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Dr. Alan Feller

Why NOT to get an FUE- Interview with Dr. Willaim Reed- by Dr. Feller and Bloxham

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I like this thread!

 

Just one thing, those w/fine hair and a bit lower density w/less avg. hairs per follicle (on avg.) and that are losing their hair at age 25 or younger - watch out!

 

I've been on minoxidil since the early 90's and am now using 30% minox compounded from a pharmacy the last 18+ months, been on propecia since about '96 or '97 and switched to avodart in '02. Use a 400+diode laser helmet since June '17 (high quality), been using nizoral 2% shampoo for 15+ years & have had 8,500 grafts done since '91. Last two surgeries were 2250 fut in 2004 and 5000 fut in March '17.

 

I'm 50 and have been losing my hair since probably age 21. It NEVER stops - regardless of how hard you try.

 

It's a progressive disease. Young guys 'hope' they have stabilized, and sure - at times you will.

 

Hair transplants for at least 50% are a lifetime commitment if you want really good results and you don't have thick/dense Spanish or Italian or Mediterranean hair.

 

Ever seen Indian or Asian guy's hair? It's poor in density and thickness and overall quality.

 

It's a long road and MANY guys even w/early hair loss will see what I am writing about once you hit your 40's (hairloss can accelerate no matter what) once you've been on drugs/lotions for 15+ years.

 

Good luck and yea; I'm gonna' do a couple FUE surgeries AFTER my final fut surgery next year. I'm hoping I have another 2-3K left in FUT.

 

peace

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Very interesting - thanks Gasthoerer. I've no idea who any of the 'extremists' might be! I was however hoping that this thread might have expired...

Maybe I really made a mistake. The main point of my post was the origin of my discussion with Dr. Feller: Would a reputable FUT/FUE clinic recommend FUE first (only)? The answer is here for everyone to see. Seems everyone is now focusing on this badly chosen word.

The sketchy part of this is your assumption about future loss and how many grafts you'll need … it's earlier and worse. Also you say you don't blindly trust any doc but then seem to trust a doctor's coverage value equation in the next sentence.

 

Also 10k grafts from just FUE is pretty much unheard of ... yeah you might actually be in that top % but I'd be very careful making plans on that.

You are right with your questions. Of course the 5000 FU is just an assumption (maybe I did not made that clear enough). But my hairloss is very a-typical and it is exactly as my fathers. Also, I am almost 40 years old and I responded well to FIN. I know it is an estimate, but let us call it an estimated guess by 3 clinics who saw me in person and also reviewed my family pics.

10 000 FU is on the top end, you are right. But 3 recommended clinics came to this conclusion and I still (!) recalculated it with a tool provided by a 4th clinic (which was presented in an international hair transplantation workshop), based on the measurements by the clinics. What else can I do?

Also, I am above average in density in all 3 areas (~100 FU/cm2) and above in density and number of multis. My donor is soo thick, it makes the rest of the hair look even weaker :-/

How long did you have to wait for the consultation with Doctor Feriduni?

6 month!

But nothing feller or bloxham has said has been successfully refuted.

You are one of the most dedicated an experienced members, but also one of the most “outspoken”. I doubt that I can change your mind and I accept your opinion. We just have to agree to disagree.

IMO Dr. Feller/Bloxham refuted themselves when they said they expect 99 % growth in a minor case. It is simple: Either the 3 forces can be overcome or they cannot. Obviously they can!

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You can't magically create new grafts by doing strip prior to FUE.

 

I like your math approach, especially as some members an even clinics have proven to have some major issues with math (to calculate %, to distinguish between % and %-point, to calculate density). However, in your approach, you might (!) miss the point of e. g. donor laxity. If FUE reducses laxity due to scaring then this could explain the benefit of FUT first and FUE later.

 

It is just a comment, as ifetime grafts is not my main concern, I did not focus on it.

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Finally, Dr. Konior told me that the way to max out donor is to strip out before FUE'ing out. IF you think you know more then that guy then you really are delusional.

