Best Doctor for Diffuse loss- Hasson or Rahal?

[mhaider1991]

Hi All,

I am a 27 year old patient with diffuse loss (will post pics soon) and have narrowed my choices down to Hasson and Rahal. I was considering Diep at one point, but due to some questionable things I've read regarding him not standing by his work and his donor site, I've removed him from my list. Between Hasson and Rahal, who is better for diffuse loss and to get the most coverage in one procedure? My hair loss will deff require more surgeries for the future, so I don't have the one and done attitude- but I do want the most coverage possible in one go.

Edited January 1, 2019 by mhaider1991

[home1212]

Both are top notch doctors with stellar reputations, both do mega-sessions, however they each may recommend different approaches to address your specific hair loss pattern. They have both been pioneers in the business with outstanding results for their patients. You should have separate consultations with both, either in person or with pics or Skype, and determine on your own, which is the best for your specific situation. Diffuse loss is not always best tackled in one session and may require another or multiple surgeries. Without any pics of your hair loss, we can't tell.

Edited January 1, 2019 by home1212

[Gasthoerer]

You should look into clinics using implanted pens. Usually this clinics have great results with diffuse thinning. Lorenzo or Freitas could be starting points for your research. 

[mhaider1991]

5 hours ago, Gasthoerer said:

You should look into clinics using implanted pens. Usually this clinics have great results with diffuse thinning. Lorenzo or Freitas could be starting points for your research. 

I have great respect for both of those surgeons- however FUE is not an option for me. Frankly speaking, I don't consider them FUT specialists even though they are exceptional surgeons and FUE specialists. One reason why I narrowed down it to Hasson and Rahal is due to their strong FUT expertise.

[Gasthoerer]

OK, I misunderstood your request. If you focus is a strip megesession H&W would be my choice from the two clinics. Another one would be Hattingen in Europe. Both are strip megasession Experts. Rahal woould be my favorite for hairlines.

I am not aware of a FUT specialist well known for work on diffused thinners or using an implanted pen. But maybe there are. I have seen some nice cases on YouTube for diffused thinners from Arocha if I remember correctly. But not patient reports. 

[Spaceman]

Konior uses stick and place for diffuse thinners and does great FUT work. No mega sessions though. All of the surgeons mentioned are excellent. HnW is probably your best bet for FUT mega sessions. As close to one and done as you will get. You should strongly consider Finasteride for 6 months before surgery if you’re not already on it.

Edited January 1, 2019 by Spaceman

[mhaider1991]

55 minutes ago, Gasthoerer said:

OK, I misunderstood your request. If you focus is a strip megesession H&W would be my choice from the two clinics. Another one would be Hattingen in Europe. Both are strip megasession Experts. Rahal woould be my favorite for hairlines.

I am not aware of a FUT specialist well known for work on diffused thinners or using an implanted pen. But maybe there are. I have seen some nice cases on YouTube for diffused thinners from Arocha if I remember correctly. But not patient reports. 

I would be VERY interested in Hattingen- only problem I have is tht I don't see many patient experiences from them a lot. From what I see, they have amazing results, my only concern is the lack of patient responses I see (or don't see). If I see them, I would deff consider them.

[mhaider1991]

41 minutes ago, Spaceman said:

Konior uses stick and place for diffuse thinners and does great FUT work. No mega sessions though. All of the surgeons mentioned are excellent. HnW is probably your best bet for FUT mega sessions. As close to one and done as you will get. You should strongly consider Finasteride for 6 months before surgery if you’re not already on it.

Love Konior- just doesn't do mega sessions. Leaning towards HW. Can't take finasteride for other medical purposes. 

[Melvin- Admin]

I don't think there is a "best" surgeon, but there may be a better surgeon for your specific goals. It's hard to say without pictures. It also comes down to personal preference, who's hairlines do you prefer? I don't think you could go wrong with either clinc.

[mhaider1991]

Here’s are some pics as promised

[Spaceman]

With your age and level of loss, and without Finasteride, you will continue to lose what is left on top. A HT into the front and midsection may very well accelerate the loss (permanent shock loss) in that area and you may end up back where you started.  If you go down the HT road, you will need a lot of grafts over multiple procedures. Donor management is going to be key. You need a long term plan with a conservative approach. I think you already know all of this. 

