is that you have many years ahead of you in dealing with MPB and based on the photos, you still have decent hair volume however along with that, more to lose as you already know.

 

Having said that, I would not go too high density in restoring your crown. It will likely open up further with more loss and if you keep the density reasonable, you will have better donor management for the upcoming years when you need more work.

 

You may want to consider some beard hair in that crown area to blend which can potentially save more scalp donor for the frontal zone. You definitely have a diffused loss pattern and so you want to plan your restoration accordingly.

 

I totally agree with HTSoon regarding robotic FUE or manual FUE. It really does come down to the experience and proven skill of the surgeon. None of us want any scarring and if your goal is to one day wear your hair at a buzzed hair style, I can see why you prefer FUE. Just keep in mind that you will need a fair amount of work overall and there is no guarantee that FUE scarring would not show.

 

I also agree to not lower your hairline. Again, donor management is and will always be a crucial consideration for your lifetime planning and I said earlier, you have many years ahead of you to plan for.

 

All 3 docs you are considering are good IMHO. It will really come down to who's work you like the most with other patients who have similar hair characteristics and loss patterns. And the inter-personal relationship between you and the doctor is important as well. Will the right doctor be willing to tell you things you may not want to hear but at the same time are in your best interest "or" is the doctor just willing to do whatever you wish and not prepared to do a lifetime plan with you?

 

If I were in your shoes, I might just go with 500-700 grafts in the crown area for now and just strengthen my hair line without lowering it. I think you would be surprised how nice that would look. Your crown would not look bald, maybe a little thin but you can always use concealers to make it look thicker. Then maybe do between 1200 and 1500 grafts in the frontal zone...that's it for now.

 

Let it all grow and see what you think. stay on the meds and see where your loss goes in the coming years before having any more work done.

 

Sound like a plan? Either way, wish you the best in your upcoming procedure...

[KO]

All three doctors are great, but I feel each is best at Strip surgery. Konior is great, and well respected on the forums, and of the three I prefer him, but he has a long waitlist of about a year. Have you considered traveling abroad or are you planning on staying in NA? FUE is pretty expensive here.

 

ARTAS is really interesting. While it started out as a harvesting tool, it actually now makes recipient site incisions as well (!). It may well be the future of surgery, but I personally am not 100% comfortable in going with it now. What's also unclear to me is how ARTAS results differ from surgeon to surgeon...does it commoditize the surgeon? I'm not sure. Personally, I'd like the technology to continue maturing...

[milo12]

All three doctors are great, but I feel each is best at Strip surgery. Konior is great, and well respected on the forums, and of the three I prefer him, but he has a long waitlist of about a year. Have you considered traveling abroad or are you planning on staying in NA? FUE is pretty expensive here.

 

ARTAS is really interesting. While it started out as a harvesting tool, it actually now makes recipient site incisions as well (!). It may well be the future of surgery, but I personally am not 100% comfortable in going with it now. What's also unclear to me is how ARTAS results differ from surgeon to surgeon...does it commoditize the surgeon? I'm not sure. Personally, I'd like the technology to continue maturing...

 

Hello KO,

 

I looked at Konior's results. He seems like a good doctor but he does not add enough density as other doctors do. Additionally I reviewed Rahal and noticed that he chooses to do safe cases. In other words, he works on patients who are not that bald. Sort of like "cheating" if you will.

 

As to ARTAS, I am not fond with the tech either. On the few sites that I looked at, the results looked far from impressive. The tech leaves much to be desired at this point. Could you recommend a few doctors who perform ARTAS well?

[hsrp10]

Sorry I'm not clear on the current state of your hairline (but will try to relook again anyway) but I wouldn't lower the hairline in order to plan properly for future hair loss, but you could transplant into your existing hair for added density boost though.

 

Both Konior (stick and place technique) and Shapiro excel at that.

 

Also stay away from Artas and robotic fue, and go with manual FUE if you choose FUE.

The docs you mention do manual FUE which is already a good start. As KO mentioned there are more affordable manual FUE options in Europe.

[milo12]

I would say that Dr. Hasson and Erdogan provide the best hair density in the industry right now. I would throw in Dr. Baubac in that list given more info. Everyone else safe touch ups that appear like patients have dense hair when in actuality they do not have density.

[hsrp10]

Yeah but this not your thread, OP should go conservative in consideration of future hair loss.

I don't think an aggressive approach is best here.

[milo12]

Yeah but this not your thread, OP should go conservative in consideration of future hair loss.

I don't think an aggressive approach is best here.

 

There is no such thing as ownership of a thread. Threads are made for public members to opine on, they are not property. OP should be given all the opinions and info offered to him so he can personalize a solution to meet his needs not anyone else's.

[hsrp10]

OP has lost or is losing his hair all the way back to the crown, if in your expert opinion you recommend going aggressive and very dense in such cases, let me me know how you'd plan for future loss going forward.

 

thanks

[milo12]

Well since you have appointed yourself as his doctor I will let you advise him what to do.

[hsrp10]

Well since you have appointed yourself as his doctor I will let you advise him what to do.

 

Sorry I'm not clear on the current state of your hairline (but will try to relook again anyway) but I wouldn't lower the hairline in order to plan properly for future hair loss, but you could transplant into your existing hair for added density boost though.

 

Both Konior (stick and place technique) and Shapiro excel at that.

 

Also stay away from Artas and robotic fue, and go with manual FUE if you choose FUE.

The docs you mention do manual FUE which is already a good start. As KO mentioned there are more affordable manual FUE options in Europe.

