Options for diffuse thinning

[Gasthoerer]

Dear all,

 

Being a member in this forum for quite some time (and also in a domestic forum), I would like to present my case with the hope to get some more advice. I am aware, that there are worse cases than mine, but it still bothers me. Especially as I look much younger and once had a great head of hair. When I meet people from the past, they are often surprised that I lost hair and even touch (ughh!) my balding crown. Imagine: What would happen if I touch the a.. of a women to see if she gained weight?

 

Status:

- Almost 39 years old and detected my loss 7-8 years ago, but actually it has started much earlier (as a diffuse thinner it is difficult to detect)

- I have a very good donor (~10 000 FU via FUE according to 3 clinics and my own calculation with the tool of Erdogan/Lorenzo), but no body hair etc. as a reserve.

- Hair diameter of the donor is also above average too

- I have a tendency for slightly below average scaring (keloid type)

 

Meds:

- MINOX foam since +3 years – didn’t help at all. Actually triggered the whole thing, but I am afraid to stop

- FIN since +2 years – seems to slow it down or even stop the progression, but hope for regrowth was no fulfilled.

- Alfatradiol since +1 year - no effect

- No side effects (just from liquid MINOX I got a nasty itch and redness).

 

Heritage:

- I follow my father loss: Diffuse pattern with one bad temple and a bad crown (his maybe lower). His progression never (!) stopped, but he is not on FIN only on MINOX.

- My maternal grandfather had the classic mature hairline (NW1.5) in his 40s (died early).

 

Feedback of the clinics:

- Bisanga – Most conservative in the crown (~ 1750 FU but better to wait) but most open in the front (500 – 1500 FU depending on my wish of the hairline)

- Lupanzula – Would look for crown first (~2500 FU). Front could be filled in if requested (~ 500 FU)

- Feriduni – Crown like Lupanzula (~2500 FU), Front only conservative (~500 FU, higher than my actual hairline for aesthetics).

Note: All clinics recommended FUE (even after asking directly for FUT at Feriduni).

 

Options:

a) Address hairline first ? My current plan

b) Address crown and hairline together

c) Try DUT and see if I can regrow some hair

 

PICS from 2017 added: Be aware they are partly misleading, as diffuse thinning and I sport a side part. All clinics recommended waiting when seeing only pictures.

Thanks for reading.

Edited January 2, 2018 by Gasthoerer

[Gasthoerer]

Additonal PICS:

 

- Father with > 65 years and similiar loss type but worse crown shape

- Hairline in 2016 with treatment plan after 1 year of FIN

- Hairline in 2015 before starting FIN

- Crown in 2015 before starting FIN - Like I said, crown PIC is misleading in 2015. Status was actually very similiar to the 2017 PIC.

[Justin77]

My opinion is to address the hairline first because that's going to make the biggest difference in your appearance. Your hair is in good shape overall and you don't need many grafts. If you can afford to address the crown as well, I would do it conservatively. Enough to make a visual difference, but not going crazy with density in order to keep the grafts in reserve for potential future loss.

 

I wouldn't try dutasteride just because I think it would be unpredictable and could potentially make things worse. Fin is doing it's job right now by slowing down your loss so I personally wouldn't risk any big hormonal changes by taking dut.

[gillenator]

Could not agree more with Justin's comments.

 

IMHO, you only need 400-500 grafts in the crown for now. By comparison, your crown appears to look pretty much the same over the past 2 years and you can attribute that to the finasteride.

 

My crown was the same way and I had roughly 400 grafts total added there back in 2006. I stopped using minoxidil after that and my crown still looks the same. I have also been on finasteride for many years now.

 

I would not lower your hairline but rather just reinforce and strengthen it for now. You are still young and you definitely want to manage your donor for the future.

 

You still have a good volume of hair and nice to see that your father never went completely bald. That's a good sign for you as well. The difference is that you are taking finasteride and will probably retain more hair mass as you age.