In your case, I’d recommend you consult with Dr Wong. Probably strip to start, and then FUE down the road.

Edited January 2, 2019 by Spaceman

[mhaider1991]

16 minutes ago, Spaceman said:

With your age and level of loss, and without Finasteride, you will continue to lose what is left on top. A HT into the front and midsection may very well accelerate the loss (permanent shock loss) in that area and you may end up back where you started.  If you go down the HT road, you will need a lot of grafts over multiple procedures. Donor management is going to be key. You need a long term plan with a conservative approach. I think you already know all of this. 

In your case, I’d recommend you consult with Dr Wong. Probably strip to start, and then FUE down the road.

Not even considering FUE until I'm down to at the minimum 1500 grafts, due to the need for future surgeries. I know it's a longterm commitment. Not a personal fan of FUE for my situation.

[Spaceman]

Just now, mhaider1991 said:

Not even considering FUE until I'm down to at the minimum 1500 grafts, due to the need for future surgeries. I know it's a longterm commitment. Not a personal fan of FUE for my situation.

Yes, I agree. Start with strip. And then FUE when you’re stripped out down the road.

[Gasthoerer]

OK, seeing you pics and regarding your age: You are not (!) a diffused thinner. Your crown is huge and almost slick bald. The front and mid is diffused, but so heavily that is it clear that all of this is lost after the transplant. You should plan as if this hair isn't there. My recommendation:

0) Think about medication

1) Check your family history. If there is there is a risk going towards NW6+ you should not have a transplant

2) Shave and consider SMP or Trico. Maybe you like yourself with short hair.

3) Go to reputable clinics H&W (If you are in North America) and Hattingen (if you are in Europe) who offer strip and FUE. You have to have a personal consultation. 

Options

FUT: But most likely leave the crown open. + Chance for best coverage and classic hairstyle -  Fall back (Shaving) in case of further loss / poor growth is difficult

FUE with SMP: Kind of less is more. More evenly distributed with less density but the option for a shorter hairstyle. 

Good luck

 

 

P.S.

Hattingen has an own section with tons of patient reports in a domestic forum, but you need to register as it is not allowed to publish before and after pictures in many EU countries: https://www.alopezie.de/foren/transplant/index.php?t=thread&frm_id=14&

 

[mhaider1991]

5 hours ago, Gasthoerer said:

OK, seeing you pics and regarding your age: You are not (!) a diffused thinner. Your crown is huge and almost slick bald. The front and mid is diffused, but so heavily that is it clear that all of this is lost after the transplant. You should plan as if this hair isn't there. My recommendation:

0) Think about medication

1) Check your family history. If there is there is a risk going towards NW6+ you should not have a transplant

2) Shave and consider SMP or Trico. Maybe you like yourself with short hair.

3) Go to reputable clinics H&W (If you are in North America) and Hattingen (if you are in Europe) who offer strip and FUE. You have to have a personal consultation. 

Options

FUT: But most likely leave the crown open. + Chance for best coverage and classic hairstyle -  Fall back (Shaving) in case of further loss / poor growth is difficult

FUE with SMP: Kind of less is more. More evenly distributed with less density but the option for a shorter hairstyle. 

Good luck

 

 

P.S.

Hattingen has an own section with tons of patient reports in a domestic forum, but you need to register as it is not allowed to publish before and after pictures in many EU countries: https://www.alopezie.de/foren/transplant/index.php?t=thread&frm_id=14&

 

No real significant cases of extensive baldness in my family on both sides. Max a thinning crown, but no Norwood 6s. Should also have added this: a lot of my hair loss was due to an extreme case of psoriasis which has since been "cured" (I used quotations because technically there is no cure but remedies and change in diet has led to me having virtually no psoriasis), and sometimes just a regular dry scalp, and that only during the winters. Due to this, I had lost a lot of hair since it was very extreme. 

A good percent of my hair loss was due to this and not genetic, and has been confirmed by my dermatologist as well. Obviously, the recession and pattern of hair is genetic and has definitly contributed to my hair loss- but most of it was due to my trauma. My hair has been pretty much consistent since the post psoriasis period. Can't use Propecia for this reason- it can lead to a very senesitive case of mine to stir my psoriasis back up and that's exactly what happened once I tried it. Am taking Nizoral religiously and am also thinking about a laser comb.

