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Jhonny

Number of grafts required and potential outcome - your opinion?

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Posted (edited)

Hi everyone,

I've been a silent reader for ages and thanks to you all I gained a lot of experience and knowledge!

I'm 38, been on finasteride for about 10years, stopped it 6years ago, now on minoxidil only since about 6-8months. Got dramatically worse in the last 6months(minoxidil?).

I am at the stage where I am finally planning for a hair transplant. I contacted several doctors and got very different opinions and quotations number and $ wise.

Many of you on here can praise great knowledge and I would really love to hear your opinion in terms of a number of grafts, area to focus on more and obviously what you think the outcome would be. Will I ever be able to get good overall coverage where I would look "normal"?

I am considering FUE only at this stage.

At some stage I will bother you again in regards to the Doctor that would suit my budget and needs better, but not now, don't want to bother you too much at once ūüėČ

Pics just out of the shower with noting on ūüėě

 

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Edited by Jhonny

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Posted (edited)

I think you can have an excellent result. You should focus on the hairline, front and mid sections first. You’ll probably need 5000+ grafts for desirable density. Erdogan, Lorenzo, and Hasson & Wong are your best bets for mega FUE sessions. If you’re willing to do it in stages then you have many additional options. Konior, Feriduni, etc. Also, I’d avoid the temporal regions for now. 

Edited by Spaceman

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Hi

In my opinion, given your age and current advanced state of hair loss, and pretty good donor area, I’d say you’re probably a good candidate for an Ht. I totally agree with what @Spaceman suggested for you. 

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I would solely be looking at Lorenzo and Erdogan for FUE, but also consider Hattingen clinic and Hasson/Wong for FUT as a backup if you're not happy with either of those options. I think common Erdogan 5000+ graft type procedure would be ideal, and likely a second procedure worth considering beyond that also. 

I think relatively full coverage with a conservative hairline is easily possible. The main issue is time and money, also assuming that a first procedure goes well in terms of yield of graft survival.

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What do you consider looking "normal" do you mean looking like you don't have any hair loss at all? If so I would say no. You will most likely always look like you have some thinning. Especially if you try and spread you hair apart of wet your hair. This is to be expected with hair restoration. Many patients go in to surgery expecting to restore their hair and not see any scalp. That just isn't realistic especially with extensive hair loss. I would say you require at least 5,000 grafts to achieve a good result.


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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Hi Jhonny,

At 38, you should consider going back on Finasteride (if you had no side effects previously) to try to sustain your native hair.  Your last picture in particular shows lots of hairs that are worth fighting to keep.

I would recommended a procedure of 4500-5000 grafts to rebuild you a mature age specific hairline at the level where your tuft is, some minor redefining of your temple points and strengthening of your midscalp all the way back to your vertex. 

This should make a dramatic difference to your appearance and should give you the "normal" look which I take it means walking into a room and being recognised by complete strangers as a person who is not bald/balding. You do have the option of going for a second procedure a year or more down the line to increase the density if need be. This is quite common for guys with similar extensive balding patterns and in your case would probably be another pass of approx. 2000 - 2500 grafts over the previous implanted areas. 

I remember a few years back feeling the same way, I had a similar pattern to yours which now seems just a distant bad dream.

If you follow the same path as me, it will cost you about 6,500 USD for a 4500 scalp graft procedure.

All the best.


Kindest Regards

Shera   -   UK Representative and Patient Adviser for Dr. Tejinder Bhatti     View My FUE HT Story

UK Email : darlingbudsUK@gmail.com    UK Freephone : 0800 634 8588   WhatsApp Call/Message: +44 7708 018667

I am not a medical professional. All opinions are my own and my advice should not constitute as medical advice.

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good donor.

 

If I was you I would go for FUT at Hasson & Wong. If money not a huge problem.

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17 hours ago, Spaceman said:

I think you can have an excellent result. You should focus on the hairline, front and mid sections first. You’ll probably need 5000+ grafts for desirable density. Erdogan, Lorenzo, and Hasson & Wong are your best bets for mega FUE sessions. If you’re willing to do it in stages then you have many additional options. Konior, Feriduni, etc. Also, I’d avoid the temporal regions for now. 


