FUE into existing hair - good or bad idea? Advice or opinions appreciated!

[morry]

Hope to get some advice from this great community.

Strongly considering getting an FUE procedure, and have started the long research process (with one assessment/quote from a doctor so far) - but still not 100% sure this is the right route, and would really appreciate any help making the decision.

 

I'm 39, and as you can see from pictures below, still have a decent amount of coverage with some receding at temples and fine hair/thinning on the top and crown. Most of the loss occurred over a period from my late 20s - early 30s, although I have only noticed very minimal change in the last 5 years.

 

(For anyone interested, my past hair loss seems to correlate quite closely with a long period of taking creatine, in both small and moderately high doses. As soon as I realised there might be a connection I stopped taking it altogether, and haven't noticed much change in my hair since. Obviously hard to know for sure, but the correlation does seem striking to me..)

 

The biggest issue for me is that my hairline is very different on each side, with a very thin, almost bald area around and behind my right temple. I am extremely self-conscious about it, and everything I do with my hair is aimed at concealing this area, which otherwise looks (I think) ridiculous.

Of course I would love the rest of my hair to look thicker, and to cover the thinning in my crown a little - but in general I manage these areas quite well with thickening products and careful styling.

 

I am not taking any meds. I am concerned about the side-effects with finasteride, and I am not currently noticing any significant hair loss, so I am very reluctant to start taking medication - perhaps indefinitely - that is anyway unlikely to solve the main issue of my hairline.

Family history: the men in my mother's family went bald at a much younger age than me, while my father has a very good head of hair at 70.

 

So...

The reasons I am considering a transplant are:

- with the amount of hair I currently have, I feel like a fairly small procedure to fill in the right temple and have my hairline match on both sides would make a big difference. If I am going that far I thought I could also have a light amount of filling in across the scalp to give me a little more density and slightly reduce the appearance of the crown. It's a big area, but I'm not necessarily looking for a drastic change. If I'm lucky, a single procedure now could give me a really strong look for years to come, and make me much happier!

 

The reasons I'm not sure:

- I have read a couple of comments suggesting that placing grafts into an area with existing hair has a risk of causing shock to, and possible losing, the native hair. I can't find that much information around this, but I feel fairly lucky to still have the amount of hair that I do, so I would obviously be devastated to come out of a procedure in a worse state than I went in. On the other hand, I have seen a few examples of similar operations that seem to have been really successful.

Also, the first assessment I received suggested 2500 grafts, which is a little more than I was hoping for. Was I being over-optimistic?

 

One other point - I do like to cut my hair very short at the back, and would like to keep the option of buzzing everything down at some point in the future if everything goes downhill, so I'm really not keen at all on an FUT scar.

And lastly, if anyone has any particular doctor recommendations to help narrow the field I'd be very happy to hear - I'm in the UK, but happy to travel.

 

Thanks for reading, and I greatly appreciate any opinions or advice!

[Shera]

Hi Morry,

 

It's possible that the creatine use was causing your hairloss so it's good that you realised fairly quickly and addressed it. This also may prove that DHT levels do affect you personally in terms of hair loss.

 

The Finasteride should help restrict DHT levels in your scalp thus helping to sustain any miniaturising hairs you currently have and generally should slow down the balding process. The Fin should help recover these hairs and also help 'prepare' your hair against possible shockloss if you having grafts planted amongst existing native hair to increase density.

 

Your reasons for considering a hair transplant are perfectly valid. I see no reason why a single procedure would not give you a good look for a few years much the same way mine did. However you must also realise that if you start to lose your native hair then you may feel the need to have a further procedure to address this a few years down the line. Theoretically, Finasteride use should help you to preserve you native hair, therefore delaying/halting the need for a further procedure.

 

Moving on, placing grafts into an area of existing native hair does carry a small risk of causing shockloss to the native hair. In most cases this hair will grow back over the coming months. However if the native hair is currently in a state of continuing miniaturisation meaning it was going to die out over time anyway, there may well be permanent shockloss. Again Finasteride use prior to hair surgery will help reverse this miniaturisation process and reduce the risk of permanent shockloss.

 

Therefore you do need to be careful not to go through a surgery that will risk you being less off than you are now. Looking at your pictures, I would probably hold off on the crown and concentrate on strengthening your hairline and mid scalp. Without seeing more detailed pics I would say in the region of 2000-2500 grafts should be ample. As for your crown, I have seen similar patterns recover significantly after a few months of using Finasteride, if of course you reconsider using it.

 

Also I would advise against a buzz cut and instead try to keep your hair between an inch and 1.5 inches long. From experience, I feel that this length provides the best illusion of a full set.

[Swooping]

You are an ideal candidate for medication to be honest, could really buff up your diffused areas.

 

For your hairline and to fill in the temple, I guess something like 1500-2000 grafts would suffice. If you want to enhance your crown or midscalp (if that is possible, I think you need a live consult for that) you will be looking at more.