 

I personally do agree with this: "FUT first, FUE later" gives you most lifetime grafts.

 

But: Your argument is weak.

 

Ok, Konior says so, but *** says otherwise.

Feller claims sth. and Lupanzula claims otherwise.

Who can we believe? That is the basline of this entire discussion.

 

We have to make our own mind, based on the data we have.

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I like your math approach, especially as some members an even clinics have proven to have some major issues with math (to calculate %, to distinguish between % and %-point, to calculate density). However, in your approach, you might (!) miss the point of e. g. donor laxity. If FUE reducses laxity due to scaring then this could explain the benefit of FUT first and FUE later.

 

It is just a comment, as ifetime grafts is not my main concern, I did not focus on it.

 

Definitely, I think overall lifetime grafts isn't as much of an issue for the majority of patients as some people make out though. With competent surgeons and a combination of FUE and FUT the average patient is able to obtain well into the 7000 area, and the potential of BHT and SMP for the illusion of more density makes money the greater issue than just donor numbers. Most people on this forum never get close to reaching their donor potential, even more moving into BHT transplant or SMP.

 

The only times I see that this isn't the case is for abnormally poor donor areas or cases like JBLs where you have an incompetent technician with a motorised punch doing major damage that wouldn't happen with an experienced surgeon or appropriately sized manual punch.

 

Agree with your laxity comment in regards to FUE too, interested what most surgeons think of this but I've seen a Bisanga rep suggest it isn't a major issue if it is performed competently.

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I like jsrader's post -- HT is a lifelong commitment. Young'uns who can't stop gushing about their latest FUE miracle will have a different story to tell once they hit their late 40s / 50s

 

I have gone through both FUT and FUE and my experience so far (at 10 months post op FUE) -- FUT was much much better growth than my current FUE . I had obviously no choice since my scalp was tight and " stripped out" but would I go through another FUE ? Probably not. My only hope is that my hair stays somewhat. "style-able" and I don't look like a combover freak in the next 10 years.

 

Unless you are absolutely sure you won't progress beyond a NW3-4 - FUT is the only route . I doubt if long term hair loss ever stabilizes at NW4 . People I know for 20 years who I initially thought were a NW3 now look like NW6 - their only option is to shave their head , or embark on a long and obvious HT journey.


---------------------------------------------------------------------------------------

FUT #1, ~ 1600 grafts hairline (Ron Shapiro 2004)

FUT #2 ~ 2000 grafts frontal third (Ziering 2011)

FUT #3 ~ 1900 grafts midscalp (Ron Shapiro early 2015)

FUE ~ 1500 grafts frontal third, side scalp, FUT scar repair --300 beard, 1200 scalp (Ron Shapiro, late 2016)

 

http://www.hairrestorationnetwork.com/eve/185663-recent-fue-dr-ron-shapiro-prior-fut-patient.html

---------------------------------------------------------------------------------------

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I like jsrader's post -- HT is a lifelong commitment. Young'uns who can't stop gushing about their latest FUE miracle will have a different story to tell once they hit their late 40s / 50s

 

I have gone through both FUT and FUE and my experience so far (at 10 months post op FUE) -- FUT was much much better growth than my current FUE . I had obviously no choice since my scalp was tight and " stripped out" but would I go through another FUE ? Probably not. My only hope is that my hair stays somewhat. "style-able" and I don't look like a combover freak in the next 10 years.

 

Unless you are absolutely sure you won't progress beyond a NW3-4 - FUT is the only route . I doubt if long term hair loss ever stabilizes at NW4 . People I know for 20 years who I initially thought were a NW3 now look like NW6 - their only option is to shave their head , or embark on a long and obvious HT journey.

 

Tell that to this guy

 

International Hair Loss Forum - Djeetee: 5500 FUE - Dr Erdogan - 27&28/09/16

 

It is purely a numbers game.

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I like this thread!

 

Just one thing, those w/fine hair and a bit lower density w/less avg. hairs per follicle (on avg.) and that are losing their hair at age 25 or younger - watch out!