 

Nothing is guaranteed as you know but you do appear to have the resources to maintain a nice head of hair without getting aggressive in your crown. Only time will tell how that will turn out but again, it does appear that finasteride is working well for you.

 

I also concur not to start DUT as it is highly unlikely that it will regrow anything and since finasteride is working, no need to start DUT.

[Gasthoerer]

Thank you for you input already, much appreciated. Especially about the "DUT-topic" I go back and forth for myself for month.

One comment: I never did intent to lower the hairline. Feriduni actually refuses to strengthen my current hairline as it is still below the 1/3 mark. He wants to start approx. 1 cm higher.

[Gasthoerer]

Added a 2016 pic from the side which proofs how low the hairline actually still is and maybe a glimpse of the donor (which should be more than fine).

 

Second pic shows that actually the "head shape" is more annoying to me than the "see through" effect of the crown. This missing "height" (see arrow) was also mentioned by Feriduni as one reason why more FU are required for the crown. Without proper styling it actually is even more visible than on the picture.

[gillenator]

I agree...your hairline looks good including where it is currently situated.

 

Do you by chance have a photo of your crown where the entire area can be seen rather than a side view?

[Gasthoerer]

Thank you,

 

I have no better pic of the crown than the ones in my Initial post. My understanding was that this pics are quite "telling".

[gillenator]

Maybe you can get someone to take a close up pic of your crown looking at it straight on...that's the best view to see what's going on with the area.

[mattj]

You still have a lot of hair left in both areas of concern. Basically no reputable doctor would want to lower your hairline, as it's actually in a good position already. It looks like your father's hair hasn't receded very much and his pattern looks very similar to your own. I would (cautiously) use him as a guide as for how your hairloss might progress. It would be worth asking (if you haven't already) at what age his hairloss began to see if his age of onset matches yours.

 

I'm not convinced that you should opt for surgery for the crown area yet as there is still a lot of hair remaining. Have you tried experimenting with concealers? I know they aren't a substitute for real hair, but I've seen what they can do and I think you could totally conceal the loss with very little product.

 

I think your current plan to address your hairline is a sound approach. Just strengthen it a bit.

[Gasthoerer]

Thankl you Mattj for your input,

 

yes, lowering of hairline is crazy in my particular case. Feriduni pactually planned to stay approx. 1 cm above (!) my existing hairline (Which would be very close to the 1/3 mark.

 

Have not tried concealers, but I am also no friend of that:

a) I am more concerned with the height/volume than with the see through effect (this is due to my headshape)

b) I do not like the idea that there are make-up products on my head (besides pomade :-)). As a men and in my position this would be difficult.

 

The hairlinie is currently really my first step.

Unfortunately, Canada is a little far away for personal consultation as I like Rahal's hairlines and mine is a small, but difficult case.

 

I will ask my father when is has started for him, but for diffuse thinners the start point is always difficult to determine. I discovered it way too late, unfortunately.

[mattj]

It can be hard to determine when the loss started even if, like me, your loss is more of the frontal recession kind rather than diffuse. I was blissfully unaware for several years before I noticed. It creeps up on you. As you look like you're following in your father's footsteps it's worth asking. If my pattern matched a family member I would interrogate them for all the info I could get

 

I understand your aversion to cosmetic concealers. I wouldn't want to feel dependent on them.

[gillenator]

A diffused thinning pattern does sort of creep up on you verses a more pronounced recessionary pattern of loss where there is a loss of hair shafts and corresponding density.

 

With diffused loss, there is a progressive loss of hair shaft diameter or hair caliber and the decrease in caliber equates to loss of visual coverage over a period of time. You begin to see through the scalp and eventually the hair shafts become so thin they provide little to no visual coverage. Then the hair falls out.

 

Not everyone is open to using a cosmetic however a product like Toppik can beef up the caliber of the hair shaft as the magnetic fibers cling to the hair shafts.

 

With surgery, a more careful and conservative approach is recommended to minimize shock loss of the weak diffused hair.