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Shmiggy

NW6 just looking for opinion

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Hey guys,

So I’ve been a board memeber for a while and HT amateur researcher for 10+ years. I’ve been contemplating this off an on for a long time. I’m 45 now and feel it’s time to make a decision one way or the other. I’d just like to hear what you would do if you were in my shoes.

I’ve worn my hair short my whole life so FUE is the only way I want to go. I’ve been reviewed by Bisanga, Lorenzo, SMG and Feriduni. Bisanga said “no”, the other 3 said yes with donor appropriate expectations. The donor area in the back is not as dense as I’d like it. Been on Fin for the last few years. The thinning started at 25 and seems to have plateaued around 40. Here are some shots, with the proposed area to be restored with 3000 grafts. What would you do?

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Hey,

 

great youve I’ve been on fin to help slow down the progression of loss. You could consider moving up to DUTasteride to throw everything and the kitchen sink at helping maintain what you’ve got especially if intending to go down the FUE route.

 

great surgeons / clinics mentioned and they are consistent with large FUE

 

Realistic numbers for the area you want want to cover. Get in house assessments and go from there. Rome wasn’t built in a day so take your time and meet Drs.

 

best

spex 

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5 hours ago, jj51702 said:

Why did Bisanga say no?

He felt FUE would not be enough grafts. He said ultimately if I progress to a NW 7 (please no!) I would look bad with not enough donor to fill in the lateral humps.He thought my donor area in the back was too small. He estimated a max of 4500 grafts total with FUE. He was of the belief FUT may yield more grafts.

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10 hours ago, spex said:

Hey,

 

great youve I’ve been on fin to help slow down the progression of loss. You could consider moving up to DUTasteride to throw everything and the kitchen sink at helping maintain what you’ve got especially if intending to go down the FUE route.

 

Any side effects with DUT? If you stop DUT, any chance you lose even more?

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In my opinion, do not take dutasteride unless you consult with a physician. Durasteride is a powerful drug that removes almost all of the DHT from your body. DHT is still necessary to have as a man. Furthermore, you’ve already lost the majority of your hair. Unfortunately, it’s little too late to regain that lost hair without surgical intervention. Moreover, dutasteride is not FDA approved to treat hair loss, it went through clinical trials, but was never approved. Long term what are the effects of completely inhibiting DHT? No one knows for sure. 

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I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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3 hours ago, Melvin-Moderator said:

In my opinion, do not take dutasteride unless you consult with a physician. Durasteride is a powerful drug that removes almost all of the DHT from your body. DHT is still necessary to have as a man. Furthermore, you’ve already lost the majority of your hair. Unfortunately, it’s little too late to regain that lost hair without surgical intervention. Moreover, dutasteride is not FDA approved to treat hair loss, it went through clinical trials, but was never approved. Long term what are the effects of completely inhibiting DHT? No one knows for sure. 

Thanks Melvin. I was thinking the same thing. The only reason I have been taking the fin is to hold on to what I have in the event I decide to pull the trigger on an HT. The benefit of DUT at this time probably wouldn’t produce the cosmetic reward for the risk.

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4 minutes ago, Shmiggy said:

Thanks Melvin. I was thinking the same thing. The only reason I have been taking the fin is to hold on to what I have in the event I decide to pull the trigger on an HT. The benefit of DUT at this time probably wouldn’t produce the cosmetic reward for the risk.

That's exactly my view, the risk vs reward is not tipped in your favor, I understand the desire for individuals who are Norwood 2/3 to try dutasteride, in their situation they still have nearly all of their hair left to lose. However, the majority of your hair is already gone. Stick with the Finasteride and Minoxidil and develop a good long-term strategy for your surgeries and you should be a satisfied patient.


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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A few things about your case.  You are demarcating down on the donor area.  It is likely that finateride is helping.  Pls cotinue. I would consider adding Rogaine, Laser and PRP.  These work in different ways and are thus, synergistic when used simultaneously.

The second thing I would encourage you to do is to let your hair grow longer and then revisit with the doctor(s).  I know of some that would not touch you at this particular time because you can see right through the native hair and see scalp.  They may be under the impression that you are experiencing global thinning.

You have a big pattern.  3000 placed diffusely through the front and top as you've drawn and discussed with others so far will give you a little bit more density but not "full" looking density.  My suggestion would be to concentrate the 3000 grafts towards the front and just blend a bit to the middle area.  (If youi look at the way advanced patterns lose hair, you'll notice that the majority keep the most density in the front, medium density in the middle and emptier in the back.  You could consider SMP down the road for the crown or for the entire head depending on the outome).