[Gasthoerer]

Great to hear that there are no NW6 in your family. But unfortunately this is not a guarantee. The bald genes from both sides can also add up and make you the worst of it all.  Please, stop thinking your loss is not AGA. 99.9 % it is AGA. Maybe psoriasis, has triggered it a little (!), but you have the classic pattern and your loss is strong. The typical dermatologist, does know less about hairloss than the average Joe here in the forum.

The reasons why you think your loss has stopped:

- Hairloss often comes in waves

- Hairloss visibility is not linear (From 100-60 % density reduction is hardly visible at all, this is why HT works in the first place). 

- You have lost most of your hair in NW4-5 area already. Of course your loss is slowed down. 

Summary: If you plan is based on the remaining hair your have in the front  or that your loss has stopped you make a big (!) mistake. 

P.S. If I get one dollar for everyone in the forum who thinks his loss is not AGA, I would be able to quit my job and still make living. 

[mhaider1991]

6 hours ago, Gasthoerer said:

Great to hear that there are no NW6 in your family. But unfortunately this is not a guarantee. The bald genes from both sides can also add up and make you the worst of it all.  Please, stop thinking your loss is not AGA. 99.9 % it is AGA. Maybe psoriasis, has triggered it a little (!), but you have the classic pattern and your loss is strong. The typical dermatologist, does know less about hairloss than the average Joe here in the forum.

The reasons why you think your loss has stopped:

- Hairloss often comes in waves

- Hairloss visibility is not linear (From 100-60 % density reduction is hardly visible at all, this is why HT works in the first place). 

- You have lost most of your hair in NW4-5 area already. Of course your loss is slowed down. 

Summary: If you plan is based on the remaining hair your have in the front  or that your loss has stopped you make a big (!) mistake. 

P.S. If I get one dollar for everyone in the forum who thinks his loss is not AGA, I would be able to quit my job and still make living. 

Please don't think I am not expecting to lose hair- that's not what I am saying. The reason why I am going FUT is planning for future surgeries, knowing I'm going to need more and also going to lose more. However, I do know what head started my hair loss and it was my condition. My pattern is AGA, but majority of it was due to my psoriasis. I know this for a fact because I have other medical conditions, which I'd like to keep private that have contributed to this along with my psoriasis. Those are just facts. AGA is there- but that is not the lone cause of my loss. Had it been the lone, I would not have lost as much hair as I have.

[mhaider1991]

One

6 hours ago, Gasthoerer said:

Great to hear that there are no NW6 in your family. But unfortunately this is not a guarantee. The bald genes from both sides can also add up and make you the worst of it all.  Please, stop thinking your loss is not AGA. 99.9 % it is AGA. Maybe psoriasis, has triggered it a little (!), but you have the classic pattern and your loss is strong. The typical dermatologist, does know less about hairloss than the average Joe here in the forum.

The reasons why you think your loss has stopped:

- Hairloss often comes in waves

- Hairloss visibility is not linear (From 100-60 % density reduction is hardly visible at all, this is why HT works in the first place). 

- You have lost most of your hair in NW4-5 area already. Of course your loss is slowed down. 

Summary: If you plan is based on the remaining hair your have in the front  or that your loss has stopped you make a big (!) mistake. 

P.S. If I get one dollar for everyone in the forum who thinks his loss is not AGA, I would be able to quit my job and still make living. 

There are other conditions, such as hypothryoidism and Lupus that strongly contribute to hair loss. I suffer from conditions like this as well. One problem i DID make early on on my research was to believe that all of it was AGA. Hair loss is a bitch and many things can lead to it. However, AGA is 99% of the worlds reason for it. Unfortunatly for me, it's a small part of a list of other reasons why. However, with the right medication of these conditions and stable health (such as my psoriasis) my hair has been fairly consistent and much stronger.

[Gasthoerer]

Hair loss is a bitch and for men it is 99 % AGA. You have the classic pattern: All the conditions you mentioned will not cause such a pattern, but make you lose hair everywhere (or not at all, as not all conditions you mentioned are related to hairloss).

