Confused & In Need Of Guidance

[Raker]

Greetings everyone,

First time posting but have been following many threads for several months now attempting to educate myself as I consider a HT. May I take this opportunity to congratulate all contributors on this forum, I have found this website such a huge help.

A little about me - UK based, 55 years of age & started thining about 25 years ago.In preparation for potential surgery 4 months ago started on Proscar 5mg 1/4 tablet a day, Minoxidil twice daily, MSM tablet once daily & dermal roller twice a week. 

As yet I have not decided on a surgeon and will again seek guidance but my issue is most of the consultations that I have either with the surgeon or online are offering different opinions on the crown. Most are consistent with the frontal region suggesting approx 2000-2500 graphs but it’s the crown area that is proving to be conflicting, out of the 5 consultations I’ve had 2 surgeons suggesting that 500 graphs should be implanted to the crown area with the other 3 surgeons advising against this saying that shock loss being the major factor and that the above medications I’m now taking will suffice with SMP another option. 

I’ve attached some images taken about 1 month after I started meds. 

Would really your views guys.

[Panamera13]

You have pretty good hair at your age. What's your goal?

You can use hair fibers on the crown and your hairline seems good...why HT?

Edited October 3, 2018 by Panamera13

[Raker]

Thanks Panamera, old but there’s life in the old dog yet!! I hope. 

Couldn’t be bothered with fibres etc. Why a HT? Suppose it’s something for me, perhaps take an interest in myself & if I don’t do it now then it will probably never happen. I’m hoping that at my age most the hair loss has happened and with the introduction of meds & surgery  I’ll feel like a new (but old) man. 

[1978matt]

Well you're in good shape at 55 years old with that much hair still remaining.
You could indeed have 500 in the crown provided you accept the chance it may end up looking no different afterwards, or maybe even slightly worse if the trauma accelerates the loss of surrounding hair.

 

[Raker]

Thanks Matt, can I ask you why did you travel to the USA for surgery? Surely we have the necessary skills in the UK at a similar pricing structure? 

[Melvin- Admin]

55 years old with that much hair and no grey hair, are you just bragging now haha jk. Man you’re doing great and I understand the desire, hey why not right. 

I think between 2,000-2,500 is about right the latter being a more aggressive approach. The crown is a delicate area, in fact you still have quite a bit of hair left. I’m not entirely sure the risk of shock loss is worth it IMO. You may spend months looking worse for little pay out.

Try layering your hair over the crown this would completely conceal it. Something like the picture below.

[VicTNYC]

55 years old and with very good hair quality and density, if you were younger I’d say nah you don’t really need an HT, but I agree with you when you say it’s now or never, in that case, why not, go for it if it might make you feel a bit more happier or younger! ?

[PAI Medical Group Virginia]

There are many things to consider.  If you were in your twenties, perhaps, the conversation would be totally different.  Many agree that the older we get, the breakdown of testosterone to DHT slows down, slowing down the level of loss.  It seems, but the photos you've posted that the forelock has remained the strongest.  Your corners are well receded, and there seems to be a nice bridge behind the forelock.  Not sure if that's because of the way you style your hair, (which I think you re being smart by parting on the side, (hair shingles and gives you the look of more density). That being said, look at yourself in the mirror.  Do not tilt your head down.  What do you see?  (The front). This is also the area others see when you interact with them.  Understanding that we all have a limited donor supply, lets be judicious with the grafts.  

A second point to consider is how typically hair grows.  The hair in the front grows forward.  The hair in the middle also grows forward and it shingles to that of the front.  This is the reason why, in most people, the front and middle always look a bit fuller.  Now the crown. We all have a whirl.  That is, if you think of a point on a piece of paper and drawing lines outwards from that point, you'll realize that hairs are not working together like they don in the front and top.  Because this is the spherical part of the head, it would take many, many procedures to achieve density.  You could probably put your entire donor hair in the crown and still look thin.  Eventually, when you empty the front, you will have no donor available to fill it.  You will then be asking "why did you put all the hair in the crown? When people look at me I still look bald."  So, place value to the front and the middle.  When you are happy with the density in that area, then it's time to consider grafts in the crown.

Lastly, medical therapy.  Think of the crown as a circle and you fill the circle with hair.  Now, if you've shown the propensity to lose, you will continue losing.  So, you fill the circle with hair and then you lose the native hair around it.  You end up looking like a target.  Propecia, Rogaine, Laser and PRP are the modalities approved/released by the FDA for retention of the native hair.  I would suggest you speak with your PCP or hair professional about these.