 

I've been on minoxidil since the early 90's and am now using 30% minox compounded from a pharmacy the last 18+ months, been on propecia since about '96 or '97 and switched to avodart in '02. Use a 400+diode laser helmet since June '17 (high quality), been using nizoral 2% shampoo for 15+ years & have had 8,500 grafts done since '91. Last two surgeries were 2250 fut in 2004 and 5000 fut in March '17.

 

I'm 50 and have been losing my hair since probably age 21. It NEVER stops - regardless of how hard you try.

 

It's a progressive disease. Young guys 'hope' they have stabilized, and sure - at times you will.

 

Hair transplants for at least 50% are a lifetime commitment if you want really good results and you don't have thick/dense Spanish or Italian or Mediterranean hair.

 

Ever seen Indian or Asian guy's hair? It's poor in density and thickness and overall quality.

 

It's a long road and MANY guys even w/early hair loss will see what I am writing about once you hit your 40's (hairloss can accelerate no matter what) once you've been on drugs/lotions for 15+ years.

 

Good luck and yea; I'm gonna' do a couple FUE surgeries AFTER my final fut surgery next year. I'm hoping I have another 2-3K left in FUT.

 

peace

 

Yeah I see way too many guys who seem to only care about/focus on the present and the near future when the reality is that they have 40-70 years of life left and this shit is progressive in nature while the transplanted hairs most likely are permanent. It's a recipe for disaster if you go about it the wrong way and I see sooo many young guys dense packing their newfound NW 2.5-3 hairline back to a NW 0-1 with 2500-3k FUE (I see 4-5k too which is really bad). That bitch is gunna keep going and likely the midscalp and/or crown will go as well. The grafts add up quick.

 

 

 

I like your math approach, especially as some members an even clinics have proven to have some major issues with math (to calculate %, to distinguish between % and %-point, to calculate density). However, in your approach, you might (!) miss the point of e. g. donor laxity. If FUE reducses laxity due to scaring then this could explain the benefit of FUT first and FUE later.

 

It is just a comment, as ifetime grafts is not my main concern, I did not focus on it.

 

The guy tried to talk down Konior for fuck's sake. Talk about arrogant, you think you know better then a surgeon of that caliber as a layman then you've got serious issues. There's more to it then just pure graft numbers and %'s, I'm layman as fuck and even I know it comes down to scarring/fibrosis/damage to the existing grafts left behind/etc.

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Yeah I see way too many guys who seem to only care about/focus on the present and the near future when the reality is that they have 40-70 years of life left and this shit is progressive in nature while the transplanted hairs most likely are permanent. It's a recipe for disaster if you go about it the wrong way and I see sooo many young guys dense packing their newfound NW 2.5-3 hairline back to a NW 0-1 with 2500-3k FUE (I see 4-5k too which is really bad). That bitch is gunna keep going and likely the midscalp and/or crown will go as well. The grafts add up quick.

 

 

 

 

 

The guy tried to talk down Konior for fuck's sake. Talk about arrogant, you think you know better then a surgeon of that caliber as a layman then you've got serious issues. There's more to it then just pure graft numbers and %'s, I'm layman as fuck and even I know it comes down to scarring/fibrosis/damage to the existing grafts left behind/etc.

 

So Dr. Feller is correct when he says the yield of FUE is in the average range of 75% and that no more than 1500 grafts should be extracted on any donor via FUE? Being a doctor doesn't mean they are immune from saying stupid, inaccurate and baseless statements. I didn't talk down Konior either, I said he is correct if we want to talk about absolute maximum donor capacity, but as a generality it doesn't make a huge difference.

 

Finasteride has a multi-decade efficacy and 80-90% respond with maintenence quoted by various studies. You don't care about statistics or facts clearly, but the facts say that if are if you're a norwood 3 and you get on finasteride you won't lose the rest for decades.

 

International Hair Loss Forum - Djeetee: 5500 FUE - Dr Erdogan - 27&28/09/16

 

And please, explain this case of a full blown norwood 6 to a norwood 1 with FUE if graft numbers are such an issue? Very few patients require more than 7000 grafts for full coverage and average density.

