confirm that i'm a bad HT candidate

[baldinasecond]

Hi everyone,

 

I'm a 28 year old asian male who appears to be heading to NW6. This past year I have been dealing with rapid hair loss and to which I am having hard time coping and coming to acceptance. I can't believe in as little as one year, I could lose so much hair. I just started propecia and rogaine for 1 month but I'm afraid that too much damage has been done.

 

I have done a lot of research on this forum and reading and educating myself about hair transplant but I am convinced I am a bad HT candidate which means I am faced with the decision to possibly quit the meds and accept going bald completely which is a choice I am uncomfortable at this moment (I'm very self-concious).

 

I have diffuse thinning all over. My sides and back are thinning as well, which is really bad because that's where my donor hair will be harvested.

 

I'm going to see a well known doctor this month to have his assessment. But before I do that, I just want to get opinions from the helpful community here about whether I could really achieve a cosmetic improvement given my current situation, which I doubt. I tried finding people with my hair characteristics to no avail.

 

I am not sure whether HT will be worth it, and here are my expectations

(1) restore hairline and some 1/3 on top (1st operation), was told I needed about 3500-4000 graphs

(2) leave ample graphs to fill in crown if need be (2nd operation in the future), probably another 3500 graphs.

 

I just don't think I have enough graphs to do all this due to my diffuse thinning plus the near certain progression of additional hair loss given my age. I also read asian hair characteristics are not very good at producing adequate graph count as well.

 

Here are pictures:

 

http://img693.imageshack.us/i/topwet2.jpg/

http://img14.imageshack.us/i/topwet.jpg/

http://img695.imageshack.us/i/top3h.jpg/

http://img268.imageshack.us/i/righta.jpg/

http://img6.imageshack.us/i/leftwet.jpg/

http://img697.imageshack.us/i/leftj.jpg/

http://img697.imageshack.us/i/front2s.jpg/

http://img6.imageshack.us/i/back2gw.jpg/

http://img694.imageshack.us/i/back1j.jpg/

 

What do you think?

[youngsuccess]

Pictures of wet hair often expose problem spots, but can also exacerbate the appearance of perceived thinning in otherwise intact areas. However, it's clear from your photos that your pattern is becoming pronounced.

 

I also read asian hair characteristics are not very good at producing adequate graph count as well.

 

Transplanting dark, fine donor hair on relatively fair skin can be problematic due to the contrast it presents, particularly in the hairline. This doesn't mean that great results can't be produced, but it's probably going to require a different approach than in a patient with more favorable characteristics (thicker caliber hair, darker skin, etc). The other factor is graft angulation, which seemingly might work in your favor since the natural orientation of your frontal hair appears to point/lay forward. I think this can enhance the illusion of overall density if you work with a layered style, as opposed to a transplanted area consisting of thin hairs that stand straight up (usually not a good look).

 

I am convinced I am a bad HT candidate which means I am faced with the decision to possibly quit the meds and accept going bald completely which is a choice I am uncomfortable at this moment

 

It's an understandable consideration, but many people would actually argue that staying on meds is one of your best option at this point, if in fact you're not an HT candidate yet.

 

Your expectations don't seem outrageous; however, being able to comfortably allocate 3,500 grafts to the crown is probably unrealistic. Your primary goal in my opinion should be establishing an appropriate hairline and focusing on frontal-mid scalp restoration, possibly leaving any remaining grafts for the crown at a later time. It's a gamble since you're young and hair loss is progressive and unpredictable, as you're aware.

 

I don't think anyone can guarantee that you're doomed for certain. The most troubling observation you've mentioned is the possible thinning in the donor area. The other big factor is going to be your scalp laxity. I would definitely go through with your scheduled consultation and get a few more opinions from other qualified surgeons, too. Good luck!

[..]

From what i can see your hair doesnt seem that bad , and i do not think u need a hair transplant at all, do u think u are thinnning in the back ? , or as to me it looks like there partings in between naturally thin hair. i reckon it would look so different dry.

[TC17]

I think I have to agree with .. that your hair really doesn't seem that bad. It will be interesting to see what the physician tells you, so please report back after your consultation.

[mattj]

You seem to have a realistic outlook on this, and to have done plenty of reading on the subject.

 

Looking at your photos I don't think you're 'doomed' yet. Give the medication a while and you might be pleasantly surprised. I wouldn't want to raise your hopes but I've seen finasteride work wonders on hair like yours.

[baldinasecond]

thanks for your responses.

 

i'm on the meds for a month now, but realistically I'm thinking it would just slow or halt further progression. Yes, in a few cases it does allow for some regrowth but I'm not counting on that. HT is a big investment but I want it to work out. I really do.

 

The last thing I want is to go through with the procedure and leave a big scar behind my head and still go thin and bald. I'm thinking this might be a likely scenario. What if meds stop working one day, and I realized that I don't have enough graphs remaining to fill in the crown.

 

All these questions, little answers. It's a difficult time to see these visual changes so rapidly and adjusting my perception. I realize I have to make a decision soon because it's consuming a huge part of my thinking.

 

I'm going to see Dr Rahal later this month. I've see other physicians but feel that they aren't being honest in their assessment about my expectations and just think more along the lines as to how to improve their business. Hence that's why I like to get some feedback from the community.

 

Will see what happens.

[jmg544]

hey baldinasecond, I hear you about searching for East Asian HT. It was rather difficult finding anyone on here, but continue your research and you will eventually decide what it is that you want/can do to tackle hair loss. This community is a wealth of information that has helped me along the way.