Thanks Spaceman, glad to hear your opinion. I would prefer to do it all at once but if not possible, well yes I would consider multiple procedures. I will get into choosing Doctors soon, the ones you have mentioned are top choices but honestly over my budget. Agree to avoid temporal region, for now, this is a good point!
 

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17 hours ago, CosmoKramer said:

Hi

In my opinion, given your age and current advanced state of hair loss, and pretty good donor area, I’d say you’re probably a good candidate for an Ht. I totally agree with what @Spaceman suggested for you. 

Hi mate, it looks like you were in a kind of similar situation and the result looks stunning! I agree with you not posting the Dr name yet, although I am very curious to know where I can get a result similar to yours! I would sign for it right now!

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17 hours ago, JayLDD said:

I would solely be looking at Lorenzo and Erdogan for FUE, but also consider Hattingen clinic and Hasson/Wong for FUT as a backup if you're not happy with either of those options. I think common Erdogan 5000+ graft type procedure would be ideal, and likely a second procedure worth considering beyond that also. 

I think relatively full coverage with a conservative hairline is easily possible. The main issue is time and money, also assuming that a first procedure goes well in terms of yield of graft survival.

Glad to see your reply mate! My biggest enemy is money I guess, especially when considering such a big amount of grafts! I'll talk about doctors soon in another post but Erdogan "factory" is definitely banned from my list ūüėČ

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16 hours ago, Melvin-Moderator said:

What do you consider looking "normal" do you mean looking like you don't have any hair loss at all? If so I would say no. You will most likely always look like you have some thinning. Especially if you try and spread you hair apart of wet your hair. This is to be expected with hair restoration. Many patients go in to surgery expecting to restore their hair and not see any scalp. That just isn't realistic especially with extensive hair loss. I would say you require at least 5,000 grafts to achieve a good result.

Glad to see you in my post Melvin, I'm very pleased!

I totally agree with you, I will never look full of hair. As normal I mean with good overall coverage that, with a touch of toppik I would be able to hide my scalp and look younger ūüėČ

At the moment toppik doesn't work, the bald area on my midscalp is too big and there are not enough hair for the toppik to grasp on to.

How would you guys classify the caliber of my hair? I feel like they are medium-fine which doesn't help when transplanting hair I assume.

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14 hours ago, Shera said:

Hi Jhonny,

 

 

 

 

At 38, you should consider going back on Finasteride (if you had no side effects previously) to try to sustain your native hair.  Your last picture in particular shows lots of hairs that are worth fighting to keep.

 

 

 

I would recommended a procedure of 4500-5000 grafts to rebuild you a mature age specific hairline at the level where your tuft is, some minor redefining of your temple points and strengthening of your midscalp all the way back to your vertex. 

 

This should make a dramatic difference to your appearance and should give you the "normal" look which I take it means walking into a room and being recognised by complete strangers as a person who is not bald/balding. You do have the option of going for a second procedure a year or more down the line to increase the density if need be. This is quite common for guys with similar extensive balding patterns and in your case would probably be another pass of approx. 2000 - 2500 grafts over the previous implanted areas. 

 

I remember a few years back feeling the same way, I had a similar pattern to yours which now seems just a distant bad dream.

 

If you follow the same path as me, it will cost you about 6,500 USD for a 4500 scalp graft procedure.

 

All the best.

Hi Shera, I followed your journey all the way and I must say you got a great outcome.

Finasteride killed me, like I said I stopped it 6years ago due to heavy side effects, I am not sure I am willing to take that risk again.

That's a good definition of how I would like to look after the surgery, I hope it is possible.

11 hours ago, hairman22 said:

good donor.

 

If I was you I would go for FUT at Hasson & Wong. If money not a huge problem.

Hi mate, I got a quotation from H&W and I must say I felt very offended to say the least! Ridiculously insane!

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Posted (edited)

I would NEVER get FUT.  I think it is short sighted. You end up with a huge scar as with your level of loss, you might want to shave it off even after the HT way down the road. Sure, if you wanted to extract every last possible graft then you get a few more with FUT. But completely not worth that ridiculous scar. Buzzing it off nay be your best look down the road at 55-60. Don't sacrifice that for no reason.  