[gillenator]

Morry,

 

Looks like your first post so welcome to this community. It's always nice to see other patients doing their research and getting as informed as possible.

 

I think 2500 grafts is a good number to start with addressing the frontal zone and specifically the areas in the frontal third that are barren of any hair.

 

I also would not recommend doing anything in the crown. Clearly you are going to experience more loss in that area and crowns can potentially demand as much as 60% of one's available scalp donor.

 

I also agree that you would benefit from low dose finasteride and may very well help to keep your crown from opening up with more loss. You can always start with a smaller dosage under the support of a doctor. You may never have any of the side-effects. But you will never know unless you try it. Bottom line, there's nothing available that's more effective in saving your hair than finasteride.

 

Still, it's an elective decision and if you still decide against it, than you have to plan for the worst and approach your restoration very conservatively as you are still young.

 

And if you want the option of wearing a real short hair style sometime in the future, then I agree that FUE is your best option going forward.

 

Best wishes to you..

[morry]

Thanks for the replies - it is really useful to hear some other perspectives and you all make very valid points, particularly around using finasteride.

 

@Shera - using Fin to help prepare the hair against loss after a procedure is not something I had considered, and makes a lot of sense - good advice. Thanks also for explaining the situation with possible native shockloss. It sounds like if I prepare properly then there will still be a risk of permanent loss, but a small one..? I will raise this with any doctors I consult with and see what they say.

Glad you had such a good outcome yourself. And no, I'm not considering a buzz cut any time soon! I was thinking of much further in the future, and only as a last resort!

 

@Swooping - thanks for your input; I definitely feel more comfortable getting a live consultation before committing to anything, so I'm going to look into arranging that soon.

 

@gillenator - doing my best to be informed! This is a great resource, and I plan to also document my process here so that others can hopefully benefit, whatever I decide to do.

You make a very good argument about the crown - it's not my biggest concern anyway, and I don't want to waste a lot of donor hairs so I will back off that area for now. You have convinced me I should try medicating, at least for a period of a few months, so I will see what happens.

And yes, I am planning to be quite conservative with any procedure - I don't think I need a dramatic change, and I am still optimistic I might turn out like my father, who has around the same amount of hair as me at 70.

As you say - prepare for the worst and hope for the best!

 

Thanks everyone - any other input welcome, otherwise I will update the board when I am further down the line.

[mikeyhwk]

My hair loss was almost exactly like yours, I had plenty of native hairs with diffusion in a couple pronounced spots and some loss in the crown. What all the posters have said thus far is accurate, meds should be considered and as Swooping said, for our type of hair loss if you can handle them, fin is a must. Don't let the fear scare you off, try them and see how they work for you because for diffuse loss individuals the results can be very good. My last doc, Dr Lorenzo says diffuse patients in his experience tend to respond much better than average to fin. It steadied my crown and regrew some hair in it, very happy with fin and no sides for me. I also got the exact same advice, avoid the crown and do the hairline at my first fue, I was 39 when I did my hairline (40 now), 2500 grafts and if you go thru my posting history you can see I posted a few pics of the work I had done with Dr Bisanga, turned out great, I experienced a little shock loss but it all came back. I was on fin for 5 months at that point. I was advised not to consider crown at the time because I wasn't on fin long enough to see what it could do for regrowth purposes in the crown and because there was still some minaturized hairs in the area that could be strengthened with time and meds. I waited til I was 15 months on fin before doing a 2nd op to address the crown and midscalp with Dr Lorenzo just a month ago. I have some shock loss again but I seem to be one of those that just gets it but I expect it to return like it did the first time as my hair is stronger now. My crown was a small procedure requiring 800 grafts and I have an above average donor according to both my docs with lots of grafts left even post 2 surgeries so I wasn't hesitant to address crown but you can definitely fue into existing hair successfully. Give fin a try.

[Mikey1970]

For what its worth I & many other guys have taken Finasteride for years with no side effects. I almost think the side effects concern is the result of a placebo reversal affect but that is just my opinion.

 

Be extremely careful which surgeon you select with FUE & particularly transplanting into existing hair. Anyone less than a top doc & you could experience shock loss and end up worse off. That happened to me but on the flipside I had to do exactly what you are proposing for a repair and it has paid off.

 

Best of luck.

[morry]

Thanks guys.

 

@mikeyhwk - good to hear your experience from a similar position, and looking at your photos it seems like you got an excellent result which is very encouraging. Hope the second procedure turns out just as well.

Interested to see now what meds might do for me.

 

@Mikey1970 - sounds like you fell into the unfortunate 'small risk' category - sorry that happened.

As you say, I will be very careful who I select to go with..

[gillenator]

Hope the meds, specifically low dose finasteride works out for you Morry. I have been taking it since 1996 and still working well for me.

 

Possibly your doc can start you out at .50 mg daily and slowly build it up to the recommended daily dose of 1 mg per day. Definitely worth discussing.