 

Are you able to take pics without the flash in natural lighting? My hair is like yours when wet as well.

[..]

Thing is , i dont see how a ht would improve things at this time , to me u would only get a situation were u are at now (with a strip scar at the back) your loss isnt enough to warrant a crown HT imo you have more to loose than gain. id say stick with the meds for the next year or two and see how things are then

[mattj]

Where did you graft estimates come from?

[baldinasecond]

mattj:

i got about 4K estimate from Dr. Rahal. I got about 3.5K estimate from H&W. They haven't seen me in person but I plan to see Dr. Rahal some this month. Perhaps I wouldn't fret too much about my candidacy if I weren't such a diffuse thinner.

 

..:

im looking towards the future 5, 10, 15 years down the road if meds don't work anymore, and my hair continues to fall out, or whatever reasons maybe, I don't want to jeopardize the investment and maintenance to my head by not having enough graphs. It's such a delicate balance in that I would like that assurance for potential crown filling (with sufficient graph count) and also not expose a huge scar.

 

jmg544:

i saw your pre-op pictures and it seems like you were in a lot better shape than me currently. Perhaps our texture are similar but it doesn't look like you are a diffuse thinner all over. Nice looking results by the way!

[TheEmperor]

baldinasecond,

 

I think you are well positioned to get the best of your hair loss. It comes down to your age and ability to predict how far your loss will progress.

 

Dr Rahal can plant a very dense, youthful hairline, but if you progress to a NW6 and recede down the sides, it will look terrible. It may still look inappropriate as you age, so be careful if considering lowering or rebuilding your original hairline.

 

THat said, you have some diffuse loss, and typically planting into an area with good native hair does not offer much cosmetic advantage. So if you put 4K into your crown and receded hairline, you may not get much cosmetic benefit. Of course the hair would be permanent, but depending on future loss you might need to get more grafts.

 

I think your situation is better than you think, but because you have significant native hair, the benefit of the HT will not be as great. Thus conservative advice would be to wait.

 

OTH, if you knew that you would not progress beyond a NW 4/5, you could rebuild a dense hairline and go back for touch ups as the hair behind it receded/thinned. This would provide the greatest social benefit.

 

Your options:

1) DO nothing and wait for more loss.

2) Plant within existing loss, strengthening hair, but not getting much cosmetic gain.

3) Plant a youthful dense hairline and plan for future HTs as loss progresses. This is risky if you progress to a NW6, but will provide the greatest benefit to your appearance.

[Bill - Seemiller]

Baldinasecond,

 

Quite honestly, after evaluating all of your photos, I'd give medication a full year or two before even considering a hair transplant. Also, since you appear to have some thinning in the sides and back, I wouldn't do anything until you have your scalp evaluated under magnification to see if there are signs of miniaturization in the donor area.

 

The good news is, even with wet hair (which typically makes hair appear much thinner than it really is), you still have a lot of natural hair. Thus, in my opinion, 3500 to 4000 grafts seems like a significant overestimate.

 

This of course, is just my opinion based on the photos and the information you shared.

 

Best wishes,

 

Bill

[baldinasecond]

Hello all,

 

I just came back from my consultation with Dr. Rahal. He believes 2400 grafts would restore my hairline, but this does not include filling in the frontal 1/3rd. This is interesting because he and I was confident that there will be further hair loss in the future, and that his philosophy is to not touch the areas where there is native hair. However, some surgeons would fill in the frontal 1/3 to anticipate future hair loss and I appreciate the long-term benefits and reduction in future surgeries with this strategy. I wonder if shock loss becomes an issue with this.

 

He also answered an important question of mine and thinks that I may have roughly 7000-8000 grafts available, which I think it's average. However, is that going to be enough to cover a NW6 in the worst-case scenario if I get there someday? Dr. Rahal may even think worst-case may be somewhere in the NW5 area given my family history that I explained to him, but no one can guarantee how MPB would progress.

 

 

He did say I was a candidate, and that really comes down to a personal choice for me to go with it or not, which I completely agree. I think I just need some time now to re-evaluate periodically whether I should go with it or not because this is an important decision to make. I want to be sure I am comfortable with it before I do it but I am glad I got some important questions answered.

[Sparky]

From your title it sounds like you want us to talk you out of getting an HT. At 28 I dont think your hair looks bad, my cousin is 29 and hes already a NW6 and shaves all his hair off.

 

I reckon it would take years for you to become a NW6 if at all.

 

Dont get a HT if you are unsure though, you have to be 110% sure thats its for you.

[Sparky]

Rahal would be a top choice by the way, his work always looks great.

[azn_guy]

I would like to comment on this as a fellow asian.

 

#1: your photos are taken with wet hair. why? I know many asian guys that gel their hair and what you're showing to us right now looks 100% normal to me. When I was 15 and wet my hair, it looks just like that. and I had a full head of hair (asian hair in general, you'll always see the scalp when it's wet and short)

 

#2: you're 28 so you're pretty well off but it sounds like you know you'll be a NW6 so good for you for looking into your family history

 

#3: You mentioned you're diffused thinner, I can't tell from the photos. If you're diffused thinner, YOU ARE NOT A HT candidate.

 

#4: you obviously have a receding hairline, so if I were you, and if you're comfortable with with your current hairline, simply rebuild it.

 

#5: having 7k-8k of grafts is decent, and you should think long and hard (with your doctor) on where placement should be. this will be KEY. I have roughly 9k and I used 3k of it on my frontal/mid scalp

 

#6: grow out your hair!!!

 

good luck!