I agree with the others. 5000 grafts will be a very dramatic change. With that you can have "mature" hairline maybe kind of like Ryan Reynolds. I think you would probably have to live with a bald crown in the back. But with responsible mature hairline like that you could have a completely different look.  And with 5000 grafts, you could cover the front and mid scalp with enough coverage to look like a guy with hair. Not model hair...and maybe looking a little thin in certain light. But as others have said, in most situations nobody is inspecting people's hair density and you will notice any thinness more than them.  With 5000 you would still have enough in reserve to touch things up if the sides thin more, but forget the back unless you get really obsessed and start considering beard and body hair.  I think you are the perfect candidate for HT. You can clearly tell where your balding is headed and if you make good informed choices, you will have a very dramatic result. Going from a bald guy to a mostly full head of hair framing your face is huge.  Going from a receded hairline to a really youthful hairline...not as dramatic.  So you will be for sure advised it is worth it if you have realistic expectations. 

 

Reading between the lines, it sounds like budget is a consideration. Some people are recommending some very expensive Dr.s here and they are great. And if you have unlimited funds, make sense. But most of the good clinics in Turkey and even some in India are getting great results too.  So a quality hair transplant can be had for you if you are willing to travel and roll the dice a tiny bit. I think most of the time you get just as good a result at REPUTABLE places in Turkey and India.  But you don't have much recourse if it goes bad and with Turkey especially, you have technicians doing the work, so every now and then someone get's a new or just lousy tech, so it is not as reliable. But my own guess from a year of research is 95% of the time, a good clinic in Turkey will produce 95% or more of the quality of the best HT doctors anywhere. It is not super complicated and if done properly you will reach the benchmark yield of around 90% graft survival regardless of weather it's a $5000 job in India or a $30,000 one in the US. You pay a lot more for a little added security and predictability. But it is your head, so if you can afford that huge extra price for it....then why not? 

 

No matter what...come up with a reasonable plan and expectation. Get some opinions here on what hairline you want and density.  Then when you are ready, you will be able to advocate for yourself rather than rely on one Dr's idea of what would look good or meet what he thinks in your expectation. Or worse, have a crazy idea of what looks good on you and end up like one of these guys trying to create their middleschool hairline and then ending up with a real problem when it could have been a fantastic result. 

Edited by txtransplant
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8 hours ago, Jhonny said:

Glad to see your reply mate! My biggest enemy is money I guess, especially when considering such a big amount of grafts! I'll talk about doctors soon in another post but Erdogan "factory" is definitely banned from my list ūüėČ

 

In that case I’d definitely strongly consider Lorenzo. 

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On 3/8/2019 at 11:29 AM, txtransplant said:

I would NEVER get FUT.  I think it is short sighted. You end up with a huge scar as with your level of loss, you might want to shave it off even after the HT way down the road. Sure, if you wanted to extract every last possible graft then you get a few more with FUT. But completely not worth that ridiculous scar. Buzzing it off nay be your best look down the road at 55-60. Don't sacrifice that for no reason.  

I agree with the others. 5000 grafts will be a very dramatic change. With that you can have "mature" hairline maybe kind of like Ryan Reynolds. I think you would probably have to live with a bald crown in the back. But with responsible mature hairline like that you could have a completely different look.  And with 5000 grafts, you could cover the front and mid scalp with enough coverage to look like a guy with hair. Not model hair...and maybe looking a little thin in certain light. But as others have said, in most situations nobody is inspecting people's hair density and you will notice any thinness more than them.  With 5000 you would still have enough in reserve to touch things up if the sides thin more, but forget the back unless you get really obsessed and start considering beard and body hair.  I think you are the perfect candidate for HT. You can clearly tell where your balding is headed and if you make good informed choices, you will have a very dramatic result. Going from a bald guy to a mostly full head of hair framing your face is huge.  Going from a receded hairline to a really youthful hairline...not as dramatic.  So you will be for sure advised it is worth it if you have realistic expectations. 