By the way: I think your logic is also flawed in case you are right. If you have the slightest hint, that a severe amount of your balding would come from this conditions then you should NOT opt for FUT. What happens if your donor thins out from either of these conditions? Then you are severely screwed even in the case of a good scar. 

 

[mhaider1991]

19 minutes ago, Gasthoerer said:

Hair loss is a bitch and for men it is 99 % AGA. You have the classic pattern: All the conditions you mentioned will not cause such a pattern, but make you lose hair everywhere (or not at all, as not all conditions you mentioned are related to hairloss).

By the way: I think your logic is also flawed in case you are right. If you have the slightest hint, that a severe amount of your balding would come from this conditions then you should NOT opt for FUT. What happens if your donor thins out from either of these conditions? Then you are severely screwed even in the case of a good scar. 

 

Yes and No: i mentioned two conditions (lupus & thyroid). I actually only have thyroid. But both are definitly related to hair loss, that's not even a debate. So there's that.

And I think your misunderstanding what I'm saying. I clearly have AGA, it's just the loss has been kickstarted due to other conditions as well. As far as my donor area is concerned, I've had a face to face with many doctors, including Hasson. Excellent donor with little to no chance of any thinning or loss happening in the back, and that's from Dr. Hasson. Estimation, 4500 grafts. Not concerend with the donor area, thus FUT.

[Gasthoerer]

IMO there are a lot of wrong things in you current explanations again, but let us leave it there, as your and my main conclusion lead to the same outcome (now): You have classic (and very high) balding pattern. 

I still think you should think about all the options mentioned by me above and discuss them with H&W and one other FUT/FUE clinic.

Good luck. 

[delancey]

Based on the pictures provided, your hair loss pattern closely resembles that of a NW6 (150-200 cm2). It is also likely that any hair that you still have on top will eventually be lost. With that said, I think you could get a nice result if you were willing to leave the crown alone. 

 

 

[home1212]

On 1/1/2019 at 10:28 PM, mhaider1991 said:

Here’s are some pics as promised

Whether you choose to go to H&W or Rahal, based on your degree of hair loss, you'll need at least 2 surgeries - restoration of the frontal zone in phase I and midscalp/crown in phase II - if you elect to even address your crown. Go with a conservative hairline that will suit you in the future as you age or continue to lose native hair. Best of luck to you ..

Edited January 5, 2019 by home1212

[harry_potter1]

On 1/2/2019 at 5:28 AM, mhaider1991 said:

Here’s are some pics as promised

 

1st, I truly understand your points of what kicked your hair loss, and it is perfectly normal that medical conditions would kickstart your baldness (or speed it up)

-I think your bald pattern is probably been drawn, you are probably going to lose the hair in your upper part of your head, doubt you are going to recess even more on sides. so likely you are NW 5A or 6 

-Whatever the clinic you are going for, have online consultation 1st and say all about your medical conditions. The high profile doctors cares about their reputation and would give you a good advise whether to go for surgery or not, better than any of us.

I think you are likely be able to get the surgery -if medically cleared for it- but if you tune down your expectations. Might have some limited crown coverage.

-I am happy you are smart enough to avoid FUE in your case,right choice. And that limit your option significantly. 

-Hasson & Wong are the best for you, if you can afford them then you go for them. 

-If too expensive I would say Rahal or Hattingen, both do mega sessions and have great results.  

-Contact all 3, you lose nothing from that. 

Edited January 7, 2019 by harry_potter1

[Kiwi Guy]

On 1/6/2019 at 6:52 AM, mhaider1991 said:

One

There are other conditions, such as hypothryoidism and Lupus that strongly contribute to hair loss. I suffer from conditions like this as well. One problem i DID make early on on my research was to believe that all of it was AGA. Hair loss is a bitch and many things can lead to it. However, AGA is 99% of the worlds reason for it. Unfortunatly for me, it's a small part of a list of other reasons why. However, with the right medication of these conditions and stable health (such as my psoriasis) my hair has been fairly consistent and much stronger.

Do you know if it is just hypothyroidism that contributes to hair loss or does an under-active thyroid also contribute in the same way?