With regards to your crown, and considering everything outlined above, perhaps taking the conservative approach may be a good idea.  If you are able to retain and enhance the native hair, that may be all you need. Seem, by the photos you provided, that it is the swirl, (hair growing away from the point), that is causing the "thinning look."  The fact that your hair is darker is also a contributing factor as there is a bit of contrast with the color of the skin.

Hope this helps.

 

[Raker]

18 hours ago, Melvin-Moderator said:

55 years old with that much hair and no grey hair, are you just bragging now haha jk. Man you’re doing great and I understand the desire, hey why not right. 

I think between 2,000-2,500 is about right the latter being a more aggressive approach. The crown is a delicate area, in fact you still have quite a bit of hair left. I’m not entirely sure the risk of shock loss is worth it IMO. You may spend months looking worse for little pay out.

Try layering your hair over the crown this would completely conceal it. Something like the picture below.

Thanks Melvin, no grey hair is my only claim to fame. Not sure about the layering.

The images I posted were taken when I was having a consultation so my hair was combed to one side, I’ve attached an image as to how I would normally wear my hair, covers most of my scalp until there’s a gust of wind then reality kicks in. 

[1978matt]

20 hours ago, Raker said:

Thanks Matt, can I ask you why did you travel to the USA for surgery? Surely we have the necessary skills in the UK at a similar pricing structure? 

There were not the UK options there are today when I first started looking (2011) and the exchange rate was a lot more favourable.  The first time I looked on this site I saw Konior's results and from then on he was pretty much always first choice.  I spent the next 2 years having some consultations with Farjo (+ a couple of others) and their rep knew Konior personally and sent his American friend to him.  He gave him his endorsement even if I didn't go with Farjo.

The only 3 I'd consider in the UK are Farjo, Dr Ball (Maitland) and maybe Dr Reddy (FUE only).

 

Edited October 4, 2018 by 1978matt

[Raker]

1 hour ago, 1978matt said:

There were not the UK options there are today when I first started looking (2011) and the exchange rate was a lot more favourable.  The first time I looked on this site I saw Konior's results and from then on he was pretty much always first choice.  I spent the next 2 years having some consultations with Farjo (+ a couple of others) and their rep knew Konior personally and sent his American friend to him.  He gave him his endorsement even if I didn't go with Farjo.

The only 3 I'd consider in the UK are Farjo, Dr Ball (Maitland) and maybe Dr Reddy (FUE only).

 

Cheers Matt, aiming for early next year for a HT so will keep these guys in mind. 

[Panamera13]

Hi Raker - I'm not saying you're old but rather you have very good hair and don't really need an HT (unless you're in the dating world )

Your hair is great as it is. Just better styling/cut will do wonders. Even if you have HT, you might be the only one who notices it. People pay 15K to have hair half as good as yours.

I respect your decision to go for HT but try visiting a high end salon as ask for a different type of styling ideas and you might notice enough difference to like your existing hair more. You don't want needles poking in your scalp for no reason (so try other things first just my humble opinion.)

Edited October 5, 2018 by Panamera13

[Raker]

Thanks Panamera, think I’ve already decided to run with a HT just got to figure out if I include the crown area (which I probably won’t & let the meds do their work) then decide which surgeon to employ. Although I’m based in the UK I may look further afield, thankfully cost will not be the deciding factor. 

[Spaceman]

You’re a great candidate for a HT. You have limited hair loss for your age, so it’s likely that a great HT plus meds will provide you with a pretty full head of hair for a long time. A first rate result will make you feel great when you look in the mirror. It will take years off of your appearance and you’ll be thrilled. Others will notice, though they may not know exactly what’s changed about you.

However, a result that is less than stellar will make you regret having a HT at all. And a botched result with density issues or an unnatural hairline will make you DEEPLY regret that you didn’t leave well enough alone. I cannot emphasize that enough.

I think you should go for it!  But only if you are willing to see a top 5 surgeon worldwide, regardless of price and location. There is a big drop off in quality and consistency between the very best surgeons and the rest of the field. An average result is not worth the time, trouble, or risk in your case. You’re trying to go from good to fantastic, not from bad to presentable. Very few doctors produce fantastic  results consistently. You must be willing to travel to those doctors that do, and then pay what they ask. Simple as that.