 

What can I say though, you have the intellect of a dead goldfish.

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So Dr. Feller is correct when he says the yield of FUE is in the average range of 75% and that no more than 1500 grafts should be extracted on any donor via FUE? Being a doctor doesn't mean they are immune from saying stupid, inaccurate and baseless statements. I didn't talk down Konior either, I said he is correct if we want to talk about absolute maximum donor capacity, but as a generality it doesn't make a huge difference.

 

Finasteride has a multi-decade efficacy and 80-90% respond with maintenence quoted by various studies. You don't care about statistics or facts clearly, but the facts say that if are if you're a norwood 3 and you get on finasteride you won't lose the rest for decades.

 

International Hair Loss Forum - Djeetee: 5500 FUE - Dr Erdogan - 27&28/09/16

 

And please, explain this case of a full blown norwood 6 to a norwood 1 with FUE if graft numbers are such an issue? Very few patients require more than 7000 grafts for full coverage and average density.

 

What can I say though, you have the intellect of a dead goldfish.

 

Lmao you're a clown bro. The longest study on fin was 10 years and you're here spouting off "decades" as if there's any evidence supporting that claim and have the balls to call me stupid in the same post. Might wanna look in the mirror, you're projecting.

 

The absolute general consensus is that you will start losing ground around the 10-15 year mark on fin, countless guys have experienced this to the point where it's odd to find a guy who hasn't lost ground by that point. There's also tons of guys who start losing ground after a couple years even though studies show most guys get a nice bump above baseline in the first 2 years then start a slow steady march back to baseline by year 5 or so (guess where they go after that...), it's not a magic bullet medicine it can stop working tomorrow and you're fucked.

 

You won't find me ever defending Feller on his 75% claim and you're trying to run a false equivalency by lumping FUT focused doctors in with ones like Konior who is great at both and does a lot of both, talk about moving the goalposts. We were talking about Konior, a surgeon who does both methods very well and charges out the ass for FUE so he has a vested interest in pushing it but he still will tell a prospective client that they should strip out first if they are looking like they'll need all available donor. Your attempt to minimize the graft difference is pathetic though not at all surprising.

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Lmao you're a clown bro. The longest study on fin was 10 years and you're here spouting off "decades" as if there's any evidence supporting that claim and have the balls to call me stupid in the same post. Might wanna look in the mirror, you're projecting.

 

The absolute general consensus is that you will start losing ground around the 10-15 year mark on fin, countless guys have experienced this to the point where it's odd to find a guy who hasn't lost ground by that point. There's also tons of guys who start losing ground after a couple years even though studies show most guys get a nice bump above baseline in the first 2 years then start a slow steady march back to baseline by year 5 or so (guess where they go after that...), it's not a magic bullet medicine it can stop working tomorrow and you're fucked.

 

You won't find me ever defending Feller on his 75% claim and you're trying to run a false equivalency by lumping FUT focused doctors in with ones like Konior who is great at both and does a lot of both, talk about moving the goalposts. We were talking about Konior, a surgeon who does both methods very well and charges out the ass for FUE so he has a vested interest in pushing it but he still will tell a prospective client that they should strip out first if they are looking like they'll need all available donor. Your attempt to minimize the graft difference is pathetic though not at all surprising.

 

You're the one who claimed that FUE couldn't achieve 10000 grafts and therefore isn't a good procedure, and yet I'm the clown?

 

You then claim anecdotal evidence about finasteride wearing off means anything? "The absolute general consensus"? You mean what you made up? And how in the world is 15 years of stability not worth it for someone in their 20s as a norwood 3 getting an aggressive hairline procedure?

 

I also never lumped Konior's claims in with Feller, and I asserted this in the last comment very clearly. You lack basic reading comprehension skills.

 

You're a scummy idiot plain and simple. It's bad enough you argue so poorly, but you misrepresent everything I say and move the goal posts every post you make.

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You're the one who claimed that FUE couldn't achieve 10000 grafts and therefore isn't a good procedure, and yet I'm the clown?