 

Reading between the lines, it sounds like budget is a consideration. Some people are recommending some very expensive Dr.s here and they are great. And if you have unlimited funds, make sense. But most of the good clinics in Turkey and even some in India are getting great results too.  So a quality hair transplant can be had for you if you are willing to travel and roll the dice a tiny bit. I think most of the time you get just as good a result at REPUTABLE places in Turkey and India.  But you don't have much recourse if it goes bad and with Turkey especially, you have technicians doing the work, so every now and then someone get's a new or just lousy tech, so it is not as reliable. But my own guess from a year of research is 95% of the time, a good clinic in Turkey will produce 95% or more of the quality of the best HT doctors anywhere. It is not super complicated and if done properly you will reach the benchmark yield of around 90% graft survival regardless of weather it's a $5000 job in India or a $30,000 one in the US. You pay a lot more for a little added security and predictability. But it is your head, so if you can afford that huge extra price for it....then why not? 

 

No matter what...come up with a reasonable plan and expectation. Get some opinions here on what hairline you want and density.  Then when you are ready, you will be able to advocate for yourself rather than rely on one Dr's idea of what would look good or meet what he thinks in your expectation. Or worse, have a crazy idea of what looks good on you and end up like one of these guys trying to create their middleschool hairline and then ending up with a real problem when it could have been a fantastic result. 

@txtransplant 

thanks for your email, I feel like you got all the points i wanted to clarify!

I am not considering FUT at all for all the reasons stated by you. I always thought that if the transplant doesn't go well and I have to buzz my hair down the scar will be quite visible making the things worse than before, so no FUT for me.

I am aware that filling the whole bald area would be challenging and I am willing to sacrifice a bit the temporal and crown area, I agree that hairline and midscalp are the areas that gives the first impression and a poor crown is something to be accepted for a fella close to his forties i would say. i can see that my pattern is exactly the same as my dad who is 75 now, his crown is actually way worse than mine but sides and mid-lower back are still ok so I guess that is where I am heading.

Yes budget is a big point for me and honestly like you said I keep seeing great results from Turkey, India and Belgium which are way more affordable(Belgium not really) so my choice will probably be on those countries. I live in Australia and I go back to Europe once or twice a year so travelling to those countries is not a problem.

Question, how many graft would you guys think can be harvested from my donor? 5000 + a touch up sounds a lot, not sure it can be done in my case.

Other question, if I want to preserve the donor for future touch ups and i choose to go with a lower density, can I increase the density in the future without risking to damage the existing hair? Making new incisions in between the existing hair previously implanted sounds like a big risk of transecting them to me? What do you think?

 

 

 

 

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Posted (edited)
2 hours ago, Jhonny said:

Question, how many graft would you guys think can be harvested from my donor? 5000 + a touch up sounds a lot, not sure it can be done in my case.ÔĽŅ

I think the answer to this question may depend on which surgeon you go to. In Europe, if you were go to a Belgian clinic for example, they general seem to be more conservative with the amount of grafts they feel they can extract from the donor area via FUE without leaving it looking thin. On the other hand, Turkish and some Spanish clinics push the boat out further and are comfortable extracting a larger amount without feeling they will leave the donor looking thin.

Difficult to accurately say without having your donor area hair examined, measurements taken, check for miniaturisation etc but going by your pictures your donor area looks good and another thing you have going for you is your back and sides remain high (any family history where hair back and sides have dropped?) and I'd think 5000 grafts should be pretty comfortably extracted using FUE regardless of which clinic you go to. If by touch up you mean say 1500-2000 grafts, think that may well be achievable by some clinics but will only get an accurate answer after having your hair examined.

Your expectations seem realistic and I think you can get a good result. For what you require and if budget is an important consideration, it would point to ASMED. However, if you have ruled them out, in terms of European options, I'd be saving up until you can go see someone like Lorenzo or say one of the Belgian clinics (will be over 2 sessions) etc. My figures may be off, but think for 5000 or so grafts, think I'd be looking to set aside a ballpark 16k-17k Euros figure as a minimum for one of the well reputed clinics in Spain or Belgium.

Further afield, Hasson & Wong are also a great shout but sounds like cost may be an issue with them.

Edited by Fozzie

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On ‚Äé3‚Äé/‚Äé8‚Äé/‚Äé2019 at 1:29 AM, txtransplant said:

I would NEVER get FUT.  I think it is short sighted. You end up with a huge scar as with your level of loss, you might want to shave it off even after the HT way down the road. Sure, if you wanted to extract every last possible graft then you get a few more with FUT. But completely not worth that ridiculous scar. Buzzing it off nay be your best look down the road at 55-60. Don't sacrifice that for no reason.  