Also, if you decide to touch the crown, consider packing in at least 1000, maybe 1200, blended well into the margins. You might not even notice 500 in the crown after permanent shock loss of miniaturized hairs. 

Edited October 5, 2018 by Spaceman

[Raker]

Cheers Spaceman, appreciate the advice. It’s unfortunate that even the recommended (by some individuals on this forum) & internationally recognised surgeons can’t agree ie crown some say “do it’ & some say “don’t do it’ 

I totally agree that an average result is not good enough also I’m not looking for a hairline that I would’ve had when I was 18 years old. 

What surgeons have impressed you? I’m hoping early 2019 for surgery. 

 

[Spaceman]

I had a HT earlier this year with Dr Hasson and I’m very pleased with the result. I would definitely recommend Hasson & Wong. In the US, I’d go with Konior. In Europe, de Freitas, Lorenzo, Feriduni. There are a few others to consider, but not many. Hattingen for FUT.  Couto is also world class, but not an option if you would like to get your procedure before the next World Cup. 

[Spaceman]

1 hour ago, Raker said:

Cheers Spaceman, appreciate the advice. It’s unfortunate that even the recommended (by some individuals on this forum) & internationally recognised surgeons can’t agree ie crown some say “do it’ & some say “don’t do it’ 

The crown is a more complicated area. You’ve yet to see the full benefit of meds. That takes a full year. It may be that the meds give you a nice improvement in which case you don’t need any grafts in the crown right now.

As you may know, the trouble with implanting in the crown is that as the balding progresses you can end up with a transplanted tuft in the middle of a ring of baldness. Not a good look. It can be fixed down the road if you have enough donor, but that means another procedure. 

If you’re going to do anything at all in the crown, consider a larger recipient area than what is currently bald.  Make sure the transplanted grafts are blended pretty deep into th eexisting hair around the bald spot. That will minimize the donut effect down the road. Of course, it takes a lot of grafts, so it’s not an easy call to make.

 

[Raker]

Cheers Spaceman, I’ll look at the guys that are based in Europe. One question, what are your views on Asmed? The process (use of techs & limited use of surgeon) goes against my understanding of a HT but they seem to be producing consistently good results. 

[Spaceman]

ASMED is highly tech driven, but the techs are well-trained, well-supervised, very experienced, and yes they do produce consistently good results. Erdogan's techs have even helped train the techs from other clinics (like HnW) on advanced FUE techniques. ASMED, however, is not my favorite for detailed hairline work.  I'm nitpicking now, but to my eyes, Erdogan's hairlines are a bit more linear and slightly less natural than some of the other surgeons that I mentioned.  He's started to use microscopes to improve hairline graft selection so that should help.  I wish he would shake his hand a bit when he draws, but he must have a preference for linear hairlines.

[Raker]

It probably doesn’t make sense to you but to my untrained eye it was a hairline suited to the younger man but what impressed me more was the process from pre to post surgery, very professional with all the latest technology. 

[Spaceman]

Yes, that could be. Regardless, it’s nitpicking. Erdogan’s got a great practice, by any measure. 

[Spaceman]

One last thought, which you probably already know, but for anyone else reading- regardless of which surgeon you choose, spend enough time thinking about how you want your hairline. Really think about it.  Don’t automatically go with whatever the surgeon draws. Have a conversation about it with the surgeon. Make sure you are really comfortable with it. You’re going to be seeing it a lot.

[Gasthoerer]

ASMED is a great clinic but it would not be my first choice for this case. Many better suited clinic mentioned in this thread already. 

[Raker]

55 minutes ago, Spaceman said:

One last thought, which you probably already know, but for anyone else reading- regardless of which surgeon you choose, spend enough time thinking about how you want your hairline. Really think about it.  Don’t automatically go with whatever the surgeon draws. Have a conversation about it with the surgeon. Make sure you are really comfortable with it. You’re going to be seeing it a lot.

Agree, from the 5 consultations I’ve had 3 were face to face and they all drew different hairlines, strangely I can’t even remember what my hairline was like 20 years ago. Undoubtedly there’s a tendency to be adventurous (but I won’t) common sense will prevail and I’ll choose a conservative hairline, as you say you’ve got to live with it and it’s on public display for a very long time. Thanks for your advice.

[Raker]

13 minutes ago, Gasthoerer said:

ASMED is a great clinic but it would not be my first choice for this case. Many better suited clinic mentioned in this thread already. 

Thanks Gasthoerer, who would you recommend & why?