 

You then claim anecdotal evidence about finasteride wearing off means anything? "The absolute general consensus"? You mean what you made up? And how in the world is 15 years of stability not worth it for someone in their 20s as a norwood 3 getting an aggressive hairline procedure?

 

I also never lumped Konior's claims in with Feller, and I asserted this in the last comment very clearly. You lack basic reading comprehension skills.

 

You're a scummy idiot plain and simple. It's bad enough you argue so poorly, but you misrepresent everything I say and move the goal posts every post you make.

 

You really gotta lay off the personal attacks, makes you sound like a petulant little child.

 

I didn't say it's not a good procedure because it can't achieve 10k grafts, why do you insist on continuing to project your own brand of bullshit onto others? It's a great procedure for the right situations, consistently getting 10k grafts out of a donor is not it's thing, in fact getting more then 5-6k grafts isn't it's thing. It has advantages but total graft count isn't one of them. Of course there are exceptions but it'd be a mistake for guys to assume they are that, rules are rules for a reason.

 

You conveniently ignored my pointing out of the landmark study that showed guys are back at baseline after 5 years of fin, you get around 2 years of a increased hair count then it's all downhill from there. Fin delays and slows down the inevitable, it doesn't stop it. You're one of the lucky ones if you make it 15 years without losing ground. Now hopefully there's something else on the market to replace fin by that point but you can't rely on that potentiality that much, guys 15 years ago probably thought there'd be something else by now but here we are, relying on fin still.

 

15 years (or less) will come and go then all that hair that it's been holding for you behind that NW0-1 dense pack will be vacating your head. The transplants will remain. You now have to match that density across your whole damn head to avoid a really unnatural appearance (basically the opposite of natural balding where the front thins into the middle of your head, you'll have a thick front and thin middle/back). You don't have the grafts to do that, starting the hairline that low increases the surface area to cover dramatically and you've already used a large chunk of your donor. It's not a good situation.

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You really gotta lay off the personal attacks, makes you sound like a petulant little child.

 

I didn't say it's not a good procedure because it can't achieve 10k grafts, why do you insist on continuing to project your own brand of bullshit onto others? It's a great procedure for the right situations, consistently getting 10k grafts out of a donor is not it's thing, in fact getting more then 5-6k grafts isn't it's thing. It has advantages but total graft count isn't one of them. Of course there are exceptions but it'd be a mistake for guys to assume they are that, rules are rules for a reason.

 

You conveniently ignored my pointing out of the study that showed guys are back at baseline after 5 years of fin, you get around 2 years of a increased hair count then it's all downhill from there. Fin delays and slows down the inevitable, it doesn't stop it. You're one of the lucky ones if you make it 15 years without losing ground. now hopefully there's something else on the market to replace fin by that point but you can't rely on that potentiality that much, guys 15 years ago probably thought there'd be something else by now but here we are, relying on fin still.

 

15 years will come and go then all that hair that it's been holding for you behind that NW0-1 dense pack will vacate your head. The transplants will remain. You now have to match that density across your whole damn head to avoid a really unnatural appearance (basically the opposite of natural balding where the front thins into the middle of your head, you'll have a thick front and thin middle/back). You don't have the grafts to do that, starting the hairline that low increases the surface area to cover dramatically.

 

"Lmao you're a clown bro"

 

nek minit

 

"You really gotta lay off the personal attacks, makes you sound like a petulant little child. "

 

"You provide us with hundreds of 10k graft FUE cases and maybe I'll agree that it's something a man can count on."

 

nek minit

 

"I didn't say it's not a good procedure because it can't achieve 10k grafts"

 

"You conveniently ignored my pointing out of the study that showed guys are back at baseline after 5 years of fin,"

 

*Didn't actually point out a specific study

 

"You don't have the grafts to do that, starting the hairline that low increases the surface area to cover dramatically."