[Melvin- Admin]

Well since you have appointed yourself as his doctor I will let you advise him what to do.

 

Hmmm I think sting is right.

[milo12]

Hmmm I think sting is right.

 

If you want to believe him go ahead I will not stop you. But at least voice your opinion over pms. This is a serious thread about someone needing help and I do not think he would want it disrupted.

[milo12]

Sorry I'm not clear on the current state of your hairline (but will try to relook again anyway) but I wouldn't lower the hairline in order to plan properly for future hair loss, but you could transplant into your existing hair for added density boost though.

 

Both Konior (stick and place technique) and Shapiro excel at that.

 

Also stay away from Artas and robotic fue, and go with manual FUE if you choose FUE.

The docs you mention do manual FUE which is already a good start. As KO mentioned there are more affordable manual FUE options in Europe.

 

That is fine, I can accept that. Just keep in mind that all I am doing is offering him help from a different angle. I did not know to what depth his current condition was given his norwood.

 

Konior is fine. Bernstein would also help "stretch" out the grafts over the area to create that illusion of coverage. As to density I leave that up to him to decide if he wants to go down that route or reserve if for later on with another doctor with expertise in that area.

 

After reading up on ARTAS I do agree that it is still too early in this tech to go in wuith that method. Manual is still the better choice over it.

[DavidAnderson]

@David, I'd really love to strengthen the hairline (when sunlight is shining on it, you can see straight through the the scalp all over the top of my head, and you can easily shove a pinky finger through parts of my hairline without even touching another hair), fill in the crown, and not "lower" the hairline but not have the pizza-slice shape I have right now, have something a little straighter/with temples filled in.

 

See attached for a photo from today. But as I mentioned, this is with product, blowdryed, lots of magic I put into looking that full. If my hair was buzzed you'd be able to see much more clearly how thin it is.

 

@HT thanks for the info! How do you determine if someone's going to be a Norwood 6? What's your opinion on where I'm at now?

 

Hair looks great with the magic styling, is that with hair fibres of just with hair styling product? if that is just product then I would not transplant into the crown as you will only be likely to replace miniaturised hair for transplanted as I expect you have all the hair still there it is just that Propecia has prolonged the life all this time. If you had not been on the medication I expect you would have lost a great deal more hair by now.

 

To me to you are at that difficult stage for a transplant and I am not sure you should do anything just yet. To be safe I would consider adding density behind your existing hairline and not trying to follow the current shape.

 

By doing this you will hopefully take away that see through look further back into the scalp but by retaining a perfectly natural hairline for now. I could only see if this was possible in person.

 

Hair transplants for most are all about having to style to get the best possible look and won't look strong when wet or under bright light. You are currently doing ok when styled and I agree with HTsoon that you should hang fire all the time you can pull off a decent look which you are.

[KO]

I would consider Jose Lorenzo in your case. He's really good at implanting in between native hair, with tons of cases published, and he has more of a "hairline to crown" habit, rather than frontloading grafts.

[milo12]

I would consider Jose Lorenzo in your case. He's really good at implanting in between native hair, with tons of cases published, and he has more of a "hairline to crown" habit, rather than frontloading grafts.

 

Hello KO,

 

Who whould you say is better at creating density, Lorenzo, Dorin or Erdogan?

[writehairline]

Hair looks great with the magic styling, is that with hair fibres of just with hair styling product? if that is just product then I would not transplant into the crown as you will only be likely to replace miniaturised hair for transplanted as I expect you have all the hair still there it is just that Propecia has prolonged the life all this time. If you had not been on the medication I expect you would have lost a great deal more hair by now

 

Man, I had no idea the wealth of information (and quick replies) I'd get on here. Thanks everyone!.

 

@David, my regimen is post-shower apply Rogaine foam throughout the entire top scalp (I was told that they only approved it for the crown because that's what the trials focused on), and once it's through my hair, I blow dry it (I know that probably makes it lose its effect since most of it is dried into the hair and not the scalp, but the heating of the alcohol in there seems to be what helps volumize), then I style with a thick paste from Floyd's or Axe.

 

All the pictures below are from the last year. I also like to mess with my hair a lot, including this pink/bleached dye job from the past summer, which seemed to give it a visual layer of volume.

 

So I've never used fibres, what do those do exactly? Also, why would the crown not help if the transplanted hair is just replacing miniaturized? Wouldn't it be placed along with the miniaturized?

[hsrp10]

I think you're hair looks pretty good including hairline.

Added density boost with one of the surgeons mentioned would be a good move.

 

Be careful about the dye/bleach as it could damage your hair.

[hsrp10]

Btw the poster making claims that Konior does not achieve density is false. I let it slide initially as I didn't want to take away from the thread.

 

Konior is a conservative surgeon for solid future planning, and you have to take hair characteristics individual response to Fin etc into consideration.

 

Sam Spade's dense results:

http://www.hairrestorationnetwork.com/eve/167769-3950-fut-amazing-dr-konior-10.html

 

Spanker's dense results:

https://www.hairtransplantnetwork.com/blog/home-page.asp?WebID=2514

 

My own dense results when I let my hair grow longer and was on Fin long term:

http://www.hairrestorationnetwork.com/eve/attachment.php?attachmentid=100011&d=1477810459

 

There are many others but you get the point.

Edited January 26, 2017 by hsrp10

[writehairline]

On one hand I have people telling me my hair looks good, on the other I have people telling me I'm doomed to be a norwood 6 and not to touch anything I'm going to try to set up an appointment with a doctor, but this thread has made me equal parts encouraged and discouraged haha.