This is very one sided: We are speaking of a > 5000 FU transplant. Also with FUE it is very unlikely that he can buzz down in the future. SMP in FUE scars is also not as simple as many people believe. I am not saying he should go FUT, but this is a simplification which is misleading. 

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I will soon open a new topic about doctors so i don't want to mix 

4 minutes ago, Gasthoerer said:

This is very one sided: We are speaking of a > 5000 FU transplant. Also with FUE it is very unlikely that he can buzz down in the future. SMP in FUE scars is also not as simple as many people believe. I am not saying he should go FUT, but this is a simplification which is misleading. 

Are FUE scars that visible on a buzz cut? Looking at the pictures from different patients they look invisible to me. I must admit I have never seen one in person though.

 

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Posted (edited)
1 hour ago, Fozzie said:

I think the answer to this question may depend on which surgeon you go to. In Europe, if you were go to a Belgian clinic for example, they general seem to be more conservative with the amount of grafts they feel they can extract from the donor area via FUE without leaving it looking thin. On the other hand, Turkish and some Spanish clinics push the boat out further and are comfortable extracting a larger amount without feeling they will leave the donor looking thin.

Difficult to accurately say without having your donor area hair examined, measurements taken, check for miniaturisation etc but going by your pictures your donor area looks good and another thing you have going for you is your back and sides remain high (any family history where hair back and sides have dropped?) and I'd think 5000 grafts should be pretty comfortably extracted using FUE regardless of which clinic you go to. If by touch up you mean say 1500-2000 grafts, think that may well be achievable by some clinics but will only get an accurate answer after having your hair examined.

Your expectations seem realistic and I think you can get a good result. For what you require and if budget is an important consideration, it would point to ASMED. However, if you have ruled them out, in terms of European options, I'd be saving up until you can go see someone like Lorenzo or say one of the Belgian clinics (will be over 2 sessions) etc. My figures may be off, but think for 5000 or so grafts, think I'd be looking to set aside a ballpark 16k-17k Euros figure as a minimum for one of the well reputed clinics in Spain or Belgium.

Further afield, Hasson & Wong are also a great shout but sounds like cost may be an issue with them.

I got quoted from 3000 to 7000 from different doctors so it is very confusing. 

Would 3-4000grafts give me an overall decent coverage? Do I have 7000grafts available?

I would personally go conservative since my pattern is not probably defined completely and ideally i would prefer a full coverage with lower density than high density and bald spots in a few years because not more donor available.

 

Edited by Jhonny

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Posted (edited)
5 hours ago, Jhonny said:

I would personally go conservative since my pattern is not probably defined coÔĽŅmpletely and ideally i would prefer a¬†full coverage with lower density than high density and bald spots¬†in a few years because not more donor available.

To be honest, your hair loss is quite extensive (especially when looking at the 1st and 4th picture) and a pattern has formed imo... think any experienced, reputable surgeon would be fairly confident in predicting where your hairloss is headed in the future once you've been examined. You still have some hair on the crown but without medication, the assumption is that will go and key in your case is probably if the sides and back hold up which they seem to be doing at the moment.

Personally think 3500 or so grafts with a conservative, mature hairline will give you decent coverage in the frontal/midscalp region. With a reputable surgeon, good chance you will be happy. Your crown still seems to have hair, however as mentioned, without meds you'll probably lose whatever remains there over time. I'd probably be looking at 1500 towards the crown in the first round as your crown isn't slick bald. Should improve coverage, just don't expect density in that area. Then after 18 months or so, can judge your result and look to target any lagging areas, maybe add 500 more to crown if your happy with the front.  

In your position, I think it may even be worthwhile having hair restoration in two procedures i.e target the front first and then maybe just get by with concealer on the crown as it appears you still have hair there and when the rest of the crown goes, go in for your second procedure. Obviously you can get it done in one go but I'd imagine in time your crown will start looking thinner when the native hair there eventually goes and you may look to go in again.

Edited by Fozzie
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