 

Despite the fact that 5500 grafts at 55 microns can give dense and full coverage on a norwood 6:

 

International Hair Loss Forum - Djeetee: 5500 FUE - Dr Erdogan - 27&28/09/16

 

 

I reiterate, you are not a smart person, and it seems not smart enough to argue with. You are a worm.

Edited by JeanLDD

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Yeah Jean, likely I won't go bald thanks to my family history and my hair mass count measured 99 on my vertex. It was certainly an incompetent technician. Though I can't speak about the specifics of the case with a enough research, anyone can find out about my case and steer clear from my mistake, or rather the mistake of the clinic. Fortunately the the beard hair I had placed back there has ameliorated some of it, And I'll probably have about 500 grafts more placed back there of beard/ chest. But I agree with your point, that not everyone will exhaust their donor under normal circumstances. As it stands, Norwood 7's are genuinely pretty rare. There's a stats bias here because we're on a hair loss forum.

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"Lmao you're a clown bro"

 

nek minit

 

"You really gotta lay off the personal attacks, makes you sound like a petulant little child. "

 

"You provide us with hundreds of 10k graft FUE cases and maybe I'll agree that it's something a man can count on."

 

nek minit

 

"I didn't say it's not a good procedure because it can't achieve 10k grafts"

 

"You conveniently ignored my pointing out of the study that showed guys are back at baseline after 5 years of fin,"

 

*Didn't actually point out a specific study

 

"You don't have the grafts to do that, starting the hairline that low increases the surface area to cover dramatically."

 

Despite the fact that 5500 grafts at 55 microns can give dense and full coverage on a norwood 6:

 

International Hair Loss Forum - Djeetee: 5500 FUE - Dr Erdogan - 27&28/09/16

 

 

I reiterate, you are not a smart person, and it seems not smart enough to argue with. You are a worm.

 

I called you a clown because of your personal attacks.

 

You were trying to push FUE as a realistic option for guys needing a lot of grafts. Still haven't provided even one case of FUE approaching 10k. That guy you linked still had hair in the transplanted region, he wasn't cueball and wasn't a true NW 6 since his sides were still tall and his crown is still weak afterward.

 

Anyone who's done even a modicum of research on HT knows that graft count alone is only part of the story. Hair caliber, number of multi-FU play a huge role in the final appearance so continuing to point out men that have thick dense hair to prove your point is disingenuous. I could point out NW 6 who get 5k grafts and look like shit but you'd just ignore it.

 

 

If you get a HT while relying on fin and didn't know about the 2002 5 year study on fin then you have no business calling anyone stupid. The drug buys you time, that's it.

 

060406_propeciachart.jpg

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Tofur, you have claimed that finasteride stops working over time. I don't think there is any evidence that shows that this is the case. By all accounts if it works for you in the first year it will continue to work for you long term. Hair counts may decrease slowly over time but it's still working as you will have more hair than if you never took finasteride.

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Everyone takes their hair loss 'personally' and most look for best-case scenarios both now and into the future.

 

If you lose most of your hair from the top and vertex that is 50K hairs you lost (or are miniaturizing). 12.5K transplants, about 25K hairs brings you to 50% of normal.

 

The thing is a hair transplant, even at 50% of normal density is an illusion of density (under good lighting and extremely favorable hair characteristics). At around 70% of normal density is when hair really looks normal.

 

I don't believe that 30% of normal density is cosmetically acceptable (this is marketing by doctors). Finally, the contrast between very thick donor and transplanted region will ALWAYS be fairly obvious unless you FUE out the donor to a great deal.

 

For people like me (and probably nearly 50% of hair transplant USA patients) our hair density isn't super high nor is the caliber of our hair very thick. We basically have straight/fine hair.

 

It is obvious that most young guys who are savvy on the internet w/great results post the most/best short-term results. A doctor NEVER shows poor results voluntarily nor do even 5% (much less) of poor results from customers ever get posted. Duh!

 

Would I have just had another 5K fut if avodart (better than finasteride) kept working for me after 15+ years? Oh, my crown didn't start thinning until about 2010 - aged 43.

 

That was 8 years after I began dudasteride and after using finasteride for 5 years previous to that.