My last comment, and it's a combination of observation and the comments you've made.  If you are planning on keeping the hair short, why consider transplants?  Why not SMP?  To me, doing transplants means that you care considering growing the hair out.  So, perhaps start with SMP and see if you are satisfied.  You can always add grafts depending on the outome of the medical therapy, (if you decide to take that route) which typicall takes a full year to truly assess results.  If the meds give you great results, you may have other options at that point.  If not too successful, the only thing you did was waste a year.

With regards to Dutesteride, I learned early that they decided no to go through trials because their outcome was not any better than Propecia.  Propecia is 1 mg while Dutesteride is 5 mg.  While I undestand the concept of splitting the pill and all of that, why take the risk of potentially more side effects if it has been documented that the results are not any better.  It seems, by the photo you have provided, that you are maintaining the hair in the perimeter because of the medication.  Who put you on that?  Did they take photos at the time to keep track?  If so, go back to them and review the photos and see what has happened since then.  This should give you an idea of how successful the medication has been for you.

 

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Great info Laser. I appreciate the thoughtful reply. I am currently on 1.25 mg fin from Dr. Ron at Shapiro. Just started that 2-3 years ago. Here’s some photos from Dr. Bisanga when I visited him about 5 years ago. He used some pretty harsh lighting but you can get the idea of what the fin has maintained.

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And I have considered SMP, but I like to leave the top a little longer. 1/2 inch to inch just because I’m not a fan of my head completely shaved. I think SMP is more for a completely shaved head. Think it would funny with any stubble. I grew the top out about an inch for some family photos and added dermatch and it looked really good. Was exactly how I’d want to wear it all the time if I had hair. It wasn’t thick, but for my age, looked pretty decent.

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All you are doing with SMP is minimizing the contrast between the color of the hair and the color of the scalp.  I realize that most groups doing this service discuss/show before and after photos of someone completely shaved.  I will tell you that women, particularly, will not shave their heads.  They tend to thin out right behind the front.  Unfortunately they tend to be global thinners and not very good candidates for transplatns.  There are exceptions to this.

With the comments you've made about how you look with a bit longer hair, I would give that a try and see how much of the donor you can cover.  2nd, adding other modalities to the mix might not be a good idea at this point.  

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23 hours ago, Shmiggy said:

 I’d just like to hear what you would do if you were in my shoes.

Hi There,

I was in you shoes just over a year ago and I'm 46 and had less up top in the front and mid scalp, I am over the moon with how things went for me and I think my hair looks similar to yours with my untrained eye.

Best of luck with your decision... 

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2 hours ago, john1972 said:

Hi There,

I was in you shoes just over a year ago and I'm 46 and had less up top in the front and mid scalp, I am over the moon with how things went for me and I think my hair looks similar to yours with my untrained eye.

Best of luck with your decision... 

Thanks for the reply John! What kind of procedure did you have done? How many grafts? Any pics?

***Nevermind John. I found your thread. Wow! You had amazing results for so few grafts.

Edited by Shmiggy

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15 hours ago, Shmiggy said:

Any side effects with DUT? If you stop DUT, any chance you lose even more?

No sides. If you stop any treatment you'll lose the benefits. 

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You’re more of a NW Va to be honest 

I think it comes down to how many grafts you have in the bank (ie donor area) and whether you want one big surgery (prob FUT) or possibly two smaller FUE ones.

Nothing right or wrong with either approach. It comes down to finances, your thoughts on scarring, and how desperately you want a full-ish head of hair. 

I was a NW VA and I got a conservative number of grafts (2000) in the front and a little in the mid. that’s because I didn’t want an FUT scar and I am confident my doctor can get a lot out of those 2000 grafts. but I will prob go back in a year or so and get more mid and the crown done. Another 2000 grafts. 

And I am happy to take it step by step.

Some folks are so depressed over their hair, they want it fixed now. I get it. Everyone is different.

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3 hours ago, Postdoc said:

No side effects from Dutasteride? Really?  Spex, I suggest you read the following: 

https://www.sciencedaily.com/releases/2017/06/170622110452.htm

Regards,

Postdoc

 

Not everyone reacts to medications or drugs the same way, IMO Spex has an incredible tolerance, but I can't say I would recommend anyone else to follow the same path. For example Keith Richards and Ozzy Osbourne are great examples of individuals who can take massive amounts of drugs that would kill a normal human being.

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I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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Absolutely Harry. I’m more into going a little slower too. However there are price breaks for more grafts. So that’s a consideration as well.

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2 minutes ago, Melvin-Moderator said:

Not everyone reacts to medications or drugs the same way, IMO Spex has an incredible tolerance, but I can't say I would recommend anyone else to follow the same path. For example Keith Richards and Ozzy Osbourne are great examples of individuals who can take massive amounts of drugs that would kill a normal human being.

Lol! And they both still have hair in their 70s!!!

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