 

I'm happy for younger guys who get their 1st surgery and are tickled to death for awhile; that's a good thing. But if you are in your 20's and have crown thinning/balding but a solid hairline - don't girls find that unacceptable? Haha!

 

Frankly, hair transplantation should never have been invented; most guys after age 40 can deal w/hair loss (life goes on believe it or not) and it is natural.

 

I'm locked in and knew that I was back in the early 90's. I recommend to anyone I know not to do it. It is not necessary.

 

Having written all of that - like everything as one hits 35, then 40 & then 45 and 50 years old, NOTHING in your body works as well as when you are in your 20s' and early-to-mid 30's.

 

Including your damned hair! If you are losing it early (25 years and under) it wants to all go away eventually.

 

Good luck!

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Jjsrader I think your viewpoint is overly pessimistic. It's true that not everyone will be a good candidate for a transplant and ethical Doctors will rightfully reject those. Competent research from a prospective patient should also indicate to them if they're a good candidate. However, people are different and countless men, many of whom exist outside of the USA, can have a meaningful improvements to their lives from transplants. Anyway isn't the USA one of the most ethnically diverse places in the world? There should be a whole array of men with all sorts of different hair characteristics. Don't forget that women can also improve their lives with surgery. Instead of thinking that transplants should never have been invented, why not have the view that surgery is already improving people's lives and with new innovations, they can only improve in the future.

 

I think there have been a few overly negative posts about transplants in general, different methods and treatments recently. It should be realised that both FUT and FUE can be great for suitable candidates and treatments like finasteride can help a huge percentage of hair loss sufferers. It's true that some people have it in their genes that it will be difficult for them but places like this forum are a great place to educate people about what their best options are. People with knowledge and experience are in a position to help others in the best way they can.

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Tofur, you have claimed that finasteride stops working over time. I don't think there is any evidence that shows that this is the case. By all accounts if it works for you in the first year it will continue to work for you long term. Hair counts may decrease slowly over time but it's still working as you will have more hair than if you never took finasteride.

 

No for sure fin is better then nothing, every guy losing his hair should at least try it and see if it works well for them and they don't get sides. It just doesn't truly stabilize your loss forever, it slows it down. This is totally logical, it isn't eliminating all of your DHT it's just knocking it down, your DHT sensitive follicles are still getting hit by what's remaining in your system, just not to the same degree.

 

My issue with it is when I see guys cutting up their heads on the premise that fin will forever keep their hair the way it is when they start it. There are many examples of men who switch to duasteride anywhere from 3 to 15 years into fin because they start losing significant ground and need more DHT suppression to maintain their hair. Problem with that is duasteride seems to have more side affects so it's a double edged sword.

 

Ultimately, we need something new to stop native loss. Shiseido/replicel's RCH-01 is the most promising upcoming treatment to watch for, shiseido's phase 2 results will be out Q2 of 2018.

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Everyone takes their hair loss 'personally' and most look for best-case scenarios both now and into the future.

 

If you lose most of your hair from the top and vertex that is 50K hairs you lost (or are miniaturizing). 12.5K transplants, about 25K hairs brings you to 50% of normal.

 

The thing is a hair transplant, even at 50% of normal density is an illusion of density (under good lighting and extremely favorable hair characteristics). At around 70% of normal density is when hair really looks normal.

 

I don't believe that 30% of normal density is cosmetically acceptable (this is marketing by doctors). Finally, the contrast between very thick donor and transplanted region will ALWAYS be fairly obvious unless you FUE out the donor to a great deal.

 

For people like me (and probably nearly 50% of hair transplant USA patients) our hair density isn't super high nor is the caliber of our hair very thick. We basically have straight/fine hair.

 

It is obvious that most young guys who are savvy on the internet w/great results post the most/best short-term results. A doctor NEVER shows poor results voluntarily nor do even 5% (much less) of poor results from customers ever get posted. Duh!

 

Would I have just had another 5K fut if avodart (better than finasteride) kept working for me after 15+ years? Oh, my crown didn't start thinning until about 2010 - aged 43.

 

That was 8 years after I began dudasteride and after using finasteride for 5 years previous to that.

 

I'm happy for younger guys who get their 1st surgery and are tickled to death for awhile; that's a good thing. But if you are in your 20's and have crown thinning/balding but a solid hairline - don't girls find that unacceptable? Haha!

 

Frankly, hair transplantation should never have been invented; most guys after age 40 can deal w/hair loss (life goes on believe it or not) and it is natural.

 

I'm locked in and knew that I was back in the early 90's. I recommend to anyone I know not to do it. It is not necessary.

 

Having written all of that - like everything as one hits 35, then 40 & then 45 and 50 years old, NOTHING in your body works as well as when you are in your 20s' and early-to-mid 30's.

 

Including your damned hair! If you are losing it early (25 years and under) it wants to all go away eventually.

 

Good luck!

 

I think we need more posts like the one here by jsrader .

 

I was an optimist in my late 20s when I got my first HT. Now in my 40s , things aren't looking so good and am much more realistic. Meds can work , they can stop working or they can cause problems after a point. Newly transplanted HT hair looks good until it also starts miniaturizing after a decade to two.

 

Ultimately law of averages catches up with you -- we like to think we are all unique individuals but we are not . Look at median distributions not a few outliers. And look at cases that have been in the making for 10+ years . How many of those do we see around here ?


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FUT #1, ~ 1600 grafts hairline (Ron Shapiro 2004)

FUT #2 ~ 2000 grafts frontal third (Ziering 2011)

FUT #3 ~ 1900 grafts midscalp (Ron Shapiro early 2015)

FUE ~ 1500 grafts frontal third, side scalp, FUT scar repair --300 beard, 1200 scalp (Ron Shapiro, late 2016)

 

http://www.hairrestorationnetwork.com/eve/185663-recent-fue-dr-ron-shapiro-prior-fut-patient.html

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Bro read the graph properly lol those people are still above baseline and thats not even the 10year study.

 

You shouldn't expect to keep your 'gains' on finasteride, but clinical evidence is clear that a majority stay above baseline. We still have to prepare for the event that we are a minority case that isn't so lucky so be proactive and do everything you can. Using all your grafts with FUE, going to a great doc who gives a solid yield, potentially throwing in some smp etc and at the very least having some great full head years followed by some less than perfect ones is WAY better than just getting rekt.

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jjsrader you got FUT so obviously the prospect of eventually losing eveything and having to shave is a lot worse than those who got FUE from a DR with good skill and donor management.

 

Thanks for sharing your experience though

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fortune11, according to your bio 4600 grafts were used on your hairline and frontal third. IMO that is too much and I know for myself as someone who is young and plans for worst case scenerios I would consider that bad planning and not conservative enough based on age and potential future progression.

 

Look at H&W FUT or Lorenzo FUE and see how much solid coverage can be achieved by 5000+ grafts. Def worth it if done properly. But I agree young ones should really proceed with caution when it comes to 'dense pack' hairlines and the such.

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I think we need more posts like the one here by jsrader .

 

I was an optimist in my late 20s when I got my first HT. Now in my 40s , things aren't looking so good and am much more realistic. Meds can work , they can stop working or they can cause problems after a point. Newly transplanted HT hair looks good until it also starts miniaturizing after a decade to two.

 

Ultimately law of averages catches up with you -- we like to think we are all unique individuals but we are not . Look at median distributions not a few outliers. And look at cases that have been in the making for 10+ years . How many of those do we see around here ?

 

Wait, what? Your loosing you transplanted hairs also??

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fortune11, according to your bio 4600 grafts were used on your hairline and frontal third. IMO that is too much and I know for myself as someone who is young and plans for worst case scenerios I would consider that bad planning and not conservative enough based on age and potential future progression.

 

 

Not to mention the fact that meds weren't used for the majority of the "ht journey" on a patient who's a diffuse nw6 thinner.

 

Seems like poor planning and poor decision making. A lot of confirmation bias going on ITT.

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